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102 Cards in this Set

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  • Back
Schizophrenia Diagnosis
Must have 2 or more of the characteristic symptoms during a 6 month period (or less if successfully treated)

Positive Symptoms:
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized behavior

Negative Symptoms:
-Flat Affect
-Poverty of speech
-Inability to initiate goal-directed activity
Positive Symptoms of Schizophrenia
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized behavior
Negative Symptoms of Schizophrenia
-Flat Affect
-Poverty of speech
-Inability to initiate goal-directed activity
Major Depression
Must have 5 or more of the following symptoms (2 of which must include a) depressed mood, and b) loss of interest or pleasure/anhedonia), for a period of at least 2 weeks.

- Depressed mood
- Loss of interest or pleasure in all activities
- Weight loss/weight gain
- Insomnia/hypersomnia
- Psychomotor retardation/agitation
- Fatigue/Loss of energy
- Feelings of worthlessness or guilt
- Inability to concentrate/indecisiveness
- Recurrent thoughts of death
Cluster A of Personality Disorders
Odd and Eccentric:

Paranoid, Schizotypal, Schizoid
Cluster B of Personality Disorders
Dramatic, emotional, and erratic:

Borderline, Antisocial, Histrionic, Narcissistic
Cluster C of Personality Disorders
Anxious and fearful:

Avoidant, Dependent, and OCD
Endogenous Depression
- Depression caused by a biochemical imbalance.
- Classic symptoms of depression.
- Symptoms more severe
Exogenous Depression
- Depression caused by psychosocial stressors.
- Symptoms less severe.
Folie a Deux
Shared delusion
Hypomanic
- Elevated, expansive, irritable mood that is less severe than full-blown manic symptoms.
- Not accompanied by psychotic symptoms

WAIS

Wechsler Adult Intelligence Scale
WISC-R
Wechsler Intelligence Scale for Children
Draw-A-Person Test
Provides information about a child's self image
MMPI
Predominant personality traits or behavior
Rorschach Test
Inkblot
TAT
Thematic Apperception Test
Conversion Disorder
- Loss of motor functioning
- Involuntary
Factitious Disorder
A patient intentionally produces symptoms for an external reward or goal
Malingering
A patient fakes symptoms due to a psychological need to adopt the "sick role"
Munchausen Syndrome
When someone with Factitious Disorder produces physical symptoms
Munchausen's Syndrome by Proxy
When a caregiver produces deliberate medical symptoms in a child

- Considered child abuse.
Schizotypal Personality Disorder
Magical thinking associated with this disorder
Delirium
- Changes in level of consciousness and orientation
- Caused by General medical condition, and/or substance use
- Medical emergency
- Rapid/acute onset
Dementia
- Disturbance involving memory impairment and other cognitive impairments
- Caused by general medical condition
- Can be caused by a series of strokes called vascular dementia, with patchy cognitive symptoms
- Becomes progressively worse over time
Bipolar I Disorder
Presence of only one manic episode and no past Major Depressive episodes.
Bipolar II Disorder
Presence or history of:
- 1 or more Major Depressive Episodes
- At least 1 Hypomanic episode
- No history of manic episodes.
Manic Symptoms
- Period of elevated, expansive, or irritable mood, (LASTING AT LEAST 1 WEEK)

- 3 or more of the following:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Pressured speech
- Flight of ideas or racing thoughts
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high risk for painful consequences
Best Treatment for Bipolar Disorder
Psychopharmocology treatment
Antisocial Personality Disorder
A person with a pervasive pattern of disregard for and violation of the rights of others since the age of 15.

Must have 3 or more of the following:
- Repeatedly performing acts that are grounds for arrest
- Deceitfulness
- Impulsivity
- Irritability and aggressiveness
- Reckless disregard for safety of self and others
- Consistently irresponsible
- Lack of remorse

Must be at least 18 years-old and have a history of conduct disorder with onset before age 15
Personality Disorder
An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. The pattern is manifested in two or more of these areas:
- Cognition
- Affectivity
- Interpersonal functioning
- Impulse control

Personality disorders are:
- Pervasive and inflexible
Onset in adolescence or early adulthood
Pattern is stable and of long duration
- Leads to distress and impairment
Borderline Personality Disorder
Characterized by a pattern of unstable self-image, relationships, emotions, affects, and impulse control.

Must have 5 or more of the following:
- Intense, unstable relationships
- Frantic efforts to avoid abandonment
- Impulsive behavior
- Identity disturbance
- Recureent suicidal behavior, gestures, or threats, self-mutilation
- Chronic feelings of emptiness
- Inappropriate, intense anger
- Can have transient, stress-related paranoid ideation or sever dissociate symptoms.

People with BPD use splitting as a defense mechanism
ADHD
Condition characterized by a failure to remain attentive in 2 or more settings or situations.
Oppositional Disorder
Children with this disorder display their agggressiveness by patterns of obstinate but generally passive behavior. They provoke adults and children by use of:
- Negativism
- Stubbornness
- Dawdling
- Procrastination

- Underlying aggressiveness
- No symptoms of conduct disorder
PTSD in Children, symptoms, and play
- Re-experiencing
- Repetitive play
Autistic Disorder
- Onset before age 3
- Failure to develop the usual relatedness to parents and other people
- May lack social smile
- May avoid eye contact
- May fail to cuddle
- Play schemes are rigid, repetitive, and lack variety
- May manifest over or under responsiveness to sensory stimuli

- 50% severely retarded
- 25% mildly retarded
- 25% IQ of 70 or more
Major Depressive Episode in Kids
- Younger kids may fake illness, be hyperactive, cling to parents and refuse to go to school. They may also fear the death of their parents.

- Older kids may be sulky, refuse to cooperate in family and social activities, get into trouble at school, and may abuse drugs or alcohol.
Identity Disorder
A severe distress regarding a youngster's inability to integrate various aspects of his or her acceptable sense of self.
Rhett's Disorder
The development of persistent and progressive developmental regression after a period of normal development.
- Onset usually before age 4
- Seen only in females
Aspberger's Disorder
Severe and sustained impairment of social interactions and restricted, repetitive patterns of behavior, interests, and activities.
- More common in boys
Side Effects of Antipsychotic Drugs
- Sedation
- Postural hypotension
- Weight gain
- Photosensitivity
- Sexual dysfunction
Breast swelling (gynecomastia)

Anticholinergic Side Effects:
- Dry mouth
- Blurred vision
- Urinary hesitation
- Constipation

- Tardive Dyskinesia: Abnormal involuntary movements of the lips, jaw, face, and twitching

Extrapyramidal symptoms:
- Parkinsonian syndrome: Tremor, rigidity, and slowed movement

Akinesia: Slowness in all natural movements

Akathisia: Inner restlessness, purposeful motor movement

Acute Dystonic Reactions: Involuntary muscle spasms or tightening of face
Tardive Dyskinesia
Abnormal involuntary movements of the lips, jaw, face, and twitching
Parkinsonian syndrome
Tremor, rigidity, and slowed movement
Akinesia
Slowness in all natural movements
Akathisia
Inner restlessness, purposeful motor movement
Acute Dystonic Reactions
Involuntary muscle spasms or tightening of face
Neuroleptic Malignant Syndrome
- Medical emergency
- Occurs soon after starting a neuroleptic
- Fever
- Muscle rigidity
- Mental status changes
- Tachycardia: Fast heart rate
Commonly used (typical) Antipsychotic Drugs
Usually neuroleptics and major tranqullizers

- Thorazine (Choloromazine)
- Prolixin (Fluphenazine)
- Haldol (Haloperidol)

Others:
- Mellaril
- Stelazine
- Navane
What are Atypical Antipsychotic drugs most effective for?
- Negative symptoms of schizophrenia
- Less extrapyramidal symptoms
- Lower risk for Tardive Dyskinesia
Atypical Antipsychotic Drugs
- Clozapine (Clozaril)
- Risperidone (Risperdal)
Clozapine
- Antipsychotic Drug
- 5ht Blocker, affinity of D4 receptor for clozapine

Side Effects:
- Increased saliva, drooling
- Sedation
- Nausea
- Hypotension and dizziness
- Tachycardia
- Weight gain
- Increased risk of seizures
- Increased rick of agranulocytosis.

Useful in treatment-resistant patients
Risperidone
Atypical Antipsychotic

- 5HT and D5 antagonist

Side Effects:
- Sedation **
- Headache, dry mouth, constipation, blurred vision, urinary retention, palpitations, nervousness
Antidepressant Drugs
- TCA's (Trycyclic Antidepressants)
- MAOI's (Miniamine Oxidase Inhibitors)
TCA's (Trycyclic Antidepressants)
- Tofranil *
- Elavil *
- Aventyl, Pamelor, Norpramin, Adapin, Sinequan

Side Effects:

Autonomic, anticholinergic:

- Dry mouth, blurred vision, constipation, urinary hesitancy/retention, sweating, sensitivity to heat

Cardivascular:
- Postural hypotension, tachycardia, change in EKG arrhythmias

Percipitation of hypomania in some bipolar patients

- Contraindicated for patients with heart disease
- Lethal when overdosed
- Therapeutic effects take 2-3 weeks to begin
MAOI's (Monoamine Oxidase Inhibitors)
- Nardil
- Parnate
- Marplan

- Most effective for treating atypical depressions and non-endogenous depressions

Side Effects:
- Hypertension (if taking a high dose, using with a TCA, or consuming a food with high tyramine)

- Adverse drug reactions (Stimulants, appetite suppressants, cold remedies, cocaine derivatives, TCA's, any medicine that raises blood pressure)

- Dietary restrictions: Foods with high levels of tyramine (ex: beer, wine, cheese, beef or chicken liver etc.)
What are MAOI's most effective at treating?
- Atypical depressions
- Non-endogenous depressions
Second-Generation Antidepressants
- Similar effectiveness to TCA's and MAOI's, but reduced side effects.

- Asendin
- Desyrel
- Ludiomil
- Wellbutrin
- Effexor
- Serzone

- SSRIs
SSRI's (Selective Serotonin Reuptake Inhibitors)
- Prozac
- Zoloft
- Paxil

- Effect comparable to TCA's

Side Effects (dose-related):
- Weight loss
- Nausea
- Diarrhea
- Nervousness (Floxetine/Prozac)
- Insomnia

- Less toxic to the heart and safer in overdose than TCA's
What are Mood Stabilizers Used to Treat?
Bipolar Disorder
Mood Stabilizers
- Lithium (Li)
- Anticonvulsants (Tegretol, Depakote)
Lithium (Li)
- Small difference between toxic and therapeutic levels
- Need to periodically check blood levels, thyroid, and kidney)

Side Effects:

- Thyroid Gland: Enlarging, and making it underactive

- Renal/Kidney: Increased drinking and urination

- Gastrointestinal: Gastric irritation, anorexia, cramps, nausea, vomitting, diarrhea

- Central Nervous System (CNS) and Neuromuscular: Mental dullness, decreased memory and concentration, headache, fatigue, muscle weakness, hand tremor

- Weight gain
- Avoid during 1st trimester of pregnancy
- Requires 2 or more weeks to see therapeutic effects, fully contain an episode of mania
- Most effective in preventing recurrences of mania and depression
Carbamazepine (Tegretol)
- Mood stabilizer

- Avoid taking it during pregnancy (particularly during 1st trimester)

- May depress bone marrow function

- Requires monitoring of blood count
Valproic Acid (Depakote)
- Mood Stabilizer

- Most effective for rapid cycling and mixed bipolar disorders

- Avoid taking it during pregnancy (particularly during 1st trimester)
What meds are used to treat Panic Disorder With or Without Agoraphobia?
- TCA's
- MAOI's
- Xanax
- SSRI's
What meds are used to treat OCD?
- TCA's (Anafranil)
- MAOI's
- SSRI's (Luvox, Zoloft)
What meds are used to treat specific phobia and Social Phobia?
- Beta Blockers (Propanolol) for somatic symptoms of stage fright.

- Paxil (Social Phobia)
What meds are used to treat Generalized Anxiety Disorder?
Benzodiazepines
Benzodiazepines
- Useful for symptoms of Generalized Anxiety Disorder
- Safer than barbiturates

- Benzodiazepines commonly used as minor tranquilizers: Valium, Librium, Ativan, Tranxene

- Difficult to discontinue
- Drug most commonly used in overdoses

Side Effects:

- Impaired muscle coordination (psychomotor functions)
- Impairment in short-term memory (anterograde memory)
Anxiolytic Drugs (Minor Tranquilizers)
- Barbituates

- Formerly used: Methaqualone (Quaaludes, Sopors), Hydroxyine (Atarax, Visaril), Meprobamate (Miltown)

- Anti-psychotic drugs

For Generalized Anxiety Disorder, can use BuSpar, but it takes 2 weeks to see effects)
Barbituates
- Minor tranquilizer
- High abuse potential
- Dangerous when combined with alcohol
Drugs used to induce sleep (Hypnotic Drugs)
- Benzodiazepines: Dalmane, Halcion, Restoril

- Barbituates, Chloral hydrate

- Trazadone (Desyrel)
Drugs that are Used to Treat Hyperactivity in Children
- Psychostimulants:
- Ritalin
- Aderall (amphetamine)
Side Effects of Psychostimulants
- Insomnia
- Decreased appetite
- Stomachaches
- Headaches
- Jitteriness
What is the strongest predictor for developing an alcohol problem?
A family history of alcoholism
Risk factors for alcoholism
- Demographic: Male/poor/unemployed
- Family: Family history of alcoholism
- Social: Peers, cultural norms
- Genetic: Inherited predisposition
- Psychiatric: Depression, anxiety, low self-esteem, low tolerance for stress
Behavioral: Use of other substances, conduct disorder, antisocial personality disorder, impulsivity etc.
Biopsychosocial Model (Substance Abuse)
Holistic model that incorporates: -
- Hereditary predisposition,
- Emotional/psychological problems
- Social influences
- Environmental problems.
Medical/Biological Model (Substance Abuse)
- Addiction is considered a medical disease

A) Genetic causes: Inherit vulnerability to addiction

B) Brain Reward Mechanisms:
Substances act on parts of brain and reinforce continued use by producing pleasurable feelings

C) Altered Brain Chemistry: Habitual use of substances alter brain chemistry and continued use of substances is required to avoid feeling discomfort from the brain imbalance
Clinical Model (Substance Abuse)
Substances are used to escape painful problems of life.
Alcohol Assessment Instruments
- CAGE-AID
- TWEAK TEST: To screen pregnant women
- (MAST) Michigan Alcoholism Screening Test
What should you do if a client with a long-standing substance abuse problem comes in for psychotherapy?
Refer for substance abuse treatment before beginning psychotherapy
What should a person with alcoholic problems be assessed for?
- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications
- Emotional/Behavioral conditions (Psychiatric evaluation)
- Treatment acceptance or resistance
- Relapse potential or continued use potential
- Recovery/Living environment
Wernicke's Encephalopathy and Korsakoff's Syndrome
Disorders associated with chronic abuse of alcohol. They are caused by a thiamine (Vitamin B1) deficiency resulting from the chronic consumption of alcohol.

- A person with Korsakoff's Syndrome has memory problems

- Treatment is administration of thiamine

- Korsakoff's syndrome is also called Alcohol-Induced Persisting Amnestic Disorder Due to Thiamine Deficiency

- Found under Amnestic Disorders rather than substance abuse disorders
Substance Abuse
A maladaptive pattern of abuse leading to significant impairment in functioning or distress.
- The person continues to abuse substances despite persistent or recurrent negative consequences and problems related to employment, school, interpersonal relationships, social situations, and legal issues.
Substance Dependence
May involve a physiologic tolerance in which increasing amounts of substances are required to achieve intoxication and withdrawal symptoms occur.
- The person takes larger amount of the substance while trying to cut down or control substance use.
- Life centers around obtaining and using the substance despite ongoing negative consequences associated with its use
What is required to make a diagnosis of substance dependence?
- You do not need to have tolerance or withdrawal symptoms to make a diagnosis (tolerance and withdrawal are only 2 of the 7 criteria)
- You do need evidence of a significant impairment in functioning or distress, such as family, legal, or employment problems.
Goals of Treatment for Substance Abuse
1. Abstinence from substances
2. Maximizing life functioning
3. Preventing or reducing the frequency and severity of relapse
Symptoms of Alcohol Withdrawal Delirium
- Delirium
- Hallucinations
- Delusions
- Agitated behavior
- Autonomic hyperactivity (sweating and rapid pulse)
Stages of Substance Abuse Treatment
1. Stabilization: Focus is on establishing abstinence, accepting substance abuse problem, and committing self to making changes

2. Rehabilitation/Habilitation: Focus is on remaining substance free by establishing a stable lifestyle, developing coping and living skills, increasing supports, and grieving loss of substance use

3. Maintenance: Focus is on stabilizing gains made in treatment, relapse prevention, and termination
Which three categories of substance require detoxification?
- Central Nervous System depressants such as Alcohol, Barbiturates, and Benxodiazapines
- Opiates (Heroine)
- Cocaine
What are the Physiological and Behavioral Signs of Cocaine Intoxication?
- Dilated pupils
- High feeling
- Euphoria
- Hyperactivity
- Restlessness
- Anxiety
- Impaired Judgment
- Tachycardia
- Perspiration or chills
- Nausea or vomitting
Muscle Weakness
- Increased blood pressure

With chronic cocaine use, you might see:
- Depression of pulse, blood pressure, mood, and psychomotor activity
Biologically Based Treatment Modality for Substance Abuse
Replace an illict drug with a prescribed medication:

- Antabuse
- Methadone
- Nalterxone
Antabuse
A medication which produces highly unpleasant side effects if the patient drinks alcohol, such as: flushing, nausea, vomiting, Hypotension, and anxiety

- A form of aversion therapy
Methadone
Synthetic narcotic taken instead of opiates
Naltrexone
Drug used to reduce cravings for alcohol
Treatment Setting Goal for Substance Abuse Treatment
The goal is to math the patient's needs with the least restrictive treatment environment that is safe and effective
Continuum of care settings for Substance Abuse from most intensive to least intensive
- Inpatient hospitalization (including inpatient detox and rehab)
- Residential treatment
- Intensive outpatient treatment
- Outpatient treatment

PTSD

The person has been exposed to a traumatic event in which both of the following were present:


(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.


(2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.




The traumatic event is persistently reexperienced in one (or more) of the following ways:




(3) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.


(4) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.


(5) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience; illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.


(6) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.


(7) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.




Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:




(8) Efforts to avoid thoughts, feelings, or conversations associated with the trauma


(9) Efforts to avoid activities, places, or people that arouse recollections of the trauma


(10) Inability to recall an important aspect of the trauma


(11) Markedly diminished interest or participation in significant activities


(12) Feeling of detachment or estrangement from others


(13) Restricted range of affect (e.g., unable to have loving feelings)


(14) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal lifespan)




D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:


(1) Difficulty falling or staying asleep


(2) Irritability or outbursts of anger


(3) Difficulty concentrating


(4) Hypervigilance


(5) Exaggerated startle response




Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.




Specify if:


Acute: if duration of symptoms is less than 3 months


Chronic: if duration of symptoms is 3 months or more Specify if: With Delayed Onset: if onset of symptoms is at least 6 months after the stressor.

Acute Stress Disorder
The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actualor threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person’s response involved intense fear, helplessness, or horror. Note: In children, this may beexpressed instead by disorganized or agitated behavior.

B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) ofthe following dissociative symptoms:
(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness(2) a reduction in awareness of his or her surroundings (e.g., “being in a daze”)
(3) derealization
(4) depersonalization
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

C. The traumatic event is persistently reexperienced in at least one of the following ways:
Recurrentimages, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; ordistress on exposure to reminders of the traumatic event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings,conversations, activities, places, people).

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poorconcentration, hypervigilance, exaggerated. startle response, motor restlessness).F. The disturbance causes clinically significant distress or impairment in social, occupational, or otherimportant areas of functioning or in:; the individual's ability to pursue some necessary task, such asobtaining necessary assistance or mobilizing personal resources by telling f..:. members about thetraumatic experience.

F. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4weeks of the traumatic event.

G. The disturbance is not due to the direct physiological effects substance (e.g., a drug of abuse, amedication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder,and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

Conduct Disorder
A. A repetitive and persistent pattern 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 three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

Aggression to people and animals
(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
(7) has forced someone into sexual activity Destruction of property
(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others' property (other than by fire setting)Deceitfulness or theft
(10) has broken into someone else's house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules
(13) often stays out at night despite parental prohibitions, beginning before age 13 years (14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Specify type based on age at onset: Childhood-Onset Type:
onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years (new code as of 10/01/96: 312.81)
Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years (new code as of 10/01/96: 312.82) (new code as of 10/01/96: 312.89 Unspecified Onset)

Specify severity: Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others
Moderate: number of conduct problems and effect on others intermediate between "mild" and "severe"
Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

Somatization Disorder
A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.


B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:
(1) four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination) (2) two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)
(3) one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)
(4) one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)

C. Either (1) or (2): (1) after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication) (2) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings D. The symptoms are not intentionally feigned or produced (as in Factitious Disorder or Malingering).

Oppositional Defiant Disorder
A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others (7) is often angry and resentful
(8) is often spiteful or vindictive
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder. D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Hypochondriasis
A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.
B. The preoccupation persists despite appropriate medical evaluation and reassurance.
C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).
D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The duration of the disturbance is at least 6 months.
F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder. Specify if: With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable