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Diagn
Acute Stress Disorder - The primary feature is the development of characteristic negative mood, and arousal, avoidance, dissociative, and intrusion symptoms that typically begin immediately after a trauma and last for a minimum of three days up to a month. The person is exposed to an event that involved or threatened death, serious injury, or sexual violation. At least nine symptoms need to be experienced which include but are not limited to exaggerated startle response, altered sense of reality, sleep disturbance, distressing memories, recurrent dreams, and an inability to experience positive emotions. The event is persistently re-experienced by the person and there is typically a noted avoidance of stimuli that arouse recollections. This type of disturbance causes significant distress or an impairment to social, occupational, or other areas of necessary functioning. D: Adjustment Disorders, panic disorders, PTSD CBT, Stimulant Use Disorder - Substance abuse and dependence is now a single disorder measured on a continuum from mild to severe. Each substance is addressed as a separate use disorder but based on same overarching criteria. 11 criteria, 2-3 must be met in order to diagnose mild, six or more for severe. Duration of symptoms: 12 months.
- AA, family therapy, antabus. LEAST: psychodynamic treatment Adjustment disorder with.... (depressed mood, anxiety, disturbance of conduct) - CHANGED. stress-response syndromes of emotional or behavioral symptoms in response to an identifiable stressor occuring within 3 months of the onset. Once the stressor has ended, the symptoms do not presist for more than an additional 6 months. 1 or more of the following: depressed mood (sadness and depression); anxiety (nervousness, jitteriness, worry, separation anxiety), disturbance of conduct (sudden changes in behavior combined with feelings of depression or anxiety); maladaptive reactions. 6 subtypes: Depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct, unspecified. studies suggest that adults with adjustment disorders have a good long-term prognosis while adolescents with this disorder eventually may develop major psychiatric illnesses. Antisocial Personality Disorder - ****Reckless and and lacks empathy. High risk of criminality********
Pervasive pattern of disregard for and violation of the rights of others, occuring since age 15 years, as indicated by 3+
- Failure to conform ot social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
- Deceitfulness, as inidcated by lying, use of aliases, conning
- Impulsivity or failure to plan ahead
- Irritability and aaggressiveness, physical fights or assaults.
- Reckless disregard for safety of self and others
COnsistent irresponsibilty , failure to susteain consistent work behavior or honor financial obligations
- Lack of remorse. B. at least 18 years. evidence of CD with onset before age 15 years. C/D: Narsissitic PD- APD seeks materialistic gain while NPD seeks personal glory. T: Individual therapy accompanied by family or couples therapy. Once improvement is seen group therapy useful. psychodynamic interventions generally used. cognitive interventions. Personality Disorders - Impairments in personality (self and interpersonal) and the presence of pathological personality traits. ADHD - CHANGED. Symptoms are devided into 2 categories: Inattention and Hyperactivity/Impulsivity. Predominantly inattention or hyperactivity: 6+ in subtype, less than 6 in second subtype. Combined: 6+ in both subtypes. Most kids have combined. Children under 17 must have at least 6 symptoms while 17+ must have 5. SOme of the symptoms must be present before age 12.Symptoms will appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not appear for a year or more. Disruptive Mood Dysregulation Disorder (DMDD) -
disorders, ADHD, OCD. TREATMENT: Medication, CBT, family-focused, interpersonal, psycho-edu. Mood graphs, Child Abuse - DSM 5- Found under "conditions that may be a focus of clinical attention. Child maltreatment Conduct Disorder - A repetitive and presistent Patter of behavior in which the basic rights of others or major age- appropriate societal norms or rules are violated, as manifested by the presence of 3+ criteria in the past 12 months, with at least 1 present in the past 6 months. 1) Aggression to people and animals. 2) Destruction of property, 3)Deceitfulness or theft 4) Serious violations of rules. B. Behavior causes clinically sig impairment in social, academic, or occupation functioning. C. If 18+, not antisocial personality disorder. TYPES: CHildhood-onset- at least one criterion prior to age 10, Adolescent onset, absence prior to age 10. Severity. CAUSES: Genetics, environmental, psychological Anorexia - Persistent restriction of energy intake leading to significantly low body weight. Either an intense fear of gaining weight or of becoming fat, or persistant behavior that interferes with weight gain. Disturbance in the way one's body weight or shape is experienced, or persistant lack of recognition of the seriousness of current weight. D: Bulimia Nervosa, Avoidant/Restrictive Food intake Disorder, OCD T: Initial focus is to restore one's nutiritional state, stabilize eating use behavioral approaches, insight- oriented psychotherapy follows. Behavioral, cogntitive, eclectic, psychodynamics and family therapy. Bulimia Nervosa - Recurrent episodes of binge eating. Characterized by1 of the following: - Eating, in a desecrate period of time (within 2 hours, e.g.) an amount of food that is definitely larger than most people would eat during a similar period of time. - A sense of lack of control over eating during the episode. 2) Recurrent in appropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, laxatives, or excessive exercise. 3) Binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. T: CBT, interpersonal, nutritional counseling, insight oriented psychotherapy, pharmacotherapy. Self- esteem issues. Appetite suppressants and antidepressants. Binge Eating -
Recurrent episodes of binge eating, an episode is characterized by BOTH: eating in a discrete period of time more.... AND a sense of lac˚ of control. 2) marked distress about eating 3) associated with 3+: eating much more rapidly, eating until fleeing uncomfortably full, eating large abouts when not feeling hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself. Pica - non-nutrive substances for at least one month, inappropriate to the developmental level of individual, not part of culturally supported or socially normative practices. OTHER SPECIFIED FEEDING OR EATING DISORDER- people who meet some but not all of the diagnostic criteria for other eating disorders. Oppositional Defiant Disorder (ODD) - Generally occurs in children from ages 6-18, with an onset around 8. Characterized by a noncompliant, belligerent, argumentative interaction with authority figures, usually adults. Negative symptoms persist for a min of 6 months. The violation of social norms is not seen (as in CD). Learning Disorders - Math, reading or written expression. When substantially below that expected for the person's age, schooling and level of intelligence. Can be seen as early as kindergarten and as late as fourth grade. Sometimes not seen until adulthood. Low self esteem and social skills deficits may correlate all 3. Diagnosing: Get a written release to speak with teachers to make sure the educational setting is appropriate. TREATMENTS: Behavioral, cog-behavorial, psychodynamic, play therapy, reality therapy, family therapy and parent training. Structured settings, family involvement in order to help the family as a unit. OCPD - Pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control. This begins in early adulthood, is present in a variety of contexts and is indicated by 4 criteria out of list of 8. These symptoms interfere with normal functioning and create significant distress. Theyr are ultimately unproductive, paying more attention to the details of orderliness while sacrificing tas˚ completion. Work very hard but at the sacrifice of leisure or pleasurable activities. Relationships are characterized by control, warm expression and intimacy are seldom a part of their experiences or interpersonal relationships, shows rigidity and stubbornness, inflexible about matters of morality, ethics, values. DIFFERS FROM OCD> OCD charachteriezd by rItuals and repetitive thoughts rather than personality charachteristics.
situation such as poor diet, lack of nutrition, dev. issues. Differential diagnosis: Autism, factitious disorder, nonsuicidal self-injury, anorexia/other eating disorder (some presentations include ingestion of nonnutritive substances as a means to control appitite). Avoidant Personality Disorder - A pervasive patter of social inhibition, feelings of inadequecy, and hypersensitivity to negative evalution, beg. by early adulthood and present in a variety of contexts, 4+:
- Avoids occupational activities that involve sig interpersonal contact b/c of fears of criticism, disapp. or rejection.
- Unwililng to get involved with people unless certain of being liked.
- Shows restraint within intimate relationships because of fear of being shamed or ridiculed.
- Preoccupied with being criticized
- Inhibited in new interpersonal situations
- views self as socially inept, personally unappealing or inferior to others
- usually reluctant to take personal risks or to engaged in new activities. *starts in childhood as shyness, isolation and fear of strangers. D/C: Social phobia (very, very similar-APD has an early onset and no clear precipitants, a stable course) agrophobia. often co-occur. Shizoid PD do not desire social relationships while those with ADP avoid relationships because of fears of negative evaluation. Social communication Disorder - Marked by problems with expressive language development as documented by scores on standardized individually measures of expressive language development and receptive language development. The difficulties must interfer with academic or occupational achievement or social communication. Criteria are not met for pervasive developmental disorder or mixed receptive- expressive language diosorer. Dependent Personality Disorder - A Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of seperation, beginning by early adulthood and present in a variety of contexts, as indicatied by 5+:
- Difficulty making everyday decisions w/o an excessive amount of advice and reassurance
- Needs others to assume responsibility for most major areas of life.
- Has difficulty expressing disagreement with others because of fear of loss of suport or approval.
- Difficulty initiating projects or doing things on own.
- Goes to excessive lengths to obtain nurturance and support, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone. 7. Urgently seeks another relationship as a source of care and support when one ends.
- Unrealistically preoccupied with fears of being left to care for self. D/C: Dependency arising from other disorders (i.e. depression), personality disorders. Borderlines: enraged rather than clingy when threatened with abandonment. Too frieghtened to allow someone so much control over their life. Nightmare Disorder - Nightmares acute: moderate--> 1 month or less subacute: moderate--> more than 1 month but less than 6 persistent: mild --> more than 6 months subacute: severe Global Developmental Disorder - CHildren under 5. DIagnosed when a child had not meet expected developmental milsetones in several areas of intellectual functioning. Given because child is too young for systematic assessments of intellectual functioning, so children givven this diagnosis must be reassessed after a period of time. Distruptive Mood Dysregulation Disorder - Main feature is chronic, severe irritability as manifested by frequent temper tantrums and persistently irritable or angry mood between temper tantrums. Symptoms should have an onset prior to 10 years of age and have lasted at least 12 months. Temper outbursts need to occur in at least two settings and be observable by others. Temper outbursts occur, on average, 3 + x/week. They must also occur freq. are out of proportion in intensity or duration to the istuation and inconsistent with developmental level. Child has to be at least 6 and no older than 18. The age of onset (via history or observation) should be before 10. CANNOT coexist with ODD (Mood symptoms rare) , Intermittent explosive disorder, or Bipolar (episodic). CAN coexist (comorbidity is very high) with MDD, ADHD, CD and SD. If meet criteria for DMDD and one that it can't coexist with diagnose DMDD. Persistent Depressive Disorder -
B. Fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of the panic. C. The situations almost always provoke fear or anxiety D. Situations are actively avoided, require the presence of a companion or are endured with intense fear or anxiety. E. Fear is out of proportion to to the actual danger. F. Persistent, typically lasting for 6 months or more. G. Causes clinically significant distress or impairment in functioning. Diagnoses irrespective of the presence of a panic disorder. If meet criteria for panic disorder and agro, both will be assigned. D/C: Specific phobia, situational type--> Diagnose if fear is limited to one of the agor situation. Criterion B- Fear of developing panic or help not available in situations. Anxiety disorders, mood, substance T: Behavioral and CBT, drugs (MAOIs). Specific Phobia - A. Marked fear or anxiety about a specific object or situation. B. Persistent, typically 6m+ C. Phobic object or situation always causes fear Differential: Criteria is very similar to agoraphobia. HOWEVER: If fears only one of agoraphobia situations then specific phobia. If fears two or more then agoraphobia. - As opposed to Agoraphobia, fear is about specific object/situation and not fear of the embarrassment of reaction. T: Exposure Therapy treatments (desensitization), relaxation and social skills. Antidepressents may be indicated, CBT, psychodynamics, group. relaxation. Disable fears. Social Anxiety Disorder - A. Marked fear or anxiety about 1+ social situations in whcih the individual is exposed to possible scrutiny by otheres. examples include social interactions and performing in front others. in Kids the anxiety must occur in peer settings and not just with adults. B. Fear that they will act in a way or show anxiety symptoms that will be negatively evalutated. C. social situations must always provoke fear and anxiety. D. Social siatuions are avoided or endured with intense fear or anxiety.
E. out of proportion. F. persistent, typically lasting for 6 months +. G. Clinically sig distress in functioning. Specify if: performance only. C/D: Agor.-> Social anxiety is Fear of scrutiny Generalize Anxiety Disorder - A. Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities. B. Hard to control worry. C. The anxiety and worry are associated with 3+ of the following 6 symptoms (with at least some having been present for more days than not for the past 6 months.
- Restlessness or feeling keyed up
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance D. Anxiety, worry or physical symptoms cause clinically sig distress Major Depressive Disorder - A. 5 + of following symptoms must 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/pleasure.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others. (in children mood can be irritable).
- Markedly diminsihed interest or pleasure in all, or almost all, activities most of the day, nearly every day (sub or observed).
- sig. weight loss or gain or decrease or increase in appetitie nearly every day.
- Insomnia or hyposomnia nearly every day.
- psychomotor agitation or retardation nearly every day.
Narcissistic Personality Disorder - Pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy, beginning by early adulthood and persent in a variety of contexts. 5+:
- Grandiose sense of self-importance
- Precoccupied iwth fantasies of unlimited success, power, brillance, beauty or ideal love.
- Belives that they are special, and unique and can only be understood by, or should associate with other special or high status people
- Requires excessive admiration sense of entitlement
- interpersonally exploitative
- lacks empathy
- often envious of others or believes that others are envious of them
- Shoes arrogant, haughty behavior or attitudes. D/C: Historonic, borderline PD. Differentiate by grandiosity. Mania/hypom. Mood change. SUbstance use. Histrionic Personality Disorder - Pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:
- Uncomfortable in situations in which they are not center of attn.
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
- Displays rapidly shifting and shallow expresion of emotions.
- consistently uses physical appearance to draw attn. to self
- Style of speech that is excessively impressionistic and lacking in detail
- Shows self-dramatization, theatricality and exaggerated expression of emotion
- Suggestible
- Considers relationships to be more intimate than they actually are. Borderline Personality Disorder -
Pervasive pattern of instablity of interpersonal relationships, self-image and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extreems of idealization and devaluation
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- impulsivity in at least two areas that are potentially self-damaging (spending sex, sub abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior
- Affective instability due to marked reactivity of mood. (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate intense anger or difficulty congtrolling anger
- Transient, stress related paranoid ideation or sever dissociate symptoms D/C: Depressive and bipolar: Often co-occurs. Only diagnose BDD if pattern of behavior had an early onset and long-standing course. Enuresis - Repeatedly voiding of urine into bed or clothes, involuntary or intentional B. freq of at least twice a week for at least 3 consecutive months or the presence of clinically sig distress or impairment in social, academic (occ)areas of functioning. C. age is at least 5 years. Specify: nocturnal only, dirunal only, both. Encopresis - Excerting feces in inappropriate places. Either controlled or uncontrolled. After age 4. General Personality Disorder - Enduring pattern of inner experience and behavior that deviates markedly from the expecations of culture. 2+:
- Cognitiation
Pervasive pattern of detachment from social relationships and a restricted range of expressions of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4+:
- Neither desires nor enjoys close relationships, including family.
- Almost always chooses solitary activities
- little to no interest in sexual experiencs.
- Takes pleasure in few if any activities.
- Lacks close friends or confidants other than relatives
- Appears indifferent to the praise or criticism of others
- Shows emotional coldness, detachment or flattened affectivity.
- If criteria are met prior to onset of shizophrenia, add premorbid. C/D: Delusional, schizophrenia, bipolar or depression iwth psychotic features- all have a period of psychotic symptoms. Schizotypal personality Disorder - **** High functioning psychotics, known for oddness and delusional behaviors.***** Pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual disortions and eccentricities of behavior, beg. early adulthood and present in variety of contexts:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms.
- Unusual perceptual experiences, including bodily illusions
- Odd thinking and speech (vaguem circumstantial, overelaborate)
- Suspiciousness or paranoid ideation
- Inappropriate or constricted affect
- Behavior or appearance that is odd, eccentric or peculiar
- Lack of close friends or confidants other than first-degree relatives
- Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements of self. C/D: Delusional, schizophrenia, bipolar or depression iwth psychotic features- all have a period of psychotic symptoms.
Differentiate from shizoid and paranoid pd in that it has marked peculiar behavior and cog/perceptual problems. Cluster A Personality Disorders - Characterized by coldness, suspicion, and odd behavior. Paranoid, shizoid, schizotypal Cluster B Personality Disorders - Characterized by aggressive and attention-seeking behaviors. 1) Antisocial 2) borderline 3) histironic, 4) Narcissistic Cluster C Personality disorders - Characterized by withdrawal. Avoidant, Dependent, obsessive-compulsive Obsessive-Compulsive Personality Disorder - Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, opennes and efficiency, beginning by early adulthood and present in a variety of contexts: 4+:
- Is preoccupied with details, rules, lists, order, org, or schedules to the extent that the major point of the activity is lost.
- Shows perfectionism that interferes with task completion 3.Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
- overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values.
- unable to discard worn-out or worthless objects even when they have no sentimental value
- Reluctant to delegate tasks
- adopts a miserly spending style toward both self and others.
- Shows rigidity and stubbordness C/D: OCD involves rituals and repetitive thoughts rather than personality characteristics. Personality Change due to another Medical Condition - Medical condition causes pesoanlity change
- Difficulty concentrating or mind blank
- Irritability
- Muscle tension
- Sleep disturbance D: Bipolar II, Adjustment Disorder with Anxiety, Anxiety disorder due to another medical condition, social anxiety, PTSD T: CBT, behavioral, self-monitoring, relaxation, exposure methods. Multimodel approach, Computer based training, Obsessive-Compulsive Disorder - A. Presence of obsessions, compulsions or both.
- Obsessions: Persistent thoughts, urges or images that are experienced that cause marked anxiety or distress. Attempts to ignore or suppress or to nuatrilize them through compulssion
- Compulsions: Repetitive behaviors or mental acts aimed at preventing or reducing anxiety or distress. B. Time consuming Specify: with good or fair insight, poor insight, absent insight/delusional beliefs, tic related T: Behavioral, CBT, REB. Exposure and response prevention for ritualizers. Obsessions respond best to imaginal exposure and thought stopping. Moderate to severe symptoms are prescribed psychotherapy and medication. Intermittent Explosive Disorder - Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either:
- Verbal aggression or physical aggression toward property, animals individuals occurring 2x week for a period of 3 months Physical aggression does not result in damage or destruction of property and does not result in physical injury.
- 3 behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period. B. Not premeditated C. At least 6 Differential: DMDD characterized by a persistently negative mood state most of the day, neary every day, between impulsive aggressive outburts. DMDD can only be given when the onset of recurrent,
problematic, impulsive, aggressive outbursts is before age 10. Should not be made for the first time after age 18. Bipolar I Disorder - Classic manic-depressive. Must meet the criteria for a manic episode which may be followed hypomanic or major depressive episodes. Manic: 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 of hospitalization). B. 3+: Inflated sense of self, grandiose, decreased sleep, flight of ideas, distractibility. C. Marked impairment in... functioning... or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic feature. Harm to self or others.
- May be followed by hypomanic episode or MDD. Neither are required. T: Psychoed, CBT, Deal with acute manic and acute depression. Include patient in diagnosis and treatment. Lithium. Bipolar II: - Must meet criteria for current or past hypomanic episode and criteria for the current or past Major Depress episode. A. Mania-light. B. The hypomanic episode is not severe enough to cause marked impairment in... functioning, or to necessitate hospitalization, and there are no psychotic features Tx: CBT, Lithium... Cyclothymic Disorder - A. For at least 2 years (1 in kids 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 2-year period the hypomanic and depressive periods have been present for at least half the time and individual has not been without the symptoms for more than 2 months. C. Criteria for major depressive, mania or hypomania have not been met. D/C: Bipolar I, II Assessment: MMPI-