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157 Cards in this Set

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Describe agoraphobia.
The fear of situations or places where there may be trouble obtaining help when anxious.
Describe panic attack.
Brief episode in which a patient feels intense dread with physical and other symptoms. It begins suddenly and peaks rapidly.
Describe panic disorder.
Repeated attacks with worry about additional attacks. Usually occurs with agoraphobia.
Describe agoraphobia w/o history of panic disorder.
A codable form of agoraphobia related to FEAR of developing panic-like symptoms. Full criteria for panic disorder not met.
Describe specific phobia.
Patients fear specific objects or situations: animals, storms, heights, blood, airplaines, being closed in, vomiting, choking, becoming ill.
Describe social phobia.
Patients imagine themselves embarrassed when they speak, write, eat, or use a public urinal.
Describe obsessive-compulsive disorder.
Patients bothered by repeated thoughts or behaviors that appear senseless.
Describe posttraumatic stress disorder.
Patients repeatedly relive a severely traumatic event, such as combat or natural disaster.
Describe acute stress disorder.
Much like posttraumatic stress disorder. Duration: less than a month
Describe generalized anxiety disorder.
No episodes of acute panic. Patients feel tense or anxious much of the time.
Describe anxiety disorders due to general medical condition.
Panic attacks or GAD symptoms can be caused by numerous medical conditions.
Describe substance-induced anxiety disorder.
Anxiety symptoms that don't necessarily fulfill criteria for any of the former mentioned disorders.
Describe anxiety disorder NOS.
Prominent anxiety symptoms that do not fit neatly into any of the former mentioned groups.
Describe other causes of anxiety symptoms.
Avoidance behavior associated with sexual aversion (classified with sexual dysfunctions).
How do patients cope with agoraphobia?
Avoids situations or places, endures them with material distress, requires a companion.
What precipitates a panic attack.
Pt. develops severe fear or discomfort that peaks within 10 minutes.
List symptoms of panic attack.
chest pain, chills or hot flashes, choking sensation, derealization or depersonalization, dizzy, fear of dying, fears of loss on control, heart pounding, nausea, numbness, sweating, shortness of breath, trembling.
List criteria for agoraphobia without history of panic disorder.
Pt. has agoraphobia related to fear of experiencing panic-like symptoms. Pt. never fulfilled criteria for panic disorder. Organicity ruled out. If GMC, fears clearly exceed those usually present with disorder.
List criteria for panic disorder with agoraphobia.
Pt. has unexpected recurrent panic attacks. for 1 mo or more pt. has one or more: ongoing concern for the next attack, wrory as to significance of attack, change in behavior to ward off next attack. Pt. has agoraphobia, panic attacks are not directly caused by a gmc or by the used of substances, including meds. Not better explained by another anxiety or mental disorder.
List criteria for panic disorder without agoraphobia.
Same as above only without agoraphobia.
List criteria for specific phobia.
Pt. experiences excessive fear set off by cue that's present or anticipated. Stimulus almost always provokes response as panic attack or symptoms that do not meet criteria of panic attack. Pt. realizes fear is unreasonable. Pt. avoids stimulus or endures it with distress. Pt. under 18 must have symptoms 6 mos. or longer. Fear interferes with pt.'s usual routines. Symptoms not better explained by another anxiety or mental disorder.
List coding types for specific phobias.
Situational (airplane travel, being closed in), natural environment (storms), blood-injection-injury, animals, other (situations that might lead to illness, choking, vomiting.
List criteria for social phobia.
Pt. fears social or performance situation (embarrassment). stimulus causes anxiety (cued or situationally predisposed PA), Pt. knows fear is unreasonable, fear interferes with normal functioning, not better explained by another mental disorder, under 18-6 mos or longer, organicity ruled out, phobia not related to pt.'s other mental disorder or gmc.
List Obsessions criteria for obsessive-compulsive disorder.
Obsessions: recurring thoughts, etc. which cause anxiety, ideas not just extreme worries about ordinary things, pt. tries to neutralize by thoughts or behavior, pt. aware that ideas are product of pt.'s own mind.
List Compulsions criteria for obsessive-compulsive disorder.
Compulsions: Pt. feels need to repeat physical or mental behaviors, Behavior occurs as response to obsessions, Aim of behavior is to reduce distress, behaviors not realistically related to events they are supposed to counteract.
T or F. During some part of OCD, pt. recognizes that obsessions are unreasonable or excessive.
Obsessions and/or compulsions of OCD are associated with at least one of the following:
They cause severe distress.
They take up time (more than 1 hr. per day).
They interfere with pt.'s normal routines.
T or F. The symptoms of OCD are directly caused by a general medical condition or by use of substances, including meds.
F. They are NOT directly caused...including meds.
T or F. If pt. has another Axis I disorder, the content of obsessions or compulsions is not restricted to it.
What is critical to specify with a diagnosis of OCD?
Specify if: with poor insight, meaning pt. is unaware that the thoughts or behaviors are unreasonable.
Which two elements must be present with an unusual traumatic event for the diagnosis of PTSD
Pt experienced unusually traumatic event with a. actual threatened death or injury to pt. or others, b. pt. felt intense fear, horror, helplessness.
How does the PTSD relive the traumatic event?
a. intrusive distressing thoughts, images. b. repeated, distressing dreams, c. flashbacks, hallucinations, d. marked mental distress, e. physiological reactions
Explain how pt. avoids the trauma-related stimuli and reflects general numbing (3 or more for diagnosis)
Tries to avoid feelings, activities that recall the event. Cannot recall important features of event, experiences marked loss of interest in former activities, feels detached from other people, restricted ability to love, feels life will be brief or unfulfilled.
List the symptoms of hyperarousal that are not present prior to witnessing a traumatic event.
Insomnia, angry outbursts, poor concentration, excessive vigilance, increased startle response.
How long must at least two of the above symptoms last for a diagnosis of PTSD?
Longer than one month.
How do PTSD symptoms impair general functioning?
These symptoms cause clinically important distress or impair work, social or personal functioning.
List specific coding notes for PTSD.
Acute: symptoms lasted less than 3 mos. Chronic: Symptoms lasted 3 mos. or longer. With delayed onset: symptoms did not appear until at least 6 mos. after the event.
How are young children particularly affected by PTSD?
Response to event may be agitation or disorganized behavior. Young children may relive the event through play, trauma-specific re-enactment, or nightmares.
List criteria for acute stress disorder.
Pt. has traumatic event where actual or threatened death or serious illness. Pt. felt intense fear, horror, or helplessness.
Pt. must experience three or more symptoms of dissociation for diagnosis of Acute Stress Disorder. List them all.
Feelings of detachment or numbing out, diminished awareness of surroundings, derealization, depersonalization, amnesia.
Pt. must repeatedly re-experience the event of acute stress disorder in one or more of the following ways.
Recollections (dreams, flashbacks, illusions, etc.), Sense of reliving the event, mental distress as reaction to reminds of event.
Which disorder causes pt. to strongly avoid activities, coversations, feelings, people places, or thoughts reminiscent of a traumatic event?
Acute stress disorder.
List the marked symptoms of anxiety of Acute Stress Disorder.
Excessive vigilance, insomnia, irritability, poor concentration, restlessness or increased startle response.
Which disorder must at least one of the following apply? Pt. feels marked distress, personal functioning impaired, pt. blocked from getting help or telling others about traumatic event?
Acute Stress disorder
Symptoms of which disorder begin within four weeks and last from 2 days to 4 weeks?
Acute Stress disorder
Name the last three criteria not yet mentioned in acute stress disorder.
Organicity ruled out, disorder not merely a wrosening of another Axis I or II disorder, brief psychotic disorder ruled out.
List time duration for diagnosis of generalized anxiety disorder.
For more than half the days in at least six months, pt. experiences excessive anxiety with trouble controlling these feelings.
List the symptoms pt. must have three or more of to be diagnosed with GAD.
Restlessness, tires easily, trouble concentrating, irritability, increased muscle tension, trouble sleeping.
T or F. In generalized anxiety disorder, aspects of another Axis I disorder provide the focus of the anxiety and worry.
F. aspects of another Axis I disorder DO NOT provide...worry.
T or F. GAD does not occur only during a mood disorder, psychotic disorder, PTSD, or a pervasive developmental disorder.
Out of the following: restlessness, tires easily, trouble concentrating, irritability, increased muscle tension, trouble sleeping, how many must a child have to be diagnosed with GAD?
One out of the six mentioned symptoms.
List the other Axis I disorders with which worry is a concern.
Anorexia Nervosa (weight), OCD (contamination), Panic Disorder (fear of attack), SAD (separation from home), Social Phobia (public embarrassment), Somatoform disorders (having physical symptoms)
List criteria for Anxiety Disorder due to General Medical Condition.
a. Pt. has prominent anxiety, compulsions, obsessions, or panic attacks. b. Lab findings show GMC that seems related, c. No other mental disorder better accounts for symptoms, d. symptoms impair functioning, e. symptoms don't occur solely during delirium.
List specifications for coding Anxiety Disorder due to GMC.
With generalized anxiety, with panic attacks, with obsessive-compulsive symptoms.
In Anxiety Disorder due to GMC, DSM-IV specifically mentions that a disorder precipitated by the stress of a serious medical illness must be ruled out. Which disorder is that?
Adjustment disorder with anxiety. (p. 280 DSM-IV Made Easy)
Coding Note: In Axis I diagnosis, when you include the name of the actual general medical condition, what corresponding notes go on Axis III?
On Axis III, code the specific general medical condition.
List criteria for substance-induced anxiety disorder.
Pt. has prominent anxiety, compulsions, obsessions, or panic attacks.
History, physical exam, or laboratory tests substantiate that either one of two conditions reveal that a substance-induced anxiety disorder is likely.
The symptoms have developed within a month of substance intoxication or withdrawal. Medication use has caused the symptoms.
Besure to to specify the following when coding substance-induced anxiety disorder.
a. Code whether alcohol 291.8, or amphetamine-like substance 292.89. b. Specify whether with GAD, Panic attacks, phobic symptoms. c. Depending on onset specify with onset during intoxication or during withdrawal.
Give example of how to code Thyroxin-induced anxiety disorder.
Axis I: Thyroxin-Induced Anxiety disorder, with GAD
Axis III Thyroid replacement (Thyroxin)
List categories possible under Anxiety Disorder NOS.
Fear of offensive body odor (avoid social contact), mixed anxiety-depressive disorder (do not meet criteria for either), phobic symptoms due to another disorder (medical or mental i.e. AIDS), Other (can't tell what causes the anxiety but pt. has the disorder)
Describe somatization disorder.
Multiple, unexplained symptoms (including pain and mood symptoms). Found almost exclusively in women.
Describe undifferentiated somatoform disorder.
A residual category for pts. who do not meet criteria for any other somatoform disorder. Useful for pts. who almost meet criteria for somatization disorder.
Describe conversion disorder
Isolated symptoms that seem to have no physical cause
Describe pain disorder
Pain in question has no apparent physical or physiological basis, or it far exceeds the usual.
Describe hypochondriasis.
The unfounded fear of a serious, often life-threatening illness such as cancer or heart disease may warrant this diagnosis.
Describe body dysmorphic disorder
Physically normal pts believe that parts of their bodies are misshapen or ugly.
Describe somatoform disorder NOS.
A catchall category for pts. whose somatoform symptoms fail to meet criteria for any of the other disorders, including undifferentiated.
List other causes of somatic complaints.
GMC, mood disorder, substance use, factitious disorder, malingering
List criteria for conversion disorder.
At least one symptom suggests neurological or GMC and is not limited to pain or sexual dysfunction. Appropriate nvestigation does not fully explain symptom. Conflict precedes onset of symptom, suggesting psychological factors present. Pt. doesn't feign symptoms for money.
T or F Conversion Disorder is diagnosed in the presense of culturally sanctioned behavior or experience.
F, it is not a culturally sanctioned behavior or experience to be considered a conversion disorder.
Symptoms of conversion disorder must be serious enough to produce at least one the following three:
It warrants medical evaluation, it causes clinically important distress, it impairs personal functioning.
T or F. Conversion disorder occurs solely during somatization disorder.
F It DOES NOT occur solely during somatization disorder, and no other mental disorder better explains it.
List the four types of symtoms or deficits which must be specified when coding conversion disorder.
1. with motor symptom 2. with seizures or convulsions 3. with sensory symptom 4. with mixed presentation
Describe criteria for somatization disorder
Starts before age 30 with physical complaints over several yrs. Pt sought tx for symptoms or symptoms impaired functioning.
How many pain symptoms must a person have for somatization disorder?
Four or more
How many gastrintestinal symptoms must a person have for somatization disorder?
Two or more, excluding pain
How many pseudoneurological symptoms must a person have for somatization disorder?
At least one
For either pain, gastrointestional, or pseudoneurological symptoms, ONE of the following conditions must be met. List them.
1. Physical or lab reports determine symtom cannot be fully explained by GMC or by use of substances. 2. If pt. does have GMC, the impairment exceeds what would generally be expected.
T or F Pt. consciously feigns symptoms of somatization disorder for material gain or to occupy the sick role.
F Pt. DOES NOT consciously feign...the sick role.
Describe the physical complaints of undifferentiated somatoform disorder
Trouble breathing, chest pain, painful urination, fatigue, etc.
Name the two conditions, of which one must be met, for above symptoms to be counted as undifferentiated somataform disorder.
1. Physical or lab tests determine symtom cannot be fully explained by GMC or by the use of substances. 2. If pt. does have GMC, the impairment or complaints exceed what would be expected.
How long does the condition impairing functioning and symptoms have to exist be considered undifferentiated somatoform disorder?
Six months or longer.
List two conditions which must be ruled out prior to diagnosing undifferentiated somatoform disorder.
The disorder is better explained by another mental disorder, and patient consciously feigns symptoms for material gain.
List criteria for pain disorder.
1. Clinically important pain in one or more body areas. 2. Pain impairs personal functioning. 3. Psychological factors factor in onset. 4. Other disorders ruled out (mood, anxiety, psychotic) and pt. does not have Dyspareunia. 5. Pt. doesn't feign symptoms or try to occupy sick role.
When pain disorder is associated with both psychological factors and a GMC, coding must be specified as to which two criteria?
Acute: has lasted less than six months
Chronic: has lasted six months or longer. In addition (p. 301) code site of pain on Axis III (abdominal, back, back, low, etc.)
Describe criteria for hypochondriasis.
Pt. becomes preoccupied with fears of having serious illness. Appropriate medical investigation does not relieve the ideas. Ideas are not delusional or restricted to body appearance. Symptoms cause distress that impairs functioning. Lasted six months or longer. Not better explained by GAD, MDD, OCD, Panic disorder, SAD, or different somatoform disorder. Specify when: with poor insight.
List criteria for body dysmorphic disorder.
Pt. preoccupied with imaginary defect of appearance or slight physical flaw. Impairs personal functioning. Another disorder (Anorexia Nervosa) does not better explain preoccupation.
List categories which make up somatoform disorder not otherwise specified. These are thought of as provisional.
1. pseudocyesis-false pregnancy 2. transient hypochondriacal states-meet criterfor hypochondriasis except have not lasted for six month requirement. 3. total environmental allergy syndrome-pts. claim to be allergic to most foods, gases, apparel, anything they contact. 4. chronic fatigue syndrome-aka fibromyalgia, pts. report long-standing fatigue states 5. other-unexplained physical symptoms lasting less than six months may be categorized here.
Describe factitious disorder
Pts. make up symptoms for the purpose of assuming the sick role. Material gain is not an issue.
Describe malingering
Pts. devise symptoms for material gain: obtaining money or drugs, avoiding work or punishment.
Which symptoms resemble the manufactured symptoms of malingering.
Isolated symptoms of conversion disorder that seem to have no physical cause. Multiple, unexplained symptoms (including pain and mood) of somatization disorder.
T or F Pts. with factitious disorder may also have a genuine personality disorder
T or F Factitious disorder begins late in life rather than earlier.
F This disorder begins early in life and is more common in males than in females. It often starts with a hospitilization for genuine physical problems.
List the criteria for factitious disorder.
Pt. intentionally feighns physical or mental symptoms. Pt. motive is to occupy sick role. No other motives are apparant ( gain, revenge, avoiding legal responsibility)
List the coding notes on factitious disorder.
Code based on: with psychological signs and symptoms, with physical signs and symptoms, with combined psychological and physical signs and symptoms (neither predominates)
Describe dissociative amnesia
Pt. cannot remember important personal information...usually stress-related.
Describe dissociative fugue
Pt. suddenly travels away from home and cannot remember important details about the past
Describe dissociative identity disorder
One or more additional identities intermittently seize control of the patient's behavior
Describe depersonalization disorder
Episodes of detachment, as if the pt. is observing his or her own behavior from outside. Pt. does not actually have memory loss in this condition
Describe dissociative disorder NOS
Pts. who have symptoms suggestive of any of the disorders above, but who do not meet criteria for any one of them, may be catagorized here
T or F When dissociative symptoms are encourntered in the course of other mental diagnoses, a separate diagnosis of a dissociative disorder is not ordinarily given.
Describe Posttraumatic Stress Disorder
A MONTH OR MORE following a severe trauma, the pt. may not remember important aspects of personal history
Descirbe acute stress disorder
Immediately following a severe trauma, pts. may not remember important aspects of personal history.
Describe substance-induced disorders
Use of alcohol or other substances may produce blackouts, in which the pt. does not recall what happened while intoxicated. Alternatively, there may be state-dependent learning: important information learned while intoxicated is only recalled the next time the pt. is intoxicated.
Describe somatization disorder
Pts. who have long history of many somatic symptoms that cannot be explained on baiss of known disease mechanisms can also forget important aspects of personal history.
Describe sleepwalking disorder
Sleepwalking resembles the dissociative disorders, in that there is amnesia for purposeful behavior. But it is classified elsewhere in order to keep all sleep disorders together
Describe Malingering with regard to other causes of severe memory loss
Some patients consciously feign symptoms of memory loss. There object is material gain, avoiding punishment or obtaining money or drugs.
Describe the two most common patterns of dissociative amnesia
Localized or circumscribed (pt. has recall for none of the events during a particular time like wartime or natural disaster). Selective (certain portions of a time have been forgotten, such as birth of a child...less common)
Describe the three less common patterns of dissociative amnesia
Generalized (all life experiences forgotten) Continuous (Pt. forgets all events from given time forward to present...extremely rare now) Systematized (Pt. has forotten certian classes of information, such as that relating to family or to work)
Which group represents the highest cases of dissociatiive amnesia?
Young women...begins suddenly usually following severe stress, physical injury, guilt of adultery, abandonment by spouse, or internal conflict over sexual issues.
List criteria for dissociative amnesia
Pts. main problem is at least one episode of inability to recall important personal information. Information usually concerns trauma or stress. Symptoms cause impaired personal functioning. DA does not ocur solely during DID, DF, PTSD, ASD, or SD.
List criteria for dissoociative fugue
Pt. suddenly travels from home and cannot recall personal history. Pt. confused about identity or assume new identity. Symptoms do not occur solely as part of DID. Organicity ruled out. Symptoms impair personal functioning.
List criteria for dissociative identity disorder
Pt. has at least two distinct identities. Each has relatively lasting pattern of sensing, thinking about, and relating to self and environment. At least two of these personalities repeatedly assume control of person's behavior...usually more than two. Pts. inability to remember important personal info not better explained by common forgetfulness. Organicity ruled out.
List the coding note for children presenting with symptoms of DID
Symptoms cannot be attributed to fantasy play, including imaginary playmates
List criteria for depersonalization disorder
Lasting or recurring feeling of being detached from one's own body as if in a dream. Reality testing in tact (pt. knows it's not true). Causes impaired personal functioning. Doesn't occur solely in course of another mental disorder (ASD, PD, Schizophrenia, different dissociative disorder). Organicity ruled out.
Describe dissociative disorder not otherwise specified
This category is for pts. whose symptoms represent a change in the normally integrative function of identity, memory, or consciousness, but do not meet criteria for above dissociative disorders
Describe the following Dissociative Disorder NOS: Derealization without depersonalization
Pt. has a sense that the exterior world is unreal or odd vs. a sense of being cut off or detached from one's self (as in depersonalization).
Describe the following Dissociative Disorder NOS: Brainwashing
People who have been indoctrinated may develop dissociative states
Describe the following Dissociative Disorder NOS: Coma or loss of consciousness
These can be dissociative when they are not due to a GMC
Describe the following Dissociative Disorder NOS: Ganser's syndrome
The syndrome of approximate answers, also known by German word vorbeireden (talking past the point or appear to be deliberately false). How many legs does a cow have? Five). It was once classified as factitious disorder.
Describe the following Dissociative Disorder NOS: Conditions similar to DID
Some pts. may not fully meet criteria for DID. They may not have two FULLY formed personality states or may not have amnesia
Describe the following Dissociative Disorder NOS: Dissociative Trance Disorder
Category covers certain dissociative conditions not generally encountered in Western societies (amok, koro, latah, pibloktoq, culture-bound syndrome).
T or F With the exception of thse that bear gender-specific names, any of the sexual dysfunctions can apply to both males and females
Describe the two LOW sexual desire disorders
Hypoactive (pt. not interested in sex, though performance may be adequate once activity has been initiated). Sexual aversion (Pt. finds the idea of genital sexual contact repugnant).
Describe sexual AROUSAL disorders
Female sexual arousal disorder (female doesn't lubricate adequately to permit vaginal sex). Male erectile disorder (male's erection isn't sufficient to begin or complete sexual relations).
Describe ORGASMIC disorders
Female orgasmic disorder (despite normal period of sexual excitement, woman's climax either delayed, or not at all). Male orgasmic disorder (Same as female). Premature ejaculation (man experiences repeated instances of climax before, during, or just after penetration.
Describe sexual PAIN disorders (2)
Dyspareunia: pain occurs in woman or man in genitals at some point during sexual intercourse (often during insertion)
Sexual dysfunction due to GMC: caused by anatomical or other physical problems
Describe SUBSTANCE-INDUCED sexual dysfunction
Many of these problems caused by intoxication or wtihdrawal from alcohol or other substances
Use this category when not sure WHY a pt. has sexual dysfunction.
Describe NON-SEXUAL mental disorders (the last in the list of Secondary and other sexual dysfunctions)
Many pts. develop sexual dysfunction as a result of other mental disorders. lack of interest in sex may be encountered in Somatization disorder, MDD, and Schizophrenia.
Describe the term paraphilias.
The paraphilias include a variety of sexual behaviors that most people reject as distasteful, unusual, or abnormal. Nearly all of them are practiced largely, perhaps exclusively by males.
Describe Exhibitionism, Fetishism, and Frotteurism (paraphilias).
Exhibitionism: pt. has urges to expose genitals to unsuspecting strangers. Fetishism: pt. has sexual urges related to use of inanimate objects. Frotteurism: pt. has urges related to rubbing the genitals against an unsuspecting person.
Describe Pedophilia, Sexual Masochism, and Sexual Sadism (paraphilias).
Pedophilia: Pt. has urges involving sexual activities with children. Sexual Masochism: pt. has sexual urges related to being injured, bound, or humiliated. Sexual Sadism: Pt. has sexual urges related to inflicting suffering or humiliation on someone else.
Describe Transvestic Fetishism, Voyeurism, and Paraphilia NOS.
Transvestic Fetishism: A heterosexual man has sexual urges related to cross-dressing. Voyeurism: Pt has urges related to viewing some unsuspecting person disrobing, naked, or engaging in sexual activity.
Describe both GENDER IDENTITY disorders
Gender identity disorders: Pts. strongly identify with the opposite gender and are uncomfortable with their assigned gender roles. Some request sex reassignment surgery to relieve this discomfort. Gender Identity NOS: Category is especially for intersex conditions (hermaphrodites) and people with ambiguous sexual assignment.
Describe OTHER (SEXUAL DISORDER NOS)category of sexual and gender identity disorders.
Sexual Disorder NOS: This is a catch-all category for sexual problems that do not meet the criteria for any of the foregoing sexual or gender identity disorders.
List the TYPE CODES that apply to sexual dysfunctions
SPECIFY if: due to psychological factors or due to combined factions of psychological and general medical condition. SPECIFY if: Lifelong Type (throughout pts. active sexual life), or Acquired Type (there was a time when pt. did not have this dysfunction. SPECIFY if Generalized Type (occurs with all partners in all situations), or Situational Type (occurs only with certain partners or in some situations)
List criteria for HYPOACTIVE SEXUAL DESIRE disorder
Desire for fantasy about sexual activity deficient or absent (age and life circumstances considered). It causes marked distress/problems. Other Axis I disorders ruled out. Organicity ruled out.
List criteria for SEXUAL AVERSION disorder
Pt. dislikes and avoids all or nearly all genital contact with sex partner. Other Axis I disorders ruled out. It causes marked distress/problems
List criteria for FEMALE SEXUAL AROUSAL disorder
Pt. cannot lubricate enough. Other Axis I disorders ruled out. Organicity ruled out. It causes marked distress/problems
List criteria for MALE ERECTILE disorder
Pt. cannot get or keep erection. Other Axis I disorders ruled out. Organicity ruled out. It causes marked distress/problems.
List criteria for FEMALE ORGASMIC disorder
After normal phase of sexual excitement, orgasm is delayed or missing (judgement based on sexual experience, adequate foreplay, and norms for her age). Other Axis I disorders ruled out. Organicity ruled out. it causes marked distress/problems.
List criteria for MALE ORGASMIC disorder
After normal phase of sexual excitement, orgasm is delayed or missing (judgement based on sexual experience, adequate foreplay, and norms for his age). Other Axis I disorders ruled out. Organicity ruled out. it causes marked distress/problems.
With minimal sexual stimulation, pt. often ejaculates earlier than he wants to. (Clinician considers age, novelty of situation or partner, frequency of sex, and other factors). It is not directly caused by use of substances. Causes marked distress/problems.
List criteria for DYSPAREUNIA, a SEXUAL PAIN disorder.
Pt. often experiences genital pain with intercourse. Vaginismus and inadequate lubrication ruled out. Other Axis I disorders ruled out (except for another sexual dysfunction). Organicity ruled out. Causes marked distress/problems.
Woman has repeated spasms of vaginal muscles which interferes with sex. Causes marked distress/problems. Other Axis I disorders ruled out (except for another sex dysfunction). Organicity ruled out.
Sexual dysfunction dominates clinical picture. Causes marked distress/problems. Lab findings suggest that GMC can fully explain the symptoms. Another mental disorder (MDD) cannot better explain.
List the coding notes for SEXUAL DYSFUNCTION due to GENERAL MEDICAL CONDTION. Remember to code the specific medical condition on Axis III
See p. 358 in DSM IV Made Easy
Sexual dysfunction dominates. Causes marked distress/problems. Lab data substantiate that substance use explains the symptoms by either a. symptoms have developed within a month of intoxication or b. medication use has caused symptoms. Finally, no other sexual dysfunction better explains symptoms.
Coding notes for SUBSTANCE-INDUCED SEXUAL DYSFUNCTION are as follows:
See p. 359 in DSM IV Made Easy (alchohol or all others)
In addition to coding WHETHER OR NOT SUBSTANCE-INDUCED SEXUAL DYSFUNCTION is induced by ALCOHOL OR OTHER SUBSTANCES, be sure to specify the category of impairment.
Example: with impaired desire, with impaired arousal, with impaired orgasm, or with sexual pain. also specify if: with onset during intoxication.
T or F Substance-induced sexual dysfunction should be diagnosed instead of substance intoxication only if the sexual symptoms are serious enough to warrant independent clinical evaluation and exceed those that would be expected for syndrome of intoxication.
List symptoms that indicate a non-substance-induced sexual dysfunction better explains pts. symptoms.
Symptoms begin before use of substance. Symptoms persist a MONTH or MORE AFTER substance use stops. Symptoms are MORE SEVERE than would be expected from amount and extent of substance use. Pt has previous episodes of disorder independent of substance use.
Describe the use of SEXUAL DYSFUNCTION NOS
Absent erotic feelings: where the pt. has normal arouseal and orgasmic phases, but little in the way of erotic feelings. Undiagnosed: you believe that pt. has sexual dysfunction but YOU DON'T KNOW THE CAUSE.
List criteria for EXHIBITIONISM
Repeatedly for at least SIX MONTHS, pt. has intense desires, fantasies, or behavior concerning genital self-exposure. Causes marked distress, or impaired functioning, or pt. acted on desires.