psychopathology exam 4

when would you diagnose Disruptive Mood Dysregulation Disorder (DMDD)?

if someone meets the criteria for ODD and major depressive disorder

oppositional defiant disorder (ODD) DSM criteria

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

1. Often loses temper.

2. Is often touchy or easily annoyed.

3. Is often angry and resentful.

4. Often argues with authority figures or, for children and adolescents, with adults.

5. Often actively defies or refuses to comply with requests from authority figures or with rules.

6. Often deliberately annoys others.

7. Often blames others for his or her mistakes or misbehavior.

8. Has been spiteful or vindictive at least twice within the past 6 months.

B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.

C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

severity levels of ODD

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).

Moderate: Some symptoms are present in at least two settings.

Severe: Some symptoms are present in three or more settings.

for children with ODD under the age of 5

symptoms should be present on most days for a 6 month period

for those with ODD over the age of 5

symptoms should be present at least once a week for a 6 month period

general features of ODD

a behavioral disorder in children and teens marked by frequent anger, arguing, defiance, and spite toward authority figures. lasts at least six months and affects daily life at home, school, or with peers.

conduct disorder DSM criteria

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 at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

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.

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).

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).

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 the 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.

three subtypes and specifiers of conduct disorder

childhood onset, adolescent onset, unspecified onset

childhood onset

symptoms are present prior to age 10

- Childhood onset is associated with more severe symptoms and a greater likelihood that symptoms will persist into adulthood (likely to develop Antisocial Personality Disorder)

adolescent onset

symptoms are not present prior to age 10

unspecified onset

insufficient evidence to determine onset age

age cutoff for "childhood onset" conduct disorder

age 10

risk factors associated with conduct disorder

- substance abuse

- dropping out of school/poor academic achievement

- mood and anxiety disorders

- incarceration

- family/social problems

intermittent explosive disorder (IED) DSM criteria

A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following:

1. Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals.

2. Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.

B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.

C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g., money, power, intimidation).

D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning, or are associated with financial or legal consequences.

E. Chronological age is at least 6 years (or equivalent developmental level).

F. The recurrent aggressive outbursts are not better explained by another mental disorder

how many outbursts/episodes of destructive behavior are required for IED?

at least three outbursts involving destruction or physical harm within a 12-month period

what are the characteristics of the behavioral outbursts in IED?

reactive, unplanned, and out of proportion from the situation that provoked them

pyromania DSM criteria

A. Deliberate and purposeful fire setting on more than one occasion.

B. Tension or affective arousal before the act.

C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences).

D. Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath.

E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (e.g., in major neurocognitive disorder, intellectual disability [intellectual developmental disorder], substance intoxication).

F. The fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

general features of pyromania

a disorder where a person feels a strong urge to set fires deliberately, gaining pleasure or relief from doing so, without any clear motive like revenge or financial gain

kleptomania DSM criteria

A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

B. Increasing sense of tension immediately before committing the theft.

C. Pleasure, gratification, or relief at the time of committing the theft.

D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.

E. The stealing is not better explained by Conduct Disorder, a manic episode, or Antisocial Personality Disorder.

general features of kleptomania

a disorder where a person repeatedly steals items they don't need or could afford, driven by tension before theft and relief or gratification afterward

substance use DSM criteria

the DSM criteria for a substance use disorder is mostly the same across all 10 classes of drugs:

A. A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Substance is often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

3. A great deal of time is spent in activities necessary to obtain substance, use substance, or recover from its effects.

4. Craving, or a strong desire or urge to use substances.

5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substance.

7. Important social, occupational, or recreational activities are given up or reduced because of substance use.

8. Recurrent substance use in situations in which it is physically hazardous.

9. 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 substance.

10. Tolerance, as defined by either of the following:

- A need for markedly increased amounts of substance to achieve intoxication or the desired effect.

- A markedly diminished effect with continued use of the same amount of substance

11. Withdrawal, as manifested by either of the following:

- The characteristic withdrawal syndrome for substance

- Substance or a closely related substance is taken to relieve or avoid withdrawal symptoms.

10 classes of substance use disorder

alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, other/unknown

tolerance of substance

when a person needs more of a substance to achieve the same effect or when the same amount has less effect over time

withdrawal from a substance

the physical or mental symptoms that occur when a person stops or reduces use of a substance, often leading them to take more of it or a similar substance to relieve those symptoms

CDC's recommended limits for alcohol consumption

1 drink (or less) a day for women, 2 drinks (or less) a day for men

number of symptoms required to specify a mild substance abuse disorder

2-3 symptoms

number of symptoms required to specify a moderate substance abuse disorder

4-5 symptoms

number of symptoms required to specify a severe substance abuse disorder

6+ symptoms

FDA's recommended daily dose of caffeine for adults

up to 400mg of caffeine

what is the psychoactive substance in cannabis?

delta-9-tetrahydrocannabinol (THC)

what is nystagmus?

when your eyes move quickly and uncontrollably, which can make it hard to see clearly or stay balanced

examples of hallucinogens

peyote, LSD, psilocybin, DMT, ayahuasca

has withdrawal been documented with hallucinogenic drugs?

no

primary use for opioids

pain relief

which class of drugs do benzodiazepines fall under?

sedatives, hypnotics, and anxiolytics

what two substances are listed under "stimulants" in the DSM?

cocaine and amphetamine-type substances

which two substance use disorders (minus tobacco) does the FDA have approved medications to treat?

alcohol use disorders (AUD) and opioid use disorders (OUD)

what medications are available to treat opioid use disorder?

buprenorphine, methadone, and naltrexone

residential treatment programs for substance use disorders

individuals live in a treatment setting and engage in a variety of treatments including: medication management, individual psychotherapy, group psychotherapy, psychosocial rehab groups

intensive outpatient programs for substance use disorders

individuals do not live in the treatment setting, typically 3-5 days per week for a half or full day.

erectile disorder DSM criteria

A. At least one of the three following symptoms must be experienced on

almost all or all occasions of sexual activity. 1. Marked difficulty in obtaining an erection during sexual activity.

2. Marked difficulty in maintaining an erection until the completion of sexual activity.

3. Marked decrease in erectile rigidity.

B. The symptoms in Criterion A have persisted for a minimum duration of

approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the

individual.

D. The sexual dysfunction is not better explained by a nonsexual mental

disorder or as a consequence of severe relationship distress or other

significant stressors and is not attributable to the effects of a

substance/medication or another medical condition.

genito-pelvic pain/penetration disorder

A. Persistent or recurrent difficulties with one (or more) of the following:

- Vaginal penetration during intercourse.

- Marked vulvovaginal or pelvic pain during vaginal intercourse or

penetration attempts.

- Marked fear or anxiety about vulvovaginal or pelvic pain in

anticipation of, during, or as a result of vaginal penetration.

- Marked tensing or tightening of the pelvic floor muscles during

attempted vaginal penetration.

B. The symptoms in Criterion A have persisted for a minimum duration of

approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the

individual.

D. The sexual dysfunction is not better explained by a nonsexual mental

disorder or as a consequence of a severe relationship distress or other

significant stressors and is not attributable to the effects of a

substance/medication or another medical condition.

what are the circumstances in which sexual dysfunction may exist and may not be diagnosed as a mental disorder?

Usually it must cause significant distress, last for a certain time (6 months), and not be fully explained by another issue like a medical condition or substance use.

what is the technical definition of "almost all or occasions of sexual activity"?

75-100% of the time

what is the minimum duration of symptoms for all of the sexual dysfunctions

6 months

voyeuristic disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors. B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

frotteuristic disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.

B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

minimum age requirement for voyeuristic disorder

18 years old

general features of frotteuristic disorder

When someone gets sexual pleasure from rubbing against another person without their permission. It usually happens in crowded places like buses or trains. For it to be a disorder, it must happen often for at least 6 months and cause problems or stress in the person's life.

minimum amount of symptoms for children with gender dysphoria

- At least 6 symptoms are required.

- One of the symptoms must be a strong desire to be (or insistence

that they are) a different gender.

- Last for at least 6 months

- Cause significant distress or problems in daily life

minimum amount of symptoms for adults with gender dysphoria

- At least 2 symptoms are required.

- Last for at least 6 months

- Cause significant distress or problems in daily life

insomnia disorder DSM criteria

A. A predominant complaint of dissatisfaction with sleep quantity or quality.

B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.

C. The sleep difficulty occurs at least 3 nights per week.

D. The sleep difficulty is present for at least 3 months.

E. The sleep difficulty occurs despite adequate opportunity for sleep.

F. Insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder.

G. Insomnia is not attributable to the physiological effects of a substance.

H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

sleep stages

1. REM sleep

2. Stage N1

3. Stage N2

4. Stage N3

REM sleep

rapid eye-movement sleep

- approximately 25% of sleep

stage N1

transition from wakefulness to sleep (approximately 5% of sleep)

stage N2

about 50% of time spent asleep

stage N3

deep sleep (slow-wave sleep)

- approximately 20% of sleep

recommended number of hours of sleep for newborns (0-3mo)

14-17 hours

recommended number of hours of sleep for infants (4-11mo)

12-16 hours (including naps)

recommended number of hours of sleep for toddlers (1-2 years)

11-14 hours (including naps)

recommended number of hours of sleep for preschoolers (3-5 years)

10-13 hours (including naps)

recommended number of hours of sleep for children (6-12 years)

9-12 hours

recommended number of hours of sleep for teens (13-18 years)

8-10 hours

recommended number of hours of sleep for adults (18-64 years)

7-9 hours

recommended number of hours of sleep for older adults (65+ years)

7-8 hours

symptoms associated with Insomnia disorder

- difficulty initiating sleep

- difficulty maintaining sleep

- awakening early in the morning and an inability to return to sleep

symptoms associated with non-rapid eye movement sleep arousal disorder (NREMSAD)

sleepwalking, sleep terrors, little or no memory of the event the next day, unresponsive during the episode

possible psychological/cognitive symptoms associated with sleep deprivation

- makes it hard to focus, think clearly, or remember things

- can cause mood swings, irritability, anxiety, and low motivation

- people may feel confused, stressed, or sad

- in extreme cases, they might have hallucinations