Spring Final

Question 1

Medication-Induced Postural Tremor

Answer 1

Fine tremor (usually in the range of 8-12 Hz) occurring during attempts to maintain a posture and developing in association with the use of medication (e.g., lithium, antidepressants, valproate). This tremor is very similar to the tremor seen with anxiety, caffeine, and other stimulants.

Question 2

Neurocognitive Domains

Answer 2

Complex attention

Executive functioning

Learning and memory

Language Perceptual-motor - sensory information

Social cognition - social cues, theory of mind, social norms, etc.

Question 3

Schizoid Personality Disorder (2)

Answer 3

A. A pervasive pattern of detachment from social relationships and a restricted range of

expression of emotions in interpersonal settings, beginning by early adulthood and

present in a variety of contexts, as indicated by four (or more) of the following:

1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Tal<es></es>

<p>5. Lacks close friends or confidants other than first-degree relatives.</p>

<p>6. Appears indifferent to the praise or criticism of others.</p>

<p>7. Shows emotional coldness, detachment, or flattened affectivity.</p>

<p>B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or</p>

<p>depressive disorder with psychotic features, another psychotic disorder, or autism</p>

<p>spectrum disorder and is not attributable to the physiological effects of another medical</p>

<p>condition.</p>

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Question 4

Premature Ejaculation - prevalence

Answer 4

1-3% Early ejaculation is a common occurrence: 20-30% of men experience it

Acquired form has later onset and typically disappears during 40’s

Lifelong is stable throughout life

Age and relationship length are negatively associated with prevalence

Question 5

Major or Mild Neurocognitive Disorder With Lewy Bodies

Answer 5

A. The criteria are met for major or mild neurocognitive disorder.

B. The disorder has an insidious onset and gradual progression.

C. The disorder meets a combination of core diagnostic features and suggestive diagnostic

features for either probable or possible neurocognitive disorder with Lewy bodies.

For probable major or mild neurocognitive disorder with Lewy bodies, the individual

has two core features, or one suggestive feature with one or more core features.

For possible major or mild neurocognitive disorder with Lewy bodies, the individual

has only one core feature, or one or more suggestive features.

1. Core diagnostic features:
   a. Fluctuating cognition with pronounced variations in attention and alertness.
   b. Recurrent visual hallucinations that are well formed and detailed.
   c. Spontaneous features of parkinsonism, with onset subsequent to the development

of cognitive decline.

2. Suggestive diagnostic features;
   a. Meets criteria for rapid eye movement sleep behavior disorder.
   b. Severe neuroleptic sensitivity.

D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative

disease, the effects of a substance, or another mental, neurological, or systemic

disorder.

Question 6

Narcissistic Personality Disorder (9 symptoms)

Answer 6

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack

of empathy, beginning by early adulthood and present in a variety of contexts, as indicated

by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents,

expects to be recognized as superior without commensurate achievements).

2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal

love.

3. Believes that he or she is “special” and unique and can only be understood by, or

should associate with, other special or high-status people (or institutions).

4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable

treatment or automatic compliance with his or her expectations).

6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own
   ends) .
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

Question 7

Neurocognitive Changes from DSM-IV

Answer 7

Dementia and Amnestic Disorder –> Major Neurocognitive Disorder

Mild NCD is new

Renamed “etiological subtypes”

Question 8

Inhalant Intoxication Criteria (4)

Answer 8

A. Recent intended or unintended short-term, high-dose exposure to inhalant substances,

including volatile hydrocarbons such as toluene or gasoline.

B. Clinically significant problematic behavioral or psychological changes (e.g., belligerence,

assaultiveness, apathy, impaired judgment) that developed during, or shortly after,

exposure to inhalants.

C. Two (or more) of the following signs or symptoms developing during, or shortly after,

inhalant use or exposure:

1. Dizziness.
2. Nystagmus.
3. Incoordination.
4. Slurred speech.
5. Unsteady gait.
6. Lethargy.
7. Depressed reflexes.
8. Psychomotor retardation.
9. Tremor.
10. Generalized muscle weakness.
11. Blurred vision or diplopia.
12. Stupor or coma.
13. Euphoria.

D. The signs or symptoms are not attributable to another medical condition and are not better

explained by another mental disorder, including intoxication with another substance.

Question 9

Cannabis Intoxication (4)

Answer 9

A. Recent use of cannabis.

B. Clinically significant problematic behavioral or psychological changes (e.g., impaired

motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment,

social withdrawal) that developed during, or shortly after, cannabis use.

C. Two (or more) of the following signs or symptoms developing within 2 hours of cannabis

use:

1. Conjunctival injection.
2. Increased appetite.
3. Dry mouth.
4. Tachycardia.

D. The signs or symptoms are not attributable to another medical condition and are not better

explained by another mental disorder, including intoxication with another substance.

Question 10

Sedative, Hypnotic, or Anxiolytic Withdrawal Criteria (4)

Answer 10

A. Cessation of (or reduction in) sedative, liypnotic, or anxiolytic use that has been prolonged.

B. Two (or more) of the following, developing within several hours to a few days after the cessation

of (or reduction in) sedative, hypnotic, or anxiolytic use described in Criterion A:

1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
2. Hand tremor.
3. Insomnia.
4. Nausea or vomiting.
5. Transient visual, tactile, or auditory hallucinations or illusions.
6. Psychomotor agitation.
7. Anxiety.
8. Grand mal seizures.

C. The signs or symptoms in Criterion B cause clinically significant distress or impairment

in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not

better explained by another mental disorder, including intoxication or withdrawal from

another substance.

Question 11

Cluster C

Answer 11

Anxious, fearful

Avoidant

Dependent

Obsessive-Compulsive

Question 12

Tobacco Withdrawal Criteria (4)

Answer 12

A. Daily use of tobacco for at least several weeks.

B. Abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed

within 24 hours by four (or more) of the following signs or symptoms:

1. Irritability, frustration, or anger.
2. Anxiety.
3. Difficulty concentrating.
4. Increased appetite.
5. Restlessness.
6. Depressed mood.
7. Insomnia.

C. The signs or symptoms in Criterion B cause clinically significant distress or impairment

in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributed to another medical condition and are not better

explained by another mental disorder, including intoxication or withdrawal from another

substance.

Question 13

Phencyclidine (Hallucinogen) Intoxication (4)

Answer 13

A. Recent use of phencyclidine (or a pharmacologically similar substance).

B. Clinically significant problematic behavioral changes (e.g., belligerence, assaultiveness,

impulsiveness, unpredictability, psychomotor agitation, impaired judgment) that

developed during, or shortly after, phencyclidine use.

C. Within 1 hour, two (or more) of the following signs or symptoms:

Note: When the drug is smoked, “snorted,” or used intravenously, the onset may be

particularly rapid.

1. Vertical or horizontal nystagmus.
2. Hypertension or tachycardia.
3. Numbness or diminished responsiveness to pain.
4. Ataxia.
5. Dysarthria.
6. Muscle rigidity.
7. Seizures or coma.
8. Hyperacusis.

D. The signs or symptoms are not attributable to another medical condition and are not better

explained by another mental disorder, including Intoxication with another substance.

Question 14

Substance/Medication-Induced Major or Mild Neurocognitive Disorder

Answer 14

A. The criteria are met for major or mild neurocognitive disorder.

B. The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal.

C. The involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment.

D. The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence).

E. The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder.

Question 15

Cluster A

Answer 15

Odd, eccentric

Paranoid

Schizoid

Schizotypal

May be related to Psychotic Disorders -Exclusion criteria for psychotic disorders

Question 16

V & Z Codes

Answer 16

Psychosocial Stressors

Adverse life events

Contextual influence

Can have v and z codes as ‘diagnosis’ or reason for visit

Other conditions that may be the focus of clinical attention:

• Relationship problems
• Abuse/neglect
• Education and Occupational Problems -

Housing and Economic Problems

• Other problems related to the social environment
• social rejection/acculturation for immigrants
• “Phase of life” problems
• 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 (risk factors in one’s personal history ex: self-harm)

Question 17

Delirium Specifiers

Answer 17

Specify the etiology -

substance intoxication/withdrawal

• medication-induced
• due to another medical condition
• due to multiple etiologies

Specify if acute/persistent

Specify activity level: hyperactive, hypoactive or mixed

Question 18

Delayed ejaculation - prevalence

Answer 18

Prevalence unknown

• least common male sexual complaint
• <1% report problems with ejaculation lasting >6 months
• 75% of men report always ejaculating

Incidence increases after age 50

Often associated with distress in both partners

Can contribute to difficulties in conception

Question 19

Male hypoactive sexual desire disorder - prevalence and risk factors

Answer 19

1.8% of men

Common to have low sexual desire: 6% of men ages 18-24 and 41% of men ages 66-74

Associated with erectile/ejaculatory concerns

Risk factors:

Mood/anxiety disorders

Alcohol use

Sexual trauma

Question 20

Obsessive Compulsive Personality Disorder (8 symptoms)

Answer 20

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and inteφersonal

control, at the expense of flexibility, openness, and efficiency, beginning by

early adulthood and present in a variety of contexts, as indicated by four (or more) of the

following:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent

that the major point of the activity is lost.

2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a

project because his or her own overly strict standards are not met).

3. Is excessively devoted to work and productivity to the exclusion of leisure activities and

friendships (not accounted for by obvious economic necessity).

4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or

values (not accounted for by cultural or religious identification).

5. Is unable to discard worn-out or worthless objects even when they have no sentimental

value.

6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his

or her way of doing things.

7. Adopts a miserly spending style toward both self and others; money is viewed as

something to be hoarded for future catastrophes.

8. Shows rigidity and stubbornness.

Question 21

Female Sexual Response Cycle - Kingsberg

Answer 21

Question 22

Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease

Answer 22

A. The criteria are met for major or mild neurocognitive disorder.

B. There is insidious onset and gradual progression of impairment in one or more cognitive

domains (for major neurocognitive disorder, at least two domains must be impaired).

C. Criteria are met for either probable or possible Alzheimer’s disease as follows:

For major neurocognitive disorder:

Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise,

possible Alzheimer’s disease should be diagnosed.

1. Evidence of a causative Alzheimer’s disease genetic mutation from family history

or genetic testing.

2. All three of the following are present:
   a. Clear evidence of decline in memory and learning and at least one other cognitive

domain (based on detailed history or serial neuropsychological testing).

b. Steadily progressive, gradual decline in cognition, without extended plateaus.
c. No evidence of mixed etiology (i.e., absence of other neurodegenerative or

cerebrovascular disease, or another neurological, mental, or systemic disease

or condition likely contributing to cognitive decline).

For mild neurocognitive disorder:

Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s

disease genetic mutation from either genetic testing or family history.

Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s

disease genetic mutation from either genetic testing or family history, and all

three of the following are present:

1. Clear evidence of decline in memory and learning.
2. Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular

disease, or another neurological or systemic disease or condition likely

contributing to cognitive decline).

D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative

disease, the effects of a substance, or another mental, neurological, or systemic

disorder.

Question 23

Erectile Disorder (4)

Answer 23

A. At least one of the three following symptoms must be experienced on almost all or all

(approximately 75%-100%) occasions of sexual activity (in identified situational contexts

or, if generalized, in all contexts):

1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of sexual activity.
3. Marked decrease in erectile rigidity.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately

6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a

consequence of severe relationship distress or other significant stressors and is not attributable

to the effects of a substance/medication or another medical condition.

Specify whether:

Lifelong: The disturbance has been present since the individual became sexually active.

Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:

Generaiized: Not limited to certain types of stimulation, situations, or partners.

Situationai: Only occurs with certain types of stimulation, situations, or partners.

Question 24

Frotteuristic Disorder (2)

Answer 24

Often comorbid w CD

A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.

B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if: In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to touch or rub against a nonconsenting person are restricted.

In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Question 25

Delayed ejaculation (4)

Answer 25

A. Either of the following symptoms must be experienced on almost all or all occasions (approximately 75%-100%) of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and without the individual desiring delay: 1. Marked delay in ejaculation. 2. Marked infrequency or absence of ejaculation. B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: Generalized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners.

Question 26

Stimulant Withdrawal Criteria (4)

Answer 26

A. Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use. B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A: 1. Fatigue. 2. Vivid, unpleasant dreams. 3. Insomnia or hypersomnia. 4. Increased appetite. 5. Psychomotor retardation or agitation. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Specify the specific substance that causes the withdrawal syndrome (i.e., amphetamine- type substance, cocaine, or other stimulant).

Question 27

Caffeine Intoxication Criteria (4)

Answer 27

A. Recent consumption of caffeine (typically a high dose well in excess of 250 mg). B. Five (or more) of the following signs or symptoms developing during, or shortly after, caffeine use: 1. Restlessness. 2. Nervousness. 3. Excitement. 4. Insomnia. 5. Flushed face. 6. Diuresis. 7. Gastrointestinal disturbance. 8. Muscle twitching. 9. Rambling flow of thought and speech. 10. Tachycardia or cardiac arrhythmia. 11. Periods of inexhaustibility. 12. Psychomotor agitation. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Question 28

Genito-pelvic pain/penetration disorder (4)

Answer 28

A. Persistent or recurrent difficulties with one (or more) of the following: 1. Vaginal penetration during intercourse. 2. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts. 3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration. 4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of a severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function.

Question 29

Voyeuristic Disorder - prevalence and risk

Answer 29

Prevalence and course unknown -estimated lifetime 12% in males, 4% females Risk factors: -childhood sexual abuse -substance misuse -sexual preoccupation/hypersexuality

Question 30

Gender Dysphoria in Children (2)

Answer 30

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1): 1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender). 2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire: or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing. 3. A strong preference for cross-gender roles in make-believe play or fantasy play. 4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender. 5. A strong preference for playmates of the other gender. 6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities. 7. A strong dislike of one’s sexual anatomy. 8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender. B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning. Specify if; With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensitivity syndrome).

Question 31

Gambling Disorder Specifiers

Answer 31

Specify if: Episodic: Meeting diagnostic criteria at more than one time point, witli symptoms subsiding between periods of gambling disorder for at least several months. Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years. In early remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met for at least 3 months but for less than 12 months. in sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met during a period of 12 months or longer. Specify current severity: Mild: 4-5 criteria met. iModerate: 6-7 criteria met. Severe: 8-9 criteria met.

Question 32

Sexual Sadism Disorder (2)

Answer 32

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors. B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in sadistic sexual behaviors are restricted. In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Question 33

Sedative, Hypnotic, or Anxiolytic Intoxication Criteria (4)

Answer 33

A. Recent use of a sedative, hypnotic, or anxiolytic. B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, sedative, hypnotic, or anxiolytic use. C. One (or more) of the following signs or symptoms developing during, or shortly after, sedative, hypnotic, or anxiolytic use: 1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus. 5. Impairment in cognition (e.g., attention, memory). 6. Stupor or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Question 34

Pedophilic Disorder - Prevalence

Answer 34

Prevalence unknown Awareness of sexual interest in children develops around puberty -awareness typically precedes engaging in sexual behaviors, which begins in later teenage years Pedophilia is lifelong condition, but may or may not meet criteria for disorder Risk factors: -antisocial personality disorder -child sexual abuse Penile plethysmograph used as diagnostic marker 50% or more have other paraphilias

Question 35

Antisocial PD - prevalence

Answer 35

.2 - 3.3% -more common in males -approx. 70% forensic/prison settings, substance abuse clinic Chronic but decreasing severity with age Deceit and manipulation are core features Frequently lack empathy, are arrogant, excessively self-assured, display superficial charm, are irresponsible and exploitive in sexual relationships

Question 36

Histrionic Personality Disorder - associated features

Answer 36

Impaired relationships with sexual partners and friends Crave novelty, stimulation and excitement

Question 37

Transvestic Disorder - prevalence onset and course

Answer 37

Prevalence unknown, but rare Almost exclusively in males, majority identify as heterosexual May have "purging and acquistion" behavior Autogynephilia increases likelihood of Gender Dysphoria ONset may occur in childhood or early adolescence Course varies -Severity and impairment may be highest during adulthood -sexual arousal may diminish with age although cross-dressing persists

Question 38

Delirium (5)

Answer 38

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

Question 39

Erectile disorder - prevalence

Answer 39

Prevalence unknown -13-21% of men (ages 40-80) report occasional problems -20% of men fear erectile problems with first sexual experience, 8% experienced -Often minimal after first attempt Age-related increase after age 50 Acquired type often associated with biological factors

Question 40

Gambling Disorder Specifiers

Answer 40

Specify if: Episodic: Meeting diagnostic criteria at more than one time point, witli symptoms subsiding between periods of gambling disorder for at least several months. Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years. In early remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met for at least 3 months but for less than 12 months. in sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met during a period of 12 months or longer. Specify current severity: Mild: 4-5 criteria met. iModerate: 6-7 criteria met. Severe: 8-9 criteria met.

Question 41

Substance Use Disorder Criteria (1)

Answer 41

A. A problematic pattern of substance use (except caffeine) leading to clinically significant impairment or distress 2 of the following within 12-month period 1. Substance is taken in larger amounts or over a longer period than intended 2. Persistent desire or unsuccessful effort to cut down or control use 3. Great deal of time spent obtaining, using or recovering from substance 4. Craving or strong urge for substance 5. Recurrent use resulting in failure to fulfill major role obligations at work, school or home 6. Continued use despite it causing or exacerbating social or interpersonal issues 7. Important social, occupational or recreational activities are given up or reduced because of substance use 8. Recurrent substance use in situations in which it is physically hazardous. 9. Substance 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 the substance to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the substance 11. Withdrawl (except hallucinogens) as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance b. substance is taken to relieve or avoid withdrawal symptoms. Specify if: Early remission: criteria previously met but none have been met for 3 months but for less than 12 Sustained remission: criteria previously met but not over last 12 months In a controlled environment

Question 42

Major Neurocognitive Disorder - Specifiers

Answer 42

Etiological subtype With/without behavioral disturbance (mood swings, agitation, wandering off, disinhibition, sleep disturbance, etc.) Severity -Mild: difficulties with instrumental activities of daily living (activities that allow you to live independently, e.g., grocery shopping, driving, etc.) Moderate: difficulties with basic activities (basic hygiene, eating, etc.) Severe: fully dependent

Question 43

Neuroleptic-Induced Parkinsonism/ Other Medication-Induced Parkinsonism

Answer 43

Parkinsonian tremor, muscular rigidity, akinesia (i.e., loss of movement or difficulty initiating movement), or bradykinesia (i.e., slowing movement) developing within a few weeks of starting or raising the dosage of a medication (e.g., a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.

Question 44

Gender Dysphoria in Adults (2)

Answer 44

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following: 1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics). 2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics). 3. A strong desire for the primary and/or secondary sex characteristics of the other gender. 4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender). 5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender). 6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender). B. The condition is associated with clinically significant distress or impairment in social, occupationali^or other important areas of functioning. Specify if: With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensitivity syndrome). Coding note: Code the disorder of sex development as well as gender dysphoria. Specify if: Posttransttion: The individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treatment regimen—namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in a natal female).

Question 45

Tardive Dystonia/ Tardive Akathisia

Answer 45

Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinuation or dosage reduction.

Question 46

Fetishistic Disorder (3)

Answer 46

A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors. B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the puφose of tactile genital stimulation (e.g., vibrator). Specify: Body part(s) Nonliving object(s) Other Specify if: in a controiied environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted. in fuii remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Question 47

Caffeine Withdrawal Criteria (4)

Answer 47

A. Prolonged daily use of caffeine. B. Abrupt cessation of or reduction in caffeine use, followed within 24 hours by three (or more) of the following signs or symptoms: 1. Headache. 2. Marked fatigue or drowsiness. 3. Dysphoric mood, depressed mood, or irritability. 4. Difficulty concentrating. 5. Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness). C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not associated with the physiological effects of another medical condition (e.g., migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Question 48

Genito-pelvic pain/penetration disorder - prevalence unknown

Answer 48

Prevalence unknown 15% of women report pain during intercourse in North America Often associated with other sexual dysfunctions

Question 49

Dependent Personality Disorder - prevalence and associated features

Answer 49

.49 - .6% -more common in females Associated features: Often characterized by pessimism and self-doubt, belittle their abilities, self-criticize Often results in imbalanced relationships and may be willing to tolerate abusive behavior OFten results in social and occupational impairment Often comorbid with mood and anxiety disorders, cluster B/C Risk factors: Childhood illness Separation anxiety disorder

Question 50

Fetishistic Disorder - onset and course

Answer 50

Onset typically in puberty Continuous course fluctuating in frequency/intensity May experience sexual dysfunction without object Almost exclusively males -may steal and collect objects

Question 51

Mild Neurocognitive Disorder (4)

Answer 51

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. \*modest is 1-2 SD below mean (not below previous level of functioning) B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required). C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Question 52

Schizotypal Personality Disorder (2)

Answer 52

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Ideas of reference (excluding delusions of reference). 2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, bizarre fantasies or preoccupations). 3. Unusual perceptual experiences, including bodily illusions. 4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped). 5. Suspiciousness or paranoid ideation. 6. Inappropriate or constricted affect. 7. Behavior or appearance that is odd, eccentric, or peculiar. 8. Lack of close friends or confidants other than first-degree relatives. 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizotypal personality disorder (premorbid).”

Question 53

Intake considerations with personality disorders

Answer 53

Cluster A -transient psychotic symptoms -interpersonal challenges -difficulties relating to others -paranoid ideation -odd ideas Cluster B -impulse-control problems -boundary issues Cluster C -anxiety and fearfulness -desire to please

Question 54

Delirium specifier - prevalence, course, associated features

Answer 54

1-2% -increases with age -greater in hospital populations Course: Typically full recovery w or w/o treatment -early intervention shortens duration of delirium -if underlying cause is untreated may result in coma, seizures or death -at greater risk for functional impairment and institutional placement Associated Features: Sleep-wake cycle disturbance Emotional disturbance (anxiety, fear, depression, anger, euphoria, apathy) Unpredictable/labile emotions

Question 55

Gender Dysphoria: changes from DSM-IV

Answer 55

Gender Dysphoria vs. Gender Identity Disorder -gender incongruence rather than cross-gender identification -focus on dysphoria rather than identity Separate criteria for children vs adults/adolescents Use of the term "gender" instead of "sex" Posttransition specifier

Question 56

Major neurocognitive disorder (4)

Answer 56

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. \*can't just be tests because we can't tell if it is a decline \*Substantial cognitive decline is 2+ SD from the mean (not previous functioning) B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications). C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Question 57

Major or Mild Neurocognitive Disorder Due to HIV Infection

Answer 57

A. The criteria are met for major or mild neurocognitive disorder. B. Tliere is documented infection witfi human immunodeficiency virus (HIV). C. The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis. D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

Question 58

Female Sexual Reponse Cycle

Answer 58

Question 59

Dependent Personality Disorder (7 symptoms)

Answer 59

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life. 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.) 4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Question 60

Medication-Induced Acute Dystonia

Answer 60

Abnormal and prolonged contraction of the muscles of the eyes (oculogyric crisis), head, neck (torticollis or retrocollis), limbs, or trunk developing within a few days of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.

Question 61

Neuroleptic Malignant Syndrome

Answer 61

Although neuroleptic malignant syndrome is easily recognized in its classic full-blown form, it is often heterogeneous in onset, presentation, progression, and outcome. The clinical features described below are those considered most important in making the diagnosis of neuroleptic malignant syndrome based on consensus recommendations. very rare (.01 - .02% of those treated with antipsychotic drugs) 20% fatal

Question 62

Major/Mild NCD - prevalence

Answer 62

Family member may view this as "normal" if aging (especially mild NCD) Distinguish from Malingering/Factitious Disorder Prevalence: at age 65, 1-2% for major NCD, 2-10% for mild NCD -varies depending on etiology and increases with age -more common in females (especially Alzheimers) Course varies across etiology (can fluctuate or remain static) May have comorbid diagnosis of Neurodevelopmental Disorder if NCD onsets in early childhood Differentiate from normal declines, MDD, Delirium, SLD, Neurodevelopmental

Question 63

Medication-lnduced Acute Akathisia

Answer 63

Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g., fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.

Question 64

Sexual Masochism Disorder (2)

Answer 64

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or othenwise made to suffer, as manifested by fantasies, urges, or behaviors. B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to restriction of breathing. Specify if: In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in masochistic sexual behaviors are restricted. In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at last 5 years while in an uncontrolled environment.

Question 65

Exhibitionistic Disorder (2)

Answer 65

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors. B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify whether: Sexually aroused by exposing genitals to prepubertal children Sexually aroused by exposing genitals to physically mature individuals Sexually aroused by exposing genitals to prepubertal children and to physically mature individuals Specify if; In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted. In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Question 66

Antisocial Personality Disorder (4)

Answer 66

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others. 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Question 67

Other specified/unspecified mental disorder due to another medical condition

Answer 67

residual category causes clinically significant distress or impairment Must be established that disturbance is caused by medical condition Must code and list medical condition first

Question 68

Paraphilic changes from DSM-IV

Answer 68

Paraphilia does not equal paraphilic disorder Must meet Criterion B: Paraphilia causes clinically significant distress or impairment OR Harm/risk of harm to others -another person's psychological distress -injury or death -involving unwilling persons or persons unable to give legal consent (e.g. minors, intoxicated people, dependent adults, etc.)

Question 69

Borderline Personality Disorder - Associated features

Answer 69

Pattern of undermining themselves the moment a goal is to be realized High risk of suicide Paranoia Recurrent job loss, separation/divorce common Childhood history of physical sexual abuse, neglect, early parental loss, and hostile conflict Often co-morbid with: mood disorders substance use disorders ADHD Other PDs PTSD

Question 70

10 Classes of drugs

Answer 70

Alcohol Sedatives, Hypnotics and Anxiolytics (anti-anxiety) Caffeine Tobacco Stimulants Hallucinogens Cannabis Inhalants Opioids Other

Question 71

Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease

Answer 71

A. The criteria are met for major or mild neurocognitive disorder. B. The disturbance occurs in the setting of established Parkinson’s disease. C. There is insidious onset and gradual progression of impairment. D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder. Major or mild neurocognitive disorder probably due to Parkinson’s disease should be diagnosed if 1 and 2 are both met. major or mild neurocognitive disorder possibly due to Parkinson's disease should be diagnosed if 1 or 2 is met: 1. There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline). 2. The Parkinson’s disease clearly precedes the onset of the neurocognitive disorder.

Question 72

Histrionic Personality Disorder (8 symptoms)

Answer 72

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Is uncomfortable in situations in which he or she is not the center of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. 3. Displays rapidly shifting and shallow expression of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. 7. Is suggestible (i.e., easily influenced by others or circumstances). 8. Considers relationships to be more intimate than they actually are.

Question 73

Avoidant Personality Disorder (7 symptoms)

Answer 73

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. ' 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Question 74

Pedophilic Disorder (3)

Answer 74

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger). B. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty. C. The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A. Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old. Specify whether: Exclusive type (attracted only to children) Nonexclusive type Specify if: Sexually attracted to males Sexually attracted to females Sexually attracted to both Specify if: Limited to incest

Question 75

Avoidant Personality Disorder - prevalence and associated features

Answer 75

2.4% Associated features: -fearfulness/shyness might elicit ridicule or teasing -longing to be an active participant in social life -impaired social and occupational functioning Begins in childhood with shyness and isolation and individual becomes increasingly shy and avoidant in adolescence and early adulthood Often comorbid with anxiety, mood disorders, dependent personality, borderline personality and Cluster A disorders

Question 76

Male Sexual Response Cycle

Answer 76

Question 77

Frotteuristic Disorder - prevalence

Answer 77

Prevalence and course is unknown -uninvited touching/rubbing of another person: up to 30% males -10-14% of those with other parphilic disorders have comorbid diagnosis Onset late adolescence, early adulthood

Question 78

Alcohol Intoxication Criteria (4)

Answer 78

A. Recent ingestion of alcohol. B. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. C. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus. 5. Impairment in attention or memory. 6. Stupor or coma. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Question 79

Gambling Disorder Criteria (2)

Answer 79

A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. Is restless or irritable when attempting to cut down or stop gambling. 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. 4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 6. After losing money gambling, often returns another day to get even (“chasing” one’s losses). 7. Lies to conceal the extent of involvement with gambling. 8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. 9. Relies on others to provide money to relieve desperate financial situations caused by gambling. B. The gambling behavior is not better explained by a manic episode.

Question 80

Opioid Intoxication Criteria (4)

Answer 80

A. Recent use of an opioid. B. Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use. C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use: 1. Drowsiness or coma. 2. Slurred speech. 3. Impairment in attention or memory. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Specify if: With perceptual disturbances: This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.

Question 81

Personality Disorders

Answer 81

An enduring pattern of inner experiences and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment Appears in the areas of cognition, affect, interpersonal functioning and impulse control Requires evaluation of long-term patterns of functioning; often more than one interview is necessary to confirm diagnosis Can code "traits" Although unusual, PDs can be diagnosed in children if traits appear to be pervasive, persistent, are not limited to a developmental phase, and have been present for at least one year (except antisocial PD) PD does not all of sudden appear in late life (but could be undetected) Can not appear exclusively during the presence of an Axis 1 disorder (axis 1 all disorders except mental retardation and PDs) Cultural considerations

Question 82

Tardive Dyskinesia

Answer 82

Involuntary athetoid or choreiform movements (lasting at least a few weeks) generally of the tongue, lower face and jaw, and extremities (but sometimes involving the pharyngeal, diaphragmatic, or trunk muscles) developing in association with the use of a neuroleptic medication for at least a few months. Symptoms may develop after a shorter period of medication use in older persons. In some patients, movements of this type may appear after discontinuation, or after change or reduction in dosage, of neuroleptic medications, in which case the condition is called neuroleptic withdrawal-emergent dyskinesia. Because withdrawal-emergent dyskinesia is usually time-limited, lasting less than 4-8 weeks, dyskinesia that persists beyond this window is considered to be tardive dyskinesia. Tardive - longer term

Question 83

Borderline PD - prevalence

Answer 83

1.6-5.9% -20% in psychiatric inpatients More common in females Instability, impulsivity, suicide risk decrease with age Cultural and developmental considerations: -adolescence

Question 84

Female sexual interest/arousal disorder - prevalence unknown

Answer 84

Prevalence unknown Associated with orgasm problems, pain during sexual activity, infrequent sex, and couple discrepancies in desire

Question 85

Alcohol Withdrawal Criteria (4)

Answer 85

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. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Specify if: With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium.

Question 86

What is a drug?

Answer 86

A substance other than food intended to affect the structure or function of the body

Question 87

Factors to consider when diagnosing sexual dysfunctions

Answer 87

Lack of adequate sexual stimulation? --\> No diagnosis Partner factors Relationship factors Individual vulnerability & Psychiatric comorbidity Cultural/religious Medical problems

Question 88

Major or Mild Frontotemporal Neurocognitive Disorder

Answer 88

A. The criteria are met for major or mild neurocognitive disorder. B. The disturbance has insidious onset and gradual progression. C. Either (1) or (2); 1. Behavioral variant; a. Three or more of the following behavioral symptoms: i. Behavioral disinhibition. ii. Apathy or inertia. iii. Loss of sympathy or empathy. iv. Perseverative, stereotyped or compulsive/ritualistic behavior. v. Hyperorality and dietary changes. b. Prominent decline in social cognition and/or executive abilities. 2. Language variant: a. Prominent decline in language ability, in the form of speech production, word finding, object naming, grammar, or word comprehension. D. Relative sparing of learning and memory and perceptual-motor function. E. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder. Probable frontotemporal neurocognitive disorder is diagnosed if either of the following is present; othenwise, possible frontotemporal neurocognitive disorder should be diagnosed: 1. Evidence of a causative frontotemporal neurocognitive disorder genetic mutation, from either family history or genetic testing. 2. Evidence of disproportionate frontal and/or temporal lobe involvement from neuroimaging. Possible frontotemporal neurocognitive disorder is diagnosed if there is no evidence of a genetic mutation, and neuroimaging has not been performed

Question 89

Female orgasmic disorder

Answer 89

A. Presence of either of the following symptoms and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts): 1. Marked delay in, marked infrequency of, or absence of orgasm. 2. Markedly reduced intensity of orgasmic sensations. B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: Generaiized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners. Specify if: Never experienced an orgasm under any situation.

Question 90

Cluster B

Answer 90

Dramatic, emotional, erratic Antisocial Borderline Histrionic Narcissistic

Question 91

Substance use disorder groupings

Answer 91

Impaired control (1-4) Social Impairment (5-7) Risky use (8-9) Pharmacological criteria (10-11)

Question 92

Schizotypal PD - prevalence and associated features

Answer 92

.5-4% more common in males Associated features: -Odd/eccentric behavior results in teasing -poor peer relations/isolation -depression/anxiety Differential Diagnosis: Schizophrenia and Mood disorders w/ Psychotic features ASD Paranoid and Schizoid PD Depression \*30-50% have comorbid depression (for which they are more likely to seek Tx)

Question 93

Exhibitionistic disorder - prevalence

Answer 93

Prevalence unknown - possibly 2-4% in males Typically onset in adolescence/early adulthood Risk factors -antisocial personality disorder, alcohol use disorder and pedophilic interest -childhood sexual abuse, sexual preoccupation/hypersexuality

Question 94

Narcissistic PD - prevalence

Answer 94

.6-2% -more common in males Associated features: -very sensitive to criticism or defeat (i.e. narcissistic injury) -impaired interpersonal relationships -Impaired performance or vocational functioning -may develop depressed mood, social withdrawal -often comorbid with other cluster B disorders, mood disorders, anorexia, and substance use disorder Developmental considerations

Question 95

Paranoid Personality Disorder (2)

Answer 95

A. A pervasive distrust and suspiciousness of others such that their nfiotives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. 4. Reads hidden demeaning or threatening meanings into benign remarks or events. 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).”

Question 96

Paranoid Personality Disorder - Associated Features

Answer 96

Difficulty with or lack of close relationships Argumentative Cold/reserved Self-sufficient/autonomous Rigid, need for control Critical of others May be premorbid to psychotic disorders

Question 97

Voyeuristic Disorder (3)

Answer 97

A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors. B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age. Specify if: In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in voyeuristic behavior are restricted. Ex: military, prison, psych hospital, etc. In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Question 98

Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury

Answer 98

A. The criteria are met for major or mild neurocognitive disorder. B. There is evidence of a traumatic brain injury—that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following: 1. Loss of consciousness. 2. Posttraumatic amnesia. 3. Disorientation and confusion. 4. Neurological signs (e.g., neuroimaging demonstrating injury; a new onset of seizures; a marked worsening of a preexisting seizure disorder; visual field cuts; anosmia; hemiparesis). C. The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the acute post-injury period.

Question 99

Major or Mild Vascular Neurocognitive Disorder

Answer 99

A. The criteria are met for major or mild neurocognitive disorder. B. The clinical features are consistent with a vascular etiology, as suggested by either of the following: 1. Onset of the cognitive deficits is temporally related to one or more cerebrovascular events. 2. Evidence for decline is prominent in complex attention (including processing speed) and frontal-executive function C. There is evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits. D. The symptoms are not better explained by another brain disease or systemic disorder. Probable vascular neurocognitive disorder is diagnosed if one of the following is present; othenvise possible vascular neurocognitive disorder should be diagnosed: 1. Clinical criteria are supported by neuroimaging evidence of significant parenchymal injury attributed to cerebrovascular disease (neuroimaging-supported). 2. The neurocognitive syndrome is temporally related to one or more documented cerebrovascular events. 3. Both clinical and genetic (e.g., cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) evidence of cerebrovascular disease is present. Possible vascular neurocognitive disorder is diagnosed if the clinical criteria are met but neuroimaging is not available and the temporal relationship of the neurocognitive syndrome with one or more cerebrovascular events is not established.

Question 100

Major or Mild Neurocognitive Disorder Due to Prion Disease

Answer 100

A. The criteria are met for major or mild neurocognitive disorder. B. There is insidious onset, and rapid progression of impairment is common. C. There are motor features of prion disease, such as myoclonus or ataxia, or biomarker evidence. (jerky movements, loss of bodily movements) D. The neurocognitive disorder is not attributable to another medical condition and is not better expiated by another mental disorder. Has to do with folded protein

Question 101

Major or Mild Neurocognitive Disorder Due to Huntington’s Disease

Answer 101

A. The criteria are met for major or mild neurocognitive disorder. B. There is insidious onset and gradual progression. C. There is clinically established Huntington’s disease, or risk for Huntington’s disease based on family history or genetic testing. D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder. -- Caused by dominant allele - 50% if one parent has Huntington's Average age is 40 Median survival rate is 15 yrs after symptoms show

Question 102

Antidepressant Discontinuation Syndrome

Answer 102

Can happen if you quit meds cold turkey Basically antidepressant withdrawl Antidepressant discontinuation syndrome is a set of symptoms that can occur after an abrupt cessation (or marked reduction in dose) of an antidepressant medication that was taken continuously for at least 1 month. Symptoms generally begin within 2-4 days and typically include specific sensory, somatic, and cognitive-emotional manifestations. Frequently reported sensory and somatic symptoms include flashes of lights, "electric shock" sensations, nausea, and hyperresponsivity to noises or lights. Nonspecific anxiety and feelings of dread may also be reported. Symptoms are alleviated by restarting the same medication or starting a different medication that has a similar mechanism of action— for example, discontinuation symptoms after withdrawal from a serotonin-norepinephrine reuptake inhibitor may be alleviated by starting a tricyclic antidepressant. To qualify as antidepressant discontinuation syndrome, the symptoms should not have been present before the antidepressant dosage was reduced and are not better explained by another mental disorder (e.g., manic or hypomanie episode, substance intoxication, substance withdrawal, somatic symptom disorder).

Question 103

Frontotemporal NCD info

Answer 103

degeneration or atrophy of frontal lobe decline in functioning is worse than in alzheimers

Question 104

Sexual Dysfunctions & Gender Dysphoria

Answer 104

Often comorbid Cannot give to someone if it's only due to lack of adequate stimulation (inexperience, partner not knowing how, etc.) New categories: female sexual interest/arousal disorder Genito-pelvic pain/penetration disorder

Question 105

Schizoid Personality - prevalence and associated features

Answer 105

3.1-4.9% More prevalent in males Associated features -tend to be single, unmarried, poor relationships -subject to teasing, rejection -maybe premorbid to psychosis

Question 106

Obsessive-Compulsive Disorder - prevalence and associated features

Answer 106

2.1 - 7.9% -more common in men (2:1) Associated features: -decision-making is time-consuming -upset or angry when control is lost -may seem overly self-righteous -'Type A' personality -formal/serious quality to relationships, lack emotionality -anxiety disorders are risk factor for OCPD -associated w/ mood disorders and eating disorders Differentiated from OCD by the absence of obsessions and compulsions

Question 107

Transvestic Disorder (2)

Answer 107

A. Over a period of at least 6 months, recurrent and intense sexual arousal from crossdressing, as manifested by fantasies, urges, or behaviors. B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: With fetishism: If sexually aroused by fabrics, materials, or garments. With autogynephiiia: If sexually aroused by thoughts or images of self as female. Specify if: in a controiied environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted, in fuii remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Question 108

Opioid Withdrawal Criteria (4)

Answer 108

A. Presence of either of the following; 1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer). 2. Administration of an opioid antagonist after a period of opioid use. B. Three (or more) of the following developing within minutes to several days after Criterion A: 1. Dysphoric mood. 2. Nausea or vomiting. 3. Muscle aches. 4. Lacrimation or rhinorrhea. 5. Pupillary dilation, piloerection, or sweating. 6. Diarrhea. 7. Yawning. 8. Fever. 9. Insomnia. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Question 109

Premature (early) ejaculation (4)

Answer 109

A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it. Note: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities. B. The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts). C. The symptom in Criterion A causes clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether; Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: Generalized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners.

Question 110

Male hypoactive sexual desire disorder (4)

Answer 110

A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life. B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to thes effects of a substance/medication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the Individual became sexually active. Acquired; The disturbance began after a period of relatively normal sexual function. Specify whether: Generaiized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners.

Question 111

Borderline Personality Disorder (9 symptoms)

Answer 111

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or selfmutilating behavior covered in Criterion 5.) 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Question 112

Sexual Masochism Disorder - prevalence

Answer 112

Prevalence and course unknown -2.2% males, 1.3% females involved in sexual masochism in Australia (not necessarily disordered) Late adolescence/early adulthood Risk of accidental death, especially with asphyxiation

Question 113

Medication-induced movements disorders and other adverse effects of medication

Answer 113

Not a mental disorder Included in DSM so clinician's can recognize if one of them is happening to their client

Question 114

Paranoid Personality Disorder - Prevalence

Answer 114

2.2-4.4% More prevalent in males Higher risk for those with relatives with psychotic disorders

Question 115

Cannabis Withdrawal Criteria (4)

Answer 115

A. Cessation of cannabis use tliat lias been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months). B. Three (or more) of the following signs and symptoms develop within approximately 1 week after Criterion A: 1. Irritability, anger, or aggression. 2. Nervousness or anxiety. 3. Sleep difficulty (e.g., insomnia, disturbing dreams). 4. Decreased appetite or weight loss. 5. Restlessness. 6. Depressed mood. 7. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache. C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Question 116

Female sexual interest/arousal disorder (4)

Answer 116

A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following: 1. Absent/reduced interest in sexual activity. 2. Absent/reduced sexual/erotic thoughts or fantasies. 3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate. 4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts). 5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/ erotic cues (e.g., written, verbal, visual). 6. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts). B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: Lifelong: The disturbance has been present since the individual became sexually active. Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: Generalized: Not limited to certain types of stimulation, situations, or partners. Situational: Only occurs with certain types of stimulation, situations, or partners.

Question 117

Diagnosing PDs

Answer 117

1. Need to verify that it's been life-long, early adulthood. Will likely need multi-informant data 2. Two of four: cognitive, interpersonal, affective and impulsive 3. Symptoms must affect several areas of patient's life: home/personal, social, work, school 4. Does patient meet full criteria? 5. If under 18, must be present for at least 1 year (clinical judgment) 6. Rule out other pathology 7. Evaluate for other PDs (PDs highly comorbid) 8. Record all both axis 1 and personality traits on a single axis

Question 118

Female orgasmic disorder - prevalence

Answer 118

10-40% of women have orgasmic problems (not necessarily with distress) Experiences of orgasm increase with age Often related to problems of sexual interest/arousal Not correlated with sexual satisfaction in women

Question 119

Sexual sadism disorder - prevalence and risk factors

Answer 119

Prevalence unknown -estimates vary: 2-30% -\<10% of sex offenders in US -37-75% sexually motivated homicides Person wants complete control over non-consenting partner/victim Sexual acts involving choking, pricking, tying up, spanking, whipping -risk of causing accidental death Mental anguish/humiliation