Uploaded by Stephanie Steele-Wren

Diagnostic Criteria & Etiologies

Diagnostic Criteria
Intellectual Disability
Duration of symptoms
Neurodevelopmental Disorders
Diagnostic Criteria
Deficits in intellectual fx and adaptive fx
≥2 SDs below mean on intellectual ax
Before age 5
Fail to meet developmental milestones in ≥1 intellectual fx
Global Developmental
Before age 12
Specific Learning d/o
Tourette’s d/o
Persistent Motor or Vocal
Tic d/o
≥ 6 months
≥ 1 year
--Before age 18
Schizophreniform d/o
≥ 6 months
1 – 6 months
Brief Psychotic d/o
1 day to <1 month
Delusional d/o
≥ 1 month
Dissociative Identity d/o
Dissociative Amnesia
Depersonalization /
Derealization d/o
Compiled by Winty Fu
Deficits in social communication, social interaction
Restricted, repetitive patterns of beh/interests
≥6 symptoms in inattention and/or hyperactivity-impulsitivity
≥ 2 settings
Expectation based on chronological age
At least 1 vocal tic + multiple motor tics
At least 1 motor or vocal tic
Schizophrenia Spectrum
--Delusions / Hallucinations / Disorganized speech
AND Grossly disorganized behaviors / Negative symptoms
--AND Impairment in functioning
--Delusions / Hallucinations / Disorganized speech
± Grossly disorganized behaviors / Negative symptoms
Return to full functioning
--Delusions AND No impairment
Dissociative Disorders
--2 or more personality states with experience of possession
Gaps in recall of personal info, ordinary and traumatic events
--Inability to recall personal information
Forms of amnesia:
Localized (most common) - all info in a specific period of time
Selective – cannot some events in a specific period of time
Generalized (common in veterans, sexual assault victims) –
whole life history
Systematized – specific category
Continuous – forget new event as it occurs
Episodes of depersonalization and/or derealization
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Diagnostic Criteria
Bipolar I
Bipolar II
Cyclothymic d/o
Disruptive Mood
Dysregulation d/o
Major Depressive d/o
Persistent Depressive d/o
Premenstrual Dysphoric
Separation Anxiety d/o
Specific Phobia
Social Anxiety d/o
Panic d/o
Duration of Symptoms
Manic – 1 week
Hypomanic – 4 days
Depressive – 2 weeks
≥ 2 years for adults
≥ 1 year for children & adol
Duration of symptoms
≥ 12 months
2 weeks
Adults: ≥ 2 years
Children & Adol: ≥ 1 year
≥ 2 symptomatic cycles
Duration of Symptoms
Adults: ≥ 6 months
Children & Adol: ≥ 4 weeks
≥ 6 months
Body Dysmorphic d/o
Hoarding d/o
Compiled by Winty Fu
Symptoms of hypomanic AND depressive symptoms
Present for over half of the time
Not symptom free for ≥ 2 months
Depressive Disorders
Diagnostic Criteria
Before age 10
Dx after age 6 and before age 18
Recurrent temper outbursts at least 3 times per week
--≥ 5 symptoms
----Anxiety Disorders
Diagnostic Criteria
≥ 6 months
Bipolar Disorders
Diagnostic Criteria
--Manic ± Hypomanic / Major Depressive episode
--Hypomanic episode AND Major Depressive episode
Fear of being embarrassed/humiliated in ≥1 social situations
Panic attacks
Related maladaptive changes ≥ 1 month after panic attacks
Fear/Anxiety in ≥2 situations
Escape will be difficult / Help is unavailable
--Obsessive-Compulsive and Related Disorders
Duration of Symptoms
Diagnostic Criteria
----Obsessions + Compulsions + ≥ 1 hour/day
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Diagnostic Criteria
Reactive Attachment d/o
Disinhibited Social
Engagement d/o
Acute Stress d/o
Adjustment d/o
Somatic Symptom d/o
Illness Anxiety d/o
Conversion d/o
Factitious d/o
Compiled by Winty Fu
Trauma- and Stress-Related Disorders
Diagnostic Criteria
Before age 5
Dx after 9+ months old
Inhibited and socially withdrawn towards adult caregivers
Social and emotional disturbance
Extreme insufficient care as cause of disturbed behavior
----Dx after 9+ months old
Child actively approaches and interacts with unfamiliar adults.
Extreme insufficient care as cause
>1 month
--Exposure to actual/threatened death, serious injury or sex
Intrusion. Persistent avoidance of event-associated stimuli.
Negative alterations in cognitions and mood.
Marked alterations in arousal and reactivity
3 days to 1 month after
--Exposure to actual/threatened death, serious injury or sex
violence. Intrusion. Avoidance.
Dissociative symptoms.
Negative mood. Arousal symptoms.
Remit within 6 months after Within 3 months
termination of stressor
of onset of
Somatic Symptoms and Related Disorders
Duration of Symptom
Diagnostic Criteria
--Somatic symptoms cause distress/disruptions in daily life
Excessive thoughts/feelings/behs related to symptoms
--Preoccupations with having serious illness
≥ 6 months
Absence/mild somatic symptoms
High anxiety about health
Excessive health-related beh/Maladaptive avoidance
----Disturbance of voluntary motor or sensory functioning
Incompatibility between symptoms and medical conditions
----Falsify physical/psychological symptoms
Present to others as ill/impaired
***Without obvious external rewards (vs Malingering)
Imposed on either self or others
Duration of Symptoms
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Diagnostic Criteria
Anorexia Nervosa
(elevated serotonin)
Duration of Symptoms
≥ 1 month
Bulimia Nervosa
(low serotonin)
(low endorphin)
≥ 3 months
Binge-eating d/o
Duration of Symptoms
≥ 3 months
Compiled by Winty Fu
Feeding and Eating Disorders
Diagnostic Criteria
--Dx after age 2
Persistent eating of non-nutritive, non-food substance
Inappropriate to developmental level
Not part of culturally sanctioned practice
--Restriction of energy intake results in sig. low body weight
Intense fear of gaining weight
Disturbed body image
--Recurrent episodes of binge eating
Inappropriate compensatory behaviors to prevent weight gain
Self-evaluation influenced by body weight and shape
Binge eating + compensatory beh at least once a week
--Recurrent episodes of binge eating
Distress about binge eating
Binge eating at least once a week
Elimination Disorders
Diagnostic Criteria
--Dx after age 5
Repeated voiding of urine into bed/clothes
At least twice a week
Nocturnal subtype – nREM, slow-wave sleep; more common
in boys
--Dx after age 4
Repeated involuntary/intentional passage of faeces into
inappropriate places at least once a week
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Diagnostic Criteria
Obstructive Sleep Apnea
Sleep-wake Disorders
Diagnostic Criteria
--Dissatisfaction with sleep quality or quantity
At least 3 nights a week
--Excessive sleepiness despite a main sleep period of over 7 hrs
At least 3 times a week
--Sleep attacks at least 3 times a week
Cataplexy/Hypocretin deficiency/REM sleep latency ≤15mins
--Obstructive apnea / Hypopnea
NREM Sleep Arousal d/o
REM Sleep Behavior d/o
Nightmare d/o
Duration of Symptoms
Insomnia d/o
Hypersomnolence d/o
≥ 3 months
Duration of Symptoms
Erectile d/o
Pain/Penetration d/o
Premature / Early
Gender Dysphoria
≥ 6 months
Duration of Symptoms
≥ 6 months
Duration of Symptoms
Frotteuristic d/o
Compiled by Winty Fu
Incomplete awakening from sleep (first 1/3 of major sleep)
Sleepwalking / sleep terrors
No recall on dream + Amnesia for the episode
--Arousal during sleep AND vocalization ± complex motor beh
During REM sleep (>90 mins after sleep onset)
Alert and oriented on awakening
--Well-remembered dreams inv. threats to survival/security
During REM sleep (2nd half of major sleep)
Fully alert on awakening
Sexual Dysfunctions
Diagnostic Criteria
--Difficulty in obtaining and maintaining an erection
Reduced erectile rigidity
≥ 6 months
Ejaculation within 1 minute of vaginal penetration or before
the person desires it low serotonin
Gender Dysphoria
Diagnostic Criteria
--Marked incongruence between one’s experienced/expressed
gender and assigned gender
Children: ≥ 6 symptoms
Adolescents & adults: ≥ 2 symptoms
Paraphilic Disorders
Diagnostic Criteria
--Intense and recurrent sex arousal from touching/rubbing
against a nonconsenting person
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Diagnostic Criteria
Transvestic d/o
Pedophilic d/o
Intermittent Explosive
NCD due to Alzheimer’s
Vascular NCD
NCD with Lewy Bodies
(cortical area affected)
Frontotemporal NCD
Compiled by Winty Fu
Intense and recurrent sex arousal from cross-dressing
Dx after age 16
≥5years older than the children
Disruptive, Impulse Control and Conduct Disorders
Duration of Symptoms
Diagnostic Criteria
≥ 6 months
--Angry/irritable mood, Argumentative/ Defiant behaviors,
At least 1 symptom in past 6
Persistent behaviors that violate the basic rights of others
and/or age-appropriate social norms or rules
4 features: Aggression to people and animal, Destruction to
property, Deceitfulness/Theft, Serious violation of rules
----Dx after age 6
Inability to control aggressive impulses by
Verbal / Physical aggressive at least twice a week for 3 months
3 behavioral outbursts inv. Damage to property and/or injury
to people or animals within 12 months
Neurocognitive Disorders
----Disturbance in attention and awareness
Fluctuate in severity over a course of day
----Decline in learning and memory
Steadily progressive and gradual decline in cognition
----Decline in complex attention and frontal executive functioning
----Fluctuating cognition with pronounced variations in attention
and awareness
Recurrent visual hallucinations
Parkinson features with onset after cognitive decline
REM sleep behavior d/o
----Behavior disinhibition, apathy or inertia, loss of empathy,
preservative behavior, hyperorality and dietary change
Decline in language ability
Sparing of memory and learning, perceptual-motor fx
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Diagnostic Criteria
Paranoid PD
Schizoid PD
Schizotypal PD
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Avoidant PD
Dependent PD
Obsessive-Compulsive PD
Compiled by Winty Fu
Personality Disorders – Cluster A
Core Features
Distrust and suspiciousness
Detachment from interpersonal relationship
Neuroticism & Conscientiousness – Low
Restricted range of emotional expressions in social settings
Agreeableness – High
Acute discomfort with and reduced capacity for close relationships
Cognitive or perceptual distortions (odd beliefs and magical thinking)
Eccentricities of behaviors
Personality Disorders – Cluster B
Core Features
Big Five Personality Traits
Dx after age 18
Neuroticism – High
Disregard for and violations of the rights of others since age 15
Agreeableness & Conscientious – Low
Code 49/94 (psychopathic-hypomania) on MMPI
Instability in interpersonal relationship, self-image and affect
Marked impulsivity
Excessive emotionality and attention seeking
Neuroticism & Conscientious – High
Need for admiration
Agreeableness – Low
Lack of empathy
Personality Disorders – Cluster C
Social inhibition
Feelings of inadequacy
Hypersensitivity to negative emotions
Need to be taken care of
Submissive and clinging behaviors, fear of separation
Preoccupation with orderliness, perfection, mental and Neuroticism & Conscientiousness – High
interpersonal control
Agreeableness – Low
Severely limits flexibility, openness and efficiency
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Diagnostic Criteria
Brain Abnormalities
Tourette’s d/o
Fluency d/o
Schizophreniform d/o
Seasonal Affective d/o
Specific phobia
Compiled by Winty Fu
Good Prognostic Indicators
Neurodevelopmental Disorders
Elevated serotonin
Ability to speak by age 5 to 6
Abnormal dopamine
Late onset of symptoms
IQ ≥ 70
Smaller and lower activity level in caudate nucleus, globus
pallidus, PFC
Elevated dopamine
Hypersensitive dopamine receptors in caudate nucleus
Onset in age 2 to 7
Severity at age 8 as predictor
Schizophrenia Spectrum Disorders
Good premorbid adjustment
Acute and late onset
Presence of precipitating events
Enlarged ventricles
Brief duration of active-phase symptoms
Smaller hippocampus, amygdala, global pallidus
Elevated dopamine
Family history of mood disorders
Mesolimbic pathway  +ve symptoms
No family history of schizophrenia
Mesocortical pathway  -ve and cognitive symptoms
Onset of prominent psychotic symptoms within 4
Hypofrontality  Negative symptoms
weeks of noticeable changes in behavior or functioning
Confusion / Perplexity
Good premorbid functioning
No blunted / flat affect
Depressive Disorders
Catecholamine hypothesis – deficiency in norepinephrine
Indolamine hypothesis – Low serotonin
Elevated cortisol; Atrophy of neurons in hippocampus
Faulty suprachiasmatic nucleus (SCN) in hypothalamus
Anxiety Disorders
Abnormal serotonin, norepinephrine, GABA levels
Low serotonin (also in PTSD)
? Low GABA
Overreactive right caudate nucleus, OFC, cingulate cortex
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Diagnostic Criteria
Anorexia Nervosa
Bulimia Nervosa
Substance Use d/o
Severity depends on
no. of symptoms
Alzheimer’s Disease
Parkinson’s Disease
Huntington’s Disease
Dominant autosomal
gene disease
Smaller subthalamic nucleus (part of basal ganglia)
Feeding and Eating Disorders
High serotonin
Low serotonin
Low endogenous opioid Beta-endorphin
Substance-related Disorders
Elevated dopamine in mesolimbic system
Alcohol-primary effect on GABA
Nicotine mimics Ach at nicotinic receptor sites
*Nicotine nasal spray as most effective replacement.
Nicotine gum as the least effective.
Neurocognitive Disorders
Degeneration of acetylcholine (Ach) cells
Formation of amyloid-predominant neurotic plagues and
tau-predominant neurofibrillary tangles in hippocampus,
amygdala and entrorhinal cortex
Excessive glutamate receptor activity
APOE4 gene variant
Degeneration of dopamine receptors in substantia nigra
Imbalance between dopamine and acetylcholine
Degeneration of GABA-secreting cells in basal ganglia
Excessive glutamate receptor activity
Abnormal nigrostriatal pathway (a dopamine pathway)
HIV infection affects deep white matter in subcortical
brain areas
↓ dopamine receptors in putamen and ventral striatum
(part of basal ganglia)
Smoking cessation:
Age 35+, male, college education, married or living
with a partner, smoke-free home, non-smoking policy
at home, start smoking at later age, low nicotine
dependence level
Stage 1 (1 to 3 years): Anterograde amnesia, anomia,
sadness, deficits in visuospatial skills (wandering)
Stage 2 (2 to 10 years): Retrograde amnesia,
indifference/irritability, fluent aphasia, restlessness,
ideomotor apraxia, acalculia
Stage 3 (8 to 12 years): Severely impaired intellectual
fx, limb rigidity, apathy, urinary and fecal incontinence
Mental changes (e.g. irritability or anhedonia) before
motor disturbances
Mid-age onset (ages 35-40)
Stage 0: Normal; 0.5: Equivocal
Stage 1: Mild – perform most but most demanding
aspects of work
Stage 2: Moderate - Cannot work, need assistance to
Stage 3: Severe – Major intellectual incapacity, motor
Stage 4: End Stage – Vegetative, mute,
Baumgartern’s 6 phases: Dx  Post-dx turning point
 Immersion  Post-immersion turning point 
Integration  Disclosure
Compiled by Winty Fu
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Diagnostic Criteria
Beta (fully awake) 
Alpha 
Stage 1
(esp. endogenous)
Sleep d/o
Enuresis - nocturnal
Theta (Sleep spindles & K Complex)
Stage 2
 Delta (Slow-wave sleep)
Stage 3 & 4
Reduction in
Increase in
Sleep continuity
REM density
Slow-wave (nREM) sleep
Sleep latency
REM latency (i.e. earlier onset of REM sleep)
Stage 3 & 4 sleep
Immediate sedation  Increase in Stage 3 & 4 sleep  Reduced REM sleep
+ Increased wakefulness  Increased REM  Reduced Stage 3 & 4 sleep
Reduced sleep continuity
Vivid dreams
Occurs in slow-wave (nREM) sleep
More common in boys
nREM & REM sleep
Total sleep time
Sleep patterns across lifespan
REM precedes nREM + REM to 50% of total sleep time
3 months old
nREM precedes REM
6 months old
REM to 30% of total sleep time
REM to 20% of total sleep time
Compiled by Winty Fu
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