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NPE > DSM-5 Diagnoses > Flashcards

DSM-5 Diagnoses Flashcards

1
Q

Diagnosis criteria of adjustment disorder:

A

o Event must have occurred within 3 months of symptom onset
o Distress must be out of proportion to the event
and/or
o there is significant impairment in the person’s ability to function in some area of life (work, social etc).

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2
Q

What is adjustment disorder?

A

o Behavioural or emotional reaction in response to an identifiable situation or event in a person’s life

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3
Q

When is adjustment disorder excluded as a diagnosis?

A

o if normal bereavement
o is an exacerbation of another preexisting disorder
o if symptoms longer than 6 months after event

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4
Q

what are the subtypes of AD?

A
  • Subtypes (6). With specifiers:
    o with depressed mood
    o with anxious mood
    o with mixed anxiety and depressed mood
    o with disturbance of conduct
    o with mixed disturbance of emotions and conduct
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5
Q

What is antisocial personality disorder?

A

o pattern of disregard for, and violation of, the rights of others, criminality, impulsivity, and a failure to learn from experience.

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6
Q

What cluster are antisocial personality disorders?

A

Cluster B

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7
Q

What is the diagnosis criteria for antisocial?

A

o 4 criteria required:
- Evidence of a persistent disregard for, and violation of, the rights of others since age 15. This can be met by any 1 of the 7 patterns of behaviour:
* Failure to conform to social norms with respect to criminal activity (with or without arrest)
* Deceitfulness - Lying or manipulation
* Impulsivity or failure to plan ahead
* Fighting or assaults
* Disregard of the safety of self or others
* Irresponsibility
* Lack of remorse
- 18 years or older at diagnosis time
- History prior to 15 must indicate a pattern of behaviour that would have supported a diagnosis of conduct disorder
- The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

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8
Q

when is diagnosis excluded for antisocial PD?

A

o When associated with substance use disorders
o schizophrenia or bipolar disorder.
o other personality disorders

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9
Q

What is ADHD?

A

o Neurodevelopmental disorder characterized by a pattern of inattention and/or hyperactivity-impulsivity behaviour that has persisted for at least 6 months and clearly interferes with function or development in multiple domains.

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10
Q

How many symptoms needed for diagnosis for ADHD by age?

A

o For under 17 - 6+ symptoms
o For over 17 - 5+ symptoms

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11
Q

What are the inattention symptoms of ADHD?

A
  • Often making careless mistakes
  • Difficulty sustaining attention
  • Not listening
  • Easily sidetracked
  • Difficulty organizing tasks
  • Avoidance of tasks
  • Requiring sustained mental effort
  • Losing things
  • Easily distracted
  • Forgetful in daily activities
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12
Q

What are the hyperactive / impulsivity symptoms of ADHD?

A
  • Often fidgeting
  • Leaving their seat
  • Restlessness (adults)
  • Inappropriate running around
  • Unable to play quietyly (for adults unable to quitly engage in leisure activities)
  • Difficulty being still for extended time periods
  • Excessive talking
  • Blurting out answers
  • Difficulty turn taking
  • Often interrupts others
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13
Q

What are the specifiers of ADHD?

A
  • inattention or hyperactive-impulsive categories or a mixed
  • specification of severity: mild, moderate or severe and if the disorder is in partial remission
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14
Q

What is needed for diagnosis of ASD?

A
  • Social deficits in communication and interaction (lack of reciprocity, facial expressions and eye contact)
  • Behavioural deficits (restricted or repetitive interests and abnormal sensory response)
  • Evidence of the presence of these deficits in early development (even if not recognized at the time)
  • Deficits must cause sig. impairment in functioning
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15
Q

What is specification for ADHD?

A

o Emphasis on functional impairment evidenced by the inclusion of a 3 tiered severity rating based on level of support needed to address the deficits

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16
Q

What is bipolar 1?

A
  • At least 1 manic episode during a person’s life which may be preceded or followed by hypomanic or depressive episodes.
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17
Q

What is bipolar 2?

A
  • both current or past hypomanic episode and current or past major depressive episode.
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18
Q

o Manic Episode criteria:

A
  • 1st criteria:
  • Emotional domain
  • Behavioural Domain
  • 2nd criteria:
  • 3/+ symptoms present to a sig. degree during the mood disturbance (4 required if primary mood irritability) and must represent a change from usual behaviour
    o Symptoms include: inflated self esteem, less need for sleep, being more talkative, racing thoughts, being easily distracted, increases in either goal directed or purposeless activity, and engaging excessively in risky impulsive behaviour (e.g. sexual indiscretions and spending sprees)
  • 1 week
  • 3rd criteria:
  • Disturbance causes marked impairment in function or requires hospitalization
  • 4th criteria:
  • Excludes episodes solely to drugs or a medical condition unless the condition persists beyond the physiological effect of the medical treatment
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19
Q

o Hypomanic episode criteria:

A
  • 1 and 2 criteria:
  • Same first 2 criteria of manic episode (emotional and behavioural domains and 3+ symptoms) but shorter duration (4 days)
  • 3rd Criteria:
  • Episode clearly an uncharacteristic change in usual behaviour
  • 4th:
  • change in behaviour is observable by others
  • 5th:
  • Episode is not severe enough to cause marked impairment or hospitalization
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20
Q

Bipolar: Major Depressive Episode criteria

A
  • Requires 5 or more symptoms from:
  • Depressed mood most day, nearly every day (children may show irritable mood)
  • Diminished pleasure or interest in almost all activities most day, nearly every day
  • Gaining or losing 5% of more of body weight in month without dieting or an increase or decrease in appetite most days
  • Sleeping too little or much nearly every day
  • Being observably physically agitated or slowed
  • Feeling worthless or guilty nearly everyday
  • Reduced concentration or indecisiveness
  • Suicidal thoughts with or without a plan, or a suicide attempt
  • These cause sig. impairment in functioning.
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21
Q

What is BPD?

A

o Personality disorder.
o Long term pattern of instability across several domains: relationships, self-image, and mood along with impulsive behaviour that starts by early adulthood and shows up in variety of contexts

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22
Q

What is needed to diagnose BPD?

A

: At least 5 of the following:
- Frantic efforts to avoid real or imagined abandonment (not including suicidal or self-harming behaviour)
- Intense and unstable relationships that tend to alternate between being seen as perfect or worthless
- Unstable sense of self
- Impulsive behaviour in at least two areas that can be self-damaging (not including suicidal or self-harming behaviour)
- Recurrent suicidal threats or actions or self-mutilating behaviour (cutting, burning, etc.)
- Unstable mood that is highly reactive to changes in circumstances
- Feelings of emptiness (chronic)
- Intense and difficult to control anger
- Stress-related paranoid ideas or dissociative symptoms

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23
Q

What is conduct disorder?

A

o Repeated pattern of persistent behaviour characterized by the disregard for the rights of others or major violation of age appropriate social rules and norms

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24
Q

what is needed for diagnosis of conduct disorder?

A

o At least 3 symptoms present in past 12 months (1 must be in the past 6 months)
o Symptoms divided into 4 categories
- 1. Aggression to people or animals
- 2. Destruction of property
- 3. Deceitfulness or theft
- 4. Serious violation of rules
o Behaviour must cause clinical sig. problems in functioning,
o if 18+ they do not meet criteria for antisocial personality disorder

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25
Q

What specifications for conduct disordeR?

A

o Age of onset (childhood, adolescence or unspecified)
o Limited prosocial emotions (lack of guilt, empathy, concern with performance, of lack of expressed feeling)
o Current severity (mild, mod, sev.)

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26
Q

what is important to know about dementia and the DSM?

A
  • Not a diagnostic classification in DSM BUT instead is retained in neurocognitive disorders and been kept as an alternative term for major neurocognitive disorder
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27
Q

Diagnosis for dementia

A

o cognitive decline in 1 or more domains (complex attention, exec. Func., learning and mem, lang., perceptual-motor, or social cog.)
o Decline should be substantial and demonstrated by both concern by individual and clinician and performance on an objective assessment shows decline from previous or expected performance (usually 2 SD below norm)
o Deficits also impact being independent in everyday settings (e.g. paying bills)

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28
Q

specification for dementia

A

o Whether or not onset is due to a specific medical condition (e.g. Alzheimer’s, Parkinson’s, substance induced)

29
Q

what are feeding and eating disorders categorised by?

A

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

30
Q

what is Pica?

A
  • eating of nonfood items at an inappropriate developmental level
31
Q

what is rumination disorder?

A
  • Repeated regurgitation of food for at least 1 month, not associated with a medical condition and not occurring exclusively in the context of another eating disorder.
32
Q

what is Avoidant/restrictive food intake disorder:

A
  • Disturbed eating behaviour evidenced by one or more of the following:
  • (a) Not meeting appropriate nutritional and/or energy needs associated with significant weight loss;
  • (b) not meeting expected weight gain in children,
  • (c) nutritional deficiency; or
  • (d) dependence on enteral feeding (i.e., feeding via digestion of the gastrointestinal tract) or nutritional supplements.
  • The symptoms have a marked impact on psychosocial functioning.
33
Q

Diagnosis for AN:

A
  • Restriction of food relative to requirements resulting in sig. low body weight
  • Sig fear of gaining weight or persistent efforts to avoid weight fain in spite of low body weight
  • Distorted perception of body weight or shape or lack of recognition of the seriousness of low body weight
34
Q

specifiers for AN

A

o Specifiers:
- Bingeing/purging
- Should relate to current symptoms rather than course of disorder

35
Q

diagnosis for bulimia

A
  • Eating abnormal amount of food in discrete period (e.g. 2 hours) and feeling eating Is out of control
  • Compensating for binge with behaviours to avoid weight gain (e.g. vomiting, laxatives, fasting, excessive exercise)
  • Binges and compensation behaviours both occur on average at least once a week for 3 months
  • Self evaluation is unduly focused on body shape or weight
  • Does not occur only in presence of AN
36
Q

o Specifiers for bulimia

A
  • Relate to remission (partial or full) and severity (mild, mod, sev.)
37
Q

diagnosis for binge eating disorder

A
  • Eating abnormal amount of food in discrete period (e.g. 2 hours) and feeling eating Is out of control
  • 3 or more of following: eating more rapidly than normal, eating until uncomfortably full, eating when not hungry, solitary or hidden eating due to embarrassment, feelings of disgust, depression or guilt afterward
  • Marked distress at bingeing
  • Occurs on average 1 time per week for 3 months
  • Not compensated by behaviours associated with purging
38
Q

what is GAD?

A

o Excessive anx and worry most of the time for 6+ months about a number of things (work, performance, relationships)

39
Q

diagnosis criteria for GAD is:

A

o 6+ months
o Worry is difficult to control
o 3+ symptoms (only 1 for children):
- Restless, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance. At least 1 must be most days for 6 months
o Symptoms cause clinically sig distress or impair functioning in important areas

40
Q

Diagnosis for Major Depressive Episode

A

o 5+ symptoms present in same 2-week period that are a change from previous functioning:
- at least 1 is depressed mood or loss of interest or pleasure
- Depressed mood most day, nearly every day (children may show irritable mood)
- Diminished pleasure or interest in almost all activities most day, nearly every day
- Gaining or losing 5% of more of body weight in month without dieting or an increase or decrease in appetite most days
- Sleeping too little or much nearly every day
- Being observably physically agitated or slowed
- Feeling worthless or guilty nearly everyday
- Reduced concentration or indecisiveness
- Suicidal thoughts with or without a plan, or a suicide attempt
o These cause sig. impairment in functioning.

41
Q

Diagnosis for Persistent Depressive Disorder (Dysthymia):

A
  • Depressed mood most of the time for 2+ years (1 for children or teens)
  • If MDE criteria has also been met, both disorders can be diagnosed.
  • 2+ symptoms must be present:
    o Loss of appetite or over eating
    o Sleeping too much or too little
    o Lack of energy
    o Low self-esteem, indecision or poor concentration and hopelessness
  • These cause sig. impairment in functioning.
  • Symptoms never absent for more than 2 months in the time period
  • MDE can also be present during entire time period
42
Q

what is ocd

A

o Presence of obsessions, compulsions or both

43
Q

OCD: what are obsessions

A

unwanted, intrusive and recurrent thoughts, urges or images that are experienced as distressing
- Criteria: person tries to suppress obsessive thought/urge or that they attempt to neutralize them with a compulsive thought or action.

44
Q

OCD: what are compulsions

A

repetitive mental or physical behaviours the person feels compelled to act out within the context of a rigid set of rules.
- Criteria: thought or act must be aimed at reducing anx or preventing a negative consequence and not realisitally connected to the feared consequence or are excussive

45
Q

what is the time criteria for OCD

A
  • Time consuming nature (more than 1 hour per day)
46
Q

specifiers for OCD

A

o Insight (good, poor, absent) and tic related symptoms (history of tic disorder)

47
Q

what are Somatic Symptom and Related Disorders

A

o Share common features of prominent somatic symptoms that cause significant distress and impairment.
o somatic symptoms may or may not be medically explained,
o primary issue being the pairing of the symptoms with abnormal behaviours, feelings, and thoughts in relation to them.

48
Q

diagnosis for Somatic Symptom and Related Disorders

A

o 1+ distressing somatic symptoms are present
o excessive thoughts, feelings, or behaviours related to the symptoms by at least 1 of the following:
- disproportionate thoughts about the seriousness of symptoms;
- high levels of health anxiety; 

- excessive time spent on symptoms or health concerns.
o Recognition that while a given symptom may not be consistently present, there should be an ongoing period of being symptomatic (greater than 6 months).

49
Q

Specifiers for Somatic Symptom and Related Disorders

A

o With predominant pain (previously pain disorder) and current severity (mild, moderate, severe).

50
Q

what is panic disorder

A

o unexpected and recurrent panic attacks

51
Q

what is a panic attack

A

refers to an intense surge of fear or discomfort that typically reaches a peak within minutes

52
Q

what is the diagnosis criteria for panic disorder?

A

o panic attack
o contains at least 4 of the following symptoms:
- Changes to heart (increased rate, palpitations, or pounding),
- sweating,
- shaking,
- sensations of smothering or shortness of breath,
- feelings of choking,
- chest pain, or tight-ness,
- nausea,
- dizziness,
- feeling hot or chilled,
- numbness or tingling,
- feeling unreal or detached,
- fear of losing control or going crazy,
- fear of dying.
o Additionally, at least 1 attack was followed by at least 1 month of worry about additional attacks and/or behaviour changes designed to avoid a future panic attack.

53
Q

what is PTSD?

A

o exposure to a traumatic event coupled with intrusive recollections, avoidant behaviours, changes to thoughts and moods, and increased reactivity that last more than 1 month after the event or its consequences.

54
Q

diagnosis for PTSD:

A

o The traumatic event itself:
- must have included actual or threatened death, serious injury, or sexual violence,
- exposure to the trauma
- and details of the traumatic event
o Criteria related to intrusive symptoms include 1 or more of the following:
- Involuntary distressing memories of the event that are recurrent,
- distressing dreams,
- flashbacks,
- psychological distress at internal or external cues that resemble or symbolise some aspect of the event,
- physiological reactions to such cues.
o The behavioural avoidance:
- avoiding memories, thoughts or feelings related to the event, and/or avoiding external reminders (e.g., conversations and places).
o Negative changes in thoughts and mood are evidenced by 2 or more symptoms as follows:
- Not being able to remember parts of the event (not related to injury or substances),
- negative beliefs and expectations about self and world,
- distorted thoughts about the cause or consequences of the event (guilt, blaming others, etc.),
- persistent negative emotions (fear, horror, etc.),
- reduction in interest or participation in activities,
- feeling detached from others,
- inability to feel positive emotions.
o Evidence of reactivity consists of 2 or more of the following:
- Irritability,
- reckless or self-destructive behaviour,
- hypervigilance,
- easily startled,
- poor concentration,
- sleep disturbance.
o These symptoms should have at least 1-month duration and cause significant distress or impairment in function.

55
Q

PTSD diagnosis:

A

Traumatic Event itself (actual, exposure or details)
Intrusive symptoms (1 or more)
Behavioural avoidance
Negative changes In thoughts and mood (2 or more symptoms)
Evidence of reactivity (2 or more)
1 month duration of symptoms

56
Q

PTSD specifiers

A

indicate dissociative symptoms (e.g., depersonalisation or derealisation) or delayed expression.

57
Q

PTSD for children:

A

o have a separate and altered set of criteria – e.g. the traumatic event itself excludes electronic media as a means of exposure (e.g., games and/or movies).
o Negative alterations in cognitions have been added to the criteria for children, including:
- Increased frequency of negative emotional states,
- diminished interests or participation, which includes restricted play, social withdrawal, and reduced display of positive emotions

58
Q

what is needed for Schizophrenia diagnosis?

A

o 1 or more positive symptoms (delusions, hallucinations or disorganized speech) along with disorganized or catatonic behaviour and/or negative symptoms (e.g. reduced emotional expression, or avolition) that have been present a sig amount of time during 1 month period (unless treated successfully)
o Lower than previous levels of functioning in 1 or more areas for a significant portion of the time since onset of the disorder.
o at least 6 months with at least 1 month of symptoms meeting the first criterion.

59
Q

Exclusion criteria for schizophrenia?

A

o Ruling out schizoaffective disorder, depressive or bipolar disorder with psychotic features, due to lack of manic or major depressive episodes or, in the presence of mood disorders, they were present for a minority of the time.

60
Q

what are the specifiers for schizophrenia ?

A

o available for denoting course of the disorder (e.g., first episode) with catatonia, and severity of symptoms

61
Q

what is social anxiety?

A

o Characterized by intense fear of social situations in which the individual may be negatively evaluated by others
o May relate to fear of displaying the symptoms of anx, or be more general fear of judgement as being somehow inferior and rejection.

62
Q

Diagnosis for social anxiety

A

o Anxiety in social situations must be consistent but may vary across different situations (anticipatory, or panic attack)
o Social situations either avoided or endured with difficulty
o Anx is out of proportion to the threat posed and is persistent – 6 months of longer
o Avoidance/distress = clin sig.

63
Q

what is the specifier for social anxiety?

A

o Individuals who only show in the context of performance which impacts on profession.

64
Q

what are substance use disorders?

A

o Cognitive, behavioural and physical symptoms that indicate continued use in the face of significant substance-related problems

65
Q

how to diagnose substance use disorders?

A

o 10 classes of substances considered within the disorders and specific symptoms may vary
o Diagnosis based on a pathological pattern of behaviours related to using the substance. These criteria are grouped as follows:
- Impaired control
- Social impairment or failure to fulfil important obligations
- Risky use
- Pharmacological criteria: Tolerance and withdrawal symptoms are not required for diagnosis of the disorder but are helpful in gauging the severity of the disorder and danger of relapse.

66
Q

what are cluster C personality disorders?

A

‘Unusual or odd behaviors’

Avoidant
Dependent
Obsessive-compulsive

ODD = DAO

67
Q

What are cluster B personality disorders?

A

‘dramatic or emotional behaviors’

BPD
Antisocial
Histrionic
Narcissistic

B = BAHN

68
Q

What are cluster A personality disorders?

A

‘Anxious or fearful behaviors’

Paranoid
Schizoid
Schizotypal

A = Anx - PSS

NPE (6 decks)

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