dx criteria

Question 1

Restricting Type AN

Answer 1

3 months of no binging or purging (no self-induced vomiting or use of laxatives)
 Excessive exercising, fasting, dieting

Question 2

Major Depressive Episode (and in elderly)

Answer 2

At least five (4 for elderly)of the following for a 2-week period with at least one either (1) depressed mood or (2) loss of interest or pleasure:
 Depressed mood most of the day, nearly every day
 Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day (anhedonia)
 Significant weight loss or weight gain when not dieting (usu loss)
 Insomnia or hypersomnia nearly every day (antisuppressnats make worse)
 Psychomotor agitation or retardation nearly every day
 Fatigue or loss of energy nearly every day
 Feelings of worthlessness or excessive guilt
 Diminished ability to think or concentrate

Question 3

Bipolar I Disorder (has mania)

Answer 3

• Single manic episode is necessary to diagnose. (Patient only need one “pole” of the bipolar for this diagnosis.)
• At least one manic or mixed episode.
• Major depressive episode not required for diagnosis
o But is usually is the episode that presents first

Question 4

Delusional Disorder

Answer 4

o	Delusions (not always “nonbizzare”, ie. involving situations that could occur in real life such as being followed, poisoned, or infected, having a disease, being loved at a distance) of at least 1 month’s duration.
o	Has never met criterion A for schizophrenia (for more than a few hours).
o	Apart from the impact of the delusion, functioning is not impaired and behavior is not odd or bizarre.

Question 5

Bipolar II Disorder (mania)

Answer 5

• Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes

Question 6

Schizophreniform

Answer 6

o Meets criteria A, D and E for schizophrenia.

o An episode of the disorder lasts at least 1 month but less than 6 months. (schizo must be more than 6 mos)

Question 7

Schizophrenia

Answer 7

A. Two (or more) of the Following for Most of 1 Month; at least one of the first 3 symptoms
 Delusions
 Hallucinations
 Disorganized Speech
 Grossly Disorganized or Catatonic Behavior
 Negative Symptoms

B. Marked social or occupational dysfunction.

C. Duration of at least 6 months of persistent symptoms such as attenuated forms of group A symptoms (above) or negative symptoms. At least 1 month of this must include a group A symptom.

D. Symptoms of schizoaffective and mood disorder ruled out.

E. Substance abuse and medical conditions ruled out as etiologic

Question 8

Schizoaffective Disorder

Answer 8

o Uninterrupted period of illness with either a major depressive episode or manic episode concurrent with symptoms that meet criterion A for schizophrenia.
o Same period of illness, have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

Question 9

Catatonic Type of Schizophrenia

Answer 9

The clinical picture is dominated by at least two of the following:
• Motoric immobility as evidenced by catalepsy or stupor.
• Excessive motor activity (apparently purposeless and not influenced by external stimuli).
• Extreme negativism or mutism.
• Peculiarities of voluntary movement such as posturing, stereotyped movements, prominent mannerisms or prominent grimacing.
• Echolalia or echopraxia.

Question 10

Hypomanic Episode

Answer 10

Similar to manic episode but is less severe. Episodes only need to last 4 days and must not include psychotic features
o No social/occupational impairment

Question 11

Panic Disorder

Answer 11

Both (1) and (2):

(1) Recurrent unexpected panic attacks. (See next slide for criteria of panic attacks.)

(2) At least one attack followed by 1 month or more of one or more:
o Persistent concern about additional attacks.
o Worry about the implications of the attack or its consequences (ie losing control, heart attack, etc).
o Significant change in behavior related to the attacks.

Question 12

Generalized Anxiety Disorder

Answer 12

	Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, for most of day, about a number of events or activities.
	It is difficult to control the worry.
	The anxiety and worry are associated with at least three persisting for more days than not of the past 6 months:
•	Restlessness or Feeling On Edge
•	Easily Fatigued
•	Difficulty Concentrating
•	Irritability
•	Muscle Tension
•	Sleep Disturbance

Question 13

Cyclothymic Disorder

Answer 13

• Characterized as dysthymic disorder with intermittent hypomanic periods
• Patient who, over the last 2 years (1 year for children), experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for major depressive disorder)
• During the first 2 years the patient may not have major depressive, manic, or mixed episode.

Question 14

Binge-eating/purging type AN

Answer 14

3 months of the binging and purging behaviors
 Self-induced vomiting
 Misuse of laxatives, diuretics, enemas

Question 15

Manic Episode

Answer 15

Abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week with at least three of the following:
o During the mood disturbance and increased energy, three of the following:
 Inflated Self-Esteem or Grandiosity
 Decreased Need for Sleep (not tired)
 More Talkative (pressured/push of speech)
 Flight of Ideas / Racing Thoughts
 Distractibility
 Increased Goal-Oriented Behavior
 Excessive Involvement in Pleasurable Activities

Question 16

Panic Attack

Answer 16

A discrete period of intense fear or discomfort, in which four or more of the following developed abruptly and reached peak within 10 minutes and usually last <25 mins: Now specified as “unexpected and expected” panic attack
o	Palpitations
o	Sweating
o	Trembling / Shaking
o	Sensations of Shortness of Breath
o	Chest Pain or Discomfort
o	Feeling Dizzy / Unsteady / Lightheaded
o	Fear of Losing Control or Going Crazy or Dying
o	Paresthesias
o	Chills or Hot Flashes

Question 17

Brief Psychotic Disorder

Answer 17

Presence of at least of the the following:
 Delusions
 Hallucinations
 Disorganized Speech
 Grossly Disorganized or Catatonic Behavior

Duration of an episode of the disturbance is at least 1 day and no more than 1 month, with eventual return to premorbid level of functioning.

Question 18

Persistent Depressive Disorder (Dysthymic Disorder)***

Answer 18

• Depressed mood for most of the day (at least 2 years in duration for adults and 1 year for children) that has not been severe enough to meet criteria for major depressive episode.
• During 2 years, cannot be w/o sx for >2mo at a time (is continuous)
• Patients must never have met criteria for manic episode, mixed episode, or hypomanic episode.