Bekah Dsm Iv - Substance Related Disorders

Front 1

What are the Diagnostic Criteria for Substance Dependence?

Back 1

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the substance

(2) Withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance 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 the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present)
Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)

Front 2

What are the six specifiers for Substance Dependence?

Back 2

1. Early Full Remission
2. Early Partial Remission
3. Sustained Full Remission
4. Sustained Partial Remission
5. On Agonist Therapy
6. In a Controlled Environment

Front 3

What is meant by the Substance Dependence Specifier Early Full Remission?

Back 3

This specifier is used if, for at least 1 month, but for less than 12 months, no criteria for Dependence or Abuse have been met.

Front 4

What is meant by the Substance Dependence Specifier Early Partial Remission?

Back 4

This specifier is used if, for at least 1 month, but less than 12 months, one or more criteria for Dependence or Abuse have been met (but the full criteria for Dependence have not been met).

Front 5

What is meant by the Substance Dependence Specifier Sustained Full Remission?

Back 5

This specifier is used if none of the criteria for Dependence or Abuse have been met at any time during a period of 12 months or longer.

Front 6

What is meant by the Substance Dependence Specifier Sustained Partial Remission?

Back 6

This specifier is used if full criteria for Dependence have not been met for a period of 12 months or longer; however, one or more criteria for Dependence or Abuse have been met.

Front 7

What is meant by the Substance Dependence Specifier On Agonist Therapy?

Back 7

This specifier is used if the individual is on a prescribed agonist medication, and no criteria for Dependence or Abuse have been met for that class of medication for at least the past month (except tolerance to, or withdrawal from, the agonist). This category also applies to those being treated for Dependence using a partial agonist or an agonist/antagonist.

Front 8

What is meant by the Substance Dependence Specifier In a Controlled Environment?

Back 8

This specifier is used if the individual is in an environment where access to alcohol and controlled substances is restricted, and no criteria for Dependence or Abuse have been met for at least the past month. Examples of these environments are closely supervised and substance-free jails, therapeutic communities, or locked hospital units.

Front 9

What are the Diagnostic Criteria for Substance Abuse?

Back 9

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Front 10

What are the Codes and Diagnostic Criteria for Alcohol Intoxication?

Back 10

Code 303.00

A. Recent ingestion of alcohol.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion.

C. One (or more) of the following signs, developing during, or shortly after, alcohol use:
(1) slurred speech
(2) incoordination
(3) unsteady gait
(4) nystagmus
(5) impairment in attention or memory
(6) stupor or coma

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 11

What are the Codes and Diagnostic Criteria for Alcohol Withdrawal?

Back 11

Code 291.81

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

B. Two (or more) of the following, developing within several hours to a few days after Criterion A:
(1) autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)
(2) increased hand tremor
(3) insomnia
(4) nausea or vomiting
(5) transient visual, tactile, or auditory hallucinations or illusions
(6) psychomotor agitation
(7) anxiety
(8) grand mal seizures

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: With Perceptual Disturbances

Front 12

What are the Codes and Diagnostic Criteria for Amphetamine Intoxication?

Back 12

Code 292.89

A. Recent use of amphetamine or a related substance (e.g., methylphenidate).

B. Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of amphetamine or a related substance.

C. Two (or more) of the following, developing during, or shortly after, use of amphetamine or a related substance:

(1) tachycardia or bradycardia
(2) pupillary dilation
(3) elevated or lowered blood pressure
(4) perspiration or chills
(5) nausea or vomiting
(6) evidence of weight loss
(7) psychomotor agitation or retardation
(8) muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
(9) confusion, seizures, dyskinesias, dystonias, or coma

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 13

What are the Codes and Diagnostic Criteria for Amphetamine Withdrawal?

Back 13

Code 292.00

A. Cessation of (or reduction in) amphetamine (or a related substance) use that has been heavy and prolonged.

B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:

(1) fatigue
(2) vivid, unpleasant dreams
(3) Insomnia or Hypersomnia
(4) increased appetite
(5) psychomotor retardation or agitation

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 14

What are the Codes and Diagnostic Criteria for Caffeine Intoxication?

Back 14

Code 305.90

A. Recent consumption of caffeine, usually in excess of 250 mg (e.g., more than 2-3 cups of brewed coffee).

B. Five (or more) of the following signs, developing during, or shortly after, caffeine use:

(1) restlessness
(2) nervousness
(3) excitement
(4) Insomnia
(5) flushed face
(6) diuresis
(7) gastrointestinal disturbance
(8) muscle twitching
(9) rambling flow of thought and speech
(10) tachycardia or cardiac arrhythmia
(11) periods of inexhaustibility
(12) psychomotor agitation

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder).

Front 15

What is the Code and Diagnostic Criteria for Cannabis Intoxication?

Back 15

Code 292.89

A. Recent use of cannabis.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.

C. Two (or more) of the following signs, developing within 2 hours of cannabis use:

(1) conjunctival injection
(2) increased appetite
(3) dry mouth
(4) tachycardia

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:
With Perceptual Disturbances

Front 16

What is the Code and Diagnostic Criteria for Cocaine Intoxication?

Back 16

Code 292.89

A. Recent use of cocaine.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of cocaine.

C. Two (or more) of the following, developing during, or shortly after, cocaine use:

(1) tachycardia or bradycardia
(2) pupillary dilation
(3) elevated or lowered blood pressure
(4) perspiration or chills
(5) nausea or vomiting
(6) evidence of weight loss
(7) psychomotor agitation or retardation
(8) muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
(9) confusion, seizures, dyskinesias, dystonias, or coma

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:
With Perceptual Disturbances

Front 17

What is the Code and Diagnostic Criteria for Cocaine Withdrawal?

Back 17

Code 292.00

A. Cessation of (or reduction in) cocaine use that has been heavy and prolonged.

B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:

(1) fatigue
(2) vivid, unpleasant dreams
(3) Insomnia or Hypersomnia
(4) increased appetite
(5) psychomotor agitation or retardation

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 18

What is the Code and Diagnostic Criteria for Hallucinogen Intoxication?

Back 18

Code 292.89

A. Recent use of a hallucinogen.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, hallucinogen use.

C. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use.

D. Two (or more) of the following signs, developing during, or shortly after, hallucinogen use:

(1) pupillary dilation
(2) tachycardia
(3) sweating
(4) palpitations
(5) blurring of vision
(6) tremors
(7) incoordination

E. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 19

What is the Code and Diagnostic Criteria for Inhalant Intoxication?

Back 19

Code 292.89

A. Recent intentional use or short-term, high-dose exposure to volatile inhalants (excluding anesthetic gases and short-acting vasodilators).

B. Clinically significant maladaptive behavioral or psychological changes (e.g., belligerence, assaultiveness, apathy, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, use of or exposure to volatile inhalants.

C. Two (or more) of the following signs, developing during, or shortly after, inhalant use or exposure:

(1) dizziness
(2) nystagmus
(3) incoordination
(4) slurred speech
(5) unsteady gait
(6) lethargy
(7) depressed reflexes
(8) psychomotor retardation
(9) tremor
(10) generalized muscle weakness
(11) blurred vision or diplopia
(12) stupor or coma
(13) euphoria

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 20

What is the Code and Diagnostic Criteria for Nicotine Withdrawal?

Back 20

Code 292.00

A. Daily use of nicotine for at least several weeks.

B. Abrupt cessation of nicotine use, or reduction in the amount of nicotine used, followed within 24 hours by four (or more) of the following signs:

(1) dysphoric or depressed mood
(2) Insomnia
(3) irritability, frustration, or anger
(4) anxiety
(5) difficulty concentrating
(6) restlessness
(7) decreased heart rate
(8) increased appetite or weight gain

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 21

What is the Code and Diagnostic Criteria for Opioid Intoxication?

Back 21

Code 292.89

A. Recent use of an opioid.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, opioid use.

C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use:

(1) drowsiness or coma
(2) slurred speech
(3) impairment in attention or memory

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:
With Perceptual Disturbances

Front 22

What is the Code and Diagnostic Criteria for Opioid Withdrawal?

Back 22

Code 292.00

A. Either of the following:

(1) cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)
(2) administration of an opioid antagonist after a period of opioid use

B. Three (or more) of the following, developing within minutes to several days after Criterion A:

(1) dysphoric mood
(2) nausea or vomiting
(3) muscle aches
(4) lacrimation or rhinorrhea
(5) pupillary dilation, piloerection, or sweating
(6) diarrhea
(7) yawning
(8) fever
(9) Insomnia

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 23

What is the Code and Diagnostic Criteria for Phencyclidine Intoxication?

Back 23

Code 292.89

A. Recent use of phencyclidine (or a related substance).

B. Clinically significant maladaptive behavioral changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, phencyclidine use.

C. Within an hour (less when smoked, "snorted," or used intravenously), two (or more) of the following signs:

(1) vertical or horizontal nystagmus
(2) hypertension or tachycardia
(3) numbness or diminished responsiveness to pain
(4) ataxia
(5) dysarthria
(6) muscle rigidity
(7) seizures or coma
(8) hyperacusis

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:
With Perceptual Disturbances

Front 24

What is the Code and Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication?

Back 24

Code 292.89

A. Recent use of a sedative, hypnotic, or anxiolytic.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, sedative, hypnotic, or anxiolytic use.

C. One (or more) of the following signs, developing during, or shortly after, sedative, hypnotic, or anxiolytic use:

(1) slurred speech
(2) incoordination
(3) unsteady gait
(4) nystagmus
(5) impairment in attention or memory
(6) stupor or coma

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Front 25

What is the Code and Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Withdrawal?

Back 25

Code 292.00

A. Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use that has been heavy and prolonged.

B. Two (or more) of the following, developing within several hours to a few days after Criterion A:

(1) autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)
(2) increased hand tremor
(3) Insomnia
(4) nausea or vomiting
(5) transient visual, tactile, or auditory hallucinations or illusions
(6) psychomotor agitation
(7) anxiety
(8) grand mal seizures

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

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:
With Perceptual Disturbances

Front 26

What is the Code and Diagnostic Criteria for Polysubstance Dependence?

Back 26

Code 304.80

Polysubstance dependence refers to a substance related disorder where an individual meets the criteria for Substance Dependence but uses at least three different classes of substances indiscriminately and does not have a favorite drug that qualifies for dependence on its own.

Front 27

What is the Code and Diagnostic Criteria for Hallucinogen Persisting Perception Disorder (Flashbacks)?

Back 27

Code 292.89

A. The reexperiencing, following cessation of use of a hallucinogen, of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia).

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

C. The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better accounted for by another mental disorder (e.g., Delirium, Dementia, Schizophrenia) or hypnopompic hallucinations.

Front 28

10 Separate classes of Substances

Back 28

1. alcohol

2. caffeine

3. cannabis

4. hallucinogens

5. inhalants

6. opioids

7. sedatives, hypnotics, anxiolytics

8. stimulants

9. tobacco

10. other

Front 29

How substances affect the body

Back 29

1. Instead of achieving reward system activation through adaptive behaviors, drugs of abuse directly activate the reward pathways

2. feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

3. change in brain circuits that may persist beyond detoxification

Front 30

How substances affect the individual

Back 30

1. social impairment

2. impaired control

3. risky use

4. pharmacological criteria

Front 31

General estimate of severity

Back 31

mild: presence of two or three symptoms

moderate: four to five symptoms

severe: six or more symptoms

Front 32

Behavioral and physical symptoms of AUD

Back 32

1. withdrawal: develop 4-12 hours after reduction of intake following prolonged, heavy alcohol ingestion

2. tolerance

3. craving: strong desire to drink that makes it difficult to think of anything else and that often results in the onset of drinking

4. mid teens

5.40-60% genetics

6. higher in males

7. higher in HIspanics

Front 33

Essential ideas

Back 33

1. consider the psychological function of the behavior

2. despite damaging consequences, behavior serves a purpose

Front 34

Self Regulation

Back 34

1. how a client manages the process of adapting to internal and external environmental demands, how one perceives and attempts to meet one's own needs, how one acts as one's own caregiver

2. AT-self regulation

3. external becomes internal-self governing way of adaptation

4. SUD, BD etc external compensatory mechanism used to fix impaired ability to self regulate

Front 35

Dimensions and Dialectics of Self Regulation

Back 35

1.Dimensions: think the various aspects that make up the self (physiology, emotions, cognitions, sense of self, interpersonal relatedness, behavior

2. Dysregulation: represents an extreme of overshooting or undershooting an attempt to balance

a. self: pathological grandiosity vs. intense self loathing

b. affect: over emote vs alexithymia

c. interpersonal: dependence vs counterdepdendnece

**Trauma=negative impact on self regualation

Front 36

Affect Tolerance

Back 36

intensity of the emotion that the person experiences and the ability to modulate that emotion (manage it without becoming disabled)

Front 37

Self Medication

Back 37

self medication hypothesis-physiological effects of individuals drug of choice compensates for deficit in self