DSM Disorders- Differential Crriteria Flashcards

1
Q

What is the most effective, evidence-based treatment for Bulimia Nervosa?

A

Cognitive-behavioral Therapy (CBT) – used to change underlying eating disorder cognitions & behaviors

Combined TX using pharmacotherapy + CBT = mazimum efficacy.

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2
Q

Stages Of Psychosexual Development (Freud)

A

Freud’s theory of psychosexual development proposes that = the id’s libido (sexual energy) centers on a different part of the body during each stage of development and the personality results from how conflicts are resolved at each stage

The 5 stages of development are:

  1. ) oral
  2. ) anal
  3. ) phallic
  4. ) Latency
  5. ) genital
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3
Q

DELIRIUM ? (diagnostic criteria)

A

A diagnosis of Delirium requires:
(a) a disturbance in attention & awareness that develops over a short period of time (usually hours to a few days),

Represents a change from baseline functioning,

Fluctuates in severity over the course of a day

and (b) an additional disturbance in cognition
(e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, perceptual distortions).

SX NOT due to another Neurocognitive Disorder
+
DOES NOT occur during a severely reduced level of arousal (e.g., during a coma),

**SX = are a direct result of physiological consequence of:
(A) MEDICAL CONDITION 
(B) SUBSTANCE INTOXICATION / WITHDRAWAL
                  and/or 
(C) TOXIN EXPOSURE
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4
Q

Conduct Disorder

A

The diagnosis of Conduct Disorder requires:

– persistent behavior that violates basic rights of others
AND/OR
- age-appropriate social norms /rules

*Evidenced by a min of :
1) 3 SX within the past year (12 months)
+
2) at least 1 SX in the past 6 months.

SX are divided into 4 categories:

         (1) aggression to people / animals
         (2) destruction of property
         (3) deceitfulness or theft
         (4) a serious violation of rules. 

SX = must cause significant impaired functioning
and

***CANNOT dx ADULTS (over age 18) who meet criteria for Antisocial Personality Disorder.

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5
Q

Graphic assessment techniques include:

(1) the genogram and (2) ecomap.

A

(1) the genogram = depicts family relationships over several generations + info on significant life events, family structure & roles, etc.
(2) ecomap = provides info on the strength and nature of relationships between family members and people, in the social environment.

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6
Q

Bipolar 1

A

Bipolar I Disorder requires:
– at least 1 manic episode that lasts for at least 1 week
–is present most of the day nearly every day
–and includes at least 3 characteristic symptoms

(e.g., inflated self-esteem / grandiosity;
decreased need for sleep; flight of ideas)

SX = marked impairment in social / work functioning
+ require hospitalization to avoid harm to self/others
OR or include psychotic features.

DX =may also include 1 or more episodes of hypomania or major depression.

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7
Q

Posttraumatic Stress Disorder (PTSD)

(SX = MORE THAN 1 MONTH)

**For individuals of all ages = SX must be present over 1 month + cause clinically significant distress / impaired functioning.

A

For adults/teens/children older than 6yr (aka 7yr old +),
PTSD requires:

(1) a) exposure to actual or threatened death (b) serious injury or
c) sexual violence;

(2) min 1 intrusion SX Re: event
(3) persistent avoidance of stimuli RE: event
(4) negative changes in cognition or mood RE: event

(5) marked change in arousal a reactivity RE: event
…………………………………………………………………………………………………………
*For children 6 yrs or younger (5yr or below)
PTSD Dx requires:

(1) exposure to actual or threatened death, serious injury, or sexual violence in at least one of the following ways; or learning the event occurred to a caregiver:
(2) min 1 intrusion SX Re: event

(c) persistent avoidance of stimuli / or negative changes in
thoughts/ mood > Re: event

(d) Altered arousal / reactivity > Re: event.

**For individuals of all ages = SX must be present over 1 month + cause clinically significant distress / impaired functioning.

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8
Q

Antisocial Personality Disorder

A

Antisocial Personality Disorder (diagnostic criteria):

(1) : a pattern of disregard & violation of others rights
(2) : SX present by age 15

(3): Includes min of 3 Sx
(*Sx e.g.,)
–fails to conform to social norms/lawful bhvr
–deceitfulness
–impulsivity
–reckless disregard for safety of self / others
–lack of remorse

*(4): CT MUST BE 18 years old
AND
**
HX of CONDUCT DX before 15 yrs.

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9
Q

What diagnosis requires:

(1) pattern of disregard/violation of others rights
(2) SX must be present by age ________

(3) Inclues a minimum of _____ SX
[Symptoms:}
–(no conform to social normals/lawful behavior)
–(deceitful)
–(impulsive)
–(reckless disregard for safetly of self/other
–(lacks remorse)

(C) ***CT must be____ yrs (or older)
AND
NEEDS hx of CONDUCt Dx before _____ yrs

A

ANTISOCIAL PERSONALITY DISORDER:

(1) : a pattern of disregard & violation of others rights
(2) : SX present by age 15

(3): Includes min of 3 SYMPTOMS
(*Sx e.g.,)
–fails to conform to social norms/lawful bhvr
–deceitfulness
–impulsivity
–reckless disregard for safety of self / others
–lack of remorse

*(4): CT MUST BE 18 years old
AND
**
HX of CONDUCT DX before 15 yrs.

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10
Q

Which diagnostic criteria applies to _________ Dx?

1) : CT must be 18yr +
2) SX present before 15yr
3) Includes min 3 SX
* (4): MUST have HX of CONDUCT DX before 15 yrs.

A

ANTISOCIAL PERSONALITY DISORDER:

(1) : a pattern of disregard & violation of others rights
(2) : SX present by age 15

(3): Includes min of 3 SYMPTOMS
(*Sx e.g.,)
–fails to conform to social norms/lawful bhvr
–deceitfulness
–impulsivity
–reckless disregard for safety of self / others
–lack of remorse

*(4): CT MUST BE 18 years old
AND
**
HX of CONDUCT DX before 15 yrs.

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11
Q

_________________ Disorder criteria, involes?

(1): recurrent pattern of:
– (a) angry/irritable mood
– (b) argumentative/defiant behavior
– (c) or vindictiveness

(2): Min of 4 SX > shown in interactions w/min 1 person
(*cannot be siblling)
[Sx e.g.,}
– (a) Loses tempoer
– (b) Argues with Authority figures
– (c) Wont comply w/authority requests/rules
– (d) Blames others for his/her mistakes.

(3) SX = 6 month (min duration)
(4) Causes distress for CT/others in immediate social env

A

Oppositional Defiant Disorder:

(1): recurrent pattern of:
– (a) angry/irritable mood
– (b) argumentative/defiant behavior
– (c) or vindictiveness

(2): Min of 4 SX > shown in interactions w/min 1 person
(*cannot be siblling)
[Sx e.g.,}
– (a) Loses tempoer
– (b) Argues with Authority figures
– (c) Wont comply w/authority requests/rules
– (d) Blames others for his/her mistakes.

(3) SX = 6 month (min duration)
(4) Causes distress for CT/others in immediate social env

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12
Q

SX duration = 6 months > applies to which Disorders?

A

Oppositional Defiant disorder
Posttraumatic Stress Disorder
Schizophrenia
Opposition Defiant Disorder

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13
Q

SX duration = 1 week (7 days) > applies to which Disorders?

A

BiPolar 1 –(manic episode for a week min -7 days)

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14
Q

SX duration = 1 month (30 days) months > applies to which Disorders?

A

Acute Stress Disorder (less than 1 month)

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15
Q

Oppositional Defiant Disorder
VS
Conduct Disorder

A

Oppositional Defiant Disorder:

             VS 

Conduct Diordser = *(worst) –
SX present since age 15yr + in later life results in
= ANTISOCIAL PERSONALITY Dx

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16
Q

Intellectual Disability

A

Intellectual Disability is diagnosed in the presence of

(a) deficits in intellectual functions
(e. g.,
a) reasoning; (b) problem solving (c) abstract think

(b) deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one or more activities of daily life; and (
(c) onset of intellectual + adaptive deficits duringdevelopmental period.
* 4degrees of severity (mild, moderate, severe, profound) > based on adaptive functng in concept-social-practical domains

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17
Q

Mental Status Exam

A

A mental status exam (MSE) uses:
– questions
– simple tasks = info on CTscurrent mental state
– Observation
(e.g., appearance, thought content, affect)

***USED to determine if CTs Sx needs referral to Dr/Psyc

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18
Q

Major Depressive Disorder

[SIDEGAPS

A
sad mood 
interest loss 
diet changes 
worthless/
poor concetration 
sleep changes
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19
Q

Major Depressive Disorder

[SIDEGAPS

A

A diagnosis of Major Depressive requires

(1) At least 5 Sx of a major depressive episode nearly
– (a) every day for at least two weeks, with
– (b) at least 1 Sx being depressed mood or loss of
interest / pleasure.

SX are depressed mood;
*(or, in kidss/teens, a depressed or irritable mood);
[e.g.,]
–(a) markedly diminished interest or pleasure in
most or all activities;
–(b) significant weight loss when not dieting or
weight gain or a decrease/increase in appetite;
–(c) insomnia or hypersomnia;
–(d) psychomotor agitation or retardation;
–(e) fatigue or loss of energy;
–(f) feelings of worthless or excessive guilt; –
–(h) diminished ability to think or concentrate;
–(i)recurrent thoughts of death, recurrent suicidal
ideation, or a suicide attempt.

**Symptoms cause clinically significant distress or impaired functioning.

...................................... ACRONYM 
[SIGEGAPS]
sad mood 
interest loss 
diet changes 
esteem (low)
appetite changes 
poor concetration 
Suicidal thoughts
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20
Q

DIAGNOSING: (D-E-M-R/P-R)

D:\_\_\_
E:\_\_\_
M:\_\_\_
R/P:\_\_\_
R:\_\_\_
A

DSM DIAGNOSING (using acronym D-E-M-R/P-R)

D = Disorders (all clinical Dx + conditions)

            - DSM Dx
            - "other" mental Dx
            - Medication induced / adverse side effects
            - V Codes
            - Personality Dx
            - Mental Retardation 

E = Environmental + Psychosocial problems
(list of all problems that may impact Dx,Tx, Prognosis)
-ICD codes “F____”

M = Medical Conditions
(all conditions possibly relevant to understanding
/ management of Dx)

R/P = Rule Out / Provisional
(use when uncertain of Dx)
-Coded on insurance AS IF CT HAS THAT DX

R = Reasoning
(show why you chose Dx / what were the Sx)

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21
Q

DIFFERENTIAL DIAGNOSIS

steps

A
  • Start = Figure out category of Dx/ conditions similar to
    CT SX
  1. Rule Out:
    (a) Drug/ Alcohol
    (b) Medical Conditions > (refer=medical evaluation)
  2. Determine CATEGORY
    (make hierarchy of Dx – use decision trees)
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22
Q

In each Section (or “Category”) of DSM Disorders, it includes:

A
  • Specific Disorders
  • Substance / Medication-Induced
  • Due to Another Medical Condition
  • Other Specified
  • Unspecified

(*within each diagnosis–the chapter includes: ICD-10 codes + Diagnostic criteria + Prevalence + Differential Diagnosis)

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23
Q

⟪NEURODEVELOPMENTAL DISORDERS⟫
(1st Ch. of Mental Disorders in DSM)

……………………………………………………………………..
✦What are the Categories of listed in the DSM under Neurodevelopmental Dx (6)?
+
✦Name each specific DSM disorder within each sub-category? (13)
……………………………………………………………………..

⟦AKA: Name the ‘Category’ listed under Neurodevelopmental Disorders + the specific diagnosis?⟧

⟦EXAMPLE⟧
⋞DSM≽Neurodevelopmental Dx
⦑Category⦒Communication Disorders
⩿Disorder⪀ Language Disorder
……………………………………………………………………..
⭐︎٭⚝✦⟐⟢⟠⋅⟡⋇⊘⊗⋄⧫⋆∙∘∗⊨
≫≪⩾⩽⪪⪫⟪⟫≼≽⦑⦒⫸⫷⦗⦘⟦⟧⊒⊑>< ⋞≽⩿⪀ ……………………………………………………………………..

A

⟪ NEURODEVELOPMENTAL DISORDERS ⟫

Neurodevelopmental: Sub-categories (6)
+
Specific Diagnosis
……………………………………………………………………………………

(I) INTELLECTUAL
1 • Intellectual Disability
2 • Global Developmental Delay

(II) COMMUNICATION 
      3 • Language dx
      4 • Speech Sound dx
      5 • Childhood-Onset Fluency 
      6 • Social (Pragmatic) Communication 

(III) AUTISM SPECTRUM (7)

(IV) ADHD (8)

(V) SPECIFIC LEARNING DISORDER (9)

(VI) MOTOR DISORDERS
10 • Developmental Coordination dx
11 • Stereotypic Movement dx
⟢ (VI-a) TIC DISORDERS
12 • Tourette’s dx
13 • Persistent(chronic) Motor or Vocal Tic

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24
Q

⫷SCHIZOPHRENIA SPECTRUM
&
OTHER PSYCHOTIC DISORDERS⫸

……………………………………………………………………..
✦Name each DSM disorder listed under “schizophrenia spectrum & other psychotic disorders”? (7)
……………………………………………………………………..

A

DSM - SCHIZOPHRENIA SPECTRUM & OTHER PSYCHOTIC DISORDERS

……………………………………………………………………………………

     1 • Schizotypal Peronality 
     2 • Delusional 
     3 • Brief Psychotic
     4 • Schizophreniform 
     5 • Schizophrenia 
     6 • Schizoaffective [*bipolar vs depressive type]
     7  • Catatonia
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25
Q

⫷ ADHD⫸ (diagnostic criteria)
……………………………………………………………………..

Sx duration \_\_\_\_\_\_
   (Sx must last for a min of..)
                   \+ 
Onset \_\_\_
   (Sx must be present by...)
................................................................................
A

Sx duration = 6 months (min)
+
Onset = before 12yr

26
Q

Delusional Disorder

A

Fixed Bizarre beliefs (not seeing or hearing things)

✦SX Duration = 1 MONTH (min)

Delusions either “Bizarre” (not plausible) OR “Non-bizarre” (could be possible)

Categories of Delusional beliefs

  - Erotomanic
  - Grandiose
  - Jealous 
  - Persecutory 
  - Somatic
27
Q

SCHIZOPHRENIA

A

SX duration =

2 or more for at least 1 month:
A) Delusions
B) Hallucinations
C) Disorganized Speech

Must have:
Grossly disorganized or catatonic behavior

28
Q

⫷ Differentiate by SX duration⫸
……………………………………………………………………..

Brief Psychotic dx

         [VS] 

Schizophreniform

         [VS] 

Schizophrenia
……………………………………………………………………..

A

Brief psychotic = 0-1 Month

Schizophreniform = 1-6 months

Schizophrenia = at least 6 months

29
Q

Schizoaffective Disorder

A

Depression OR Bipolar + Schizophrenia =
SCHIZOAFFECTIVE

(you have the diagnostic for Bipolar or Depression + Sx of Schizophrenia)

30
Q

In the DSM-5, level of severity of Alcohol Use Disorder and other Substance Use Disorders, is based on _________

A

= number of symptoms

The DSM-5 distinguishes between three levels of severity of the Substance Use Disorders based on the number of symptoms:
–mild (2 or 3 symptoms);
–moderate (4 or 5 symptoms);
–severe (6 or more symptoms).

31
Q

Main SX of PTSD are ______

A

exposure or witness to a life-threatening event

nightmares

flashbacks

hypervigilance

32
Q

Timeline (duration) of SX for Generalized anxiety disorder (GAD) ?

A

SX present for AT LEAST = 6 months

33
Q

Adjustment Disorder requires _____?

A

SX present within 3 months of a life stressor
SX last no longer than 6 months

(aka stressor > SX present within 3 months–6 mo max)

34
Q

Bipolar I requires ____?

A

manic episode (7 days)

35
Q

Bipolar 2 requires ____?

A

Hypomanic episode + Major Depressive episode?

36
Q

a CT with Borderline PD will present SX such as ______

A

history of relationship problems

history of job loss

37
Q

When making a formal diagnosis = 1st RULE OUT >

A

1st thing to be aware of = Medical conditions that affect mental health

medical condition (contributing or exaserbating issue)

38
Q

MEDICAL CONDITIONS THAT AFFECT MENTAL HEALTH

A

If given answer related to an assessment > refer ct to Dr for a physical

Factor in / follow up on changes in medication

If ct is referred by dr > at some point get a release

39
Q

When to refer to a medical doctor

A

Changes in medication
medication non compliance
OR referred by doctor > coordinate w/dr

Any chronic medical condition > refer to dr for physical

Any indication of biological/medical sx > ct has exteme fatigue = refer to dr (for any medical symptoms)

40
Q

After you rule out medical condition > next thing to rule out =

A

substance use

41
Q

ALCOHOL/DRUG USE ….procedure

A

Active Use = find out how much someone is using
Assessment > Ask about = quantity of use + frequency of use

History of Use = ask if currently using + address history

Interventions > address past use + help maintain sobriety (whats been working; tell me about habits; coping mechanisms; dealing with urges to use)

42
Q

TREATING ADHD

A

Criteria = problems in 2+ settings (home + school)
> if not, look at Learning Disability

ADHD TX =
> Kid needs structure + support
> Parents support group + managing
> **Social skills group

Tx planning > 2 good resources for family:
= psychiatrist + support group for parents

43
Q

Tall tell signs of Autism/Aspbergers

A

issues w/social interaction + limited social activity + nonresponsive to social clues

TX includes Parents of autistic child:
process diagnosis + grief work
Help families process that information + parent support groups

44
Q

DIFFERENCES BETWEEN:
Attachment disorders -
Reactive vs. Disinhibited Social Engagement

A

Attachment disorders = Unique to childhood

Reactive = child is disengaged from world, withdrawn, don’t seek caregivers

Disinhibited Social Engagement = overly friendly + superficially affectionate with strangers

TREATMENT OF ATTACHMENT DISORDERS =

○ With both attachment disorders =
play therapy to build trusting relationships + psychoeducation to caregivers RE: how to properly engage

Child teacher = help to redirect child behavior

45
Q

Conduct vs. ODD vs. Disruptive mood regulation disorder

A

Conduct = person breaking laws
> violation law; vandalizes; assaul ppl; steals; robbery

ODD = problems with authority
> argumentative; push limits; don’t follow directions

Disruptive mood dysregulation disorder = (kid bipolar)
> Constant state of Irritablility
> angry outbursts tantrums multiple times a week
> cant regulate negative mood
> extreme outbursts

46
Q

which childhood disorder represents the following SX:

> Constant state of Irritablility
> angry outbursts tantrums multiple times a week
cant regulate negative mood
extreme outbursts

A

Disruptive mood regulation disorder = (kid bipolar)
> Constant state of Irritablility
> angry outbursts tantrums multiple times a week
> cant regulate negative mood
> extreme outbursts

47
Q

which childhood disorder represents the following SX?

= argumentative; push limits; don’t follow directions

A

Oppositional Defiant Disorder

ODD = problems with authority

48
Q

which childhood disorder represents the following SX:

= violation law; vandalizes; assaul ppl; steals; robbery

A

Conduct = person breaking laws

49
Q

Which childhood disorder is represented by the following symptoms:

Anxious + worried about leaving caregiver; distress during separation; worry about separation

A

IN children = separation anxiety disorder

50
Q

all 3 psychotic disorders are differentiated by…

A

Timeline of symptoms

IN order to differentiate btwn them…look at TIMELINE of sx
NOT severity

51
Q

PSYCHOTIC DISORDERS…

If test doesn’t give you a timeline; the right answer could include all 3 if CT has hallucinations

A

TRUE

52
Q

Brief Psychotic….sx present for

A

Brief Psychotic = sx present less than 1 month

53
Q

Schizophreniform SX duration…

A

Schizophreniform = 1-6 months

54
Q

Schizophrenia SX duration…

A

Schizophrenia = 6 months

55
Q

MDD vs. Bipolar differentials

A

If MDD or BPD > medication should be part of discussion

BIPolar 1 > medication necessary (discuss medication as tx option)

56
Q

GAD vs. Adjustment Dx Criteria

A

GAD = SX = AT LEAST 6 MONTHS
(general worry in various set)

ADJUSTMENT D/O = sx 3–6 months (max)

SX MUST BE PRESENT WITHIN 3 MONTHS OF STRESSFUL EVENT & CAN’T EXCEED 6 MONTHS ;

57
Q

tall tell SX of a PTSD

A

tall tell SX of a PTSD = no flashbacks / nightmares

Part of DX criteria of a stress D/O =
• some kind of life-threatening event or exposure to threatening event;

58
Q

When to choose “ V Codes”

A

consider V Code as something to pick ONLY when that is the focus of TX & CT’s main/most pressing concerns

Ex: So the primetime I would ever pick (V.Occupational Problem) in an answer set like this one is ONLY if that CT really is a person that was referred by their employees assistance program & most pressing concerns are work-related

59
Q

Alcohol Use D/o

A

If stem mentions CT’s drinking (vague or unknown)

  1. assess quantity / frequently of use
  2. willingness to stop
  3. provide referral to Substance Abuse Assessment

ALCOHOL USE D/0 - INITIAL PHASE REFERRALS

> YES = SUBSTANCE ABUSE ASSESSMENT

> NO “ALCOHOLICS ANONYMOUS” = I don’t know how drinking & if is willing to quit; AA is really for people who are able to admit they have a problem

> NO “SUBSTANCE ABUSE TREATMENT” = not enough info on quantity, frequency, or severity of use (CT’s issues doesn’t constitute sending to TX > it may turn out they only has 1 glass a day and doesn’t constitute need for TX

So in the initial phase of treatment
> ALCOHOLICS ANONYMOUS
> SUBSTANCE ABUSE TREATMENT
I wouldn’t present these referrals in first initial session(s)

60
Q

What Diagnosis would you consider if the CT had….

history of interpersonal problems where’d you’d see problems maintaining relationships, multiple marriages, problems losing jobs;

A

BORDERLINE PD

DBT = best treatment