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Flashcards in DSM IV 1 Deck (44):
0

What criteria are common across most diagnoses?

Symptoms:
- cause clinically significant impairment
- are not due to a general medical condition
- are not due to substance use
- are not better accounted for by another diagnosis

1

What is a polythetic criteria set?

The structure used for the DSM-IV's categorical approach: individuals need only meet a subset of symptoms to receive a diagnosis.

2

How does the DSM-IV define a mental disorder?

"a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress... or disability... or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom..." (pp. xxxi)

3

What are the key criteria of a Major Depressive Episode?

A. Five or more of the following for a two-week period, representing a change in functioning:
- depressed mood (must include this or anhedonia)
- anhedonia (must include this or depressed mood)
- unintended change of +/- 5% body weight or in appetite
- insomnia or hypersomnia
- observable psychomotor agitation or retardation
- fatigue
- feelings of worthlessness or guilt
- reduced concentration or increased indecisiveness
- recurrent thoughts of death or suicide
C. Never been Manic, Mixed, or Hypomanic episodes.

(B DiffDx: bereavement; D, E common criteria)

NOTE: Major Depressive Episode is not a codable disorder.

4

What are the key criteria of a Manic Episode?

A. At least one week of distinct abnormally and persistently elevated or irritable mood.
B. Three or more of the following significantly present during A (four if only irritable):
- inflated self-esteem
- decreased need for sleep
- talkativeness or pressure to talk
- flight of ideas, subjective racing thoughts
- distractibility
- increased goal-directed activity or psychomotor agitation
- excessive involvement in pleasurable but risky activities

(C DiffDx: substance/medication; D, E common criteria)

NOTE: Manic Episode is not a codable disorder.

5

What are the key criteria of a Mixed Episode?

A. Non-temporal criteria for both Manic and Major Depressive episodes are met for at least one week.

(B common criteria; C DiffDx: substance/medication)

NOTE: Mixed Episode is not a codable disorder.

6

What are the key criteria for a Hypomanic Episode?

A. At least four days of distinct abnormally and persistently elevated or irritable mood.
B. Three or more of the following significantly present during A (four if only irritable):
- inflated self-esteem
- decreased need for sleep
- talkativeness or pressure to talk
- flight of ideas, subjective racing thoughts
- distractibility
- increased goal-directed activity or psychomotor agitation
- excessive involvement in pleasurable but risky activities
C. Episode associated with an unequivocal change that is uncharacteristic of non-symptomatic state
D. Observable by others.
E. *Not* severe enough to cause marked impairment and no psychotic features.

(F common criteria)

7

What are the key criteria of Major Depressive Disorder, Single Episode?

A. Presence of a Major Depressive Episode
C. Never been Manic, Mixed, or Hypomanic episodes.

(B DiffDx: Schizoaffective Disorder)

8

What are the key criteria of Major Depressive Disorder, Recurrent?

A. Presence of two or more Major Depressive Episodes
C. Never been Manic, Mixed, or Hypomanic episodes.

(B DiffDx: Schizoaffective Disorder)

9

What are the specifiers for Major Depressive Disorder, Single Episode or Recurrent?

Specifiers describe onset, severity, course, features, remission.

Specifiers if current:
- Mild/Moderate/Severe w/ or w/o Psychotic Features (w/PF Severe only)
Specifiers if not current:
- In Partial/Full Remission
Specifiers if Recurrent:
- Longitudinal Course Specifiers (w/ and w/o Interepisode Recovery)
- w/Seasonal Pattern
Other specifiers:
- Chronic
- w/Catatonic Features
- w/Melancholic Features
- w/Atypical Features
- w/Postpartum Onset

10

What are the key criteria for Dysthymic Disorder?

A. Depressed mood most of the day more days than not for at least two years (subjective or objective).
B. During depression at least two of the following:
- disturbed appetite
- disturbed sleep
- fatigue
- low self-esteem
- poor concentration or indecisiveness
- feelings of hopelessness
C. Never being w/o symptoms in A and B for more than two months at a time
D. No Major Depressive Disorder for first two years
E. Never been Manic, Mixed, or Hypomanic episodes
F. Does not occur during the course of a chronic psychotic disorder, e.g., Schizophrenia

(G common criteria)

11

What are the specifiers for Dysthymic Disorder?

- Early Onset (< 21yo)
- Late Onset (> 21yo)
- w/Atypical Features

12

What is the key criterion for Bipolar I Disorder, Single Manic Episode?

A. Presence of only one Manic Episode and no past Major Depressive Episodes.

(B DiffDx: Schizoaffective Disorder)

13

What are the key criteria for Bipolar I Disorder, Most Recent Episode Manic or Mixed?

A. Currently or most recently in a Manic or Mixed episode
B. There has previous been at least one Major Depressive, Manic, or Mixed episode.

(C DiffDx: Schizoaffective Disorder)

14

What are the key criteria for Bipolar I Disorder, Most Recent Episode Hypomanic, Depressed?

A. Currently or most recently in a Hypomanic or Major Depressive episode
B. There has previously been at least one Manic, or Mixed episode.

(C common criteria; D DiffDx: Schizoaffective Disorder)

15

What are the key criteria for Bipolar I Disorder, Most Recent Episode Unspecified?

A. Criteria, except for duration, currently or most recently met or Manic, Hypomanic, or Major Depressive episode
B. There has previous been at least one Manic, or Mixed episode.

(C, E common criteria; D DiffDx: Schizoaffective Disorder)

16

What are the specifiers for Bipolar I Disorder?

Specifiers describe onset, severity, course, features, remission.

Specifiers for all Bipolar I except Single Manic Episode:
- Longitudinal Course Specifiers (w/ and w/o Interepisode Recovery)
- w/Seasonal Pattern
- w/Rapid Cycling
Specifier for Single Manic Episode only:
- Mixed
Specifiers for all Bipolar I except Most Recent Episode Unspecified:
- Mild/Moderate/Severe w/ or w/o Psychotic Features (w/PF Severe only)
- w/Catatonic Features
- w/Postpartum Onset
- In Partial/Full Remission
Specifiers Most Recent Episode Depressed only:
- Chronic
- w/Melancholic Features
- w/Atypical Features

17

What are the criteria for Bipolar II Disorder?

A. Presence or history of one or more Major Depressive Episode.
B. Presence or history of one or more Hypomanic Episodes.
C. Never been a Manic or Mixed episode.

(D DiffDx: Schizoaffective Disorder; E common criteria)

aka Recurrent Major Depressive w/Hypomanic episodes

18

What are the specifiers for Bipolar II?

Specifiers for onset, severity, features, last episode, and chronicity.

Most recent episode:
- Hypomanic
- Depressed
Other specifiers:
- Mild/Moderate/Severe (hypomania, and therefore BD II, never has psychotic features)
- Chronic
- w/Catatonic Features
- w/Melancholic Features
- w/Atypical Features
- w/Postpartum Onset

19

What are the criteria for Cyclothymic Disorder?

A. For at least two years, presence of numerous periods both of hypomanic and depressive symptoms, of which the latter do not meet criteria for Major Depressive Episode.
B. Never being w/o symptoms in A for more than two months at a time.
C. No Major Depressive, Manic, or Mixed episodes during first two years.

(D DiffDx: Schizoaffective Disorder; E, F common criteria)

20

What are the key criteria for Mood Disorder Due to (general medical condition)?

A. Prominent and persistent mood disturbance:
1) depressed mood or anhedonia
2) elevated or irritable mood

B. Evidence that disturbance is direct consequence of general medical condition.

(C DiffDx: Adjustment Disorder; D, E common criteria)

See also specifiers

21

What are the key criteria for Substance-Induced Mood Disorder?

A. Prominent and persistent mood disturbance:
1) depressed mood or anhedonia
2) elevated or irritable mood

B. Evidence that disturbance:
1) developed during or w/in one month of substance intoxication or withdrawal
2) etiologically related to use of medication

(C DiffDx: non-substance-induced mood disorder; D, E common criteria)

See also specifiers

22

What are the key criteria for Agoraphobia?

A. Anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help may not be available, esp. in the event of a Panic Attack.
B. Situations are avoided or endured with distress or anxiety or require the presence of a companion.

(C DiffDx)

NOTE: Agoraphobia is not a codable disorder.

23

What are the symptoms of Panic Attack?

Discrete period of intense fear or discomfort with four of the below symptoms developing abruptly and peaking within 10 minutes:
- pounding heart or accelerated pulse
- sweating
- trembling/shaking
- shortness of breath
- feeling of choking
- chest pain
- nausea/abdominal stress
- dizziness, lightheadedness
- derealization or depersonalization
- fear of going crazy/losing control
- fear of dying
- parethesias
- chills/hot flushes

NOTE: Panic Attack is not a codable disorder.

24

What are the key criteria for Specific Phobia?

A. Marked and persistent fear that is excessive and unreasonable cued by the presence or anticipation of a specific object or situation.
B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, e.g., Panic Attack.
C. Person recognizes the fear as excessive or unreasonable.
D. Phobic situation is avoided or endured with anxiety/distress.

(E, G, common criteria; F children <18yo at least 6 months)

25

What are the types (specifiers) of Specific Phobia?

- Animal
- Natural Environment
- Blood-Injection-Injury
- Situational
- Other

26

What are the key criteria for Social Phobia?

A. Marked and persistent fear of social or performance situations with exposure to unfamiliar others and/or scrutiny. Fear that person will act in a way that will be humiliating or embarrassing.
B. Exposure to the social/performance situation almost invariably provokes an immediate anxiety response, e.g., Panic Attack.
C. Person recognizes the fear as excessive or unreasonable.
D. Social/performance situation is avoided or endured with anxiety/distress.

(E, H, common criteria; F children <18yo at least 6 months; G DiffDx: Panic/Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, Pervasive Developmental Disorder, Schizoid Personality Disorder, Avoidant Personality Disorder [if Generalized])

27

What is the specifier for Social Phobia?

Generalized

28

What are the symptoms of obsession?

- intrusive, distressing, recurrent and persistent thoughts, impulses, images that are not simply excessive worries about real-life problems
- person having the thoughts attempts to suppress or neutralize them and recognizes them as products of his/her mind (not imposed from outside)

29

What are the symptoms of compulsion?

- repetitive behaviors or mental acts the performer feels driven to do, according to rigid rules, in response to an obsession, and intended to prevent a dreaded event or situation or reduce associated distress
- these behaviors are not realistically connected with the event or distress they are meant to address

30

What are the key criteria for Obsessive-Compulsive Disorder?

A. Either obsessions or compulsions.
B. Subjective recognition that obsessions or compulsions are excessive or unreasonable.

(C, E, common criteria; D DiffDx: eating disorders, Trichotillomania, Body Dysmorphic Disorder, Substance Use Disorder, Hypochondriasis, Paraphilia, Major Depressive Disorder)

31

What is the specifier for Obsessive-Compulsive Disorder?

With Poor Insight

32

What are the differential diagnoses for Agoraphobia, Specific Phobia, and Social Phobia?

Specific Phobia is limited to one or a few specific situations; Social Phobia is limited to social situations.

33

What are the criteria for a traumatic event in PTSD or ASD?

1. Person experienced event involving actual or threatened death or serious injury to self or others.
2. Person responded to event with intense fear, helplessness, or horror.

34

How are traumatic events re-experienced in PTSD and ASD?

1) Recurrent and intrusive thoughts, images, perceptions.
2) Recurrent distressing dreams.
3) Acting as if the event were recurring (reliving, illusions, hallucinations, etc.).
4) Intense distress at exposure to cues of event.
5) Physiological reactivity at exposure to cues of event.

35

What are some of the arousal symptoms associated with PTSD and ASD?

- difficulty sleeping
- irritability/angry outbursts
- difficulty concentrating
- hypervigiliance
- exaggerated startle response
- motor restlessness (ASD only)

36

What are some of the avoidance behaviors associated with PTSD and ASD?

- efforts to avoid thoughts, feelings, or conversations associated with trauma
- efforts to avoid activities, places, or people associated with trauma

37

What are some of the dissociative symptoms associated with PTSD and ASD?

- dissociative amnesia
- restricted range of affect
- anhedonia*
- feeling detached or estranged from others*
- sense of foreshortened future (not expecting to have career, marriage, children, etc.)*
- reduced awareness (dazedness)**
- derealization**
- depersonalization**

*PTSD only
**ASD only

38

What are the key criteria for Posttraumatic Stress Disorder?

A. Exposure to a traumatic event
B. Trauma is re-experienced
C. Persistent avoidance of stimuli associated with event
D. Persistent arousal symptoms
E. Duration of disturbance is more than one month

(F common criteria)

39

What are the key criteria for Acute Stress Disorder?

A. Exposure to a traumatic event
B. Dissociative symptoms during or after event
C. Trauma is re-experienced
D. Persistent avoidance of stimuli associated with event
E. Persistent arousal symptoms
G. Duration of disturbance is at least 2 days and not more than 4 weeks and occurs within 4 weeks of trauma

(F common criteria; H DiffDx: Brief Psychotic Disorder)

40

What are the criteria for Adjustment Disorder?

A. Emotional or behavioral symptoms in response to identifiable stressor(s) w/in 3 months of stressor.
B. Symptoms/behavior are either:
- in excess of what would be expected or
- significantly impairing
E. Symptoms do not persist for more than 6 months after stressor ends.

(C common criteria; D DiffDx: Bereavement)

42

What are the key criteria for Generalized Anxiety Disorder?

A. Excessive anxiety and worry about a range of issues more days than not for at least 6 months.
B. Person has difficulty controlling worry.
C. Anxiety/worry is associated with at least 3 of the following:
- restlessness, feeling keyed up
- being easily fatigued
- concentration issues
- irritability
- muscle tension
- disturbed sleep

(D DiffDx: Panic Disorder, Social Phobia, OCD, Separation Anxiety Disorder, Anorexia Nervosa, Somatization Disorder, Hypochondriasis, PTSD)

(E, F common criteria)

43

What are the key criteria for Anxiety Disorder Due to (general medical condition)?

A. Prominent and persistent anxiety, Panic Attacks, or obsessions or compulsions.
B. Evidence that disturbance is direct consequence of general medical condition.
D. Does not occur exclusively in a delirium.

(C DiffDx: Adjustment Disorder w/Anxiety; E common criterion)

See also specifiers

44

What are the key criteria for Substance-Induced Anxiety Disorder?

A. Prominent and persistent anxiety, Panic Attacks, or obsessions or compulsions.
B. Evidence that disturbance:
1) developed during or w/in one month of substance intoxication or withdrawal
2) etiologically related to use of medication
D. Does not occur exclusively in a delirium.

(C DiffDx: non-substance-induced anxiety disorder; E common criteria)

See also specifiers