DSM V Criteria Psychiatry Flashcards
Substance abuse disorder
A problematic pattern of the substance use leading to clinically significant impairment or distress, as manifested by ≥2 of the following in the past 12 months: (WITHDRAW THE [SUBSTANCE]):
Work, school, home - failure to fulfil major role obligations
Interpersonal or social consequences - problems socially caused by the effects of the substance (i.e. pissing people off)
Too much time spent using or obtaining the substance (salience) Hazardous use - recurrent use of substances in which it is physically risky
Desire for the drug - craving is strong urge
Reinstatement - persistent desire to cut down which is unsuccessful
Activities (important ones) given up - because desire is so strong they neglect their hierarchy of needs
Withdrawal - withdrawal sx present, after developing these the individual is likely to consume the substance again to relieve the symptoms. not always relevant to some (phencyclidine, hallucinogens, inhalants)
The characteristic withdrawal syndrome
Substance is taken (or one that is closely related) to relieve or avoid withdrawal sx
Tolerance
A need for markedly increased amounts of alcohol to achieve intoxication or desired effect
Markedly diminished effect with continued use of the same amount of alcohol
Harmful use continued despite knowing there is a persistent recurrent physical or psychological problem Exceeds intended amount over time
Definition of a personality disorder + its 4 points
Personality disorder = an enduring pattern of inner experiences and behaviours that deviates markedly from societal expectations. Characterised by:
- Onset in late adolescence/early adulthood
- Pervasive and inflexible
- Remains stable throughout life
- Leads to significant impairment and distress
What is the familial history theme in Cluster A+B+C
A (weird/mad) = family hx of schizophrenia
B (wild/bad) = family hx mood disorders
C (worried/sad) = family hx of anxiety
Paranoid personality disorder criteria + mnemonic
What was their parenting style like?
Paranoid personality disorder
Pervasive distrust + suspiciousness of others, intepreting their motives as malevolent, presenting in a variety of contexts with ≥4 symptoms (SUSPECT):
Spousal infidelity suspect
Unforgiving (bears grudges)
Suspects others of deceiving/exploiting them
Perceives attack on character and reacts immediately
Enemy or friend? Preoccupied with trustworthiness
Confiding in others is feared
Threats are interpreted in benign remarks/events
Parenting style: harsh + punitive
Schizoid personality disorder criteria + mnemonic
What was their parenting style like?
Schizoid personality disorder
Pervasive pattern of detachment from social relationships and restricted range of emotions in interpersonal settings. They are reclusive + eccentric + restricted affect. ≥4 symptoms (DISTANT):
Detached/flat affect - emotionally cold
Indifferent to praise or criticism
Sexual experiences are of little interest
Tasks done alone
Absence of close friends
Neither desires nor enjoys close relationships
Takes pleasure in few/no activities
Parenting: cold or emotionally neglectful. Their is a role of biology in the aetiology of schizoid PD.
Schizotypal personality disorder criteria + mnemonic
Difference between schizoid + schizotypal in terms of relationships?
Two ddx for schizotypal PD
Schizotypal personality disorder
Pervasive pattern of interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships. And cognitive/perceptual distortions and eccentricities of behaviour. ≥5 symptoms of (ME PECULIAR):
Magical thinking - i.e. clairvoyance, superstitious
Experiences unusual perceptions, e.g. illusions
Paranoid ideations
Eccentric behaviour or appearance
Constricted/inappropriate affect
Unusual thoughts/speech - vague, circumstantial, overelaborated, etc.
Lack close friends
Ideas of reference - must exclude delusions of reference
Anxiety in social situations
Rule out psychotic or pervasive developmental disorders (not part of the A criteria)
Difference between schizoid + schizotypal in terms of relationships= schizoid has NO desire for relationships, whereas schizotypal is interested but socially inept.
2 key ddx: pervasive developmental disorder, or psychotic disorder
Borderline PD criteria + mnemonic
Borderline PD = pervasive pattern of instability in: relationships, emotions, self-image and marked impulsivity (RESI). Need ≥5 symptoms (IMPULSIVE):
Impulsive in at least 2 self-damaging ways
Mood/affect instability
Paranoia or dissociation under stress
Unstable self-image
Labile + intense relationships
Suicidal attempts or gestures
Inappropriate anger
Vulnerable to abandonment (real or imagined) –> frantically try to avoid it
Emptiness (feelings of)
Narcissistic PD criteria + mnemonic
Narcissistic PD = pervasive pattern of need for admiration, grandiosity and lack of empathy. ≥5 symptoms (GRANDIOSE):
Grandiose - exaggerates their achievements, undervalues others
Requires constant attention and admiration
Arrogant
Needs to be special and associates with high-status people
Dreams about success, power, beauty, love
Interpersonally exploitative - takes advantage of others for one’s own gain
Others: lack of empathy
Sense of entitlement
Envious of others
Antisocial PD criteria + mnemonic
Antisocial PD = pervasive pattern of disregard for and violation of the rights of others, in a person >18. Begins as ODD since >15.
≥5 symptoms (CORRUPT):
Cannot conform to societal norms (or moral, laws)
Obligations ignored
Reckless
Remorseless
Underhanded - lies ALL the time, hence need collateral hx
Poor preparation - impulsive
Temper - angry and aggressive
Histrionic PD criteria + mnemonic
Histrionic PD = pervasive pattern of attention-seeking and excessive emotionality. ≥5 symptoms of (ACTRESSS): Appearance used to attract others Centre of attention always Theatrical = excessive dramatics to gain attn Relationships perceived more intimate than they are Easily influenced Seductive Shifting rapidly between emotions Speech is impressionistic but vague
Adjustment disorder criteria+ mnemonic
Adjustment disorder mnemonic: 3SSNN:
<3mo of onset of stressor
Significant sx clinically causing impairment in soc/occup/acad functioning/ severe distress OOP to the stimulus
Sx not attributable to another MHD or exacerbation of pre-exisiting MHD
Not normal bereavement
No longer sx present >6mo after stressor terminated
Criteria:
[A] behavioural or emotional sx in response to an identifiable stressor within 3months of onset of stressor
[B] causes clinically significant impairment as evidenced by one or both of:
- Marked distress in excess of what would be expected of the stressor (OOP)
- Significant impairment in social/occupational/academic functioning
[C] Sx do not fulfil criteria for another MHD, or not attributable to an exacerbation of pre-existing MHD
[D] Sx do not represent normal bereavement pattern
[E] once stressor has terminated, the sx do not persist for an additional 6mo.
Generalised anxiety disorder criteria + mnemonic
Generalised anxiety disorder: 6mo of hard-to-control worry, C-FIRST
[A] excessive anxiety + worry for more days than not, for 6months
[B] difficult to control the worry
[C] ≥3 of C-FIRST:
Concentration reduced
Fatigued
Irritable (Amberg)
Restless
Sleep disturbed
Tension (muscular)
[D] Causes clinically significant impairment in social/occupational/academic functioning
[E] not attributable to another substance or GMC, or MHD [F}
Dysthymia/persistent depressive disorder criteria + mnemonic
Dysthmia= HE’S 2 SAD
[A] depressed mood for most of the day, nearly every day for AT LEAST 2 years (identified by self or others)
[B] while depressed, presence of ≥2 (HES SAD):
Hopelessness
Energy reduced, or fatigue
Self-esteem is low
Sleep increased or decreased
Appetite increased or decreased
Decision-making impaired or poor concentration
[C] the individual has neverb een without sx in [A]+[B] for ore than 2months
[D] criteria for major depressive disorder MAY be continuously present for 2 years
[E] never been mania/hypomania/cyclothymic OR [F} not persistent schizoaffective/schizophrenia or other psychotic spectrum
[G] not attributable to substance or GMC
[H] cause clinically significant distress or impairment in social, occupational or other areas of functioning
