412 DSM criteria midterm 2

Question 1

Substance Use Disorder

Answer 1

• problematic pattern of use leading to clinically significant impairment or distress as manifested by at least TWO symptoms in a 12-MONTH PERIOD
• type of substance is a specifier
• 4 main categories of symptoms: physical dependence (physiological), risky use, social problems, impaired control

Question 2

SUD symptoms (11)

Answer 2

(1) Substance is often taken in larger amounts or over a longer period than was intended.
(2) There is a persistent desire or unsuccessful effort to cut down or control substance use.
(3) A great deal of time is spent in activities necessary to obtain substance, use the substance, or recover from its effects.
(4) There is a craving or a strong desire or urge to use the substance.
(5) Recurrent substance use results in failure to fulfill major role obligations at work, school, or home.
(6) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
(7) Important social, occupational, or recreational activities are given up or reduced because of substance use.
(8) There is 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 the substance.
(10) Tolerance, as defined by either or both of the following:
- A need for markedly increased amounts of substance to achieve intoxication or desired effect.
- Markedly diminished effect with continued use of the same amount of the substance.
(11) Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for a substance.
- The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

Question 3

SUD specifiers

Answer 3

• in early remission: None of the criteria have been met for at least 3 months but for less than 12 months (except “craving”)
• in sustained remission: None of the criteria have been met at any time during a period of 12 months or longer (except “craving”)
• In a controlled environment: where access to substance is restricted.
• mild: 2-3 symptoms
• moderate: 4-5 symptoms
• severe: 6+ symptoms

Question 4

Separation Anxiety Disorder

Answer 4

(A) Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least THREE symptoms
(B) fear, anxiety, or avoidance is persistent, lasting at least 4 WEEKS in children and adolescents and typically 6 MONTHS or more in adults
(C) clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
(D) not caused by another disorder like ASD, delusions/hallucinations in psychotic disorders, agoraphobia, GAD, illness anxiety disorder

Question 5

symptoms in SAD (8)

Answer 5

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

Question 6

Specific Phobia

Answer 6

(A) Marked fear or anxiety about a specific object or situation (in children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging)
(B) The phobic object or situation almost always provokes immediate fear or anxiety.
(C) The phobic object or situation is actively avoided or endured with intense fear or anxiety.
(D) The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
(E) The fear, anxiety, or avoidance is persistent, typically lasting 6 MONTHS or more.
(F) clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(G) The disturbance is not better accounted for by another mental disorder

Question 7

Specific Phobia specifiers

Answer 7

• animal
• natural environment
• blood, injection, injury
• situational
• other

Question 8

Social Anxiety Disorder

Answer 8

(A) Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed, or performing in front of others (in children, the anxiety must occur in peer settings and not just during interactions with adults)
(B) The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
(C) The social situations almost always provoke fear or anxiety (in children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking away, or failing to speak)
(D) The social situations are avoided or endured with intense fear or anxiety.
(E) The fear or anxiety is out of proportion to the actual danger posed by the social situation and to the sociocultural context.
(F) The fear, anxiety, or avoidance is persistent, typically lasting for 6 MONTHS or more.
(G) clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(H) not attributable to the direct physiological effects of a substance or another medical condition.
(I) not better explained by the symptoms of another mental disorder
(J) If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive
Specify: performance only

Question 9

Panic Disorder

Answer 9

(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 at least FOUR SYMPTOMS occur (can emerge from either calm or anxious state)
(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
(2) Significant maladaptive change in behavior related to the attacks
(C) Not due to a substance or other medical condition
(D) not better accounted for by another disorder

Question 10

Panic attack symptoms

Answer 10

(1) Palpitations, pounding heart, or accelerated heart rate.
(2) Sweating.
(3) Trembling or shaking.
(4) Sensations or 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.
Culture-specific symptoms should not count toward the four requires symptoms.

Question 11

Agoraphobia

Answer 11

(A) Marked fear or anxiety about TWO situations
(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
(C) The agoraphobic situations almost always provoke fear or anxiety.
(D) The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
(E) The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
(F) The fear, anxiety, or avoidance is persistent, typically lasting for 6 MONTHS or more.
(G) clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(H) If another medical condition is present, the fear, anxiety, or avoidance is clearly excessive.
(I) not better explained by the symptoms of another mental disorder.
Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

Question 12

situations in agoraphobia

Answer 12

(1) Using public transportation
(2) Being in open spaces (parking lots, marketplaces, bridges).
(3) Being in enclosed spaces (shops, theatres, cinemas).
(4) Standing in line or being in a crowd.
(5) Being outside of the home alone.

Question 13

Generalized Anxiety Disorder

Answer 13

(A) Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 MONTHS, about a number of events or activities.
(B) difficult to control the worry.
(C) THREE (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
Note: Only ONE item is required for children
(D) clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(E) not due to the general physiological effects of a substance or a another medical condition
(F) The disturbance is not better explained by another mental disorder.

Question 14

GAD symptoms

Answer 14

(1) Restlessness or feeling keyed up or on edge.
(2) Being easily fatigued.
(3) Difficulty concentrating or mind going blank.
(4) Irritability.
(5) Muscle tension.
(6) Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).

Question 15

Obsessive-Compulsive Disorder

Answer 15

(A) Presence of obsessions, compulsions, or both:
(B) The obsessions or compulsions are time-consuming (e.g., take more than 1 HOUR PER DAY) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(C) not attributable to the physiological effects of a substance or another medical condition.
(D) not better explained by the symptoms of another mental disorder

Question 16

Obsessions

Answer 16

(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).

Question 17

Compulsions

Answer 17

(1) Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
(2) The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

Question 18

OCD specifiers

Answer 18

• with good or fair insight: recognizes that obsessive–compulsive disorder beliefs are definitely or probably not true or that they may or may not be true
• with poor insight: thinks obsessive–compulsive disorder beliefs are probably true
• absent insight or delusional beliefs: completely convinced that obsessive–compulsive disorder beliefs are true
• tic-related: current or past history

Question 19

Major Depressive Disorder

Answer 19

(A) FIVE (or more) 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 irritability (only in youth) or
(2) loss of interest or pleasure
(B) clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(C) not attributable to the physiological effects of a substance or to another medical condition
(D) 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 hypomanic episode.

Question 20

MDD symptoms

Answer 20

(1) Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others. (Note: In children and adolescents, can be irritable mood.)
(2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation).
(3) Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gains.)
(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

Question 21

MDD specifiers

Answer 21

• anxious distress *also relevant for PDD
• mixed features (manic)
• melancholic (severe anhedonia)
• atypical features *also relevant for PDD
• psychotic features
• catatonia
• peripartum
• seasonal

Question 22

Persistent Depressive Disorder

Answer 22

(A) Depressed or irritable mood for most of the day, on more days than not, as indicated by either subjective account or observation by others for at least two years (Note: only ONE YEAR in children in adolescents)
(B) Presence of at least TWO of the following:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness
(C) During the 1 year period, the person has never been without symptoms for more than 2 MONTHS at a time

Question 23

PDD specifiers

Answer 23

• anxious distress
• atypical features
• with intermittent major depressive episodes (1-2 distinct major episodes)
• with persistent depressive episodes (meeting full criteria for MDD frequently or they last a long time)

Question 24

Disruptive Mood Dysregulation Disorder

Answer 24

(A) Severe recurrent temper outbursts manifested verbally and/or behaviourally that are grossly out of proportion in intensity or duration to the situation or provocation
(B) Outbursts are inconsistent with developmental level
(C) Outbursts occur, on average, 3 or more times per week
(D) Mood between outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others
(E) Symptoms are present for 12 MONTHS or more
(F) Not diagnosed before age 6 or after age 18
(G) Age of onset of outbursts are irritable mood is before age 10
(H) Child has never met criteria (except duration) for a manic or hypomanic episode (even lasting one day)

Question 25

Intellectual Developmental Disorder

Answer 25

• includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met:
  (A) Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience (clinical assessment and individualized, standardized intelligence testing)
  Note: no narrow IQ score cutoff, but the diagnosis wouldn’t be appropriate in people with IQs within 1SD of the mean
  (B) Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
  (C) Onset of intellectual and adaptive deficits during the developmental period

Question 26

IDD severity specifiers

Answer 26

• mild, moderate, severe, profound
• not based on IQ scores, but impairment in domains of adaptive functioning
• conceptual (ability to think), practical (performing adaptive activities), social (relationships) skills

Question 27

ASD criterion A

Answer 27

(A) Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
- 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.
- 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.
- 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.
*need all three

Question 28

ASD criterion B

Answer 28

(B) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least TWO of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- 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).
- 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).
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of 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).

Question 29

Autism Spectrum Disorder

Answer 29

(A) social communication + interaction (social-emotional reciprocity + nonverbal communication + relationships)
(B) TWO restrictive and repetitive interests and behaviours (motor movements, sameness/inflexibility, intense interests, hyper/hyposensory reactivity)
(C) Symptoms must be present in early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)
(D) clinically significant impairment in social, occupational, or other important areas of current functioning
(E) not better explained by IDD

Question 30

ASD DDx

Answer 30

• Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level
• Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Question 31

ASD specifiers

Answer 31

• With or without accompanying intellectual impairment
• With or without accompanying language impairment
• Associated with a known medical or genetic condition or environmental factor
• Associated with another neurodevelopmental, mental, or behavioral disorder
• With catatonia

Question 32

ASD severity specifiers

Answer 32

• for A and B criteria, rate severity
  (1) requiring support
  (2) requiring substantial support
  (3) requiring very substantial support

Question 33

Social Communication Disorder

Answer 33

• deficits in communication for social purposes
• impairment of ability to change context for the needs of the listener
• difficulties following rules for conversation and storytelling (taking turns, rephrasing when misunderstood, using verbal/nonverbal signals to regulate interaction)
• restricted, repetitive patterns of bx and interests have never been present