Diagnostic criteria Flashcards
Psychosis
Positive symptoms
- Delusions
- Conceptual disorganization
- Perceptual disturbances
- Catatonic symptoms
Negative symptoms
- Blunted affect
- Restricted affect
- Poor rapport
- Passive/apathetic social life or social withdrawal
- Lack of spontaneity and poverty of speech
Delusions examples
- Ideas of reference
- Grandiose
- Paranoid
- Nihilistic
- Erotomanic
Conceptual disorganization examples
- Clang association
- Loosing association
- Neologism
- Tangentiality
- Circumstantiality
- Blocking
Perceptual disturbances examples
- Hallucinations
- Illusions
Catatonic symptoms examples
Diagnosis require 3 of:
- Retarded symptoms: stupor, catalepsy, waxy flexibility, negativism, mutism
- Excited symptoms: stereotyping, agitation/grimacing, echolalia, echopraxia
- Other: mannerism
Schizophrenia
A: Two or more (one of which is 1-3), for 1 month
- 1: Delusions, 2: Hallucinations, 3: Disorganized speech, 4: Grossly disorganized or catatonic behaviour, 5: Negative symptoms
B: Decreased level of function (eg work, self-care)
C: At least 6 months of continuous signs of disturbance (must include one month of A symptoms and may include prodromal/residual symptoms)
D: Rule out schizoaffective disorder or bipolar disorder with psychotic features
E: Rule out other causes (GMC, substances)
F: If history of ASD or communication disorder of childhood onset, additional schizophrenia diagnosis is only made if hallucinations or delusions for at least 1 month
Schizophreniform disorder
- Criterion A, D, and E of schizophrenia are met
- Last 1-6 months (<1 month=brief psychotic disorder, > 6 months=schizophrenia)
Brief psychotic disorder
- Criterion A1-4, D and E of schizophrenia are met
- Last 1 day to 1 month (1-6 months=schizophreniform disorder)
Schizoaffective disorder
A: Concurrent psychotic disorder (Criterion A Schizophrenia) and major mood episode
B: Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
C: Major mood episode symptoms are present for the majority of the total duration of active and residual periods of illness
D: Not attributable to substance or other medical condition
Delusional disorder
A: The presence of one or more delusions with a duration of 1 month or longer
B: Criterion A for schizophrenia has never been met
C: Functioning is not markedly impaired and behaviour is not obviously bizarre or odd
D: If manic or major depressive episode have occured, these have been brief
E: Not attributable to substance or medical disorder
Panic disorder
A: Recurrent unexpected panic attacks: abrupt surge of intense fear/discomfort with 4 or more of “students fear the 3c´s”
B: 1 month or more of “anxiety about panic attacks”
C: Not attributable to substance or medical condition (acs, hyperthyroidism, pheochromocytoma, hypoglycemia, asthma etc)
D: Not better explained by other mental disorder
Symptoms of panic attack
Students fear the 3 c´s
- Sweating
- Trembling
- Unsteadiness, dizziness, light-headed, faint
- Depersonalization, derealization
- Excessive heart rate, palpitations
- Nausea, abdominal distress
- Tingling, paresthesias
- SOB
- Fear of dying, loosing control, going crazy
- Chest pain/discomfort
- Chills or heat sensation
- Choking
Agoraphobia
A: Marked fear or anxiety about 2 or more of:
- 1: Public transport, 2: Open spaces, 3: Enclosed spaces, 4: In line/crowd, 5: Outside home alone
B: Individuals fear or avoid these situations due to escape being difficult, help not available in case of panic or embarrassing symtoms
C: Agoraphobic situations almost always provoke fear and anxiety
D: Agoraphobic situations are actively avoided, require companion or endured with intense fear/anxiety
E: Fear/anxiety out of proportion to actual danger
F: Persistent, typically last >6 months
G: Cause clinically significant distress or impairment in social, functional or other areas of functioning
H: If another medical condition present, fear/anxiety/avoidance is clearly excessive
G: Not better explained by another mental disorder, not related exclusively to obsessions, perceived flaws in physical appearance, reminders of traumatic event or fear of separation
GAD
A: Excessive anxiety or worry (more days than not in 6 months, about a nr of events/activities)
B: Difficult to control worry
C: Associated with 3 or more of:
- 1: Concentration issues/mind going blank, 2: Fatigue, 3: Irritability, 4: Restlessness, 5: Sleep disturbance, 6: Tension (muscle)
D: Cause clinically significant distress or impairment in social, functional, other areas of functioning
E: Not attributable to medical condition or substance
F: Not better explained by another mental disorder
OCD
A: Presence of obsessions, compulsions or both
B: Obsession or compulsion are time consuming or cause clinically significant distress
C: Not attributable to substance or medical condition
D: Not better explained by another mental condition
Obsessions definition
1) Recurrent persistent thoughts, urges or images. Intrusive and unwanted. Cause marked anxiety or distress.
2) Individual attempts to ignore or suppress or neutralize them with some other thought or action (compulsions)
Compulsions definition
1) Repetitive behaviors or mental acts that individual feels driven to perform due to obsession or according to rules
2) Behaviors/mental acts are aimed at preventing or reducing anxiety/distress, or prevent dreaded event or situation
PTSD
A: Exposure to actual or threatened death, serious injury or sexual violence in one or more of:
- 1: Directly experience, 2: Witnessing, 3: Hearing about close family/friend, 4: Repeated or extreme exposure to aversive details of traumatic event
B: Presence of one or more of intrusion symptoms, beginning after trauma
- 1: Memories, 2: Dreams, 3: Flashbacks, 4: Psychologic distress when cues symbolize/resemble event, 5: same, but resemble aspect of event
C: Persistent avoidance of stimuli associated with event (internal or external reminders)
D: Negative alterations in cognitions and mood associated with event (se notes)
E: Marked alterations in arousal and reactivity associated with event (se notes)
F: Duration of disturbance (criteria B-E) is > 1 month
G: Clinically significant distress or impairment in social, occupational or other functioning
H: Not attributable to substance or medical condition
Adjustment disorder
A: Development of emotional or behavioral symptoms to identifiable stressors occurring within 3 months of onset of stressors
B: Clinically significant (either excess distress than expected or impairment in functioning)
C: Not meet criteria for another mental disorder or exacerbation of pre-existing mental disorder
D: Do not present normal bereavement
E: Once stressor has terminated, symptoms do not persist longer than 6 months
Criteria for substance use disorder
“PEC WITH MCAT”
- use despite Physical/psycholological problem
- failure in External roles (work)
- Craving
- Withdrawal
- continue despite Interpersonal problems
- Tolerance
- use in Hazardous situations
- More/for longer period than intended
- Can´t cut down
- Activities given up (social, occupational, recreational)
- excessive Time spent using/finding substance
Mild: 2-3, moderate: 4-5, severe: >6
Prochaska´s stages of change
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
Alcohol withdrawal stages
1) onset 12-18 hours after last drink
- Tremor, sweating, agitation, cramps, diarrhea, sleep disturbance
2) onset 7-48 hours
- Seizures (tonic-clonic, non-focal and brief)
3) onset 48 hours
- Visual, auditory, olfactory or tactile hallucinations
4) onset 3-5 days
- Delirium tremens, confusion, delusion, hallucination, agitation, tremor, autonomic hyperactivity (fever, tachycardia, HTN)
Delirium tremens
Alcohol withdrawal delirium
- Autonomic hyperactivity (diaphoresis, tachyc, HTN)
- Hand tremor
- Insomnia
- Psychomotor agitation
- Anxiety
- Nausea, vomiting
- Tonic-clonic seizures
- Hallucinations (visual/tactile/auditory)
- Persecutory delusions
CIWA-A score
Physical (5): n/v, tremor, agitation, paroxysmal sweats, headache/fullness
Psychological/cognitive (2): anxiety, orientation/clouding of sensorium
Perceptual (3): tactile, auditory or visual disturbances
Suicide risk factors
“SAD PERSONS”
- Sex (male)
- Age > 60 years
- Depression
- Previous attempts
- Ethanol abuse
- Rational thinking loss (delusion, hallucination, hopelessness)
- Suicide in family
- Organized plan
- No spouse/support system
- Serious illness/pain
Anorexia nervosa
A: Intake and weight
B: Fear or behavior (fear of fat, interferes with weight gain)
C: Perception (body image)
BMI severity (kg/m2)
- Mild > 17
- Moderate < 17
- Severe < 16
- Extreme: < 15
Athletic triad
1: Disordered eating
2: Amenorrhea
3: Osteoporosis
Bulimia nervosa
A: Recurrent episodes of binge-eating (short time, a lot, lack of control)
B: Recurrent inappropriate compensatory behavior (vomit, laxatives, enemas, fasting, excessive exercise)
C: A and B at least once a week for 3 months
D: Self-evaluation based on body shape and weight
E: Disturbance not exclusively during episodes of anorexia nervosa
Signs of bulimia nervosa
- Russels sign (knuckle callus)
- Tooth decay
- Perioral skin irritation
- Periocular and palatal petechiae
- Metabolic alkalosis (unless laxatives: acidosis)
- Hypokalemia
Binge-eating disorder
- Binge-eating, often alone, feeling disgusted and guilty
- At least once per week for 3 months
Delirium
A: Attention and awareness
B: Acute and fluctuating
C: Cognitive changes
D: Not better explained by neurocognitive disorder or occur in context of severely reduced arousal
E: Direct physiological cause (medical condition, substance, withdrawal etc)
CAM
Confusion assessment method Need 1 + 2 + (3 or 4): 1: Acute and fluctuating 2: Inattention 3: Disorganized thinking 4: Altered level of conciousness
Insomnia
- Lack of sleep (difficulty falling asleep, not relaxed sleep or early awakening, or subjective feeling)
- Present even when good conditions for sleep
- Cause daytime problems with reduced function
Hypersomnolence
A: Self-reported sleepiness despite main sleep period lasting at least 7 hours, with at least one symptom:
- 1: recurrent periods of sleep or lapses into sleep within the same day, 2: prolonged main sleep period >9 hrs and non-restorative, 3: difficulty being fully awake after abrupt awakening
B: Hypersomnolence last 3x/week for at least 3 months
C: Significant distress or impairment in cognitive, social, occupational or other areas of functioning
D: Not better explained by of exclusively during the coarse of another sleep disorder
E: Not caused by a substance
F: Coexisting medical or mental disorders do not adequately explain hypersomnolence
Restless leg syndrome/Periodic limb movement in sleep
- Urge to move accompanied by uncomfortable sensation that begins or worsens with rest, and are partially or totally relieved with movement.
- Worse in evening/night
- Cannot be accounted for by another medical/behavioral condition
- RLS refers to the sensation, PLMS refers to the manifestation
Narcolepsy
A: Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. At least 3x/week over last 3 months.
B: At least one of the following:
- 1: Episode of cataplexy, 2: Hypocretin deficiency, 3: Nocturnal sleep polysomnography show REM sleep latency less than/equal to 15 minutes
Major depressive episode
A: 5 or more of “MSIGECAPS” during 2 week period, represent a change from previous functioning. At least one of the symptoms is either 1: Depressed mood or 3: Anhedonia
B: Cause clinically significant distress or impairment in social, occupational or other area of functioning.
C: Not caused by substance or medical condition
Manic episode
A: Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy. Last > 1 week, most of the day, nearly everyday.
B: During the period of mood disturbance and increased energy or activity, 3 or more of “GST-PAID”
Major depressive episode A symptoms
MSIGECAPS
- Mood (depressed)
- Sleep (increased/decreased)
- Interest (decreased - anhedonia)
- Guilt
- Energy (decreased)
- Concentration (decreased)
- Appetite (decreased/increased)
- Psychomotor (agitation/retardation)
- Suicidal ideation
Manic episode B symptoms
GST-PAID
- Grandiosity
- Sleep (decreased need)
- Talkative
- Pleasurable activity, painful consequences
- Activity (increased goal-directed activity or psychomotor agitation)
- Ideas (flight of)
- Distractible
Hypomanic episode
- Criterion A and B of manic episode is met, but duration is 4 days or longer
- Episode not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization
- Absence of psychotic features
Mixed feature mood disorder
- If meeting full criteria for a major depressive episode, the patient has most days 3 or more of criteria B of manic episode
- If meeting full criteria for a manic/hypomanic episode, the patient has most days 3 or more of criteria A of major depressive episode (can´t count: psychomotor agitation, insomnia, concentration problems, weight changes)
Major depressive disorder
A: Presence of an MDE
B: The MDE is not better explained by schizoaffective disorder and not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder NOS
C: There has never been a manic episode or a hypomanic episode
Persistent depressive disorder
DSM IV: “dysthymia”
DSM-V:
A: Depressed mood for most of the day, more days than not, for > 2 years
B: While depressed, 2 or more of the following:
- Appetite (increased/decreased)
- Insomnia/hypersomnia
- Low energy/fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
C: During the 2 year period, the patient has not been without symptom A and B for more than 2 months
D: Criteria for MDD may be continuously present for 2 years
E: There has never been a manic episode or hypomanic episode, and criteria have never been met for cyclothymic disorder
F: Not better explained by persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
G: Not caused by substance or medical disorder
H: Cause clinically significant distress or impairment in social, occupational or other important areas of functioning
Bipolar I
At least one manic episode
Bipolar II
At least one MDE, 1 hypomanic and no manic episodes
Cyclothymia
Numerous episodes of hypomanic and depressive symptoms (not meeting criteria for full hypomanic or MDE) for > 2 years. Never without symptoms for >2 months
Sexual disorder
All sexual disorders have same B-D criteria
A: Varies
B: Persisted for at least 6 months
C: Cause significant distress in individual
D: Not better explained by nonsexual mental disorder, stressors or substance/medical condition
Male hypoactive sexual desire disorder: Criterion A
Persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire for sexual activity
Female sexual interest/arousal disorder: Criterion A
Lack of/reduced sexual interest arousal, with at least 3 of:
- Absent/reduced interest in sexual activity
- // sexual/erotic thoughts or fantasies
- // initiation of sexual activity and typically unreceptive to partners initiative
- // sexual excitement/pleasure during sexual activity
- // sexual interest/arousal in response to any internal or external sexual/erotic cues
- // genital or nongenital sensations during sexual activity
Male erectile disorder: Criterion A
At least 1 of: - Marked difficulty obtaining erection - // maintaining erection - Marked decrease in erectile rigidity Experienced on 75-100 % of sexual activities
Female orgasmic disorder: Criterion A
Either of:
- Delay, infrequency or absence of orgasm
- Reduced intensity of orgasm
For 75-100 % of sexual activities
Delayed ejaculation: Criterion A
Either of:
- Marked delay in ejaculation
- Marked infrequency or absence of ejaculation
For 75-100 % of sexual activities
Premature (early) ejaculation: Criterion A
Within 1 minute of vaginal penetration and before individual wishes it
Genito-pelvic pain/penetration disorder: Criterion A
One or more of: - Difficulty having intercourse - Genito-pelvic pain - Fear of pain or penetration - Tension in pelvic floor muscles Previously: dyspareunia or vaginismus
Paraphilia criterion and types
- Sexual stimuli or acts that deviates from normal
- Must have experienced intense and recurrent arousal from fantasy for at least 6 months and to have acted on their fantasy
Types:
- Voyeristic (kikking “bon voyage”)
- Exhibitionistic (blotting, “på exhibition i skogen”)
- Frotteuristic (gnikking, “mot frotté”)
- Sexual masochism
- Sexual sadism
- Pedophilic
- Fetishistic
- Transvestic
- Other (zoophilia, necrophilia etc)
- Unspecified
Gender dysphoria in children
A: Marked incongruence between experienced/expressed gender and assigned gender. At least 6 months duration. 6 or more of:
- 1: Strong desire to be of other gender (must have), 2: Cross-dressing, 3: Cross-gender roles in play/fantasy, 4: Prefer toys, games, activities of other gender, 5: Prefer friends of other gender, 6: Reject own gender toys, games, activities, 7: Dislike of own sexual anatomy, 8: Desire for sexual characteristics of other gender
B: Cause significant distress or impairment in social, occupational or other area of functioning
Gender dysphoria in adolescents
A: Marked incongruence between experienced/expressed gender and assigned gender. At least 6 months duration. 2 or more of:
- 1: Marked incongruence between experienced/expressed gender and primary/secondary sexual characteristics, 2: Desire to be rid of primary/secondary sexual characteristics, 3: Desire for opposite primary/secondary sexual characteristics, 4: Desire to be other gender, 5: Desire to be treated as other gender, 6: Conviction that one has feelings and reactions of other gender
B: Cause significant distress or impairment in social, occupational or other area of functioning
Dementia
A: Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains based on
- 1: Concern, 2: Impairment in cognitive performance (tests)
B: Interfere with everyday activities
C: Not exclusively in context of delirium
D: Not better explained by other mental disorder
Somatic symptom disorder
Formerly somatoform disorder
A: One or more somatic symptoms that are distressing or result in significant disruption of daily life
B: Excessive thoughts/feelings/behaviors related to somatic symptom or associated health concern. At least one of:
- 1: Disproportionate and persistent thoughts about seriousness of symptoms, 2: High anxiety level of health, 3: Excessive time and energy
C: State of being symptomatic is persistent (usually >6 months)
Illness anxiety disorder
Formerly hypochondriasis
- Preoccupied with having or acquiring a serious illness
- Symptoms not present (or mild)!
- High level of health anxiety
- Excessive health-related behaviors or maladaptive avoidance
- At least 6 months
- Not better explained by other mental disorder
Conversion disorder
- One or more symptoms of altered voluntary or sensory function
- Physical findings show incompatibility between symptom and recognized neurological or medical conditions
- Not better explained by other mental or medical condition
- Cause distress or impaired functioning
Cluster A personality disorders
“Mad”
1) Paranoid PD
2) Schizoid PD
3) Schizotypal PD
Cluster B personality disorders
“Bad”
1) Borderline PD
2) Antisocial PD
3) Narcissistic PD
4) Histrionic PD
Cluster C personality disorder
“Sad”
1) Avoidant PD
2) Dependent PD
3) Obsessive-compulsive PD
Paranoid PD symtoms
“SUSPECT”
- Suspicious
- Unforgiving
- Spousal infidelity
- Perceive attacks on character
- Enemies or friends?
- Confiding in others is feared
- Threats interpreted in benign remarks
Schizoid PD symtoms
“DISTANT”
- Detached/flat affect
- Indifferent to praise or criticism
- Sexual experiences of little interest
- Tasks done solitarily
- Absence of close friends
- Neither desires nor enjoys close relationships
- Takes pleasure in few (if any) activities
Schizotypal PD symtoms
“ME PECULIAR”
- Magical thinking
- Experiences unusual perceptions
- Paranoid ideation
- Eccentric behavior or appearance
- Constricted or inappropriate affect
- Unusual thinking or speech
- Lacks close friends
- Ideas of reference
- Anxiety in social situations
Borderline PD symtoms
“IMpULSIVE”
- Impulsive
- Mood/affect
- Unstable self image
- Labile intense relationships
- Suicidal gestures/self-harm
- Inappropriate anger
- aVoiding abandonment
- Emptiness (feeling of)
Antisocial PD symtoms
“CORRUPT”
- Cannot conform to law
- Obligations ignored
- Reckless disregard for safety
- Remorseless
- Underhanded/deceitful
- Planning insufficient (impulsive)
- Temper (irritable or aggressive)
Narcissistic PD symtoms
“GRANDIOSE”
- Grandiose
- Required admiration
- Arrogant
- Needs to be special (and associate with other specials)
- Dreams of success, power, beauty, lover
- Interpersonally exploitive
- Others (lack empathy)
- Sense of entitlement
- Envious (or believes other are)
Histrionic PD symtoms
“ACTRESSS”
- Appearance to attract attention
- Centre of attention
- Theatrical
- Relationships (believed to be more intimate than they are)
- Easily influenced
- Seductive behavior
- Shallow
- Speech (impressionistic and vague)
Avoidant PD symtoms
“CRINGES”
- Criticism and rejection preoccupies thoughts
- Restraint in relationships
- Inhibited in new relationships
- Needs to be sure of being liked before engaging
- Gets around occupational activities requiring interpersonal contact
- Embarrassment prevent new activity or risks
- Self-viewed as unappealing or inferior
Dependent PD symtoms
“RELIANCE”
- Reassurance required
- Expressing disagreement difficult
- Life responsibilities assumed by others
- Initiating projects difficult (no confidence)
- Alone (helpless/uncomfortable when alone)
- Nurturance
- Companionship sought urgently
- Exaggerated fears of being left to care for self
Obsessive-compulsive PD symtoms
“SCRIMPER”
- Stubborn
- Cannot discard worthless objects
- Rule/detail obsessed
- Inflexible in matters of morality, ethics, values
- Miserly
- Perfectionistic
- Excludes leisure to devotion to work
- Reluctant to delegate others
- *No compulsions (opposed to OCD)
Autism spectrum disease
A: Persistent deficits in social communication and interaction across multiple contexts:
- 1: Deficits in social-emotional reciprocity, 2: Deficits in non-verbal communication, 3: Deficits in developing, maintaining and understanding relationships
B: Restricted, repetitive patterns of behavior, interests or activities. At least 2 of:
- 1: Stereotyped or repetitive motor movements, use of objects or speech, 2: Insistence on sameness, inflexible adherence to routines or ritualized patterns, 3: Highly restricted, fixated interests that are abnormal in intensity or focus, 4: Hyper- or hyporeactivity to sensory imput or unusual interest in sensory aspects of environment
C: Symptoms must be present in early developmental period
D: Cause significantly impairment in functioning
E: Not better explained by intellectual disability or global developmental delay
ADHD
- Children < 17 years require > 6 symptoms of both hyperactivity and inattention (> 17 requires >5):
- Symptoms often occur
- More than one setting
- For at least 6 months
- Present before 12 years
- Impair function
- Excessive for developmental level of child
Hyperactivity symptoms (ADHD)
1) Excessive fidgeting
2) Not able to sit still
3) Feeling restless
4) Difficulty playing quietly
5) Excessive talking
6) Difficulty waiting turns
7) Blurts out answers
8) Interruption of others
Inattention symptoms (ADHD)
1) Careless mistakes
2) Difficulty maintaining attention in play, school, home
3) Fails to follow through
4) Difficulty organizing tasks, activities, belongings
5) Avoid tasks with consistent mental effort
6) Loses objects required for tasks or activities
7) Easily distracted by irrelevant stimuli
8) Forgetfulness in routine activities
Mental status exam
“ASEPTIC”
- Appearance and behavior
- Speech
- Emotions and affect
- Perception
- Thought process and content
- Insight
- Cognition
