DSM for Ddx Flashcards
Depression
Inclusion vs exclusion
NB persistent depressive 2 years
MDD/MDE-
Inclusion Criteria- A1 or A2+ 5 from A + B
Exclusion C-E
A1- Depressed Mood most of the day
A2- Anhedonia
A3-9: Significant wt loss/increased or decreased appetite every day; insomnia/hypersomnia every day; psychomotor agitation/retardation every day; fatigue/energy loss every day; worthlessness/excessive guilt every day; poor concentration, every day; recurrent thoughts about death +- suicidal ideation/attempt
B: Sts cause significant distress/loss of function
C: Medical or substance
D: 2 wks of delusions/hallucinations
E: Hx of mania/hypomania
GAD
Inclusion: A+B+ at least 3 from C + at least 1 from D
Exclusion: E, F
A: Excessive worry/anxiety more days than not, 6 mths, number of events
B: difficult to control worry
C(3 of these): restless; tired easily; concentrating/going blank; irritable; tension in muscles; sleep disturbance
D: affect function
E: Substance or medical condition
F: Other anxiety disorder
Agoraphobia
Inclusion A-H
Exclusion I
A: Marked fear or anxiety in 2 of: public transport; being in open spaces; enclosed spaces; standing in line or crowd; outside of home alone
B: fears or avoids A, as fear of no escape or help if panic sts/ fear of embarrassing moment related to med condition
C: Situations almost always provoke fear or anxiety
D: Actively avoided/require a companion/endured with fear
E: fear out of context of actual danger
F: fear/avoidance 6 months or more
G: loss of function
H: If another med condition present, excessive worry
I: other mental disorder
PTSD
Inclusion: 1 from A, B + C; 2 from D+E, F, G
Exclusion: H
A: direct experience of traumatic event; witnessing in person traumatic event; learning of traumatic event affecting close friend/family; repeated exposure to detail of a traumatic event (not media), unless work related
B: recurrent/ intrusive memories; distressing dreams; flashbacks (feels or acts as if event occurring); intense/prolonged psychological distress at exposure to related cue; physical sts at exposure to cue
C: Avoidance of traumatic cues: memories; remidners (people, places, conversations)
D: alterations in cognition or mood associated with event: inability to remeber an aspect of event; persistent exaggerated negative beliefs about onself or others; blaming themself or other; negative emotional state; detachment/estrangmemnt from others; cannot experience positive emotions
E: Arousal/reactivity: irritable/angry outbursts; reckless/ self destructive behaviour; hypervigilance; exaggerated startle response; concentration hard; sleep disturbance
F: 1 month of sts
G: loss of function
H: drugs/organic cause
Schizophrenia
think about brief psychotic disorder (less than a month), schizoaffective, depression w psychosis, mania with psychosis, drug/substance induced psychosis
Inclusion: 2 from A (of which one mst be form the first 3), B and C
Exclusion D and E
(NB 1 month of these)
A1: Delusions
A2: Hallucinations
A3: disorganised speech
A_: groslly disorganised /catatonic; negative sts (alogia, avolition, anhedonia, flat affect)
B: Marked lack of function
C: 6 month duration
D/E: significant mood disorder, pathology or drugs/med hx
Alcohol/drug abuse disorder
At least 2 of the criteria 11 total)
1: Substance taken in larger amounts or over a longer period than intended
2: Persistent desire or unsuccessful effort to cut down or control alcohol use
3: A great deal of time is spent in activities necessary to obtain substance or recover from its effects
4: Craving or strong urge to use the substance
5: Recurrent use + failure in obligation to wokr/school
6: Because of substance use, frequent interpersonal problems and still using substance
7: Important social/recreational/work related activities given up because of substance use
8: recurrent substance use in physically hazardous situation (drive, operate machinery)
9: Continue to use despite knowing it has caused recurrent physical/psychological problem that is worsened by substance
10: Tolerance ( A need for more substance to achieve same effect OR less effect with continual use)
11: Withdrawal characterised by either within several hours/ days after stopping withdrawal sts or substance is taken to relieve withdrawal symptoms
Somatoform vs Conversion vs hypochondriasis
Somatic Symptom
A-C
A: one or more somatic symptoms that are distressing/affecting daily life
B: 1 of these 3: disproportionate and excessive thoughts about seriousness these symptoms; persistently high levels of anxiety about health or sts; excessive time and energy devoted to these time and symptoms
C: state of symptomatology > 6mths
Borderline Personality Disorder
At least 5 criteria (of 9)
1: frantic efforts to avoid real or imagined abandonment (how did they keep from leaving)
2: pattern of unstable and intense interpersonal relationships., characterised by loving then devaluing/despising them
3: Identity disturbance (unsteady image of self)
4: two accountsof potentially damaging impulsivity (gambling, sexual encounters, driving, drugs)
5: recurrent suicidal behaviour, self harming, gestures, threats
6: Affective instability
7: chronic feeling of emptiness
8: inappropriate/intense anger or difficulty controlling anger
9: transient stress related paranoia or dissociative events
Mania
Inclusion A, 3/4 from B, C
Exclusion D, E
A: Distinct period of abnormally elevated, expansive or irritable mood for a week/hospitalised (4 days for hypomania)
B: Inflated self esteem/grandiosity; less need for sleep; more talkative than usual/pressured; flight of ideas or subjective thought racing; distractability;more goal directed activity/new tasks or psychomotor agitation; excess risky behaviours with consequences
C: Marked impairment in function or hospital or psychotic features
D: substance/organic cause
E: 2 weeks of delusions or hallucinations (i.e consider psychotic dx)
OCD
Inclusion: A1 & A2 for obsessions and/or compulsions, B
Exclusion: C or D
A:
Obsessions
1: Persistent, recurrent thoughts/urges/images experienced that are intrusive/unwanted and cause distress
2: Attempts to ignore thoughts or suppress with another thought or action (compulsion)
Compulsions:
1: Repetitive behaviours or mental acts the individual feels drive to do in response to obsession or rules that must be applied to rigidly
2: Behaviours aimed at preventing or reducing anxiety or distress, however not connected in a realistic way with what they are designed to neutralise
B: Take up >1hour every day or markedly reduce function
Panic Disorder
Inclusion 4 from A, 1 from B
A: Recurrent, unexpected panic attacks with 4 of these symptoms: heart racing/pounding; sweat; tremble/shake; trouble catching your breath; sensation of choking; chest pain/pressure; nausea; dizzy/light headed; chills/hot; numbness/tingling in fingers/feet; unreal/surreal feeling, detached; fear might be going crazy; fear you might die
B: At least one of the attacks has been followed by 1 month or ore of the following: concern about additional attacks or their consequences; maladaptive behaviour to avoid having them e.g not exercising/unfamiliar place
Exclude if substance/med condition
Better accounted for by other disorder
Social Phobia
Inclusion A-G
Exclusion H-J
A: Marked fear or anxiety in social situations where exposed to scrutiny by others (conversation, eating/drinking in public, unfamiliar people
B: Worried that will show anxiety/sts and be evaluated negatively
C: Social situations almost always provoke fear/angst
D: Avoided/endured with fear/anxiety
E: Fear out of proportion with situation
F: 6 months plus
G: loss of function
H: Substance/organic
I: better accounted for
J: if another condition excessive angst
Alcohol withdrawal sts
Heart racing; sweating; tremor; seizures; sleep disturbance; N&V, hallucinations, angst
Hypochondriasis/Illness anxiety
A-E, exclude if other disorder fits
A: preoccupation with having or acquiring serious illness
B: Somatic sts not present, if so are mild. If med condition present or strong family history (high risk) preoccupation is excessive
C: high level of anxiety about health, easily alarmed
D: Performs excessive health related behaviours (checking body for sts) or maladaptive avoidance (avoiding doc/hosp)
E: 6 months at least (specific illness might have changed overtime)
