Abnormal Flashcards
1
Q
Interoceptive conditioning
A
an effective component of cognitive-behavioral therapy for the treatment of panic disorder. This intervention involves activity that generates physical sensations associated with panic attacks. Some examples of these activities include breathing through a thin straw, spinning in a swivel chair, and running in place.
2
Q
learned helplessness model
A
Abramson, Metalsky, and Alloy’s (1989) assert that a sense of hopelessness is a proximal cause of some types of depression. Attributions about negative life events contribute to depression only to the degree that these attributions foster a sense of hopelessness.
3
Q
Cyclothymic disorder
A
characterized by a disturbance of mood involving hypomanic episodes and periods of depressed mood. The DSM-5 diagnosis of cyclothymic disorder requires the presence of symptoms for at least two years in adults and one year in children and adolescents.
4
Q
catecholamine hypothesis
A
some types of depression are due to a lower-than-normal level of norepinephrine.
5
Q
schizophrenia - better prognosis
A
female gender, acute and late onset of symptoms, the presence of a precipitating event, and family history of a mood disorder.
6
Q
essential features of delirium
A
disturbances in attention and awareness
7
Q
According to Marlatt and Gordon (1985), which of the following result(s) from an “overlearned habit pattern”?
A
assert that addictive behaviors result from overlearned maladaptive habit patterns that have developed because they produce immediate gratification (reinforcement).
8
Q
A DSM-5 diagnosis of specific learning disorder requires the individual’s academic skills to be “substantially and quantifiably below those expected for:
A
the individual’s chronological age
9
Q
Criterion A for a manic episode
A
a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy
10
Q
The prevalence rates of major depressive disorder for boys and girls before puberty then in adolescence
A
equal before puberty then the rate for females is about 1.5-3X higher than the rate for males
11
Q
age restrictions for disruptive mood dysregulation disorder
A
must not be assigned for the first time when the individual is less than six years of age or more than 18 years of age, and the onset of symptoms must occur before age 10.
12
Q
Research outcomes have linked obsessive-compulsive disorder to overactivity in which of the following brain regions?
A
the caudate nucleus (which is involved in the initiation and control of movement) tends to be overactive in individuals with OCD. Studies have also indicated that the reduction of obsessions and compulsions following treatment with cognitive-behavioral therapy or an SSRI is accompanied by a decrease in activity in the caudate nucleus.
13
Q
In the DSM-5, sleep terror is included where?
A
sleep terror is a type of non–rapid eye movement sleep arousal disorder. Sleepwalking is the other type of sleep arousal disorder in this category.
14
Q
Drugs that interfere with the breakdown of ____________ are used to treat memory loss and other cognitive problems in individuals with mild to moderate Alzheimer’s disease.
A
Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), and tacrine (Cognex) are used to temporarily improve or slow the progression of memory loss and other cognitive impairments during early stages of Alzheimer’s disease. These drugs prevent the breakdown of acetylcholine, which is important for learning, memory, and other cognitive functions.
15
Q
The differential diagnosis of major depressive disorder and mild neurocognitive disorder in older adults can be difficult because of the overlap in cognitive symptoms. However, the presence of which of the following suggests that major depressive disorder is the more appropriate diagnosis?
A
A lack of cooperation during testing is more characteristic of patients with depression than of those with a neurocognitive disorder, who tend to be cooperative but inaccurate in their responses.
16
Q
A DSM-5 diagnosis of erectile disorder requires the presence of characteristic symptoms for a minimum duration of approximately _____ months.
A
the presence of characteristic symptoms for a minimum duration of about six months for all the sexual dysfunctions, except substance/medication-Induced sexual dysfunction, for which no minimum duration is specified.
17
Q
the symptoms of oppositional defiant disorder are categorized into three groups:
A
angry/irritable mood, argumentative/defiant behavior, and vindictiveness
18
Q
ACUTE STRESS DISORDER
A
The diagnosis of Acute Stress Disorder requires the development of at least nine symptoms following exposure to actual or threatened death, severe injury, or sexual violation in at least one of four ways (direct experience of the event; witnessing the event in person as it happened to others; learning that the event occurred to a close family member or friend; repeated or extreme exposure to aversive details of the event). Symptoms can be from any of five categories (intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms), have a duration of three days to one month, and cause clinically significant distress or impaired functioning.
19
Q
ADJUSTMENT DISORDERS:
A
The Adjustment Disorders involve the development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of the onset of the stressor(s). Symptoms must be clinically significant as evidenced by the presence of marked distress that is not proportional to the severity of the stressor and/or significant impairment in functioning, and they must remit within six months after termination of the stressor or its consequences.
20
Q
AGORAPHOBIA
A
A diagnosis of Agoraphobia requires the presence of marked fear of or anxiety about at least two of five situations (using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone). The individual fears or avoids these situations due to a concern that escape might be difficult or help will be unavailable in case they develop incapacitating or embarrassing symptoms; and the situations nearly always provoke fear or anxiety and are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear or anxiety is persistent, is not proportional to the threat posed by the situations, and causes clinically significant distress or impaired functioning.
21
Q
ALCOHOL-INDUCED DISORDERS (WITHDRAWAL, KORSAKOFF SYNDROME, SLEEP DISORDER)
A
Alcohol Withdrawal is diagnosed in the presence of at least two characteristic symptoms within several hours to a few days following cessation or reduction of alcohol consumption: autonomic hyperactivity; hand tremor; insomnia; nausea or vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; generalized tonic-clonic seizures. The DSM-5-TR distinguishes between two types of Alcohol-Induced Major Neurocognitive Disorder – nonamnestic-confabulatory type and amnestic-confabulatory type. The amnestic-confabulatory type is also known as Korsakoff Syndrome, and it is characterized by anterograde and retrograde amnesia and confabulation and has been linked to a thiamine deficiency. Alcohol-Induced Sleep Disorder is usually of the insomnia type and can be the result of either Intoxication or Withdrawal.
22
Q
ANOREXIA NERVOSA:
A
The essential features of Anorexia Nervosa are (a) a restriction of energy intake that leads to a significantly low body weight; (b) an intense fear of gaining weight or becoming fat or behavior that interferes with weight gain; and (c) a disturbance in the way the person experiences their body weight or shape or a persistent lack of recognition of the seriousness of their low body weight
23
Q
ANTISOCIAL PERSONALITY DISORDER:
A
Antisocial Personality Disorder is characterized by a pattern of disregard for and violation of the rights of others that has occurred since age 15 and involves at least three characteristic symptoms – e.g., failure to conform to social norms with respect to lawful behavior; deceitfulness; impulsivity; reckless disregard for the safety of self and others; lack of remorse. The person must be at least 18 years old and have a history of Conduct Disorder before 15 years of age.
24
Q
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A
ADHD is the appropriate diagnosis when the individual has at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity and symptoms had an onset prior to 12 years of age, are present in at least two settings (e.g., home and school), and interfere with social, academic, or occupational functioning. About 15% of children with ADHD continue to meet the full diagnostic criteria for the disorder as young adults and another 60% meet the criteria for ADHD in partial remission. In adults, inattention predominates the symptom profile.
25
AUTISM SPECTRUM DISORDER
For a diagnosis of Autism Spectrum Disorder, the individual must exhibit (a) persistent deficits in social communication and interaction across multiple contexts as manifested by deficits in social-emotional reciprocity, nonverbal communication, and the development, maintenance, and understanding of relationships; (b) restricted, repetitive patterns of behavior, interests, and activities as manifested by at least two characteristic symptoms (e.g., stereotyped or repetitive motor movements, use of objects, or speech; inflexible adherence to routines, or ritualized patterns of behavior); (c) the presence of symptoms during the early developmental period; and (d) impaired functioning as the result of symptoms. The best outcomes are associated with an ability to communicate by age 5 or 6, an IQ over 70, and increased adaptive functioning.
26
AVOIDANT PERSONALITY DISORDER
Avoidant Personality Disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by at least four characteristic symptoms – e.g., avoids work activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval; is unwilling to get involved with people unless certain of being liked; is preoccupied with concerns about being criticized or rejected; views self as socially inept, inferior, or unappealing to others.
27
BEHAVIORAL PEDIATRICS (HOSPITALIZATION, COMPLIANCE):
Hospitalized children are at increased risk for emotional and behavioral problems, and children ages one to four tend to have the most negative reactions to hospitalization. Children and adolescents with chronic medical conditions have higher rates of school-related problems (e.g., CNS irradiation and intrathecal chemotherapy for leukemia have been linked to impaired neurocognitive functioning and learning disabilities). Compliance with medical regimens is a particular problem for adolescents.
28
BEHAVIORAL THEORY OF DEPRESSION (LEWINSOHN)
Lewinsohn’s behavioral theory attributes depression to a low rate of response-contingent reinforcement.
29
BIPOLAR I DISORDER
A diagnosis of Bipolar I Disorder requires at least one manic episode that lasts for at least one week, is present most of the day nearly every day, and includes at least three characteristic symptoms – e.g., inflated self-esteem or grandiosity; decreased need for sleep; flight of ideas. Symptoms must cause marked impairment in social or occupational functioning, require hospitalization to avoid harm to self or others, or include psychotic features. This disorder may include one or more episodes of hypomania or major depression. Treatment usually includes lithium or an anti-seizure medication and cognitive-behavior therapy or other form of therapy.
30
BIPOLAR II DISORDER
A diagnosis of Bipolar II Disorder requires at least one hypomanic episode and at least one major depressive episode. A hypomanic episode lasts for at least four consecutive days and involves at least three symptoms that are also associated with a manic episode but are not severe enough to cause marked impairment in functioning or require hospitalization. A major depressive episode lasts for at least two weeks and involves at least five characteristic symptoms, at least one of which must be a depressed mood or a loss of interest or pleasure.
31
BORDERLINE PERSONALITY DISORDER
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and marked impulsivity. At least five characteristic symptoms must be present – e.g., frantic efforts to avoid abandonment; pattern of unstable, intense interpersonal relationships that are marked by fluctuations between idealization and devaluation; an identity disturbance involving a persistent instability in self-image or sense of self; recurrent suicide threats or gestures; transient stress-related paranoid ideation or severe dissociative symptoms.
32
BRIEF PSYCHOTIC DISORDER
Brief Psychotic Disorder is characterized by the presence of one or more of four characteristic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) with at least one symptom being delusions, hallucinations, or disorganized speech. Symptoms are present for at least one day but less than one month with an eventual return to full premorbid functioning.
33
BULIMIA NERVOSA
Bulimia Nervosa is characterized by (a) recurrent episodes of binge eating that are accompanied by a sense of a lack of control; (b) inappropriate compensatory behavior to prevent weight gain (e.g., self-induced vomiting, excessive exercise); and (c) self-evaluation that is unduly influenced by body shape and weight.
34
CONCORDANCE RATES FOR SCHIZOPHRENIA
The rates of Schizophrenia are higher among individuals with genetic similarity, and the greater the similarity, the higher the concordance rates: For example, for biological siblings, the rate is 10%; and, for identical (monozygotic) twins, the rate is 48%.
35
CONDUCT DISORDER
The diagnosis of Conduct Disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months. Symptoms are divided into four categories: aggression to people and animals; destruction of property; deceitfulness or theft; and serious violation of rules. Symptoms must cause significant impairment in functioning, and the disorder cannot be assigned to individuals over age 18 who meet the criteria for Antisocial Personality Disorder.
36
CONVERSION DISORDER
The symptoms of Conversion Disorder involve disturbances in voluntary motor or sensory functioning and suggest a serious neurological or other medical condition (e.g., paralysis, seizures, blindness, loss of pain sensation) with evidence of an incompatibility between the symptom and recognized neurological or medical conditions.
37
CYCLOTHYMIC DISORDER
Cyclothymic Disorder involves fluctuating hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode, with symptoms lasting for at least two years in adults or one year in children and adolescents. Symptoms cause significant distress or impairment in functioning.
38
DELUSIONAL DISORDER
Delusional Disorder involves one or more delusions that last at least one month. Overall psychosocial functioning is not markedly impaired, and any impairment is directly related to the delusions. The DSM-5-TR distinguishes between the following subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified.
39
DELIRIUM
A diagnosis of Delirium requires (a) a disturbance in attention and awareness that develops over a short period of time, represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day and (b) an additional disturbance in cognition (e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, perceptual distortions). Symptoms must not be due to another Neurocognitive Disorder and must not occur during a severely reduced level of arousal (e.g., during a coma), and there must be evidence that symptoms are the direct physiological consequence of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin.
40
DEPENDENT PERSONALITY DISORDER
Dependent Personality Disorder involves a pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation as manifested by at least five symptoms – e.g., has difficulty making decisions without advice and reassurance from others; fears disagreeing with others because it might lead to a loss of support; has difficulty initiating projects on their own; goes to great lengths to gain nurturance and support from others; is unrealistically preoccupied with fears of being left to care for themselves.
41
DEPRESSIVE COGNITIVE TRIAD
According to Beck,
the cognitive profile for
depression involves a cognitive triad – i.e., negative beliefs about oneself, the world (situation), and the future.
42
DIALETICTIC BEHAVIOR THERAPY
Linehan’s (1987) Dialectical Behavior Therapy (DBT) was designed as a treatment for Borderline Personality Disorder and incorporates three strategies: (a) group skills training to help clients regulate their emotions and improve their social and coping skills; (b) individual outpatient therapy to strengthen clients’ motivation and newly-acquired skills; and (c) telephone consultations to provide additional support and between-sessions coaching. Research has confirmed that it reduces premature termination from therapy, psychiatric hospitalizations, and parasuicidal behaviors.
43
DIAGNOSTIC UNCERTAINTY
When using the DSM-5-TR, diagnostic uncertainty about a client’s diagnosis is indicated by coding one of the following: Other specified disorder is coded when the clinician wants to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis, while unspecified disorder is coded when the clinician does not want to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis.
44
DISSOCIATIVE AMNESIA
A diagnosis of Dissociative Amnesia requires an inability to recall important personal information that cannot be attributed to ordinary forgetfulness and causes clinically significant distress or impaired functioning. It is often related to exposure to one or more traumatic events. The most common forms of amnesia are localized and selective.
45
DOPAMINE HYPOTHESIS
The dopamine hypothesis attributes Schizophrenia to elevated levels of or oversensitivity to dopamine.
46
DSM-5-TR
The DSM-5-TR utilizes a categorical approach that divides the mental disorders into types that are defined by a set of diagnostic criteria and requires the clinician to determine whether or not a client meets the minimum criteria for a given diagnosis. To allow for individual differences, it includes a polythetic criteria set for most disorders that requires a client to present with only a subset of characteristics from a larger list. It provides a nonaxial assessment system in which all mental and medical diagnoses are listed together with the primary diagnosis listed first.
47
ENURESIS
Enuresis involves repeated voiding of urine into the bed or clothes at least twice a week for three or more consecutive months. Urination is usually involuntary but can be intentional and is not due to substance use or a medical condition. Enuresis is diagnosed only when the individual is at least five years old or the equivalent developmental level. The bell-and-pad (urine alarm) is the most common treatment.
48
ERECTILE DISORDER
A diagnosis of Erectile Disorder requires the presence of at least one of three symptoms (marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until completion of sexual activity, marked decrease in erectile rigidity) on all or almost all occasions of sexual activity.
49
EXPRESSED EMOTION AND SCHIZOPHRENIA
A high level of expressed emotion by family members toward the member with Schizophrenia is associated with a high risk for relapse and rehospitalization. High expressed emotion is characterized by open criticism and hostility toward the patient or, alternatively, overprotectiveness and emotional overinvolvement
50
FACTITIOUS DISORDER
Individuals with Factitious Disorder Imposed on Self falsify physical or psychological symptoms that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so. Individuals with Factitious Disorder Imposed on Another falsify physical or psychological symptoms in another person, present that person to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an external reward. For both types of Factitious Disorder, falsification of symptoms can involve feigning, exaggeration, simulation, or induction (e.g., by ingestion of a substance or self-injury).
51
GENDER DYSPHORIA
For Gender Dysphoria in Children, the diagnostic criteria are a marked incongruence between assigned gender at birth and experienced or expressed gender as evidenced by a strong desire to be the other sex and at least five symptoms – e.g., strong preference for wearing clothes of the other gender; strong preference for cross-gender roles during play; strong preference for toys and activities typically used or engaged in by the other gender; strong preference for playmates of the other gender; strong desire for primary and/or secondary sex characteristics of one’s experienced gender. For Gender Dysphoria in Adolescents and Adults, the marked incongruence between assigned gender and experienced or expressed gender must be manifested by at least two symptoms – e.g., marked incongruence between one’s primary and/or secondary sex characteristics and one’s experienced or expressed gender; strong desire for the primary and/or secondary sex characteristics of the other gender; strong desire to be of the other gender; strong conviction that one has the feelings and reactions that are characteristic of the other gender. For both disorders, symptoms must have a duration of at least six months and cause clinically significant distress or impaired functioning.
52
GENERALIZED ANXIETY DISORDER
GAD involves excessive anxiety and worry about multiple events or activities, which are relatively constant for at least six months, the person finds difficult to control, and cause clinically significant distress or impaired functioning. Anxiety and worry must include at least three characteristic symptoms (or at least one symptom for children) – restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance. Treatment usually involves cognitive-behavioral therapy or a combination of cognitive-behavioral therapy and pharmacotherapy.
53
GENITO-PELVIC PAIN/PENETRATION DISORDER
This disorder is diagnosed in the presence of persistent difficulties involving at least one of the following: vaginal penetration during intercourse; genito-pelvic pain during intercourse or penetration attempts; anxiety about genito-pelvic pain before, during, or as a result of vaginal penetration; tensing of pelvic floor muscles during attempted vaginal penetration.
54
HISTRIONIC PERSONALITY DISORDER
Histrionic Personality Disorder is characterized by a pervasive pattern of emotionality and attention-seeking as manifested by at least five characteristic symptoms – e.g., discomfort when not the center of attention; inappropriately sexually seductive or provocative; rapidly shifting and shallow emotions; consistent use of physical appearance to gain attention; considers relationships to be more intimate than they are.
55
INSOMINA DISORDER
Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity that is associated with at least one characteristic symptom – difficulty initiating sleep; difficulty maintaining sleep; early-morning awakening with an inability to return to sleep. The sleep disturbance occurs at least three nights each week, has been present for at least three months, occurs despite sufficient opportunities for sleep, and causes significant distress or impaired functioning.
56
INTELLECTUAL DEVELOPMENTAL DISORDER (INTELLECTUAL DISABILITY)
ellectual Developmental Disorder (Intellectual Disability) is diagnosed in the presence of (a) deficits in intellectual functions (e.g., reasoning, problem solving, abstract thinking); (b) deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one or more activities of daily life; and (c) an onset of intellectual and adaptive functioning deficits during the developmental period. Four degrees of severity (mild, moderate, severe, and profound) are based on adaptive functioning in conceptual, social, and practical domains.
57
LEARNED HELPLESSNESS MODEL
Seligman’s learned helplessness model proposes that depression is due to exposure to uncontrollable negative events and internal, stable, and global attributions for those events. A reformulation of the theory by Abramson, Metalsky, and Alloy emphasizes the role of hopelessness.
58
MAJOR DEPRESSIVE DISORDER
A diagnosis of Major Depressive Disorder requires the presence of at least five symptoms of a major depressive episode nearly every day for at least two weeks, with at least one symptom being depressed mood or loss of interest or pleasure. Symptoms are depressed mood (or, in children and adolescents, a depressed or irritable mood); markedly diminished interest or pleasure in most or all activities; significant weight loss when not dieting or weight gain or a decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthless or excessive guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt. Symptoms cause clinically significant distress or impaired functioning. Treatment usually includes cognitive-behavioral therapy and an SSRI or other antidepressant.
59
MAJOR DEPRESSIVE DISORDER WITH PERIPARTUM ONSET
The peripartum onset specifier is applied to Major Depressive Disorder, Bipolar I Disorder, and Bipolar II Disorder when the onset of symptoms is during pregnancy or within four weeks postpartum. Symptoms may include anxiety and a preoccupation with the infant’s well-being or, in extreme cases, delusional thoughts about the infant
60
MAJOR DEPRESSIVE DISORDER WITH SEASONAL PATTERN
The seasonal pattern specifier is applied to Major Depressive, Bipolar I Disorder, and Bipolar II Disorder when there is a temporal relationship between the onset of a mood episode and a particular time of the year. This condition is also known as Seasonal Affective Disorder (SAD) and, in the Northern Hemisphere, most commonly occurs during the winter months. People with SAD usually experience hypersomnia, increased appetite and weight gain, and a craving for carbohydrates.
61
MAJOR AND MILD NEUROCOGNITIVE DISORDERS
Major Neurocognitive Disorder (formerly Dementia) is diagnosed when there is evidence of significant decline from a previous level of functioning in one or more cognitive domains that interferes with the individual’s independence in everyday activities and does not occur only in the context of Delirium. Mild Neurocognitive Disorder (formerly Cognitive Disorder NOS) is the appropriate diagnosis when there is evidence of a modest decline from a previous level of functioning in one or more cognitive domains that does not interfere with the individual’s independence in everyday activities and does not occur only in the context of Delirium. Subtypes are based on etiology and include Major and Mild Neurocognitive Disorder Due to Alzheimer’s Disease, Vascular Disease, Traumatic Brain Injury, HIV infection, Parkinson’s Disease, and Huntington’s Disease.
62
MALINGERING
Malingering is included in the DSM-5-TR with Other Conditions that May Be a Focus of Clinical Attention. It involves the intentional production, faking, or gross exaggeration of physical or psychological symptoms to obtain an external reward (e.g., to avoid criminal prosecution or obtain financial compensation).
63
MARLATT AND GORDON/RELAPSE PREVENTION THERAPY
Marlatt and Gordon view addiction as an “overlearned maladaptive habit pattern,” and their relapse prevention therapy focuses on identifying circumstances that increase the risk for relapse and implementing cognitive and behavioral strategies that help the client prevent and cope effectively with lapses.
64
NARCISSISTIC PERSONALITY DISORDER
Narcissistic Personality Disorder involves a pervasive pattern of grandiosity, need for admiration, and lack of empathy as indicated by at least five characteristic symptoms – e.g., has a grandiose sense of self-importance; is preoccupied with fantasies of unlimited success, power, beauty, love; believes they are unique and can be understood only by other high-status people; requires excessive admiration; has a sense of entitlement; lacks empathy; is often envious of others or believes others are envious of them.
65
NARCOLEPSY
Narcolepsy is characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime naps that occur at least three times per week and have been present for at least three months. The diagnosis also requires episodes of cataplexy, a hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes.
66
NEUROCOGNITIVE DISORDER DUE TO ALZHEIMER'S DISEASE
This disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, there is an insidious onset and gradual progression of impairment in one or more cognitive domains (or at least two domains for Major Neurocognitive Disorder), and the criteria for probable or possible Alzheimer’s disease are met. It involves a slow, progressive decline in cognitive functioning that can be described in terms of the following stages: Stage 1 (1 to 3 years) involves anterograde amnesia (especially for declarative memories); deficits in visuospatial skills (wandering); indifference, irritability, and sadness; and anomia. Stage 2 (2 to 10 years) is characterized by increasing retrograde amnesia; flat or labile mood; restlessness and agitation; delusions; fluent aphasia; acalculia; and ideomotor apraxia (inability to translate an idea into movement). Stage 3 (8 to 12 years) entails severely deteriorated intellectual functioning; apathy; limb rigidity; and urinary and fecal incontinence.
67
NON-RAPID EYE MOVEMENT SLEEP AROUSAL DISORDER
This disorder involves recurrent episodes of incomplete awakening that usually occur during the first third of the major sleep episode and are accompanied by sleepwalking (getting out of bed during sleep and walking around) and/or sleep terror (an abrupt arousal from sleep that often begins with a panicky scream and is accompanied by intense fear and signs of autonomic arousal). The individual has limited or no recall of an episode upon awakening, and the disturbance causes significant distress or impaired functioning.
68
OBSESSIVE-COMPULSIVE DISORDER
OCD is characterized by recurrent obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning: Obsessions are persistent thoughts, impulses, or images that the person experiences as intrusive and unwanted and that they attempt to ignore or suppress, and compulsions are repetitious and deliberate behaviors or mental acts that the person feels driven to perform either in response to an obsession or according to rigid rules. A combination of exposure with response prevention and the tricyclic clomipramine or an SSRI is usually the treatment-of-choice for OCD.
69
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
Obsessive-Compulsive Personality Disorder is characterized by a persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control that severely limits the individual’s flexibility, openness, and efficiency. At least four characteristic symptoms must be present – e.g., exhibits perfectionism that interferes with task completion; is excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is reluctant to delegate work to others unless they are willing to do it their way; adopts a miserly spending style toward self and others.
70
OPIOD WITHDRAWAL
Opioid Withdrawal occurs following cessation or reduction in the use of an opioid following prolonged or heavy use or administration of an opioid antagonist following a period of opioid use. The diagnosis requires at least three characteristic symptoms: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or sweating; diarrhea; yawning; fever; insomnia.
71
OPPOSITIONAL DEFIANT DISORDER
Oppositional Defiant Disorder involves a recurrent pattern of an angry/irritable mood, argumentative/defiant behavior, or vindictiveness as evidenced by at least four characteristic symptoms that are exhibited during interactions with at least one person who is not a sibling – e.g., often loses temper; often argues with authority figures; often actively refuses to comply with requests from authority figures or with rules; often blames others for their mistakes.
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OUTLINE FOR CULTURAL FORMULATION
The DSM-5-TR’s Outline for Cultural Formulation provides guidelines for assessing four factors: the client’s cultural identity; the client’s cultural conceptualization of distress; the psychosocial stressors and cultural factors that impact the client’s vulnerability and resilience; and cultural factors relevant to the relationship between the client and therapist.
73
PANIC DISORDER
Panic Disorder is characterized by recurrent unexpected panic attacks with at least one attack being followed by one month of persistent concern about having additional attacks or about their consequences and/or involving a significant maladaptive change in behavior related to the attack. Cognitive behavioral interventions that incorporate exposure are the treatment-of-choice for this disorder.
74
PARANOID PERSONALITY DISORDER
Paranoid Personality Disorder involves a pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent. The diagnosis requires the presence of at least four characteristic symptoms – e.g., suspects that others are exploiting, harming, or deceiving them without a sufficient basis for doing so; reads demeaning content into benign remarks or events; persistently bears grudges; is persistently suspicious about the fidelity of their spouse or sexual partner without justification.
75
PARAPHILIC DISORDERS
The Paraphilic Disorders include Voyeuristic, Exhibitionistic, Frotteuristic, Sexual Sadism, Pedophilic, Fetishistic, and Transvestic Disorders. These disorders are characterized by an “intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners ...[that] is currently causing distress or impairment to the individual or ... has entailed personal harm, or risk of harm, to others” (APA, 2022, pp. 780).
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PERSISTENT DEPRESSIVE DISORDER
Persistent Depressive Disorder is characterized by a depressed mood (or in children and adolescents, a depressed or irritable mood) on most days for at least two years in adults or one year in children and adolescents as indicated by the presence of at least two characteristic symptoms – poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness. During the two-or one-year period, the individual has not been symptom-free for more than two months, and symptoms cause clinically significant distress or impaired functioning.
77
POSTTRAUMATIC STRESS DISORDER (PTSD)
The diagnosis of PTSD requires exposure to actual or threatened death, serious injury, or sexual violence; presence of at least one intrusion symptom related to the event; persistent avoidance of stimuli associated with the event; negative changes in cognition or mood associated with the event; and marked change in arousal and reactivity associated with the event. Symptoms must have a duration of more than one month and must cause clinically significant distress or impaired functioning. The treatment-of-choice is a comprehensive cognitive-behavioral intervention that incorporates exposure, cognitive restructuring, and anxiety management or similar techniques.
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PREMATURE EJACULATION
Premature Ejaculation is diagnosed in the presence of a persistent or recurrent pattern of ejaculation during partnered sexual activity within about one minute of vaginal penetration or before the person desires it. The disturbance must have been present for at least six months, be experienced on all or almost all occasions of sexual activity, and cause clinically significant distress. Treatment often includes use of the start-stop or squeeze technique
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PROGNOSIS FOR SCHIZOPHRENIA
A better prognosis for Schizophrenia is associated with good premorbid adjustment, an acute and late onset, female gender, the presence of a precipitating event, a brief duration of active-phase symptoms, insight into the illness, a family history of a mood disorder, and no family history of Schizophrenia.
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PROLONGED GRIEF DISORDER
Prolonged Grief Disorder is defined as intense yearning or longing for the deceased (often with intense sorrow and emotional pain), and preoccupation with thoughts or memories of the deceased.
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REACTIVE ATTACHMENT DISORDER
Reactive Attachment Disorder is characterized by a pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as manifested by a lack of seeking or responding to comfort when distressed and a persistent social and emotional disturbance. The diagnosis requires evidence that the child has experienced extreme insufficient care that is believed to be the cause of the disturbed behavior. Symptoms must be apparent before the child is five years of age, and the child must have a developmental age of at least nine months.
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RISK FACTORS FOR SUICIDE
High risk for suicide is associated with a warning; previous attempts; a plan (especially one involving a lethal weapon); male gender; being divorced, separate, or widowed; and feelings of hopelessness. For most age groups, the rates are highest for Whites; an exception is for Native American/Alaskan Native individuals ages 15 to 34 who have a rate 2.5 times higher than the national average for this age group. Of the mental disorders, the highest risk is associated with Major Depression and Bipolar Disorder. Suicide attempters (vs. completers) are most likely to be female.
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SCHIZOID PERSONALITY DISORDER
Schizoid Personality Disorder involves a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings with at least four characteristic symptoms – doesn’t desire or enjoy close relationships; almost always chooses solitary activities; has little interest in sexual relationships; takes pleasure in few activities; lacks close friends or confidents other than first-degree relatives; seems indifferent to praise or criticism; exhibits emotional coldness or detachment.
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SCHIZOPHRENIA
A diagnosis of Schizophrenia requires the presence of at least two active phase symptoms – i.e., delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms – for at least one month with at least one symptom being delusions, hallucination, or disorganized speech. There must be continuous signs of the disorder for at least six months, and symptoms must cause significant impairment in functioning. Treatment usually includes an antipsychotic drug, cognitive-behavioral therapy, psychoeducation, social skills training, supported employment, and other interventions for the individual with Schizophrenia and psychosocial interventions for their family.
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SCHIZOPHRENIFORM DISORDER
The diagnostic criteria for Schizophreniform Disorder are identical to those for Schizophrenia except that the disturbance is present for at least one month but less than six months and impaired social or occupational functioning may occur but is not required.
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SCHIZOTYPAL PERSONALITY DISORDER
Schizotypal Personality Disorder is diagnosed in the presence of (a) pervasive social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and (b) eccentricities in cognition, perception, and behavior as manifested by the presence of at least five symptoms – e.g., ideas of reference; odd beliefs or magical thinking that influence behavior; bodily illusions and other unusual perceptions; is suspicious or has paranoid ideation; inappropriate or constricted affect; lacks close friends or confidents other than first-degree relatives; excessive social anxiety.
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SEPARATION ANXIETY DISORDER
Separation Anxiety Disorder involves developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures as evidenced by at least three symptoms – e.g., recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures; persistent excessive fear of being alone; repeated complaints of physical symptoms when separation from an attachment figure occurs or is anticipated. The disturbance must last at least four weeks in children and adolescents or six months in adults and must cause clinically significant distress or impaired functioning.
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SOCIAL ANXIETY DISORDER
Social Anxiety Disorder involves intense fear or anxiety about one or more social situations in which the individual may be exposed to scrutiny by others. The individual fears that they will exhibit anxiety symptoms in these situations that will be negatively evaluated; they avoid the situations or endures them with intense fear or anxiety; and their fear or anxiety is not proportional to the threat posed by the situations. The fear, anxiety, and avoidance are persistent and cause clinically significant distress or impaired functioning. Exposure with response prevention is an effective treatment, and its benefits may be enhanced when it is combined with social skills training or cognitive restructuring and other cognitive techniques.
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SPECIFIC LEARNING DISORDER
Specific Learning Disorder is diagnosed when a person exhibits difficulties related to academic skills as indicated by the presence of at least one characteristic symptom that persists for at least six months despite the provision of interventions targeting those difficulties. The diagnosis requires that the individual’s academic skills are substantially below those expected for their age, interfere with academic or occupational performance or activities of daily living, began during the school-age years, and are not better accounted for by another condition or disorder or other factor such as uncorrected visual or auditory impairment or psychosocial adversity.
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SPECIFIC PHOBIA
Specific Phobia is characterized by intense fear or anxiety about a specific object or situation, with the individual either avoiding the object or situation or enduring it with marked distress. The fear or anxiety is not proportional to the danger posed by the object or situation, is persistent (typically lasting for at least six months), and causes clinically significant distress or impaired functioning. The treatment-of-choice is exposure with response prevention (especially in vivo exposure).
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SUBSTANCE-INDUCED DISORDERS
The Substance-Induced Disorders include Substance Intoxication, Substance Withdrawal, and Substance/Medication-Induced Mental Disorders. The latter “are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or toxins” (APA, 2022, p. 551) and include Substance/Medication-Induced Psychotic Disorder, Substance/Medication-Induced Depressive Disorder, and Substance/Medication-Induced Neurocognitive Disorders.
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SUBSTANCE USE DISORDERS
The Substance Use Disorders are characterized by “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems” (APA, 2022, p. 546) as manifested by at least two symptoms during a 12-month period – e.g., substance used in larger amounts or for a longer period of time than intended; persistent desire or unsuccessful efforts to cut down or control use; craving for the substance; recurrent substance use despite persistent social problems caused or worsened by substance use; recurrent substance use in situations in which it is physically dangerous to do so; tolerance; withdrawal.
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TOBACCO USE DISORDER/SMOKING CESSATION INTERVENTIONS
Interventions for Tobacco Use Disorder are most likely to lead to long-term abstinence when they include three elements: (a) nicotine replacement therapy; (b) multicomponent behavioral therapy that includes, for example, skills training, relapse prevention, stimulus control, and/or rapid smoking; and (c) support and assistance from a clinician
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TOBACCO WITHDRAWAL
Tobacco Withdrawal is characterized by the development of at least four characteristic symptoms within 24 hours of abrupt cessation or reduction in the use of tobacco – i.e., irritability or anger, anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia.
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TOURETTE'S DISORDER
Tourette’s Disorder is characterized by the presence of at least one vocal tic and multiple motor tics that may appear simultaneously or at different times, may wax and wane in frequency, have persisted for more than one year, and began prior to age 18.
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UNCOMPICATED BEREAVEMENT
Uncomplicated Bereavement is included in the DSM-5-TR with Other Conditions That May Be a Focus of Treatment and is described as “a normal reaction to the death of a loved one” (APA, 2022, p. 835). Uncomplicated bereavement may include symptoms of a major depressive episode, but the individual usually experiences the symptoms as normal and may be seeking treatment for insomnia, anorexia, or other associated symptoms.
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VASCULAR NEUROCOGNITIVE DISORDER
Vascular Neurocognitive Disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with a vascular etiology, and there is evidence of cerebrovascular disease from the individual’s history, a physical examination, and/or neuroimaging that is considered sufficient to account for their symptoms. The course and extent of recovery depend on the cause of the disorder and may involve an acute onset with partial recovery, a stepwise decline, or a progressive course with fluctuations in symptom severity and plateaus that vary in duration.
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indolamine hypothesis
describes depression as a the result of low levels of serotonin
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tricyclics (TCA)
antidepressants most effective for "classic" depression that involves vegetative (bodily) sxs, a worsening of sxs in the morning, an acute onset and short duration of sxs, and sxs of moderate severity
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monoamine oxidase inhibitors (MAOIs)
best for those who do not respond to TCA or SSRI and/or who have atypical sxs (anxiety, hypersomnia, hyperphagia, interpersonal sensitivity)
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SSRI (selective serotonin reuptake inhibitors)
first line for moderate to severe; fewer side effects and lower risk for fatal overdose
