Unusual DSM diagnoses

Question 1

Chronic fatigue syndrome

Answer 1

Decline in energy with no clear medical etiology
- diagnosed after 6 months of severe fatigue
- poor sleep, muscle pain, headaches, impaired memory or concentration, joint pain, postexertive malaise laster longer than 24 hours and an improvement in symptoms when lying down. Can present with flu like symptoms
- 80% have comorbid depression
Treatment: graded exercise theory and CBT
- Avoid aggressive exercise
- Medications have not been shown to be effective

Question 2

Disinhibited social engagement disorder

Answer 2

a child actively approaches and interacts with unfamiliar adults
- child has experienced a pattern of insufficient care

Question 3

Reactive attachment disorder

Answer 3

pattern of inhibited, emotionally withdrawn behavior toward adults and minimal social or emotional responsiveness toward others.
- history of insufficient care

Question 4

Rumination disorder

Answer 4

repeated regurgitation of food

Question 5

seasonal pattern specifier added to bp1 and bp2 and MDD

Answer 5

depressive symptoms that occur at a certain time of the year with complete remission of symptoms at other times of the year

• often characterized by hypersomnia, hyperphagia, and psychomotor slowing
• 2 episodes during the same season of the previous 2 year
• seasonal depressive episodes must substantially outnumber nonseasonally related depressive episodes during lifetime
• associated with carb craving
• light therapy most effective in morning (can precipitate hypomania)
• thought to be related to abnormal melatonin metabolism

Question 6

Cyclothymia

Answer 6

less severe form of bipolar, alternation between hypomania and moderate depression (do not meet full criteria for hypomania or MDD)

• exists for 2 years to make diagnosis
• equally common in men and women
• substance use often cooccurs
• occurs late adolescence/early adulthood

Question 7

dysthymic disorder

Answer 7

decreased mood over a 2 year period

2 or more of the following
with poor appetite or overeating, sleep problems, fatigue, low self-esteem, poor concentration and feeling of hopelessness

during 2 year must never be without symptoms for 2 months at a time

Question 8

intermittent explosive disorder

Answer 8

recurrent behavioral outbursts representing a failure to control aggressive impulses

• verbal aggression or physical aggression toward property occurring twice weekly for 3 months
• may include 3 behavioral outburst involving damaging property or physical assault within 12 month period
• magnitude out of proportion to stressor

Question 9

frotteuristic disorder

Answer 9

over a period of at least 6 month, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person
- the individual has acted on these urges with nonconsenting person or the urges casue distress/impairment

Question 10

Kleptomania is in what part of DSM5

Answer 10

impulse control disorder

Question 11

rapid cycling

Answer 11

• four mood episodes over past 12 months

- female more likely than men

Question 12

delusional disorder

Answer 12

bizarre or non bizarre delusion for at least 1 months duration

Question 13

transvestic fetishism

Answer 13

• at least a 6 month period-pt has recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving cross dressing

Question 14

partialism (oralism)

Answer 14

categorized under other specific paraphilic disorder

- concentrate their sexual activity on one part of the body to the exclusion of all others

Question 15

urophillia

Answer 15

paraphilla, other specified paraphilia disorder

• intense desire to urinate on a partner or be urinated on
• may also be associated with sexual arousal via the insertion of foreign objects into the urethra

Question 16

sexual sadism disorder

Answer 16

at least 6 months of recurrent intense sexually arousing fantasies, sexual urges or behaviors involving acts in which psychological or physical suffering of the victim is sexually exciting to the person

Question 17

sexual masochism

Answer 17

6 months of fantasies urges or behaviors involving acts of being humiliated, beaten bound or otherwise being made to suffer
- to meet criteria it needs to cause distress or impairment

Question 18

fetishistic disorder

Answer 18

5 motnhs intense sexually arousing fantasies urges or behaviros involving the use of nonliving objects

Question 19

poor prognostic indicators for paraphilias

Answer 19

early age of onset, lack of guilt or shame about the act, high frequency of acts, and concomitant substance use

Question 20

what are good prognostic indicators for paraphilias

Answer 20

normal intelligence, absence of substance abuse, abscence of personality disorders, presence of normal adult attachements, abscens of concomitant axis 1 mental disorders, presence of only one paraphilia

Question 21

what are psychiatric interventions to treat paraphilias

Answer 21

reduction of sexual drives, external control, treatment of comorbid conditions, dynamic therapy and cbt

Question 22

cross dressers

Answer 22

those who dress as opposite gender but continue to identify with their brith assigned gender (different from transvestic disorder)

Question 23

what monitoring does testosterone therapy need

Answer 23

cbc- increased hemoglobin and hematocrit can lead to stroke
liver-testosterone is processed in the liver
may increase likilhood of lipid abnormalties and diabetes

Question 24

transgender women on estrogen, progesterone or testosterone blockers should have what tested

Answer 24

prolactin- as pts on estrogen can develop prolactinomas

Question 25

can permanent sterility be an outcome of hormone therapy

Answer 25

yes