DSM criteria Flashcards

Question

# male hypoactive sexual desire disorder other info

Answer 1

**Prevalence**: only a small proportion of men have a persistent, distressing lack of desire - 1.8% (16-44) **Development and course** - Short-term changes are not diagnosed - Normative age-related decline in sexual desire **Risk/prognostic factors** - Temperamental: mood and anxiety disorders appear as strong predictors + low self-esteem affects sexual desire - Environmental: alcohol use + sociacultural context - Genetic and physiological: endocrine disorders, age & testosterone (unclear) **Differential diagnosis** - Nonsexual mental disorders - Substance/medication use - may explain lack of desire - Another medical condition - if present, no diagnosis - Interpersonal factors - if present, no diagnosis - Other sex dysfunctions - can co-occur **Comorbidities** - Depression/other mental disorders - Endocrinological factors

Answer 2

A. A persistent or recurrent pattern of **ejaculation occurring during partnered sexual activity within approx 1 minute following vaginal penetration and before the individual wishes it** B. Symptoms must be present for at least **6 months** and experienced on most occasions of sex C. Symptoms cause distress D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress/other sig stressors; not due to medication/substance or another mental condition Specify whether: Lifelong / acquired Generalized / situational Specify severity

Answer 3

Self-reported estimates are sufficient 1 minute is an appropriate cutoff for early ejaculation in lifelong premature ejaculation Similar across sexual orientations **Associated features:** - Often complain of a sense of lack of control over ejaculation - Report apprehension about their anticipated inability to delay ejaculation

Answer 4

**Prevalence**: 1%-3% would be diagnosed - However, 20-30% of males report concern about how rapidly they ejaculate **Development and course** - Some men may experience EE during initial encounters but gain ejaculatory control over time - Acquired: usually appears around 40 yrs - little known about this - Age and relationship length negatively associated with prevalence **Risk and prognostic factors** - Temperamental: may be more common in men with anxiety disorders, especially social phobia - Genetic and physiological: moderate genetic contribution of lifelong EE + thyroid disease, prostatitis, drug withdrawal **Differential diagnosis** - Substance/medication induced sexual dysfunction - Ejaculatory concerns that do not meet criteria → necessary to identify males with normal latencies who desire longer latencies and males who have episodic premature ejaculation (in these cases, no diagnosis) **Comorbidity** - Associated with erectile problems - Lifelong may be associated with certain anxiety disorders - Acquired premature ejaculation: prostatitis, thyroid disease & drug withdrawal

Answer 5

A. Presence of either of the following experienced on almost all/all (75%-100%) occasions of sex 1. Marked **delay in/infrequency of/absence of orgasm** 2. Markedly **reduced intensity of orgasmic sensations** B. Symptoms persist for a minimum duation of approximately **6 months** C. Symptoms cause clinically sig distress D. Not better explained by.... Specify if: - Lifelong/acquired - Generalized/situational - Never experienced an orgasm under any situation Specify severity

Answer 6

Women vary widely in their ability/intensity of orgasm - also vary in subjective descriptions The causes are usually multifactorial or cannot be determined If interpersonal or significant contextual factors exist → then a diagnosis would not be made A woman's experiencing orgasm through clitoral stimulation but not during intercourse would not meet criteria **Associated features supporting diagnosis:** - Generally, associations between specific patterns of personality traits/psychopathology and orgasmic dysfunction - not supported - Orgasm difficulties often co-occur w/problems related to sexual interest and arousal

Answer 7

**Prevalence**: rates for female orgasmic problems vary from 10-42% - however, these estimates don't take into account the presence of distress **Development and course**: - Women show more variety in age of first orgasm and reports increase with age - Many women learn to experience orgasm **Risk and prognostic factors**: - Temperamental: anxiety, concerns about pregnancy, etc., - Environmental: strong association between relationship problems, physical/mental health & sociocultural factors - Genetic and physiological: many physiological factors influence **Differential diagnosis**: - Nonsexual mental disorders - Substance/medication - Interpersonal factors - Other sexual dysfunctions- may occur in association with other sexual dysfunctions **Comorbidity**: OD female may have co-occurring sexual interest/arousal difficulties

Answer 8

A. **Lack of, or sig reduced, sexual interest/arousal, as manifested by at least 3 of the following** - Absent/reduced interest in sexual activity - Absent/reduced sexual/erotic thoughts or fantasies - No/reduced initiation of sexual activity, and typically unreceptive to partner's initiations - Absent/reduced sexual excitement during sexual activity in almost all sexual encounters - Absent/reduced interest/arousal in response to any sexual/erotic cues - Absent/reduced genital/nongenital sensations during sex B. Symptoms persists for approx 6 months C. Symptoms cause clinical sig distress D. Not better explained by.... Specify if: - Lifelong/acquired - Generalized/situational - Never experienced an orgasm under any situation Specify severity

Answer 9

Difficulties in desire and arousal often simultaneously characterize the complaints of women with this disorder Short-term changes in sexual interest/arousal are common and may be adaptive responses to events in a women's life and do not represent a sexual dysfunction **Associated features supporting diagnosis:** - FSIAD is frequently associated with problems in experiencing orgasm, pain during sex, infrequent sexual activity, and couple-level discrepancies in desire - Relationship difficulties and mood disorders are also common - Unrealistic expectations and norms regarding the 'appropriate' level of sexual interest along with poor sexual techniques/lack of info about sexuality

Answer 10

**Prevalence**: unknown - too varied across settings and factors **Development and course**: - There are normative changes in sexual interest and arousal across the life span - desire may decrease w age **Risk and prognostic factors**: - Temperamental: neg cog about sexuality and past history of mental disorders - Environmental: incl., relationship difficulties, partner sexual functioning, and developmental history - Genetic and physiological: appears to be a strong influence of genetic factors on vulnerability to sexual problems in women **Differential diagnosis**: - Nonsexual mental disorders: depressive disorders - Substance/medication use - Another medical condition - if yes, no diagnosis - Interpersonal factors - if yes, no diagnosis - Other sexual dysfunctions: can be comorbid - Inadequate or absent sexual stimuli - important to assess the adequacy of sexual stimuli within the women's sexual experience **Comorbidity:** - Depression, thyroid problems, anxiety, urinary incontinence, etc., - IBS - Depression - Sexual/physical abuse in adulthood

Answer 11

A. **Persistent or recurrent difficulties with 1 (or more) of the following**: - Vaginal penetration during intercourse - Marked vulvovaginal or pelvic pain during vaginal intercourse/penetration attempts - Marked fear/anxiety about this pain in anticipation/during/or as a result of vaginal penetration - Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration B. symptoms persist for approximately 6 months C. symptoms cause clinically sig distress D. Not better explained by... Specify whether: - Lifelong / acquired - Generalized / situational Specify severity

Answer 12

4 commonly comorbid symptom dimensions 1. Difficulty having intercourse 2. Genito-pelvic pain - usually characterized as superficial or deep 3. Fear of pain or vaginal penetration - avoidance similar to phobia 4. Tension of the pelvic floor muscles - can vary from reflexive-like spasms to voluntary muscle guarding Diagnosis can be made just based on one but all should be assessed **Associated features supporting diagnosis:** - Frequently associated with other sexual dysfunctions - Sometimes desire/interest is preserved in sexual situations that do not require penetration - Avoidance of gynecological examinations despite medical recommendations is also frequent - Symptoms significantly diminish feelings of femininity

Answer 13

**Prevalence** - unknown, however, approx 15% of US women report pain during sex **Development and course:** - Generally unclear - Because women don’t seek treatment till they experience problems in sexual functioning, it is difficult to characterize it as lifelong or acquired - Complaints peak during early adulthood and in the peri- postmenopausal period **Risk and prognostic factors**: - Environmental: sexual and physical abuse often listed - Genetic and physiological: onset of pain is sometimes linked to a history of vaginal infections **Differential diagnosis**: - Another medical condition - common - Somatic symptom and related disorders - not clear whether the two can be differentiated as they are relatively new disorders - Inadequate sexual stimuli - if inadequate foreplay arousal this may lead to pain **Comorbidity:** - Common with other sexual difficulties - Relationship distress - Disorders related to the pelvic floor/reproductive organs

Answer 14

A. A predominant complaint of **dissatisfaction with sleep quality or quality**, associated with one or more of the following: 1. **Difficulty initiating sleep** 2. **Difficulty maintaining sleep**, characterized by frequent awakenings or problems returning to sleep after awakenings 3. **Early-morning awakening** with inability to return to sleep B. The sleep disturbance causes clinically significant distress/impairment C. The sleep difficulty occurs at least **3 nights per week** D. Is present for at least **3 months** E. It occurs despite adequate opportunity for sleep F. Not better explained by and does not occur exclusively during the course of another sleep-wake disorder G. The insomnia is not attributable to the physiological effects of a substance H. Coexisting mental disorders do not adequately explain the predominant complaint of insomnia Specify if comorbid Specify if: - **Episodic**: symptoms last at least 1 month but less than 3 months - **Persistent**: symptoms last 3 months or longer - **Recurrent**: two (or more) episodes within the space of 1 year

Answer 15

Different manifestations of insomnia can occur at different times of the sleep period Difficulty maintaining sleep is the most common single symptom of insomnia, followed by difficulty falling asleep **Nonrestorative sleep** = a complaint of poor sleep quality that doesn't leave the indiv rested upon awakening despite adequate duration **Associated features supporting diagnosis:** - A preoccupation with sleep and distress due to the inability to sleep may lead to a **vicious cycle** → the more the individual strives to sleep, the more frustration builds and further impairs sleep - Inso may be accompanied by a variety of daytime complaints and symptoms - incl fatigue, decreased energy, and mood disturbances

Answer 16

**Prevalence**: around 30% of adults report insomnia symptoms - Around 6-10% have symptoms meeting disorder criteria - Generally, most prevalent of all sleep disorders - More common among females - Most commonly observed as a comorbid condition with another medical condition/mental disorder **Development and course:** - First episode is more common in young adulthood - Situational (acute) insomnia: usually lasts a few days/weeks and is often associated with life events or rapid changes in sleep schedules or environment - Episodic insomnia: recurrent episodes of sleep difficulties associated with the occurrence of stressful events **Risk and prognostic factors:** - Temperamental: anxiety or worry-prone personality/cog styles, increased arousal predisposition, and tendency to repress emotions - Environmental: noise, light, temperature, and high altitude may increase vulnerability - Genetic and physiological: female gender, and advancing age + insomnia is heritable **Differential diagnosis:** - Breathing-related sleep disorders: as many as half of individuals with sleep apnea may report insomnia symptoms, a feature that is more common among females and older adults - Narcolepsy: may cause insomnia, but it's distinguished by the predominance of symptoms of excessive daytime sleepiness, cataplexy, sleep paralysis and sleep-related hallucinations - Parasomnias: characterized by a complaint of unusual behaviors or events during sleep that may lead to intermittent awakenings and difficulty resuming sleep' - Substance/medication-induced sleep disorder, insomnia type **Comorbidity**: - Insomnia is a common comorbidity of many medical conditions - Mental disorders: most common are bipolar, depressive, and anxiety disorders - Insomnia patients may misuse medication or alcohol to help with nighttime sleep, anxiolytics to combat tension/anxiety, and caffeine to combat excessive fatigue

Answer 17

A. **Self-reported excessive sleepiness** (hypersomnolence) despite a main sleep period lasting at least 7 hours, with **at least one of the following**: - Recurrent periods of sleep or lapses into sleep within the same day - A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing) - Difficulty being fully awake after abrupt awakening B. Hypersomnolence occurs at least **3 times per week**, for at least **3 months** C. Causes significant distress/impairment D. Not better explained by and doesn't occur exclusively during the course of another sleep disorder E. Not attributable to a substance F. Comorbid disorders don't explain the predominant complaint of hypersomnolence Specify if: - Acute: less than 1 month - Subacute: 1-3 months - Persistent: more than 3 months Specify severity - Mild: difficulty maintaining alertness 1-2 days/week - Moderate: difficulty maintaining alertness 3-4 days/week - Severe: difficulty maintaining alertness 5-7 days/week

Answer 18

A. Recurrent periods of an **irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day**. Must occur at least **3 times per week over 3 months** B. Presence of at least one of the following: 1. **Episodes of cataplexy**, defined as either (a) or (b), occurring at least a few times per month a. In individuals with long-standing disease, brief episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking b. In children/individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers 2. **Hypocretin deficiency** as measured using cerebrospinal fluid 3. **Polysomnography showing REM sleep latency less than/equal to 15 minutes**, or a multiple sleep latency test showing a mean sleep latency less/equal to 8 minutes and two or more sleep-onset REM episodes

Answer 19

A. Either (1) or (2): 1. Evidence by polysomnography of **at least 5 obstructive apneas or hypopneas per hour of sleep and either of the following**: -Nocturnal breathing disturbances; snoring, snorting, breathing pauses, etc., -Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities 2. Evidence by **polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep** regardless of accompanying symptoms Specify severity: - Mild: Apnea hypopnea index less than 15 - Moderate: Apnea hypopnea index is 15-30 - Severe: Apnea hypopnea index is greater than 30 Severity is measured by a count of the number of apneas plus hypopneas per hour of sleep (apnea hypopnea index) using polysomnography

Answer 20

**OSAH is the most common breathing-related sleep disorder** Characterized by repeated episodes of upper airway obstruction (apneas and hypopneas) during sleep **Apnea** refers to the total absence of airflow, and **hypopnea** refers to a reduction in airflow Diagnosed on the basis of polysomnographic findings and symptoms If evidence of 15 or more OSAH per hour of sleep, the diagnosis can be made in the absence of other symptoms **Associated features supporting diagnosis:** - Bc of sleep disturbance, indiv may report symptoms of insomnia - Other common symptoms are heartburn, nocturia, morning headaches, dry mouth, erectile dysfunction, and reduced libido - Hypertension may occur in 60% of patients

Answer 21

**Prevalence**: 1%-2% of children, 2%-15% of middle-aged adults, and more than 20% of older individuals - May be particularly high among: males, older adults, obese individuals & certain racial/ethnic groups **Development and course:** - Age distribution follows a J-shaped distribution = some observations at one end, very few in the middle, and a large number at the end - Course in older age is unclear - Usually has an insidious onset, gradual progression, and persistent course **Risk and prognostic factors:** - Genetic and physiological: the major risk factors are obesity and male gender + genetic syndromes that reduce upper airway patency, menopause and various endocrine symptoms + strong genetic basis **Differential diagnosis:** - Primary snoring and other sleep disorders: differentation requires polysomnography - Insomnia disorder: may coexist → diagnose both - ADHD: ADHD in children may include symptoms that may also be the result of symptoms of OSAH - Substance/medication **Comorbidity:** - Heart diseases, diabetes, systemic hypertension - Depression

Answer 22

A. Evidence by polysomnography of **5 or more central apneas per hour of sleep** B. Not better explained by another current sleep disorder Specify whether: - **Idiopathic central sleep apnea**: caused by variability in respiratory effort but without evidence of airway obstruction - **Cheyne-stokes breathing**: a pattern of periodic crescendo-decrescendo variation in tidal volumes leading to apneas - **Central sleep apnea w comorbid with opioid use**: pathogenesis attributed to the effects of opioids on the respiratory rhythm Different from OSAH because the throat muscles relax and block the airway It occurs because the **brain doesn't send proper signals to the muscles that control breathing** - i.e., not a physical obstruction but rather a lack of communication between the brain and the muscles that control breathing

Answer 23

A. Polysomnography demonstrates **episodes of decreased respiration associated with elevated CO2 levels** - Note: in the absence of objective measurement of CO2, persistent low levels of hemoglobin oxygen saturation may indicate hypoventilation B. Not better explained by another current sleep disorder Specify if: - Idiopathic hypoventilation - not attributable to any readily identified condition - Congenital central alveolar hypoventilation - Comorbid sleep-related hypoventilation

Answer 24

A. A persistent/recurrent pattern of **sleep disruption** that is primarily due to an **alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual's social/proffesional schedule** B. This leads to excessive sleepiness, insomnia, or both C. This causes clinically significant distress or impairment Specify if: - **Delayed sleep phase type**: a pattern of delayed sleep onset and awakening times, with an inability to fall asleep and awaken at a desired / normative time - **Advanced sleep phase typ**e: a pattern of advanced sleep onset and awakening times, with an inability to remain awake or asleep until the desired time - **Irregular sleep-wake type**: disorganized pattern, such that the timing of sleep and wake periods is variable throughout the 24-hour period - **Non-24-hour sleep-wake type**: a pattern of sleep-wake cycles that is not synchronized to the 24-hour environment, with a consistent daily drift (usually to later and later times) of sleep onset and wake times - **Shift work type**: alterations due to a shift in work schedule requiring unconventional work hours - **Unspecified**

Answer 25

A. Recurrent episodes of **incomplete awakening from sleep**, usually occurring during the first third of the major sleep episode, **accompanied by either one of the following**: - **Sleepwalking**: repeated episodes of rising from bed during sleep and walking about - **Sleep terrors**: recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream B. **No or little** (e.g., only a single visual scene) **dream imagery is recalled** C. **Amnesia** for the episode is present D. Episodes cause clinically significant distress/impairment E. Not attributable to a substance F. Comorbid disorders don't explain this Specify whether: - Sleepwalking type - specify if: with sleep-related eating or with sleep-related sexual behavior (sexsomnia) - Sleep terror type

Answer 26

A. Repeated occurrences of **extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity** that usually occur during the 2nd half of the major sleep episode B. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert C. Causes distress/impairment D. Not attributable to substance E. Not explained by comorbidities Specify if: during sleep onset Specify if: - W/associated non-sleep disorder - W/associated other medical condition - W/associated other sleep disorder Specify if: - Acute: 1 month or less - Subacute: more than 1, less than 6 months - Persistent: more than 6 months Specify severity: - Mild - less than one episode per week on average - Moderate - one or more per week but not nightly - Severe - every night

Answer 27

A. Repeated **episodes of arousal during sleep associated with vocalization and/or complex motor behaviors** B. The behaviors **arise during REM sleep** and therefore usually occur more than 90 min after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occurring during daytime naps C. Upon awakening, the individual is **completely awake, alert and not confused or disoriented** D. Either of these: - REM sleep without atonia or polysomnographic recording - A history suggestive of REM sleep behavior disorder and established synucleinopathy diagnosis (e.g., parkinson's) E. Distress/impairment F. Not substance G. Not explained by comorbidity

Answer 28

A. An **urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs**, characterized by all of the following; - The urge begins or worsens during periods of rest/inactivity - The urge is partially or totally relieved by movement - The urge is worse in the evening or at night than during the day, or occurs only in the evening or at night B. symptoms occur at least 3 times per week and have persisted for at least 3 months C. Distress/impairment D. Not substance E. Not explained by comorbidity

Answer 29

A. A prominent and severe **disturbance in sleep** B. There's evidence from the history, physical examination, or lab findings of both (1) and (2): - The symptoms in Crit A **developed during or soon after substance intoxication or after withdrawal** from or exposure to a medication - The **involved substance is capable of producing the symptoms** in criterion A C. Not better explained by a sleep disorder that is not substance/medication-induced D. Doesn't occur exclusively during the course of delirium E. Causes distress/impairment