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DSM 5 first 8 weeks > DSM 5 First 8 weeks > Flashcards

DSM 5 First 8 weeks Flashcards

1
Q

What is a Mental State?

A

Sensorium
1. a sensory nerve center.

2. the state of an individual as regards to	 	    consciousness or mental awareness.
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2
Q

Thoughts

A

ideas, concepts

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3
Q

Feelings

A

subjective emotional states

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4
Q

Perceptions

A

functioning of 5 senses

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5
Q

Cognitions

A

abilities of intelligence, memory, attention, calculations

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6
Q

Behaviors

A

actions

outward manifestations of internal mental states

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7
Q

What is a Mental Disorder?

A

Thoughts delusions, thought disorder

Feelings depression, anxiety, mania

Perceptions hallucinations (5 senses)

Cognitions memory disturbance, orientation

Behaviors compulsions, violence, suicide

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8
Q

Normal versus Abnormal

A

Clinically significant distress or impairment in social/occupational/relational functioning

Causes suffering

Viewed as “illness” out of the ordinary

Everyone experiences levels of suffering

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9
Q

Problems in living and “mental disorders

A

Problems: difficulties of every day life

	miserable, yet differ in magnitude 		& impairment

Disorders: significant impairment

	consistent
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10
Q

Symptoms & Signs

A

Symptoms: expressed subjectively

		unobservable

		must be reported

Signs: observable

		affect

		behavior
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11
Q

The DSM: Descriptive vs. Explanatory

A

No theoretical explanations for psychological events

Describes & categorizes

Describes subjective experience

“Precise description and categorization of abnormal experience”

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12
Q

The Diagnostic Exam

A

Introduction: how person would like to be addressed?

		set expectations; explain 				interview

		“What are you hoping to obtain 			help with?”

Listen: uninterrupted speech guides your MSE

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13
Q

The Diagnostic Exam,History of Present Illness:

A

“why now”?

last time person felt emotionally well

precipitating factors; extenuating 	circumstances

perceived level of impairment
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14
Q

The Diagnostic Exam,Past Psychiatric History:

A

first notice symptoms?

first sought treatment?

hospitalization; how many times, for how long?

medications; frequency/dose; effectiveness

ECT
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15
Q

The Diagnostic Exam, Safety:

A

harm to self: previous attempts
history of in family

harm to others:	people
			animals
			property

threats

aggression

theft
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16
Q

The Diagnostic Exam, Review of Systems

A

MOOD: have you been feeling sad, blue, irritable, depressed?

	loss of interest

	feeling different than “normal”

	periods of mood elevation
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17
Q

The Diagnostic Exam:Psychosis:

A

seeing things, visions, hearing things

	people following you

	special powers: mind reading

	messages from television/radio
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18
Q

The Diagnostic Exam:Anxiety:

A

past several months have you frequently worried about a number of things in your life?

	objects, places, situations

	panic or panic attacks
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19
Q

The Diagnostic Exam, Obsessions & Compulsions:

A

do you frequently experience unwanted thoughts, images or urges?

any physical acts you feel you have to do?
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20
Q

The Diagnostic Exam, Trauma:

A

worst thing ever happened?

		witness/experienced event in 			which self/others seriously 				injured?

		abuse?
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21
Q

The Diagnostic Exam, Dissociation:

A

trouble remembering?

		loss of time

		feeling detached from body

		experiencing others as “unreal”
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22
Q

The Diagnostic Exam, Somatic Concerns:

A

worry; illnesses

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23
Q

The Diagnostic Exam, Eating/Feeding:

A

appearance; restrictions

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24
Q

The Diagnostic Exam, Sleeping:

A

inadequate; poor quality

			lapses into; increased 					need

			unusual behaviors

			early morning wakening
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25
Q

Mental Status Examination

A 
Appearance
Behavior
Speech
Mood
Affect
Thought Process {Form}
Thought Content
Cognition & Intellectual Resources
Insight & Judgment
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26
Q

Neurodevelopmental Disorders

first appear in early developmental periods

A 
Intellectual Disability		
	Assesses:	cognitive capacity (IQ)
			adaptive functioning
New Additions:
	Communication Disorders
	Autism Spectrum Disorders

Changes:
Attention-Deficit/Hyperactivity Disorder (lifespan)
Specific Learning Disorder (reading &math etc.)

Inclusions: Motor Disorders

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27
Q

Intellectual Disability Disorder (pg.33)
319 (ICD 9)
(Intellectual Developmental Disorder; ICD terminology)

A 
Deficits:	intellectual functioning  
			IQ 70 (two standard deviations 						from the mean)
			reasoning
			problem solving
			planning
			abstract thinking
			judgment
			academic learning
Confirmed by assessment & standardized intelligence testing
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28
Q

Deficits: Adaptive Functioning

A

does not meet sociocultural & developmental standards for personal independence and social responsibility

limit functioning in 1 or more activities daily life
	communication
	social participation
	independent living

Across multiple environments:
school, home, work, community

Onset: developmental period (before school)

29
Q

Development & Course

A 
Onset:  intellectual/adaptive deficits
	during developmental period
		age & characteristics determined by: 
			etiology & 
			severity of brain dysfunction
First 2 years of life; severe intellectual disability: 
	delayed milestones:
		social 	
		motor
		language

School age: mild disabilities

30
Q

Neurodevelopmental Disorders

A

Acquired (rather than genetic) form of ID:
head trauma/TBI
meningitis
encephalitis

When disability secondary to loss of previously acquired cognitive skills: may diagnose both:
Intellectual Disability
Neurocognitive Disorder

Prevalence: 6 per 1000
Males more often diagnosed than females

31
Q

Neurodevelopmental Disorders

A

Communication Disorders

Onset: childhood
steady course
usually lifelong functional impairment

Deficits: Speech: expressive production of sounds

	Language:		form, function & use of 						symbols

	Communication: verbal/nonverbal 							  beha
32
Q

Social (Pragmatic) Communication Disorder

315.39 (F80.89) page 47

A

Pragmatic language: using language appropriately
(5 yrs. of age)
Persistent difficulties in the social use of nonverbal/verbal communication: (all areas)
deficits in communication for social reasons

difficulty/inability to match communication to 	context or needs of the listener

difficulty following conversation rules

difficulties understanding inferences, metaphors
33
Q

Autism Spectrum Disorder 299.00 (F84.0)

Pg. 50

A

A. Persistent deficits in social
communication/interaction across multiple
settings
social-emotional reciprocity

nonverbal communicative behaviors

developing, maintaining & understanding 				relationships

Severity: see table 2: page 52

34
Q

Autism Spectrum Disorder, repetitive patterns of behavior, interests or activities

A

stereotyped/repetitive motor movements

insistence on sameness; inflexible adherence 	to routines

highly restricted, fixated interests; abnormal in 	intensity or focus

hyper- or hyporeactivity to sensory input

Specify severity: table 2 (page 52)

35
Q

Autism Spectrum Disorder,

A

Symptoms present in early developmental period
may not manifest until social demands exceed individual capacity

Clinically significant impairment in social, occupational & other areas of functioning

DSM-IV-TR
autistic disorder
PDD-NOS Autism Spectrum Disorder
Asperger’s

Marked deficits in social communication; no ASD criteria: Social (pragmatic) Communication Disorder

36
Q

Attention-Deficit/Hyperactivity Disorder pg. 59

A

A persistent pattern of inattention and/or
hyperactivity-impulsivity which interferes with
functioning or development

Inattention: 6+ sx Inattention cont.
does not follow through on instructions; fails to do home work

difficulty organizing tasks & activities

avoids/reluctant/dislikes tasks which require 	sustained levels of attention

looses things

easily distracted

forgetful \+ months
fails to give attention to details; careless 	mistakes

difficulty sustaining attention

doesn’t seem to listen when spoken to directly
37
Q

Attention-Deficit/Hyperactivity Disorder pg. 59

A

Hyperactivity & Impulsivity: 6+ sx. 6+ mos.
fidgets, taps hands/feet; squirms

leaves seat in seated situations

runs/climbs about when not appropriate

unable to play quietly; interrupts & intrudes

“on the go”  “driven by a motor”

blurts out answers 

difficulty taking turns
38
Q

Attention-Deficit/Hyperactivity Disorder

A

Several inattentive or hyperactive-impulsive
symptoms were present
prior to age 12

are present in two or more settings

Specifiers: pp. 58-59

Co-Occurring:
language/ motor/social development delays

Associated Features:
irritability, mood lability; low frustration tolerance

39
Q

Attention-Deficit/Hyperactivity Disorder

A

Development:

preschool: hyperactivity
elementary: inattention
adolescence: fidgetiness, jitteriness, 				restlessness, impatience

More common in males

More likely to develop conduct disorder > antisocial personality disorder

More likely to be: injured/ more accidents
obese
substance use disorders

40
Q

Tic Disorders: page 81

A

Tic: sudden, rapid, recurrent, nonrhythmic motor movement or vocalization

Onset: before age 18

Tourette’s Disorder: 307.23 (F95.2)

Persistent (Chronic) Motor or Vocal Tic Disorder
307.22 (F95.1)

Provisional Tic Disorder: 307.21 (F95.0)

41
Q

Schizophrenia Spectrum & Other Psychotic Disorders

A

schizotypal personality disorder
delusional disorder
brief psychotic disorder
schizophreniform disorder
substance/medication induced psychotic disorder
psychotic disorder/another medication condition
attain associated with another mental disorder
catatonic disorder due to another medication condition

42
Q

Schizophrenia Spectrum & Other Psychotic Disorders,Abnormalities in one or more:

A

delusions

hallucinations

disorganized thinking (speech)

disorganized(grossly)or abnormal behavior
	include catatonia

negative symptoms
43
Q

Schizophrenia Spectrum & Other Psychotic Disorders Delusions

A

persecutory: fear of being harmed
referential: comments/gestures >at oneself
somatic: preoccupation health/organs
erotomanic: other person in love with
grandiose: belief of exceptional abilities
nihilistic: major catastrophe will occur

44
Q

Schizophrenia Spectrum & Other Psychotic Disorders, Delusions

A

Bizarre:
impossible; out of cultural realm

typically involves loss of control over mind and/or 	body
	thought withdrawal
	thought insertion
	delusions of control

Nonbizarre:
plausible; highly unlikely

45
Q

Schizophrenia Spectrum & Other Psychotic Disorders

Hallucinations

A

Disturbance in perceptions
no outside stimulus
involuntary
clear & vivid

Auditory: most common
voices (familiar or unfamiliar)
separate from one’s thoughts

Hypnogogic & Hypnopompic
occur while falling to/waking up from sleep
within range of normal experience

46
Q

Schizophrenia Spectrum & Other Psychotic DisordersDisorganized Thinking (Speech)

A

Formal thought disorder
inferred by disorganized speech

substantially impairs effective communication

	derailment/loose associations
		topic to topic

	word salad/incoherence

	tangential
		answers mildly related
47
Q

Schizophrenia Spectrum & Other Psychotic Grossly Disorganized or Abnormal Motor Behavior(Includes Catatonia)

A

Manifestations:
silliness
unpredictable agitation
unable to perform ADLs

Catatonic Behavior:
decreased reactions to environmental stimuli

Negativism- resists directions/instructions
Mutism & stupor- lack of verbal/motor responses
Catatonic excitement: purposeless & excited motor activity

48
Q

Schizophrenia Spectrum & Other Psychotic Catatonic Features

A

rigid, inappropriate or bizarre posture

stereotyped movements (stereotypy)
rocking; marching in place, caressing self
crossing/uncrossing legs

staring

grimacing

mutism

echoing of speech

49
Q

Schizophrenia Spectrum & Other Psychotic

Negative Symptoms

A 
Most prominent in Schizophrenia:
	diminished emotional expression
		reductions in expression:
			face
			eye contact
			prosody        (rhythm/intonation speech)
			hand/head/face movements
avolition
	reduction in self-initiated activities
		long periods of sitting
		disinterest in social activities
50
Q

Schizophrenia Spectrum & Other Psychotic

Negative Symptoms

A

Alogia: reduction in speech output

Anhedonia: decreased ability to experience pleasure

Asociality: lack of interest in social interactions

51
Q

Schizophrenia Spectrum & Other Psychotic Disorders presented with gradient of psychopathology

A

Practitioners:

consider least severe first

	then review time-limited conditions

		exclude all other conditions which may 				present with psychosis.
52
Q

Schizophrenia Spectrum & Other Psychotic
Assessment Measures
psychiatry.org/dsm5
see page 734

A

Administer at the initial client/patient interview

Monitors client progress

Level 1 questions: brief survey of 13 domains for adults

			12 domains for child and 						adolescent clients

Level 2 questions: more in-depth assessment of certain domains.

53
Q

Schizophrenia Spectrum & Other PsychoticSchizophrenia Spectrum & Other Psychotic
Assessment Measures
psychiatry.org/dsm5
see page 734

A

Severity Measures: disorder specific
correspond to diagnostic criteria

Review Assessment Measures page 742-743:

symptom severity predicts degree of cognitive and/or 	neurobiological deficits
	reviews primary symptoms of psychosis
		hallucinations
		disorganized speech
		disorganized behavior
		delusions
		negative symptoms
54
Q

Schizophrenia Spectrum & Other Psychotic

Delusional Disorder297.1 (F22)

A

Diagnostic Criteria: page 90

Specify Subtypes:
	erotomanic
	grandiose
	jealous
	persecutory
	somatic
	mixed		no one theme predominant
	unspecified	dominant belief not described in types or 			cannot be clearly determined
55
Q

Schizophrenia Spectrum & Other Psychotic

Delusional Disorder297.1 (F22)

A

Specify:
with bizarre content

Course Specifiers:
only use after 1 year duration of the disorder

Severity Specifiers:		
	quantitative 
	last 7 days
	assesses primary symptoms of psychosis
		use Assessment Measures (pp. 743-744)
56
Q

Schizophrenia Spectrum & Other Psychotic

Delusional Disorder

A

Specify:
with bizarre content

Course Specifiers:
only use after 1 year duration of the disorder

Severity Specifiers:		
	quantitative 
	last 7 days
	assesses primary symptoms of psychosis
		use Assessment Measures (pp. 743-744)
57
Q

Schizophrenia Spectrum & Other Psychotic

Delusional Disorder

A

Associated Features:

factual insight; not true insight

legal difficulties

irritable, dysphoric mood

litigious/antagonistic behavior

anger & violence
	persecutory
	jealous
	erotomanic
58
Q

Schizophrenia Spectrum & Other Psychotic

Delusional Disorder

A

More prevalent in adults

May develop schizophrenia

Strong familial relationship:
schizophrenia
schizotypal personality disorder

Functional impairment more limited
relationship distress generally due to delusional beliefs

behavior/appearance “normal”
59
Q

Schizophrenia Spectrum & Other Psychotic

Brief Psychotic Disorder298.8 (F23)

A

Diagnostic Criteria: page 94

Subtypes: none

Specify:
with marked stressors
(brief reactive psychosis)

without marked stressors

with postpartum onset
	during pregnancy
	4 weeks postpartum
60
Q

Schizophrenia Spectrum & Other Psychotic

Brief Psychotic Disorder

A 
Associated Features:
	emotional upheaval
	rapid, intense affect shifts
	increase suicide risk (acute episode)
	severe level of impairment
		supervision required
		poor judgment
		cognitive impairments
		delusions

Onset:
average age mid 30s

Predisposition: schizotypal/borderline personality disorders

61
Q

Schizophrenia Spectrum & Other Psychotic

Schizophreniform Disorder

A

Diagnostic Criteria: pages 96-97

Specify:
	with good prognostic features
		two of the following are present
			*good premorbid functioning
			*onset of psychotic symptoms within 4 			  weeks
			*confusion/perplexity
			*no blunted/flat affect
	without good prognostic features
with catatonia
62
Q

Schizophrenia Spectrum & Other Psychotic

Schizophreniform Disorder

A

Severity Specifiers
quantitative assessment of primary symptoms of psychosis

Diagnostic Features
	Schizophreniform Disorder is distinguished from 	Schizophrenia
		duration of symptoms	
			at least 1 month
			less than 6 months
does not have functional impairment requirement

2/3 diagnosed > schizophrenia or schizoaffective

63
Q

Schizophrenia Spectrum & Other Psychotic

Schizophrenia

A 
Associated Features:
	inappropriate affect
	dysphoric mood
	disinterest in eating
	depersonalization		(disengaged)
	derealization			(surroundings not real)
	somatic
	anxiety/phobias
	sensory processing
	cognitive deficits
64
Q

Schizophrenia Spectrum & Other Psychotic

Schizophrenia

A 
Associated Features (cont.)
	anosognosia:		unaware of illness
				{treatment noncompliance}
**aggression:		more frequent in males

			past history of violence, 					substance, impulsivity
Course Development:
	late teens – mid 30s
	first psychotic episode
		males:		early 20s
		females: 	late 20s
65
Q

Schizophrenia Spectrum & Other Psychotic

Schizophrenia

A

Course Development cont.

onset typically insidious
earlier onset > poorer prognosis

Higher risk of suicide
command response

Significant social/occupational impairment

High comorbidity with substance-related disorders

Reduction in life expectancy

66
Q

Schizoaffective Disorder

A

Diagnostic Criteria: pg. 105
positive symptoms
AND concurrent major mood episode

Specify:
295.70 (F25.0) Bipolar Type
manic episode
295.70 (F25.1) Depressive Type

with catatonia

Course Specifiers: after one year (pg.106)

67
Q

Schizoaffective Disorder

A

Associated Features:
frequent occupational functioning impairment

less severe negative symptoms

anosognosia:		common  (poor insight)

increased risk for MDD or BD

substance related disorders  & anxiety disorders 	common

Onset: early adulthood

68
Q

Substance/Medication Induced Psychotic Disorder

A

Diagnostic Criteria: page 110
Need one or both:
hallucinations
delusions

Specify:
with onset during intoxication
with onset during withdrawal

Severity Specifiers: page111
assess primary symptoms of psychosis
each rated for severity within past 7 days

69
Q

Substance/Medication Induced

A 
Substances associated with intoxication:
	alcohol
	cannabis
	hallucinogens	(includes PCP)
	stimulants 		(includes cocaine)
	anxiolytics
	inhalants
	sedatives

With withdrawal:
alcohol hypnotics
anxiolytics “other”
sedatives

DSM 5 first 8 weeks (1 decks)

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