DSM-5-TR Diagnoses Flashcards
What’s the difference between cultural idiom of distress, cultural explanation or perceived cause, and cultural syndrome?
Cultural idiom of distress = phrase commonly used to describe problems, suffering, or symptoms in that culture (“I feel so depressed” - does not necessarily mean the person has depression, just that they are sad or feeling low)
Cultural explanation or perceived cause = what does that group attribute the cause of disorder or distress to? e.g., some cultures may attribute the cause of psychological distress to karma or schizophrenia to spirits
Cultural syndrome = a cluster of symptoms that often appear in a specific cultural group, with distinct features (may not be present in DSM)
What is the difference between subtypes and specifiers?
Subtypes = “specify whether”
Specifiers = “specify if”
What is the difference between other specified and unspecified?
Other specified -> you provide reason for why the person does not meet full diagnostic criteria, but may benefit from similar therapeutic interventions as the diagnostic category of interest
Unspecified -> you cannot provide reason for why the person does not meet full diagnostic criteria, often due to lack of testing (e.g., emergency setting, disabilities prevent testing), but may benefit from similar therapeutic interventions as the diagnostic category of interest
What does the provisional modifier mean?
Individual currently does not meet full criteria, but is expected to likely meet it in upcoming short-term (e.g., if symptoms need to be present for at least 6 months, and it is expected that they will be but it has not yet been 6 months); warrants re-evaluation to update diagnosis
What are the current three sections of the DSM-5-TR?
1 - DSM-5 Basics
2 - Diagnostic Criteria and Codes
3 - Emerging Measures and Models
What are the diagnostic groupings in the DSM-5-TR?
1 - Neurodevelopmental Disorders
2 - Schizophrenia Spectrum and Other Psychotic Disorders
3 - Bipolar and Related Disorders
4 - Depression Disorders
5 - Anxiety Disorders
6 - Obsessive-Compulsive Disorders
7 - Trauma- and Stressor-Related Disorders
8 - Dissociative Disorders
9 - Somatic Symptom and Related Disorders
10 - Feeding and Eating Disorders
11 - Elimination Disorders
12 - Sleep-Wake Disorders
13 - Sexual Dysfunctions
14 - Gender Dysphoria
15 - Disruptive, Impulse-Control, and Conduct Disorders
16 - Substance-Related and Addictive Disorders
17 - Neurocognitive Disorders
18 - Personality Disorders
19 - Paraphilic Disorders
20 - Other Mental Disorders and Additional Codes
21 - Medication-Induced Movement Disorders and Other Adverse Effects of Medication
22 - Other Conditions that may be a Focus of Clinical Attention
What is the diagnostic criteria for an intellectual developmental disorder?
A = deficits in intellectual functions confirmed by both clinical assessment and individualized standardized intelligence testing (70 +- 5 or ~2nd percentile, with margin for error)
B = deficits in adaptive functioning that limit functioning in one or more activities of daily living (i.e., conceptual, social, practical), across multiple environments (e.g., school, home, community, work)
C = onset of A + B needs to be in developmental period*
*before 18 years of age according to DSM-5-TR
*debated, AAIDD argues this should be 22
What were the key changes to diagnostic criteria for intellectual developmental disorder from DSM-IV to DSM-5?
- instead of mental retardation, it is now labelled as intellectual developmental disorder or intellectual disability
- instead of IQ, it is the adaptive functioning scores that determine severity - this is because IQ scores are less accurate on lower and upper ends of curve, and because this determines level of support that will be needed
What is the specifier for IDD?
Mild
Moderate
Severe
Profound
How would you determine severity level of IDD - conceptual domain?
Mild - likely will not notice anything in early childhood, deficits will start to present in school-age/adolescence; these will include problems in acquiring academic skills (across the board - reading, writing, math) and executive functioning skills (e.g., planning, organizing, etc.); may be described as more “concrete” learners (lots of repetition and one-on-one direct instruction required to acquire academic/conceptual skills)
Moderate - preschool years, language will likely be delayed; significant problems in acquiring academic skills; as adults, they will need ongoing assistance to complete daily conceptual tasks (someone else may take over this - such as money management)
Severe - attainment of any conceptual skills is limited, may not acquire written language; extensive caretaking will be required lifelong
Profound - conceptual understanding is stuck in physical world, at most, they can sort and use objects in a goal-directed fashion
How would you determine severity level of IDD - social domain?
Mild - capable of having social relationships (friends, partners, etc.), but will present as delayed or immature in their social capacities; for examples, may get easily manipulated by peers, not understand social cues, may not understand sarcasm; delayed language skills may further impact this if present
Moderate - spoken language is less complex than peers; may have relationships outside of family in adulthood, but may require ongoing assistance from caregivers in social interactions; will require significant supports and/or accommodations in workplace
Severe - limited spoken language, often just single words or phrases; will understand simple speech and gestures; relationships with family and familiar others can be helpful and joyful
Profound - non-verbal; may understand some simple instructions, emotional cues, or gestures; relationships with family and familiar others can be helpful and joyful
What factors can impact intellectual testing?
- Flynn effect
- practice effects
- brief or group screening tests
- highly discrepant individual subtest/index scores
- co-occurring disorders that impact communication, language, and/or motor or sensory function
- instruments normed on a different sample that is not representative of client
How would you determine severity level of IDD - practical domain?
Mild - may present with age-appropriate personal care abilities but will require some support with complex tasks such as grocery shopping, meal prepping, transportation, money management, child care, etc.; recreational skills will often resemble same-aged peers, but may be delayed in judgement around well-being and sportsmanship; can have a job that is not conceptually demanding, and may require some support in workplace
Moderate - may require extensive support in childhood and teaching/reteaching of personal care and other basic household skills, but can obtain this by adulthood; can have a job with limited social and conceptual demands, but will likely require extensive accommodations and support from employer; can develop recreational abilities, but this may be a bit delayed and require extensive teaching/reteaching
Severe - requires support for all activities of daily living (lifelong), such as meals, personal care, reactional tasks; skill acquisition will always require long-term teaching; maladaptive behaviour (including self-injury) may be present
Profound - is completely dependent on others for activities of daily living (may have additional physical impairments that make it difficult to carry out daily tasks); simple reactional activities may involve listening to music, watching movies, participating in water activities (all with assistance); maladaptive behaviour may be present
What is the prevalence of intellectual disabilities?
~0.5-1.5% (in Canada it is estimated to be around 0.2-0.5%)
- higher in lower SES countries
- slightly higher in males than females (1.6:1 for mild IDD)
When an intellectual disability results from a loss of previously acquired cognitive skills (e.g., TBI), how would you diagnose this?
both the intellectual developmental disorder and neurocognitive disorder
