DSM Highlights and Review

Department of Psychiatry and Behavioral Sciences

Major Psychotic Disorders

Schizophrenia

  • Present for a significant portion of one-month period (without treatment), two or more of:
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Grossly disorganized or catatonic behavior
    • Negative symptoms (flat affect, avolition, alogia)
  • Only one of the above are required if: delusions are bizarre or voices consist of running commentary or two or more voices conversing.
  • Continuous signs of disturbance for at least six months, including prodromal or residual symptoms.

Schizoaffective Disorder

  • Concurrent major depressive, manic, or mixed episode and symptoms meeting criteria A for schizophrenia.
  • Delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms.
  • Mood symptoms are presence for a substantial portion of the total duration of the illness.

Delusional Disorder

  • Non-bizarre delusions (things that conceivably could occur in real life).
  • Schizophrenia Criteria A never met.
    • Tactile and olfactory hallucinations may be present if related to delusional theme
  • Functioning not markedly impaired and behavior not obviously odd.

Major Mood Episodes

Major Depressive Episode

  • During same two-week period, at least five of the following:
    • Depressed mood*
    • Sleep disturbance
    • Decreased interest or pleasure*
    • Excessive or inappropriate guilt or feelings of worthlessness
    • Loss of energy, fatigue
    • Diminished concentration
    • Appetite with or without weight loss
    • Psychomotor agitation or retardation (observable)
    • Recurrent thoughts of death
  • *At least one symptom must be depressed mood or decreased interest/pleasure.

Bereavement vs. Major Depressive Episode

  • Think MD if symptoms persist longer than two months or there is:
    • Marked functional impairment
    • Morbid preoccupation with worthlessness
    • Suicidal ideation
    • Psychotic symptomatology
    • Psychomotor retardation

Manic Episode

  • Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary).
  • Three or more of the following (four if mood is only irritable):
    • Decreased need for sleep
    • Ideas racing
    • Grandiosity
    • Concentration disturbance (distractibility)
    • Agitation or increase in goal-directed activity
    • Painful pleasure type of activity
    • Speech pressured
  • Manic-like episodes clearly caused by somatic therapies (meds, ECT, etc.) should not count toward a diagnosis of Bipolar I.

Hypomanic Episode

  • As above for Manic Episode, except:
    • Duration is four-day minimum
    • Unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
    • Observable by others
    • Not severe enough to cause marked impairment in functioning, require hospitalization, or be associated with any psychotic features

Major Mood Disorders

Major Depressive Disorder

  • One or more major depressive episodes.
  • Never a manic, mixed, or hypomanic episode (unless substance or treatment induced).

Bipolar I Disorder

  • At least one manic or mixed episode.
  • Major depressive episode not required.

Bipolar II Disorder

  • At least one hypomanic episode.
  • At least one major depressive episode.
  • Never a manic or mixed episode.

Cyclothymic Disorder

  • Numerous periods with hypomanic symptoms.
  • Numerous periods with depressive symptoms that do not meet MD criteria.
  • Two-year duration, not without symptoms for longer than two months at a time.
  • No major depressive, manic, or mixed episode in first two-years of disturbance.

Dysthymic Disorder

  • Depressed mood for most of the day, more days than not, for at least two years.
  • Not without symptoms for longer than two months at a time.
  • No major depressive episode in first two years of disturbance.
  • Never a manic, mixed, or hypomanic episode.

Anxiety Disorders

Panic Disorder

  • Recurrent unexpected panic attacks.
  • At least one of the attacks has been followed by one month or more of at least one of:
    • Persistent concern about having additional attacks
    • Worry about the implications of the attack or its consequences
    • Significant change in behavior related to the attacks

Posttraumatic Stress Disorder

  • Experienced or witnessed event that involved actual or threatened death or serious injury to self or others.
  • Response involved intense fear, helplessness, or horror.
  • Re-experiencing of the traumatic event.
  • Avoidance of stimuli associated with the trauma and numbing or general responsiveness.
  • Increased arousal symptoms.

Generalized Anxiety Disorder

  • Excessive anxiety and worry, more days than not for at least six months.
  • Difficult to control the worry.
  • Three or more of the following (Mnemonic: STRICT):
    • Sleep disturbance
    • Tense muscles
    • Restlessness or feeling keyed up or on edge
    • Irritability
    • Concentration problem or mind going blank
    • Tires easily (fatigue)

Obsessive-Compulsive Disorder

  • Either:
    • Obsessions (recurrent thoughts, impulses, or images) or
    • Compulsions (repetitive behaviors or mental acts)
  • At least one of:
    • Causes marked distress
    • Are time consuming (more than one hour per day)
    • Significantly interfere with routines, functioning, or relationships

Adjustment Disorders

  • Development of symptoms in response to an identifiable stressor occurring within three months of stressor.
  • And either:
    • Marked distress in excess of what would be expected or
    • Significant impairment in functioning
  • Once stressor or consequences have terminated, symptoms do not persist for more than additional six months.

Personality Disorders

General Criteria for a Personality Disorder

  • Enduring pattern of inner experience and behavior that deviates markedly from cultural expectations.
  • Manifestations in two or more of the following areas:
    • Cognition
    • Affectivity
    • Interpersonal functioning
    • Impulse control
  • Inflexible and pervasive across broad range of situations.
  • Stable and long duration; traceable back to at least adolescence or early adulthood.

Borderline Personality Disorder

  • Pervasive pattern of instability of:
    • Interpersonal relationships
    • Self-image
    • Affects
  • Marked impulsivity.
  • As indicated by five or more of the following:
    • Efforts to avoid abandonment
    • Pattern of unstable and intense interpersonal relationships; alternating between extremes of idealism and devaluation
    • Identity disturbance
    • Impulsivity in at least two potentially self-damaging areas
    • Recurrent suicidal behavior, threats, or self-mutilation
    • Affective instability
    • Feelings of emptiness
    • Intense anger
    • Transient, stress-related paranoia

Substance Use Disorders

Substance Dependence

  • Over 12 months, three or more of:
    • Tolerance
    • Withdrawal
    • Substance taken in larger amount or over longer period than intended
    • Persistent desire or unsuccessful efforts to cut down
    • Great deal of time spent obtaining, using, or recovering from use
    • Important activities given up or reduced
    • Continued use despite consequences
  • Without or with physiological dependence (presence of tolerance or withdrawal).

Substance Abuse

  • Over 12 months, one or more of:
    • Failure to fulfill major role obligations
    • Recurrent use in physically hazardous situations
    • Recurrent substance-related legal problems
    • Continued use despite having persisting or recurring problems

Cognitive Disorders

Delirium

  • Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.
  • Change in cognition not better accounted for by dementia.
  • Develops over a short period.

Dementia

  • Multiple cognitive deficits, including: memory impairment and one or more of:
    • Aphasia
    • Apraxia
    • Agnosia
    • Disturbance in executive functioning (planning, organizing, sequencing, etc.)
  • Gradual onset.