DSM-5 Manual (Ongoing Build)

A variant of taijin kyofusho, characterized by fear of having an offensive body odor (also termed olfactory reference syndrome).

"Other Specified Obsessive-Compulsive and Related Disorder, Jikoshu-kyofu"

Related to dhat syndrome, an episode of sudden and intense anxiety that the penis (or the vulva and nipples in females) will recede into the body, possibly leading to death

"Other Specified Obsessive-Compulsive and Related Disorder, Koro"

Patient presents with preoccupation with partner's perceived infidelity. It frequently results in repetitive behaviors and it's now causing significant impairments. There are no sx of delusional disorder, jealous type or paranoid personality disorder. What's the dx?

"Other Specified Obsessive-Compulsive and Related Disorder, Obsessional jealousy"; This is characterized by nondelusional preoccupation with a partner's perceived infidelity. The preoccupations may lead to repetitive behaviors or mental acts in response to the infidelity concerns; they cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; and they are not better explained by another mental disorder such as delusional disorder, jealous type, or paranoid personality disorder

What is Shubo-kyofu?

"Other Specified Obsessive-Compulsive and Related Disorder, Shubo-kyofu"; A variant of taijin kyofusho that is similar to body dysmorphic disorder and is characterized by excessive fear of having a bodily deformity. (Taijin kyofusho a Japanese culture-specific syndrome, the disorder (sho) of fear (kyofu) of interpersonal relations (taijin); feeling extremely embarrassed of themselves or fearful of displeasing others when it comes to the functions of their bodies or their appearances. These bodily functions and appearances include their faces, odor, actions, or even looks. They do not want to embarrass other people with their presence. This culture-bound syndrome is a social phobia based on fear and anxiety.)

Dx for Attenuated psychosis syndrome (characterized by psychotic-like symptoms that are below a threshold for full psychosis - sx are less severe and more transient, and insight is relatively maintained)

"Other Specified Schizophrenia Spectrum and Other Psychotic Disorder"

Dx for Delusional sx in partner of individual with delusional disorder

"Other Specified Schizophrenia Spectrum and Other Psychotic Disorder"

Dx for Delusions with significant overlapping mood episodes

"Other Specified Schizophrenia Spectrum and Other Psychotic Disorder"

Dx for Persistent auditory hallucinations without other features.

"Other Specified Schizophrenia Spectrum and Other Psychotic Disorder"

Patient seems to meet most criteria for Body Body dysmorphic, though the focus of us disorder is his nose, which IS severely misshapen. What's the dx?

"Other specified obsessive-compulsive and related disorder, Body dysmorphic-like disorder with actual flaws"; This is similar to body dysmorphic disorder except that the defects or flaws in physical appearance are clearly observable by others (i.e., they are more noticeable than "slight"). In such cases, the preoccupation with these flaws is clearly excessive and causes significant impairment or distress.

Patient presents with enormous distress that his head is extremely large and pointed. He meets the criteria for Body dysmorphic disorder but he doesn't perform repetitive behaviors or mental acts. What's the dx?

"Other specified obsessive-compulsive and related disorder, Body dysmorphic-like disorder without repetitive behaviors."

Man presents complaining of chewing his nails. He's tried to break the habit but can't. They are now causing significant distress. He denies any features of trichotillomania, excoriation disorder, stereotypic movement disorder, or any nonsuicidal self-injury. What's the dx?

"Other specified obsessive-compulsive and related disorder, Body-focused repetitive behavior disorder"; This is characterized by recurrent body focused repetitive behaviors (e.g., nail biting, lip biting, cheek chewing) and repeated attempts to decrease or stop the behaviors. These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and are not better explained by trichotillomania (hair-pulling disorder), excoriation (skin picking) disorder, stereotypic movement disorder, or nonsuicidal self-injury.

Re Category B of Schizophreniform, an episode of the disorder 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"

Individuals with SEIZURE disorders may exhibit complex behavior during seizures or post-ictally with subsequent AMNESIA. Some individuals with a SEIZURE disorder engage in NONPURPOSIVE WANDERING that is limited to the period of seizure activity. Conversely, behavior during a dissociative FUGUE is usually purposeFUL, complex, and goal directed and may last for days, weeks, or longer. Occasionally, individuals with a seizure disorder will report that earlier autobiographical memories have been:

"wiped out" as the seizure disorder progresses. Such memory loss is not associated with traumatic circumstances and appears to occur randomly. Serial eegs usually show abnormalities. Telemetric eeg monitoring usually shows an association between the episodes of amnesia and seizure activity. Dissociative and epileptic amnesias may coexist.

This specifier _________ is applied if these features are present at the most severe stage of the episode. There is a near-complete absence of the capacity for pleasure, not merely a diminution. A guideline for evaluating the lack of reactivity of mood is that even highly desired events are not associated with marked brightening of mood. Either mood does NOT brighten AT ALL, or it brightens ONLY partially (e.g., up to 20% -40% of normal for only MINUTES at a time).

"with melancholic features", The "distinct quality" of mood that is characteristic of this specifier is experienced as qualitatively different from that during a nonmelancholic depressive episode. A depressed mood that is described as merely more severe, longer lasting, or present without a reason is not considered distinct in quality. Psychomotor changes are nearly always present and are observable by others. Melancholic features exhibit only a modest tendency to repeat and are more likely to occur in those with psychotic features

Of the 5 Sx required for MDD, at least 1 must be

(1) depressed mood or (2) loss of interest or pleasure

The lifetime prevalence of delusional disorder has been estimated at around _____ %, and the most frequent subtype is:

0.2% ; the most frequent subtype of delusional disorder is persecutory. Delusional disorder, jealous type, is probably more common in males than in females, but there are no major gender differences in the overall frequency of delusional disorder.

Lifetime prevalence of schizophrenia is about _______%:

0.3%-0.7%; The sex ratio differs but emphasis on negative Sx and longer duration of disorder (associated with poorer outcome) shows higher incidence rates for males, though definitions allowing for the inclusion of more mood symptoms and brief presentations (associated with better outcome) show equal risks for both sexes.

The lifetime prevalence of cyclothymic disorder is approximately _______% and is equally common in males and females though females may be more likely to present for treatment than males.

0.4%-l%

Criterion I of DMDD states there has never been a distinct period lasting more than _______ during which the full symptom criteria, except duration, for a MANIC or hypoMANIC episode have been met.

1 day

In certain individuals with PERSONALITY DISORDERS, psychosocial STRESSORS may precipitate brief periods of psychotic symptoms. These symptoms are USUALLY TRANSIENT and DO NOT warrant a separate diagnosis unless psychotic symptoms persist for at least _______, then an additional diagnosis of brief psychotic disorder may be appropriate.

1 day

Excoriation disorder is associated with distress as well as with social and occupational impairment. The majority of individuals with this condition spend at least:

1 hour per day picking, thinking about picking, and resisting urges to pick. Many individuals report avoiding social events as well as going out in public. A majority of individuals with the disorder also report experiencing work interference from skin picking on at least a daily or weekly basis. Many students with excoriation disorder report missing school & having experienced difficulties managing responsibilities. Medical complications of skin picking include tissue damage, scarring, and infection and can be LIFE-threatening. Rarely, synovitis of the wrists due to chronic picking has been reported. Skin picking often results in significant tissue damage and scarring. It frequently requires antibiotic treatment for infection, and on occasion it may require surgery.

B. At least one of the attacks has been followed by _____________ of the following: 1. PERSISTENT concern or worry about ADDITIONAL panic attacks or their consequences (e.g., losing control, having a heart attack, "going crazy"). 2. A significant MALADAPTIVE change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations). C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders). D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder: in response to circumscribed phobic objects or situations, as in specific phobia: in response to obsessions, as in obsessive-compulsive disorder: in response to reminders of traumatic events, as in posttraumatic stress disorder: or in response to separation from attachment figures, as in separation anxiety disorder).

1 month (or more) of one or both

Schizophrenia lasts for at least 6 months and includes at least

1 month of ACTIVE-PHASE symptoms

How many needed for Criterion A and Criterion B of "With melancholic features?" A. _____of the following present during the most severe period of the current episode; 1. Loss of PLEASURE in all, or almost all, activities. 2. Lack of REACTIVITY to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens). B. _____ of the following: 1. A distinct quality of depressed mood characterized by PROFOUND despondency, despair, and/or moroseness or by so-called empty mood. 2. Depression that is regularly worse in the MORNING. 3. Early-morning AWAKENING (i.e., at least 2 hours before usual awakening). 4. Marked PSYCHOMOTOR agitation or retardation. 5. Significant anorexia or WEIGHT loss. 6. Excessive or inappropriate guilt.

1 of A, >=3 of B

Twelve-month prevalence of bulimia nervosa among young females is:

1%-1.5%

The dissociative AMNESIA of individuals with dissociative identity disorder manifests in three primary ways:

1) as GAPS in REMOTE MEMORY of personal LIFE EVENTS (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) LAPSES in DEPENDABLE MEMORY (e.g., of what happened today, of well-leamed skills such as how to do their job, use a computer, read, drive); and 3) DISCOVERY of EVIDENCE of their everyday actions and tasks that they DO NOT RECOLLECT doing (e.g., finding unexplained objects in their shopping bags or among their possessions; finding perplexing writings or drawings that they must have created; discovering injuries; "coming to" in the midst of doing something).

In ADHD, academic deficits, school-related problems, and peer neglect tend to be most associated with elevated symptoms of _________, whereas peer rejection and, to a lesser extent, accidental injury are most salient with marked symptoms of _________

1) inattention and 2) hyperactivity or impulsivity

Schizophrenia course specifiers are only to be used after a ______ duration of the disorder and if they are not in contradiction to the diagnostic course criteria

1-year

Criterion A for SOCIAL (Pragmatic) COMMUNICATION Disorder requires PERSISTENT difficulties in the social use of verbal/nonverbal COMMUNICATIONS as manifested by: (list 4 things)

1. DEFICITS in using COMMUNICATION for social purposes 2. IMPAIRMENT of the ability to CHANGE communication to MATCH CONTEXT or the NEEDS of the LISTENER 3. DIFFICULTIES FOLLOWING RULES for conversation and storytelling 4. DIFFICULTIES UNDERSTANDING WHAT IS NOT EXPLICITLY STATED (e.g., making inferences) and nonliteral or ambiguous meanings

Specific Learning Disorder Criterion A says: Difficulties learning and using academic skills, as indicated by the presence of at least one of the following Sx that have persisted >= 6 months, DESPITE the provision of interventions that target those difficulties. What are the 6 sx listed?

1. DIFFICULT READING 2. DIFFICULTY UNDERSTANDING READING 3. Difficulties with SPELLING 4. Difficulties with WRITTEN EXPRESSION 5. Difficulties with MATH 6. Difficulties with MATH REASONING

Diagnostic Criterion A for ASD discusses persistent deficits in social communication and social interaction across multiple contexts, currently or BY HISTORY. Name the 3 listings:

1. Deficits in social-emotional RECIPROCITY 2. Deficits in NONVERBAL communicative behaviors 3. DEFICITS in developing, maintaining, and understanding RELATIONSHIPS

Depersonalization/Dereallzation Disorder A. The presence of PERSISTENT or RECURRENT experiences of depersonalization, derealization, or both: 1. Depersonalization 2. Derealization Define 1 &2. How do they differ?

1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and / or physical numbing). 2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

Criterion A for Bulimia Nervosa says: Recurrent episodes of binge eating. An episode of binge eating is characterized by both of what 2 things?

1. Eating, in a discrete period of time (e.g., within any 2-hour period), AMOUNT of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A SENSE OF LACK OF CONTROL over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). AMOUNT AND SENSE OF LACK OF CONTROL

ADHD Criterion A discusses a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). What are 1 and 2?

1. INATTENTION: >=6 SX have persisted for at least 6 MONTHS to a degree that is INCONSISTENT with developmental LEVEL & that NEGATIVELY impacts directly on social and academic/occupational activities 2. HYPERACTIVITY & IMPULSIVITY: >=6 SX have persisted for at least 6 MONTHS to a degree that is INCONSISTENT with developmental level and that negatively IMPACTS directly on social and academic / occupational activities

Examples of presentations that can be specified using "Other Specified Schizophrenia Spectrum and Other Psychotic Disorder" include:

1. Persistent auditory hallucinations without other features. 2. Delusions with significant overlapping mood episodes 3. Attenuated psychosis syndrome: characterized by psychotic-like symptoms that are below a threshold for full psychosis (sx are less severe and more transient, and insight is relatively maintained). 4. Delusional sx in partner of individual with delusional disorder

Post Traumatic Stress Disorder B. Presence of one (or more) of the following INTRUSION symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: (5 features)

1. RECURRENT, involuntary, and intrusive distressing MEMORIES of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. RECURRENT distressing DREAMS in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content. 3. DISSOCIATIVE reactions (e.g., FLASHBACKS) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological DISTRESS at EXPOSURE to internal or external CUES that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological REACTIONS to internal or external CUES that symbolize or resemble an aspect of the traumatic event(s).

Re Avoidant/Restrictive Food Intake Disorder, Criterion A states: An eating or FEEDING DISTURBANCE (e.g., apparent LACK OF INTEREST in eating or food; AVOIDANCE based on the SENSORY CHARACTERISTICS of food; CONCERN about AVERSIVE CONSEQUENCES of eating) as manifested by PERSISTENT FAILURE to meet appropriate nutritional and/or energy needs associated with ONE (or more) of what 4 S/S?

1. Significant WEIGHT LOSS (or FAILURE to ACHIEVE expected weight GAIN or faltering growth in children). 2. Significant NUTRITIONAL DEFICIENCY. 3. DEPENDENCE on ENTERAL feeding or oral nutritional SUPPLEMENTS. 4. Marked INTERFERENCE with psychosocial FUNCTIONING.

ASD Criterion B is: RESTRICTIVE, REPETITIVE patterns of behavior, interests, or activities, as manifested by at least TWO of the following, currently or by hx. List the 4 descriptors:

1. Stereotyped or repetitive MOTOR movements, USE of OBJECTS, or SPEECH (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia) 2. Insistence on SAMENESS, INFLEXIBLE adherence to routines, or RITUALIZED patterns of verbal or nonverbal behavior 3. Highly restricted, FIXATED INTERESTS that are abnormal in intensity or focus 4. HYPER- or HYPOREACTIVITY to sensory input or unusual interest in sensory aspects of the environment

The 12-month prevalence of dissociative identity disorder among adults in a small U.S. community study was:

1.5%. The prevalence across genders in that study was 1.6% for males and 1.4% for females.

Every year approximately _____% of adolescents and adults have a diagnosis of agoraphobia. Females are twice as likely as males to experience agoraphobia. Agoraphobia may occur in childhood, but incidence peaks in late adolescence and early adulthood. Twelve-month prevalence in individuals older than 65 years is 0.4%. Prevalence rates do not appear to vary systematically across cultural/racial groups.

1.7%

Specific phobia usually develops in early childhood, with the majority of cases developing prior to age:

10 years. The median age at onset is between 7 and 11 years, with the mean at about 10 years. Situational specific phobias tend to have a later age at onset than natural environment, animal, or blood-injection-injury specific phobias. Specific phobias that develop in childhood and adolescence are likely to wax and wane during that period. However, phobias that do persist into adulthood are unlikely to remit for the majority of individuals.

Reported lifetime rates of comorbidity between major depressive disorder and panic disorder vary widely, ranging from ___________ in individuals with panic disorder. In approximately one-third of individuals with both disorders, the depression precedes the onset of panic disorder. In the remaining two-thirds, depression occurs coincident with or following the onset of panic disorder. A subset of individuals with panic disorder develop a substance-related disorder, which for some represents an attempt to treat their anxiety with alcohol or medications. Comorbidity with other anxiety disorders and illness anxiety disorder is also common.

10% to 65%

The 12-month prevalence of anorexia nervosa among young females is approximately 0.4% and the female-to-male ratio is thought to be about:

10:1

In the general population, the 12-month prevalence estimate for trichotillomania in adults and adolescents is 1%-2%. Females are more frequently affected than males, at a ratio of approximately:

10:1, F:M. Among children with trichotillomania, males and females are more equally represented.

12-month prevalence estimates for panic attacks in the U.S. is _____% in adults; estimates don't differ significantly among races; European countries are around 3%. Females are more frequently affected than males, although this gender difference is more pronounced for panic disorder. Panic attacks can occur in children but are relatively rare until puberty and decline in older individuals.

11.2%

For Disruptive Mood Dysregulation Disorder, Criteria A-D must be present for ________, and during that time, the individual has not had a period lasting __________ without all of the symptoms in Criteria A-D.

12 or more months; 3 or more consecutive months (Criterion E)

ADHD begins in childhood. The requirement that several sx be present before ____ years old conveys the importance of a substantial clinical presentation during childhood. An earlier age at onset is not specified because of difficulties in establishing precise childhood onset retrospectively.

12 years old

What % of self-identified shy individuals in the United States meet diagnostic criteria for social anxiety disorder?

12%

Re Body Dysmorphic Disorder, the mean age at disorder onset is 16-17 years, the median age at onset is 15 years, and the most common age at onset is:

12-13 years. Two-thirds of individuals have disorder onset before age 18. Subclinical body dysmorphic disorder symptoms begin, on average, at age 12 or 13 years.

Symptoms of ASD are typically recognized at what age?

12-24 months of age but may be seen < 12 months if developmental delays are severe, or noted > 24 months if symptoms are more subtle.

Median age at onset of social anxiety disorder in the United States is:

13 years; 75% have an age at onset between 8 and 15 years. The disorder sometimes emerges out of a childhood history of social inhibition or shyness. Onset can also occur in early childhood; it may follow a stressful or humiliating experience or it may be insidious, developing slowly. First onset in adulthood is relatively rare and is more likely to occur after a stressful or humiliating event or after life changes that require new social roles (e.g., marrying someone from a different social class, receiving a job promotion). Social anxiety disorder may diminish after an individual with fear of dating marries and may reemerge after divorce. Among individuals presenting to clinical care, the disorder tends to be particularly persistent.

Anxiety and substance use disorders occur in individuals with bipolar II disorder at a higher rate than in the general population. Approximately _____% of individuals with bipolar II disorder have at least one lifetime eating disorder, with BINGE-eating disorder being more common than bulimia nervosa and anorexia nervosa.

14%

Cyclothymic disorder usually begins in adolescence or early adult life, usually has an insidious onset and a persistent course. There is a ______% risk that an individual with cyclothymic disorder will subsequently develop bipolar I disorder or bipolar II disorder.

15%-50% risk

The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least _____ times that of the general population.

15x

Mean age at onset of the first manic, hypomanic, or major depressive episode is approximately _____ years for bipolar I disorder.

18 yo, though onset occurs throughout the life cycle, including first onsets in the 60s or 70s.

Cyclothymic Disorder Diagnostic Criteria B B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than _______ at a time.

2 months

In full remission: During the past _______, no significant signs or symptoms of the disturbance were present

2 months

During the 2 yr (1 yr for C/A) period in Persistent Depressive Disorder, the patient has never been without sx longer than ______

2 months at a time.

What sx are considered for MDE but not for Persistent Depressive Disorder?

2. MARKEDLY DIMINISHED INTEREST or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). (MDE) 3. SIGNIFICANT WEIGHT loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) (MDE) vs 1. Poor appetite or overeating. 7. Feelings of WORTHLESSNESS or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). (MDE) vs 4. Low self-esteem. 5. PsychoMOTOR agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). (MDE) 9. Recurrent THOUGHTS OF DEATH (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide (MDE)

Nearly all individuals with body dysmorphic disorder experience impaired psychosocial functioning. Impairment can range from moderate (avoidance of some social situations) to extreme and incapacitating (being completely housebound). On average, psychosocial functioning and quality of life are markedly poor. About ______% of youths with body dysmorphic disorder report dropping out of school d/t their sx.

20% drop out of school; Impairment in social functioning, including avoidance, is common. Individuals may be housebound because of their body dysmorphic disorder symptoms, sometimes for years. A high proportion of adults and adolescents have been psychiatrically hospitalized.

The prevalence of disinhibited social attachment disorder is unknown but appears to be rare, occurring in a minority of children, even those who have been severely neglected and subsequently placed in foster care or raised in institutions. In such high-risk populations, the condition occurs in about:

20% of children in high-risk populations

The median age at onset for panic disorder in the United States is:

20-24 years. A small number of cases begin in childhood, and onset after age 45 years is unusual but can occur. The usual course, if the disorder is untreated, is chronic but waxing and waning. Some individuals may have episodic outbreaks with years of remission in between, and others may have continuous severe symptomatology. Only a minority of individuals have full remission without subsequent relapse within a few years. The course of panic disorder typically is complicated by a range of other disorders, in particular other anxiety disorders, depressive disorders, and substance use disorders.

Conduct disorder co-occurs in about ________% children or adolescents with the combined presentation of ADHD.

25%

In the United States, the mean age at onset of OCD is 19.5 years, and ____% of cases start by age 14 years.

25% start by 14 yo. Onset after age 35 years is unusual but does occur. Males have an earlier age at onset than females: nearly 25% of males have onset before age 10 years.

ADHD is more frequent in MALES than in females in the general population, with a ratio of approximately:

2:1 in children and 1.6:1 in adults. FEMALES are more likely than males to present primarily with INATTENTIVE features.

Criterion C of GAD lists 6 sx. How many are required for adults? For children?

3 for adults, 1 for children 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

what's criterion B for bipolar II?

3 of 4 (if mood is only irritable) symptoms occuring from mood and energy change, representing a noticeable change from baseline; 1. self-esteem 2. less sleep 3. More talkative. 4. Flight of ideas 5. Distractibility 6. goal-directed activity/ agitation. 7. involvement w/ consequences

By what age do stereotypic movements typically begin within?

3 years. SIMPLE stereotypic movements are COMMON in INFANCY. In children who develop COMPLEX motor stereotypies, approximately 80% exhibit symptoms BEFORE 24 months of age, 12% between 24 and 35 months, and 8% at 36 months or older.

Re Stereotypic Movement Disorder, SIMPLE STEREOTYPIC MOVEMENTS are COMMON in young TYPICALLY developing children. COMPLEX stereotypic movements are MUCH LESS COMMON, occurring in approximately

3%-4%; it increases to 4% - 16% of individuals with INTELLECTUAL DISABILITY engaging in STEREOTYPY and self-injury. The risk increases with severity of intellectual disability.

Difficulty initiating sleep is defined by a subjective sleep latency > 20-30 minutes; difficulty maintaining sleep is defined by time awake after sleep onset > 20-30 minutes. Although there is no standard definition of early-morning awakening, this sx involves awakening at least:

30 minutes before the scheduled time and before total sleep time reaches 6&1/2 hours.

Although many individuals with bipolar disorder return to a fully functional level between episodes, approximately _____% show severe impairment in work role function.

30%

Approximately ______% of individuals with social anxiety disorder experience remission of symptoms within 1 year, and about _____% experience remission within a few years.

30% in 1 year, 50% within a few years; For approximately 60% of individuals WITHOUT a specific treatment for social anxiety disorder, the course takes several years or longer

The percentage of individuals with agoraphobia reporting panic attacks or panic disorder PRECEDING the ONSET of agoraphobia ranges from:

30% in community samples to more than 50% in clinic samples. The majority of individuals with panic disorder show signs of anxiety and agoraphobia before the onset of panic disorder.

In two-thirds of all cases of agoraphobia, initial onset is before age:

35 years. There is a substantial incidence risk in late adolescence and early adulthood, with indications for a second high incidence risk phase after age 40 years. First onset in childhood is rare. The overall mean age at onset for agoraphobia is 17 years, although the age at onset without preceding panic attacks or panic disorder is 25-29 years.

Catatonia is typically diagnosed in an inpatient setting and occurs in up to _____% of individuals with schizophrenia, but the majority of catatonia cases involve individuals

35% of schizophrenics; majority with depressive or bipolar disorders

LANGUAGE DISORDER emerges during the EARLY developmental period; there is considerable variation in early vocabulary acquisition and early word combinations, and INDIVIDUAL DIFFERENCES are NOT PREDICTIVE of later outcomes until about age:

4 YEARS, then individual differences in language ability become more stable, with better measurement accuracy, and ARE HIGHLY PREDIVTIVE of later outcomes

With peripartum onset: This specifier can be applied to the current or, if the full criteria are not currently met for a mood episode, most recent episode of mania, hypomania, or major depression in bipolar I or bipolar I! disorder if onset of mood symptoms occurs during pregnancy or in the _______weeks following delivery.

4 weeks following delivery; Note: Mood episodes can have their onset either during pregnancy or postpartum. Although the estimates differ according to the period of follow-up after delivery, between 3% and 6% of women will experience the onset of a major depressive episode during pregnancy or in the weeks or months following delivery.

Many parents first observe excessive motor activity when the child is a toddler, but SX are DIFFICULT to DISTINGUISH from normative behaviors BEFORE age:

4 years. ADHD is most often identified during elementary school years, and inattention becomes more prominent and impairing.

Tic disorders typically begin at about age:

4-6 years, with the incidence of new-onset tic disorders decreasing in the teen years. New ONSET of tic Sx in adulthood is EXCEEDINGLY RARE and is associated with exposures to DRUGS (e.g., excessive cocaine use) or is a result of a CNS INSULT (postviral encephalitis)

How much higher is the relative risk of specific learning disorder in reading and mathematics amongst first-degree relatives of individuals with these learning difficulties?

4-8 times higher for reading and 5-10 times higher for mathematics

Population surveys suggest that ADHD occurs in most cultures in about ___% of children and about ____% of adults.

5% of children and about 2.5% of adults

The prevalence of specific learning disorder across the academic domains of reading, writing, and mathematics is _______ % among school-age children across different languages and cultures, adults is approximately ____%

5%-15% school-age, 4% adults

The prevalence of DEVELOPMENTAL COORDINATION disorder in children ages 5-11 years is:

5%-6% (in children age 7 years, 1.8% are diagnosed with severe developmental coordination disorder and 3% with probable developmental coordination disorder).

Approximately ______% of individuals with schizophrenia die by suicide; about ____% attempt suicide on one or more occasions

5%-6% die by suicide; 20% attempt; many more have significant SI. Suicidal behavior is sometimes in response to COMMAND HALLUCINATIONS to harm oneself or others.

The course of DEVELOPMENTAL COORDINATION disorder is variable but STABLE at least to 1 year follow-up. Although there may be improvement in the longer term, PROBLEMS PERSIST through adolescence in an estimated _____ % of children

50%-70% of children.

At 2 YO, only ________ % of speech may be understandable.

50%; overall speech should be intelligible >= age 4 years

Social Anxiety Disorder F. The fear, anxiety, or avoidance is PERSISTENT, typically lasting for ______________ G. The fear, anxiety, or avoidance causes clinically SIGNIFICANT DISTRESS or impairment in social, occupational, or other important areas of functioning. H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or ASD. J. If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. Specify if: Performance only: If the fear is restricted to speaking or performing in public

6 months or more.

What's the allowable age range for 1st time dx of Disruptive Mood Dysregulation Disorder?

6 yo to age 18 yo (Criterion G)

About 1/3 of adults report insomnia sx, 10%-15% experience daytime impairments, and ______ have sx that meet criteria for insomnia disorder.

6% -10% meet criteria for insomnia disorder; 40%-50% of individuals with insomnia also present with a comorbid mental disorder.

What % of manic episodes occur immediately before a major depressive episode?

60%

Approximately _____% of individuals with bipolar II disorder have three or more co-occurring mental disorders

60%; ; 75% have an anxiety disorder; 37% have a substance use disorder. Children and adolescents with bipolar II have a HIGHER rate of co-occurring anxiety disorders compared with those with bipolar I, and the anxiety disorder most often predates the bipolar disorder.

Re suicide attempts, Individuals with specific phobia are up to ____% more likely to make an attempt than are individuals without the diagnosis.

60%; However, it is likely that these elevated rates are primarily due to comorbidity with personality disorders and other anxiety disorders

_______ % of children with Childhood-onset fluency disorder RECOVER from the DYSFLUENCY, with severity of fluency disorder at age ________ PREDICTING RECOVERY or PERSISTENCE into adolescence and beyond

65%-85%; >=8 YO = PERSISTENT

The 12-month prevalence estimate of social anxiety disorder for the United States is approximately:

7%; It's lower around the world, around 0.5%-2.0%; Prevalence rates decrease with age. The 12-month prevalence for older adults ranges from 2% to 5%. In general, higher rates of social anxiety disorder are found in females than in males (with odds ratios ranging from 1.5 to 2.2), and the gender difference in prevalence is more pronounced in adolescents and young adults.

Twelve-month prevalence of MDE in the United States is approximately _____%, with marked differences by age group such that the prevalence in 18- to 29-year-old individuals is ______ than the prevalence in individuals age 60 years or older.

7%; threefold higher in 18-29 vs >= 60

Disinhibited Social Engagement Disorder D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (the disturbances in Criterion A began following the pathogenic care in Criterion C). E. The child has a developmental age of at least _____________. Specify if: Persistent: The disorder has been present for more than 12 months. Specify current severity: Disinhibited social engagement disorder is specified as severe when the child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

9 months

In the United States, brief psychotic disorder may account for ____% of cases of first-onset psychosis. Brief psychotic disorder is twofold more common in _______ than in _______

9%; females than in males

The prevalence among U.S. adults for Body Dysmorphic Disorder is 2.4% (2.5% in females and 2.2% in males). Outside the United States, current prevalence is approximately 1.7%-1,8%. The current prevalence is among dermatology patients is:

9-15%, 7%-8% among U.S. cosmetic surgery patients, 3%-16% among international cosmetic surgery patients (most studies), 8% among adult orthodontia patients, and 10% among patients presenting for oral or maxillofacial surgery.

How many who have a single manic episode go on to have recurrent mood episodes?

90%

What are the cutoff frequencies for Binge-eating severity?

: The minimum level of severity is based on frequency of episodes of binge eating. (level of severity may be ^ to reflect other sxs and degree of functional disability) Mild: 1-3 per week Moderate: 4-7 per week Severe: 8-13 per week. Extreme: 14 or more per week

Hypomania vs mania time frame for dx

>= 4 consecutive days for hypomania, mania is at least 1 week, unless hospitalized then it's automatic regardless of time

What of individuals with bipolar II disorder qualify for the specifier, "with rapid cycling?"

>= four mood episodes (hypomanic or major depressive) within the previous 12 months is noted by the specifier "with rapid cycling," which is met by approximately 5%-15%

Re: Bulimia Nervosa, Criterion C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least ___________ for ____________. D. Self-evaluation is UNDULY influenced by body shape and weight. E. The disturbance does NOT occur exclusively during episodes of ANOREXIA nervosa.

>= once a week for 3 months (Bulimia)

Cyclothymic Disorder Diagnostic Criteria A A. For at least ________ (at least _______ in children and adolescents) there have been numerous periods with hypomanic SYMPTOMS that do NOT meet criteria for a hypomanic EPISODE and numerous periods with depressive SYMPTOMS that do not meet criteria for a major depressive EPISODE.

>=2 years for adults, >= 1 year in children/adolescents

What is a tic?

A SUDDEN, rapid, RECURRENT, NONrhythmic MOTOR movement or VOCALIZATION

There is an average _____ fold increased risk among adult relatives of individuals with bipolar I and bipolar II disorders.

A family hx of bipolar disorder is one of the strongest and most consistent risk factors for bipolar disorders. There is an average 10-fold increased risk among adult relatives of individuals with bipolar I and bipolar II disorders. Magnitude of risk increases with degree of kinship.

What are neurodevelopmental disorders?

A group of conditions with onset in the developmental period, typically manifest EARLY in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning

This is the definition for ___________: a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning; Are usually associated with significant distress or disability in social, occupational, or other important activities

A mental disorder; an expectable or culturally approved response to a common stressor or loss, such as the death of a loved one does not qualify; Socially deviant behavior (political, religious, or sexual) and conflicts that are primarily between the individual and society do not qualify unless the deviance or conflict results from a dysfunction in the individual

This new dx is for a more chronic form of depression, >=2 yrs in adults, >=1 yr in children. It includes what DSM-IV diagnostic categories?

A more chronic form of depression, PERSISTENT DEPRESSIVE DISORDER, diagnosed when the mood disturbance continues for at least 2 years in adults or 1 year in children. This diagnosis, new in DSM-5, includes both the DSM-IV diagnostic categories of chronic major depression and dysthymia

What is olfactory reference syndrome?

A preoccupation focused on the belief that one emits a foul or offensive body odor (not a DSM-5 disorder).

Summarize the criteria for Specific Learning Disorder

A) Specific learning problem for >= 6 mo DESPITE INTERVENTION B) SKILLS are substantially /quantifiably LOW for age, cause significant interference, shown by test & clinical assessment. If >= 17 yo hx of impairing learning difficulties may be substituted for tests. C. BEGAN during SCHOOL-AGE years but may not become fully manifest until the demands exceed capacities D. Not better accounted for by...

Schizophrenia Diagnostic Criteria

A. >= 2, each present for a significant portion of time during a 1 mos period (or less if successfully treated). At least 1 of these must be (1 ), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech. 4. Grossly disorganized /catatonic behavior. 5. Negative symptoms B. For a significant portion of time since onset, LEVEL OF FUNCTIONING IS MARKEDLY BELOW PRIOR LEVEL C. CONTINUOUS signs persist for at least SIX MONTHS, at least ONE MONTH of SX (or less if successfully treated) that MEET CRITERION A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, signs may be manifested by only negative Sx or >= 2 Sx listed in Criterion A in attenuated form. D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features are r/o b/c either no major depressive or manic episodes have occurred w/ active-phase Sx or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. E. not attributable to the physiological effects of a substance F. If hx of ASD or a communication disorder of childhood onset, the additional dx of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required Sx of schizophrenia, are also present for at least 1 month

Criteria A-C represent a major depressive episode. Summarize them.

A. >= Five sx present during the same 2-week, represent a change from previous functioning, at least one is either (1) depressed mood or (2) loss of interest or pleasure B. Sx cause clinically significant distress or impairment C. Not attributable to the effects of a substance or medical condition

MDE criteria re bipolar II

A. >=Five of the following sx have been present during the same 2-week period and represent a change from previous functioning; at least one of the sx is either (1 ) depressed mood or (2) loss of interest or pleasure. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others (In children and adolescents, can be irritable mood) 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day 3. Significant weight loss when not dieting or weight gain ( change of more than 5% of bw in a mo), or change in appetite nearly every day. 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others; NOT merely subjective feelings) 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day 9. Recurrent thoughts of death, recurrent SI without a specific plan, a suicide attempt, or a specific plan for committing suicide. B. The sx cause clinically significant distress or impairment C. not attributable to the physiological effects of a substance or another medical condition.

Hypomanic Episode criteria

A. A distinct period of abnormally & persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting >= 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy and activity, three (or more) of the following sx (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility, as reported or observed. 6. Increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation. 7. Excessive involvement in activities that have a high potential for painful consequences C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is NOT severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment).

For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode:

A. A distinct period of abnormally and persistently ELEVATED, expansive, or IRRITABLE MOOD and abnormally and persistently increased goal-directed ACTIVITY or energy, lasting at least 1 WEEK and present MOST of the day, NEARLY every day (or any duration if hospitalized). B. During the period of mood disturbance and increased energy or activity, >= 3 of the following sx (FOUR if the mood is ONLY irritable) are present to a significant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed ACTIVITY (socially, at work or school, or sexually) or psychoMOTOR agitation (i.e., purposeless non-goal-directed activity). 7. Excessive involvement in activities that have a high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational FUNCTIONING or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. Not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.

Summarize the major criteria for Avoidant / Restrictive Food Intake disorder.

A. An eating or FEEDING DISTURBANCE manifested by PERSISTENT FAILURE to meet nutritional / energy needs. B. NOT better explained by lack of food or cultural practice. C. Does NOT occur exclusively during the course of anorexia nervosa or bulimia nervosa or body dysmorphia. D. NOT attributable to a concurrent medical condition / mental disorder. If it co-occurs, the severity exceeds that expected and warrants additional clinical attention.

What are the diagnostic criteria for Tourette's Disorder?

A. BOTH multiple MOTOR AND one or more VOCAL tics have been present at SOME time during the illness, although NOT necessarily concurrently. B. The tics may wax and wane in frequency but have persisted for MORE than 1 YEAR since first tic onset. C. Onset is BEFORE age 18 years. D. The disturbance is NOT attributable to the physiological effects of a SUBSTANCE (e.g., cocaine) or another medical CONDITION (e.g., Huntington's disease, postviral encephalitis)

Intellectual disability (intellectual developmental disorder) is a disorder with onset during the DEVELOPMENTAL period that includes both INTELLECTUAL and ADAPTIVE functioning deficits in conceptual, social, and practical domains. The following THREE criteria must be met:

A. Deficits in intellectual functions B. Deficits in adaptive functioning C. Onset during the developmental period.

Summarize each letter criteria for PTSD

A. Exposure B. Intrusion symptoms C. Persistent avoidance of stimuli D. Negative alterations in cognition and mood E. Marked alterations in arousal and reactivity F. Duration > 1 month. G. Clinically significant distress or impairment H. Not attributable to effects of a substance or medical condition.

Major Depressive Episode in bipolar I dx

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others (Note: In children and adolescents, can be IRRITABLE mood.) 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day indicated by either subjective account or observation). 3. Significant weight loss when not dieting or weight gain (CHANGE of more than 5% of body weight in 1 mo), or decrease or increase in APPETITE nearly every day. (Note: In children, consider failure to make expected weight gain.) 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others;NOT MERELY SUBJECTIVE feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The sx cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or another medical condition.

The specifier "Depressive episode, with mixed features" Criterion A requires that full criteria are met for ______ and at least how many of manic / hypomanic Sx?

A. Full criteria are met for a MDE, and at least THREE of the following manic / hypomanic Sx are present during the majority of days of the current or most recent episode of depression: 1. Elevated, expansive mood. 2. Inflated self-esteem or grandiosity. 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Increase in energy or goal-directed activity (socially, at work, school, sexually) 6. Increased or excessive involvement in activities that have a high potential for painful consequences 7. Decreased need for sleep B. Mixed symptoms are observable by others and represent a change from the person's usual behavior. C. For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features. D. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment).

Can you summarize criteria A-F for Autism Spectrum Disorder?

A. PERSISTENT DEFICITS in social COMMUNICATION and social INTERACTION B. RESTRICTED, REPETITIVE PATTERNS of behavior, interests, or activities C. Symptoms must be PRESENT in the EARLY developmental period D. Symptoms cause clinically significant IMPAIRMENT in social, occupational, or other important areas of current functioning. E. These disturbances are NOT better explained by intellectual disability or global developmental delay.

Can you name the major criteria for Language Disorder?

A. PERSISTENT DIFFICULTIES in the ACQUISITION and USE of language B. Language abilities are SUBSTANTIALLY and QUANTIFIABLY below those expected for age, resulting in functional limitations C. ONSET of symptoms is in the EARLY developmental period. D. NOT attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay

Summarize the major dx criteria for ADHD

A. PERSISTENT pattern of INATTENTION and/or HYPERACTIVITY-IMPULSIVITY that INTERFERES with functioning or development B. Several inattentive or hyperactive-impulsive SYMPTOMS present PRIOR TO AGE 12 years. C. Several inattentive or hyperactive-impulsive SYMPTOMS are present in TWO OR MORE SETTINGS. D. Clear EVIDENCE that the SYMPTOMS INTERFERE with or reduce the quality of FUNCTIONING. E. The sx do NOT occur exclusively during the course of schizophrenia or another psychotic disorder, are not better explained by another mental disorder

What are the diagnostic criteria for Pica?

A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 MONTH. B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. C. The eating behavior is not part of a culturally supported or socially normative practice. D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability, ASD, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.

Psychotic Disorder Due to Another Medical Condition Diagnostic Criteria

A. Prominent hallucinations or delusions. B. There is evidence from the hx, pe, or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition. C. not better explained by another mental disorder. D. does not occur exclusively during the course of a delirium. E. causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify whether: With delusions or With hallucinations Include the name of the other medical condition in the name of the mental disorder

Summarize the diagnostic criteria for Anorexia Nervosa.

A. RESTRICTION of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory & physical health. Significantly low weight is a weight less than minimally normal or, for children & adolescents, less than that minimally expected. B. Intense FEAR of GAINING weight or of BECOMING FAT, or persistent BEHAVIOR that interferes with weight gain, even though at a significantly low weight. C. DISTURBANCE in the way in which one's body WEIGHT or SHAPE is EXPERIENCED, UNDUE INFLUENCE of body weight /shape on self-evaluation, OR PERSISTENT LACK OF RECOGNITION of the SERIOUSNESS of the current low body weight.

What is criterion A of Disruptive Mood Dysregulation Disorder?

A. Severe RECURRENT temper OUTBURSTS manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are GROSSLY out of proportion in intensity or duration to the situation or provocation.

Schizoaffective Disorder Diagnostic Criteria

A. UNINTERRUPTED period of illness during which there is a major MOOD EPISODE (major depressive or manic) CONCURRENT with Criterion A of schizophrenia. The major depressive episode must include Criterion A1 : Depressed mood. B. Delusions or hallucinations for >= 2 WEEKS in the ABSENCE of major mood episode (depressive or manic) during the LIFETIME of the illness. C. Sx that meet criteria for a major mood episode are present for the MAJORITY of the total duration of active & residual portions of illness. D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

The essential feature of Reactive Attachment Disorder is:

ABSENT or grossly underdeveloped ATTACHMENT between the child and putative caregiving adults. Furthermore, when distressed, children with this disorder do NOT RESPOND more than minimally to comforting efforts of caregivers. Thus, the disorder is associated with the absence of expected comfort seeking and response to comforting behaviors.

Specifiers used for intellectual disability are defined on the basis of ____ and not ____

ADAPTIVE functioning, not IQ - adaptive functioning DETERMINES the level of SUPPORTS required and IQ measures are less valid in the lower end of the IQ range

The most frequently coexisting condition with DEVELOPMENTAL COORDINATION disorder is:

ADHD. Others include speech and language disorder; specific learning disorder (especially reading and writing); ASD; disruptive and emotional behavior problems; and joint hypermobility syndrome

ADHD is elevated in the first-degree biological relatives of individuals with:

ADHD. The heritability of ADHD is substantial.

Especially in adolescents and children, ______ may be misdiagnosed as bipolar disorder.

ADHD; Many sx overlap, such as rapid speech, racing thoughts, distractibilty, and less need for sleep. The "double counting" of symptoms toward both ADHD and bipolar disorder can be avoided if the clinician clarifies whether the symptom(s) represents a distinct episode.

Most children and adolescents with DMDD have sx that also meet criteria for:

ADHD; a lesser percentage of children with ADHD have symptoms that meet criteria for disruptive mood dysregulation disorder.

Compared with Childhood-Onset Fluency Disorder (Stuttering), later-onset cases are diagnosed as:

ADULT-ONSET fluency disorder

Environmental nonspecific RISK factors that may contribute to risk of ASD are:

ADVANCED PARENTAL AGE, LOW BIRTH WEIGHT, or fetal exposure to VALPROATE

The general incidence of schizophrenia tends to be slightly lower in females, particularly among treated cases. Age at onset is later in females, with a second mid-life peak. Sx tend to be more:

AFFECT-LADEN among females, and there are MORE PSYCHOTIC Sx, as well as greater propensity for psychotic Sx to WORSEN in later life, LESS FREQUENT NEGATIVE Sx and disorganization.

Childhood-onset fluency disorder, or developmental stuttering, occurs by age ______ for 80%-90% of affected individuals

AGE 6 (age at onset ranging from 2 to 7 years)

__________ and __________ behavior can occur with persecutory, jealous, and erotomanic types.

ANER and VIOLENT behavior; The individual may engage in litigious or antagonistic behavior (e.g., sending hundreds of letters of protest to the government). Legal difficulties can occur, particularly in jealous and erotomanic types.

Adolescents and adults with ASD are prone to:

ANXIETY and DEPRESSION

A common characteristic of individuals with delusional disorder is the ________ of their behavior and appearance when their delusional ideas are not being discussed or acted on

APPARENT NORMALITY

The preoccupations and repetitive behaviors of body dysmorphic disorder differ from obsessions and compulsions in OCD in that the former focus only on:

APPEARANCE. These disorders have other differences, such as POORER INSIGHT in body dysmorphic disorder.

Extreme reaction to or rituals involving taste, smell, texture, or appearance of food or excessive food restrictions are common and may be a presenting feature of:

ASD

Some children with this disorder experience developmental PLATEAUS OR REGRESSION, with a gradual or relatively rapid deterioration in social behaviors or use of language, often during the first 2 years of life. Such losses are rare in other disorders and may be a useful "red flag".

ASD

Many individuals previously diagnosed with Asperger's disorder would now receive a diagnosis of:

ASD WITHOUT LANGUAGE or INTELLECTUAL impairment

What is the gender predilection in ASD?

ASD is diagnosed FOUR times more often in MALES than in females though FEMALES show more INTELLECTUAL DISABILITY, suggesting that girls WITHOUT accompanying INTELLECTUAL IMPAIRMENTS or language delays may go UNRECOGNIZED.

SOCIAL (Pragmatic) COMMUNICATION Disorder DDx

ASD is the primary diagnostic consideration for individuals presenting with social communication deficits. ASD also INCLUDES the presence of RESTRICTED / REPETITIVE patterns. Individuals with ASD MAY ONLY DISPLAY the restricted/repetitive PATTERNS during the EARLY DEVELOPMENT PERIOD, so OBTAIN a comprehensive HISTORY. Other DDx: ADHD, Social Anxiety Disorder, Intellectual Disability, Global Developmental Delay

Is ASD a degenerative disorder? What is the pattern of learning and compensation?

ASD isn't a degenerative disorder. It's typical for learning & compensation to continue throughout life. Sx are often most marked in early childhood & early school years, with DEVELOPMENTAL GAINS typical in LATER CHILDHOOD in at least SOME areas. A small proportion deteriorate behaviorally during adolescence, most improve. ONLY a MINORITY live and work INDEPENDENTLY in adulthood & they remain naive & vulnerable. Many adults report compensating to mask difficulties in public but suffer from the stress & effort of maintaining a socially acceptable facade.

Motor deficits are often present, including odd gait, clumsiness, and other abnormal motor signs (e.g., walking on tiptoes). Self injury (e.g., head banging, biting the wrist) may occur, and disruptive/challenging behaviors are more common in children and adolescents with:

ASD than other disorders, including intellectual disability.

This FAMILY HX appears to increase the RISK for SOCIAL (pragmatic) COMMUNICATION disorder:

ASD, communication disorders, or SPECIFIC LEARNING disorder

Tic disorder DDx

Abnormal movements that may accompany medical conditions, Substance-induced and paroxysmal dyskinesias, Myoclonus, OCD, STEREOTYPIC MOVEMENT disorder (Motor stereotypies >3 yo, longer duration (seconds to minutes), constant repetitive fixed, exacerbation when engrossed in activities, lack of a premonitory urge, cessation with distraction)

What % of individuals with bipolar II will ultimately develop a manic episode?

About 5%-15% of individuals with bipolar II disorder will ultimately develop a manic episode, which changes the diagnosis to bipolar I disorder, regardless of subsequent course.

Rates of this disorder occurring after the following events are: 13%-21% of MVA, 14% of mild TBI, 19% of assault, 10% of severe burns, and 6%-12% of industrial accidents. Higher rates (i.e., 20%-50%) are reported following interpersonal traumatic events, including assault, rape, and witnessing a mass shooting.

Acute Stress Disorder

Acute Stress Disorder A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways: (4 ways)

Acute Stress Disorder A. Exposure to actual or threatened death, serious injury, or sexual violation in ONE (or more) of the following ways: 1. Directly EXPERIENCING the traumatic event(s). 2. WITNESSING, in person, the event(s) as it occurred to others. 3. LEARNING that the event(s) occurred to a CLOSE family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing REPEATED or extreme EXPOSURE to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

Acute stress disorder is distinguished from PTSD because the symptom pattern in acute stress disorder is restricted to a duration of ___________ to __________ following exposure to the traumatic event.

Acute stress disorder is restricted to a duration of 3 days to 1 month following exposure to the traumatic event.

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring WITHIN THREE MONTHS of the onset of the stressor(s). B. These symptoms or behaviors are clinically SIGNIFICANT, as evidenced by one or both of the following: 1. Marked distress that is OUT OF PROPORTION to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant IMPAIRMENT in social, occupational, or other important areas of functioning. C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. D. The symptoms do not represent normal bereavement. E. Once the stressor or its consequences have terminated, the symptoms DO NOT persist for more than an additional SIX MONTHS. Specify whether: With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant. With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant. With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant. With disturbance of conduct: Disturbance of conduct is predominant. With mixed disturbance of emotions and conduct: Both emotional sx (e.g., depression, anxiety) and a disturbance of conduct are predominant. For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.

Adjustment Disorder

A patient directly witnessed the traumatic death of a sibling but doesn't meet all the other criteria of PTSD. What's the dx? How about if the patient meets other criteria but the stressor does not meet the severity of Criterion A of PTSD?

Adjustment disorder. In adjustment disorders, the stressor can be of any severity or type rather than that required by PTSD Criterion A. The diagnosis of an adjustment disorder is used when the response to a stressor that meets PTSD Criterion A does not meet all other PTSD criteria (or criteria for another mental disorder). An adjustment disorder is also diagnosed when the symptom pattern of PTSD occurs in response to a stressor that does not meet PTSD Criterion A (e.g., spouse leaving, being fired)

A mother is overly concerned about her children and spouse and experiences marked discomfort when they're not around. What's the most likely dx?

Adults with the Separation Anxiety Disorder are typically overconcerned about their offspring and spouses and experience marked discomfort when separated from them. They may also experience significant disruption in work or social experiences because of needing to continuously check on the whereabouts of a significant other.

For a dx of Persistent Depressive Disorder requires what mood, for how long? (Adults and children/adolescents)

Adults: depressed, >= 2 yrs, Child/Adolescent, can also be irritable, >= 1 yr; "most of the day, more days than not"

There is some evidence for the overdiagnosis of schizophrenia compared with schizoaffective disorder in

African American and Hispanic populations, so care must be taken to ensure a culturally appropriate evaluation including both psychotic & affective sx

Cultural differences exist but individuals with ASD are markedly impaired against the norms for their culture. Cultural and socioeconomic factors may affect age at recognition or diagnosis; In the U.S., late or underdiagnosis of autism spectrum disorder frequently occurs among:

African American children

What is the typical course for enuresis?

After age 5 years, the rate of spontaneous remission is 5%-10% per year. Most children with the disorder become continent by adolescence, but in approximately 1% of cases the disorder continues into adulthood. Diurnal enuresis is uncommon after age 9 years. While occasional diurnal incontinence is not uncommon in middle childhood, it is substantially more common in those who also have persistent nocturnal enuresis. When enuresis persists into late childhood or adolescence, the frequency of incontinence may increase, whereas continence in early childhood is usually associated with a declining frequency of wet nights.

A patient meets the criteria for Agoraphobia and Panic Disorder. What's the dx?

Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual's presentation meets criteria for panic disorder and agoraphobia, BOTH diagnoses should be assigned.

Of the various phobias, which has the strongest and most specific association with the genetic factor that represents proneness to phobias?

Agoraphobia, heritability is 61%

What is Alice in Wonderland syndrome?

Alice in Wonderland syndrome is a disorienting neurological condition that affects perception. People experience size distortion such as micropsia, macropsia, pelopsia, or teleopsia. Size distortion may occur of other sensory modalities.

What disorder do catatonic Sx indicate?

Although catatonia has historically been associated with schizophrenia, catatonic symptoms are NONSPECIFIC and may occur in other mental disorders (e.g., BIPOLAR or DEPRESSIVE disorders with catatonia) and in MEDICAL CONDITIONS (catatonic disorder due to another medical condition)

Individuals with delusional disorder may have nonbizarre delusions and/or hallucinations related to the delusional theme that focus on being rejected by or offending others. How does this compare with social anxiety disorder?

Although extent of insight into beliefs about social situations may vary, many individuals with social anxiety disorder have good INSIGHT that their beliefs are out of proportion to the actual threat posed by the social situation.

Patient presents with symptoms that is not explained by neurological disease and the symptom is "bizarre." What other general principle is needed to diagnose Conversion Disorder?

Although the diagnosis requires that the symptom is NOT explained by neurological disease, it should not be made simply because results from investigations are normal or because the symptom is "bizarre." There must be clinical findings that show clear evidence of INCOMPATIBILITY with neurological disease.

Comorbid substance use disorder and conduct disorder are more common among males than among females. Among U.S. military personnel and combat veterans who have been deployed to recent wars in Afghanistan and Iraq, co-occurrence of PTSD and mild TBI is ______%

Among U.S. military personnel and combat veterans who have been deployed to recent wars in Afghanistan and Iraq, co-occurrence of PTSD and mild TBI is 48%

There is an increased risk of anorexia nervosa and bulimia nervosa among 1st degree biological relatives of individuals. An increased risk of bipolar and depressive disorders has also been found among first-degree relatives of individuals with anorexia nervosa, particularly relatives of individuals with the _________________ type.

An increased risk of BIPOLAR and DEPRESSIVE disorders has also been found among first-degree RELATIVES of individuals with anorexia nervosa, particularly relatives of individuals with the BINGE-EATING / PURGING type. Concordance rates for anorexia nervosa in monozygotic twins are significantly higher than those for dizygotic twins. A range of brain abnormalities has been described in anorexia nervosa using fMRI & PET.

Name 101 substances that can evoke anxiety sx

Anesthetics and analgesics, sympathomimetics or other bronchodilators, anticholinergics, insulin, thyroid preparations, oral contraceptives, antihistamines, antiparkinsonian medications, corticosteroids, antihypertensive and cardiovascular medications, anticonvulsants, lithium carbonate, antipsychotic medications, and antidepressant medications. Heavy metals and toxins (e.g., organophosphate insecticide, nerve gases, carbon monoxide, carbon dioxide, volatile substances such as gasoline and paint) may also cause panic or anxiety symptoms.

Patient previously met full criteria for Anorexia Nervosa. Now his body weight has been increased to WNL for a sustained period, though he still has intense fear of becoming fat and still believes his body is large and out of shape. What's the dx now?

Anorexia Nervosa, In partial remission, used when Criterion A (low body weight) hasn't been met for a sustained period (in a patient who previously met full criteria for anorexia nervosa) BUT EITHER Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) OR Criterion C (disturbances in self-perception of weight and shape) ARE STILL MET.

What's in the DDx for Bulimia Nervosa?

Anorexia nervosa, binge-eating/purging type; Binge-eating disorder; KLEINE-LEVIN syndrome (features disturbed eating behavior, but the characteristic psychological features of bulimia nervosa, such as overconcem with body shape and weight, are not present); MDD, with ATYPICAL features (If criteria for both disorders are met, both dx should be given); BORDERLINE PERSONALITY DISORDER (Binge-eating behavior is included in the impulsive behavior criterion that is part of the definition of borderline personality disorder. If the criteria for both borderline personality disorder and bulimia nervosa are met, both diagnoses should be given)

In patients with hoarding disorder, what may often be the main reason for consultation, and why?

Individuals are unlikely to spontaneously report hoarding symptoms, and these symptoms are often not asked about in routine clinical interviews. Instead, it is comorbidities, like mood or anxiety disorders or OCD, which are highly comorbid, that instigate consultation.

What are signs that a person is feigning dissociative identity disorder?

Individuals who feign dissociative identity disorder do NOT report the SUBTLE symptoms of intrusion characteristic of the disorder; instead they tend to overreport well-publicized symptoms of the disorder, such as dissociative amnesia, while underreporting less-publicized comorbid symptoms, such as depression. Individuals who feign dissociative identity disorder tend to be relatively UNDISTURBED by or may even seem to enjoy "having" the disorder. In contrast, individuals with genuine dissociative identity disorder tend to be ASHAMED of and OVERWHELMED by their symptoms and to UNDERREPORT their symptoms or deny their condition. Sequential observation, corroborating history, and intensive psychometric and psychological assessment may be helpful in assessment. Individuals who malinger dissociative identity disorder usually create limited, stereotyped alternate identities, with feigned amnesia, related to the events for which gain is sought. For example, they may present an "all-good" identity and an "all-bad" identity in hopes of gaining exculpation for a crime.

Patient meets the criteria for both DMDD and ODD. What's the dx?

Individuals whose symptoms meet criteria for both DMDD and ODD should ONLY be given the diagnosis of disruptive mood dysregulation disorder. ("DMDD has more letters than ODD so it wins")

Patient meets criteria for MDD for 2 years. What's the dx?

Individuals whose symptoms meet major depressive disorder criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder.

Individuals with PTSD are _______% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder (e.g., depressive, bipolar, anxiety, or substance use disorders).

Individuals with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder (e.g., depressive, bipolar, anxiety, or substance use disorders).

What kind of temperament is characteristically seen in individuals with depersonalization / derealization disorder?

Individuals with depersonalization / derealization disorder are characterized by HARM-AVOIDANT temperament, immature defenses, and both disconnection and overconnection schemata. Immature defenses such as idealization / devaluation, projection and acting out result in denial of reality and poor adaptation. Cognitive disconnection schemata reflect defectiveness and emotional inhibition and subsume themes of abuse, neglect, and deprivation. Overconnection schemata involve impaired autonomy with themes of dependency, vulnerability, and incompetence

What must be taken into account when monitoring for depression in those with dissociative identity disorder?

Individuals with dissociative identity disorder are often depressed, and their symptoms may appear to meet the criteria for a major depressive episode. Rigorous assessment indicates that this depression in some cases does not meet full criteria for major depressive disorder. Other specified depressive disorder in individuals with dissociative identity disorder often has an important feature: the depressed mood and cognitions fluctuate because they are experienced in some identity states but not others.

Dissociative identity disorder may be confused with schizophrenia or other psychotic disorders. What is different about the perception of the sx in DID?

Individuals with dissociative identity disorder experience these symptoms as caused by ALTERNATE identities, do NOT have DELUSIONAL EXPLANATIONS for the phenomena, and often describe the symptoms in a personified way (e.g., "I feel like someone else wants to cry with my eyes").

OCD is much more common in individuals with certain other disorders than would be expected based on its prevalence in the general population; when one of those other disorders is diagnosed, the individual should be assessed for OCD as well. Examples include:

Individuals with schizophrenia or schizoaffective disorder, the prevalence of OCD is approximately 12%. Rates of OCD are also elevated in bipolar disorder; eating disorders, such as anorexia nervosa and bulimia nervosa; and Tourette's disorder.

How do infants with RUMINATION disorder typically present?

Infants with rumination disorder display a characteristic position of straining and arching the back with the head held back, making sucking movements with their tongue. They may give the impression of gaining satisfaction from the activity. They may be irritable and hungry between episodes of regurgitation. WEIGHT LOSS and FAILURE to make EXPECTED weight gains are common features in infants with rumination disorder. Malnutrition may occur despite the infant's apparent hunger and the ingestion of relatively large amounts of food, particularly in severe cases, when regurgitation immediately follows each feeding episode and regurgitated food is expelled.

What is the pattern of ASD onset typically like?

It may include early developmental delays or losses of social or language skills. In cases where skills have been lost, parents or caregivers may give a hx of a gradual or relatively rapid deterioration in social behaviors or language skills, typically between 12-24 months old. There are rare instances of regression occurring after 2 yrs of normal development (previously described as childhood disintegrative disorder).

Anorexia nervosa commonly begins during adolescence or young adulthood. It rarely begins before ________ or after age ________.

It rarely begins before puberty or after age 40, but cases of both early and late onset have been described. The onset of this disorder is often associated with a stressful life event, such as leaving home for college. The course and outcome of anorexia nervosa are highly variable. Younger individuals may manifest atypical features, including denying "fear of fat." Older individuals more likely have a longer duration of illness. Clinicians should NOT exclude anorexia nervosa from the ddx solely on the basis of older age.

A. Panic attacks or anxiety is predominant in the clinical picture. B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. C. The disturbance is not better explained by another mental disorder. D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Anxiety Disorder Due to Another Medical Condition; e.g., anxiety disorder due to pheochromocytoma

Re adults with OCD comorbidities, what is the likelihood of an OCD adult having anxiety disorder? Depressive or bipolar disorder? Obsessive-compulsive personality disorder? Tic disorder?

Anxiety disorders, 76% 63% for any depressive or bipolar disorder, with the most common being major depressive disorder [41%]). Obsessive-compulsive PD ranges from 23% to 32% Up to 30% of individuals with OCD also have a lifetime tic disorder. (comorbid tic disorder is most common in males with onset of OCD in childhood). A triad of OCD, tic disorder, and ADHD can also be seen in children.

What is anxiety sensitivity and how does it relate to risk of panic attacks?

Anxiety sensitivity is the disposition to believe that sx of anxiety are harmful. Increased anxiety sensitivity is a risk factor for the onset of panic attacks

TRANSIENT depersonalization/derealization symptoms lasting hours to days are COMMON in the general population. The 12-month prevalence of depersonalization / derealization disorder is thought to be much less than for transient symptoms but estimates for the disorder are unavailable. In general, approximately __________ of all adults have experienced at least one lifetime episode of depersonalization/derealization.

Approximately ONE-HALF of all adults have experienced at least one lifetime episode of depersonalization / derealization. Lifetime prevalence in U.S. and non-U.S. countries is approximately 2%. The gender ratio for the disorder is 1:1.

Name the physical s/s of anorexia nervosa.

Attributable to starvation; Amenorrhea, usually a CONSEQUENCE of the WEIGHT LOSS, but in a MINORITY of individuals it MAY ACTUALLY PRECEDE WEIGHT LOSS. In prepubertal females, menarche maybe delayed. Constipation, abdominal pain, cold intolerance, lethargy, excess energy. EMACIATION; significant hypotension, hypothermia; Lanugo, a fine downy body hair; Peripheral edema, especially during weight restoration or cessation of laxative/diuretic abuse. Petechiae/ecchymoses, may indicate a bleeding diathesis. Yellowing of the skin associated with hypercarotenemia. Like bulimia nervosa, self-induced vomiting = salivary gland hypertrophy esp. the parotid glands, dental enamel erosion. Scars or calluses on the dorsal surface of the hand from repeated contact with the teeth while inducing vomiting

What is the gender predilection for Avoidant / Restrictive Food Intake disorder?

Avoidant/restrictive food intake disorder is equally common in males and females in infancy and early childhood, but when comorbid with ASD, has a male predominance.

What DSM-IV dx does AVOIDANT / RESTRICTIVE FOOD INTAKE disorder replace and extend?

Avoidant/restrictive food intake disorder replaces and extends the DSM-IV diagnosis of feeding disorder of infancy or early childhood.

Encopresis A. Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional. B. At least one such event occurs __________ for at least ___________ C. Chronological age is at least ________ (or equivalent developmental level).

B. At least ONE such event occurs each month for at least THREE MONTHS C. Chronological age is at least FOUR YEARS (or equivalent developmental level).

Criterion A for Childhood-Onset Fluency Disorder (Stuttering) requires persistent disturbances in normal fluency & time patterning of speech inappropriate for the individual's age and language skills, characterized by frequent and marked occurrences of sound repetitions or prolongations, broken words (e.g., pauses within a word), audible or silent blocking (filled or unfilled pauses in speech), circumlocutions (word substitutions to avoid problematic words), words produced with an excess of physical tension, Monosyllabic whole-word repetitions (e.g., "I-I-I-I see him"). What are B-D?

B. Causes ANXIETY about speaking or limitations in effective communication C. The ONSET of symptoms is in the EARLY developmental period. D. The disturbance is NOT attributable to a speech-MOTOR or SENSORY deficit, DYSFLUENCY associated with neurological insult or another medical condition and is not better explained by another mental disorder.

Acute Stress Disorder B. Presence of NINE (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred: (14 sx)

B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred: Intrusion Symptoms 1. Recurrent, involuntary, and intrusive distressing MEMORIES of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing DREAMS in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content. 3. DISSOCIATIVE reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological DISTRESS or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Negative Mood 5. Persistent INABILITY to experience POSITIVE emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). Dissociative Symptoms 6. An ALTERED SENSE of the reality of one's surroundings or oneself (e.g., seeing oneself from another's perspective, being in a daze, time slowing). 7. INABILITY to REMEMBER an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). Avoidance Symptoms 8. Efforts to AVOID distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 9. Efforts to AVOID EXTERNAL reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Arousal Symptoms 10. SLEEP disturbance (e.g., difficulty falling or staying asleep, restless sleep). 11. IRRITABLE behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects. 12. HyperVIGILANCE. 13. Problems with CONCENTRATION. 14. Exaggerated STARTLE response.

Dissociative Identity Disorder A. DISRUPTION of IDENTITY characterized by TWO or more DISTINCT personality states, which may be described in some cultures as an experience of POSSESSION. The disruption in identity involves marked DISCONTINUITY in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. What's Criterion B?

B. RECURRENT GAPS in the RECALL of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Enuresis Criteria A. Repeated voiding of urine into bed or clothes, whether involuntary or INTENTIONAL B. The behavior is clinically significant as manifested by either a frequency of **_____________** for at least **____________** *****OR***** the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. C. Chronological age is at least 5 years (or equivalent developmental level). D. The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).

B. The behavior is clinically significant as manifested by either a frequency of at least *****TWICE A WEEK***** for at least THREE CONSECUTIVE MONTHS or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. C. Chronological age is at least 5 years (or equivalent developmental level). D. The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Binge-Eating Disorder A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an AMOUNT of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. 2. A sense of LACK OF CONTROL over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with ______ (or more) of the following:

B. The binge-eating episodes are associated with THREE (or more) of the following: 1. Eating much more RAPIDLY than normal. 2. Eating until feeling UNCOMFORTABLY full. 3. EATING large amounts of food WHEN NOT feeling physically HUNGRY. 4. EATING ALONE because of feeling embarrassed by how much one is eating. 5. Feeling DISGUSTED with oneself, DEPRESSED, or very GUILTY AFTERWARD. C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nen/osa and does not occur exclusively during the courseof bulimia nervosa or anorexia nervosa

Separation Anxiety Disorder Criteria B-D B. The fear, anxiety, or avoidance is persistent, lasting at least __________ in children and adolescents and typically __________ in adults. C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning. D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults. "the duration criterion for adults should be used as a general guide, with allowance for some degree of flexibility"

Criterion A for Agoraphobia requires marked fear or anxiety about 2 or more out of 5 situations. What does B require?

B. The individual FEARS OR AVOIDS these situations because of thoughts that ESCAPE might be DIFFICULT or HELP might NOT be available in the event of developing PANIC-like SX or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence)

OCD Criterion B requires obsessions or compulsions to be time-consuming or cause clinically significant distress or impairment. How long is that?

B. The obsessions or compulsions are time-consuming (e.g., take MORE THAN 1 HOUR per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Initial manifestations of specific learning disorder may be:

BEHAVIORAL (reluctance to engage in learning, oppositional behavior)

Careful attention should be given to the possibility that a recurrent disorder like _________ may be responsible for any recurring psychotic episodes.

BIPOLAR disorder or recurrent acute exacerbations of schizophrenia

Need for treatment is a complex decision that takes into consideration symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient's distress (mental pain) associated with the symptom(s), disability related to the patient's sx, risks and benefits of available treatments, and other factors (e.g., psychiatric symptoms complicating other illness).

BUT clinicians may encounter individuals whose sx do NOT meet full criteria for a mental disorder BUT who demonstrate a clear need for treatment or care. The fact that some individuals do not show all sx indicative of a dx should not be used to justify limiting their access to appropriate care.

What British show is best watched to learn about the applications of hypnosis?

Benny Hill

Remission rates are higher for binge-eating disorder than for bulimia nervosa or anorexia nervosa. How persistent is binge-eating disorder? How does its course compare with BN? How about crossover to other eating disorders?

Binge-eating disorder appears to be relatively persistent & the course is comparable to that of BN in terms of severity and duration. Crossover from binge-eating disorder to other eating disorders is UNCOMMON. Those with BED typically respond better to tx than BN.

What 2 disorders may resemble cyclothymic disorder?

Bipolar I disorder, with rapid cycling, and bipolar II disorder, with rapid cycling. Both disorders may resemble cyclothymic disorder by virtue of the frequent marked shifts in mood. By definition, in cyclothymic disorder the criteria for a major depressive, manic, or hypomanic episode has never been met, whereas the bipolar I disorder and bipolar II disorder specifier "with rapid cycling" requires that full mood episodes be present.

Patient has numerous periods of hypomanic sx and numerous periods of depressive sx that do not meet symptom or duration criteria for a MDE. What's the dx?

Bipolar II disorder is distinguished from cyclothymic disorder by the presence of one or more MDE. If a MDE occurs after the first 2 years of cyclothymic disorder, the ADDITIONAL diagnosis of bipolar II disorder is given.

Bipolar disorder is more common in ______ income than in _______ income countries

Bipolar disorder is more common in high-income than in low-income countries (1.4 vs. 0.7%).

Schizoaffective disorder specifiers

Bipolar type, Depressive type, with catatonia

Patient has delusional beliefs about his appearance and demonstrates prominent appearance preoccupation and related repetitive behaviors. He has no other psychotic sx. What's the dx?

Body Dysmorphic disorder, with absent insight / delusional beliefs, NOT Delusional Disorder. Many individuals with BODY DYSMORPHIC disorder have delusional appearance beliefs (complete conviction that their view of perceived defects is accurate). Appearance-related ideas or delusions of reference are common in body dysmorphic disorder; however, unlike schizophrenia or schizoaffective disorder, body dysmorphic disorder involves prominent appearance preoccupations and related repetitive behaviors, and disorganized behavior and other psychotic symptoms are absent (except for appearance beliefs, which may be delusional).

A teenaged female stares at and is preoccupied with other students' nose size and shape, noticing the "defect" in their appearance. What's the dx?

Body dysmorphic disorder by proxy, a form of body dysmorphic disorder in which individuals are preoccupied with defects they perceive in another person's appearance.

If a woman meets the criteria for MDD and Premenstrual Dysphoric Disorder, what's the dx?

Both. Although the diagnosis of premenstrual dysphoric disorder should not be assigned in situations in which an individual only experiences a premenstrual exacerbation of another mental or physical disorder, it can be considered in addition to the diagnosis of another mental or physical disorder if the individual experiences sx & changes in level of functioning that are characteristic of premenstrual dysphoric disorder and markedly different from the sx experienced as part of the ongoing disorder.

A. Presence of *ONE* (or more) of the following symptoms. At least *ONE* of these must be (1), (2), or (3): 1. DELUSIONS 2. HALLUCINATIONS 3. DISORGANIZED SPEECH (e.g., frequent derailment or incoherence). FOUR IS INSUFFICIENT BY ITSELF: 4. Grossly DISORGANIZED or CATATONIC BEHAVIOR. Note: Do not include a symptom if it is a culturally sanctioned response. B. Duration of an episode of the disturbance is AT LEAST 1 DAY but LESS than 1 MONTH, with eventual FULL RETURN to premorbid level of functioning. C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Brief Psychotic Disorder

At what age does BN usually begin? During or after what event does it frequently begin?

Bulimia nervosa commonly begins in adolescence or young adulthood. Onset before puberty or after age 40 is uncommon. The binge eating frequently begins during or after an episode of dieting to lose weight. Experiencing multiple stressful life events also can precipitate onset of bulimia nervosa.

What is the typical age for onset of primary enuresis? Secondary?

By definition, primary enuresis begins at age 5 years. The most common time for the onset of secondary enuresis is between ages 5 and 8 years, but it may occur at any time.

ASD Criterion A is about persistent social and communication deficits, B is about restrictive, repetitive patterns. What are C-E?

C. Symptoms must be present in the EARLY DEVELOPMENTAL PERIOD (but may NOT become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically SIGNIFICANT IMPAIRMENT in social, occupational, or other important areas of current functioning. E. These disturbances are NOT better explained by intellectual disability or global developmental delay.

Patient has sleep difficulty a couple times a week. Does that qualify for Insomnia Disorder? What's the cutoff? How long must it persist?

C. The sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months.

Other terms used to describe DEVELOPMENTAL COORDINATION disorder include:

CHILDHOOD DYSPRAXIA, specific developmental disorder of motor function, and clumsy child syndrome

Describe complex motor tics.

COMPLEX MOTOR TICS are longer (SECONDS); often include a COMBINATION of SIMPLE tics such as simultaneous head turning and shoulder shrugging. COMPLEX tics can APPEAR PURPOSEFUL, such as a tic-like sexual or obscene gesture (copropraxia) or a tic-like imitation of someone else's movements (echopraxia).

A. The clinical picture is dominated by three (or more) of the following symptoms: 1. Stupor (i.e., no psychomotor activity; not actively relating to environment). 2. Catalepsy (i.e., passive induction of a posture held against gravity). 3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner). 4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]). 5. Negativism (i.e., opposition or no response to instructions or external stimuli). 6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity). 7. Mannerism (i.e., odd, circumstantial caricature of normal actions). 8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). 9. Agitation, not influenced by external stimuli. 10. Grimacing. 11. Echolalia (i.e., mimicking another's speech). 12. Echopraxia (i.e., mimicking another's movements).

Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

A marked decrease in reactivity to the environment describes:

Catatonic behavior; ranges from resistance to instructions {negativism) to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses {mutism and stupor)

An elderly immigrant patient presents with sx of conversion and dissociation. His daughter tells you that his behavior is common in their culture. While peculiar, it hasn't resulted in clinically significant distress or disability.. What's the dx?

Changes resembling conversion (and dissociative) symptoms are common in certain culturally sanctioned rituals. If the symptoms are fully explained within the particular cultural context and do not result in clinically significant distress or disability, then the diagnosis of conversion disorder is not made.

In bipolar II, females are more likely than males to report hypomania with mixed depressive features and a rapid-cycling course. In females, __________ may be a specific trigger for a hypomanic episode, which can occur in 10%-20%.

Childbirth may be a specific trigger for a hypomanic episode, occurring in 10%-20% of females in nonclinical populations and most typically in the early postpartum period. Distinguishing hypomania from the elated mood and reduced sleep that normally accompany the birth of a child may be challenging. Postpartum hypomania may foreshadow the onset of a depression that occurs in about half of females who experience postpartum "highs." Accurate detection of bipolar II disorder may help in establishing appropriate treatment of the depression, which may reduce the risk of suicide and infanticide

Diagnostic Criteria A. Disturbances in the normal fluency and time patterning of speech inappropriate for the individual's age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following: Sound and syllable repetitions, Sound prolongations of consonants as well as vowels, Broken words (e.g., pauses within a word), Audible or silent blocking (filled or unfilled pauses in speech), Circumlocutions (word substitutions to avoid problematic words), Words produced with an excess of physical tension, Monosyllabic whole-word repetitions (e.g., "I-I-I-I see him"),

Childhood-Onset Fluency Disorder (Stuttering)

This disorder is characterized by disturbances of the normal fluency and motor production of speech, including repetitive sounds or syllables, prolongation of consonants or vowel sounds, broken words, blocking, or words produced with an excess of physical tension:

Childhood-onset fluency disorder (stuttering)

A 10 yo patient presents with significant changes in mood within the same day. What's a likely dx?

Children with ADHD may show significant changes in mood within the SAME day; such lability is distinct from a manic episode, which must last 4 or more days to be a clinical indicator of bipolar disorder, even in children.

Re comorbidities, prepubertal children with tic disorders are more likely to experience _______ than are teenagers and adults, who are more likely to experience ________.

Children: ADHD, OCD, and separation anxiety disorder Teens/Adults: MDD, substance use disorder, or bipolar disorder.

Why is it useful to ask individuals presenting with depressive sx to identify the last period of at least 2 months during which they were entirely free of depressive sx?

Chronicity of depressive sx substantially increases the likelihood of underlying personality, anxiety, and substance use disorders and decreases the likelihood that treatment will be followed by full symptom resolution.

Early-onset persistent depressive disorder is strongly associated with DSM-IV:

Cluster B ("dramatic, emotional, erratic" cluster); and, Cluster C ("anxious, fearful") personality disorders.

What's in the DDx for Anorexia Nervosa?

Consider especially when the presenting features are atypical (e.g., onset after age 40 years). Medical conditions (e.g., gastrointestinal disease, hyperthyroidism, occult malignancies, AIDS. Serious weight loss may occur in medical conditions without disturbance in the way their body weight or shape is experienced or intense fear of weight gain or persist in behaviors that interfere with appropriate weight gain. Acute weight loss associated with a medical condition can occasionally be followed by the onset or recurrence of anorexia nervosa, which can initially be masked by the comorbid medical condition. Rarely, AN develops after bariatric surgery. MDD= severe weight loss may occur, but most individuals with major depressive disorder do not have either a desire for excessive weight loss or an intense fear of gaining weight. Schizophrenics may exhibit odd eating behavior and occasionally experience significant weight loss, but they rarely show the fear of gaining weight and the body image disturbance required for a diagnosis of anorexia nervosa. Substance use disorders; Features of AN overlap with social phobia, OCD, and body dysmorphic disorder, e.g. humiliated or embarrassed to be seen eating in public; may perceive defect in bodily appearance, as in body dysmorphic disorder. If the individual with AN has social fears that are LIMITED to EATING behavior ALONE, dx of social phobia should not be made; Re: Individuals with bulimia nervosa vs. anorexia nervosa, binge-eating/purging type, individuals with bulimia nervosa maintain body WEIGHT at or ABOVE a minimally normal level.

With this type of amnesia, an individual forgets each event as it occurs.

Continuous amnesia is when an individual forgets each new event as it occurs.

A. ONE or more symptoms of altered VOLUNTARY motor or SENSORY function. B. Clinical findings provide evidence of INCOMPATIBILITY between the symptom and recognized neurological or medical conditions. C. The symptom or deficit is not better explained by another medical or mental disorder. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Conversion Disorder (Functional Neurological Symptom Disorder)

An individual with OCD is completely convinced that her OCD beliefs are true. Is the Dxx delusional disorder or OCD?

Correct diagnosis is OCD, with absent insight/delusional beliefs specifier

For schizoaffective, at some time Criterion A for schizophrenia has to be met. What criteria doesn't need to be met?

Criteria B (social dysfunction) and F (exclusion of ASD or other communication disorder of childhood onset) for schizophrenia do NOT have to be met.

Does crossover between the types of Anorexia Nervosa happen?

Crossover between the subtypes over the course of the disorder is not uncommon so subtype description should be used to describe current sx rather than longitudinal course. Most individuals with the binge-eating/purging type of anorexia nervosa who binge eat also purge through self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Some individuals with this subtype of anorexia nervosa do not binge eat but do regularly purge after the consumption of small amounts of food.

An explanatory model that provides a culturally conceived etiology or cause for symptoms, illness, or distress:

Cultural explanation or perceived cause (e.g., maladi moun - from Haitian Creole meaning "evil or sickness caused or sent by others")

A way of talking about suffering among individuals of a cultural group referring to shared concepts of pathology and ways of expressing features of distress:

Cultural idiom of distress, e.g., kufungisisa ("thinking too much" in Shona)

This is a cluster of co-occurring, relatively invariant symptoms found in a specific cultural group. It may or may not be recognized as an illness within the culture but such cultural patterns may nevertheless be recognizable by an outside observer.

Cultural syndrome (e.g. ataque de nervios - Puerto Rico syndrome, a culturally-bound psychological disorder similar to a panic attack, exclusive to Latino cultures)

There are clear associations, as well as some neuroanatomical correlates, of depression with stroke, Huntington's disease, Parkinson's disease, and traumatic brain injury. Among the neuroendocrine conditions most closely associated with depression are:

Cushing's disease and hypothyroidism. There are numerous other conditions thought to be associated with depression, such as multiple sclerosis. However, the literature's support for a causal association is greater with some conditions, such as Parkinson's disease and Huntington's disease, than with others, for which the differential diagnosis may be adjustment disorder, with depressed mood.

The listing of medical conditions that are said to be able to induce mania is never complete, and the clinician's best judgment is the essence of this diagnosis. Among the best known of the medical conditions that can cause a bipolar manic or hypomanic condition are

Cushing's disease, multiple sclerosis, as well as stroke and traumatic brain injuries

PTSD D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: (7 thingamabobs)

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "No one can be trusted," 'The world is completely dangerous," "My whole nervous system is permanently ruined"). 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Neurodevelopmental motor disorders include:

DEVELOPMENTAL COORDINATION disorder, STEREOTYPIC MOVEMENT disorder, and TIC disorders.

Two negative symptoms are particularly prominent in schizophrenia, they are:

DIMINISHED EMOTIONAL EXPRESSION and AVOLITION

In individuals with severe irritability, particularly children and adolescents, care must be taken to apply the dx of bipolar disorder only to those who have had a clear episode of mania or hypomania—that is, a distinct time period, of the required duration, during which the irritability was clearly different from the individual's baseline and was accompanied by the onset of Criterion B symptoms. When a child's irritability is persistent and particularly severe, what dx would be more appropriate?

DMDD would be more appropriate. Indeed, when any child is being assessed for mania, it is essential that the sx represent a clear change from the child's typical behavior.

Hoarding disorder is not diagnosed if the sx are judged to be a direct consequence of another medical condition (Criterion E), such as traumatic brain injury, surgical resection for treatment of a tumor or seizure control, cerebrovascular disease, infections of the CNS (e.g., herpes simplex encephalitis), or neurogenetic conditions such as Prader-Willi syndrome. Damage to what area of the brain has been linked to excessive accumulation of objects?

Damage to the ANTERIOR VENTROMEDIAL PREFRONTAL and CINGULATE CORTICES has been particularly associated with the excessive accumulation of objects. In these individuals, the hoarding behavior is not present prior to the onset of the brain damage and appears shortly after the brain damage occurs. Some of these individuals appear to have little interest in the accumulated items and are able to discard them easily or do not care if others discard them, whereas others appear to be very reluctant to discard anything.

Restriction of energy intake relative to requirements leading to significantly low body weight is a core feature of anorexia nervosa. However, individuals with ANOREXIA NERVOSA also display a fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, as well as specific disturbances in relation to PERCEPTION and EXPERIENCE of their own body weight and shape. These features are NOT present in AVOIDANT / RESTRICTIVE FOOD INTAKE disorder, and the two disorders should NOT be diagnosed concurrently. In which anorexia nervosa patients is the ddx especially difficult?

Ddx is difficult in individuals with anorexia nervosa who deny any FEAR of FATNESS but nonetheless engage in persistent behaviors that prevent weight gain and who do NOT recognize the medical seriousness of their low weight—a presentation sometimes termed "non-fat phobic anorexia nervosa."

A. The presence of one (or more) delusions with a duration of 1 MONTH or longer. B. Criterion A for schizophrenia has NEVER been met. Note: HALLUCINATIONS, if present, are NOT prominent and are RELATED to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation). C. Apart from the impact of the delusion(s) or its ramifications, functioning is NOT markedly impaired, and behavior is NOT obviously bizarre or odd. D. If manic or major depressive episodes have occurred, these have been BRIEF relative to the duration of the delusional periods. E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Delusional Disorder

A patient has somatic symptom beliefs and behavior that are stronger than those found in somatic symptom disorder. What is the likely dx?

Delusional Disorder, Somatic Subtype. In somatic symptom disorder, the individual's beliefs that somatic symptoms might reflect serious underlying physical illness are NOT held with delusional intensity. Nonetheless, the individual's beliefs concerning the somatic symptoms can be FIRMLY held. In contrast, in delusional disorder, somatic subtype, the somatic symptom beliefs and behavior are stronger than those found in somatic symptom disorder.

Compare/contrast Borderline PD and Dependent PD with Separation Anxiety Disorder

Dependent personality disorder is characterized by an indiscriminate tendency to RELY on others, whereas separation anxiety disorder involves concern about the PROXIMITY and safety of main attachment figures. Borderline personality disorder is characterized by fear of ABANDONMENT by loved ones, but OTHER problems, in identity, self-direction, interpersonal functioning, and impulsivity are additionally central to that disorder, whereas they are not central to separation anxiety disorder.

Patient has had depressive Sx for longer than 2 years. What's the dx?

Depends on the # and which sx. The criteria for a major depressive episode include four sx that are absent from the symptom list for persistent depressive disorder, so a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will NOT meet criteria for Persistent Depressive Disorder. If full criteria for a MDE have been met at some point during the current episode of illness, they should be given a diagnosis of MDD. Othenwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted.

A patient has depersonalization and derealization sx, in addition to the symptoms of panic attacks. What's in your ddx? How would you differentiate? What is the likely dx?

Depersonalization / derealization is one of the sx of panic attacks, increasingly common as panic attack severity increases. Therefore, depersonalization / derealization disorder should NOT be diagnosed when the sx occur ONLY during panic attacks that are part of panic disorder, social anxiety disorder, or specific phobia. In addition, it is not uncommon for depersonalization / derealization symptoms to first begin in the context of new-onset panic attacks or as panic disorder progresses and worsens. In such presentations, the diagnosis of depersonalization/derealization disorder can be made if 1) the depersonalization/derealization component of the presentation is very prominent from the start, clearly exceeding in duration and intensity the occurrence of actual panic attacks; or 2) the depersonalization / derealization continues after panic disorder has remitted or has been successfully treated.

What are the results of reality testing in a patient with Depersonalization / Dereallzation Disorder?

Depersonalization/Dereallzation Disorder B. During the depersonalization or derealization experiences, REALITY TESTING REMAINS INTACT. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

The criterion symptoms for major depressive disorder must be present nearly every day to be considered present, with the exception of weight change and suicidal ideation. What must not only be present nearly every day, but must also be present MOST of the day?

Depressed MOOD must be present for MOST of the day, in addition to being present nearly EVERY day.

Functionai Consequences of Brief Psychotic Disorder

Despite HIGH RATES OF RELAPSE, for most individuals, OUTCOME IS EXCELLENT in terms of social functioning and symptomatology.

What is Developmental coordination disorder?

Developmental COORDINATION disorder is characterized by deficits in the acquisition and execution of coordinated MOTOR SKILLS and is manifested by clumsiness and slowness or inaccuracy of performance of motor skills that cause interference with activities of daily living.

A. ACQUISITION and EXECUTION of COORDINATED MOTOR skills is substantially below that expected given age and opportunity for skill learning. Difficulties are manifested as CLUMSINESS as well as SLOWNESS and INACCURACY of performance B. The motor skills deficit in A SIGNIFICANTLY and PERSISTENTLY INTERFERES with activities of daily living appropriate to age and impacts academic/school productivity, vocational activities, leisure, and play. C. Onset of symptoms is in the EARLY DEVELOPMENTAL period. D. The motor skills deficits are not better explained by intellectual disability (Intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder)

Developmental Coordination Disorder

Associated features of PTSD include: Developmental regression and Auditory pseudo-hallucinations. What are these?

Developmental regression, e.g. loss of language in young children. Auditory pseudo-hallucinations, i.e. having the sensory experience of hearing one's thoughts spoken in one or more different voices. Paranoid ideation may also happen in PTSD.

Dhat syndrome

Dhat syndrome is a condition found in the cultures of the Indian subcontinent in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine. The condition has no known organic cause. In traditional Hindu spirituality, semen is described as a "vital fluid". The discharge of this "vital fluid", either through sex or masturbation, is associated with marked feelings of anxiety and dysphoria. Often the patient describes the loss of a whitish fluid while passing urine. At other times, marked feelings of guilt associated with what the patient assumes is "excessive" masturbation are noted. Can happen with women and leucorrhea.

How does the role of dieting differ between Binge-eating disorder and BN?

Dieting FOLLOWS the development of binge eating, this is in contrast to BN, in which dysfunctional dieting usually PRECEDES onset of binge eating.

Reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech are all examples of:

Diminished emotional expression (top 2 negative sx of schizophrenia, along with avolition)

When interviewing a patient with potential Persistent Depressive Disorder, what is particularly important to do?

Directly prompt them about sx. Because these symptoms have become a part of the individual's day-to-day experience, particularly in the case of early onset (e.g., "I've always been this way"), they may not be reported unless the individual is directly prompted

Disinhibited Social Engagement Disorder A. A pattern of behavior in which a child actively approaches and interacts with UNFAMILIAR adults and exhibits at least TWO of the following: (4 features)

Disinhibited Social Engagement Disorder A. A pattern of behavior in which a child actively approaches and interacts with UNFAMILIAR adults and exhibits at least TWO of the following: 1. Reduced or ABSENT RETICENCE in approaching and interacting with unfamiliar adults. 2. OVERLY FAMILIAR verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries). 3. Diminished or ABSENT CHECKING BACK with adult caregiver after venturing away, even in unfamiliar settings. 4. WILLINGNESS TO GO OFF with an unfamiliar adult with minimal or no hesitation.

Disinhibited Social Engagement Disorder B. The behaviors in Criterion A are not limited to impulsivity but include:

Disinhibited Social Engagement Disorder B. The behaviors in Criterion A are not limited to: IMPULSIVITY (as in ADHD) but include socially DISINHIBITED behavior.

Disinhibited Social Engagement Disorder C. The child has experienced a pattern of:

Disinhibited Social Engagement Disorder C. The child has experienced a pattern of EXTREMES of INSUFFICIENT care as evidenced by at least ONE of the following: 1. SOCIAL NEGLECT or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. REPEATED CHANGES of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in UNUSUAL SETTINGS that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

What disorders are most commonly comorbid with PICA? In comorbid presentations, what is typically ingested?

Disorders most commonly comorbid with PICA are ASD and INTELLECTUAL DISABILITY, and, to a lesser degree, schizophrenia and OCD. Pica can be associated with trichotillomania and excoriation disorder. In COMORBID PRESENTATIONS, the HAIR or SKIN is typically INGESTED. Pica can also be associated with avoidant / restrictive food intake disorder, particularly in individuals with a strong sensory component to their presentation. When an individual is known to have PICA, ASSESSMENT should include consideration of the possibility of GI COMPLICATIONS, POISONING, infection, and nutritional deficiency.

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age at onset of Criteria A-E is 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., ASD, PTSD, separation anxiety disorder, persistent depressive disorder). Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including MDD, ADHD, CD, and substance use disorders. Individuals whose symptoms meet criteria for both DMDD and ODD should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned. K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition

Disruptive Mood Dysregulation Disorder

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: It most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury / TBI, other neurological condition). D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder. Specifiers: Dissociative amnesia without dissociative fugue Dissociative amnesia with dissociative fugue, With dissociative fugue

Dissociative Amnesia

Patient says, "I hear a little girl crying in a closet and an angry man yelling at her." What's on your ddx?

Dissociative identity disorder may be confused with schizophrenia or other psychotic disorders. The personified, internally communicative inner voices of dissociative identity disorder, especially of a child (e.g., "I hear a little girl crying in a closet and an angry man yelling at her"), may be mistaken for psychotic hallucinations. Dissociative experiences of IDENTITY FRAGMENTATION or POSSESSION, and of PERCEIVED LOSS of CONTROL over thoughts, feelings, impulses, and acts, may be CONFUSED WITH signs of FORMAL THOUGHT DISORDER, such as THOUGHT INSERTION or WITHDRAWAL. Individuals with dissociative identity disorder may also report visual, tactile, olfactory, gustatory, and somatic hallucinations, which are usually related to posttraumatic and dissociative factors, such as partial flashbacks.

Patient presents with relatively rapid shifts in mood - sometimes in minutes, sometimes in hours. What should be kept in the DDx?

Dissociative identity disorder. The relatively rapid shifts in mood in individuals with this disorder—typically within minutes or hours, in contrast to the slower mood changes typically seen in individuals with bipolar disorders—are due to the rapid, subjective shifts in mood commonly reported across dissociative states, sometimes accompanied by fluctuation in levels of activation. Furthermore, in dissociative identity disorder, elevated or depressed mood may be displayed in conjunction with overt identities, so one or the other mood may predominate for a relatively long period of time (often for days) or may shift within minutes.

What is the course of BN usually like?

Disturbed eating behavior persists for at least several years in a high percentage. The course may be chronic or intermittent, with periods of remission alternating with recurrences of binge eating. Over longer-term follow-up, the Sx of many individuals appear to diminish with or without treatment, although treatment clearly impacts outcome. Periods of remission longer than 1 year are associated with better long-term outcome. Significantly elevated risk for mortality (all-cause and suicide) has been reported. The CMR (crude mortality rate) for bulimia nervosa is nearly 2% per decade. Diagnostic cross-over from initial bulimia nervosa to anorexia nervosa occurs in a minority of cases (10%-15%). Individuals who do experience cross-over to anorexia nervosa commonly will revert back to bulimia nervosa or have multiple occurrences of cross-overs between these disorders. A subset of individuals with bulimia nervosa continue to binge eat but no longer engage in inappropriate compensatory behaviors, and therefore their symptoms meet criteria for binge-eating disorder or other specified eating disorder. Diagnosis should be based on the current (i.e., past 3 months) clinical presentation.

A young ruminates over the size of her nose every morning for 30 minutes while applying makeup. What's the dx?

Dunno, prolly normal but NOT Body dysmorphic disorder. With it, the preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3-8 hours per day), and usually difficult to resist or control.

Frequently, an individual's reaction to a trauma initially meets criteria for acute stress disorder. The sx of PTSD and the relative predominance of different symptoms may vary over time. Duration of the symptoms also varies, with complete recovery within _________ occurring in approximately one-half of adults.

Duration of the symptoms also varies, with complete recovery within 3 MONTHS occurring in approximately 50% of adults, while some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years.

With mood-congruent psychotic features

During manic episodes, the content of all delusions and hallucinations is consistent with the typical manic themes of grandiosity, invulnerability, etc., but may also include themes of suspiciousness or paranoia, especially with respect to others' doubts about the individual's capacities, accomplishments, and so forth.

For Criterion B of Bipolar Dx, what determines the # of Sx necessary to qualify? What is the #?

During the period of mood disturbance and increased energy or activity, >= 3 if mood is abnormally and persistently elevated or expansive; if the mood is IRRITABLE then need FOUR Sx: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed ACTIVITY (socially, at work or school, or sexually) or psychoMOTOR agitation (i.e., purposeless non-goal-directed activity). 7. Excessive INVOLVEMENT in activities that have a high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

What portions of the brain are implicated in OCD?

Dysfunction in the orbitofrontal cortex, anterior cingulate cortex, and striatum have been most strongly implicated

PTSD E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: (6 things)

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems with concentration. 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Using DSM-IV, many labeled both classic, episodic presentations of mania and NON-episodic presentations of severe IRRITABILITY as bipolar disorder in children. In DSM-5, the term bipolar disorder is explicitly reserved for

EPISODIC presentations of BIPOLAR symptoms.

The essential feature of a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of 13 physical and cognitive symptoms occur. _____ of these 13 symptoms are physical (e.g., palpitations, sweating), while ______ are cognitive (i.e., fear of losing control or going crazy, fear of dying).

Eleven physical (e.g., palpitations, sweating), two are cognitive (i.e., fear of losing control or going crazy, fear of dying).

Non-epileptic seizures are more common in patients who also have:

Epilepsy.. In conversion disorder, the presence of neurological disease that causes similar symptoms is a RISK factor

What are the specifiers for Insomnia Disorder?

Episodic: Symptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two (or more) episodes within the space of 1 year

Simple motor tics are of short duration (milliseconds). Give common examples.

Eye blinking, shoulder shrugging, and extension of the extremities.

You have a new patient who you're told may have ASD or a communication disorder of childhood onset who is now displaying Sx that are causing you to consider schizophrenia. How do these disorders affect a schizophrenia diagnosis?

F. If hx of ASD or a communication disorder of childhood onset, the additional dx of schizophrenia is made ONLY IF PROMINENT DELUSIONS OR HALLUCINATIONS, in addition to the other required Sx of schizophrenia, are also present for at least 1 month

Does cyclothymic disorder cause clinically significant distress?

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

T/F To meet criteria for OCD, compulsions must not be connected in a realistic way to the feared event (e.g., arranging items symmetrically to prevent harm to a loved one)

FALSE. Compulsions are typically performed in response to an obsession with the aim being to reduce distress or to prevent a feared event. These compulsions are EITHER are NOT connected in a realistic way to the feared event or are clearly EXCESSIVE (e.g., showering for hours each day).

T/F, the 1st step in RUMINATION disorder is involuntary retching?

FALSE. Previously swallowed food that may be partially digested is brought up into the mouth WITHOUT apparent nausea, involuntary retching, or disgust. The food may be re-chewed and then ejected from the mouth or re-swallowed. Regurgitation in rumination disorder should be frequent, occurring at least several times per week, typically daily.

T/F For the diagnosis of Enuresis to be made, the behavior must be manifested by a frequency of at least twice a week for at least 3 consecutive months.

FALSE. While that is one avenue for diagnosis, the 2nd portion of the criterion states: "or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning."

________is the emotional response to real or perceived imminent threat, whereas _________ is anticipation of future threat.

FEAR is the emotional response to real or perceived imminent threat, whereas ANXIETY is anticipation of future threat.

Females with dissociative identity disorder present more frequently with:

FEMALES with dissociative identity disorder present more frequently with ACUTE dissociative states (e.g., flashbacks, amnesia, fugue, functional neurological [conversion] symptoms, hallucinations, self-mutilation). MALES commonly exhibit more CRIMINAL or violent behavior than females; among males, common triggers of acute dissociative states include combat, prison conditions, and physical or sexual assaults.

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. B. The individual presents another individual (victim) to others as ill, impaired, or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Factitious Disorder Imposed on Another

A caregiver to a young child describes sx consistent with avoidant/restrictive food intake disorder then it's discovered that physical symptoms such as failure to gain weight were induced by the caregiver. What's the child's diagnosis?

Factitious disorder imposed on another is the diagnosis of the CAREGIVER

T/F Though the sx of Persistent Depressive Disorder can be challenging and long-lasting, by definition they do not cause clinically significant distress or impairment.

False. H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Criterion A for OCD discusses recurrent and persistent thoughts, urges, or images. They are intrusive and unwanted and by definition, always cause marked anxiety or distress. T/F?

False. "...in MOST individuals cause marked anxiety or distress" OCD Diagnostic Criteria A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Compulsions are defined by (1) and (2): 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts

T/F To be diagnosed, enuresis and encopresis must be involuntary occurrences.

False. Both disorders may be voluntary or involuntary.

T/F Re Criterion D for Encopresis, the behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition, like constipation.

False. D. The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition EXCEPT through a mechanism involving constipation. Specify whether: WITH constipation and OVERFLOW incontinence, or WITHOUT constipation and overflow incontinence

Bipolar II is a milder form of Bipolar I. T/F

False. Despite the substantial differences in duration and severity between a manic and hypomanic episode, bipolar II is not a "milder form" of bipolar I. Compared with bipolar I, bipolar II have greater chronicity of illness & spend, on average, more time in the depressive phase of their illness, which can be severe and/or disabling.

T/F Hypersomnolence Disorder must be diagnosed based upon sleep studies or other objective data.

False. Hypersomnolence Disorder Criterion A says: "Self-reported" excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms: 1. Recurrent periods of sleep or lapses into sleep within the same day. 2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing). 3. Difficulty being fully awake after abrupt awakening.

T/F. The diagnosis of conversion disorder requires a judgment that the symptoms are not intentionally produced (i.e., not feigned).

False. The diagnosis of conversion disorder does not require the judgment that the symptoms are not intentionally produced (i.e., not feigned), as the definite absence of feigning may not be reliably discerned. The phenomenon of la belle indifférence (i.e., lack of concern about the nature or implications of the symptom) has been associated with conversion disorder but it is not specific for conversion disorder and should not be used to make the diagnosis. Similarly the concept of secondary gain (i.e., when individuals derive external benefits such as money or release from responsibilities) is also not specific to conversion disorder and particularly in the context of definite evidence for feigning, the diagnoses that should be considered instead would include factitious disorder or malingering

Fear and anxiety overlap, but they also differ, with fear more often associated with_______________and anxiety more often associated with _________________

Fear is more often associated with: surges of AUTONOMIC arousal necessary for fight or flight, thoughts of immediate DANGER, and ESCAPE behaviors; Anxiety is more often associated with MUSCLE tension and VIGILANCE in preparation for future danger and cautious or AVOIDANT behaviors.

Considering a ddx including depersonalization / derealization disorder vs sx being caused by a medical condition, what is your workup?

Features such as onset after age 40 years or the presence of atypical symptoms and course in any individual suggest the possibility of an underlying medical condition. In such cases, it is essential to conduct a thorough medical and neurological evaluation, which may include standard LABoratory studies, VIRAL titers, an EEG, VESTIBULAR testing, VISUALtesting, SLEEP studies, and/or brain IMAGING. When the suspicion of an underlying seizure disorder proves difficult to confirm, an AMBULATORY EEG may be indicated; although TEMPORAL LOBE epilepsy is most commonly implicated, PARIETAL and FRONTAL LOBE epilepsy may also be associated.

What features may help diagnose that a panic attack is secondary to a substance or medical condition?

Features such as onset after age 45 years or the presence of atypical symptoms during a panic attack (e.g., vertigo, loss of consciousness, loss of bladder or bowel control, slurred speech, amnesia)

Re the MDD Sx of having Feelings of worthlessness or excessive or inappropriate guilt nearly every day (not merely self-reproach or guilt about being sick), the guilt may not be delusional, T/F

Feelings of worthlessness or excessive or inappropriate guilt (which MAY be delusional) nearly every day (not merely self-reproach or guilt about being sick).

Which sex is more likely to be diagnosed with OCD? Does it vary for children?

Females are affected at a shghtly higher rate than males in adulthood, although males are more commonly affected in childhood.

In bipolar I, how do women differ from men?

Females are more likely to experience rapid cycling and mixed states and to have higher rates of lifetime eating disorders. Females with bipolar I or II disorder are more likely to experience depressive symptoms than males. They also have a higher lifetime risk of alcohol use disorder than are males and a much greater likelihood of alcohol use disorder than do females in the general population.

What is the ratio of MDE in F:M?

Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence.

When do 50% of postpartum major depressive episodes start?

Fifty percent of "postpartum" major depressive episodes actually begin prior to delivery. Thus, these episodes are referred to collectively as PERIPARTUM episodes. Women with peripartum major depressive episodes often have severe anxiety and even panic attacks. Prospective studies have demonstrated that mood and anxiety sx during pregnancy, as well as the "baby blues," increase the risk for a postpartum major depressive episode

For Brief Psychotic Disorder, how many Sx from Category A are needed? For Schizopheniform Disorder?

For Brief Psychotic D/O, ONE, at least ONE of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (4. Grossly disorganized or catatonic behavior - INSUFFICIENT ALONE) For SCHIZOPHRENIFORM Disorder, **TWO**, at least ONE from 1,2,3 and there is also a #5 to choose for negative sx

In those with depersonalization / derealization disorder, what disorders have high comorbidities? What personality disorder are frequently co-occurring?

For those with depersonalization / derealization disorder, comorbidities were high for UNIPOLAR DEPRESSIVE disorder and for any ANXIETY disorder, with a significant proportion of the sample having BOTH disorders. Comorbidity with PTSD was low. The three most commonly co-occurring personality disorders were avoidant, borderline, and obsessive-compulsive.

In bipolar I, how does functional recovery correlate with recovery from symptoms, especially with respect to occupational recovery?

Functional recovery lags substantially behind recovery from sx, especially with respect to occupational recovery, resulting in lower socioeconomic status despite equivalent levels of education; those w/ bipolar I perform more poorly than healthy individuals on cognitive tests & cognitive impairments may persist through the lifespan, even during euthymic periods.

Schizophrenia onset may be abrupt or insidious; majority manifest slow and gradual development of a variety of S/S. Half complain of depressive symptoms. Earlier age at onset has traditionally been seen as a predictor of worse prognosis. HOWEVER, the effect of age at onset is likely related to:

GENDER, with males having worse premorbid adjustment, lower educational achievement, more prominent negative Sx, cognitive impairment, and worse outcome. Impaired cognition is common, and alterations in cognition are present DURING development and PRECEDE the emergence of psychosis, taking the form of stable cognitive impairments during adulthood. COGNITIVE IMPAIRMENTS MAY PERSIST when other Sx are in remission and contribute to the disability of the disease.

Some children UNDER age 5 years whose presentation will EVENTUALLY meet criteria for INTELLECTUAL disability have deficits that meet criteria for:

GLOBAL DEVELOPMENTAL delay

What is Global developmental delay?

GLOBAL developmental delay is diagnosed when an individual FAILS to meet expected developmental MILESTONES in SEVERAL areas of intellectual functioning. The diagnosis is USED for individuals who are UNABLE to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing.

What medical conditions are important to differentiate from the regurgitation in rumination disorder?

Gastroparesis, pyloric stenosis, hiatal hernia, and Sandifer syndrome in infants should be ruled out by appropriate physical examinations and laboratory tests.

Patient is preoccupied with, and has a desire to be rid of her primary and secondary sex characteristics. What's the dx?

Gender dysphoria. Body dysmorphic disorder should not be diagnosed if the preoccupation is limited to discomfort with or a desire to be rid of one's primary and/or secondary sex characteristics in an individual with gender dysphoria.

In what ways does the prevalence of Binge-eating disorder differ from BN?

Gender ratio is far less skewed in binge-eating, also binge-eating disorder is as prevalent among females from racial or ethnic minority groups as has been reported for white females; binge-eating is more frequently normal/overweight/obese.

45 yo M patient presents meeting many criteria for depersonalization / derealization disorder. What should be on your ddx?

Given the rarity of disorder onset after age 40 years, in such cases the individual should be examined more closely for underlying MEDICAL conditions (e.g., brain lesions, seizure disorders, sleep apnea). LESS than 20% of individuals experience onset AFTER age 20 years and only 5% after age 25 years.

What is essential for identifying symptoms and for assessing adaptive functioning in Px with intellectual disability?

Knowledgeable informants

What is Koro?

Koro, a culturally related disorder that usually occurs in epidemics in Southeastern Asia, consists of a fear that the penis (labia, nipples, or breasts in females) is shrinking or retracting and will disappear into the abdomen, often accompanied by a belief that death will result. Koro differs from body dysmorphic disorder in several ways, including a focus on DEATH rather than preoccupation with perceived ugliness. Dysmorphic concern (which is not a DSM-5 disorder) is a much broader construct than, and is not equivalent to, body dysmorphic disorder. It involves symptoms reflecting an overconcern with slight or imagined flaws in appearance.

Premenstrual Dysphoric Disorder B. One (or more) of the following symptoms must be present: Name the 4 sx

L 1. Marked affective LABILITY (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection). i 2. Marked IRRITABILITY or ANGER or increased interpersonal CONFLICTS. A 4. Marked ANXIETY, tension, and/or feelings of being keyed up or ON EDGE. M 3. Marked depressed MOOD, feelings of HOPELESSNESS, or SELF-DEPRECATING thoughts.

Perception-like experiences that occur without an external stimulus are:

Hallucinations; They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders.

The most common associated feature of SOCIAL (pragmatic) COMMUNICATION disorder is:

LANGUAGE IMPAIRMENT (Language Disorder), which is characterized by a history of DELAY in reaching language MILESTONES and structural language problems

A patient is diagnosed with a serious illness and acutely has severe health-related anxiety. What is in the ddx/dx?

Health-related anxiety is a NORMAL response to serious illness and is NOT a mental disorder. Such nonpathological health anxiety is clearly related to the medical condition and is typically TIME-LIMITED. If the health anxiety is SEVERE enough, an ADJUSTMENT DISORDER may be diagnosed. However, ONLY when the health anxiety is of sufficient DURATION, SEVERITY, and DISTRESS can ILLNESS ANXIETY DISORDER be diagnosed. Thus, the diagnosis requires the continuous persistence of disproportionate health-related anxiety for at least 6 months.

The communication disorders include:

LANGUAGE disorder, SPEECH SOUND disorder, SOCIAL (pragmatic) COMMUNICATION disorder, and CHILDHOOD-ONSET FLUENCY disorder (stuttering).

In this syndrome, there are both STEREOTYPIC DYSTONIC movements and SELF-MUTILATION of fingers, lip biting, and other forms of self-injury unless the individual is restrained.

LESCH-NYHAN

A police officer tells her husband gruesome, agonizing details about the torture and death of a child at the hands of an abusive parent. Can this cause PTSD in the husband?

Here's what DSM-V says: "Indirect exposure through learning about an event is limited to experiences affecting close relatives or friends and experiences that are violent or accidental (e.g., death due to natural causes does not qualify). Such events include violent personal assault, suicide, serious accident, and serious injury." So, I think so?

The genetics of ASD are:

Heritability estimates for ASD range from 37% to 90%, based on twin concordance rates. Currently, as many as 15% of cases of ASD appear to be associated with a known genetic mutation. However, even when an ASD IS associated with a known genetic mutation, it does NOT appear to be FULLY PENETRANT. Risk for the remainder of cases appears to be polygenic, with hundreds of genetic loci making relatively small contributions.

Restricted social contact & difficulties with self-care ARE associated with schizoaffective d/o, but neg sx may be:

LESS SEVERE & less persistent than those seen in schizophrenia. Anosognosia is also common in schizoaffective d/o but deficits may be less severe. Individuals with schizoaffective d/o may be at increased risk for later developing episodes of MDD or Bipolar Dep.

Anxious distress has been noted as a prominent feature of both bipolar and major depressive disorder in both primary care and specialty mental health settings. Why is it clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning and monitoring of response to treatment?

High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse.

What are helpful Diagnostic Indicators or lab abnormalities observed in anorexia nervosa?

LEUKOPENIA is common, with loss of all cell types but with apparent lymphocytosis. Mild ANEMIA, THROMBOCYTOPENIA, rarely, bleeding problems. DEHYDRATION = ^BUN; Hypercholesterolemia, ^ LFTs; Hypomagnesemia, hypozincemia, hypophosphatemia, hyperamylasemia; Vomiting =metabolic alkalosis, hypochloremia, hypokalemia; laxative abuse = metabolic acidosis; T4 = low-normal; T3 are decreased, ^ reverse T3; Females = low estrogen, males = low testosterone; BRADYCARDIA, rarely, arrhythmias; QTc prolongation; osteopenia/osteoporosis; EEG = Diffuse abnormalities, i.e. metabolic encephalopathy, from fluid and electrolyte disturbances; Decreased resting energy expenditure. S/S are attributable to starvation.

What is the most common form of dissociative amnesia?

LOCALIZED amnesia, a failure to recall events during a circumscribed period of time, is the most common form of dissociative amnesia. Localized amnesia may be broader than amnesia for a single traumatic event (e.g., months or years associated with child abuse or intense combat). In SELECTIVE amnesia, the individual can recall SOME, but NOT all, of the events during a circumscribed period of time. Thus, the individual may remember part of a traumatic event but not other parts. Some individuals report both localized and selective amnesias.

A 5'10", 225 pounds with 8% body fat, teenage male lifts weights 2 hour a day, eats a "clean" diet, & denies steroid use. He says he likes feeling strong and being this lean and muscular. He has several other hobbies that are important to him and says he doesn't think about his appearance much. Does he meet the criteria for Muscle Dysmorphia (a form of body dysmorphic disorder)?

Hmmm...I'd vote for subclinical Body Dysmorphic Disorder. He has some of the features. But, he is aware of his greater than average muscularity and doesn't perceive it as insufficient. Muscle dysmorphia occurs almost exclusively in males and consists of preoccupation with the idea that one's body is TOO SMALL or INSUFFICIENTLY LEAN OR MUSCULAR. Individuals with this form of the disorder actually have a normal-looking body or are even very muscular. They may also be preoccupied with other body areas, such as skin or hair. A majority (but not all) diet, exercise, and/or lift weights excessively, sometimes causing bodily damage. Some use potentially dangerous anabolic-androgenic steroids and other substances to try to make their body bigger and more muscular.

How does one differentiate between Hoarding disorder vs. an individual with OCD?

Hoarding disorder symptoms focus EXCLUSIVELY on the persistent difficulty discarding or parting with possessions, marked distress associated with discarding items, and excessive accumulation of objects. However, if an individual has obsessions that are typical of OCD (e.g., concerns about incompleteness or harm), and these obsessions lead to compulsive hoarding behaviors (e.g., acquiring all objects in a set to attain a sense of completeness or not discarding old newspapers because they may contain information that could prevent harm), a diagnosis of OCD should be given instead.

The prevalence of clinically significant hoarding in the U.S. and Europe is about 2%-6%. Hoarding disorder affects both males and females, but some epidemiological studies have reported a significantly greater prevalence among males. This contrasts with clinical samples, which are predominantly female. Hoarding symptoms appear to be almost three times more prevalent in ________________ compared with __________________.

Hoarding symptoms appear to be almost three times more prevalent in older adults (ages 55-94 years) compared with younger adults (ages 34-44 years). Hoarding symptoms may first emerge around ages 11-15 years, start interfering with the individual's everyday functioning by the mid-20s, and cause clinically significant impairment by the mid-30s. Participants in clinical research studies are usually in their 50s. Thus, the severity of hoarding increases with each decade of life. Once symptoms begin, the course of hoarding is often CHRONIC, with few individuals reporting a waxing and waning course.

Patient has grossly disorganized motor and catatonic behavior and severe negative Sx. What's the Dx?

I don't know but it's not Schizophrenia because 1 Sx must be 1,2,3 1. Delusions. 2. Hallucinations. 3. Disorganized speech.

Patient describes marked fear and anxiety only when being in a crowd. What's the dx?

I don't know but it's not agoraphobia, as it describes 2 or more of the following 5: Diagnostic Criteria A. Marked fear or anxiety about two (or more) of the following five situations: 1. Using PUBLIC transportation (e.g., automobiles, buses, trains, ships, planes). 2. Being in OPEN spaces (e.g., parking lots, marketplaces, bridges). 3. Being in ENCLOSED places (e.g., shops, theaters, cinemas). 4. Standing in LINE or being in a crowd. 5. Being OUTSIDE of the home ALONE.

A child doesn't speak at all for almost the entire first month. What's the dx?

I don't know, but it's not Selective Mutism; Criterion C. The duration of the disturbance is at least 1 MONTH (not limited to the first month of school).

What duration is required for dx of IED? DMDD?

IED requires only 3 months of active Sx, in contrast to the 12-month requirement for DMDD. Thus, these two diagnoses should not be made in the same child. For children with outbursts and intercurrent, PERSISTENT irritability, only the diagnosis of disruptive mood dysregulation disorder should be made.

Associated Features Supporting Diagnosis of Schizophrenia

INAPPROPRIATE AFFECT (e.g., laughing in the absence of an appropriate stimulus); DYSPHORIC MOOD DEPERSONALIZATION, DEREALIZATION, and somatic concerns may occur and sometimes reach delusional proportions; ANXIETY and PHOBIAS; Impaired cognitive functioning; some show social cognition deficits, including deficits in the ability to infer the intentions of other people (theory of mind), and may attend to and then interpret irrelevant events or stimuli as meaningful, perhaps leading to the generation of explanatory delusions.

In PRESCHOOL, the main manifestation is HYPERACTIVITY. In ELEMENTARY school, it's:

INATTENTION - During adolescence, signs of hyperactivity (e.g., running and climbing) are less common and may be confined to fidgetiness or an inner feeling of jitteriness, restlessness, or impatience.

This disorder is characterized by deficits in GENERAL mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience:

INTELLECTUAL developmental disorder - deficits result in impairments of ADAPTIVE FUNCTIONING, such that the individual fails to meet standards of personal independence and social responsibility in one or more aspects of daily life, including communication, social participation, academic or occupational functioning, and personal independence at home or in community settings.

Re Stereotypic Movement Disorder, in most TYPICALLY developing children, these movements RESOLVE over time or can be suppressed. Onset of complex motor stereotypies may be in infancy or later in the developmental period. Among what group do the stereotyped, self-injurious behaviors frequently PERSIST for years, even though the typography or pattern of self-injury may change?

INTELLECTUAL disability

Onset of generalized amnesia is usually sudden. How quick is the onset with localized and selective amnesias?

Less is known about the onset of localized and selective amnesias because these amnesias are seldom evident, even to the individual. Although overwhelming or intolerable events typically precede localized amnesia, its onset may be delayed for hours, days, or longer.

What's the gender predilection for Developmental Coordination Disorder?

MALE>female, ratio between 2:1 and 7:1

What gender is more likely to be diagnosed with INTELLECTUAL disability?

MALES > females (around 1.2-1.6 to 1)

Criteria A-C represent a Major Depressive Episode. What makes MDD?

MDD is: MDE (A-C) A. >= Five sx present during the same 2-week, represent a change from previous functioning, at least one is either (1) depressed mood or (2) loss of interest or pleasure B. Sx cause clinically significant distress or impairment C. Not attributable to the effects of a substance or medical condition plus D-E, D. Occurrence of MDE is NOT BETTER EXPLAINED by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has NEVER been a MANIC episode or a hypoMANIC episode.

DMDD can coexist with

MDD, ADHD, CD, and substance use disorders.

To meet the diagnostic criteria for Bipolar II, the MDE must last at least ________, and the hypomanic episode must last at least _______

MDE at least 2 weeks, hypomanic at least 4 days

What are the STEREOTYPIC MOVEMENT Disorder severity descriptors?

MILD: Symptoms are EASILY SUPPRESSED by sensory stimulus or distraction. MODERATE: Symptoms require EXPLICIT PROTECTIVE MEASURES and behavioral modification. SEVERE: CONTINUOUS MONITORING and protective measures are required to prevent serious injury

what's criterion A for bipolar II?

MOOD AND ENERGY A. A distinct period of abnormally & persistently elevated, expansive, or irritable mood & abnormally & persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

In schizoaffective disorder, _______ and ______ occur TOGETHER and were preceded or are followed by

MOOD EPISODE and the ACTIVE-PHASE symptoms of schizophrenia occur together; preceded or are followed by at least TWO WEEKS of DELUSIONS or HALLUCINATIONS WITHOUT prominent mood symptoms

There is some controversy about whether obsessive-compulsive and related disorders can be attributed to Group A streptococcal infection. Sydenham's chorea is the NEUROLOGICAL manifestation of rheumatic fever, which is in turn due to Group A streptococcal infection. Sydenham's chorea is characterized by a combination of:

MOTOR and NONMOTOR features. Nonmotor features include obsessions, compulsions, attention deficit, and emotional lability. Although individuals with Sydenham's chorea may present with nonneuropsychiatric features of acute rheumatic fever, such as carditis and arthritis, they may present with obsessive-compulsive disorder-like symptoms; such individuals should be diagnosed with obsessive-compulsive and related disorder due to another medical condition.

What is macropsia (also known as megalopia)?

Macropsia (also known as megalopia) is a neurological condition affecting human visual perception, in which objects within an affected section of the visual field appear larger than normal, causing the person to feel smaller than they actually are.

Re Body Dysmorphic Disorder, females and males have more similarities than differences in clinical features. However, males are more likely to have __________________, and females are more likely to have a comorbid _____________.

Males are more likely to have genital preoccupations, females are more likely to have a comorbid eating disorder. Muscle dysmorphia occurs almost exclusively in males.

What are some features of RUMINANT disorder in adults?

Malnutrition might also occur, particularly when the regurgitation is accompanied by restriction of intake. Adolescents and adults may attempt to disguise the regurgitation behavior by placing a hand over the mouth or coughing. Some will avoid eating with others because of the acknowledged social undesirability of the behavior. This may extend to an avoidance of eating prior to social situations, such as work or school (e.g., avoiding breakfast because it may be followed by regurgitation).

Patient presents with short-duration hypomanic episodes (2-3 days) overlapping a current MDE and has a Hx of major depressive episodes. What's the Dx?

If the hypomanic Sx were separate, not overlapping with MDE, the Dx would be "Other Specified Bipolar and Related Disorder." Because they overlap, the Dx is major depressive episode, with mixed features.

Patient with persistent depressive disorder also currently meets criteria for a major depressive episode. What's the dx?

If the individual's symptoms currently meet full criteria for a major depressive episode, then it's PDD "with intermittent major depressive episodes, with current episode"

A military vet has intense anxiety when in a marketplace that reminds her of a dangerous market in Iraq. What is the dx?

If the sx are d/t PTSD, the dx of PTSD trumps Agoraphobia. Also, agoraphobia must contain 2 triggering events.

A. Preoccupation with having or acquiring a serious illness. B. Somatic symptoms are NOT present or, if present, are ONLY MILD in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly EXCESSIVE or disproportionate. C. There is a high level of ANXIETY about health, and the individual is easily alarmed about personal health status. D. The individual performs excessive health-related BEHAVIORS (e.g., repeatedly checks his or her body for signs of illness) or exhibits MALADAPTIVE AVOIDANCE (e.g., avoids doctor appointments and hospitals). E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, GAD, body dysmorphic disorder, OCD, or delusional disorder, somatic type.

Illness Anxiety Disorder

Individuals with depersonalization / derealization disorder are characterized by harm-avoidant temperament, immature defenses, and both disconnection and overconnection schemata. What are examples given for immature defenses?

Immature defenses such as idealization / devaluation, projection and acting out, which result in denial of reality and poor adaptation.

The second part of ADHD, the HD portion considers hyperactivity and:

Impulsivity - hasty actions that occur in the moment without forethought and that have high potential for harm to the individual.

Name some common comorbidities of Separation Anxiety Disorder in children and adults.

In CHILDREN, separation anxiety disorder is highly comorbid with GAD and SPECIFIC phobia. In ADULTS, common comorbidities include SPECIFIC phobia, PTSD, PANIC disorder, GAD, social anxiety disorder, agoraphobia, OCD, and personality disorders. Depressive and bipolar disorders are also comorbid with separation anxiety disorder in adults

The most common precipitating substances for depersonalization / derealization sx are the illicit drugs marijuana, hallucinogens, ketamine, ecstasy, and salvia. Do cases involving these count as d/d disorder or ever lead to it?

In about 15% of all cases of depersonalization/derealization DISORDER, the sx are precipitated by ingestion of such substances. If the symptoms persist for some time in the ABSCENCE of any further substance or medication use, the diagnosis of depersonalization/ derealization disorder applies. This diagnosis is usually easy to establish since the vast majority of individuals with this presentation become highly phobic and aversive to the triggering substance and do not use it again.

Patient is very concerned about her weight and considers herself fat, though she appears to be of appropriate weight. What's the dx?

In an individual with an eating disorder, concerns about being fat are considered a sx of the eating disorder rather than body dysmorphic disorder. However, weight concerns may occur in body dysmorphic disorder. Eating disorders and body dysmorphic disorder can be comorbid, in which case both should be diagnosed.

Essential features of schizophrenia are the same in childhood, but it's more difficult to make the diagnosis. Why?

In children, DELUSIONS and HALLUCINATIONS may be less elaborate than in adults; VISUAL hallucinations are MORE COMMON & should be DISTINGUISHED from normal FANTASY PLAY. DISORGANIZED SPEECH occurs in many disorders with childhood onset (ASD), as does DISORGANIZED BEHAVIOR (ADHD). These Sx shouldn't be attributed to schizophrenia without consideration of the more common disorders of childhood.

What are the most common sx of Somatic Symptom Disorder in children?

In children, the most common sx are recurrent ABDOMINAL pain, HA, FATIGUE and NAUSEA. A single prominent sx is more common in children than in adults. Parents' response to the sx is important, as this may determine the level of associated distress.

In what demographic is Somatic Symptom Disorder frequently underdiagnosed?

In older individuals, somatic symptoms and concurrent medical illnesses are common. Somatic symptom disorder may be underdiagnosed in older adults either because certain somatic symptoms (e.g., pain, fatigue) are considered part of normal aging or because illness worry is considered "understandable" in older adults who have more general medical illnesses and medications than do younger people. Concurrent depressive disorder is common in older people who present with numerous somatic symptoms.

Why was disruptive mood dysregulation disorder added in DSM-5?

In order to address concerns about the potential for the overdiagnosis of and treatment for bipolar disorder in children, a new diagnosis. It refers to the presentation of children with persistent irritability and frequent episodes of extreme behavioral dyscontrol, in children up to 12 years of age. Its placement in the depressive disorders chapter reflects the finding that children with this symptom pattern typically develop unipolar depressive disorders or anxiety disorders, rather than bipolar disorders, as they mature into adolescence and adulthood.

Define the personality trait of harm avoidance.

In psychology, harm avoidance (HA) is a personality trait characterized by excessive worrying; pessimism; shyness; and being fearful, doubtful, and easily fatigued. In MRI studies HA was correlated with reduced grey matter volume in the orbito-frontal, occipital and parietal regions.

Separation anxiety disorder can be best differentiated from agoraphobia by examining COGNITIVE IDEATION. In separation anxiety disorder, the thoughts are about ______________, whereas in agoraphobia the focus is on ___________.

In separation anxiety disorder, the thoughts are about detachment from significant others and the home environment (i.e., parents or other attachment figures), whereas in agoraphobia the focus is on panic-like sx or other incapacitating or embarrassing sx in the feared situations

A child with ASD presents with frequent temper outbursts when his routines are disturbed. What is the dx?

In that instance, the temper outbursts would be considered secondary to the ASD and the child should NOT receive the diagnosis of DMDD.

Criterion B for Anorexia Nervosa states patients typically display an intense fear of gaining weight or of becoming fat. This intense fear of becoming fat is usually NOT alleviated by weight loss. In fact, concern about weight gain may INCREASE as weight falls. Younger individuals with anorexia nervosa, as well as some adults, MAY NOT RECOGNIZE or ACKNOWLEDGE FEAR of weight GAIN. If they can't, how is the dx made?

In the absence of another explanation for the significantly low weight, CLINICIAN INFERENCE drawn from collateral history, observational data, physical & lab findings, or longitudinal course either indicating a fear of weight gain or supporting persistent behaviors that prevent it MAY BE USED to establish Criterion B.

Certain behaviors are sometimes described as ''compulsive," including sexual behavior (paraphilias), gambling (gambling disorder), and substance use (e.g., alcohol use disorder). How do these behaviors differ from the compulsions of OCD?

In these behaviors, the person usually derives pleasure from the activity and may wish to resist it only because of its deleterious consequences.

What test invariably distinguishes dissociative amnesia from feigned amnesia?

There is no test, battery of tests, or set of procedures that invariably distinguishes dissociative amnesia from feigned amnesia. Individuals with factitious disorder or malingering have been noted to continue their deception even during hypnotic or barbiturate-facilitated interviews. Feigned amnesia is more common in individuals with 1) acute, florid dissociative amnesia; 2) financial, sexual, or legal problems; or 3) a wish to escape stressful circumstances BUT True amnesia can be associated with those same circumstances. Many individuals who malinger confess spontaneously or when confronted.

Over 70% of outpatients with dissociative identity disorder have attempted suicide; multiple attempts are common, and other self-injurious behavior is frequent. Why is assessment of suicide risk complicated in dissociative identity disorder?

There may be amnesia for past suicidal behavior or the presenting identity may not feel suicidal and is unaware that other dissociated identities do

What does reality testing demonstrate in depersonalization/derealization disorders?

These alterations of experience are accompanied by intact reality testing. Depersonalization / derealization disorder is characterized by clinically significant persistent or recurrent depersonalization (i.e., experiences of unreality or detachment from one's mind, self, or body) and/or derealization (i.e., experiences of imreality or detachment from one's surroundings).

If a patient described these feelings, what dx would you lean towards? "I am no one, I have no self, I know I have feelings but I don't feel them, my thoughts don't feel like my own, my head is filled with cotton."

These are examples of the essential features of depersonalization / derealization disorder, which presents with persistent or recurrent episodes of depersonalization, derealization, or both. Episodes of depersonalization are characterized by a feeling of unreality or detachment from, or unfamiliarity with, one's whole self or from aspects of the self (Criterion Al). The depersonalization experience can sometimes be one of a split self, with one part observing and one participating, known as an "out-of-body experience" in its most extreme form. The unitary symptom of "depersonalization" consists of several symptom factors: anomalous body experiences (i.e., unreality of the self and perceptual alterations); emotional or physical numbing; and temporal distortions with anomalous subjective recall.

What are cross-cutting symptom and diagnosis specific severity measures?

These provide QUANTITATIVE ratings of important clinical areas that are designed to be used at the initial evaluation to establish a BASELINE for COMPARISON with ratings on subsequent encounters to monitor changes and inform treatment planning.

Re Schizophreniform what doe the specifier, "With good prognostic features" mean, i.e. what does it require?

This specifier requires the presence of at least **TWO** of the following features: ONSET of prominent psychotic symptoms WITHIN FOUR WEEKS of the first NOTICEABLE CHANGE in usual behavior or functioning; CONFUSION or PERPLEXITY: GOOD PREMORBID social and occupational FUNCTIONING; and ABSENCE of blunted or FLAT AFFECT. GOOD FUNCTIONING BEFORE, QUICK, CONFUSING ONSET, NO NEGATIVE AFFECT.

Delusional Disorder Grandiose type:

This subtype applies when the central theme of the delusion is the conviction of having some great (but UNRECOGNIZED) talent or insight or having made some important discovery; less commonly, the individual may have the delusion of having a special relationship with a prominent individual or of being a prominent person (in which case the actual individual may be regarded as an impostor). Grandiose delusions may have a religious content.

. Delusional Disorder Jeaious type:

This subtype applies when the central theme of the individual's delusion is that his or her spouse or lover is UNFAITHFUL, without due cause, based on incorrect inferences supported by small bits of "evidence" (e.g., disarrayed clothing). The individual with the delusion usually confronts the spouse or lover and attempts to intervene in the imagined infidelity.

What disorder does this describe? They wax and wane in severity, changing affected muscle groups and vocalizations over time. As children get older, they report them being associated with a premonitory urge — a somatic sensation that precedes it, with tension reduction following expression of it. When they are associated with a premonitory urge, they may be experienced as not being completely ''involuntary" in that it can be resisted. An individual may also feel the need to perform it in a specific way or repeat it until he or she achieves the feeling that the it has been done "just right."

Tics

Are tics involuntary?

Tics are generally experienced as involuntary but can be VOLUNTARILY SUPPRESSED for lengths of time; can include almost any muscle group or vocalization; common tic symptoms = eye blinking or throat clearing

Panic disorder refers to recurrent _____________ panic attacks (Criterion A). A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of a list of 13 physical and cognitive symptoms occur.

UNEXPECTED; The term recurrent literally means more than one unexpected panic attack. The term unexpected refers to a panic attack for which there is no obvious cue or trigger at the time of occurrence—that is, the attack appears to occur from out of the blue, such as when the individual is relaxing or emerging from sleep (nocturnal panic attack).

This category is reserved for individuals >5 YO when ASSESSMENT of the degree of INTELLECTUAL disability is DIFFICULT or impossible because of associated sensory or physical IMPAIRMENTS, as in blindness or prelingual deafness; locomotor disability; or presence of severe problem behaviors or co-occurring mental disorder.

UNSPECIFIED Intellectual Disability (This category should only be used in exceptional circumstances and requires reassessment after a period of time)

DEFICITS in COMPREHENSION of language are frequently UNDERESTIMATED, as children may be good at:

USING CONTEXT to infer meaning

How do the perceptual differences in Separation Anxiety Disorder differ from hallucinations in a psychotic disorder?

Unlike the hallucinations in psychotic disorders, the unusual perceptual experiences that may occur in separation anxiety disorder are usually based on a MISPERCEPTION of an actual stimulus, occur only in CERTAIN situations (e.g., nighttime), and are REVERSED by the PRESENCE of an attachment figure.

This generalization is used for presentations in which the patient exhibits characteristic sx of the disorder that cause clinically significant DISTRESS or impairment BUT do NOT meet the full criteria for the disorder.

Unspecified __________ Disorder

This conveys a two- to threefold risk for ADHD:

VERY LOW BIRTH WEIGHT (less than 1,500 grams) but most children with low birth weight do not develop ADHD. ADHD is correlated with SMOKING during pregnancy but may reflect common genetic risk. There may be a hx of child abuse, neglect, multiple foster placements, neurotoxin exposure (e.g., lead), infections (e.g., encephalitis), or etoh exposure in utero.

DSM-IV Axis V consisted of the Global Assessment of Functioning (GAF) scale, representing the clinician's judgment of the individual's overall level of "functioning on a hypothetical continuum of mental health-illness." This was replaced with:

WHO Disability Assessment Schedule (WHODAS)

Brief psychotic episode specifiers

WITH MARKED STRESSOR(s) (brief reactive psychosis) WITHOUT MARKED STRESSOR(s) WITH POSTPARTUM ONSET: If onset is DURING pregnancy or WITHIN 4 WEEKS postpartum. Specify if: WITH CATATONIA

Some individuals with PTSD cannot recall part or all of a specific traumatic event (e.g., a rape victim with depersonalization and/or derealization sx who cannot recall most events for the entire day of the rape). When that amnesia extends beyond the immediate time of the trauma, what's the dx?

When amnesia extends beyond the immediate time of the trauma, a comorbid diagnosis of dissociative amnesia is warranted.

Patient admits to frequently picking his skin, he says to improve the appearance of a defect. What's the dx?

When skin picking is intended to IMPROVE THE APPEARANCE of perceived skin defects, BODY DYSMORPHIC disorder, rather than excoriation (skin-picking) disorder, is diagnosed. When hair removal (plucking, pulling, etc) is intended to improve perceived defects in the appearance of facial or body hair, body dysmorphic disorder is diagnosed rather than trichotillomania.

What type of disorders frequently precede agoraphobia and what disorders frequently occur as a result of agoraphobia?

Whereas other anxiety disorders (e.g., separation anxiety disorder, specific phobias, panic disorder) frequently precede onset of agoraphobia, depressive disorders and substance use disorders typically occur secondary to agoraphobia.

When a brain injury occurs in the context of a traumatic event (e.g., traumatic accident, bomb blast, acceleration/deceleration trauma), sx of acute stress disorder may appear. An event causing head trauma may also constitute a psychological traumatic event, and tramautic brain injury (TBI)-related neurocognitive symptoms are not mutually exclusive and may occur concurrently. Sx of acute stress disorder and TBI-related neurocognitive symptoms can overlap. Whereas reexperiencing and avoidance are characteristic of acute stress disorder and not the effects of TBI, _________________ are more specific to TBI (neurocognitive effects) than to acute stress disorder.

Whereas reexperiencing and avoidance are characteristic of acute stress disorder and not the effects of TBI, persistent disorientation and confusion are more specific to TBI (neurocognitive effects) than to acute stress disorder.

Re Acute Stress Disorder, dissociative states may last from a few seconds to several hours, or even days, during which components of the event are relived and the individual behaves as though experiencing the event at that moment. While dissociative responses are common DURING a traumatic event, ONLY dissociative responses that persist beyond __________ after trauma exposure are considered for the diagnosis of acute stress disorder.

While dissociative responses are common DURING a traumatic event, ONLY dissociative responses that persist BEYOND THREE days after trauma exposure are considered for the diagnosis of acute stress disorder.

Does Brief psychotic disorder, schizophreniform disorder, and schizophrenia require the criterion of IMPAIRED social and occupational FUNCTIONING?

While such impairments may potentially be present, they are not necessary for a diagnosis of Brief Psychotic D/O and schizophreniform disorder. It IS REQUIRED FOR SCHIZOPHRENIA.

What are the subtypes for Specific Learning Disorder?

With IMPAIRMENT in READING (dyslexia) With impairment in WRITTEN EXPRESSION With impairment in MATHEMATICS (dyscalculia) Specify severity

In recording the name of a diagnosis, terms should be listed in the following order: major depressive disorder, single or recurrent episode, severity/psychotic/remission specifiers, followed by as many of the following specifiers without codes that apply to the current episode. Specify:

With anxious distress With mixed features With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern (recurrent episodeonly)

Bipolar I disorder specifiers

With anxious distress With mixed features With rapid cycling With meianchoiic features With atypicai features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern

This specifier can be applied when these features predominate during the majority of days of the current or most recent major depressive episode. A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events). B. Two (or more) of the following features: 1. Significant weight gain or increase in appetite. 2. Hypersomnia. 3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs). 4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment. C. Criteria are not met for "with melancholic features" or "with catatonia" during the same episode.

With atypical features; Note: "Atypical depression" has historical significance (i.e., atypical in contradistinction to the more classical agitated, "endogenous" presentations of depression that were the norm when depression was rarely diagnosed in outpatients and almost never in adolescents or younger adults) and today does not connote an uncommon or unusual clinical presentation as the term might imply.

Individuals with dissociative identity disorder are often misdiagnosed with a bipolar disorder, most often bipolar II disorder. How can they be differentiated?

With dissociative identity disorder, there are relatively rapid shifts in mood in individuals—typically within minutes or hours, in contrast to the slower mood changes typically seen in individuals with bipolar disorders. These rapid, subjective shifts in mood are commonly reported across dissociative states, sometimes accompanied by fluctuation in levels of activation. Furthermore, in dissociative identity disorder, elevated or depressed mood may be displayed in conjunction with overt identities, so one or the other mood may predominate for a relatively long period of time (often for days) or may shift within minutes.

Within the diagnosis of ASD, individual clinical characteristics are noted through the use of specifiers such as:

With or without accompanying INTELLECTUAL impairment; with or without accompanying structural LANGUAGE impairment; associated with a KNOWN medical /genetic /environmental/acquired CONDITION; associated with another neurodevelopmental, mental, or behavioral disorder), as well as specifiers that describe the autistic symptoms (age at first concern; with or without loss of established skills; severity).

This specifier applies to the lifetime pattern of mood episodes. The essential feature is a REGULAR seasonal pattern of at least one type of episode (i.e., mania, hypomania, or depression). The OTHER types of episodes may NOT follow this pattern. E.g., an individual may have seasonal manias, but his or her depressions do not regularly occur at a specific time of year. A. There has been a regular temporal relationship between the onset of manic, hypomanic, or major depressive episodes and a particular time of the year (e.g., in the fall or winter) in bipolar I or bipolar II disorder. Note: Do not include cases in which there is an obvious effect of seasonally related psychosocial stressors (e.g., being unemployed every winter). B. Full remissions (or a change from major depression to mania or hypomania or vice versa) also occur at a characteristic time of the year (e.g., depression disappears in the spring). C. In the last 2 years, the individual's manic, hypomanic, or major depressive episodes have demonstrated a temporal seasonal relationship, as defined above, and no non-seasonal episodes of that polarity have occurred during that 2-year period. D. Seasonal manias, hypomanias, or depressions (as described above) substantially outnumber any nonseasonal manias, hypomanias, or depressions that may have occurred over the individual's lifetime

With seasonal pattern

What worsens TICS? What improves them?

Worsened by: stress, exciting events, anxiety, excitement, and exhaustion; Better during: calm, focused activities. Individuals may have fewer tics when engaged in schoolwork or tasks at work than when relaxing at home after school or in the evening.

Patient has had 2 MDE and a hypomanic episode that caused significant impairment. What's the dx?

Would likely qualify for the diagnosis of manic episode and, therefore, for a lifetime diagnosis of bipolar I disorder.

Schizophreniform disorder is distinguished by its difference in duration: the duration of illness is at least 1 month but less than 6 months... does that include prodromal and residual phases?

Yes, INCLUDES prodromal, active, and residual phases

Can the dx of DMDD and MDD coexist?

Yes, but only if the DMDD does not occur only during MDE

A patient who is hospitalized has a distinct period of abnormally and persistently ELEVATED, expansive, or IRRITABLE MOOD and abnormally and persistently increased goal-directed ACTIVITY or energy, for 3 days, that is present MOST of the day, NEARLY every day. Does that qualify Criterion A?

Yes, it must be at least 7 days unless they are hospitalized

A 3 yo has been ingesting dirt for 5 months. Could that meet the criteria for PICA?

Yes, must persist greater than 1 month, with a minimum age of 2 years suggested for a pica diagnosis to exclude developmentally normal mouthing of objects by infants that results in ingestion.

A patient seems to meet all the criteria for Somatic Symptom Disorder BUT history shows that, though he has been persistently symptomatic for the past 7 months, he never has any one somatic symptom consistently; they are always changing. Would he still meet the requirements for diagnosis?

Yes. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Dissociative disorders are characterized by:

a DISRUPTION of and/or DISCONTINUITY in the normal INTEGRATION of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.

Individuals with dissociative identity disorder are often misdiagnosed with:

a bipolar disorder, most often bipolar II disorder.

Individuals with ASD, schizophrenia or another psychotic disorder, or severe intellectual disability may have problems in social communication and be unable to speak appropriately in social situations. In contrast, selective mutism should be diagnosed only when:

a child has an established capacity to speak in some social situations (e.g., typically at home).

Approximately 75% of individuals with hoarding disorder have:

a comorbid mood or anxiety disorder. The most common comorbid conditions are MDD (up to 50% of cases), social anxiety disorder (social phobia), and GAD. Approximately 20% of individuals with hoarding disorder also have sx that meet criteria for OCD.

For a dx of bipolar II disorder, it is necessary to meet the following criteria:

a current or past HYPOmanic episode AND a current or past MDE: Hypomanic Episode A. A distinct period of abnormally & persistently elevated, expansive, or irritable mood & abnormally & persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance & increased energy & activity, three (or more) of the following sx have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility 6. Increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation. 7. Excessive involvement in activities that have a high potential for painful consequences C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is NOT severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. F. The episode is not attributable to the physiological effects of a substance

Avolition

a decrease in motivated self-initiated purposeful activities. The individual may sit for long periods of time and show little interest in participating in work or social activities

Panic attacks function as a marker and prognostic factor for severity of diagnosis, course, and comorbidity across an array of disorders, including, but not limited to, the anxiety disorders (e.g., substance use, depressive and psychotic disorders). Panic attack may therefore be used as:

a descriptive specifier for any anxiety disorder as well as other mental disorders.

Bipolar II most often begins with a depressive episode and is not recognized as bipolar II disorder until

a hypomanic episode occurs; this happens in about 12% of individuals with the initial diagnosis of major depressive disorder. Anxiety, substance use, or eating disorders may also precede the diagnosis, complicating its detection. Many individuals experience several episodes of major depression prior to the first recognized hypomanic episode.

Up to 30% of individuals with OCD have ______________. This is most common in _________ with onset of OCD in childhood.

a lifetime tic disorder. This is most common in males with onset of OCD in childhood. These individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course, and pattem of familial transmission.

INTELLECTUAL disability is categorized as a neuroDEVELOPMENTAL disorder and is distinct from the neuroCOGNITIVE disorders, which are characterized by:

a loss of cognitive functioning

The essential feature of catatonia is

a marked psychomotor disturbance that may involve decreased motor activity, decreased engagement during interview or physical examination, OR EXCESSIVE OR PECULIAR motor activity.

Premenstrual syndrome differs from premenstrual dysphoric disorder in that:

a minimum of five sx is not required, and there is no stipulation of affective sx for individuals who have premenstrual syndrome

Diagnosis of a mental disorder is NOT equivalent to:

a need for treatment

A stereotypy is:

a repetitive or ritualistic movement, posture, or utterance. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place.

If catatonia occurs exclusively during the course of a delirium or neuroleptic malignant syndrome, re diagnosis:

a separate diagnosis of catatonic disorder due to another medical condition is not given

Re Intellectual disability, Individual cognitive profiles based on neuropsychological testing are more useful for understanding intellectual abilities than:

a single IQ score. Such testing may identify areas of relative strengths and weaknesses, an assessment important for academic and vocational planning.

The appearance of delusions de novo in a person > 35 yo without a known hx of a primary psychotic d/o should suggest the possibility of

a substance/medication induced psychotic disorder; even a prior hx of a primary psychotic disorder does not rule out the possibility of a substance / medication-induced psychotic disorder.

What is verbal dyspraxia?

a term used for speech PRODUCTION problems

Dissociative identity disorder is characterized by:

a) the presence of TWO or more DISTINCT PERSONALITY states or an experience of POSSESSION and b) RECURRENT episodes of AMNESIA.

Dissociative symptoms are experienced as:

a) unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience (i.e., "positive" dissociative symptoms such as fragmentation of identity, depersonalization, and derealization) and/or b) inability to access information or to control mental functions that normally are readily amenable to access or control (i.e., '"negative" dissociative symptoms such as amnesia).

ADHD Criterion A discusses a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by 1 and/or 2, with #1 saying: 1. INATTENTION: >=6 SX have persisted for at least 6 MONTHS to a degree that is INCONSISTENT with developmental LEVEL & that NEGATIVELY impacts directly on social and academic/occupational activities What are the listed symptoms under 1?

a. FAILS to give CLOSE ATTENTION b. DIFFICULTY SUSTAINING ATTENTION c. Does NOT seem to LISTEN d. Does NOT FOLLOW THROUGH e. Difficulty ORGANIZING f. AVOIDS/dislikes/reluctant to engage in tasks that require SUSTAINED MENTAL EFFORT g. LOSES THINGS h. EASILY DISTRACTED i. FORGETFUL in daily activities

ADHD Criterion A discusses a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by 1 and/or 2, with #2 saying: 2. HYPERACTIVITY & IMPULSIVITY: >=6 SX have persisted for at least 6 MONTHS to a degree that is INCONSISTENT with developmental level and that negatively IMPACTS directly on social and academic / occupational activities. (>=17 yo >=5 SX required) What are the listed sx for #2?

a. FIDGETS/TAPS HANDS / SQUIRMS IN SEAT b. LEAVES SEAT when remaining seated is expected c. RUNS/CLIMBS where it is inappropriate d. UNABLE to play or engage QUIETLY e. "on the go," acting as if "DRIVEN BY A MOTOR" f. TALKS EXCESSIVELY g. BLURTS OUT ANSWER h. Difficulty WAITING i. INTERRUPTS/intrudes on others

Psychotic disorders can occur in association with intoxication with the following classes of substances: alcohol; cannabis; hallucinogens, including phencyclidine and related substances; inhalants; sedatives, hypnotics, and anxiolytics; stimulants (including cocaine); and other (or unknown) substances. Psychotic disorders can occur in association with WITHDRAWAL from

alcohol; sedatives, hypnotics, and anxiolytics; and other (or unknown) substances.

Social Anxiety Disorder (Social Phobia) Diagnostic Criteria B. The individual FEARS that he or she will act in a way or show anxiety symptoms that will be NEGATIVELY evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others). C. The social situations _____________ provoke fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations. D. The social situations are AVOIDED or ENDURED with intense fear or anxiety. E. The fear or anxiety is OUT of PROPORTION to the actual threat posed by the social situation and to the sociocultural context.

almost always

Both acute stress disorder and posttraumatic stress disorder contain dissociative symptoms, such as:

amnesia, flashbacks, numbing, and depersonalization/derealization.

Current neural systems models for specific phobia emphasize the __________ and related brain structures, much as in other anxiety disorders.

amygdala

Many individuals with ASD also have intellectual impairment and/or language impairment (e.g., slow to talk, language comprehension behind production). Even those with average or high intelligence have:

an UNEVEN PROFILE of ABILITIES. The GAP between INTELLECTUAL and ADAPTIVE functional skills is often LARGE.

Season of birth has been linked to incidence of schizophrenia, including late winter/early spring in some locations and summer for the deficit form of the disease. Incidence is higher for children growing up in:

an URBAN environment and for some minority ethnic groups

This diagnosis of Psychological Factors Affecting Other Medical Conditions should be reserved for situations in which the effect of the psychological factor on the medical condition is evident and the psychological factor has clinically significant effects on the course or outcome of the medical condition. Abnormal psychological or behavioral symptoms that develop in response to a medical condition are more properly coded as:

an adjustment disorder (a clinically significant psychological response to an identifiable stressor). There must be reasonable evidence to suggest an association between the psychological factors and the medical condition, although it may often not be possible to demonstrate direct causality or the mechanisms underlying the relationship

Major neurocognitive disorder may cooccur with intellectual disability, e.g. :

an individual with Down syndrome who develops Alzheimer's disease, an individual with intellectual disability who loses further cognitive capacity following a head injury

Culture is transmitted within the family and social systems so diagnostic assessment must therefore consider whether:

an individual's experiences differ from sociocultural norms, leading to difficulties in adaptation

Many individuals with OCD have dysfunctional beliefs. These beliefs can include:

an inflated sense of RESPONSIBILITY and the tendency to overestimate THREAT; PERFECTIONISM and INTOLERANCE of UNCERTAINTY; and over-IMPORTANCE of THOUGHTS (e.g., believing that having a forbidden thought is as bad as acting on it) and the need to CONTROL thoughts.

For a major depressive episode to be considered recurrent, there must be

an interval of at least 2 consecutive months between separate episodes in which criteria are not met for a major depressive episode.

Unlike the other atypical features of depression, pathological sensitivity to perceived interpersonal rejection is a trait that has an early onset and persists throughout most of adult life. Rejection sensitivity occurs when the person is

and is not depressed (always), though it may be exacerbated during depressive periods

Some of the medications reported to evoke psychotic symptoms include

anesthetics, analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents (cyclosporine, procarbazine), corticosteroids, GI medications, muscle relaxants, NSAIDS, phenylephrine, pseudoephedrine, antidepressants, and disulfiram. Toxins reported to induce psychotic symptoms include anticholinesterases, organophosphate insecticides, sarin and other nerve gases, carbon monoxide, carbon dioxide, and volatile substances such as fuel or paint

A diagnosis of bulimia nervosa should not be given when the disturbance occurs only during episodes of:

anorexia nervosa

Re OCD, the individual attempts to ignore or suppress these obsessions (e.g., avoiding triggers or using thought suppression) or to neutralize them with _____________ or ________________

another THOUGHT or ACTION (e.g., performing a compulsion). Compulsions (or rituals) are repetitive behaviors (e.g., washing, checking) or MENTAL ACTS (e.g., counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

In clinical settings, children with selective mutism are almost always given an additional diagnosis of:

another anxiety disorder—most commonly, social anxiety disorder (social phobia)

ADHD is relatively stable through early adolescence, but some individuals have a worsened course with development of:

antisocial behaviors.

Substances implicated in medication-induced depressive disorder, with varying degrees of evidence, include:

antiviral agents (efavirenz), cardiovascular agents (clonidine, guanethidine, methyldopa, reserpine), retinoic acid derivatives (isotretinoin), antidepressants, anticonvulsants, anti-migraine agents (triptans), antipsychotics, hormonal agents (corticosteroids, oral contraceptives, gonadotropin-releasing hormone agonists, tamoxifen), smoking cessation agents (varenicline), and immunological agents (interferon).

Bipolar II disorder is MORE OFTEN THAN NOT associated with one or more co-occurring mental disorders, with ____________ being the most common.

anxiety disorders

Co-occurring mental disorders are common with Bipolar I, with the most frequent disorders being

anxiety disorders (panic attacks, social anxiety disorder, specific phobia) occurring in approximately three-fourths of individuals

Asociality

apparent lack of interest in social interactions and may be associated with avolition, but it can also be a manifestation of limited opportunities for social interactions.

Intrusive recollections in PTSD are distinguished from depressive rumination in that they:

apply only to involuntary and intrusive distressing memories.

Anxiety disorders occur more frequently in females than in males, with a ratio of:

approximately 2:1 ratio

Tics are COMMON in childhood but:

are TRANSIENT in MOST cases.

Females with social anxiety disorder report a greater number of social fears and comorbid depressive, bipolar, and anxiety disorders, whereas males:

are more likely to fear dating, have ODD OR CD, and use alcohol and illicit drugs to relieve symptoms of the disorder. Paruresis is more common in males.

Some traumatized individuals have both PTSD and dissociative identity disorder. Accordingly, it is crucial to distinguish between individuals with PTSD only and individuals who have both PTSD and dissociative identity disorder. This differential diagnosis requires that the clinician establish the presence or absence of dissociative symptoms that are not characteristic of acute stress disorder or PTSD. Some individuals with PTSD manifest dissociative symptoms that also occur in dissociative identity disorder: 1) amnesia for some aspects of trauma, 2) dissociative flashbacks (i.e., reliving of the trauma, with reduced awareness of one's current orientation), and 3) symptoms of intrusion and avoidance, negative alterations in cognition and mood, and hyperarousal that are focused around the traumatic event. On the other hand, individuals with dissociative identity disorder manifest dissociative symptoms that:

are not a manifestation of PTSD: 1) AMNESIAS for many EVERYDAY (i.e., nontraumatic) events, 2) dissociative FLASHBACKS that may be FOLLOWED by AMNESIA for the CONTENT of the flashback, 3) disruptive INTRUSIONS (UNrelated to traumatic material) by dissociated identity states into the individual's sense of self and agency, 4) infrequent, full-blown changes among different identity states.

The best established prognostic factors for individual outcome within ASD are presence or absence of:

associated intellectual disability and language impairment (e.g., functional language by age 5 years is a good prognostic sign) and additional mental health problems. Epilepsy is associated with greater intellectual disability and lower verbal ability.

Delusional disorder

at least 1 MONTH of delusions but no other psychotic symptoms

Although many individuals with bipolar II disorder return to a fully functional level between mood episodes, at least _____% continue to have some inter-episode dysfunction, and _____% transition directly into another mood episode without inter-episode recovery.

at least 15% continue to have some inter-episode dysfunction, and 20% transition directly into another mood episode without inter-episode recovery.

The diagnosis of cyclothymic disorder is given to adults who experience at least _______ years of both hypomanic and depressive periods without ever fulfilling the criteria for an episode of mania, hypomania, or major depression.

at least 2 years (for children, a full year)

Though there are no infallible guidelines for determining whether the relationship between the psychotic disturbance & the medical condition is etiological, several considerations provide some guidance. One consideration is the presence of a temporal association between the onset, exacerbation, or remission of the medical condition & that of the psychotic disturbance. A second consideration is the presence of features that are atypical for a psychotic disorder, e.g.,

atypical age at onset or presence of visual or olfactory hallucinations; the disturbance must also be distinguished from a substance/medication-induced psychotic disorder or another mental disorder (e.g., an adjustment disorder).

Observing a gesture or sound in another person may result in an individual with a tic disorder making a similar gesture (echopraxia) or sound (echolalia), which may be incorrectly perceived by others as purposeful. This can be a particular problem when the individual is interacting with:

authority figures (e.g., teachers, supervisors, police)

The average individual with specific phobia fears ______ objects or situations, and approximately _____% of individuals with specific phobia fear more than one situation or object.

average #3, 75% fear more than 1 situation or object; In such cases, multiple specific phobia diagnoses, each with its own diagnostic code reflecting the phobic stimulus, would need to be given. For example, if an individual fears thunderstorms and flying, then two diagnoses would be given: specific phobia, natural environment, and specific phobia, situational.

Given its frequent onset in childhood and its persistence into and through adulthood, social anxiety disorder may resemble a personality disorder, like:

avoidant personality disorder. Individuals with avoidant personality disorder have a BROADER avoidance pattern than those with social anxiety disorder. Nonetheless, social anxiety disorder is bidirectionally more comorbid with avoidant personality disorder than with other personality disorders.

What is the WHO Disability Assessment Schedule (WHODAS) useful for?

based on the International Classification of Functioning, Disability and Health (ICF), this has proven useful as a standardized MEASURE of DISABILITY for mental disorders

A careful hx of sx is needed to differentiate GAD from bipolar disorder, as anxious ruminations may

be mistaken for racing thoughts, and efforts to minimize anxious feelings may be taken as impulsive behavior

While the allowable age range for 1st dx of DMDD is 6-18 yo, by history or observation, the ACTUAL age at onset must be

before 10 years (Criterion H)

The clinical features of agoraphobia are relatively consistent across the lifespan, although the type of agoraphobic situations triggering fear, anxiety, or avoidance, as well as the type of cognitions, may vary. For example, in children:

being outside of the home alone is the most frequent situation feared, whereas in older adults, being in shops, standing in line, and being in open spaces are most often feared. Also, cognitions often pertain to becoming lost (in children), to experiencing panic-like symptoms (in adults), to falling (in older adults).

Define referential delusions:

belief that certain gestures, comments, environmental cues, and so forth are directed at oneself, are also common.

Define persecutory delusions:

belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group, are most common

Once a woman has had a postpartum episode with PSYCHOTIC features, the risk of recurrence with each subsequent delivery is

between 30% and 50%. Postpartum episodes must be differentiated from delirium occurring in the postpartum period, which is distinguished by a fluctuating level of awareness or attention.

In the DSM-V, recommendations for the selection and use of the most appropriate evidence-based treatment options for each disorder are:

beyond its scope

Insomnia is a common comorbidity of many medical conditions, including DM, CHD, COPD, arthritis, FM, etc. The risk relationship appears to be:

bidirectional: insomnia increases the risk of medical conditions, and medical problems increase the risk of insomnia. The direction isn't always clear and may change over time; for this reason, COMORBID INSOMNIA is the preferred terminology in the presence of coexisting insomnia with another medical condition (or mental disorder).

ADHD, any disruptive, impulse-control, or conduct disorder (IED, ODD, CD), and any substance use disorder occur in over half of individuals with

bipolar I disorder

Hypomanie episodes are common in __________disorder

bipolar I however, hypomanic episodes are not required for the diagnosis of bipolar I disorder

The most commonly diagnosed conditions in psychiatry are:

bipolar and depressive disorders

Schizophrenia and _________ likely share a genetic origin

bipolar disorder

What accounts for one-quarter of all completed suicides?

bipolar disorder

Response to mood stabilizers during a substance/medication induced mania may not necessarily be diagnostic for

bipolar disorder. A primary diagnosis of bipolar disorder must be established based on sx that remain once substances are no longer being used.

DSM-5 is organized on developmental and lifespan considerations so after early life it continues with dx that more commonly manifest in adolescence and young adulthood like ________ and ends with diagnoses relevant to adulthood and later life like ________

bipolar, depressive, and anxiety disorders then neurocognitive disorders

Delusions that express a loss of control over mind or body are generally considered to be:

bizarre

Personality disorders such as _____________ may have substantial symptomatic overlap with bipolar disorders, since mood lability and impulsivity are common in both conditions. Bipolar sx must represent a distinct episode, with a noticeable increase over baseline. A dx of a personality disorder should not be made during an untreated mood episode.

borderline personality disorder

Re LANGUAGE disorder, EXPRESSIVE ability refers to the production of vocal, gestural, or verbal signals, while RECEPTIVE ability refers to the process of receiving and comprehending language messages. Language skills need to be assessed in:

both EXPRESSIVE and RECEPTIVE modalities as these may differ in severity

Factitious disorders have similarities to substance use disorders, eating disorders, impulse-control disorders, pedophilic disorder, and some other established disorders related to:

both the persistence of the behavior and the intentional efforts to conceal the disordered behavior through deception.

Medication-induced symptoms of ADHD may be attributable to the use of medications like:

bronchodilators, INH, neuroleptics [resulting in akathisia], thyroid replacement; they're diagnosed as other specified or unspecified other (or unknown) substance-related disorders.

Do panic and anxiety occur with intoxication with cocaine or withdrawal?

can occur with both

Substance/medication-induced psychotic disorders arise during or soon after exposure to a medication or after substance intoxication or withdrawal but

can persist for weeks

PurposeLESS and EXCESSIVE motor activity without obvious cause is called:

catatonic EXCITEMENT; Other examples of catatonic behavior are repeated STEREOTYPED MOVEMENTS, staring, grimacing, mutism, and the echoing of speech

Delusional Disorder Persecutory type:

central theme of the delusion involves the individual's belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals. Small slights may be exaggerated and become the focus; may engage in repeated attempts to obtain satisfaction by legal or legislative action; are often resentful and angry and may resort to violence against those they believe are hurting them.

Catatonia can occur in the context of several medical conditions, e.g.,

cerebral folate deficiency, rare autoimmune and paraneoplastic disorders.

The essential feature of brief psychotic disorder is a disturbance that involves the SUDDEN onset of at least one of the following POSITIVE psychotic symptoms: delusions, hallucinations, disorganized speech, (grossly abnormal psychomotor behavior, including catatonia - is insufficient alone), (Criterion A). Sudden onset is defined as

change from a nonpsychotic state to a clearly psychotic state within 2 weeks, usually without a prodrome.

In children, overestimation of abilities and belief that, for example, they are the best at a sport or the smartest in the class is normal; when such beliefs are present despite clear evidence to the contrary or the child attempts feats that are clearly dangerous and, most important, represent a

change from the child's normal behavior, the grandiosity criterion should be considered satisfied.

Elimination disorders all involve the inappropriate elimination of urine or feces and are usually first diagnosed in:

childhood or adolescence.

Grossly Disorganized or Abnormai Motor Behavior (inciuding Catatonia) may manifest itself in a variety of ways, ranging from _______ to ________.

childlike "silliness" to unpredictable agitation; Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living.

If OCD is untreated, the course is usually:

chronic, often with waxing and waning symptoms. Some individuals have an episodic course, and a minority have a deteriorating course. Without treatment, remission rates in adults are low (e.g., 20% for those reevaluated 40 years later). Onset in childhood or adolescence can lead to a lifetime of OCD. However, 40% of individuals with onset of OCD in childhood or adolescence may experience remission by early adulthood. The course of OCD is often complicated by the co-occurrence of other disorders..

The core feature of disruptive mood dysregulation disorder is _____________, which has two prominent clinical manifestations, 1)_________ and 2) ____________

chronic, severe persistent irritability; frequent temper OUTBURSTS and chronic, PERSISTENTLY irritable or angry MOOD that is present between the severe temper outbursts

While the specific content of obsessions and compulsions varies among individuals, certain symptom dimensions are common in OCD, including those of:

cleaning (contamination obsessions and cleaning compulsions); symmetry (symmetry obsessions and repeating, ordering, and counting compulsions); forbidden or taboo thoughts (e.g., aggressive, sexual, and religious obsessions and related compulsions); and harm (e.g., fears of harm to oneself or others and related checking compulsions). The tic-related specifier of OCD is used when an individual has a current or past history of a tic disorder.

Many adults with ASD without intellectual or language disabilities learn to SUPPRESS repetitive behavior in public. Diagnostic criteria may be met when restricted, repetitive patterns of behavior, interests, or activities were:

clearly present DURING CHILDHOOD or at some time in the past, even if sx are no longer present

In addition to the five symptom domain areas identified in the diagnostic criteria, the assessment of ____________ is vital for making critically important distinctions between the various schizophrenia spectrum and other psychotic disorders

cognition, depression, and mania symptom domains

Generalized amnesia, a complete loss of memory for one's life history, is rare. Generalized amnesia has an acute onset; the perplexity, disorientation, and purposeless wandering of individuals with generalized amnesia usually bring them to the attention of the police or psychiatric emergency services. Generalized amnesia may be more common among:

combat veterans, sexual assault victims, and individuals experiencing extreme emotional stress or conflict.

Auditory hallucinations that involve voices speaking

complex sentences are more characteristic of schizophrenia than of psychotic disorder due to a medical condition. Other types of hallucinations (e.g., visual, olfactory) commonly signal a psychotic disorder due to another medical condition or a substance / medication-induced psychotic disorder

Psychotic disorder due to another medical condition in individuals older than 80 years is associated with

concurrent major neurocognitive disorder (dementia)

A. Criteria have been met for at least one hypomanic episode (Criteria A-F under "Hypomanic Episode") AND at least one major depressive episode (Criteria A-C under "Major Depressive Episode" above). B. There has NEVER been a manic episode. C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. D. The symptoms of DEPRESSION or the unpredictability caused by frequent ALTERNATION between periods of depression and hypomania causes clinically significant distress or IMPAIRMENT in social, occupational, or other important areas of functioning

criteria for Bipolar II Disorder

Not bipolar disorder, this disorder may result in prolonged periods of cyclical, often unpredictable mood changes (e.g., the individual may be regarded as temperamental, moody, unpredictable, inconsistent, or unreliable)

cyclothymic disorder

The essential feature of __________ disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic sx and periods of depressive sx that are distinct from each other (Criterion A). The hypomanic sx are of INSUFFICIENT number, severity, pervasiveness, or duration to meet full criteria for a hypomanic episode, and the depressive sx are of INSUFFICIENT number, severity, pervasiveness, or duration to meet full criteria for a major depressive episode.

cyclothymic disorder

Borderline personality disorder is associated with marked shifts in mood that may suggest

cyclothymic disorder. If the criteria are met for both disorders, both borderline personality disorder and cyclothymic disorder may be diagnosed

The predictors of course/outcome are largely unexplained and unpredictable and is favorable in 20% with schizophrenia; a small number recover completely. Most with schizophrenia still require:

daily living supports, many remain chronically ill, with exacerbations and remissions of active Sx, others progressively deteriorate

Anhedonia

decreased ability to experience pleasure from positive stimuli or a DEGRADATION of RECOLLECTION of pleasure previously experienced

Cognitive disconnection schemata reflect:

defectiveness and emotional inhibition and subsume themes of abuse, neglect, and deprivation.

subtype of Delusional Disorder Erotomanic type:

delusion is that another person is in love with the individual. usually of higher status (e.g., a famous individual or a superior at work) but can be a complete stranger. Efforts to contact the object of the delusion are common.

Belief that one's body or actions are being acted on or manipulated by some outside force are:

delusions of control

To separate schizoaffective disorder from a depressive or Bipolar Depression with psychotic features:

delusions or hallucinations must be present >= 2 weeks in the absence of major mood episode (depressive or manic) at some point (Criterion B for schizoaffective disorder)

Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined by abnormalities in one or more of the following five domains:

delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms

Depressive sx co-occurring with a hypomanic episode or hypomania sx co-occurring with a depressive episode are common in individuals with bipolar II disorder and are overrepresented in females, particularly hypomania with mixed features. Individuals experiencing hypomania with mixed features may not label their symptoms as hypomania, but instead experience them as

depression with increased energy or irritability

Sleep disorders are often accompanied by:

depression, anxiety, and cognitive changes that must be addressed in treatment planning and management.

If delusions occur exclusively during mood episodes, the diagnosis is

depressive or bipolar disorder with psychotic features

The lifetime risk of suicide for schizophrenia and schizoaffective disorder is 5%, and the presence of

depressive sx is correlated with higher risk for suicide. There is evidence that suicide rates are higher in North American populations than in European, Eastern European, South American, and Indian populations of individuals with schizophrenia or schizoaffective disorder

While talking, switching from one topic to another is known as:

derailment or loose associations

The development and course of anxiety disorder due to another medical condition generally follows the course of the underlying illness. This dx is not meant to include primary anxiety disorders that arise in the context of chronic medical illness. This is important to consider with older adults, who may experience chronic medical illness and then:

develop independent anxiety disorders secondary to the chronic medical illness.

Because of the shared etiological association with social neglect, reactive attachment disorder often co-occurs with:

developmental delays, especially in delays in cognition and language. Other associated features include stereotypies and other signs of severe neglect (e.g., malnutrition or signs of poor care).

In Disruptive Mood Dysregulation Disorder, the temper outbursts are inconsistent with ___________ and occur, on average, _________ per ______.

developmental level; three or more times per week (Criteria B & C)

Aberrant social behaviors manifest in young children with reactive attachment disorder but they also are key features of autism spectrum disorder. Young children with either condition can manifest dampened expression of positive emotions, cognitive and language delays, and impairments in social reciprocity. These two disorders can be distinguished based on:

differential histories of NEGLECT and on the presence of RESTRICTED INTERESTS or RITUALIZED BEHAVIORS, specific DEFICIT in social COMMUNICATION, and SELECTIVE ATTACHMENT behaviors.

Psychotic symptoms tend to _______ over the life course.

diminish; perhaps in association with normal age-related declines in dopamine activity. Negative Sx are more closely related to Px than are positive Sx and tend to be PERSISTENT. Cognitive deficits associated with the illness may not improve over time.

Name 5 negative sx of schizophrenia

diminished emotional expression, avolition, alogia, anhedonia, asociality (EeAAAA)

Alogia

diminished speech output

Adolescents endorse a broader pattern of fear and avoidance, including of dating, compared with younger children. Older adults express social anxiety at lower levels but across a broader range of situations, whereas younger adults express higher levels of social anxiety for specific situations. In older adults, social anxiety may concern:

disability due to declining sensory functioning (hearing, vision) or embarrassment about one's appearance (e.g., tremor as a symptom of Parkinson's disease) or functioning due to medical conditions, incontinence, or cognitive impairment (e.g., forgetting people's names).

What is the "internalizing group" used for the framework in DSM-5 and ICD-11?

disorders with prominent anxiety, depressive, and somatic symptoms

What is the "externalizing group" used for the framework in DSM-5 and ICD-11?

disorders with prominent impulsive, disruptive conduct, and substance use symptoms

Individuals with dissociative identity disorder typically present with comorbid depression, anxiety, substance abuse, self-injury, non-epileptic seizures, or another common symptom. They often conceal, or are not fully aware of:

disruptions in consciousness, amnesia, or other dissociative symptoms.

Depressive disorders include:

disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's capacity to function. What differs among them are issues of duration, timing, or presumed etiology

13 yo patient presents with persistent irritability and frequent episodes of extreme behavioral dyscontrol. What dx do you exclude?

disruptive mood dysregulation disorder; the cutoff is up to 12 yo

Individuals with this disorder may present with seizure-like symptoms and behaviors that resemble complex partial seizures with temporal lobe foci. These include déjà vu, jamais vu, depersonalization, derealization, out-of-body experiences, amnesia, disruptions of consciousness, hallucinations, and other intrusion phenomena of sensation, affect, and thought. Normal EEG findings, including telemetry, help differentiate non-epileptic seizures from this disorder. Also, individuals with this disorder obtain very high dissociation scores, whereas individuals with complex partial seizures do not.

dissociative identity disorder

Dissociative disorders include:

dissociative identity disorder, dissociative amnesia, depersonalization / derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.

Dissociative fugue is rare in persons with dissociative amnesia but common in:

dissociative identity disorder.

Individuals with this disorder experience a) RECURRENT, inexplicable INTRUSIONS into their conscious functioning and sense of SELF (e.g., voices; dissociated actions and speech; intrusive thoughts, emotions, and impulses), b) ALTERATIONS of sense of SELF (e.g., attitudes, preferences, and feeling like one's body or actions are not one's own), c) ODD changes of PERCEPTION (e.g., depersonalization or derealization, such as feeling DETACHED from one's body while CUTTING), and d) intermittent FUNCTIONAL NEUROLOGICAL sx.

dissociative identity disorder. Stress often produces transient exacerbation of dissociative symptoms that makes them more evident.

Disinhibited social engagement disorder can present in children who show NO signs of disordered attachment. E.g., it may be seen in children with a history of neglect who lack attachments OR whose attachments to their caregivers range from:

disturbed to secure.

In Asia, the Middle East, and Latin America, non-epileptic seizures and other FUNCTIONAL neurological sx may accompany DISSOCIATIVE AMNESIA. In cultures with highly restrictive social traditions, the precipitants of dissociative amnesia often:

do NOT involve frank trauma. Instead, the amnesia is preceded by severe psychological stresses or conflicts (e.g., marital conflict, other family disturbances, attachment problems, conflicts due to restriction or oppression).

Along the schizophrenia/psychotic spectrum, clinicians should first consider conditions that:

do NOT reach FULL criteria for a psychotic disorder or are LIMITED TO ONE DOMAIN of psychopathology. Then they should consider TIME-LIMITED conditions. Finally, the diagnosis of a schizophrenia spectrum disorder requires the EXCLUSION OF ANOTHER CONDITION that may give rise to psychosis

As dissociative anmesia begins to remit, a wide variety of affective phenomena may surface, such as:

dysphoria, grief, rage, shame, guilt, psychological conflict and turmoil, and suicidal and homicidal ideation, impulses, and acts. These individuals may have symptoms that then meet diagnostic criteria for persistent depressive disorder (dysthymia); major depressive disorder; other specified or unspecified depressive disorder; adjustment disorder, with depressed mood; or adjustment disorder, with mixed disturbance of emotions and conduct. Many individuals with dissociative amnesia develop PTSD at some point during their life, especially when the traumatic antecedents of their amnesia are brought into conscious awareness. Many individuals with dissociative amnesia have symptoms that meet diagnostic criteria for a comorbid somatic symptom or related disorder (and vice versa), including somatic symptom disorder and conversion disorder (functional neurological symptom disorder). Many individuals with dissociative amnesia have symptoms that meet diagnostic criteria for a personality disorder, especially dependent, avoidant, and borderline.

The typical age at onset of schizoaffective d/o is:

early adulthood, although onset can occur anywhere from adolescence to late in life. A significant number initially dx w/ another psychotic illness receive the dx schizoaffective d/o later when the pattern of mood episodes has become apparent. With the current diagnostic Criterion C, it is expected that the diagnosis for some individuals will convert from schizoaffective d/o to another d/o as mood symptoms become less prominent. The px for schizoaffective d/o is somewhat better than the px for schizophrenia but worse than the px for mood d/o.

With rapid cycling (can be applied to bipolar I or bipolar II disorder): Presence of at least four mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode. Note: Episodes are demarcated by either partial or full remissions of at least 2 months or a switch to an episode of the opposite polarity (e.g., major depressive episode to manic episode). Note: The essential feature of a rapid-cycling bipolar disorder is the occurrence of at least four mood episodes during the previous 12 months. These episodes can occur in any combination and order. The episodes must meet both the duration and symptom number criteria for a major depressive, manic, or hypomanic episode and must be demarcated by

either a period of FULL REMISSION or a SWITCH to an episode of the opposite polarity. Manic and hypomanic episodes are counted as being on the same pole. Except for the fact that they occur more frequently, the episodes that occur in a rapid-cycling pattern are no different from those that occur in a non-rapid cycling pattern. Mood episodes that count toward defining a rapid-cycling pattern exclude those episodes directly caused by a substance (e.g., cocaine, corticosteroids) or another medical condition.

Re child rearing, the excessive worrying of those with GAD may impair the caregiver's ability to:

encourage confidence in their children.

A number of medical conditions are known to include anxiety as a symptomatic manifestation. Examples include:

endocrine disease (e.g., hyperthyroidism, pheochromocytoma, hypoglycemia, hyperadrenocortisolism), cardiovascular disorders (e.g., CHF, PE, arrhythmia such as A FIB), respiratory illness (e.g., COPD, asthma, pneumonia), metabolic disturbances (e.g., vitamin B12 deficiency, porphyria), and neurological illness (e.g., neoplasms, vestibular dysfunction, encephalitis, seizure disorders).

Children presenting with features of DMDD disorder are predominantly male. In bipolar disorder, there is an _________ gender prevalence.

equal

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

erotomanic delusions

ASD is diagnosed only when the characteristic DEFICITS of SOCIAL communication are accompanied by:

excessively REPETITIVE behaviors, RESTRICTED interests, and INSISTENCE on SAMENESS

In Intellectual Disability, gullibility and lack of awareness of risk may result in:

exploitation by others, possible victimization, fraud, unintentional criminal involvement, false confessions, and risk for physical and sexual abuse. These features can be important in criminal cases, including ATKINS-type hearings involving the death penalty.

Individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves (i.e., there may be "__________ insight" but no true insight).

factual insight

In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is

feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure.

The lifetime prevalence for excoriation disorder in adults is 1.4% and three-quarters or more of individuals with the disorder are:

female

Conversion disorder is two to three times more common in:

females

Delusions are:

fixed beliefs that are not amenable to change in light of conflicting evidence.

Recovery typically begins within 3 months of onset for 40% of individuals with major depression and within 1 year

for 80% of individuals. Recency of onset is a strong determinant of the likelihood of near-term recovery, and many individuals who have been depressed only for several months can be expected to recover spontaneously.

Tourette's disorder is diagnosed when the individual has multiple motor AND vocal tics that have been present ______ and whose course is ______

for at least 1 YEAR AND a WAXING-WANING symptom course

The diagnostic criteria in Section II are well-established measures that have undergone extensive review while Section III are those:

for scientific evidence is not yet available to support widespread clinical use and are included to highlight the evolution and direction of scientific advances

Panic Disorder Diagnostic Criteria A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time _________ (or more) of the following symptoms occur; Note: The abrupt surge can occur from a calm state or an anxious state. 1. Palpitations, pounding heart, or accelerated heart rate. 2. Sweating. 3. Trembling or shaking. 4. Sensations of shortness of breath or smothering. 5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress. 8. Feeling dizzy, unsteady, light-headed, or faint. 9. Chills or heat sensations. 10. Paresthesias (numbness or tingling sensations). 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself). 12. Fear of losing control or "going crazy." 13. Fear of dying

four or more

Individuals with bipolar I disorder must have how many mood episodes (major depressive, manic, or hypomanic) within 1 year to receive the specifier "with rapid cycling?"

four or more mood episodes (major depressive, manic, or hypomanic) within 1 year receive the specifier "with rapid cycling."

Limited-symptom panic attacks include fewer than:

four symptoms. Panic attacks may be expected, such as in response to a typically feared object or situation, or unexpected, meaning that the panic attack occurs for no apparent reason.

Peripartum-onset mood episodes can present either with or without psychotic features. Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur in

from 1 in 500 to 1 in 1,000 deliveries and may be more common in primiparous women. The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum mood episodes but is also elevated for those with a prior history of a depressive or bipolar disorder (especially bipolar I disorder) and those with a family history of bipolar disorders.

Onset of manic symptoms (e.g., sexual or social disinhibition) in late mid-life or latelife should prompt consideration of medical conditions like

frontotemporal neurocognitive disorder and of substance ingestion or withdrawal.

In partial remission: Symptoms of the immediately previous manic, hypomanic, or depressive episode are present, but __________, or there is a period lasting less than ___________ without any significant symptoms of a manic, hypomanic, or major depressive episode following the end of such an episode.

full criteria are not met; 2 months

This influences risk of some disorders as well as particular symptoms

gender

Smoking a high dose of cocaine may produce psychosis within minutes, whereas days or weeks of high-dose alcohol or sedative use may be required to produce psychosis. Alcohol-induced psychotic disorder, with hallucinations, usually occurs only after prolonged, heavy ingestion of alcohol in individuals who have moderate to severe alcohol use disorder, and the hallucinations are

generally auditory in nature

Chronic, severe irritability, such as is seen in disruptive mood dysregulation disorder, is associated with marked disruption in a child's family and peer relationships, as well as in school performance. Because of their extremely low frustration tolerance, such children generally have difficulty succeeding in school; they are often unable to participate in the activities typically enjoyed by healthy children; their family life is severely disrupted by their outbursts and irritability; and they have trouble initiating or sustaining friendships. Levels of dysfunction in children with bipolar disorder and disruptive mood dysregulation disorder are

generally comparable. Both conditions cause severe disruption in the lives of the affected individual and their families. In both disruptive mood dysregulation disorder and pediatric bipolar disorder, dangerous behavior, suicidal ideation or suicide attempts, severe aggression, and psychiatric hospitalization are common.

ODD co-occurs with ADHD in approximately:

half of children with the combined presentation and about a quarter with the predominantly inattentive presentation

Despite the extent of distress and social impairment associated with social anxiety disorder, only about ___________ with the disorder in Western societies ever seek treatment, and they tend to do so only after 15-20 years of experiencing symptoms.

half of individuals

"Flashback" hallucinations that can occur long after the use of hallucinogens has stopped are diagnosed as

hallucinogen persisting perception disorder. If substance/medication-induced psychotic symptoms occur exclusively during the course of a delirium, as in severe forms of alcohol withdrawal, the psychotic symptoms are considered to be an associated feature of the delirium and are not diagnosed separately.

Schizotypal personality disorder

has a PERVASIVE pattern of SOCIAL and INTERPERSONAL DEFICITS, including REDUCED capacity for CLOSE relationships; cognitive or perceptual DISTORTIONS; and ECCENTRICITIES of behavior, usually beginning by EARLY adulthood but in some cases first becoming apparent in childhood and adolescence. Abnormalities of beliefs, thinking, and perception are BELOW the threshold for the diagnosis of a psychotic disorder.

The dx of cyclothymic disorder is made only if the criteria for a major depressive, manic, or hypomanic episode

have never been met (Criterion C).

Re MDD, in women, the risk for suicide attempts is

higher, and the risk for suicide completion is lower.

Name 4 metabolic conditions that may cause catatonia

hypercalcemia, hepatic encephalopathy, homocystinuria, diabetic ketoacidosis "HHHD"

Hallucinations that occur while falling asleep

hypnagogic

Hallucinations that occur when waking up

hypnopompic, are considered to be within the range of normal experience

Re Schizophreniform Category C, Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1 ) NO major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2)

if mood episodes have occurred during active-phase symptoms, they have been PRESENT FOR A MINORITY of the total duration of the active and residual periods of the illness.

Overconnection schemata involve:

impaired autonomy with themes of dependency, vulnerability, and incompetence.

ADHD is a neurodevelopmental disorder defined by:

impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and disorganization entail inability to stay on task, seeming not to listen, and losing materials, at levels that are inconsistent with age or developmental level.

In DSM-5, Axis III has been combined with Axes I and II. Clinicians should continue to list medical conditions important to the understanding/ management of an individual's mental disorder, with separate notations for:

important psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V)

A common feature of bipolar II disorder is ________, which can contribute to suicide attempts and substance use disorders.

impulsivity

In phencyclidine-induced mania, the initial presentation may be one of a delirium with affective features, which then becomes an atypically appearing manic or mixed manic state. This condition follows the ingestion or inhalation quickly, usually within HOURS or, at the most, a few DAYS. In stimulant-induced manic or hypomanic states, the response is

in MINUTES to 1 hour after one or several ingestions or injections. The episode is very brief and typically resolves over 1-2 days. With corticosteroids and some immunosuppressant medications, the mania (or mixed or depressed state) usually follows SEVERAL days of ingestion, and the higher doses appear to have a much greater likelihood of producing bipolar symptoms.

Females are twice as likely as males to experience generalized anxiety disorder. The prevalence of the diagnosis peaks:

in middle age and declines across the later years of life; The median age at onset for generalized anxiety disorder is 30 years; however, age at onset is spread over a very broad range. The median age at onset is later than that for the other anxiety disorders.

Major depressive disorder may first appear at any age, but the likelihood of onset increases markedly with puberty. In the United States, incidence appears to peak

in the 20s, however, first onset in late life is not uncommon.

For the conditions of social neglect to result in Disinhibited Social Engagement Disorder, they must generally occur:

in the first months of life (even before the disorder is diagnosed). There is no evidence that neglect beginning after age 2 years is associated with manifestations of the disorder.

In schizophrenic patients, suicide risk is higher after:

in the period AFTER a psychotic episode or hospital DISCHARGE

Children with selective mutism will speak:

in their home in the presence of immediate family members but often not even in front of close friends or second-degree relatives, such as grandparents or cousins. The disturbance is often marked by high social anxiety. Children with selective mutism often refuse to speak at school, leading to academic or educational impairment, as teachers often find it difficult to assess skills such as reading. The lack of speech may interfere with social communication, although children with this disorder sometimes use nonspoken or nonverbal means (e.g., grunting, pointing, writing) to communicate and MAY BE willing or EAGER to PERFORM or engage in social encounters when speech is NOT required (e.g., nonverbal parts in school plays).

After an individual has a manic episode with psychotic features, subsequent manic episodes are more likely to

include psychotic features

The rate of OCD among first-degree relatives of adults with OCD is approximately two times that among first-degree relatives of those without the disorder; however, among first-degree relatives of individuals with onset of OCD in childhood or adolescence, the rate is:

increased 10-fold. It has a concordance rate of 0.57 for monozygotic vs. 0.22 for dizygotic twins.

No biological marker is diagnostic for ADHD. As a group, compared with peers, children with ADHD display

increased SLOW WAVES on EEGs, REDUCED total BRAIN VOLUME on MRI and possibly a DELAY in posterior to anterior CORTICAL MATURATION (these are non-diagnostic)

In the context of co-occurring mental disorders, including anxiety disorders, depressive disorders, bipolar disorder, substance use disorders, psychotic disorders, and personality disorders, panic attacks are associated with:

increased symptom severity, higher rates of comorbidity and suicidality, and poorer treatment response. Also, full-symptom panic attacks typically are associated with greater morbidity (e.g., greater health care utilization, more disability, poorer quality of life) than limited-symptom attacks.

Prevalence rates for psychotic disorder due to another medical condition has been estimated to range from 0.21% to 0.54%. When the prevalence findings are stratified by age group

individuals older than 65 years have a significantly greater prevalence of 0.74%

The neurodevelopmental disorders frequently co-occur; individuals with autism spectrum disorder often have _____ and many children with ADHD also have _____

individuals with ASD often have INTELLECTUAL developmental disorder and and many children with ADHD also have a SPECIFIC learning disorder

Before the CATATONIA specifier is used in neurodevelopmental, psychotic, bipolar, depressive mental disorders, etc. a wide variety of other medical conditions need to be ruled out; these conditions include, but are not limited to, medical conditions due to

infectious, metabolic, neurological conditions or med S/E. Because of the seriousness of the complications, particular attention should be paid to the possibility that the catatonia is attributable to NEUROLEPTIC MALIGNANT SYNDROME

The dx of factitious disorder emphasizes the objective identification of falsification of s/s of illness, rather than an inference about:

intent or possible underlying motivation. Moreover, such behaviors, including the induction of injury or disease, are associated with deception.

The course of factitious disorder is usually one of:

intermittent episodes. Single episodes and episodes that are characterized as persistent and unremitting are both less common. Onset is usually in early adulthood, often after hospitalization for a medical condition or a mental disorder. When imposed on another, the disorder may begin after hospitalization of the individual's child or other dependent. In individuals with recurrent episodes of falsification of signs and symptoms of illness and/or induction of injury, this pattern of successive deceptive contact with medical personnel, including hospitalizations, may become lifelong.

To provide an empirically supported framework with DSM-5 and ICD-11, clustering of disorders is according to:

internalizing and externalizing factors

Many individuals develop __________ mood, which can usually be understood as a reaction to their delusional beliefs

irritable or dysphoric

Adjustment disorders are common. The percentage of individuals in outpatient mental health treatment with a principal diagnosis of an adjustment disorder ranges from approximately 5% to 20%. In a hospital psychiatric consultation setting:

it is often the most common diagnosis, frequently reaching 50%

A statistical measure that assesses level of agreement between raters that CORRECTS FOR CHANCE AGREEMENT due to PREVALENCE rates is:

kappa reliability estimates

What is khyal attacks?

khyal (wind) attacks, a Cambodian cultural syndrome involving dizziness, tinnitus, and neck soreness; (cultural expectations may influence the classification of panic attacks as expected or unexpected, as cultural syndromes may create fear of certain situations, e.g., types of exertion (associated with khyâl attacks)

The risk of acute onset of a major depressive disorder following a CVA (within 1 day to a week of the event) appears to be strongly correlated with lesion location, with greatest risk associated with:

left frontal strokes and least risk apparently associated with right frontal lesions in those individuals who present within days of the stroke. The association with frontal regions and laterality is NOT observed in depressive states that occur in the 2-6 mos following stroke.

Schizophreniform disorder is characterized by a symptomatic presentation equivalent to that of schizophrenia except for its duration (_________) and the ABSENCE OF A REQUIREMENT FOR _________

less than 6 months; absence of a requirement for a decline in functioning

Separation anxiety disorder often develops after:

life stress, especially a loss (e.g., the death of a relative or pet; an illness of the individual or a relative; a change of schools; parental divorce; a move to a new neighborhood; immigration; a disaster that involved periods of separation from attachment figures). In young adults, other examples of life stress include leaving the parental home, entering into a romantic relationship, and becoming a parent. Parental overprotection and intrusiveness may be associated with separation anxiety disorder.

Rarely, in disorganized thinking, speech may be so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia (must be severe enough to substantially impair effective communication). This is called:

linguistic disorganization, incoherence or "word salad"; Less severe disorganized thinking or speech may occur during the prodromal and residual periods of schizophrenia.

To help distinguish regression from ASD and Rett Syndrome, consider:

losses of skills BEYOND SOCIAL COMMUNICATION (e.g., loss of self-care, toileting, motor skills) or those occurring after the second birthday

Associated features of ADHD may include:

low frustration tolerance, irritability, or mood lability. By early adulthood, ADHD is associated with an increased risk of suicide attempt, primarily when comorbid with mood, conduct, or substance use disorders

ADHD clinical identification rates in the U.S. for African American and Latino populations tend to be _______ than for Caucasians.

lower - Informant Sx ratings may be influenced by cultural group of child and informant

In the U.S., the 12-month community prevalence estimate for specific phobia is about 7%-9%. Prevalence rates in are generally lower in Asian, African, and Latin American countries (2%-4%). Prevalence rates are approximately 5% in children and are approximately 16% in 13- to 17-year-olds. In older individuals, prevalence rates are:

lower in older individuals (about 3%-5%), possibly reflecting diminishing severity to subclinical levels. Females are more frequently affected than males, at a rate of approximately 2:1, although rates vary across different phobic stimuli. That is, animal, natural environment, and situational specific phobias are predominantly experienced by females, whereas blood-injection-injury phobia is experienced nearly equally by both genders

Persecutory and derogatory internal voices in dissociative identity disorder associated with depressive symptoms may be misdiagnosed as:

major depression with psychotic features.

Bereavement may induce great suffering, but it does not typically induce an episode of

major depressive disorder. When they do occur together, the depressive symptoms and functional impairment tend to be more severe and the prognosis is worse compared with bereavement that is not accompanied by major depressive disorder. Bereavement-related depression tends to occur in persons with other vulnerabilities to depressive disorders, and recovery may be facilitated by antidepressant treatment.

Individuals with bipolar I disorder who have four or more mood episodes within 1 year receive the specifier "with rapid cycling." What are the qualifying mood episodes?

major depressive, manic, or hypomanic

Simple persecutory delusions in the context of major neurocognitive disorder would be diagnosed as

major neurocognitive disorder, with behavioral disturbance.

DSM-V definitions of mental disorder were developed for clinical, public health, and research purposes and should NOT be used to:

make legal judgments on such issues as criminal responsibility, eligibility for disability compensation, and competency

In Psychological Factors affecting other Medical Conditions, the psychological factors adversely affect a medical condition; the individual's thoughts, feelings, and behavior are NOT necessarily excessive. In psychological factors affecting other medical conditions, the emphasis is on the exacerbation of the medical condition (e.g., an individual with angina that is precipitated whenever he becomes anxious). In somatic symptom disorder, the emphasis is on:

maladaptive thoughts, feelings, and behavior (e.g., an individual with angina who worries constantly that she will have a heart attack, takes her blood pressure multiple times per day, and restricts her activities).

What is the gender predilection for Specific learning disorder?

males > females (ratios range from about 2:1 to 3:1)

Based on rates of chronic and severe persistent irritability, the overall 6-month to 1-year period-prevalence of DMDD among children and adolescents probably falls in the 2%-5% range, with rates higher in

males and school-age children than in females and adolescents

Cyclothymic Disorder Diagnostic Criteria C C. Criteria for a major depressive...

manic, or hypomanic episode have never been met

The seemingly opposing clinical features and variable manifestations of the diagnosis contribute to a lack of awareness and decreased recognition of catatonia. The clinical presentation of catatonia can be puzzling, as the psychomotor disturbance may range from

marked unresponsiveness to marked AGITATION. Motoric immobility may be severe (stupor) or moderate (catalepsy and waxy flexibility). Similarly, decreased engagement may be severe (mutism) or moderate (negativism).

In children, happiness, silliness and "goofiness" are normal in the context of special occasions; however, if these sx are recurrent, inappropriate to the context, and beyond what is expected for the developmental level of the child, they may

meet Criterion A. If the happiness is unusual for a child (i.e., distinct from baseline), and the mood change occurs at the same time as symptoms that meet Criterion B for mania, diagnostic certainty is increased; however, the mood change must be accompanied by persistently increased activity or energy levels that are obvious to those who know the child well.

Hypothalamic-pituitary-adrenal axis hyperactivity had been the most extensively investigated abnormality associated with MDE & appears to be associated with

melancholia, psychotic features, and risks for eventual suicide.

In bipolar II, functional recovery lags substantially behind recovery from sx of bipolar II disorder, especially in regard to occupational recovery. Individuals with bipolar II disorder perform more poorly than healthy individuals on cognitive tests and have similar cognitive impairment as do individuals with bipolar I disorder, with the exception of

memory and semantic fluency.

Echopraxia

mimicking another's movements

Echolalia

mimicking another's speech

GAD is associated with significant disability and distress that is independent of comorbid disorders, and most non-institutionalized adults with the disorder are:

moderately to seriously disabled. GAD accounts for 110 million disability days per annum in the U.S. population.

In bipolar II, co-occurring disorders do not seem to follow a course of illness that is truly independent from that of the bipolar disorder, but rather have strong associations with

mood states. For example, anxiety and eating disorders tend to associate most with depressive sx, and substance use disorders are moderately associated with manic sx.

The expression of psychotic disorder due to different medical conditions doesn't differ substantially but nature of the underlying medical conditions is likely to change across the lifespan, with younger age groups more affected by epilepsy, head trauma, autoimmune, and neoplastic diseases of early to midlife, and older age groups

more affected by stroke disease, anoxic events, & multiple system comorbidities.

Brief psychotic disorder lasts

more than 1 day and remits by 1 month

What % of individuals with agoraphobia are completely homebound and unable to work?

more than 1/3

The risk of stuttering among first-degree biological relatives of individuals with childhood-onset fluency disorder is _______ the risk in the general population.

more than three times

Onset of persistent, fluctuating hypomanic and depressive sx late in adult life needs to be clearly differentiated from bipolar and related disorder due to another medical condition and depressive disorder due to another medical condition (e.g., ______________) before the cyclothymic disorder diagnosis is assigned.

multiple sclerosis

A complete lack of verbal and motor responses is termed:

mutism and stupor, severe Sx of catatonic behavior

Resistance to instructions is called:

negativism, a mild form of catatonic behavior

Name 4 neurological conditions that may cause catatonia

neoplasms, head trauma, cerebrovascular disease, encephalitis

Specific learning disorder commonly co-occurs with:

neuroDEVELOPMENTAL disorders - (ADHD, communication disorders, developmental coordination disorder, ASD) or other mental disorders (e.g., anxiety disorders, depressive and bipolar disorders).

Catatonia can occur in several disorders, including

neurodevelopmental, psychotic, bipolar, depressive, and other mental disorders

A variety of medical conditions may cause psychotic symptoms. These include

neurological conditions (neoplasms, cerebrovascular disease, Huntington's disease, MS, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, CNS infections), endocrine conditions (hyper/hypothyroidism, hyper- and hypoparathyroidism, hyper- and hypoadrenocorticism), metabolic conditions (hypoxia, hypercarbia, hypoglycemia), fluid or electrolyte imbalances, hepatic or renal diseases, autoimmune disorders with CNS involvement (SLE)

To count toward a major depressive episode, a symptom must either be

newly present or must have clearly worsened compared with the person's pre-episode status.

There's a strong contribution for genetics in determining risk for schizophrenia, although most individuals who have been diagnosed with schizophrenia have:

no family hx of psychosis. Liability is conferred by a spectrum of risk alleles, with each allele contributing only a small fraction to the total variance. The risk alleles identified to date are also associated with other mental disorders, including Bipolar Depression, depression, and ASD.

Stupor

no psychomotor activity; not actively relating to environment

Mutism

no, or very little, verbal response [exclude if known aphasia]

The belief that one is under surveillance by the police, despite a lack of convincing evidence is an example of a:

nonbizarre delusion

Making the diagnosis of bipolar II in children is often a challenge, especially in those with irritability and hyperarousal that is

nonepisodic (i.e., lacks the well-demarcated periods of altered mood). Nonepisodic irritability in youth is associated with an elevated risk for anxiety disorders and major depressive disorder, but not bipolar disorder, in adulthood

Schizoaffective disorder may occur in a variety of patterns. E.g., an individual may have pronounced auditory hallucinations and persecutory delusions for 2 mos before onset of a MDE. The psychotic sx & full major depressive episode are then present for 3 mos then the individual recovers completely from the MDE but the psychotic sx persist for another mo before they too disappear. During this period, the individual's sx concurrently met criteria for a MDE & Criterion A for schizophrenia, & during this same period of illness, auditory hallucinations & delusions were present both before & after the depressive phase. The total period of illness lasted for about 6 mos, with psychotic sx alone present during the initial 2 months, both depressive & psychotic sx present during the next 3 mos then psychotic sx alone present during the last month. In this instance, the duration of the depressive episode was

not brief relative to the total duration of the psychotic disturbance, and thus the presentation qualifies for a diagnosis of schizoaffective disorder.

Individuals with specific phobia are fearful or anxious about or avoidant of circumscribed objects or situations. A specific cognitive ideation is:

not featured in this disorder, as it is in other anxiety disorders.

Apart from the direct impact of the delusions, impairments in psychosocial functioning may be more circumscribed than those seen in other psychotic disorders such as schizophrenia, and behavior is

not obviously bizarre or odd

Criterion D of Hoarding Disorder states symptoms (i.e., difficulties discarding and/or clutter) must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, including maintaining a safe environment for self and others. In some cases, particularly when there is poor insight, the individual may:

not report distress, and the impairment may be apparent only to those around the individual. However, any attempts to discard or clear the possessions by third parties result in high levels of distress.

Individuals with this condition may present with nonneuropsychiatric features of acute rheumatic fever, such as carditis and arthritis (JONES Criteria); psychiatric features they may present with include:

obsessive-compulsive disorder-like symptoms; such individuals should be diagnosed with obsessive-compulsive and related disorder due to another medical condition. (Sydenham's chorea)

Mannerism

odd, circumstantial caricature of normal actions

Criterion J of Disruptive Mood Dysregulation states the behaviors do not occur exclusively during an episode

of major depressive disorder (and are not better explained by another mental disorder (ASD, PTSD, separation anxiety disorder, persistent depressive disorder)

Insight regarding body dysmorphic disorder beliefs can range from good to absent/ delusional. On average, insight is poor; _______________of individuals currently have delusional body dysmorphic disorder beliefs.

one third or more of individuals currently have delusional body dysmorphic disorder beliefs (P.244, I think it's 1/3 of patients with body dysmorphic disorder have delusions); Individuals with delusional body dysmorphic disorder tend to have greater morbidity in some areas (e.g., suicidality), but this appears accounted for by their tendency to have more severe body dysmorphic disorder symptoms

Schizoaffective disorder appears to be about ______ as common as schizophrenia.

one-third as common; Lifetime prevalence of schizoaffective disorder is estimated to be 0.3%. Incidence of schizoaffective disorder is F>M mainly due to an increased incidence of the depressive type among females

Suicide risk is high in bipolar II, with about _______ reporting a lifetime hx of suicide attempt.

one-third of individuals with bipolar II disorder report a lifetime history of suicide attempt.

Of those with provisional schizophreniform disorder, what is the typical end result?

one-third recover, 2/3 = schizophrenia or schizoaffective

Approximately __________________ of individuals with illness anxiety disorder have a transient form, which is associated with less PSYCHiatric comorbidity, more MEDical comorbidity, and less severe illness anxiety disorder

one-third to one-half

Manifestations of ADHD must be present in more than _____ setting

one; Confirmation requires consulting informants who have seen the individual in those settings. Typically, Sx vary depending on context within a given setting.

Many bipolar illnesses begin with one or more depressive episodes, and a substantial proportion of individuals who initially appear to have major depressive disorder will prove, in time, to instead have a bipolar disorder. This is more likely in individuals with

onset of the illness in adolescence, those with psychotic features, and those with a family hx of bipolar illness. The presence of a "'with mixed features" specifier also increases the risk for future manic or hypomanic diagnosis. Major depressive disorder, particularly with psychotic features, may also transition into schizophrenia, a change that is much more frequent than the reverse.

Which of these medical conditions are NOT capable of causing panic attacks? Hyperthyroidism, hyperparathyroidism, pheochromocytoma, vestibular dysfunctions, seizure disorders, arrhythmias, supraventricular tachycardia, asthma, COPD, onychocryptosis

onychocryptosis

Negativism

opposition or no response to instructions or external stimuli

Most children whose symptoms meet criteria for disruptive mood dysregulation disorder will also have a presentation that meets criteria for

oppositional defiant disorder, the reverse is NOT the case. That is, only about of 15% of individuals with ODD would meet criteria for DMDD. Even for children in whom criteria for both disorders are met, only use the diagnosis of DMDD. Nevertheless, it also should be noted that disruptive mood dysregulation disorder appears to carry a high risk for behavioral problems as well as mood problems.

ADHD frequently overlaps with disorders that are often considered to be "EXTERNALIZING disorders," such as:

oppositional defiant disorder and conduct disorder

DMDD cannot coexist with

oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder

Individuals with performance only social anxiety disorder do not fear:

or avoid nonperformance social situations.

The EXTENT of the disturbance in Childhood-Onset Fluency Disorder varies from situation to situation and often is more SEVERE when there is special PRESSURE to communicate (e.g., giving a report at school, interviewing for a job). Dysfluency is often ABSENT during:

oral READING, SINGING, or talking to INANIMATE objects or PETS.

GAD may be overdiagnosed in children. When this dx is being considered in children, one should do a thorough evaluation for the presence of:

other childhood anxiety disorders and other mental disorders to determine whether the worries may be better explained by one of these disorders. Separation anxiety disorder, social anxiety disorder (social phobia), and OCD are often accompanied by worries that may mimic those described in GAD. For example, a child with social anxiety disorder may be concerned about school performance because of fear of humiliation. Worries about illness may also be better explained by separation anxiety disorder or obsessive-compulsive disorder.

Negative symptoms account for a substantial portion of the morbidity associated with schizophrenia but are LESS PROMINENT in:

other psychotic disorders

Panic disorder should not be diagnosed if full-symptom (unexpected) panic attacks have never been experienced. In the case of only limited-symptom unexpected panic attacks, a better dx would be:

other specified anxiety disorder or unspecified anxiety disorder diagnosis

If the total duration of all mood episodes is NOT brief relative to the total duration of the delusional disturbance then a diagnosis of

other specified or unspecified schizophrenia spectrum and other psychotic disorder accompanied by other specified depressive disorder, unspecified depressive disorder, other specified bipolar and related disorder, or unspecified bipolar and related disorder is appropriate.

Hyperactivity-IMPULSIVITY entails:

overactivity, fidgeting, inability to stay seated, intruding into other people's activities, and inability to wait—symptoms that are excessive for age or developmental level.

The inclusion of a chapter on obsessive-compulsive and related disorders in DSM-5 reflects the increasing evidence of these disorders' relatedness to one another in terms of a range of diagnostic validators as well as the clinical utility of grouping these disorders in the same chapter. Clinicians are encouraged to screen for these conditions in individuals who present with one of them and be aware of:

overlaps between these conditions. At the same time, there are important differences in diagnostic validators and treatment approaches across these disorders. Moreover, there are close relationships between the anxiety disorders and some of the obsessive-compulsive and related disorders (e.g., OCD), which is reflected in the sequence of DSM-5 chapters, with obsessive-compulsive and related disorders following anxiety disorders

The dysphoria in grief is likely to decrease in intensity over days to weeks and occurs in waves, the so-called

pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations.

Catalepsy

passive induction of a posture held against gravity

Although there is a body of evidence that supports the existence of Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), it remains a controversial diagnosis. Given this ongoing controversy, the description of PANDAS has been modified to eliminate etiological factors and to designate these expanded clinical entities:

pediatric acute-onset neuropsychiatric syndrome (PANS) or idiopathic childhood acute neuropsychiatric symptoms (CANS), which deserve further study.

Re Criterion C of Social Anxiety Disorder, in children the fear or anxiety must occur in:

peer settings and not just during interactions with adults (Criterion A)

Psychotic disorders induced by amphetamine and cocaine share similar clinical features, commonly

persecutory delusions may rapidly develop shortly after use of amphetamine or a similar sympathomimetic. Cannabis induced psychotic disorder may develop shortly after high-dose cannabis use and usually involves persecutory delusions, marked anxiety, emotional lability, and depersonalization. The d/o usually remits within a day but may persist for a few days.

Content of delusions may include a variety of themes, e.g.:

persecutory, referential, somatic, religious, grandiose

ASD is characterized by:

persistent DEFICITS in SOCIAL communication and social interaction across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviors used for social interaction, and skills in developing, maintaining, and understanding relationships AND the presence of RESTRICTED, REPETITIVE patterns of behavior, interests, or activities.

The course of agoraphobia is typically:

persistent and chronic. Complete remission is rare (10%), unless the agoraphobia is treated. With more severe agoraphobia, rates of full remission decrease, whereas rates of relapse and chronicity increase. A range of other disorders, in particular other anxiety disorders, depressive disorders, substance use disorders, and personality disorders, may complicate the course of agoraphobia. The long-term course and outcome of agoraphobia are associated with substantially elevated risk of secondary major depressive disorder, persistent depressive disorder (dysthymia), and substance use disorders.

Children with symptoms suggestive of IED disorder present with instances of severe temper outbursts, much like children with DMDD. However, unlike DMDD, IED does not require

persistent disruption in mood between outbursts.

For those with Disruptive Mood Dysregulation Disorder, their mood between temper outbursts is

persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). (Criterion D)

A key feature of this Specific Phobia disorder is that the fear or anxiety is circumscribed to the presence of a particular situation or object (Criterion A), which may be termed the:

phobic stimulus

Children with SPEECH PRODUCTION difficulties may experience difficulty with:

phonological KNOWLEDGE of speech sounds or the ABILITY to COORDINATE movements for speech. Speech sound disorder is heterogeneous in its mechanisms and includes PHONOLOGICAL disorder and ARTICULATION disorder.

True somatic DELUSIONS are generally more BIZARRE (e.g., that an organ is rotting or dead) than the concerns seen in illness anxiety disorder. The concerns seen in illness anxiety disorder, though not founded in reality, are:

plausible

Childhood-onset schizophrenia cases tend to resemble:

poor-outcome adult cases, with GRADUAL ONSET and PROMINENT NEGATIVE SX.

Social Anxiety Disorder (Social Phobia) Diagnostic Criteria A. Marked fear or anxiety about one or more social situations in which the individual is exposed to ______________by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

possible scrutiny

Psychosis due to epilepsy has been further differentiated into ictal, postictal, and interictal psychosis. The most common of these is

postictal psychosis, observed in 2%-7.8% of epilepsy patients. Among older individuals, there may be a higher prevalence of the disorder in females.

A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar II diagnosis only if

preceded by a major depressive episode

Indecisiveness is a prominent feature of individuals with hoarding disorder and their first-degree relatives. Individuals with hoarding disorder often retrospectively report stressful and traumatic life events:

preceding the onset of the disorder or causing an exacerbation. Hoarding behavior is familial, with about 50% of individuals who hoard reporting having a relative who also hoards. Twin studies indicate that approximately 50% of the variability in hoarding behavior is attributable to additive genetic factors.

What brain regions have been implicated in Persistent Depressive Disorder?

prefrontal cortex, anterior cingulate, amygdala, and hippocampus have been implicated in persistent depressive disorder

After careful scientific review of the evidence, this disorder has been moved from an appendix of DSM-IV ("...for Further Study") to Section II of DSM-5. Research has confirmed a specific and treatment-responsive form of depressive disorder that begins sometime following ovulation and remits within a few days of menses and has a marked impact on functioning.

premenstrual dysphoric disorder

Whereas compulsions are usually preceded by obsessions, tics are often preceded by:

premonitory sensory urges. Some individuals have symptoms of both OCD and a tic disorder, in which case both diagnoses may be warranted.

Body dysmorphic disorder is characterized by:

preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others, and by repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (e.g., comparing one's appearance with that of other people) in response to the appearance concerns. The appearance preoccupations are not better explained by concerns with body fat or weight in an individual with an eating disorder.

Onset of separation anxiety disorder may be as early as:

preschool age and may occur at any time during childhood and more rarely in adolescence. Periods of heightened separation anxiety from attachment figures are part of normal early development and may indicate the development of secure attachment relationships (e.g., around 1 year of age, when infants may suffer from stranger anxiety). Typically there are periods of exacerbation and remission. In some cases, both the anxiety about possible separation and the avoidance of situations involving separation from the home or nuclear family (e.g., going away to college, moving away from attachment figures) may persist through adulthood. However, the majority of children with separation anxiety disorder are free of impairing anxiety disorders over their lifetimes. Many adults with separation anxiety disorder do not recall a childhood onset of separation anxiety disorder, although they may recall symptoms.

What are some of the subtypes for encopresis?

presence or absence of constipation and overflow incontinence

The course of MDD is quite variable, such that some individuals rarely, if ever, experience remission (a period of 2 or more mos with no sx, or only one or two sx to no more than a mild degree), while others experience many years with few or no symptoms between discrete episodes. It is important to distinguish individuals who

present for treatment during an exacerbation of a chronic depressive illness from those whose sx developed recently.

In neuroCOGNITIVE disorders, memory loss for personal information is usually embedded in cognitive, linguistic, affective, attentional, and behavioral disturbances, whereas in DISSOCIATIVE AMNESIA, memory deficits are:

primarily for autobiographical information; intellectual and cognitive abilities are preserved. (This is similar to the differentiation of substance abuse disorders, which also have a more global impact)

Major depressive episodes that occur in a seasonal pattern are often characterized by

prominent energy, hypersomnia, overeating, weight gain, and a craving for carbohydrates.

This specifier can be used when there is a strong presumption that the full criteria will ultimately be met for a disorder but not enough information is available to make a firm diagnosis:

provisional

Agoraphobia Criterion C. The agoraphobic situations almost always __________________________ D. The agoraphobic situations are actively AVOIDED, require the presence of a companion, or are ENDURED with intense fear or anxiety. E. The fear or anxiety is OUT of PROPORTION to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. The fear, anxiety, or avoidance is PERSISTENT, typically lasting >= 6 months. G. The fear, anxiety, or avoidance causes clinically SIGNIFICANT DISTRESS or impairment in social, occupational, or other important areas of functioning. H. If another medical condition (e.g., inflammatory bowel disease, Parkinson's disease) is present, the fear, anxiety, or avoidance is clearly excessive. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder): and are not related exclusively to obsessions (OCD), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (PTSD), or fear of separation (as in separation anxiety disorder).

provoke fear or anxiety

In ______ , the psychotic symptoms are judged to be a direct physiological consequence of another medical condition.

psychotic disorder due to another medical condition

Psychotic disorder due to another medical condition may be transient or it may be recurrent, cycling with exacerbations and remissions of the underlying condition. Although treatment of the underlying medical condition often results in a resolution of the psychosis, this is not always the case, and psychotic symptoms may persist long after the medical event e.g.,

psychotic disorder due to focal brain injury. In the context of chronic conditions such as multiple sclerosis or chronic interictal psychosis of epilepsy, the psychosis may assume a long-term course

Infanticide is most often associated with postpartum

psychotic episodes that are characterized by command hallucinations to kill the infant or delusions that the infant is possessed, but psychotic symptoms can also occur in severe postpartum mood episodes without such specific delusions or hallucinations.

Features associated with lower recovery rates in depression, other than current episode duration, include

psychotic features, prominent anxiety, personality disorders, and sx severity. The risk of recurrence becomes progessively lower over time as the duration of remission increases. The risk is higher in individuals whose preceding episode was severe, in younger individuals, and in individuals who have already experienced multiple episodes. The persistence of even mild depressive symptoms during remission is a powerful predictor of recurrence.

Trauma-and Stressor-Related Disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include:

reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorders.

Consequences of DEVELOPMENTAL COORDINATION disorder include:

reduced participation in play and sports; poor self-esteem; emotional or behavior problems; impaired academic achievement; poor physical fitness; reduced physical activity and obesity.

Consequences of ADHD:

reduced school performance, social rejection, , poorer occupational performance, attainment, attendance, higher probability of unemployment, elevated interpersonal conflict, ^ risk of conduct disorder and antisocial personality disorder, ^ substance use & incarceration, ^ injuries, ^ traffic accidents & violations, may be elevated obesity risk. Inadequate or variable self-application to tasks is interpreted by others as laziness, irresponsibility, or failure to cooperate; Peer relationships are often disrupted by peer rejection, neglect, or teasing, obtain less schooling, poorer vocational achievement, reduced intellectual scores.

Negative events in childhood (e.g., separation, death of parent) and other stressful events, such as being attacked or mugged, are associated with the onset of agoraphobia. Furthermore, individuals with agoraphobia describe the fannily climate and child-rearing behavior as being characterized by:

reduced warmth and increased overprotection.

The degree to which two clinicians could independently arrive at the same diagnosis for a given patient is:

reliability

Mood symptoms that meet full criteria for a mood episode can be superimposed on delusional disorder. Delusional disorder can be diagnosed only if the total duration of all mood episodes:

remains brief relative to the total duration of the delusional disturbance.

Stereotypy

repetitive, abnormally frequent, non-goal-directed movements

For some individuals with milder episodes of MDD, functioning may appear to be normal but

requires markedly increased effort.

In most individuals with ADHD, SX of motoric HYPERACTIVITY become LESS OBVIOUS in adolescence and ADULTHOOD, but difficulties persist with:

restlessness, INATTENTION, poor planning & impulsivity. A SUBSTANTIAL PROPORTION REMAIN RELATIVELY IMPAIRED into adulthood.

Bipolar I Disorder A. Criteria have been met for at least one manic episode B. The occurrence of the manic and major depressive episode(s) is not better explained by

schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

In schizoaffective d/o, expression of psychotic sx across lifespan is variable. Depressive or manic sx can occur before the onset of psychosis, during acute psychotic episodes, during residual periods, & after cessation of psychosis. E.g., an individual might present with prominent mood sx during the prodromal stage of schizophrenia. This is not necessarily indicative of schizoaffective disorder, since it is the co-occurrence of psychotic and mood sx that is diagnostic. For an individual with sx that clearly meet the criteria for schizoaffective disorder but who on further f/u only presents with residual psychotic symptoms (subthreshold psychosis &/or prominent neg sx), the diagnosis may be changed to

schizophrenia, as the total proportion of psychotic illness compared with mood sx becomes more prominent.

The risk for schizoaffective disorder may be increased among individuals who have a first-degree relative with

schizophrenia, bipolar dep, or schizoaffective disorder.

On average, global function in Delusional disorder is generally better than that observed in schizophrenia. Although the diagnosis is generally stable, a proportion of individuals go on to develop:

schizophrenia. Delusional disorder has a significant familial relationship with both schizophrenia and schizotypal personality disorder. Although it can occur in younger age groups, the condition may be more prevalent in older individuals

Relatives of individuals with __________ have an increased risk for schizophrenia.

schizophreniform disorder

degradation in the recollection of pleasure previously experienced

second portion of anhedonia definition

Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual's own thoughts. The hallucinations must occur in the context of a clear _______

sensorium; those that occur while falling asleep (hypnagogic - hypnagroggy) or waking up(hypnopompic - hypnapopoutabed) are considered to be within the range of normal experience. Hallucinations may be a normal part of religious experience in certain cultural contexts.

While symptoms of ODD typically DO occur in children with DMDD, *MOOD* symptoms of disruptive mood dysregulation disorder are relatively RARE in children with ODD. The key features that warrant the diagnosis of DMDD in children whose symptoms also meet criteria for ODD are the presence of

severe and frequently recurrent outbursts and a persistent disruption in mood between outbursts. In addition, the diagnosis of disruptive mood dysregulation disorder requires SEVERE impairment in at least one setting (i.e., home, school, or among peers) and mild to moderate impairment in a SECOND setting.

Some mental disorders may initially manifest with primarily somatic symptoms (e.g., major depressive disorder, panic disorder). Such diagnoses may account for the somatic symptoms, or they may occur alongside one of the somatic symptom and related disorders in this chapter. There is also considerable medical comorbidity among somatizing individuals. Although somatic symptoms are frequently associated with psychological distress and psychopathology, some somatic symptom and related disorders can arise spontaneously, and their causes can remain obscure. Anxiety disorders and depressive disorders may accompany somatic symptom and related disorders. The somatic component adds:

severity and complexity to depressive and anxiety disorders and results in higher severity, functional impairment, and even refractoriness to traditional treatments. In rare instances, the degree of preoccupation may be so severe as to warrant consideration of a delusional disorder diagnosis.

Predictive validators present with:

similar clinical course and treatment response

What are antecedent validators?

similar genetic markers, family traits, temperament, and environmental exposure

What are concurrent validators?

similar neural substrates, biomarkers, emotional and cognitive processing, and sx similarity

Waxy flexibility

slight, even resistance to positioning by examiner

With ASD, severity of _____ and ______ should be separately rated.

social COMMUNICATION difficulties and restricted, REPETITIVE BEHAVIORS

The syndrome of taijin kyofusho (e.g., in Japan and Korea) is often characterized by social-evaluative concerns, fulfilling criteria for:

social anxiety disorder, that are associated with the fear that the individual makes OTHER people uncomfortable (e.g., "My gaze upsets people so they look away and avoid me"), a fear that is at times experienced with delusional intensity. This symptom may also be found in non-Asian settings. Other presentations of taijin kyofusho may fulfill criteria for body dysmorphic disorder or delusional disorder.

Intellectual disability and ASD frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability:

social communication should be below that expected for general developmental level.

The case formulation for any given patient must involve a careful clinical history and concise summary of the base factors that may have contributed to developing a given mental disorder, such as:

social, psychological, and biological

________ delusions focus on preoccupations regarding health and organ function.

somatic

Somatic symptom disorder, emphasizes diagnosis made on the basis of positive s/s (distressing somatic symptoms PLUS abnormal thoughts, feelings, and behaviors in response to these symptoms) rather than:

somatic symptom disorder, emphasizes diagnosis made on the basis of positive s/s (distressing somatic symptoms PLUS abnormal thoughts, feelings, and behaviors in response to these symptoms) RATHER than the ABSENCE of a medical explanation for somatic symptoms.

75% of individuals previously diagnosed with hypochondriasis are subsumed under the diagnosis of somatic symptom disorder but about 25% of individuals with hypochondriasis have high health anxiety in the absence of:

somatic symptoms, and many such individuals' symptoms would not qualify for an anxiety disorder diagnosis. The DSM-5 diagnosis of illness anxiety disorder is for this latter group of individuals WITHOUT somatic sx.

Clinicians should be aware that in most countries the MAJORITY of cases of depression go unrecognized in primary care settings and that in many cultures, the presenting complaint is frequently

somatic symptoms. Among the Criterion A symptoms, insomnia and loss of energy are the most uniformly reported.

With individuals who focus on a __________ complaint, clinicians should determine whether the distress from that complaint is associated with specific depressive symptoms.

somatic; Fatigue and sleep disturbance are present in a high proportion of cases; psychomotor disturbances are much less common but are indicative of greater overall severity, as is the presence of delusional or near-delusional guilt.

Re Separation Anxiety Disorder, when extremely upset at the prospect of separation, children may show anger or occasionally aggression toward someone who is forcing separation. When alone, especially in the evening or the dark, young children may report unusual perceptual experiences (e.g., seeing people peering into their room, frightening creatures reaching for them, feeling eyes staring at them). Children with this disorder may be described as demanding, intrusive, and in need of constant attention, and, as adults, may appear dependent and overprotective. The individual's excessive demands often become a:

source of frustration for family members, leading to resentment and conflict in the family.

Language disorder is strongly associated with other neurodevelopmental disorders like

specific learning disorder (literacy and numeracy), ADHD, ASD, developmental coordination disorder and social (pragmatic) communication disorder

SUBTYPES define mutually EXCLUSIVE and jointly exhaustive phenomenological subgroupings within a diagnosis and are indicated by the instruction "Specify whether" in the criteria set whereas specifiers are:

specifiers are NOT intended to be mutually exclusive or jointly exhaustive, and as a consequence, MORE than one specifier may be given.

Posturing

spontaneous and active maintenance of a posture against gravity

In general, it is believed, that Bipolar and Related Disorder Due to Another Medical Condition, when induced by Cushing's disease, will not recur if the Cushing's disease is cured or arrested. However, it is also suggested that mood syndromes, including depressive and manic/hypomanic ones, may be episodic (i.e., recurring) in those with

static brain injuries and other central nervous system diseases.

Criterion A of STEREOTYPIC MOVEMENT disorder requires that the movements be "apparently" purposeless. However, some functions may be served by the movements, e.g.:

stereotypic movements might REDUCE ANXIETY in response to external stressors

Cultural meanings, habits, and traditions can also contribute to either _______ in the social and familial response to mental illness.

stigma or support

In contrast to schizophrenia, in schizoaffective d/o occupational functioning is:

still frequently impaired, but is NOT a defining criterion

Damage to this part of the brain, e.g., d/t cerebral infarction, is known to cause obsessive-compulsive and related sx as a manifestation:

striatal damage

Hallucinations that the individual REALIZES are substance/medication induced are not included in Substance/Medication-Induced Psychotic Disorder and instead would be diagnosed as

substance intoxication or substance withdrawal with the accompanying specifier "with perceptual disturbances" (applies to alcohol withdrawal; cannabis intoxication; sedative, hypnotic, or anxiolytic withdrawal; and stimulant intoxication).

In _______ disorder, the psychotic symptoms are judged to be a physiological consequence of a drug of abuse, a medication, or toxin exposure and cease after removal of the agent.

substance/medication induced psychotic disorder

Between 7% and 25% of individuals presenting with a first episode of psychosis are reported to have

substance/medication-induced psychotic disorder

Re PTSD, a life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event. Medical incidents that do qualify as traumatic events involve:

sudden, catastrophic events (e.g., waking during surgery, anaphylactic shock).

There are no studies that provide evidence to differentiate the risk of suicide from a MDE d/t another medical condition compared with the risk from a MDE in general. There are case reports of suicides in association with MDE associated with another medical condition. There is a clear association between serious medical illnesses and:

suicide, particularly shortly after onset or diagnosis of the illness. Thus, it would be prudent to assume that the risk of suicide for MDE associated with medical conditions is NOT less than that for other forms of MDE, and might even be greater.

Evaluating patients for evaluating individuals for MDD or bipolar II is especially challenging in those with

symptoms of irritability

Many individuals with body dysmorphic disorder have ideas or delusions of reference, believing that other people:

take special notice of them or mock them because of how they look. Body dysmorphic disorder is associated with high levels of anxiety, social anxiety, social avoidance, depressed mood, neuroticism, and perfectionism as well as low extroversion and low self-esteem. Many individuals are ashamed of their appearance and their excessive focus on how they look, and are reluctant to reveal their concerns to others. A majority of individuals receive cosmetic treatment to try to improve their perceived defects. Dermatological treatment and surgery are most common, but any type (e.g., dental, electrolysis) may be received. Occasionally, individuals may perform surgery on themselves. Body dysmorphic disorder appears to respond poorly to such treatments and sometimes becomes worse. Some individuals take legal action or are violent toward the clinician because they are dissatisfied with the cosmetic outcome.

Answers to questions that are obliquely related or completely unrelated:

tangentiality

Olfactory hallucinations are suggestive of

temporal lobe epilepsy

Bipolar and related disorder due to another medical condition usually has its onset acutely or subacutely within the first weeks or month of the onset of the associated medical condition. However, this is NOT always the case, as a worsening or later relapse of the associated medical condition may precede the onset of the manic or hypomanic syndrome. The clinician must make a clinical judgment in these situations about whether the medical condition is causative, based on

temporal sequence as well as plausibility of a causal relationship. Finally, the condition may remit before or just after the medical condition remits, particularly when treatment of the manic / hypomanic symptoms is effective.

Dissociative fugues, wherein the person discovers dissociated travel, are common in individuals with dissociative identity disorder, with patients reporting:

that they have suddenly found themselves at the beach, at work, in a nightclub, or somewhere at home (e.g., in the closet, on a bed or sofa, in the corner) with no memory of how they came to be there. Amnesia in individuals with dissociative identity disorder is not limited to stressful or traumatic events; these individuals often cannot recall everyday events as well.

The most frequently MISARTICULATED sounds also tend to be learned LATER, leading them to be called:

the ''late eight" (L, r, s, z, th, ch, dzh, and zh). Misarticulation of any of these sounds by itself could be considered WNL up to 8 YO

Individuals with bipolar II disorder typically present to a clinician during a major depressive episode and are unlikely to complain initially of hypomania. Typically, the hypomanic episodes themselves do not cause impairment. Instead, the impairment results from

the MDE or from a persistent pattern of unpredictable mood changes and fluctuating, unreliable interpersonal or occupational functioning. Individuals with bipolar II disorder may not view the hypomanic episodes as pathological or disadvantageous, although others may be troubled by the individual's erratic behavior. Clinical information from other informants, such as close friends or relatives, is often useful in establishing the diagnosis of bipolar II disorder.

The experience and significance of body weight and shape are distorted in those with Anorexia Nervosa (Criterion C). Some individuals feel globally overweight. Others realize that they are thin but are still concerned that certain body parts are "too fat", particularly:

the abdomen, buttocks, and thighs, are "too fat." They may employ a variety of techniques to evaluate their body size or weight, including frequent weighing, obsessive measuring of body parts, and persistent use of a mirror to check for perceived areas of "fat." The self-esteem of individuals with anorexia nervosa is highly dependent on their perceptions of body shape and weight. Weight loss is often viewed as an impressive achievement and a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control. Some may acknowledge being thin but they often do not recognize the serious medical implications.

Theory of mind (often abbreviated ToM)

the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires, intentions, and perspectives that are different from one's own. Deficits can occur in people with ASD, schizophrenia, ADHD, cocaine addiction and brain damage suffered from alcohol's neurotoxicity.

Re Premenstrual dysphoric disorder, a wide range of medical (e.g., migraine, asthma, allergies, seizure disorders) or other mental disorders (e.g., depressive and bipolar disorders, anxiety disorders, bulimia nervosa, substance use disorders) may WORSEN in the premenstrual phase, however:

the absence of a symptom-free period during the POSTMENSTRUAL interval obviates a diagnosis of premenstrual dysphoric disorder.

Gender differences in the pattern of OCD sx dimensions have been. E.g., females are more likely to have symptoms in ______________and males more likely to have symptoms in _________________.

the cleaning dimension for women and the forbidden thoughts and symmetry dimensions for men

In body dysmorphic disorder, the obsessions and compulsions are limited to concerns about physical appearance, whereas in trichotillomania:

the compulsive behavior is limited to hair pulling in the ABSENCE of obsessions.

In bipolar I, INCOMPLETE interepisode recovery is more common when

the current episode is accompanied by mood INCONGRUENT psychotic features

The diagnostic features of substance / medication-induced depressive disorder include the sx of a depressive disorder, such as MDD; however, the depressive sx are associated with the ingestion, injection, or inhalation of a substance and:

the depressive sx persist BEYOND THE EXPECTED LENGTH of physiological effects, intoxication, or withdrawal period. However, later on P.216 it says A depressive disorder associated with the use of substance must have its onset while the individual is using the substance or during withdrawal, if there is a withdrawal syndrome associated with the substance. Most often, the depressive disorder has its onset within the first few weeks or 1 month of use of the substance. Once the substance is discontinued, the depressive symptoms usually remit within days to several weeks, depending on the half-life of the substance/medication and the presence of a withdrawal syndrome. If symptoms persist 4 weeks beyond the expected time course of withdrawal of a particular substance/medication, other causes for the depressive mood symptoms should be considered.

Mixed features associated with a major depressive episode have been found to be a significant risk factor for

the development of bipolar I or bipolar II disorder, so it is clinically useful to note the presence of this specifier for treatment planning and monitoring of response to treatment.

Patient has the pleasure of experiencing mania and depression simultaneously, what's the Dx?

the diagnosis should be manic episode, with mixed features, due to the marked impairment and clinical severity of full mania.

Hallucinations and delusions commonly occur in the context of a delirium; a separate diagnosis of psychotic disorder due to another medical condition is not given if

the disturbance occurs exclusively during the course of a delirium

A patient has traits of hypomania, as well as psychotic features. What's the dx?

the episode is, by definition, manic.

Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms MAY be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires

the exercise of clinical judgment based on the individual's history and the cultural norms for the expression of distress in the context of loss.

Animal hoarding may be a special manifestation of hoarding disorder. Most individuals who hoard animals also hoard inanimate objects. The most prominent differences between animal and object hoarding are:

the extent of unsanitary conditions and the poorer insight in animal hoarding.

Specific phobia, situational type, should be diagnosed versus agoraphobia if:

the fear, anxiety, or avoidance is limited to one of the agoraphobic situations. Requiring fears from two or more of the agoraphobic situations is a robust means for differentiating agoraphobia from specific phobias, particularly the situational subtype. Additional differentiating features include the cognitive ideation. Thus, if the situation is feared for reasons other than panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fears of being directly harmed by the situation itself, such as fear of the plane crashing for individuals who fear flying), then a diagnosis of specific phobia may be more appropriate

Especially among immigrants, it is important to differentiate separation anxiety disorder from:

the high value some cultures place on strong interdependence among family members.

Often the predominant mood in bipolar I is irritable rather than elevated, particularly when the individual's wishes are denied or if

the individual has been using substances. Rapid shifts in mood over brief periods of time may occur and are referred to as lability (the alternation among euphoria, dysphoria, and irritability).

Any and all patient assessments must always take into account:

the individual's cultural and language context

Disorganized thinking (formal thought disorder) is typically inferred from:

the individual's speech.

In elderly individuals, memory difficulties may be the chief complaint and may be mistaken for early signs of a dementia (''pseudodementia"). When the major depressive episode is successfully treated, the memory problems often fully abate. However, in some individuals, particularly elderly persons, a major depressive episode may sometimes be

the initial presentation of an irreversible dementia.

The interval between mood episodes in the course of bipolar II disorder tends to __________ as the individual ages.

the interval decreases as the individual ages; While the hypomanic episode is the feature that defines bipolar II disorder, depressive episodes are more enduring and disabling over time. Despite the predominance of depression, once a hypomanic episode has occurred, the diagnosis becomes bipolar II disorder and never reverts to major depressive disorder.

Psychotic features of schizophrenia typically emerge between

the late teens and mid-30s; onset prior to adolescence is rare. The peak age at onset for the first psychotic episode is in the early- to mid-20s for males and in the late-20s for females.

The central feature differentiating disruptive mood dysregulation disorder and bipolar disorders in children involves

the longitudinal course of the core symptoms. In children, as in adults, bipolar I disorder and bipolar II disorder manifest as an episodic illness with discrete episodes of mood perturbation that can be differentiated from the child's typical presentation. The mood perturbation that occurs during a manic episode is distinctly different from the child's usual mood. In addition, during a manic episode, the change in mood must be accompanied by the onset, or worsening, of associated cognitive, behavioral, and physical symptoms (e.g., distractibility, increased goal-directed activity), which are also present to a degree that is distinctly different from the child's usual baseline. Thus, in the case of a manic episode, parents (and, depending on developmental level, children) should be able to identify a distinct time period during which the child's mood and behavior were markedly different from usual. In contrast, the irritability of DMDD is persistent and is present over many months; while it may wax and wane to a certain degree, severe irritability is characteristic of the child with disruptive mood dysregulation disorder. The diagnosis of disruptive mood dysregulation disorder cannot be assigned to a child who has ever experienced a full-duration hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or hypomanic episode lasting more than 1 day. Another central differentiating feature between bipolar disorders and DMDD is the presence of elevated or expansive mood and grandiosity. These symptoms are common features of mania but are not characteristic of DMDD.

Following stroke, the onset of depression appears to be very acute, occurring within 1 day or a few days of the CVA. However, in some cases, onset of the depression is weeks to months following the CVA. In the largest series, the duration of the major depressive episode following stroke was 9-11 months on average. Similarly, in Huntington's disease the depressive state comes quite early in the course of the illness. With Parkinson's disease and Huntington's disease, it often precedes:

the major motor impairments and cognitive impairments associated with each condition. This is more prominently the case for Huntington's disease, in which depression is considered to be the first neuropsychiatric symptom. There is some observational evidence that depression is less common as the dementia of Huntington's disease progresses.

Brief psychotic disorder may appear in adolescence or early adulthood, and onset can occur across the lifespan, with the average age at onset being _________.

the mid 30s; diagnosis of brief psychotic disorder requires a full remission of all symptoms and an eventual full return to the premorbid level of functioning within 1 month of onset. In some individuals, the duration of psychotic symptoms may be quite brief (e.g., a few days)

Although bipolar II disorder can begin in late adolescence and throughout adulthood, average age at onset is

the mid-20s, which is slightly later than for bipolar I disorder but earlier than for major depressive disorder.

Onset of hair pulling in trichotillomania most commonly coincides with, or follows:

the onset of, puberty (same for excoriation disorder). Sites of hair pulling may vary over time. The usual course of trichotillomania is chronic, with some waxing and waning if the disorder is untreated. Symptoms may possibly worsen in females accompanying hormonal changes (e.g., menstruation, perimenopause). For some individuals, the disorder may come and go for weeks, months, or years at a time. A minority of individuals remit without subsequent relapse within a few years of onset.

Among individuals with both persistent depressive disorder and borderline personality disorder, the covariance of the corresponding features over time suggests:

the operation of a common mechanism. Also, early onset (i.e., before age 21 years) is associated with a higher likelihood of comorbid personality disorders and substance use disorders.

Individuals with the dissociative identity disorder typically report multiple types of interpersonal maltreatment during childhood and adulthood. Nonmaltreatment forms of overwhelming early life events, such as multiple long, painful, early-life medical procedures, also may be reported. Self-mutilation and suicidal behavior are frequent. On standardized measures, these individuals report higher levels of hypnotizability and dissociativity compared with other clinical groups and healthy control subjects. Some individuals experience transient psychotic phenomena or episodes. Several brain regions have been implicated in the pathophysiology of dissociative identity disorder, including:

the orbitofrontal cortex, hippocampus, parahippocampal gyrus, and amygdala

It is important to differentiate a depressive episode from an adjustment disorder, as the onset of the medical condition is in itself a life stressor that could bring on either an adjustment disorder or an MDE. The major differentiating elements are:

the pervasiveness of the depressive picture and the number and quality of the depressive sx that the patient reports or demonstrates on the MSE.

In Dissociative Identity Disorder, chaotic identity change and acute intrusions that disrupt thought processes may be distinguished from brief psychotic disorder by:

the predominance of dissociative symptoms and amnesia for the episode, and diagnostic evaluation after cessation of the crisis can help confirm the diagnosis.

The essential feature of "Psychological factors affecting other medical conditions" is:

the presence of one or more clinically significant psychological or behavioral factors that adversely affect a medical condition by increasing the risk for suffering, death, or disability.

The differential diagnosis between brief psychotic disorder and schizophreniform disorder is difficult when

the psychotic symptoms have remitted before 1 month in response to SUCCESSFUL TREATMENT WITH MEDICATION.

Encopresis

the repeated passage of feces into inappropriate places

Enuresis

the repeated voiding of urine into inappropriate places

The ddx of sleep-wake complaints necessitates a multidimensional approach, with consideration of possibly coexisting medical and neurological conditions. Coexisting clinical conditions are:

the rule, not the exception.

The pain of grief may be accompanied by positive emotions & humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of a MDE. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than

the self-critical or pessimistic ruminations seen in a MDE. In grief, self-esteem is generally preserved, whereas in a MDE, feelings of worthlessness and selfloathing are common. If self-derogatory ideation is present in grief, it typically involves perceived failings vis-à-vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about "joining" the deceased, whereas in a major depressive episode such thoughts are focused on ending one's own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.

The systematic COMORBIDITIES seen in both clinical and community samples are likely explained by:

the sharing of genetic and environmental risk factors, as shown by twin studies

Persistent sleep disturbances (both insomnia and excessive sleepiness) are established risk factors for:

the subsequent development of mental illnesses and substance use disorders. They may also represent a prodromal expression of an episode of mental illness, allowing the possibility of early intervention to preempt or to attenuate a full-blown episode.

In clinical settings, GAD is diagnosed somewhat more frequently in females than in males (about 55%-60% of those presenting with the disorder are female). In epidemiological studies, approximately two-thirds are female. Females and males who experience GAD appear to have similar sx but demonstrate different patterns of comorbidity consistent with gender differences in the prevalence of disorders. In females, comorbidity is largely confined to the anxiety disorders and unipolar depression, whereas in males, comorbidity is more likely to extend to:

the substance use disorders as well.

The dx of Substance/Medication-Induced Psychotic Disorder should be made instead of a dx of substance intoxication or substance withdrawal only when

the sx in Criterion A (Delusions, Hallucinations) predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention

Many NORMALLY developing YOUNG children have strong preferences and ENJOY REPETITION (e.g., eating the same foods, watching the same video), so distinguishing restricted and repetitive behaviors that are diagnostic of ASD can be difficult in preschoolers. The clinical distinction is based on:

the type, frequency, and INTENSITY of the behavior (e.g., a child who daily lines up objects for hours and is VERY DISTRESSED if any item is moved)

A distinctive characteristic of many individuals with somatic symptom disorder is not the somatic symptoms per se, but instead:

the way they present and interpret them. Incorporating affective, cognitive, and behavioral components into the criteria for somatic symptom disorder provides a more comprehensive and accurate reflection of the true clinical picture than can be achieved by assessing the somatic complaints alone.

Until incontrovertible etiological or pathophysiological mechanisms are identified to fully validate specific disorders or disorder spectra, the most important STANDARD for the DSM-5 disorder criteria will be:

their clinical utility for the assessment of clinical course and treatment response of individuals grouped by a given set of diagnostic criteria.

Bipolar and related disorders are separated from the depressive disorders in DSM-5 and placed between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in recognition of

their place as a bridge between the two diagnostic classes in terms of symptomatology, family history, and genetics.

Re Anxiety disorder due to another medical condition, it must be judged that the sx are not better accounted for by another mental disorder, in particular, adjustment disorder, with anxiety, in which the stressor is the medical condition (Criterion C). In this case, an individual with adjustment disorder is especially distressed about the meaning or the consequences of the associated medical condition. By contrast, when the anxiety is due to another medical condition:

there is often a prominent physical component to the anxiety (e.g., shortness of breath)

There are minimum age requirements for diagnosing enuresis and encopresis, however:

they are based on DEVELOPMENTAL age and not solely on chronological age

Delusions are deemed bizarre if:

they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences. E.g., the belief that an outside force has removed his internal organs and replaced them with someone else's organs without leaving any wounds or scars.

By definition, psychotic symptoms do not occur in hypomanic episodes. Can they occur during MDE in Bipolar II?

they do occur but appear to be less frequent in the MDE in bipolar II disorder than in those of bipolar I

"Alien thoughts" being put into one's mind is an example of:

thought insertion (delusion)

The belief that one's thoughts have been "removed" by some outside force are termed:

thought withdrawal (delusion)

The characteristic symptoms of OCD are the presence of obsessions and compulsions (Criterion A). Obsessions are repetitive and persistent ___________, ____________, or _____________

thoughts (e.g., of contamination), images (e.g., of violent or horrific scenes), or urges (e.g., to stab someone).

Separation Anxiety Disorder Diagnostic Criteria A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least __________ of the following: 1. Recurrent excessive DISTRESS when anticipating or experiencing separation from home or from major attachment figures. 2. Persistent and excessive worry about LOSING major attachment figures or about possible harm to them, such as illness, injury, disasters, or death. 3. Persistent and excessive worry about EXXPERIENCING an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. 4. Persistent RELUCTANCE or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation. 5. Persistent and excessive fear of or reluctance about being ALONE or without major attachment figures at home or in other settings. 6. Persistent reluctance or refusal to SLEEP away from home or to go to sleep without being near a major attachment figure. 7. Repeated NIGHTMARES involving the theme of separation. 8. Repeated complaints of PHYSICAL symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

three

The Specifier, "Manic or hypomanic episode, with mixed features" requires how many Sx in Criterion A? A. Full criteria are met for a manic episode or hypomanic episode, and at least ______ of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania: 1. Prominent dysphoria or depressed mood as indicated by either subjective report or observation made by others 2. Diminished interest or pleasure in all, or almost all, activities 3. Psychomotor retardation nearly every day (observable by others; NOT merely subjective feelings of being slowed down). 4. Fatigue or loss of energy. 5. Feelings of worthlessness or excessive or inappropriate guilt 6. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. Mixed symptoms are observable by others and represent a change from the person's usual behavior. C. For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features, due to the marked impairment and clinical severity of full mania. D. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment)

three

Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with ________________ of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months); Note: Only one item is required in children. 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

three (or more)

CO-OCCURRING mental, neurodevelopmental, medical, and physical CONDITIONS are frequent in INTELLECTUAL disability, with rates of some conditions (e.g., mental disorders, cerebral palsy, and epilepsy) ____________ times higher than in the general population.

three to four times

Simple vocal tics include:

throat clearing, sniffing, and grunting; often caused by contraction of the diaphragm or muscles of the oropharynx.

Bipolar II disorder, requiring the lifetime experience of at least one episode of major depression and at least one hypomanic episode, is no longer thought

to be a "milder" condition than bipolar I disorder, largely because of the amount of time individuals with this condition spend in depression and because the instability of mood experienced by individuals with bipolar II disorder is typically accompanied by serious impairment in work and social functioning

Psychological distress following exposure to a traumatic or stressful event is quite variable. In some cases, symptoms can be well understood within an anxiety- or fear-based context. Many individuals, however, exhibit a phenotype in which, rather than anxiety- or fear-based symptoms, the most prominent clinical characteristics are anhedonic and dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms. Because of these variable expressions of clinical distress following exposure to catastrophic or aversive events, the aforementioned disorders have been grouped under a separate category:

trauma- and stressor-related disorders.

What is trùng giô?

trùnggiô (wind-related) attacks, a Vietnamese cultural syndrome associated with headaches (cultural expectations may influence the classification of panic attacks as expected or unexpected, as cultural syndromes may create fear of certain situations, e.g. atmospheric wind, associated with trùng giô attacks

When alternate personality states are not directly observed in dissociative identity disorder, the disorder can be identified by:

two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and sense οf agency (Criterion A), and 2) recurrent dissociative amnesias (Criterion B).

Criterion F of Disruptive Mood Dysregulation Disorder states that Criteria A (Severe recurrent temper outbursts manifested toward people or property that are grossly out of proportion to the situation or provocation) and Criterion D (mood between outbursts is persistently irritable or angry most of/nearly every day, observable by others) are present in at least ____of ____ settings and are severe in _____ of these.

two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.

First-degree relatives have a _________ times greater chance of having social anxiety disorder, and liability to the disorder involves the interplay of disorder-specific (e.g., fear of negative evaluation) and nonspecific (e.g., neuroticism) genetic factors.

two to six

First-degree family members of individuals with major depressive disorder have a risk for major depressive disorder ___________ higher than that of the general population. Relative risks appear to be higher for early-onset and recurrent forms. Heritability is approximately 40%, and the personality trait neuroticism accounts for a substantial portion of this genetic liability.

two- to fourfold

Individuals with dissociative amnesia are frequently:

unaware (or only partially aware) of their memory problems. Many, especially those with localized amnesia, minimize the importance of their memory loss and may become uncomfortable when prompted to address it.

The prevalence of reactive attachment disorder is unknown, but the disorder is seen relatively rarely. The disorder has been found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in populations of severely neglected children, the disorder is:

uncommon, occurring in less than 10% of such children.

Medical conditions most commonly associated with psychosis include

untreated endocrine and metabolic disorders, autoimmune disorders (SLE, N-methyl-D-aspartate (NMDA) receptor autoimmune encephalitis), or temporal lobe epilepsy.

The noctumal-only subtype of enuresis, sometimes referred to as monosymptomatic enuresis, is the most common subtype and involves incontinence only during nighttime sleep, typically during the first one-third of the night. The diurnal-only subtype occurs in the absence of nocturnal enuresis and may be referred to simply as:

urinary incontinence. Individuals with this subtype can be divided into two groups. Individuals with ''urge incontinence" have sudden urge symptoms and detrusor instability, whereas individuals with "voiding postponement" consciously defer micturition urges until incontinence results. The noctumal-and-diurnal subtype is also known as nonmonosymptomatic enuresis.

Physical and sexual abuse in childhood and other stressful or traumatic events have been associated with an increased risk for developing OCD. Some children may develop the sudden onset of obsessive-compulsive symptoms, which has been associated with different environmental factors, including:

various infectious agents and a post-infectious autoimmune syndrome.

Individuals with OCD vary in the degree of insight they have about the accuracy of the beliefs that underlie their obsessive-compulsive symptoms. Many individuals have good or fair insight, some have poor insight, and a few (4% or less) have absent insight/delusional beliefs. Insight can:

vary within an individual over the course of the illness. Poorer insight has been linked to worse long-term outcome.

The symptoms of generalized anxiety disorder tend to be chronic and wax and wane across the lifespan, fluctuating between syndromal and subsyndromal forms of the disorder. Rates of full remission are:

very low

Re DMDD, approximately half of children with severe, chronic irritability will have a presentation that continues to meet criteria for the condition 1 year later. Rates of conversion from severe, nonepisodic irritability to bipolar disorder are

very low. Instead, children with chronic irritability are at risk to develop unipolar depressive and/or anxiety disorders in adulthood

What is a nocturnal panic attack and what is it an example of?

waking from sleep in a state of panic, which differs from panicking after fully waking from sleep; it's an example of unexpected panic attack

Excessive and peculiar motor behaviors in catatonic behavior can be complex (stereotypy, i.e. the persistent repetition of an act for no obvious purpose ) or simple (agitation) and may include echolalia and echopraxia. In extreme cases, the same individual may

wax and wane between decreased and excessive motor activity. During severe stages of catatonia, the individual may need careful supervision to avoid self-harm or harming others. There are potential risks from malnutrition, exhaustion, hyperpyrexia and self-inflicted injury.

The criterion symptoms for major depressive disorder must be present nearly every day to be considered present, with the exception of

weight change and suicidal ideation

Define grandiose delusions:

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

PTSD can occur at any age, beginning after the first year of life. Symptoms usually begin:

within the first 3 months after the trauma, although there may be a delay of months, or even years, before criteria for the diagnosis are met. There is abundant evidence for what DSM-IV called "delayed onset" but is now called "DELAYED EXPRESSION," with the recognition that some symptoms typically appear immediately and that the delay is in meeting full criteria.

Re Premenstrual Dysphoric Disorder, Anecdotally, many individuals, as they approach menopause, report that symptoms:

worsen. Symptoms cease after menopause, although cyclical hormone replacement can trigger the re-expression of symptoms.

Can a person with Delusional Disorder have hallucinations?

yes, HALLUCINATIONS, if present, are NOT prominent and are RELATED to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

Schizoaffective disorder, bipolar type, may be more common in

young adults, whereas schizoaffective disorder, depressive type, may be more common in older adults.

The prevalence of winter-type seasonal pattern appears to vary with latitude, age, and sex. Prevalence increases with higher latitudes. Age is also a strong predictor of seasonality, with ________ persons at higher risk for winter depressive episodes.

younger

Hostility and aggression can be associated with schizophrenia, although spontaneous or random assault is uncommon. Aggression is more frequent for:

younger males and for individuals with a past hx of violence, non-adherence with treatment, substance abuse, and impulsivity. It should be noted that the vast majority of persons with schizophrenia are not aggressive and are more frequently victimized

How many major depressive episodes are required in bipolar I disorder dx?

zero, major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder

Re Conversion Disorder, internal inconsistency at examination is one way to demonstrate incompatibility (i.e., demonstrating that physical signs elicited through one examination method are no longer positive when tested a different way). Examples of such examination findings include:

• Hoover's sign, in which weakness of hip extension returns to normal strength with contralateral hip flexion against resistance. • Marked weakness of ankle plantar-flexion when tested on the bed in an individual who is able to walk on tiptoes; • Positive findings on the tremor entrainment test. On this test, a unilateral tremor may be identified as functional if the tremor changes when the individual is distracted away from it. This may be observed if the individual is asked to copy the examiner in making a rhythmical movement with their unaffected hand and this causes the functional tremor to change such that it copies or "entrains" to the rhythm of the unaffected hand or the functional tremor is suppressed, or no longer makes a simple rhythmical movement. • In attacks resembling epilepsy or syncope ("psychogenic" non-epileptic attacks), the occurrence of closed eyes with resistance to opening or a normal simultaneous electroencephalogram (although this alone does not exclude all forms of epilepsy or syncope). • For visual symptoms, a tubular visual field (i.e., tunnel vision)

The Specifier, "With Mixed Features" has what subheadings?

Manic or hypomanic episode, with mixed features, and Depressive episode, with mixed features

Patient is put on antidepressant and soon after begins a "manic episode". What's the dx?

Manic sx or syndromes that are attributable to the physiological effects of a drug of abuse (cocaine, amphetamine intoxication), the SE of meds (e.g., steroids, L-dopa, antidepressants, stimulants), or another medical condition do NOT count toward the diagnosis of bipolar I disorder. HOWEVER, a fully syndromal manic episode that arises and persists beyond the physiological effect of the inducing agent (i.e., after a medication is fully out of the individual's system or the effects of ECT would be expected to have dissipated completely) is sufficient evidence for a manic episode diagnosis (Criterion D).

Why is it important to catch a dx like Dissociative Identity Disorder in someone presenting with a seemingly different, comorbid disorder?

Many individuals with dissociative identity disorder present with a comorbid disorder. If not assessed and treated specifically for the dissociative disorder, these individuals often receive prolonged treatment for the comorbid diagnosis only, with limited overall treatment response and resultant demoralization, and disability.

Re Premenstrual Dysphoric Disorder, what is the significance of criterion F? F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)

Many women with bipolar or MDD or persistent depressive disorder believe they have premenstrual dysphoric disorder. However, when they chart sx they realize that the symptoms do not follow a premenstrual pattern. Women with another mental disorder may experience chronic sx or intermittent sx that are unrelated to menstrual cycle phase. However, because the onset of menses constitutes a memorable event, they may report that sx occur only during the premenstruum or that sx worsen premenstrually. The process of DDx, particularly if the clinician relies on retrospective sx only, is made more difficult because of the overlap between symptoms of premenstrual dysphoric disorder and some other diagnoses.

What are the severity cutoffs for Bulimia Nervosa?

Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

The minimum level of severity of Anorexia Nervosa is based, for adults, on current BMI or, for children and adolescents, on BMI percentile. How many ranges are listed for disease severity? What are the BMI cutoffs?

Mild: BMI > 17 kg/m^2 Moderate: BMI 16-16.99 kg/m^2 Severe: BMI 15-15.99 kg/m^2 Extreme: BMI < 15 kg/m^2

Delusional Disorder subtype when no one delusional theme predominates.

Mixed type

How does Criterion C for Schizoaffective disorder assessment differ in DSM-5 vs IV? (re Mood Sx assessment)

Mood Sx must be monitored for the entire course of a psychotic illness in 5, vs IV, which required only an assessment of the current period of illness. If the mood Sx are present for ONLY a relatively brief period, the diagnosis is schizophrenia, not schizoaffective disorder.

Is it possible to have depressive sx during a manic episode?

Mood may shift very rapidly to anger or depression. Depressive sx may occur during a manic episode and, if present, may last moments, hours, or, more rarely, days (see "with mixed features" specifier)

Do children with OCD have obsessions and compulsions, or only compulsions?

Most children have both obsessions and compulsions (as do most adults). Compulsions are more easily diagnosed in children than obsessions because compulsions are observable.

Individuals with somatic symptom disorder typically have multiple, current, somatic symptoms that are distressing or result in significant disruption of daily life (Criterion A), although sometimes only one severe symptom, most commonly ________ , is present.

Most commonly pain is present. Sx may be specific (e.g., localized pain) or relatively nonspecific (e.g., fatigue). The symptoms sometimes represent normal bodily sensations or discomfort that does not generally signify serious disease.

Most individuals with anorexia nervosa experience ___________ within 5 years of presentation.

Most individuals with anorexia nervosa experience REMISSION within 5 years of presentation. Among individuals admitted to hospitals, overall remission rates may be lower.

Patient presents with feelings of incompleteness, of losing his identity and it causes him to attempt to document and preserve all life experiences so he is accumulating too many objects and it's causing him distress. What's the likely dx?

Most likely OCD. Feelings of incompleteness (e.g., losing one's identity, or having to document and preserve all life experiences) are the most frequent OCD sx associated with this form of hoarding. The accumulation of objects can also be the result of persistently avoiding onerous rituals (e.g., not discarding objects in order to avoid endless washing or checking rituals). In OCD, the behavior is generally unwanted and highly distressing, and the individual experiences no pleasure or reward from it. Excessive acquisition is usually not present; if excessive acquisition is present, items are acquired because of a specific obsession (e.g., the need to buy items that have been accidentally touched in order to avoid contaminating other people), not because of a genuine desire to possess the items. Individuals who hoard in the context of OCD are also more likely to accumulate bizarre items, such as trash, feces, urine, nails, hair, used diapers, or rotten food. Accumulation of such items is very unusual in hoarding disorder. When severe hoarding appears concurrently with other typical symptoms of OCD but is judged to be independent from these symptoms, both hoarding disorder and OCD may be diagnosed.

DEVELOPMENTAL COORDINATION Disorder DDx

Motor impairments due to another medical condition, Intellectual disability, ADHD, ASD, Joint Hypermobility Syndrome

This is a form of body dysmorphic disorder that is characterized by the belief that one's body build is too small or is insufficiently muscular.

Muscle dysmorphia

These behaviors are often the first sign of "impending" schizophrenic disorder:

NEGATIVE SYMPTOMS are common in the prodromal and residual phases and can be severe. Individuals who had been socially active may become withdrawn from previous routines.

What is a choice for a Sx category A part of Schizophreniform that is not one for Brief Psychotic Disorder?

NEGATIVE symptoms (i.e., diminished emotional expression or avolition)

Some children with DEVELOPMENTAL COORDINATION disorder show ADDITIONAL (usually SUPPRESSED) MOTOR activity, such as CHOREIFORM movements of unsupported limbs or mirror movements. These "OVERFLOW" movements are referred to as:

NEURODEVELOPMENTAL IMMATURITIES or neurological SOFT SIGNS rather than neurological abnormalities. Their role in diagnosis is still unclear, requiring further evaluation.

DSM-5 is organized on developmental and lifespan considerations, beginning with diagnoses thought to reflect developmental processes that manifest EARLY in life like:

NEUROdevelopmental and SCHIZOphrenia spectrum and other psychotic disorders

Many individuals with MILD to MODERATE TIC disorder severity experience:

NO DISTRESS or IMPAIRMENT in functioning and may even be UNAWARE. Individuals with more severe symptoms generally have more impairment in daily living, but EVEN individuals with MODERATE to SEVERE TIC disorders may function well. The presence of ADHD or OCD, can have greater impact on functioning.

The evaluation of the sx of a MDE is especially difficult when they occur in an individual who also has a general medical condition (cancer, stroke, MI, DM, pregnancy). Some of the criterion S/S of a MDE are identical to those of general medical conditions (weight loss w/ DM; fatigue w/cancer; hypersomnia early in pregnancy, insomnia later in pregnancy or postpartum). Such sx count toward a MDE except when they are clearly & fully attributable to a general medical condition. To assess patients in these situations, what should one do?

NONVEGETATIVE sx of DYSPHORIA, ANHEDONIA, GUILT, WORTHLESSNESS, impaired concentration or indecision, and suicidal thoughts should be assessed with such cases. Definitions of MDE that have been modified to include only these nonvegetative sx appear to identify nearly the same individuals as do the full criteria.

Differential diagnosis for Language Disorder includes:

NORMAL variations in language, SENSORY IMPAIRMENT, INTELLECTUAL disorder, neurological disorders (EPILEPSY, acquired APHASIA, Landau-Kleffner syndrome), LANGUAGE REGRESSION in a child < 3 YO may be a sign of ASD or LANDAU-KLEFFNER syndrome. > 3 yo language loss may be a symptom of SEIZURES

DDx for Speech Sound Disorder

NORMAL variations in speech, SENSORY impairment, STRUCTURAL deficits like cleft palate, DYSARTHRIA d/t motor disorder like CP, Selective MUTISM (an anxiety disorder with a lack of speech in one or more settings)

The most consistently described risk factor is a past hx of suicide attempts or threats, BUT it should be remembered that most COMPLETED suicides are

NOT preceded by unsuccessful attempts. Other features associated with an increased risk for completed suicide include male sex, being single or living alone, and having prominent feelings of hopelessness. The presence of borderline personality disorder markedly increases risk for future suicide attempts

In Somatic Symptom Disorder, somatic symptoms without an evident medical explanation are:

NOT sufficient to make this diagnosis. The individual's suffering is AUTHENTIC, whether or not it is medically explained.

Individuals with depersonalization / derealization disorder may have difficulty describing their symptoms and may think they are "crazy" or "going crazy". Another common experience is the fear of irreversible brain damage. A commonly associated symptom is a subjectively altered sense of time (i.e., too fast or too slow), as well as a subjective difficulty in vividly recalling past memories and owning them as personal and emotional. Vague somatic symptoms, such as head fullness, tingling, or lightheadedness, are not uncommon. Individuals may suffer extreme rumination or obsessional preoccupation (e.g., constantly obsessing about whether they really exist, or checking their perceptions to determine whether they appear real). Varying degrees of anxiety and depression are also common associated features. Individuals with depersonalization / derealization disorder have been found to have physiological HYPOREACTIVITY to EMOTIONAL STIMULI. Neural substrates of interest include:

Neural substrates of interest for depersonalization / derealization disorder include: the hypothalamic-pituitary-adrenocortical axis, inferior parietal lobule, and prefrontal cortical-limbic circuits.

Delusion about a conviction that a major catastrophe will occur:

Nihilistic delusions

What is the BMI cutoff for Anorexia Nervosa?

No magic number, it's part of the clinical decision. For adults, a BMI of 18.5 has been CDC and WHO as the LOWER limit of NORMAL weight. BMI < 17 is considered by WHO to indicate moderate or severe thinness; therefore, an individual with a BMI LESS THAN 17 would likely be considered to have a significantly low weight. An adult with a BMI 17 to 18.5, or even above 18.5, might be considered to have a significantly low weight if clinical hx or other physiological information supports this judgment. CDC uses BMI-for-age < 5th percentile for underweight; but BMI above this benchmark may be judged to be significantly underweight in light of failure to maintain expected growth trajectory.

Patient self-induces vomiting or inappropriate compensatory behaviors one to two times per month. Could that qualify for BN?

No, must be >= once a week for 3 months (Bulimia)

Re Major Depressive Episode Criterion A #5, a patient describes extreme restlessness and/or feeling slowed down. Does that qualify?

No. #5 is Psychomotor agitation or retardation nearly every day (observable by others; NOT MERELY SUBJECTIVE feelings of restlessness or being slowed down).

Would an individual who is afraid to speak in public receive a diagnosis of social anxiety disorder? (this activity is not routinely encountered on the job and the individual is not significantly distressed about it.)

No. Criterion G for Social Anxiety Disorder states the fear, anxiety, and avoidance must interfere significantly with the individual's normal routine, occupational or academic functioning, or social activities or relationships, or must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. However, if the individual avoids, or is passed over for, the job or education he or she really wants because of social anxiety symptoms, Criterion G is met.

Nocturnal enuresis is more common in ________ while diurnal incontinence is more common in _________

Nocturnal enuresis is more common in males. Diurnal incontinence is more common in females.

Which of the following emotional reactions to a traumatic event is no longer a part of Criterion A for PTSD, fear, helplessness, or horror?

None. Emotional reactions to the traumatic event (e.g., fear, helplessness, horror) are no longer a part of Criterion A.

DDx for Stereotypic Movement Disorder

Normal development, ASD, TIC disorders (later onset, specific body parts)

DDx for Specific Learning Disorder

Normal variations, Intellectual Disability, Learning difficulties due to neurological or sensory disorders, Neurocognitive disorders, ADHD (frequently comorbid), Psychotic Disorders

Every night when this patient comes home she checks that the door is locked several times. What's the dx?

Normal. Criterion B of OCD emphasizes that obsessions and compulsions must be time-consuming (e.g., more than 1 hour per day) or cause clinically significant distress or impairment to warrant a diagnosis of OCD. This criterion helps to distinguish the disorder from the occasional inrusive thoughts or repetitive behaviors that are common in the general population (e.g., double-checking that a door is locked).

Patient has difficulty falling asleep some days, difficulty staying asleep other days, but doesn't have any significant problem as a result. What's the dx?

Not Insomnia Disorder; Criterion B:. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.

What is Body identity integrity disorder(apotemnophilia)?

Not a DSM-5 disorder, Body identity integrity disorder(apotemnophilia) involves a desire to have a limb amputated to correct an experience of mismatch between a person's sense of body identity and his or her actual anatomy. The concern does not focus on the limb's appearance, as it would in body dysmorphic disorder.

Patient presents with spouse, spouse complains patient persistently has difficulty parting with possessions, regardless of value. Patient says he just feels the need to save things and is distressed when he doesn't. As a result, the garage, basement and attic are filled with "junk", according to his spouse. What's the dx?

Not hoarding disorder. Criterion C requires congestion and clutter of ACTIVE living areas, substantially compromising their intended use. Criteria are: A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities). D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in MDD, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in ASD)

A patient has an unexpected panic attack. The attacks then become expected. What's the dx?

Not panic disorder. Sometimes an unexpected panic attack is associated with the ONSET of another anxiety disorder, but then the attacks become expected, whereas panic disorder is characterized by RECURRENT UNEXPECTED panic attacks.

Risk factors associated with worse tic severity include:

OBSTETRICAL complications, older PATERNAL age, LOWER BIRTH WEIGHT, and MATERNAL SMOKING during pregnancy

The prevalence of body dysmorphic disorder is elevated in first-degree relatives of individuals with:

OCD

Trichotillomania is more common in individuals with:

OCD and their first-degree relatives than in the general population (same with excoriation disorder).

DDx for Delusional Disorder

OCD, Delirium, major neurocognitive disorder, psychotic disorder due to another medical condition, and substance/medication-induced psychotic disorder, Schizophrenia and schizophreniform disorder, Depressive and bipolar disorders and schizoaffective disorder

Obsessive-Compulsive and related disorders include:

OCD, body dysmorphic disorder, hoarding disorder, trichotillomania (hairpulling disorder), excoriation (skin-picking) disorder, substance/medication-induced obsessive-compulsive and related disorder, obsessive-compulsive and related disorder due to another medical condition, and other specified obsessive-compulsive and related disorder and unspecified obsessive-compulsive and related disorder (e.g., body-focused repetitive behavior disorder, obsessional jealousy)

A patient presents with OCD with poor insight and delusional OCD beliefs and does not have any other features of schizophrenia or schizoaffective disorder. What's the dx?

OCD. Some individuals with OCD have poor insight or even delusional OCD beliefs. However, they have obsessions and compulsions (distinguishing their condition from delusional disorder) and do not have other features of schizophrenia or schizoaffective disorder (e.g., hallucinations or formal thought disorder).

DDx for ADHD

ODD, Intermittent explosive disorder, stereotypic movement disorder, some cases of ASD, Tourette's, Specific learning disorder, Intellectual disability, Reactive attachment disorder, Anxiety disorders, Depressive & Bipolar Disorder, DMDD (most with DMDD have Sx that also meet criteria for ADHD), Substance Use Disorders, Personality disorders, Psychotic Disorders, Medication-induced symptoms of ADHD, Neurocognitive Disorders

Rates of comorbidity in disruptive mood dysregulation disorder are extremely high. It is RARE to find individuals whose symptoms meet criteria for DMDD ALONE. Comorbidity between DMDD and other syndromes appears higher than for many other pediatric mental illnesses; the strongest overlap is with

ODD. Not only is the overall rate of COMORBIDITY high in DMDD, but also the range of comorbid illnesses appears particularly DIVERSE. These children typically present to the clinic with a wide range of disruptive behavior, mood, anxiety, and even autism spectrum sx and dx.

An individual wiith ASD or COMMUNICATION DISORDER must have symptoms that meet full criteria for schizophrenia, with PROMINENT HALLUCINATIONS or DELUSIONS for at least:

ONE MONTH, in order to be diagnosed with SCHIZOPHRENIA as a comorbid condition

The DSM-IV term somatoform disorders was confusing and is replaced by somatic symptom and related disorders. In DSM-IV there was a great deal of overlap across the somatoform disorders and a lack of clarity about the boundaries of diagnoses. Although individuals with these disorders primarily present in medical rather than mental health settings, nonpsychiatric physicians foimd the DSM-IV somatoform diagnoses difficult to understand and use. The current DSM-5 classification recogrüzes this overlap by reducing the total number of disorders as well as their subcategories. THE PREVIOUS CRITERIA:

OVEREMPHASIZED THE CENTRALITY OF MEDICALLY UNEXPLAINED SX. Such symptoms are present to various degrees, particularly in conversion disorder, BUT somatic symptom disorders can also accompany DIAGNOSED medical disorders. The reliability of determining that a somatic symptom is medically unexplained is limited, and grounding a diagnosis on the absence of an explanation is problematic and REINFORCES MIND-BODY DUALISM. It is not appropriate to give an individual a mental disorder diagnosis solely because a medical cause cannot be demonstrated. Furthermore, the presence of a medical diagnosis does not exclude the possibility of a comorbid mental disorder, including a somatic symptom and related disorder. Perhaps because of the predominant focus on lack of medical explanation, individuals regarded these diagnoses as pejorative and demeaning, implying that their physical symptoms were not "real." The new classification defines the major diagnosis, somatic symptom disorder, on the basis of positive symptoms (distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms). However, medically unexplained symptoms remain a key feature in conversion disorder and pseudocyesis (other specified somatic symptom and related disorder) because it is possible to demonstrate definitively in such disorders that the symptoms are not consistent with medical pathophysiology.

How does OCD compare with Obsessive- Compulsive Personality Disorder?

Obsessive-compulsive personality disorder is not characterized by intrusive thoughts, images, or urges or by repetitive behaviors that are performed in response to these intrusions; instead, it involves an enduring and pervasive maladaptive pattern of EXCESSIVE PERFECTIONISM and RIGID CONTROL. If an individual manifests sx of both OCD and obsessive-compulsive personality disorder, both diagnoses can be given.

What is cataplexy?

Often associated with narcolepsy, cataplexy is a medical condition in which strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious.

What is jamais vu?

Often described as the opposite of déjà vu, jamais vu involves a sense of eeriness and the observer's impression of seeing the situation for the first time, despite rationally knowing that he or she has been in the situation before. Jamais vu is sometimes associated with certain types of aphasia, amnesia, and epilepsy.

Often INSOMNIA or FATIGUE is the presenting complaint, and failure to probe for accompanying symptoms will result in underdiagnosis of:

Often insomnia or fatigue is the presenting complaint for MDD, and failure to probe for accompanying depressive sx will result in underdiagnosis. Sadness may be denied at first but may be elicited through interview or inferred from facial expression and demeanor.

Older patients may underendorse the dx of Panic Disorder. Why?

Older individuals may retrospectively endorse explanations for the panic attack (which would preclude the diagnosis of panic disorder), even if an attack might actually have been unexpected in the moment (and thus qualify as the basis for a panic disorder diagnosis). Careful questioning of older adults is required to assess whether panic attacks were expected before entering the situation, so that unexpected panic attacks and the diagnosis of panic disorder are not overlooked.

Atkins v. Virginia

On June 20, 2002, the Supreme Court issued a landmark ruling ending the execution of those with intellectual disability. The Court held that it is a violation of the Eighth Amendment ban on cruel unusual punishment to execute death row inmates with "mental retardation".

Patient has had one or more hypomanic episodes, has never met full criteria for a major depressive episode or a manic episode, but does have a persistent depressive disorder. What's the Dx?

One or more hypomanic episodes in an individual with an established diagnosis of persistent depressive disorder (dysthymia), gets both diagnoses, dysthmia and Other Specified Bipolar and Related Disorder.

Patient begins AD and soon after experiences increased irritability, edginess, and agitation. What's the dx?

One or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not sufficient for diagnosis of a manic or hypomanic episode, nor necessarily an indication of a bipolar disorder diathesis.

What % of the risk of GAD can be explained by genetics?

One-third of the risk of experiencing generalized anxiety disorder is genetic, and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly major depressive disorder.

Which of these diagnoses can coexist? Rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge-eating disorder, pica

Only PICA may be assigned in the presence of any other feeding and eating disorder. The diagnostic criteria for rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder result in a classification scheme that is MUTUALLY EXCLUSIVE, so during a single episode ONLY ONE of these can be assigned.

What is the typical course of Tourette's Disorder?

Onset 4-6 years, peak at 10-12 years; decline in severity during adolescence. Many adults with tic disorders experience diminished Sx. A small percentage will have persistently severe or worsening Sx in adulthood.

What can the onset of PICA occur?

Onset of pica can occur in childhood, adolescence, or adulthood, although childhood onset is most commonly reported.

What is the typical onset and course of RUMINANT disorder like?

Onset of rumination disorder can occur in infancy, childhood, adolescence, or adulthood. The age at onset in infants is usually between ages 3 and 12 months. In INFANTS, the disorder frequently REMITS spontaneously, but its course CAN BE PROTRACTED and can result in medical emergencies (e.g., severe malnutrition). It CAN potentially BE FATAL, particularly in infancy. Rumination disorder can have an episodic course or occur continuously until treated. In infants, as well as in older individuals with intellectual disability (intellectual developmental disorder) or other neurodevelopmental disorders, the regurgitation and rumination BEHAVIOR appears to have a SELF-SOOTHING or self-stimulating function, SIMILAR to that of other repetitive motor behaviors such as HEAD BANGING.

How can OCD impair the mother-infant relationship?

Onset or exacerbation of OCD, as well as symptoms that can interfere with the mother-infant relationship (e.g., aggressive obsessions leading to avoidance of the infant), have been reported in the peripartum period.

Re encopresis, in the "without constipation and overflow incontinence" subtype, feces are likely to be of normal form and consistency, and soiling is intermittent. Feces may be deposited in a prominent location. This is usually associated with the presence of what disorder?

Oppositional defiant disorder or conduct disorder - or may be the consequence of anal masturbation. Soiling without constipation appears to be less common than soiling with constipation.

Patient presents with short-duration hypomanic episodes (2-3 days) and a Hx of major depressive episodes. What's the Dx?

Other Specified Bipolar and Related Disorder.

Patient, 21yo, presents with multiple episodes of hypomanic symptoms that do not meet criteria for a hypomanic episode and multiple episodes of depressive symptoms that do not meet criteria for a major depressive episode that persist for 18 months. She's never met full criteria for a major depressive, manic, or hypomanic episode and does not meet criteria for any psychotic disorder. During the course of the disorder, the hypomanic or depressive symptoms are present for more days than not, the individual has not been without symptoms for more than 2 months at a time, and the symptoms cause clinically significant distress or impairment. What's the Dx?

Other Specified Bipolar and Related Disorder. Had the duration been >= 24 months or the patient had been a child or adolescent (duration >= 12 months), the Dx would've been Cyclothymia.

This category is for acute, transient conditions that typically last less than 1 month, and sometimes only a few hours or days. These conditions are characterized by constriction of consciousness; depersonalization; derealization; perceptual disturbances (e.g., time slowing, macropsia); micro-amnesias; transient stupor; and/or alterations in sensory-motor functioning (e.g., analgesia, paralysis). Dx?

Other Specified Dissociative Disorder, Acute dissociative reactions to stressful events

What is the likely dx for: identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia

Other Specified Dissociative Disorder, Chronic and recurrent syndromes of mixed dissociative symptoms

This condition is characterized by an acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli. The unresponsiveness may be accompanied by minor stereotyped behaviors (e.g., finger movements) of which the individual is unaware and/or that he or she cannot control, as well as transient paralysis or loss of consciousness. Dx?

Other Specified Dissociative Disorder, Dissociative trance (The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice)

Individuals who have been subjected to intense coercive persuasion (e.g., brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in, or conscious questioning of, their identity. What's the dx?

Other Specified Dissociative Disorder, identity disturbance due to prolonged and intense coercive persuasion

Dx for when all of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual's weight is within or above the normal range:

Other Specified Feeding or Eating Disorder, Atypical anorexia nervosa

When all of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than 3 months

Other Specified Feeding or Eating Disorder, Binge-eating disorder (of low frequency and/or limited duration)

When all of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months:

Other Specified Feeding or Eating Disorder, Bulimia nervosa (of low frequency and/or limited duration)

Dx for recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There Is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual's sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication

Other Specified Feeding or Eating Disorder, Night eating syndrome

Dx for recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting: misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

Other Specified Feeding or Eating Disorder, Purging disorder

This category applies to presentations in which sx characteristic of an obsessive-compulsive and related disorder that cause clinically SIGNIFICANT distress or impairment in social, occupational, or other important areas of functioning predominate but do NOT meet the full criteria for any of the disorders in the obsessive-compulsive and related disorders diagnostic class. The other specified obsessive-compulsive and related disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific obsessive-compulsive and related disorder. This is done by recording "other specified obsessive-compulsive and related disorder" followed by the specific reason (e.g., "body-focused repetitive behavior disorder").

Other Specified Obsessive-Compulsive and Related Disorder

Patient presents meeting most of the criteria for Illness Anxiety Disorder, it's been going on for 3 months. What's the dx?

Other Specified Somatic Symptom and Related Disorder, Brief illness anxiety disorder

Patient seems to meet most of the sx of Somatic Symptom disorder and it's been going on for the last 4 months. What's the dx?

Other Specified Somatic Symptom and Related Disorder, Brief somatic symptom disorder

Patient meets the criteria for Illness Anxiety Disorder, except for Criterion D: The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals). What's the dx?

Other Specified Somatic Symptom and Related Disorder, Illness anxiety disorder without excessive health-related behaviors

What's the dx? A false belief of being pregnant that is associated with OBJECTIVE signs and reported symptoms of pregnancy:

Other Specified Somatic Symptom and Related Disorder, Pseudocyesis

Patient experiences traumatic event that changes his mood and behaviors. It doesn't meet criteria for PTSD or Acute Stress Disorder and the onset of symptoms was greater than 3 months after the stressor. What's the dx?

Other Specified Trauma- and Stressor-Related Disorder, Adjustment-like disorders with delayed onset of symptoms that occur more than 3 months after the stressor

Patient experiences trauma with resulting behavioral and mood sx but doesn't meet criteria for PTSD or Acute Stress Disorder. Though the stressor is not of a prolonged duration, the sx last 8 months. What's the dx?

Other Specified Trauma- and Stressor-Related Disorder, Adjustment-like disorders with prolonged duration of more than 6 months without prolonged duration of stressor.

How is Ataque de nervios documented?

Other Specified Trauma- and Stressor-Related Disorder, Ataque de nervios

Patient presents with severe and persistent mourning reaction after losing his spouse, out of proportion to what would normally be expected. What's a possible dx

Other Specified Trauma- and Stressor-Related Disorder, Persistent complex bereavement disorder

What's the dx? Patient presents with depressed affect and one of the other eight sx of a MDE. It's associated with clinically significant distress and impairment, has persisted for 15 days, and patient has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for mixed anxiety and depressive disorder symptoms.

Other specified depressive disorder, Depressive episode with insufficient symptoms

What's the dx? Patient describes recurrent brief depression, concurrent presence of depressed mood and four other sx of depression for 13 days at least once per month (not associated with the menstrual cycle) for more than 12 consecutive months. Patient has never met criteria for any other depressive or bipolar disorder and does not currently meet active or residual criteria for any psychotic disorder.

Other specified depressive disorder, Recurrent brief depression; "other specified depressive disorder followed by the specific reason"

Patient describes short-duration depressive episode of 12 days, with depressed affect and four of the other eight sx of a MDE associated. It's asociated with clinically significant distress and impairment that persists for more than 4 days, but less than 14 days; He has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for recurrent brief depression

Other specified depressive disorder, Short-duration depressive episode (4-13 days)

Patient complains of sleep difficulties that meets all criteria with regard to frequency, intensity, distress, and impairment for Insomnia Disorder except it's only been going on 1 month. What's the dx?

Other specified insomnia disorder

When a complaint of nonrestorative sleep (complaint of poor sleep quality that does not leave the individual rested upon awakening despite adequate duration) occurs in isolation (i.e., in the absence of difficulty initiating and/or maintaining sleep) but all diagnostic criteria with regard to frequency, duration, and daytime distress and impairments are otherwise met, what's the dx?

Other specified insomnia disorder or unspecified insomnia disorder is made.

What disorder are these the criteria for? A. Single OR multiple motor OR vocal tics have been present, but NOT BOTH motor and vocal B. Tics may wax/wane in frequency but have PERSISTED for more than 1 YEAR since onset. C. Onset is BEFORE age 18 years. D. NOT attributable to the effects of a substance (e.g., cocaine) or medical condition (e.g., Huntington's disease, postviral encephalitis). E. Criteria HAVE NEVER BEEN MET for TOURETTE's disorder.

PERISTENT (Chronic) MOTOR OR VOCAL TIC Disorder Specify if: With motor tics only With vocal tics only

What personality disorders and traits may predispose the individual to the development of brief psychotic disorder?

PERSONALITY DISORDERS and traits (e.g., schizotypal personality disorder; borderline personality disorder; or traits in the psychoticism domain, such as perceptual dysregulation, and the NEGATIVE AFFECTIVITY DOMAIN, such as suspiciousness) may predispose the individual to the development of the disorder

Because loss of interest or pleasure is common in schizophrenia, to meet Criterion A for schizoaffective disorder, the major depressive episode must include:

PERVASIVE DEPRESSED MOOD (i.e., the presence of markedly diminished interest or pleasure is insufficient)

Patient informs you that he has been eating tissues. What's in your ddx?

PICA can usually be distinguished from the other feeding and eating disorders by the consumption of nonnutritive, nonfood substances BUT some presentations of ANOREXIA NERVOSA include ingestion of nonnutritive, nonfood substances, such as paper tissues, as a means of attempting to control appetite. In such cases, WHEN the eating of nonnutritive, nonfood substances is primarily used as a means of WEIGHT CONTROL, ANOREXIA NERVOSA is the primary diagnosis.

What are risk factors for specific learning disorder?

PREMATURITY, very LOW BIRTH WEIGHT, prenatal exposure to NICOTINE

DEVELOPMENTAL COORDINATION disorder is more common with:

PRENATAL exposure to ETOH and in PRETERM and low-birth-weight children

Late-onset (>40 yo) of schizophrenia are overrepresented by FEMALES, who may have married. Often, the course is characterized by a predominance of PSYCHOTIC Sx with:

PRESERVATION of AFFECT and SOCIAL FUNCTIONING. Such late-onset cases can still meet the diagnostic criteria for schizophrenia; it is not yet clear whether this is the same condition as schizophrenia diagnosed prior to mid-life (e.g., prior to age 55 years)

PTSD C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

PTSD C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

The PTSD Specifier, "With dissociative symptoms" contains what 2 subtypes? Specify whether: With dissociative symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

PTSD, With DISSOCIATIVE symptoms: Both or either: 1. DEPERSONALIZATION: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly). 2. DEREALIZATION: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted)

Patient experienced the traumatic death of his mother in a car accident but didn't meet the diagnostic criteria of PTSD til 8 months after the accident. What's the dx?

PTSD, With delayed expression; If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

What type of mental disorder are panic attacks?

Panic Attack Specifier Note: Symptoms are presented for the purpose of identifying a panic attack; however, panic attack is NOT a mental disorder and cannot be coded. Panic attacks can occur in the context of any anxiety disorder as well as other mental disorders (depressive disorders, PTSD, substance use disorders) & some medical conditions (cardiac, respiratory, vestibular, GI). When the presence of a panic attack is identified, it should be noted as a specifier ("posttraumatic stress disorder with panic attacks"). For panic disorder, the presence of panic attack is contained within the criteria for the disorder and panic attack is NOT used as a specifier.

What is responsible for the highest number of medical visits among the anxiety disorders?

Panic disorder is associated with high levels of social, occupational, and physical disability; considerable economic costs; and the highest number of medical visits among the anxiety disorders, although the effects are strongest with the presence of agoraphobia.

Although there is a body of evidence that supports the existence of this condition, it remains a controversial diagnosis. It is believed to be a post-infectious autoimmune disorder characterized by the sudden onset of obsessions, compulsions, and/or tics accompanied by a variety of acute neuropsychiatric symptoms in the absence of chorea, carditis, or arthritis, after Group A streptococcal infection.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

What is pelopsia?

Pelopsia is a vision perception disorder in which objects appear nearer than they actually are. Pelopsia can be caused by psychoneurotic phenomena, changes in atmospheric clarity, or sometimes by wearing a corrective lens

A. DEPRESSED mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 YEARS Note: In children and adolescents, mood can be IRRITABLE and duration must be at least 1 YEAR. B. Presence, while depressed, of TWO (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for >= 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Persistent Depressive Disorder

Does PICA only occur in those with intellectual disability?

Pica CAN occur in otherwise NORMALLY developing CHILDREN, whereas IN ADULTS, it appears more likely to occur in the context of INTELLECTUAL DISABILITY or other mental disorders.

"Postconcussive" symptoms (e.g., headaches, dizziness, sensitivity to light or sound, irritability, concentration deficits) are equally common in brain-injured and NON-brain-injured populations. What is the significance of this when determining a Ddx?

Postconcussive symptoms (e.g., headaches, dizziness, sensitivity to light or sound, irritability, concentration deficits), which occur frequently following mild traumatic brain injury, are also frequently seen in individuals with ACUTE STRESS DISORDER. Postconcussive symptoms are equally common in brain-injured and non-brain-injured populations, and the frequent occurrence of postconcussive symptoms could be attributable to acute stress disorder symptoms.

Posttraumatic Stress Disorder Note: The following criteria apply to adults, adolescents, and children older than _____________ A. Exposure to actual or threatened death, serious injury, or sexual violence in ______ (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as it occurred to others. 3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains: police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

Posttraumatic Stress Disorder Note: The following criteria apply to adults, adolescents, and children older than 6 years. For children SIX years and younger, see corresponding criteria below. A. Exposure to actual or threatened DEATH, serious INJURY, or SEXUAL VIOLENCE in ONE (or more) of the following ways: 1. Directly EXPERIENCING the traumatic event(s). 2. WITNESSING, in person, the event(s) as it occurred to others. 3. LEARNING that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. EXPERIENCING REPEATED or EXTREME EXPOSURE to aversive details of the traumatic event(s) (e.g., first responders collecting human remains: police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

Associated with a higher risk of schizophrenia for the developing fetus are:

Pregnancy and birth complications with HYPOXIA and GREATER PATERNAL AGE; other prenatal and perinatal adversities, including stress, infection, malnutrition, & maternal DM have been linked with schizophrenia but the vast majority with these risks do not develop schizophrenia.

Premenstrual Dysphoric Disorder Diagnostic Criteria A. In the majority of menstrual cycles, at least ______ symptoms must be present in ______________________, start to improve within a few days after ________________, and become minimal or absent _______________________.

Premenstrual Dysphoric Disorder Diagnostic Criteria A. In the majority of menstrual cycles, at least FIVE symptoms must be present in THE FINAL WEEK BEFORE THE ONSET OF MENSES, start to improve within a few days after THE ONSET OF MENSES, and become minimal or absent IN THE WEEK POSTMENSES.

Based on Criterion A, brief psychotic disorder can be dx with only one sx. What are the 3 sx that meet this koala-fication?

Presence of *ONE* (or more) of the following symptoms. At least *ONE* of these must be (1), (2), or (3): 1. DELUSIONS 2. HALLUCINATIONS 3. DISORGANIZED SPEECH (e.g., frequent derailment or incoherence).

MDD requires 5 of 9 listed sx, Persistent Depressive Disorder requires how many of the listed sx? What are they?

Presence, while depressed, of TWO (or more) of the following: *Thinking 5. Poor concentration or difficulty making decisions. *Hopelessness 6. Feelings of hopelessness. *Energy 3. Low energy or fatigue. *Appetite 1. Poor appetite or overeating. *Sleep 2. Insomnia or hypersomnia. *Self-Esteem 4. Low self-esteem.

Describe "primary" enuresis and "secondary".

Primary is when the individual has NEVER established urinary CONTINENCE. In "Secondary" type, the disturbance develops after a period of established urinary continence. There are no differences in prevalence of comorbid mental disorders between the two types.

What disorder is this? A. Single or multiple motor *AND*/OR vocal tics. B. The tics have been present for LESS THAN 1 year since first tic onset. C. Onset is BEFORE age 18 years. D. Not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington's disease, postviral encephalitis). E. Criteria have NEVER BEEN MET for TOURETTE's disorder or PERSISTENT (chronic) motor or vocal tic disorder

Provisional Tic Disorder

The MDD Sx "Diminished ability to THINK or concentrate, or indecisiveness, nearly every day" may either be by subjective account or as observed by others, whereas this Sx must be observed by others

PsychoMOTOR AGITATION or RETARDATION nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

A. A medical symptom or condition (other than a mental disorder) is present. B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways: 1. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition. 2. The factors interfere with the treatment of the medical condition (e.g., poor adherence). 3. The factors constitute additional well-established health risks for the individual. 4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention. C. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder). Specify current severity: Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension treatment). Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma). Severe: Results in medical hospitalization or emergency room visit. Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symptoms).

Psychological Factors Affecting Other Medical Conditions

Of the 9 typical Sx given for MDD, which one MUST be observable by others, not merely subjective feelings?

Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

Which has a worse prognosis, children with RECEPTIVE language impairments or EXPRESSIVE?

RECEPTIVE impairments are more RESISTANT to treatment and READING difficulties are frequently seen. Language disorders are highly HERITABLE, and family members are more likely to have a history of language impairment

What is Criterion B for Bulimia Nervosa?

RECURRENT INAPPROPRIATE COMPENSATORY BEHAVIORS in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

Complex vocal tics include:

REPEATING ONE'S OWN sounds or words {palilalia), repeating the LAST-HEARD word or phrase (echolalia), or uttering socially unacceptable words (obscenities, ethnic, racial, or religious slurs, i.e. coprolalia). Importantly, coprolalia is an abrupt, SHARP BARK/GRUNT utterance and lacks the PROSODY of similar inappropriate speech observed in human interactions

Reactive Attachment Disorder A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by BOTH of the following:

Reactive Attachment Disorder A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by BOTH of the following: 1. The child rarely or minimally seeks comfort when distressed. 2. The child rarely or minimally responds to comfort when distressed.

Reactive Attachment Disorder B. A PERSISTENT social and emotional disturbance characterized by at LEAST TWO of the following: (3 features)

Reactive Attachment Disorder B. A PERSISTENT social and emotional disturbance characterized by at LEAST TWO of the following: 1. Minimal social and emotional RESPONSIVENESS to others. 2. Limited positive AFFECT. 3. Episodes of unexplained IRRITABILITY, SADNESS, or FEARFULNESS that are evident even during nonthreatening interactions with adult caregivers.

Reactive Attachment Disorder C. The child has experienced a pattern of EXTREMES of INSUFFICIENT care as evidenced by at least ONE of the following: (3 features)

Reactive Attachment Disorder C. The child has experienced a pattern of EXTREMES of INSUFFICIENT care as evidenced by at least ONE of the following: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

Reactive Attachment Disorder D. The care in Criterion ___ is presumed to be responsible for the disturbed behavior in Criterion ___

Reactive Attachment Disorder D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).

Reactive Attachment Disorder E. The criteria are not met for ______________

Reactive Attachment Disorder E. The criteria are not met for ASD

Reactive Attachment Disorder F. The disturbance is evident before age _____ G. The child has a developmental age of at least _______ Specify if: Persistent: The disorder has been present for more than 12 months. Specify current severity: Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

Reactive Attachment Disorder F. The disturbance is evident before age 5 years. G. The child has a developmental age of at least 9 months. Specify if: Persistent: The disorder has been present for more than 12 months. Specify current severity: Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

What are the essential features of BN, summed up?

Recurrent episodes of BINGE EATING (too much, no control) (Criterion A), recurrent INAPPROPRIATE COMPENSATORY BEHAVIORS to prevent weight gain (Criterion B), and SELF-EVALUATION that is UNDULY influenced by body SHAPE and WEIGHT (Criterion D). To qualify for the diagnosis, the binge eating and inappropriate compensatory behaviors must occur, on average, at least ONCE PER WEEK for 3 MONTHS (Criterion C).

What is the heritability of nocturnal enuresis?

Risk for childhood nocturnal enuresis is approximately 3.6 times higher in offspring of enuretic mothers and 10.1 times higher in the presence of paternal urinary incontinence.

What are the diagnostic criteria for Rumination Disorder?

Rumination Disorder A. Repeated regurgitation of food over a period of at least 1 MONTH. Regurgitated food may be re-chewed, re-swallowed, or spit out. B. The repeated regurgitation is NOT attributable to an associated GI or other medical condition (e.g., GERD, PYLORIC STENOSIS). C. The eating disturbance does NOT occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant / restrictive food intake disorder. D. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability [Intellectual developmental disorder] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.

Rates of comorbidity with substance-related disorders are high in schizophrenia. >50% schizophrenics have tobacco use disorder. Comorbidity with anxiety disorders is increasingly recognized, rates of OCD and panic disorder are elevated; ________ or ________ personality disorder may sometimes PRECEDE ONSET of schizophrenia.

SCHIZOTYPAL or PARANOID; Life expectancy is reduced because of weight gain, DM, metabolic syndrome, cardiovascular and pulmonary disease. Poor engagement in health maintenance behaviors increases risk of chronic disease, but other factors, (meds, lifestyle, cigarettes, and diet) play a role.

DDx of Childhood-onset fluency disorder

SENSORY deficits, NORMAL speech dysfluencies, MEDICATION SE, adult-onset dysfluencies (think NEUROLOGICAL INSULT), TOURETTE'S disorder

Specific learning disorder is associated with increased risk for:

SI and suicide attempts

Premenstrual Dysphoric Disorder (Criterion B has a list of sx then C does too...) C. ONE (or more) of the following symptoms MUST additionally be present, to reach a total of FIVE symptoms when combined with symptoms from Criterion B above. What are the 7 sx listed in C?

SLEEP PROBLEMS OVERWhelmed/ OO control C CONCENtration Problem INTEREST decreased APPETITE LETHARGY PHYSICAL sx

What disorder is this? A. PERSISTENT difficulties in the social use of verbal/nonverbal COMMUNICATION B. The DEFICITS result in functional LIMITATIONS C. The onset of the symptoms is in the EARLY developmental period D. The sx are NOT attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by ASD, intellectual disability, global developmental delay, etc.

SOCIAL (Pragmatic) COMMUNICATION Disorder

LANGUAGE disorder, particularly EXPRESSIVE deficits, may be found to co-occur with:

SPEECH SOUND disorder

A. REPETITIVE, seemingly DRIVEN, and APPARENTLY PURPOSELESS motor behavior B. The repetitive motor behavior INTERFERES with social, academic, or other activities and may result in self-injury. C. Onset is in the EARLY DEVELOPMENTAL period. D. The repetitive motor behavior is NOT attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder

STEREOTYPIC MOVEMENT Disorder; Specify if: With OR without self-INJURIOUS behavior Specify if: Associated with a known medical or genetic condition, neurodevelopmental disorder, or environmental factor (e.g., Lesch-Nyhan syndrome, intellectual disability, intrauterine alcohol exposure)

This disorder is diagnosed when an individual has REPETITIVE, seemingly DRIVEN, and apparently PURPOSELESS motor behaviors, such as hand flapping, body rocking, head banging, self-biting, or hitting:

STEREOTYPIC movement disorder - The movements interfere with social, academic, or other activities. If the behaviors cause self-injury, this should be specified as part of the diagnostic description.

TIC disorders are characterized by the presence of motor or vocal tics which are:

SUDDEN, rapid, RECURRENT, NONRHYTHMIC, STEREOTYPED motor movements or vocalizations.

Individuals with a diagnosis of INTELLECTUAL disability with co-occurring mental disorders are at risk for:

SUICIDE - they think about suicide, make suicide attempts, and may die from them. Thus, screening for suicidal thoughts is essential in the assessment process.

What is Sandifer syndrome?

Sandifer syndrome involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic GERD, esophagitis, or the presence of hiatal hernia.

To decide if one's presentation meets Criterion C of schizoaffective d/o, review total duration of psychotic illness (active & residual sx) & determine when significant mood sx (untreated or in need of treatment w/ AD and/or mood-stabilizing meds) accompanied psychotic sx. This requires sufficient hx & clin. judgment. If one w/ a 4-yr hx of active & residual sx of schizophrenia develops depressive & manic episodes that, taken together, don't occupy > 1 yr during the 4-yr hx of psychotic illness, what's the dx?

Schizophrenia, as it does not meet Criterion C of schizoaffective d/o

A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) DESPITE speaking in other situations. B. The disturbance INTERFERES with educational or occupational achievement or with social communication. C. The duration of the disturbance is at least 1 MONTH (not limited to the first month of school). D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation. E. The disturbance is not better explained by a communication disorder (e.g., childhood onset fluency disorder) and does not occur exclusively during the course of ASD, schizophrenia, or another psychotic disorder.

Selective Mutism Diagnostic Criteria

DDx of ASD

Selective mutism, Language disorder, Social (pragmatic) communication disorder, Intellectual disability without autism spectrum disorder, Stereotypic movement disorder, ADHD, schizophrenia, Rett syndrome (Disruption of social interaction may be OBSERVED during the REGRESSIVE phase of RETT syndrome from 1-4 yo; many affected young GIRLS MAY have a presentation that MEETS diagnostic criteria for ASD BUT after this period, MOST w/ Rett syndrome IMPROVE their SOCIAL communication skills, and autistic features are no longer an area of concern)

Heritability of Separation Anxiety Disorder in children was estimated at ____% in a community sample of 6-year-old twins, with higher rates in girls. Children with separation anxiety disorder display particularly enhanced sensitivity to respiratory stimulation using C02-enriched air.

Separation Anxiety Disorder shows about 73% heritability

What is the most prevalent anxiety disorder in children younger than 12 years?

Separation anxiety disorder decreases in prevalence from childhood through adolescence and adulthood and is the most prevalent anxiety disorder in children younger than 12 years. The 12-month prevalence of separation anxiety disorder among adults in the United States is 0.9%-1.9%. In children, 6- to 12-month prevalence is estimated to be approximately 4%. In adolescents in the United States, the 12-month prevalence is 1.6%. In clinical samples of children, the disorder is equally common in males and females. In the community, the disorder is more frequent in females.

Re conversion disorder, what are positive and negative prognosticators?

Short duration of symptoms and acceptance of the diagnosis are positive prognostic factors. Maladaptive personality traits, the presence of comorbid physical disease, and the receipt of disability benefits may be negative prognostic factors.

This is listed as an environmental risk factor for panic attacks and panic disorder..

Smoking

A patient shows impairment in social communication and social interactions but does NOT show restricted and repetitive behavior or interests. What's the likely dx?

Social (pragmatic) communication disorder

A consolidation of autistic disorder, Asperger's disorder, and PERVASIVE DEVELOPMENTAL DISORDER into autism spectrum disorder, symptoms represent a continuum of mild to severe impairments in these two domains:

Social communication and restrictive repetitive behaviors/interests

A. ONE or MORE somatic sx that are DISTRESSING or result in significant DISRUPTION of daily life. B. EXCESSIVE thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least ONE of the following: 1. DISPROPORTIONATE and PERSISTENT thoughts about the SERIOUSNESS of one's symptoms. 2. Persistently high level of ANXIETY about health or symptoms. 3. Excessive TIME and ENERGY devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Somatic Symptom Disorder

A new category in DSM-5, Somatic Symptom and related disorders, includes the diagnoses of:

Somatic symptom disorder, Illness anxiety disorder, Conversion disorder (functional neurological symptom disorder), psychological factors affecting other medical conditions, Factitious disorder, other specified somatic symptom and related disorder, and unspecified somatic symptom and related disorder. All of the disorders in this chapter share a common feature: the prominence of somatic symptoms associated with significant distress and impairment. Individuals with disorders with prominent somatic symptoms are commonly encountered in primary care and other medical settings but are less commonly encountered in psychiatric and other mental health settings. These reconceptualized diagnoses, based on a reorganization of DSM-IV somatoform disorder diagnoses, are more useful for primary care and other medical (nonpsychiatric) clinicians

This Delusional Disorder subtype applies when the central theme of the delusion involves bodily functions or sensations.

Somatic type; Most common is the belief that the individual emits a foul odor; that there is an infestation of insects on or in the skin; that there is an internal parasite; that certain parts of the body are misshapen or ugly; or that parts of the body are not functioning.

Can ASD be diagnosed in adulthood?

Some come for 1st dx in adulthood, perhaps prompted by the dx in a child or a breakdown of relations at work or home. Obtaining detailed developmental hx may be difficult. It's important to consider self-reported difficulties. Where clinical observation suggests criteria are currently met, it MAY be diagnosed, provided there is NO evidence of good SOCIAL and communication skills in CHILDHOOD. The absence of developmental information in itself should not do so.

Is it possible for ASD patients to develop catatonic-like motor behavior (or was this question just randomly generated)?

Some individuals develop catatonic-like motor behavior (slowing and "freezing" mid-action), but these are typically not of the magnitude of a catatonic episode. However, it is possible for individuals with ASD to experience a marked deterioration in motor symptoms and display a full catatonic episode with symptoms such as MUTISM, POSTURING, GRIMACING and WAXY FLEXIBILITY. The risk period for comorbid catatonia appears to be greatest in the adolescent years.

This symptom or impairment is the most common predictor of non-adherence to treatment in schizophrenia, and it predicts higher relapse rates, increased number of involuntary treatments, poorer psychosocial functioning, aggression, and a poorer course of illness.

Some individuals with psychosis may lack insight or awareness of their disorder (ANSOGNOSIA). This lack of "'insight" includes unawareness of Sx of schizophrenia and may be present throughout the entire course of the illness. Unawareness of illness is typically a symptom of schizophrenia itself rather than a coping strategy. It is comparable to the lack of awareness of neurological deficits following brain damage.

A. Marked fear or anxiety about a SPECIFIC object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging. B. The phobic object or situation almost always provokes IMMEDIATE fear or anxiety. C. The phobic object or situation is ACTIVELY avoided or ENDURED with intense fear or anxiety. D. The fear or anxiety is OUT of PROPORTION to the actual danger posed by the specific object or situation and to the sociocultural context. E. The fear, anxiety, or avoidance is PERSISTENT, typically lasting for 6 MONTHS or more. F. The fear, anxiety, or avoidance causes clinically significant DISTRESS or impairment in social, occupational, or other important areas of functioning. G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia): objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder)

Specific Phobia Diagnostic Criteria

This disorder is diagnosed when there are specific deficits in an individual's ability to perceive or process information efficiently and accurately. The individual's performance of the affected skill is well below average for age, or acceptable performance levels are achieved only with extraordinary effort; may occur in individuals identified as intellectually gifted and manifest only when the learning demands or assessment procedures (e.g.,timed tests) pose barriers that cannot be overcome by their innate intelligence and compensatory strategies.

Specific learning disorder

How does one differentiate between Specific phobia, other type, "situations that may lead to choking or vomiting" vs. Avoidant / Restrictive Food Intake disorder?

Specific phobia, other type, "situations that may lead to choking or vomiting" can represent the primary trigger for the fear, anxiety, or avoidance required for dx. Distinguishing specific phobia from avoidant/restrictive food intake disorder is difficult when fear of choking / vomiting has resulted in avoidance. Although avoidance or restriction of food intake secondary to fear of choking / vomiting can be conceptualized as specific phobia, in situations WHEN THE EATING PROBLEM BECOMES THE PRIMARY FOCUS, AVOIDANT / RESTRICTIVE FOOD INTAKE DISORDER is the DX.

Bipolar II Specifiers

Specify current or most recent episode: Hypomanic Depressed Specify if: With anxious distress With mixed features With rapid cycling With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern (Applies only to the pattern of major depressive episodes) Specify course if full criteria for a mood episode are not currently met: in partial remission In full remission Specify severity if full criteria for a mood episode are currently met: Mild Moderate Severe

The Bipolar and Related Disorders Specifier "With anxious distress" requires how many of the following Sx for mild/moderate/moderate-severe and severe? The presence of ______ of the following symptoms during the majority of days of the current or most recent episode of mania, hypomania, or depression: 1. Feeling keyed up or tense. 2. Feeling unusually restless. 3. Difficulty concentrating because of worry. 4. Fear that something awful may happen. 5. Feeling that the individual might lose control of himself or herself.

Specify current severity: Mild: Two symptoms. Moderate: Three symptoms. Moderate-severe: Four or five symptoms. Severe: Four or five symptoms with motor agitation

Unique specifiers for Persistent Depressive Disorder

Specify if: -Early onset: If onset is before age 21 years. -Late onset: If onset is at age 21 years or older. Specify if (for most recent 2 years of persistent depressive disorder): -With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years. -With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period. -With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode. -With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years

Common Specific Phobia specifiers

Specify if: Code based on the phobic stimulus: -Animal (e.g., spiders, insects, dogs). -Natural environment (e.g., heights, storms, water). -Blood-injection-injury (e.g., needles, invasive medical procedures). -Situational (e.g., airplanes, elevators, enclosed places). -Other (e.g., situations that may lead to choking or vomiting: in children, e.g., loud sounds or costumed characters).

Specify if: With anxious distress: Anxious distress is defined as the presence of at least _____ of the following symptoms during the majority of days of a major depressive episode or persistent depressive disorder (dysthymia): 1. Feeling keyed up or tense. 2. Feeling unusually restless. 3. Difficulty concentrating because of worry. 4. Fear that something awful may happen. 5. Feeling that the individual might lose control of himself or herself.

Specify if: With anxious distress: Anxious distress is defined as the presence of at least two symptoms Specify current severity: -Mild: Two symptoms. -Moderate: Three symptoms. -Moderate-severe: Four or five sx -Severe: Four or five symptoms and with motor agitation

What are the specifiers for OCD?

Specify if: With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusionai beiiefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. Specify if: Tic-related: The individual has a current or past history of a tic disorder.

What are the Somatic Symptom Disorder specifiers?

Specify if: Witli predominant pain (previously pain disorder) Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months). Specify current severity: Mild: Only one of the symptoms specified in Criterion B is fulfilled. Moderate: Two or more of the symptoms specified in Criterion B are fulfilled. Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom)

What are the specifiers for Conversion Disorder?

Specify symptom type: With weakness or paralysis With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait disorder) With swallowing symptoms With speech symptom (e.g., dysphonia, slurred speech) With attacks or seizures With anesthesia or sensory loss With special sensory symptom (e.g., visual, olfactory, or hearing disturbance) With mixed symptoms Specify if: Acute episode; Symptoms present for less than 6 months. Persistent: Symptoms occurring for 6 months or more. Specify if: With psychological stressor (specify stressor) Without psychological stressor

What are the specifiers for Illness Anxiety Disorder?

Specify whether: Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used. Care-avoidant type: Medical care is rarely used.

What are the additional specifier types listed for Anorexia Nervosa?

Specify whether: RESTRICTING TYPE: During the last 3 MONTHS the individual has NOT engaged in recurrent episodes of BINGE EATING or PURGING behavior (self-induced vomiting, laxatives, diuretics, enemas). This subtype describes presentations in which weight loss is accomplished primarily through DIETING, FASTING, OR EXCESSIVE EXERCISE. BINGE-EATING/PURGING type: During the last 3 MONTHS, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting, laxatives, diuretics, enemas).

PTSD Specifiers

Specify whether: With dissociative symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following: 1. DEPERSONALIZATION: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly). 2. DEREALIZATION: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). Specify if: With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

What are the ASD specifiers?

Specify: With/without accompanying INTELLECTUAL IMPAIRMENT With/without accompanying LANGUAGE IMPAIRMENT ASSOCIATED with a unknown medical or genetic CONDITION or environmental factor ASSOCIATED with another neurodevelopmental, mental, or behavioral DISORDER With CATATONIA

What disorder is this? A. Persistent difficulty with speech sound production B. The disturbance causes limitations in effective communication C. Onset of symptoms is in the early developmental period. D. The difficulties are not attributable to congenital or acquired conditions

Speech Sound Disorder

If one previously was Dx as Tourette's disorder but now only has vocal OR motor tic, the Dx is:

Still Tourette's, once met it negates a possible diagnosis of persistent (chronic) motor or vocal tic disorder

Body dysmorphic disorder usually has acute onset. T/F

Subclinical concerns usually evolve gradually to the full disorder, although some individuals experience abrupt onset of body dysmorphic disorder. The disorder appears to usually be chronic, although improvement is likely when evidence-based treatment is received. The disorder's clinical features appear largely similar in children/adolescents and adults. Body dysmorphic disorder occurs in the elderly, but little is known about the disorder in this age group. Individuals with disorder onset before age 18 years are more likely to attempt suicide, have more comorbidity, and have gradual (rather than acute) disorder onset than those with adult-onset body dysmorphic disorder.

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive, or irritable mood, with or without depressed mood, or markedly diminished interest or pleasure in all, or almost all, activities. B. There is evidence from the history, physical examination, or laboratory findings of both (1)and (2): 1. The sx in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the sx in Criterion A. C. The disturbance is not better explained by a bipolar or related disorder that is not substance / medication-induced. Such evidence of an independent bipolar or related disorder could include the following: The sx precede the onset of the substance/medication use; the sx persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance / medication-induced bipolar and related disorder (e.g., a history of recurrent non-substance/medication-related episodes). D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning Specify if: With onset during intoxication With onset during withdrawal

Substance/Medication-Induced Bipolar and Related Disorder Diagnostic Criteria

Re Panic Disorder, culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. How many of these sx are required for dx?

Such symptoms should not count as one ofthe four required symptoms.

In dissociative amnesia, when may suicide risk be highest?

Suicidal behavior may be a particular risk when the amnesia remits suddenly and overwhelms the individual with intolerable memories.

Suicidal thoughts occur at some point in as many as _____________ of individuals with OCD. Suicide attempts are also reported in up to __________ of individuals with OCD; the presence of comorbid major depressive disorder increases the risk.

Suicidal thoughts in about half of those with OCD; Attempts in up to one-quarter of those with OCD

What drugs are known to cause depersonalization / derealization symptoms?

Symptoms may be induced by substances such as tetrahydrocannabinol, hallucinogens, ketamine, MDMA (3,4-methylenedioxymethamphetamine; "ecstasy") and salvia. Marijuana use may precipitate new-onset panic attacks and depersonalization / derealization symptoms simultaneously

In this type of amnesia, the individual loses memory for a specific category of information (e.g., all memories relating to one's family, a particular person, or childhood sexual abuse).

Systematized amnesia, the individual loses memory for a specific category of information (e.g., all memories relating to one's family, a particular person, or childhood sexual abuse).

A full manic episode emerges during antidepressant treatment (medication, electroconvulsive therapy) BUT persists at a fully syndromal level beyond the physiological effect of that treatment. What's the dx?

That is sufficient evidence for a manic episode and therefore, a bipolar I diagnosis.

F>M for bipolar I, T/F? Prevalence?

The 12-month prevalence estimate in the U.S. was 0.6% for bipolar I disorder as defined in DSM-IV. Twelve-month prevalence of bipolar I disorder across 11 countries ranged from 0.0% to 0.6%. The lifetime male-to-female prevalence ratio is approximately 1.1:1.

What's the prevalence of bipolar II?

The 12-month prevalence of bipolar II disorder is between 0.3% to 0.8%

Symptoms of depersonalization / derealization disorder are highly distressing and are associated with major morbidity. Why is this important to remember and sometimes challenging to discern?

The affectively FLATTENED and ROBOTIC demeanor that depersonalization / derealization disorder patients often demonstrate may appear INCONGRUENT with the EXTREME EMOTIONAL PAIN reported by those with the disorder. Impairment is often experienced in both interpersonal and occupational spheres, largely due to the HYPOEMOTIONALITYwith others, subjective difficulty in focusing and retaining information, and a general sense of disconnectedness from life.

What kind of awareness of their actions occurs with Trichotillomania and Excoriation (skin-picking) disorder?

The body focused repetitive behaviors that characterize these two disorders are NOT triggered by obsessions or preoccupations; however, they may be preceded or accompanied by various emotional states, such as feelings of anxiety or boredom. They may also be preceded by an increasing sense of tension or may lead to gratification, pleasure, or a sense of relief when the hair is pulled out or the skin is picked. Individuals with these disorders may have VARYING degrees of conscious awareness of the behavior while engaging in it, with some individuals displaying more focused attention on the behavior (with preceding tension and subsequent relief) and other individuals displaying more automatic behavior (with the behaviors seeming to occur without full awareness).

With mood-incongruent psychotic features

The content of delusions and hallucinations is inconsistent with the episode polarity themes, or the content is a mixture of mood-incongruent and mood-congruent themes

What is the typical course for depersonalization / derealization disorder?

The course of depersonalization / derealization disorder is often persistent. About one-third of cases involve discrete episodes; another third, continuous symptoms from the start; and still another third, an initially episodic course that eventually becomes continuous. While in some individuals the intensity of symptoms can wax and wane considerably, others report an unwavering level of intensity that in extreme cases can be constantly present for years or decades. Internal and external factors that affect symptom intensity vary between individuals, yet some typical patterns are reported. Exacerbations can be triggered by stress, worsening mood or anxiety symptoms, novel or overstimulating settings, and physical factors such as lighting or lack of sleep.

Summarize the course and any danger of PICA.

The course of the disorder can be protracted and can result in medical emergencies (e.g., intestinal obstruction, acute weight loss, poisoning). The disorder can potentially be fatal depending on substances ingested.

What is the crude mortality rate (CMR) for anorexia nervosa?

The crude mortality rate (CMR) for anorexia nervosa is approximately 5% per decade. Death most commonly results from medical complications associated with the disorder itself or from suicide.

Though Persistent Depressive Disorder can last a long time, how does it impact functioning compared to MDD?

The degree to which persistent depressive disorder impacts social and occupational functioning is likely to vary widely, but effects can be as GREAT OR GREATER than those of MDD

In Bipolar II, is the MDE and hypomanic episode required to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning?

The depressive episodes or hypomanic FLUCTUATIONS must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; however, for hypomanic episodes, this requirement does NOT have to be met.

An individual with body dysmorphic disorder is completely convinced that his or her delusional body dysmorphic disorder beliefs are true. What is the Dx?

The diagnosis of body dysmorphic disorder, with absent insight / delusional beliefs specifier, NOT delusional disorder.

A patient is diagnosed with MDD and meets the criteria for Insomnia Disorder. What's the dx?

The dx of insomnia disorder is given whether it occurs independently or is comorbid with another mental disorder (e.g., MDD), medical condition, or another sleep disorder (e.g., a breathing-related sleep disorder). It's often impossible to establish the precise nature of the relationship between them, and it may change over time; it's not necessary to make a causal attribution between the two. However, a concurrent insomnia dx should only be considered when the insomnia is sufficiently severe to warrant independent clinical attention; otherwise, no separate dx is necessary.

The dx of panic disorder requires UNEXPECTED RECURRENT panic attacks. What's the dx if patients have expected and unexpected panic attacks?

The dx would be panic disorder. Approximately one-half of individuals with panic disorder have expected panic attacks as well as unexpected panic attacks. Thus, the presence of expected panic attacks does not rule out the diagnosis of panic disorder.

A pregnant patient confides in you that she occasionally gets such strong cravings for chalk that she occasionally eats some. What's the dx?

The eating of nonnutritive, nonfood substances may also manifest in pregnancy, when specific cravings (e.g., chalk or ice) might occur. The DIAGNOSIS OF PICA DURING PREGNANCY IS ONLY APPROPRIATE IF SUCH CRAVINGS LEAD TO THE INGESTION of nonnutritive, nonfood substances TO THE EXTENT THAT THE EATING OF THE SUBSTANCES POSES POTENTIAL MEDICAL RISKS.

What is the essence of the Disconnection & Rejection schema?

The essence of the Disconnection & Rejection schema domain is the general expectation that your basic needs will be met by others in an UNPREDICTABLE or INCONSISTENT way. Many people who identify with schemas within this domain come from families perceived as cold, detached, explosive, lonely, abusive, or rejecting. The framework is: (1) Abandonment/Instability (2) Mistrust/Abuse (3) Emotional Deprivation (4) Defectiveness/Shame (5) Social Alienation/Rejection

What's the prevalence of Tourette's in school-age children? What is the gender predilection?

The estimated prevalence of Tourette's disorder ranges from 3 to 8 per 1,000 in school-age children. M>f, ratio varying from 2:1 to 4:1.

Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, as a result of a strong perceived need to save the items and to distress associated with discarding them. Hoarding disorder differs from normal collecting. For example, symptoms of hoarding disorder result in the accumulation of a large number of possessions that congest and clutter active living areas to the extent that their intended use is substantially compromised. Which form characterizes most but not all individuals with hoarding disorder?

The excessive acquisition form of hoarding disorder, which consists of excessive collecting, buying, or stealing of items that are not needed or for which there is no available space.

Criterion A of Acute Stress Disorder details required exposure. Category B lists resulting sx. What are the 5 categories?

The five categories Criterion B of Acute Stress Disorder are: INTRUSION, NEGATIVE MOOD, DISSOCIATION, AVOIDANCE, and AROUSAL SX

Describe the typical frequency and severity of panic attacks.

The frequency and severity of panic attacks vary widely. In terms of frequency, there may be moderately frequent attacks (e.g., one per week) for months at a time, or short bursts of more frequent attacks (e.g., daily) separated by weeks or months without any attacks or with less frequent attacks (e.g., two per month) over many years. Persons who have infrequent panic attacks resemble persons with more frequent panic attacks in terms of panic attack symptoms, demographic characteristics, comorbidity with other disorders, family history, and biological data. In terms of severity, individuals with panic disorder may have both full-symptom (four or more symptoms) and limited-symptom (fewer than four symptoms) attacks, and the number and type of panic attack symptoms frequently differ from one panic attack to the next. However, more than one unexpected full-symptom panic attack is required for the diagnosis of panic disorder.

Individuals with dissociative identity disorder often present identities that appear to encapsulate a variety of severe personality disorder features, suggesting a differential diagnosis of personality disorder, especially of the borderline type. How are these differentiated?

The individual's longitudinal variability in personality style (due to inconsistency among identities) differs from the PERVASIVE and PERSISTENT dysfunction in affect management and interpersonal relationships typical of those with PERSONALITY disorders.

T/F The risk of completed suicide lessens in middle and late life.

The likelihood of suicide ATTEMPTS lessens in middle and late life, although the risk of COMPLETED suicide does not.

The mean age at onset of depersonalization / derealization disorder is:

The mean age at onset of depersonalization/derealization disorder is 16 years, although the disorder can start in early or middle childhood; a minority cannot recall ever not having had the symptoms. LESS than 20% of individuals experience onset AFTER age 20 years and only 5% after age 25 years. Onset in the fourth decade of life or later is highly unusual. Onset can range from extremely sudden to gradual. Duration of depersonalization / derealization disorder episodes can vary greatly, from brief (hours or days) to prolonged (weeks, months, or years).

Removal from the traumatic circumstances underlying the dissociative amnesia (e.g., combat) may bring about a rapid return of memory. The memory loss of individuals with dissociative fugue may be:

The memory loss of individuals with dissociative FUGUE may be particularly REFRACTORY. Onset of PTSD symptoms may decrease localized, selective, or systematized amnesia. The returning memory, however, may be experienced as flashbacks that alternate with amnesia for the content of the flashbacks.

The number of lifetime episodes (both hypomanic and/or major depressive episodes) tends to be higher for which, bipolar I, bipolar II, MDD?

The number of lifetime episodes (both hypomanie and major depressive episodes) tends to be higher for bipolar II disorder than for major depressive disorder or bipolar I disorder. However, individuals with bipolar I disorder are actually more likely to experience hypomanic symptoms than are individuals with bipolar II disorder.

T/F Some cases of OCD have acute onset.

The onset of sx is typically gradual; however, acute onset has also been reported.

The defining feature of dissociative identity disorder is the presence of two or more distinct personality states or an experience of possession (Criterion A). How overt or covert are these personality states?

The overtness or covertness of these personality states varies as a function of psychological motivation, current level of stress, culture, internal conflicts and dynamics, and emotional resilience. Sustained periods of identity disruption may occur when psychosocial pressures are severe and/or prolonged. In many POSSESSION-form cases of dissociative identity disorder, and in a small proportion of non-possession-form cases, manifestations of alternate identities are HIGHLY OVERT. Most individuals with NON-possession-form dissociative identity disorder do NOT OVERTLY display their discontinuity of identity for long periods of time; only a small minority present to clinical attention with observable alternation of identities.

What makes the postpartum period unique?

The postpartum period is unique with respect to the degree of NEUROENDOCRINE alterations and PSYCHOSOCIAL adjustments, the potential impact of BREAST-FEEDING on treatment planning, and the long-term IMPLICATIONS of a history of postpartum mood disorder on subsequent family PLANNING.

Patient presents complaining that he is dead or the world is not real. What's the likely dx and important ddx?

The presence of INTACT REALITY TESTING specifically regarding the depersonalization / derealization sx is essential to differentiating depersonalization/derealization disorder from psychotic disorders. Rarely, POSITIVE-symptom schizophrenia can pose a diagnostic challenge when NIHILISTIC delusions are present. For example, an individual may complain that he or she is dead or the world is not real; this COUD BE EITHER a subjective experience that the individual knows is not true or a delusional conviction.

How does one differentiate the sx in one with depersonalization / derealization disorder vs psychotic disorders? What sometimes poses a diagnostic challenge in this regard?

The presence of INTACT REALITY TESTING specifically regarding the depersonalization / derealization sx is essential to differentiating depersonalization/derealization disorder from psychotic disorders. Rarely, POSITIVE-symptom schizophrenia can pose a diagnostic challenge when NIHILISTIC delusions are present. For example, an individual may complain that he or she is dead or the world is not real; this could be either a subjective experience that the individual knows is not true or a delusional conviction.

Who's more likely to attempt suicide, Bipolar I or II? How about to succeed?

The prevalence rates of lifetime attempted suicide in bipolar II and bipolar I disorder are to be similar (32.4% and 36.3%). However, the lethality of attempts may be higher in bipolar II than bipolar I disorder. There's a 6.5-fold higher risk of suicide among first-degree relatives of bipolar II probands compared with those with bipolar I disorder.

How do the depressive episodes of Bipolar II compare with Bipolar I?

The recurrent MDE are often more frequent and lengthier than those occurring in bipolar I disorder.

If relatives have bipolar I, does that increase risk for bipolar II?

The risk of bipolar II disorder tends to be highest among relatives of individuals with bipolar II disorder, as opposed to individuals with bipolar I disorder or major depressive disorder.

Patient complains of somatic symptoms but actually has a medical condition that explains those symptoms. Is Somatic Symptom Disorder a possible dx?

The sx may or may not be associated with another medical condition. The diagnoses of somatic symptom disorder and a concurrent medical illness are NOT mutually exclusive, and FREQUENTLY occur together. E.g., an individual may become seriously disabled by sx of somatic symptom disorder after an uncomplicated MI even if the MI itself did not result in any disability. IF another medical condition or high risk for developing one is present (e.g., strong family history), the thoughts, feelings, and behaviors associated with this condition are EXCESSIVE (Criterion B).