Diagnostic and Statistical Manual Fifth Edition Audio Crash Course™
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TABLE OF CONTENTS PREFACE .................................................................................................................................. 1 CHAPTER ONE: NEURODEVELOPMENTAL DISORDERS .............................................................. 7 Intellectual Disabilities .............................................................................................................. 7 Intellectual Disability (Intellectual Developmental Disorder) .................................................. 7 Global Developmental Delay .................................................................................................... 8 Communication Disorders ........................................................................................................ 9 Language Disorder .................................................................................................................. 10 Speech Sound Disorder (previously Phonological Disorder or 315.39) .................................. 11 Childhood-Onset Fluency Disorder (Stuttering) (315.35) ....................................................... 12 Social (Pragmatic) Communication Disorder .......................................................................... 13 Autism Spectrum Disorder (299.0) ......................................................................................... 15 Attention Deficit Hyperactivity Disorder (314.0X) .................................................................. 17 Specific Learning Disorders (315) ........................................................................................... 19 Motor Disorders ...................................................................................................................... 20 Developmental Coordination Disorder (314.5) ...................................................................... 20 Stereotypic Movement Disorder (307.3) ................................................................................ 22 Provisional Tic Disorder (307.21) ............................................................................................ 23 Tourette’s Disorder (307.23) .................................................................................................. 23 Persistent (Chronic) Motor or Vocal Tic Disorder ................................................................... 25 Key Takeaways ........................................................................................................................ 26 Quiz ......................................................................................................................................... 27
CHAPTER TWO: SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS ................ 31 Schizotypal Personality Disorder (301) ................................................................................... 31 Delusional Disorder (297.1) .................................................................................................... 32 Brief Psychotic Disorder (298.8) ............................................................................................. 35 Schizophreniform Disorder (295.40) ...................................................................................... 36 Schizophrenia (259.90) ........................................................................................................... 37 Schizoaffective Disorder (295.70) ........................................................................................... 39 Substance or Medication-induced Psychosis (292.9) ............................................................. 39 Psychotic Disorder due to a Medical Condition ..................................................................... 41 Catatonia (Multiple DSM-V Codes) ......................................................................................... 41 Key Takeaways ........................................................................................................................ 42 Quiz ......................................................................................................................................... 43 CHAPTER THREE: BIPOLAR AND RELATED DISORDERS ........................................................... 47 Bipolar I Disorder (296) ........................................................................................................... 47 Bipolar II Disorder (296.89) ..................................................................................................... 50 Cyclothymic Disorder (301.13) ............................................................................................... 51 Medication or Substance-induced Bipolar Disorder............................................................... 52 Key Takeaways ........................................................................................................................ 54 Quiz ......................................................................................................................................... 55 CHAPTER FOUR: DEPRESSIVE DISORDERS .............................................................................. 59 Disruptive Mood Dysregulation Disorder (296.99)................................................................. 59 Major Depressive Disorder (296.20-296.36) .......................................................................... 60 Dysthymia (300.4) ................................................................................................................... 62 Premenstrual Dysphoric Disorder (625.4) .............................................................................. 64 Substance or Medication-induced Depressive Disorder ........................................................ 66 Depressive Disorder due to a Medical Condition (293.83)..................................................... 67 Key Takeaways ........................................................................................................................ 69
Quiz ......................................................................................................................................... 70 CHAPTER FIVE: ANXIETY DISORDERS ..................................................................................... 75 Separation Anxiety Disorder (309.21) .................................................................................... 75 Selective Mutism (312.23) ...................................................................................................... 77 Specific Phobia (300.29).......................................................................................................... 78 Social Anxiety Disorder (300.23) ............................................................................................. 80 Panic Disorder (300.01)........................................................................................................... 81 Specified Panic Attack ............................................................................................................. 82 Generalized Anxiety Disorder (300.02) ................................................................................... 84 Agoraphobia (300.22) ............................................................................................................. 85 Substance/medication-Induced Anxiety Disorder (292.8) ..................................................... 87 Anxiety due to a Medical Condition (293.84) ......................................................................... 88 Key Takeaways ........................................................................................................................ 89 CHAPTER SIX: OBSESSIVE COMPULSIVE AND RELATED DISORDERS........................................ 95 Obsessive compulsive Disorder (300.3) .................................................................................. 95 Body Dysmorphic Disorder (300.7) ......................................................................................... 96 Hoarding Disorder (300.3) ...................................................................................................... 99 Trichotillomania (312.39)...................................................................................................... 100 Excoriation Disorder (698.4) ................................................................................................. 103 Substance/Medication-Induced Obsessive-Compulsive and Related Disorder ................... 104 Obsessive-Compulsive and Related Disorder Due to Another Medical Condition .............. 105 Key Takeaways ...................................................................................................................... 106 Quiz ....................................................................................................................................... 107 CHAPTER SEVEN: TRAUMA AND STRESSOR-RELATED DISORDERS ....................................... 111 Reactive Attachment Disorder (313.89) ............................................................................... 111 Disinhibited Social Engagement Disorder (313.89) .............................................................. 112
Posttraumatic Stress Disorder (309.81) ................................................................................ 114 Acute Stress Disorder (308.3) ............................................................................................... 116 Adjustment Disorders ........................................................................................................... 117 Other Specified Trauma- and Stressor-Related Disorder (309.89) ....................................... 118 Key Takeaways ...................................................................................................................... 120 Quiz ....................................................................................................................................... 121 CHAPTER EIGHT: DISSOCIATIVE DISORDERS......................................................................... 125 Dissociative Identity Disorder (300.14) ................................................................................ 125 Dissociative Amnesia (300.12) .............................................................................................. 127 Depersonalization/Derealization Disorder (300.6) ............................................................... 129 Other Specified Dissociative Disorder (300.15) .................................................................... 131 Key Takeaways ...................................................................................................................... 132 Quiz ....................................................................................................................................... 133 CHAPTER NINE: SOMATIC SYMPTOMS AND RELATED DISORDERS ....................................... 137 Somatic Symptom Disorder (300.82) .................................................................................... 137 Illness Anxiety Disorder (300.7) ............................................................................................ 139 Conversion Disorder (Functional Neurological Symptom Disorder) (300.11) ...................... 141 Psychological Factors Affecting Other Medical Conditions (316)......................................... 142 Factitious Disorder (300.19) ................................................................................................. 143 Key Takeaways ...................................................................................................................... 145 CHAPTER TEN: FEEDING AND EATING DISORDERS ............................................................... 151 Pica (307.52) ......................................................................................................................... 151 Rumination Disorder (307.53) .............................................................................................. 153 Avoidant/Restrictive Food Intake Disorder (307.59) ............................................................ 154 Anorexia Nervosa (307.1) ..................................................................................................... 155 Bulimia Nervosa (307.51)...................................................................................................... 157
Binge-Eating Disorder (307.51) ............................................................................................. 159 Other Specified Feeding or Eating Disorder (307.59) ........................................................... 160 Key Takeaways ...................................................................................................................... 162 Quiz ....................................................................................................................................... 163 CHAPTER ELEVEN: ELIMINATION DISORDERS....................................................................... 167 Enuresis (307.6) .................................................................................................................... 167 Encopresis (307.7) ................................................................................................................. 169 Other Specified Elimination Disorder (787.60 or 788.39) .................................................... 170 Key Takeaways ...................................................................................................................... 172 Quiz ....................................................................................................................................... 173 CHAPTER TWELVE: SLEEP WAKE DISORDERS ....................................................................... 177 Insomnia Disorder (780.52) .................................................................................................. 177 Hypersomnolence Disorder (780.54) .................................................................................... 179 Narcolepsy (347.00) .............................................................................................................. 181 Breathing-Related Sleep Disorders ....................................................................................... 182 Obstructive Sleep Apnea Hypopnea (327.23)....................................................................... 182 Central Sleep Apnea .............................................................................................................. 183 Sleep-Related Hypoventilation (327.24) ............................................................................... 183 Parasomnias .......................................................................................................................... 184 Circadian Rhythm Sleep-Wake Disorders ............................................................................. 184 Non–Rapid Eye Movement Sleep Arousal Disorders............................................................ 185 Sleepwalking (307.46) ........................................................................................................... 186 Sleep Terrors (307.46) .......................................................................................................... 187 Nightmare Disorder (307.47) ................................................................................................ 188 Rapid Eye Movement Sleep Behavior Disorder (327.42) ..................................................... 189 Restless Legs Syndrome (333.94) ......................................................................................... 190 Substance/Medication-Induced Sleep Disorder ................................................................... 191
Other Specified Insomnia Disorder (780.52) ........................................................................ 191 Unspecified Insomnia Disorder (780.52) .............................................................................. 192 Other Specified Hypersomnolence Disorder (780.54).......................................................... 192 Key Takeaways ...................................................................................................................... 193 Quiz ....................................................................................................................................... 194 CHAPTER THIRTEEN: SEXUAL DISORDERS ............................................................................ 199 Delayed Ejaculation (302.74) ................................................................................................ 199 Erectile Disorder (302.72) ..................................................................................................... 200 Female Orgasmic Disorder (302.73) ..................................................................................... 201 Female Sexual Interest/Arousal Disorder (302.72) .............................................................. 202 Genito-Pelvic Pain/Penetration Disorder (302.76) ............................................................... 202 Male Hypoactive Sexual Desire Disorder (302.71) ............................................................... 203 Premature (Early) Ejaculation (302.75)................................................................................. 204 Substance/Medication-Induced Sexual Dysfunction (Various Codes) ................................. 205 Gender Dysphoria (302.85) ................................................................................................... 205 Key Takeaways ...................................................................................................................... 208 Quiz ....................................................................................................................................... 209 CHAPTER FOURTEEN: DISRUPTIVE, IMPULSE CONTROL, AND CONDUCT DISORDERS ........... 213 Oppositional Defiant Disorder (313.81)................................................................................ 213 Intermittent Explosive Disorder (312.34) ............................................................................. 214 Conduct Disorder (312.81) .................................................................................................... 215 Antisocial Personality Disorder (301.7) ................................................................................ 217 Pyromania (312.33) ............................................................................................................... 219 Kleptomania (312.32) ........................................................................................................... 220 Other Specified Disruptive, Impulse-Control, and Conduct Disorder (312.89) .................... 221 Key Takeaways ...................................................................................................................... 222 Quiz ....................................................................................................................................... 223
CHAPTER FIFTEEN: SUBSTANCE ABUSE AND RELATED DISORDERS....................................... 227 Substance-Related Disorders ................................................................................................ 227 Alcohol-Related Disorders .................................................................................................... 227 Caffeine-Related Disorders ................................................................................................... 229 Cannabis-Related Disorders .................................................................................................. 231 Hallucinogen-Related Disorders ........................................................................................... 233 Inhalant-Related Disorders ................................................................................................... 234 Sedative-, Hypnotic-, or Anxiolytic-Related Disorders ......................................................... 235 Stimulant-Related Disorders ................................................................................................. 237 Tobacco-Related Disorders ................................................................................................... 237 Non-Substance-Related Disorders ........................................................................................ 239 Gambling Disorder (312.31) .................................................................................................. 239 Key Takeaways ...................................................................................................................... 241 Quiz ....................................................................................................................................... 242 CHAPTER SIXTEEN: NEUROCOGNITIVE DISORDERS .............................................................. 247 Delirium (293.0) .................................................................................................................... 247 Major Neurocognitive Disorder (294.X)................................................................................ 249 Mild Neurocognitive Disorder (331.83) ................................................................................ 250 Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease .................................. 251 Major or Mild Frontotemporal Neurocognitive Disorder with Frontotemporal Disease .... 252 Major or Mild Neurocognitive Disorder with Lewy Bodies .................................................. 253 Major or Mild Vascular Neurocognitive Disorder ................................................................. 253 Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury............................... 254 Substance/Medication-Induced Major or Mild Neurocognitive Disorder ........................... 255 Major or Mild Neurocognitive Disorder Due to HIV Infection.............................................. 255 Major or Mild Neurocognitive Disorder Due to Prion Disease ............................................. 256 Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease ................................... 256 Major or Mild Neurocognitive Disorder Due to Huntington’s Disease ................................ 257
Major or Mild Neurocognitive Disorder Due to Multiple Etiologies .................................... 257 Unspecified Neurocognitive Disorder (799.59) .................................................................... 258 Key Takeaways ...................................................................................................................... 259 Quiz ....................................................................................................................................... 260 CHAPTER SEVENTEEN: PERSONALITY DISORDERS ................................................................ 265 Cluster A Personality Disorders ............................................................................................ 265 Paranoid Personality Disorder (301.0) .................................................................................. 265 Schizoid Personality Disorder (301.20) ................................................................................. 267 Schizotypal Personality Disorder (301.22) ............................................................................ 268 Cluster B Personality Disorders............................................................................................. 269 Antisocial Personality Disorder (301.7) ................................................................................ 269 Borderline Personality Disorder (301.83) ............................................................................. 270 Histrionic Personality Disorder (301.50) ............................................................................... 271 Narcissistic Personality Disorder (301.81) ............................................................................ 272 Cluster C Personality Disorders............................................................................................. 273 Avoidant Personality Disorder (301.82)................................................................................ 274 Dependent Personality Disorder (301.6) .............................................................................. 275 Obsessive-Compulsive Personality Disorder (301.4) ............................................................ 276 Key Takeaways ...................................................................................................................... 278 Quiz ....................................................................................................................................... 279 CHAPTER EIGHTEEN: PARAPHILIC DISORDERS ..................................................................... 283 Voyeuristic Disorder (302.82) ............................................................................................... 283 Exhibitionistic Disorder (302.4)............................................................................................. 284 Frotteuristic Disorder (302.89) ............................................................................................. 285 Sexual Masochism Disorder (302.83) ................................................................................... 286 Sexual Sadism Disorder (302.84) .......................................................................................... 287 Pedophilic Disorder (302.2) .................................................................................................. 288
Fetishistic Disorder (302.81) ................................................................................................. 289 Transvestic Disorder (302.3) ................................................................................................. 290 Key Takeaways ...................................................................................................................... 292 Quiz ....................................................................................................................................... 293 CHAPTER NINETEEN: MEDICATION-INDUCED MOVEMENT DISORDERS (DIMD) ................... 297 Types of Movement Disorders.............................................................................................. 297 Pathophysiology and Diagnosis of DIMD .............................................................................. 299 Treatment of DIMD ............................................................................................................... 299 Medication-induced Akathisia (333.99)................................................................................ 300 Medication-induced Acute Dystonia (333.72) ...................................................................... 300 Key Takeaways ...................................................................................................................... 301 Quiz ....................................................................................................................................... 302 SUMMARY ........................................................................................................................... 307 COURSE QUESTIONS AND ANSWERS ................................................................................... 313
PREFACE This course will attempt to unlock some of the rigidity of the Diagnostic and Statistical Manual, Fifth Edition or “DSM-V.” The DSM-V is a lengthy manual that reads like a dictionary of mental health terms, designed to make the abstract concepts of mental illness and categorize them. This is partly so that mental health workers can understand what the patient is suffering from in specific ways and partly to satisfy insurance and regulatory issues. There are around a hundred different categorized mental disorders in the DSM-V. Several of them state “other specified” mental health disorders that are covered as much as possible in this course. They usually involve a combination of other mental disorders but don’t fit neatly in any one category. Others will state “unspecified” mental health disorders, which will be less commonly covered in this course. These can mean just about anything that broadly fits into one of the larger categories. These are “catchall” categories that are difficult to clearly discuss. All other specified mental illnesses are covered in the chapters of this course. The subject of chapter one is neurodevelopmental disorders. These are usually diagnosed in infancy or childhood. They include various intellectual disabilities, communication disorders such as stuttering or language delays, autism spectrum disorders, ADHD, learning disorders and movement disorders (such as tics). While these are widely differing disorders, they are all associated with some abnormality in a child’s neural circuitry. Chapter two focuses on psychotic disorders and those that resemble schizophrenia. They range from the very short duration of brief psychotic disorder to the lifelong personality disorder called schizotypal personality disorder. Each of these will have characteristic psychotic features as a main component of the disorder but will differ in overall symptomatology and illness length.
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Chapter three covers disorders that fall under the umbrella-term of “bipolar disorders.” These are related mood disorders that are characterized by extreme fluctuations in mood. By definition, these patients will have at least one manic episode as seen by an elevation in mood. Some patients will have a reduction in mood when not truly manic. A select few will have rapid-cycling disease with frequent fluctuations in mood. Chapter four examines the different depressive disorders. It primarily includes major depressive disorder and dysthymia but also includes less commonly seen disorders, such as premenstrual dysphoric disorder and disruptive mood dysregulation disorder. As with many psychiatric classifications within the DSM-IV, there is discussion of substance or medicationinduced depressive disorder and depression due to a medical condition. Anxiety disorders are the topic of chapter five. There are many mental illnesses that fall under this category. Some primarily affect children, such as separation anxiety. Some are very specific, such as specific phobia, agoraphobia, and social anxiety disorder. Others have no obvious focus, including panic disorder and generalized anxiety disorder. These and anxiety disorders caused by substances and medical conditions are covered in detail in this chapter. Chapter six discusses obsessive compulsive disorder (OCD) and related disorders. The related disorders have a wide range of symptoms and causes. They include things like body dysmorphic disorder, hoarding disorder, excoriation disorder, and trichotillomania. There are categories for OCD that is related to substance use and to a medical condition. Chapter seven focuses on the phenomenon of trauma and on trauma and stressor-related disorders. The most well-known example is post-traumatic stress disorder; however, there are many other trauma and stress-related disorders. These include reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder, and adjustment disorders. There is also a category called other specified trauma and stressor-related disorder, which includes any disorder that has mixed features that don’t fit into any other specific category. Dissociative disorders are the topic of chapter eight. These are unique disorders that sometimes have their basis in trauma but can be stress-induced. The DSM-V has listed four 2
different dissociative disorders. The most well-known is dissociative identity disorder, formerly known as “multiple personality disorder.” Other dissociative disorders include dissociative amnesia, depersonalization/derealization disorder, and other specified dissociative disorder, which carries features of several of the other known dissociative disorders. The topic of chapter nine in the course is the different somatic disorders, beginning with somatic symptom disorder. There are several different somatic disorders with psychological origins or features that are recognized by the DSM-V as distinct entities. These include illness anxiety disorder, conversion disorder, and factitious disorder. There is a category for “psychological factors affecting other medical conditions,” which involves the different psychological states that influence the outcome of physical disorders. The major topic of chapter ten is feeding and eating disorders. This is a new category in the DSM-V and includes disorders like rumination disorder and pica in order to have an improved method of evaluating and treating eating-related disorders. The typical eating disorders, anorexia nervosa, bulimia, and binge-eating disorders remain as part of this classification. A newer sub-classification of other specified feeding and eating disorder has been added to identify individuals who do not fit neatly in any other category. The focus of chapter eleven in the course is elimination disorders. The DSM-V recognizes only three elimination disorders, including enuresis, encopresis, and other specified elimination disorder. These tend to occur in children but can also occur in older people as well, especially if they have developmental disabilities. There can be physical, neurological, and psychiatric reasons behind having an elimination disorder, which will be discussed in this chapter. Sleep-wake disorders are discussed in chapter twelve. They include a variety of sleep-related medical and psychological disorders affecting adults and children. The most common disorder is insomnia disorder; however, there are people with hypersomnolence disorder, narcolepsy, and breathing-related sleep disorders like sleep apnea. There are a number of disorders classified as parasomnias, including nightmare disorder, sleep terrors, and sleepwalking. Restless legs syndrome is also listed in the DSM-V as a sleep-wake disorder.
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Chapter thirteen is about sexual disorders, which include those related to otherwise normal human sexuality. Men may have erectile disorder, delayed ejaculation, hypoactive sexual desire disorder, and premature ejaculation, while women can have female orgasmic disorder, female arousal disorder, and genito-pelvic pain/penetration disorder. Both men and women can have gender dysphoria or sexual dysfunction related to the use of a substance or substances. The main topic of chapter fourteen is disruptive, impulse control, and conduct disorders, which can affect children, adolescents, and adults. These include oppositional defiant disorder, intermittent explosive disorder, conduct disorder, and antisocial personality disorder. Also mentioned in this classification of DSM-V disorders are pyromania and kleptomania. The DSMV includes, in addition, a special category for other specified disruptive, impulse control, and conduct disorders. Chapter fifteen is about the DSM-V category of substance abuse and related disorders. It includes a variety of substances of abuse and their complications. Each has unique features that separate it from other substance abuse disorders and has different types of people at risk for the disorder. In addition, gambling disorder is included as a “related disorder” as it shares similar features to substance use disorders. Chapter sixteen in the course covers neurocognitive disorders, such as delirium and dementia. Both of these can cause mild, moderate, or severe cognitive deficits, which can be transient (as in delirium) or lifelong (as in most types of dementia). The DSM-V recognizes that there are major and mild neurocognitive disorders. There are different diagnoses for major or mild neurocognitive disorders with multiple different etiologies listed by the DSM-V. The topic of chapter seventeen is personality disorders. These are mental disorders defined as having a rigid and enduring pattern of thinking, behaving, and functioning that is considered out of the norm and that causes difficulty with the patient’s levels of functioning in work, school, relationships, and social activities. The individual is so tuned into their behavior and thinking that they often blame others for their difficulties and don’t recognize themselves as
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