DSM-V Term 1 Flashcards
How does Panic Disorder differ from Panic Attacks (Criteria A & B)
Panic Disorder
- Recurrent, UNEXPECTED, panic attacks
- Followed by > 1 month persistent worry about future PA/consequences OR maladaptive beh. change
Panic Attack Criteria
A: abrupt surge of fear/discomfort, peaks within minutes, with > 4 symptoms present
*13 possible symptoms
B: >1 month of 1) OR 2)
- persistent worry about future PA or consequences
- maladaptive behavioural change
C/D: Not due to substance, medical condition, another diagnosis.
What are the symptoms of Panic Attacks
- Heart rate
- sweating
- Shaking
- Shortness of breath
- feelings of choking
- Chest pain
- Nausea
- Feeling dizzy,
- temperature sensations
- numbness/tingling
- derealization
- “going crazy”
- Fear of dying
Panic Disorder: Differential Diagnoses
- Agoraphobia
- Other Anxiety Disorders
- Panic Attacks
- Medical conditions/substance induced
- Are the Cued or UNCUED
Agoraphobia Criteria
A: Marked fear/anxiety in > 2 situations
- public transportation
- open spaces
- closed spaces
- standing in line/crowds
- being outside of the home
B: Fear or Avoidance because **fear escape will not be possible or help not available
- Situations ~always produce fear/anxiety
- Avoid or endure with difficulty
- Out of proportion
- Persistent, > 6 months
- Clinically significant distress
*Not better explained
Key Features of Agoraphobia
- Fear ESCAPE will not be possible or help not available
- - if panic-like Ss, embarrassment, etc.
Agoraphobia: Differential Diagnoses
Specific phobia *if only one situation or cognitions aren’t about escape/panic Ss/no help
Separation anxiety disorder *anxiety over detachment/home
Social phobia *fear negative evaluation
Panic Disorder *Don’t Dx agoraphobia if avoidance behaviours b/c panic Ss do not extend to 2+ agoraphobic situations
Acute Stress/PTSD *If fear b/c reminder of traumatic event
MDD *if avoidance not related to fear of panic Ss or embarrassment/lack of escape
GAD Diagnostic Criteria
A: Excessive anxiety/worry for > 6 months about a range of activities/events
B: Difficult to control worry
C: Associated with >3 Ss, more days than not, >6months
- Restlessness, on edge
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbances
D: Significant distress/impairment
*Not better explained
Key features of GAD
- > 6 months
- Excessive worrying on RANGE of topics
- Difficult to control
- Cognitive and somatic symptoms
GAD vs. MDD
MDD *Diagnostic hierarchy** If MDD it needs to be fully remitted for GAD Dx.
Social Anxiety Disorder: Criteria
A: Fear/anxiety of SOCIAL situations where they can be JUDGED/Scrutinized
B: **Negative EVALUATION
C: Situations ~always –> fear/anxiety
D: Avoided or endured with intense fear
E: Out of proportion
F: Persistent > 6 months
G: Significant distress
*Not better explained
Social Anxiety Disorder Key Features
- *Fear of negative evaluation!
* *Fear/avoidance of situations where they may be scrutinized
Social Anxiety Disorder vs. Panic Disorder
Panic Disorder *fear of the attacks/consequences themselves (not negative eval.)
Social Anxiety Disorder vs. Agoraphobia
Agoraphobia *Fear Escape/help not available
Social Anxiety Disorder vs. Autism SD
in SAD social communication capabilities and age-appropriate r/s are present
Social Anxiety Disorder vs. Avoidant personality disorder
APD *broader avoidance pattern
Social Anxiety Disorder vs. Body Dysmorphic Dx
Body Dysmorphic Dx *if social anxiety only b/c of their beliefs about their appearance then no separate Dx of SAD applied.
Social Anxiety Disorder vs. Major Depressive Disorder
MDD *feel unworthy of being liked/bad (in SAD fear neg. eval. b/c of social beh. or physical Ss)
Social Anxiety Disorder vs. GAD
GAD *social worries a part, but not limited to fear of evaluation
Social Anxiety Disorder vs. Selective Mutism
Selective mutism *may fear to speak because of negative evaluation, but do not fear social situations where speaking is not required
GAD vs. OCD
OCD *obsessions are inappropriate/intrusive, compulsions
GAD vs. Social anxiety Disorder
Social Anxiety Disorder **Anxiety over being evaluated
GAD vs. PTSD
PTSD *Trauma
OCD: Obsessions
- Recurrent, persistent thoughts/urges/images that are intrusive/unwanted and cause marked anxiety/distress
AND - Individual attempts to ignore/suppress or neutralize thoughts (e.g., with a compulsion)
OCD: Compulsions
- Repetitive behavoiurs or mental acts driven to perform in response to obsession/rules that must be followed
AND - Aimed at preventing/reducing anxiety or dreaded event/outcome. *not connected in realistic way or excessive
OCD: Criteria
A: Obsessions OR compulsions (or both)
B: Significant distress
C: Not better explained
OCD Specifiers
- Insight
- with good or fair insight (may not be true)
- with poor insight (probably true)
- with absent insight/delusional beliefs (definitely true)
*Tic-related
OCD vs. OCPD
OCPD * pervasive pattern of perfectionism and rigid control
Social Anxiety Disorder: Specifiers
- Performance only
Required Symptoms for MDD
Either
1) Depressed mood
OR
2) Loss of interest (anhedonia)
Time criteria for MDD
> 2 week period, ~all day(s)
MDD Dx Criteria
A: 5+ Ss, same 2+ week period, change from baseline. Must include 1) depressed mood or 2) Loss of interest. ~most of day, nearly every day
- Depressed mood
- Loss of interest/pleasure
- Weight changes
- Sleep disturbances (insomnia/hypersomnia)
- Psychomotor agitation or retardation
- Fatigue
- Worthlessness or excessive/inappropriate guilt
- Difficulty concentrating, indecisiveness
- thoughts of death or suicidal thoughts
B: significant distress/impairment
C: not due to substance/medical condition
D: not better explained…
E: ***NEVER been a MANIC or HYPOMANIC episode
Severity and remisson ratings in MDD
Mild (just meets criteria)
Moderate
Severe *if psychotic features automatically severe
In partial remission (subclinical Ss for 2+ months)
In full remission (no Ss for 2+ months)
Persistent Depressive Disorder (Dysthymia): Criteria
A: Depressed mood more days than not, most of the day, 2+ years
B: 2+ Ss when depressed
- poor appetite or overeating
- Insomnia/hypersomnia
- Fatigue, low energy
- low self-esteem
- poor concentration/indecisive ness
- Feelings of hopelessness
C: During the 2+ years, No period of >2+ without Ss of Criteria A & B
D: MDD may be present the whole time
E: no manic or hypomanic episodes
F/G: not better explained…
H: significant distress/impairment
Dysthymia: Time criteria
2+ years, more days than not, most of the day
Dysthymia: Severity specifier
Mild, moderate, severe
Dysthymia: PDD specifiers
- with pure dysthymic syndrome (full criteria for MDD have not been met in preceding 2 years)
- with persistent MDE - full MDE criteria met throughout 2 year period
- with intermittent MDE, with current episode - MDE criteria currently met, but periods of 8+ weeks without MDE criteria met
- with intermittent MDE, without current episode
Anxious Distress Specifier can be applied to:
- MDD
- ## Persistent depressive disorder
with anxious distress (MDD/dysthymia): Criteria
2+ symptoms during majority of days of episode
- feeling keyed up or tense
- Feeling unusually restless
- Difficulty concentrating b/c of worry
- Fear that something awful may happen
- Feeling that the individual might lose control
Specify if Mild (2 Ss), moderate (3 Ss), Moderate-severe (4-5 Ss), severe (4-5 Ss with motor agitation)
with mixed features (in MDD/dysthymia)
3+ manic Ss present ~all time of episode
- Elevated, expansive mood
- grandiosity
- more talkative, pressured talking
- Flight of ideas, racing thoughts
- increased goal-directed activity or energy
- Increased risk-taking beh.
- Decreased need for sleep
*If meet full criteria for hypomanic or manic episode give Bipolar I or Bipolar II
with melancholic features (MDD/dysthymia)
During most every period
1. loss of pleasure in ~all activities
OR
2. lack of reactivity to usually pleasurable stimuli
3+ Ss
- depressed mood with profound despondency, despair, moroseness, empty mood
- Depression is worse in morning
- early-morning awakening
- psychomotor agitation or retardation
- significant anorexia or weight loss
- excessive/inappropriate guilt
with atypical features (MDD, dysthymia)
A: mood reactivity (mood brightens in response to positives)
B: 2+ Ss
1. significant weight gain or increased appetite
2. hypersomnia
3. leaden paralysis (heavy)
4. long-standing pattern of interpersonal rejection sensitivity –> impairment
*melancholic features not met
