Final (DSM)

Question 1

Selective Mutism - Associated Features (6)

Answer 1

Shyness Fear of embarrassment

Social Isolation/Withdrawal

Clinging

Tantrums/Oppositional Behavior

Often comorbid with social anxiety

Occasionally comorbid with communication disorder

Question 2

Specific Phobia Specifiers

Answer 2

Animal

Natural

Environment

Blood-Injection-Injury

Situational

Other

Question 3

Selective Mutism Etiology, Risk and Prognostic Factors

Answer 3

Temperament

-Negative affectivity and behavioral inhibition

Environment

-Social inhibition, overprotective and controlling behavior among parents

Genetics

-Shared genetic factors with social anxiety disorder

Question 4

MDD Prevalence

Answer 4

Lifetime 12-20%

12 month in US: 7%

Male to female 1:2

-but no difference in symptoms, course, treatment response, or functional consequences

Onset can occur at any age, with increased risk after puberty, and incidence peaking in the 20s

Question 5

Obsessions (OCD)

Answer 5

recurrent or persistent thoughts, urges, or images that are experienced as intrusive and unwanted and caused marked anxiety and distress

Types: Taboo (aggressive/violent/sexual), Symmetry, Harm to self/others, Religious, Contamination, Doubt

Question 6

Social Anxiety Disorder - Prevalence, Development, and Course

Answer 6

7% Prevalence

• lower for older adults
• more pronounced in adolescents/young adults
  1. 5-2x more common in females
• Females: comorbid with depressive, biopolar, and anxiety disorders
• Males: comorbid with ODD/CD and substance use

Majority (~75%) have onset between 8-15 years

-first onset in adulthood is rare

Onset may follow stressful/humiliating event

30% experience remission in 1 year

About half seek treatment

Question 7

Trung gio

Answer 7

(“hit by the wind” or “to catch wind”)

Found among Vietnamese Panic attack (associated with headaches, feeling unwell) experienced after walking into a windy environment

• May attribute attack to exposure to wind
• May avoid atmospheric wind

Question 8

MDD - Differential Diagnosis - ADHD

Answer 8

Distractibility and low frustration tolerance can occur in both attention-deficit/ hyperactivity disorder and a major depressive episode; if the criteria are met for both, attention-deficit/hyperactivity disorder may be diagnosed in addition to the mood disorder. However, the clinician must be cautious not to overdiagnose a major depressive episode in children with attention-deficit/hyperactivity disorder whose disturbance in mood is characterized by irritability rather than by sadness or loss of interest.

Question 9

Separation Anxiety Disoder Criteria (4)

Answer 9

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized

Question 10

Anxiety Disorders DSM-IV

Answer 10

Anxiety disorders in the DSM-IV were split into three categories in the DSM-5:

Anxiety Disorders

Obsessive Compulsive Disorder

PTSD & Acute Stress Disorder

Question 11

Body Dysmorphic Disorder Criteria (4)

Answer 11

A. Preoccupation with one or more perceived defects or flaws in physical appearance that

are not observable or appear slight to others.

• often try to change how they look
• excessive fixation on defect

B. At some point during the course of the disorder, the individual has performed repetitive

behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking)

or mental acts (e.g., comparing his or her appearance with that of others) in response

to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational,

or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or

weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Question 12

Panic Disorder - Prevalence

Answer 12

Panic Attacks: 11.2% adults in US in last year

-30% had at least one PA in lifetime

Panic Disorder: 2-3% adults/adolescence

Question 13

Panic Disorder Criteria (4)

Answer 13

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.

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
12. Fear of losing control or “going crazy.”
13. 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:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
2. 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).

Question 14

Severity specifiers - depressive disorders

Answer 14

Severity is based on the number of criterion symptoms, the severity of those symptoms, and the degree of functional disability.

Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.

Moderate: The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for “mild” and “severe.”

Severe: The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.

Question 15

Excoriation Disorder Criteria (5)

Answer 15

A. Recurrent skin picking resulting in skin lesions.

B. Repeated attempts to decrease or stop skin picking.

C. The skin picking causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.

D. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine)
or another medical condition (e.g., scabies).

E. The skin picking is not better explained by symptoms of another mental disorder (e.g.,
delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived
defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic
movement disorder, or intention to harm oneself in nonsuicidal self-injury).

Question 16

Disruptive Mood Dysregulation Disorder Criteria (11)

Answer 16

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

C. The temper outbursts occur, on average, three or more times per week.

D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).

E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.

F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.

G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.

H. By history or observation, the age at onset of Criteria A-E is before 10 years.

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.

Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).

Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.

K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.

Question 17

OCD Etiology and Risk Factors

Answer 17

Genetics

-First degree relatives have 6x risk of developing OCD

Biology

-Brain differences: the caudate nucleus and orbitofrontal cortex

Environment

-Child abuse/trauma, life stressors, family maintenance

Question 18

Agoraphobia Prevalence

Answer 18

1. 7% adults and adolescents
   - less common in childhood and older adults

Question 19

Major Depressive Disorder Specifiers

Answer 19

Severity/Course (based on number and severity of symptoms): Mild Moderate Severe

With psychotic features

In partial remission

In full remission

Unspecified

Other specifiers:

With anxious distress

With mixed features

WIth melancholic features

With atypical features

WIth mood-congruent psychotic features

With mood-incongruent psychotic features

With catatonia

With peripartum onset (aka postpartum depression)

With seasonal pattern

Question 20

Major Depressive Disorder Criteria (5)

Answer 20

A. 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.

Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note: Criteria A-C represents a major depressive episode.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

Question 21

Panic Disorder - Etiology, Risk, Prognostic Factors

Answer 21

Genetics/physiological

• Family history
• Respiratory problems (e.g. asthma)
• Amygdala response (activates sympathetic nervous system)

Temperament

• Negative affectivity, anxiety sensitivity
• History of limited-symptom attacks

Environment

• Childhood history of abuse
• Smoking
• Life stressors

Question 22

Social Anxiety Disorder - Associated Features

Answer 22

Lack of assertiveness

Poor body language and nonverbal

Shy/withdrawn Blushing

Live at home longer

Limit employment opportunities

Substance use

Question 23

Persistent Depressive Disorder - Criteria B Symptoms (6)

Answer 23

1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.

Question 24

Premenstruel Dysphoric Disorder - Criteria B Symptoms (4)

Answer 24

1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

Question 25

Emotion and Physiology

Answer 25

Autonomic nervous system controls physiological arousal Sympathetic division (arousing): dilates pupils, decreases salivation, creates perspiration, accelerates heart, inhibits digestion, secretes stress hormones Parasympathetic division (calming): contracts pupils, increases salivation, dries skin, decreases respiration, slows heart, activates digestion, decreases secretion of stress hormones

Question 26

Panic Loop

Answer 26

1. Body Sensations: an unusual bodily sensation (e.g. pounding heart) makes you react with fear that something bad is about to happen 2. Panic Attack: your continued overreaction to the bodily sensation triggers more fear and eventually leads to a full panic attack 3. High Anxiety: once the panic attack subsides, you are left feeling anxious in a very sensitive state 4. Fear of Fear: Your fear of having another panic attack keeps your anxiety levels high and this leads to further unusual bodily sensations. The panic loop is now established.

Question 27

Trichotillomania Disorder (5)

Answer 27

A. Recurrent pulling out of one’s hair, resulting in hair loss. B. Repeated attempts to decrease or stop hair pulling. C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition). E. The hair pulling is not better explained by the symptoms of another mental disorder (e. g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder) .

Question 28

Hoarding Disorder DSM-IV Changes

Answer 28

Hoarding used to be diagnosed under OCD, OCPD, and Anxiety NOS but now it is its own disorder

Question 29

Body Dysmorphic Disorder - Culture and Gender Considerations

Answer 29

Taijin Kyofusho - Shubo-kyofu (fear of body deformity) - Jikoshu-kyofu (fear of having offensive body odor) Males: muscle dysmorphia and genital preoccupations Females: comorbid eating disorders

Question 30

Premenstrual Dysphoric Disorder - Onset and Course

Answer 30

Onset at any time Symptoms peak in intensity around the time of menses onset Premenstrual phase is a risk period for suicide Symptoms seem to worsen approaching menopause, but cease thereafter Hormone replacement can re-trigger symptoms Use of oral contraceptives help

Question 31

MDD - Differential Diagnosis - Sadness

Answer 31

periods of sadness are inherent aspects of the human experience. These periods should not be diagnosed as a major depressive episode unless criteria are met for severity (i.e., five out of nine symptoms), duration (i.e., most of the day, nearly every day for at least 2 weeks), and clinically significant distress or impairment. The diagnosis other specified depressive disorder may be appropriate for presentations of depressed mood wiih clinically significant impairment that do not meet criteria for duration or severity.

Question 32

Agoraphobia Etiology, Risk and Prognostic Factors

Answer 32

Genetics/physiological - family history - heritability = 61% Temperament -Negative affectivity, anxiety sensitivity Environment - Stressful life events - Reduced family warmth and overprotectiveness

Question 33

MDD Recovery

Answer 33

Recurrence is common - 2 episodes = 70% recurrence - 3 episodes = 90% recurrence 20% recover within 3 months of onset 80% recover within 1 year

Question 34

Selective Mutism Criteria (5)

Answer 34

A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations. B. The disturbance interferes with educational or occupational achievement or with social communication. C. The duration of the disturbance is at least 1 month (not limited to the first month of school). D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation. E. The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Question 35

Social Anxiety Disorder Criteria (10)

Answer 35

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults. B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others). C. The social situations almost always provoke fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations. D. The social situations are avoided or endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from bums or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. Specify if: performance only

Question 36

Separation Anxiety Disorder Prevalence, Development, and Course

Answer 36

Most prevalent among children younger than 12 - Children 4% - Adolescents 1.6% - Adults .09% - 1.9% Separation Anxiety is part of normal early development Onset as early as preschool age, commonly during childhood, and rarely in adolescence and beyond Majority of children grow out of it Anxiety is manifested differently depending on age

Question 37

HPA Axis

Answer 37

Question 38

With mixed features - depressive specifier (4)

Answer 38

A. At least three of the following manic/hypomanic symptoms are present nearly every day during the majority of days of a major depressive episode: 1. Elevated, expansive mood. 2. Inflated self-esteem or grandiosity. 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Increase in energy or goal-directed activity (either socially, at work or school, or sexually). 6. Increased or excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, foolish business investments). 7. Decreased need for sleep (feeling rested despite sleeping less than usual; to be contrasted with insomnia). B. Mixed symptoms are observable by others and represent a change from the person’s usual behavior. C. For individuals whose symptoms meet full criteria for either mania or hypomania, the diagnosis should be bipolar I or bipolar II disorder. D. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment). Note: Mixed features associated with a major depressive episode have been found to be a significant risk factor for the development of bipolar I or bipolar II disorder. As a result, it is clinically useful to note the presence of this specifier for treatment planning and monitoring of response to treatment.

Question 39

Agoraphobia Onset

Answer 39

Peaks in late adolescence to early adulthood - mean age of onset is 17 years - later onset if without panic attacks/disorder (25-29) 30-50% have preceding panic attacks/disorder 2:1 female to male ratio

Question 40

Premenstruel Dysphoric Disorder - Criteria C Symptoms (7)

Answer 40

1. Decreased interest in usual activities (e.g., work, school, friends, hobbies). 2. Subjective difficulty in concentration. 3. Lethargy, easy fatigability, or marked lack of energy. 4. Marked change in appetite; overeating; or specific food cravings. 5. Hypersomnia or insomnia. 6. A sense of being ovenwhelmed or out of control. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

Question 41

Obsessive-Compulsive Disorder Critieria (4)

Answer 41

A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Compulsions are defined by (1) and (2): 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts. B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder)

Question 42

MDD Etiology

Answer 42

Diathesis-Stress Model Genetic - Heritability = 40% - Risk increased 2-4x with first degree relative with depression - Neuroticism (negative affectivity) Environmental - adverse childhood experiences - stressful life events

Question 43

GAD Onset

Answer 43

Onset at any time, median age of onset is 30 -rare prior to adolescence Early onset predicts comorbidity and impairment

Question 44

Body Dysmorphic Disorder - Prevalence and Onset

Answer 44

2. 4% prevalence rate in the U.S. - Approx equal, perhaps slightly higher in females Mean age of onset is 16-17 years -2/3 have onset prior to age 18 Childhood onset (essentially severity) predicts suicidality, comorbidity

Question 45

With anxious distress - depressive specifier

Answer 45

Anxious distress is defined as the presence of at least two of the following symptoms during the majority of days of a major depressive episode or persistent depressive disorder (dysthymia): 1. Feeling keyed up or tense. 2. Feeling unusually restless. 3. Difficulty concentrating because of worry. 4. Fear that something awful may happen. 5. Feeling that the individual might lose control of himself or herself. Specify current severity: Mild: Two symptoms. Moderate: Three symptoms. Moderate-severe: Four or five symptoms. Severe: Four or five symptoms and with motor agitation. Note: Anxious distress has been noted as a prominent feature of both bipolar and major depressive disorder in both primary care and specialty mental health settings. High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning and monitoring of response to treatment.

Question 46

Body Dysmorphic Disorder - Associated Features

Answer 46

Delusions of reference Anxiety (especially social anxiety) Social Avoidance Depressed Mood Low Self-Esteem Perfectionism

Question 47

Taijin Kyofusho

Answer 47

"Interpersonal fear disorder" in Japan and Korea Fear of making other people uncomfortable One's appearance and actions are inadequate or offensive - facial blushing - offensive body odor - inappropriate gaze - stiff/awkward facial expressions or movements - body deformity Broader construct than social anxiety -may meet criteria for body dysmorphic disorder and delusional disorder Related to interdependent self-construal

Question 48

Premenstrual Dysphoric Disorder Criteria (6)

Answer 48

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses. B. One (or more) of the following symptoms must be present: 1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection). 2. Marked irritability or anger or increased interpersonal conflicts. 3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. 4. Marked anxiety, tension, and/or feelings of being keyed up or on edge. C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above. 1. Decreased interest in usual activities (e.g., work, school, friends, hobbies). 2. Subjective difficulty in concentration. 3. Lethargy, easy fatigability, or marked lack of energy. 4. Marked change in appetite; overeating; or specific food cravings. 5. Hypersomnia or insomnia. 6. A sense of being ovenwhelmed or out of control. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year. D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders). F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.) G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).

Question 49

Course specifiers - depressive disorders

Answer 49

In partial remission: Symptoms of the immediately previous major depressive episode are present, but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a major depressive episode following the end of such an episode. In full remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

Question 50

OCD Specifiers

Answer 50

Specify if: With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. Specify if: Tic-related: The individual has a current or past history of a tic disorder. -typically males with OCD onset in childhood

Question 51

MDD Presentation

Answer 51

Irritability instead of sadness among children/adolescents Fatigue and insomnia are common -may be presenting complaint Psychomotor disturbances and psychosis are uncommon but indicate greater severity Impairment - Less efficiency, poorer performance - Impaired cognition (memory, concentration) - Missed work/school - Social isolation - Personal hygiene

Question 52

Selective Mutism Prevalence, Development and Course

Answer 52

Rare (.3% - 1%) Mostly diagnosed among young children Usually manifests before age 5, but may not be noticed until the child enters school Usually outgrown as child ages but social anxiety may remain `

Question 53

Separation Anxiety Disorder Etiology, Risk, and Prognostic Factors

Answer 53

Genetic -Heritability of 73% in twin study Environmental -Often develops after a life stressor (e.g. death, divorce, change of home/school, immigration, period of separation from loved ones)

Question 54

DMDD - Differential Diagnosis - MDD and PDD

Answer 54

Can be comorbid BUT, if irritability present only in context of MDD or PDD, dx should only be MDD or PDD (no comorbid DMDD)

Question 55

MDD - Bipolar Conversion

Answer 55

Bipolar transition more likely if: Onset in adolescence Psychotic features Mixed features Family history of bipolar

Question 56

Panic Disorder changes from DSM-IV

Answer 56

Panic Disorder with Agoraphobia, Panic Disorder without Agoraphobia, and Agoraphobia without history of Panic Disorder became Panic Disorder Agoraphobia

Question 57

Hoarding Disorder - Associated Features

Answer 57

Perfectionism Indecisiveness Avoidance Procrastination Difficulty planning/organizing Distractibility Animal Hoarding - can be defined as the accumulation of a large number of animals and a failure to provide minimal standards of nutrition, sanitation, and veterinary care and to act on the deteriorating condition of the animals (including disease, starvation, or death) and the environment (e.g., severe overcrowding, extremely unsanitary conditions).

Question 58

Disruptive Mood Dysregulation Disorder - Prevalence, Development, and Course

Answer 58

Prevalence is unclear -estimated at 2-5% Predominantly diagnosed in males Suicide risk, aggression, and hospitalization are common Symptoms become less common over time into adulthood Conversion from DMDD to Bipolar is low More likely to convert MDD and/or anxiety in adulthood Comorbidity is high

Question 59

Specific Phobia Development and Course

Answer 59

Typically develops following a traumatic event Onset at any age, but usually in early childhood - Majority develop before age 10 - Situational type tends to develop later Person often changes living circumstances/behaviors to avoid phobic object/situation -impairment increase with number of feared objects/situations Phobias persisting into adulthood are unlikely to remit

Question 60

Hoarding Disorder Criteria (6)

Answer 60

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities). D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).

Question 61

PDD Specifiers

Answer 61

Specify if: With anxious distress (p. 184) With mixed features (pp. 184-185) With melancholic features (p. 185) With atypical features (pp. 185-186) With mood-congruent psychotic features (p. 186) With mood-incongruent psychotic features (p. 186) With péripartum onset (pp. 186-187) Specify if: In partial remission (p. 188) In full remission (p. 188) Specify if: Early onset: If onset is before age 21 years. Late onset: If onset is at age 21 years or older. Specify if (for most recent 2 years of persistent depressive disorder): With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years. With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period. With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode. ' With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years. Specify current severity: Mild (p. 188) Moderate (p. 188) Severe (p. 188)

Question 62

Compulsions (OCD)

Answer 62

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Types: Ordering, Counting, Checking, Praying, Cleaning/Washing

Question 63

Hoarding Disorder - Comorbidity

Answer 63

MDD Social Anxiety GAD OCD

Question 64

Premenstrual Dysphoric Disorder vs PMS

Answer 64

PMS has no minimum number of symptoms and no specific symptoms required PMDD requires a minimum of five symptoms, one of which must be mood symptom -PMDD is more severe than PMS Confirmed by prevalence rates - 20% meet PMS - 1.8% - 5.8% meet PMDD

Question 65

Panic Disorder - Onset and Development

Answer 65

Median age of onset for Panic Disorder is 20-24 years - relatively rare in children - lower prevalence in older adults - believed to be due to the autonomic nervous system slowing in old age More common among women than men -2:1 female to male

Question 66

Ataque de nervios

Answer 66

"attack of nerves" Found among Latinos Common symptoms - intense anxiety, anger, grief - trembling - fainting/seizure episodes - depersonalization/derealization - uncontrollable screaming or crying - heat in one's chest and head - verbal/physical aggression - suicidal gestures May experience longer than a few minutes -Occur frequently as a result of stressful family event, may avoid family conflict Used to indicate an episode of loss of control in response to a stressor

Question 67

DMDD - Differential Diagnosis - ADHD

Answer 67

Unlike children diagnosed with bipolar disorder or oppositional defiant disorder, a child whose symptoms meet criteria for disruptive mood dysregulation disorder also can receive a comorbid diagnosis of ADHD, major depressive disorder, and/or anxiety disorder. However, children whose irritability is present only in the context of a major depressive episode or persistent depressive disorder (dysthymia) should receive one of those diagnoses rather than disruptive mood dysregulation disorder. Children with disruptive mood dysregulation disorder may have symptoms that also meet criteria for an anxiety disorder and can receive both diagnoses, but children whose irritability is manifest only in the context of exacerbation of an anxiety disorder should receive the relevant anxiety disorder diagnosis rather than disruptive mood dysregulation disorder. In addition, children with autism spectrum disorders frequently present with temper outbursts when, for example, their routines are disturbed. In that instance, the temper outbursts would be considered secondary to the autism spectrum disorder, and the child should not receive the diagnosis of disruptive mood dysregulation disorder.

Question 68

GAD - Criteria C Symptoms

Answer 68

3 or more symptoms (1 in children) 1. Restlessness or 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).

Question 69

MDD vs Grief

Answer 69

MDD Expression of mood: Despair and hopelessness Time course: Steady or waning Stability of mood: Persistent Response to humor, distraction: Little or none Content of thought: Largely unrelieved thoughts of own misery Self-esteem: Guilt, blame, worthlessness Passing of time: Time crawls Death, dying: Wish for own death, suicidal plans Clinical impairment: Yes Grief Expression of mood: loss or emptiness Time course: decrease with time (weeks) Stability of mood: surges and retreats Response to humor, distraction: may bring relief Content of thought: memories, thoughts of departed, but some positive thoughts regarding others Self-esteem: "I've done my best" Passing of time: time passes as before Death, dying: Life is still worth living Clinical impairment: No

Question 70

GAD Course

Answer 70

Many report feeling anxious all their lives Chronic course, waxes and wanes -Full remission is low

Question 71

Generalized Anxiety Disorder Criteria (6)

Answer 71

A. 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 is required in children. 1. Restlessness or 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 mental 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).

Question 72

OCD Feedback Loop

Answer 72

Prefrontal Cortex to Striatum (Caudate Nucleus - Brain Filter) to Thalamus (Brain Router) back to PFC People w OCD have increased activity in PFC

Question 73

Agoraphobia Criteria (9)

Answer 73

A. Marked fear or anxiety about two (or more) of the following five situations: 1. Using public transportation (e.g., automobiles, buses, trains, ships, planes). 2. Being in open spaces (e.g., parking lots, marketplaces, bridges). 3. Being in enclosed places (e.g., shops, theaters, cinemas). 4. Standing in line or being in a crowd. 5. Being outside of the home alone. B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence). C. The agoraphobic situations almost always provoke fear or anxiety. D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder): and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder). Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

Question 74

GAD Prevalence

Answer 74

12 month 0.9% adolescents and 2.9% adults -lifetime: 9% 2:1 female to male ratio

Question 75

Specific Phobia Prevalence

Answer 75

12-month prevalence: 7-9% - 5% children - 16% adolescents - 3-5% adults Typically development in childhood and adolescence Common to have multiple specific phobias - 75% has more than one specific phobia - Average person fears 3 objects/situations 2: 1 female to male ratio - Fear of blood-injection-injury is equal across genders Asian Americans and Latinos have a lower prevalence

Question 76

Depression Stats

Answer 76

As measured by disability life years (DALY) By 2030 depression will be the top-ranking cause of potential life years lost due to premature mortality as well as years of productive life lost... ...costs include impaired quality of life, relationships, diminished work capacity, and increased mortality from comorbid depression interacts with poverty in a negative cycle because it is related to lower productivity, fewer work days, and lower educational attainment 18% increase in depression over last decade

Question 77

Trichotillomania and Excoriation Disorder - Prevalence, Development and Course

Answer 77

1-2% Prevalence Gender ratio: - Trichotillomania - 10:1 (female to male) - Excoriation 3:1 (female to male) Onset usually during adolescence after puberty Chronic if untreated

Question 78

Persistent Depressive Disorder Criteria (7)

Answer 78

This disorder represents a consolidation of DSM-lV-defined chronic major depressive disorder and dysthymic disorder. A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. B. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not mee| criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Othenwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted.

Question 79

OCD Development and Course

Answer 79

Onset typically in adolescence and young adulthood - Mean age of onset is 19.5 years - Onset typically earlier in males (1/4 males report onset before age 10) - Onset after age 35 is unusual Early onset and poor insight predicts poorer prognosis Course is chronic if untreated

Question 80

Panic Disorder - Associated Features

Answer 80

Many have intermittent or constant feelings of anxiety -often comorbid with other anxiety disorders Also comorbid with depression, bipolar disorder, and substance use Approx 1/4 to 1/3 have nocturnal panic attacks -wakes up in a state of panic (not triggered by a nightmare) -- considered unexpected

Question 81

Predictors of lower recovery or high recurrence in MDD

Answer 81

- longer episode duration - psychotic features - anxiety - personality disorder - symptom severity - early onset - multiple episodes - lower remission duration or partial remission

Question 82

Hoarding Disorder - Prevalence, Development and Course

Answer 82

Estimated 2-5% in the US Three times more prevalent among older adults -Although onset tends to be in adolescence, with increasing severity as one ages Mixed findings about gender rates -more acquisition in females Chronic course

Question 83

Body Dysmorphic Disorder - Comorbidity and Differentials

Answer 83

Often comorbid with: - Depression - Social Anxiety - OCD Differentiate from: - Eating Disorders - OCD and related disorders - Anxiety disorders - Psychosis

Question 84

Agoraphobia Course

Answer 84

Chronic if untreated Course is dependent on severity and comorbidity 1/3 are homebound and are unable to work

Question 85

Social Anxiety Disorder Differentials and Comorbidity

Answer 85

Differentials - Normal shyness - Agoraphobia - Selective Mutism Often comorbid with - MDD - Other anxiety - Substance use - Body dysmorphic disorder - Avoidant Personality Disorder

Question 86

Specific Phobia Criteria (7)

Answer 86

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging. B. The phobic object or situation almost always provokes immediate fear or anxiety. C. The phobic object or situation is actively avoided or endured with intense fear or anxiety. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia): objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Question 87

Panic Attack Specifer

Answer 87

Not to be confused with Panic Disorder Not part of the criteria, but a panic attack happens in the absence of real danger Expected (specfic trigger or cue) and unexpected types 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. 1. Palpitations, pounding heart, or accelerated heart rate. 2. Sweating. 3. Trembling or shaking. 4. Sensations of shortness of breath or smothering. 5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress. 8. Feeling dizzy, unsteady, light-headed, or faint. 9. Chilis or heat sensations. 10. Paresthesias (numbness or tingling sensations). 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself). 12. Fear of losing control or “going crazy.” 13. 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. Note: Symptoms are presented for the purpose of identifying a panic attack

Question 88

Hoarding Disorder - Specifiers

Answer 88

Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. Specify if: With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic. With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

Question 89

With melancholic features - depressive specifier (2)

Answer 89

A. One of the following is present during the most severe period of the current episode: 1. Loss of pleasure in all, or almost all, activities. 2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens). B. Three (or more) of the following; 1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood. 2. Depression that is regularly worse in the morning. 3. Early-morning awakening (i.e., at least 2 hours before usual awakening). 4. Marked psychomotor agitation or retardation. 5. Significant anorexia or weight loss. 6. Excessive or inappropriate guilt. Note: The specifier “with melancholic features” is applied if these features are present at the most severe stage of the episode. There is a near-complete absence of the capacity for pleasure, not merely a diminution. A guideline for evaluating the lack of reactivity of mood is that even highly desired events are not associated with marked brightening of mood. Either mood does not brighten at all, or it brightens only partially (e.g., up to 20%-0% of normal for only minutes at a time). The “distinct quality” of mood that is characteristic of the “with melancholic features” specifier is experienced as qualitatively different from that during a nonmelancholic depressive episode. A depressed mood that is described as merely more severe, longer lasting, or present without a reason is not considered distinct in quality. Psychomotor changes are nearly always present and are observable by others. Melancholic features exhibit only a modest tendency to repeat across episodes in the same individual. They are more frequent in inpatients, as opposed to outpatients; are less likely to occur in milder than in more severe major depressive episodes; and are more likely to occur in those with psychotic features.

Question 90

PDD Prevalence and Course

Answer 90

Early onset - before 21 Late - 21 or older Often has early onset Early onset more likely to have comorbid substance use and personality disorders Prevalence: .5% for dysthymia 1.5% for chronic depression Course is chronic by definition

Question 91

Khyal attacks ("wind attacks")

Answer 91

Found among Cambodians Common symptom - dizziness - palpations - shortness of breath - cold extremities - tinnitus - neck soreness Concern that khyal (wind-like substance) will rise in the body May avoid over-exertion of body More about rising of wind in one's body rather than external wind

Question 92

Specific Phobia Diagnostic Considerations

Answer 92

must take into account sociocultural context and normal development -children more fearful but it tends to be transient overlap with agoraphobia panic attacks may occur overlap with PTSD

Question 93

DMDD vs Bipolar

Answer 93

DMDD was added to distinguish children with persistent, irritable mood from children with bipolar disorder Some researchers view that nonepisodic irritability is indicative of bipolar disorder -may account for sharp increase in prevalence rates How to distinguish? - BD consists of distinct mood episodes - DMDD is characterized by severe, nonepisodic irritability - Elevated, expansive mood and grandiosity in BD - Age of onset is during childhood for DMDD, whereas onset for BD prior to adolescence is uncommon

Question 94

Panic Disorder - Course

Answer 94

If untreated, course tends to be chronic The minority have full remission without relapse -rarely goes away untreated Lower in ethnic minority groups