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NPE > DSM > Flashcards

DSM Flashcards

1
Q

Adjustment disorder criteria

A

A. within 3 months onset

B. marked distress + impacts on functional

C. NOT meeting criteria for others = CANNOT be diagnosed with others

D. Not normal

E. Gone once stressor gone - cannot persist for more than 6 months

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2
Q

Adjustment disorder vs PTSD vs Acute stress disorder

A

Can be diagnosed immediately

PTSD and acute stress: requires symptom severity and types (following a traumatic event)

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3
Q

Adjustment vs normative stress reactions

A

Magnitude of distress exceeds normal

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4
Q

Adjustment disorder vs depression vs anxiety

A

Has specifiers for both anxiety and depression

Have to meet full criteria for anxiety or depression

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5
Q

Major depressive disorder

A

A. 5 or more - 2 week
- depressed mood
- loss interest
- weight change 5%
- insomnia or hypersomnia
- agitation or retardation
- fatigue, loss energy
- feeling worthless, guilt
- decreased ability to think, concentrate
- thoughts of death

B. Impairments
C. No substance or medication
D. Not better explained by x
E. No manic or hypomanic episodes

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6
Q

MDD vs bipolar

A

No mani or hypermania

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7
Q

MDD vs ADHD

A
  • distractibility and low frustration
  • co-morbid
  • primary disturbance - depression = sadness and loss of interest
    ADHD = irritability
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8
Q

MDD vs sadness

A

Duration, severity and impacts (depression more)

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9
Q

Bipolar I - Manic episode

A

A. At least 1 week, most day
B. 3 or more:
- inflated self esteem
- decreased need for sleep
- more talkative
- flight of ideas
- distractibility
- increase goal-directed activities
- excessive involvement in activities

C. Mood disturbance

D. No substance

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10
Q

Bipolar I - hypomanic episode

A

A. Mini mania - not as intense - at least 4 consecutive days

B. 3 or more:
- inflated self esteem
- decreased need for sleep
- more talkative
- flight of ideas
- distractibility
- increase goal-directed activities
- excessive involvement in activities

C. Uncharacteristic of the person

D. Change in mood and function observed by others

E. Impairments - NO NEED for hospital
(If there is psychotic feature —> manic)

F. No substance

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11
Q

Bipolar I - depressive episode

A

same as depression

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12
Q

Bipolar I

A

Mania

MAY have depressive OR hypomania

Psychotic features

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13
Q

Bipolar II

A

Depressive (current or past) and hypomania

NO mania

MUST NOT ever had manic episode
MUST have depression

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14
Q

Mania vs hypomania

A

Mania: can be with psychotic features
Hypomania: no psychotic features

Mania: hospitalisation and persisted at least 1 week
Hypomania: not require hospitalisation, will need to have persisted for 4 days

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15
Q

Generalised anxiety GAD

A

A. Excessive worry, most days, at least 6 months

B. Hard to control worry

C. 3 or more (only 1 for children)
- restlessness
- easily fatigued
- difficulty concentrating or mind blanks
- irritability
- muscle tension
- sleep disturbance

D. Impairments
E. No substance or others
F. Not better explained by Social phobia, panic disorder, OCD, Separation anxiety, PTSD, Anorexia, somatic, schiz

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16
Q

Separation anxiety

A

A. Inappropriate fear of being separated from attached figure evidenced by 3 or more:
- recurrent distress when separated from home and attached figure
- worry about losing attached figure
- worry about experience event causing separation
- refusing and reluctance to go out, away from home
- fear of being alone without major figure
- reluctance to sleep away
- repeated nightmares theme of separation
- repeated complaints of physical symptoms when being separated

B. At least 4 weeks in children and 6+ months for adults

C. Impairment
D. Not better explained by ASD, psychotic, agoraphobia, GAD, illness anxiety

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17
Q

Social anxiety

A

A. Fear of social situations (being criticised)

B. Fear of showing symptoms and being evaluated

C. Almost always when being in social situations

D. Avoided and endured

E. More than actual threat

F. More than 6 months

G. Impairments

H. No substance

I. Not explained by panic, body dysmorphic, autism

Specify: performance only

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18
Q

Panic disorder

A

A. Recurrent unexpected panic attacks - 4 or more
- Pounding heart
- sweating
- trembling, shaking
- shortness or breath
- choking
- chest pain
- nausea
- dizzy
- numbness and tingling
- decrealization
- fear of loss control
- fear of dying

B. At least one attacks followed by 1+ month of (both)
- persistent worry about having panic attacks
- maladaptive change in behaviours

C. No substance
D. Not better explained by social phobia, specific phobia, ocd, ptsd, separation anxiety

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19
Q

Anxiety disorders

A

GAD: multiple domains, cannot be controlled

Separation: being separated from attached figure

Social: social situations, being criticised, embarrassed

Panic: having panic attacks, changes of behaviour to avoid this

Agoraphobia: being outside home in 2+ situations, not being able to escape, help not available

Specific phobia: avoiding objects/ circumstances

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20
Q

Somatic symptom disorder

A

A. 1+ somatic symptoms causing distress or disruption

B. Excessive thoughts, feelings, behaviours - one of the following:
- persistent thoughts about seriousness of symptoms
- high level of anxiety
- time and energy devoted to health concerns

C. State of being symptomatic is 6+ months

Can occur in anxiety - tend to be acute
Main source of anxiety is not about somatic symptoms

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21
Q

OCD

A

A. Obsessions, compulsions or both

Obsessions (both)
- persistent thoughts, urges or images - causing anxiety or distress
- attempts to ignore or suppress

Compulsions (both)
- repetitive behaviour - responding to obsession, must be applied rigidly
- aim to reduce or prevent anxiety

B. Time consuming, impairment
C. No substance
D. Not better explained by others

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22
Q

OCD vs anxiety

A

Anxiety does not have obsession, compulsions and rituals

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23
Q

OCD vs psychotic

A

No compulsions in delusion or hallucinations in OCD

24
Q

OCD vs OCPD (personality disorder)

A

Can have both
No intrusive thoughts or repetitive behaviours in OCPD
Excessive perfectionism and rigid control for OCPD

25
Q

PTSD

A

A. Exposure to actual threat:
- direct experience
- witness
- learning about the event (of close family member)
- exposure to aversive traumatic events (police)

B. One or more
- memories
- dreams
- flashbacks
- distress
- resemble of events

C. Avoiding situations (1+)
- avoid memories
- avoid reminders eg people, places

D. Alterations in cognitions (2 or more)
- inability to remember
- negative beliefs about self
- distorted cognitions about the cause and consequences —> blaming self or others
- negative emotional state eg anger, fear, guilt
- diminished interest
- feeling detachment
- inability to have positive emotions

E. Alterations in arousal (2 or more):
- irritable
- hypervigilance
- exaggerated startle response
- difficult concentrating
- sleep disturbance

F. MORE THAN 1 MONTH
G. Impairments
H. No substance

26
Q

PTSD vs Acute stress

A

Acute stress: 3 days to 4 weeks
PTSD: more than one month

Adjustment disorder: within 3 months, gone within 6 months after stressor gone

27
Q

PTSD vs Anxiety

A

What is the sources of anxiety?
Is it about the trauma and efforts to avoid trauma?

28
Q

ODD (oppositional defiant disorder)

A

A. Angry mood, defiant behaviour, at least 6 months, - 4 or more:
- angry: losing temper, touchy and easily annoyed, angry and resentful
- argumentative: argue with authority, define and refuse to comply, annoy others, blame others
- vindictiveness: spiteful twice within 6 months (trying or wanting to harm others)

B. Associated w distress in social context (eg family, peer group), OR impact functioning

C. No psychotic, substance, not meet disruptive mood disorder

29
Q

Conduct disorder

A

A. Repetitive and persistent - violating social norms and rights of others - 3 or more over 12 months:
- aggression:
— bullies, threatens
— physical fights
— weapon use and physical harm to others
— cruel to people/ animal physically
— mugging, snatching, armed robbery
— force someone to sexual activity
— intention to cause damage
— destroy others’ property

  • deceitfulness or thef
    — broken into others house, cars
    — lies to obtain goods, or avoid obligation
    — shop lifting
  • violations of rules
    — stay out at night despite parents prohibition (before age 13)
    — run away from hime at least twice
    — truant from school (before age 13)

B. Impairment
C. Younger than 18
If older, do not criteria for antisocial personality disorder

30
Q

Antisocial personality disorder

A

A. Disregard, violating rights or others since 15, 3 or more:
- failure to conform social norms, acts grounded for arrest
- lying, conning others
- impulsive and failure to plan ahead
- irritability, repeating physical fight
- reckless disregard for safety of others
- irresponsibility, failure to sustain obligations
- lack of remorse

31
Q

ODD vs Conduct vs Antisocial

A

ODD:
- commonly in childhood
- less severe than CD - no aggression towards others
- emotional dysregulation is not criteria for conduct

Conduct:
- commonly for adolescents
- more severe than ODD, typically leads to antisocial
- impulsivity like ADHD, but about disregard for others

Antisocial:
- older than 18 - onset since 15
- antisocial aspects

32
Q

Borderline personality disorder

A

A. Instability of interpersonal relationships, self images, affects, impulsivity, beginning in ADULTHOOD, 5 or more:
- frantic efforts to avoid real or imagined abandonment
- unstable, intense interpersonal relationships
- unstable self images and sense of self
- impulsivity - at least 2: spending, sex, substance, reckless driving, binge eating
- suicidal behaviour, self mutilating behaviour
- reactivity of mood
- chronic feelings of emptiness
- intense anger
- paranoid ideas

Main: chronic feelings of emptiness, challenges with relationships, fear of abandonment, suicidal behaviour, intense and unstable relationships

Can have multiple personality disorder

33
Q

Schizophrenia

A

A. 2 or more significant portion of time, during 1 month, at least one is (1), (2) or (3):
- (1) delusion
- (2) hallucination
- (3) disorganised speech (incoherence)
- (4) disorganised or disrupt awareness of world around (catatonic)
- (5) negative symptoms eg diminished emotional expression

B. Functioning

C. Continued disturbance for at least 6 months, meet A for at least 1 month

D. No depression or bipolar w psychotic feature
- no depressive symptoms
- mood episodes present for a minority

E. No substance

F. History of autism or communication disorder —> require prominent delusions or hallucinations

34
Q

Auditory vs visual hallucination

A

Wont be just occur during depressive episodes like Depression or manic episodes like Bipolar - in schiz, this happens anytime.

6 months or more of symptoms for schiz >< different from schiz disorder or psychotic disorder (briefer in duration)

35
Q

Anorexia

A

A. Restriction of energy taken in, low body weight

B. Fear of gaining weight, getting fat, behaviour to stop weight gain

C. Disturbance with body weight and shapes, lack of recognition for low body weight

Specify:
- restricting type: last 3 months, not engaged in binge eating or purging behaviour, doing dieting, fasting, exercise
- binge-eating: last 3 months, binge eating and purging (self induced vomiting, use of laxatives, enemas)

36
Q

Bulimia

A

A. Binge eating:
- eating a larger amount of food in 2 hours
- lack of control over eating

B. Compensatory behaviour to prevent weight gain eg self induced vomiting, laxatives, medications, exercise

C. Both occur at least once a week for 3 months

D. Self evaluation is influenced by body shape and weight

E. Not occur during episodes of anorexia

37
Q

Binge eating disorder

A

A. Recurrent binge eating: both
- eat a lot more
- lack of control

At least once a week for 3 MONTHS

B. 3 or more
- more and rapidly
- eat until feeling uncomfortably full
- eat large amount when not hungry
- eat alone as feeling embarrased
- feeling disgusted and depressed and guilt

C. Marked distress

D. Not using compensatory behaviour

38
Q

Anorexia, bulimia, binge

A

Anorexia:
- restrict food intake
- fear of becoming fat
- lose at least 15% body weight

Bulimia:
- binge eating then purging
- bulimia should not occur in an episode of anorexia
- normal body weight

Binge:
- no compensation behaviour
- does not occur during course of bulimia or anorexia

39
Q

Autism

A

A. Deficits in communication and social interactions, across multiple contexts
- social-emotional reciprocity, abnormal social approach, reduced sharing of interest
- deficits in nonverbal communicative behaviour eg eye contact, deficits in understanding gestures, lack facial expression
- deficits in understanding relationships, difficulties adjusting behaviour, making friends, absence of interest in peers

B. Restricted, repetitive patterns of behaviour, interest, activities, 2 or more:
- repetitive motor movements use of objects or speech
- insistence in sameness, inflexibility, ritualised patterns of behaviours
- fixated interest, abnormal in intensity
- reactivity to sensory input, unusual interest in sensory aspects of the environments

C. Present in EARLY developmental period
D. Impairments
E. Not better explained by ID, developmental delays.

40
Q

ADHD

A

A. Inattentive and or hyperactive impulsivity. (1) or (2);
(1): inattentive 6 or more for 6 months, impacting social academic activities
- fail to give close attention to details, make careless mistakes
- difficulties sustain attention in tasks or play
- does not seem to listen when spoken directly
- does not follow through conversations, fail to finish school work, chores, duties
- difficulties organising tasks and activities
- avoid and reluctant to engage in tasks requiring efforts
- lose things
- distracted by stimuli (can be unrelated thoughts)
- forgetful in daily activity
(2) hyperactive, impulsivity, 6 or more in 6 months
- fidgety
- leave seats when need to stay
- run or climb when inappropriate
- unable to engage in leisure activities quietly
- on the go
- talk excessively
- blurt out the answer before the question completed, cannot wait for turn in conversation
- difficulties waiting for turn, waiting in line
- interrupts or intrude others

B. Present prior age of 12

C. 2 or more settings

D. Reduced functioning

E. Do not occur during the court of schiz or others

41
Q

ADHD vs ASD

A

Social communication challenges - key for ASD only

Hyperactive and impulsive - key for ADHD only

42
Q

Neurocognitive disorder - Mild

A

A. Cognitive decline compared to before one or more (complex attention, executive function, learning and memory, perceptual-motor, social cognition)
- concern of individual or clinician
- impairments - standardised measurement or another clinician’s assessment

B. Do NOT interfere capacity for independence (preserved abilities, compensatory strategies)
C. Do not occur in context of delirium

43
Q

Neurocognitive disorder - major

A

A. Significant cognitive decline compared to before one or more (complex attention, executive function, learning and memory, perceptual-motor, social cognition)
- concern of individual or clinician
- impairments - standardised measurement or another clinician’s assessment

B. Deficits in independence (requiring assistance with complex tasks eg medication, paying bills)
C. Do NOT occur during the context of delirium

44
Q

Major and mild neurocognitive

A

Both are not better explained by others eg mdd, schiz

Specify due to: alzheimers, hiv infection, others, unspecify

45
Q

Complex attention

A

Complex attention (sustain attention, divided attention, selective attention, processing speed)

Major: easily distracted, unable to attend unless inout is restricted and simplified, holding information in mind, unable to perform mental calculations, taking longer to do tasks

Mild: take longer, errors in tasks, thinking easier without disruption by tv etc.

46
Q

Executive function

A

Planning, decision making, working memory, responding to feedback, error correction, mental flexibility

Major: abandons complex project, need to focus on one task at a time; rely on others for daily activities and making decisions

Mild: need more effort for complex tasks, difficulties w multitasking, fatigue when need to organise, plan and make decisions, effort require to follow shifting conversation

47
Q

Learning and memory

A

Immediate memory, recent memory, long term memory, implicit learning

Major: difficulties with expressive and receptive language; prefers general pronouns than names, cannot recall names, grammatical errors, echolalia

Mild: word finding difficulties, substitute general for specific terms, avoid using names, omission or incorrect use or articles, prepositions, auxiliary verbs

48
Q

Perceptual motor

A

Abilities subsumed under the terms visual perception, visuo-constructional perceptual-motor, praxis, and gnosis)

Major: difficulties with familiar activities, navigating environments, more confused at dusk, when shadows and lowering levels of light change perceptions

Mild: rely on maps more, use notes and follow others to new places, lost or turn around when not concentrating; less precise in parking,

49
Q

Social cognition

A

Recognition of emotions, theory of mind

Major: behaviour is out of acceptable, making decisions regarding safety, little insights into changes

Mild: subtle changes in behaviour or attitude, change in personality, less ability to recognise social cues, facial expression, decreased empathy

50
Q

Delirium

A

A. Disturbance in attention and awareness (reduced orientation to the environment)

B. Develops over a short period eg hours to days, tend to fluctuate in severity during the court of a day

C. Addition disturbance in cognition (eg memory, disorientation, language, perception, visuospatial)

D. A and C are not better explained by another preexisting disorder,

E. No medical or substance

51
Q

Substance related and addictive
- alcohol
- cannabis
- opioids
- stimulants

A

A. Problematic patterns, significant impairment, 2 or more within 12 months
- take large amount for longe period
- persistent desire or unsuccessful efforts to cut or control
- time spent to recover from substance
- craving, strong urge to use
- failure to fulfil roles, obligations
- social and interpersonal problems
- giving up on social, occupational, recreational
- substance use in physically hazardous situations
- continued despite knowledge
- tolerance
- withdrawal

52
Q

Tolerance

A
  • need for more
  • cannot get the same effects with the same amount
53
Q

Withdrawal

A
  • withdrawal symtoms
  • the substance is taken to relieve withdrawal symptoms
54
Q

Alcohol withdrawl

A

2 or more within several hours to a few days:
- automatic hyperactivity
- increased HAND TRERMOR
- insomnia
- nausea or vomiting
- transient visual, tactile, auditory hallucination, illusions
- psychomotoragitagion
- anxiety
- generalised tonic-clonic SEIZURES

55
Q

Cannabis withdrawal

A

3 or more within one week:
- irritability, anger, AGGRESSION
- nervousness or anxiety
- sleep difficulties
- decreased appetite or weightloss
- restlessness
- DEPRESSED mood
- PHYSICAL DISCOMFORT eg abdominal pain, tremor, sweating fever, chills, headache

56
Q

Opioid withdrawal

A

3 or more within minutes to several days:
- dysphoric
- nausea or vomiting
- muscle ACHES
- lacrimation or rhinorrhea
- pupillary dilation, sweating
- diarrhea
- YAWNING
- FEVER

57
Q

Stimulant withdrawal

A

Dysphoric mood and 2 or more within a few hours to several days:
- fatigue
- vivid, UNPLEASANT DREAMS
- insomnia, HYPERSOMNIA
- INCREASED APPETITE
- psychomotor retardation or AGITATION

NPE (5 decks)

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