first partial exam (disorders)

Question 1

autism spectrum disorder (ASD)

Answer 1

A. persistent impairments in social relations and interactions in multiple contexts as shown by ALL:
1. problems with social-emotional reciprocity (no back-and-forth conversations, emotions/interests/affect sharing…)
2. problems with non-verbal communication of social interactions (eg: eye contact, interpreting hand gestures, body language)
3. problems in forming, maintaining understanding relationships (eg: behaviour is not adjusted to different social occasions, no interest in forming friendships…)

B. restricted + repetitive patterns of behavior/activities/interests, as shown by 2:
1. stereotyped + repetitive movements/use of objects/speech
2. inflexibility, insistence on sameness, rituals of verbal/nonverbal behavior
3. restricted, fixated interests that are abnormally intense
4. hyper- or hyporeactivity to sensory inputs in the environment

Question 2

severity levels for autism

Answer 2

level 1: requiring support
- noticeable impariments in social communication without support, seems not to initiate social interactions, atypical reactions to overtures from others,
- inflexibility, no planning skills (no independence)

level 2: substantial support
- impairments in social communication (verbal + nonverbal) with support, reduced/abnormal reponses, limited initiation of interaction
- inflexibility, coping problems with change OR other repetitive behaviours, noticed by observers + interphere some areas

level 3: very substantial support
- severe deficits in social communication causing severe functional impariments, very limited initiation of interactions, minimal response to social overtures
- inflexibility, extreme difficulties coping with change OR other repetitive behaviors that interfere with functioning in ALL AREAS

Question 3

ADHD

Answer 3

A. attention and/or hyperactivity impulsivity that interferes with functioning/developing marked by 1 and/or 2

1. inattention: 6 or more for more than 6 months, inconsistent with development + impairs social/academic activities
   a. no attention to detail OR careless mistakes in activities (various settings)
   b. hard to sustain attention in tasks/games
   c. often doesn’t listen
   d. doesn’t follow through instructions and doesn’t finish tasks (various settings)
   e. difficulties organizing
   f. avoidance/dislike/reluctance of tasks involving sustained mental effort
   g. loses things for tasks + activities
   h. easily distracted
   i. forgetful in daily activities
2. hyperactivity and impulsivity: at least 6 for 6 months, inconsistent with development + impairs social and academic/work level
   a. fidgeting
   b. leaves seat when supposed to be seated
   c. runs about/climb in inappropriate situations (in adults and adolescents –> restlessness)
   d. unable to play/do leisure activities quietly
   e. often “on the go” (eg: unable to remain still for long time)
   f. excessive talk
   g. blurts out answer before question is finished
   h. hard to wait for their turn
   i. interrupts others

Question 4

delusional disorder

Answer 4

A. 1/more delusions for 1 or more months

Question 5

brief psychotic disorder

Answer 5

A. 1/more of the following. must include 1, 2 or 3
1. delusions
2. hallucinations
3. unorganized speech
4. grossly disorganized/catatonic behaviour

B. symptoms last at least 1 day but less than 1 month (may even return to premorbid functioning)

Question 6

schizophreniform

Answer 6

A. 2/more of the following, each for at least 1 month (less if treated). must include 1, 2 or 3
1. delusions
2. hallucinations
3. unorganized speech
4. grossly disorganized/catatonic behaviour
5. negative symptoms

B. at least 1 month but less than 6

Question 7

schizophrenia

Answer 7

A. 2/more of the following, each for at least 1 month (less if treated). must include 1, 2 or 3
1. delusions
2. hallucinations
3. unorganized speech
4. grossly disorganized/catatonic behaviour
5. negative symptoms

B. impairments in 1/more areas of functioning during symptoms

C. continuous disturbance for at least 6 months. at least 1 month MUST present 1 symptom from criterion A + may have prodromal stage.
- in prodromal stage, EITHER negative symptoms OR at least 2 symptoms from criterion A

Question 8

schizoaffective disorder

Answer 8

A. uninterrupted period with a mood episode (major depressive with depressed mood or manic/hypomanic) + criterion A for schizophrenia

B. delusions OR hallucinations for 2/more weeks without mood episode

C. symptoms of major mood episode present for majority of the duration (active + residual phases)

Question 9

manic episode

Answer 9

A. abnormally + persistently elevated/expansive/irritable mood AND increased activity/energy for at least 1 week nearly every day (or duration of hospitalizaion)

B. during A, noticeable change in behavior as marked by 3 (4 if the mood is only irritable)
1. + self-esteem/sense of grandiosity
2. less need for sleep
3. more talkative
4. flight of ideas
5. distractable (reported by observer)
6. + goal-directed activity (work/school/sexually) OR psychomotor agitation
7. engages in acitivity potentially very harmful

C. mood distarbance causes functioal impairments/hospitalization OR there are psychotic features

Question 10

hypomanic episode

Answer 10

A. abnormally + persistently elevated/expansive/irritable mood AND increased activity/energy for at least 4 days, most of the day nearly every day

B. during A, noticeable change in behavior as marked by 3 (4 if the mood is only irritable)
1. + self-esteem/sense of grandiosity
2. less need for sleep
3. more talkative
4. flight of ideas
5. distractable (reported by observer)
6. + goal-directed activity (work/school/sexually) OR psychomotor agitation
7. engages in acitivity potentially very harmful

C. episode = inequivocable change in functioning

D. mood distarbance + change in functioning = noticeable

Question 11

depressive episode

Answer 11

A. 5/more symptoms all present for at least 2 weeks that cause change in functioning; MUST be at least either 1 or 2 (not attributable to other medical conditions):
1. depressed mood most of the day nearly every day (self-reported or by others)
2. much less/no interest in pleasurable activities most of the day nearly every day
3. significant weight loss (no dieting)/gain/change in appetite almost every day (chilrend: fail to gain expected weight)
4. insomnia/hypersomnia every day
5. psychomotor agitation/retardation nearly every day
6. fatigue/loss of energy nearly every day
7. worthlessness/excessive guilt nearly every day
8. - able to think/concentrate OR indecisive nearly every day
9. thoughts of death/suicide (planned or unplanned) or suicidal attempt

Question 12

bipolar I

Answer 12

A. manic episode

Question 13

bipolar II

Answer 13

A. hypomanic episode
+ major depressive episode

Question 14

major depressive disorder

Answer 14

A. depressive episode (A1: in children + adolescents can be irritable mood)

Question 15

persistent depressive disorder

Answer 15

A. depressed mood (most of the day, amjority of the days) for at least 2 years (self-reported or by others) (in children/adolescents can be irritable mood for at least 1 year)

B. when depressed 2/more of:
1. less appetite/overeating
2. insomnia/hypersomnia
3. low energy/fatigue
4. low self-esteem
5. less concentration/ability to make decisions
6. hopelessness

Question 16

specific phobia

Answer 16

A. marked fear/anxiety for a specific object (in children: freezing, tantrums, clinging or crying)

B. phobic object/situation almost always caused anxiety/fear

C. phobic object is almost always avoided or endured with fear/anxiety

D. fear/anxiety = disproportionate based on the object and sociocultural context

E. fear/anxiety/avoidance = persistent for at least 6 months

Question 17

social anxiety disorder

Answer 17

A. fear/anxiety of social situations involving possible judgement (in children: anxiety in interaction with PEERS)

B. person is afraid they will be judged due to how they act/anxiety reaction

C. social situation almost always causes fear/anxiety

D. socail situations = avoided/endured with fear and anxiety

E. fear + anxiety = disproportionate

F. fear/anxiety/avoidance for at least 6 months

Question 18

types of persistence specifiers for PDD

Answer 18

with
1. pure dysthimic syndrome: full criteria for major depressive episode not met for recent 2 years

2. persisent major depressive episode: full criteria for major depressive episode met for preceding 2 years
3. intermittent major depressive episode, with current episode: full crtieria for major depressive episode currently met BUT not met for at least 8 weeks in previous 2 years
4. intermittent major depressive episode, without current episode: full criteria not currently met, but 1/more depressive episodes in the previous 2 years

Question 19

panic attack specifier

Answer 19

abrupt attack of intense fear/discomfort, peaks within minutes, marked by 4/more of:
1. palpitations/punding heart/accelerated heart rate
2. sweating
3. trembling/shaking
4. sensations of shortness of breath/smothering
5. feelings of choking
6. chest pain/discomfort
7. nausea/abdominal distress
8. feeling dizzy/light-headed/unsteady OR faint
9. chills/heat sensation
10. paresthesias (numbness/tingling sensation)
11. derealization (feel out of reality) OR depersonalization (detatched from self)
12. feeling like losing control or going crazy
13. fear of dying

Question 20

panic syndrome

Answer 20

A. recurrent + unexpected panic attacks

B. at least one attack = followed for 1 month by either of:
1. persistent preoccupation with other panic attacks /their consequences
2. significant maladaptive change in behavior related to avoiding attacks

Question 21

agoraphobia

Answer 21

A. marked fear/anxiety of 2/more of:
1. using public transports
2. being in open places
3. being in closed places
4. standing in line/crowd
5. being outside of own home alone

B. situations = avoided becasue they think they can’t escape or can’t get help in case of panic-like/other debilitating symptoms

C. agoraphobic situation almost always casues fear/anxiety

D. agoraphobic situations = acitvely avoided/need a companion/endured with fear/anxiety almost always

E. fear/anxiety is disproportionate

F. fear/anxiety/avoidance = persistent for at least 6 months

Question 22

generalized anxiety

Answer 22

A. excessive anxiety and worry (apprehensive expectation) for more days than not for at least 6 months about various situations

B. hard to control the worry

C. anxiety + worry associated with 3/more (in children 1) (some of them present for most of the time in past 6 months):
1. restlessness/feeling on the edge
2. easily fatigued
3. hard to concentrate OR going mind blank
4. irritability
5. muscle tension
6. sleep disturbances (hard to fall/stay asleep, restlessness, unstasfying sleep)

Question 23

obsessive-compulsive disorder

Answer 23

A. obsessions/compulsion or BOTH

• obsessions defined by 1 and 2:
  1. recurrent thoughts/images/urges, soemtimes experienced as unwanted/intrusive, cause anxiety/distress in majority
  2. attempt to ignore/suppress them OR neutralize them with other action
• compulsions defined by 1 and 2:
  1. repetitive behavior in response to obsession/according to rigid rules
  2. aim = preventing/reducing anxiety/distress/dreaded event BUT actually not connected to it/clearly excessive
  –> children might not be able to tell the aim

Question 24

body dysmorphic disorder

Answer 24

A. preoccupation with 1/more perceived physical flaws that are actually unobservable/are slight to others

B. at some point –> mental acts (eg: comparison) or repetitive behavior in response to concerns

Question 25

post-traumatic stress disorder
- only general domain, not specific

Answer 25

A. exposure to actual/theretened death, (sexual) violence (direct, indirect or witnessing)

B. at least 1 intrustion symptom after the event (memories, dreams, dissociation…)

C. after the event, avoidance of stimuli (internal or external) that are associated

D. negatively altered mood/congitions beginning or worsening after the event (eg: not remembering all details of the vent, inability to experience positive emotions, no participation in pleasurable acitivities…) (at least 2 symptoms)

E. alteration in arousal/reacitivity beginning/worsening after the event (eg: hypervigilance, + startle response…) (at least 2 symptoms)

F. A, B, C, D and E for at least 1 month

Question 26

acute stress disorder

Answer 26

A. exposure to actual/theretened death, (sexual) violence (direct, indirect or witnessing)

B. after/worsening during traumatic events –> at least 9 symptoms from any of:
1. intrusion
2. negative mood
3. dissociation (eg. not remembering aspects of the event…)
4. avoidance
5. arousal (eg: sleep, hypervigilance, + startle response…)

C. disturbances in criterion B = from 3 days to 1 month after trauma

Question 27

adjustment disorder

Answer 27

A. emotional/behavioral symptoms = due to identifiable stressor; within 3 months from stressor onset

B. symptoms = clinically significant as shown by 1 and/or 2:
1. marked distressed, out of proportion to stressor/its intensity/external and cultural factors affecting
2. functional impairments

C. symptoms don’t meet criteria for other disorder/not exacerbation of pre-existing disorder

Question 28

dissociative identity disorder

Answer 28

A. distruption of identity (2/more personalities), in some cultures –> experience of possession
- discontinuity in sense of self and agency
- alterations in behavior, affect, consciousness, memory, perception, cognition and/or sensory-motor functioning
- observable by others

B. gaps in recalling everyday events, personal info and/or traumatic events (inconsistent with ordinary forgetting)

C. symptoms –> clinically significant distress/functional impairments

Question 29

dissociative amnesia

Answer 29

A. inability to recall autobiographical memory (trauma-related often) unconsistent with ordinary forgetting
- either localised/specific to traumatic events or general about life/identity

Question 30

depersonalisation/derealization disorder

Answer 30

A. presence + recurrence of depersonalization, derealization or both
- depersonalisation: unreality/detachment or feeling observer of own thoughts/feelings/sensations/action
- derealization: unreality/detachment from surrounding (feel unreal, foggy…)

B. reality testing = intact

Question 31

somatic symptom disorder

Answer 31

A. somatic symptoms that are distressing/distruption of daily life

B. excessive thoughts/feelings/behaviors related to somatic symptoms/health concerns showed by at least 1:
1. disproportionate/persistent thoughts about symptom severity
2. persistent high anxiety about symptoms/health
3. excessive time/energy devoted to symptoms/health concerns

Question 32

illness anxiety

Answer 32

A. preoccuaption with having/getting serious illness

B. somatic symptoms = not present/only mild
if medical condition/high risk of developing it —> disproportionate preoccupation

C. high anxiety about health, person = easily alarmed by personal health status

D. excessive health-related behaviors/maladaptive avoidance

Question 33

conversion disorder

Answer 33

A. 1/symptoms of altered voluntary motor/sensory function

B. symptoms not comaptible with known neurologicla disorders (supported by clinical findings)

Question 34

anorexia nervosa

Answer 34

A. restriction of energy intake that leads to significantly low weight (based on age, development, sex and physical trajectory) (low BMI)

B. fear of gaining weight/getting fat OR behaviors preventing weight gain

C. disturbed experience of body weight/shape, body weight/shape infleunces self-evaluation OR no recognition of seriousness of current underweigth status

Question 35

bulimia nervosa

Answer 35

A. recurrent episodes of binge-eating; each episode is defined by:
1. eating great amount of food in a short period of time (mroe than other people would in similar context)
2. perceived lack of control during episode

B. recurrent compensatory behavior to prevent weight gain

C. binge + compensation at least 1 a week for 3 months

D. body shape/weight influence self-evaluation

Question 36

oppositional defiant disorder

Answer 36

A. pattern of angry/irritable mood, argumentative/defiant behavior and vindictiveness for 6 months at least as shown by 4 from any category, in interactions with at least 1 person (not a sibling):

1. angry/irritable mood:
   a. loose temper often
   b. touchy/easily annoyed
   c. angry/resentful
2. argumentative/defiant behavior
   a. argues with authorities (children –> with adults)
   b. defies/doesn’t comply with authorities’ orders
   c. deliberately annoys others
   d. blames others for won mistakes/behaviors
3. vindictiveness
   a. at least twice in past 6 months

note: use persistence + frequency to differentiate normal
- <5 years: vindictiveness almost everyday for 6 motnhs
- > 5 years: vindictiveness at least 1 a week for 6 months

Question 37

conduct disorder

Answer 37

A. repetitive + persisten behavior that violates basic rights of others/volates major age-approapriate societal values adn norms. manifested by 3 of 15 criteria form any category (at least 1 criterion present in past 6 months)

• aggression to people/animals
  a. bullies/threatens/intimidates others
  b. initiates physical fights
  c. used a weapon that can seriuously harm others
  d. has been physically cruel to others
  e. has been phyicially cruel to animals
  f. has stolen when confronting someone (eg: mugging)
  g. has forced someone in sexual act
• destruction of property
  a. has set smth on fire with the purpose of hurting others
  b. has destructed a property (other than fire)
• deceitfulness or theft
  a. broke into someone’s house/building/car
  b. lies to obtain goods/favors/avoid obligations
  c. stole without hurting someone
• serious violation of rules
  a. often stays out at night despite parents prihibit (before 13 years)
  b. runs away overnight at least twice when still living with parents OR once without coming back for a lengthy period
  c. often ditches school (before 13 years)

Question 38

alcohol use disorder

Answer 38

A. problematic pattern of alcohol use leading to clinically significant impairments/distress, as shown by 2/more symptoms, within 12 months:
1. alcohol take in larger amounts/for a longer period than intended
2. persistent desire/unseccessful attempts to cut down/control use
3. much time devoted to obtain/use/recover from alcohol
4. cravings
5. recurrent use = failure to fulfill role at school/work/home
6. continued use despite social/interpersonal problems caused/exacerbated by alcohol use
7. giving up/reducing important social/occupational/recreational activities becasue of alcohol
8. recurrent use even when physically hazardous
9. continued use even if they know they have recurrent/persistent physical/psychological problems caused/exacerbated by alcohol
10. tolerance shown by at least 1 of:
a. need more alcohol to reach intoxication/desired effects
b. diminished effect when consuming usual amount
11. withdrawal shown by 1 of:
a. alcohol withdrawal syndrome (criteria A and B)
b. alcohol/related substance taken to relieve withdrawal

Question 39

general criteria for personality disorders

Answer 39

A. enduring pattern of inner experiences/behaviors that deviates markedly from one’s cultural expectations and it’s manifested in 2/more areas:
1. cognition (perception of self/others/events)
2. affectivity
3. interpersonal functioning
4. impulse control

pattern is persistent, pervasive and problematic

Question 40

paranoid personality disorder

Answer 40

A. pervasive distrust/suspiciousness of others (actions + motives = bad) beginning in early adulthood and present in various contexts, shown by 4 at least:
1. supects that others are exploiting/harming/deceiving them (no basis)
2. preoccupied with unjustified doubts of friends/associates loyalty/trustworthiness
3. reluctant to confide in others –> fear information will be used against them
4. reads hidden malevolent/threatening meaning in benevolent events/remarks
5. persistently bears grudges
6. perception of attacks on character/reputation that are not perceived by others + readily reacts agrinly/counterattacks
7. recurrent suspicion of fidelity of spouse/sexual partner (no justification)

Question 41

schizoide personality disorder

Answer 41

A. pervasive pattern of detachment + restricted emotional range in interpersonal realtionships beginning by early adulthood in various contexts, as shown by at least 4:
1. doesn’t desire/enjoy close relationships (not even family)
2. almost always –> solitary activities
3. little/no interest in sexual experiences
4. pleasure in few/no activities
5. no close friends/confidants except first-degree relatives
6. indifferent to others’ criticism
7. emotional coldness/detachment/no affectivity

Question 42

schizotypal personality disorder

Answer 42

A. persistent pattern of social + interpersonal deficits marked by discomfort/reduced capacity for close realtionships + cognitive/perceptual disotortions + eccentric behavior. begins by early adulthood in various context, marked by at least 5:
1. ideas of reference (including delusions of reference)
2. odd beliefs/magical thinking influencing behaviour + inconsistent with culture
3. unusual perceptual experiences (body illusions included)
4. odd thinking + speech
5. suspiciousness/paranoid ideas
6. inappropriate/constrained affect
7. behavior that seems odd/eccentric/peculiar
8. no close friends/confidants eccept first-degree relatives
9. excessive social anxiety that deosn’t diminish when getting to know other + associated with paranoid fears (not with negative self-judgement)

Question 43

antisocial personality disorder

Answer 43

A. pervasive pattern of disregard of others’ rights, beginning at 15 and shown by 3/more:
1. no complying with social norms of lawful behavior –> performs acts that could lead to arrest
2. deceitfulness (lying, use aliases, deceit others for profit/pleasure)
3. impulsivity/problems planning ahead
4. irritability + aggressiveness –> fight
5. reckless disregard for own/others’ safety
6. consistent irresponsibility –> no consistent work behavior/honor financial obligations
7. no remorse

C. evidence of conduct syndrome before age 15

Question 44

borderline personality disorder

Answer 44

A. pervasive pattern of instable interpersonal relationships/self-immage/affect AND impulsivity, begins in early adulthood and extends to various contexts. at least 5:
1. extreme efforts to avoid abandonment (real/imagined)
2. unstable + intense personal relationships marked by periods of idealization and devaluation
3. identity disturbance (unstable self-image/sense of self)
4. impulsivity in at least 2 areas that are potentially harmful (eg: sex, spending, binge-eating)
5. suicidal ideation/threats/self-mutilation
6. less stability due to highly reactive mood
7. chronic emptiness
8. inappropriate/intense/uncontrollable anger
9. transient/stress-related paranoid ideation OR dissociation

Question 45

histrionic personality disorder

Answer 45

A. persistent pattern of excessive emotionality + attention seeking. begins by early adulthood, shown by at least 5:
1. uncomfortable in situations where he/she’s not the center of attention
2. interactions characterised by inappropriate sexually seductive behavior
3. rapid shift/shallow display of emotions
4. consistent use of physical appearence to draw attention
5. speech = too impressionistic + lacks details
6. emotions = self-dramatization, theatrical, exaggerated
7. suggestibility
8. relationships = considered more intimate than actually

Question 46

narcissistic personality disorder

Answer 46

A. peravise pattern of grandiosity, need for admiration and no empathy. begins in early adulthood + characterized by 5/more:
1. exaggerated self-importance
2. fantasies of unlimited success, power, beauty and brilliance
3. believes to be special/unique and can only interact with/be understood by other high-order ppl/institutions
4. needs excessive admiration
5. sense of entitlement (expects favorable treatment/others to automatically comply with their ideas)
6. exploits others
7. no empathy
8. envies other OR believes they envy them
9. arrogant/naughty behaviors/attitudes

Question 47

avoidant personality disorder

Answer 47

A. pervasive pattern of social inhibition, inadequacy + hypersensitivity to negative evaluation. begins by adulthood, shown in at least 4:
1. avoidance of occupation activities involving contact because fears criticism/rejection/disapproval
2. not involving with people unless sure about being liked
3. restrained in intimate relationships bc fears ridicule/shame
4. preoccupied with rejection/criticism in social situations
5. inhibited in new interactions –> fears inadequacy
6. self = viewed as inept, unappealing and inferior
7. reluctant to take risk/try new activities bc may embarass themselves

Question 48

dependent personality disorder

Answer 48

A. pervasive + excessive need to be taken care of that leads to clinginess + fear of separation. by adulthood, shown by at least 5:
1. hard to make decisions without excessive reassurance/advice from others
2. needs others to take responsibility in major life areas
3. hard to express disagreement bc fears loss of support/approval (unrealistic)
4. hard to initiate project/do things on their own (bc no self-confidence)
5. long way to obtain care/support of others, including engaging in unpleasant things
6. uncomfortable when alone –> fears they can’t take care of themselves
7. when one relationship ends immediately tries to replace it
8. unrealistically preoccupied by fears of having to take care of themselves alone

Question 49

obsessive-compulsive personality disorder

Answer 49

A. pervaise pattern of preoccupation with order/interpersonal control/perfectionism at the expenses of flexibility/openness/efficiency. begins by early adulthood and generalizes to other contexts. evidenced by at least 4:
1. so preoccupied with order/schedule/list/organizations that looses main point of activity
2. perfectionism interferes with completing task
3. so preoccupied with work/productvity that neglects leisure activities with friends
4. over conscious/scrupulous/ inflexible about ethics/values/morals (not explained by culture/religion)
5. unabe to discard wornout objects when not valuable anymore
6. reluctant to work with others/delegate unless they submit to his/her way of doing
7. miserly spending style for self and others; money = something to hoard
8. rigid + stubborn