Diagnostic Classification systems Flashcards
What are the 2 main diagnositc classification systems used in psychology
- The Diagnostic and Statistial Manual of Mental disorders 5 edition
- International Classification of Diseases Tneth revision
What does th ICD-10 do
It lissts codes of disease and their signs and symptoms as well as other relevant information to inform diagnosis of mental illness
What are some draw backs of the way the Australian Bureau of Statistics collects Mental Health Infromation
- IT uses the ICD-10 which has different criteria to the DSM which leads to prevalence rates taht do not directly compare with the DSM -5
- THe way the ABS groups their information there is not specific statistics for particular disorders
- The survey data is based on self report rather than clinical diagnosis
- There is always a lag between the publication and collection of the ABS for example the most recent ABS health survey conducted in 2012 has not yet been released
What should be used instead of teh ABS information on Mental Health
The DSM-5 statistics
What is Adjustment disorder
A behavioural or emotional reaction in response to an identifiable situation or event in a person’s life
What is the time period between onset of symptoms and event for adjustment disorder
3 months
What are the two most important factors for diagnosis of adjustment disorder 1
- The response is out of proportion to the event
2. There is significant impairment in the person’s ability to function in some are of their life social or occupational
When is adjustment disorder diagnosis exclued
- Normal Bereavement
- Exacerbation of another preexisting disorder
- If symptoms persist fo longer than 6 months after the end of the identified stressor
What are the 5 subtypes of adjustment disorder
- With depressed mood
- With anxious mood
- WIth mixed anxiety and depressed mood
- With disturbance of conduct
- With mixed disturbance of emtions and conduct
What are the outpatient and inpatient prevalence rates of adjustment disorder
Outpatient - 5% to 20%
Inpatient - can be as high as 50%
What are the 4 criteria required for a diagnosis of antisocial personality disorder
- Persistent disregard for and violation of the rights of others since the age of 15
- Person must be at least 18 years of age at the time of diagnosis
- Behaviour prior to age 15 would have support a diagnosis of conduct disorder
- Must not occur in the context of schizophrenia or bipolar
What are the 7 patterns of antisocial behaviour
- criminal activity
- lying or Manipulation
- Lack of remorse
- Impulsivity
- Fighing or assault
- Disregard of the safety of self or others
- Irresponsibility
WHat is the prevalence rates of antisocial personality disorder in forensice settings vs non-forensic settiongs
Can be greater to 70% in forensic
0.2% to 3.3% in non-forensic
What type of disorder is ADHD
A neurodevelopmental disorder
What defines ADHD
A pattern of inattention or hyperactivity-imuplsivity behaviour that persists for at least 6 months and clearly interferes with function or development in multiple domains
What is the criteria for diagnosis of ADHD for those under 17
Must have 6 or more symptoms from the inattention and or hyperactivity-impulsivity symptoms
What is the criteria for diagnosis of ADHD for those over 17
5 or more symptoms
What are the inattention symptoms of ADHD
- Often makes careless mistakes
- Difficulty sustaining attention
- Not listening
- Is easily side-tracked
- Difficulty organising tasks
- Avoidance of tasks requiring sustained mental effort
- Losing things
- Easily distracted
- Being forgetful in daily activities
What are the hyperactivity or impulsivity symptoms of ADHD
- Often fidgeting
- LEaving their seat
- Restlessness - adults
- Inapppropriate running around
- unable to play quietly - for adults unable to quietly engage in leisure activities
- Difficulty being stil for an extended time
- Excessive takling
- Blurtin out answers
- Difficulty turn taking
- OFten interrupts others
What are the qualifiying factors for an ADHD diagnosis
- Several symptoms present prior to age 12
- Symptoms are not better explained by another disorder
- Symptoms do not occur in the context of a psychotic disorder
What are the specifications of severity for ADHD
- Mild
- Moderate
- Severe
What are the prevalence rates of ADHD
5% for children 2.5% for adults
What type of disorder is ASD
A neurodevelopmental disorder
What are the 3 diagnostic criteria for ASD
- Social deficits in communication and interaction
- Behavioural deficits
- Evidence of deficits in early development even if not recognised at the time
What is included in the Social Deficits Criteria of ASD
- Lack of reciprocity
- Facial expression
- Eye contact
What is included in the behavioural deficits criteria of ASD
- Restricted or repetitive interests
2. Abnormal sensory response
What are some key factors needed for a diagnosis of ASD
Defecits impair functioning, deficits cannot be better explained by ID or global developmental delay
What is also important the diganosis of ASD
Functional impairment measured through an adaptive test?
What is the prevalence rates of ASD
1% across adults and child population
What distinguishes Bipolar 1 from related disorders
It can only be diagnosed with evidence of at least one manic episode during the person’s lifetime
What are the 4 criteria of a manic episode
- Emotional/behavioural changes that last a week and are present on most days
- Requires 3 or moresymtpomsbe present to a signifiant degree during the mood disturbance 4 required if the category is irritable mood
- The disturbance causss marked impairment in function or requires hospitalisation due to safety concerns
- Excludes episodes attributed solely to drugs or a medical condition
What are the emotion and behavioural changes during a manic episode
Emotional - elevated, expansive or irritable mood at an abnormal level
Behavioural - Persistent and abnormal increases in energy or goal-directed behaviour
What are the symptoms of the second criteria of bipolar
- Inflated self-esteem
- Less need for sleep
- Being more talkative
- Racing thoughts
- Being easily distracted
- Increases in goal directed or purposeless actvity
- Engaging in risky impulsive behaviour
Do individuals with Bipolar 1 also demonstrate hypomania and depressive episodes
Yes
What is Hypomania
a mood state or energy level that is elevated above normal, but not so extreme as to cause impairment — the most important characteristic distinguishing it from mania
What are the prevalence 12 month prevalence rate in Australia for Bipolar 1
Women - 1.6%
Men - 1.8%
What are the criteria for a diagnosis of bipolar II
- The presence of both a current or past hypomanic episode and a current or past major depressive episode
What is the difference between the criteria for ahypomanic episode and a manic episode
Hypomanicepisode criteria is shorter 4 days as opposed to a week
What is the 3rd, 4th and 5th criteria for a hypomanic episode
- The episode is unchracteristic to the person’s usual behaviour
- THe change is observable by others
- The episode is not severe enough to cause marked impairment or hospitalisation
What prescription medication may create symptoms similar to hypomania and what are the symptoms
Antidepresssant medication
- Irratibility
- Edginess
- Agitation
What are the criteria required for a major depressive episode
- Depressed mood most of the day nearly every day - this may be irritability in children and adolescents
- Diminisehd pleasure or interest in almost all activities most of the day nearly every day
- Gaining or losing 5% or more of body weight in a month without dieting or having an increase or decrease in appetite most days
- SLeeping too little or too much nearly every day
- Being observably either physically agitated or slwoed down
- Feeling tired or less energetic most days
- Feeling worthless or guilty nearly every day
- Reduced concentration or indecisiveness
- Suicidal thoughts with or without a plan
How many of the symptoms are required to meet a depressive episode
5
How can Borderline personality disorder be described
As a long-term pattern of instability across the domains of relationships, self-image, mood as well as impulsive behaviour.
To meet the criteria for BPD how many of the symptoms must an individual exhibit
5
What are the criteria for BPD
- Frantic efforts to avoid real or imagined abandonment
- Intense and unstable relationships that tend to alternate between being seen as perfect or worthless
- Unstable sense of self
- Impulsive behaviour in at least two areas that can be self damaging
- Recurrent suicidal threats or action or self-mutilating
- Unstable modd that is highly reactive to changes in circumstances
- Feelings of emptiness
- Intense and difficult to control anger
- Stress-related paranoid ideas or dissociative symptoms
What are the prevalence rates of BPD
1.6% to 5.9%
Are there higher rates of BPD in out patient or inpatient psychiatric care
THere are higher rates in outpatient care 10%
How can Conduct Disorder be described
As a repeated pattern of persistent behaviour that is characterised by disregard for the rights of others or major violation of age appropriate social rules and norms
How many symptoms must be present and for how long to diagnose conduct disorder
3 symptoms for 12 months with at least one occuring in the last 6 months
What the 4 categories of behaviour in the conduct disorder criteria
- Aggression to people or animals - threatening, bullying, intimidating, starting fights, using a weapon, physically cruel to people or animals, has used confrontation to steal, or forced another into sexual actvity
- Destruction of property: Setting a fire to cause damage, destroying the property of others
- Deceitfulness or theft - Breaking in, lying to obtain goods or favours or t avoid obliations, stealing without confrontation
- Serious violations of rules : Staying out at night against parent’s rules before the age of 13, running away from home at least twice and staying out overnight, running away from home at least twice, stayingn out overnight, skipping school prior to age 13
What are the 3 categories of specification for ODD
- Age of onset childhood, adolescence, or unspecified
- If onset occurs with limited proscoial emotions
- Severity - mild, moderate or severe
What are some of the prosocial behaviours lacked by those with ODD?
lack of guilty, emptahy concern with performance, or lack of expressed feeling
What are the prevalence rates for ODD
ranges from 2% to 10% with higher rate in males than females
Is demntia a dignostic classification in the DSM-5
but it is retained within the neurocognitive disorders and has been kept as an alternative term for major neurocognitive disorder
What is dementia called in the DSM-5`
Major Neurocognitive disorder
WHat are the essential features of major neurocognitive disorder
Cognitive decline across the following domains
- Complex attention
- Executive function
- Learning
- Memory
- Language
- Perceptual-motor
- Social cognition
How does one demonstrate major neurocognitive disorder
- Conercen by the individual or a clinician
- performance on an objective assessment that shows decline from previous expected performance
- The deficits interfere with independence and everyday activities
What is an exclusion criteria for major neurcognitive disorder
The deficits are not in the context of a delirium
What is a specification of major neurocognitive disorder
Whether or not onset is due to a specifical medical condition
What medical conditions are related to major neurocognitive disorder
Alzheimer’s disorder, parkinson’s, substance induced
What are the prevalence rates of dementia
1% to 2% at age 65
as high as 30% by age 85
What are the 2 characterists of feeding and eating disorders
- Persistent disturbance in eating or related behaviour that leads to altered consumption or absoprtion of food
- Significant impairment in physical health or psychological function
What are teh subtypes of feeing and eatings disorders
- Pica - the eating of non-food items at an inappropriate developmental level. It is not a cultural expression and if severe and presented with another mental disorder can warrant a separate diagnosis
- Rumination disorder - Repeated regurgitation of food for at least 1 month which is not associated with a medical condition and is not occuring in the context of another eating disorder.
- Avoidant/restrictive food intake disorder
What are the characteristics of Avoidant/restrictive food intake disorder
- Not meeting appropriate nutritional and or energy needs associated with significant weight loss
- Not meetin gexpected weight gain in children
- Nutritional deficiency
- Dependence on enternal feeding
What are the exclusion cirteria of avoidant/restrictive food intake disorder
- nOt explained by lack of food or cultural practice
- NOt occurring in the presence of anorexia or builimia or body dysmorphia
- Not attributed to a medical or mental condition
What are the 3 criteria of Anorexia Nervosa
- Restriction of food relative to requirements resulting in significant low body weigh
- Significant fear of gaining weight or persistent effors to avoid weight gain in spight of low body weight
- Distorted perception of body weight or shape or lack of recognition of the seriouness of the low body weight
What are the two subtypes of Anorexia Nervosa
Bingeing
Purging
What are the prevalence rates for young females of Anorexia
0.4% in a 12 month period
What is the female to male ratio of anorexia
10 to 1
What are 5 characteristics of builimia nervosa
- Eating an abnormal amount of food in a discreate period and a feeling of the eating being out of control
- Compensating for the binge with behaviours to loose weight - purging behaviours
- Binges and compensatory behaviour occurs at least once a week for 3 months
- Self-evaluation is unduly focused on body shape and weight
- It does not occur only in the presence of anorexia
What are the specifiers of bulimia
Partial or full remission and mild,moderate, severe
What are the differences between bulimia and binge eating disorder
- The eating behaviour includes eating more rapidly, eating till uncomforably full, eatig when not hungry, solitary or hidden eating due to embarrassment feelings of disuust depression or guilt afterward
- Marked distress at bingeing
- Binge eating is not compensated with purging
What are the key features of GAD
Excessive anxiety and worry most of the time for at least 6 months about anumber thing. Spreads across work, performance and relationships
What are the 5 additional criteria to be met for GAD
- Worry is difficult to controle
- 3 or more of the following symptoms (only one in children) - restlessness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbances
- Symptoms cause clinically significant distress impair funtioning
4
What is the exclusionary criteria for GAD
- If symptoms are due to the effects of a substance
2. If the symptoms are better explained by another mental health disorder
What are the 3 criteria for a major depressive episode
- 5 or more symptoms present in the same 2 week period that are a change from previous functioning. One must be depressed mood or anhedonia
- Symptoms cause significant distress or impairment
- Must not be related to substance use or a medical condition
What er the 5 possible symptoms of a major depressive episode
- Depressed mood most of the day nearly every day
- Diminished pleasure or interest in almost all activities most of the day nearly every day
- Either gaining or losing 5% or more of body weight in a month without dieting or decreased of increased appetite most days
- Sleeping too little or too much nearly every day
- Being either agitated or slowed down
- Tired less energy
- Worhtless or guilt
- Reduced concentration or indecisiveness
- Suicidality
What age group is 3 times more likely to have major depressive disorder
18 to 29 year olds than those aged 60 and over
What is Dysthymia
A persistent depressive disorder which involves having a depressed mood that is present most of the time and has gone on for at least 2 years
2 or more symptoms of the following must be present for what disorder
- Loss of appetite
- Sleeping too much or too little
- Lack of energy
- Low self-esteem, indecision or poor concentration and hopelessness
Dysthimia
Can Dysthimia and a major depressive episode co-occur
Yes
How long must symptoms persist for Dysthimia
1 or 2 years and must not be absent for more than 2 months
What is the exclusionary criteria for dysthimia
- Manic or hypomanic episode
- Cyclothymic disorder
- Drug use or another disorder
What are the main features of OCD
The presence of obsessions and compulsions or both
WHat is an obsession
An obsession is an unwanted intrusive and recurrent thought, urge or image that are distressing. The THe person tries to suppress the thought or neutralise these thoughts with a compulsive thought or action
What is a compulsion
A repetitive mental or physical behaviour that a person feels compelled to act out within the context of a rigid set of rules. These behaviour reduce anxiety or prevent a negative consequent
What is an important criteria of OCD
IT is time consuming in nature in that the obsessions or comuplsion take up more than 1 hour per day or they cause significant distress or impairment
What are 2 exclusions of OCD
Symptoms are not related to substance or medical condition. Symptoms are not better explained by another mental disorder
What are the 2 specfiers of OCD
- Insight - good poor absent
2. Tic related symtpoms
What is the common feature of somatic related disorders
SOmatic symptoms that cause significant distress and impairment
WHat are the diagnostic criteria for somatic symptom disorder
- One or more distressing somatic symptoms are present that result in significant disruption of daily life
- Excessive thoughts, feelings or behaviours related to : Disproportionate thoughts about the seriousness of symptoms, high levels of health anxiety, excessive time spent on symptoms or health concerns
- Recognition that whil a given symptom may not be consistently present ther should be an ongoing period of being sypmtomatic - greater than 6 months
What are the specifiers of Somatic symptom related disorders
- Pain 2. Severity - mild, moderate, severe
WHat is the main feature of panic disorder
Unexpected and recurrent panic attacks
What are the symptoms of a panic attack
- Changes to heart rate, sweating, shaking, sensations of smothering, shortness of breath, feelings of choking, chest pain, tightness, nausea, dizziness, feeling hot or chilled - physcial feelings
- Attack is followed by 1 month of worryy about future attacks and changed behaviour to avoid a future panic attack
- THe panic is not attributed to the effects of a drug ofr medcial condition
How would you describe PTSD
Exposure to a traumatic event followed by intrusive recollections, avoidant behaviour, changes to thoughts and moods and increased reactivity
How long do the symptoms have to be present for
More than a month
What is considered a traumatic event
Actual or threatened death, serious injury or sexual violence
What is considered exposure to trauma
Direct experience, witnessing, learning of the event, or a friend or family member experiencing it or details of the traumatic event
How would you describe an intrusive symptom
Involuntary distressing memories of an event that are recurrent. It might also be a dream or a flash back and is usually triggered by cues that resemble some aspect of the event
What processes are associated with PTSD
- NOt being able to remember the event
- Negative beliefs and expectations about self and world
- Distored thougths about causes or consequences of the event
- Feeling detached from others and withdrawing
WHat is reactivity in PTSD
It might be irritability, reckless or self destructive behaviour, hypervigilance, easily startled, poor concentration and sleep disturbance
What are the specifiers of PTSD
Dissociative symptoms or delayed expression
What is difference in the criteria for PTSD for children under 6
Traumatic events exlcude electronic media as a form of exposure. Also negative alterations in cognitions like negative emotional states, diminished interests or participation, restricted play, withdrawal
What are the positive symptoms of Schizophrenia
- Delusions
- Hallucinations
- Disorganised speech
- disorganised or catatonic behaviour
What are the negative symptoms of Schizophrenia
- Reduced emotional expression
2. Avolition
WHat is avolition
the lack of motivation or ability to do tasks or activities that have an end goal, such as paying bills or attending a school function.
How long should disturbances be present for Schizophrenia
6 months with at least 1 month of symptoms meeting the criteria of positive or negative symptoms
What are the exclusionary criteria of Schizophrenia
- You must first rule out schizoaffective disorder, depressiv or bipolar disorder with psychotic features
How would you distinguish between Schizophrenia and Depressive of bipolar disorders
Through the lack of manic or major depressive episods
What are the two specifiers of Schizophrenia
- With catatonia
2. Severity of symptoms
What are the features of Separation Anxiety
Fear or anxiety about being separated from attachment figures that is excessive and developmentally inappropriate
How many symptoms must be present for Separation Anxiety
3
What are the symptoms of Separation anxiety
- Distress anticipating separation and during separatio n
- Extreme worry about loss of or harm to attachment figure
- Worry about events like getting lost or kidnapped
- Refusal to go places
- Excessive fear of being alone
- Refusal to sleep away from home.
- Nightmares with separtion themes repated physical complaints when separated
HOw long do symptoms need to be present for separation anxiety
4 weeks in children and 6 months in adults
What is a definition of social anxiety
Intense fear of social situations in which you might be evaluated negatively by others, a general fear of judgment and of being inferior
What is the defining feature of Substance Use disorder
COntinued use of a substance in the face of significant substance related problems
What is impaired control in substance use disorder
Consuming more than intended for longer periods and the inability to cut down as well as spending a lot of time getting taking or recovering from the substance and craving it
What are the pharmacological criteria of substance use disorder
Tolerance, withdrawal whilst not mandatory for diagnosis it can help gauge the sevirty of the disorder as well as relapse
