DSM IV 1 Flashcards
Priority 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.
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
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)
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.
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.
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.
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)
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)
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)
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
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)
What are the specifiers for Dysthymic Disorder?
- Early Onset (< 21yo)
- Late Onset (> 21yo)
- w/Atypical Features
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)
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)
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)
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)
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
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
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
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)
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
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
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.
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.
