DSM-5 Diagnostic Criteria

Histrionic PD

-Excessive emotionality and attention seeking. -Discomfort in situations in which not center of attention. -Rapidly shifting and shallow expression of emotions (exaggerated display of emotion). -Seductive behavior, but may have sexual dysfunction. -Relationships characterized by lack of stability, shallowness, "manipulation", or dependency. -May be associated with somatic complaints.

Narcissistic PD

-Grandiosity, need for admiration, lack of empathy. -Feeling of special importance may alternate with feelings of special unworthiness. -Fragile self-esteem. -Disturbed interpersonal relationships due to lack of empathy, exploitativeness. -Depressed mood common.

Borderline PD

-Instability in interpersonal relationships, self-image, and affect. Marked impulsivity. -Marked and persistent identity disturbance, often pervasive (self-image, sexual orientation, long-term goals or career choice, types of friends or lovers, values). -Feelings of emptiness or boredom. -Unstable and intense interpersonal relationships; extremes of idealization and devaluation. -Difficulty in being alone. -Affective instability, marked mood shifts—depression, anxiety, anger or irritability (any of which may be intense). -Difficulty appropriately expressing anger. -Self-mutilation to relieve feelings of emptiness or to express anger. -Impulsive. Drug abuse, spending, sex, binge eating, gambling. -Recurrent suicidal threats and behaviors. -Depression, transient psychotic or dissociative symptoms may occur under stress.

Obsessive-Compulsive PD

-Preoccupation with orderliness, perfectionism, and control. -Preoccupation with rules, efficiency, trivial details, procedures, and form. -Inability to see broad picture. -Sensitive to status in relationships. -Decision making difficult because of fear of making a mistake. -Conscientious, moralistic, scrupulous, judgmental of self and others. -Stingy with emotions and material possessions. -Difficulty expressing "soft" emotions. -Depression and anger common.

Avoidant PD

-Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation. -Unwilling to enter relationship unless given unusually strong guarantee of acceptance. -Avoidance of significant interpersonal contact. -Fear of saying something inappropriate, foolish, or being unable to answer a question. -Generalized timidity. -Desire for affection and acceptance, but lack of ability to relate comfortably. -Distinguish from Social Anxiety Disorder—humiliation is concern but usually specific situation is avoided rather than personal relationships (may be comorbidity).

Dependent PD

-Submissive and clinging behavior related to excessive need to be taken care of. -Inability to make everyday decisions without excessive amount of advice and reassurance from other. Will allow others to make most of their important decisions. -Difficulty initiating projects. -Tendency to feel uncomfortable or helpless when alone. -Easily hurt by criticism and disapproval; subordinate themselves to others

Cyclothymic Disorder

2 year period (at least): hypomanic symptoms, depressive symptoms A. For at least 2 years (at least 1 year 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. 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 2 months at a time. C. Criteria for a major depressive, manic, or hypomanic episode have never been met [?—see next slide]. D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. E. The symptoms are not attributable to the physiological effects of a substance or another medical condition (e.g., hyperthyroidism). F. The symptoms cause clinically significant distress or impairment...

Neurocognitive Disorder with Lewy Bodies

A and B major or mild NCD....insidious onset and gradual. Core diagnostic features • Fluctuating cognition with pronounced variations in attention and alertness • Recurrent visual hallucinations that are well formed and detailed • Spontaneous features of parkinsoniasm, with onset subsequent to the development of cognitive decline Suggestive diagnostic features: • Meets criteria for rapid eye movement sleep behavior disorder • Severe neuroleptic sensitivity

Personality Change due to Another Medical Condition

A persistent personality disturbance that represents a change from the individual's previous characteristic personality pattern. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. Specify type: Labile type. Disinhibited type. Aggressive type. Apathetic type. Paranoid type. Other type. Combined type. Unspecified type

Schizophreniform Disorder

A) 2 or more of the following, each present for a significant amount of time during a 1 month period (or less if successfully treated). At least one must be 1, 2, or 3. *1. Delusions. *2. Hallucinations. *3. Disorganized speech. 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression of avolition). B. An episode of the disorder lasts at least one month but less than six months. C. Schizoaffective disorder and depressive or bipolar disorder have been ruled out. D. Not attributable to substance or another medical condition. Specifiers: -With good prognostic features (psychotic symptoms within 4 weeks of behavior change onset, confusion/perplexity, good premorbid functioning, absence of blunted/flat affect) -Without good prognostic features (if two or more features above have not been present)

Schizophrenia

A) ACTIVE PHASE. 2 or more of the following, each present for a significant amount of time during a 1 month period (or less if successfully treated). At least one must be 1, 2, or 3. *1. Delusions. *2. Hallucinations. *3. Disorganized speech. 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression of avolition). *1,2,3 are psychotic symptoms. B) For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas (such as work, interpersonal relations, or self-care) is markedly below the level achieved prior to the onset. C) Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms that meet Criterion A and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form. D) Schizoaffective Disorder and depressive or bipolar disorder have been ruled out because either: 1. no major depressive or manic episodes have occurred concurrently with the active-phase symptoms 2. if mood symptoms 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) The disturbance is not attributable to the physiological effects of a substance. F) If there is a history of autism spectrum disorder of a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made ONLY if prominent delusions OR hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month. Specify if: With catatonia.

Brief Psychotic Disorder

A) One or more of the following symptoms. At least one must be 1, 2, or 3. *1. Delusions. *2. Hallucinations. *3. Disorganized speech. 4. Grossly disorganized or catatonic behavior. NO NEGATIVE SYMPTOMS Duration of an episode of the disturbance is at least one day but less than one month with eventual full return to premorbid functioning Not better explained by major depressive of bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia/catatonia Specify if: -With marked stressors -Without marked stressors -With peripartum onset (if onset is during pregnancy or within 4 weeks postpartum)

Neurocognitive Disease due to TBI

A. ...major or mild NCD. B. There is evidence of a TBI that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull with at least one or more of the following: 1. Loss of consciousness 2. Posttraumatic amnesia 3. Disorientation and confusion 4. Neurological signs C. The NCD presents immediately after the occurrence of the TBI or immediately after recovery of consciousness and persists pasts the acute post-injury period

Delirium

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day C. An additional disturbance in cognition (memory deficit, disorientation, language, perception) D. The disturbances in criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as a coma Specify whether: • Substance intoxication delirium, substance withdrawal, medication-induced, medical condition, multiple etiologies • Acute (hours, days) or persistent (weeks, months) • Hyperactive, hypoactive, or mixed Predisposing factors: old age, young age, previous brain damage, prior episodes, malnutrition, impairment, alcohol dependence Treatment • Primary: identify and eliminate cause of delirium • Environmental management: quiet, simple orderly, and unhurried setting. Protect pt from injury, orient to reality, reassure safety.

Psychological Factors Affecting Other Medical Conditions

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 anti-hypertension 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).

Substance Use Disorder

A. A problematic pattern of...use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. ... is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control...use. 3. A great deal of time is spent in activities necessary to obtain..., use..., or recover from its effects. 4. Craving, or a strong desire or urge to use... [new] 5. Recurrent...use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued...use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of.... 7. Important social, occupational, or recreational activities are given up or reduced because of...use. 8. Recurrent...use in situations in which it is physically hazardous. 9. ...use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by... 10. Tolerance, as defined by either of the following: -A need for markedly increased amounts of...to achieve intoxication or desired effect. -A markedly diminished effect with continued use of the same amount of.... 11. Withdrawal, as manifested by either of the following: The characteristic withdrawal syndrome for... (refer to Criteria A and B of the criteria set for...withdrawal). ...(or a closely related substance) is taken to relieve or avoid withdrawal symptoms. Overall areas of concern. Impaired control: symptoms 1-4. Social impairment: symptoms 5-7. Risky use: symptoms 8-9. Pharmacological criteria (i.e., physiological dependence): symptoms 10-11. Specify severity: Mild = 2-3, Moderate = 4-5, Severe > 6 symptoms.

Major Depressive Disorder

A. At least 5 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. 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). 3. Significant weight loss or weight gain. 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day . 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt. 8. Diminished ability to think or concentrate, or indecisiveness. 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 symptoms 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 to another medical condition. -Note: Criteria A-C represent a major depressive episode. D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, etc... E. ...never been a manic episode or a hypomanic episode.

Substance Withdrawal

A. Development of a substance-specific problematic behavioral change, with physiological and cognitive concomitants, that is due to the cessation of, or reduction in, heavy and prolonged substance use. (Withdrawal is usually, but not always, associated with a substance use disorder. Most individuals with withdrawal have an urge to re-administer the substance to reduce the symptoms.)

Mild Neurocognitive Disorder

A. Evidence of modest cognitive decline from a previous level of performance in one or more of the cognitive domains based on 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in function 2. A modest impairment in cognitive performance, preferably documented by neuropsychological testing B. The cognitive deficits do not interfere with capacity for independence in everyday activities but greater effort, compensatory strategies, or accommodations may be required C. ...do not occur exclusively in the context of a delirium D. ...not better explained by another mental disorder

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 three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): -Restlessness or feeling keyed up or on edge. -Being easily fatigued. -Difficulty concentrating or mind going blank. -Irritability. -Muscle tension. -Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment... E. ...not attributable to...substance 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).

Acute Stress Disorder

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following...[same as PTSD]. 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). 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.) 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. C. Duration...3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria. D. ...clinically significant distress or impairment... E. ...not attributable to substance or another medical condition (e.g., mild TBI) and is not better explained by brief psychotic disorder.

Factitious Disorder Imposed on Another (Previously Factitious Disorder by Proxy)

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. ...not better explained by another mental DO.... Note: The perpetrator, not the victim, receives this diagnosis.

Premenstrual Dysphoric Disorder

A. In majority of menstrual cycles, > 5 symptoms must be present in final week before the onset of menses, start to improve within a few days after onset of menses, become minimal or absent in the week postmenses. B. Marked: affective lability; irritability or anger or increased interpersonal conflict; depressed mood, hopelessness, self-deprecating thoughts; anxiety, tension, keyed up/on edge. C. Decreased interest, difficulty concentrating, lethargy, appetite change/overeating/food cravings; hypersomnia, insomnia; overwhelmed or out of control; physical symptoms, e.g., breast tenderness/swelling, bloating, joint/muscle pain. Note: Diagnosis is confirmed by 2 months prospective symptom rating. (Diagnosis based on interview is "provisional" prior to gathering 2 months prospective ratings.)

Vascular Neurocognitive Disorder

A. Major or mild NCD...insidious onset and gradual B. The clinical features are consistent with a vascular etiology C. There is evidence of cerebrovascular disease from physical exam or neuroimaging to account for neurocognitive deficits D. The symptoms are not better explained by.. E. Probable vascular neurocognitive disorder if one of the following present; otherwise possible vascular neurocognitive disorder diagnosed: 1. Clinical criteria are supported by neuroimaging evidence 2. The neurocognitive syndrome is temporarily related to one or more documented cerebrovascular events 3. Both clinical and genetic evidence of cerebrovascular disease is present

Specific Phobia

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). 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). Specifiers: 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).

Social Anxiety Disorder

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny 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). 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 almost always provoke fear or anxiety. 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. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. ...clinically significant... H. ...not attributable to...substance...or another medical condition. I. ...not better explained by another mental disorder... 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.

Agoraphobia

A. Marked fear or anxiety about two (or more) of the following five situations: -Using public transportation (e.g., automobiles, buses, trains, ships, planes). -Being in open spaces (e.g., parking lots, marketplaces, bridges). -Being in enclosed places (e.g., shops, theaters, cinemas). -Standing in line or being in a crowd. -Being outside of the home alone. Note that fear of only one of these situations is likely to be diagnosed as a specific phobia (situational). 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 symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence). C. The agoraphobic situations almost always provoke fear or anxiety. 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 for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment... 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 (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder). Note: 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.

Somatic Symptom Disorder

A. One or more somatic symptoms 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 > 1 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). Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain. 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 1 of the symptoms specified in Criterion B fulfilled. Moderate: Two or more of the ...symptoms... Severe: Two or more of the ...symptoms, plus multiple somatic complaints (or one very severe somatic symptom).

Gambling Disorder

A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. Is restless or irritable when attempting to cut down or stop gambling. 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. 4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 6. After losing money gambling, often returns another day to get even ("chasing" one's losses). 7. Lies to conceal the extent of involvement with gambling. 8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. 9. Relies on others to provide money to relieve desperate financial situations caused by gambling. The gambling behavior is not better explained by a manic episode. Episodic: Meeting diagnostic criteria at more than one time point, with symptoms subsiding between periods of gambling disorder for at least several months. Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years.

Hoarding Disorder

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. ...clinically significant distress or impairment... (including maintaining a safe environment for self and others). E. The hoarding is not attributable to another medical condition (e.g., brain injury, Prader-Willi syndrome, cerebrovascular disease). F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder). Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. Specify insight: Good/fair, Poor, Absent/Delusional

Illness Anxiety Disorder

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 > 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, BDD, OCD, or delusional disorder, somatic type. 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.

Body Dysmorphic Disorder

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns. C. ...clinically significant distress or impairment... D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. Specify if: -With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case. -degree of insight: Good/Fair, Poor, Absent/Delusional

Obsessive Compulsive Disorder

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. 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 [hair-pulling disorder]; 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). 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/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. -Tic-related: The individual has a current or past history of a tic disorder.

Trichotillomania (Hair-Pulling Disorder)

A. Recurrent pulling out of one's hair, resulting in hair loss. B. Repeated attempts to decrease or stop hair pulling. C. ...clinically significant distress or impairment... D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition). E. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).

Excoriation (Skin-Picking) Disorder

A. Recurrent skin picking resulting in skin lesions. B. Repeated attempts to decrease or stop skin picking. C. ...clinically significant distress or impairment... D. ...not attributable to...substance or medical... E. The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).

Panic Disorder

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 four (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. B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following: -Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, "going crazy"). -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. ...not attributable to...substance 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). Panic Attack Specifier: Panic attacks can occur in the context of any mental disorder and some medical conditions. Panic attacks act as a marker/prognostic factor for severity of diagnosis, course, comorbidity across an array of disorders. Thus, panic attacks may be added as a specifier to other DSM-5 disorders (e.g., anxiety disorders, depressive disorders, bipolar disorders, eating disorders, OCD, psychotic disorders). When the presence of a panic attack is identified, it should be noted as a specifier (e.g., "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.

Frontotemporal NCD

A. The criteria are met for major or mild NCD. B. ...insidious onset and gradual progression. C. Either 1 or 2: 1. Behavioral variant: a. Three or more of the following behavioral symptoms: apathy or inertia, loss of sympathy or empathy, perseverative, hyperorality and dietary changes, prominent decline in social cognition and or/executive abilities 2. Language variant: a. Prominent decline in language ability D. Relative sparing of learning and memory and perceptual motor function (helps distinguish from Alzheimer's)

Neurocognitive Disorder due to Alzheimer's Disease

A. The criteria are met for major or mild neurocognitive disorder. B. There is insidious onset and gradual progression of impairment in one or more cognitive domain (for major NCD at least 2 domains must be impaired) C. Criteria are met for either probable or possible Alzheimer's disease as follows (see handout)

Adjustment Disorders

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 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: -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. -Significant impairment in...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 6 months. Specify whether: With depressed mood. With anxiety. With mixed anxiety and depressed mood. With disturbance of conduct. With mixed disturbance of emotions and conduct. Unspecified

Substance Intoxication

A. The essential feature is the development of a reversible substance-specific syndrome due to the recent ingestion of a substance. B. The clinically significant problematic behavioral or psychological changes associated with intoxication (e.g., belligerence, mood lability, impaired judgment) are attributable to the physiological effects of the substance on the central nervous system and develop during or shortly after use of the substance.

Normal/healthy personality

Ability to cope with the environment in a flexible manner. Capacity to function autonomously and competently. Tendency to adjust to social environment effectively and efficiently. Subjective sense of contentment and satisfaction. Ability to fulfill one's potential.

Schizotypal PD

Acute discomfort in close relationships, cognitive or perceptual distortions and eccentricities of behavior. Disturbance of thought content may include paranoid ideation, suspiciousness, odd beliefs, magical thinking. Unusual perceptual experiences. Odd speech and expression of ideas. Note: Considered part of Schizophrenia Spectrum.

10 separate drug classes

Alcohol; caffeine; cannabis; phencyclidine [or similarly acting arylcyclohexylamines]; hallucinogen; inhalant; opioid; sedative, hypnotic, or anxiolytic; stimulant; tobacco [note DSM-5 does not say nicotine]; and other.

Schizoaffective Disorder

An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of Schizophrenia. Delusions or hallucinations for two or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness. Major mood episode present for the majority of the total duration of the illness. Specifiers -Bipolar type -Depressive type

Difference between BP2 and Cyclothymic

Bipolar II disorder is distinguished from cyclothymic disorder by the presence of one or more major depressive episodes. If a major depressive episode occurs after the first 2 years of cyclothymic disorder, the additional diagnosis of bipolar II disorder is given.

Major Neurocognitive Disorder

Called dementia in previous editions of the DSM (and this term is still widely used in medicine) A. Evidence of significant cognitive decline (distinguishes from neurodevelopmental disorder) from a previous level of performance in one or more cognitive domains based on 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in function 2. A substantial impairment in cognitive performance, preferably documented by neuropsychological testing B. The cognitive deficits interfere with independence in everyday activities (i.e., the individual requires assistance in performing complex instrumental activities of daily living [IADL]- bills, medications) C. The cognitive deficits do not occur exclusively in the context of a delirium D. ...are not better explained by another mental disorder (major depressive disorder, schizophrenia) Specifiers • Presumed etiology (whether due to Alzheimer's, vascular disease, etc.) • With behavioral disturbance • Without behavioral disturbance • Severity

2nd Gen/Atypical antipsychotic drugs

Clozapine -no reported tardive dyskinesia -most common side effects: increased saliva production, sedation, nausea, tachycardia, weight gain, higher seizure risk -Increased risk of agranulocytosis. Weekly blood monitoring and 1 week rx. -Associated with fatal heatstroke Different mechanism of action from 1st gen Different profile of side effects Increased effectiveness with affective symptoms as well as psychotic symptoms Better tolerated than typical antipsychotic drugs Other atypical antipsychotic drugs: Risperdal Zyprexa Seroquel Geodon Abilify Invega Saphris Latuda Fanapt

3 Clusters of PD

Cluster A. Odd or eccentric cluster. Paranoid PD, Schizoid PD, Schizotypal PD. Cluster B. Dramatic, emotional, erratic cluster. Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD. Cluster C. Anxious or fearful. Avoidant PD, Dependent PD, Obsessive-compulsive PD.

Persistent Depressive Disorder

Consolidates Dysthymic Disorder and Chronic Major Depressive Disorder. (Criteria ~ Dysthymic Disorder) 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. B. Presence, while depressed, at least 2 of the following: -Poor appetite or overeating. -Insomnia or hypersomnia. -Low energy or fatigue. -Low self-esteem. -Poor concentration or difficulty making decisions. -Feelings of hopelessness. C. During the 2-year period of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 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. ...not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. 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.

Schizoid PD

Detachment from social relationships. Restricted range of emotional expression. Neither desire nor enjoy close relationships. Indifferent to praise and criticism. Unable to express aggressiveness or hostility.

Negative symptoms

Diminished function Alogia- diminished fluency of speech/thought Affect blunted - diminished emotional expression Avolition - diminished drive Anhedonia - diminished capacity to feel pleasure Abulia - diminished motivation

Antisocial PD

Disregard for and violation of the rights of others. (Individual must be at least 18 and have history of Conduct Disorder before 15.) Not synonymous with criminality, but is inability to conform to social norms. Irritable and aggressive, promiscuous. No remorse about effects of their behavior on others. Question of diminished acting out after 30. Frequently associated with drug and alcohol use and criminal behavior.

Positive Symptoms

Distorted function Hallucinations - distorted perception Delusions - distorted inferential thought Disorganized speech - distorted thought/language Bizarre behavior - distorted behavior monitoring Inappropriate affect - distorted affect

Paranoid PD

Distrust and suspiciousness. Other's motives interpreted as malevolent. Expectation of being exploited or harmed. Look for hidden meanings. Usually argumentative, exaggerates difficulties.

Tricyclic antidepressants

Elavil (amitriptyline), Tofranil (imipramine), Norpramin (desipramine), Sinequan (doxepin), Pamelor (nortriptyline), Anafranil (clomipramine) These drugs are very effective, but are not used as often because of side effects and toxicity. They can cause dangerous drug interactions, especially with alcohol. However, sometimes the side effects can be used positively, as in giving a drug with sedative side effects to an anxious or insomnic patient. Examples of drugs in this class are Elavil, doxepin, imipramine, desipramine.

Definition of Personality Disorder

Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Manifested in >2: cognition (ways of interpreting self, others, events); affectivity (range, intensity, lability, and appropriateness of emotional response); interpersonal functioning, impulse control.

Gender ratio of Bipolar Disorder

Equally common males and females MDD: twice as common in females (1.5-3 beginning in adolescence)

Malingering

Essential feature: intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives, e.g., avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. Differs from Factitious Disorders in that the motivation for the symptom production in Malingering is external incentives, whereas in Factitious Disorder there is an absence of external incentives. Malingering should be strongly suspected if any combination of the following is noted: -Medicolegal context of presentation (e.g., the individual is referred by an attorney to the clinician for examination, or the individual self-refers while litigation or criminal charges are pending). -Marked discrepancy between the individual's claimed stress or disability and the objective findings and observations. -Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen. -The presence of antisocial personality disorder.

SSRIs

Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro) currently approved for use in U.S. Overall therapeutic efficacy comparable to TCA's in patients with unipolar depression. Exposure to SSRIs increased the risk of completed or attempted suicide among adolescents, the risk was decreased among adults. Among people aged 65 or more years, exposure to SSRIs had a protective effect.

Bipolar I Disorder

For a diagnosis of BP1, it is necessary to have met the criteria for a manic episode at some point. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes (MDEs). Manic Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally or persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, at least 3 of the following symptoms (4 if mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: -inflated self esteem or grandiosity -decreased need for sleep -more talkative than usual -flight of ideas, racing thoughts -distractibility -increase in goal-directed activity or psychomotor agitation -excessive involvement in activities that have a high potential for painful consequences 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 D. The episode is not attributable to the physiological effects of a substance or to another medical condition. Criteria A-D constitute a manic episode. At least one lifetime manic episode required for diagnosis of BP1. Hypomanic episode A. A distinct period of abnormally and persistently elevated, expansive, or elevated mood and abnormally and 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 and increased energy/activity, three or more of the following symptoms (4 if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: -Inflated self-esteem or grandiosity. -Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). -More talkative than usual or pressure to keep talking. -Flight of ideas or subjective experience that thoughts are racing. -Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. -Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. -Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). 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 or another medical condition. Note: A full hypomanic episode that emerges during antidepressant treatment but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis. Note: Criteria A-F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder. Major Depressive Episode A. At least 5 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 (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (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 (as indicated by either subjective account or observation). 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.) 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 symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to... Note: Criteria A-C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder. Diagnosing Bipolar I Disorder. Criteria have been met for at least one manic episode (Criteria A-D under "Manic Episode" above). 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.

Bipolar II Disorder

Hypomania + MDE Criteria have been met for at least one hypomanic episode (Criteria A-F under "Hypomanic Episode" above) and at least one major depressive episode (Criteria A-C under "Major Depressive Episode" above). There has never been a manic episode. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by... 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.

Treatment of BP

Lithium is longest used. Effective, but some individuals have adverse or allergic reactions. Unpleasant side effects. Anticonvulsant medications (Tegretol-carbamazepine, Depakote/Depakene-valproate) common alternatives or adjuncts to lithium. Antipsychotic medications may be added or used independently as mood stabilizers. Sometimes combined with antipsychotic or antidepressant. 70-90% of individuals with "typical" bipolar illness respond. Frequently effective in 1-2 weeks but may take longer to contain the affective episode fully.

Meds for Generalized Anxiety Disorder

Many medications have been demonstrated to be effective in reducing symptoms of GAD. Benzodiazepines, TCA's, SSRI's, Buspar.

Meds for OCD

Medications active in serotonin (5HT) neurotransmitter system. SSRI's, TCA's (esp. Anafranil/ clomipramine). (MAOI's also effective but rarely used for OCD.) Sometimes Buspar (buspirone) used as adjunctive medication.

PTSD

Note: The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, there are different criteria. 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. B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). 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.) 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). 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: -Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). -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). 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"). D. Negative alterations in cognitions and mood, cont'd -Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. -Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). -Markedly diminished interest or participation in significant activities. -Feelings of detachment or estrangement from others. -Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). 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: -Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. -Reckless or self-destructive behavior. -Hypervigilance. -Exaggerated startle response. -Problems with concentration. -Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). F. Duration of the disturbance (Criteria B and C and D and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 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: -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). -Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). -With delayed expression [Note: not delayed onset]: 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).

Meds for Panic Disorder with or without Agoraphobia

Panic Disorder with or without Agoraphobia: SSRI's, TCA's, alprazolam (Xanax). (MAOI's also effective but very rarely used for Panic.)

Pathological personality

Pathological personality. Adaptive inflexibility. -Few alternative ways to relate to others, achieve goals, and cope with stress. These few alternatives are practiced rigidly and imposed on situations for which they are ill suited Tenuous stability. -Fragility or lack of resilience under conditions of subjective stress. Vicious circles. -Individual's habitual perceptions, needs, and behaviors perpetuate and intensify preexisting difficulties. -Individuals restrict their opportunities for new learning, misconstrue essentially benign events, and provoke reaction from others that reactivate their earlier problems. Cognitive distortions.

Factitious Disorder

Physical or psychological symptoms that are intentionally produced or feigned. Sense of intentionally producing a symptom is subjective, and can only be inferred by an outside observer. Compulsive quality to production of behaviors. Production of symptoms "voluntary" in the sense that they are deliberate and purposeful (intentional), but not in the sense that the acts can be controlled. Behavior appears to be under "voluntary" control and is used to pursue goals that are involuntarily adopted. A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself 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 with Physical Symptoms. Factitious Disorder with Psychological Symptoms. Factitious Disorder by Proxy.

Meds for PTSD

SSRI's (venlafaxine (Effexor), paroxetine (Paxil)) are approved for PTSD, effective for all three major clusters of PTSD symptoms. (Meds may be less effective than CBT (PE, CPT) and perhaps EMDR.) Some indication that combat-related PTSD may not respond as well to meds, though recent research suggests that prazosin (Minipress) is promising. Propranolol may be effective as a preventive agent.

Conversion Disorder (Functional Neurological Symptom Disorder)

Show psychological distress in physical ways 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. ...clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. Specify: 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, hearing) With mixed symptoms Specify if: Acute episode: Symptoms <6 months. Persistent: Symptoms > 6 months. Specify if: With psychological stressor(specify stressor) Without psychological stressor Note: Pseudocyesis, a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy, is diagnosed as an Other Specified Somatic Symptom and Related Disorder rather than as a conversion disorder.

Antipsychotic drugs- symptoms targeted?

Synonyms: neuroleptics, major tranquilizers Symptoms most likely to respond: agitation, hallucinations, delusions, combativeness, sleep disturbance, tension, paranoid behavior, disorganized thinking (positive symptoms) Symptoms less likely to respond: negative symptoms, impaired judgment, lack of insight, withdrawal, depression, cognitive impairment

Side effects of antipsychotic drugs

Tardive Dyskinesia: abnormal, involuntary movements (twitching, snakelike writhing) involving the tongue, lips, jaw, face, extremities, and occasionally the trunk (wtf is the trunk) -Symptoms may persist indefinitely after discontinuation of meds. Rx: limit exposure to antipsychotic drugs Parkinsonian symptoms: tremor, rigidity, slowed movement (Rx: Artane, cogentin) Akathisia: compulsion to be in motion- need to be in motion rather than specific movements (Rx: lower dose of antipsychotic) Acute dystonic reactions: impaired or disordered muscle tone, involuntary muscle contractions, particularly around the mouth, jaw, face, neck (Rx: valium, benzos) Sedation: tolerance tends to develop over days/weeks Seizures: uncommon Neuroleptic malignant syndrome: fever. muscular rigidity, stupor Anticholinergic effects: peripheral, CNS, serious toxicity

BP and suicide

The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. In fact, bipolar disorder may account for one-quarter of all completed suicides. A past history of suicide attempt and percent days spent depressed in the past year are associated with greater risk of suicide attempts or completions. Approximately one-third of individuals with bipolar II disorder report a lifetime history of suicide attempt. The prevalence rates of lifetime attempted suicide in bipolar II and bipolar I disorder appear to be similar (32.4% and 36.3%, respectively). Lethality higher in BP2 than BP1

Delusional Disorder

The presence of one or more delusions with a duration of one month or longer. Criterion A for Schizophrenia has never been met. (Hallucinations, if present, are not prominent and are related to delusions) Functioning is not markedly impaired and behavior is not obviously bizarre or odd. If manic/major depressive episodes have occurred, they have been brief relative to the duration of the delusional periods. Not attributable to substance/other medical condition. Not better explained by another mental disorder such as body dysmorphic disorder or OCD. Specifiers: -with bizarre content -Erotomanic type: the affected person believes that another person is in love with him or her. This belief is usually applied to someone with higher status or a famous person, but can also be applied to a complete stranger. -Grandiose type: A person with this type of delusional disorder has an over-inflated sense of worth, power, knowledge, or identity. The person might believe he or she has a great talent or has made an important discovery. -Jealous type: a person with this type of delusional disorder believes that his or her spouse or sexual partner is unfaithful. -Persecutory type: People with this type of delusional disorder believe that they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them -Somatic type: delusions that the person has some physical defect or general medical condition -Mixed type: delusions characteristic of more than one of the above types but no one theme predominates -Unspecified type

Commonly used typical antipsychotic drugs

Thorazine Mellaril Stelazine Prolixin Navane Haldol Trilafon

BP specifiers

With anxious distress: -at least two anxiety symptoms during the majority of days of the current/most recent episode of mania, hypomania or depression. -Symptoms: Feeling keyed up or tense, feeling unusually restless, difficulty concentrating because of worry, fear that something awful may happen, feeling that the individual might lose control of himself or herself. -High levels of anxiety have been associated with higher risk of suicide, longer duration of illness, higher risk of poor treatment response. -Specify severity based on number of anxiety symptoms: mild to severe. With mixed features: can be added to mania and hypomania if depressive features are present or to episodes of depression when features of mania or hypomania are present (> 3 symptoms from other pole). Manic/Hypomanic Episode mixed features symptoms: -Prominent dysphoria or depressed mood... -Diminished interest or pleasure... -Psychomotor retardation -Fatigue or loss of energy. -Feelings of worthlessness or excessive or inappropriate guilt -Recurrent thoughts of death, suicidal ideation, or a suicide attempt or specific plan for committing suicide. With rapid cycling (> 4 mood episodes past 12 months) With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia. With peripartum onset: can be applied to current/most recent episode of mania, hypomania, or depression in Bipolar I or II if onset of mood symptoms was during or in the 4 weeks following delivery. -50% of episodes of "postpartum" depression actually began before delivery. With seasonal pattern: regular temporal relationship between onset of manic, hypomanic, or depressive episodes and a particular time of year. Does not include cases where there is an obvious psychosocial stressor related to the season. Past 2 years no non-seasonal episodes; full remission also at a characteristic time of year; seasonal episodes outnumber non-seasonal episodes.

Catatonia

a state of psychogenic motor immobility and behavioral abnormality manifested by stupor

Meds for Social Phobia

beta-blockers, e.g., Inderal (propranolol) reduce physical symptoms but do little for cognitive/mood symptoms. SSRI's, e.g., Paxil.

Echopraxia

mimicking another's movements

Echolalia

mimicking another's speech

Stupor

no psychomotor activity; not actively relating to environment

Mutism

no, or very little, verbal response

Agitation

not influenced by external stimuli

Mannerism

odd, circumstantial caricature of normal actions

Negativism

opposition or no response to instructions or stimuli

Catalepsy

passive induction of a posture held against gravity

Monoamine Oxidase Inhibitors (MAOI's)

phenelzine (Nardil), tranylcypromine (Parnate) Side effects of greatest concern: Hypertension particular problem if high dose of MAOI taken, if TCA or stimulant is taken, or if a high tyramine containing diet is consumed.

Stereotypy

repetitive, abnormally frequent, non-goal-directed movements

Waxy flexibility

slight, even resistance to positioning by examiner

Posturing

spontaneous and active maintenance of a posture against gravity

Most common type of dementia

• Alzheimer's disease believed to be the most common type of dementia (60-90%, followed by vascular dementia and dementia with Lewy bodies (less than 20%) • 30% of people with AD also have VaD

Domains of Cognitive Function

• Complex attention: ability to sustain, divide, and selectively focus attention; processing speed • Executive ability: planning, decision making, working memory, responding to feedback/error correction, mental flexibility • Learning and memory: immediate and recent memory (includes both free and cued recall, recognition memory) • Language: expressive language (including naming, fluency, grammar, and syntax) and receptive language • Visuoconstructional-perceptual ability: construction, visual perception • Social cognition: recognition of emotions, theory of mind, behavioral regulation

FAST Screen for Stroke

• Facial weakness: ask the person to smile • Arm weakness: ask the person to raise both arms • Speech problems: ask the person to talk and speak a simple sentence • Time: get a person to the ER quickly (Sometimes: tongue- ask person to stick out tongue. Is it crooked?)

Types of brain damage

• Head trauma: may result in either temporary dysfunction (concussion) or permanent damage • Closed head injury: skull not penetrated • Open head injury: skull penetrated • Acceleration/deceleration rotational forces: result in differential movement of brain and vessels inside the skull • Tumors: malignant/nonmalignant • Brain malformations and early life damage • Diseases of circulatory system: o Impairs flow of blood to brain o Stroke o Apnea o Vascular dementia o Aneurysm o Arteriovenous formations • Degenerative and demyelinating diseases o Disorders which specifically attack CNS o Slowly progressive and incurable, may stem from endogenous physiological defect, but not all are genetic o Multiple sclerosis, Alzheimer's disease, Pick's disease, Huntington's disease • Alcohol and other drug damage o Dependence: effects related to alcohol and other drugs, inborn metabolic defects, dietary habits, and nutritional effects of alcohol o Alcohol-induced Persisting Amnestic Disorder produced by thiamine deficiency o Intoxication and withdrawal symptoms • Toxic, infectious, and metabolic illnesses: caused by toxins taken into the body, toxins not removed, electrolyte imbalance, nutritional deficiencies, disease (encephalitis, AIDS, meningitis, syphilis), disease affecting another part of the body primarily and brain secondarily (high fever, pneumonia, lupus), metabolic disorders • Epilepsy: symptoms of many diseases and not a disease itself

Neurocognitive Disorders

• In DSM-IV this group is called Delirium, Dementia, Amnestic, and Other Cognitive Disorders • Includes disorders in which primary clinical deficit is in cognitive function. Distinguished from neurodevelopmental disorders.

Meds to treat Alzheimer's

• Medications that increase acetylcholine (Ach) activity in the brain tend to improve memory (cholinesterase inhibitor) • Cognitive enhancers increase ACh by blocking acetylcholinesterase (AChE), the main enzyme that breaks down ACh • Medications don't prevent or reverse deterioration in Alzheimer's, but they may delay cognitive loss and help maintain function • Start on cholinesterase inhibitor as soon as diagnosis is made • Tacrine- first cognitive enhancer • Donezepil- as effective as tacrine, safer, easier to tolerate • Galantamine- decreases rate of decline of memory and other cognitive functions • Rivastigmine (Exalon)- short acting • Memantine (Namenda)- has been found to improve cognitive functioning as well as psychological symptoms of dementia (i.e., depression). • Solanezumab: a drug in phase 3 development for the treatment of AD Memantine (Namenda). Memantine has been found to improve cognitive functioning as well as psychological symptoms of dementia (such as depression). Decreases rate of cognitive and functional decline in adults with moderate to severe SDAT. Most common side effects—constipation, cough, dizziness, headache, hypertension, confusion. Not AChE inhibitor—reduces abnormally high levels of glutamate. May be taken with AChE inhibitor.

Screening for Dementia

• Mini-Mental State Examination (MMSE) and adaptations. Most widely used instrument for dementia screening. • The Mini-Cog is a briefer screen that is often used in primary care settings. Consists of the clock drawing test (CDT) and three item recall. • Montreal Cognitive Assessment (MoCA): screens for both MCI and dementia o Cognitive complaints AND functional decline MMSE. If MMSE is normal MoCA. o Cognitive complaints without functional impairment MoCA first o 100% of AD pts had abnormal MoCA • St. Louis University Mental Status (SLUMS) o Screens for both MCI and dementia • Rowland Universal Dementia Assessment (RUDAS)

Principles of management of treatment of AD

• Treat what is treatable without aggravating existing symptoms • Support caregivers who are affected by the disease