DSM5 Flashcards
What is the difference between other specified disorder or unspecified disorder?
other SPECIFIED disorder = certainty about what criteria is missing
UNspecified disorder = not sure what is missing
What is the new term for “NOS”?
other specified disorder or unspecified disorder
What is the age of onset of Intellectual Disability?
“the early developmental period”
trying not to be too rigid on age of onset
How is severity of ID determined?
based on adaptive functioning in conceptual, social and practical domains AND IQ.
What are the diagnostic criteria for Autism Spectrum Disorder?
persistent deficits in social communication
restricted, repetitive patterns of behavior, interests and activities
symptoms present from early developmental period
What are better prognostic indicators for ASD?
communication skills by age 5 or 6, IQ over 70, later onset of Sx.
What is the change in age of onset for ADHD from DSM4 to DSM5?
onset before age 12 (was age 7)
How many symptoms does an individual under age 17 need for an ADHD diagnosis?
5
etiology of ADHD
lower-than-normal activity in frontal lobes and BASAL GANGLIA
Tx for ADHD
stimulant medications
behavioral management
neurofeedback (EEG biofeedback)
Diagnostic criteria for Specific Learning Disorder
difficulties with academics indicated by presence of AT LEAST ONE Sx for at least 6 MONTHS despite provision of appropriate interventions. (Sounds like RTI)
subtypes of SLD
with impairment in…
…reading
…written expression
…mathematics
What is the new name for Stuttering?
Childhood Onset Fluency Disorder
Tx for Childhood Onset Fluency Disorder?
habit reversal training (awareness training, competing response training, and social support)
reduce stress in the family
Diagnostic criteria for Tourette’s Disorder
multiple motor tics
one or more vocal tics
duration of at least one year
age of onset before age 18
Schizoprehia Spectrum Disorders duration
Schizophrenia = 60 days or more
Schizophreniform Disorder = 30 - 60 days
Brief Psychotic Disorder = 1 - 30 days
Schizophrenia Dx criteria
at least TWO active phase symptoms for at least ONE MONTH
with one Sx being delusions, hallucinations or disorganized speech, grossly disorganized or catatonic behavior, or negative Sx
continuous signs of disturbance for at least 6 MONTHS
level of functioning has been below level achieved prior to onset for significant portion of time
prognosis of Schizophrenia
better prognosis = good premorbid adjustment abrupt and LATER onset precipitating stressor female insight into illness no family history
etiology of Schizophrenia
heredity
excessive levels of dopamine
enlarged ventricles
hypofrontality
Schizophreniform Disorder criteria
2 or more active phase Sx
30 - 60 days duration
at least one being delusions, hallucinations, or disorganized speech
Brief Psychotic Disorder diagnostic criteria
one or more Sx
at least one being delusions, hallucinations, or disorg speech
duration: 1- 30 days
Schizoaffective Disorder diagnostic criteria
concurrent Sx of Schizophrenia and major depression or manic episode
EXCEPT for a period of at least 2 weeks without mood Sx
manic episode
abnormally and persistent elevated, expansive or irritable mood
goal-directed activity or energy
for AT LEAST ONE WEEK
with at least THREE Sx
sx cause impaired functioning, require hospitalization, and/or include psychotic features
hypomanic episode
same as manic except:
for at least FOUR DAYS
does not require hospitalization or impair functioning, no psychotic features
major depressive episode
5 or more Sx
at least one being depressed mood or loss of interest or pleasure
Sx last for AT LEAST TWO WEEKS
cause significant distress or impaired functioning
Sx of major depressive episode
insomnia or hypersomnia
fatigue
feelings of worthlessness
impaired ability to think or concentrate
Bipolar I
at least one manic episode
may or may not be preceded or followed by major depressive or hypomanic episodes
marked impairment in functioning or require hospitalization
MANIA but not necessarily with MDD episode
Bipolar II
at least one hypomanic episode + at least one MDD
Must include MDD episode
Cyclothymic Disorder
numerous periods of hypomanic + depressive symptoms
for AT LEAST TWO YEARS in adults, ONE YEAR in child/adolescents
Major Depressive Disorder
at least one MDD episode
need at least FIVE Sx with one being depressed mood
MDD specifiers
–with peripartum onset
onset during pregnancy or four weeks following delivery
10-20% have symptoms sufficiently severe for MDD Dx
– with seasonal pattern
hypersomnia, overeating, weight gain, carb craving
temporal pattern with time of year
Persistent Depressive Disorder
different from MDD
depressed mood for at least TWO YEARS in adults, ONE YEAR in child/adolescents
MDD is one episode
Beck’s cognitive triad model of depression
negative view of self, world, and future
best therapies for depression
CBT, interpersonal
highest rates of suicide
highest for Whites
except Native Americans ages 15-34 (rate 2.5 times higher than national average for that age group)
duration of Separation Anxiety Disorder
4 weeks in children/adolescents
6 months in adults
(Adults can have it too now due to no more kid section of DSM)
Social Anxiety Disorder (used to be social phobia)
intense fear/anxiety about social situations due to exposure to scrutiny by others
avoids situation or endures them with marked distress
Panic Disorder treatment
best treatment: exposure with response prevention
CBT
Agoraphobia
fear/anxiety about 2 of 5 situations,, due to concern that escape might be difficult or help unavailable in case of panic-like or embarassing symptoms.
best treatment for agoraphobia
in vivo exposure with response prevention
GAD treatment
best: CBT
medications: SSRIs, benzos, anxiolytics
OCD treatment
exposure with response prevention
clomipramine (tricyclic) or SSRI
Reactive Attachment Disorder
inhibited, emotionally withdrawn behavior toward adult caregivers
history of extreme insufficient care
Disinhibited Social Engagement Disorder
inappropriate and overly familiar verbal and physical behavior with unfamiliar adults
history of extreme insufficient care
PTSD symptom categories
intrusion symptoms
avoidance of stimuli associated with event
negative alterations in cognition and mood
alterations in arousal
PTSD treatment
CBT with exposure, cognitive restructuring, anxiety management
EMDR
Somatic Symptom Disorder
presence of at lest one somatic symptom
causes distress or significant disruption of daily life
excessive thoughts, feelings, or behaviors related to symptoms
Conversion Disorder diagnosis
disturbance in voluntary motor or sensory functioning suggesting serious neurological or medical condition BUT is incompatible with recognized medical conditions
causes distress or impaired functioning
what is the “conversion V” on the MMPI2?
elevated scales 1 and 3, depressed scale 2
1 - somatic (high)
2 - depression (low)
3 - hysteria (high)
Factitious Disorder Imposed on Self or Another
FALSIFICATION of symptoms in oneself or another
engages in deception even in ABSENCE OF EXTERNAL REWARD
Malingering = same, but FOR an external reward
Frotteuristic Disorder
rubbing on nonconsenting adult
history of acting on urges or experiencing significant distress or impaired functioning
Transvestic Disorder
cross-dressing for purpose of sexual arousal
cause distress or impaired functioning
Substance Use Disorder
continue to use despite significant substance-related problems.
4 Sx categories:
impaired control
social impairment
risky use
pharmacological criteria (tolerance and withdrawal)
Sx of Alcohol Withdrawal
autonomic hyperactivity hand tremor insomnia nausea, vomiting transient hallucinations anxiety psychomotor agitation generalized tonic-clonic seizures
Alcohol-Induced Major Neurocognitive Disorder 2 types
nonamnestic-confabulatory
amnestic-confabulatory (aka Korsakoff’s Syndrome) – includes both retro and anterograde amnesias
Marlatt’s relapse prevention therapy (RPT)
identifies circumstances that increase risk of relapse:
situations that elicit strong emotions, alcohol-related cues
Personality Disorders characterized by:
stable, enduring pattern of inner experience and behavior
deviates from expectation of person’s culture
is pervasive
began in early adulthood
causes significant distress or impairment
Cluster A: Odd-Eccentric Behaviors
Paranoid: distrusting and suspicious
Schizoid: indifference to interpersonal relationships + restricted range of emotion. They chose NOT TO HAVE CONTACT WITH OTHERS.
Schizotypal: interpersonal deficits + eccentricities in cognition, perception, and behavior. They are ODD but WANT CONNECTION with others.
What is the difference between Schizoid and Schizotypal?
Schizoid does not want contact with others.
Schizotypal is odd, but WANTS contact with others.
(SchizoTYPAL is the type that wants connection.)
Cluster B Personality Disorders: Dramatic, Emotional or Erratic
Antisocial: disregard for and violation of rights of others; lack of empathy, inflated sense of self, superficial charm.
Borderline: impulsive, unstable personal relationships and self-image.
Histrionic: excessive emotionality and attention-seeking.
Narcissistic: grandiosity, need for admiration, lack of empathy.
Cluster C Personality Disorders: Anxiety or Fearfulness
Avoidant: social inhibition, feelings of inadequacy, hypersensitive to negative evaluation. (fearful of humilitation by social contact)
Dependent: need to be taken care of, submissive/clingy behavior, fear of separation. (get into unhealthy reciprocal relationships)
Obsessive-Compulsive: preoccupied with orderliness, perfectionism, interpersonal control. DOES NOT HAVE COMPULSIONS LIKE OCD.
overly consciensious, dedicated to work, makes others feel poorly.
Biological siblings are ___ times more likely to develop Sxhizophrenia than the general population.
10
The highest rates of suicide for individuals ages 15-34 are for
Native Americans
Differential diagnosis between PTSD and Acute Stress Disorder?
PTSD = only after one month of symptom duration
Acute Stress Disorder = symptoms for less than one month (2 days - 4 weeks)
criteria for two types of Neurocognitive Disorder
major = more than-2.0 SD mild = -1 to -2.0 SD
neuropsych measure in complex attention, learning and memory, perceptual-motor, social cognition
changes to Substance Use & Dependence
- merged into one disorder w/spectrum of severity
- 2-3 Sx = mild
4-5 Sx = moderate
6 or more = severe - legal problems REMOVED
- cravings ADDED
Depersonalization Disorder changed to…
Depersonalization/Derealization Disorder
Is Dissociative Fugue a separate disorder or a specifier?
now a specifier
How did Dissociative Identity Disorder Criteria A change?
expanded to include functional neurological symptoms
identity transitions can be observed by others or self
gaps in memory can be every day events not just the trauma
Somatization Disorder and Undifferentiated Somatoform Disorder are now merged into ______.
Somatic Symptom Disorder (and is now a spectrum disorder)
What is Binge-Eating Disorder?
new, essentially Bulimia Nervosa without recurrent inappropriate compensatory behavior
What are the new Breathing-Related Sleep Disorders?
Obstructive Sleep Apnea
Hypopnea (“underbreathing” or shallow breathing)
Central Sleep Apnea
Sleep-related Hypoventilation
What are the 3 new symptom categories for ODD?
angry/irritable mood
argumentative/defiant behavior
vindictiveness
What is the new modifier for Conduct Disorder, and what does it mean?
“with limited prosocial emotions” means more severe presentation
What are the changes to SLD?
all one diagnosis now, with subtypes
6 months intervention with little or no gains
NO MORE discrepancy formula
Severity ratings: mild, moderate, severe
What is the new specifier for Body Dysmorphic Disorder?
“with muscular dysmorphia”
What are the changes to Acute Stress Disorder and PTSD?
trauma event must be explicit
criterion re: subjective reaction REMOVED
What are the changes to PTSD?
now Sx in 2 clusters
diagnostic thresholds lowered for children and adolescents
separate criteria for child under age 6
What happened to Hypochondriasis?
now Somatic Symptom Disorder
– OR –
Illness Anxiety Disorder
Pain Disorder = can be medically explained
What are the changes to Autism?
now a single condition, with different levels of severity, across 2 domains: social communication, restricted, repetitive behaviors
Level 1 - requires support
Level 2 - requires substantial support
Level 3 - requires very substantial support
What are the new specifiers for Autism?
with/without intellectual impairment
with/without language impairment
associated with known medical or genetic condition or environmental factor
associated with another neurodevelopmental, mental or behavioral disorder
with catatonia
What are the changes to ADHD?
examples added to facilitate application across lifespan
cross situational requirement = strengthened “several Sx in each setting”
age of onset now changed to before 12
subtypes replaced with: “presentation specifiers”
adults = 5 Sx
children=6 Sx
Delerium, Dementia & Amnestic and Other Cognitive disorders are now called ______.
Nuerocognitive Disorders
Schizophrenia and Other Psychotic Disorders renamed ______.
Schizophrenic Spectrum and Other Psychotic Disorders
Intellectual Disability severity is determined by….
adaptive functioning, NOT IQ
conceptual, social, practical
What does ‘global delay’ mean?
ID under age 5 and cannot be assessed
New name for Phonological Disorder?
Speech-Sound Disorder
Social (pragmatic) Communication Disorder is new. Does it overlap with ASD?
no! It is own classification.
differential Dx between situational type of Specific Phobia, Agoraphobia, and Social Anxiety Disorder?
Specific Phobia==> anxiety involves only ONE situation and related only to situation itself
Social Anxiety Disorder==> fear is related to being negatively evaluated by others; person is usually calm when left alone (not true for Agorophobia.)
Specific Phobia==> only involves one situation related to situation itself
Anorexia may be attributed to ______ levels of ______.
high serotonin
fasting lowers serotonin
Bulimia may be attributed to _____ levels of ______.
low serotonin
binging increases serotonin
What are the 4 symptom groups for Substance Use Disorders?
impaired control
social impairment
risky use
tolerance and withdrawal (pharmacological criteria)
What is the difference between Schizoid and Schizotypal Personality Disorder?
schizotypal = bizarre/eccentric; DISCOMFORT with personal relationships
schizoid = detached from personal relationships; restricted range of emotion in interpersonal settings
