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35 Cards in this Set
- Front
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Mental Status Exam (MSE).
Give component headings. |
Appearance, attitude, behaviour
Speech Mood & Affect Thought process & content Perception Abnormal interpretation & experiences Sensorium & Cognition Insight & Judgement "Assessed Mental State To Be Positively Clinically Unremarkable": |
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Mental Status Exam (MSE) mnemonic
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"Assessed Mental State To Be Positively Clinically Unremarkable":
Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns] ASEPTIC A- Appearance and Behaviour S- Speech E- Emotion [mood and affect] P- Perception [Hallucination and illusion] T- Thought content and process I- Insight and Judgement C- Cognition |
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Mnemonic for examination of cognition:
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GOAL-CRAMP
‘I’d like to start off by asking you a few questions to test your concentration and memory……….' G- general: Alertness and Co-operation O- orientation: Time and Place A- attention: WORLD backwards and Serial Sevens L- language: Naming and Repetition C- calculation: Division and Subtraction R- right Hemisphere Function: Intersecting pentagons and Clock-face A- abstraction: Proverbs and Similarities M- memory: Short term and Long-term memory P- praxis: Wave good-bye and Comb hair |
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Depression Symptoms Mnemonic
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S leep changes: increase during day or decreased sleep at night
I nterest (loss): of interest in activities that used to interest them G uilt (worthless): depressed elderly tend to devalue themselves E nergy (lack): common presenting symptom (fatigue) C ognition/C oncentration: reduced cognition &/or difficulty concentrating A ppetite (wt. loss); usually declined, occasionally increased P sychomotor: agitation (anxiety) or retardations (lethargic) S uicide/death preocp. |
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What are the 3 broad classes of antipsychotic ADR?
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1. Anticholinergic (dry mouth, blurred vision, urinary retention, ED)
2. Dopamine blockade (parkinsonian sx, akathisia, TD, dystonia, gynecomastia, malignant neuroleptic syndrome) 3. Hypersensitivity (photosensitivity dermatitis, cholestatic jaundice, neutrophilia (clozapine)) |
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causes of delirium
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Drug intoxication
Alcohol Anxiolytics Digoxin L-dopa 'Street drugs' Withdrawal states Alcohol (delirium tremens) Anxiolytic sedatives Metabolic disturbance Uraemia Liver failure Anoxia Cardiac failure Electrolyte imbalance Postoperative states Endocrine disturbance Diabetic ketosis Hypoglycaemia Systemic infections Pneumonia Urinary tract infection Septicaemia Viral infections Intracranial infection Encephalitis Meningitis Other intracranial causes Space-occupying lesions Raised intracranial pressure Head injury Subdural haemorrhage Cerebral contusion Concussion Nutritional and vitamin deficiency Thiamine (Wernicke's encephalopathy) Vitamin B12 Nicotinic acid Epilepsy Status epilepticus Post-ictal states |
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causes of dementia
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Degenerative type
Senile dementia of Alzheimer's Front temporal dementia* Huntington's chorea Parkinson's disease Normal-pressure hydrocephalus Multiple sclerosis Hereditable Alzheimer's Mutation of presenilin-1 Intracranial space-occupying lesions Tumour Subdural haematomas Traumatic Head injuries Boxing encephalopathy Infections and related conditions Encephalitis Neurosyphilis HIV (AIDS dementia) Jacob-Creutzfeldt disease Vascular Multi-infarct dementia Carotid artery occlusion Metabolic Uraemia Hepatic failure Toxic Alcoholic dementia Heavy-metal poisoning Anoxia Anaemia Carbon monoxide poisoning Cardiac arrest Chronic respiratory failure Vitamin deficiency Vitamin B12 Folic acid Thiamine (Wernicke-Korsakoff's syndrome) Endocrine Myxoedema Addison's disease |
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DSM 4 Criteria:
Paranoid Personality Disorder |
≥ 4 of:
1. Suspects without sufficient basis that others are exploiting, harming, deceiving him/her 2. Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends 3. Reluctant to confide in others due to unwarranted fear that the information will be used maliciously against them 4. Reads hidden demanding/threatening meanings into benign remarks/events 5. Persistently bears grudges (unforgiving of insults, injuries, slights) 6. Perceives attacks on his/her character or reputation that are not apparent to others & is quick to react angrily or counterattack 7. Has recurrent suspicions without justification, regarding fidelity of sexual partner |
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DSM 4 Criteria:
Schizoid Personality Disorder |
≥4 of:
1. Neither desires nor enjoys close relationships (including family) 2. Almost always chooses solitary activities 3. Has little interest in having sexual experiences 4. Takes pleasure in few if any activities 5. Lacks close friends other than 1st degree relatives 6. Appears indifferent to praise/criticism of others 7. Shows emotional coldness, attachment or flattened affect |
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DSM 4 Criteria:
Schizotypal Personality Disorder |
≥5 of:
1. Ideas of reference (excludes delusions of reference) 2. Odd beliefs / magical thinking that influences behaviour (inconsistent with subculture norms) 3. Unusual perceptual experiences (including bodily illusions) 4. Odd thinking & speech 5. Suspiciousness or paranoid ideation 6. Inappropriate or constricted affect 7. Behaviour / Appearance that is odd, eccentric, peculiar 8. Lack of close friends / confidants 9. Excessive social anxiety that doesn't diminish with familiarity and tend to be associated with paranoid fears |
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DSM 4 Criteria:
Antisocial Personality Disorder |
≥3 of:
1. Failure to conform to social norms with respect to lawful behaviors 2. Deceitfulness (repeated lying, use of alias or conning others for personal profit or pleasure) 3. Impulsivity or failure to plan ahead 4. Irritability or aggressiveness as indicated by repeated physical fights or assaults 5. Reckless disregard for safety of self or others 6. Consistent irresponsibility, as indicated by respected failure to sustain consistent work behaviour or honor financial obligation 7. Lack of remorse, as indicated by being infifferent to or rationalizing having hurt/mistreated/stolen from another + evidence of conduct disorder with onset before 15 yo |
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DSM 4 Criteria:
Borderline Personality Disorder |
≥5 of:
1. frantic efforts to avoid real/imagined abandonment 2. a pattern of unstable & intense interpersonal relationships characterised by alternating between extremes of idealisation & devastation 3. identity disturbance: markedly & persistently usntable self-image or sense of self 4. impulsivity ≥ 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating) 5. recurrent suicidal behaviour, gestures/threats or self-mutilating behaviour 6. affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability, anxiety usually lasting a only few hours) 7. chronic feeling of emptiness 8. inappropriate intense anger/difficulty controlling anger 9. transiet stress-related paranoid ideation or severe dissociative symptoms |
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DSM 4 Criteria:
Histrionic Personality Disorder |
≥ 5 of:
1. is uncomfortable in situations in which he/she is not the centre of attention 2. interaction with others is often characterised by iappropriate sexually seductive/provocative behaviour 3. displays rapidly shifting & shallow expression of emotions 4. consistently uses physical appearance to draw attention to self 5. has a style of speech that is excessively impressionistic and lacking in detail 6. shows self-dramatization, theatricality and exaggerated expression of emotion 7. is suggestible (ie. easily influenced by others or circumstances) 8. considers relationships to be more intimate than they actually are |
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DSM 4 Criteria:
Narcissistic Personality Disorder |
≥ 5 of:
1. has a grandiose sense of self-importance (eg. exaggerates achievements or talents, expects to be recognised as superior without commensurate achievements) 2. is preoccupied with fantasies unlimited success, power, brilliance, beauty or ideal love 3. believes that he/she is "special" and unique and can only be understood by or should associate with other special/high status people 4. requires excessive admiration 5. has a sense of entitlement (ie. unreasonable expectation of favorable treatment or automatic compliance with his/her expectations) 6. is interpersonally explictative (ie. takes advantage of others to achieve his/her own ends) 7. lacks empathy (is unwilling to recognise/identify with the feelings and needs of others) 8. is often envious of others/believes that others are envious of him/her 9. shows arrogant, haughty behaviours/attitudes |
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DSM 4 Criteria:
Avoidant Personality Disorder |
≥4 of:
1. avoids occupational activities that involve significant interpersonal contat because of fears of criticism, disapproval/rejection 2. is unwilling to get involved with people unless certain of being liked 3. shows restraint within intimate relationships because of fear of being shamed/ridiculed 4. is preoccupied with being criticised/rejected in social situations 5. is inhibited in new interpersonal situations because of feelings of inadequacy 6. views self as socially inept, personally unappealing or inferior to others 7. is unusually reluctant to take personal risks or engage in new activities because they may prove embarassing |
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DSM 4 Criteria:
Dependent Personality Disorder |
≥ 5 of:
1. difficulty making everday decisions without an excessive amount of advice & reassurance from others 2. needs others to assume responsibility for most major areas of his/her life 3. has difficulty expressing disagreement with others because of fear of loss of support/approval 4. has difficulty initiating projects/doing things on his/her own (due to a lack of self-confidence in judgement/abilities rather than a lack of motivation/energy) 5. goes to excessive lengths to obtain nurturance & support from others, to the point of volunteering to do things that are unpleasant 6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself/herself 7. urgently seeks another relationship as a source of care & support when a close relationship ends 8. is unrealistically preoccupied with fears of being left to take care of himself/herself |
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DSM 4 Criteria:
Passive-Aggressive Personality Disorder |
≥4 of:
1. passively resists fulfilling routine social & occupational tasks 2. complains of being misunderstood and unappreciated by others 3. is sullen & argumentative 4. unreasonably criticises & scorns authority 5. expresses envy & resentment towrads those apparently more fortunate 6. voices exaggerated & persistent complaints of personal misfortune 7. alternates between hostile defiance and contrition |
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DSM 4 Criteria:
*Major Depressive Episode |
≥5 symptoms for ≥ 2 weeks, with ≥1 being depressed mood or anhedonia:
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gain 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide |
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DSM 4 Criteria:
Premenstrual Dysphoric Disorder |
In most menstrual cycles during the past year, five (or more) of the following symptoms occurred during the final week before the onset of menses, started to improve within a few days after the onset of menses, and were minimal or absent in the week postmenses, with at least one of the symptoms being either (1), (2), (3), or (4):
(1) marked affective laibility (e.g., mood swings; feeling suddenly sad or tearful or increased sensitivity to rejection) (2) marked irritability or anger or increased interpersonal conflicts (3) markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts (4) marked anxiety, tension, feelings of being "keyed up" or "on edge" (5) decreased interest in usual activities (e.g., work, school, friends, hobbies) (6) subjective sense of difficulty in concentration (7) lethargy, easy fatigability, or marked lack of energy (8) marked change in appetite, overeating, or specific food cravings (9) hypersomnia or insomnia (10) a subjective sense of being overwhelmed or out of control (11) other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain |
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DSM 4 Criteria:
Chronic Depressive Disorder (Dysthymia) |
A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder. G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: Early Onset: if onset is before age 21 years Late Onset: if onset is at age 21 years or older Specify (for most recent 2 years of Dysthymic Disorder): With Atypical Features |
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DSM 4 Criteria:
Bipolar II Disorder |
A. Presence (or history) of one or more Major Depressive Episodes.
B. Presence (or history) of at least one Hypomanic Episode. C. There has never been a Manic Episode or a Mixed Episode. D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
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DSM 4 Criteria:
Cyclothymic Disorder |
A. For at least 2 years, the presence of numerous periods with hypomanic symptoms (see Criteria for Hypomanic Episode) and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year.
B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time. C. No Major Depressive Episode (Criteria for Major Depressive Episode), or Manic Episode (Criteria for Manic Episode) has been present during the first 2 years of the disturbance. Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed). D. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. E. Symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment). F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
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DSM 4 Criteria:
*Manic Episode |
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree, and represent a noticeable change from usual behavior: 1. inflated self-esteem or grandiosity 2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. more talkative than usual or pressure to keep talking 4. flight of ideas or subjective experience that thoughts are racing 5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed 6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment). Note: A full manic episode emerging during antidepressant treatment (medication, ECT, etc) and persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess or agitation following antidepressant use) are not taken as sufficient for diagnosis of a manic episode. |
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DSM 4 Criteria:
*Hypomanic Episode |
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree: 1. inflated self-esteem or grandiosity 2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. more talkative than usual or pressure to keep talking 4. flight of ideas or subjective experience that thoughts are racing 5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed 6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. F. The episode is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment). Note: A full hypomanic episode emerging during antidepressant treatment (medication, ECT etc) and persisting beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode. |
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DSM 4 Criteria:
Schizophrenia |
A. Characteristic symptoms: ≥2 of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated):
(1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior (5) negative symptoms, i.e., affective flattening, alogia, or avolition Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other. B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the activephase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated). |
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Schizophrenia Subtypes
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295.30 Paranoid Type
A type of Schizophrenia in which the following criteria are met: A. Preoccupation with one or more delusions or frequent auditory hallucinations. B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect. 295.10 Disorganized Type A type of Schizophrenia in which the following criteria are met: A. All of the following are prominent: (1) disorganized speech (2) disorganized behavior (3) flat or inappropriate affect B. The criteria are not met for Catatonic Type. 295.20 Catatonic Type A type of Schizophrenia in which the clinical picture is dominated by at least two of the following: (1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor (2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli) (3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism (4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing (5) echolalia or echopraxia 295.90 Undifferentiated Type A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type. 295.60 Residual Type A type of Schizophrenia in which the following criteria are met: A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). |
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Classification of Longitudinal Course for Schizophrenia
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applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms:
Episodic With Interepisode Residual Symptoms. This specifier applies when the course is characterized by episodes in which Criterion A for Schizophrenia is met and there are clinically significant residual symptoms betweenthe episodes. With Prominent Negative Symptoms can be added if prominent negative symptoms are present during these residual periods. Episodic With No Interepisode Residual Symptoms. This specifier applies when the course is characterized by episodes in which Criterion A for Schizophrenia is met and there are no clinically significant residual symptoms between the episodes. Continuous. This specifier applies when characteristic symptoms of Criterion A are met throughout all (or most) of the course. With Prominent Negative Symptoms can be added if prominent negative symptoms are also present. Single Episode In Partial Remission. This specifier applies when there has been a single episode in which Criterion A for Schizophrenia is met and some clinically significant residual symptoms remain. With Prominent Negative Symptoms can be added if these residual symptoms include prominent negative symptoms. Single Episode In Full Remission. This specifier applies when there has been a single episode in which Criterion A for Schizophrenia has been met and no clinically significant residual symptoms remain. Other or Unspecified Pattern. This specifier is used if another or an unspecified course pattern has been present. |
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DSM 4 Criteria:
Obsessive-Compulsive Disorder |
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4): 1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress 2. The thoughts, impulses, or images are not simply excessive worries about real-life problems 3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action 4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion) Compulsions as defined by (1) and (2): 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly 2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder). E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. |
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DSM 4 Criteria:
Alcohol Use Disorder |
A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (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.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) 4.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 (Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.) 5.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 (Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.) 6.the substance is often taken in larger amounts or over a longer period than was intended 7.there is a persistent desire or unsuccessful efforts to cut down or control substance use 8.a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects 9.important social, occupational, or recreational activities are given up or reduced because of substance use 10.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. 11.Craving or a strong desire or urge to use a specific substance. Severity specifiers: Moderate: 2-3 criteria positive Severe: 4 or more criteria positive |
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DSM 4 Criteria:
Substance Dependence |
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., chainsmoking), 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) |
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DSM 4 Criteria:
Alcohol Withdrawal |
A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
B. Two (or more) of the following, developing within hours to 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. Generalized tonic-clonic 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, or intoxication or withdrawal from another drug. |
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DSM 4 Criteria:
Alcohol Intoxication |
A. Recent ingestion of alcohol.
B. Clinically significant problematic 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 or intoxication with another substance. |
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DSM 4 Criteria:
Acute Stress Disorder |
A. 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 B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms: 1. 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: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress 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, poor concentration, hypervigilance, exaggerated startle response, motor restlessness). F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual’s ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience. G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. |
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DSM 4 Criteria:
PTSD |
A. 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 B. The traumatic event is persistently reexperienced in one (or more) of the following ways: 1. 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. 2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. 3. 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. 4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event 5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event C. 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: 1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma 2. Efforts to avoid activities, places, or people that arouse recollections of the trauma 3. Enability to recall an important aspect of the trauma 4. Markedly diminished interest or participation in significant activities 5. Feeling of detachment or estrangement from others 6. Restricted range of affect (e.g., unable to have loving feelings) 7. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) 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 E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
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Pyschosocial Interview For Adolescents Mnemonic?
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HEADSS
H ome & Environment E ducation & Employment Activities D rugs S exuality S uicide/Depression |
