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Flashcards in DSM IV 3 Deck (30):

Describe the key diagnostic criteria and onset specifiers for Conduct Disorder.

At least three examples of misconduct for at least 12 months, with at least one present in the last 6:
- aggression to people and animals
- destruction of property
- deceitfulness or theft
- serious rule violations

If before age 10, Childhood Onset; if after age 10, Adolescent Onset.


Describe the key diagnostic criteria for Oppositional Defiant Disorder.

At least four Sx persisting at least six months:
- negativism, irritability, argumentativeness, vindictiveness, defiance to adults
- does not result in conflict with law

Sx occur considerably more frequently than normal for age and do not meet criteria for Conduct Disorder.


What are the key criteria for Pica?

- persistent ingestion of non-nutritive substances, inappropriate to developmental level
- not culturally sanctioned
- at least one month


What are the key criteria for Rumination Disorder?

- repeated regurgitation and rechewing of food for one month (previously normal functioning)

DiffDx: Anorexia Nervosa, Bulimia Nervosa


What are the major criteria for Feeding Disorder of Infancy or Early Childhood?

- persistent failure to eat, leading to weight loss or failure to gain weight for at least one month


Describe the key criteria for Tourette's Disorder.

A. multiple motor and at least one vocal tics
B. tics occur daily, frequently, and nearly every day or intermittently for more than one year, with no tic-free period greater than three consecutive months
C. onset before age 18


Describe the key criteria for Chronic Motor or Vocal Tic Disorder.

A. motor or vocal tics, but not both
B. tics occur daily, frequently, and nearly every day or intermittently for more than one year, with no tic-free period greater than three consecutive months
C. onset before age 18

(i.e., like Tourette's, but only one kind of tic instead of both)


Describe key criteria for Encopresis.

A. repeated voluntary or involuntary inappropriate passage of feces (into clothing, onto floor)
B. at least one event per month for three months
C. chronological or developmental age at least four


Describe the key criteria of Enuresis.

A. Repeated inappropriate voiding of urine (into clothes or bed).
B. Frequency of either at least twice per week for three consecutive months or presence of clinically significant distress or dysfunction
C. Chronological or developmental age of at least five years.


Describe the key criteria of Separation Anxiety Disorder.

A. Developmentally inappropriate and excessive anxiety at separation from home or attachment figures as evidenced in at least three distinct behaviors (see DSM for list).
B. Duration at least four weeks.
C. Onset is before age 18.


Describe key criteria for Selective Mutism.

- failure to speak in specific circumstances when person able to speak otherwise for at least one month
- not due to ignorance of spoken language


Describe the key criteria of Reactive Attachment Disorder of Infancy or Early Childhood.

A. Before age 5, either
- persistent failure to respond socially in developmentally appropriate manner (e.g., excessive inhibition, hypervigilance, strong ambivalence, contradiction)
- diffuse, indiscriminate attachment behaviors
C. Presence of pathogenic care (persistent disregard of child's emotional and/or physical needs, repeated changes of caregiver preventing stable attachment)
D. Presumption that care in C results in Sx in A.

(B. DiffDx: Mental Retardation, Pervasive Developmental Disorder)


Describe the key criteria for Stereotypic Movement Disorder.

- clinically significant, repetitive, seemingly driven, nonfunctional motor behaviors occurring for at least four weeks

DiffDx: OCD, tics, Pervasive Developmental Disorder, Trichotillomania (also, if MR present movement clinically sufficient to warrant separate focus)


What are the key criteria for Mental Disorders Due to A General Medical Condition?

- evidence that disorder is direct physiological consequence of medical (Axis III) condition
* occur closely in time
* representative of primary disorder or are atypical
* medical condition is known to produce mental symptoms
- mental disorder DGMC not better explained by primary (Axis I) mental disorder
- symptoms do not occur solely during delirium (except for Delirium DGMC)

NOTE: Personality Change DGMC and Catatonic Disorder DGMC vary from the above organization.


What are the key criteria for Personality Change Due to A General Medical Condition?

A. Persistent and marked change in behavior patterns
B. Evidence of concurrent medical condition producing these patterns

NOTE: Multiple types, e.g., Labile, Disinhibited, Aggressive, etc.


What are the criteria for Delirium?

A. Disturbance of consciousness.
B. Change in cognition or development of perceptual disturbance.
C. Disturbances develop quickly (hours to days), fluctuates diurnally, and is of relatively short duration (< 1mo).
D. Evidence of a causal general medical condition or substance.


What are the key criteria for Catatonic Disorder Due to A General Medical Condition?

A. Catatonia:
* motoric immobility
* excessive motor activity
* extreme negativism or mutism
* peculiarities of voluntary movement
* echolalia
* echopraxia
B. Evidence of concurrent medical condition producing these patterns


DiffDx: Substance-Induced Mood/Psychotic Disorder vs. Substance Intoxication/Withdrawal or other mood/psychotic disorder.

Substance Intoxication/Withdrawal is ruled out if there is temporal discontinuity with substance use. If no Hx of previous mood/psychotic Sx and current Sx is significant enough to warrant separate clinical attention, Substance Induced Mood/Psychotic Disorder Dx may be justified.


What are key criteria for all forms of Dementia?

A. Memory problems plus at least one of the following:
* aphasia
* apraxia
* agnosia
* executive functioning disturbance
C. Evidence of causal general medical condition or persistent effects of a substance.


What is the key criterion for Hallucinogen Persisting Perception Disorder (Flashbacks)?

A. Re-experiencing perceptual symptoms of hallucinogen ingestion, after cessation of use of hallucinogens.


What are the two key criteria for Delirium, Dementia, and Amnestic and Other Cognitive Disorders?

A. Significant change and impairment in cognition or memory.
B. Evidence that symptoms are direct physiological consequence of general medical condition, substance, or combination.


What criteria distinguish Dementia of the Alzheimer's Type?

- gradual onset and continuing cognitive decline
- not due to other CNS or systemic conditions known to produce cognitive decline (e.g., Parkinson's, hypothyroidism)


What is the distinguishing criterion for Vascular Dementia?

- focal neurological signs and symptoms, as from stroke, or laboratory evidence of cerebrovascular disease


What are the key criteria for Amnestic Disorder (two types)?

A. Anterograde or retrograde amnesia

AD Due to General Medical Condition:
- evidence of causal general medical condition

Substance-Induced Persisting AD:
- evidence of causal, persistent effects of a substance.


List the seven subtypes of Delusional Disorder.

- Erotomanic
- Grandiose
- Jealous
- Persecutory
- Somatic
- Mixed
- Unspecified


DiffDx: Somatization Disorder, Undifferentiated Somatoform Disorder, Pain Disorder, Hypochondriasis.

- Somatization Disorder is most severe, requiring at least eight different somatic complaints of at least four different types over the course of several years.
- Undifferentiated Somatoform Disorder requires only at least one somatic complaint persisting at least six months
- Pain Disorder requires only a preoccupation with pain (no other physical Sx)
- Hypochondriasis requires a preoccupation with fears of having disease(s) which entails no delusions and the patient can acknowledge his/her fears are exaggerated, but persists despite reassurances of wellness


DiffDx: Factitious Disorders (FD, FD w/Psychological Sx, FD w/Physical Sx), Malingering.

- Factitious Disorders resemble compulsions in that the feigning of Sx is voluntary and purposeful but the individual does not have complete control over them
- Malingering (not a codable disorder) has a clear external goal and the feigning of Sx is under the individual's control


DiffDx: Schizoid and Schizotypal Personality Disorders.

- Schizoid PD: characterized by social isolation and restricted affect
- Schizotypal PD: characterized by peculiarities of thought, appearance, and behaviors, but not meeting criteria for Schizophrenia and psychoses, if present, are transient


DiffDx: Schizoid/Schizotypal and Avoidant Personality Disorders

- Avoidant PD: characterized by desire for interpersonal relationships but avoidance of them
- Schizo- PDs: characterized by lack of desire for interpersonal relationships


DiffDx: Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder

- OCD: characterized by intrusive thoughts and ritualistic behaviors
- OCPD: preoccupation with rules, morality, control, orderliness, perfectionism; no intrusive thoughts