dsm-iv categories and diagnosis

Schizophrenia2 or more of the following s/s for significant

portion of time during 1-month period: delusions, hallucinations, disorganized speech,

disorganized behavior, negative symptoms. Continuous social/occupational dysfunction for

at least 6 month

types of schizophrenia

paranoid, disorganized, catatonic, or undifferentiated

Major Depression

Five s/s present for 2 > wks and represent a change form previous functioning. at least one of the /s is depressed mood or loss of pleasure.

Wt loss, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished abilityt othink or

concentrate, recurrent thoughts of death.

Bipolar I (manic Episode)

Presence of current of previous manic episode. Abnormally and persistently elevated, exansive

or irritable mood, lasting at least 1 wk. Characterized by 3 or more of the following:

inflated self-esteem, decreased need for sleep, more talkative than usual, flight of ideas,

distractibility, increased goal-directed activity, excessive involvement in pleasurable activities.

Panic disorderRecurrent, unexpected panic attacks. At least

one of the attacks has been followed by 1 month of: persistent concern aobut having additional

attacks or worrying about implications

pagina 1 van 22Quizlet › Printing flashcards of DSM-IV categories and diagnosis

12-5-2010http://quizlet.com/2259295/flashcards/

Personalitythe enduring pattern of inner experience and

behavior that is established in the late teens or early adulthood

Personality disorders

dianosed when people experience clinically significant distress or impairment related to

longstanding inflexible and pervasive patterns

Areas where problematic behavior is manifested for personality disorders

cognition, affectivity, interpersonal functioning and impulse control

Cognition ways of perceiving and interpreting self, othr people, and events

Affectivity the range, intensity, lability and appropriateness of emotional response



Cluster A odd and eccentric

cluster B dramatic and emotional

Cluster C Anxious and fearful

odd and eccentric personality types

paranoid, schizoid, and schizotypal

dramatic and emotional personality types

antisocial, borderline, histrionic and narcissistic



anxious and fearful personality types

avoidant, dependent and obsessive compulsive

Schizophrenia2 or more of the following 1> month: delusions,

hallucinations, disorganized speech, disorganized behavior, negative symptoms.

continuous social/occupational dysfuncition for at least 6 months

types of schizophrenia

paranoid, disorganized, catatonic or undifferentiated

mood disorders

major depression, dysthymia, bipolar I and Bipolar II, cyclothymia

Major Depression

5> symptoms that have been present for 2 weeks or more and represent a change from

previous functioning. At least one of the sympotoms is depressed mood or loss of

pleasure other symptoms weight loss, insomnia or hypersomnia, psychomotor agitation or

retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished

ability to think or concentrate, recurrent thoughts of death



Bipolar I (manic episode)

Presence of current or previous manic episode. A distinct period of abnormally and peristently elevated, expansive, or irritable mood, lasting

at least one week, characterized by 3 or more of the following: inflated self-esteem, decreased

need for sleep, more talkative than usual, flight of ideas, distractibility, increased in goal-directed activity, excessive involvement in

pleasurable activities.

Panic disorderrecurrent unexpected panic attacks, at least one of the attacks has been followed by one moth of

persistent concern aobut having additional attacks and worry aobut implications.

GADexcessive anxiety and worry, occurrig more

days than not for at least 6 months. The anxiety and worry are associated with 3 or more of the

following 6 symptoms: restlessness, being easily fatigued, difficulty concentrating,

irritability, muscle tension, sleep disturbance

Phobia: specific, social or agaraphobia

marked persistent fear that is excessive or unreasonable, cued by the presence or

anticipation of a specific object or situaTION, THE PERSON RECOGNIZES THAT THE

FEAR IS EXCESSIVE AND THE STIMULUS IS AVOIDED

OCDeither obsessions or compulsions that cause

marked distress are time-consuming, and interfere with functioning



obsessionsrecurrent and persistent thoughts, impulses or

images that are intrusive and inappropriatecompulsions

compulsions repetitive behaviors that the person feels driven to perform; aimed at anxiety reduction

PTSDperson has been exposed to a traumatic event

which is persistently re-experienced. Persistent avoidance of stimuli associated with the trauma

and numbing of general responsivenss. Persistent symptoms of increased arousal.

Duration is >1 month

substance abuseadministration of any drug in a culturally disapproved manner that causes adverse

consequences and continue use takes place despite social and interpersonal problems.

recurrent use of substance abuse causes

failure in role responsibilities, physicallyhazardous situations and legal

problems.



Two types of substance dependence

physical and psychological dependence.

substance dependence

substance is often taken in larger amounts or over a longer period than intended. Time is spent in activiteis necessary to obtain the

substance. social, occupational, recreational activities given up because of use. Unsuccessful

efforts to cut down use.

physical dependencea physiologic state of neuro-adaptation

producded by repeated administration of a drug, necessitaiting continued administration to prevent withdrawal syndrome. Tolerance

may take place.

Tolerance need for increasing amounts for desired effect

psychological dependence

repeats use to produce pleasure or avoid discomfort. Cravings for a drug.



Intoxicationreversible substance-speific syndrome caused by substance ingestion. Maladaptive behavior

due to substances. symptoms not due to medical conditions or other mental disorder.

Withdrawal

substance-specific syndrome caused by cessation of prolonged and heavy use. substance specific syndrome causing

impairment in social, occupational, and other areas of functioning. Symptoms not due to medical condition or accounted for other

mental disorder. Withdrawal symptoms are generally the opposite of intoxication

symptoms.

Separation anxiety disorder

developmentally inappropriate and escessive anxiety concerning separation from home or

attachment figures. repeated nightmares, repeated somatic symptoms . Persistent worry,

onset prior to age 18

AutismQualitative impairment in social interaction

and communication. restricted repeetitive and stereotyped patterns of behavior interest and acctivities. Delays or abnormal fucntioning in

at least one of the following with onset prior to age 3: social interaction, language or symbolic

or imaginative play.

ADHD

Six or more symptoms of inattention hthat have persisted for at least 6 months to a degreee tha

is maladaptive and inconsistent with developmental level. six ormore sympotms of hyperactivity-impulsivity that have persisted

for at least 6 months to a degree that is maladaptive and inconsistent with

developmental level. symptoms that cause impairment were present before age 7.



OPPOSITIONAL DEFIANT DISORDER

A pattern of negativistic , hostile, and defiant behavior. Loses temper, argues, annoys,

blames, easily annoyed

CONDUCT DISORDER

Repetitive and persistent pattern of behavior in which the basic rights of others, or societal

norms or rules, are violated: aggression toward people or animals, destruction of property,

deceitfulness or theft and serious violations of rules.

EATING DISORDERS

Bullemia and anorexia

BULEMIArecurrent episodes of binge eating with

recurrent inappropriate compesatory behaviors at least 2 times per week for 3 months. may be

purging or nonopurging type. May be of normal weight.

ANOREXIARefusal to maintain body weight at or above

85% of expected, intense fear of gaining weight, distrbance in self-perception, ammenorrhea for

at least 2 consecutive cycles. Restricting or binge/purge types.



Cognitive disordersdementia or

delirium

dementiaonset is grudual of multiple cognitive deficits including memory loss and at least one of the

following aphasia, apraxia, agnosia and isturbed executive funtioning. Impairment in

social or occupational functioning.

dellirium

a disturbance in consciousness that is accompanied by a change in cognition that

cannot be better accounted for by a preexisting or evolving dementia. Acute confusion.

disturbance develops over a short period of time (usually hours to days) and tends to

fluctuate during the course of the day. May demonstrate psychomotor agitation or

depression.

Acculturation problem

The focus of clinical attention is a problem involving adjustment to a different culture

Cuture bound syndromes

mental disorders particular to certain cultures i.e. Amok, brain fag, ataque de nervios, evil eye.



Head abnormalities associated to menal d/o

progressively severe headache

Nystagmus and mental disorders

associated with substance intoxication and brain lesions

oculogyric crisis and mental disorders

neuroleptic induced dystonia

high fever and sore throat and mental disorders

agranulocytosis, greatest risk with clozapine

Thyroid enlargement hypothyroidism



respiratory findings of anxiety hyperventiolatin, asthma, SOB

Lamothrigine amy cause rash associated with risk of Stevens-Johnson syndrome as a side effect

Lithium may cause fine motor tremors

Gait and balance disturbances association with mental disorders

encaphalopathy, intoxicaitn and cerebellar injuries

disorientation, confusion and mental disorders

delirium, anticholinergic toxicity



weakness and numbness may be caused by

cerebrovascular events

Anxiety may be a result ofdrug intoxication or withdrawal,

stimulants or seizures

ECG changes may result from tricyclics, anticholinergics, some antipsychotics (e.g Geodon)

orthostatic hypotension may be caused by

tryicyclics, antipsychotics and antihypertensives

Tachycardia may be caused by anxiety, stimulants, anorexia



Hypertension may be caused byantipsychotics, MAOI-induced

hypertensive crisis

Bradycardia may be caused byBeta-blockers, anorexia or

parkinson's

Anxiety may be caused by

Anemia, angina, congestive heart failure, mitral valve prolapse, tachycardia

Gi distress and nausea may be caused lithium, SSRIs

Abnormal glucose metabolism may be caused by antipsychotics



Hyperprolactinemia may be caused by

antipsychotic dopaminergic blockade

Depression may be caused by Hypothyroidism, chronically elevated cortisol (prolonged stress response)

Anxiety may be caused by

Hyperthyroidism, hypoglycemia, premenstrual syndrome

polyuria and polydipsia may be caused by

lithium adverse affect, renal disease or drugs that reduce renal clearance, may increase

serum conctration of drugs that are excreted by the kidneys

Sexual dysfunction may be caused by

side effect from antihypertensives, antidepressants, antihistamines or

antispamodics



Body symmetry may be affected by

dystonias, CVAs, lesions

Dystonias muscle spasms as a rsult of Parkinsonism side effects

Types of abnormal movements:dyskinesis, dystonia,

bradykinesia, akathesia

Gait disturbances may be a result

Cerebellalr dysfunction such as seen with alcoholic encephalopathy, substance use

disorders

Swallowing problems may be a result of

Parkinson's disease, advanced dementia, antipsychotic-induced dystonias



Axis IV primary support groupdeath, health problems, abuse,

dysfunction

Axis IV social environment categories

Death of friend, living alone, discrimination

Axis IV education categoriesIlliteracy, academic problems, inadequate

school environment, discord with teachers or fellow student

Axis IV occupation categories unemployment, job dissatisfaction, job change, discord with boss or coworkers

Axis IV Hoursing categoriesHomelessness, inadequate

housing, unsafe neighborhood



Axis IV economicsextreme poverty,

inadquate financees, insufficient welfare support

Axis IV access to healht care Inadequate or unavailable care, inadequate transportation or heatlh insurance

GAF Global Assessment of Funcitoning

Purpose of GAF

useful for documenting baseline fucntioning and tracking progress with treatment

Outcome identification may include

functional, clinical, satisfaction and financial indicators



Good outcomes may be defined as

measurable, specific, time-lined, realistic and evidence based

Maslow's HIerarchy of needs(from bottom to top of pyramid) biological and

physiological needs, safety needs, belongingness and love needds, safety needs,

ans self actualization

Maslow defined biological and physiological needs

air food shelter warmth sex sleep

Maslow defined safety needsprotection, security, order, law,

limits, stability, etc

Maslow's belongingness and love needs

family, affection, relationships, work group



Maslow's esteem needsachievement, status,

responsibility and reputation

maslow's self actualization personal growth and fulfillment

Nursing interventions to reduce the likelihood of harm

reduce stimulation in the millieu, remove lethal material, separate from other patients, contract

for safety, constant one-on=one monitoring, maintain safety: observe for escalation, remain

calm: defuse with least restrictive means.

descalating communication strategies

speak in a calm, low voice, respect need for personal space, avoid intense eye contact,

acknowledge the patient's feelngs and reassure that staff are ther to help, communicate

expected behavior, communicate consequences of unacceptable behavior, give opportunity for

time out

Seclusions or restraints

may only be used where preventive and de-escalating strategies have failed. It requires a team response with a designated team leader, notify security if necessary, need to remove all

other patients form the area and when the leader expresses concern for the patient's safety

and behavior. Must document the behaviors, the attempts treatments, and the rationale for

terminating the intervention



types of inforamtion used to evaluate individual's response to treatment

physical exam findings, mental status changes, laboratory tests results, scores on rating scales

Scales used to evaluate response to nursing care or medications

AIMS, Clinical institute withdrawal Assessment for Alcohol Withdrawal, The brief psychiatric

rating scale

AIMS scale useful for quantification of presence of EPS.

AREAS OF ASSESSMENT

AIMS

movements from not to severe while sitting, standing, walking, in the tongue, mouth, rapid

finger-thumb tappping, passive flexion and extension of the arms

CIWA-Ainstrument that helps assessment of alcohol

wthdrawal and serves as a guide in the treatment of the condition during

detoxification form alcohol



time interval for CIWA-A scores assessment

every 30 minutes until the scores are reduced to ,10 for 3 consecutive assessments or for 4

hours

The Brief Psychiatric Rating Scale

An 18-item scale measuring positive symptoms, affective symptoms, and general

psychopathology. Can be rated on observation of the patient or may be used to monitor

outcomes of treatment



dsm-iv categories and diagnosis

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