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)
Specific phobia epi
* 12mo prev: 7-9% * follows traumatic event * Risk factors: neuroticism, parental overprotectiveness, parental loss, phys/sex abuse, genetic
Social anxiety criteria
* 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
Social anxiety specifiers
* performance only - restricted to speaking/performing in public
Social anxiety prevalence
* 12mo prev: 7% * F=M *
Social anxiety risk factors
beh. inhibition, abuse, early adversity, genetic
Social anxiety age of onset
avg age 13yrs (1st onset in adult RARE)
Panic attack criteria
≥4 of: - palpitations - sweating - trembling - SOB - choking - CP - N/V - dizzy - chills/heat - paraesthesias - derealization/depersonalization - fear of losing control/crazy - fear of dying
Panic d/o criteria
* recurrent unexpected panic attacks * > 1month of worry re panic attacks and/or maladaptive beh change
Panic d/o epi
* 12mo prev: 2-3% * F:M = 2:1
Panic d/o risk factors
neuroticism, anxiety sensitivity (believes sx harmful),abuse, smoking, stressors,
Panic d/o age of onset
* avg age 20-24yo * unusual after 45yo or childhood
Agoraphobia criteria (separate Dx now)
* 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)
Agoraphobia epi
* 12mo prev: 2% * F:M = 2:1
Agoraphobia course
remission rates <10%
Agoraphobia comorbidity
30-50% w/ panic attacks
Agoraphobia risk factors
* neuroticism, abuse, early adversity, cold/overprotective family environment * 61% heritability
Agoraphobia age of onset
* in 2/3 onset * 2nd peak >40yo * in childhood RARE
GAD criteria
* escessive anxiety most days >6 months re many topics * difficult to control worry * ≥3 of {restless, fatigue, [], irritability, tension, sleep disturbance}
GAD epi
* 12mo prev: 1-3%; lifetime 9% * F:M = 2:1
GAD age of onset
* avg age 30yo but broad range * early onset –> comorbidities
GAD risk factors
neuroticism, harm avoidance, adversity, overprotection, 1/3 genetic
Most common comorbidity in BD I/II d/o?
anxiety and related disorders - 50-75%
Rates of anxiety d/o in MDD?
60%
1st line tx for panic disorder
* CBT (esp exposure) * Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, paroxetine CR, sertraline, venlafaxine XR
1st line tx for specific phobia
ERP
1st line tx of social anxiety d/o
* CBT (+/- d-cycloserin NMDA partial agonist) * Escitalopram, fluvoxamine, fluvoxamine CR, paroxetine, paroxetine CR, pregabalin (>600mg/day), sertraline, venlafaxine XR
1st line tx for GAD
* Acceptance-based beh], meta-cognitive, CBT - intolerance of uncertainty, adjunctive MBCT * Agomelatine, duloxetine, escitalopram, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine XR
OCD criteria
* obsessions and/or compulsions * time-consuming (>1h/day) or distress/impairment
OCD specifiers
* good/fair insight * poor insight (“prob true”) * absent insight/delusional beliefs * tic-related - current or past Hx of tic d/o
OCD epi
* 12mo prev: 1% * F>M in adulthood * mean age 19yo * unusual >35yo * chronic if untreated * RF: abuse, adversity, genetic (2x in 1st degree rel)
Gen comorbidity rate in OCD
* 60-90% (mood, other anxiety, somatoform etc)
1st line for OCD
* CBT w/ ERP * danger ideation reduction therapy, DIRT > ERP * CBT+Rx > Rx but not > CBT alone * Escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
1st line for PTSD
* TF-CBT, EMDR, CPD * comb tx > each alone * sertraline, fluoxetine, venlafaxine, paroxetine * prazosin for nightmares
Body dysmorphic disorder criteria
* 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
Body dysmorphic d/o specifiers
* muscle dysmorphia - too small/insufficiently muscular; specify even if not only concern * good/fair/poor/absent insight/delusional beliefs
Body dysmorphic d/o prevalence
2% (point) up to 15% in derm pts
Body dysmorphic d/o age of onset
mean 16-17yo most common 12-13 2/3 have it before 18yo
Body dysmorphic d/o course
chronic can improve with tx
Body dysmorphic d/o risk/prognostic factors
* neglect, abuse, elevated in 1st degree relatives
Hoarding d/o criteria
* persistent diff discarding possessions, regardless of value * perceived need to save the items * accumulation that clutters and compromises intended use
Hoarding d/o specifiers
* excessive acquisition (80-90%) * good/fair/poor/absent insight/delusional beliefs
Hoarding d/o prevalence
point - 2-6% M>F
Hoarding d/o age of onset
11-15yo (first sx), usually interferes with fxn by mid-20s
Hoarding d/o course
chronic, waxing and waning severity increases with age
Hoarding d/o risk/prognostic factors
indecisiveness adverse events in early life familial - 50% in twin studies
Hoarding d/o comorbidities
75% - mood or anxiety d/o most common: MDD, GAD, social phobia 20% - OCD
Trichotillomania criteria
* recurrent pulling of hair, resulting in hair loss * repeated attempts to stop/decrease
Trichotillomania prevalence
12mo - 1-2% F:M = 10:1
Trichotillomania course
chronic if untreated
Trichotillomania risk/prognostic factors
* genetic vulnerability - common in OCD families
Trichotillomania comorbidity
MDD, excoriation
Excoriation d/o criteria
* recurrent skin picking resulting in lesions * repeated attempts to decrease/stop
Excoriation prevalence
lifetime 1% F:M = 3:1
Excoriation age of onset
adolescence, usually starts with acne
Excoriation course
chronic, waxing/waning if untreated
Excoriation risk/prognostic factors
common in OCD families
Somatic symptom d/o criteria
* ≥1 somatic sx * ≥1 of {disproportionate/persistent thoughts, persistent high anxiety, excessive time and E devoted to sx concern} * persistent (typically >6months)
Somatic symptom disorder specifiers
* with predominant pain * Persistent (severe sx, impairment, duration >6months) * Severity
Somatic symptom d/o prevalence
5-7% F>M
Somatic symptom d/o risk/prognostic factors
* neuroticism * low education, low SES * stressful life events * older age, female * hx of childhood adversity
Illness anxiety d/o criteria
* 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)
Illness anxiety d/o specifiers
* Care-seeking type * Care-avoidant type
Illness anxiety d/o prevalence
12mo : 1% - 10%
Illness anxiety d/o risk factors
* major life stress, hx of abuse, hx of serious childhood illness * 1/3 have a transient form
Conversion d/o criteria
* ≥1 sx of altered voluntary motor or sensory fxn * incompatibility btwn sx and known medical conditions
Conversion d/o specifiers
* 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
Conversion d/o prevalence
unknown 5% of referrals to neuro clinics
Conversion d/o risk/prognostic factors
* maladaptive personality traits * hx of abuse/neglect * neurological disease that causes similar sx * Positive prognosis: short duration, acceptance of the dx
Psychological factors affecting other medical conditions - criteria
* 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
Factitious d/o criteria (imposed on self)
* 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
Factitious d/o prevalence
unknown 1% of hospital patients
Reactive attachment d/o criteria
* 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)
Reactive attachment d/o prevalence
unknown but rare (even in severely neglected children <10%)
Reactive attachment d/o course
W/o remediation and recovery via normative caregiving, signs may persist for several years
Reactive attachment d/o risk/prognostic factors
* serious social neglect * prognosis depends on quality of caregiving environment after
Reactive attachment d/o comorbidities
* other conditions assoc w/ neglect: cognitive/language delays, sterotypies, medical conditions * depressive sx
Disinhibited social engagement d/o criteria
* ≥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)
Disinhibited social engagement d/o prevalence
unknown in high-risk populations: 20%
Disinhibited social engagement d/o course
often persists even if caregiving improved
PTSD criteria (age >6yo)
* 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
PTSD specifiers
* with dissociative sx (depersonalization or derealization) * with delayed expression
PTSD prevalence
lifetime 9% 12mo 4%
PTSD risk/prognostic factors
* 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
Acute stress disorder criteria
* PTSD criterion A (exposure) * ≥9 combined of intrusion sx, negative mood, dissociative sx, avoidance, arousal sx * duration 3 days - 1 month after trauma
Acute stress d/o prevalence
* 20-50% if interpersonal assault *
Acute stress d/o risk/prognostic factors
* prior mental d/o; neuroticism; perceived severity, avoidant coping style; catastrophic appraisals * prior trauma * female gender * elevated reactivity prior to trauma
Adjustment d/o criteria
* emotional or beh sx 6mo
Adjustment d/o specifiers
* 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)
Adjustment d/o prevalence
in OPD psych: 5-20% in hospital psychiatric consultation: up to 50%
Adjustment d/o risk/prognostic factors
disadvantaged life circumstances
