DSM-5 diagnostic criteria and mnemonics – Flashcards
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Schizophrenia
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>/= 2: delusions, hallucinations, disorganized speech, disorganized behavior, negative Sx's (>/= 1 of first 3) x >/= 1 month; + >/= 6 months total duration of illness (including prodrome)
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Neuroleptic Malignant Syndrome
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*FEVER* *F*ever *E*ncephalopathy *V*itals unstable *E*levated WBC/CPK *R*igidity (lead-pipe) Rx: dantrolene
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Schizophreniform
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like schizophrenia but between 1 and 6 months duration
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Brief Psychotic disorder
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like schizophrenia but between 1 day and 1 month duration
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Schizoaffective disorder
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-meet criteria for schizophrenia, plus -mood disorder (major depressive episode, manic episode, or mixed episode) for majority of duration of illness -delusions or hallucinations in the absence of mood symptoms (x2 wks)
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Delusional disorder
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-delusions >/= 1 month -don't meet criteria for schizophrenia -functioning not significantly impaired -specifier: bizarre delusions
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Catatonia
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->/= 3/12 symptoms -specifier for depression, bipolar, and psychotic d/o's
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Manic episode
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-elevated, expansive, or irritable mood plus >/=3 of *DIG FAST* for >/=1 week -or if requiring hospitalization, E psychosis, or signif impaired functioning *D*istractability *I*rresponsibility (don't care about consquences) *G*randiosity *F*light of Ideas/racing thoughts *A*ctivity increase (goal-directed) *S*leep decrease *T*alkativeness (pressured speech)
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Major Depressive episode
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-depressed mood or anhedonia + >/=4 other *SIGECAPS* for at least 2 wks *S*leep change *I*nterest decreased (anhedonia) *G*uilt *E*nergy decrease *C*oncentration problems *A*ppetite change *P*sychomotor retardation *S*uicidal ideation
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Hypomanic episode
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like manic episode but >/= 4 days, no psychosis, no hospitalization, no significant impairment in functioning -elevated, expansive, or irritated mood + 3 DIG FAST Sx's
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Major Depressive disorder
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-major depressive episode w/o manic episodes (which would be bipolar) -note if mania and depression co-occur can say MDD "w/ mixed features"
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Bipolar I
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presence of a manic episode (-/+ a depressed episode)
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Bipolar II
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hypomanic episode + major depressive episode
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Persistent Depressive disorder
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= DSM-IV dysthymia + chronic depressive d/o -depressed mood majority of the time x 2 years plus >/=2: -poor [ ], hopelessness, change in appetite, change in sleep, low energy, low self-esteem (SIGECAPS-ish) -no major depressive episodes or manic episodes -don't go >2 months w/o Sx's -*no psychotic symptoms - if so consider alternate dxs!
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Cyclothymic disorder
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-alternating depressive Sxs (mild-moderate) and hypomania x >/=2 years -no major depressive episodes (-> bipolar II) -no manic episodes (-> bipolar I)
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Adjustment disorder
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-maladaptive behavioral or emotional Sxs -develop w/in 3 months of an acute stressor (non-life threatening, that would be PTSD) -typically resolve w/in 6 months after stressor done
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Panic Attack
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>/= 4 of *PANNICCCSSS* *P*alpitations *A*bdominal distress *N*umbness, *N*ausea *I*ntense fear of death *C*hoking, *C*hills, *C*hest pain *S*weating, *S*haking, *S*hortness of breath
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Panic disorder
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>/=1 panic attack plus 1 month of -worry about having additional panic attacks -worry about the consequences of having attacks -changed behavior b/c of attacks
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Agoraphobia, Specific Phobia, Social Phobia, Social Phobia - performance only
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-fear in excess of reality ->/= 6 months -interferes with functioning -behavior altered to avoid stimulus -immediate anxiety upon exposure to stimulus -agoraphobia must E for >/2 agoraphobic situations -Rx: -systemic desensitization (CBT) -SSRI (paroxetine) for social phobia -BB for social phobia - performance only
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PTSD
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-experienced, witnessed, or indirectly experienced a potentially harmful or fatal event -*PAaiN* Sxs >/= 1 month *A*rousal x2 (hypervigilence, insomnia, startle response, irritable, aggression) *a*voidance (internal and external reminders) *i*ntrusions (flashbacks, dreams, memories, physiologic rxns) *N*egative feelings/Sxs x2 (impaired memory of trauma, -ve self-worth, pathological blame, -ve emotions, detachment, emotional numbness) -Rx: antidepressants: SSRI, TCA, MAOI; therapy: CBT, EMDR
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Acute stress disorder
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-like PTSD but < 1 month of Sxs and event occurred < 1 month ago -same treatment as for PTSD
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Generalized Anxiety disorder
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->/= 6 months of >/= 4 Sxs including worry/anxiety: *WATCHERS* *W*orry/anxiety *A*voidance of situations *T*ension in muscles *C*oncentration difficulty *H*yperarousal or irritability *E*asy fatiguability *R*estlessness *S*leep disturbances -Rx: antidepressants (SSRIs, venlafaxine, buspirone) + CBT
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OCD
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>/= 1 hr/day obsessions and/or compulsions
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Biological factors for BPS formulation
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genetics/FH medical diseases accidents, injuries substances, medications labs, testing current symptoms
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Psychological factors for BPS formulation
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coping strategies personality disorders history of trauma or loss problem solving skills development cognitive processes/distortions previous reactions to stress
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Social factors for BPS formulation
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social supports living situation job/school legal problems bullies/friends financial stressors cultural/spiritual beliefs
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Personality Disorders
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*CAPRI* *C*ognition *A*ffect *P*ersonal *R*elations *I*mpulse control
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Paranoid personality disorder
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general distrust of others plus 4 of *SUSPECT*: *S*pousal infidelity suspected *U*nforgiving (holds grudges) *S*uspicious that ppl are exploiting or deceiving *P*erceives attacks on character, quick to counter-attack *E*nemy or friend? relucatnt to *C*onfide in others *T*hreats seen in benign remarks Rx: psychotherapy
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Schizoid personality disorder
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general withdrawal plus 4 of *DISTANT* *D*etached or flattened affect *I*ndifferent to criticism *S*exual relations not interested *T*asks done solitarily *A*bsence of close friend *N*either desires nor enjoys close relationships *T*akes please in few activities *Relationships* -doesn't want -no sex -chooses to be alone -few friends *Emotions* -cold -pleasure in few activities -indifferent to criticism or praise Rx: psychotherapy
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Schizotypal personality disorder
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eccentric plus 5 ~schizoid like plus odd/eccentric/magical thinking type stuff
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Antisocial personality disorder
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disregard for laws, wellbeing of others must have had conduct disorder as a kid and be >18 +3 of criteria Rx: DBT, behavioral therapy
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Borderline personality disorder
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5 of *IMPULSIVE* *I*mpulsive *M*oody *P*aranoid under stress *U*nstable self-image *L*abile, intense relationships *S*uicidal (10%) *I*nappropriate anger *V*ulnerable to abandonment *E*mptiness Rx: DBT
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Histrionic personality disorder
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5
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Narcissistic personality disorder
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5
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Avoidant personality disorder
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4
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Dependent personality disorder
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5
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Obsessive Compulsive personality disorder
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4
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Substance Use disorder
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>/=2 for at least 12 months *WIL(c)D and ADDICTeD* *W*ork, school, home obligations failure *I*nterpersonal or social consequences *c*ravings *D*angerous use *A*ctivities given up or reduced *D*ependence - tolerance *D*ependence - withdrawal *I*nternal consequences, physical or psychological *C*an't cut down or control use *T*ime-consuming use *D*uration or amt of use is greater than intended -mild: 2-3 criteria -moderate: 4-5 criteria -severe: 6+ criteria -early remission: 3-12 months w/o Sxs (except cravings) -sustained remission: 12 months w/o Sxs (except cravings)
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Suicide Risk
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*SAD PERSONS* *S*ex - male *A*ge - > 60 *D*epression *P*revious attempt *E*thanol/drug abuse *R*ational thinking loss *S*uicide in family *O*rganized plan / access *N*o support *S*ickness (GMC)
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Oppositional Defiant disorder
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>/= 6 months of >/= 4 symptoms: *angry/irritable mood*: -loses temper -touchy -resentful *argumentative/defiant*: -argues w/ authority -defies authority -deliberately annoys people -blames others for mistakes *vindictiveness*: -vindictive twice weekly -for kids 5 at least once/week -*co-morbid substance use, ADHD, mood d/o's* -Rx: psychotherapy, parent management training
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Delirium
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-change in consciousness (awareness of environment, attention) -change in cognition (memory, language, orientation) -change from baseline -fluctuating symptoms causes: *AEIOU TIPS* *A*lcohol intox, withdrawal *E*lectrolyte imbalance *I*atrogenic *O*2 down (hypoxemia) *U*remia *T*rauma *I*nfection *P*oison/toxins (other drugs) intox, withdrawal *S*eizure or post-ictal
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Neuro-Cognitive Decline (mild vs major)
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-MAJOR: cognition >2 SD below normal and interferes w/ independence -MINOR: cognition 1-2 SD below normal and does not interfere w/ independence (may need to make accommodations) -formerly known as dementia (impairment in cognitive fxns ex. memory, language, executive function with maintained level of consciousness)
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Complicated/Prolonged grief
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>/= 6 months with >/= 4: -difficulty moving on in life -numbness/detachment -bitterness -feeling that life is empty w/o the deceased -trouble accepting the loss -feeling that the future holds no meaning w/o the deceased -agitation -new onset difficulty trusting others
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Addiction
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*4 C's*: *C*ravings loss of *C*ontrol use despite *C*onsequences *C*ompulsive use
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Conduct disorder
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>/= 3 Sx's w/in the following categories for 1 year: -serious violation of rules -deceitfulness or theft -aggression toward people & animals -destruction of property -co-morbid ADHD, learning disabilities -risk mood disorder, suicidality, substance use, criminal behavior -up to 40% progress to antisocial personality disorder
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Attention-Deficit/Hyperactivity disorder (ADHD)
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>/=6 inattention OR hyperactivity symptoms for >/= 6 months (or mixed type) -*inattention*: careless mistakes, can't sustain attention, doesn't seem to listen, doesn't follow through, struggles to organize tasks, dislikes mental effort, loses objects necessary for tasks, distractible, forgetful -*hyperactivity*: fidgets, leaves seat, runs, climbs, unable to stay quiet, on teh go, talks excessively, blurts out, cannot wait turn, interrupts, acts w/o thinking -present by age 12 (7 in DSM-IV) -Rx: stimulants; if FH tics use TCAs instead
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Autism Spectrum disorder
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*big picture: deficits in social communication & interaction and restricted repetitive behaviors/interests/activities* -deficits in social-emotional reciprocity, -deficits in non-verbal communicative behaviors, -deficits in developing and maintaining relationships, *all beginning in early childhood AND >/=2 of*: -stereotyped or repetitive speech, motor mvmts, or use of objects -excessive adherence to routines / resistance to change -highly restricted, fixated interests of abnml intensity or focus -hyperreactivity or hyporeactivity to sensory input
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Tourette disorder
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-multiple motor AND at least one vocal tic -onset before age 18 ->/= 12 mo (< 3 months w/o any tics) -usually starts w/ eye tics then vocal then motor -co-morbid w/ ADHD and OCD -Rx: antipsychotics (haldol, pimizole); alpha-agonists (clonidine) - less effective but better SE profile so more often used
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Somatic Symptom disorder
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-somatic symptoms plus abnormal thoughts, behaviors, or feelings -includes what in DSM-IV was somatization disorder
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Illness Anxiety disorder
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-high anxiety about an illness without somatic symptoms -6 months (DSM-IV) -note M>F (only somatic symptom d/o w/ M>F) -80% also have depression or anxiety
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Bulimia Nervosa
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-binge eating + compensatory behaviors at least once per week for 3 months -usually more ego-dystonic than anorexia -Rx can include SSRIs -*don't use drugs that lower the sz thresshold, like buprioprion*
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Binge eating disorder
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-once per week x 3 months (same time criteria as bulimia)
