Psychopathology: DSM 5 Disorders

Question 1

Grief vs Major Depressive Episode

Answer 1

• Grief
  
  • feelings of emptiness and loss
• MDE
  
  • depressed mood
  • inability to anticipate happiness

Question 1

Premenstrual Dysphoric Disorder

Answer 1

• Depressive Disorder
  
  • five symptoms the week prior to period and improve withing a few days of period coming
  • one or more these symptoms
    
    • affective lability (mood swings, sensitive)
    • irritability or anger
    • depressed mood
    • anxiety
  • one or more of these symptoms
    
    • decreased interest
    • concentration difficulty
    • lethargy
    • appetite changes
    • sleep problems
    • physical symptoms
  • present within the past year
  • needs to be confirmed by prospecive daily ratings of at least 2 symptoms for 2 months
    
    • if this is not done–> provisional diagnosis

Question 1

Manic Episode

Answer 1

• one event in lifetime required for Bipolar 1
• persistent elevated or irritable mood and increased goal-directed activity
  
  • lasts at least 1 week
• During mood disturbance at least 3 or 4 if only irritable
  
  • increase self-esteem
  • less need for sleep
  • more talkative
  • flight of ideas
  • distractability
  • increase in goal directed activity
  • involvement in high risk activity
• cause marked impairment in functioning
• requires major life desturbance or hospitalization

Question 1

Major Depressive Episode

Answer 1

• common, but **not required for bipolar 1 **
• present during same two-week period
• One of the following
  
  • depressed mood or loss of interest
• 4 or more of the following
  
  • weight loss or gain
  • sleep disturbances
  • psychomotor agitation or retardation
  • fatigue
  • feelings of worthlisness
  • lack of ability to concentrate
  • thoughts of death (recurrent)
• cause impairment in functioning

Question 1

Anxiety

Answer 1

anticipation of future threat

Question 1

Anxiety Disorder Due to Another Medical Condition

Answer 1

• Panic Attacks or anxiety is predomincant in the clinical picture
• findings that the disturbance is the direct pathophysiological consequence of another medical condition
• not better explained by another mental disorder
• not exclusively during delirium
• NOT MEANT TO INCLUDE PRIMARY ANXIETY DISORDERS THAT ARISE IN THE CONTEXT OF CHRONIC MENTAL ILLNESS

Question 1

• Obsessive Compulsive and Related Disorders
  
  • preoccupation with one or ore defects or flaws in physical appearance that or not observable to others
  • performced repetitive behaviors or mental acts in response to concern
  • clinically significant distress
  • not better explained by concerns with body fat or weigh in an individual whose diagnositic symptoms meet criteria for an eat disorder
  • specify if
    
    • with muscle dysmorphia
      
      • preoccupied with the idea that body is insufficiently muscular

Answer 1

Body Dysmorphic Disorder

Question 1

• Cultural syndromes:
  
  • —Clusters of invariant symptoms that tend to co-occur among individuals in specific cultural groups, communities, or contexts
• —Cultural idioms of distress:
  
  • —A way of talking about suffering among people in a cultural group
  • —Ex: For western clinicians, major depressive disorder (MDD) is considered a “syndrome,” or cluster of symptoms that appear to “hang together.” But it can also be considered an “idiom of distress,” in that Westerners commonly talk of feeling “depressed” in everyday life.
• —Cultural explanations of distress or perceived causes:
  
  • —Cultural explanation or perceived cause for etiology, sxs, illness, or distress

Answer 1

What were the DSM IV “culture-bound syndromes” replaced by

Question 1

• recurrent MDD
  
  • temporal relationship
  • full remissions
  • last two years demonstrate relationship
  • seasonal outnumber nonseasonal

Answer 1

Seasonal Pattern Depressive Specifier

Question 1

• applied to Bipolar I or II
• at least 4 mood episodes in last 12 months
  
  • meet criteria for manic, hypomanic, or MDE
• episodes marked by partial or full remission for 2 months or one of opposite polarity

Answer 1

Rapid Cycling Specifier for Bipolar or Related Disorders

Question 1

Psychological Factors Affecting Other Medical Conditions

Answer 1

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • medical symptom or condition is present
    • psycholigcal or behavioral factors adversely affect the med condition in one or more:
      
      • factors have influenced the course as shown by a close temporal association between psych factors and development and delayed recovery
      • interfere with treatment
      • constitute well-established health risks for individual
      • influence the underlying pathophysiology which exacerbates symptoms to necessitate med attentions
    • not better explained by another med condition
    • Specify
      
      • mild: increases med risk
      • moderate: aggrevates
      • severe: results in hospitalization
      • extreme: results in severe, life-threatening risk
  • Prevalence
    
    • unclear
    • more common than somatic symptom disorder
  • Onset
    
    • can occur across the lifespan
      
      • can be characteristic of life stages
  • Gender
  • Differentials
    
    • mental disorder due to another medical condition
    • adjustment disorder
    • somatic symptom disorder
    • illness anxiety disorder
  • Comorbidity
    
    • requires relavent psychological or behavioral syndrome or trait

Question 1

Factitious Disorder

Answer 1

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • falsification of physical signs or symptoms, or induction of injury or dease, associated with identified deception
    • presents themself as ill, injured, or impaired
    • deceptive behavior is evident even in the absence of obvious external rewards
    • specify
      
      • single episode
      • recurrent episodes
  • Prevalence
    
    • unknown, but probably 1%
    • single episodes are less common
  • Onset
    
    • usually during early adulthood, often after hospitalization
  • Gender
  • Differentials
    
    • somatic symptom disorder
    • malingering
    • conversion disorder
    • borderline personality disorder
    • medical condition not associated with intentional symptom falsification
  • Comorbidity

Question 1

Catatonia (more indepth)

Answer 1

• can occur in several disorders, including neurodevelopmental, psychotic, bipolar, depressive, and other mental disorders
• can also be catanonic disorder due to another medical condition

Question 1

Schizophreniform Disorder

DSM Criteria

Answer 1

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • 2 or more of the following, each present for a significant portion of the time during 1 month. At least 1 must be present 1,2, or 3
      
      • Delusions
      • Hallucinations
      • Disorganized speech
      • Grossly disorganized or catatonic behavior
      • negative symptoms
    • Episode lasts at least 1 month, but less than 6 months
      
      • when the diagnosis must be made without waiting for recovery, it should be qualified as provisional
    • schizoaffective, depressive, bipolar with psychotic features have been rule out
      
      • no major depressive or manic have occurred
      • mood episodes have occured during active-phase symptoms, thahve have been present for a minority of duration of the active and residual preiods of the illness
  • Specifiers
    
    • good prognostic features
    • without good prognostic features
    • with catatonia
    • severity
  • Onset
    
    • between late teens and mid 30s
  • Prevalence
    
    • five fold less than schizophrenia
    • higher with the specifier of with good prognostic features
  • Differentials
    
    • other mental disorders and medical conditions
    • brief psychotic disorders
  • Comorbid

Question 1

Narcissistic Personality Disorder

Answer 1

• A pattern of gradiosity, need for admiration, and a lack of empathy

Question 1

Personality Disorders Cluster B

Answer 1

• Disorders
  
  • antisocial
  • borderline
  • histrionic
  • narcissistic
• Characteristics
  
  • dramatic
  • emotional eratic
• Prevalence
  
  • 6%

Question 1

Dissociative Amnesia DSM Diagnostic Criteria

Answer 1

• Diagnostic Criteria
  
  • inability to recall autobiographical info, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting
    
    • localized (specific period of time) or selective (can recall some, but not all of one’s life history) or generalized (one’s life history)
  • not attributable to a substance or medical or neurological conditions
  • not explained by dissociative identity disorder, PTSD, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder
  • Specify if with or without fugue
    
    • fugue: purposeful travel or bewildered wandering
• Prevalence
  
  • 1.8%
    
    • 1% for men and 2.6% for women
• Development and Course
  
  • it is usually sudden
• Differentials
  
  • Dissociative Identity Disorder
  • PTSD
  • Substance-related disorders
  • neurocognitive disorders
  • posttraumatic amnesia due to brain injury
  • seizure disorder
  • catatonic stupor
  • facticious disorder and malingering
  • normal and age related changes in memory
• Comorbidity
  
  • PDD
  • MDD
  • Adjustment Disorder

Question 1

Frotteuristic Disorder

Answer 1

• Diagnostic Criteria
  
  • Over a period of at least 6 months
    
    • recurrent intense sexual arousal from touching or rubbing against a nonconsenting person
      
      • manifested by fantasies, urges, or behaviors
  • Has acted on sexual urges with nonconsenting or the sexual urges or fantasies cause clinically significant distress
• Specifiers
  
  • in a controlled environment
  • in full remission
• Prevalence
  
  • acts may occur in up to 30% adult males
  • 10-14% of adult males outpatient settings
  • appear to be fewer females
• Differentials
  
  • Conduct disorder and antisocial personality disorder
  • Substance use disorder
• Comorbidity
  
  • hypersexuality and other paraphillic disorders
  • exhibitionistic disorder and voyeuristic disorder
  • APD, depressive, bipolar, anxiety, and substance

Question 1

Fetishistic Disorder

Answer 1

• Diagnostic Criteria
  
  • over a period of at least 6 months
    
    • recurrent and intense sexual arousal from either nonliving objects or a highly specific focus on nongenital body parts
  • Fantasies, sexual urges or behaviors cause clnically significant distress
  • Fetish objects are not limited to articles of clothing used in cross dressing or things like vibrators
• Specifiers
  
  • body parts
  • non living objects
  • other
  • in a controlled environment
  • in full remission
• Development and Course
  
  • usually during puberty is onset
  • reported almost exclusively in males
• Differential Diagnosis
  
  • Transvestic Disorder
  • Sexual masochism disorder or paraphic disorder
  • fetishistic behavior without fetishistic disorder

Question 1

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • one or more somatic symptoms that are distressting or result in a significant disruption of daily life
    • Excessive thoughts, feelings or behaviors related to somatic symptoms or associated health concerns manifested by one:
      
      • disproportionate and persistant thoughts about seriousness of symptoms
      • high level of anxiety about health
      • time and energy devoted to symptoms
    • one somatic symptom may be continuously present (6 months typically)
    • Specify
      
      • predominant pain
        
        • if predominantly involve pain
      • persistent
        
        • more than 6 months
      • Severity
        
        • mild: one symptom
        • moderate: 2 or more
        • Severe: 2 or more, plus multiple somatic complaints
  • Prevalence
    
    • not known
    • higher than somatization disorder (
    • around 5-7%
  • Onset
    
    • common in older individuals
      
      • maybe underdiagnosed in older adults
  • Gender
    
    • females tend to report more somatic symptoms
  • Differentials
    
    • other med conditions
    • GAD
    • depressive disorders
    • illness anxiety disorder
    • conversion disorder (neurological)
    • delusional disorder
    • BDD
    • OCD
  • Comorbidity
    
    • high comorbidity with medical disorders
    • anxiety and depressive

Answer 1

Somatic Symptom Disorder

Question 2

• Feeding and Eating Disorders
  
  • Diagnostic Criteria
    
    • repeated regurgitation of food over a period of 1 month (several times a week, typically daily)
      
      • may be re-chewed, reswallowed, or spit-out
    • not associated with gastrointestinal or medical condition
    • no excuslively with AN, BN, or avoidant or restrictive food intake
    • specify if
      
      • in remission
        
        • after full criteria was met, but has not been met for a sustained period of time
  • Prevalence/Onset
    
    • typically higher in individuals with intellectual disability
    • can occur during infancy, childhood, adolescence, adulthood
      
      • infancy: 3-12 months and remits spontaneously, but can be fatal
        
        • appears self-soothing
  • Gender
  • Differentials
    
    • gastrointestinal conditions
    • AN or BN
  • Comorbidity
    
    • concurrent med condition
    • anxiety

Answer 2

Rumination Disorder

Question 3

Unspecified Bipolar and Related Disorder

Question 3

• Grief
  
  • feelings of emptiness and loss
• MDE
  
  • depressed mood
  • inability to anticipate happiness

Answer 3

Grief vs Major Depressive Episode

Question 3

• Feeding and Eating Disorders
  
  • Diagnostic Criteria
    
    • eating or feeding disturbance (lack of interest, avoidance based on sensory characteristics of food, concern of aversive consequence) manifested by failure to meet appropriate nutritional or energy needs by ** 1 or more of the following:**
      
      • weight loss (lack of growth in kids)
      • nutritional deficiency
      • dependence on enternal feeding or oral nutritional supplements
      • interference psychosocial functioning
    • not better explained by lack of food or culturally sanctioned practice
    • not exclusively by the course of AN or BN, no evidence of the way in which one’s body weight or shape is experienced
  • Prevalence
  • Onset
    
    • commonly develops in infancy or early childhood and may persist to adulthood
  • gender
    
    • equally common in girls and boys
    • in ASD more common in boys
  • Differentials
    
    • other medical conditions
    • specific neurological
    • RAD
    • ASD
    • specific phobia, social anxiety
    • AN
    • OCD
    • MDD
    • Schizo
    • Factitious
  • Comorbidity
    
    • Anxiety, OCD, ASD

Answer 3

Avoidant/Restrict Food Intake Disorder

Question 3

• Cluster B
  
  • Diagnostic Certeria
    
    • pervasive patter of instability of interpersonal relationships, self-image, and affects, marked impulsivity, beginning by early adulthood. 5 or more off the following:
      
      • efforts to avoid abandonment
      • pattern of unstable and intense personal relationships. Alternating between idealization and devaluation
      • identity disturbance: unstable self-image
      • impulsivity in two areas that are self-damaging (not suicidal or self-mutilating)
      • recurrent suicidal behavior, gestures, or threats, or self-mutilating beahvior
      • affective instability due to a marked reactivity of mood (intense episodic mood)
      • chronic feelings of emptiness
      • inappropriate, intense anger
      • transient, stress-related paranoid ideation
  • Prevalence
    
    • 1.6%, but higher in mental health and psychiatric inpatient
    • decreases in older age groups
    • 75% in females
  • Onset
    
    • chronic instability in early adulthood
    • risk of suicide in young adult years and wanes in aging
    • 30s and 40s have greater stabliity
  • Differential
    
    • depressive and bipolar
    • other personality disorders
    • personality change due to another medical condition
    • substance use disorders
    • identity problems
      *

Answer 3

Borderline Personality Disorder

Question 4

• Depressive Disorder
  
  • persistent disturbance in mood that predomintate in clinical picture
    
    • depressed mood or interest loss
  • Findings show
    
    • developed during substance intoxication or withdrawal
    • substance is capable of producing symptoms
  • not exclusively during delirium
  • mild substance use disorder is comorbid–> 1 as 4th character
  • moderate/severe substance use disorder is comorbid –> 2 as 4th character
  • no comorbid substance use disorder–> 9 as 4th character
  • Specifiers:
    
    • onset during intoxication or withdrawal

Answer 4

Substance/Medication Induced Depressive Disorder

Question 4

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • medical symptom or condition is present
    • psycholigcal or behavioral factors adversely affect the med condition in one or more:
      
      • factors have influenced the course as shown by a close temporal association between psych factors and development and delayed recovery
      • interfere with treatment
      • constitute well-established health risks for individual
      • influence the underlying pathophysiology which exacerbates symptoms to necessitate med attentions
    • not better explained by another med condition
    • Specify
      
      • mild: increases med risk
      • moderate: aggrevates
      • severe: results in hospitalization
      • extreme: results in severe, life-threatening risk
  • Prevalence
    
    • unclear
    • more common than somatic symptom disorder
  • Onset
    
    • can occur across the lifespan
      
      • can be characteristic of life stages
  • Gender
  • Differentials
    
    • mental disorder due to another medical condition
    • adjustment disorder
    • somatic symptom disorder
    • illness anxiety disorder
  • Comorbidity
    
    • requires relavent psychological or behavioral syndrome or trait

Answer 4

Psychological Factors Affecting Other Medical Conditions

Question 4

• Characterized by disruption of and discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior
• Positive
  
  • dissociative symptoms
    
    • fragmentation of identity
    • depersonalization
    • derealization
  • inability to access information or control mental functions
• Negative
  
  • amnesia

Answer 4

Dissociative Disorders

Question 5

• Pattern of detachment from social relationships and a restricted range of emotional expression

Answer 5

Schizoid Personality Disorder

Question 6

• mood reactivity
• two or more:
  
  • weight gain
  • hypersomnia
  • heavy feeling in arms or legs
  • rejection sensitivity

Answer 6

Atypical Features for Depressive Specifier

Question 7

• Manic Episode (at least one in lifetime)
  
  • persistent elevated or irritable mood and increased goal-directed activity
    
    • lasts at least 1 week
  • During mood disturbance at least 3 or 4 if only irritable
    
    • increase self-esteem
    • less need for sleep
    • more talkative
    • flight of ideas
    • distractability
    • increase in goal directed activity
    • involvement in high risk activity
  • cause marked impairment in functioning
• Hypomanic Episode (common but not required for diagnosis)
  
  • persistently elevated or irritable mood
    
    • lasts at least 4 consecutive days
  • 3 of the following symptoms or 4 if only irritable
    
    • inflated self-esteem
    • decreased need for sleep
    • more talkative
    • flight of ideas
    • distractible
    • increase in goal-directed activity
    • involvement in high risk activities
  • change in functioning and is observable by others
  • not severe enough to cause impairment in functioning
• **Major Depressive Episode **(common, but not required for bipolar 1)
  
  • present during same two-week period
    
    • One of the following
      
      • depressed mood or loss of interest
    • 4 or more of the following
      
      • weight loss or gain
      • sleep disturbances
      • psychomotor agitation or retardation
      • fatigue
      • feelings of worthlisness
      • lack of ability to concentrate
      • thoughts of death (recurrent)
    • cause impairment in functioning

Answer 7

Bipolar 1 Disorder

Question 7

Persecutory Delusions

Answer 7

• belief that one is going to be harmed, harrassed, by an individual, organization etc.
• most common delusion

Question 7

Schizophrenia

Answer 7

• lasts for at least 6 months
• includes at least 1 month of the active phase of symptoms

Question 9

Specifiers for Bipolar and Related Disorders

Answer 9

• Anxious distress
• Mixed features
  
  • manic or hypomanic episode with mixed features
    
    • full criteria for manic or hypomanic
    • at least 3 of the following
      
      • dysphoria or depressed mood
      • loss of interest
      • psychomotor retardation
      • fatigue
      • feelings of worthlessness
      • thoughts of death
  • Depressive episode, with mixed features
    
    • full criteria met for MDE
    • at least three of the following manic/hypomanic symptoms
      
      • elevated mood
      • inflated self-esteem
      • more talkative
      • flight of ideas
      • increase in energy/goal-directed
      • increase in risk activitives
      • decreased need for sleep
• Rapid Cycling
  
  • applied to Bipolar I or II
  • at least 4 mood episodes in last 12 months
    
    • meet criteria for manic, hypomanic, or MDE
  • episodes marked by partial or full remission for 2 months or one of opposite polarity
• Meloncholic features
• Atypical features
• Psychotic features
  
  • mood-congruent or mood-incongruent
• Catatonia
  
  • can be applied to mania or depression
• Peripartum Onset
• Seasonal Pattern
• Remission type
  
  • partial
    
    • less than 2 months without symptoms
  • full
    
    • no symptoms for at least 2 months
• Severity
  
  • mild, moderate, severe

Question 9

• Context
• Continuum
• Cultural relativism

Answer 9

What are the 3 C’s to classifying psychological disorders

Question 9

Histrionic Personality Disorder

Answer 9

• A pattern of excessive emotionality and attention seeking

Question 9

• Cluster A
  
  • Diagnostic Certeria
    
    • pervasive patter of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adultood, indicated by 4 or more:
      
      • neither desires or enjoys close relationships
      • chooses solitary activities
      • has little interest in have sexual experieces
      • takes pleasure in few activies
      • lacks few friends other than first degree relatives
      • appears indifferent to praise or criticism
      • shows emotional coldness, detachment, or flattened affect
    • if met prior to onset of schizophrenia (premorbid)
  • Prevalence
    
    • 4.9% is comorbid
    • very uncommon in clinical settings
    • 3.1% prevalence in alcohol study
  • Onset
    
    • first apparent in childhood and adolescence with solitariness, poor peer relations, underachievement
    • slightly more often in males
  • Differential
    
    • other mental disorders with psychotic symptoms
    • ASD
    • personality changes due to another med condition
    • substance use disorder
    • other personality disorders and personality traits
      *

Answer 9

Schizoid Personality Disorder

DSM Criteria

Question 10

Substance/Medication-Induced Anxiety Disorder

Answer 10

• Panic attacks or anxiety is predominant in the clinical picture
• evidence in findings
  
  • symptoms developed during or soon after a substance
  • substance is capable of producing symptoms
• disturbance is not better explained by another disorder
  
  • do not persist 1 month after cessation or onset before meds
• not exclusively during delirium
• specifiers:
  
  • with onset during intoxication
  • withonset during withdrawal
  • with onset after medication use
  • type of medication or substance

Question 10

• abnormally elevated or irritable mood and energy that predominates the clinical picure
• evidence of direct pathophysiological consequence of med condition
• no just during delirium
• causes clinically significant distress
• Specificiers
  
  • manic features
    
    • full criteria for manic or hypomanic episode
  • manic or hypomanic like episode
    
    • D not met for manic:
      
      • not attributible to physiological effects of substance
    • F not met for hypomanic:
      
      • not attributible to physiological effects of substance
  • mixed features
    
    • symptoms of depression also present, but do not predominate clinical picture

Answer 10

Bipolar and Related Disorder Due to Another Medical Condition

Question 10

Dissociative Disorders

Answer 10

• Characterized by disruption of and discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior
• Positive
  
  • dissociative symptoms
    
    • fragmentation of identity
    • depersonalization
    • derealization
  • inability to access information or control mental functions
• Negative
  
  • amnesia

Question 11

Psychotic Features Depressive Specifier

Answer 11

• mood-congruent psychotic features
  
  • consistent with depressive themes
• mood-incongruent psychotic features
  
  • does not include typical depressive themes

Question 11

Recurrent

Answer 11

• more than expected (panic attacks)

Question 11

DSM-II

Answer 11

• Similar to DSM-I
  
  • Eliminated term “reaction”
• 182 disorders
• Minimal changes
  
  • Increased attention to children and adolescence
  • “homosexuality not a d/o”
  • More psychodynamic perspective

Question 11

erotomanic delusions

Answer 11

• when an individual believes falsely that another person is in love with him or her

Question 11

• full description found in Personality disorders
• pervasive pattern of social and interpersonal deficits
  
  • reduced capacity for close relationships
  • cognitive or perceptual distortions
  • eccentricities of behavior
• onset usually in early adulthood
  
  • in some cases in childhood and adolescence
• abnormalities of beliefs, thinking, and perception are below the threshold for diagnosis of psychotic d/o

Answer 11

Scizotypal personality Disorder

Question 12

Major Depressive Disorder

Answer 12

• Depressive Disorders
  
  • 5 or more symptoms that are change in previous functioning
    
    • one has to be
      
      • **depressed mood or loss of interest **
    • diet change (weight loss or gain)
    • insomnia or hypersomnia
    • psychomotor agigation or retardation
    • loss of energy
    • worthliness or guilt
    • lack of concentration or indeciveness
    • thoughts of death
  • clinically significant distress
  • not related to substance or medical condition
  • never hypermanic or manic episode
  • Specifiers and Severity
    
    • mild, moderate, severe
    • psychotic features
    • in partial remission, in full remission
    • unspecified
  • Not better explained by
    
    • schizoaffective
    • schizophrenia
    • schiophreniform
    • delusional disorder

Question 13

• presentation and symptoms of bipolar disorders, but do not meet full criteria
• clinician states why it does not meet full criteria
• Examples of presentations
  
  • short-duration hypomanic episodes (2-3 days) and major depressive episodes
    
    • meet full criteria for hypomanic, but short
    • do not overlap in time with major depressive episode (at least one lifetime history)
  • hypomanic episodes with insufficient symptoms and major depressive episodes
    
    • at least one lifetime history of MDE
    • hypomanic episode do not meet full criteria, but experienced one or more
    • hypomanic symptoms do not overlap with MDE
  • hypomanic episode without prior major depressive episode
    
    • never met full criteria for MDE or manic episode
  • short-duration cyclthymia
    
    • multiple episodes of hypomanic (not meeting criteria)
    • multiple episodes of MDE (not meeting criteria)
    • less than 2 years for adults or 1 for kids

Answer 13

Other Specified Bipolar and Related Disorder

Question 13

emotional response to real or perceived imminent threat

Answer 13

Fear

Question 13

Other Specified Somatic Symptom and Related Disorder

Answer 13

• Somatic Symptom and Related Disorders
  
  • Brief somatic symptom disorder
    
    • ​less than 6 months
  • Brief illness anxiety
    
    • ​less than 6 months
  • illness anxiety disorder without excessive health related behaviors​
  • pseudocyesis
    
    • ​false belief of being pregnant that is associated with objective signs and reported symptoms of pregancy

Question 13

• A pattern of instability in interpersonal relationships, -image, and affects, and marked impulsivity

Answer 13

Borderline Personality Disorder

Question 14

Obesseive-Compulsive and Related Disorder due to Another Medical Condition

Answer 14

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair-pulling, other body focused rep behaviors or other symptoms predominante in clinical picture
• lab findings show direct pahophysiological consequence of med condition
• not better explained by another mental disorder
• not during dilirium
• clinically significant distress
• specifiers
  
  • with obsessive-compulsive disorder-like symptoms
  • with appearance preoccupations
  • with hoarding symptoms
  • with hairpulling symptoms
  • with skin picking symptoms

Question 14

Avoidant/Restrict Food Intake Disorder

Answer 14

• Feeding and Eating Disorders
  
  • Diagnostic Criteria
    
    • eating or feeding disturbance (lack of interest, avoidance based on sensory characteristics of food, concern of aversive consequence) manifested by failure to meet appropriate nutritional or energy needs by ** 1 or more of the following:**
      
      • weight loss (lack of growth in kids)
      • nutritional deficiency
      • dependence on enternal feeding or oral nutritional supplements
      • interference psychosocial functioning
    • not better explained by lack of food or culturally sanctioned practice
    • not exclusively by the course of AN or BN, no evidence of the way in which one’s body weight or shape is experienced
  • Prevalence
  • Onset
    
    • commonly develops in infancy or early childhood and may persist to adulthood
  • gender
    
    • equally common in girls and boys
    • in ASD more common in boys
  • Differentials
    
    • other medical conditions
    • specific neurological
    • RAD
    • ASD
    • specific phobia, social anxiety
    • AN
    • OCD
    • MDD
    • Schizo
    • Factitious
  • Comorbidity
    
    • Anxiety, OCD, ASD

Question 15

Depressive Disorder Due to Another Medical Condition

Answer 15

• Depressive Disorder
  
  • depressed mood or loss of interest the predominates clinical picture
  • findings suggest it is a direct pathophysiological consequence of med condition
  • no exclusively during delirium
  • Specifiers
    
    • depressive features
    • major-depressive like features
    • mixed features
  • considerations
    
    • temporal
    • features atypical to mood disorder

Question 15

Delusions

Answer 15

• Schizophrenia Spectrum and Other Psychotic Disorders
• fixed beliefs that are not amenable to change in light of conflicting evidence.
• deemed bizarre
  
  • if clearly implausible and not understandable
• thought withdrawal
  
  • express a loss of control over mind or body are bizzarre
  • include the belived that one’s thoughts have been removed by some outside force
• delusions of control
  
  • actions are being acted on or manipulated by some outside force

Question 17

Social Anxiety Disorder (Social Phobia)

Answer 17

• Anxiety Disorder
• fear or anxiety in one or more social situations in which the individual is exposed to scrutiny of others
  
  • with children must occur with peers, not just adults
• fears they will act in a way that will show anxiety symptoms and will be negatively evaluated
• social situations provoke anxiety
• social situations are avoided or endured with intense fear
• out or proportion
• lasting 6 or more months
• Prevalence
  
  • 7% in the US
• Age of onset
  
  • 13
  • 75% have onset between 8-15
• specifier:
  
  • performance only

Question 17

• IV:
  
  • listed 25 “culture bound syndromes”
  • list was heterogeneous
• V:
  
  • now a “Glossary of Cultural Concepts of Distess”
    
    • Lists 9 of the best studied concepts
  • Section III includes chapter on cultural formulation

Answer 17

Cultural improvements from DSM IV to DSM V

Question 17

• Pattern of disregard for, and violation of, the rights of others

Answer 17

Antisocial Personality Disorder

Question 18

DSM-IV

Answer 18

• six year effort
• comprebensive lit reviews
• worked with developers of ICD-10 to coordinate
• Minimal changes
  
  • 297 disorders
  • “Clinical significance” added
  • More conservative in terms of need for science to back up criteria
    *

Question 18

• six year effort
• comprebensive lit reviews
• worked with developers of ICD-10 to coordinate
• Minimal changes
  
  • 297 disorders
  • “Clinical significance” added
  • More conservative in terms of need for science to back up criteria
    *

Answer 18

DSM-IV

Question 19

Hypomanic Episode

Answer 19

• not required for Bipolar 1, but common
• persistently elevated or irritable mood
  
  • lasts at least 4 consecutive days
• 3 of the following symptoms or 4 if only irritable
  
  • inflated self-esteem
  • decreased need for sleep
  • more talkative
  • flight of ideas
  • distractible
  • increase in goal-directed activity
  • involvement in high risk activities
• change in functioning and is observable by others
• not severe enough to cause impairment in functioning

Question 19

nocturnal panic attack

Answer 19

• waking from sleep in a state of panic

Question 19

Excoriation (Skin-Picking) Disorder

Answer 19

• Recurrent skin picking in skin lesionss (spend at least an hour a day)
• repeated attempts to stop
• causes clinically significant stress
• not attributable to other
• not ususally in presence of others
• prevalence
  
  • 1.4%
• gender differences
  
  • 3/4 are female
• age of onset
  
  • typically in adolescence or puberty
  • may present at various ages

Question 19

• presented for the purposes of identifying a panic attack–> not a mental disorder, noted as a specifier
• abrupt surge of intense fear or discomfort that reaches a peak within minues with 4 or more of the following symptoms
  
  • palpitations
  • sweating
  • trembling
  • shortness of breath
  • chest pain
  • nausea
  • dizziness
  • chills or heat
  • paresthesias
  • derealization
  • fear of losing control
  • fear of dying

Answer 19

Panic Attack Specifier

Question 19

Sexual Masochism Disorder

Answer 19

• Over a period of at least 6 months
  
  • recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors
  • Fantasies, sexual urges, or behaviors cause clinically significant distress
• Specificiers
  
  • with asphyxiophilia
    
    • practice of achieving sexual arousal related to restriction of breathing
  • in a controlled environment
  • in full remission
• Prevalence
  
  • 2.2% males and 1.3% females
• Development
  
  • mean age of onset is 19.3

Question 20

• Anxious distress
• Mixed features
  
  • manic or hypomanic episode with mixed features
    
    • full criteria for manic or hypomanic
    • at least 3 of the following
      
      • dysphoria or depressed mood
      • loss of interest
      • psychomotor retardation
      • fatigue
      • feelings of worthlessness
      • thoughts of death
  • Depressive episode, with mixed features
    
    • full criteria met for MDE
    • at least three of the following manic/hypomanic symptoms
      
      • elevated mood
      • inflated self-esteem
      • more talkative
      • flight of ideas
      • increase in energy/goal-directed
      • increase in risk activitives
      • decreased need for sleep
• Rapid Cycling
  
  • applied to Bipolar I or II
  • at least 4 mood episodes in last 12 months
    
    • meet criteria for manic, hypomanic, or MDE
  • episodes marked by partial or full remission for 2 months or one of opposite polarity
• Meloncholic features
• Atypical features
• Psychotic features
  
  • mood-congruent or mood-incongruent
• Catatonia
  
  • can be applied to mania or depression
• Peripartum Onset
• Seasonal Pattern
• Remission type
  
  • partial
    
    • less than 2 months without symptoms
  • full
    
    • no symptoms for at least 2 months
• Severity
  
  • mild, moderate, severe

Answer 20

Specifiers for Bipolar and Related Disorders

Question 20

• Adjustment-like disorder with delayed onset of symptoms that occur more than 3 months after the stress
• Adjustment like disorder with prolonged duration of more than 6 months without prolonged duration of stressor
• Ataque de nervios
• Other cultural syndromes
• persistent complex bereavement disorder
  
  • severe and persistent grief and mourning reactions

Answer 20

Other Specified Trauma Stressor-Relate Disorder

Question 20

Brief Psychotic Disorder

Answer 20

• Lasts more than one day and remits by 1 month

Question 20

Personality Disorders Cluster C

Answer 20

• Disorders
  
  • Avoidant
  • Dependent
  • Obsessive-Compulsive
• Characteristics
  
  • anxious
  • fearful
• Prevalence
  
  • 9.1%

Question 21

• more than expected (panic attacks)

Answer 21

Recurrent

Question 22

• thinks beliefs are probably true

Answer 22

with poor insight specifier

Question 23

• Culture shapes the experience and expression of the symptoms, signs, and behaviors that are criteria for diagnosis

Answer 23

Effect of culture on DSM diagnoses

Question 24

• common, but **not required for bipolar 1 **
• present during same two-week period
• One of the following
  
  • depressed mood or loss of interest
• 4 or more of the following
  
  • weight loss or gain
  • sleep disturbances
  • psychomotor agitation or retardation
  • fatigue
  • feelings of worthlisness
  • lack of ability to concentrate
  • thoughts of death (recurrent)
• cause impairment in functioning

Answer 24

Major Depressive Episode

Question 25

Agoraphobia

Answer 25

• Anxiety Disorders
• Marked fear or anxiety about 2 or more of the following:
  
  • public transportation
  • open spaces
  • enclosed spaces
  • standing in line or in a crowd
  • outside of the home alone
• Individual avoids these situations because of thoughts that escape might be difficult or help might be difficult in the event of panic like symptoms
• situations provoke fear
• actively avoided, require companion
• out of proportion
• 6 months or more
• diagnosed irrespective of panic disorder
• Prevalence
  
  • 1.7% recieve a diagnosis every year
• Gender differences
  
  • 2:1 female to male
• comorbidity
  
  • majority of cases are comorbid

Question 26

• extreme loss of motor skill or even constant hyperactive motor activity

Answer 26

Catatonia Depressive Specifier

Question 27

Bulimia Nervosa

Answer 27

• Feeding and Eating Disorders
  
  • Dignostic Criteria
    
    • recurrent episodes of binge eating
      
      • eating, in a descrete period of time (2 hours), an amount that is larger than what most individuals would eat
      • a sense of a lack of control
    • recurrent inapproriate compensatory behaviors in order to prevent weight gain; vomiting, laxatives, etc
    • bince eating and compensatory behavior occur on **average once a week for three months **
    • self-eval is influenced by body shape and weight
    • does not occur exclusively during episodes of AN
    • Severity
      
      • Mild: 1-3 per week
      • Moderate: 4-7
      • Severe: 8-13
      • Extreme: 14 or more
  • Prevalence
    
    • within normal BMI (18.5-30)
    • 1%-1.5%
  • Onset
    
    • highest among young adults, peaks in older adolescence
    • rare before puberty and after 40
    • crude mortality is 2% per decade
    • cross over from BN to AN happens in 10 to 15%
  • Gender
    
    • more in females, but little is known about females
  • Differentials
    
    • AN
    • BED
    • MDD
    • Klein-Levin Syndrome
      
      • neurological condition with disturbed eating, but not overconcerned with weight or body shape
    • Borderline Personlity Disorder
      
      • both can be given
  • Comorbidity
    
    • depressive
    • anxiety

Question 28

• reptitive behaviors or mental acts that an individual feels driven to perform in respornse to an obsession or according to rules that must be applied rigidly

Answer 28

compulsions

Question 28

• one event in lifetime required for Bipolar 1
• persistent elevated or irritable mood and increased goal-directed activity
  
  • lasts at least 1 week
• During mood disturbance at least 3 or 4 if only irritable
  
  • increase self-esteem
  • less need for sleep
  • more talkative
  • flight of ideas
  • distractability
  • increase in goal directed activity
  • involvement in high risk activity
• cause marked impairment in functioning
• requires major life desturbance or hospitalization

Answer 28

Manic Episode

Question 29

Dissociative Identity Disorder

Answer 29

• Presence of two or more distinct personality states or an experiences of possession
• recurrent episodes of amnesia
• recurrent, inexplicable instrusions into their conscious functioning and impulses
• alterations of sense of self
• odd changes of perception
• intermittent functional neurological symptoms
  
  • stress often produces transient exacerbation of dissociative symptoms

Question 30

• Body dysmorphic-like disorder with actual flaws
  
  • the flaws are observable by others
• body dysmorphic-like disorder without repetitive behaviors
  
  • not performed repetitive behaviors or mental acts in response to appearance concerns
• body-focuses repetitive hahavior disorder
  
  • recurrent body focused repetitive behavior and attempts to decrease or stop
• obsessional jealousy
  
  • percieved infidelity leading to repeated behaviors
• Shubo-kyofu
  
  • fear of having a body deformity
• Koro
  
  • sudden anxiety that the penis will decede into the body
• Jikoshu-kyofu
  
  • fear of having an offensive body odor

Answer 30

Other Specified Obsessive-Compuslve and Related Disorded

Question 32

General Personality Disorder

Answer 32

• Diagnostic Criteria
  
  • enduring pattern of inner experience that deviates markedly from expectations of culture in 2 or more:
    
    • Cognition
    • Affectivity
    • Interpersonal functioning
    • Impulse Control
  • pattern is inflexible and pervasive
  • pattern leads to clinically sgnificant distress
  • pattern is stable and of long duration–> traced to adolescence or early adulthood
• Prevalence
• Onset
  
  • those diagnosed before 18, must have features for at least 1 year
  • requires onset no later than early adulthood
• Gender
  
  • antisocial is more common in males
  • borderline, histrionic, dependent more common in females
• Differential
  
  • other mentale disorders and personality traits
  • psychotic disorders
  • anxiety and depressive disorders
  • PTSD
  • personality changes due to another medical condition
    
    • like brain tumor
• Comorbid

Question 32

• Diagnostic Criteria
  
  • over a period of at least 6 months
    
    • sexual arousal from cross-dressing from fantasies, urges, or behaviors
  • Fantasies, urges, behaviors causes distress
• Specifiers
  
  • fetishism
    
    • sexual aroused by fabrics, materials, garments
    • decreases likelihood of gender dysphoria
  • autogynephilia
    
    • thoughts or images of self as female
    • increases likelihood of gender dysphoria in men
  • controlled environment
  • full remission
• Prevalence
  
  • rare in males (less than 3%)
    
    • majority are heterosexual
  • extremely rare in females
• Development
  
  • first signs begin in childhood
  • sometimes continuous and others are episodic
• Differentials
  
  • fetishistic disorder
  • gender dysphoria
• Cormobidity
  
  • other paraphillia

Answer 32

Transvestic Disorder

Question 33

unexpected

Answer 33

• there is no obvious cue or trigger (panic attack)

Question 33

Obsessive-compulsive Personality Disorder

Answer 33

• A pattern of preoccupation with orderliness, perfectionism, and control

Question 33

Depersonalization/Derealization DSM Diagnostic Criteria

Answer 33

• Diagnostic Criteria
  
  • Presence of one or both
    
    • Depersonalization
      
      • experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions
    • Derealization
      
      • experiences of unreality or detachment with respect to surroundings
  • reality testing remains intact
  • not better explained by schizophrenia, panic disorder, MDD, acute stress disorder, PTSD, or another dissociate disorder
• Prevalence
  
  • 2%
  • gender ratio is roughly equally
• Development
  
  • mean age of onset is 16
  • 20% experience onset after age 20
  • only 5% after age 25
• Differentials
  
  • Illness Anxiety Disorder
  • MDD
  • OCD
  • other Dissociative Disorders
  • Anxiety Disorders
  • Psychotic Disorders
  • Substance/Medication-Induced Disorders
• Comorbidity
  
  • unipolar depression
  • anxiety disorder
  • PTSD was low
  • Personlity disorder
    
    • avoidant
    • borderline
    • OCPD

Question 35

DSM-V Structure

Answer 35

• Three major sections
  
  • Introductin and how to use the DSM
  • Diagnostic criteria and codes
  • Emerging measures and models
    
    • Assessment toold
    • cultural formulation
    • alternative model for personality disorders
    • conditions for further study

Question 37

Specific Objectives of CFI is DSM-V

Answer 37

• modify culturally determined criteria to be more equivalent across cultures
• specific diagnostic criteria changed to petter apply across diverse cultures
• address cultural concepts of distress

Question 38

Binge-Eating

Answer 38

• Feeding and Eating Disorders
  
  • Dignostic Criteria
    
    • recurrent episodes of binge eating
      
      • eating, in a descrete period of time (2 hours), an amount that is larger than what most individuals would eat
      • a sense of a lack of control
    • Episodes associated with 3 or more:
      
      • eating much more rapidly than normal
      • uncomfortably full
      • large amounts of food when not hungry
      • eating alone because you are embarrassed about how much food
      • disgusted, depressed, or guilty after
    • distress about binge eating
    • at least once a week for 3 months
    • not associated with compensatory behaviors
  • Prevalence
    
    • 1.6 % for females
    • 0.8% for males
  • Onset
    
    • typically begins in young adulthood or adolescence
  • Gender
    
    • higher in females slightly
  • Differentials
    
    • BN
    • bipolar and depressive
    • Borderline personlity
  • Comorbidity
    
    • bipolar, depressive, anxiety

Question 39

What are the components of the CFI

Answer 39

—Semi-structured interview

• —16 questions that focuses on individual experience and social context
• —Objective is to assess cultural factors using a person-centered approach (we are not putting people into a box, we are seeing it from their perspective)

—Divided into 2 columns,

• —Questions on the right, instructions on the left
• —Two versions: one for client, one for an informant,

—12 Supplementary Modules

• —Provide additional questions to flesh out domains assessed briefly in the 16-item CFI (core CFI)
• —Questions that can be used during the cultural assessment of particular groups, such as children and adolescents, older adults, immigrants and refugees, and caregivers

Question 39

Depersonalization/Derealization

Answer 39

• experiences of unreality or detachment from one’s mind, self or body (depersonalization)
• experienct of unreality or detachment from one’s surroundings (derealization)
• intact reality testing
• no evidenct of any distinction between individuals with predominantly depersonalization vs derealization
  
  • can have one or the other or both

Question 40

• characterized by at least 1 month of delusions, but no other psychotic symptoms

Answer 40

Delusional Disorder

Question 41

• Intended to serve as a practical, funcitonal, and flexible guide for organizing informaiton that can aid in teh accurate diagnosis and treatmet of mental disorders.
• Information is of value to all professionals associated with various aspects of mental health care.
• Tool for collecting and communicating accurate publiv health statistics on mental disorder morbidity and mortality

Answer 41

What is the purpose of the DSM?

Question 43

• Over a period of at least 6 months
  
  • recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors
  • Fantasies, sexual urges, or behaviors cause clinically significant distress
• Specificiers
  
  • with asphyxiophilia
    
    • practice of achieving sexual arousal related to restriction of breathing
  • in a controlled environment
  • in full remission
• Prevalence
  
  • 2.2% males and 1.3% females
• Development
  
  • mean age of onset is 19.3

Answer 43

Sexual Masochism Disorder

Question 44

• Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more:
  
  • direct experience in traumatic event
  • witnessing event as occured to others
  • learned even occured to close friend or fam
  • experiencing repeated or extreme exposure to aversive details of the traumatic even
• 9 symptoms from any of the 5 categories
  
  • intrusion symptoms
    
    • distressing memories
    • distressing dreams
    • dissociative reactions
    • psychological distress in reaction to external cues
  • negative mood
    
    • inability to experience positive emotions
  • dissociative symptoms
    
    • altered sense of reality of one’s surroundings or one’s self
    • inability to remember an important aspect of traumatic event
  • avoidance symptoms
    
    • effort to avoid distressing memories, thoughts or feelings
    • effort to avoid external reminders
  • arousal symptoms
    
    • sleep disturbance
    • irritable behavior
    • hypervigilance
    • problems with concentration
    • exaggerated startle response
• duration is 3 days to 1 month

Answer 44

Acute Stress Disorder

Question 46

Exhibitionistic Disorder

Answer 46

• Over a period of at least 6 months
  
  • recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, fantasies, urges, or behaviors
• Individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause distress
• Specifiers
  
  • sexually aroused by exposing genitals to prepubertal children
  • sexually aroused by exposing genitals to physically mature indiviuals
  • sexually aroused by exposing genitals to prepubertal children and to physically mature individuals
  • in a controlled environment or in full remission
• Prevalence
  
  • 2-4% in males, but unknown in females
    
    • may be half as often in females
• Development and Course
  
  • become aware during adolescence
  • age may be associated with decreasing
• Differentials
  
  • Conduct and antisocial
  • Substane USe disorders
• Comorbity
  
  • Depressive, bipolar, anxiety, substance
  • hypersexuality, ADHD, other paraphillic, antisocial

Question 47

Pedophilic Disorder

Answer 47

• Diagnostic Criteria
  
  • Over a period of at least 6 months
    
    • recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving prepubescent child or children (13 years or younger)
  • Has acted on these urges, or these sexual urges or fantasies cause marked distress or interpersonal difficulty
  • The individual is at least 16 and at least 5 years older than the child in A
    
    • do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year old
• Specifiers
  
  • exclusive type (attracted to only children)
  • nonexclusive
  • sexually attracted to females
  • sexually attracted to both
  • limited to incest
• Prevalence
  
  • 3-5% in males, but unknown in females​
• Development
  
  • minimum of age 16
• Differentials
  
  • antisocial personality disorder
  • alcohol and substance use disorders
  • OCD
• Comorbidity
  
  • substance use disorders
  • depressive, bipolar, anxiety, antisocial disorder, paraphilic

Question 47

• Over a period of at least 6 months
  
  • recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, fantasies, urges, or behaviors
• Individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause distress
• Specifiers
  
  • sexually aroused by exposing genitals to prepubertal children
  • sexually aroused by exposing genitals to physically mature indiviuals
  • sexually aroused by exposing genitals to prepubertal children and to physically mature individuals
  • in a controlled environment or in full remission
• Prevalence
  
  • 2-4% in males, but unknown in females
    
    • may be half as often in females
• Development and Course
  
  • become aware during adolescence
  • age may be associated with decreasing
• Differentials
  
  • Conduct and antisocial
  • Substane USe disorders
• Comorbity
  
  • Depressive, bipolar, anxiety, substance
  • hypersexuality, ADHD, other paraphillic, antisocial

Answer 47

Exhibitionistic Disorder

Question 48

Pica

Answer 48

• Feeding and Eatin disorders
• Diagnostic Features
  
  • Persistent eating of nonnutritve, nonfood substances over a period of at least 1 month
  • inappropriate to developmental level
    
    • minimum of age 2 is suggested
  • not culturally supported or socially normative
• Prevalence
  
  • unclear
• Development and course
  
  • childhood onset is most common
    
    • in normally developing children
  • in adults
    
    • in intellectual disability
  • during pregnancy
• Gender
  
  • both, but only in females during pregnancy
• Differentials
  
  • AN
    
    • nonfood
  • Factitious D/O
    
    • intentional to have a physical symptom
  • Nonsuicidal self-injury and personality d/o
    
    • swallow items for self-harm
• Comorbidity
  
  • autism spectrum
  • intellectual disability

Question 49

Somatic Symptom Disorder

Answer 49

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • one or more somatic symptoms that are distressting or result in a significant disruption of daily life
    • Excessive thoughts, feelings or behaviors related to somatic symptoms or associated health concerns manifested by one:
      
      • disproportionate and persistant thoughts about seriousness of symptoms
      • high level of anxiety about health
      • time and energy devoted to symptoms
    • one somatic symptom may be continuously present (6 months typically)
    • Specify
      
      • predominant pain
        
        • if predominantly involve pain
      • persistent
        
        • more than 6 months
      • Severity
        
        • mild: one symptom
        • moderate: 2 or more
        • Severe: 2 or more, plus multiple somatic complaints
  • Prevalence
    
    • not known
    • higher than somatization disorder (
    • around 5-7%
  • Onset
    
    • common in older individuals
      
      • maybe underdiagnosed in older adults
  • Gender
    
    • females tend to report more somatic symptoms
  • Differentials
    
    • other med conditions
    • GAD
    • depressive disorders
    • illness anxiety disorder
    • conversion disorder (neurological)
    • delusional disorder
    • BDD
    • OCD
  • Comorbidity
    
    • high comorbidity with medical disorders
    • anxiety and depressive

Question 50

• Cluster B
  
  • Diagnostic Certeria
    
    • A pervasive pattern of disregard for and violation of the rights of others, occuring since age 15. 3 or more:
      
      • failrure to conform to social norms regarding laws (grounds for arrest)
      • deceitfulness, repeated lying for personal profit or pleasure
      • impulsivity
      • irritability and aggresiveness (physical fights)
      • disregard for safety of self and others
      • consistent irresponsibility
      • lack of remorse: indifferent or rationalizing hurting, mistreating or stealing
    • at least 18
    • evidence of conduct disorder before 15
    • not exclusively during schizophrenia or bipolar
  • Prevalence
    
    • 0.2%-3.3%
    • highest prevalence is males with alcohol use disorder which is 70%
  • Onset
    
    • cannot be diagnosed before 18, but must be present before 15
    • usually becomes less evident by 40s
    • more common in males than females
      
      • underdiagnosed in females
  • Differential
    
    • substance use disorders
    • schizophrenia and bipolar disorders
    • other personality disorders
    • criminal behavior not associated with a personality disorder
  • Comorbidity

Answer 50

Antisocial Personality Disorder

Question 51

• Anxiety Disorders
• Recurrent unexpected panic attacks
  
  • Panic attack
    
    • abrupt surge of intense fear or discomfort that reaches a peak within minues with 4 or more of the following symptoms
      
      • palpitations
      • sweating
      • trembling
      • shortness of breath
      • chest pain
      • nausea
      • dizziness
      • chills or heat
      • paresthesias
      • derealization
      • fear of losing control
      • fear of dying
• at least one attacks has been followed by 1 month of one or both:
  
  • persistent worry about additional panic attacks
  • maladaptive change in behavior related to attacks

Answer 51

Panic Disorder

Question 52

Other specified Anxiety Disorder

Answer 52

• symptoms characteristic of anxiety disorder cause clnicaly significant distress or impairment, but do not meet criteria
• clinicians chooses to communicate why the criteria is not met
  
  • limited symptom attacks
  • generalized anxiety not occuring more days than not
  • khal cap (wind atttacks)–> see glossary of cultural concepts
  • ataque de nervios

Question 54

DSM and ICD

Answer 54

Harmonized with WHO’s ICD

Question 55

Catatonia Depressive Specifier

Answer 55

• extreme loss of motor skill or even constant hyperactive motor activity

Question 55

• 2 of the following:
  
  • tense, restless, concentration difficulty, fear that something awful will happen, feel might lose control

Answer 55

Anxious Distress Depressive Specifier

Question 57

• Field trials
• Robust debate about scientific evidence supporting contents
• Major changes
  
  • 541 diagnoses
  • Reorganized to emphasize dimensional approach
  • Integrated findings from neuroscience and genetics research
• Principles:
  
  • Usable by clinicians
  • Guided by research
  • Continuity with previous DSMs
  • No a priori constraints on changes
  • “Living Document”

Answer 57

Development of DSM V

Question 58

compulsions

Answer 58

• reptitive behaviors or mental acts that an individual feels driven to perform in respornse to an obsession or according to rules that must be applied rigidly

Question 59

Effect of culture on DSM diagnoses

Answer 59

• Culture shapes the experience and expression of the symptoms, signs, and behaviors that are criteria for diagnosis

Question 61

• Cluster B
  
  • Diagnostic Certeria
    
    • pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood. 5 or more:
      
      • uncomfortable in situations where they are not the center of attention
      • interactions are characterized by inappropriate sexually seductive or provocative behavior
      • rapidly shifting or shallow emotions
      • physical appearance to draw attention
      • style of speech that is excessively impressionistic and lacking detail
      • self-dramatization, theatrical, exaggerated emotion
      • suggestible (influenced by others)
      • considers relationships more intimate than they are
  • Prevalence
    
    • 1.84%
    • more frequent in females
  • Onset
  • Differential
    
    • other personality disorders and personality traits
    • personality change due to another medical condition
    • substance use disorders
  • Comorbidity

Answer 61

Histrionic Personality Disorder

DSM Criteria

Question 62

Specific Phobia

Answer 62

• Anxiety Disorder
• Marked anxiety or fear about a specific object or situation
• provokes immediate fear or anxiety
• actively avoided or endured with fear
• out of proportion to actual danger
• 6 months or more
• Specify if:
  
  • animal
  • natural environment
  • blood-injection-injury
  • situational
  • other (this is where vomiting is)
• Prevalence
  
  • 7-9% adults
  • 16% in adolscents
• Gender Differences
  
  • females more than males

Question 63

Negative Symptoms

Answer 63

• substantial portions of morbidity associated with schizophrenia
• diminished emotional expression
  
  • reductions in the expressions of the emotion in the face, eye contact, intonation of speech, and movements of the hand, head, and face that normally give an emotional speech emphasis
• avolition
  
  • is a decrease in motivated self-initiated activities
  • others include:
    
    • alogia
      
      • dimished speech output
    • anhedonia
      
      • decreased ability to experience pleasure from positive stimuli
    • asociality
      
      • apparent lack of interest in social interactions

Question 64

Schizoid Personality Disorder

Answer 64

• Pattern of detachment from social relationships and a restricted range of emotional expression

Question 65

What were the DSM IV “culture-bound syndromes” replaced by

Answer 65

• Cultural syndromes:
  
  • —Clusters of invariant symptoms that tend to co-occur among individuals in specific cultural groups, communities, or contexts
• —Cultural idioms of distress:
  
  • —A way of talking about suffering among people in a cultural group
  • —Ex: For western clinicians, major depressive disorder (MDD) is considered a “syndrome,” or cluster of symptoms that appear to “hang together.” But it can also be considered an “idiom of distress,” in that Westerners commonly talk of feeling “depressed” in everyday life.
• —Cultural explanations of distress or perceived causes:
  
  • —Cultural explanation or perceived cause for etiology, sxs, illness, or distress

Question 65

• not required for Bipolar 1, but common
• persistently elevated or irritable mood
  
  • lasts at least 4 consecutive days
• 3 of the following symptoms or 4 if only irritable
  
  • inflated self-esteem
  • decreased need for sleep
  • more talkative
  • flight of ideas
  • distractible
  • increase in goal-directed activity
  • involvement in high risk activities
• change in functioning and is observable by others
• not severe enough to cause impairment in functioning

Answer 65

Hypomanic Episode

Question 65

• Cluster C
  
  • Diagnostic Certeria
    
    • pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood, indicated by 4 or more:
      
      • preoccupied with details, rules, lists, order, organization, schedules to the extent that major point of activity is lost
      • shows perfectionism that inferes with task completion
      • exvessively devotes to work and productivity to exclusion of leisure activities
      • overconscientious, scrupulous, and inflexible about matters of morality, ethics, or value
      • unable to discard worn-out or worthless objects even when that have no sentimental value
      • reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
      • adopts a miserly spending style
      • rigidity and stubbornness
  • Prevalence
    
    • 2.1%-7.9%
    • twice as often among males
  • Onset
  • Differential
    
    • OCD
    • hoarding disorder
    • other personality disorders and personality traits
    • personality change due to another medical conditiion
    • substance use disorders
  • Comorbidity

Answer 65

Obsessive-Compuslive Personality Disorder

DSM Criteria

Question 66

Schizophreniform Disorder

Answer 66

• characterized by symptomatic presentation equivalent to that of schizophrenia except the duration (less than 6 months) and the absense of the requirement of the decline in functioning

Question 68

Schizotypal (Personality) Disorder

DSM Criteria

Answer 68

• Schizophrenia Spectrum and other psychotic disorders
  
  • diagnostic criteria
    
    • one or more delusions with a duration of 1 month or longer
    • schizophrenia has never been met
      
      • hallucinations are not prominent and are related to delusional theme
    • function is not markedly impaired
    • if manic or major depressive episode has occured, have been brief relative to the duration of delusional periods
  • prevalence
    
    • 0.2%
      
      • percusatory is the most frequent subtype
      • delusional, jealous,
        
        • more frequent in men
      • cultural context must be taken into consideration
  • ontset
    
    • can occur in younger age groups, usually more prevalent in older individuals
  • differentials
    
    • ocd and related disorders
    • delirum, major neurocognitive disorder, psychotic disorder due to another med condition, and substance-induced psychotic disorder
    • schizophrenia and schizophreniform disorder
    • depressive and bipolar disorders and schizoaffective disorders
  • comorbid
  • subtypes
    
    • erotomanic type
      
      • central theme of delusion is that another person is in love with them
    • grandiose type
      
      • conviction of having some great (but unrecognized) talen or insight or having made some important discovery
    • jealous type
      
      • his or her spouse is unfaithful
    • persecutory type
      
      • the individuals belief that he or she is being conspired against, cheated, spied on… in the pursuit of longterm goals
    • somatic type
      
      • bodily functions or sensations
    • mixed type
      
      • no one delusional theme predominates
    • unspecified
      
      • belief cannot be clearly determined
    • with bizarre content
      
      • they are clearly implausible, not understandable, and not derived from ordinary life experiences
  • specifiers
    
    • after 1 year duration with disorder
      
      • first episode, currently in acute episode
      • first episode, currently in partial remisison
      • first episode, currently in full remission
      • mutiple epsidsodes with same as above
      • continuous
      • unspecified
      • severity

Question 69

Development of DSM V

Answer 69

• Field trials
• Robust debate about scientific evidence supporting contents
• Major changes
  
  • 541 diagnoses
  • Reorganized to emphasize dimensional approach
  • Integrated findings from neuroscience and genetics research
• Principles:
  
  • Usable by clinicians
  • Guided by research
  • Continuity with previous DSMs
  • No a priori constraints on changes
  • “Living Document”

Question 69

• An expectable or culturally approved response to a common stressor or loss
• Socially deviant behavior (e.g., political, religious, or sexual) and/or conflicts that are primarily between the individual and society, unless the deviance or conflict results from a dysfunction in the individual

Answer 69

What is Psychopathology not?

Question 69

Schizotypal Personality Disorder

DSM Criteria

Answer 69

• Cluster A
  
  • Diagnostic Certeria
    
    • Pervasive Pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive and perceptual distortions and eccentricities of behavior, with 5 or more
      
      • ideas of reference
      • odd beliefs or magical thinking
      • unusual perceptual experiences
      • odd thinking and speech
      • suspiciousness or paranoid ideation
      • inappropriate or constricted affect
      • behavior or appearance that is odd, eccentric, peculiar
      • lack of close friends
      • exessive social anxiety that is associated with paranoid fears
  • Prevalence
    
    • 0-1.9% in clinical, but estimated to be higher in general
  • Onset
    
    • stable course
    • may be first apparent in childhood or adolescence
  • Differential
    
    • other mental disorders with psychotic symptoms
    • neurodevelopmental disorders
    • personality change due to another medical condition
    • substance use disorders
    • other personality disorders and personality traits
  • Comorbidity

Question 71

Scizotypal personality Disorder

Answer 71

• full description found in Personality disorders
• pervasive pattern of social and interpersonal deficits
  
  • reduced capacity for close relationships
  • cognitive or perceptual distortions
  • eccentricities of behavior
• onset usually in early adulthood
  
  • in some cases in childhood and adolescence
• abnormalities of beliefs, thinking, and perception are below the threshold for diagnosis of psychotic d/o

Question 73

• Cluster A
  
  • Diagnostic Certeria
    
    • pervasive distrust and suspiciousness of others such their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts with 4 or more:
      
      • suspects that others are exploiting, harming, or deceiving
      • preoccupied with unjustified doubts about loyalty or trustworthiness of friends or associates
      • reluctant to confide in others because of unwarranted fear that the info will be used maliciously against him or her
      • reads hidden meaning or threatening meanings
      • persistening bears grudges
      • perceieves attacks on character that are not apparent
      • recurrent suspicions of fidelity
      • if with schizophrenia add (premorbid)
  • Prevalence
    
    • 2.3%
    • may be more common in males
  • Onset
    
    • first apparent in childhood and adolescence as solitary with poor peer support, social anxiety, eccentric
  • Differential
    
    • other mental disorders with psychotic symptoms
    • personality change due to another medical condition
    • substance use
    • paranoid traits associated with physical handicaps
    • other personality disorders and personality traits
  • Comorbidity
    
    • substance abuse

Answer 73

Paranoid Personality Disorder

DSM Criteria

Question 74

• symptoms characteristic of anxiety disorder cause clnicaly significant distress or impairment, but do not meet criteria
• clinicians chooses to communicate why the criteria is not met
  
  • limited symptom attacks
  • generalized anxiety not occuring more days than not
  • khal cap (wind atttacks)–> see glossary of cultural concepts
  • ataque de nervios

Answer 74

Other specified Anxiety Disorder

Question 75

• symptoms characteristic of anxiety disorder cause clnicaly significant distress or impairment, but do not meet criteria
• clinicians chooses not to communicate why the criteria is not met
• insufficient information

Answer 75

Unspecified Anxiety Disorder

Question 76

• BDD specifier
• preoccupied with the idea that body is insufficiently muscular

Answer 76

with muscle dysmorphia specificer

Question 76

• Pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent

Answer 76

Paranoid Personality Disorder

Question 78

Schizoid Personality Disorder

DSM Criteria

Answer 78

• Cluster A
  
  • Diagnostic Certeria
    
    • pervasive patter of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adultood, indicated by 4 or more:
      
      • neither desires or enjoys close relationships
      • chooses solitary activities
      • has little interest in have sexual experieces
      • takes pleasure in few activies
      • lacks few friends other than first degree relatives
      • appears indifferent to praise or criticism
      • shows emotional coldness, detachment, or flattened affect
    • if met prior to onset of schizophrenia (premorbid)
  • Prevalence
    
    • 4.9% is comorbid
    • very uncommon in clinical settings
    • 3.1% prevalence in alcohol study
  • Onset
    
    • first apparent in childhood and adolescence with solitariness, poor peer relations, underachievement
    • slightly more often in males
  • Differential
    
    • other mental disorders with psychotic symptoms
    • ASD
    • personality changes due to another med condition
    • substance use disorder
    • other personality disorders and personality traits
      *

Question 79

Schizoaffective Disorder

DSM Criteria

Answer 79

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • An uninterrupted period of illness during which there is a major mood episode ( major depressive or manic) concurrent with criterion A of schizophrenia
    • delusions or hallucinations for 2 or more weeks in the absense of a major mood episode (depressive or major) during the lifetime duration of the illness
    • symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
    • not due to substance
  • Specifiers
    
    • bipolar type
      
      • manic episode
    • depressive
    • with catatonia
    • episode type
    • severity
  • Onset
    
    • early adulthood
      
      • can occur anywhere from adolescence to late in life
  • Prevalence
    
    • 0.3%
  • Differentials
    
    • other mental disorders and medical conditions
    • psychotic disorder due to another med condition
    • schizophrenia, bipolar and depressive disorders
  • Comorbid
    
    • substance use and anxiety disorders
  • other
    
    • suicide risk is 5%
      
      • higher in north america

Question 80

Who is the CFI for?

Answer 80

Any patient, any setting, especially:

• —Cases of social and cultural differences
• —Difficulties evaluating symptoms
• —Difficulties evaluating severity and impairment
• —Disagreement between client and clinician over course of care
• —Limited adherence or engagement in treatment

Question 81

• Cluster C
  
  • Diagnostic Certeria
    
    • pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivy to negative eval, beginning by early adulthood, indicated by 4 or more:
      
      • avoids occupational activties that involve significant interpersonal contact due to fear of criticism, disapproval, or rejection
      • unwilling to get invoved with people unless certain of being like
      • restrain in intimate relationships due to fear of being shamed
      • preoccupied with being criticized or reject in social situations
      • feelings of inadequacy in new interpersonal situations
      • views self as socially inept, unappeally, inferior
      • reluctant to take risks or enage in new activites
  • Prevalence
    
    • 2.4%
  • Onset
    
    • should be used with great caution in children and adolescents
    • may dissipate with age
  • Differential
    
    • anxiety disorders
    • other personality disorders and personliaty traits
    • personality change due to another medical change
    • substance use disorders
  • Comorbidity

Answer 81

Avoidant Personality Disorder

DSM Criteria

Question 82

• Depressive Disorder
  
  • five symptoms the week prior to period and improve withing a few days of period coming
  • one or more these symptoms
    
    • affective lability (mood swings, sensitive)
    • irritability or anger
    • depressed mood
    • anxiety
  • one or more of these symptoms
    
    • decreased interest
    • concentration difficulty
    • lethargy
    • appetite changes
    • sleep problems
    • physical symptoms
  • present within the past year
  • needs to be confirmed by prospecive daily ratings of at least 2 symptoms for 2 months
    
    • if this is not done–> provisional diagnosis

Answer 82

Premenstrual Dysphoric Disorder

Question 83

• one of the following at most severe stage of episode
  
  • loss of pleasure
  • lack of reactivity
• three of the following
  
  • depressed mood
  • worse in morning
  • early-morning awakening
  • psychomotor agitation or retardation
  • weight loss
  • guilt

Answer 83

Melancholic Features Depressive Specifier

Question 85

• hoarding specifier
  
  • if difficulty discardting is accompanied by excessive aquisition that is not need need or for which there is no space
  • 80-90%

Answer 85

with excessive acquisition specifier

Question 86

Any patient, any setting, especially:

• —Cases of social and cultural differences
• —Difficulties evaluating symptoms
• —Difficulties evaluating severity and impairment
• —Disagreement between client and clinician over course of care
• —Limited adherence or engagement in treatment

Answer 86

Who is the CFI for?

Question 87

• A pattern of preoccupation with orderliness, perfectionism, and control

Answer 87

Obsessive-compulsive Personality Disorder

Question 89

Dissociative Identity Disorder DSM Criteria

Answer 89

• Diagnostic Criteria
  
  • Disruption of identity characterized by 2 or more distinct personality states (possession in some cultures). Involves discontinuity in sense of sense and agency accompanied by alterations in
    
    • affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning
  • Recurrent gaps in recall of everyday events, personal info, and or traumatic events that inconsistent with ordinary forgetting
  • clinically significant distress
  • not culturally accepted or religious practice
    
    • children, not better explained by imaginary playmates
• Prevalence
  
  • 1.5%
  • equal across genders
    
    • women predominate adult clinical, but not child
      
      • more acute
    • males deny traumatic histories
• Development
  
  • may manifest at any age, may increasingly intrude into awareness with advancing age
  • triggered by
    
    • removal from the traumatizing situation
    • individuals children reaching the same age at which abuse happened
    • later traumatic experiences
    • death of abuser
  • 70% have attempted suicide
• Differentials
  
  • MDD
  • Other specified dissociative disorder
  • Bipolar Disorders
  • PTSD
  • Psychotic Disorders
  • Personlity Disorders
  • Conversion Disorders
  • Facticious DIsorder
  • Malingering
  • Seizure
• Comorbid
  
  • often recieve the comorbid diagnosis
  • PTSD
  • Personality Disorders
  • Conversion
  • Eating Disorders
  • Substance Related Disorders
  • OCD
  • Sleep Disorders

Question 90

Hoarding Disorder

Answer 90

• Obsessive-Compulsive and Related Disorders
  
  • Persistent Difficulty discarding possessions regardless of value
  • due to need to save items and distress associated with discarding
  • results in accumulation of possessions and compromises living and if uncluttered it is only due to third parties
  • clinically significant distress–> cannot maitain safe enviro
  • specifiy if
    
    • with excessive aquisition
      
      • if difficulty discardting is accompanied by excessive aquisition that is not need need or for which there is no space
  • Prevalence
    
    • 2-6%
  • Age of onset
    
    • usually emerge 11-15
    • interfere with functioning around mid 20s
    • clinically significant impairment around 30s
  • gender differebces
    
    • greater differences among males
    • clinical samples more females
    • 3 times more likely in older adults
    • diagnostically: females display more excessive aquisition
  • comobidity
    
    • 75% have a comorbidy anxiety or mood disorder

Question 91

• Anxiety Disorders
  
  • Excessive anxiety and worry occurring more days than not in the past 6 months
  • difficulty controlling worry
  • 3 or more of the symptoms (only 1 in kids)
    
    • restlessness
    • easily fatigued
    • difficulty concentrating and mind blank
    • irritability
    • muscle tension
    • sleep disturbance

Answer 91

Generalized Anxiety Disorder

Question 91

• Diagnostic Criteria
  
  • Over a period of at least 6 months
    
    • recurrent intense sexual arousal from touching or rubbing against a nonconsenting person
      
      • manifested by fantasies, urges, or behaviors
  • Has acted on sexual urges with nonconsenting or the sexual urges or fantasies cause clinically significant distress
• Specifiers
  
  • in a controlled environment
  • in full remission
• Prevalence
  
  • acts may occur in up to 30% adult males
  • 10-14% of adult males outpatient settings
  • appear to be fewer females
• Differentials
  
  • Conduct disorder and antisocial personality disorder
  • Substance use disorder
• Comorbidity
  
  • hypersexuality and other paraphillic disorders
  • exhibitionistic disorder and voyeuristic disorder
  • APD, depressive, bipolar, anxiety, and substance

Answer 91

Frotteuristic Disorder

Question 92

It’s complex. Consider:

• Symptom severity
• Symptom salience (e.g., suicidal ideation)
• Patient distress and/or disability

Answer 92

Is diagnosis of a mental disorder equivalent to need for treatment?

Question 92

grandiose delusions

Answer 92

• when an individual believes that he or she has exceptional abilities, wealth or fame

Question 94

• With
  
  • anxious distress
    
    • 2 of the following:
      
      • tense, restless, concentration difficulty, fear that something awful will happen, feel might lose control
  • mixed features
    
    • 3 of the following:
      
      • elevated mood, inflated self-esteem, more talkative, flight of ideas, increase in energy, excessive involvement, decreased need for sleep
    • features observable by others
    • do not meet criteria for full hypomania or mania
  • melancholic features
    
    • one of the following at most severe stage of episode
      
      • loss of pleasure
      • lack of reactivity
    • three of the following
      
      • depressed mood
      • worse in morning
      • early-morning awakening
      • psychomotor agitation or retardation
      • weight loss
      • guilt
  • Aypical features
    
    • mood reactivity
    • two or more:
      
      • weight gain
      • hypersomnia
      • heavy feeling in arms or legs
      • rejection sensitivity
  • Psychotic features
    
    • mood-congruent psychotic features
      
      • consistent with depressive themes
    • mood-incongruent psychotic features
      
      • does not include typical depressive themes
  • Catatonia
    
    • extreme loss of motor skill or even constant hyperactive motor activity
  • Peripartum onset
    
    • during pregnancy or 4 weeks after delivery
    • can be with or without psychotic features
  • Season Pattern
    
    • recurrent MDD
      
      • temporal relationship
      • full remissions
      • last two years demonstrate relationship
      • seasonal outnumber nonseasonal
• Severity
  
  • mild, moderate, severe
• Remission status
  
  • partial or full

Answer 94

Specifiers for Depressive Disorders

Question 95

Schizotypal Personality Disorder

Answer 95

• Pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

Question 96

Transvestic Disorder

Answer 96

• Diagnostic Criteria
  
  • over a period of at least 6 months
    
    • sexual arousal from cross-dressing from fantasies, urges, or behaviors
  • Fantasies, urges, behaviors causes distress
• Specifiers
  
  • fetishism
    
    • sexual aroused by fabrics, materials, garments
    • decreases likelihood of gender dysphoria
  • autogynephilia
    
    • thoughts or images of self as female
    • increases likelihood of gender dysphoria in men
  • controlled environment
  • full remission
• Prevalence
  
  • rare in males (less than 3%)
    
    • majority are heterosexual
  • extremely rare in females
• Development
  
  • first signs begin in childhood
  • sometimes continuous and others are episodic
• Differentials
  
  • fetishistic disorder
  • gender dysphoria
• Cormobidity
  
  • other paraphillia

Question 98

Schizoaffective

Answer 98

• Mood episode and the active-phase episode of schizophrenia occur together and were preceeded or follow by at least 2 weeks of hallucinations without prominant mood symptoms

Question 100

• Cluster A
  
  • Diagnostic Certeria
    
    • Pervasive Pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive and perceptual distortions and eccentricities of behavior, with 5 or more
      
      • ideas of reference
      • odd beliefs or magical thinking
      • unusual perceptual experiences
      • odd thinking and speech
      • suspiciousness or paranoid ideation
      • inappropriate or constricted affect
      • behavior or appearance that is odd, eccentric, peculiar
      • lack of close friends
      • exessive social anxiety that is associated with paranoid fears
  • Prevalence
    
    • 0-1.9% in clinical, but estimated to be higher in general
  • Onset
    
    • stable course
    • may be first apparent in childhood or adolescence
  • Differential
    
    • other mental disorders with psychotic symptoms
    • neurodevelopmental disorders
    • personality change due to another medical condition
    • substance use disorders
    • other personality disorders and personality traits
  • Comorbidity

Answer 100

Schizotypal Personality Disorder

DSM Criteria

Question 102

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • 2 or more of the following, each present for a significant portion of the time during 1 month. At least 1 must be present 1,2, or 3
      
      • Delusions
      • Hallucinations
      • Disorganized speech
      • Grossly disorganized or catatonic behavior
      • negative symptoms
    • Episode lasts at least 1 month, but less than 6 months
      
      • when the diagnosis must be made without waiting for recovery, it should be qualified as provisional
    • schizoaffective, depressive, bipolar with psychotic features have been rule out
      
      • no major depressive or manic have occurred
      • mood episodes have occured during active-phase symptoms, thahve have been present for a minority of duration of the active and residual preiods of the illness
  • Specifiers
    
    • good prognostic features
    • without good prognostic features
    • with catatonia
    • severity
  • Onset
    
    • between late teens and mid 30s
  • Prevalence
    
    • five fold less than schizophrenia
    • higher with the specifier of with good prognostic features
  • Differentials
    
    • other mental disorders and medical conditions
    • brief psychotic disorders
  • Comorbid

Answer 102

Schizophreniform Disorder

DSM Criteria

Question 104

• modify culturally determined criteria to be more equivalent across cultures
• specific diagnostic criteria changed to petter apply across diverse cultures
• address cultural concepts of distress

Answer 104

Specific Objectives of CFI is DSM-V

Question 105

Specifiers for Depressive Disorders

Answer 105

• With
  
  • anxious distress
    
    • 2 of the following:
      
      • tense, restless, concentration difficulty, fear that something awful will happen, feel might lose control
  • mixed features
    
    • 3 of the following:
      
      • elevated mood, inflated self-esteem, more talkative, flight of ideas, increase in energy, excessive involvement, decreased need for sleep
    • features observable by others
    • do not meet criteria for full hypomania or mania
  • melancholic features
    
    • one of the following at most severe stage of episode
      
      • loss of pleasure
      • lack of reactivity
    • three of the following
      
      • depressed mood
      • worse in morning
      • early-morning awakening
      • psychomotor agitation or retardation
      • weight loss
      • guilt
  • Aypical features
    
    • mood reactivity
    • two or more:
      
      • weight gain
      • hypersomnia
      • heavy feeling in arms or legs
      • rejection sensitivity
  • Psychotic features
    
    • mood-congruent psychotic features
      
      • consistent with depressive themes
    • mood-incongruent psychotic features
      
      • does not include typical depressive themes
  • Catatonia
    
    • extreme loss of motor skill or even constant hyperactive motor activity
  • Peripartum onset
    
    • during pregnancy or 4 weeks after delivery
    • can be with or without psychotic features
  • Season Pattern
    
    • recurrent MDD
      
      • temporal relationship
      • full remissions
      • last two years demonstrate relationship
      • seasonal outnumber nonseasonal
• Severity
  
  • mild, moderate, severe
• Remission status
  
  • partial or full

Question 105

• Psychotic patients
  
  • —Misdiagnosis for psychotic patients occurred with patients from all ethno-cultural groups, especially recently settled immigrants.
  • —After using the CF, 49% of the patients with an intake diagnosis of psychotic disorder were re-diagnosed as non-psychotic and 5 % of the patients with a referral diagnosis of non-psychotic disorder were diagnosed as having a psychotic disorder.
• Non-psychotic patients
  
  • —Adding the CFI to ordinary psychiatric diagnosing led to major revisions of diagnosis for 56% of patients
    —Many in anxiety disorders, especially PTSD

Answer 105

What did research on the OCF (from the DSM-IV) find?

Question 106

Generalized Anxiety Disorder

Answer 106

• Anxiety Disorders
  
  • Excessive anxiety and worry occurring more days than not in the past 6 months
  • difficulty controlling worry
  • 3 or more of the symptoms (only 1 in kids)
    
    • restlessness
    • easily fatigued
    • difficulty concentrating and mind blank
    • irritability
    • muscle tension
    • sleep disturbance
  • Prevalence
    
    • 0.9% in adolescents
    • 2.9% in adults in US
    • .4-3.6% in other countries
    • more common in European descent
  • Gender differences
    
    • 2:1 female to male ratio
  • age of onset
    
    • median age of onset 30 (manifested as anxious temperament)
    • spread across broad range
    • most AD are sooner in life

Question 107

Borderline Personality Disorder

Answer 107

• Cluster B
  
  • Diagnostic Certeria
    
    • pervasive patter of instability of interpersonal relationships, self-image, and affects, marked impulsivity, beginning by early adulthood. 5 or more off the following:
      
      • efforts to avoid abandonment
      • pattern of unstable and intense personal relationships. Alternating between idealization and devaluation
      • identity disturbance: unstable self-image
      • impulsivity in two areas that are self-damaging (not suicidal or self-mutilating)
      • recurrent suicidal behavior, gestures, or threats, or self-mutilating beahvior
      • affective instability due to a marked reactivity of mood (intense episodic mood)
      • chronic feelings of emptiness
      • inappropriate, intense anger
      • transient, stress-related paranoid ideation
  • Prevalence
    
    • 1.6%, but higher in mental health and psychiatric inpatient
    • decreases in older age groups
    • 75% in females
  • Onset
    
    • chronic instability in early adulthood
    • risk of suicide in young adult years and wanes in aging
    • 30s and 40s have greater stabliity
  • Differential
    
    • depressive and bipolar
    • other personality disorders
    • personality change due to another medical condition
    • substance use disorders
    • identity problems
      *

Question 109

• 3 of the following:
  
  • elevated mood, inflated self-esteem, more talkative, flight of ideas, increase in energy, excessive involvement, decreased need for sleep
• features observable by others
• do not meet criteria for full hypomania or mania

Answer 109

Mixed Features Depressive Specifier

Question 110

Guides in assessing cultural factors infliencing clients’ perspectives of symptoms and treatment outcomes

• —Questions about clients’ background in terms of culture, race, ethnicity, religion or geographical origin
• Opportunity for clients to define their distress in their own words and relate this to how others, who may not share their culture, see their problems
• Gives clinicians a more comprehensive foundation on which to base both diagnosis and care
  —Much more individual

Answer 110

How does the CFI work

Question 111

• Trauma and Stressor-Related Disorders
  
  • consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregiver manifested by
    
    • rarely seeking comfort when distressed
    • rarely responding to comfort when distressed
  • persistent social and emotional disturbance characterized by 2:
    
    • minimal social responsiveness
    • limited positive affect
    • episodes of unexplained irritability, sadness or fearfulness
  • child has experienced patterns of extremes or insufficient care, evidenced by 1:
    
    • social neglect or deprivation in having basic emotional needs mets
    • repeated changes of primary caregiver
    • rearing in unusual settings
  • care is presumed to be responsible for disturbed behavior
  • does not meet ASD
  • evident before age 5
  • has developmental age of at least 9 months
  • Specify if
    
    • persistent
      
      • present for more than 9 months
    • severe
      
      • exhibits all symotoms at high levels
  • social neglect is a required risk factor

Answer 111

Reactive Attachment Disorder

Question 113

• Depressive Disorder
  
  • depressive symptoms with clinically significant distress
    
    • do not feel full criteria for any of the disorders
  • specificers
    
    • recurrent brief depression
      
      • depressed mood and four other symptoms
      • 2-13 days per month
    • short duration depressive episode (4-13 days)
      
      • depressed affect and 4 of the 8 symptoms for depresive episode
    • Depressive episode with insufficient symptoms
      
      • depressed affect and 1 of the 8 symptoms for DE

Answer 113

Other Specificied Depressive Disorder

Question 114

Severity Depressive Specifier

Answer 114

• Mild
  
  • few symptoms
  • manageable
• Moderate
  
  • between mild and severe in symptoms and ability to manage
• Severe
  
  • symptoms substantially in excess of those needed to qualify
  • high impairment

Question 115

with poor insight specifier

Answer 115

• thinks beliefs are probably true

Question 117

with good or fair insight specifier

Answer 117

• recognizes the beliefs are probably not true

Question 118

• Feeding and Eating Disorders
  
  • Dignostic Criteria
    
    • recurrent episodes of binge eating
      
      • eating, in a descrete period of time (2 hours), an amount that is larger than what most individuals would eat
      • a sense of a lack of control
    • recurrent inapproriate compensatory behaviors in order to prevent weight gain; vomiting, laxatives, etc
    • bince eating and compensatory behavior occur on **average once a week for three months **
    • self-eval is influenced by body shape and weight
    • does not occur exclusively during episodes of AN
    • Severity
      
      • Mild: 1-3 per week
      • Moderate: 4-7
      • Severe: 8-13
      • Extreme: 14 or more
  • Prevalence
    
    • within normal BMI (18.5-30)
    • 1%-1.5%
  • Onset
    
    • highest among young adults, peaks in older adolescence
    • rare before puberty and after 40
    • crude mortality is 2% per decade
    • cross over from BN to AN happens in 10 to 15%
  • Gender
    
    • more in females, but little is known about females
  • Differentials
    
    • AN
    • BED
    • MDD
    • Klein-Levin Syndrome
      
      • neurological condition with disturbed eating, but not overconcerned with weight or body shape
    • Borderline Personlity Disorder
      
      • both can be given
  • Comorbidity
    
    • depressive
    • anxiety

Answer 118

Bulimia Nervosa

Question 119

Mixed Features for Bipolard and Related Disorders

Answer 119

• manic or hypomanic episode with mixed features
  
  • full criteria for manic or hypomanic
• at least 3 of the following
  
  • dysphoria or depressed mood
  • loss of interest
  • psychomotor retardation
  • fatigue
  • feelings of worthlessness
  • thoughts of death
• Depressive episode, with mixed features
  
  • full criteria met for MDE
• at least three of the following manic/hypomanic symptoms
  
  • elevated mood
  • inflated self-esteem
  • more talkative
  • flight of ideas
  • increase in energy/goal-directed
  • increase in risk activitives
  • decreased need for sleep

Question 119

Voyeuristic Disorder

Answer 119

• Diagnostic Criteria
  
  • Over a period of 6 months
    
    • recurrent and intense sexual arousal from observing an unsuspecting person who is naked, taking off their clothes, engaging in sexual activities, as manifested by fantasies, urges, or behaviors
    • has acted on urges with nonconsentingperson, or sexual urges or fantasies cause clinically significant distress or impairment…
    • must be at least 18
• Specifiers
  
  • in a controlled environment
    
    • living in institutional setting or restricted
  • in full remission
    
    • for at least 5 years
• Prevalence
  
  • 12% in males and 4% in females
  • 3:1 male to female
• Development and Course
  
  • must be at least 18
  • likely to vary with age
• Differentials
  
  • conduct disorder and antisocial personality disorder
  • substance use disorders
• Comorbidity
  
  • hypersexuality
  • other paraphilic disorders: exhibitionistic disorder
  • depressive, biopolar, anxiety, substance use disorder
  • ADHD, conduct, and antisocial personality disorder

Question 120

These developments created a need for a

1840 US government

• Government collected census data on mentla illness
• 40 years later there were 7 categories of mental illness

1917 Bureau of the Census

• Used Statistical Manual for the Use of Institutions for the Insane
• separated mental illness into 22 groups

WWII U.S. Army (1940-1045ish)

• nomenclature developed by Army to better incorporate presentations of WWII servicemen and veterans

1940 WHO

• Concurrently WHO published ICD-6
• 26 diagnoses
• 10 categories fo rpsychoses, 9 for psychoneurosis, and 7 for disorders of character, behavior, and intelligence

Answer 120

Progression of mental illness classification starting at 1840

Question 122

How does the CFI work

Answer 122

Guides in assessing cultural factors infliencing clients’ perspectives of symptoms and treatment outcomes

• —Questions about clients’ background in terms of culture, race, ethnicity, religion or geographical origin
• Opportunity for clients to define their distress in their own words and relate this to how others, who may not share their culture, see their problems
• Gives clinicians a more comprehensive foundation on which to base both diagnosis and care
  —Much more individual

Question 123

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • Presence of one or more of the following (has to be at least 1,2, or 3)
      
      • delusions
      • hallucinations
      • disorganized speech
      • grossly disorganized or catatonic behavior
    • episode is 1 day to 1 month and then returns to ful functioning
    • not better explained by major depressive or bipolar disorder
  • Specifiers
    
    • marked stressor
    • without marked stressor
    • with postpartum onset
    • with catatonia
    • severity
  • Onset
    
    • adolesence or early adulthood
    • average age being mid 30s
  • Prevalence
    
    • 9%
      
      • more common in developing countries
      • 2:1 females to males
      • be aware of culture
  • Differentials
    
    • other med conditions
    • substance related disorders
    • depressive and bipolar disoders
    • other psychotic disorders
    • malingering and facticious
    • personality disorders
  • Comorbid

Answer 123

Brief Psychotic Disorder

DSM Criteria

Question 124

Rapid Cycling Specifier for Bipolar or Related Disorders

Answer 124

• applied to Bipolar I or II
• at least 4 mood episodes in last 12 months
  
  • meet criteria for manic, hypomanic, or MDE
• episodes marked by partial or full remission for 2 months or one of opposite polarity

Question 126

• lasts for at least 6 months
• includes at least 1 month of the active phase of symptoms

Answer 126

Schizophrenia

Question 128

Dependent Personality Disorder

Answer 128

• A patter of submissive and clinging behavior related to an excessive need to be taken care of

Question 129

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • two or more of the following, each present for a significant portion of the time during a 1 month period. At least 1, 2, or 3
      
      • Delusions
      • Hallucinations
      • Disorganized Speech
      • Grossly disorganized or catatonic behavior
      • Negative symptoms
    • level of functioning in one or more areas is markedly below the level of achieved prior to onset
    • continuous signs of disturbance persist for at least 6 months
      
      • must include at least 1 month of symptoms thtat meet Criterion A
    • schizoaffective, bipolar with psychotic features, and depressive have been ruled out
    • if history of ASD or communication disorder, the additional schizophrenia diagnosis is only made if prominent delusions
  • Specifiers
    
    • first episode, currently in acute episode (etc.)
    • with catatonia
    • severity
  • Onset
    
    • late teends and the mid 30s
      
      • prior to adolescence is rare
      • peak age for first psychotic episode is early to mid 20s for males and late 20s for females
  • Prevalence
    
    • 0.3-0.7%
    • variations by race/ethnicity
    • negative symptoms/longer duration higher in males
    • mood symptoms and brief presentations equivalent in both
  • Differentials
    
    • major depressive or bipolar with psychotic or catatonic features
    • schizoaffective
    • schizophreniform
    • delusional disorder
    • schizotypal personality disorder
    • obessive complusive disorder and BDD
    • PTSD
    • ASD or communication disorder
  • Comorbid
    
    • substance abuse (over half)
    • anxiety disorders
  • other
    
    • 5-6% commit suicide
    • 20% attempt suicide
    • life expectancy is reduced

Answer 129

Schizophrenia

Question 131

Persistent Depressive Disorder (Dysthymia)

Answer 131

• Depressive Disorder
  
  • consolidation of chronic MDD and dysthymic from DSM IV
    
    • depressed mood most of the time for at least 2 years
      
      • ​1 year in children
    • ​​​two or more of these symptoms
      
      • appetite problems
      • sleep disturbances
      • fatigue
      • low self-esteem
      • poor concentration or decision making
      • hopelessness
    • not without symptoms for more than 2 months
    • MDD may be continuously present for 2 years
      
      • not noted as seperate diagnoses, but a specifier
    • no manic or hypermanic episodes
    • not better explained by any type of schizophrenia
    • Specifiers
      
      • anxious, mixed, atypical features, mood-congruent with psychotic, mood-incongruent with psychotic, peripartum onset
      • partial remission, full remission
      • early or late onset
      • pure dysthymic syndrome, persistent MDD, intermittent major depressive episodes with current episode, intermittent major depressive episode without current episode
      • mild, moderate, severe
    • Prevalence
      
      • 0.5%
      • 1.5% for chronic MDD
    • Age of onset
      
      • often has insidious, early onset, which is usually chronic (before 21)
      • higher likelihood of comorbid personality disorder and substance use
    • Gender Differences
      
      • N/A

Question 132

Delusional Disorder

Answer 132

• characterized by at least 1 month of delusions, but no other psychotic symptoms

Question 134

• can occur in several disorders, including neurodevelopmental, psychotic, bipolar, depressive, and other mental disorders
• can also be catanonic disorder due to another medical condition

Answer 134

Catatonia (more indepth)

Question 136

• Pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

Answer 136

Schizotypal Personality Disorder

Question 137

—Semi-structured interview

• —16 questions that focuses on individual experience and social context
• —Objective is to assess cultural factors using a person-centered approach (we are not putting people into a box, we are seeing it from their perspective)

—Divided into 2 columns,

• —Questions on the right, instructions on the left
• —Two versions: one for client, one for an informant,

—12 Supplementary Modules

• —Provide additional questions to flesh out domains assessed briefly in the 16-item CFI (core CFI)
• —Questions that can be used during the cultural assessment of particular groups, such as children and adolescents, older adults, immigrants and refugees, and caregivers

Answer 137

What are the components of the CFI

Question 138

*

Answer 138

Substance Intoxication and Withdrawal

Question 140

Mixed Features Depressive Specifier

Answer 140

• 3 of the following:
  
  • elevated mood, inflated self-esteem, more talkative, flight of ideas, increase in energy, excessive involvement, decreased need for sleep
• features observable by others
• do not meet criteria for full hypomania or mania

Question 141

• Diagnostic Criteria
  
  • Presence of one or both
    
    • Depersonalization
      
      • experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions
    • Derealization
      
      • experiences of unreality or detachment with respect to surroundings
  • reality testing remains intact
  • not better explained by schizophrenia, panic disorder, MDD, acute stress disorder, PTSD, or another dissociate disorder
• Prevalence
  
  • 2%
  • gender ratio is roughly equally
• Development
  
  • mean age of onset is 16
  • 20% experience onset after age 20
  • only 5% after age 25
• Differentials
  
  • Illness Anxiety Disorder
  • MDD
  • OCD
  • other Dissociative Disorders
  • Anxiety Disorders
  • Psychotic Disorders
  • Substance/Medication-Induced Disorders
• Comorbidity
  
  • unipolar depression
  • anxiety disorder
  • PTSD was low
  • Personlity disorder
    
    • avoidant
    • borderline
    • OCPD

Answer 141

Depersonalization/Derealization DSM Diagnostic Criteria

Question 142

Factitious Disorder Imposed In Another

Answer 142

• previously Factious disorder by proxy
  
  • falsification of physical or psychological signs or symptoms, or induction of injury or disease, IN ANOTHER, associated with identified deception
  • presents another individual (victim) to others as ill, impaired, or injured
  • deceptive behavior is evident even in absence of obvious external rewards
  • perpetrator receives diagnosis

Question 143

• there is no obvious cue or trigger (panic attack)

Answer 143

unexpected

Question 145

Antisocial Personality Disorder

Answer 145

• Cluster B
  
  • Diagnostic Certeria
    
    • A pervasive pattern of disregard for and violation of the rights of others, occuring since age 15. 3 or more:
      
      • failrure to conform to social norms regarding laws (grounds for arrest)
      • deceitfulness, repeated lying for personal profit or pleasure
      • impulsivity
      • irritability and aggresiveness (physical fights)
      • disregard for safety of self and others
      • consistent irresponsibility
      • lack of remorse: indifferent or rationalizing hurting, mistreating or stealing
    • at least 18
    • evidence of conduct disorder before 15
    • not exclusively during schizophrenia or bipolar
  • Prevalence
    
    • 0.2%-3.3%
    • highest prevalence is males with alcohol use disorder which is 70%
  • Onset
    
    • cannot be diagnosed before 18, but must be present before 15
    • usually becomes less evident by 40s
    • more common in males than females
      
      • underdiagnosed in females
  • Differential
    
    • substance use disorders
    • schizophrenia and bipolar disorders
    • other personality disorders
    • criminal behavior not associated with a personality disorder
  • Comorbidity

Question 146

• persistent disturbance in mood that predominates clinical picture
  
  • elevated or irritable mood
• Findings show
  
  • symptoms develop during or soon after intoxication or withdrawal
  • substance is capable of producing symptoms
• no just during dilirium
• causes clinically significant distress
• Specifier
  
  • onset during intoxication
  • onset during with drawal

Answer 146

Substance/Medication Induced Bipolar Related Disorder

Question 146

Dependent Personality Disorder

Answer 146

• Cluster C
  
  • Diagnostic Certeria
    
    • pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood, indicated by 5 or more:
      
      • difficulty making everyday decisions without advice and reassurance
      • needs others to assume responsibilit for most areas of his or her life
      • difficulty expressing disagreement with others because of fear of loss of support or disapproval
      • difficulty initiating projects or doing things on own
      • goes to excessive lengths to obtain support
      • uncomfortable or helpless when alone due to fear of being unable to care for self
      • seeks relationship as a source of care and support when one ends
      • unrealisticly preccocupied with fears of being left
  • Prevalence
    
    • 0.49%
    • more frequently diagnosed in women
  • Onset
    
    • should be used with caution if at all in children and adolescents
  • Differential
    
    • other mental disorders and medical conditions
    • other personality disorders and personality traits
    • personality change due to another medical condition
    • substance use disorders
  • Comorbidity

Question 147

nihilistic delusions

Answer 147

• involve the conviction that a major catastrophe will occur

Question 148

• Diagnostic Criteria
  
  • Disruption of identity characterized by 2 or more distinct personality states (possession in some cultures). Involves discontinuity in sense of sense and agency accompanied by alterations in
    
    • affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning
  • Recurrent gaps in recall of everyday events, personal info, and or traumatic events that inconsistent with ordinary forgetting
  • clinically significant distress
  • not culturally accepted or religious practice
    
    • children, not better explained by imaginary playmates
• Prevalence
  
  • 1.5%
  • equal across genders
    
    • women predominate adult clinical, but not child
      
      • more acute
    • males deny traumatic histories
• Development
  
  • may manifest at any age, may increasingly intrude into awareness with advancing age
  • triggered by
    
    • removal from the traumatizing situation
    • individuals children reaching the same age at which abuse happened
    • later traumatic experiences
    • death of abuser
  • 70% have attempted suicide
• Differentials
  
  • MDD
  • Other specified dissociative disorder
  • Bipolar Disorders
  • PTSD
  • Psychotic Disorders
  • Personlity Disorders
  • Conversion Disorders
  • Facticious DIsorder
  • Malingering
  • Seizure
• Comorbid
  
  • often recieve the comorbid diagnosis
  • PTSD
  • Personality Disorders
  • Conversion
  • Eating Disorders
  • Substance Related Disorders
  • OCD
  • Sleep Disorders

Answer 148

Dissociative Identity Disorder DSM Criteria

Question 149

• Similar to DSM-I
  
  • Eliminated term “reaction”
• 182 disorders
• Minimal changes
  
  • Increased attention to children and adolescence
  • “homosexuality not a d/o”
  • More psychodynamic perspective

Answer 149

DSM-II

Question 150

Referential Delusions

Answer 150

• belief that certain gestures, comments, environmental cues, are directed at oneself

Question 151

• Lasts more than one day and remits by 1 month

Answer 151

Brief Psychotic Disorder

Question 152

Is diagnosis of a mental disorder equivalent to need for treatment?

Answer 152

It’s complex. Consider:

• Symptom severity
• Symptom salience (e.g., suicidal ideation)
• Patient distress and/or disability

Question 154

• A patter of submissive and clinging behavior related to an excessive need to be taken care of

Answer 154

Dependent Personality Disorder

Question 156

• Representation of developmental issues related to diagnosis
  
  • Organization reflects a lifespan approach
  • Integrated gender and cultural issues
• Integration of scientific findings from the latest research in genetics and neuroimaging
• Autism Spectrum Disorder
  
  • Colsolidation of autistic disorder, Asperger’s disorder, and pervasive development disorder
• Streamlined classification of bipolad and depressive disorders
  
  • Inclusion of all of the component criteria within the respective criteria for each disorder.
  • Explanatoy notes for differentiating bereavement and major depressive disorders
• Restructuring of substance use disorders for consistence and clarity
  
  • New overarching category of substance use disorders
  • Differentation between “dependence” and “addiciton”
• Enhanced specificity for major and mild neurocognitive disorders
• Transition in conceptualizing personality disorder
  
  • No major changes
• Section III: new disorders and features
  
  • Highlights disorders that require urther study but are not sifficiently well established to be in the main DSM
• Online enhancements
  
  • Cultural Formulation Interview
  • Online assessment tools

Answer 156

Overall Changes from DSM IV to 5

Question 156

• Diagnostic Criteria
  
  • Over a period of at least 6 months
    
    • recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving prepubescent child or children (13 years or younger)
  • Has acted on these urges, or these sexual urges or fantasies cause marked distress or interpersonal difficulty
  • The individual is at least 16 and at least 5 years older than the child in A
    
    • do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year old
• Specifiers
  
  • exclusive type (attracted to only children)
  • nonexclusive
  • sexually attracted to females
  • sexually attracted to both
  • limited to incest
• Prevalence
  
  • 3-5% in males, but unknown in females​
• Development
  
  • minimum of age 16
• Differentials
  
  • antisocial personality disorder
  • alcohol and substance use disorders
  • OCD
• Comorbidity
  
  • substance use disorders
  • depressive, bipolar, anxiety, antisocial disorder, paraphilic

Answer 156

Pedophilic Disorder

Question 158

PTSD Specifiers

Answer 158

• With dissociative symptoms
  
  • Depersonalization
    
    • feeling detached from mental processes or body, as if in a dream, unreality of self or body
  • Derealization
    
    • unreality of surroundings
• delayed expression
  
  • full criteria not met until 6 months after event

Question 160

Major changes of DSM V

Answer 160

• Multi-axial system eliminated
  
  • Removes artificial distinctions between medical and mental disorders
• “Not otherwise specified” (NOS) eliminated
  
  • New option Not Elsewhere Classified includes specifiers of why condition does not meet a more specific disorder
• Organization of chapters
  
  • to demonstrate how disorders relate to one another
• Addresses age and development as a part of diagnosis and classification
• Culture discussed more explicitly to bring greater attention to cultural cariations
  
  • Outline for cultural formation
  • Framework for assessing cultural features of a client’s problem

Question 162

• Depressive Disorder
  
  • full criteria for depressive disorder is not met
  • clinican chooses not to specify reason

Answer 162

Unspecified Depressive Disorder

Question 163

Reactive Attachment Disorder

Answer 163

• Trauma and Stressor-Related Disorders
  
  • consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregiver manifested by
    
    • rarely seeking comfort when distressed
    • rarely responding to comfort when distressed
  • persistent social and emotional disturbance characterized by 2:
    
    • minimal social responsiveness
    • limited positive affect
    • episodes of unexplained irritability, sadness or fearfulness
  • child has experienced patterns of extremes or insufficient care, evidenced by 1:
    
    • social neglect or deprivation in having basic emotional needs mets
    • repeated changes of primary caregiver
    • rearing in unusual settings
  • care is presumed to be responsible for disturbed behavior
  • does not meet ASD
  • evident before age 5
  • has developmental age of at least 9 months
  • Specify if
    
    • persistent
      
      • present for more than 9 months
    • severe
      
      • exhibits all symotoms at high levels
  • social neglect is a required risk factor

Question 165

PTSD for child 6 years and younger

Answer 165

• actual or threatened death, serious injury, or sexual violence in 1 or more:
  
  • direct traumatic event
  • witnesss event occuring to others esp. caregiver
    
    • not media
  • learning even occured to parent or caregiver
• presence of 1 or more symptoms associated with event:
  
  • distressing memories
    
    • may appear as play reenactment
  • distressing dreams related to event
    
    • may not be able to tell it is related
  • flashbacks making it feel like the event is recurring–> play may reenactment
  • psychological distress
  • psychological distress
• one in the following:
  
  • persistent avoident stimuli after event
    
    • places or physical reminders
    • avoid people or conversations or interpersonal situations
  • negative alterations in cognitions
    
    • frequency of negative emotional states
    • diminished interest
    • socially withdrawn
    • reduction in positive emotions
• alterations in arousal and reactivity in 2:
  
  • irritable behavior
  • hypervigilance
  • exaggerated startle response
  • problems with concentration
  • sleep disturbance
• duration more than 1 month
  *

Question 168

• actual or threatened death, serious injury, or sexual violence in 1 or more:
  
  • direct traumatic event
  • witnesss event occuring to others esp. caregiver
    
    • not media
  • learning even occured to parent or caregiver
• presence of 1 or more symptoms associated with event:
  
  • distressing memories
    
    • may appear as play reenactment
  • distressing dreams related to event
    
    • may not be able to tell it is related
  • flashbacks making it feel like the event is recurring–> play may reenactment
  • psychological distress
  • psychological distress
• one in the following:
  
  • persistent avoident stimuli after event
    
    • places or physical reminders
    • avoid people or conversations or interpersonal situations
  • negative alterations in cognitions
    
    • frequency of negative emotional states
    • diminished interest
    • socially withdrawn
    • reduction in positive emotions
• alterations in arousal and reactivity in 2:
  
  • irritable behavior
  • hypervigilance
  • exaggerated startle response
  • problems with concentration
  • sleep disturbance
• duration more than 1 month
  *

Answer 168

PTSD for child 6 years and younger

Question 170

• Inability to recall autobiographical info that is inconsistent with normal forgetting, but may or may not involve purposeful travel or bewildered wandering (fugue)–> fugue is rare
• Can be localized
  
  • an event or period of time
• Selective
  
  • specific aspect of an event
• Generalized
  
  • idendity and life history

Answer 170

Dissociative Amnesia

Question 172

• A pattern of social inhibition, feelings of inadequacy, and hypersensitive to negative evaluation

Answer 172

Avoidant Personality Disorder

Question 174

• substantial portions of morbidity associated with schizophrenia
• diminished emotional expression
  
  • reductions in the expressions of the emotion in the face, eye contact, intonation of speech, and movements of the hand, head, and face that normally give an emotional speech emphasis
• avolition
  
  • is a decrease in motivated self-initiated activities
  • others include:
    
    • alogia
      
      • dimished speech output
    • anhedonia
      
      • decreased ability to experience pleasure from positive stimuli
    • asociality
      
      • apparent lack of interest in social interactions

Answer 174

Negative Symptoms

Question 175

Substance-Related and Addictive Disorders

Answer 175

• 10 class of drugs, alcohol, caffeine, cannabis, hallucinogens, inhalants, opiods, sedatives, hynoptics, stimulants, tobacco, and other
• taken in excess, but not fully distinct
• intense activation of reward system that normal activities may be neglected
• drugs of abuse directly activate the reward pathway
• two groups: substance use (intoxication, withdrawal, and other substance/medication-induced mental disorders) and substance-induced

Question 176

• Somatic Symptom and Related Disorders
  
  • Brief somatic symptom disorder
    
    • ​less than 6 months
  • Brief illness anxiety
    
    • ​less than 6 months
  • illness anxiety disorder without excessive health related behaviors​
  • pseudocyesis
    
    • ​false belief of being pregnant that is associated with objective signs and reported symptoms of pregancy

Answer 176

Other Specified Somatic Symptom and Related Disorder

Question 177

• 10 class of drugs, alcohol, caffeine, cannabis, hallucinogens, inhalants, opiods, sedatives, hynoptics, stimulants, tobacco, and other
• taken in excess, but not fully distinct
• intense activation of reward system that normal activities may be neglected
• drugs of abuse directly activate the reward pathway
• two groups: substance use (intoxication, withdrawal, and other substance/medication-induced mental disorders) and substance-induced

Answer 177

Substance-Related and Addictive Disorders

Question 179

• Atypical AN
  
  • all criteria are met for AN are met except that despite significant weight loss, individuals weight is within normal range
• Bulimia Nervosa (of low frequency and/or limited duration)
  
  • All criteria are met except, binge eating and compensatory behaviors occur, on average less than once a week and or less than 3 months
• BED (of low frequency and/or limited duration)
  
  • All criteria are met except, except binge eating behaviors occur on average less than once a week and or less than 3 months
• Purging Disorder
  
  • recurrent purging to influence weight or shape with the absense of binge eating

Answer 179

Other specified Feeding or Eating Disorder

Question 180

• belief that certain gestures, comments, environmental cues, are directed at oneself

Answer 180

Referential Delusions

Question 181

Bipolar 1 Disorder

Answer 181

• Manic Episode (at least one in lifetime)
  
  • persistent elevated or irritable mood and increased goal-directed activity
    
    • lasts at least 1 week
  • During mood disturbance at least 3 or 4 if only irritable
    
    • increase self-esteem
    • less need for sleep
    • more talkative
    • flight of ideas
    • distractability
    • increase in goal directed activity
    • involvement in high risk activity
  • cause marked impairment in functioning
• Hypomanic Episode (common but not required for diagnosis)
  
  • persistently elevated or irritable mood
    
    • lasts at least 4 consecutive days
  • 3 of the following symptoms or 4 if only irritable
    
    • inflated self-esteem
    • decreased need for sleep
    • more talkative
    • flight of ideas
    • distractible
    • increase in goal-directed activity
    • involvement in high risk activities
  • change in functioning and is observable by others
  • not severe enough to cause impairment in functioning
• **Major Depressive Episode **(common, but not required for bipolar 1)
  
  • present during same two-week period
    
    • One of the following
      
      • depressed mood or loss of interest
    • 4 or more of the following
      
      • weight loss or gain
      • sleep disturbances
      • psychomotor agitation or retardation
      • fatigue
      • feelings of worthlisness
      • lack of ability to concentrate
      • thoughts of death (recurrent)
    • cause impairment in functioning

Question 183

DSM-III

Answer 183

• Coordinated with development if ICD-9
• Changes from DSM II
  
  • 265 disorders
  • Multiaxial classification system
• Aim to produce a science-driven document (as opposed to psychodynamic)
• Work on construction and validation of criteria
• development of semistructured interviews
• Biology and genetics played a key role
• This was revised

Question 185

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • An uninterrupted period of illness during which there is a major mood episode ( major depressive or manic) concurrent with criterion A of schizophrenia
    • delusions or hallucinations for 2 or more weeks in the absense of a major mood episode (depressive or major) during the lifetime duration of the illness
    • symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
    • not due to substance
  • Specifiers
    
    • bipolar type
      
      • manic episode
    • depressive
    • with catatonia
    • episode type
    • severity
  • Onset
    
    • early adulthood
      
      • can occur anywhere from adolescence to late in life
  • Prevalence
    
    • 0.3%
  • Differentials
    
    • other mental disorders and medical conditions
    • psychotic disorder due to another med condition
    • schizophrenia, bipolar and depressive disorders
  • Comorbid
    
    • substance use and anxiety disorders
  • other
    
    • suicide risk is 5%
      
      • higher in north america

Answer 185

Schizoaffective Disorder

DSM Criteria

Question 186

• Diagnostic Criteria
  
  • Over a period of 6 months
    
    • recurrent and intense sexual arousal from the physical or phsychological suffering of another person, as manifested by fantasies, urges or behaviors
    • acted on urges with a nonconsenting person, or urges or fantasies cause clinically significant distress
• Specifiers
  
  • in a controlled environment
  • in full remission
• Prevalence
  
  • 2 to 30%
  • less tha 10% among sexual offenders
• Development
  
  • aware as young adults
  • mean age is 19.4

Answer 186

Sexual Sadism Disorder

Question 188

Narcissistic Personality disorder

DSM Criteria

Answer 188

• Cluster B
  
  • Diagnostic Certeria
    
    • pervasive patter of grandiosity (fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood, and indicated by 5 or more:
      
      • grandiose sense of self importance
      • preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
      • believes he or she is special and unique and can only associate with people of high status
      • requires excessive admiration
      • sense of entitlement
      • interpersonally exploitative
      • lacks empathy
      • envious of others and believe people envy him ro her
      • arrogant
  • Prevalence
    
    • 0-6.2%
    • 50-75% are male
  • Onset
  • Differential
    
    • other personality disorders and personality traits
    • mania or hypomania
    • substance use disorders

Question 189

• Depressive Disorder
  
  • consolidation of chronic MDD and dysthymic from DSM IV
    
    • depressed mood most of the time for at least 2 years
      
      • ​1 year in children
    • ​​​two or more of these symptoms
      
      • appetite problems
      • sleep disturbances
      • fatigue
      • low self-esteem
      • poor concentration or decision making
      • hopoelessness
    • not without symptoms for more than 2 months
    • MDD may be continuously present for 2 years
      
      • not noted as seperate diagnoses, but a specifier
    • no manic or hypermanic episodes
    • not better explained by any type of schizophrenia
    • Specifiers
      
      • anxious, mixed, atypical features, mood-congruent with psychotic, mood-incongruent with psychotic, peripartum onset
      • partial remission, full remission
      • early or late onset
      • pure dysthymic syndrome, persistent MDD, intermittent major depressive episodes with current episode, intermittent major depressive episode without current episode
      • mild, moderate, severe

Answer 189

Persistent Depressive Disorder (Dysthymia)

Question 191

Cyclothymic Disorder

Answer 191

• at least 2 years (1 if you are a child or adolescent)
  
  • numerous periods with hypomanic symptoms not meeting criteria for episode
    
    • insufficient number, severity, pervasiveness, or duration
  • numerous periods with depressive symptoms not meeting criteria for episode
    
    • insufficient number, severity, pervasiveness, or duration
  • where both of these symptoms have been present half of time and not without symptoms for 2 months
  • clinically significant distress must be present
• never met criteria for major depressive, manic, or hypomanic episode
  
  • upon the occurence of these: a disorder change is due
• Prevalence
  
  • 0.4-1%
  • mood disorder clinics: 3-5%
• age of onset
  
  • adolescence or early life
  • for children who have it: mean of 6.5
• gender difference
  
  • equal

Question 192

Harmonized with WHO’s ICD

Answer 192

DSM and ICD

Question 193

What is Psychopathology?

Answer 193

According to DSM-5

• Characterized by clinically significant disturbance in cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
• Usually associated with significant distress or disability in social, occupational, or other important activities.
• Often viewed on a continuum

Question 193

• Cluster B
  
  • Diagnostic Certeria
    
    • pervasive patter of grandiosity (fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood, and indicated by 5 or more:
      
      • grandiose sense of self importance
      • preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
      • believes he or she is special and unique and can only associate with people of high status
      • requires excessive admiration
      • sense of entitlement
      • interpersonally exploitative
      • lacks empathy
      • envious of others and believe people envy him ro her
      • arrogant
  • Prevalence
    
    • 0-6.2%
    • 50-75% are male
  • Onset
  • Differential
    
    • other personality disorders and personality traits
    • mania or hypomania
    • substance use disorders

Answer 193

Narcissistic Personality disorder

DSM Criteria

Question 195

• Mood episode and the active-phase episode of schizophrenia occur together and were preceeded or follow by at least 2 weeks of hallucinations without prominant mood symptoms

Answer 195

Schizoaffective

Question 196

STRUCTURE

• Deleting the multiaxial system
• Legitimate disorders removed or remodeled (e.g., Asperger’s Disorder)
• “Clinically significant distress or impairment in social or occupational functioning” - Still no procedures to make this determination
• Remains a psychiatric “checklist” versus comprehensive assessment

IMPLICATIONS of DX

• Increasing tendency to “medicalize” patterns of behavior and mood that are not considered to be particularly extreme
• Pathologizing normal behavior (e.g., the argument of Disruptive Mood Disregulation Disorder being akin to temper tantrum disorder)
• Changes make it easy to diagnose sub-clinical disorders (e.g., changes to Bipolar Disorder, dropping bereavement exclusion for depressive disorders)
• Conversely, DSM-5 is normalizing pathological behaviors (e.g., some construe DSM-5 is normalizing pedophilia)

INFLUENCES

• Undue influence of politics, pharmaceutical industry, research grants
• Sacrificing science, i.e., over-relying on reliability at the sake of validity

Answer 196

DSM -V Criticisms

Question 197

• Presence of two or more distinct personality states or an experiences of possession
• recurrent episodes of amnesia
• recurrent, inexplicable instrusions into their conscious functioning and impulses
• alterations of sense of self
• odd changes of perception
• intermittent functional neurological symptoms
  
  • stress often produces transient exacerbation of dissociative symptoms

Answer 197

Dissociative Identity Disorder

Question 198

Acute Stress Disorder

Answer 198

• Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more:
  
  • direct experience in traumatic event
  • witnessing event as occured to others
  • learned even occured to close friend or fam
  • experiencing repeated or extreme exposure to aversive details of the traumatic even
• 9 symptoms from any of the 5 categories
  
  • intrusion symptoms
    
    • distressing memories
    • distressing dreams
    • dissociative reactions
    • psychological distress in reaction to external cues
  • negative mood
    
    • inability to experience positive emotions
  • dissociative symptoms
    
    • altered sense of reality of one’s surroundings or one’s self
    • inability to remember an important aspect of traumatic event
  • avoidance symptoms
    
    • effort to avoid distressing memories, thoughts or feelings
    • effort to avoid external reminders
  • arousal symptoms
    
    • sleep disturbance
    • irritable behavior
    • hypervigilance
    • problems with concentration
    • exaggerated startle response
• duration is 3 days to 1 month

Question 199

• Panic Attacks or anxiety is predomincant in the clinical picture
• findings that the disturbance is the direct pathophysiological consequence of another medical condition
• not better explained by another mental disorder
• not exclusively during delirium
• NOT MEANT TO INCLUDE PRIMARY ANXIETY DISORDERS THAT ARISE IN THE CONTEXT OF CHRONIC MENTAL ILLNESS

Answer 199

Anxiety Disorder Due to Another Medical Condition

Question 200

• Diagnostic Criteria
  
  • inability to recall autobiographical info, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting
    
    • localized (specific period of time) or selective (can recall some, but not all of one’s life history) or generalized (one’s life history)
  • not attributable to a substance or medical or neurological conditions
  • not explained by dissociative identity disorder, PTSD, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder
  • Specify if with or without fugue
    
    • fugue: purposeful travel or bewildered wandering
• Prevalence
  
  • 1.8%
    
    • 1% for men and 2.6% for women
• Development and Course
  
  • it is usually sudden
• Differentials
  
  • Dissociative Identity Disorder
  • PTSD
  • Substance-related disorders
  • neurocognitive disorders
  • posttraumatic amnesia due to brain injury
  • seizure disorder
  • catatonic stupor
  • facticious disorder and malingering
  • normal and age related changes in memory
• Comorbidity
  
  • PDD
  • MDD
  • Adjustment Disorder

Answer 200

Dissociative Amnesia DSM Diagnostic Criteria

Question 201

• Depressive Disorder (new to DSM 5)
  
  • recurrent temper outburts (verbal or behavioral)
  • inconsistent with developmental age
  • 3 or more times per week
  • persistently irritable or angry
  • present for 12 months or more
    
    • no period of 3 plus months without symptoms
  • 2 out of 3 settings
  • diagnosis made age 6-18
  • age of onset criteria before 10
  • no day with manic or hypermanic episode
• cannot be comord with
  
  • ODD
    
    • more of a mood component
      
      • most people with DMDD meet ODD, but not reverse
  • intermittant explosive
    
    • does not require persistent disruption of mood between bursts
  • bp
    
    • cannot have hypomanic or manic episode, persistent mood
• can be comorbid with
  
  • MDD, ADHD, CD, substance-abuse
• at risk to develop: unipolar depressive or anxiety disorders

Answer 201

Disruptive Mood Dysregulation

Question 203

• reflect a more inclusive description of the range of psychopathology across the globe, not just the particular constructs or exemplars most commonly encountered in the US, Western Europe, and Canada.
• to help avoid misdiagnosis
• improve raport
• obtain clinically useful information
• therapeutic efficacy
• guide research
• clarify cultural epidemiology

Answer 203

Objective of CFI

Question 205

Bipolar II Disorder

Answer 205

• Meet **criteria for hypomanic episode and depressive episode **with no manic episode
• ​​Fluctuations cause clinically significant distress
  
  • ​hypomanic episode​
    
    • persistently elevated or irritable mood
    • lasts at least 4 consecutive days
    • 3 of the following symptoms or 4 if only irritable
      
      • inflated self-esteem
      • decreased need for sleep
      • more talkative
      • flight of ideas
      • distractible
      • increase in goal-directed activity
      • involvement in high risk activities
    • change in functioning and is observable by others
    • not severe enough to cause impairment in functioning
• depressive episode
  
  • present during same two-week period
  • One of the following
    
    • depressed mood or loss of interest
  • 4 or more of the following
    
    • weight loss or gain
    • sleep disturbances
    • psychomotor agitation or retardation
    • fatigue
    • feelings of worthlisness
    • lack of ability to concentrate
    • thoughts of death (recurrent)
  • cause impairment in functioning
• Specifiers
  
  • current episode of hypomanic and depressive
  • others are consistent with depressive specifiers
    *

Question 205

Antisocial Personality Disorder

Answer 205

• Pattern of disregard for, and violation of, the rights of others

Question 207

Separation Anxiety Disorder

Answer 207

• Anxiety Disorders
• developmentally inappropriate fear or anxiety related to separation from an individual they are attached to
• 3 of the following:
  
  • recurrent excessive distress
    
    • when anticipating or experiencing separation
    • worry about losing individual or harm
    • worry about an untoward event that causes separation
  • reluctance
    
    • to or refusal to go out because of fear of separation
    • about being alone
    • to sleep away from home or go to sleep without
  • nightmares about separation
  • complaints about physical symptoms
• 6 months or more in adults, 4 weeks in children
• *

Question 208

• Grossly disorganized or abnormal motor behavior
  
  • childlike silliness to unpredictable agitation
    
    • problems may be noted in goal-directed activity to difficulties in performing activities of daily living
• Catatonia
  
  • marked decrease in reactivity to environment
    
    • negativism
      
      • resistance to instructions
    • rigid inappropriate posture
    • mutism and stupor
      
      • lack of motor and verbal responses
    • catatonic excitement
      
      • excessive motor activity without cause

Answer 208

Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)

Question 210

• recurrent and persistent thoughts, urges or images that are experiences as intrusive and unwanted

Answer 210

Obsessions

Question 212

with muscle dysmorphia specificer

Answer 212

• BDD specifier
• preoccupied with the idea that body is insufficiently muscular

Question 213

Atypical Features for Depressive Specifier

Answer 213

• mood reactivity
• two or more:
  
  • weight gain
  • hypersomnia
  • heavy feeling in arms or legs
  • rejection sensitivity

Question 213

• Anxiety Disorder
• Marked anxiety or fear about a specific object or situation
• provokes immediate fear or anxiety
• actively avoided or endured with fear
• out of proportion to actual danger
• 6 months or more
• Specify if:
  
  • animal
  • natural environment
  • blood-injection-injury
  • situational
  • other (this is where vomiting is)

Answer 213

Specific Phobia

Question 214

• Meet **criteria for hypomanic episode and depressive episode **with no manic episode
• ​​Fluctuations cause clinically significant distress
  
  • ​hypomanic episode​
    
    • persistently elevated or irritable mood
    • lasts at least 4 consecutive days
    • 3 of the following symptoms or 4 if only irritable
      
      • inflated self-esteem
      • decreased need for sleep
      • more talkative
      • flight of ideas
      • distractible
      • increase in goal-directed activity
      • involvement in high risk activities
    • change in functioning and is observable by others
    • not severe enough to cause impairment in functioning
• depressive episode
  
  • present during same two-week period
  • One of the following
    
    • depressed mood or loss of interest
  • 4 or more of the following
    
    • weight loss or gain
    • sleep disturbances
    • psychomotor agitation or retardation
    • fatigue
    • feelings of worthlisness
    • lack of ability to concentrate
    • thoughts of death (recurrent)
  • cause impairment in functioning
• Specifiers
  
  • current episode of hypomanic and depressive
  • others are consistent with depressive specifiers
    *

Answer 214

Bipolar II Disorder

Question 215

Fear

Answer 215

emotional response to real or perceived imminent threat

Question 216

Anxious Distress Depressive Specifier

Answer 216

• 2 of the following:
  
  • tense, restless, concentration difficulty, fear that something awful will happen, feel might lose control

Question 217

stereotyped movement

Answer 217

• repetitive, seemingly, driven, non functional motor behavior
  
  • premotor sensory urges

Question 219

• Anxiety Disorder
• consistent failure to speak in specific social situations where there is an expectation to speak despite speaking in other situations
• interferes with educational, occupational, or social
• at least 1 month (not limited to first month of school)
• not attributed to lack of knowledge
• not explained by communication d/o

Answer 219

Selective Mutism

Question 220

• when an individual believes falsely that another person is in love with him or her

Answer 220

erotomanic delusions

Question 222

• individual intentionally behaves in ways that are designed to prevent or minimize contact with phobic objects or situations

Answer 222

Active Avoidance

Question 223

Histrionic Personality Disorder

DSM Criteria

Answer 223

• Cluster B
  
  • Diagnostic Certeria
    
    • pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood. 5 or more:
      
      • uncomfortable in situations where they are not the center of attention
      • interactions are characterized by inappropriate sexually seductive or provocative behavior
      • rapidly shifting or shallow emotions
      • physical appearance to draw attention
      • style of speech that is excessively impressionistic and lacking detail
      • self-dramatization, theatrical, exaggerated emotion
      • suggestible (influenced by others)
      • considers relationships more intimate than they are
  • Prevalence
    
    • 1.84%
    • more frequent in females
  • Onset
  • Differential
    
    • other personality disorders and personality traits
    • personality change due to another medical condition
    • substance use disorders
  • Comorbidity

Question 224

• involve the conviction that a major catastrophe will occur

Answer 224

nihilistic delusions

Question 225

• Diagnostic Criteria
  
  • enduring pattern of inner experience that deviates markedly from expectations of culture in 2 or more:
    
    • Cognition
    • Affectivity
    • Interpersonal functioning
    • Impulse Control
  • pattern is inflexible and pervasive
  • pattern leads to clinically sgnificant distress
  • pattern is stable and of long duration–> traced to adolescence or early adulthood
• Prevalence
• Onset
  
  • those diagnosed before 18, must have features for at least 1 year
  • requires onset no later than early adulthood
• Gender
  
  • antisocial is more common in males
  • borderline, histrionic, dependent more common in females
• Differential
  
  • other mentale disorders and personality traits
  • psychotic disorders
  • anxiety and depressive disorders
  • PTSD
  • personality changes due to another medical condition
    
    • like brain tumor
• Comorbid

Answer 225

General Personality Disorder

Question 226

Unspecified Anxiety Disorder

Answer 226

• symptoms characteristic of anxiety disorder cause clnicaly significant distress or impairment, but do not meet criteria
• clinicians chooses not to communicate why the criteria is not met
• insufficient information

Question 228

Why was there a need for a common diagnostic system?

Answer 228

At this point, there were several different diagnostic systems

• Differed in emphasis on phenomenology, etiology, and course as defining features
• Some included only a handful of diagnostic categories; others thousands
• Differed with respect to whether the principle objective was clinical use, research, or statistics

A need for a classification to

• Minimized confusion
• Create consensus among the field
• Help mental health professionals communicate using a common diagnostic language
• (way for people to communicate within the field)

Question 229

Illness Anxiety Disorder

Answer 229

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria (previously hypochondiasis)
    
    • preoccupation with having serious illness
    • somatic symptoms not present, or if present they are mild. if med condition is presentm the preoccupation is excessive
    • high level of anxiety about health and easily alarmed about personal health status
    • performs excessive health related behaviors or exhibits maladaptive avoidance
    • present for last 6 months, but specific illness may change
    • Specify if
      
      • care-seeking
        
        • medical care frequently used
      • care avoidant
        
        • medical care rarely used
  • Prevalence
    
    • 1.3-10%
    • or 3-8% for 6 months
  • Onset
    
    • generally thought to be chronic relapsing
    • increases with age
  • Gender
  • Differentials
    
    • other med conditions
    • somatic symptom
    • anxiety disorders
    • OCD
    • MDD
    • psychotic
  • Comorbidity
    
    • anxiety and depressive

Question 230

• perception-like experiences that occur wuthout an external stimulus
• vivid and clear, with the full force and impact of normal perceptions and not under voluntary control
• auditory
• must occur in the context of a clear sensorium
• within normal experience or part of religious experience
  
  • hyponagogic
    
    • while falling asleep
  • hypnopompic
    
    • waking up

Answer 230

Hallucinations

Question 232

Progression of mental illness classification starting at 1840

Answer 232

These developments created a need for a

1840 US government

• Government collected census data on mentla illness
• 40 years later there were 7 categories of mental illness

1917 Bureau of the Census

• Used Statistical Manual for the Use of Institutions for the Insane
• separated mental illness into 22 groups

WWII U.S. Army (1940-1045ish)

• nomenclature developed by Army to better incorporate presentations of WWII servicemen and veterans

1940 WHO

• Concurrently WHO published ICD-6
• 26 diagnoses
• 10 categories fo rpsychoses, 9 for psychoneurosis, and 7 for disorders of character, behavior, and intelligence

Question 233

Disorganized Thinking

Answer 233

• or thought disorder
• inferred from the individual’s speech
  
  • derailment or loose association
    
    • may switch from one topic to another
  • tangentiality
    
    • answers to questions may be obliquely related or completely unrelated
  • incoherence
    
    • speech may severely disorganized that is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization
    • must be severe enough to impair communication

Question 235

• Panic attacks or anxiety is predominant in the clinical picture
• evidence in findings
  
  • symptoms developed during or soon after a substance
  • substance is capable of producing symptoms
• disturbance is not better explained by another disorder
  
  • do not persist 1 month after cessation or onset before meds
• not exclusively during delirium
• specifiers:
  
  • with onset during intoxication
  • withonset during withdrawal
  • with onset after medication use
  • type of medication or substance

Answer 235

Substance/Medication-Induced Anxiety Disorder

Question 236

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • One or more symptoms of altered voluntary motor or sensory function
    • clinical findings provide evidence of incompatibility between symtpom and recognized neurological or med conditions
    • symptom or deficit is not better explained by anything else
    • clinically significant distress
    • Specify if
      
      • with weakness or paralysis
      • abnormal movemt
      • swallowing symptoms
      • speech symptoms
      • attacks or seizures
      • anesthesia or sensory loss
      • special sensory symptom
      • mix symptoms
    • specify if
      
      • acute epsiode
        
        • less than 6 months
      • persistent
        
        • more than 6 months
    • specify if
      
      • psychological stressor
      • without psychological stressor
  • Prevalence
    
    • 5% of neurology clinics
    • .002%
  • Onset
    
    • non-epiletic attacks peaks in 30s
    • motor symptoms peak in 40s
    • symptoms can be transient or persistent
    • better prognosis if younger
• Gender
  
  • 2 or 3 times more common in females
• Differentials
  
  • neurological disease
  • somatic symptom disorder
  • factitious disorder or malingering
  • dissociative disorder
  • BDD
  • panic disorder
• Comorbidity
  
  • anxiety (panic), depressive
  • somatic symptom

Answer 236

Conversion Disorder (Functional Neurological Symptom Disorder)

Question 237

Obsessive-Compulsive Disorder

Answer 237

• Presense of obsessions, compulsions, or both
  
  • Obsessions
    
    • recurrent and persistent thoughts, urges, or images that are experienced, cause unwanted distress or anxiety
  • Compulsions
    
    • repititve behaviors
    • preventing and reducing anxiety
  • time consuming (1 hr per day)
  • not attributable to substance
  • not due to medical condition
  • specify if
    
    • with good or fair insight
      
      • recognizes beliefs are noth true
    • with poor insight
      
      • believes beliefs are probably true true
    • with absent insight/delusional beliefs
      
      • completely convinced that beliefs are true
    • tic related
      
      • current or past history of tic disorder

Question 238

Overall Changes from DSM IV to 5

Answer 238

• Representation of developmental issues related to diagnosis
  
  • Organization reflects a lifespan approach
  • Integrated gender and cultural issues
• Integration of scientific findings from the latest research in genetics and neuroimaging
• Autism Spectrum Disorder
  
  • Colsolidation of autistic disorder, Asperger’s disorder, and pervasive development disorder
• Streamlined classification of bipolad and depressive disorders
  
  • Inclusion of all of the component criteria within the respective criteria for each disorder.
  • Explanatoy notes for differentiating bereavement and major depressive disorders
• Restructuring of substance use disorders for consistence and clarity
  
  • New overarching category of substance use disorders
  • Differentation between “dependence” and “addiciton”
• Enhanced specificity for major and mild neurocognitive disorders
• Transition in conceptualizing personality disorder
  
  • No major changes
• Section III: new disorders and features
  
  • Highlights disorders that require urther study but are not sifficiently well established to be in the main DSM
• Online enhancements
  
  • Cultural Formulation Interview
  • Online assessment tools

Question 239

Paranoid Personality Disorder

Answer 239

• Pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent

Question 240

Conversion Disorder (Functional Neurological Symptom Disorder)

Answer 240

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • One or more symptoms of altered voluntary motor or sensory function
    • clinical findings provide evidence of incompatibility between symtpom and recognized neurological or med conditions
    • symptom or deficit is not better explained by anything else
    • clinically significant distress
    • Specify if
      
      • with weakness or paralysis
      • abnormal movemt
      • swallowing symptoms
      • speech symptoms
      • attacks or seizures
      • anesthesia or sensory loss
      • special sensory symptom
      • mix symptoms
    • specify if
      
      • acute epsiode
        
        • less than 6 months
      • persistent
        
        • more than 6 months
    • specify if
      
      • psychological stressor
      • without psychological stressor
  • Prevalence
    
    • 5% of neurology clinics
    • .002%
  • Onset
    
    • non-epiletic attacks peaks in 30s
    • motor symptoms peak in 40s
    • symptoms can be transient or persistent
    • better prognosis if younger
• Gender
  
  • 2 or 3 times more common in females
• Differentials
  
  • neurological disease
  • somatic symptom disorder
  • factitious disorder or malingering
  • dissociative disorder
  • BDD
  • panic disorder
• Comorbidity
  
  • anxiety (panic), depressive
  • somatic symptom

Question 241

with absent/delusional belief specifier

Answer 241

• convinced the beliefs are true

Question 242

• Obsessive-compulsive and related disorder
  
  • recurrent pulling out of one’s hair, resulting in hair loss
  • repeated attempts to stop
  • clinically significant distress
  • not attributable
• Prevalence
  
  • 1-2%
• Age of onset
  
  • can be at infancy
  • commonly starts in puberty
• Gender differences
  
  • 10:1 female to male

Answer 242

Trichotillomania (hairpulling)

Question 244

• Diagnostic Criteria
  
  • over a period of at least 6 months
    
    • recurrent and intense sexual arousal from either nonliving objects or a highly specific focus on nongenital body parts
  • Fantasies, sexual urges or behaviors cause clnically significant distress
  • Fetish objects are not limited to articles of clothing used in cross dressing or things like vibrators
• Specifiers
  
  • body parts
  • non living objects
  • other
  • in a controlled environment
  • in full remission
• Development and Course
  
  • usually during puberty is onset
  • reported almost exclusively in males
• Differential Diagnosis
  
  • Transvestic Disorder
  • Sexual masochism disorder or paraphic disorder
  • fetishistic behavior without fetishistic disorder

Answer 244

Fetishistic Disorder

Question 245

Substance/Medication Induced Bipolar Related Disorder

Answer 245

• persistent disturbance in mood that predominates clinical picture
  
  • elevated or irritable mood
• Findings show
  
  • symptoms develop during or soon after intoxication or withdrawal
  • substance is capable of producing symptoms
• no just during dilirium
• causes clinically significant distress
• Specifier
  
  • onset during intoxication
  • onset during with drawal

Question 246

Dissociative Amnesia

Answer 246

• Inability to recall autobiographical info that is inconsistent with normal forgetting, but may or may not involve purposeful travel or bewildered wandering (fugue)–> fugue is rare
• Can be localized
  
  • an event or period of time
• Selective
  
  • specific aspect of an event
• Generalized
  
  • idendity and life history

Question 248

• Depressive Disorders
  
  • 5 or more symptoms that are change in previous functioning
    
    • one has to be
      
      • **depressed mood or loss of interest **
    • diet change (weight loss or gain)
    • insomnia or hypersomnia
    • psychomotor agigation or retardation
    • loss of energy
    • worthliness or guilt
    • lack of concentration or indeciveness
    • thoughts of death
  • clinically significant distress
  • not related to substance or medical condition
  • never hypermanic or manic episode
  • Specifiers and Severity
    
    • mild, moderate, severe
    • psychotic features
    • in partial remission, in full remission
    • unspecified
  • Not better explained by
    
    • schizoaffective
    • schizophrenia
    • schiophreniform
    • delusional disorder

Answer 248

Major Depressive Disorder

Question 249

Posttraumatic Stress Disorder (6 and older)

Answer 249

• Trauma and stressor-related Disorders
  
  • exposure to actual or threatened death serious injury, or sexual violence in 1 or more
    
    • direct experience
    • witness occurring to others
    • learning occured to close friend or family
    • experiencing repeated or extreme exposure to details of event
      
      • does not relate to media unless work related
  • 1 or more of the following after event
    
    • recurrent, distressing memories of event
      
      • child: repititive play
    • recurrent, distressing dreams
      
      • child: frightening dreams without recognizeable content
    • dissociate reactions, loss of awareness of present surroundings
      
      • child: reenactment
    • intense or prolonged psychological distress at exposure to internal or external cues that symbolize aspect of event
    • marked physiological reaction
• persistent avoidance of stimuli associated with event
  
  • memories, thoughts, or feelings
  • external reminders
• Negative alterations in cognitions and mood as evidenced by 2:
  
  • inability to remember an important aspect of event
  • persistent or exaggerated negative beliefs about oneself
  • distorted cognitions about the cause of event
  • diminshed interest in activities
  • feelings of detachment
  • inability to experience positive emotions
• alterations in arousal and reactivity with even in 2:
  
  • irritability or angry outburst
  • self-destructive behavior
  • hypervigilence
  • exaggerated startle response
  • difficulty concentrating
  • sleep disturbance
• distrubance is more than 1 month
• not attributable to substance

Question 250

Bipolar and Related Disorder Due to Another Medical Condition

Answer 250

• abnormally elevated or irritable mood and energy that predominates the clinical picure
• evidence of direct pathophysiological consequence of med condition
• no just during delirium
• causes clinically significant distress
• Specificiers
  
  • manic features
    
    • full criteria for manic or hypomanic episode
  • manic or hypomanic like episode
    
    • D not met for manic:
      
      • not attributible to physiological effects of substance
    • F not met for hypomanic:
      
      • not attributible to physiological effects of substance
  • mixed features
    
    • symptoms of depression also present, but do not predominate clinical picture

Question 251

• Recurrent skin picking in skin lesions
• repeated attempts to stop
• causes clinically significant stress
• not attributable to other
• not ususally in presence of others
• age of onset
  
  • puberty or adolesence
• prevalence
  
  • 1.4%
• gender differ
  
  • 3/4 are female

Answer 251

Excoriation (Skin-Picking) Disorder

Question 252

Trichotillomania (hairpulling)

Answer 252

• Obsessive-compulsive and related disorder
  
  • recurrent pulling out of one’s hair, resulting in hair loss
  • repeated attempts to stop
  • clinically significant distress
  • not attributable
  • 10:1 female to male

Question 253

What are the 3 C’s to classifying psychological disorders

Answer 253

• Context
• Continuum
• Cultural relativism

Question 254

Anorexia Nervosa

Answer 254

• Feeding and Eating Disorders
  
  • Dignostic Criteria
    
    • Restriction of energy intake relative to requirements, leading to signifanctly low body weight (less than minimally normal)
    • intense fear of gaining weight or becoming fat, or persistant behavior that interferes with weight gain
    • disturbance in the way in which one’s body weight or shape is experience, lack of recognition of seriousness of the curren low body weight
    • specify
      
      • in partial remission or full remission
    • subtypes
      
      • binge-eating/purging type
        
        • binge eat also purge
      • restricting
        
        • last 3 months, not engaged binge-purge, primarily though dieting, fasting, or exercise
    • Severity
      
      • mild: BMI > 17
      • moderate: BMI 16-16.99
      • severe: BMI 15-15.99
      • extreme: BMI
  • Prevalence
    
    • 0.4%
  • Onset
    
    • commonly begins during adolesence
    • rarely begins before puberty or after 40
  • Gender
    
    • occurs across cultures
      
      • post-industrialized societies
  • Differentials
    
    • Medical conditions
    • MDD
    • schizo
    • substance use
    • Social anxiety
    • BN
    • Avoidant/restrictive food intake
  • Comorbidity
    
    • bipolar
    • depressive
    • anxiety

Question 255

Paranoid Personality Disorder

DSM Criteria

Answer 255

• Cluster A
  
  • Diagnostic Certeria
    
    • pervasive distrust and suspiciousness of others such their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts with 4 or more:
      
      • suspects that others are exploiting, harming, or deceiving
      • preoccupied with unjustified doubts about loyalty or trustworthiness of friends or associates
      • reluctant to confide in others because of unwarranted fear that the info will be used maliciously against him or her
      • reads hidden meaning or threatening meanings
      • persistening bears grudges
      • perceieves attacks on character that are not apparent
      • recurrent suspicions of fidelity
      • if with schizophrenia add (premorbid)
  • Prevalence
    
    • 2.3%
    • may be more common in males
  • Onset
    
    • first apparent in childhood and adolescence as solitary with poor peer support, social anxiety, eccentric
  • Differential
    
    • other mental disorders with psychotic symptoms
    • personality change due to another medical condition
    • substance use
    • paranoid traits associated with physical handicaps
    • other personality disorders and personality traits
  • Comorbidity
    
    • substance abuse

Question 257

Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)

Answer 257

• Grossly disorganized or abnormal motor behavior
  
  • childlike silliness to unpredictable agitation
    
    • problems may be noted in goal-directed activity to difficulties in performing activities of daily living
• Catatonia
  
  • marked decrease in reactivity to environment
    
    • negativism
      
      • resistance to instructions
    • rigid inappropriate posture
    • mutism and stupor
      
      • lack of motor and verbal responses
    • catatonic excitement
      
      • excessive motor activity without cause

Question 258

• Feeding and Eating Disorders
  
  • Dignostic Criteria
    
    • recurrent episodes of binge eating
      
      • eating, in a descrete period of time (2 hours), an amount that is larger than what most individuals would eat
      • a sense of a lack of control
    • Episodes associated with 3 or more:
      
      • eating much more rapidly than normal
      • uncomfortably full
      • large amounts of food when not hungry
      • eating alone because you are embarrassed about how much food
      • disgusted, depressed, or guilty after
    • distress about binge eating
    • at least once a week for 3 months
    • not associated with compensatory behaviors
  • Prevalence
    
    • 1.6 % for females
    • 0.8% for males
  • Onset
    
    • typically begins in young adulthood or adolescence
  • Gender
    
    • higher in females slightly
  • Differentials
    
    • BN
    • bipolar and depressive
    • Borderline personlity
  • Comorbidity
    
    • bipolar, depressive, anxiety

Answer 258

Binge-Eating

Question 259

Peripartum Onset Depressive Specifier

Answer 259

• during pregnancy or 4 weeks after delivery
• can be with or without psychotic features

Question 260

• Anxiety Disorders
• developmentally inappropriate fear or anxiety related to separation from an individual they are attached to
• 3 of the following:
  
  • recurrent excessive distress
    
    • when anticipating or experiencing separation
    • worry about losing individual or harm
    • worry about an untoward event that causes separation
  • reluctance
    
    • to or refusal to go out because of fear of separation
    • about being alone
    • to sleep away from home or go to sleep without
  • nightmares about separation
  • complaints about physical symptoms
• 6 months or more in adults, 4 weeks in children
• Prevalence
  
  • 0.9-1.9% in adults
  • 4% in chldren
• Gender
  
  • children: more equal (clinically), clinically females
  • adults, females
• heritability estimate is 73%, with higher rates for girls

Answer 260

Separation Anxiety Disorder

Question 261

• manic or hypomanic episode with mixed features
  
  • full criteria for manic or hypomanic
• at least 3 of the following
  
  • dysphoria or depressed mood
  • loss of interest
  • psychomotor retardation
  • fatigue
  • feelings of worthlessness
  • thoughts of death
• Depressive episode, with mixed features
  
  • full criteria met for MDE
• at least three of the following manic/hypomanic symptoms
  
  • elevated mood
  • inflated self-esteem
  • more talkative
  • flight of ideas
  • increase in energy/goal-directed
  • increase in risk activitives
  • decreased need for sleep

Answer 261

Mixed Features for Bipolard and Related Disorders

Question 263

• or thought disorder
• inferred from the individual’s speech
  
  • derailment or loose association
    
    • may switch from one topic to another
  • tangentiality
    
    • answers to questions may be obliquely related or completely unrelated
  • incoherence
    
    • speech may severely disorganized that is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization
    • must be severe enough to impair communication

Answer 263

Disorganized Thinking

Question 264

• Cluster C
  
  • Diagnostic Certeria
    
    • pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood, indicated by 5 or more:
      
      • difficulty making everyday decisions without advice and reassurance
      • needs others to assume responsibilit for most areas of his or her life
      • difficulty expressing disagreement with others because of fear of loss of support or disapproval
      • difficulty initiating projects or doing things on own
      • goes to excessive lengths to obtain support
      • uncomfortable or helpless when alone due to fear of being unable to care for self
      • seeks relationship as a source of care and support when one ends
      • unrealisticly preccocupied with fears of being left
  • Prevalence
    
    • 0.49%
    • more frequently diagnosed in women
  • Onset
    
    • should be used with caution if at all in children and adolescents
  • Differential
    
    • other mental disorders and medical conditions
    • other personality disorders and personality traits
    • personality change due to another medical condition
    • substance use disorders
  • Comorbidity

Answer 264

Dependent Personality Disorder

Question 266

• Three major sections
  
  • Introductin and how to use the DSM
  • Diagnostic criteria and codes
  • Emerging measures and models
    
    • Assessment toold
    • cultural formulation
    • alternative model for personality disorders
    • conditions for further study

Answer 266

DSM-V Structure

Question 268

Melancholic Features Depressive Specifier

Answer 268

• one of the following at most severe stage of episode
  
  • loss of pleasure
  • lack of reactivity
• three of the following
  
  • depressed mood
  • worse in morning
  • early-morning awakening
  • psychomotor agitation or retardation
  • weight loss
  • guilt

Question 270

According to DSM-5

• Characterized by clinically significant disturbance in cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
• Usually associated with significant distress or disability in social, occupational, or other important activities.
• Often viewed on a continuum

Answer 270

What is Psychopathology?

Question 272

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair-pulling, other body focused rep behaviors or other symptoms predominante in clinical picture
• lab findings show direct pahophysiological consequence of med condition
• not better explained by another mental disorder
• not during dilirium
• clinically significant distress
• specifiers
  
  • with obsessive-compulsive disorder-like symptoms
  • with appearance preoccupations
  • with hoarding symptoms
  • with hairpulling symptoms
  • with skin picking symptoms

Answer 272

Obesseive-Compulsive and Related Disorder due to Another Medical Condition

Question 273

• Trauma and Stress-Related Disorders
  
  • development of emotional or behavioral symptoms in response to idetifiable stressor occurring within 3 months of onset of the stressor
  • symptoms are clinically significant as evidenced by 1 or both:
    
    • marked distress out of proportion to the stressor taking into account context
    • significant impairment in functioning
  • impairment does not meet criteria for another mental disorder and is not an exacerbation of a preexisting mental disorder
  • do not represent normal bereavement
  • once the stressor has terminated, sympoms do not persist for more than 6 months

Answer 273

Adjustment Disorders

Question 274

Unspecified Depressive Disorder

Answer 274

• Depressive Disorder
  
  • full criteria for depressive disorder is not met
  • clinican chooses not to specify reason

Question 275

Obsessive-Compuslive Personality Disorder

DSM Criteria

Answer 275

• Cluster C
  
  • Diagnostic Certeria
    
    • pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood, indicated by 4 or more:
      
      • preoccupied with details, rules, lists, order, organization, schedules to the extent that major point of activity is lost
      • shows perfectionism that inferes with task completion
      • exvessively devotes to work and productivity to exclusion of leisure activities
      • overconscientious, scrupulous, and inflexible about matters of morality, ethics, or value
      • unable to discard worn-out or worthless objects even when that have no sentimental value
      • reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
      • adopts a miserly spending style
      • rigidity and stubbornness
  • Prevalence
    
    • 2.1%-7.9%
    • twice as often among males
  • Onset
  • Differential
    
    • OCD
    • hoarding disorder
    • other personality disorders and personality traits
    • personality change due to another medical conditiion
    • substance use disorders
  • Comorbidity

Question 276

Seasonal Pattern Depressive Specifier

Answer 276

• recurrent MDD
  
  • temporal relationship
  • full remissions
  • last two years demonstrate relationship
  • seasonal outnumber nonseasonal

Question 278

• cluster of cognitive, behavioral, physiological sympoms indicated that individual continuses using substance despite significant substance related problems
  
  • 10 classes (except caffeine)
  • underlying change in brain cercuits that may persist beyond detox espectially if sever
  • severe may benefit from long-erm approaches to treatment
  • Criterion
    
    • impaired control
    • social impent
    • risky use
    • pharmalogical criteria
  • Severity and Specifiers
    
    • based upon the number of symptom criteria endorsed
      
      • mild: 2 to 3 symptoms
      • moderate: four to five
      • sever: six or more
  • Example: moderate alpraxolam use disorder NOT moderate sedative use. name the actual substance
  • do not use the word addiction
  • substance use describes a wider range of behavior

Answer 278

Substance Use Disorder

Question 279

Avoidant Personality Disorder

DSM Criteria

Answer 279

• Cluster C
  
  • Diagnostic Certeria
    
    • pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivy to negative eval, beginning by early adulthood, indicated by 4 or more:
      
      • avoids occupational activties that involve significant interpersonal contact due to fear of criticism, disapproval, or rejection
      • unwilling to get invoved with people unless certain of being like
      • restrain in intimate relationships due to fear of being shamed
      • preoccupied with being criticized or reject in social situations
      • feelings of inadequacy in new interpersonal situations
      • views self as socially inept, unappeally, inferior
      • reluctant to take risks or enage in new activites
  • Prevalence
    
    • 2.4%
  • Onset
    
    • should be used with great caution in children and adolescents
    • may dissipate with age
  • Differential
    
    • anxiety disorders
    • other personality disorders and personliaty traits
    • personality change due to another medical change
    • substance use disorders
  • Comorbidity

Question 280

At this point, there were several different diagnostic systems

• Differed in emphasis on phenomenology, etiology, and course as defining features
• Some included only a handful of diagnostic categories; others thousands
• Differed with respect to whether the principle objective was clinical use, research, or statistics

A need for a classification to

• Minimized confusion
• Create consensus among the field
• Help mental health professionals communicate using a common diagnostic language
• (way for people to communicate within the field)

Answer 280

Why was there a need for a common diagnostic system?

Question 281

Substance/Medication-Induced Obsesive-Compulsive and Related Disorder

Answer 281

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair-pulling, other body focused rep behaviors or other symptoms predominante in clinical picture
• evidence in lab findings that
  
  • symptoms developed during or soon after meds
  • meds are capable of producing symptoms
• sympoms not better explained by ocd that is not substance induced
  
  • sympmoms did not precede onset
• not primarily during dilirium
  *

Question 282

Disruptive Mood Dysregulation

Answer 282

• Depressive Disorder (new to DSM 5)
  
  • recurrent temper outburts (verbal or behavioral)
  • inconsistent with developmental age
  • 3 or more times per week
  • persistently irritable or angry
  • present for 12 months or more
    
    • no period of 3 plus months without symptoms
  • 2 out of 3 settings
  • diagnosis made age 6-18
  • age of onset criteria before 10
  • no day with manic or hypermanic episode
• cannot be comord with
  
  • ODD
    
    • more of a mood component
      
      • most people with DMDD meet ODD, but not reverse
  • intermittant explosive
    
    • does not require persistent disruption of mood between bursts
  • bp
    
    • cannot have hypomanic or manic episode, persistent mood
• can be comorbid with
  
  • MDD, ADHD, CD, substance-abuse
• at risk to develop: unipolar depressive or anxiety disorders

Question 283

• waking from sleep in a state of panic

Answer 283

nocturnal panic attack

Question 285

• when an individual believes that he or she has exceptional abilities, wealth or fame

Answer 285

grandiose delusions

Question 286

• mood-congruent psychotic features
  
  • consistent with depressive themes
• mood-incongruent psychotic features
  
  • does not include typical depressive themes

Answer 286

Psychotic Features Depressive Specifier

Question 287

• Feeding and Eatin disorders
• Diagnostic Features
  
  • Persistent eating of nonnutritve, nonfood substances over a period of at least 1 month
  • inappropriate to developmental level
    
    • minimum of age 2 is suggested
  • not culturally supported or socially normative
• Prevalence
  
  • unclear
• Development and course
  
  • childhood onset is most common
    
    • in normally developing children
  • in adults
    
    • in intellectual disability
  • during pregnancy
• Gender
  
  • both, but only in females during pregnancy
• Differentials
  
  • AN
    
    • nonfood
  • Factitious D/O
    
    • intentional to have a physical symptom
  • Nonsuicidal self-injury and personality d/o
    
    • swallow items for self-harm
• Comorbidity
  
  • autism spectrum
  • intellectual disability

Answer 287

Pica

Question 288

• clinically significant impairment with symptoms related to bipolar and related disorders
  
  • criteria not fully met
• clinicians not to specify why the criteria has not fully been met

Answer 288

Unspecified Bipolar and Related Disorder

Question 289

DSM -V Criticisms

Answer 289

STRUCTURE

• Deleting the multiaxial system
• Legitimate disorders removed or remodeled (e.g., Asperger’s Disorder)
• “Clinically significant distress or impairment in social or occupational functioning” - Still no procedures to make this determination
• Remains a psychiatric “checklist” versus comprehensive assessment

IMPLICATIONS of DX

• Increasing tendency to “medicalize” patterns of behavior and mood that are not considered to be particularly extreme
• Pathologizing normal behavior (e.g., the argument of Disruptive Mood Disregulation Disorder being akin to temper tantrum disorder)
• Changes make it easy to diagnose sub-clinical disorders (e.g., changes to Bipolar Disorder, dropping bereavement exclusion for depressive disorders)
• Conversely, DSM-5 is normalizing pathological behaviors (e.g., some construe DSM-5 is normalizing pedophilia)

INFLUENCES

• Undue influence of politics, pharmaceutical industry, research grants
• Sacrificing science, i.e., over-relying on reliability at the sake of validity

Question 290

Panic Disorder

Answer 290

• Anxiety Disorders
• Recurrent unexpected panic attacks
  
  • Panic attack
    
    • abrupt surge of intense fear or discomfort that reaches a peak within minues with 4 or more of the following symptoms
      
      • palpitations
      • sweating
      • trembling
      • shortness of breath
      • chest pain
      • nausea
      • dizziness
      • chills or heat
      • paresthesias
      • derealization
      • fear of losing control
      • fear of dying
• at least one attacks has been followed by 1 month of one or both:
  
  • persistent worry about additional panic attacks
  • maladaptive change in behavior related to attacks

Question 291

with excessive acquisition specifier

Answer 291

• hoarding specifier
  
  • if difficulty discardting is accompanied by excessive aquisition that is not need need or for which there is no space
  • 80-90%

Question 293

somatic delusions

Answer 293

• focus on preoccupations regarding health and organ functions

Question 294

Substance Intoxication and Withdrawal

Answer 294

*

Question 295

Other Specified Obsessive-Compuslve and Related Disorded

Answer 295

• Body dysmorphic-like disorder with actual flaws
  
  • the flaws are observable by others
• body dysmorphic-like disorder without repetitive behaviors
  
  • not performed repetitive behaviors or mental acts in response to appearance concerns
• body-focuses repetitive hahavior disorder
  
  • recurrent body focused repetitive behavior and attempts to decrease or stop
• obsessional jealousy
  
  • percieved infidelity leading to repeated behaviors
• Shubo-kyofu
  
  • fear of having a body deformity
• Koro
  
  • sudden anxiety that the penis will decede into the body
• Jikoshu-kyofu
  
  • fear of having an offensive body odor

Question 296

• during pregnancy or 4 weeks after delivery
• can be with or without psychotic features

Answer 296

Peripartum Onset Depressive Specifier

Question 297

• Disorders
  
  • Avoidant
  • Dependent
  • Obsessive-Compulsive
• Characteristics
  
  • anxious
  • fearful
• Prevalence
  
  • 9.1%

Answer 297

Personality Disorders Cluster C

Question 298

• With dissociative symptoms
  
  • Depersonalization
    
    • feeling detached from mental processes or body, as if in a dream, unreality of self or body
  • Derealization
    
    • unreality of surroundings
• delayed expression
  
  • full criteria not met until 6 months after event

Answer 298

PTSD Specifiers

Question 299

• Schizophrenia Spectrum and Other Psychotic Disorders
• fixed beliefs that are not amenable to change in light of conflicting evidence.
• deemed bizarre
  
  • if clearly implausible and not understandable
• thought withdrawal
  
  • express a loss of control over mind or body are bizzarre
  • include the belived that one’s thoughts have been removed by some outside force
• delusions of control
  
  • actions are being acted on or manipulated by some outside force

Answer 299

Delusions

Question 300

• recognizes the beliefs are probably not true

Answer 300

with good or fair insight specifier

Question 301

Selective Mutism

Answer 301

• Anxiety Disorder
• consistent failure to speak in specific social situations where there is an expectation to speak despite speaking in other situations
• interferes with educational, occupational, or social
• at least 1 month (not limited to first month of school)
• not attributed to lack of knowledge
• not explained by communication d/o
• Age of onset
  
  • usually before 5
• Prevalence
  
  • 0.03-1% depending on the setting
• Gender difference
  
  • does not vary by gender

Question 302

• Chronic and recurrent syndromes of mixed dissociate symptoms
  
  • identity disturbance associated with less than marked discontinuities in sense of self and agency or alteratios of identities or episodes of possession in an individual who reports no dissociative amensia
• Identity disturbance due to prolonged and intense coercive persuasion
  
  • individuals who have been subjected to intest persuasion (brainwashing, thought reform, etc) may present with prolonged changes in, or conscious questioning of, their identity
• Acute dissociative reaction to stressful events
  
  • for acute, transcient conditions that typically last less than 1 month, and sometimes only a few hours or days
  • conditions are characterized by constriction of consciousness; depersonalization; derealization, etc
• Dissociative trance
  
  • acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli

Answer 302

Other Specified Dissociative Disorder

Question 303

• previously Factious disorder by proxy
  
  • falsification of physical or psychological signs or symptoms, or induction of injury or disease, IN ANOTHER, associated with identified deception
  • presents another individual (victim) to others as ill, impaired, or injured
  • deceptive behavior is evident even in absence of obvious external rewards
  • perpetrator receives diagnosis

Answer 303

Factitious Disorder Imposed In Another

Question 304

• Multi-axial system eliminated
  
  • Removes artificial distinctions between medical and mental disorders
• “Not otherwise specified” (NOS) eliminated
  
  • New option Not Elsewhere Classified includes specifiers of why condition does not meet a more specific disorder
• Organization of chapters
  
  • to demonstrate how disorders relate to one another
• Addresses age and development as a part of diagnosis and classification
• Culture discussed more explicitly to bring greater attention to cultural cariations
  
  • Outline for cultural formation
  • Framework for assessing cultural features of a client’s problem

Answer 304

Major changes of DSM V

Question 305

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair-pulling, other body focused rep behaviors or other symptoms predominante in clinical picture
• evidence in lab findings that
  
  • symptoms developed during or soon after meds
  • meds are capable of producing symptoms
• sympoms not better explained by ocd that is not substance induced
  
  • sympmoms did not precede onset
• not primarily during dilirium
  *

Answer 305

Substance/Medication-Induced Obsesive-Compulsive and Related Disorder

Question 306

Hallucinations

Answer 306

• perception-like experiences that occur wuthout an external stimulus
• vivid and clear, with the full force and impact of normal perceptions and not under voluntary control
• auditory
• must occur in the context of a clear sensorium
• within normal experience or part of religious experience
  
  • hyponagogic
    
    • while falling asleep
  • hypnopompic
    
    • waking up

Question 307

• Disorders
  
  • Paranoid
  • Schizoid
  • Schizotypal
• Characteristics
  
  • odd or eccentric
• Prevalence
  
  • 5.7%

Answer 307

Personality Disorders Cluster A

Question 308

• with depressed mood
  
  • low mood, tearfulness, or feelings of hopelessness
• with anxiety
  
  • nervousness, worry, seperation anxiety
• with mixed anxiety and depressed mood
  
  • combo of the above
• with disturbance of conduct
  
  • disturbance of conduct
• with mixed disturbance of emotions and conduct
  
  • both emotional symptoms and conduct
• unspecified
  
  • maladaptive reactions that are not classifiable as one of the above

Answer 308

Adjustment Disorder Specifiers

Question 309

Unspecified Bipolar and Related Disorder

Answer 309

• clinically significant impairment with symptoms related to bipolar and related disorders
  
  • criteria not fully met
• clinicians not to specify why the criteria has not fully been met

Question 310

Brief Psychotic Disorder

DSM Criteria

Answer 310

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • Presence of one or more of the following (has to be at least 1,2, or 3)
      
      • delusions
      • hallucinations
      • disorganized speech
      • grossly disorganized or catatonic behavior
    • episode is 1 day to 1 month and then returns to ful functioning
    • not better explained by major depressive or bipolar disorder
  • Specifiers
    
    • marked stressor
    • without marked stressor
    • with postpartum onset
    • with catatonia
    • severity
  • Onset
    
    • adolesence or early adulthood
    • average age being mid 30s
  • Prevalence
    
    • 9%
      
      • more common in developing countries
      • 2:1 females to males
      • be aware of culture
  • Differentials
    
    • other med conditions
    • substance related disorders
    • depressive and bipolar disoders
    • other psychotic disorders
    • malingering and facticious
    • personality disorders
  • Comorbid

Question 311

Other Specificied Depressive Disorder

Answer 311

• Depressive Disorder
  
  • depressive symptoms with clinically significant distress
    
    • do not feel full criteria for any of the disorders
  • specificers
    
    • recurrent brief depression
      
      • depressed mood and four other symptoms
      • 2-13 days per month
    • short duration depressive episode (4-13 days)
      
      • depressed affect and 4 of the 8 symptoms for depresive episode
    • Depressive episode with insufficient symptoms
      
      • depressed affect and 1 of the 8 symptoms for DE

Question 312

• Mild
  
  • few symptoms
  • manageable
• Moderate
  
  • between mild and severe in symptoms and ability to manage
• Severe
  
  • symptoms substantially in excess of those needed to qualify
  • high impairment

Answer 312

Severity Depressive Specifier

Question 313

• Diagnostic Criteria
  
  • Over a period of 6 months
    
    • recurrent and intense sexual arousal from observing an unsuspecting person who is naked, taking off their clothes, engaging in sexual activities, as manifested by fantasies, urges, or behaviors
    • has acted on urges with nonconsentingperson, or sexual urges or fantasies cause clinically significant distress or impairment…
    • must be at least 18
• Specifiers
  
  • in a controlled environment
    
    • living in institutional setting or restricted
  • in full remission
    
    • for at least 5 years
• Prevalence
  
  • 12% in males and 4% in females
  • 3:1 male to female
• Development and Course
  
  • must be at least 18
  • likely to vary with age
• Differentials
  
  • conduct disorder and antisocial personality disorder
  • substance use disorders
• Comorbidity
  
  • hypersexuality
  • other paraphilic disorders: exhibitionistic disorder
  • depressive, biopolar, anxiety, substance use disorder
  • ADHD, conduct, and antisocial personality disorder

Answer 313

Voyeuristic Disorder

Question 314

Substance/Medication Induced Depressive Disorder

Answer 314

• Depressive Disorder
  
  • persistent disturbance in mood that predomintate in clinical picture
    
    • depressed mood or interest loss
  • Findings show
    
    • developed during substance intoxication or withdrawal
    • substance is capable of producing symptoms
  • not exclusively during delirium
  • mild substance use disorder is comorbid–> 1 as 4th character
  • moderate/severe substance use disorder is comorbid –> 2 as 4th character
  • no comorbid substance use disorder–> 9 as 4th character
  • Specifiers:
    
    • onset during intoxication or withdrawal

Question 315

• at least 2 years (1 if you are a child or adolescent)
  
  • numerous periods with hypomanic symptoms not meeting criteria for episode
    
    • insufficient number, severity, pervasiveness, or duration
  • numerous periods with depressive symptoms not meeting criteria for episode
    
    • insufficient number, severity, pervasiveness, or duration
  • where both of these symptoms have been present half of time and not without symptoms for 2 months
  • clinically significant distress must be present
• never met criteria for major depressive, manic, or hypomanic episode
  
  • upon the occurence of these: a disorder change is due

Answer 315

Cyclothymic Disorder

Question 317

• repetitive, seemingly, driven, non functional motor behavior
  
  • premotor sensory urges

Answer 317

stereotyped movement

Question 318

DSM-I

Answer 318

• US armed forces wanted a guide for diagnosis of servicemen
• Developed by American Psychiatric Association
• Variant of ICD-6
• 106 disorders or “reactions” (to enviornment)
• Only one diagnosis could be applied to children
• Focus on clinical utility
  
  • 3 categories of psychopathology
  • organic brain syndromes
  • functional disorders (impair in everyday life)
  • mental deficiency (cognitive/attentional)

Question 319

• Coordinated with development if ICD-9
• Changes from DSM II
  
  • 265 disorders
  • Multiaxial classification system
• Aim to produce a science-driven document (as opposed to psychodynamic)
• Work on construction and validation of criteria
• development of semistructured interviews
• Biology and genetics played a key role
• This was revised

Answer 319

DSM-III

Question 320

Cultural improvements from DSM IV to DSM V

Answer 320

• IV:
  
  • listed 25 “culture bound syndromes”
  • list was heterogeneous
• V:
  
  • now a “Glossary of Cultural Concepts of Distess”
    
    • Lists 9 of the best studied concepts
  • Section III includes chapter on cultural formulation

Question 321

What did research on the OCF (from the DSM-IV) find?

Answer 321

• Psychotic patients
  
  • —Misdiagnosis for psychotic patients occurred with patients from all ethno-cultural groups, especially recently settled immigrants.
  • —After using the CF, 49% of the patients with an intake diagnosis of psychotic disorder were re-diagnosed as non-psychotic and 5 % of the patients with a referral diagnosis of non-psychotic disorder were diagnosed as having a psychotic disorder.
• Non-psychotic patients
  
  • —Adding the CFI to ordinary psychiatric diagnosing led to major revisions of diagnosis for 56% of patients
    —Many in anxiety disorders, especially PTSD

Question 322

• Presense of obsessions, compulsions, or both
  
  • Obsessions
    
    • recurrent and persistent thoughts, urges, or images that are experienced, cause unwanted distress or anxiety
  • Compulsions
    
    • repititve behaviors
    • preventing and reducing anxiety
  • time consuming (1 hr per day)
  • not attributable to substance
  • not due to medical condition
  • specify if
    
    • with good or fair insight
      
      • recognizes beliefs are noth true
    • with poor insight
      
      • believes beliefs are probably true true
    • with absent insight/delusional beliefs
      
      • completely convinced that beliefs are true
    • tic related
      
      • current or past history of tic disorder

Answer 322

Obsessive-Compulsive Disorder

Question 323

Panic Attack Specifier

Answer 323

• presented for the purposes of identifying a panic attack–> not a mental disorder, noted as a specifier
• abrupt surge of intense fear or discomfort that reaches a peak within minues with 4 or more of the following symptoms
  
  • palpitations
  • sweating
  • trembling
  • shortness of breath
  • chest pain
  • nausea
  • dizziness
  • chills or heat
  • paresthesias
  • derealization
  • fear of losing control
  • fear of dying

Question 324

• focus on preoccupations regarding health and organ functions

Answer 324

somatic delusions

Question 325

Other Specified Dissociative Disorder

Answer 325

• Chronic and recurrent syndromes of mixed dissociate symptoms
  
  • identity disturbance associated with less than marked discontinuities in sense of self and agency or alteratios of identities or episodes of possession in an individual who reports no dissociative amensia
• Identity disturbance due to prolonged and intense coercive persuasion
  
  • individuals who have been subjected to intest persuasion (brainwashing, thought reform, etc) may present with prolonged changes in, or conscious questioning of, their identity
• Acute dissociative reaction to stressful events
  
  • for acute, transcient conditions that typically last less than 1 month, and sometimes only a few hours or days
  • conditions are characterized by constriction of consciousness; depersonalization; derealization, etc
• Dissociative trance
  
  • acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli

Question 326

Adjustment Disorder Specifiers

Answer 326

• with depressed mood
  
  • low mood, tearfulness, or feelings of hopelessness
• with anxiety
  
  • nervousness, worry, seperation anxiety
• with mixed anxiety and depressed mood
  
  • combo of the above
• with disturbance of conduct
  
  • disturbance of conduct
• with mixed disturbance of emotions and conduct
  
  • both emotional symptoms and conduct
• unspecified
  
  • maladaptive reactions that are not classifiable as one of the above

Question 327

• Schizophrenia Spectrum and other psychotic disorders
  
  • diagnostic criteria
    
    • one or more delusions with a duration of 1 month or longer
    • schizophrenia has never been met
      
      • hallucinations are not prominent and are related to delusional theme
    • function is not markedly impaired
    • if manic or major depressive episode has occured, have been brief relative to the duration of delusional periods
  • prevalence
    
    • 0.2%
      
      • percusatory is the most frequent subtype
      • delusional, jealous,
        
        • more frequent in men
      • cultural context must be taken into consideration
  • ontset
    
    • can occur in younger age groups, usually more prevalent in older individuals
  • differentials
    
    • ocd and related disorders
    • delirum, major neurocognitive disorder, psychotic disorder due to another med condition, and substance-induced psychotic disorder
    • schizophrenia and schizophreniform disorder
    • depressive and bipolar disorders and schizoaffective disorders
  • comorbid
  • subtypes
    
    • erotomanic type
      
      • central theme of delusion is that another person is in love with them
    • grandiose type
      
      • conviction of having some great (but unrecognized) talen or insight or having made some important discovery
    • jealous type
      
      • his or her spouse is unfaithful
    • persecutory type
      
      • the individuals belief that he or she is being conspired against, cheated, spied on… in the pursuit of longterm goals
    • somatic type
      
      • bodily functions or sensations
    • mixed type
      
      • no one delusional theme predominates
    • unspecified
      
      • belief cannot be clearly determined
    • with bizarre content
      
      • they are clearly implausible, not understandable, and not derived from ordinary life experiences
  • specifiers
    
    • after 1 year duration with disorder
      
      • first episode, currently in acute episode
      • first episode, currently in partial remisison
      • first episode, currently in full remission
      • mutiple epsidsodes with same as above
      • continuous
      • unspecified
      • severity

Answer 327

Schizotypal (Personality) Disorder

DSM Criteria

Question 328

Other Specified Bipolar and Related Disorder

Answer 328

• presentation and symptoms of bipolar disorders, but do not meet full criteria
• clinician states why it does not meet full criteria
• Examples of presentations
  
  • short-duration hypomanic episodes (2-3 days) and major depressive episodes
    
    • meet full criteria for hypomanic, but short
    • do not overlap in time with major depressive episode (at least one lifetime history)
  • hypomanic episodes with insufficient symptoms and major depressive episodes
    
    • at least one lifetime history of MDE
    • hypomanic episode do not meet full criteria, but experienced one or more
    • hypomanic symptoms do not overlap with MDE
  • hypomanic episode without prior major depressive episode
    
    • never met full criteria for MDE or manic episode
  • short-duration cyclthymia
    
    • multiple episodes of hypomanic (not meeting criteria)
    • multiple episodes of MDE (not meeting criteria)
    • less than 2 years for adults or 1 for kids

Question 329

Personality Disorders Cluster A

Answer 329

• Disorders
  
  • Paranoid
  • Schizoid
  • Schizotypal
• Characteristics
  
  • odd or eccentric
• Prevalence
  
  • 5.7%

Question 330

• A pattern of excessive emotionality and attention seeking

Answer 330

Histrionic Personality Disorder

Question 332

• characterized by symptomatic presentation equivalent to that of schizophrenia except the duration (less than 6 months) and the absense of the requirement of the decline in functioning

Answer 332

Schizophreniform Disorder

Question 333

• Depressive Disorder
  
  • depressed mood or loss of interest the predominates clinical picture
  • findings suggest it is a direct pathophysiological consequence of med condition
  • no exclusively during delirium
  • Specifiers
    
    • depressive features
    • major-depressive like features
    • mixed features
  • considerations
    
    • temporal
    • features atypical to mood disorder

Answer 333

Depressive Disorder Due to Another Medical Condition

Question 334

Substance Use Disorder

Answer 334

• cluster of cognitive, behavioral, physiological sympoms indicated that individual continuses using substance despite significant substance related problems
  
  • 10 classes (except caffeine)
  • underlying change in brain cercuits that may persist beyond detox espectially if sever
  • severe may benefit from long-erm approaches to treatment
  • Criterion
    
    • impaired control
    • social impent
    • risky use
    • pharmalogical criteria
  • Severity and Specifiers
    
    • based upon the number of symptom criteria endorsed
      
      • mild: 2 to 3 symptoms
      • moderate: four to five
      • sever: six or more
  • Example: moderate alpraxolam use disorder NOT moderate sedative use. name the actual substance
  • do not use the word addiction
  • substance use describes a wider range of behavior

Question 335

Adjustment Disorders

Answer 335

• Trauma and Stress-Related Disorders
  
  • development of emotional or behavioral symptoms in response to idetifiable stressor occurring within 3 months of onset of the stressor
  • symptoms are clinically significant as evidenced by 1 or both:
    
    • marked distress out of proportion to the stressor taking into account context
    • significant impairment in functioning
  • impairment does not meet criteria for another mental disorder and is not an exacerbation of a preexisting mental disorder
  • do not represent normal bereavement
  • once the stressor has terminated, sympoms do not persist for more than 6 months
  • Prevalence
    
    • 5-20% in outpatient
    • 50% in hospital (used as a catch all)
  • Gender differences
    
    • not in DSM

Question 336

• experiences of unreality or detachment from one’s mind, self or body (depersonalization)
• experienct of unreality or detachment from one’s surroundings (derealization)
• intact reality testing
• no evidenct of any distinction between individuals with predominantly depersonalization vs derealization
  
  • can have one or the other or both

Answer 336

Depersonalization/Derealization

Question 337

• Anxiety Disorders
• Marked fear or anxiety about 2 or more of the following:
  
  • public transportation
  • open spaces
  • enclosed spaces
  • standing in line or in a crowd
  • outside of the home alone
• Individual avoids these situations because of thoughts that escape might be difficult or help might be difficult in the event of panic like symptoms
• situations provoke fear
• actively avoided, require companion
• out of proportion
• 6 months or more
• diagnosed irrespective of panic disorder

Answer 337

Agoraphobia

Question 338

Body Dysmorphic Disorder

Answer 338

• Obsessive Compulsive and Related Disorders
  
  • preoccupation with one or ore defects or flaws in physical appearance that or not observable to others
  • performced repetitive behaviors or mental acts in response to concern
  • clinically significant distress
  • not better explained by concerns with body fat or weigh in an individual whose diagnositic symptoms meet criteria for an eat disorder
  • specify if
    
    • with muscle dysmorphia
      
      • preoccupied with the idea that body is insufficiently muscular

Question 339

• Disorders
  
  • antisocial
  • borderline
  • histrionic
  • narcissistic
• Characteristics
  
  • dramatic
  • emotional eratic
• Prevalence
  
  • 6%

Answer 339

Personality Disorders Cluster B

Question 340

• Anxiety Disorder
• fear or anxiety in one or more social situations in which the individual is exposed to scrutiny of others
  
  • with children must occur with peers, not just adults
• fears they will act in a way that will show anxiety symptoms and will be negatively evaluated
• social situations provoke anxiety
• social situations are avoided or endured with intense fear
• out or proportion
• lasting 6 or more months
• specifier:
  
  • performance only

Answer 340

Social Anxiety Disorder (Social Phobia)

Question 341

Schizophrenia

Answer 341

• Schizophrenia and Other Psychotic Disorders
  
  • Diagnostic Criteria
    
    • two or more of the following, each present for a significant portion of the time during a 1 month period. At least 1, 2, or 3
      
      • Delusions
      • Hallucinations
      • Disorganized Speech
      • Grossly disorganized or catatonic behavior
      • Negative symptoms
    • level of functioning in one or more areas is markedly below the level of achieved prior to onset
    • continuous signs of disturbance persist for at least 6 months
      
      • must include at least 1 month of symptoms thtat meet Criterion A
    • schizoaffective, bipolar with psychotic features, and depressive have been ruled out
    • if history of ASD or communication disorder, the additional schizophrenia diagnosis is only made if prominent delusions
  • Specifiers
    
    • first episode, currently in acute episode (etc.)
    • with catatonia
    • severity
  • Onset
    
    • late teends and the mid 30s
      
      • prior to adolescence is rare
      • peak age for first psychotic episode is early to mid 20s for males and late 20s for females
  • Prevalence
    
    • 0.3-0.7%
    • variations by race/ethnicity
    • negative symptoms/longer duration higher in males
    • mood symptoms and brief presentations equivalent in both
  • Differentials
    
    • major depressive or bipolar with psychotic or catatonic features
    • schizoaffective
    • schizophreniform
    • delusional disorder
    • schizotypal personality disorder
    • obessive complusive disorder and BDD
    • PTSD
    • ASD or communication disorder
  • Comorbid
    
    • substance abuse (over half)
    • anxiety disorders
  • other
    
    • 5-6% commit suicide
    • 20% attempt suicide
    • life expectancy is reduced

Question 342

• A pattern of gradiosity, need for admiration, and a lack of empathy

Answer 342

Narcissistic Personality Disorder

Question 343

Borderline Personality Disorder

Answer 343

• A pattern of instability in interpersonal relationships, -image, and affects, and marked impulsivity

Question 344

• Obsessive-Compulsive and Related Disorders
  
  • Persistent Difficulty discarding possessions regardless of value
  • due to need to save items and distress associated with discarding
  • results in accumulation of possessions and compromises living and if uncluttered it is only due to third parties
  • clinically significant distress–> cannot maitain safe enviro
  • specifiy if
    
    • with excessive aquisition
      
      • if difficulty discardting is accompanied by excessive aquisition that is not need need or for which there is no space

Answer 344

Hoarding Disorder

Question 345

What is the purpose of the DSM?

Answer 345

• Intended to serve as a practical, funcitonal, and flexible guide for organizing informaiton that can aid in teh accurate diagnosis and treatmet of mental disorders.
• Information is of value to all professionals associated with various aspects of mental health care.
• Tool for collecting and communicating accurate publiv health statistics on mental disorder morbidity and mortality

Question 346

Obsessions

Answer 346

• recurrent and persistent thoughts, urges or images that are experiences as intrusive and unwanted

Question 347

• US armed forces wanted a guide for diagnosis of servicemen
• Developed by American Psychiatric Association
• Variant of ICD-6
• 106 disorders or “reactions” (to enviornment)
• Only one diagnosis could be applied to children
• Focus on clinical utility
  
  • 3 categories of psychopathology
  • organic brain syndromes
  • functional disorders (impair in everyday life)
  • mental deficiency (cognitive/attentional)

Answer 347

DSM-I

Question 348

Disinhibited Social Engagement Disorder

Answer 348

• Trauma and Stressor-Related Disorder
  
  • Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits 2:
    
    • reduced hesitance in approaching or interacting with unfamiliar adults
    • overly familiar verbal or physical behavior
    • diminished checking with adult caregiver
    • willingness to go off with unfamiliar adult with minimal or no hesitation
  • not limited to impulsivity
  • experienced pattern of extremes of insufficient care as evidenced by
    
    • social neglect or deprivation in lack of having basic emotional needs met
    • repeated changes in primary caregiver
    • rearing in unusual settings
  • care is presumed responsible for the disturbed behavior
  • developmental age of at least 9 months
• specify if
  
  • persistent
  • severe

Question 349

Active Avoidance

Answer 349

• individual intentionally behaves in ways that are designed to prevent or minimize contact with phobic objects or situations

Question 350

anticipation of future threat

Answer 350

Anxiety

Question 351

• Feeding and Eating Disorders
  
  • Dignostic Criteria
    
    • Restriction of energy intake relative to requirements, leading to signifanctly low body weight (less than minimally normal)
    • intense fear of gaining weight or becoming fat, or persistant behavior that interferes with weight gain
    • disturbance in the way in which one’s body weight or shape is experience, lack of recognition of seriousness of the curren low body weight
    • specify
      
      • in partial remission or full remission
    • subtypes
      
      • binge-eating/purging type
        
        • binge eat also purge
      • restricting
        
        • last 3 months, not engaged binge-purge, primarily though dieting, fasting, or exercise
    • Severity
      
      • mild: BMI > 17
      • moderate: BMI 16-16.99
      • severe: BMI 15-15.99
      • extreme: BMI
  • Prevalence
    
    • 0.4%
  • Onset
    
    • commonly begins during adolesence
    • rarely begins before puberty or after 40
  • Gender
    
    • occurs across cultures
      
      • post-industrialized societies
  • Differentials
    
    • Medical conditions
    • MDD
    • schizo
    • substance use
    • Social anxiety
    • BN
    • Avoidant/restrictive food intake
  • Comorbidity
    
    • bipolar
    • depressive
    • anxiety

Answer 351

Anorexia Nervosa

Question 352

• Trauma and Stressor-Related Disorder
  
  • Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits 2:
    
    • reduced hesitance in approaching or interacting with unfamiliar adults
    • overly familiar verbal or physical behavior
    • diminished checking with adult caregiver
    • willingness to go off with unfamiliar adult with minimal or no hesitation
  • not limited to impulsivity
  • experienced pattern of extremes of insufficient care as evidenced by
    
    • social neglect or deprivation in lack of having basic emotional needs met
    • repeated changes in primary caregiver
    • rearing in unusual settings
  • care is presumed responsible for the disturbed behavior
  • developmental age of at least 9 months
• specify if
  
  • persistent
  • severe
• prevalence
  
  • unknown
  • 20% in very, very high risk populations
• Age of onset
  
  • must be at least 9 months
• Gender differences
  
  • none listed

Answer 352

Disinhibited Social Engagement Disorder

Question 353

Sexual Sadism Disorder

Answer 353

• Diagnostic Criteria
  
  • Over a period of 6 months
    
    • recurrent and intense sexual arousal from the physical or phsychological suffering of another person, as manifested by fantasies, urges or behaviors
    • acted on urges with a nonconsenting person, or urges or fantasies cause clinically significant distress
• Specifiers
  
  • in a controlled environment
  • in full remission
• Prevalence
  
  • 2 to 30%
  • less tha 10% among sexual offenders
• Development
  
  • aware as young adults
  • mean age is 19.4

Question 354

• convinced the beliefs are true

Answer 354

with absent/delusional belief specifier

Question 355

What is Psychopathology not?

Answer 355

• An expectable or culturally approved response to a common stressor or loss
• Socially deviant behavior (e.g., political, religious, or sexual) and/or conflicts that are primarily between the individual and society, unless the deviance or conflict results from a dysfunction in the individual

Question 356

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria (previously hypochondiasis)
    
    • preoccupation with having serious illness
    • somatic symptoms not present, or if present they are mild. if med condition is presentm the preoccupation is excessive
    • high level of anxiety about health and easily alarmed about personal health status
    • performs excessive health related behaviors or exhibits maladaptive avoidance
    • present for last 6 months, but specific illness may change
    • Specify if
      
      • care-seeking
        
        • medical care frequently used
      • care avoidant
        
        • medical care rarely used
  • Prevalence
    
    • 1.3-10%
    • or 3-8% for 6 months
  • Onset
    
    • generally thought to be chronic relapsing
    • increases with age
  • Gender
  • Differentials
    
    • other med conditions
    • somatic symptom
    • anxiety disorders
    • OCD
    • MDD
    • psychotic
  • Comorbidity
    
    • anxiety and depressive

Answer 356

Illness Anxiety Disorder

Question 357

Other specified Feeding or Eating Disorder

Answer 357

• Atypical AN
  
  • all criteria are met for AN are met except that despite significant weight loss, individuals weight is within normal range
• Bulimia Nervosa (of low frequency and/or limited duration)
  
  • All criteria are met except, binge eating and compensatory behaviors occur, on average less than once a week and or less than 3 months
• BED (of low frequency and/or limited duration)
  
  • All criteria are met except, except binge eating behaviors occur on average less than once a week and or less than 3 months
• Purging Disorder
  
  • recurrent purging to influence weight or shape with the absense of binge eating

Question 358

Objective of CFI

Answer 358

• reflect a more inclusive description of the range of psychopathology across the globe, not just the particular constructs or exemplars most commonly encountered in the US, Western Europe, and Canada.
• to help avoid misdiagnosis
• improve raport
• obtain clinically useful information
• therapeutic efficacy
• guide research
• clarify cultural epidemiology

Question 359

Other Specified Trauma Stressor-Relate Disorder

Answer 359

• Adjustment-like disorder with delayed onset of symptoms that occur more than 3 months after the stress
• Adjustment like disorder with prolonged duration of more than 6 months without prolonged duration of stressor
• Ataque de nervios
• Other cultural syndromes
• persistent complex bereavement disorder
  
  • severe and persistent grief and mourning reactions

Question 360

Avoidant Personality Disorder

Answer 360

• A pattern of social inhibition, feelings of inadequacy, and hypersensitive to negative evaluation

Question 361

• Somatic Symptom and Related Disorders
  
  • Diagnostic Criteria
    
    • falsification of physical signs or symptoms, or induction of injury or dease, associated with identified deception
    • presents themself as ill, injured, or impaired
    • deceptive behavior is evident even in the absence of obvious external rewards
    • specify
      
      • single episode
      • recurrent episodes
  • Prevalence
    
    • unknown, but probably 1%
    • single episodes are less common
  • Onset
    
    • usually during early adulthood, often after hospitalization
  • Gender
  • Differentials
    
    • somatic symptom disorder
    • malingering
    • conversion disorder
    • borderline personality disorder
    • medical condition not associated with intentional symptom falsification
  • Comorbidity

Answer 361

Factitious Disorder

Question 362

Rumination Disorder

Answer 362

• Feeding and Eating Disorders
  
  • Diagnostic Criteria
    
    • repeated regurgitation of food over a period of 1 month (several times a week, typically daily)
      
      • may be re-chewed, reswallowed, or spit-out
    • not associated with gastrointestinal or medical condition
    • no excuslively with AN, BN, or avoidant or restrictive food intake
    • specify if
      
      • in remission
        
        • after full criteria was met, but has not been met for a sustained period of time
  • Prevalence/Onset
    
    • typically higher in individuals with intellectual disability
    • can occur during infancy, childhood, adolescence, adulthood
      
      • infancy: 3-12 months and remits spontaneously, but can be fatal
        
        • appears self-soothing
  • Gender
  • Differentials
    
    • gastrointestinal conditions
    • AN or BN
  • Comorbidity
    
    • concurrent med condition
    • anxiety

Question 363

• Trauma and stressor-related Disorders
  
  • exposure to actual or threatened death serious injury, or sexual violence in 1 or more
    
    • direct experience
    • witness occurring to others
    • learning occured to close friend or family
    • experiencing repeated or extreme exposure to details of event
      
      • does not relate to media unless work related
  • 1 or more of the following after event
    
    • recurrent, distressing memories of event
      
      • child: repititive play
    • recurrent, distressing dreams
      
      • child: frightening dreams without recognizeable content
    • dissociate reactions, loss of awareness of present surroundings
      
      • child: reenactment
    • intense or prolonged psychological distress at exposure to internal or external cues that symbolize aspect of event
    • marked physiological reaction
• persistent avoidance of stimuli associated with event
  
  • memories, thoughts, or feelings
  • external reminders
• Negative alterations in cognitions and mood as evidenced by 2:
  
  • inability to remember an important aspect of event
  • persistent or exaggerated negative beliefs about oneself
  • distorted cognitions about the cause of event
  • diminshed interest in activities
  • feelings of detachment
  • inability to experience positive emotions
• alterations in arousal and reactivity with even in 2:
  
  • irritability or angry outburst
  • self-destructive behavior
  • hypervigilence
  • exaggerated startle response
  • difficulty concentrating
  • sleep disturbance
• distrubance is more than 1 month
• not attributable to substance

Answer 363

Posttraumatic Stress Disorder (6 and older)

Question 364

• belief that one is going to be harmed, harrassed, by an individual, organization etc.
• most common delusion

Answer 364

Persecutory Delusions