PHRM845 Exam 4-Lecture 51

Question 1

DSM-5: number of people that could be diagnosed with a mental health disorder

Answer 1

1 in 5

Question 2

Is 5 in DSM-5 a number or roman numeral?

Answer 2

NUMBER

Question 3

When was the publication of DSM-5?

Answer 3

May 2013

Question 4

When was the publication of the DSM-5, TR added? What changes did it make?

Answer 4

-March 2022; added further SDOH and cultural factors in diagnosis. (Mental illness from lived things, no longer self-caused as previously believed)
-Not trying to silo someone into a diagnosis, but now looking at lived experiences

Question 5

Challenging, but positive transition for mental health providers with DSM-5

Answer 5

-DSM-IV had been used for 20 years, so it was difficult to transition
-DSM-5 dropped the multi-axial assessment because it negatively separated psychiatric and mental health disorders
-DSM-5 was reorganized to reflect disorders across a continuum based on developmental and lifespan considerations.

Question 6

Are mental health disorders identifiable?

Answer 6

No because there is no objective information

Question 7

Mental health disorders begin with

Answer 7

-Neurodevelopmental disorders which encompass disorders previously considered to be childhood diagnosis

Question 8

What are the neurodevelopmental disorders?

Answer 8

-Intellectual disabilities and delays; communication disorders
-Autism spectrum disorders (deletes the diagnosis of Asperger’s disorder)
-Attention-deficit/hyperactivity disorder

Question 9

Schizophrenia spectrum, depression, bipolar disorder: Did any specific psychotic disorders get deleted?

Answer 9

NO; only deleted schizophrenia subtypes

Question 10

What is special about bipolar and related disorders and depressive disorders?

Answer 10

Bipolar and related disorders and depressive disorders have separate chapters–with bipolar found between schizophrenia spectrum and depressive disorders–reflecting the overlapping nature of bipolar disorder
**Overlap of symptoms

Question 11

In previous DSM editions, the anxiety disorders existed in one BIG chapter. In DSM-5, they are separated into…

Answer 11

-Anxiety disorders: includes GAD, social anxiety disorder, and panic disorder (arise out of fight or flight mechanism)

Question 12

New separate chapters in DSM-5 for …

Answer 12

OCD, trauma- and stressor-related disorders

Question 13

To decrease stigma, substance related disorders are no longer seen as

Answer 13

Abuse and dependence (puts blame on the person)

**Now seen as substance use disorders

Question 14

For substance-related disorders, there is a set criteria for all substance that only vary with symptom presentation based on type of substance used including…

Answer 14

-Alcohol
-Caffeine
-Cannabis
-Hallucinogens
-Inhalants
-Opioids
-Sedatives/hypnotics/
anxiolytics
-Stimulants
-Tobacco
-Other
-Includes gambling disorder–other behavioral excesses have been studied, but not included yet (internet, shopping, etc)

Question 15

What causes substance-disorders?

Answer 15

The inhibition is gone

Question 16

Neurocognitive disorders were previously referred to as ___

Answer 16

Dementia

Question 17

Neurocognitive disorders are categorized into…

Answer 17

Major and mild neurocognitive disorders
-Specifics include types (Alzheimer’s, etc)

Question 18

Rating scales are difficult because you wonder…

Answer 18

-Who is doing the rating
-What is rated

Question 19

Rating scale for depression: Patient Health Questionnaire (PHQ-9)

Answer 19

-9 questions to screen for depression and suicidal thinking
-Patient-rated

Question 20

Rating scale for depression: Beck Depression Inventory (BDI)

Answer 20

-Primarily for research
-Very validated over time for change in meds
-21-item; patient-rated

Question 21

Mood disorders questionnaire (MDQ)

Answer 21

Designed to be a patient-rated screening tool for bipolar I (mania and depression)
**Often presents as unipolar depression; may make diagnosis worse if it is not treated for the right thing
**Not designed to diagnose bipolar II

Question 22

Any manic disorder is ____, not ____

Answer 22

bipolar; depression

Question 23

What is used to diagnose depression?

Answer 23

No objective sign in depression, so we must use rating scales

Question 24

Hamilton Depression rating scale (HAM-D, HDRS)

Answer 24

-Clinician-rated
-Validated in clinical trials; gold-standard for evaluating change over time

Question 25

Montgomery-Asberg Depression Rating Scale (MADRS)

Answer 25

-Validated in clinical trials
-Gold standard
-May be more relevant based upon comparison to BDI

Question 26

Bipolar disorder and Generalized Anxiety: Young Mania Rating Scale (YMRS)

Answer 26

-11 item
-Clinician rated by patient report of symptoms over the past 48 hours
-Used to evaluate symptoms at baseline and over time

Question 27

Hamilton Anxiety Rating Scale (HAM-A)

Answer 27

-Clinician-rated

Question 28

Schizophrenia rating scale: Positive and Negative Syndrome Scale (PANSS)

Answer 28

-Gold-standard scale: 20% reduction in symptoms indicates antipsychotic efficacy
-Clinician-rated

Question 29

Schizophrenia Rating Scale: Brief Psychiatric Rating Scale (BPRS)

Answer 29

-Gold standard scale in clinical trials
-Clinician-rated

Question 30

Antipsychotics are good at treating ___; ____ don’t do well with tx

Answer 30

-Positive issues
-Social interactions

Question 31

Movement side effects of antipsychotics: SAS

Answer 31

Simpson-Angus scale
-Evaluates drug-induced parkinsonian symptoms
-Clinician-rated

Question 32

Movement side effects of antipsychotics: BARS

Answer 32

Barnes Akathisia Scale
-Clinician-rated
-Objective observation of akathisia (Motor restlessness)

Question 33

What causes Tardive Dyskinesia/Overall Movement side effect?

Answer 33

The unblocking of dopamine receptors

Question 34

Abnormal Involuntary Movement Scale (AIMS)

Answer 34

Assesses tardive dyskinesia
-Clinician-rated

Question 35

Extrapyramidal symptoms rating scale (ESRS)

Answer 35

Assesses parkinsonian symptoms, akathisia, dystonia, and tardive dyskinesia in one rating scale.
-Clinician-rated
-Very time-consuming, so not always effective for clinic use

Question 36

Clinical Global Impressions (CGI)

Answer 36

-Assesses overall psychiatric functioning
-CGI-S=Severity
-CGI-I=Improvement
-Used to assess change over time: can assess efficacy of other rating scales

Question 37

Global Assessment of Functioning (GAF)

Answer 37

-Assesses overall psychiatric functioning
-Clinician-rated
-0-100 (100 is perfect function)
-Variable results based on clinician evaluation and experience (“cop out” when used in clinical trials)