DSM-5 Diagnoses Flashcards

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1
Q

How would you define Adjustment Disorder?

A

Adjustment Disorder is a behavioural or emotional reaction in response to an identifiable situation or event in a person’s life.

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2
Q

What are the essential features of Adjustment Disorder?

A
  1. The event or situation must have occurred within 3 months of the onset of the symptoms.
  2. The distress felt must be out of proportion to the event and/or there is significant impairment functionally.
  3. It is not normal bereavement.
  4. Symptoms do not persist for longer than 6 months after the end of the identified stressor or its consequences.
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3
Q

What are the subtypes of Adjustment Disorder?

A
  1. Depressed mood
  2. Anxious mood
  3. Mixed anxiety and depressed mood
  4. Disturbance of conduct
  5. Miced disturbance of emotions and conduct
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4
Q

How would you define Antisocial Personality Disorder?

A

A personality disorder characterised by persistent antisocial, irresponsible, or criminal behaviour, often impulsive or aggressive, with disregard for harm/distress caused to others and an inability to maintain long-term social/personal relationships.

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5
Q

What are the essential features of Antisocial Personality Disorder?

A
  1. Persistent disregard for, and violation of, the rights of others since the age of 15 years. This is met by engaging in any of the 7 behaviour patterns: criminal activity, lying or manipulation, impulsivity, fighting or assaults, disregard for safety of self or others, irresponsibility, and lack of remorse.
  2. Person is at least 18 years of age at the time of diagnosis.
  3. History prior to age 15 indicates a pattern of behaviour that would have supported a diagnosis of conduct disorder.
  4. Behaviour does not occur in the context of schizophrenia or bipolar disorder.
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6
Q

How would you define Attention-Deficit/Hyperactivity Disorder?

A

ADHD is a neurodevelopmental disorder charactereised by a pattern of inattention and/or hyperactivity-impulsivity behaviour that has persisted for at least 6 months and clearly intereferes with function or development in multiple domains (school, work, social).

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7
Q

What are the essential features of ADHD?

A
  1. Having six or more symptoms from the inattention and/or hyperactivity-impulsivity presentation (for under 17 years), or five or more (for those aged 17+).
    - Inattention = making careless mistakes, difficulty sustaining attention, not listening, being easily sidetracked, difficulty organising tasks, avoidance of tasks requiring sustained mental effort, losing things, easily distracted, being forgetfull in daily activities.
    - Hyperactivity-impulsivity = fidgeting, leaving their seat, restlessness, inappropriate running around, unable to play/do leisure activities quietly, difficulty sitting still for extended time, excessive talking, blurting out answers, difficulty turn taking, interrupting others.
  2. Several symptoms must be present prior to the age of 12.
  3. Symptoms do not occur in the context of a psychotic disorder.
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8
Q

How is ADHD specified?

A

Specification of presentation = whether symptoms fall primarily into the inattention or hyperactivity-impulsivity categories, or are mixed.

Specification of severity = mild, moderate, or severe.

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9
Q

How would you define Autism Spectrum Disorders?

A

ASDs are neurodevelopmental disorders, characterised by difficulties in social interaction and communication, and by restricted or repetitive patterns or thought and behaviour.

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10
Q

What are the essential features of ASD?

A
  1. Social deficits in communication and interaction (e.g. lack of reciprocity, facial expressions and eye contact).
  2. Behavioural deficits (e.g. restricted or repetitive interests and abnormal sensory response).
  3. Evidence of the presence of these deficits in early development even if not recognised at the time
  4. Currently causing significant impairment in functioning.
  5. Not better explained by an intellectual disability or global developmental delay.
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11
Q

How would you define Bipolar I disorder?

A

Bipolar I disorder requires evidence of at least one manic episode during a person’s lifetime, which MAY be preceded or followed by a hypomanic or depressive episode.

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12
Q

What are the essential features of a manic episode?

A
  1. Emotional changes (elevated, expansive, or irritable mood) at levels that appear abnormal, and behavioural change (persistent and abnormal increases in energy or goal-directed behaviour).
  2. Emotional and behavioural changes must last at least 1 week and be present on most days, for most of the day.
  3. 3+ symptoms must be present during the mood disturbance and represent a change in usual behaviour (inflated self-esteem, less need for sleep, being more talkative, racing thoughts, being easily distracted, increases in goal-directed or purposeless activity, engaging in risky impulsive behaviour).
  4. The disturbance causes marked impairment in function or requires hospitalisation due to safety concerns or psychotic featues.
  5. Episodes cannot be attributed to drugs or medical conditions.
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13
Q

What are the essential features of Bipolar II disorder?

A
  1. Presence of both a current or past hypomanic episode and a current or past major depressive episode.
  2. The episode is clearly and uncharacteristic change in the person’s usual behaviour.
  3. The change in behaviour is observable by others.
  4. The episode is NOT severe enough to cause marked impairment or hospitalisation.
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14
Q

How is a hypomanic episode different from a manic episode?

A

Both manic and hypomanic episode involve:

  1. Emotional and behavioural changes (elated, expansive, or irritable mood; energy, or goal-directed behaviour)
  2. 3-4+ symptoms representing a change from normal behaviour (inflated self-esteem, less need for sleep, being more talkative, racing thoughts, being easily distracted, increased goal-directed or purposeless activity, engaging in risky/impulsive behaviours).

Hypomanic episode durations are 4 days only, where as a manic episode is 1 week.

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15
Q

What are the essential features for a Major Depressive Episode?

A

5+ of the following symptoms:

  1. Depressed mood most of the day, nearly everyday
  2. Diminished pleasure or interest in almost all activities for most of the day, nearly everyday
  3. Gaining or losing 5%+ of body weight in a month without dieting, or having a change in appetite most days
  4. Sleeping too much or too litter nearly everyday
  5. Being observably either physially agitated or slowed down
  6. Feeling tired or less energetic most days
  7. Feeling worthless or guilty nearly everyday
  8. Reduced concentration or indecisiveness
  9. Suicidal thoughts with or without a plan, or a suicide attempt
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16
Q

How would you define Borderline Personality Disorder?

A

BPD is a long-term pattern of instability across several domains:

  • Relationships
  • Self image
  • Mood
  • Behaviour - impulsivity

It starts by early adulthood and shows up in a variety of contexts.

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17
Q

What are the essential features of BPD?

A

5+ of the following:

  1. Frantic efforts to avoid real or imagined abandonment
  2. Intense and unstable relationships that tend to alternate between being seen as perfect or worthless
  3. Unstable sense of self
  4. Impulsive behaviour in at least two ares that cna be self-damaging
  5. Recurrent suicidal threats or actions or self-mutilating behaviour
  6. Unstable mood that is highly reactive to changes in circumstances
  7. Feelings of emptiness (chronic)
  8. Intense and difficult to control anger
  9. Stress-related paranoid ideas or dissociative symptoms
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18
Q

How would you define Conduct Disorder?

A

Conduct Disorder is a repeated pattern of persistent behaviour characterised by disregard for the rights of others or major violation of age-appropriate social rules and norms.

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19
Q

What are the essential features of Conduct Disorder?

A

3+ symptoms present for 12 months (with at least one occuring in past 6 months):

  1. Aggression to people or animals (threatens bullies, intimdates others, starts fights, used a weapon, physical cruelty, using confrontation of a victim to steal, forced another into sexual activity).
  2. Destruction of property (setting a fire to cause dmage, destorying others’ property).
  3. Deceitfulness or theft (breaking into a house/car/building, lying to obtain goods/favours or to avoid obligations, stealing without confrontation or breaking/entering).
  4. Serious violation of rules (staying out past curfew before 13 years of age, running away frm home at least twice and staying out overnight - or once if it’s more lengthy absence, skipping school prior to 13 years).
  5. Must cause impairment in functioning - school, social, occupational
  6. If person is 18y+ they do not meet the criteria for Antisocial Personality Disorder
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20
Q

How is Conduct Disorder specified?

A
  1. Age of onset = childhood, adolescence or unspecified
  2. With limited prosocial emotions = lack of guilt, empathy, concern for performance, or lack of expressed feeling
  3. Severity = mild, moderate or severe
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21
Q

How would you define Major Neurocognitive Disorder?

A

MND is decreased mental function due to a medical disease other than a psychiatric illness. MND is an umbrella term describing a decline in memory, intellectual ability, reasoning, and social skills, as well as changes in normal emotional reactions.

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22
Q

What are the essential features of MND?

A
  1. Cognitive decline in 1+ domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition).
  2. Decline must be substantial and demonstrated by concern by the individual or clinician as well as performance on an objective assessment showing decline from previous function or expected performance (2 SDs below the norm).
  3. The deficits interfere with being independent in everyday activities.
  4. Exclusion criterion = deficits are not in the context of a delirium
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23
Q

How can MND be specified?

A

MND specification is based on the onset trigger e.g.:

  1. Alzheimer’s disorder
  2. Parkinson’s
  3. Substance Induced
  4. Huntington’s disease
  5. Prion disease
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24
Q

How would you define feeding and eating disorders?

A

Persistent disturbance in eating or related behaviour that leads to altered consumption or absorption of food, and significant impairment in physical health or psychological function.

25
Q

How would you define Pica disorder?

A

The eating of nonfood items at an inappropriate developmental level. The behaviour is not a cultural expression and if severe enough and presented with another mental disorder, can warrant a separate diagnosis.

26
Q

How would you define Rumination Disorder?

A

Repeated regurgitation of food for at least 1 month, which is not associated with a medical condition and is not occurring exclusively in the context of another eating disorder. If severe enough and in the presence of another mental or medical disorder, it can warrant a separate diagnosis.

27
Q

What are the essential features of Avoidant/Restrictive Food Intake Disorder?

A

Disturbed eating behaviour evidenced by 1+ of the following:

  1. Not meeting appropriate nutritional and/or energy needs associated with significant weight loss.
  2. Not meeting expected weight gain in children.
  3. Nutritional deficiency.
  4. Dependence on enteral feeding (via the gastrointestinal tract) or nutritional supplements

The symptoms must have a significant impact on psychosocial functioning.

Exclusion criteria:

  1. Not explained by lack of food or cultural practice
  2. Not occurring in the context of anorexia or bulimia or distorion in the experience of body weight/shape
  3. Not attributed to a medical or mental condition unless its severity warrants additional clinical attention
28
Q

What are the essential features for Anorexia Nervosa?

A
  1. Restriction of food relative to requirements resulting in significantly low body weight.
  2. Significant fear of gaining weight, or persistent efforts to avoid weight gain in spite of low body weight.
  3. Distorted perception of body weight or shape or lack of recognition of the seriousness of the low body weight.

Specifiers = bingeing/purging at current (not over the course)

29
Q

What are the essential features of Bullimia Nervosa?

A

Recurrent episodes of binge eating characterised by:

  1. Eating an abnormal amount of food in a discrete period (e.g. 2 hours) and a feeling of the eating being out of control.
  2. Compensating for the binge with behaviours to avoid weight gain e.g. vomiting, laxatives, fasting, or excessive exercise.
  3. The binges and compensation behaviours both occur on average at least once a week for 3 months.
  4. Self-evaluation is unduly focused on body shape or weight.
  5. It does not occur only in the presence of anorexia.

Specifiers:

  1. Remission = partial or full
  2. Severity = mild, moderate, severe, and extreme
30
Q

What are the essential features of Binge-Eating Disorder?

A

Recurrent episodes of binge eating characterised by:

  1. Eating an abnormal amount of food in a discrete period (e.g. 2 hours) and a feeling of the eating being out of control.
  2. 3+ behaviours: eating more rapidly than normal, eating until uncomfortable full, eating when not hungry, solitary or hidden eating due to embarrassment, feelings of disgust, depression or guilt afterwards.
  3. Marked distress at the bingeing.
  4. Binge eating occurs on average occurs at least once a week for 3 months.
  5. Binge eating is not compensated for by behaviours associated with purging.

Specifiers:

  1. Remission = partial or full
  2. Severity = mild, moderate, severe, extreme
31
Q

How would you define Generalised Anxiety Disorder?

A

GAD is characterised by excessive or unrealistic anxiety about two or more aspects of life (work, relationships, finance, etc) often accompanied by physiological responses/symptoms.

32
Q

What are the essential features of GAD?

A

Excessive anxiety and worry most of the time for at least 6 months about a number of things, as well as:

  1. Worry is difficult to control.
  2. 3+ symptoms (1 in chilrdren): restless, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance. At least one must be present most days for at least 6 months.
  3. The symptoms cause significant distress or functional impairment.
  4. Not better explained due to substance use, medicla condition or another mental disorder.
33
Q

How would you define Major Depressive Disorder?

A

A disorder characterised by persistently depressed mood or loss of interest in activities, causing impairment in daily life.

34
Q

What are the essential features of persistent depressive disorder (dysthymia)?

A
  1. Depressed mood present for most of the time and has gone on for at least 2 years (1 year for children or adolescents).
  2. 2+ symptoms must be present: loss of appetite or overeating, sleeping too much or too little, lack of energy, low self-esteem or indecision or poor concentration or hopelessness.
  3. During the 1- or 2-year period the above symptoms have never been absent for more than 2 months.
  4. An MDE can also have been present during the entire 2-year period.
35
Q

What are the exclusion criteria for PDD (dysthymia)?

A
  1. Person has never had a manic or hypomanic episode.
  2. Person has never met criteria for cyclothymic disorder.
  3. Disorder is not better explained by another disorder, druges or medical condition.
36
Q

How would you define Obsessive Compulsive Disorder?

A

OCD is where unreasonable excessive thoughts and fears (obsessions) lead to repetitive behaviours (compulsions).

37
Q

What are the essential features for OCD?

A
  1. Presence of obsessions (unwanted, intrusive, and recurrent thoughts, urges, or images that are distressing) or compulsions (repetitive mental or physical behaviours that the person feels compelled to act out within the context of a rigid set of rules), or both.
  2. The person attempts to suppress the obsessive thought/urge/image or neutralise it with a compulsive thought or action.
  3. For compulsions, the thought or act must be aimed at reducing anxiety or preventing a negative consequence and are not realistically connected to the feared consequence or are excessive.
  4. Obsessions and/or compulsions must consume at least 1 hour per day and cause distress or impairment.
38
Q

What are the specifiers for OCD?

A
  1. Insight = good, poor, absent

2. Tic-related symptoms

39
Q

How would you define somatic symptom and related disorders?

A

These disorders have prominent somatic symptoms that cause significant distress and impairment. The somatic symptoms may or may not be medically explained, but the primary issues is the pairing of the symptoms with abnormal behaviours, feelings and thoughts related to them.

40
Q

What are the essential features for Somatic Symptom Disorder?

A
  1. 1+ distressing somatic symptoms are present that result in significant disruption to daily life.
  2. The presence of excessive thoughts, feelings, or behaviours related to the symptoms by at least one of the following: disproportionate thoughts about the seriousness of symptoms; high levels of health anxiety; excessive time spent on symptoms or health concerns.
  3. Recognition that while a given symptom may not be consistently present, there should be an ongoing period of being symptomatic (6 months +).
41
Q

What are the specifiers for Somatic Symptom Disorder?

A
  1. With predominant pain (previously pain disorder)

2. Current severity (mild, moderate, severe)

42
Q

How would you define Panic Disorder?

A

Panic Disorder is characterised by unexpected and repeated episodes of intense fear accompanied by physical symptoms.

43
Q

What are the essential features of Panic Disorder?

A
1. Unexpected and recurrent panic attacks - which are intense surge of fear or discomfort, reaching a peak within minutes and containing 4 of the following:
A. Changes to heart = increased rate, palpitations or pounding
B. Sweating
C. Shaking
D. Sensations of smothering or shortness of breath
E. Feelings of choking
F. Chest pain or tightness
G. Nausea
H. Dizziness
I. Feeling hot or chilled
J. Numbness or tingling
K. Feeling unreal or detached
L. Fear of losing control or going crazy
M. Fear of dying

B. At least one attack was followed by at least 1 month of worry about additional attacks and/or behaviour changes designed to avoid a future panic attack

44
Q

How would you define Post-Traumatic Stress Disorder?

A

PTSD is a condition of persistent mental and emotional stress occurring as a result of a traumatic experiencing, typically involving sleep disturbance and constant vivid recall of the experience, with dulled responses to others and the outside world.

45
Q

What are the essential features of PTSD?

A
  1. Exposure to a traumatic event
    Note: the tramatic event itself (must have included actual or threatened death, serious injury, or sexual violence), exposure to the trauma (direct experience, witnessing, learning of a violent or accidental traumatic event of a friend/family member, repeated or extreme exposure), and details of the traumatic event (first respondents collecting remains, repeat exposure to details of child abuse).
  2. 1+ intrusive symptoms = Involuntary distressing memories of the event that are recurrent, distressing dreams, flashbacks, psychological distress at cues of the event, physiological reactions to cues of the event.
  3. Behavioural avoidance = avoiding memories, thoughts or feelings related to the event, and/or avoiding external reminders
  4. 2+ negative changes in thoughts and mood = not being able to remember parts of the event, negative beliefs and expectations about self/world, distorted thoughts about the cause/consequence of the event (guilt/blame), persisten negative emotions (fear/horror), reduction in interest or participation in activities, feeling detached from others, inability to feel positive emotions
  5. 2+ evidence of reactivity = irritability, reckless or self-destructive behaviour, hypervigilance, easily startled, poor concentration, sleep disturbaned (for at least 1 month)
46
Q

What are the PTSD specifiers?

A
  1. Dissociative symptoms = depersonalisation or derealisation
  2. Delayed expression
47
Q

How would you define schizophrenia?

A

Schizophrenia is a long-term mental disorder involving a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.

48
Q

What are the essential features of Schizophrenia?

A
  1. Presence of 1+ positive symptoms (delusions, hallucinations, or disorganised speech), along with disorganised or catatonic behaviour and/or negative symptoms (reduced emotional expression, or avolition) that have been present for a significant amount of time during a 1-month period.
  2. Lower than previous levels of functioning in one or more areas for a significant portion of time since the onset of the disorder.
  3. Signs the disturbance has persisted for at least 6 months, with at least 1 month meeting full criterion 1.

Must rule out: schizoaffective disorder, despressive or bipolar disorder with psychotic features, due to lack of manic or major depressive episodes.

49
Q

What are the Schizophrenia specifiers?

A
  1. Course of the episode e.g. first episode
  2. With catatonia
  3. Severity of symptoms
50
Q

How would you define Separation Anxiety

A

Anxiety provoked in a young child by separation or the threat of separation frm its mother or main carer.

51
Q

What are the essential features of Separation Anxiety?

A
  1. Fear or anxiety in the face of separation from attachment figures.
  2. The fear or anxiety is considered excessive or developmentally inappropriate.
  3. 3+ of the following:
    A. Distress when anticipating or experiencing the separation.
    B. Excessive worry about loss of or harm to the attachment figure.
    C. Worry about events that could cause accidental separation e.g. getting lost/kidnapped.
    D. Refusal to go places due to fear of separation.
    E. Excessive fear of being alone without the attachment figue.
    F. Refusal to sleep away from home or go to sleep without the attachment figure.
    G. Nightmares with separation themes and repeated physical complaints when separation occurs or is anticipated.
  4. Symptoms persist for 4 weeks in children, and 6 months in adults
52
Q

How would you define Social Anxiety Disorder?

A

Social interactions where one may be judged lead to irrational anxiety, fear, self-consciousness and embarrassment.

53
Q

What are the essential features of Social Anxiety Disorder?

A
  1. Intense fear of social situations in which the individual may be evaluated negatively by others.
  2. Anxiety for social situations must be consisten but may vary in form across situations e.g. anticipatory anxiety, panic attack.
  3. Social situations are avoided or endured with difficulty.
  4. Anxiety is out of proportion to the actual threat imposed and is persistent, lasting 6+ months.
  5. Avoidance or distress is significant and impairs function.

Note: specify whether the social anxiety is performance only.

54
Q

How would you define substance use disorders?

A

Substance use disorders arae cognitive, behavioural and physical symptoms that indicate continued use in the face of significant substance-related problems. There are 10 classes of substances considered within the disorders and symptoms may vary across the classes when considering intoxication and withdrawal.

55
Q

What are the essential features of substance use disorder?

A
  1. Pathological pattern of behaviours related to using the substance.
  2. Impaired control = taking more than intended or for longer periods, failed attempts to quit/cut down, spending a lot of time getting/taking/recovering from the substance, cravings.
  3. Social impairment or failure to fulfil imporant obligations, continued use in the face of negative consequences, giving up important activities or roles.
  4. Risky use = using substances in hazardous contexts, continued use despite knowledge that it is causing or worsening physical or psychological problems.
  5. Pharmacological criteria = tolerance has developed (higher dose needed for the effect), withdrawal symptoms are present when substance is removed. These are not requried for diagnosis but help to gauge severity of the disorder and danger of relapse.
56
Q

How would you define Oppositional Defiant Disorder?

A

ODD is characterised by a frequent and persistent pattern of angry/irritable mood, argumentative/defiant behaviour or vindictiveness.

57
Q

What are the essential features of ODD?

A
  1. A pattern of angry/irritable mood, argumenatative/defiant behaviour, or vindictiveness lasting 6 months or more, with at least 4 of the following:
    * Angry/irritable mood = loses temper, touchy/easily annoyed, angry/resentful
    * Argumentative/defiance behaviour = arges with authority figues, actively defies/refuses to comply with authority figue requests/rules, deliberately annoys others, blames others for their mistakes/misbehaviour
    * Vindictiveness = has been spiteful or vindictive at least twice within the past 6 months
  2. Disturbance in behaviour is associated with distress in the individual or others in their immediate social context e.g. family, peers or colleagues; or impacts negatively on social, educational, occupational, or other important areas of functioning.
  3. Behaviours do not occur exclusively in the course of a psychotic, substance use, depressive or bipolar disorder.
58
Q

What are the severity specifiers for ODD?

A
  • Mild = symptoms are confined to one setting e.g. home, school, work, with peers
  • Moderate = symptoms are present in at least 2 settings
  • Severe = symptoms are present in 3+ settings