DSM Dx/Criteria Flashcards
DSM IV Axes
I psychiatric dx
II personality d/o, MR, developmental delays
III medical conditions
IV psychosocial/environmental px affecting tx
V global clinician rating GAF
GAF scale
100 -91
Superior functioning in a wide range of
activities, life’s problems never seem to
get out of hand, is sought out by others because of his or her many positive
qualities. No symptoms.
90-81
Absent or minimal symptoms
(e.g., mild anxiety before an exam
), good
functioning in all areas, interested and involved in a wide range of activities.
socially effective, generally satisfied with life, no more than everyday problems
or concerns
(e.g. an occasional argument with family members).
80 - 71
If symptoms are present, they are transient and expectable reactions to
psychosocial stressors
(e.g., difficulty concentrat
ing after family argument);
no more than slight impairment in social, occupational or school functioning
(e.g.,
temporarily failing behind in schoolwork).
70 - 61
Some mild symptoms
(e.g. depressed mood and mild insomnia)
OR some difficulty in social, occupational, or school functioning
(e.g., occasional
truancy, or theft within the household)
, but generally functioning pretty well, has
some meaningful interpersonal relationships.
60 - 51
Moderate symptoms
(e.g., flat affect and circumstantial speech, occasional panic
attacks)
OR moderate difficulty in social, occupational, or school functioning
(e.g.. few
friends, conflicts with
peers or co-workers).
50 - 41
Serious symptoms
(e.g.. suicidal ideation, severe obsessional rituals, frequent
shoplifting)
OR any serious impairment in social
, occupational, or school functioning
(e.g.,
no friends, unable to keep a job).
40 - 31
Some impairment in realit
y testing or communication
(e.g., speech is at times
illogical, obscure, or irrelevant)
OR major impairment in several areas, such as work or school, family relations,
judgment, thinking, or mood
(e.g., depressed man avoids friends, neglects family,
and is unable to work; child frequently beats
up younger children, is defiant at home,
and is failing at school).
30 - 21
Behavior is considerably influenced by delusions or hallucinations
OR serious impairment in communication or judgment
(e.g., sometimes
incoherent, acts grossly inappropriat
ely, suicidal preoccupation)
OR inability to function in almost all areas
(e.g., stays in bed all day; no job, home,
or friends).
20 - 11
Some danger of hurting self or others
(e.g., suicide attempts without clear
expectation of death; frequently violent; manic excitement)
OR occasionally fails to maintain minimal personal hygiene
(e.g., smears feces)
OR gross impairment in communication
(e.g., largely incoherent or mute).
10 - 1
Persistent danger of severely hurting self or others
(e.g., recurrent violence)
OR persistent inability to main
tain minimal personal hygiene
OR serious suicidal act with clear expectation of death.
0
Inadequate information.
Time criteria for MDD
sx last at least 2 weeks
time criteria for dysthymic d/o
depressive mood for atleast 2 years
time criteria for bipolar 1 d/o
(mania) persistently elevated, expansive or irritable mood lasting at least 1 week
* does not have to have depressive episode
criteria for bipolar II d/o
*depressive episode at least 1
*hypomanic episode at least 1
hypomanic has to last for at least 4 days
*never have psychotic sx or manic or mixed episode
criteria for cyclothymic d/o
hypomanic and depressive sx that don’t meet criteria for MDD or bipolar
*sx last at least 2 years and not with out sx for longer than 2 months
criteria for panic d/o
period of intense fear/discomfort
*4 sx phys/behav and reach peak within 10min
1 month or mor of at least having a concern about future attacks or worry of attacks or change in behavior r/t attacks
criteria for social phobia/social anxiety d/o
persistent fear of 1 or more social/performance situations
*if under 18 must last at least 6 months
criteria for OCD
marked distress, time consuming (more than 1 hour per day)
can have obsession=thoughts or compulsions=behaviors
criteria for PTSD
sx last greater than 1 month and exposed to traumatic event or threatened
acute-less than 3 months
chronic-great than 3 months
criteria for acute stress d/o (ASD)
sx last at least 2 days but not longer than 4 wks or 1 month
criteria for GAD
excessive worry/anxiety for at least 6 months
criteria for dementia
2 or more of: Aphasia (language), Apraxia (motor), Agnosia (recognizing objects), and executive functioning px
criteria for schizophrenia
hallucinations, delusions, disorganized thoughts and speech and behavior and negative sx (need 2 or more for at least 1 month unless bizarre delusions or hallucinations consisting of voice keeping running commentary or 2 or more voices conversing with each other)
*continuous s/s persistis at least 6 months
criteria for schizoaffective d/o
have schizophrenia along with depressive episode or manic or mixed episode
delusions or hallucinations in absence of mood issue have to last for at least 2 weeks and mood sx present for substantial portion of total duration of active and residual periods
*have mood in between + sx
criteria for schizophreniform d/o
criteria met for schizophrenia except that the s/s have been present for at least 1 month but less than 6 months
criteria for brief psychotic d/o
have 1 or more (delusion, hallucination, disorganized speech and behavior) lasting 1 day but less than 1 month with full return to premorbid funcitoning
criteria for delusional d/o
non bizarre delusions for at least 1 month
subtypes: erotomanic (believes another is in love with them); grandiose, jealous, persecutory, somatic, mixed, unspecified type
alcohol withdrawal
tremulousness 68 hours after cessation psychotic and perceptual 8-12 hours seizures 12-24 hours DT's any first 72 hours delerium can occu in 1 week after cessation
sx: autonomic hyperactivity, increased hand tremor, insomnia, n/v, transient hallucinations/illusions, psychomotor agitation, anxiety, grand mal seizures
CIWA scoring
0-9 absent or minimal w/drawal
10-19 mild to mod
> or equal to 20 severe w/ drawal
tx often BZDs
acute intoxication of opiods
criteria
apathy/sedation, disinhibition, psychomotor retardation, impaired attention and judgment;
atleast 1 of the following (drowsy, slurred speech, pupillary constriction, decreased LOC)
opioid w/drawal
n/v, runny nose or lacrimation, pupillary dilation, piloerection, diaphroesis, diarrhea, yawning, fever, insomnia
cluster A personality d/o
paranoid, schizotypal, schizoid
can be very defensive
bizare, eccentric, loners
cluster B personality d/o
antisocial, BPD, histrionic, narcissistic
dramatic, erratic, egocentric
cluster C personality d/o
OCPD, dependent, avoidant
avoidant, anxious, fearful
general dx criteria for personality d/o
2 or more effected (cognition, affectivity, interpersonal fx, impulse control)
pattern is stable and of long duration
criteria for conduct d/o
formal dx: 7-18 y/o
before 10 childhood onset
after 10 adolescent onset
greater than 18 meet criteria for ASPD
criteria for ODD
precursors: 3-7 y/o d/o: 8 y/o
criteria for autism
lack awareness of other; may tx them like objects
abnormal communication
repetitive behaviors
stereotypical movements
criteria for Rett’s d/o
*affects only females normal development until 5months; onset 1 year old -they cease to gain developmental milestones -loss of skills already required sterotypic hand movements seizures, scoliosis and hypertonicity
criteria for asperger’s d/o
like autism but *speech is not affected
criteria for ADHD
px in at least 2 settings
age criteria of 7 y/o
criteria for MR
code on axis II IQ less than 70 mild 50-17 IQ mod 35-50 severe 20-35 profound below 20 onset before 18 y/o
Fetal Alcohol Syndrome characterizations
not coded in DSM IV
Physical signs: skin folds in corner of eyes
low nasal bridge
short nose
**indistinct philantrum (groove between nose and upper lip)
**thin upper lip
small head circumference
small midface
What age populations most at risk for suicide?
Teens and older adults
What is the number one cause of suicide in teens?
depression
adolescents have a irritable mood more often than a sad mood
Assessing cluster A
pervasive distrust, suspiciousness, with odd unusual behaviors,
Paranoid personality, schizoid, schizoidtypal
Assessing cluster B
pervasive problems with relationships and affect/mood
borderline, histrionic, antisocial, narscistic
Assessing cluster C
pervasive anxiety, fear
avoidant, dependent, obsessive
what is personality
emotional, cognitive and behavioral attributes of a person
- enduring pattern of precieving reality and thinking about things
- ingrained and developed early but can be altered
what is egosyntronic
consistent with personality; it is behavior based on personality that is comfortable
what is egodystonic
incosistent with personality; it is behavior based on personality that is uncomfortable
When does abstract thinking develop
greater than age 12
Time frame for oppositional defiant disorder
6 months and greater
childhood onset for CD is…
before age 10 is childhood
after age 10 is adolescent
Neurotransmitters in ADHD
DA and NE
brain region in ADHD
PFC, basal ganglia, and RAS (reticular activating system)
Substance abuse
has to maladaptive
has to cause problems and they still use the substance
has to be 12 months
substance dependence
cognitive, behavioral, physiological sx
addiction
has to be 12 months
Delerium Tremens
first 24-72 hours (1-3 days)
n/v, sweats, tremors, tactile distrubances, anxiety, agitation, visual and auditory disturbances, HA, altered sensorium
CIWA scores
mild w/drawal 0-8
mod 9-15
severe greater than 15
max score 67
substance abuse
drugs used for cravings
naltrexone
acomporosate
ondansetron
buprenophrine
Aversive treatment in substance abuse
disulfram (Antabuse)
- need to be alcohol free for at least 12 hours and anything with alcohol in like mouthwash for up to 2 weeks after stoping med
- monitor liver
- can induce mania
etiology of substance related disorders
reinforcement
brain based on changes to structure and fx
- positive rewards result in social rewards commonly associated with drug use such as euphoria and is mediated by DA pathways
- negative rewards are aversive such as anxiety and depression mediated by GABA pathways
- reinforcement occurs in the ventral demential area in nucleus accumbent (reward center)
- DA relased and further release of neuropeptides this enhances pleasure experience and with repeated use DA system becomes sensitized and eventually associated with stimuli (like pics of the drug)
Neuroadaptation related to substance abuse
this is how tolerance and withdrawal occur. changes can be enduring for years causing increased risks for relapse. it explains how you can pick up a drink after years of sobriety and have same level of tolerance and physical impact.
the most commonly abuse illegal drug
marijuana
the most commonly abuse legal drug
alcohol
CAGE scoring
2 or more indicate clinically significant and risk for dependency
Psychotropics
are lipophilic, extensively metabolized in liver though phase of oxidative reactions phase II glucuronide conjugation and evolve changes in CYP450 monooxygenases
CYP system
- superfamily of isoenzymes located in endoplasmic reticulum mainly in liver
- isoenzymes responsible for oxidized metabolism and exonbiotics as well as endogenous compounds like prostaglandins, fatty acids, steroids
- CYP enzymes classified by amino acid sequence
- the # is “family” which over 4j0% identify with family members and # is equal to individual isoenzyme
- major CYP enzymes in metabolism of drugs: families 1 2 3 with the isoforms CYP1A2, 2C9, 2C19, 2D6, 3A4
- each CYP isoform is specific gene product-family genetics but effected by environment
Delirium
is a syndrome not disease
subtypes (hyperactive, hypoactive, mixed/cycles)
screening tool CAM confusion assessment method
Hallmark s/s of AD
amyloid plaques, neurofibillary tangles
genetically autosomal dominant
decrease in Ach and NE
Hallmark s/s of VD
carotid bruits, fundoscopic abnormalities, enlarged cardiac chambers
Hallmark s/s of HIV dementia
parenchymal abnormalities on MRI
*caution with drug interactions between Antivirals and Antipsychotics
Hallmark s/s of frontotemporal dementia
gliosis, picks bodies
*changes in personality
Hallmark s/s of Creutzfeldt-Jakob dementia
fatal, rapid
Hallmark s/s Huntington’s dementia
subcortical and mostly motor abnormalities
Hallmark s/s Lewy body
lew inclusion bodies in cortex (protein bodies)
- recurrent visual hallucinations
- adversely react to antipsychs
amaurosis fugax
unilateral vision loss, curtain over eye
Namenda
10-20mg
N-methyl-D-aspartate glutamate receptor antagonist
*prevents over excitation of glutamate and promotes synaptic plascticity
cholinesterase inhibitors
for mild to mod dementia
aricept 5-10 mg
rivastigmine (exelon) 1.5-6mg BID for AD and PD
transdermal 9.5 daily
what does psychotic mean
inability to test reality
mesolimbic
limbic system
info processing
**Where positive sx arise in schizo
mesocortical
frontal cortex
attention, concentration, executive fx
**where negative sx arise/cognitive sx in schizo
catatonia
motor sx
immobility-catalepsy
OR
excessive purposeless movement
soft signs of schizo
- astenognosis (loose ability to judge the shape of object by touch)
- twichtes, tics, rapid eye blinking
- dysdiadochokinesia (impairment of ability to perform rapidly alternating movements
- impaired find motor movement, left-right confused
- mirroring
astenognosis
loose ability to judge shape of object by touch
parietal lobe px
dysdiadochokinesia
impairment to perform rapidly alternating movements
cerebellum px
Hard signs in schizo
- weakness
2. decreased reflexes
How anti psychos work on DA pathways
mesolimibic - decrease positive signs by blocking DA
mesocortical - decrease negative signs by increasing DA
nigrostriatla - block 5HT which causes DA to increase and Ach to decrease and prevent or decrease chance of EPS
tuberoinfundibular - DA inhibit prolactin
The higher the potency of blocking DA….
the increased risk of EPS
DA and Ach are inversely related…so decreasing DA will increase Ach
The lower the potency of blocking DA…
the less risk of EPS
decrease DA you increase Ach; inversely related
What does caffeine and nicotine do to antipsychotics?
they decrease the concentration/effects of the antipsychotic meds
neuroleptic malignant syndrome labs
increase CPK, WBC, LFT
treatment for neuroleptic malignant syndrome
dantrolene bromocriptine *stops the blocking of DA antipyretic for hyperthermia or cooling blanket hydration BZD for catatonic sx
What is the black box warning on antipsychotics in older adults?
they can increase risk of mortality in older adults with dementia
schizophrenia time frame
greater than 6 months
schizophreniform time frame
less than 6 months and may not have impairments in fx
erotomanic
delusion focused on false belief that another is in love with them
usually spiritual or famous
usually stalking
brief psychotic d/o lasts…
1 day and less than 1 month
theories in anxiety d/o
freud-psychodynamic: anxiety initially from experiences from birth; conflict with id and superego; increase use of defense mechanisms
sullivan-interpersonal: px between interpersonal relationships and self becomes identified by our we perceive others to view us
neurobiological: px with limbic, midbrain, and areas of cortex; HPA axis, autonomic response; decrease levels of GABA, (GABA and 5HT suppress HPA axis)
cyclothymic d/o
similar to bipolar but less severe
- hypomania and dysthymia sx
- risk developing BP disorder
depolarization
initial phase, excitatory, Na and Ca in
repolarization
restore phase, inhibitory, K leaves
potency
dose required to cause effect
therapeutic index
level where desired effect is achieved and below level of toxicity
- margin of safety with high index
- low index low safety margin
tachyphylaxis
acute decline in therapeutic response
