DSM Disorders- Differential Crriteria Flashcards
What is the most effective, evidence-based treatment for Bulimia Nervosa?
Cognitive-behavioral Therapy (CBT) – used to change underlying eating disorder cognitions & behaviors
Combined TX using pharmacotherapy + CBT = mazimum efficacy.
Stages Of Psychosexual Development (Freud)
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:
- ) oral
- ) anal
- ) phallic
- ) Latency
- ) genital
DELIRIUM ? (diagnostic criteria)
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
Conduct Disorder
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.
Graphic assessment techniques include:
(1) the genogram and (2) ecomap.
(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.
Bipolar 1
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.
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.
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.
Antisocial Personality Disorder
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.
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
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.
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.
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.
_________________ 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
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
SX duration = 6 months > applies to which Disorders?
Oppositional Defiant disorder
Posttraumatic Stress Disorder
Schizophrenia
Opposition Defiant Disorder
SX duration = 1 week (7 days) > applies to which Disorders?
BiPolar 1 –(manic episode for a week min -7 days)
SX duration = 1 month (30 days) months > applies to which Disorders?
Acute Stress Disorder (less than 1 month)
Oppositional Defiant Disorder
VS
Conduct Disorder
Oppositional Defiant Disorder:
VS
Conduct Diordser = *(worst) –
SX present since age 15yr + in later life results in
= ANTISOCIAL PERSONALITY Dx
Intellectual Disability
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
Mental Status Exam
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
Major Depressive Disorder
[SIDEGAPS
sad mood interest loss diet changes worthless/ poor concetration sleep changes
Major Depressive Disorder
[SIDEGAPS
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
DIAGNOSING: (D-E-M-R/P-R)
D:\_\_\_ E:\_\_\_ M:\_\_\_ R/P:\_\_\_ R:\_\_\_
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)
DIFFERENTIAL DIAGNOSIS
steps
- Start = Figure out category of Dx/ conditions similar to
CT SX
- Rule Out:
(a) Drug/ Alcohol
(b) Medical Conditions > (refer=medical evaluation) - Determine CATEGORY
(make hierarchy of Dx – use decision trees)
In each Section (or “Category”) of DSM Disorders, it includes:
- 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)
⟪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
……………………………………………………………………..
⭐︎٭⚝✦⟐⟢⟠⋅⟡⋇⊘⊗⋄⧫⋆∙∘∗⊨
≫≪⩾⩽⪪⪫⟪⟫≼≽⦑⦒⫸⫷⦗⦘⟦⟧⊒⊑>< ⋞≽⩿⪀ ……………………………………………………………………..
⟪ 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
⫷SCHIZOPHRENIA SPECTRUM
&
OTHER PSYCHOTIC DISORDERS⫸
……………………………………………………………………..
✦Name each DSM disorder listed under “schizophrenia spectrum & other psychotic disorders”? (7)
……………………………………………………………………..
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
⫷ ADHD⫸ (diagnostic criteria)
……………………………………………………………………..
Sx duration \_\_\_\_\_\_ (Sx must last for a min of..) \+ Onset \_\_\_ (Sx must be present by...) ................................................................................
Sx duration = 6 months (min)
+
Onset = before 12yr
Delusional Disorder
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
SCHIZOPHRENIA
SX duration =
2 or more for at least 1 month:
A) Delusions
B) Hallucinations
C) Disorganized Speech
Must have:
Grossly disorganized or catatonic behavior
⫷ Differentiate by SX duration⫸
……………………………………………………………………..
Brief Psychotic dx
[VS]
Schizophreniform
[VS]
Schizophrenia
……………………………………………………………………..
Brief psychotic = 0-1 Month
Schizophreniform = 1-6 months
Schizophrenia = at least 6 months
Schizoaffective Disorder
Depression OR Bipolar + Schizophrenia =
SCHIZOAFFECTIVE
(you have the diagnostic for Bipolar or Depression + Sx of Schizophrenia)
In the DSM-5, level of severity of Alcohol Use Disorder and other Substance Use Disorders, is based on _________
= 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).
Main SX of PTSD are ______
exposure or witness to a life-threatening event
nightmares
flashbacks
hypervigilance
Timeline (duration) of SX for Generalized anxiety disorder (GAD) ?
SX present for AT LEAST = 6 months
Adjustment Disorder requires _____?
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)
Bipolar I requires ____?
manic episode (7 days)
Bipolar 2 requires ____?
Hypomanic episode + Major Depressive episode?
a CT with Borderline PD will present SX such as ______
history of relationship problems
history of job loss
When making a formal diagnosis = 1st RULE OUT >
1st thing to be aware of = Medical conditions that affect mental health
medical condition (contributing or exaserbating issue)
MEDICAL CONDITIONS THAT AFFECT MENTAL HEALTH
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
When to refer to a medical doctor
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)
After you rule out medical condition > next thing to rule out =
substance use
ALCOHOL/DRUG USE ….procedure
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)
TREATING ADHD
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
Tall tell signs of Autism/Aspbergers
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
DIFFERENCES BETWEEN:
Attachment disorders -
Reactive vs. Disinhibited Social Engagement
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
Conduct vs. ODD vs. Disruptive mood regulation disorder
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
which childhood disorder represents the following SX:
> Constant state of Irritablility
> angry outbursts tantrums multiple times a week
cant regulate negative mood
extreme outbursts
Disruptive mood regulation disorder = (kid bipolar)
> Constant state of Irritablility
> angry outbursts tantrums multiple times a week
> cant regulate negative mood
> extreme outbursts
which childhood disorder represents the following SX?
= argumentative; push limits; don’t follow directions
Oppositional Defiant Disorder
ODD = problems with authority
which childhood disorder represents the following SX:
= violation law; vandalizes; assaul ppl; steals; robbery
Conduct = person breaking laws
Which childhood disorder is represented by the following symptoms:
Anxious + worried about leaving caregiver; distress during separation; worry about separation
IN children = separation anxiety disorder
all 3 psychotic disorders are differentiated by…
Timeline of symptoms
IN order to differentiate btwn them…look at TIMELINE of sx
NOT severity
PSYCHOTIC DISORDERS…
If test doesn’t give you a timeline; the right answer could include all 3 if CT has hallucinations
TRUE
Brief Psychotic….sx present for
Brief Psychotic = sx present less than 1 month
Schizophreniform SX duration…
Schizophreniform = 1-6 months
Schizophrenia SX duration…
Schizophrenia = 6 months
MDD vs. Bipolar differentials
If MDD or BPD > medication should be part of discussion
BIPolar 1 > medication necessary (discuss medication as tx option)
GAD vs. Adjustment Dx Criteria
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 ;
tall tell SX of a PTSD
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;
When to choose “ V Codes”
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
Alcohol Use D/o
If stem mentions CT’s drinking (vague or unknown)
- assess quantity / frequently of use
- willingness to stop
- 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)
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;
BORDERLINE PD
DBT = best treatment