Guide to HiTOP and DSM Flashcards

Question

# Internalizing spectrum - fear - ch5 anxiety syndromes Panic disorder

Answer 1

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. 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). **SURP-rise**! **S**udden **U**nexpected **R**ecurrent **P**anic attacks Give **rise** to anxiety

Answer 2

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. ## Footnote B is especially important

Answer 3

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. 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. **I MURDER**??? Intrusive **M**ind-based (realise it's not coming from the physical world) **U**nwanted **R**esistent to attempts of making them go away **D**istressing **E**go-dystonic (realise that those are not their actual wishes) **R**ecurrent ## Footnote Obsessive thinking is different from ruminating or from voices in one's head (hallucination)

Answer 4

Chapter 5: Anxiety syndromes - **Generalized Anxiety syndrome** Chapter 4: Depressive syndromes - Disruptive Mood Dysregulation syndrome - **Major Depressive syndrome** - **Persistent Depressive syndrome (Dysthymia)** - Premenstrual Dysphoric syndrome Chapter 7: trauma- and stressor-related syndromes - Reactive Attachment syndrome - Disinhibited Social Engagement syndrome - **Posttraumatic Stress syndrome** - **Acute Stress syndrome** - **Adjustment syndrome**

Answer 5

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): 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). **EGADS**, I'm so **MISERA**ble! **E**xcessive **G**eneralized **A**nxiety **D**aily (or most days) **S**ix months **M**uscle tension **I**rritability **S**leep disturbance **E**nergy **R**estlessness **A**ttention ## Footnote Included in distress because it's not about specific fear but about worrying and ruminating in general and most of the time. Often comorbid with MDD and Persistent depressive syndrome

Answer 6

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). 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. 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 represent 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 hypomanie episode) SIGECAPS: **depressed mood** + **S**leep disorder (increase/decrease) **I**nterest (diminished) **G**uilt (worthlessness, hopelessness, regret) **E**nergy (poor/low) **C**oncentration (poor) **A**ppetite disorder (increase/decrease) **P**sychomotor (retardation/agitation) **S**uicidality ## Footnote IMPORTANT! This disorder contains a depressive episode - DE is never a syndrome on its own, it's a part of a syndrome We only need to know criterion A by heart but we need to know the difference between an episode and MDD

Answer 7

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. 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. *we also need to know 4 specifier for type of persistence* Specify if (for most recent 2 years of persistent depressive disorder): 1. With **pure dysthymic syndrome**: Full criteria for a major depressive episode have not been met in at least the preceding 2 years. 2. With **persistent major depressive episode**: Full criteria for a major depressive episode have been met throughout the preceding 2-year period. 3. 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. 4. 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.

Answer 8

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as it occurred to others. 3. 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. 4. 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). B. Presence of one (or more) of the following **intrusion** symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occured C. **Persistent avoidance of stimuli** associated with the traumatic event(s), beginning after the traumatic event(s) occurred D. **Negative alterations in cognitions and mood** associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred E. **Marked alterations in arousal and reactivity** associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. ## Footnote We need to know the criteria groups (e.g. B intrusions), not the details of each group (so I didn't include them because it's sooo long)

Answer 9

A. Exposure to actual or threatened death, serious injury, or sexual violence B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociative symptoms, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred (you need not know the specific symptoms for each of these criteria). C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure.

Answer 10

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational, or other important areas of functioning. C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. (D. The symptoms do not represent normal bereavement. E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.) [note: this is assessed at step 5 of the step-wise approach, because it is a **residual category**, like ‘mental disorder not otherwise specified’. So we never diagnose it together with another disorder. Because this is something we diagnose when all the other categories are not fitting]

Answer 11

1. **Dissociative Identity syndrome** 2. **Dissociative Amnesia** 3. **Depersonalization/Derealization syndrome** ## Footnote Linked to the internalizing spectrum because very often occuring in trauma and stressor related syndromes. If the dissociation is the main symptom then the diagnosis is one of the syndromes in this chapter

Answer 12

A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory- motor functioning. These signs and symptoms may be observed by others or reported by the individual. B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. ## Footnote In healthy individuals, they behave differently and may have varying personalities in different situations but there is a connection between those and they are continous but for individuals with dissociation there is no continuum

Answer 13

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

Answer 14

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: 1. **Depersonalization**: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing). 2. **Derealization**: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). B. During the depersonalization or derealization experiences, reality testing remains intact. ## Footnote It's not a hallucination or delusion

Answer 15

Chapter 2. Schizophrenia spectrum and other psychotic disorders 1. **Delusional Syndrome** 2. **Brief Psychotic Syndrome** 3. **Schizophreniform**: Psychotic syndrome, low/medium severity 4. **Schizophrenia**: Psychotic syndrome, medium/high severity 5. **Schizoaffective**: Psychotic syndrome with mood episodes (*subfactor mania*) ## Footnote Exclusion criteria psychotic syndrome: you only need to know that the psychotic syndromes in DSM-5 are mutually exclusive, i.e. one can only have one of them). He said that the schizoterms are problematic so he is trying to avoid them

Answer 16

A. The presence of one (or more) delusions with a duration of 1 month or longer. ## Footnote Delusion = thought about the world that is clearly not true (1 or 2 people; if more than group which then it's not delusion)

Answer 17

A. Presence of one (or more) of the following symptoms: 1) Delusions, 2) Hallucinations, 3) Disorganized speech, 4) grossly disorganized or catatonic behavior. (i.e. the same as criterion A for the others, except negative symptoms). At least one of these must be 1, 2 or 3. B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

Answer 18

A. Two (or more) of the following, each present for a significant portion of time during a 1- month period (or less if successfully treated). At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition). B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”

Answer 19

A. Two (or more) of the following, each present for a significant portion of time during a 1- month period (or less if successfully treated). At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition). B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning) C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Answer 20

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia. **Note**: The major depressive episode must include Criterion A1: depressed mood B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness. *[note: otherwise it may be ‘depressive’ or ‘bipolair I’ with psychotic]* C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness. *[note: otherwise it may be an other psychotic disorder comorbid with a mood disorders]* ## Footnote In case of mood symptoms and psychotic symptoms there are multiple possibilties for diagnoses

Answer 21

**Chapter 3**: Bipolair and related syndromes ↪ Manic episode ↪ Hypomanic episode ↪ Depressive episode - **Bipolar I Disorder** - **Bipolar II Disorder** - Cyclothymic Disorder ## Footnote The episodes are part of Bipolar I and II. an episode is not itself a syndrome in DSM-5 but a criterion for a syndrome. In mild cases the internalizing spectrum is stronger and in severe cases the thought disorder spectrum is stronger

Answer 22

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puroseless non-goal-directed activity). 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. DIGFAST: **Euphoria/irritability** + **D**istractibility **I**ndiscretion (excessive involvement in pleasurable activities) **G**randiosity **F**light of ideas **A**ctivity increase **S**leep deficit (decreased need for sleep) **T**alkativeness (pressured speech) ## Footnote C distinguishes manic from hypomanic episode

Answer 23

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puroseless non-goal-directed activity). 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others.

Answer 24

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. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). 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. 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.

Answer 25

A. Criteria have been met for at least one manic episode ## Footnote this disorder contains a manic episode. Not necessarily a depressive episode.

Answer 26

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode (B. There has never been a manic episode.) ## Footnote This disorder contains both a hypomanic and a depressive episode. We only need to know A but B clarifies the difference between Bipolar I and II

Answer 27

A specifier that can be given with Bipolar I or Depressive syndromes Bipolar I: With psychotic features: Delusions and/or hallucinations are present at any time in the current manic or major depressive episode in Bipolar I or in current major depressive episode in Bipolar II: Depressive: With psychotic features: Delusions and/or hallucinations are present at any time in the current major depressive episode: And then this is same for both bipolar and depressive, you specify whether: - With mood-congruent psychotic features: The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. - With mood-incongruent psychotic features: The content of the delusions or hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes. ## Footnote We must know when to give this specifier, not further details but I included them just to be aware of them

Answer 28

Anhedonia - inability to experience pleasure, joy, and enjoy life - Often related to detachment from one's emotions and from other (affective interpersonal detachment) In DSM: Dysthymia (MDD), and then personality disorders (which we don't need to know for this exam)

Answer 29

**Chapter 15**: Disruptive, Impulse-Control, and Conduct Syndromes 1. **Oppositional Defiant Syndrome (ODD)** 2. Intermittent Explosive Syndrome 3. **Conduct Syndrome (CD)** 4. Pyromania 5. Kleptomania **Chapter 1:** Neurodevelopmental syndromes - Attention Deficit Hyperactivity Syndrome (ADHD) ## Footnote These are in the subfactor antisocial behaviour

Answer 30

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. **Angry/Irritable Mood** 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. **Argumentative/Defiant Behavior** 4. Often argues with authority figures or, for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior. **Vindictiveness** 8. Has been spiteful or vindictive at least twice within the past 6 months. ## Footnote Doesn't involve criminal behaviour - what differentiates it from conduct disorder

Answer 31

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months: **Aggression to People and Animals** 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity. **Destruction of Property** 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting). **Deceitfulness or Theft** 10. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). **Serious Violations of Rules** 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years. ## Footnote If adults - antisocial personality syndrome (where one of the criteria is that when they were childreb they would have met the criteria for conduct syndrome)

Answer 32

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1 **Inattention**: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. 1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). 2. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). 3. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). 4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). 5. Often has difficulty organizing tasks and activities 6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). 7. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). 8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). 9. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). 2 **Hyperactivity and impulsivity**: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: *The note is the same as in inattention* 1. Often fidgets with or taps hands or feet or squirms in seat. 2. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). 3. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) 4. Often unable to play or engage in leisure activities quietly. 5. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). 6. Often talks excessively. 7. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation). 8. Often has difficulty waiting his or her turn (e.g., while waiting in line). 9. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Answer 33

**Alcohol Use Syndrome** Alcohol Intoxication Alcohol Withdrawal Unspecified Alcohol-Related Disorder And Caffeine, Cannabis, Different kinds of recreational drugs, certain medications, tobacco, gambling ## Footnote We only need to learn the criteria for alcohol use syndrome - The criteria for the others are mostly the same and you don’t need to know the difference by heart

Answer 34

A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. Alcohol is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire or urge to use alcohol. 5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal) b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Time 2 CUT DOWN PAL: **Time** spent (**2** or more) **C**ravings **U**nable to stop **T**olerance **D**angerous **O**thers affected **W**ithdrawal **N**eglects responsibilities **P**roblem made worse **A**ctivities stopped **L**arger amounts or for longer

Answer 35

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A: 1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 2. Increased hand tremor. 3. Insomnia. 4. Nausea or vomiting. 5. Transient visual, tactile, or auditory hallucinations or illusions. 6. Psychomotor agitation. 7. Anxiety. 8. Generalized tonic-clonic seizures.

Answer 36

[…] Use Syndrome Criteria are very comparable and you do not need to learn these differences […] Intoxication Criteria depend on the specific substance. You do not need to know these. […] Withdrawal Criteria depend on the specific substance. You do not need to know these. ## Footnote We need to know that intoxication and withdrawal are important, possible cause of psychopathology (as described in the differential diagnosis chapter 1)

Answer 37

Chapter 14: Gender dysforia Chapter 17: Neurocognitive syndromes (just know that there are all types of dementia) Chapter 19: Paraphilic disorder (pedophilic, masochism, sadism...) - we just need to know the general overview what the chapter includes, nothing to learn by heart Chapter 22: Other Conditions That May Be a Focus of Clinical Attention

Answer 38

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current **severity**: Severity is based on social communication impairments and restricted, repetitive patterns of behavior (next flashcard) (C. Symptoms must be present in the early developmental period) ## Footnote Only A, B by heart

Answer 39

There are three levels: (we don't need to know the descriptions of each level) Level 1: ''Requiring support'' Level 2: ''Requiring substantial support'' Level 3: ''Requiring very substantial support'' The levels have different description for social communication and then for restrictive, repetitive behaviours

Answer 40

- Relational Problems - Abuse and Neglect - Educational and Occupational Problems - Housing and Economic Problems - Other Problems Related to the Social Environment - Problems Related to Crime or Interaction With the Legal System - Other Health Service Encounters for Counseling and Medical Advice - Problems Related to Other Psychosocial, Personal, and Environmental Circumstances - Other Circumstances of Personal History ## Footnote Just be aware that these exist

Guide to HiTOP and DSM Flashcards

(65 cards)