Exam 2 DSM V Criteria Flashcards
A. Six months with prominent tension, worry & apprehension
B. Difficulty controlling symptoms
C. At least three symptoms from list of six
- Restlessness
- Easy fatigability
- Poor concentration
- Irritability
- Muscle tension
- Sleep disturbance
GAD
A. Marked/persistent fear of one or more social/performance
situations, with possible scrutiny by others
B. Fear of showing anxiety symptoms that will be negatively evaluated
C. Social situation always provokes fear or anxiety
D. Situations are avoided or enduring with intense fear
E. Fear is out of proportion to event
F. Persistent: 6 months or more
SAD
Mild GAD tx
10-15 60 min CBT sessions
Moderate/Severe GAD Tx
1st: SSRI/SNRI + CBT
2nd: Buspirone/hydroxyzine or BZs + CBT
3rd: Quentiapine
last: TCAs
1st line SAD tx…
CBT +/- SSRI/SNRI
Performance anxiety tx
propranolol/atenolol
short-term BZ
A. Discrete period of intense fear or discomfort, in which four (or more) of the
following symptoms developed abruptly and reached a peak within 10 minutes
(i.e. Panic Attack):
1) palpitations, pounding heart, or accelerated heart rate
2) sweating
3) trembling or shaking
4) sensations of shortness of breath or smothering
5) feeling of choking
6) chest pain or discomfort
7) nausea or abdominal distress
8) feeling dizzy, unsteady, lightheaded, or faint
9) derealization (feelings of unreality) or depersonalization (being detached from oneself)
10) fear of losing control or going crazy
11) fear of dying
12) paresthesias (numbness or tingling sensations)
13) chills or hot flushes
Panic d/o
at least 1 month of one (or more) of the following:
- Persistent concern about having additional attacks or worry
about the implications of the attack or their consequences (e.g.,
losing control, having a heart attack, “going crazy”) - Significant maladaptive change in behavior related to attacks
Panic d/o
Panic d/o tx
CBT + SSRI/SNRI +/- Clonazepam PRN
A. Marked/persistent excessive/unreasonable fear of
presence or anticipation of specific object/situation
B. Exposure almost invariably provokes immediate
anxiety response, may be panic attack
C. Avoided or endured with intense anxiety/distress
D. Fear/anxiety is out of proportion to stimulus
E. 6 months or longer
Specific Phobias
Phobia tx
short term CBT
Pharm: SSRI/SNRI, short term BZs PRN
A. Either obsessions or compulsions or both
Obsessions defined by (1) and (2):
¨ 1. Recurrent & persistent thoughts, impulses, or images experienced as
intrusive & inappropriate, and cause marked anxiety or distress
¨ 2. Attempts to ignore or suppress the thoughts, or to neutralize them with
other thought/action (by performing compulsion)
Compulsions defined by (1) and (2):
¨ 1. Repetitive behaviors or mental acts, driven to perform in response to obsession or according to rigid rules
¨
2. Aimed at preventing/reducing distress, preventing dreaded event;
however not connected in realistic way or are clearly excessive
B. O/C are time consuming (>1 hr/day) or cause impairment
OCD
Possessions: persistent difficulty discarding regardless
of value
B. Perception is to need to save items and distress would
occur with discarding them
C. Results in accumulation until they congest and clutter
active living areas, and compromise their intended use
hoarding d/o
Tx for OBDs
CBT, exposure and response prevention (ERP)
SSRI/SNRI
clomipramine (TCA)
Psychological response to an identifiable stressor(s) resulting in clinically significant emotional or behavioral symptoms
A. Symptoms develop w/in 3 months of stressor
B. Distress out of proportion to event and significant impairment
in social/occupational functioning
C. Not due to another mental disorder
D. Rule out Bereavement
E. Must resolve w/in 6 months following stressor
Adjustment d/o
Tx for adjustment d/o
psychotherapy/group therapy
drugs for sxs
med specifically indicated for bulimia…
fluoxetine
med specifically indicated for binge eating d/o
vyvanse
excessive anxiety and worry occurring most days, lasting >6 months, that interfere with daily life, are impossible to control, are not caused by other mental health conditions, and three of the following symptoms:
- restlessness
- fatigue
- trouble concentrating
- irritability
- muscle tension
- sleep problems
GAD
Mnemonic: Macbeth Frets Constantly Regarding Illicit Sins
GAD:
Muscle tension fatigue concentration difficulty restlessness irritability sleep disturbance
The below are risk factors for…
■ Current & past psychiatric illness ■ Current symptoms ■ Family history ■ Stressors ■ Change in treatment
suicide
What is the biggest risk factor for suicide?
previous attempt
The below sxs are concerning for what?
■ Anhedonia ■ Impulsivity ■ Hopelessness or despair ■ Anxiety, panic ■ Insomnia ■ Command hallucinations ■ Psychosis
suicide
The below factors are risks for..
■ Event causing humiliation, shame, despair ■ Chronic pain or acute medical problem ■ Sexual or physical abuse ■ Substance intoxication or withdrawal ■ Pending incarceration or homelessness ■ Legal problem ■ Inadequate social support, isolation ■ Perceived burden on others
suicide
what risk classification for suicide?
■ Agitated ■ Anxious ■ Psychomotor activity ■ Emotional lability ■ Global insomnia ■ Appetite disturbance ■ High level distress ■ Desperation ■ Akathisia ■ Alcohol intoxicated
observable high risk
what risk classification for suicide?
■ Somnolent, sleepy, sleeping ■ Calm ■ Hungry, eating ■ Self-directed actions – “I want…” ■ Future directed actions ■ Manipulative
observable low risk
regarding suicide, what are the below?
■ Children at home ■ Sense of responsibility to family ■ Pregnancy ■ Religiosity ■ Life satisfaction ■ Positive social support ■ Effective clinical care ■ Easy access to interventions/ support ■ Support from ongoing providers ■ Skills in problem solving, conflict resolution ■ Cultural/religious beliefs
protective factors
Suicide Assessment Five Step Evaluation and Triage (SAFE-T)
Identify RFs
Identify PFs
Conduct suicide inquiry
Determine risk level/intervention
document
The below assess what factor of suicide?
– Do you ever feel like giving up?
– Do you ever feel life’s not worth living?
– Do you wish you could go to sleep & not wake up?
– Have you been thinking about death recently?
– Have things gotten to the point that you’ve thought about ending your life?
ideation
The below assess what factor of suicide?
– How likely are you to act on those thoughts?
– What prevents you from acting on those thoughts?
intent
High risk of suicide interventions
admit w. suicide precautions
Moderate risk of suicide interventions
+/- admit depending on RFs
low risk suicide interventions
outpatient referral, crisis number
6 facets of suicide risk management
stabilize medical conditions
safe containment
repeated observation/assessment
consider initiation of tx
remove/tx modifiable RFs
dispo (in vs out patient)
Suicide Risk Mnemonic:
SAD PERSONS
Sex (male)
Age (< 19, > 45)
Depression
Previous attempt Excessive etoh/substance use Rational thinking loss Separated/single Organized Plan No social support Sickness
2 mental health conditions that confer increased risk of suicide
MDD
alcohol/substance addiction
