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DSM-IV Study Priorities/Tips
Concentrate on essential features and glossary

KNOW: Schizophrenia, Personality Disorders, Mood Disorders, Anxiety Disorders, Also, Autism Disorder, Separation Anxiety Disorder, Delusional Disorder, Anorexia & Bulimia.(Be familiar w/ both essential features and characteristic Sx).
Mental Disorder (According to DSM-IV)
Conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and that is associated with present distress (a painful Sx) or a disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death,pain, disability, or an important loss of freedom.

Must cause significant disress or impairment, and not be an expectable response to a particular event (ie, death of a loved one).

Whatever original cause, must be currently manifestation of behavioral, psychological, biological dysfunction in the person. Deviant behavior or conflicts btw person & society are NOT mental disorders unless is a Sx of personal dysfunction.  There is NO assumption that each disorder is distinct from one another or absence of disorder.
Descriptive Approach of DSM-IV
Disorders due to a General Medical Condition are among those with known etiology, pathophysiological processes. Most disorders, this is unknown.

DSM-IV usually defines disorders solely with a description of clinical features, consisting of identifiable behavioral signs or Sx w/ minimal amount of inference on part of observer.
Atheoretical (As basic feature of DSM-IV)
DSM does not include a theory as to the etiology for pathophysiologic process for most disorders.
List of Basic Features of DSM-IV
Mental Disorder
Descriptive Approach
Diagnosis Criteria
Diagnosis Hierarchies
Multiaxial evaluation system - Axes
DSM-IV Diagnosis Criteria
DSM provides criteria as guides for making Dx - enhances interjudge Dx reliability. Use of index of Sx of which certain #, but no single Sx, is required to make a Dx.

Sometimes, are primary or major Sx (essential or defining features, Criterion A) which must be present and secondary Sx of which a certain # must be present.

Some disorders specify particular temporal pattern or duration of illness that must be present. ie, Panic Disorder (onset to peak < or = 2 yrs), Schizophrenia (duration > or = 6 mos).
2 Principles Governing DSM-IV Diagnostic Hierarchies
1. Substance use or general medical conditions must be ruled out before Sx can be attributed to a disorder and therefore before a DSM Dx can be made

2. If a person has Sx of a more pervasive disorder (like schizophenia) which has assd Sx which might present as the defning Sx of a less pervasive disorder (dysthymia), then ONLY THE MORE PERVASIVE DISORDER is diagnosed.
Multiaxial Evaluation System
DSM-IV uses a multiaxial system in order to make sure any information which may be of value in diagnosis and treatment planning is recorded

Axis I & II: Comprise ALL classified mental disorders plus V Codes (Conditions not attributed to mental disorder that are a focus of attention or treatment). Multiple disorders on either or both Axes may be diagnosed. When more than one diagnosis made, the principal diagnosis is the one chiefly responsible for initiating evaluation & Tx. In these Axes, should specify severity of disorder (mild, moderate, severe, in full remission, partial remission, or residual state). Should also note specifiers & subtypes.
    - Axis I: Clinical syndromes & V Codes, including developmental disorders
- Axis II: includes only Personality Disorders & mental retardation, personality traits &/or the habitual use of a particular defense mechanism

Axis III: General Medical Conditions which are either etiologically significant/potentially related to mental disorder &/OR important to overall mgmt of the case.

Axis IV: Psychosocial & Environmental Problems which may effect Dx, Tx, or prognosis, or which may dev't fully/partially as a consequence of Sx & which need consideration in mgmt plan.

Axis V: Global Assessment of Functioning (GAF). Overall rating of age-appropriate psychological, social & occupational functioning. Do not include physical or environmental impairments to functioning. Usually refers to current functioning but rating may also be given for specific past time periods (i.e. highest level of functioning in past year, etc). Scale from 1 (lowest level of functioning = immediate/persistent danger to self or others, suicidal act w/ clearly deadly intent, or persistent inability to maintain minimal personal hygene) to 100 (superior functioning - problems never out of hand, sought out for positive qualities, no Sx).
List of Basic Medical Terminology & Body Systems Should Know for Exam (11)
Circulatory System
Transports blood throughout body (heart, arteries, veins, related blood transport organs)
Digestive System
Made of organs which break down food into proteins, vitamins, minerals, carbs, fats, which body needs for energy, growth & repair.
Endocrine System
Made of group of glands which produce hormones (body's long-distance messengers) - chemicals which control functions such as metabolism, growth & sexual dev't.
Immune System
Made of organs, tissues, cells & cell products which work together to defend the body against infection & disease.
Lymphatic System
Also a defense system, filters out organisms that cause disease, produces white blood cells, and generates disease fighting anti-bodies. Also distributes fluids and nurishment in the body and drains excess fluids and proteins so that tissues do not swell.
Muscular System
Made up of tissues that work with the skeletal system to control movement of the body. Some muscles are voluntary, some involuntary (controlled automatically by nervous system & hormones).
Nervous System
Made up of brain, spinal cord, and nerves. Body's control system and one of most important systems in the body. Sends, receives and processes nerve impulses which tell your muscles and organs what to do/how to respond to the environment.
Reproductive System
Allows production of children. Sperm fertilizes egg/ovum in fallopian tube; travels to uterus where fetus dev'ps over 9 mos.
Respiratory System
Includes nose, trachea and lungs. Brings air into body & removes CO2.
Skeletal System
Made up of bones, ligaments & tendons. Shapes the body and protects organs. Works with muscular system to help he body move.
Urinary System
Made up of kidneys, bladder. Eliminates waste from the body and cleans the blood. Waste combines with water to form urine.
Conditions which present with psychotic symptoms (*High probability topic for question)
Bipolar 1 Disorder, Major Depression, Substance Induced Mental Disorders and Mental Disorders due to a General Medical Condition (i.e. Amphetamine Induced Psychotic Disorder with Delusional features, Hallucinogen Induced Psychotic Disorder with Hallucinations), Delusional Disorder, Borderline Personality Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder.
Important Criteria for Diagnosing Schizophrenia (*High probability topic for question)
To be diagnosed with Schizophrenia, a person must experience a period of active psychotic symptoms. Much of what used to be called latent schizophrenia would now be called Schizotypal Personality Disorder. If bizarre behavior, impaired communication, impaired social interaction, restricted repertoire of activities and interests, but no delusions or hallucinations are present in a child, consider Autistic Disorder.
Period of Duration for Diagnosis of:
Brief Psychotic Disorder
Schizophreniform Disorder
(*High probability topic for question)
Brief Psychotic Disorder = < 1 mo
Schizophreniform Disorder = < 6 mo
Schizophrenia = > 6 mo
Bipolar I Disorder Requires...
(*High probability topic for question)
Requires at least one period of mania
Diagnosis of anxiety Sx related to separation from parental figure
(*High probability topic for question)
Although it is a form of phobic reaction, should be Dx as Separation Anxiety Disorder
Various conditions which may cause panic attacks & depressive Sx (*High probability topic for question)
If panic attack or depression caused by substance/drug, it is called Substance Induced Anxiety Disorder or a Substance Induced Mood Disorder (i.e. Resperine may cause Sx of Major Depression). If panic attack caused by general medical condition, it is called Anxiety Disorder or Mood Disorder due to a General Medical Condition (i.e. individual with hypothyroidism experiences panic attacks).
Obsessions vs.
(*High probability topic for question
Obsessive brooding - preoccupations, worries and ruminations usually characteristic of depression. Obsessions (related to OCD Dx) distinguished from obsessive brooding by four factors: 1)  Causes significant distress, 2) Takes up more than 1 hr/day, 3) Sx significantly interfere with relationships/work/daily functioning, 3) Individual recognizes his/her obsessions are unreasonable or excessive.
Antisocial Personality Disorder Vs. Conduct Disorder (*High probability topic for question)
Same/similar Sx

Antisocial Personality Disorder = > Age 18
Conduct Disorder  = < Age 18

Dx of ASPD requires that Sx have been present prior to age of 15.
Delusional Disorder Vs. Paranoid Schizophrenia (*High probability topic for question)
Delusional Disorder considered to produce less impairment.

Both disorders assd with psychotic Sx, but Paranoid Schizophrenia assd with prominent auditory hallucinations and bizarre delusions which are not characteristic of Delusional Disorder
Substance Related Disorders (*High probability topic for question)
Drug/Alcohol Intoxication and Withdrawal; + Drug/Alcohol Abuse and Dependence
Disorders which are, by definition, Reactions. (*High probability topic for question)
PTSD, Adjustment Disorder, Acute Stress Disorder, Bereavement
Disorders which are by definition, chronic(*High probability topic for question)
Personality Disorders, Schizophrenia (> or = 6 mo), Dysthymic Disorder & Cyclothymic Disorder (> or = 2 yrs), Generalized Anxiety Disorder (> or  = 6 mo), Hypochondriasis (> or = 6 mo), Somatization Disorder (several yrs).
Paraphilias vs Sexual Dysfunction

Parasomnia vs Dyssomnia

(*High probability topic for question)
Paraphilia = inappropriate sexual practice or object

Sexual dysfunction = inhibition of sexual response

Parasomnia = abnormal event occurring during sleep or between sleep & waking

Dyssomnia = disturbance in amount, timing or quality of sleep
Somatoform Disorders such as Body Dysmorphic Disorder or BDD
(*High probability topic for question)
Somatoform Disorders: disorders characterized by physical complaints that appear to be medical in origin but cannot be explained in term of physical disease, substance abuse or by another mental disorder.

BDD:  Condition marked by excessive preoccupation with imaginary/minor defect in face/localized part of body. Severe enough to cause decline in functioning (often due to lost time obsessing over "defect").
Neurovegetative/"Classic" signs of Depression (*High probability topic for question)
Changes in appetite/weight
sleep disturbance
decrease in energy
decreased sexual desire and function
Conversion Disorder (*High probability topic for question)
Disorder assd with actual loss of motor function or Sx/defecits that affect voluntary motor function, client does NOT produce them voluntarily
Factitious Disorder vs. Malingering (*High probability topic for question)
* In both disorders, client intentionally produces Sx but the incentives are different.

Malingerer: fakes/produces Sx to obtain external reward or achieve a goal

Factitious Disorder: Produces Sx due to psych need to adopt the "sick role." **When someone with this disorder produces phys Sx, it's called Munchausen Syndrome**
Munchausen Syndrome by Proxy vs. Munchausen Syndrome (*High probability topic for question)
Munchausen Syndrome by Proxy: Caregiver, primarily a parent, produces deliberate medical Sx in a child (usually appearing as repeated, unexplainable illnesses). **This is considered a form of child abuse.

Munchausen Syndrome: When someone with Factitious Disorder produces PHYS Sx in themselves, due to psych need to fill "sick role."
Hyperthyroidism (*High probability topic for question)
Can mimic Sx of mania, and/or can present w/ Sx of depression
Mood Disorder (*High probability topic for question)
Refers to disturbance of mood, other Sxs that occur together for minimal duration of time, & are not due to other physical or mental illness.
Dysthymic Disorder (*High probability topic for question)
Depressed mood for most of the day for at least 2 years in adults. In children & adolescents, Sx only need to be present for 1 year & can manifest as irritability. During 2 year period, Sx are never absent for longer than 2 consecutive months.
More than 2m ppl, ~1% of pop over 18 in any given yr, have bipolar disorder.

Classic form of illness, involves recurrent episodes of mania & depression, called Bipolar I Disorder. 

Rapid cycling occurs when 4 or more episodes of illness occur w/in 12 month period

Mixed state is the presence of both depression & mania @ the same time.

Children & adolescents can also dev't bipolar disorder. More likely to affect children of parents w/ the disorder. Children & adolescents often experience very fast mood swings between depression & mania many times w/in a day. Children w/ mania are more likely to be irritable & prone to destructive tantrums than to be overly happy/elated. Bipolar can be difficult to distinguish from other problems which may occur in children.

In Bipolar, there is a distinct period during which predominant mood elevated, expansive, or irritable, usually accompanied by a major depressive episode. The manic episode consists of an elevated mood that may be described as euphoric or unusually good - those close to the person recognize it as excessive. Disturbance is severe enough to impair normal activities & relations w/ others. Manic episodes usually begin suddenly w/ Sx intensifying over few days. Episodes may last from few days to months.

Manic Sx: Inflated self-esteem; decreased need for sleep while feeling full of energy; loud & rapid speech that is difficult to interrupt; continuous flow of speech w/ abrupt changes of topic; distractibility; restlessness; increased sociability; disorganized, flamboyant, or bizarre activities. May be rapid shifts of elevated mood to anger, depression.       

Depressive Sx: Sadness, loss of interest in usual activities, sleep & appetite disturbances. Feelings of worthlessness, guilt. Difficulties thinking or concentrating. Suicidal thoughts or reoccuring thoughts of death. 

BIPOLAR II DISORDER: Involves milder episodes of hypomania that alternate w/ depression. Presence or Hx of more 1 or more depressive episodes, 1 or more hypomanic episodes, but NO manic episodes or mixed episodes. 

Personality Disorders (*High probability topic for question)
An induring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. Pattern is manifested in 2+ areas:
1. cognition (perceiving & interpreting self, others, events
2. affectivity (range, intensity, appropriateness of emotional response)
3. interpersonal functioning OR
4. impulse control     

Cluster A: Odd & Eccentric (*High probability topic for question)
Schizoid Personality Disorder
Paranoid Personality Disorder
Schizotypal Personality Disorder
Cluster B: Dramatic, emotional, erratic (*High probability topic for question)
Antisocial Personality Disorder
Borderline Personality Disorder
Narcissistic Personality Disorder
Histrionic Personality Disorder
Cluster C: Anxious and fearful (*High probability topic for question)
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Schizoid Personality Disorder (*High probability topic for question)
Introverted, withdrawn, solitary, emotionally cold and distant. Absorbed with own thoughts & feelings, fearful of closeness/intimacy w/ others
Paranoid Personality Disorder (*High probability topic for question)
Interpreting actions of others as deliberately threatening or demeaning. Untrusting, unforgiving, prone to angry/aggressive outbursts
Schizotypal Personality Disorder (*High probability topic for question)
Pattern of peculiarities. Odd or eccentric manners of speaking/dressing. Strange, outlandish or paranoid beliefs. Signs/display of "magical thinking."
Antisocial Personality Disorder (*High probability topic for question)
Impulsive, irresponsible, callous. History of legal difficulties, belligerent & irresponsible behavior, aggressive and even violent relationships. No respect for others.
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