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1_Psychiatry Royal College 2017 > DSM5 criteria > Flashcards

DSM5 criteria Flashcards

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1
Q

delusional disorder

A

≥1 delusion for > 1 mo NEVER met criteria for SCZ hallucinations may be present, but not prominent and related to the delusion fx is not markedly impaired subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified Specify: With bizarre content

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2
Q

Delusional disorder specifiers

A

* Use after >1yr duration * First episode,/Multiple episodes, currently in acute episode/partial remission/full remission * Continuous * Unspecified * Specify current severity

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3
Q

Delusional disorder prevalence

A

* 0.2% lifetime * no major gender diff * persecutory most common

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4
Q

Brief psychotic disorder

A

* ≥1 of {delusions, hallucinations, disorg. speech, disorg/catatonic beh} * 1 day - 1 month

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5
Q

Brief psychotic disorder specifiers

A

* With marked stressors (brief reactive) * Without marked stressors * With peripartum onset (preg or 4wks postpartum) * With catatonia * Specify current severity

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6
Q

Brief psychotic disorder epidemiology and course

A

* 9% of FEP * F:M = 2:1 * Avg onset mid-30s * High rates of relapse but excellent outcome

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7
Q

Schizophreniform disorder

A

* ≥ 2 Sx of psychosis (delusions, hallucinations, disorganized speech, disorg/catatonic beh, negative symptoms) * 1-6 months * R/O mood/schizoaff

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8
Q

Schizophreniform disorder specifiers

A

* with/without good prognostic features (prominent psychotic sx within 4 weeks of noticeable change; confusion/perplexity; premorbid fxn; absence of flat/blunted affect) * with catatonia * severity

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9
Q

schizophreniform d/o epidemiology/course

A

* incidence overall similar to scz; in US

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10
Q

Schizophrenia criteria

A

* ≥ 2 psychotic sx for 1month * fxn markedly decreased most of the time since onset * continuous sx >6 months * R/O SCZ-aff/mood

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11
Q

Schizophrenia specifiers

A

* FEP/multiple episodes, currently in acute episode/partial remission/full remission * Continuous * Unspecified * with catatonia * severity

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12
Q

Aggression risk in SCZ

A

* young males * Hx of violence * non-adherence to tx * substance abuse * impulsivity

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13
Q

Anosognosia in SCZ

A

* Sx of SCZ, not a coping strategy * predicts relapse, involuntary tx, fxn, aggression, course of illness

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14
Q

Neuro soft signs in SCZ

A

* motor coordination * sensory integration * motor sequencing of complex movements * L-R confusion * disinhibition of associated movements

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15
Q

SCZ - prevalence

A

* Lifetime prevalence: 0.3-0.7% * F=M if including all Sx

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16
Q

SCZ - age of onset

A

late teens to mid-30s Peak age: early 20s for M, late 20s for F

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17
Q

SCZ - risk/prognostic factors

A

* Age of onset prob linked to gender (worse course in M => worse in early age of onset) * 20% good outcome * Negative Sx more related to prognosis, more persistent * Cognitive Sx may not improve * 20% suicide attempt; 5-6% complete

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18
Q

Schizoaffective d/o criteria

A

* uninterrupted period of major mood episode + Criteria A SCZ * Delusions or hall x >2wks W/O mood episode * Mood Sx present majority of total duration of illness

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19
Q

Schizoaffective d/o specifiers

A

* Bipolar/depressive type * Catatonia * FEP/multiple episodes, currently in acute episode/partial/full remission * Continuous * Severity

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20
Q

Schizoaffective disorder prevalence

A

* lifetime prevalence 0,3% * F>M

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21
Q

Schizoaffective d/o age of onset

A

early adulthood but anywhere from teens to late life

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22
Q

Substance/Med-induced psychotic D/O

A

* ≥1 of delusions/hallucinations * Both: sx developed during or soon after intox/withdrawal AND substance is capable of producing the Sx * R/O delirium * R/O other psychotic d/o (e.g. persistent sx or preceding substance etc)

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23
Q

Substance/Med-induced psychotic d/o specifiers

A

* Onset during intoxication * Onset during withdrawal * Severity

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24
Q

Disruptive mood dysregulation disorder - criteria

A

temper outbursts: - severe and recurrent - ≥ 3x/week - inconsistent with dev. level - irritable most of the time - >12 months - >2-3 settings _ 6-18yo - no manic symptoms >1 day

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25
Q

Major depressive disorder - criteria

A

* 2 weeks + change of previous fxn * 5 of {mood, interest, sleep, wt, psychomotor, energy, guilt/worthlessness, [], SI}

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26
Q

MDD- specifiers

A

* anxious distress * mixed features * melancholic features * atypical features * mood-congruent psychotic features * mood-incongruent psychotic features * catatonia * peripartum onset * seasonal pattern

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27
Q

Anxious distress

A

≥ 2 sx: * tense * restless * diff. [] 2nd worry * fear something bad will happen * fear might lose control of self

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28
Q

Anxious distress severity

A

* Mild - 2 sx * moderate - 3 sx * mod-severe: 4-5 sx * severe: 4-5 sx + agitation

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29
Q

Mixed features in MDD

A

* ≥ 3 manic sx during most of MDE

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30
Q

Melancholic features

A

* during most severe period of MDE: * 1 of {anhedonia or lack of reactivity to pleasurable stimuli} * ≥ 3 of {despair/empty mood, worse in AM, AM awakening, psychomotor agitation or retardation, we loss , excessive guilt}

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31
Q

Atypical features

A

* mood reactivity * ≥ 2 of {wt gain/increased appetite, , hypersomnia, leaden paralysis, long-standing rejection sensitivity} * NO melancholia or catatonia in same episode

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32
Q

Seasonal pattern

A

* regular temporal relationship w/ season ( not psychosocial stressors) * full remissions or (hypo)mania * in last 2yrs, 2 MDE w/ temporal relationship and no MDE out of season * seasonal > non-seasonal episodes

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33
Q

Persistent depressive disorder

A

* >2 years depressed mood (1yr for child) * 2 sx of {appetite change, sleep change, fatigue, low self-esteem, poor [] or decision making, hopelessness} *

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34
Q

Persistent depressive disorder - specifiers

A

* all specifiers as MDD * early/late onset (21yo) * pure dysthymic syndrome (no MDE in past 2 years) * persistent MDE (meets criteria for full 2 years) * intermittent MDE, with/ wi/o current episode * severity

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35
Q

MDD epidemiology

A

* 12mo prevalence: 7% * F:M = 1.5-3x * 18-29yo: 3x prevalence in >60yo

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36
Q

MDD - course

A

* variable course * 40% recover in 3mo, 80% in 1yr * poor prognosis: episode duration, psychosis, anxiety, personality d/o, severity * BD more likely if mixed features, psychosis, FHx of BD

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37
Q

MDD - age of onset

A

any age but peak onset in 20s

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38
Q

Persistent depressive d/o - epidemiology

A

* 0.5% 12mo prevalence for dysthymia * 1.5% for chronic MDD * early, insidious course

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39
Q

Premenstrual dysphoric disorder

A

* most cycles in past 1 yr , ≥5 sx in final wk, improve in a few days * ≥ 1 of {affective lability, irritability, depressed mood/hopelessness, anxiety/tension/keyed up}\ * ≥ 1 of {anhedonia, []. energy, appetite, sleep, overwhelmed, phys. sx} *

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40
Q

PMDD prevalence

A

* 12mo prevalence: 2-6%

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41
Q

PMDD risk factors

A

stress, trauma, seasonal changes, no OCP

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42
Q

Manic episode criteria

A

* elevated/irritable mood AND increased energy x >1wk * ≥3 of {grandiosity, dec. sleep, talkative, flight of ideas/racing thoughts, distractibility, goal-directed activity/agitation, painful consequences} * marked impairment or hospitalization or psychosis

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43
Q

Hypomanic episode criteria

A

* mood AND energy x >4 days * ≥3 of {grandiosity, sleep, talkative, flight of ideas, distractibility, goal-directed/agitation, painful consequences} * uncharacteristic change in fxn

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44
Q

Bipolar I OR II specifiers

A

* anxious distress * mixed features (≥3 sx of MDE most days during (hypo)manic episode) * rapid cycling (≥4 episodes of any mood in 12 months) * melancholic features (for MDE or mixed) * atypical features (MDE or mixed) * psychotic features * catatonia * peripartum onset * seasonal pattern

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45
Q

Bipolar I epi

A

* 12mo prevalence: 0.6% * M:F = 1.1 : 1

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46
Q

Bipolar I course

A

* >90% recurrence of mood episodes * ~60% of manic episodes occure right before MDE * high income > low income countries * FHx - strongest risk factor * psychotic features predict future psychotic features * mood-incongruent psychosis –> incomplete recovery

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47
Q

Bipolar I avg age of onset

A

18yo

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48
Q

Bipolar II prevalence

A

* 12mo prev: 0.3-0.8%

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49
Q

Bipolar II course

A

* often starts with MDE * higher lifetime episodes than BD I

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50
Q

Bipolar II age of onset

A

avg age mid-20s

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51
Q

Bipolar II risk/prognostic factors

A

* FHx of BD II (not so much MDE/BD I) most predictive * rapid-cycling –> worse prognosis * younger, less severe –> return to baseline fxn * education, less duration, married –> assoc with recovery * F more likely to have mixed or rapid-cycling * 1/3 suicide attempts; more lethal than in BD I

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52
Q

Cyclothymic d/o criteria

A

* >2 yrs of numerous periods of hypomanic or depressive Sx not meeting criteria for episode * Sx periods present for >50% of the time *

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53
Q

Cyclothymic d/o epi

A

* lifetime prev: 0.4-1% * M=F

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54
Q

Cyclothymic d/o course

A

insidious onset, persistent course

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55
Q

Cyclothymic d/o risk factors

A

* MDD, BD I and II in 1st degree relatives * increased familial risk of substance use

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56
Q

Substance/Medication induced bipolar and related d/o

A

* prominent mood disturbance: elevated/irritable OR depressed OR anhedonia * related to intox or withdrawal of substance capable of producing the Sx * NOTE: ?? no need for full criteria of (hypo)mania/MDE

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57
Q

* Separation anxiety d/o criteria

A

* dev inappropriate anxiety re anticipated or experienced separation * ≥3 of {recurrent excessive distress, worry about losing attachment figures, about untoward event that causes separation, reluctance to go anywhere, fear of being alone, refusal to sleep away from home or w/o attachment figure, nightmares re separation, physical sx with separation} * >4wks

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58
Q

Specific phobia criteria

A

* marked fear * phobic object/situation almost always provokes anxiety * out of proportion to danger * >6 months

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59
Q

Specific phobia specifiers

A

* animal * natural environment (ht, storm etc) * blood-injection-injury * situational * other (e.g. clowns, sounds, vomiting etc) * common to have several phobias (avg 3)

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60
Q

Specific phobia epi

A

* 12mo prev: 7-9% * follows traumatic event * Risk factors: neuroticism, parental overprotectiveness, parental loss, phys/sex abuse, genetic

61
Q

Social anxiety criteria

A

* anxiety re 1 or more social situations with scrutiny * negatively evaluated (embarrassing or offending) * the social situations almost always provoke anxiety * social situations avoided or endured with intense fear * out of proportion to actual threat/sociocultural context * >6 months

62
Q

Social anxiety specifiers

A

* performance only - restricted to speaking/performing in public

63
Q

Social anxiety prevalence

A

* 12mo prev: 7% * F=M *

64
Q

Social anxiety risk factors

A

beh. inhibition, abuse, early adversity, genetic

65
Q

Social anxiety age of onset

A

avg age 13yrs (1st onset in adult RARE)

66
Q

Panic attack criteria

A

≥4 of: - palpitations - sweating - trembling - SOB - choking - CP - N/V - dizzy - chills/heat - paraesthesias - derealization/depersonalization - fear of losing control/crazy - fear of dying

67
Q

Panic d/o criteria

A

* recurrent unexpected panic attacks * > 1month of worry re panic attacks and/or maladaptive beh change

68
Q

Panic d/o epi

A

* 12mo prev: 2-3% * F:M = 2:1

69
Q

Panic d/o risk factors

A

neuroticism, anxiety sensitivity (believes sx harmful),abuse, smoking, stressors,

70
Q

Panic d/o age of onset

A

* avg age 20-24yo * unusual after 45yo or childhood

71
Q

Agoraphobia criteria (separate Dx now)

A

* anxiety re ≥2 of {public transport, open spaces, enclosed spaces, in line or crowd, out of home alone} * fears or avoids b/c of thoughts escape may be diff/help not available * situations almost always provoke anxiety * actively avoided/companion/endured w/ intense fear * out of proportion to danger * persistent (usually >6mo)

72
Q

Agoraphobia epi

A

* 12mo prev: 2% * F:M = 2:1

73
Q

Agoraphobia course

A

remission rates <10%

74
Q

Agoraphobia comorbidity

A

30-50% w/ panic attacks

75
Q

Agoraphobia risk factors

A

* neuroticism, abuse, early adversity, cold/overprotective family environment * 61% heritability

76
Q

Agoraphobia age of onset

A

* in 2/3 onset * 2nd peak >40yo * in childhood RARE

77
Q

GAD criteria

A

* escessive anxiety most days >6 months re many topics * difficult to control worry * ≥3 of {restless, fatigue, [], irritability, tension, sleep disturbance}

78
Q

GAD epi

A

* 12mo prev: 1-3%; lifetime 9% * F:M = 2:1

79
Q

GAD age of onset

A

* avg age 30yo but broad range * early onset –> comorbidities

80
Q

GAD risk factors

A

neuroticism, harm avoidance, adversity, overprotection, 1/3 genetic

81
Q

Most common comorbidity in BD I/II d/o?

A

anxiety and related disorders - 50-75%

82
Q

Rates of anxiety d/o in MDD?

A

60%

83
Q

1st line tx for panic disorder

A

* CBT (esp exposure) * Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, paroxetine CR, sertraline, venlafaxine XR

84
Q

1st line tx for specific phobia

A

ERP

85
Q

1st line tx of social anxiety d/o

A

* CBT (+/- d-cycloserin NMDA partial agonist) * Escitalopram, fluvoxamine, fluvoxamine CR, paroxetine, paroxetine CR, pregabalin (>600mg/day), sertraline, venlafaxine XR

86
Q

1st line tx for GAD

A

* Acceptance-based beh], meta-cognitive, CBT - intolerance of uncertainty, adjunctive MBCT * Agomelatine, duloxetine, escitalopram, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine XR

87
Q

OCD criteria

A

* obsessions and/or compulsions * time-consuming (>1h/day) or distress/impairment

88
Q

OCD specifiers

A

* good/fair insight * poor insight (“prob true”) * absent insight/delusional beliefs * tic-related - current or past Hx of tic d/o

89
Q

OCD epi

A

* 12mo prev: 1% * F>M in adulthood * mean age 19yo * unusual >35yo * chronic if untreated * RF: abuse, adversity, genetic (2x in 1st degree rel)

90
Q

Gen comorbidity rate in OCD

A

* 60-90% (mood, other anxiety, somatoform etc)

91
Q

1st line for OCD

A

* CBT w/ ERP * danger ideation reduction therapy, DIRT > ERP * CBT+Rx > Rx but not > CBT alone * Escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

92
Q

1st line for PTSD

A

* TF-CBT, EMDR, CPD * comb tx > each alone * sertraline, fluoxetine, venlafaxine, paroxetine * prazosin for nightmares

93
Q

Body dysmorphic disorder criteria

A

* preoccupation with ≥ 1 defect/flaw, not observable to others * at some point in the course, repetitive beh or mental acts in response to appearance concerns

94
Q

Body dysmorphic d/o specifiers

A

* muscle dysmorphia - too small/insufficiently muscular; specify even if not only concern * good/fair/poor/absent insight/delusional beliefs

95
Q

Body dysmorphic d/o prevalence

A

2% (point) up to 15% in derm pts

96
Q

Body dysmorphic d/o age of onset

A

mean 16-17yo most common 12-13 2/3 have it before 18yo

97
Q

Body dysmorphic d/o course

A

chronic can improve with tx

98
Q

Body dysmorphic d/o risk/prognostic factors

A

* neglect, abuse, elevated in 1st degree relatives

99
Q

Hoarding d/o criteria

A

* persistent diff discarding possessions, regardless of value * perceived need to save the items * accumulation that clutters and compromises intended use

100
Q

Hoarding d/o specifiers

A

* excessive acquisition (80-90%) * good/fair/poor/absent insight/delusional beliefs

101
Q

Hoarding d/o prevalence

A

point - 2-6% M>F

102
Q

Hoarding d/o age of onset

A

11-15yo (first sx), usually interferes with fxn by mid-20s

103
Q

Hoarding d/o course

A

chronic, waxing and waning severity increases with age

104
Q

Hoarding d/o risk/prognostic factors

A

indecisiveness adverse events in early life familial - 50% in twin studies

105
Q

Hoarding d/o comorbidities

A

75% - mood or anxiety d/o most common: MDD, GAD, social phobia 20% - OCD

106
Q

Trichotillomania criteria

A

* recurrent pulling of hair, resulting in hair loss * repeated attempts to stop/decrease

107
Q

Trichotillomania prevalence

A

12mo - 1-2% F:M = 10:1

108
Q

Trichotillomania course

A

chronic if untreated

109
Q

Trichotillomania risk/prognostic factors

A

* genetic vulnerability - common in OCD families

110
Q

Trichotillomania comorbidity

A

MDD, excoriation

111
Q

Excoriation d/o criteria

A

* recurrent skin picking resulting in lesions * repeated attempts to decrease/stop

112
Q

Excoriation prevalence

A

lifetime 1% F:M = 3:1

113
Q

Excoriation age of onset

A

adolescence, usually starts with acne

114
Q

Excoriation course

A

chronic, waxing/waning if untreated

115
Q

Excoriation risk/prognostic factors

A

common in OCD families

116
Q

Somatic symptom d/o criteria

A

* ≥1 somatic sx * ≥1 of {disproportionate/persistent thoughts, persistent high anxiety, excessive time and E devoted to sx concern} * persistent (typically >6months)

117
Q

Somatic symptom disorder specifiers

A

* with predominant pain * Persistent (severe sx, impairment, duration >6months) * Severity

118
Q

Somatic symptom d/o prevalence

A

5-7% F>M

119
Q

Somatic symptom d/o risk/prognostic factors

A

* neuroticism * low education, low SES * stressful life events * older age, female * hx of childhood adversity

120
Q

Illness anxiety d/o criteria

A

* preoccupation with having/acquiring serious illness * No/mild somatic sx * high anxiety re health * excessive health-related beh OR maladaptive avoidance * >6mo (may change illnesses during this time)

121
Q

Illness anxiety d/o specifiers

A

* Care-seeking type * Care-avoidant type

122
Q

Illness anxiety d/o prevalence

A

12mo : 1% - 10%

123
Q

Illness anxiety d/o risk factors

A

* major life stress, hx of abuse, hx of serious childhood illness * 1/3 have a transient form

124
Q

Conversion d/o criteria

A

* ≥1 sx of altered voluntary motor or sensory fxn * incompatibility btwn sx and known medical conditions

125
Q

Conversion d/o specifiers

A

* weakness or paralysis * abnormal movement * swallowing symptoms * speech symptoms * attacks or seizures * anesthesia or sensory loss * special sensory sx * mixed sx * acute episode ( 6mo) * w/ psychological stressor

126
Q

Conversion d/o prevalence

A

unknown 5% of referrals to neuro clinics

127
Q

Conversion d/o risk/prognostic factors

A

* maladaptive personality traits * hx of abuse/neglect * neurological disease that causes similar sx * Positive prognosis: short duration, acceptance of the dx

128
Q

Psychological factors affecting other medical conditions - criteria

A

* a medical sx or dx * ≥1 factor adversely affecting the medical condition by {close temporal association, interfere w/ tx (e.g adherence), additional health risks, influence the underlying pathophysiology} * not better explained by another mental d/o

129
Q

Factitious d/o criteria (imposed on self)

A

* falsification of phys/psych signs or sx or induction of injury/disease, w/ deception * presents as ill, impaired, injured * evident even in absence of obvious external awards * Specify: single or recurrent episodes

130
Q

Factitious d/o prevalence

A

unknown 1% of hospital patients

131
Q

Reactive attachment d/o criteria

A

* child rarely/minimally seeks AND responds to comfort when distressed * ≥2 of {minimal social/emotional responsiveness, limited positive affect, episodes of unexplained irritability, sadness or fearfulness even when non-threatening interactions} * Hx of ≥1 of {social neglect or deprivation, repeated changes of primary cargivers, rearing in unusual settings that limit selective attachments} * disturbance is caused by the above * R/O ASD * 9mo - 5yo * Specify if persistent (>12mo)

132
Q

Reactive attachment d/o prevalence

A

unknown but rare (even in severely neglected children <10%)

133
Q

Reactive attachment d/o course

A

W/o remediation and recovery via normative caregiving, signs may persist for several years

134
Q

Reactive attachment d/o risk/prognostic factors

A

* serious social neglect * prognosis depends on quality of caregiving environment after

135
Q

Reactive attachment d/o comorbidities

A

* other conditions assoc w/ neglect: cognitive/language delays, sterotypies, medical conditions * depressive sx

136
Q

Disinhibited social engagement d/o criteria

A

* ≥2 of {reduced reticence in approaching strangers, overly familiar beh, diminished checking back w/ caregiver even in unfamiliar settings, willing to go off with stranger w/o hesitation} * Not limited to impulsivity (e.g. ADHD) * ≥1 on Hx {social neglect, changes in caregivers, unusual settings} * above causes the disturbance * >9 months of age * Specify if persistent (>12mo)

137
Q

Disinhibited social engagement d/o prevalence

A

unknown in high-risk populations: 20%

138
Q

Disinhibited social engagement d/o course

A

often persists even if caregiving improved

139
Q

PTSD criteria (age >6yo)

A

* Exposure to actual or threatened death, serious injury or sexual violence in ≥1 of {directly experiencing, witnessing in person, learning it happened to close family/friend, repeated/extreme exposure to aversive details - e.g. 1st responders} * ≥1 of {intrusive memories, nightmares, dissoc. rxns/flashbacks, intense/prolongued distress at exposure to cues, phys. rxn to cues} * avoidance: ≥1 of {memories/thoughts/feelings associated, external reminders} * negative alterations in cognition/mood: ≥2 of {inability to remember important aspect, negative beliefs re self/others/world, distorted cognitions/blame, negative emotional state, diminished interest, detachment from others, inability to experience positive emotions * alterations in arousal/reactivity: ≥2 of {irritable, reckless, hypervigilance, exaggerated startle, [], sleep disturbance} * >1mo duration

140
Q

PTSD specifiers

A

* with dissociative sx (depersonalization or derealization) * with delayed expression

141
Q

PTSD prevalence

A

lifetime 9% 12mo 4%

142
Q

PTSD risk/prognostic factors

A

* Pre-traumatic: childhood emotional problems, prior mental d/o, lower SES, prior trauma, chldhood adversity, lower intelligence, cultural characteristics (fatalistic), minority race/ethnos, family psych hx. Social support - protective * Peritraumatic: severity of trauma, perceived threat, personal injury, interpersonal violence; for military - being perpetrator; dissociation. * Post-traumatic: negative appraisals, poor coping strategies, acute stress d/o, exposure to repeated reminders, subsequent adverse life events, losses. Social support - protective

143
Q

Acute stress disorder criteria

A

* PTSD criterion A (exposure) * ≥9 combined of intrusion sx, negative mood, dissociative sx, avoidance, arousal sx * duration 3 days - 1 month after trauma

144
Q

Acute stress d/o prevalence

A

* 20-50% if interpersonal assault *

145
Q

Acute stress d/o risk/prognostic factors

A

* prior mental d/o; neuroticism; perceived severity, avoidant coping style; catastrophic appraisals * prior trauma * female gender * elevated reactivity prior to trauma

146
Q

Adjustment d/o criteria

A

* emotional or beh sx 6mo

147
Q

Adjustment d/o specifiers

A

* with depressed mood * with anxiety * with mixed anxiety and depressed mood * with disturbance of conduct * with mixed disturbance of emotions and conduct * unspecified * acute ( 6mo)

148
Q

Adjustment d/o prevalence

A

in OPD psych: 5-20% in hospital psychiatric consultation: up to 50%

149
Q

Adjustment d/o risk/prognostic factors

A

disadvantaged life circumstances

1_Psychiatry Royal College 2017 (6 decks)

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