DSM5 criteria Flashcards
delusional disorder
≥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
Delusional disorder specifiers
* Use after >1yr duration * First episode,/Multiple episodes, currently in acute episode/partial remission/full remission * Continuous * Unspecified * Specify current severity
Delusional disorder prevalence
* 0.2% lifetime * no major gender diff * persecutory most common
Brief psychotic disorder
* ≥1 of {delusions, hallucinations, disorg. speech, disorg/catatonic beh} * 1 day - 1 month
Brief psychotic disorder specifiers
* With marked stressors (brief reactive) * Without marked stressors * With peripartum onset (preg or 4wks postpartum) * With catatonia * Specify current severity
Brief psychotic disorder epidemiology and course
* 9% of FEP * F:M = 2:1 * Avg onset mid-30s * High rates of relapse but excellent outcome
Schizophreniform disorder
* ≥ 2 Sx of psychosis (delusions, hallucinations, disorganized speech, disorg/catatonic beh, negative symptoms) * 1-6 months * R/O mood/schizoaff
Schizophreniform disorder specifiers
* 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
schizophreniform d/o epidemiology/course
* incidence overall similar to scz; in US
Schizophrenia criteria
* ≥ 2 psychotic sx for 1month * fxn markedly decreased most of the time since onset * continuous sx >6 months * R/O SCZ-aff/mood
Schizophrenia specifiers
* FEP/multiple episodes, currently in acute episode/partial remission/full remission * Continuous * Unspecified * with catatonia * severity
Aggression risk in SCZ
* young males * Hx of violence * non-adherence to tx * substance abuse * impulsivity
Anosognosia in SCZ
* Sx of SCZ, not a coping strategy * predicts relapse, involuntary tx, fxn, aggression, course of illness
Neuro soft signs in SCZ
* motor coordination * sensory integration * motor sequencing of complex movements * L-R confusion * disinhibition of associated movements
SCZ - prevalence
* Lifetime prevalence: 0.3-0.7% * F=M if including all Sx
SCZ - age of onset
late teens to mid-30s Peak age: early 20s for M, late 20s for F
SCZ - risk/prognostic factors
* 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
Schizoaffective d/o criteria
* 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
Schizoaffective d/o specifiers
* Bipolar/depressive type * Catatonia * FEP/multiple episodes, currently in acute episode/partial/full remission * Continuous * Severity
Schizoaffective disorder prevalence
* lifetime prevalence 0,3% * F>M
Schizoaffective d/o age of onset
early adulthood but anywhere from teens to late life
Substance/Med-induced psychotic D/O
* ≥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)
Substance/Med-induced psychotic d/o specifiers
* Onset during intoxication * Onset during withdrawal * Severity
Disruptive mood dysregulation disorder - criteria
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
Major depressive disorder - criteria
* 2 weeks + change of previous fxn * 5 of {mood, interest, sleep, wt, psychomotor, energy, guilt/worthlessness, [], SI}
MDD- specifiers
* anxious distress * mixed features * melancholic features * atypical features * mood-congruent psychotic features * mood-incongruent psychotic features * catatonia * peripartum onset * seasonal pattern
Anxious distress
≥ 2 sx: * tense * restless * diff. [] 2nd worry * fear something bad will happen * fear might lose control of self
Anxious distress severity
* Mild - 2 sx * moderate - 3 sx * mod-severe: 4-5 sx * severe: 4-5 sx + agitation
Mixed features in MDD
* ≥ 3 manic sx during most of MDE
Melancholic features
* 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}
Atypical features
* mood reactivity * ≥ 2 of {wt gain/increased appetite, , hypersomnia, leaden paralysis, long-standing rejection sensitivity} * NO melancholia or catatonia in same episode
Seasonal pattern
* 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
Persistent depressive disorder
* >2 years depressed mood (1yr for child) * 2 sx of {appetite change, sleep change, fatigue, low self-esteem, poor [] or decision making, hopelessness} *
Persistent depressive disorder - specifiers
* 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
MDD epidemiology
* 12mo prevalence: 7% * F:M = 1.5-3x * 18-29yo: 3x prevalence in >60yo
MDD - course
* 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
MDD - age of onset
any age but peak onset in 20s
Persistent depressive d/o - epidemiology
* 0.5% 12mo prevalence for dysthymia * 1.5% for chronic MDD * early, insidious course
Premenstrual dysphoric disorder
* 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} *
PMDD prevalence
* 12mo prevalence: 2-6%
PMDD risk factors
stress, trauma, seasonal changes, no OCP
Manic episode criteria
* 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
Hypomanic episode criteria
* mood AND energy x >4 days * ≥3 of {grandiosity, sleep, talkative, flight of ideas, distractibility, goal-directed/agitation, painful consequences} * uncharacteristic change in fxn
Bipolar I OR II specifiers
* 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
Bipolar I epi
* 12mo prevalence: 0.6% * M:F = 1.1 : 1
Bipolar I course
* >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
Bipolar I avg age of onset
18yo
Bipolar II prevalence
* 12mo prev: 0.3-0.8%
Bipolar II course
* often starts with MDE * higher lifetime episodes than BD I
Bipolar II age of onset
avg age mid-20s
Bipolar II risk/prognostic factors
* 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
Cyclothymic d/o criteria
* >2 yrs of numerous periods of hypomanic or depressive Sx not meeting criteria for episode * Sx periods present for >50% of the time *
Cyclothymic d/o epi
* lifetime prev: 0.4-1% * M=F
Cyclothymic d/o course
insidious onset, persistent course
Cyclothymic d/o risk factors
* MDD, BD I and II in 1st degree relatives * increased familial risk of substance use
Substance/Medication induced bipolar and related d/o
* 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
* Separation anxiety d/o criteria
* 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
Specific phobia criteria
* marked fear * phobic object/situation almost always provokes anxiety * out of proportion to danger * >6 months
Specific phobia specifiers
* animal * natural environment (ht, storm etc) * blood-injection-injury * situational * other (e.g. clowns, sounds, vomiting etc) * common to have several phobias (avg 3)