DSM5 criteria Flashcards
1
Q
delusional disorder
A
≥1 delusion for > 1 mo NEVER met criteria for SCZ hallucinations may be present, but not prominent and related to the delusion fx is not markedly impaired subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified Specify: With bizarre content
2
Q
Delusional disorder specifiers
A
* Use after >1yr duration * First episode,/Multiple episodes, currently in acute episode/partial remission/full remission * Continuous * Unspecified * Specify current severity
3
Q
Delusional disorder prevalence
A
* 0.2% lifetime * no major gender diff * persecutory most common
4
Q
Brief psychotic disorder
A
* ≥1 of {delusions, hallucinations, disorg. speech, disorg/catatonic beh} * 1 day - 1 month
5
Q
Brief psychotic disorder specifiers
A
* With marked stressors (brief reactive) * Without marked stressors * With peripartum onset (preg or 4wks postpartum) * With catatonia * Specify current severity
6
Q
Brief psychotic disorder epidemiology and course
A
* 9% of FEP * F:M = 2:1 * Avg onset mid-30s * High rates of relapse but excellent outcome
7
Q
Schizophreniform disorder
A
* ≥ 2 Sx of psychosis (delusions, hallucinations, disorganized speech, disorg/catatonic beh, negative symptoms) * 1-6 months * R/O mood/schizoaff
8
Q
Schizophreniform disorder specifiers
A
* with/without good prognostic features (prominent psychotic sx within 4 weeks of noticeable change; confusion/perplexity; premorbid fxn; absence of flat/blunted affect) * with catatonia * severity
9
Q
schizophreniform d/o epidemiology/course
A
* incidence overall similar to scz; in US
10
Q
Schizophrenia criteria
A
* ≥ 2 psychotic sx for 1month * fxn markedly decreased most of the time since onset * continuous sx >6 months * R/O SCZ-aff/mood
11
Q
Schizophrenia specifiers
A
* FEP/multiple episodes, currently in acute episode/partial remission/full remission * Continuous * Unspecified * with catatonia * severity
12
Q
Aggression risk in SCZ
A
* young males * Hx of violence * non-adherence to tx * substance abuse * impulsivity
13
Q
Anosognosia in SCZ
A
* Sx of SCZ, not a coping strategy * predicts relapse, involuntary tx, fxn, aggression, course of illness
14
Q
Neuro soft signs in SCZ
A
* motor coordination * sensory integration * motor sequencing of complex movements * L-R confusion * disinhibition of associated movements
15
Q
SCZ - prevalence
A
* Lifetime prevalence: 0.3-0.7% * F=M if including all Sx
16
Q
SCZ - age of onset
A
late teens to mid-30s Peak age: early 20s for M, late 20s for F
17
Q
SCZ - risk/prognostic factors
A
* Age of onset prob linked to gender (worse course in M => worse in early age of onset) * 20% good outcome * Negative Sx more related to prognosis, more persistent * Cognitive Sx may not improve * 20% suicide attempt; 5-6% complete
18
Q
Schizoaffective d/o criteria
A
* uninterrupted period of major mood episode + Criteria A SCZ * Delusions or hall x >2wks W/O mood episode * Mood Sx present majority of total duration of illness
19
Q
Schizoaffective d/o specifiers
A
* Bipolar/depressive type * Catatonia * FEP/multiple episodes, currently in acute episode/partial/full remission * Continuous * Severity
20
Q
Schizoaffective disorder prevalence
A
* lifetime prevalence 0,3% * F>M
21
Q
Schizoaffective d/o age of onset
A
early adulthood but anywhere from teens to late life
22
Q
Substance/Med-induced psychotic D/O
A
* ≥1 of delusions/hallucinations * Both: sx developed during or soon after intox/withdrawal AND substance is capable of producing the Sx * R/O delirium * R/O other psychotic d/o (e.g. persistent sx or preceding substance etc)
23
Q
Substance/Med-induced psychotic d/o specifiers
A
* Onset during intoxication * Onset during withdrawal * Severity
24
Q
Disruptive mood dysregulation disorder - criteria
A
temper outbursts: - severe and recurrent - ≥ 3x/week - inconsistent with dev. level - irritable most of the time - >12 months - >2-3 settings _ 6-18yo - no manic symptoms >1 day
25
Major depressive disorder - criteria
\* 2 weeks + change of previous fxn \* 5 of {mood, interest, sleep, wt, psychomotor, energy, guilt/worthlessness, [], SI}
26
MDD- specifiers
\* anxious distress \* mixed features \* melancholic features \* atypical features \* mood-congruent psychotic features \* mood-incongruent psychotic features \* catatonia \* peripartum onset \* seasonal pattern
27
Anxious distress
≥ 2 sx: \* tense \* restless \* diff. [] 2nd worry \* fear something bad will happen \* fear might lose control of self
28
Anxious distress severity
\* Mild - 2 sx \* moderate - 3 sx \* mod-severe: 4-5 sx \* severe: 4-5 sx + agitation
29
Mixed features in MDD
\* ≥ 3 manic sx during most of MDE
30
Melancholic features
\* during most severe period of MDE: \* 1 of {anhedonia or lack of reactivity to pleasurable stimuli} \* ≥ 3 of {despair/empty mood, worse in AM, AM awakening, psychomotor agitation or retardation, we loss , excessive guilt}
31
Atypical features
\* mood reactivity \* ≥ 2 of {wt gain/increased appetite, , hypersomnia, leaden paralysis, long-standing rejection sensitivity} \* NO melancholia or catatonia in same episode
32
Seasonal pattern
\* regular temporal relationship w/ season ( not psychosocial stressors) \* full remissions or (hypo)mania \* in last 2yrs, 2 MDE w/ temporal relationship and no MDE out of season \* seasonal \> non-seasonal episodes
33
Persistent depressive disorder
\* \>2 years depressed mood (1yr for child) \* 2 sx of {appetite change, sleep change, fatigue, low self-esteem, poor [] or decision making, hopelessness} \*
34
Persistent depressive disorder - specifiers
\* all specifiers as MDD \* early/late onset (21yo) \* pure dysthymic syndrome (no MDE in past 2 years) \* persistent MDE (meets criteria for full 2 years) \* intermittent MDE, with/ wi/o current episode \* severity
35
MDD epidemiology
\* 12mo prevalence: 7% \* F:M = 1.5-3x \* 18-29yo: 3x prevalence in \>60yo
36
MDD - course
\* variable course \* 40% recover in 3mo, 80% in 1yr \* poor prognosis: episode duration, psychosis, anxiety, personality d/o, severity \* BD more likely if mixed features, psychosis, FHx of BD
37
MDD - age of onset
any age but peak onset in 20s
38
Persistent depressive d/o - epidemiology
\* 0.5% 12mo prevalence for dysthymia \* 1.5% for chronic MDD \* early, insidious course
39
Premenstrual dysphoric disorder
\* most cycles in past 1 yr , ≥5 sx in final wk, improve in a few days \* ≥ 1 of {affective lability, irritability, depressed mood/hopelessness, anxiety/tension/keyed up}\ \* ≥ 1 of {anhedonia, []. energy, appetite, sleep, overwhelmed, phys. sx} \*
40
PMDD prevalence
\* 12mo prevalence: 2-6%
41
PMDD risk factors
stress, trauma, seasonal changes, no OCP
42
Manic episode criteria
\* elevated/irritable mood AND increased energy x \>1wk \* ≥3 of {grandiosity, dec. sleep, talkative, flight of ideas/racing thoughts, distractibility, goal-directed activity/agitation, painful consequences} \* marked impairment or hospitalization or psychosis
43
Hypomanic episode criteria
\* mood AND energy x \>4 days \* ≥3 of {grandiosity, sleep, talkative, flight of ideas, distractibility, goal-directed/agitation, painful consequences} \* uncharacteristic change in fxn
44
Bipolar I OR II specifiers
\* anxious distress \* mixed features (≥3 sx of MDE most days during (hypo)manic episode) \* rapid cycling (≥4 episodes of any mood in 12 months) \* melancholic features (for MDE or mixed) \* atypical features (MDE or mixed) \* psychotic features \* catatonia \* peripartum onset \* seasonal pattern
45
Bipolar I epi
\* 12mo prevalence: 0.6% \* M:F = 1.1 : 1
46
Bipolar I course
\* \>90% recurrence of mood episodes \* ~60% of manic episodes occure right before MDE \* high income \> low income countries \* FHx - strongest risk factor \* psychotic features predict future psychotic features \* mood-incongruent psychosis --\> incomplete recovery
47
Bipolar I avg age of onset
18yo
48
Bipolar II prevalence
\* 12mo prev: 0.3-0.8%
49
Bipolar II course
\* often starts with MDE \* higher lifetime episodes than BD I
50
Bipolar II age of onset
avg age mid-20s
51
Bipolar II risk/prognostic factors
\* FHx of BD II (not so much MDE/BD I) most predictive \* rapid-cycling --\> worse prognosis \* younger, less severe --\> return to baseline fxn \* education, less duration, married --\> assoc with recovery \* F more likely to have mixed or rapid-cycling \* 1/3 suicide attempts; more lethal than in BD I
52
Cyclothymic d/o criteria
\* \>2 yrs of numerous periods of hypomanic or depressive Sx not meeting criteria for episode \* Sx periods present for \>50% of the time \*
53
Cyclothymic d/o epi
\* lifetime prev: 0.4-1% \* M=F
54
Cyclothymic d/o course
insidious onset, persistent course
55
Cyclothymic d/o risk factors
\* MDD, BD I and II in 1st degree relatives \* increased familial risk of substance use
56
Substance/Medication induced bipolar and related d/o
\* prominent mood disturbance: elevated/irritable OR depressed OR anhedonia \* related to intox or withdrawal of substance capable of producing the Sx \* NOTE: ?? no need for full criteria of (hypo)mania/MDE
57
\* Separation anxiety d/o criteria
\* dev inappropriate anxiety re anticipated or experienced separation \* ≥3 of {recurrent excessive distress, worry about losing attachment figures, about untoward event that causes separation, reluctance to go anywhere, fear of being alone, refusal to sleep away from home or w/o attachment figure, nightmares re separation, physical sx with separation} \* \>4wks
58
Specific phobia criteria
\* marked fear \* phobic object/situation almost always provokes anxiety \* out of proportion to danger \* \>6 months
59
Specific phobia specifiers
\* animal \* natural environment (ht, storm etc) \* blood-injection-injury \* situational \* other (e.g. clowns, sounds, vomiting etc) \* common to have several phobias (avg 3)
60
Specific phobia epi
\* 12mo prev: 7-9% \* follows traumatic event \* Risk factors: neuroticism, parental overprotectiveness, parental loss, phys/sex abuse, genetic
61
Social anxiety criteria
\* anxiety re 1 or more social situations with scrutiny \* negatively evaluated (embarrassing or offending) \* the social situations almost always provoke anxiety \* social situations avoided or endured with intense fear \* out of proportion to actual threat/sociocultural context \* \>6 months
62
Social anxiety specifiers
\* performance only - restricted to speaking/performing in public
63
Social anxiety prevalence
\* 12mo prev: 7% \* F=M \*
64
Social anxiety risk factors
beh. inhibition, abuse, early adversity, genetic
65
Social anxiety age of onset
avg age 13yrs (1st onset in adult RARE)
66
Panic attack criteria
≥4 of: - palpitations - sweating - trembling - SOB - choking - CP - N/V - dizzy - chills/heat - paraesthesias - derealization/depersonalization - fear of losing control/crazy - fear of dying
67
Panic d/o criteria
\* recurrent unexpected panic attacks \* \> 1month of worry re panic attacks and/or maladaptive beh change
68
Panic d/o epi
\* 12mo prev: 2-3% \* F:M = 2:1
69
Panic d/o risk factors
neuroticism, anxiety sensitivity (believes sx harmful),abuse, smoking, stressors,
70
Panic d/o age of onset
\* avg age 20-24yo \* unusual after 45yo or childhood
71
Agoraphobia criteria (separate Dx now)
\* anxiety re ≥2 of {public transport, open spaces, enclosed spaces, in line or crowd, out of home alone} \* fears or avoids b/c of thoughts escape may be diff/help not available \* situations almost always provoke anxiety \* actively avoided/companion/endured w/ intense fear \* out of proportion to danger \* persistent (usually \>6mo)
72
Agoraphobia epi
\* 12mo prev: 2% \* F:M = 2:1
73
Agoraphobia course
remission rates \<10%
74
Agoraphobia comorbidity
30-50% w/ panic attacks
75
Agoraphobia risk factors
\* neuroticism, abuse, early adversity, cold/overprotective family environment \* 61% heritability
76
Agoraphobia age of onset
\* in 2/3 onset \* 2nd peak \>40yo \* in childhood RARE
77
GAD criteria
\* escessive anxiety most days \>6 months re many topics \* difficult to control worry \* ≥3 of {restless, fatigue, [], irritability, tension, sleep disturbance}
78
GAD epi
\* 12mo prev: 1-3%; lifetime 9% \* F:M = 2:1
79
GAD age of onset
\* avg age 30yo but broad range \* early onset --\> comorbidities
80
GAD risk factors
neuroticism, harm avoidance, adversity, overprotection, 1/3 genetic
81
Most common comorbidity in BD I/II d/o?
anxiety and related disorders - 50-75%
82
Rates of anxiety d/o in MDD?
60%
83
1st line tx for panic disorder
\* CBT (esp exposure) \* Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, paroxetine CR, sertraline, venlafaxine XR
84
1st line tx for specific phobia
ERP
85
1st line tx of social anxiety d/o
\* CBT (+/- d-cycloserin NMDA partial agonist) \* Escitalopram, fluvoxamine, fluvoxamine CR, paroxetine, paroxetine CR, pregabalin (\>600mg/day), sertraline, venlafaxine XR
86
1st line tx for GAD
\* Acceptance-based beh], meta-cognitive, CBT - intolerance of uncertainty, adjunctive MBCT \* Agomelatine, duloxetine, escitalopram, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine XR
87
OCD criteria
\* obsessions and/or compulsions \* time-consuming (\>1h/day) or distress/impairment
88
OCD specifiers
\* good/fair insight \* poor insight ("prob true") \* absent insight/delusional beliefs \* tic-related - current or past Hx of tic d/o
89
OCD epi
\* 12mo prev: 1% \* F\>M in adulthood \* mean age 19yo \* unusual \>35yo \* chronic if untreated \* RF: abuse, adversity, genetic (2x in 1st degree rel)
90
Gen comorbidity rate in OCD
\* 60-90% (mood, other anxiety, somatoform etc)
91
1st line for OCD
\* CBT w/ ERP \* danger ideation reduction therapy, DIRT \> ERP \* CBT+Rx \> Rx but not \> CBT alone \* Escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
92
1st line for PTSD
\* TF-CBT, EMDR, CPD \* comb tx \> each alone \* sertraline, fluoxetine, venlafaxine, paroxetine \* prazosin for nightmares
93
Body dysmorphic disorder criteria
\* preoccupation with ≥ 1 defect/flaw, not observable to others \* at some point in the course, repetitive beh or mental acts in response to appearance concerns
94
Body dysmorphic d/o specifiers
\* muscle dysmorphia - too small/insufficiently muscular; specify even if not only concern \* good/fair/poor/absent insight/delusional beliefs
95
Body dysmorphic d/o prevalence
2% (point) up to 15% in derm pts
96
Body dysmorphic d/o age of onset
mean 16-17yo most common 12-13 2/3 have it before 18yo
97
Body dysmorphic d/o course
chronic can improve with tx
98
Body dysmorphic d/o risk/prognostic factors
\* neglect, abuse, elevated in 1st degree relatives
99
Hoarding d/o criteria
\* persistent diff discarding possessions, regardless of value \* perceived need to save the items \* accumulation that clutters and compromises intended use
100
Hoarding d/o specifiers
\* excessive acquisition (80-90%) \* good/fair/poor/absent insight/delusional beliefs
101
Hoarding d/o prevalence
point - 2-6% M\>F
102
Hoarding d/o age of onset
11-15yo (first sx), usually interferes with fxn by mid-20s
103
Hoarding d/o course
chronic, waxing and waning severity increases with age
104
Hoarding d/o risk/prognostic factors
indecisiveness adverse events in early life familial - 50% in twin studies
105
Hoarding d/o comorbidities
75% - mood or anxiety d/o most common: MDD, GAD, social phobia 20% - OCD
106
Trichotillomania criteria
\* recurrent pulling of hair, resulting in hair loss \* repeated attempts to stop/decrease
107
Trichotillomania prevalence
12mo - 1-2% F:M = 10:1
108
Trichotillomania course
chronic if untreated
109
Trichotillomania risk/prognostic factors
\* genetic vulnerability - common in OCD families
110
Trichotillomania comorbidity
MDD, excoriation
111
Excoriation d/o criteria
\* recurrent skin picking resulting in lesions \* repeated attempts to decrease/stop
112
Excoriation prevalence
lifetime 1% F:M = 3:1
113
Excoriation age of onset
adolescence, usually starts with acne
114
Excoriation course
chronic, waxing/waning if untreated
115
Excoriation risk/prognostic factors
common in OCD families
116
Somatic symptom d/o criteria
\* ≥1 somatic sx \* ≥1 of {disproportionate/persistent thoughts, persistent high anxiety, excessive time and E devoted to sx concern} \* persistent (typically \>6months)
117
Somatic symptom disorder specifiers
\* with predominant pain \* Persistent (severe sx, impairment, duration \>6months) \* Severity
118
Somatic symptom d/o prevalence
5-7% F\>M
119
Somatic symptom d/o risk/prognostic factors
\* neuroticism \* low education, low SES \* stressful life events \* older age, female \* hx of childhood adversity
120
Illness anxiety d/o criteria
\* preoccupation with having/acquiring serious illness \* No/mild somatic sx \* high anxiety re health \* excessive health-related beh OR maladaptive avoidance \* \>6mo (may change illnesses during this time)
121
Illness anxiety d/o specifiers
\* Care-seeking type \* Care-avoidant type
122
Illness anxiety d/o prevalence
12mo : 1% - 10%
123
Illness anxiety d/o risk factors
\* major life stress, hx of abuse, hx of serious childhood illness \* 1/3 have a transient form
124
Conversion d/o criteria
\* ≥1 sx of altered voluntary motor or sensory fxn \* incompatibility btwn sx and known medical conditions
125
Conversion d/o specifiers
\* weakness or paralysis \* abnormal movement \* swallowing symptoms \* speech symptoms \* attacks or seizures \* anesthesia or sensory loss \* special sensory sx \* mixed sx \* acute episode ( 6mo) \* w/ psychological stressor
126
Conversion d/o prevalence
unknown 5% of referrals to neuro clinics
127
Conversion d/o risk/prognostic factors
\* maladaptive personality traits \* hx of abuse/neglect \* neurological disease that causes similar sx \* Positive prognosis: short duration, acceptance of the dx
128
Psychological factors affecting other medical conditions - criteria
\* a medical sx or dx \* ≥1 factor adversely affecting the medical condition by {close temporal association, interfere w/ tx (e.g adherence), additional health risks, influence the underlying pathophysiology} \* not better explained by another mental d/o
129
Factitious d/o criteria (imposed on self)
\* falsification of phys/psych signs or sx or induction of injury/disease, w/ deception \* presents as ill, impaired, injured \* evident even in absence of obvious external awards \* Specify: single or recurrent episodes
130
Factitious d/o prevalence
unknown 1% of hospital patients
131
Reactive attachment d/o criteria
\* child rarely/minimally seeks AND responds to comfort when distressed \* ≥2 of {minimal social/emotional responsiveness, limited positive affect, episodes of unexplained irritability, sadness or fearfulness even when non-threatening interactions} \* Hx of ≥1 of {social neglect or deprivation, repeated changes of primary cargivers, rearing in unusual settings that limit selective attachments} \* disturbance is caused by the above \* R/O ASD \* 9mo - 5yo \* Specify if persistent (\>12mo)
132
Reactive attachment d/o prevalence
unknown but rare (even in severely neglected children \<10%)
133
Reactive attachment d/o course
W/o remediation and recovery via normative caregiving, signs may persist for several years
134
Reactive attachment d/o risk/prognostic factors
\* serious social neglect \* prognosis depends on quality of caregiving environment after
135
Reactive attachment d/o comorbidities
\* other conditions assoc w/ neglect: cognitive/language delays, sterotypies, medical conditions \* depressive sx
136
Disinhibited social engagement d/o criteria
\* ≥2 of {reduced reticence in approaching strangers, overly familiar beh, diminished checking back w/ caregiver even in unfamiliar settings, willing to go off with stranger w/o hesitation} \* Not limited to impulsivity (e.g. ADHD) \* ≥1 on Hx {social neglect, changes in caregivers, unusual settings} \* above causes the disturbance \* \>9 months of age \* Specify if persistent (\>12mo)
137
Disinhibited social engagement d/o prevalence
unknown in high-risk populations: 20%
138
Disinhibited social engagement d/o course
often persists even if caregiving improved
139
PTSD criteria (age \>6yo)
\* Exposure to actual or threatened death, serious injury or sexual violence in ≥1 of {directly experiencing, witnessing in person, learning it happened to close family/friend, repeated/extreme exposure to aversive details - e.g. 1st responders} \* ≥1 of {intrusive memories, nightmares, dissoc. rxns/flashbacks, intense/prolongued distress at exposure to cues, phys. rxn to cues} \* avoidance: ≥1 of {memories/thoughts/feelings associated, external reminders} \* negative alterations in cognition/mood: ≥2 of {inability to remember important aspect, negative beliefs re self/others/world, distorted cognitions/blame, negative emotional state, diminished interest, detachment from others, inability to experience positive emotions \* alterations in arousal/reactivity: ≥2 of {irritable, reckless, hypervigilance, exaggerated startle, [], sleep disturbance} \* \>1mo duration
140
PTSD specifiers
\* with dissociative sx (depersonalization or derealization) \* with delayed expression
141
PTSD prevalence
lifetime 9% 12mo 4%
142
PTSD risk/prognostic factors
\* Pre-traumatic: childhood emotional problems, prior mental d/o, lower SES, prior trauma, chldhood adversity, lower intelligence, cultural characteristics (fatalistic), minority race/ethnos, family psych hx. Social support - protective \* Peritraumatic: severity of trauma, perceived threat, personal injury, interpersonal violence; for military - being perpetrator; dissociation. \* Post-traumatic: negative appraisals, poor coping strategies, acute stress d/o, exposure to repeated reminders, subsequent adverse life events, losses. Social support - protective
143
Acute stress disorder criteria
\* PTSD criterion A (exposure) \* ≥9 combined of intrusion sx, negative mood, dissociative sx, avoidance, arousal sx \* duration 3 days - 1 month after trauma
144
Acute stress d/o prevalence
\* 20-50% if interpersonal assault \*
145
Acute stress d/o risk/prognostic factors
\* prior mental d/o; neuroticism; perceived severity, avoidant coping style; catastrophic appraisals \* prior trauma \* female gender \* elevated reactivity prior to trauma
146
Adjustment d/o criteria
\* emotional or beh sx 6mo
147
Adjustment d/o specifiers
\* with depressed mood \* with anxiety \* with mixed anxiety and depressed mood \* with disturbance of conduct \* with mixed disturbance of emotions and conduct \* unspecified \* acute ( 6mo)
148
Adjustment d/o prevalence
in OPD psych: 5-20% in hospital psychiatric consultation: up to 50%
149
Adjustment d/o risk/prognostic factors
disadvantaged life circumstances
