Dx Flashcards
Depression Risk Factors
Genetic Loading Prior Episode of MDD Female Gender Postpartum Period Medical Comorbidity Single Marital Status Significant Environmental Stressors, Especially multiple losses
MDD Dx Criteria
Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning, at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood Most of the day, nearly every day; may be subjective (e.g. feels sad, empty, hopeless) or observed by others (e.g. appears tearful); in children and adolescents, can be irritable mood
Loss of interest/pleasure Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others
Weight loss or gain Significant weight loss (without dieting) or gain (change of >5% body weight in a month), or decrease or increase in appetite nearly every day; in children, may be failure to gain weight as expected
Insomnia or hypersomnia Nearly every day
Psychomotor agitation or retardation
Nearly every day and observable by others (not merely subjectively restless or slow)
Fatigue Or loss of energy, nearly every day
Feeling worthless or excessive/inappropriate guilt
Nearly every day; guilt may be delusional; not merely self reproach or guilt about being sick
Decreased concentration Nearly every day; may be indecisiveness; may be subjective or observed by others
Thoughts of death/suicide Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide Additional required criteriaMust have all 4, plus ≥5 depressive symptoms above
Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Episode not attributable to physiological effects of a substance or another medical condition
Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
No history of manic or hypomanic episode
Exclusion does not apply if all manic-like or hypomanic-like episodes are substance-induced or are attributable to physiological effects of another medical condition
Questions to ask to get MDD Dx
How has your mood been? Do you still participate in things you enjoy? Have you gained or lost any weight? How is your sleep? How is your energy level? Any feelings of worthlessness or guilt? How is your concentration? Any thoughts of suicide?
GAD Dx Critiera
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least
6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least
some symptoms having been present for more days than not for the past 6 months):
Note: Only one item required in children.
1. Restlessness, feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse,
a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about
having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia],
contamination or other obsessions in obsessive-compulsive disorder, separation from attachment
figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder,
gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived
appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder,
or the content of delusional beliefs in schizophrenia or delusional disorder).
Questions to ask for GAD
Do you find yourself worrying? (will report excessive anxiety or worry)
How long as it been going on (should be more days than most for at lease 6 months)
What do you experience physically or emotionally (3 or more: restless, fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance)
Inquire if these symptoms are causing distress in life, social live, work etc.
Ask about substance use (rule out)
Ask about medical disorders (rule out)
Panic Disorder Dx Criteria
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious state.
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or “going crazy.”
Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).
Questions to ask for panic disorder
Can you describe how your feeling? Go into detail on the experience (abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and includes: palpitations, sweating, trembling, SOB, choking, chest pain, nausea, chills.
Have you been worried this will happen again? (one of the attacks needs to be followed by 1 month of this and the item below)
Have there been any changes to your behavior in order to ensure they don’t happen again?
PTSD Dx Criteria
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to others.
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Questions to Ask for PTSD
Determine if there was a actual or threatened death, serious event, assault ect. either witnessed or personally experienced.
Ask if they are thinking about the moment, if so how often? Are they dreaming about it? Are there flashbacks or distress when there are ither internal or external cues? (Only need one of these).
Are they attempting to avoid stimuli associated with the traumatic event?
Has their mood been impacted? ( trouble with memory surrounding the event, exaggerated negative beliefs, distorted cognitions, negative emotional state, diminished interest, detachment from others, inability to experience positive emotion NEED TWO of these)
Marked alterations in arousal and reactivity? ( Irritable behavior, recklessness, hypervigilance, startle response, concentration issues, sleep issues, NEED TWO)
How long as the above been going on? ( Needs to be a month or more)
Disturbance needs to be clinically significant
Disturbance is not caused by anything else.
Bipolar 1 Dx Criteria
To meet the criteria for bipolar I disorder a person must meet both A and B:
A. Criteria met for at least one manic episode (criteria A-D under manic episode below)
B. There is not a better explanation for the manic episode or major depressive episode in
another diagnosis. For example:
• Schizoaffective disorder
• Schizophrenia
• Schizophreniform disorder
• Delusional disorder
• Other specified or unspecified schizophrenia spectrum
• Other psychotic disorder
Note: a hypomanic episode may occur before or after a manic or major depressive
episode.
A. Lasts at least one week, or
any length if hospitalized due
to mania
Abnormal and persistent extreme expression of emotion or irritable mood and
abnormal and persistent increase in activity or energy
B. During criteria A
symptoms, three or more of
these symptoms (four if mood
is only irritable)
• Inflated self-esteem and grandiosity
• Decrease in need for sleep
• More talkative than baseline or fast talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (reported or seen)
• Increase in goal-directed activity (socially, at work, school or sexually) or
movements that serve no purpose
• Excessive engagement in activities with high risk of painful results (e.g.,
unrestrained buying sprees, sexual indiscretions or foolish business
investments)
C. Mood disturbance severity • Causes marked impairment in social or occupational functioning or
• Requires hospitalization to prevent harm or
• There are psychotic traits
D. Differential diagnosis • Substance use and medical causes are ruled out
Questions for bipolar disorder 1
There is a description of abnormal and persistent extreme moods and abnormal increase in activity or energy. (LASTS FOR ONE WEEK)
Is there inflated self-esteem, decrease in need for sleep, more talkative, flight of ideas, distractibility, increase in goal-directed activity, excessive engagement in activates. (Need three or more).
Does it cause marked impairment in functioning or require hospitalization or have psychotic traits?
Rule out other causes
Bipolar 2 hypomania lasts for 4 days
