Mnemonics Flashcards
Schizophrenia
Mnemonics
DSM 5
DDx
DHSSAF
D ELUSIONS
HALLUCINATIONS
NEG SYMPTOMS BEFORE
social withdrawal
Speech less low
Anhedonia loss of interest
Flat affect
“PRGCEJS”
• Persecutory
• Erotomanic
• Reference
• Grandiose
• Jealous
Control - broadcasting/ insertion
• Somatic
Needs 2+ for 6 months
1 of them delusions or hallucinations
“Delusional HALL DISorganized Negatives”
• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behavior
• Negative symptoms (flat affect, lack of motivation)
< 1 month brief psychotic disorder
1-6 months schizophreniform
> 6 months schizophrenia
Mood w psychosis and 2 weeks only psychosis w/out mood schizoaffective
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- Persecutory Delusions (“People Are After Me”)• “Do you think people are trying to harm or plot against you?”
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- Erotomanic Delusions (“They’re in Love with Me”)
Patient believes a famous person or stranger is secretly in love with them.
• “Do you believe someone, maybe a celebrity or a stranger, is in love with you?
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- Reference Delusions (“Everything is About Me”)
Patient believes random events, TV, songs, or news are sending them messages.
• “ when u watch TV Do you think they are talking about you
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- Grandiose Delusions (“I Am Special or Powerful”)• “Do you feel like you have a super powers,
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- Jealous Delusions (“My Partner Is Cheating”)
Patient is convinced their partner is unfaithful without proof.
• “Do you believe your partner is cheating on you,
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- Somatic Delusions (“There’s Something Wrong with My Body”)
Patient believes they have a serious medical problem despite no evidence.
• “Do you think something strange is happening inside your body?”
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7./Control) (“ Controlled”)
• Delusions of Control: • “Do you think others can put thoughts into your head?” Or read your mind
MDD
Mnemonic
DSM 5
Lasige caps
Low mood
Anhedonia
Sleep
Guilt
Energy
Concentration
Appetite
Psychomotor activity
Suicidal thoughts
ALWAYS; is it affecting your life?
How did it affect your life?
at least 5 symptoms (including depressed mood or anhedonia) for ≥2 weeks, causing significant distress or impairment.
Bipolar
Mnemonic
DSM 5
Scenario impulsive behavior speeding
No sleep
Suicidal impulsive
EEIDIG FAST
ELEVATED mood
HIGH ENERGY
Irritable mode
/
DISTRACTABILITY
INSOMNIA IMPULSIVITY endulging in reckless behavior like speeding spending a lot of money shopping
GRANDIOSITY
Flight of ideas
ACTIVITY have u noticed ur doing a lot of activities
SPEECH
TALKATIVE
Bipolar I Disorder
• At least one manic episode, with or without major depressive episodes.
Bipolar II Disorder
• At least one hypomanic episode > 4 days/ and at least one major depressive episode 2 wks.
• No manic episodes.
Mania 1 wk/ or any duration if hospitalization/ psychosis/ impairment
Hypomania 4 days
No hospitalization
No Psychosis
No impairment
3 or more symptoms/// 4 if mood is only irritable
OCD
“OCDTISH
• Obsessions
• Compulsions
• Distress or dysfunction
Time consuming 1/pe day
INTERFERE UR LIFE
Skin picking
Hair pulling
Other anxiety
DSM-5 Criteria for Obsessive-Compulsive Disorder (OCD)
A. Obsessions (Recurrent and persistent thoughts, urges, or images)
• Person experiences distressing, unwanted thoughts, urges, or images that they try to ignore or suppress.
• Common obsessions: Contamination, harm, doubts, symmetry, or religious concerns.
B. Compulsions (Repetitive behaviors or mental acts)
• Person feels driven to perform these actions to reduce distress or prevent a feared event.
• Common compulsions: Washing, checking, repeating, counting, or mental rituals (e.g., praying, silently repeating a word).
C. Time-consuming or cause significant distress or impairment
• The obsessions and compulsions take up more than 1 hour per day or interfere with daily functioning (e.g., work, relationships).
D. Not due to substance use or medical condition
• The symptoms cannot be better explained by another mental disorder (e.g., eating disorder, anxiety disorder).
Obsessions:
• “Do you ever have thoughts that are troubling or make you feel anxious, even if you don’t want to have them?”
• Compulsions: • “Do you feel the need to do certain things repeatedly (like washing your hands or checking things) to feel better or relieve anxiety?”
GAD
WACTCFRSI
Mnemonic: “WATCHERS” for GAD
1. Worry excessive (uncontrollable, about multiple things for ≥6 months)
2. Anxiety difficult to control
3. Tension in muscles
4. Concentration difficulty (mind going blank)
5. Hyperarousal or restlessness (on edge)
6. Easy fatigue
7. Restlessness and irritability
8. Sleep disturbance (trouble falling or staying asleep)
IMPAIRMENT/ interfere w ur life
GAD is characterized by excessive anxiety and worry about multiple aspects of life (work, school, health, relationships, etc.) for at least 6 months, which is difficult to control and causes distress or impairment.
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Full DSM-5 Criteria for GAD:
A. Excessive worry and anxiety for ≥ 6 months
• About multiple events or activities (work, school, relationships, health, etc.).
B. Difficulty controlling the worry.
C. The anxiety is associated with at least 3 or more of the following (only 1 required in children):
1. Restlessness or feeling keyed up/on edge.
2. Easily fatigued.
3. Difficulty concentrating (mind goes blank).
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling asleep, staying asleep, or restless sleep).
D. Causes significant distress or impairment.
E. Not due to another disorder, substance, or medical condition.
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Easy Questions to Ask for GAD:
• “Do you worry excessively about multiple things, even when there’s no reason to?” (Excessive worry)
• “Do you find it hard to control your worries?” (Uncontrollable worry)
• “Do you feel restless or on edge most days?” (Restlessness)
• “Do you get tired easily even if you’re not doing much?” (Fatigue)
• “Do you struggle to focus because your mind feels overwhelmed?” (Concentration issues)
• “Do you feel more irritable than usual?” (Irritability)
• “Do your muscles feel tight or tense all the time?” (Muscle tension)
• “Do you have trouble falling or staying asleep?” (Sleep disturbance)
Eating disorder
AN
Nervosa (AN)
RFDo MCB
RESTRICT INTAKE; how, fasting skipping meals, low amount of food/ how much is ur caloric intake
Excessive fear of gaining weight
Distorted self image; u see urself overweight despite being thin?
Obsession; recurrent thoughts about weight loss
Avoid looking at the mirror, why?
Checking weight repeatedly! How many times per day when was the last/ how many kg
Caloric intake
BMI
BINGE PURGE; vomiting laxatives
Bullying at school
Mnemonic: “FEAR FOOD”
1. Fear of gaining weight (intense fear despite being underweight)
2. Eating restriction (significantly reduced intake, leading to low body weight)
3. Altered body image (distorted perception of weight/shape)
4. Refusal to maintain a normal weight
5. Food obsession (preoccupation with calories, dieting)
6. Overuse of weight control methods (excessive exercise, fasting)
7. Osteoporosis and other complications (bradycardia, lanugo, amenorrhea, etc.)
8. Denial of severity (lack of insight)
✅ Subtypes:
• Restricting type: No bingeing/purging; weight loss via diet, fasting, exercise.
• Binge-Eating/Purging type: Engages in bingeing or purging (vomiting, laxatives, diuretics).
> > >
DSM-5 Criteria:
✅ A. Restriction of energy intake → Leading to significantly low body weight for age, sex, and health.
✅ B. Intense fear of gaining weight → Or persistent behavior that prevents weight gain, even when underweight.
✅ C. Distorted body image → Disturbance in self-perception, undue influence of weight on self-evaluation, or denial of the seriousness of low body weight.
Subtypes:
1. Restricting Type: Weight loss via dieting, fasting, or excessive exercise, no binge/purge in the last 3 months.
2. Binge-Eating/Purging Type: Episodes of binge eating or purging (vomiting, laxatives, diuretics, enemas) in the last 3 months.
….
Easy Questions to Ask for Eating Disorders
• “Do you worry excessively about your weight or body shape?”
• “Do you restrict food intake, skip meals, or eat very little?” (AN)
• “Do you ever feel out of control while eating large amounts of food?” (BN, BED)
• “Do you make yourself vomit or use laxatives to control weight?” (BN, AN)
• “Do you ever eat alone due to embarrassment about how much you eat?” (BED)
• “Do you feel guilty or distressed after eating?” (BN, BED)
Anorexia Nervosa:
• “Do you intentionally restrict your food intake?”
• “Do you fear gaining weight even though others say you’re underweight?”
• “Do you feel overweight despite being thin?”
Eating disorder
BN
BE
BN
BCPNGE
BINGE
CANT CONTROL
PURGING
NOT UNDERWT
GUILT
EXCESS FOCUS ON SHAPE AND WT
BINGE EATING
BCG RAA
BINGE
CANT CONTROL
GUILT
RAPID ALOT ALONE
NO PURGING
2️⃣ Bulimia Nervosa (BN)
Mnemonic: “BINGE”
1. Binge eating (large amounts, lack of control)
2. Inappropriate compensatory behaviors (vomiting, fasting, excessive exercise, laxatives)
3. Not underweight (unlike anorexia)
4. Guilt & shame (distress over eating behaviors)
5. Excessive focus on body shape/weight
✅ Key Criteria:
• Binge eating & compensatory behaviors at least once a week for 3 months.
• Patients maintain normal or overweight BMI (vs. AN).
3️⃣ Binge-Eating Disorder (BED)
Mnemonic: “BED”
1. Binge episodes (large amounts, loss of control)
2. Eating rapidly, uncomfortably full, or when not hungry
3. Distress & guilt (but no compensatory behaviors)
✅ Key Criteria:
• Binge eating at least once a week for 3 months.
• No purging or compensatory behaviors (vs. BN).
• Associated with obesity, emotional distress.
Easy Questions to Ask for Eating Disorders
• “Do you worry excessively about your weight or body shape?”
• “Do you restrict food intake, skip meals, or eat very little?” (AN)
• “Do you ever feel out of control while eating large amounts of food?” (BN, BED)
• “Do you make yourself vomit or use laxatives to control weight?” (BN, AN)
• “Do you ever eat alone due to embarrassment about how much you eat?” (BED)
• “Do you feel guilty or distressed after eating?” (BN, BED)
>
2️⃣ Bulimia Nervosa (BN)
DSM-5 Criteria:
✅ A. Recurrent binge-eating episodes characterized by:
1. Eating an excessive amount of food in a short period (e.g., <2 hours).
2. Loss of control over eating during the episode.
✅ B. Recurrent compensatory behaviors to prevent weight gain (e.g., vomiting, laxatives, fasting, excessive exercise).
✅ C. Episodes occur at least once per week for 3 months.
✅ D. Self-evaluation is excessively influenced by weight and body shape.
✅ E. Not exclusively during anorexia episodes (if BMI is extremely low → diagnose AN).
Severity (Based on Purging Frequency):
• Mild: 1–3 episodes/week
>
-Eating Disorder (BED)
DSM-5 Criteria:
✅ A. Recurrent binge-eating episodes, characterized by:
1. Eating an excessive amount of food in a short period.
2. Loss of control during the episode.
✅ B. Binge episodes are associated with ≥3 of the following:
1. Eating more rapidly than normal.
2. Eating until uncomfortably full.
3. Eating large amounts when not hungry.
4. Eating alone due to embarrassment.
5. Feeling disgusted, depressed, or guilty after eating.
✅ C. Marked distress regarding binge eating.
✅ D. Episodes occur at least once per week for 3 months.
✅ E. No compensatory behaviors (unlike BN).
Severity (Based on Frequency):
• Mild: 1–3 episodes/week
Bulimia Nervosa:
• “Do you eat large amounts of food and feel out of control?”
• “Do you ever make yourself vomit, use laxatives, or exercise excessively to control weight?”
• “Does your body shape strongly affect how you feel about yourself?”
Binge-Eating Disorder:
• “Do you eat large amounts of food in a short time, even when not hungry?”
• “Do you eat alone because you’re embarrassed by how much you eat?”
• “Do you feel guilty, depressed, or disgusted after eating?”
PTSD
TRAUMSI
TRAUMA L T EVENT
RELIVE IT FLASHBACKS NIGHTMARES
AVOIDANCE
UNABLE TO FUNCTION; guilty blame urself
M forget imp details about the trauma.. memory
SLEEP
Irritable/ INTERFERE W UR LIFE
DSM-5 Criteria for PTSD (Post-Traumatic Stress Disorder)
To diagnose PTSD, symptoms must be present for ≥1 month after exposure to a traumatic event. The DSM-5 criteria are grouped into five key categories: (A) Trauma exposure, (B) Intrusions, (C) Avoidance, (D) Negative alterations in cognition/mood, and (E) Hyperarousal.
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DSM-5 Criteria for PTSD
✅ A. Exposure to a traumatic event (directly, witnessing, learning about it happening to a loved one, or repeated exposure to traumatic details).
✅ B. Intrusive symptoms (≥1 required)
• Nightmares
• Flashbacks
• Distressing memories
• Severe emotional distress when reminded of the trauma
• Physical reactions (e.g., sweating, racing heart) when exposed to trauma cues
✅ C. Avoidance symptoms (≥1 required)
• Avoiding thoughts, feelings, or conversations related to the trauma
• Avoiding people, places, or situations that remind them of the trauma
✅ D. Negative changes in cognition/mood (≥2 required)
• Memory impairment (not remembering important parts of the trauma)
• Persistent negative beliefs (e.g., “I am bad,” “The world is dangerous”)
• Blaming oneself or others excessively for the trauma
• Persistent negative emotions (fear, anger, guilt, shame)
• Loss of interest in previously enjoyed activities
• Feeling detached or estranged from others
• Difficulty experiencing positive emotions (happiness, love)
✅ E. Hyperarousal/Reactivity symptoms (≥2 required)
• Irritability or angry outbursts
• Reckless or self-destructive behavior
• Hypervigilance (being overly alert and cautious)
• Exaggerated startle response
• Difficulty concentrating
• Sleep disturbances (insomnia, nightmares)
✅ F. Symptoms last >1 month
✅ G. Symptoms cause significant distress or impairment
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Mnemonic for PTSD: “TRAUMA”
T - Traumatic event exposure
R - Re-experiencing (flashbacks, nightmares)
A - Avoidance of reminders
U - Unable to function normally (negative thoughts, detachment)
M - Mood alterations (guilt, negativity)
A - Arousal increased (hypervigilance, insomnia, irritability)
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Questions to Ask for PTSD
Trauma Exposure
• “Have you experienced or witnessed a life-threatening or traumatic event?”
• “Do you frequently think about or relive that event?”
Intrusive Symptoms
• “Do you have distressing memories or nightmares about the event?”
• “Do you feel like the event is happening again?”
Avoidance
• “Do you try to avoid thinking or talking about the event?”
• “Do you avoid certain people, places, or activities because they remind you of what happened?”
Negative Cognition/Mood
• “Do you blame yourself for what happened?”
• “Have you lost interest in things you used to enjoy?”
• “Do you feel distant from others?”
Hyperarousal
• “Do you feel constantly on edge or easily startled?”
• “Are you having trouble sleeping?”
• “Do you find yourself being more irritable or angry?”
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Would you like a practice case or additional mnemonics?
Borderline
DSM-5 Criteria for Borderline Personality Disorder (BPD)
a person must have at least 5 out of the 9 symptoms listed below. These symptoms must be persistent, start in early adulthood, and cause significant distress or impairment.
> > > >
Emotions
Interpersonal relationships
Impulsive
COGNITION
RICE
FOR any perosnality disorder 2 of these for is affected/ + early in life cuz its a personality;)
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Mnemonic: “I DESPAIRR”
1. Instability in relationships → Intense, unstable relationships (idealizing then devaluing others).
2. Distorted self-image → Unstable sense of identity or self-worth.
3. Emptiness → Chronic feelings of emptiness.
4. Suicidal behavior → Recurrent suicidal threats, gestures, or self-harm.
5. Paranoia or dissociation → Stress-related paranoia or dissociative symptoms.
6. Anger issues → Intense, inappropriate anger or difficulty controlling it.
7. Impulsivity → Risky behaviors (spending, sex, substance abuse, reckless driving, binge eating).
8. Relationship instability → Frantic efforts to avoid real or imagined abandonment.
9. Rapid mood shifts → Emotional instability with frequent mood swings.
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Easy Questions to Ask for BPD:
• “Do your relationships tend to be intense and unstable?” (Unstable relationships)
• “Do you ever feel like you don’t really know who you are?” (Identity disturbance)
• “Do you often feel empty inside?” (Chronic emptiness)
• “Have you ever had thoughts of harming yourself or made suicide attempts?” (Suicidal behavior)
• “Do you ever feel extremely paranoid or disconnected from reality, especially during stress?” (Paranoia/Dissociation)
• “Do you struggle with sudden outbursts of anger?” (Anger issues)
• “Do you ever engage in reckless behaviors that you later regret?” (Impulsivity)
• “Do you go to extreme lengths to prevent people from leaving you?” (Fear of abandonment)
• “Do your emotions shift quickly throughout the day?” (Mood instability)
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This mnemonic makes it easier to remember the 9 criteria for BPD in exams! Let me know if you need a summary sheet or flashcards to study!
Antisocial
LIL MANG
LEGAL ISSUES MULTIPLE ARREST
IMPULSIVE RECKLESS BEHAVIOUR
LYING MANIPULATING OTHERS FOR PERSONAL GAIN
AGGRESSIVE FIGHTS W OTHERS
NEGLECT RESPONSIBILITY
GUILT NO
Usually substance:///
Conduct
DSM-5 Criteria for Antisocial Personality Disorder (ASPD)
To diagnose ASPD, the following criteria must be met:
A. Pattern of disregard for and violation of others’ rights, since age 15, with at least 3 of the following:
1. Failure to conform → Repeatedly breaking laws, engaging in criminal behavior.
2. Deceitfulness → Lying, using aliases, conning others for personal gain.
3. Impulsivity → Acting without thinking, trouble planning ahead.
4. Irritability & aggression → Frequent fights, physical assaults.
5. Reckless disregard for safety → Endangering self or others.
6. Responsibility neglect → Failing to sustain work or financial obligations.
7. Lack of remorse → Indifference or rationalizing hurting others.
Mnemonic: “F DIIRRL” (Like a “feral” person—reckless and lawless)
• Failure to conform (criminal acts)
• Deceitfulness (lying, manipulation)
• Impulsivity (no planning)
• Irritability & aggression (fights, violence)
• Reckless disregard for safety
• Responsibility neglect (work, finances)
• Lack of remorse (no guilt)
B. Must be at least 18 years old.
C. Evidence of conduct disorder before age 15.
D. Symptoms not due to schizophrenia or bipolar disorder.
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Easy Questions to Ask for ASPD:
• “Have you had legal problems or been arrested multiple times?” (Criminal behavior)
• “Do you lie often, even for personal gain?” (Deceitfulness)
• “Do you act impulsively without thinking of consequences?” (Impulsivity)
• “Have you been in frequent fights or acted aggressively towards others?” (Irritability/Aggression)
• “Do you put yourself or others in danger without concern?” (Recklessness)
• “Have you struggled to hold down a job or manage responsibilities?” (Neglect of responsibility)
• “Do you feel guilty when you hurt or manipulate others?” (Lack of remorse)
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This mnemonic “F DIIRRL” will help you quickly recall the 7 key criteria for ASPD! Let me know if you need a cheat sheet or extra study tricks!
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Conduct Disorder (CD) – The Precursor to Antisocial Personality Disorder (ASPD)
Conduct Disorder (CD) is a childhood or adolescent disorder (diagnosed before age 18) characterized by a persistent pattern of violating social norms, the rights of others, and rules. It is often considered a precursor to Antisocial Personality Disorder (ASPD) if symptoms continue into adulthood.
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DSM-5 Criteria for Conduct Disorder (CD)
To be diagnosed, a person must display at least 3 behaviors from the following 4 categories in the past 12 months, with at least 1 behavior in the past 6 months:
- Aggression to People and Animals
• Bullies, threatens, or intimidates others.
• Physical fights.
• Weapon use (to harm others).
• Animal cruelty.
• Harming people physically.
• Stealing with confrontation (mugging, armed robbery).
• Forced sexual activity. - Destruction of Property
• Arson (fire-setting with intent to cause harm).
• Destroying property (vandalism, breaking things). - Deceitfulness or Theft
• Breaking into houses, buildings, or cars.
• Lying to manipulate others.
• Stealing without confronting (shoplifting, forgery). - Serious Violation of Rules
• Stays out late (before age 13, against parents’ rules).
• Runs away from home (at least twice).
• Truancy (skipping school before age 13).
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Mnemonic for Conduct Disorder: “BAD SLAP RULES”
• Bullies
• Aggressive fights
• Destroys property
• Stealing (with or without confrontation)
• Lying & deceit
• Arson
• Physical harm
• Running away
• Unauthorized breaking & entering
• Late nights (before age 13)
• Early school truancy
• Sexual coercion
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Types of Conduct Disorder:
1. Childhood-Onset Type: Symptoms appear before age 10 (worse prognosis, more likely to lead to ASPD).
2. Adolescent-Onset Type: Symptoms appear after age 10 (less severe, may not progress to ASPD).
3. Unspecified Onset: Age of first symptoms unknown.
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Key Difference: Conduct Disorder vs. Oppositional Defiant Disorder (ODD)
• ODD: Defiant, argumentative, and irritable without serious rule-breaking or harm.
• CD: Aggressive, violent, and violates the rights of others.
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Easy Questions to Ask for Conduct Disorder:
• “Have you ever hurt animals or people on purpose?” (Aggression)
• “Have you ever stolen something, either by force or secretly?” (Theft)
• “Have you set fires or destroyed property for fun?” (Destruction)
• “Do you often skip school or stay out late without permission?” (Rule-breaking)
• “Have you ever broken into a house, building, or car?” (Deceitfulness)
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Connection Between CD and ASPD
• If symptoms persist into adulthood (after age 18), the person may develop Antisocial Personality Disorder (ASPD).
• However, not all kids with CD will develop ASPD—some may improve with intervention.
Let me know if you need a quick reference sheet or study tips!
OCPD
SRFW
PDM
Follow strict rules
Can’t be flexible
Work rather than friends
Perfectionism
Can’t discard
Money saved not spent
DSM-5 Criteria for Obsessive-Compulsive Personality Disorder (OCPD)
OCPD is a pervasive pattern of preoccupation with orderliness, perfectionism, and control, at the expense of flexibility, openness, and efficiency. It affects various areas of life and begins in early adulthood.
To diagnose OCPD, a person must exhibit at least 4 of the 8 criteria below.
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Mnemonic: “LAW FIRMS” (People with OCPD often work in law firms—rigid, structured, perfectionist!)
1. Loses point of activity → Overly focused on rules, lists, and details, losing sight of the bigger picture.
2. Ability to discard → Struggles to get rid of worthless objects (not due to emotional attachment like hoarding).
3. Worthless delegation → Unwilling to delegate tasks unless others do them exactly their way.
4. Friendship excluded → Prioritizes work and productivity over friendships and leisure.
5. Inflexible → Rigid, stubborn, and unwilling to compromise.
6. Reluctant to spend → Miserly spending; sees money as something to be hoarded for future disasters.
7. Morality obsession → Overly conscientious and strict about morals, ethics, and values.
8. Stubborn perfectionism → Extreme perfectionism that interferes with task completion.
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Easy Questions to Ask for OCPD:
• “Do you feel the need to follow strict rules, lists, or schedules, even when unnecessary?” (Preoccupation with rules)
• “Do you struggle to finish tasks because they’re never perfect enough?” (Perfectionism)
• “Do you have trouble throwing things away, even if they have no real value?” (Inability to discard)
• “Do you dislike delegating tasks because others won’t do them ‘right’?” (Control issues)
• “Do you prioritize work over relationships and leisure activities?” (Workaholism)
• “Do you see money as something to be saved, rather than spent on enjoyment?” (Miserliness)
• “Are you extremely rigid about morals, ethics, or values?” (Moral rigidity)
• “Do you find it difficult to adapt to changes or be flexible?” (Stubbornness)
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Key Differences: OCPD vs. OCD
Feature OCPD OCD
Ego-syntonic (Feels right, part of identity) ✅ Yes ❌ No (Ego-dystonic, distressing)
Perfectionism & control ✅ Yes ✅ Yes
Obsessions & compulsions ❌ No ✅ Yes
Willing to seek help? ❌ Rarely (thinks behavior is correct) ✅ Often (finds symptoms distressing)
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This “LAW FIRMS” mnemonic makes it easier to recall the 8 OCPD criteria! Let me know if you need flashcards or practice cases!
SUBSTANCE use disorder
9 C TW
DSM-5 Criteria for Substance Use Disorder (SUD)
To diagnose Substance Use Disorder (SUD), a person must meet at least 2 out of 11 criteria within a 12-month period. The severity is classified as:
• Mild: 2–3 symptoms
• Moderate: 4–5 symptoms
• Severe: 6 or more symptoms
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DSM-5 Criteria for SUD (The 11 Symptoms)
✅ 1. Loss of Control
• Using larger amounts or for longer periods than intended
✅ 2. Unsuccessful efforts to cut down
• Repeated unsuccessful attempts to reduce or quit
✅ 3. Excessive time spent
• A lot of time spent obtaining, using, or recovering from the substance
✅ 4. Cravings
• Strong urges or desires to use the substance
✅ 5. Neglecting Responsibilities
• Failure to fulfill obligations at work, school, or home
✅ 6. Continued use despite social problems
• Ongoing use despite relationship issues caused by substance use
✅ 7. Giving up activities
• Stopping or reducing important social, occupational, or recreational activities
✅ 8. Use in hazardous situations
• Using substances in dangerous situations (e.g., driving, operating machinery)
✅ 9. Continued use despite health problems
• Knowing that substance use is causing physical or mental health problems, but continuing anyway
✅ 10. Tolerance
• Needing higher doses to achieve the same effect
• Reduced effect when using the same amount
✅ 11. Withdrawal
• Experiencing withdrawal symptoms when stopping use
• Using the substance (or something similar) to relieve withdrawal
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Mnemonic for Substance Use Disorder: “11 Cs”
- Control loss (larger amounts, longer periods)
- Cut down unsuccessful attempts
- Craving
- Consuming time (obtaining, using, recovering)
- Commitment failures (work, school, home)
- Conflict in relationships (but still using)
- Cancelled activities (social, work, hobbies)
- Careless use (dangerous situations)
- Continuing despite health issues
- Changing tolerance (higher doses needed)
- Chills & shakes (withdrawal symptoms)
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Questions to Ask for Substance Use Disorder
Pattern of Use
• “How often do you use [substance]?”
• “Have you ever felt that you should cut down on your use?”
Control & Cravings
• “Do you ever use more than you planned?”
• “Do you ever feel a strong urge to use?”
Impact on Life
• “Has your substance use affected your work, school, or home responsibilities?”
• “Has it caused problems in your relationships?”
Risky Behavior & Health Effects
• “Have you used substances in dangerous situations, like driving?”
• “Have you continued using despite knowing it harms your health?”
Tolerance & Withdrawal
• “Do you feel like you need more to get the same effect?”
• “Have you experienced withdrawal symptoms when stopping?”
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Would you like mnemonics for specific substances (e.g., alcohol, opioids)?
SUICIDE
ADJUSMENT DISORDER
SMSAIR
Stressful event
Mood low anxious
Sleep
Appetite
Interfere w life work job relationships
Reckless behavior drinking aggression
صارلها سترس وبعد ٣ شهور جاها اضطراب التأقلم تغيرت تصرفاتها وشخصيتها بسببه
مايقعد اكثر من ٦ شهور
حزن وتوتر
ب
DSM-5 Criteria for Adjustment Disorder (AD)
Adjustment Disorder occurs when a person develops emotional or behavioral symptoms in response to a stressful event, which significantly impairs their daily functioning.
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DSM-5 Criteria for Adjustment Disorder
✅ A. Stressor Exposure
• Symptoms begin within 3 months of an identifiable stressor (e.g., breakup, job loss, moving, illness).
✅ B. Disproportionate Symptoms
• Emotional or behavioral symptoms are excessive compared to what would be expected for the stressor.
✅ C. Functional Impairment
• Symptoms cause significant distress or interfere with work, school, social life, or daily functioning.
✅ D. Not Due to Another Disorder
• Symptoms do not meet criteria for another psychiatric disorder (e.g., MDD, PTSD).
✅ E. Not Normal Bereavement
• The reaction is more severe than a typical grief response.
✅ F. Symptoms Last No More Than 6 Months After the Stressor Ends
• If symptoms persist longer, another disorder (e.g., depression, anxiety) may be present.
⸻
Types of Adjustment Disorder (Specify Type)
1. With Depressed Mood → Low mood, tearfulness, hopelessness
2. With Anxiety → Nervousness, worry, difficulty concentrating
3. With Mixed Anxiety & Depressed Mood → Combination of both
4. With Disturbance of Conduct → Behavioral problems (e.g., aggression, reckless behavior)
5. With Mixed Disturbance of Emotions & Conduct → Emotional + behavioral symptoms
6. Unspecified → Symptoms that don’t fit into a specific category
⸻
Mnemonic for Adjustment Disorder: “STRESS”
S - Stressor (identifiable trigger within 3 months)
T - Too much reaction (out of proportion)
R - Relationships & work affected (functional impairment)
E - Excludes other mental disorders
S - Short-term (resolves within 6 months after stressor ends)
S - Symptoms vary (anxiety, depression, conduct disturbance)
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Questions to Ask for Adjustment Disorder
Identifying the Stressor
• “Has anything stressful happened in your life recently?”
• “When did you start feeling this way?”
Emotional Symptoms
• “Do you feel more sad, anxious, or overwhelmed than usual?”
• “Have you noticed any changes in your sleep or appetite?”
Behavioral Changes
• “Has this stress affected your work, school, or relationships?”
• “Have you been engaging in reckless behaviors (e.g., drinking, aggression)?”
Duration & Severity
• “Do you feel like your reaction is stronger than what you expected?”
• “Do you think these feelings would improve if the stressor went away?”
⸻
🙌🏻
No, if symptoms last more than 6 months after the stressor ends, it does not automatically make it PTSD. Instead, it suggests that:
1. Another mental disorder may be present, such as:
• Major Depressive Disorder (MDD) → If persistent low mood, anhedonia, worthlessness, or suicidal thoughts develop.
• Generalized Anxiety Disorder (GAD) → If excessive worry and tension persist beyond the stressor.
• Persistent Complex Bereavement Disorder → If grief remains intense and disabling for over a year.
2. PTSD is only diagnosed if the stressor was traumatic, meaning it involved:
• Actual or threatened death, serious injury, or sexual violence
• Symptoms include flashbacks, nightmares, hypervigilance, avoidance, and dissociation
3. If symptoms persist but don’t fit another diagnosis, it could be:
• Persistent Adjustment Disorder (a controversial concept in DSM-5)
• Other Specified Stressor-Related Disorder
⸻
Key Difference: PTSD vs. Prolonged Adjustment Disorder
Feature PTSD Adjustment Disorder
Stressor Type Trauma (life-threatening) Any stressor (e.g., breakup, job loss)
Key Symptoms Intrusive memories, nightmares, hypervigilance, avoidance Depressed mood, anxiety, conduct problems
Duration > 1 month (can last years) Resolves within 6 months of stressor ending
Dissociation? Possible Uncommon
Treatment Focus Trauma processing (e.g., CBT, EMDR) Stress management & coping skills
⸻
Bottom Line:
• If symptoms persist beyond 6 months but do not involve trauma, adjustment disorder is no longer the best diagnosis → Consider MDD, GAD, or another condition.
• If the original stressor was a traumatic event, and symptoms include flashbacks, avoidance, and hyperarousal, then PTSD should be considered.
Would you like a case scenario to practice distinguishing them?
Somatic+++ other disorders here! Anxiety-?
SOMATIC
DSM-5 Criteria for Somatic Symptom Disorder (SSD)
Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, feelings, or behaviors related to physical symptoms that cannot be fully explained by a medical condition.
⸻
DSM-5 Criteria for SSD
✅ A. One or more distressing somatic symptoms
• The person has at least one physical symptom (e.g., pain, fatigue, GI issues) that is distressing or disrupts daily life.
✅ B. Excessive thoughts, feelings, or behaviors related to symptoms, with at least ONE of the following:
1. Disproportionate thoughts about the seriousness of symptoms.
2. High health-related anxiety (persistent worry about illness).
3. Excessive time and energy devoted to health concerns.
✅ C. Symptoms last for at least 6 months
• The specific symptom may change, but the distress remains persistent.
⸻
Mnemonic for SSD: “SOMATIC”
S - Symptoms (1+ distressing somatic symptoms)
O - Overthinking about symptoms (disproportionate concern)
M - Medical anxiety (high health-related worry)
A - Activities affected (excessive time spent on health)
T - Time (symptoms last ≥6 months)
I - Illness preoccupation (persistent despite reassurance)
C - Changing symptoms, but ongoing distress
⸻
Questions to Ask for Somatic Symptom Disorder
Symptoms & Distress
• “Do you have any physical symptoms that bother you daily?”
• “How much do these symptoms interfere with your life?”
Thoughts & Anxiety
• “Do you often worry that your symptoms might be something serious?”
• “Have doctors told you that your symptoms are not due to a major illness?”
• “Even after medical reassurance, do you still feel concerned?”
Behavioral Impact
• “How much time do you spend thinking about your health?”
• “Have these symptoms caused you to visit multiple doctors?”
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How is SSD Different from Other Disorders?
Disorder Key Features
Illness Anxiety Disorder (IAD) Fear of illness, no significant physical symptoms
Conversion Disorder Neurological symptoms (e.g., paralysis, blindness) without medical cause
Factitious Disorder Intentional symptom fabrication for psychological gain
Malingering Intentional symptom exaggeration for external gain (e.g., avoiding work, getting disability benefits)
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Would you like mnemonics for Illness Anxiety Disorder or Conversion Disorder too?
MAJOR NEUROCOGNITIVE DISORDER
In DSM-5, what was traditionally known as “dementia” is now classified under the category Major Neurocognitive Disorder. Here are the DSM-5 criteria for this condition:
⸻
DSM-5 Criteria for Major Neurocognitive Disorder (formerly Dementia)
A. Evidence of Significant Cognitive Decline
• There is evidence of significant decline from a previous level of performance in one or more cognitive domains, such as:
• Learning and memory
• Language
• Executive function
• Complex attention
• Perceptual-motor function
• Social cognition
• The decline must be documented by clinical assessment and standardized neuropsychological testing (where available).
B. Interference with Independence in Everyday Activities
• The cognitive decline interferes with independence in everyday activities (e.g., managing finances, medication management, or personal hygiene).
• The severity of decline will determine whether the individual requires assistance with daily living tasks.
C. Not Due to Delirium
• The cognitive impairments are not better explained by another condition such as delirium (an acute confusional state) or a mental disorder (e.g., depression or schizophrenia).
⸻
Specifiers and Severity
Mild Neurocognitive Disorder
• The cognitive decline is noticeable but does not interfere significantly with independence in daily activities.
Major Neurocognitive Disorder
• The cognitive decline significantly interferes with independence in daily activities and may require assistance in routine tasks.
⸻
Causes (Subtypes of Major Neurocognitive Disorder)
The DSM-5 allows clinicians to specify the underlying cause of Major Neurocognitive Disorder, such as:
• Alzheimer’s Disease
• Vascular Neurocognitive Disorder
• Lewy Body Dementia
• Frontotemporal Neurocognitive Disorder
• Parkinson’s Disease
• HIV Infection
• Traumatic Brain Injury
• Substance/Medication-Induced Neurocognitive Disorder
• Huntington’s Disease
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Mnemonic for Major Neurocognitive Disorder Criteria: “MIND”
• M - Memory and cognitive domains (Learning and Memory, Language, Attention, etc.)
• I - Interference with daily life activities (e.g., inability to manage finances, medications)
• N - Not due to delirium or other mental conditions
• D - Decline is significant and objective (proven by testing)
⸻
Questions to Ask During Assessment
1. Cognitive Decline:
• “Have you noticed any changes in your memory or thinking compared to a few years ago?”
• “Do you feel that your ability to concentrate or recall things has worsened recently?”
2. Daily Functioning:
• “Do you have difficulty with activities like managing money, remembering appointments, or taking your medications?”
• “Has anyone noticed you forgetting things more often or becoming confused in everyday situations?”
3. Exclusion of Other Causes:
• “Have you had any episodes of confusion, disorientation, or sudden memory loss that could be related to an acute medical condition?”
• “Have you been diagnosed with conditions like depression or schizophrenia that could affect your memory or thinking?”
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Here’s a mnemonic to help you remember one question for each of the 6 cognitive domains in Major Neurocognitive Disorder:
Mnemonic: “C-LEAPS”
Each letter corresponds to one cognitive domain, with a key question to ask:
⸻
1. C - Complex Attention • “Do you find it harder to concentrate on tasks, especially when there are distractions around?” 2. L - Learning and Memory • “Have you noticed that you forget things more often than you used to (e.g., appointments, names of people)?” 3. E - Executive Function • “Do you have difficulty planning or organizing tasks, like preparing a meal or managing your daily schedule?” 4. A - Ability to Use Language • “Do you find it harder to find the right words during conversations?” 5. P - Perceptual-Motor Function • “Have you had trouble with activities that require hand-eye coordination, like driving or writing?” 6. S - Social Cognition • “Do you sometimes find yourself misinterpreting social situations or saying something that others find inappropriate?”
- Complex Attention
This domain refers to the ability to focus and concentrate on tasks, especially in complex or distracting environments.
Questions to Ask:
• “Do you find it harder to concentrate on tasks, especially when there are distractions around?”
• “Have you noticed that you get easily distracted or have trouble staying focused for long periods?”
• “Do you struggle to keep track of multiple tasks at once (e.g., paying bills, talking on the phone while doing other tasks)?”
⸻
- Executive Function
This domain involves higher-level cognitive skills such as planning, organizing, problem-solving, and decision-making.
Questions to Ask:
• “Do you have difficulty planning or organizing tasks, like preparing a meal or organizing your daily schedule?”
• “Is it harder for you to make decisions or solve problems that you used to handle easily?”
• “Do you find yourself needing help to follow through with tasks or manage multiple steps of a plan?”
⸻
- Learning and Memory
This domain concerns both short-term and long-term memory, especially the ability to learn new information and recall it later.
Questions to Ask:
• “Have you noticed that you forget things more often than you used to (e.g., appointments, names of people, or where you left things)?”
• “Do you have trouble remembering recent conversations or events?”
• “Do you find it harder to remember new information, such as learning how to use a new phone or remembering the details of a new task?”
⸻
- Language
This domain involves the ability to produce and understand speech, as well as reading and writing.
Questions to Ask:
• “Do you find it harder to find the right words during conversations?”
• “Has anyone told you that you mix up words or use the wrong word when speaking?”
• “Do you have difficulty understanding things people are saying, or reading instructions and stories?”
⸻
- Perceptual-Motor Function
This domain involves the ability to interpret and respond to visual, auditory, and other sensory input, and to coordinate motor functions.
Questions to Ask:
• “Have you had trouble with activities that require hand-eye coordination, like driving, cooking, or writing?”
• “Do you have difficulty recognizing familiar objects or places?”
• “Do you ever get lost when going to places you’ve been to many times before, like your own house or grocery store?”
⸻
- Social Cognition
This domain refers to the ability to understand and respond to social cues and emotions in yourself and others.
Questions to Ask:
• “Have you noticed any changes in how you relate to others or understand their feelings?”
• “Do you have difficulty recognizing facial expressions or understanding what others might be thinking or feeling?”
• “Do you sometimes find yourself misinterpreting social situations or saying something that others find inappropriate?”
Delirium
DSM-5 Criteria for Delirium
Delirium is a neurocognitive disorder characterized by an acute onset of confusion, disorientation, and disturbances in attention, cognition, and consciousness. Here’s the DSM-5 breakdown:
⸻
A. Disturbance in Attention and Awareness
• A reduced ability to focus, sustain, or shift attention.
• Marked reduction in the ability to perceive the environment clearly.
⸻
B. Develops Over a Short Period of Time (Hours to a Few Days)
• The disturbance fluctuates in severity throughout the day.
• The symptoms develop over a short period of time (hours to days) and represent a change from baseline functioning.
⸻
C. Additional Cognitive Disturbance
• At least one of the following:
• Memory deficits (e.g., short-term memory problems).
• Disorientation (e.g., unaware of time, place, or person).
• Language impairment (e.g., incoherent speech or difficulty understanding).
• Visuospatial ability impairment (e.g., inability to recognize familiar objects or faces).
• Perceptual disturbances (e.g., hallucinations or delusions).
⸻
D. Evidence of an Underlying Medical Condition
• Direct physiological cause: The disturbance is due to a medical condition, substance intoxication or withdrawal, or other physiological causes (e.g., medication, infection, metabolic disturbance, or brain injury).
⸻
E. Not Better Explained by Another Disorder
• The disturbance cannot be better explained by another cognitive disorder (such as major neurocognitive disorder or dementia).
⸻
Specifier for Delirium:
• Substance Intoxication Delirium
• Substance Withdrawal Delirium
• Delirium Due to a Medical Condition
• Delirium Due to Multiple Etiologies
⸻
Mnemonic to Remember the Criteria: “AT A DAY”
• A - Attention and Awareness: Reduced focus, sustain, or shift.
• T - Time: Develops quickly (hours to days), fluctuates.
• A - Additional Cognitive Impairment: Memory, disorientation, language, visuospatial, or perceptual problems.
• D - Direct Physiological Cause: Due to medical condition or substances.
• A - Absence of Better Explanation: Not another cognitive disorder.
• Y - You (the clinician) must identify and treat the underlying cause!
⸻
Questions to Ask When Assessing for Delirium:
1. Attention and Awareness:
• “Are you finding it difficult to focus on tasks or conversations lately?”
• “Do you feel disoriented, like you’re confused about where you are or what time it is?”
2. Cognitive Disturbance:
• “Have you been forgetting things or feeling a bit confused, especially in the last few hours or days?”
• “Are you having trouble speaking or understanding what people are saying?”
3. Medical History:
• “Have you recently had an illness, been hospitalized, or started any new medications?”
• “Have you experienced any changes in your sleep pattern or appetite recently?”
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Delirium is an acute and reversible condition that can often be treated if identified early, and it is important to rule out other causes such as dementia or psychosis when diagnosing. Let me know if you need further information!
MMSE
Panic disorder
DSM-5 Criteria for Panic Disorder
Panic Disorder is characterized by recurrent, unexpected panic attacks and persistent concern about having more attacks or changing behavior due to them.
D PANICS STFAC
SPONTANEOUS TRIGGERED
FUTURE.. ANXIOUS
AVOID SITUATIONS
Caffeine
RECURRENT
⸻
DSM-5 Criteria for Panic Disorder
✅ A. Recurrent, Unexpected Panic Attacks
A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes, with 4 or more of the following symptoms:
Mnemonic: “STUDENTS FEAR the 3 C’s”
S - Sweating
T - Trembling or shaking
U - Unsteady (dizziness)
D - Derealization (feeling unreal) or Depersonalization (feeling detached from oneself)
E - Elevated heart rate (palpitations)
N - Nausea or abdominal distress
T - Tingling (paresthesias)
S - Shortness of breath
F - Fear of losing control or “going crazy”
E - Experiencing chest pain or discomfort
A - Avoidance behavior (changing routines due to fear of attacks)
R - Racing thoughts or fear of dying
C - Chills or hot flashes
C - Choking sensation
C - Chest pain
✅ B. Persistent Concern or Behavioral Changes
At least one month of one or both:
1. Worrying about having more attacks or their consequences (e.g., “I’m going to die”).
2. Avoidance behaviors (e.g., avoiding exercise, unfamiliar places, or certain activities).
✅ C. Not Due to a Medical Condition or Substance Use
• Rule out medical causes (e.g., hyperthyroidism, arrhythmias).
✅ D. Not Explained by Another Mental Disorder
• Not better explained by social anxiety disorder, phobias, PTSD, or OCD.
⸻
Questions to Ask for Panic Disorder
Identifying Panic Attacks
• “Have you ever had sudden episodes of intense fear or discomfort that come out of nowhere?”
• “Do these episodes peak within minutes and include physical symptoms like heart racing, sweating, or feeling like you can’t breathe?”
Concerns & Avoidance
• “Do you worry about having another panic attack?”
• “Have you changed your behavior or avoided certain places because of your fear of attacks?”
Exclusion Questions
• “Has a doctor ruled out any medical causes for these symptoms?”
• “Do these episodes only happen in specific situations (like social settings)?”
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Mnemonic for Panic Disorder: “PANICS”
P - Palpitations, Paresthesias
A - Abdominal distress
N - Nausea, Numbness
I - Intense fear of losing control
C - Chest pain, Choking
SLEEP DISORDERS
Insomnia/
3-3
INIEC
INITIATE SLEEP
NIGHT AWAKWNING- early morning awakening
Irritable can’t concentrate fatigue low energy
Interfere w life impairement work relationships studies
DSM-5 Criteria for Insomnia Disorder
Insomnia disorder is characterized by difficulty falling asleep, staying asleep, or waking up too early, leading to daytime impairment.
⸻
A. Main Sleep Complaint
• Difficulty with one or more of the following:
1. Trouble initiating sleep (difficulty falling asleep).
2. Trouble maintaining sleep (frequent awakenings or difficulty returning to sleep).
3. Early-morning awakening with an inability to return to sleep.
⸻
B. Daytime Dysfunction Due to Sleep Problems
• Fatigue or low energy
• Difficulty with concentration or memory
• Irritability or mood disturbances
• Impaired work/school/social performance
⸻
C. Sleep Problem Occurs at Least 3 Times Per Week
⸻
D. Duration of at Least 3 Months
⸻
E. Not Explained by Another Sleep Disorder
• The symptoms are not due to another sleep disorder (e.g., sleep apnea, restless leg syndrome).
⸻
F. Not Due to a Medical Condition, Substance, or Medication
• The sleep disturbance is not due to drug use, medications, or medical conditions like pain or depression.
⸻
Mnemonic to Remember the DSM-5 Criteria: “INSOMNIA”
I - Initiation of sleep is difficult
N - Night awakenings are frequent
S - Self-reported sleep dissatisfaction
O - Occurs at least 3 times per week
M - Months (at least 3 months of symptoms)
N - Not due to another sleep disorder
I - Impaired daytime functioning
A - Absence of substance or medical cause
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Questions to Ask for Insomnia Disorder:
1. Onset – “Do you have difficulty falling asleep?”
2. Maintenance – “Do you wake up often during the night and struggle to go back to sleep?”
3. Early Awakening – “Do you wake up too early and can’t go back to sleep?”
4. Daytime Dysfunction – “Do you feel tired, unfocused, or irritable during the day?”
5. Duration – “How long have you been experiencing sleep problems?”
6. Frequency – “Does this happen at least 3 times per week?”
7. Underlying Causes – “Do you have any medical conditions, take any medications, or use substances that might affect your sleep?”
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Would you like mnemonics for other sleep disorders too?
DSM-5 Criteria for Sleep Disorders
There are several sleep disorders outlined in the DSM-5, each with its own criteria. Below is an overview of the most common ones:
⸻
- Insomnia Disorder
DSM-5 Criteria for Insomnia Disorder
✅ A. Difficulty initiating or maintaining sleep, or waking up too early
• Despite having the opportunity to sleep, the person struggles to fall asleep, stay asleep, or wakes up too early and cannot return to sleep.
✅ B. Sleep disturbance causes distress or impairment
• The sleep issues cause significant distress or impairment in daily functioning (e.g., mood, energy, cognitive performance).
✅ C. Occurs at least 3 times per week
• The sleep disturbances occur at least 3 nights per week for at least 3 months.
✅ D. Not better explained by other conditions
• The insomnia is not due to another medical condition, psychiatric disorder, or substance use.
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- Hypersomnolence Disorder
DSM-5 Criteria for Hypersomnolence Disorder
✅ A. Excessive sleepiness despite sleeping at least 7 hours
• The person experiences excessive sleepiness during the day even after having adequate sleep at night (typically 7+ hours).
✅ B. Recurrent sleep episodes during the day
• Frequent naps or difficulty staying awake during activities like driving, talking, or working.
✅ **C. The sleepiness is at least 3 times per week for 3 months.
✅ D. No other explanation for the excessive sleepiness
• The excessive daytime sleepiness cannot be explained by another condition (e.g., sleep apnea, narcolepsy, or substance use).
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- Narcolepsy
DSM-5 Criteria for Narcolepsy
✅ A. Recurrent episodes of excessive daytime sleepiness
• The person experiences uncontrollable sleep episodes at inappropriate times (e.g., during work, conversation, or meals).
✅ B. At least one of the following:
1. Cataplexy: Sudden loss of muscle tone or strength triggered by emotions (e.g., laughter, surprise).
2. Hypocretin deficiency: Low levels of hypocretin (a brain chemical that regulates sleep) in cerebrospinal fluid.
3. REM sleep abnormalities: Sleep-onset REM periods (rapid eye movement sleep begins immediately after falling asleep).
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- Breathing-Related Sleep Disorders (e.g., Obstructive Sleep Apnea)
DSM-5 Criteria for Obstructive Sleep Apnea Hypopnea
✅ A. Polysomnographic evidence of apnea or hypopnea
• The person experiences repeated episodes of apnea (breathing stops) or hypopnea (shallow breathing) during sleep, usually seen in a sleep study.
✅ B. Evidence of daytime impairment or distress
• This disorder leads to excessive daytime sleepiness, fatigue, or unrefreshing sleep.
⸻
- Circadian Rhythm Sleep-Wake Disorders
DSM-5 Criteria for Circadian Rhythm Sleep-Wake Disorders
✅ A. A mismatch between an individual’s internal biological clock and external demands (e.g., sleep-wake schedule)
• This mismatch leads to difficulty sleeping at socially acceptable times.
✅ B. Impaired functioning
• The disorder causes significant impairment or distress in daily life (e.g., difficulty with work or social interactions).
Types include:
• Delayed Sleep Phase Disorder: Late-night sleep patterns, difficulty waking up in the morning.
• Advanced Sleep Phase Disorder: Early evening sleep onset and early morning awakening.
• Shift Work Disorder: Sleep disturbance due to working night shifts or irregular hours.
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- Parasomnias (Abnormal Sleep-Related Events)
DSM-5 Criteria for Parasomnias
Types of Parasomnias:
• Nightmares: Disturbing dreams that wake the person and are often related to stress or trauma.
• Sleepwalking: Recurrent episodes of leaving the bed or performing complex behaviors while still asleep.
• Sleep Terror Disorder: Sudden arousal from sleep, usually accompanied by screaming, confusion, and fear, without full awakening.
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- Restless Legs Syndrome (RLS)
DSM-5 Criteria for Restless Legs Syndrome
✅ A. Urge to move the legs, usually accompanied by uncomfortable sensations
• The person experiences an urge to move the legs with uncomfortable sensations (e.g., creeping, crawling, tingling).
✅ B. The urge to move occurs or worsens during periods of rest or inactivity
• Symptoms worsen when at rest, especially during periods of inactivity like sitting or lying down.
✅ C. Relief from moving
• The person experiences relief of symptoms when moving or walking.
✅ D. Worsens in the evening or night
• Symptoms tend to worsen in the evening or at night, affecting sleep.
⸻
Mnemonic for Sleep Disorders: “SLEEPING”
S - Sleeping difficulties (Insomnia, Hypersomnia)
L - Loss of muscle tone (Narcolepsy – Cataplexy)
E - Excessive daytime sleepiness (Hypersomnolence, Narcolepsy)
E - External sleep interference (Circadian Rhythm Disorders, Shift Work)
P - Parasomnias (Nightmares, Sleepwalking, Sleep Terrors)
I - Impaired functioning (Breathing-Related, Insomnia, Narcolepsy)
N - Nighttime breathing problems (Apnea, Hypopnea)
G - General sleep disturbances (RLS, Hypersomnolence)
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Would you like to practice questions to help differentiate these sleep disorders or focus on a specific one?
Illness anxiety disorder
AONTVC6
Anxiety excessive or fear
Overthinking
No px just fear of disease
Time consuming
Multiple Dr visits
Disease changes
6months
DSM-5 Criteria for Illness Anxiety Disorder (IAD)
Illness Anxiety Disorder (IAD) involves excessive preoccupation with having or acquiring a serious illness, despite having little or no symptoms. It is primarily focused on anxiety about health rather than actual physical complaints.
⸻
DSM-5 Criteria for Illness Anxiety Disorder
✅ A. Preoccupation with having or acquiring a serious illness
• The individual is excessively worried about developing or having a serious medical condition.
✅ B. Somatic symptoms are not present, or if present, are only mild
• Mild symptoms may be present, but they do not explain the intense worry or anxiety.
✅ C. High level of anxiety about health
• The person is easily alarmed about their health status and consistently exhibits health-related behaviors (e.g., checking for signs of illness) or avoids medical situations due to fear of illness.
✅ D. The individual performs excessive health-related behaviors or avoids medical care
• Examples include frequent visits to doctors or constantly checking symptoms on the internet.
✅ **E. Symptoms must be present for at least 6 months
• The preoccupation with illness persists for at least 6 months, but the specific illness feared may change over time.
✅ F. The illness-related preoccupation is not better explained by another mental disorder
• It is not explained by somatic symptom disorder, panic disorder, generalized anxiety disorder, or another psychiatric condition.
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Mnemonic for Illness Anxiety Disorder: “HEALTH”
H - High level of health anxiety
E - Excessive health-related behaviors or avoidance
A - Alarmed by mild symptoms (or no symptoms)
L - Long-standing concern (6 months)
T - Transient illness worries (changing illness focus)
H - Hypochondriacal fear, not explained by other disorders
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Questions to Ask for Illness Anxiety Disorder
Health Anxiety
• “Are you constantly worried about having a serious illness, even if your doctor says there’s no problem?”
• “How often do you find yourself checking for physical symptoms or Googling health concerns?”
Behavioral Impact
• “Do you find yourself frequently visiting doctors or taking unnecessary medical tests because of health worries?”
• “Do you avoid situations or people because of the fear of being exposed to illness?”
Duration
• “How long have you been concerned about your health in this way?”
• “Has this worry persisted for several months, even if no serious illness was found?”
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Would you like to dive deeper into differential diagnosis between IAD and other anxiety disorders?
Conversion Malingering/ factious?
Always write malingering / factious as differentials for every disorder in this category
STI
ASK ABOUT THE PX
SOCRATES, FIRST TIME? ANY OTHER SYMPTOMS.
INTERFERE W UR LIFE?
TESTS CAME NEGATIVE W NO MEDICAL EXPLANATION DOES THAT SURPRISE U?
DSM-5 Criteria & Differences Between Somatic Disorders, Conversion Disorder, Malingering, and Factitious Disorder
- Conversion Disorder (Functional Neurological Symptom Disorder)
DSM-5 Criteria:
• A. One or more symptoms of altered voluntary motor or sensory function (e.g., paralysis, blindness, seizures, mutism).
• B. Clinical findings show that the symptoms are not explained by a neurological or medical condition.
• C. The symptoms cause significant distress or impairment.
• D. The symptoms are not intentionally produced (i.e., not feigned).
Key Features:
• Symptoms do not follow known neurological pathways.
• Patients are often not distressed by their symptoms (La Belle Indifférence).
• Triggered by stress or trauma.
• Unconscious motivation (the patient is NOT faking).
⸻
- Malingering (NOT a DSM-5 Disorder, but a Clinical Concept)
Definition:
• Intentionally faking or exaggerating symptoms for an external gain (e.g., avoiding work, obtaining disability benefits, evading legal consequences).
Key Features:
• Symptoms stop once the gain is achieved.
• Inconsistent history & exaggerated complaints.
• No real distress; the goal is to obtain a benefit.
Mnemonic to differentiate malingering: “MONEY”
• M - Medico-Legal situation (occurs in legal cases, military, disability claims).
• O - Obvious secondary gain (financial, avoiding prison, etc.).
• N - Not consistent with known medical conditions.
• E - Exaggerated symptoms.
• Y - You stop questioning, they stop complaining.
⸻
- Factitious Disorder (Munchausen Syndrome)
DSM-5 Criteria:
• A. Falsification of symptoms or induction of injury/disease.
• B. Presents self as ill, impaired, or injured.
• C. Deceptive behavior occurs even in the absence of external rewards.
• D. Not better explained by another mental disorder.
Key Features:
• Patient is INTENTIONALLY creating symptoms, but for internal psychological needs (to be in the “sick role”), not for money or external benefits.
• Can also be Factitious Disorder Imposed on Another (FDIA) (e.g., a mother harming her child to assume the “caregiver” role).
Mnemonic to differentiate factitious disorder: “FAKE”
• F - Faking symptoms, but for psychological gain.
• A - Attention-seeking (loves being in the “sick role”).
• K - Knows how to fake medical signs/symptoms (may even tamper with tests).
• E - External rewards absent (no financial or legal gain).
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- Somatic Symptom Disorder (SSD)
DSM-5 Criteria:
• A. One or more distressing somatic symptoms (pain, fatigue, GI issues, etc.).
• B. Excessive thoughts, feelings, or behaviors related to these symptoms (e.g., excessive worry, anxiety, frequent doctor visits).
• C. Lasts 6+ months, even if the actual symptom changes over time.
Key Features:
• Symptoms are REAL but excessive preoccupation with them.
• Patient is NOT faking—they truly believe they are sick.
• Frequent doctor visits, but reassurance does not relieve their distress.
Mnemonic: “SOMATIC”
• S - Suffering is real.
• O - Overthinking about symptoms.
• M - Multiple organ complaints possible.
• A - Anxiety about health.
• T - Time-consuming doctor visits.
• I - Impairment in daily life.
• C - Chronic (6+ months).
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- Illness Anxiety Disorder (Hypochondriasis)
DSM-5 Criteria:
• A. Preoccupation with having or acquiring a serious illness.
• B. Minimal or no actual somatic symptoms.
• C. High level of health anxiety and excessive health-related behaviors (e.g., frequent doctor visits, excessive online research).
• D. Lasts 6+ months, though the specific feared illness may change.
Key Features:
• Unlike SSD, the main issue is fear of illness, NOT actual symptoms.
• Patients misinterpret normal bodily sensations as signs of disease.
• Excessive reassurance-seeking, but no relief.
Mnemonic: “ILLNESS”
• I - Intense health anxiety.
• L - Lacks severe physical symptoms.
• L - Lasts 6+ months.
• N - Negative tests don’t reassure.
• E - Excessive doctor visits or avoidance.
• S - Scanning body for signs of illness.
• S - Switches between different feared diseases.
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Key Differences Between These Disorders
Disorder Symptoms Intentional? Gain Type Example
Somatic Symptom Disorder (SSD) Real but excessive preoccupation No Psychological “I have pain, and I’m scared it’s serious.”
Illness Anxiety Disorder (IAD) Fear of being sick, minimal/no symptoms No Psychological “I feel fine, but what if I have cancer?”
Conversion Disorder Neurological symptoms (blindness, paralysis) No Psychological “I suddenly can’t move my legs after trauma.”
Factitious Disorder Fakes or induces symptoms Yes Psychological (wants to be sick) Injects insulin to fake hypoglycemia.
Malingering Fakes or exaggerates symptoms Yes External (money, legal) Feigns back pain to get disability benefits.
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How to Differentiate Conversion Disorder, Malingering, and Factitious Disorder?
1. Is the patient faking symptoms intentionally?
• No → It’s likely Conversion Disorder (psychological stress manifests as neurological symptoms).
• Yes → Move to step 2.
2. What is the patient’s motivation?
• If they want external rewards (money, avoiding work/prison) → Malingering.
• If they just want attention from being in the “sick role” → Factitious Disorder.
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Final Mnemonic to Remember the Key Differences: “FAKE IT”
F - Factitious Disorder → Fakes illness for attention (internal gain).
A - Anxiety (Illness Anxiety Disorder) → Afraid of illness but no real symptoms.
K - Krazy Neurology (Conversion Disorder) → Neurological symptoms without medical cause.
E - External Gain (Malingering) → Faking illness for benefits (money, legal issues).
I - Intense Symptoms (Somatic Symptom Disorder) → Real symptoms with extreme worry.
T - Too much doctor-shopping (Common in SSD & IAD).
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Would you like practice questions to solidify the differences?
Tics
Social anxiety disorder
DSM-5 Criteria for Social Anxiety Disorder (Social Phobia)
To be diagnosed with Social Anxiety Disorder (SAD), a person must meet the following criteria:
A. Marked Fear or Anxiety
• Intense fear or anxiety about one or more social situations where the person is exposed to possible scrutiny by others (e.g., conversations, public speaking, eating in public).
B. Fear of Negative Evaluation
• The person fears they will act in a way or show symptoms that will be negatively evaluated (e.g., embarrassing, humiliating, or leading to rejection).
C. Social Situations Almost Always Provoke Anxiety
• Social situations consistently cause fear or anxiety.
D. Avoidance or Endurance with Distress
• The person either avoids social situations or endures them with intense fear/anxiety.
E. Disproportionate Fear
• The fear/anxiety is excessive and out of proportion to the actual threat posed by the situation.
F. Persistent (6+ Months)
• The symptoms last for 6 months or more.
G. Significant Impairment
• The fear/anxiety causes significant distress or impairment in social, occupational, or daily functioning.
H. Not Due to Another Condition
• The symptoms are not due to substance use, a medical condition, or another mental disorder (e.g., autism, body dysmorphic disorder).
Specifier: Performance-Only Type
• Some people have social anxiety only in performance situations (e.g., public speaking) but not in general social interactions.
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Mnemonic for Social Anxiety Disorder: “AFRAID”
• A - Avoidance of social situations.
• F - Fear of humiliation or negative evaluation.
• R - Reacts with intense anxiety in social settings.
• A - Always anxious in feared situations.
• I - Impairment in daily life due to anxiety.
• D - Duration of 6+ months.
Would you like sample questions for history-taking?
