diagnostic criteria and rating scales Flashcards
DSM 5 criteria for catatonia
In DSM-5, criteria for catatonia are met when the clinical picture is dominated by at least three of the following [2]:
●Stupor (decreased psychomotor activity or decreased reactivity to the environment)
DSM 5 criteria for catatonia
●Catalepsy (passively allowing the examiner to position the body or a body part)
●Waxy flexibility (slight, even resistance to positioning by the examiner, as in bending a candle)
●Mutism (lack of verbal response; not applicable to patients with an established aphasia)
●Negativism (motiveless resistance to instructions or external stimuli)
●Posturing (voluntarily maintaining a position of the body or a body part against gravity for a long time)
●Mannerisms (odd movements)
●Stereotypy (repetitive movements that are not goal directed and often are awkward or stiff)
●Agitation or excessive motor activity that is purposeless and not influenced by external stimuli
●Grimacing
●Echolalia (mimicking another person’s speech)
●Echopraxia (mimicking another person’s movements
Rating scales for catatonia
Bush Francis scale 23 items
Rating scales for suicidal ideations
Columbia suicide severity scale
Diagnostic criteria for intellectual disability
Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.
need three criteria:
A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract
thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life,
such as communication, social participation, and independent living, across multiple
environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period.
Specifier for intellectual disability
Mild
Moderate
Severe
Profound
Intellectual disability
prevalence
which gender
most common co-occurring (4)
prevalence 1%
more likely in male
most common co occurring are ADHD, depressive and bipolar, anxiety, ASD, impulse control disorder and major neurocognitive disorder
diagnostic criteria for autistic spectrum disorder
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at
least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g.,
strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects,visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become
fully manifest until social demands exceed limited capacities, or may be masked by
learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
Specifier for ASD
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
rating scales for ASD
childhood autism rating scale (CARS) 15 to 60
The Autism Spectrum Rating Scales (ASRS™) (2-18 years old)
Autism Diagnostic Observation Schedule (ADOS)
The Autism Spectrum Quotient (AQ-10) tool is recommended for use with adults with possible autism who do not have a moderate or severe ASD
Rating scales for ADHD
Conners Abbreviated Symptom Questionnaire
Vanderbilt Assessment Scales
SNAP-IV 26-Item Teacher and Parent Rating Scale
Diagnostic Interview for ADHD in adults (DIVA)
DSM criteria for ADHD
ADHD
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details,work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents and
adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older
adolescents and adults, returning calls, paying bills, keeping appointments).
- Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
Prevalence of ADHD
2.5% in adults, 5% in children
risk factors for adhd
-low birth weight, smoking during pregnancy, history of child abuse, neglect, multiple foster placements, neurotoxin exposure (e.g., lead), infections (e.g., encephalitis), or alcohol exposure in utero. Family history
dsm criteria for tourette’s disorder
Tourette’s Disorder
A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis).
rating scales for tourettes
Yale Global Tic Severity Scale (YGTSS)
Tourettes disorder scales
PTSD rating
CAPS 5
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a 30-item structured interview that corresponds to the DSM-5 criteria for PTSD.
diagnosis for bipolar disorder 1
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or
more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-goal-directed activity). - Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. functional impairment or need hospitalisation
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication, other treatment) or to another medical condition.
A full manic episode that emerges during antidepressant treatment is considered mania?
Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of treatment is sufficient for mania
difference between hypomania and mania
diff between hypomanic
1) time line: 4 consecutive days
2) The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.
3) If there are psychotic features, the episode is, by definition, manic.
Criteria for depression
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1) pervasive depressed mood/(irritable mood for children and adolescent)
2) anhedonia
3) poor sleep
4) poor or inc in appetite or loss of weight of 5% in a month
5) psychomotor retardation
6) neg cognition of guilt
7) suicidal ideation
8) poor concentration/indecisiveness
9) Loss of energy
things need for diagnosis of bp1 and bp2
?need manic/depressive episode
diagnosis for bipolar disorder
has one manic episode
for bipolar 2 disorder
need to have one hypomanic and at least one MDD episode
Difference in bipolar 1 and 2 in terms of development
Difference in bipolar 1 and 2 in terms of development
Bipolar 2 develop slightly later than bipolar 1 but earlier than MDD
Number of lifetime episode tends to be higher for bp2
bipolar 1 is equal in gender, bipolar 2 is in more common in females
Specifier for MDD/bipolar (11)
specifier for bipolar/depression: with psychotic features With anxious distress With mixed features With rapid cycling With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern
Criteria for cyclothymic
A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do not meet criteria for
a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), the hypomanic
and depressive periods have been present for at least half the time and the individual
has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
what are the main criterion for Substance/Medication-Induced Bipolar and Related Disorder
Substance/Medication-Induced Bipolar and Related Disorder: symptoms develop during or soon after substance intoxication or withdrawal or after exposure to a medication
The meds/substance is capable of producing the symptoms
What is the specifier for Bipolar and Related Disorder Due to Another Medical Condition
What is the specifier for Bipolar and Related Disorder Due to Another Medical Condition
with manic features, with manic or hypomanic like episode, with mixed features
specifier for anxious distress
2 out of 5
1) key up or tense
2) unusually restlessness
3) Diff concentrating
4) fear that something awful may happen
5) may lose control of oneself
Diagnosis criteria with mixed features
mania/hypomania episode with mixed features
eg: manic or hypomania episode with mixed features full criteria for mania/hypomania then 3 of 6 depressive symptoms 1) low mood 2) anhedonia 3) low energy 4) suicidal ideation 5) neg cognition 6) psychomotor retardation
Specifier with mixed features
Depressive episode with mixed features
full criteria for MDD with 3/7
1) fill elevated, expansive mood
2) inc sense of self
3) talkativeness
4) racing thoughts
5) inc goal directed activities
6) involvement in activities that has high potential of painful consequences
7) dec need for sleep
criteria for rapid cycling
Rapid cycling
1) 4 episode in 12 months
2) need to be switch in opposite polarity
3) need 2 months of full remission in between
Criteria for melancholic
With melancholic features: 1) 1 in 2 -lack of pleasure in activities -lack of reactivity to usually pleasurable stimuli B) 3 in 6 1) early morning awakening 2) poor appetite 3) depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood. 4) psychomotor retardation/agitation 5) depression worse in the morning 6) Guilt ++
Criteria for atypical features
With atypical features A) mood reactivity B) two of 4 1) sig weight gain 2) hypersomnia 3) leadan paralysis 4) long standing pattern of interpersonal rejection sensitivity
Timeline for peripartum onset
Timeline for peripartum onset
-during pregnancy or 4 weeks after delivery
Dissociative Identity disorder criteria
Dissociative Identity disorder
A) disruption of identity characterized by two or more distinct personality. Marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition and/or sensory motor functioning. May be observed by self or reported by the individual
B. Recurrent gaps of everyday events, important personal information and/or traumatic event
C. caused significant distress or impairment in social, occupational or other important areas of functioning
D. Not normal part of a broadly accepted cultural or religious practice
E. Not attributable to effects of substance or medical condition
Dissociative amnesia
what is the specifier
Dissociative amnesia
1) inability to recall important autobiograpical information, usually of a traumatic or stressful nature, tat is inconsistent with ordinary forgetting
2) significant distress or impairment in social occupational or other functioning
3) not attributable to substances, neurological or medical condition
4) not better explained by DID, PTSD, Acute stress disorder, Somatic symptoms disorder
Specifier: with or without dissociative fugue (apparently purposeful travel or bewildered wandering with that is associated with amnesia for identity)
Criteria for depersonalization/derealization disorder
A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g.,
perceptual alterations, distorted sense of time, unreal or absent self, emotional and/
or physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, medication) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder
specifier for adjustment disorder (6)
1) With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
2) With anxiety: Nervousness, worry, jitteriness, or separation anxiety
is predominant.
3) With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
4) With disturbance of conduct: Disturbance of conduct is predominant.
5) With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
6) Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
Adjustment disorder criteria
Adjustment disorder
A. The development of emotional or behavioral symptoms in response to an identifiable
stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of
the following:
1. Marked distress that is out of proportion to the severity or intensity of the stressor,
taking into account the external context and the cultural factors that might influence
symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder
and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its consequences have terminated, the symptoms do not persist
for more than an additional 6 months.
Acute stress disorder criteria
acute stress disorder
A) expose to actual r threatened death, serious injury or sexual violation
B) have 9 or more in the 5 category
i) intrusion: 1) intrusive memories 2) dreams 3) dissociative reaction (flashback) 4) intense distress to internal / external cues of the event
ii) neg mood: 5) unable to experience positive symptoms
iii) dissociative symptoms: 6) altered sense of the reality of one’s surroundings or oneself 7) amnesia of the events
iv) avoidance: 8) effort to avoid memories/thoughts 9) efforts to avoid external reminders
v) Arousal 1) sleep disturbance 11) irritable behavior 12) hypervigilance 13) problems with concentration 14) exaggerated startle response
C) 3 days to 1 month after the trauma
D) distress to functioning
E) not due to substance, medical condition, brief psych disorder
disruptive mood dysregulation disorder
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history or observation, the age at onset of Criteria A–E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a
highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder
and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others
