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Flashcards in DSM IV 2 Deck (44):

What are the characteristics of substance tolerance?

- a need for markedly increased amounts of the substance to achieve desired effect
- a markedly diminished effect with continued use of the same amount of substance


What are the characteristics of withdrawal?

- presence of withdrawal syndrome for specified substance
- same or related substance is taken to relieve or avoid withdrawal syndrome


What are the key criteria for Substance Dependence?

Maladaptive pattern of substance use, leading to clinical impairment, as manifested by at least 3 of the following in any 12-month period:
- tolerance
- withdrawal
- more substance is taken than intended
- persistent desire or unsuccessful efforts to reduce or control substance use
- inordinate amount of time spent obtaining and/or using substance
- important activities are given up or reduced because of substance use
- substance use is continued despite awareness of problems likely caused or worsened by substance use


What are the specifiers for Substance Dependence?

Physiological Dependence:
- With/Without (tolerance & withdrawal)

- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission
- On Agonist Therapy
- In a Controlled Environment


What are the key criteria for Substance Abuse?

A. Maladaptive pattern of substance use, leading to clinical impairment, as manifested by at least 1 of the following in any 12-month period:
- recurrent substance use resulting in failure to meet obligations
- recurrent substance use in physically hazardous situations (e.g., driving)
- recurrent substance related legal problems
- continued substance use despite recurrent social or interpersonal problems caused/worsened by substance use
B. Never met criteria for Substance Dependence.


What are the key criteria for Schizophrenia?

A. Two or more characteristic symptoms:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms, e.g., flat affect, alogia, avolition
B. Social/occupational function markedly below level achieved prior to onset
C. Persistence of disturbance for at least 6 months, including at least 1 month of Criterion A Sx.

(D-F, DiffDx: Schizoaffective Disorder, Mood disorder w/Psychotic Features, Autistic Disorder or other PDD)


What are the five subtypes of Schizophrenia?

- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Residual


What are the criteria for Schizophrenia, Paranoid Type?

A. Preoccupation with at least one delusion or frequent auditory hallucinations.
B. No significant disorganized speech, disorganized or catatonic behavior, or flat affect.


What are the criteria for Schizophrenia, Disorganized Type?

A. Disorganized speech and behavior, and flat/inappropriate affect.
B. Doesn't meet criteria for Catatonic Type.


What are the criteria for Schizophrenia, Catatonic Type?

At least two of:
- catalepsy or stupor
- excessive apparently purposeless motor activity not influenced by external stimuli
- extreme negativism or mutism
- posturing, stereotyped movement, prominent mannerisms or grimacing


What are the criteria for Schizophrenia, Undifferentiated Type?

Schizophrenia Criterion A is met, but not those for Paranoid, Disorganized, or Catatonic types.


What are the criteria for Schizophrenia, Residual Type?

A. Absence of delusions, hallucinations, disorganized speech, or catatonia.
B. Evidence of negative Sx or at least two attenuated positive Sx (e.g., odd beliefs, unusual perceptions).


What are the key criteria for Schizophreniform Disorder?

A. Criteria for Schizophrenia are met, except for duration and social/occupational disruption.
B. Episode lasts at least 1 month but less than 6.


What are the key criteria for Schizoaffective Disorder?

A. Uninterrupted co-ocurrence of Major Depressive, Manic, or Mixed episodes and symptoms of Criterion A for Schizophrenia.
B. During this period, at least 2 weeks of delusions or hallucinations in absence of mood Sx.
C. Mood Sx present for substantial portion of illness.

(D common criteria)


What are the key criteria for Delusional Disorder?

A. Non-bizarre delusions for at least 1 month.
B. Schizophrenia Criterion A is never met.
C. Functioning apart from delusions is not bizarre.
D. Only brief, if any, concurrent mood Sx.

(E common criteria)


What are the key criteria for Brief Psychotic Disorder?

A. Presence of delusions, hallucinations, disorganized speech, and/or catatonic behavior.
B. Duration of at least 1 day, but less than 1 month, with eventual return to full premorbid functioning.

(C DiffDx: Mood Disorder w/Psychotic Features, Schizoaffective Disorder, Schizophrenia)


What are the key criteria for Shared Psychotic Disorder (Folie a Deux)?

A. Delusion develops in the context of a close relationship with an already-deluded other(s).
B. Delusion is similar in content to that of the already-deluded other.
(C DiffDx: Schizophrenia, Mood Disorder w/Psychotic Features)


What are the criteria of Factitious Disorder?

A. Intentional production or feigning of symptoms.
B. Motivation is based on the assumption of a sick role.
C. External incentives are absent.


What are the types (specifiers) of Factitious Disorder?

- w/predominantly psychological Sx
- w/predominantly physical Sx
- w/combined Sx


What are the key criteria for Dissociative Amnesia?

A. Prominent disturbance is one or more episodes of inability to recall important personal information, too extensive to be explained by ordinary forgetfulness.

(B DiffDx: DID, Fugue, PTSD, ASD, Somatization; C common criteria)


What are the key criteria for Dissociative Fugue?

A. Predominant disturbance is sudden, unexpected travel away from home/work, with inability to recall one's past.
B. Confusion about or assumption of a new personal identity.

(C DiffDx: DID; D common criteria)


What are the key criteria for Dissociative Identity Disorder?

A. Presence of at least two distinct identities.
B. At least two identities recurrently take control of behavior.
C. Inability to recall important personal information, too extensive to be explained by ordinary forgetfulness.
(D common criteria)


What are the key criteria for Depersonalization Disorder?

A. Persistent/recurrent experiences of feeling as if one is detached from and an outside observer of one's mental processes or body.
B. Reality testing remains intact during depersonalization.
(C common criteria; D DiffDx: Schizophrenia, PD, ASD, other Dissociative Disorder)


What are the key criteria for Gender Identity Disorder?

A. Strong, persistent cross-gender identification, identified in children as at least four of:
- repeatedly stated desire to be or that s/he is the other sex
- strong preference for cross-dressing
- strong preference for cross-sex roles
- strong desire to participate in stereotypical pastimes of other sex
- strong preference for playmates of other sex... and in adults, similar expressions of desire to live and/or be treated as the other sex.
B. Persistent discomfort with her/his birth sex.
C. Disturbance is not concurrent with physical intersex condition.

(D common criteria)


What are the criteria and types of Anorexia Nervosa?

A. Refusal to maintain body weight at or above 85% of normal for age and height.
B. Intense fear of gaining weight or becoming fat.
C. Disturbed image/experience of body.
D. Amenorrhea (missing at least 3 menstrual cycles)
- restricting
- binge-eating/purging


What are the criteria and types of Bulimia Nervosa?

A. Recurrent episodes of binge eating, characterized by eating a clearly abnormal amount of food and a sense of lack of control.
B. Recurrent inappropriate (and not necessarily effective) compensatory behavior to prevent weight gain.
C. A&B occur on average at least 2x/week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. Not exclusively concurrent with Anorexia Nervosa.
- purging
- nonpurging


What are the symptoms of inattention?

- frequent failure to attend to details or making careless mistakes
- difficulty sustaining attention
- frequently seeming not to listen when spoken to directly
- frequently failing to follow instructions or finish tasks (not due to oppositionality)
- frequent difficulty with organizing activities
- avoidance or dislike of tasks requiring sustained mental effort
- frequent loss of items necessary for activities
- frequently easily distracted by extraneous stimuli
- frequent forgetfulness in daily activities


What are the symptoms of hyperactivity/impulsivity?

- fidgetiness
- getting up from seat when sitting is expected
- inappropriate running about, or subjective restlessness
- difficulty with engaging in quiet leisure activities
- being "on the go" or "driven"
- excessive talking

- blurting out answers before questions are finished
- difficulty waiting his/her turn
- interrupting/intruding on others


What are the key criteria and types of Attention Deficit/Hyperactivity Disorder?

A. For at least six months, at least six inattention and/or at least six hyperactivity symptoms.
B. Some of above symptoms causing impairment prior to age 7.
C. Impairment in at least two settings.

- combined (=> 6 ea inattentive and hyperactive-impulsive Sx)
- predominantly inattentive (=> 6 inattentive Sx, < 6 hyperactive-impulsive Sx)
- predominantly hyperactive-impulsive (=> 6 hyperactive-impulsive Sx, < 6 inattentive Sx)

(D common criteria; E DiffDx: Pervasive Developmental Disorder, Schizophrenia)


What are the general characteristics of dementia?

- Multiple cognitive deficits including
1) memory impairment (recall or new formation)
2) at least one of:
* aphasia
* apraxia
* agnosia
* executive functioning disturbance
- Deficits do not occur exclusively during delirium

(common criteria)


What are three types of dementia and their defining characteristics?

- cognitive deficits are gradual in onset and continue to decline

- presence of focal neurological symptoms etiologically related to the cognitive deficits

Substance-Abuse Persisting
- evidence that deficits are etiologically related to persisting effects of substance use


Why are mental retardation and the personality disorders listed on a separate Axis (II)?

to ensure that they receive proper diagnostic consideration relative to the "usually more florid" Axis I disorders


Although it is typically used for mental retardation and personality disorders, Axis II can be used to locate what else?

-defense mechanisms
- below-threshold maladaptive traits


What are the three criteria for a diagnosis of Mental Retardation?

- significantly subaverage intellectual functioning (IQ > 2SD below mean)
- clinically significant functional impairment
- onset before age 18


Apart from morphological signs, such as those associated with Down Syndrome and Fetal Alcohol Syndrome, what are some early behavioral symptoms of Mental Retardation?

- less physically active
- less vocally active
- more compliant


List the four degrees of Mental Retardation severity.

Mild: (IQ 50/55-70) 85% of MR population, difference shows in late childhood, able to reach sixth grade, and work and live independently
Moderate: (IQ 35/40-50/55) 10% of MR population, rarely progress past 2nd grade, and usually require some guidance and supervision for work and life
Severe: (IQ 20/25-35/40) 3-4% of MR population, poor motor skills, limited speech, able to learn hygiene and live communally
Profound: (IQ <20/25) 1-2% of MR population, limited motor & sensory function, require highly structured environment


What are the major etiological factors in Mental Retardation?

- 30% embryonic development (Down's, alcohol/drug use)
- 15-20% environmental issues (nurturance deprivation)
- 10% pregnancy & perinatal issues (fetal trauma or malnutrition, hypoxia)
- 5% hereditary factors (Tay-Sachs, fragile X)
- balance (30-40%) cannot be determined


What is phenylketonuria?

A heritable inability to oxidize the amino acid phenylalanine, found in protein foods. If untreated, causes damage to newborn's nervous system through buildup of abnormal metabolites. Can be treated through diet, resulting in near-normal development if caught early enough.


What is the relative frequency of occurrence of Fragile X syndrome based on sex?

twice as common in males as females


What is the basis of Down's Syndrome, or trisomy-21?

In the fertilized zygote, the 21st pair of chromosomes has an extra chromosome, caused by unequal division of the sperm and egg's share of chromosomes.


What are three types of post-natal causes of Mental Retardation?

- infection, e.g., meningitis and encephalitis
- toxic/nutritional, e.g., lead poisoning and malnutrition
- anoxia, esp. head-injury-based


Define Borderline Intellectual Functioning.

IQ 71-84

DiffDx (Mental Retardation) is based on lack of significant deficits in adaptive functioning and/or IQ >75


What are the four main areas of the Mental Status Exam, part 1, and their subdivisions?

1. General Appearance
- level of consciousness
- appearance
- manner
2. Motor Activity
- posture
- activity
3. Emotionality
- mood (subjective)
- affect (objective)
4. Thought Processes
- speech
- thought processes
- thought content
- delusional thinking
- perception


What are the nine areas of the Mental Status Exam, part 2?


1. Orientation (time, place, person)
2. Cognition (attention, concentration)
3. Memory (immediate, recent, remote)
4. General Intellect (calculations, abstract reasoning)
5. General Cortical Functioning (name objects, know right/left, etc.)
6. Insight into Disorder (nature, impact on others, etc.)
7. Defenses (e.g., denial, minimizing, rationalizing, etc.)
8. Suicidal Ideation (thoughts, plans, attempts, family history)
9. Homicidal Ideation (thoughts, plans, attempts, persons)