DSM IV, DSM 5 & SCID Flashcards
Diagnostic Statistical Manual IV Structured Clinical Interview for Diagnosis
DSM IV
Diagnostic Statistical Manual IV - this is the older version., based more on consensus
DSM 5
Diagnostic Statistical Manual 5 - this is the newer version, based more on evidence and research
Axis I
Major Mental Health Disorders - such as depression, anxiety
Axis II
Personality DIsorders and Mental Retardation
Personality Disorders and treatment
not a lot of treatment we do and not a lot of getting better - there is psychotherapy but there is not a lot of treatment to address the issue
Axis III
General Medical Conditions
Axis IV
Psychosocial & Environmental Problems
- problems that are related to mental illness
Axis V
Global Assessment of Functioning (GAF)
this is a number from 0-100 for insurance reimbursement purposes
all of us in class would be around 99
50 is the cutoff - 50 and below indicates a need for inpatient intensive care
10 or below is a serious risk for harm to self and others
DSM IV
Has 5 axis system
DSM-5 is non axial - what is combined ?
DSM-IV axes I, II, and III have been combined
What axis has been eliminated in DSM-5
Global Assessment of Functioning
WHODAS
World Health Organization Disability Assessment Schedule
This is what the DSM-5 uses instead of GAF (Global Assessment of Functioning)
NOS
not otherwise specified - would see this in old DSM IV
SCID
Structured Clinical Interview for Diagnosis
What is SCID ?
The subjective and objective process of making mental health disorder diagnoses
you are asking a barrage of questions and rating their responses and adding up numbers to see if they reach a diagnosis threshold
The etiology of most mental health disorders is _________
unknown
In the SCID, what is the first thing you do ?
Ask qualifying questions ……
Psychiatric diagnoses are ___________ from medical diagnoses
different.
Its based on how you answer questions, what you are feeling and what the clinician observes
past or present
many diagnoses make the distinction of being past or present
Alcohol dependence Present
Alcohol Dependence Past
If someone is diagnosed with Alcohol Dependence Present, what does this mean?
They have presented symptoms within the past 60 days
If someone is alcohol dependence past, what does this mean ?
The person has exhibited symptoms over 60 days ago, but not within 0-60 days
Mood disorders
Major Depressive Disorder Bipolar 1 Disorder (more severe than Bipolar 2) Bipolar 2 Disorder Dysthymic Disorder Mood D/O due to a Medical Condition Mood D/O due to Substance Abuse
Major Depressive Disorder
down and depressed most of the day, nearly every day for a two week period
lost interest or pleasure in things you usually enjoy (2 week period)
Major Depressive Disorder
Appetite - can be up or down Sleep - can be too much or none Motor (restlessness or lethargic) Feelings of Worthlessness Inappropriate Guilt Concentration, Indecisiveness Suicidal Ideation
Suicidal Ideation
best to ease into these questions
- Life is too hard
- Better off dead
- Thoughts of self-harm
- Plan
- Attempt
Bipolar I
Have diagnosis of major depressive disorder in addition to manic episodes
Manic Episodes
Has there ever been a time when you were feeling so good, so “high”, excited or hyper that other said you were not acting your normal self?
What about periods of anger, rage, that concerned others?
what is an often misdiagnosed symptom of manic episode ?
Rage
Why is it so important to distinctly identify depression and bipolar disorder ?
For med treatment, if you are bipolar and given an SSRI this is contraindicated, because it will trigger manic episodes.
Thats why its so important to make an accurate diagnosis
Bipolar I , Manic Episodes
more severe
manic episodes last at least 1 week
issues of functioning
Inflated self-Esteem Require less sleep? Thoughts racing Easily distracted Increased goal directed activity (Work, cleaning, sexual acting out) Impulsive spending or trips Mixed Episodes at same time
Bipolar II
periods of hypomania (not as severe)
manic episode is less than a week
there are no real issues of functioning
Dysthymic Disorder (DSM IV)
renamed persistent depressive disorder (DSM 5)
During the past couple of years have you been bothered by depressed mood more days than not? Appetite Sleep Energy level Feeling down on yourself Trouble concentrating
Substance Abuse DIsorders - multiple categories
Alcohol Sedatives Cannabis Stimulants Opioid Cocaine Hallucinogens/PCP Poly Drug Abuse
In DSM IV, for substance abuse disorders, they made the distinction between _________ and ___________
Abuse versus Dependence
Abuse qualifying questions
Missed work or School because you were intoxicated, high or hung over (recurrent)
What about not keeping your house clean, taking proper care of your children
Drink in situations that could be considered dangerous- drive, use machines (recurrent)
Trouble with the law (recurrent)
Dependence Qualifying Questions
Drank more than initially intended
Ever try to cut down or stop your drinking
Spent a lot of time drinking, being drunk or hung over
Lost interest in hobbies, friends due to drinking
Blackouts (recurrent)
Tolerance
Withdrawal
blackouts pertaining to alcohol
conscious while it happened but have no memory of it
SUD
Substance Use Disorder
In DSM 5, substance ________ and substance ______________ were combined into a single disorder .
Abuse; dependence
someone can have a panic attack without being diagnosed with a panic disorder. True or false
True
Anxiety Disorders
Panic Disorders - with or without agoraphobia
Panic Attacks
Social Phobias (public speaking)
Specific Phobias (animal, environmental –heights, storms, Blood, injection types, situational (flying, bridges, elevators)
Others (choking, contacting illness, clowns, children avoidance)
Obsessive Compulsive
Recurrent persistent thoughts or images causing distress
Compulsive Behaviors
repetitive, hand washing, checking, mental acts, counting, touching, cleaning aimed at reducing stress or preventing some dreaded event
PTSD
Sometimes things happen to people that are extremely upsetting, like being in a life threatening situation like a major disaster, very serious accident or fire, or being physically assaulted or raped, or seeing another person killed or hurt or hearing about something horrible that has happened to someone close to you.
PTSD symptoms
Intense Fear, helpless, horror
Recurrent or distressing recollections
Dreams, nightmares
Feeling like the event reoccurs
Distress over any cues that remind you of the event
Physical Sx – heavy breathing, heart pounding
Avoids places or people that remind you of the event
Inability to recall certain aspects of the event
Diminished interest in activities and feelings
Difficulty Sleeping - falling asleep or staying asleep Irritability, outbursts of anger Difficulty concentrating Hyper-vigilance Exaggerated startle response
Somatoform Disorders
Pain Disorder - having pain, though there is no seeming cause
Hypochondriasis - believing you have an illness when there is no evidence of it
Body Dysmorphic
Eating Disorders
Anorexia Nervosa
Bulimia
Binge Eating Disorder (new in DSM 5)
Psychotic Disorders
Schizophrenia
Diagnostic criteria for Schizophrenia
Delusions (religious, grandiose, paranoid, somatic)
Hallucinations (auditory, visual, tactile)
Disorganized speech (e.g., frequent derailment or incoherence
Grossly disorganized or catatonic behavior
Negative symptoms, i.e., affective flattening, alogia (poverty of speech), or avolition (lack of motivation)
Regarding schizophrenia, positive symptoms are the
Delusions (religious, grandiose, paranoid, somatic)
Hallucinations (auditory, visual, tactile)
Disorganized speech (e.g., frequent derailment or incoherence
Grossly disorganized or catatonic behavior
What is Schizoaffective Disorder ?
A dual diagnosis of Schizophrenia with mood disorder
Thing to note about personality disorders
medications generally are not very effective
these personalities are ingrained and don’t change much
these individuals often do not do well in groups as the symptoms become especially evident in groups
Long term individual therapy is the best course of action
