DSM-V Criteria

Question 1

DSM-V definition of a mental disorder

Answer 1

syndrome characterised by clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning associated with extreme distress or disability

Question 2

What does the DSM-V not consider a mental disorder

Answer 2

1. expectable or culturally approved response to a common stressor or los.
2. Socially deviant behaviour and conflicts that are primarily between the individual and society - that was not caused by a mental disorder

Question 3

What are the 4 main criteria for a manic episode

Answer 3

1. A distinct period of abnormality and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week and present most of the day, nearly every day.
2. During that period 3 or more of the “manic symptoms” must be present to a significant degree and represent noticeable change from usual behaviour
3. Mood disturbance is sufficiently severe to cause marked impairment in social/occupational functioning, or there are psychotic features.
4. The episode is not attributable to the physiological effects of a substance.

Question 4

What are the 7 “Manic Symptoms”

Answer 4

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feeling rested with little sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractability (attention too easily drawn to unimportant or irrelevant external stimuli) as reported or observed.
6. Increase in goal-directed activity (socially, work, school, or sexually) or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences (impulsivity)

Question 5

Bipolar I vs. Bipolar II

Answer 5

Type I = one manic episode - including full manic episode that emerges during treatment with anti-depressants but must persist at a fully syndrome level beyond the physiological effect of that treatment

Type II = one depressive and one hypomanic episode.

Question 6

What are the 6 criteria that make up a hypomanic episode

Answer 6

1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
2. During the period above three or more of the “manic symptoms” must be present”
3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
4. The disturbance in mood and the change in functioning are observable by others
5. The episode is NOT severe enough to cause marked impairment in social or work functioning to necessitate hospitalisation
6. Episode is not attributable to the effects of a substance.

Question 7

What are the three big criteria for a major depressive episode

Answer 7

1. five or more of the “depressive symptoms” have been present during the same 2 week period and represent a change from previous functioning with at least one of depressed mood or anhedonia.
2. The symptoms cause clinically significant distress or impairment in social/work or other areas of functioning.
3. The episode is not attributable to the physiological effects of a substance or another medical condition.

Question 8

What are the 9 “depressive symptoms”

Answer 8

1. Depressed mood most of the day, nearly every day, as indicative by either subjective report or observed by others (children can be irritable mood)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. significant weight loss when not dieting or weight gain (5% BM change), and decrease/increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day that is observable by others.
6. fatigue or loss of energy nearly every day
7. feeling of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate or indecisiveness nearly every day.
9. recurrent thoughts of death, suicidal ideation without a specific plan or a specific plan or attempt.

Question 9

What are the 10 specifiers you can add to a Bipolar type I diagnosis

Answer 9

1. with anxious distress
2. with mixed features
3. with rapid cycling
4. with melancholic features
5. with atypical features
6. with mood-congruent psychotic features
7. with mood-incongruent psychotic features
8. with catatonia
9. with postpartum onset
10. with seasonal pattern

Question 10

What are the big 4 criteria for Bipolar II disorder

Answer 10

1. criteria have been met for at least one hypomanic episode and at least one major depressive episode
2. there has never been a manic episode
3. the occurrent of the hypomanic and depressive episode are not better explained by other disorders. (psychotic ones)
4. The symptoms of depression or the unpredictability caused by frequent alteration between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 11

What are the three basic specifiers for mood episodes

Answer 11

mild
moderate
severe

Question 12

What are the 10 specifiers for Bipolar II disorder

Answer 12

1. with anxious distress
2. with mixed features
3. with rapid cycling
4. with mood-congruent psychotic features
5. with mood-incongruent psychotic features
6. with catatonia
7. with permpartum onset
8. with seasonal pattern
9. in partial remission
10. in full remission
    (9 and 10 are for if full mood episode criteria are not met)

Question 13

What are the 6 big criteria for Cyclothymic disorder

Answer 13

1. for at least 2 years there have been numerous periods with hypomanic symptoms that do not meet criteria and numerous periods of depressive symptoms that do not meet criteria
2. During the above period (only 1 year for child/adolescent) the hypomanic and depressive periods have been present for at least half the time an the individual has not been without the symptoms for more than two months at a time.
3. Criteria for a major depressive, manic, or hypomanic episode have never been met
4. the symptoms in criteria 1 are not better explained by other disorders (psychotic ones/personality)
5. The symptoms are not attributable to the physiological effects of a substance or other condition (thyroid)
6. The symptoms cause clinically significant distress or impairment in social, work or other areas of functioning.

Question 14

What are the 5 major criteria for substance/medication induced Bipolar/related disorders

Answer 14

1. prominent and persistent disturbance in mood that predominates in the clinical picture and is characterised by elevated expansive or irritable mood with or without depressed mood, markedly diminished interest or pleasure in all or almost all activities.
2. There is evidence that either the symptoms of criteria 1 developed during or soon after substance intoxication or withdrawal or exposure to a medication OR involved substance/medication is capable of causing symptoms
3. The disturbance is not better explained by another disorder that is not substance related. (ex. symptoms precede use of substance)
4. The disturbance does not occur exclusively during the course of a delirium
5. Causes significant distress or impairment in social, occupational or other areas of functioning.

Question 15

What are the big 6 substances that are know to cause Substance induced Bipolar

Answer 15

1. Alcohol
2. Phencyclidine
3. Hallucinogens (in general)
4. Sedatives, hypnotics, or anxiolytics
5. Amphetamine (or stimulants)
6. Cocaine

Question 16

With Substance induced Bipolar what is an important specifier you must always add

Answer 16

Onset during intoxication
OR
onset during withdrawal

Question 17

What are the 5 major criteria for Bipolar due to another medical condition

Answer 17

1. prominent and persistent period of abnormally elevated expansive, or irritable mood and abnormally increased activity or energy that predominates the clinical picture.
2. There is evidence that the disturbances is the direct pathophysiology consequence of another medical condition.
3. the disturbance is not better explained by another mental disorder
4. The disturbance does not occur exclusively during the course of a delirium
5. the disturbance causes clinically significant distress or impairment in social, work or other areas of functioning

Question 18

What are the 3 specifiers for Bipolar due to another medical condition

Answer 18

1. with manic features
2. with manic or hypomanic like episode
3. with mixed features

Question 19

What are the 4 kinda categories that fall within “other specified” bipolar and related disorders.

Answer 19

1. Short duration hypomanic episodes/MD episodes - only lasting a couple days
2. Hypomanic episodes with insufficient symptoms and major depressive episodes
3. Hypomanic episode without prior major depressive episode
4. Short duration cyclothymia (less than 2 years)

Question 20

Bipolar specifier “with anxious distress” includes what 5 things

Answer 20

1. feeling keyed up or tense
2. feeling unusually restless
3. difficulty concentrating because of worry
4. fear that something awful might happen
5. feeling that the individual might lose control of him/herself

Question 21

What are the 4 big criteria for the bipolar specifier “with mixed features” for a manic/hypomanic episode

Answer 21

1. full criteria met for manic/hypomanic episode and at least three of the “manic mixed” symptoms present during the majority of days of the episode
2. mixed symptoms are observable by others and represent change from usual behaviour
3. if both mania and depression criteria are met diagnosis should be mania with mixed features dur to the marked impairment and clinical severity of full mania
4. mixed features are not attributable to effects of a substance.

Question 22

what are the “mixed manic” symptoms (6 items)

Answer 22

1. prominent dysphoria or depressed mood
2. diminished interest or pleasure in all or almost all activities
3. psychomotor retardation
4. fatigue or loss of energy
5. feelings of worthlessness or excessive or inappropriate guilt
6. recurrent thoughts of death/suicidal plan or attempt

Question 23

What are the big 4 criteria for Bipolar specifier “with mixed features” for a depressive episode

Answer 23

1. full criteria are met for a depressive episode and at least three of the “mixed depressive” symptoms are present during the majority of days of the episode
2. mixed symptoms are observable by others and represent change from usual behaviour
3. if both full criteria for depressive and manic episode are met then the Dx should be manic episode with mixed features due to the debilitating nature of full mania
4. mixed features are not attributable to the effects of a substance

Question 24

What are the seven “mixed depressive” symptoms

Answer 24

1. elevated, expansive mood
2. inflated, self-esteem or grandiosity
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. increase in energy or goal-directed activity
6. increased or excessive involvement in activities that have a high potential for painful consequences
7. decreased need for sleep - feeling rested despite sleeping less.

Question 25

what is criteria (1 item) for Bipolar specifier “with rapid cycling”

Answer 25

presence of at least 4 mood episodes in the previous 12 months that meet criteria

Question 26

What are the 2 criteria (with subcriteria) for Bipolar specifier “with melancholic features”

Answer 26

1. one of the following is present during the most severe period of the current episode
   a. loss of pleasure in almost all activites
   b. lack of reactivity to usually pleasureable stimuli
2. Three or more of the following
   a. a distinct quality of depressed mood characterized by profound despondancy, despair, and/or moroseness or empty mood
   b. depression that is regularly worse in the morning
   c. early morning awakening
   d. significant anorexia or wt. loss
   e. excessive or inappropriate guilt

Question 27

What are the 3 criteria for the Bipolar specifier “with atypical features”

Answer 27

1. Mood reactivity (mood brightens in response to actual or potential positive events)
2. two or mor of the following
   a. significant wt. gain or increase in apptitie
   b. hypersomnia
   c. leaden paralysis (heavy leaden feelings in arms/legs)
   d. a long standing pattern of interpersonal rejection sesnsitivity (not limited to episodes of mood disturbance) that results in social/work impairment
3. criteria for “melancholic features” or “with catatonia” are not met in this same episode

Question 28

What is the criteria for Bipolar specfiier “with psychotic features”

Answer 28

delusions or hallucintations are present at any time in the episode - further specify if mood congruent or incongruent

Question 29

What is “mood congruent psychotic feautres” for bipolar

Answer 29

during manic episodes the content of all delusions and hallucinations is consistent with the typical manic themes of gradiostiy, invunerability, but also include themes of suspiciousness or paranoia espiecally regarding doubts to a person capabilities or accomplishements

Question 30

What is the definition of “mood incongruent psychotic features” for bipolar

Answer 30

content of delusions and hallucinations is inconsistent with the episode polarity or the content is a mixture of congruent and incongruent

Question 31

what is criteria for Bipolar specifier “with catatonia”

Answer 31

can apply to mania or depression if catatonic features are present for most of the episode

Question 32

What is the critreia for Bipolar specifier “with peripartum onset”

Answer 32

Episode occured during pregnancy or within 4 weeks of delivery.

Question 33

What are the 4 criteria for the Bipolar specifier “with seasonal pattern”

Answer 33

1. There has been regular temporal relationship between the onset of episodes and a particular time of the year (does not include if there are seasonally related psychostressors)
2. Full remissions also occur at a characteristic time of the year
3. In the last 2 years the individual’s manic, hypomanic or depressive episodes have demonstrated a temporal seasonal relationship and no non-seasonal episodes of that polarity have occured in 2 years
4. seasonal episodes outnumber any nonseasonal episodes over the course of the individuals lifetime.

Question 34

What are the 11 criteria for Disruptive Mood dysregulation disorder

Answer 34

1. severe recurrent temper outbursts manifested verbally and/or behaviourally that are grossly out of proportion in intensity or duration to the situation or provocation
2. outbursts are inconsistent with developmental level
3. outbursts occur, on average, three or more times per week
4. mood between outbursts is persistently irritable or angry most of the day nearly every day and is observable by others
5. 1-4 have been present for at least 12 or more months and there has not been a time where criteria have not been present for more than 3 months
   6 1-4 are present in at least two of three settings (home, school, peers) and is severe in at least one
6. diagnosis should not be made before age 6 or after age 18
7. symptoms must be present before age 10 by history or observation
8. there has never been a distinct period lasting more than 1 day during which the full symptom criteria for manic or hypomanic have been met
9. behaviours do not occur exclusively during an episode of depression and are not better explained by another mental disorder.
10. symptoms are not attributable to effects of a substance or another medical condition.

Question 35

What are the 8 major criteria for Persistent Depressive Disorder (Dysthymia)

Answer 35

1. depressed mood for most of the day for more days then not for at least 2 years
2. Presence while depressed of two or more of:
   a. poor appetite or overetaing
   b. insomnia or hypersomnia
   c. low energy or fatigue
   d. low self-esteem
   e. poor concentration or difficulty making decisions
   f. feelings of hopelessness
3. during the 2 years period (1 year for children) the individual has not not had symptoms for more than 2 months at a time
4. criteria for MDD may be continuously present for 2 years
5. No manic/hypomanic episode and criteria not met for cyclothymic disorder
6. disturbance not better explained by a persistent mental disorder (psychotic types)
7. symptoms are not better attributed to effects of substance or another medical condition
8. symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning.

Question 36

What are the 7 major criteria for Prementrual Dysphoric Disorder

Answer 36

1. in the majority of menstrual cycles, at least 5 symptoms must be present in the final week before onset of menses and become minimal or absent in the week postmenses.
2. One or more of the following symptoms must be present:
   a. marked affective liability
   b. Marked irritability or anger or increased interpersonal conflicts
   c. marked depressed mood, feelings of hopelessness of self-deprecating thoughts.
   d. marked anxiety, tension, and/or feelings of being keyed up or on edge.
3. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from 2.
   a. decreased interest in usual activities
   b. subjective difficulty in concentration
   c. lethargy, easy fatigability
   d. marked change in appetite
   e. hypersomnia or insomnia
   f. sense of being overwhelmed or out of control
   g. physical symptoms such as breast tenderness/swelling, joint/muscle pain, sensation of bloating
4. symptoms are associated with clinically significant distress or interference with work, school, social activities, or relationships
5. The disturbance is not just an exacerbation of symptoms of another disorder.
6. should confirm symptoms with prospective daily ratings during at least two symptomatic cycles.
7. The symptoms are not attributable to the effects of a substance.

Question 37

What are the 5 major criteria of Substance/Medication induced depressive disorder

Answer 37

1. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all or most activities
2. There is evidence from the history, physical exam, or laboratory findings of symptoms started during or soon after substance intox. or withdrawal or Rx exposure AND involved substance/medication is capable of producing depressive symptoms
3. The disturbance is not better explained by a depressive disorder that is not substance/Rx-induced.
4. Disturbance does not occur exclusively during the course of a delirium
5. The disturbance causes clinically significant distress or impairment in social/occupational or other areas of functioning

Question 38

What are the 5 criteria for Depressive Disorder due to another Medical Condition

Answer 38

1. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all or most activities.
2. Evidence from the history, physical exam, or lab that the disturbance is the direct consequence of another medical condition
3. The disturbance is not better explained by another mental disorder
4. The disturbance does not occur exclusively during the course of a delirium
5. The disturbance causes clinically significant distress or impairment in areas of functioning

Question 39

What are the three sorta disorders that fall under “Other Specified Depressive Disorder”

Answer 39

1. Recurrent brief depression - less than two weeks at least once per month and not met criteria for anything else at any other time
2. Short-duration depressive episode (4-13 days)
3. Depressive episode with insufficient symptoms

Question 40

What are the big 4 criteria for separation anxiety disorder

Answer 40

1. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached
2. The fear.anxiety or avoidance is persistent for at least 4 weeks in children or 6 months in adults.
3. The disturbance causes clinically significant distress or impairment in social, academic, occupational or other areas of functioning.
4. Disturbance isn’t better explained by another mental disorder. (ASD, psychotic disorders, or agoraphobia)

Question 41

In separation anxiety disorder Criteria 1 states that you need anxiety concerning separation including at least 3 of what 8 symptoms

Answer 41

1. recurrent excess distress when anticipating or experiencing separation from home or attachment figures
2. persistent and excessive worry about losing attachment figures or about harm to them
3. persistent and excessive worry about experiencing an unlikely event (ex. kidnapping) that results in separation from attachment figure
4. persistent reluctance or refusal to go out away from home to school or work due to fear of separation from attachment figure
5. persistent and excessive fear or reluctance about being alone or without attachment figure
6. persistent reluctance or refusal to sleep away from home or without being near to attachment figure
7. repeated nightmares involving the theme of separation
8. repeated complaints of physical symptoms (headaches, nausea, etc) when separation from attachment figures occurs or is anticipated.

Question 42

What are the 5 major criteria for Selective Mutism

Answer 42

1. Consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations
2. The disturbance interferes with educational or occupational achievement or with social communication
3. The duration of the disturbances is at least 1 month (NOT the first month of school)
4. The failure to speak is not attributable to lack of knowledge or comfort with the spoken language
5. The disturbance is not better explained by a communication disorder and does not occur exclusively during ASD or a psychotic disorder.

Question 43

What are the 7 major criteria for a Specific Phobia

Answer 43

1. Marked fear or anxiety about a specific object or situation
2. The phobic object or situation almost always provokes immediate fear or anxiety
3. The phobic object or situation is actively avoided or endured with intense fear or anxiety
4. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
5. The fear, anxiety or avoidance is persistent typically lasting for 6 months or more.
6. The fear, anxiety or avoidance causes clinically significant distress or impairment in areas of functioning
7. Disturbance is not better explained by another mental disorder (agoraphobia, OCD, PTSD, SAD)

Question 44

What are the 5 specifiers for specific phobias

Answer 44

1. Animal
2. Natural environment (heights, storms . .. )
3. Blood-injection-injury
4. Situational (airplanes, elevators, enclosed places)
5. Other (costumed characters, loud sounds, . . . )

Question 45

What are the 10 major criteria for Social Anxiety Disorder

Answer 45

1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (social interactions, being observed, performing) - ***Children it must occur in peer settings and not just with adults
2. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
3. The social situations almost always provoke fear or anxiety
4. The social situations are avoided or endured with intense fear or anxiety
5. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
6. The fear or anxiety is persistent lasting more than 6 months
7. The anxiety causes clinically significant distress or impairment in areas of functioning
8. The anxiety is not attributable to the physiological effects of a substance or medical condition
9. The anxiety is not better explained by another mental disorder (ASD, panic disorder, body dysmorphic)
10. If another medical condition is present the anxiety is clearly unrelated or excessive.

Question 46

What are the 4 major criteria of Panic Disorder

Answer 46

1. Recurrent unexpected panic attacks.
2. At least one of the attacks has been followed by a month of persistent concern or worry about additional panic attacks or their consequences AND/OR maladaptive change in behaviour related to the attacks
3. The disturbance is not attributable to the effects of a substance or another medical condition
4. The disturbance is not better explained by another mental disorder. (SAD, Specific phobia, OCD, PTSD, Separation anxiety)

Question 47

What is the definition of a panic attack (including the 13 symptoms)

Answer 47

Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which at least 4 of the 13 symptoms are present:
1. Palpitations, pounding heart, or accelerated HR
2. Sweating
3. Trembling or shaking
4. Sensations of SOB or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdo pain/distress
8. Feeling dizzy, unsteady, light-headed or faint
9. Chills or heat sensations
10. Paresthesias
11. Derealisation or depersonalisation
12. Fear of losing control or “going crazy”
13. Fear of dying

Question 48

What are the 8 major criteria of Agoraphobia

Answer 48

1. Marked fear or anxiety about 2 or more of the 5 situations
   a. using public transportation
   b. being in open spaces
   c. being in enclosed places
   d. standing in line or being in a crowd
   e. being outside of the home alone
2. individual fears or avoids these situations because thoughts that escape might be difficult or help might not be available in the event of developing panic like symptoms or other incapacitating or embarrassing symptoms
3. The agoraphobic situations almost always provoke fear or anxiety
4. The situations are actively avoided, require presence of a companion, or are endured with intense anxiety
5. anxiety is out of proportion to the actual danger posed by the situation or sociocultural context
6. anxiety is persistent for at least 6 months or more
7. anxiety causes significant clinically distress or impaired functioning
8. If another medical condition is present the anxiety is clearly excessive
9. Not better explained by another mental condition (SAD, PTSD, separation anxiety, body dysmorphic, OCD)

Question 49

What are the 6 major criteria of Generalised Anxiety Disorder

Answer 49

1. Excessive anxiety and worry occurring more days than not for at least 6 months about a number of activities or events
2. Individuals find it difficult to control the worry.
3. Anxiety and worry associated with three of 6 of:
   a. restlessness or feeling keyed up or on edge
   b. being easily fatigued
   c. difficulty concentrating or mind going blank
   d. irritability,
   e. muscle tension
   f. sleep disturbance (initial, middle insomnia or restlessness, unsatisfying)
4. Anxiety, worry, or physical symptoms cause clinically significant distress or impact areas of functioning
5. not attributable to effects of a substance or another medical condition
6. not better explained by another mental disorder

Question 50

What are the 5 major criteria for Substance/Medication-Induced Anxiety Disorder

Answer 50

1. Panic attacks or anxiety is predominant in the clinical picture
2. There is evidence from history/PE/labs that symptoms developed during or soon after an exposure to a substance, withdrawal or med exposure AND involved a substance/medication that is capable of producing symptoms
3. disturbance is not better explained by an anxiety disorder
4. Disturbance does not occur exclusively during the course of a delirium
5. Disturbane causes clinically significant distress or impairment in areas of functioning

Question 51

What are the 5 major criteria for Anxiety due to another medical condition

Answer 51

1. Panic attacks or anxiety is predominant in the clinical picture
2. There is evidence from Hx/PE/labs that the disturbance is the direct pathophysiology of another medical condition
3. The disturbance is not better explained by another mental disorder
4. The disturbance does not occur exclusively during a delirium
5. Disturbance causes significant distress or effects functioning

Question 52

What is the definition of obsessions

Answer 52

Recurrent and persistent thoughts, urges, or images that are both experienced at some time during the disturbance as intrusive and unwanted and that causes anxiety or distress
AND
individual attempt to ignore or suppress such thoughts urges or images or to neutralise them with some other thought or action

Question 53

What is the definition of Compulsions

Answer 53

Repetitive behaviours (hand washing, checking, ordering) or behaviours (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
AND
behaviours or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation - however they are not connected in a realistic way with what they are designed to neutralise or prevent or are clearly excessive.

Question 54

What are the 4 major criteria for Obsessive-Compulive Disorder

Answer 54

1. Presence of obsession AND/OR compulsions
2. The obsession or compulsions are time-consuming or cause clinically significant distress or impairment in areas of functioning.
3. The obsessive-compulsive symptoms are not attributable to the effects of a substance or another medical condition
4. Disturbance is not better explained by another mental disorder

Question 55

What are the 4 major criteria of Body Dysmorphic Disorder

Answer 55

1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
2. At some point during the course of the disorder the individual has performed repetitive behaviours (mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing self to others) in response to appearance concerns
3. cause distress or affect functioning
4. Not better explained by concerns with body fat/weight in an individual whose symptoms meet diagnostic criteria for an ED

Question 56

Specify body dysmorphic disorder with:

Answer 56

muscle dysmorphia - preoccupied with the idea that their body is too small or insufficiently muscular

Insight - good, poor or absent/delusional

Question 57

What are the 6 major criteria for Hoarding Disorder

Answer 57

1. Persistent difficulty discarding or parting with possessions, regardless of actual value
2. Difficulty is due to perceived need to save the items and distress associated with discarding them
3. Difficulty discarding items results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use (if certain areas are clean it is only due to intervention of third party)
4. The hoarding causes distress or impairment in functioning (maintaining a safe environment)
5. The hoarding is not attributable to another medical condition (brain injury, Prader-Willi)
6. Not better explained by another mental disorder (OCD, delusions, ASD)

Question 58

What are the 5 major criteria for Trichotilomania (hair-pulling disorder)

Answer 58

1. Recurrent pulling out of one’s hair, resulting in hair loss
2. Repeated attempts to decrease or stop hair pulling
3. The hair pulling causes distress or impairment in functioning
4. The hair pulling is not attributable to another medical condition
5. Not better explained by another mental disorder (body dysmorphic)

Question 59

What are the 5 major criteria for Excoriation (Skin-picking) Disorder

Answer 59

1. Recurrent skin picking resulting in skin lesions
2. Repeated attempts to decrease or stop skin picking
3. Skin picking causes distress or decreased functioning.
4. not attributable to substances or medical condition (cocaine or scabies . . )
5. Not better explained by another mental disorder (psychotic, body dysmorphia, NSSI)

Question 60

What are the 5 major criteria for Substance/Medication induced Obsessive Compulsive Disorder

Answer 60

1. Obsessions, compulsions, skin picking, hair pulling, or other body focused repetitive behaviours or other symptoms predominate in the clinical picture
2. There is evidence from the history/PE/labs that criteria 1 developed during or soon after exposure or withdrawal from a medication or substance and that substance/Rx is capable of producing symptoms (mainly stimulants - cocaine and amphetamines)
3. Disturbance is not better explained by an OCD mental disorder
4. Does not occur exclusively during a delirium
5. Causes significant distress or impaired functioning

Question 61

What are the 7 conditions that fall under Other Specified Obsessive-Compulsive and Related Disorders

Answer 61

1. Body dysmorphic like disorder with actual flaws
2. Body dysmorphic-like disorder without repetitive behaviours
3. Body-focused repetitive behaviour disorder
4. Obsessional jealousy - non-delusional preoccupation with a partner’s perceived infidelity.
5. Shubo-kyofu - excessive fear of having a bodily deformity
6. Koro - an episode of sudden intense anxiety that the penis (or vulva and nipples) will recede into the body possibly leading to death.
7. Jikoshu-kyofu - fear of having an offensive body odour.

Question 62

What are the 7 major criteria for Reactive Attachment Disorder

Answer 62

1. Consistent pattern of inhibited emotionally withdrawn behaviour toward adult caregivers manifested by rarely seeking comfort when distressed AND rarely responds to comfort when distressed
2. Persistent social and emotional disturbance characterised by at least 2 of:
   a. minimal social and emotional responsiveness to others
   b. limited positive affect
   c. episodes of unexplained irritability, sadness, fearfulness even during nonthreatening interactions with adult caregivers.
3. The child has experienced a pattern of extremes of insufficient care as evidenced by social neglect/deprivation in the form of not having basic emotional needs met OR repeated changes in primary caregivers that limit opportunities to form stable attachments OR rearing in unusual settings that severely limit opportunities to form selective attachments (high child:caregiver institutes)
4. care in criteria 3 presumed to be responsible for the disturbed behaviour in criteria 1.
5. The criteria are not met for ASD
6. Disturbance is evident before age 5
7. child is developmentally at least 9 months

Question 63

What are the 5 major criteria for Disinhibited Social Engagement Disorder

Answer 63

1. A pattern of behaviour in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of:
   a. reduced or absent reticence in approaching and interacting with unfamiliar adults
   b. overly familiar verbal or physical behaviour (not culturally sanctioned)
   c. Diminished or absent checking back with adult caregiver after venturing away even in unfamiliar settings
   d. willingness to go off with an unfamiliar adult with no hesitation.
2. Behaviours in criteria 1 are not limited to impulsivity but include socially disinhibited behaviour.
3. Child has experienced a pattern of extremes of insufficient care as evidenced by:
   a. social neglect or deprivation in not having emotional needs met
   b. repeated changes in primary caregivers
   c. rearing in unusual settings (orphanage)
4. Care in criteria 3 is presumed to be responsible for the disturbed behaviour in criteria 1
5. The child has a developmental age of at least 9 months.

Question 64

BIG QUESTION! What are the 8 major criteria with their subpoenas for Posttraumatic Stress Disorder (for adults)

Answer 64

1. Exposure to actual or threatened death, serious injury, or sexual violence either by directly experiencing, witnessing in person as it occurred to others, learning that it happened to a close family member or friend, experiencing repeated or extreme exposure to aversive details of the event (police, healthcare)
2. Presence of one or more intrusion symptoms associated with the event beginning after the event
   a. recurrent, involuntary and intrusive distressing memories
   b. recurrent distressing dreams in which the content and/or affect of the dream is related to the event
   c. Dissociative reactions (ex. flashbacks) in which the individual feels or acts as if the event were recurring
   d. Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the event
   e. marked physiological reactions to internal or external cues that symbolise/represent and aspect of the event.
3. Persistent avoidance of stimuli associated with the traumatic events by avoidance or efforts to avoid distressing memories/thoughts/feelings about event AND/OR avoidance or efforts to avoid external reminders reminders that arouse distressing memories, thoughts, or feelings
4. Negative alterations in cognitions and mood associated with the traumatic events beginning or worsening after the event as evidenced by:
   a. inability to remember an important aspect of the traumatic events
   b. persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
   c. persistent, distorted cognitions about the cause or consequences of the traumatic event that lead to blaming self
   d. persistent negative emotional state (fear, hour, anger, guilt, shame)
   e. marked diminished interest or participation in significant activities.
   f. feelings of detachment or estrangement from others
   g. persistent inability to experience positive emotions
5. Marked alteration in arousal and reactivity as evidenced by two or more of:
   a. irritable behaviour and angry outbursts
   b. reckless or self-destructive behaviour
   c. hyper vigilance
   d. exaggerated startle response
   e. problems with concentration
   f. sleep disturbance
6. Duration of the more than 1 month
7. The disturbance causes clinically significant distress or decreased functioning
8. not attributable to effects of another substance or medical condition.

Question 65

What is the specifier for PTSD

Answer 65

with Dissociative symptoms

1. Depersonalisation - persistent or recurrent experiences of feeling, detached from and as if one were an outside observer of one’s mental processes or body.
2. Derealisation - persistent or recurrent experiences of unreality of surroundings

Question 66

What are the 2 differences or things to note for Child PTSD criteria

Answer 66

1.recurrent, involuntary and intrusive distressing memories may be expressed as play re-enactment

2. dreams you may not be able to ascertain whether the content is related to the traumatic event

Question 67

What are the 5 major criteria for Acute Stress Disorder

Answer 67

1. Exposure to actual or threatened death, serious injury, or sexual violation in one or more of:
   a. directly exposed to event
   b. witnessing in person the event as it occurred to others.
   c. learning that the event happened to a close family member or friend
   d. experiencing repeated or extreme exposure to aversive
2. Presence of nine or more of the following symptoms from any of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal beginning or worsening after the event occurred
3. Duration of the disturbance is 3 days to 1 month after trauma exposure - persistent for at least 3 days
4. The disturbance causes distress or impairment in functioning
5. The disturbance is not attributable to the effects of a substance or another medical condition and not better explained by brief psychotic disorder.

Question 68

For acute stress disorder (and others) what are the 4 intrusion symptoms and what are the 2 dissociative symptoms

Answer 68

Intrusion
1. recurrent involuntary and intrusive distressing memories of the traumatic event.
2. Recurrent distressing dreams in which content or affect are related to events
3. Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event were recurring.
4. Intense or prolonged psychological distress or marked physiological reactions in response to internal and external cues that symbolize or resemble an aspect of the traumatic event

Disociative
1. An altered sense of reality of one’s surroundings or oneself.
2. Inability to remember important aspect of trauma events (amnesia not drugs)

Question 69

For acute stress disorder (and others) what are the 2 avoidance symptoms and 5 arousal symptoms

Answer 69

Avoidance
1. Efforts to avoid distressing memories, thoughts or feelings about or closely associated with trauma
2. Efforts to avoid external remidners

Arousal
1. Sleep disturbance
2. Irritable behaviour and angry outbursts toward people or objects
3. Hypervigilance
4. Problems with concentration
5. Exaggerated startle response

Question 70

What are the 5 major criteria for Adjustment Disorder

Answer 70

1. The development of emotional or behavioural symptoms in response to an identifiable stressor occuring within 3 months of the onset of the stressor
2. These symptoms or behaviours are clinically significant as evidenced by either marked distress that is out of proportion AND/OR significant impairment in functioning
3. Stress-disturbance does not meet criteria for another disorder and is not an exacerbation of a pre-existing disorder
4. The symptoms are not normal bereavement
5. Once the stressor or its consequences have terminated the symptoms do not persist for more than an additional 6 months.

Question 71

What are the 6 specifiers for Adjustment disorder

Answer 71

1. with depressed mood
2. with anxiety
3. with mixed anxiety and depression
4. with disturbance of conduct
5. with mixed disturbance of emotions and conduct
6. unspecified

Question 72

What are the 5 major presentations that fall under “Other specified trauma and stressor related disorder”

Answer 72

1. Adjustment-like disorders with delayed onset of symptoms (>3 months after stressor)
2. Adjustment like disorder with prolonged duration of more than 6 months without prolonged duration of stressor
3. Ataque de nervois - cultural
4. Other cultural syndromes
5. Persistent complex bereavement disorder

Question 73

What are the 5 major criteria for Delusional disorder

Answer 73

1. The presence of one or more delusions with a duration of 1 month or longer
2. Criterion A for schizophrenia has never been met (if hallucinations are present not prominent and must be related to delusion)
3. Apart from the impact of delusions or its ramifications functioning is not markedly impaired and behaviour is not odd
4. IF manic or depressive episodes have occured these have been brief relative to the duration of the delusional periods
5. Disturbance is not attributable to the effects of a substance or medical condition.

Question 74

What are the 8 delusion type specifiers for Delusional disorder

Answer 74

1. Erotomanic type - another person in love with individual
2. Grandiose type
3. Jealous type - unfaithful spouse
4. Persecutory type
5. Somatic type
6. Mixed type
7. Unspecified type
8. With bizarre content - if clearly implausible, not understandable and not derived from ordinary life experiences.

Question 75

What are the 8 episode criteria for Delusional disorder

Answer 75

acute episode, partial remission, full remission for both 1st episode or multiple episodes (6 total)
continuous
unspecified

Question 76

What are the 3 major criteria for Brief Psychotic Disorder

Answer 76

1. Presence of one or more of the following symptoms. At least one of these must be Delusions, Hallucinations, or Disorganized speech may also have grossly disorganized or catatonic behaviour.
2. Duration of an episode of the disturbance is at least 1 day but less than 1 month with eventual return to premorbid functioning
3. The disturbance is not due to substances or medical condition.

Question 77

What are the 4 major criteria for Schizophreniform disorder

Answer 77

1. Two (or more) of the following each present for a significant portion of time during a 1 month period of: Delusions, Hallucinations, Disorganized speech, Disorganized behaviour, Negative symptoms
2. An episode of the disorder last at least 1 month but less than 6 months
3. Schizoaffective, Depression, and Bipolar disorders have been ruled out.
4. Not attributable to a substance or medical condition.

Question 78

What are the 4 good prognostic features of schizophreniform disorder

Answer 78

1. onset of prominent psychotic symptoms within 4 weeks of first noticable change in usual behaviour
2. confusion or perplexity ‘
3. good premorbid social/occupational functioning.
4. absence of blunted or flat affect.

Question 79

What are the 6 major criteria for Schizophrenia

Answer 79

1. 2 or more of the follow present for a significant portion of time during a 1 month period 1must be delusion, hallucinations, or disorganized speech and otherwise can include grossly disorganized or catatonic behaviour, negative symptoms.
2. For a significant portion of time since onset of disturbance functioning has been markedly decreased.
3. Continuous signs of disturbance persist for at least 6 months
4. Schizoaffective, depression with psychosis, and bipolar have been ruled out
5. Not due to substance or medical condition
6. If history of autism or communication disorder of childhood onsest Dx only made if prominent delusions or hallucinations in addition to the other required symptoms.

Question 80

What are the 4 major criteria for Schizoaffective disorder

Answer 80

1. Uninterrupted period of illness which there is a major mood episode concurrent with criteria A (1) of schizophrenia
2. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during lifetime of illness.
3. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
4. Not due to substances or medical conditions.

Must specify whether Bipolar type or Depressive type

Question 81

What are the 5 major criteria for Substance/Medication induced psychotic disorder

Answer 81

1. Presence of one or both of delusions or hallucinations
2. There is evidence from the history, physical or lab findings of: symptoms in 1 developed during or soon after exposure to substance or withdrawal after expsoure. AND involved substance is capable of producing symptoms.
3. Disturbance is not better explained by a psychotic disorder that is not substance induced (persist >1 month after cessation of the substance)
4. Distrubance does not occur exclusively during the course of a delirium.
5. Causes clinically significant decrease in functioning.

Question 82

What are the 5 major criteria for Psychotic disorder due to another medical condition

Answer 82

1. Prominent hallucinations or delusions
2. Evidence that it is the direct pathophys of a medical condition
3. Not better explained by a mental disorder
4. Not exclusively during course of delirium,
5. Causes significant decrease in functioning or distress..

Specify if delusions or hallucinations or prominent

Question 83

What are the 12 symptoms of catatonia

Answer 83

1. Stupor (no psychomotor activity)
2. Catalepsy (passive induction of a posture)
3. Waxy flexibility (resist then break like bending candle when respositioning)
4. Mutism
5. Negativism (opposition or no response to instructions/stimuli)
6. Posturing (spontaneous and active maintenance of weird postures)
7. Mannerism (odd, circumstantial caricature of actions)
8. Stereotypy (repetitive, abnormal frequent non-goal directed movements)
9. Agitation
10. Grimacing (maintenance of odd facial expressions)
11. Echolalia (mimicking speech)
12. Echopraxia (mimicking movements)

Question 84

What are the 5 major criteria of Catatonia due to another medical condition

Answer 84

1. 3 or more of the 12 catatonia symptoms
2. evidence that it is a direct consequence of a medical condition
3. not better explained by another mental disorder
4. not during course of delirium
5. causes significant distress or impacted functioning

Question 85

What are 4 types of condition that fall under other specified schizophrenia spectrum

Answer 85

1. Persistent auditory hallucinations
2. delusions with significant overlapping mood episodes
3. attenuated psychosis syndrome
4. delusional symptoms in partner with individual with delusional disorder

Question 86

What are the 8 major criteria for insomnia disorder

Answer 86

1. A predomniant complaint of dissatisfaction with sleep quantity or quality including: difficulty initiating steep and/or difficulty maintaining steep and/or early-morning awakening 2. sleep disturbance causes significant distress or affects functioning
2. occurs at least 3 nights a week
3. present for at least 3 months
4. difficulty occurs despite adequate opportunity for steep
5. not better explained by another disorder
6. not due to medication or substance
7. co-existing medical or mental disorders do explain not well enough separate diagnosis required

Question 87

What are the 6 major criteria for hypersomnolence disorder

Answer 87

1. Self-reported excessive sleepiness despite main steep period lasting at least 7 hours with at least one of: recurrent periods or lapses into sleep within the same day; prolonged main sleep episode of more than 9 hours that is non restorative; difficulty being fully awake after abrupt awakening
2. three times per week for at least 3 months
3. significant distress
4. not better explained by another disorder
5. not due to substance or medication
6. co-existing conditions not adequate enough to explain symptoms.

Question 88

What are the 2 major criteria for narcolepsy (with sub points)

Answer 88

1. Recurrent episodes of an irrepressible need to sleep lapsing into sleep or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months.
2. The presence of at least one of the following 3:
   A. Episodes of cataplexy at least a few times a month with brief episodes of bilateral loss of muscle tone with maintained consciousness provoked by laughter or joking OR within 6 months of Dx spontaneous grimaces or jaw-opening, tongue thrusting or global hypotonia without any obvious emotional triggers.
   B. Hypocretin deficiency in CSF
   C. Nocturnal sleep polysomnography showing REM sleep latency less than or equal to 15 min and two or more sleep-onset REM periods.

Question 89

What are the 5 specifiers for narcolepsy

Answer 89

1. Without cataplexy but with hypocretin deficiency
2. Narcolepsy withcataplexy but without hypocretin deficiency
3. Autosomal dominant cerebellar ataxia, deafness, and narcolepsy
4. Autosomal dominant narcolepsy, obesity, and type II diabetes.
5. Narcolepsy secondary to another medical condition.

Question 90

What are the 2 major criteria of Obstructive Sleep Apnea Hypopnea

Answer 90

1. Either: Evidence by polysomnography of at least five obstructing apneas or hypopneas per hour of sleep and either of the following sleep symptoms: nocturnal breathing disturbances OR daytime sleepiness fatigue or unrefreshing sleep despite sufficient opportunities to sleep and not better explained by another mental disorder.
2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.

Question 91

What are the 2 major criteria for central sleep apnea

Answer 91

1. Evidence by polysomnography of five or more central apnea per hour of sleep
2. The disorder is not better explained by another current sleep disorder.

Question 92

What are the 3 specifiers for central sleep apnea

Answer 92

1. Idiopathic central sleep apnea
2. Cheyne - Stokes breathing - pattern of periodic crescendo decrescendo variation in tidal volume.
3. Central sleep apnea comorbid with opioid use

Question 93

What are the 2 major criteria for sleep related hypoventilation

Answer 93

1. Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels.
2. Disturbance is not better explained by another current sleep disorder.

Question 94

What are the 3 major criteria for circadian rhythm sleep-wake disorders

Answer 94

1. Persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between endogenous circadian rhythm and the sleep wake schedule required by an individuals physical environment or schedule.
2. The sleep disruption leads to excessive sleepiness or insomnia or both.
3. The sleep disturbance causes clinically significant distress.

Question 95

What are the 6 major criteria for a general personality disorder

Answer 95

1. An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individuals’s culture this pattern is manifested in two or more of: Cognition, Affectivity, Interpersonal functioning, or Impulse control.
2. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
3. The enduring pattern leads to distress or impairment in function
4. Pattern is stable and of long duration and its onset can be traced back to adolescence/early adulthood
5. The enduring pattern is not better explained by another mental disorder
6. enduring pattern is not attributable to effects of a substance or another medical condition.

Question 96

What are the three Cluster A personality disorders

Answer 96

1. Paranoid
2. Schizoid
3. Schizotypal

Question 97

What are the 2 major and 7 sub-criteria for paranoid PD

Answer 97

1. pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adult and present in a variety of contexts - 4 or more of:
2. suspects without basis other are exploiting harming or deceiving them
3. preoccupied with unjustified doubts about loyalty or trustworthiness of friends/associates
4. reluctant to confide in others because of fear information will be mis-used against them
5. reads hidden demeaning or threatening meanings into benign remarks or events
6. persistently bears grudges
7. percieves attacks on his or her character or reputation that are not apparent to others and quick to react angrily or to counterattack.
8. recurrent suspicions without justification regarding fidelity of spouse or sex partner.
9. Does not occur exclusively during the course of schizophrenia bipolar or MDD with psychotic features or another medical/mental condition.

Question 98

What are the two major criteria and the 7 sub-criteria for schizoid personality disorder

Answer 98

1. pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings starting in early adult and present in a variety of context including 4 or more of:
2. neither desires nor enjoys close relationships including being a part of a family
3. almost always chooses solitary activities
4. Has little if any interest in having sexual experiences with another person
5. takes pleasure in few if any activities
6. Lacks close friends or confidants other than first degree relatives
7. appears indifferent to praise or criticism of others
8. shows emotional coldness detachment or flattened affectivity.
9. does not occur exclusively during the course of schizophrenia, bipolar or other mental or medical conditions.

Question 99

What are the 2 major criteria and 9 sub-criteria of Schizotypal personality disorder

Answer 99

1. pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour beginning in early adult and present in multiple contexts including 5 or more of:
2. ideas of reference
3. odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms
4. unusual perceptual experiences including bodily illusions
5. odd thinking and speech (vague, circumstantial, metaphorical, stereotyped)
6. suspiciousness or paranoid ideation
7. inappropriate or constricted affect
8. behaviour or appearance that is odd, eccentric, or peculiar.
9. lack of close friends or confidants other than first degree relatives
10. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self.
11. does not occur exclusively during course of schizophrenia, bipolar or another mental or medical condition.

Question 100

What are the 4 Cluster B personality disorders

Answer 100

1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic

Question 101

What are the 4 major criteria and 7 sub-criteria of antisocial personality disorder

Answer 101

1. A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years as indicated by three or more of:
2. failure to conform to social norms with respect to lawful behaviours indicated by repeatedly performing acts that are grounds for arrest
3. deceitfulness as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
4. impulsivity or failure to plan ahead
5. irritability and aggressiveness as indicated by repeated physical fights or assaults
6. reckless disregard for safety of self or others
7. consistent irresponsibility as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
8. lack of remorse indicated by being indifferent to or rationalising having hurt, mistreated, or stolen from another.
9. The individual is at least 18 years old
10. There is evidence of conduct disorder with onset before age 15 years
11. behaviour not exclusively during course of schizophrenia or bipolar.

Question 102

What is the 1 major criteria with 9 subpoints for Borderline personality disorder

Answer 102

pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adult and present in a variety of contexts including 5 or more of:
1. frantic efforts to avoid real or imagined abandonment
2. pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
3. identity disturbance - markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance use, reckless driving, binge eating)
5. recurrent suicidal ideation, gestures, or threats or self-mutilating behaviour
6. affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability)
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger
9. transient stress related paranoid ideation or severe dissociative symptoms.

Question 103

What is the major criteria and 8 subpoints of Histrionic personality disorder (this is rarely diagnosed anymore due to very problematic origins)

Answer 103

pervasive pattern of excessive emotionality and attention seeking beginning in early adulthood and present in a variety of contexts including 5 or more of:
1. is uncomfortable in situations in which he or she is not the center of attention.
2. interaction with others is often characterized by inappropriate sexually seductive or provacative behaviour
3. displays rapidly shifting and shallow expression of emotions
4. consistently uses physical appearance to draw attention to self
5. has a style of speech that is excessively impressionistic and lacking in detail
6. shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. is suggestible
8. considers relationships to be more intimate then they actually are.

Question 104

What is the major criteria with 9 subpoints of Narcissistic personality disorder

Answer 104

pervasive pattern of grandiosity (in fantasy or behaviour) need for admiration, and lack of empathy, beginning in early adult and present in a variety of contexts indicated by 5 or more of:
1. has a grandiose sense of self of self-importance (exaggerates achievements, expects to be recognized as superior, etc)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. believes that he or she is “special” and unique and can only be understood by or should associate with other special or high status people.
4. requires excessive admiration
5. has a sense of entitlement
6. is interpersonally exploitative
7. lacks empathy is unwilling to recognize or identify with the feelings or needs of others.
8. is often envious of others or believes that others are envious of him or her.
9. shows arrogant, haughty behaviours or attitudes.

Question 105

What are the three cluster C personality disorders

Answer 105

1. Avoidant
2. Dependent
3. Obsessive-Compulsive

Question 106

What is the major criteria with 7 subpoints for Avoidant personality disorder

Answer 106

pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation starting in early adult and present in variety of contexts including 4 or more of:
1. avoid occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. is unwilling to get involved with people unless certain of being liked
3. shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4. preoccupied with being criticised or rejected in social settings.
5. in inhibited in new interpersonal situations because of feelings of inadequacy.
6. views self as socially inept, personally unappealing or inferior to others.
7. is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Question 107

What is the major criteria with 8 subpoints for dependent personality disorder

Answer 107

pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adult and present in a variety of contexts including 5 or more of:
1. has difficulty making everyday decisions without a n excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life
3. has difficulty expressing disagreement with others because of fear of loss of support or approval.
4. Has difficulty initiating projects or doing things on his or her own because of lack of self-confidence in judgement or abilities not motivation issue
5. goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant
6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7. urgently seeks another relationship as source of care and support when a close relationship ends
8. is unrealistically preoccupied with fears of being left to take care of himself or herself.

Question 108

What is the major criteria and 8 subpoints for obsessive compulsive personality disorder

Answer 108

pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency, starting in early adult and present in a variety of contexts including 4 or more of:
1. preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2. shows perfectionism that interferes with task completion
3. excessively devoted to work and productivity to the exclusion of leisure activities and friendships
4. overconscientious, scrupulous and inflexible abut matters of morality, ethics, or values
5. is unable to discard work-out or worthless objects even when they have no sentimental value
6. is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
7. adopts a miserly spending style toward both self and others money is viewed as something to be hoarded for future catastrophes.
8. shows rigidity and stubbornness.

Question 109

What are the five major criteria of personality change due to another medical condition

Answer 109

1. persistent personality disturbance that represents a change from the individual’s previous characteristic personality pattern.
2. there is evidence from history, physical, labs that the disturbance is the direct pathophysiological consequence of another medical condition
3. disturbance is not better explained by another mental disorder
4. disturbance does not occur exclusively during the course of a delirium.
5. disturbance causes significant distress or impairment in functioning.

Question 110

What are the 8 specifiers for personality change due to another medical condition

Answer 110

1. labile type (affect lability predominant feature)
2. disinhibited type (predominant feature poor impulse control)
3. aggressive type
4. apathetic types
5. paranoid type
6. other type
7. combined type
8. unspecified type

Question 111

What are the 6 major criteria for non-rapid eye movement sleep arousal disorders

Answer 111

1. recurrent episodes of incomplete awakening from sleep usually occuring during the first third of major sleep episode accompanied by either one of: Sleepwalking or Sleep Terrors
2. No or little dream imagery is recalled
3. amnesia for the episodes is present
4. episodes cause clinicially significant distress or impairment in functioning.
5. disturbance is not attributable to affects of a substance or medication
6. co-existing mental or medical disorders do not explain the episodes of sleepwalking or terrors.

Question 112

What is the DSM V definition of sleep walking

Answer 112

repeated episodes of rising from bed during sleep and walking about. individual will have a blank, staring face, is relatively unresponsive to the efforts of others to communicate with her or her and can be awakened only with great difficulty.

Question 113

What is the DSM V definition of sleep terrors.

Answer 113

recurrent episodes of abrupt terror arousals from sleep usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal (mydriasis, tachycardia, rapid breathing, sweating) during each episode. There is relative unresponsiveness to efforts of others to comfort individual during the episodes.

Question 114

For non-rapid eye movement sleep arousal disorder you specify if it is sleepwalking or sleep terror type but what other two specifiers exist under the sleep-walking type

Answer 114

with sleep-related eating
with sleep-related sexual behaviour (sexsomnia)

Question 115

What are the 5 major criteria of nightmare disorder

Answer 115

1. repeated occurrences of extended extremely dysphoric and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that occur generally during the second half of major sleep episode
2. on awakening from the dysphoric dream the individual rapidly becomes orientated and alert
3. the sleep disturbance causes significant distress or impairment in function
4. nightmare symptoms are not attributable to the effects of a substance or medication
5. co-existing mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.

Question 116

For nightmare disorder you specify duration of illness (acute, subacute, persistent) and severity, but what other 4 specifiers exist

Answer 116

during sleep onset
with associated non-sleep disorder
with associated other medical condition
with associated other sleep disorder

Question 117

What are the 7 major criteria of Rapid Eye Movement Sleep Behaviour Disorder

Answer 117

1. repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviours.
2. These behaviours arise during rapid eye movement sleep and therefore usually occurs more than 90 min after sleep onset, uncommon during naps.
3. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disorientated.
4. Either REM sleep without atonia on polysomnography OR history suggestive of REM sleep behaviour and an established synucleinopathy.
5. behaviours cause distress or decreased ability to function.
6. not attributable to effects of a substance or medical condition
7. co-existing mental and medical disorders do not explain the episodes.

Question 118

What are the 5 major criteria of restless legs syndrome

Answer 118

1. An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs characterized by urge to move legs begins or worsens during periods of rest or inactivity and urge to move partially or fully relieved by movement and urge to move is worse in the evening or night or only occurs then.
2. symptoms present at least three times a week for at least
3. causes significant distress or impairs ability to function.
4. Not explained better by a mental or medical condition and are not better explained by a behavioural condition
5. not attributable to substances or medications.

Question 119

What are the 5 major criteria of Substance/Medication induced sleep disorder

Answer 119

1. prominent and severe disturbance in sleep
2. evidence from lab, history, or physical of symptoms developing soon after or in withdrawal of a substance or medication and the substance is capable of causing those symptoms.
3. symptoms not better explained by another sleep disorder and not fully explained by medication or substance.
4. disturbance not during the course of delirium
5. causes significant distress.

Question 120

What are the 6 specifiers in medication/substance induced sleep disorder

Answer 120

1. Insomnia type
2. Daytime sleepiness type
3. Parasomnia type
4. Mixed type
5. with onset during intoxication
6. with onset during discontinuation/withdrawal

Question 121

What are the 6 unspecified or other specified sleep-wake disorders

Answer 121

1. Other specified insomnia disorder
2. Unspecified insomnia disorder
3. Other specified hypersomnolence disorder
4. Unspecified hypersomnolence disorder
5. Other specified sleep-wake disorder
6. Unspecified sleep-wake disorder

Question 122

What are the 3 criteria for intellectual disability (intellectual developmental disorder)

Answer 122

onset during developmental period that includes both intellectual and adaptive deficits in conceptual, social, and practical domains.
1. deficits in intellectual functions such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning and learning from experience, confirmed by clinical assessment and standardised testing.
2. deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility, without support adaptive deficits limit functioning in one or more activities of ADLs in multiple environments.
3. onset of intellectual and adaptive deficits during the developmental period.

Question 123

What are the 4 criteria for language disorder

Answer 123

1. persistent difficulties in the acquisition and use of language across modalities due to deficits in comprehension or production that include reduced vocabulary, limited sentence structure, and impairments in discourse
2. language abilities are substantially and quantifiably below those expected for age resulting in functional limitations.
3. Onset of symptoms is in the early developmental period.
4. difficulties are not attributable to hearing or other sensory impairment, motor dysfunction or another medical or neurological condition

Question 124

What are the 4 major criteria of speech sound disorder

Answer 124

1. persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages
2. disturbances causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance
3. onset is early in developmental period
4. difficulties are not attributable to congenital or acquired conditions such as CP, cleft palate, deafness, or hearing loss, TBI or others.

Question 125

What are the 4 major criteria for childhood-onset fluency disorder (stuttering)

Answer 125

1. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills persist over time characterised by at least one of:
   - sound and syllable repetitions
   - sound prolongations of consonants as well as vowels
   - broken words
   - audible or silent blocking (filled or unfilled pauses in speech)
   - circumlocutions (word substitutions to avoid problematic words)
   - words produced with an excess of physical tension
   - monosyllabic whole-word repititions
2. disturbance causes anxiety about speaking or limitations in effective communication, social or academic participation
3. onset is in early developmental period. (later cases adult onset fluency disorder)
4. disturbances is not attributable to a speech-motor or sensory deficit, dysfluency associated with neuro insult.

Question 126

What are the 4 criteria of Social (pragmatic) communication disorder

Answer 126

1. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of:
   - deficits in using communication for social purposes such as greeting and sharing information in a manner that is appropriate for social context.
   - impairment of the ability to change communication to match context or the needs of the listener such as speaking differently in a classroom than on a playground talking differently to a child than to an adult and avoiding use of overly formal language
   - difficulties following rules for conversation and storytelling such as taking turns in conversation, rephrasing when misunderstood and knowing how to use verbal and nonverbal signal to regulate interaction
   - difficulties understanding what is not explicitly stated and nonliteral or ambiguous meanings of language
2. deficits result in functional limitations in effective communication, social and academic participation
3. onset of the symptoms is in the early developmental period
4. symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar not better explained by ASD, intellectual disability, GDD, or another.

Question 127

What are the 5 major criteria for Autism Spectrum Disorder without subpoints

Answer 127

1. Persistent difficulties in social communication and social interaction across multiple contexts.
2. Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two examples
3. Symptoms must be present in the early developmental period
4. symptoms cause clinically significant impairment in social, occupational, or other areas of functioning.
5. Disturbances not better explained by intellectual disability or GDD - but intellectual disability do frequently co-occur.

Question 128

What Are the three examples that DSM-V gives for criteria A of Autism Spectrum Disorder of persistent deficits in social communication

Answer 128

1. deficits in social-emotional reciprocity, ranging, for example from abnormal social approach and failure of normal back and forth conversation to reduced sharing of interests, emotions, or respond to social interactions.
2. deficits in nonverbal communicative behaviours used for social interaction, ranging, for example from poorly integrated verbal and nonverbal communication to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and non verbal communication
3. Deficits in developing, maintaining and understanding relationships ranging for example from difficulties adjusting behaviour to suit various social contexts to difficulties in sharing imaginative play or in making friends to absence of interest in peers

Question 129

What are the 4 sup-criteria for Criterion B(2) for Autism spectrum disorder (of which you need 2 of the sub-points) for restricted repetitive patterns of behaviour . . .

Answer 129

1. Stereotyped or repetitive motor movements, use of objects or speech
2. Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behaviour (extreme distress at small changes, greeting rituals, etc)
3. Highly, restricted, fixated interests that are abnormal in intensity or focus
4. Hyper-hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.

Question 130

What are the 5 specifiers for Autism Spectrum Disorder

Answer 130

1. with or without accompanying intellectual impairment
2. with or without accompanying language impairment
3. associated with a known medical or genetic condition or environmental factor
4. associated with another neurodevelopmental, mental, or behavioural disorder
5. with catatonia

Question 131

What are the 5 major criteria of Attention-Deficit/Hyperactivity Disorder

Answer 131

1. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by Inattention (six or more inattention symptoms) AND/OR hyperactivity (six or more hyperactivity symptoms) these symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental stage and negatively impacts social and academic activities
2. severe inattentive and hyperactive-impulse symptoms were present prior to age 12 years.
3. several inattentive or hyperactive symptoms are present in two or more settings
4. clear evidence that the symptoms interfere with or reduce the quality of social academic or occupational functioning
5. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder.

Question 132

What are the 3 specifiers for ADHD

Answer 132

1. combined presentation (inattention and hyperactivity)
2. predominantly inattentive presentation
3. predominantly hyperactive/impulsivity presentation

Question 133

If someone does not meet full-criteria for ADHD you can diagnose them with what 2 options

Answer 133

1. Other specified attention-deficit/hyperactivity disorder (if gonna specify why they don’t meet criteria
2. Unspecified attention-deficit/hyperactivity disorder (don’t want to specify why they don’t meet criteria)

Question 134

What are the 4 major criteria of specific learning disorder

Answer 134

1. Difficulties learning and using academic skills as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months despite the provision of interventions that target those difficulties.
2. affected academic skills are substantially and quantifiably below those expected for the individuals age and cause significant interference with academic or occupational performance or with ADLs as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment - if older than 17 yo history must be documented history of impairment in past.
3. Learning difficulties begin during school-age years but may not become fully. manifest until the demands for those affected academic skills exceed the individuals limited capacities.
4. leraning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency.

Question 135

What are the 6 areas/sup-points that meet criteria A(1) for specific learning disorder

Answer 135

1. inaccurate or slow and effortful word reading
2. difficulty understanding the meaning of what is read
3. Difficulties with spelling
4. Difficulties with written expression (gramatical, punctuation errors, poor paragraph organization)
5. Difficulties mastering number sense, number facts, or calculation.
6. Difficulties with mathematical reasoning

Question 136

What are the 3 specifiers for specific learning disorder

Answer 136

1. with impairment in reading
2. with impairment in written expression
3. with impairment in mathematics.

Question 137

What are the 4 major criteria of Developmental Coordination Disorder

Answer 137

1. the acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness as well as slowness and inaccuracy of performance of motor skills.
2. The motor skills deficit significantly and persistently interferes with activities of daily living appropriate to chronological age and impacts academic productivity, prevocational and vocational activities, leisure, and play.
3. Onset of symptoms is in the early developmental period
4. motor skills deficits are not better explained by intellectual disability or visual impairment and are not attributable to a neuro condition affecting movement.

Question 138

What are the 4 major criteria of stereotypic movement disorder

Answer 138

1. repetitive, seemingly driven, and apparently purposeless motor behaviour
2. the repetitive motor behaviour interferes with social, academic or other activities and may result in self-injury.
3. onset is in the early developmental period.
4. the repetitive motor behaviour is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder.

Question 139

What are the 3 specifiers for stereotypic movement disorder

Answer 139

1. with self-injurious behaviour
2. without self-injurious behaviour
3. associated with a known medical or genetic condition, neurodevelopmental disorder or environmental disorder.

Question 140

What are the 4 criteria for Tourette’s disorder

Answer 140

1. both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
2. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
3. onset is before age 18 years
4. disturbance is not attributable to the physiological effects of a substance ro another medical condition.

Question 141

What are the 5 criteria for persistent (chronic) motor or vocal tic disorder. *Must specify if with motor tics only or vocal tics only

Answer 141

1. single or multiple motor or vocal tics have been present during the illness, but not both motor AND vocal
2. the tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
3. onset is before age 18 years
4. disturbance is not attributable to the physiological effects of a substance or another medical condition
5. Criteria have never been met for Tourette’s disorder

Question 142

What are the 5 major criteria for provisional tic disorder

Answer 142

1. single or multiple motor and/or vocal tics.
2. the tics have been present for less than 1 year since the first tic onset.
3. onset is before age 18 years
4. disturbance is not attributable to the physiological effects of a substance or another medical condition
5. criteria have never been met for Tourette’s disorder or persistent motor or vocal tic disorder.