-a disturbance of consciousness

-change in cognition that develop over a short period of time

-multiple cognitive deficits that include impairment in memory -Disorientation (don’t recognize people, places, etc.)

-memory impairment in the absence of other significant accompanying cognitive impairments.

-Must meet ALL three of these criteria

1. cause is biological (medical condition or substance induced)

2. Occurs independently of a dementia or delirium

3. No evidence of other cognitive deficits

-Only affects short term memory

Most frequent causes are:

1.Head trauma

2.Stroke

3.Tumors

-Majority are due to head trauma

-moral versus medical model

-Moral model won out in this country

-little money is allocated for treatment in comparison to money allocated for enforcement of drug laws

-people in treatment are stigmatized

-this makes people more prone to hide their addictions

• Characterized by
• Tremor
• rigidity
• Bradykinesia: decrease in spontaneity and movement
• Postural instability
• Gradual decline in cognitive function

Criteria for Substance Abuse

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

-failure to fulfill major role obligations at work, school, or home

-recurrent substance use in situations in which it is physically hazardous

-recurrent substance-related legal problems

-continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period.

1. tolerance, as defined by either of the following:

-a need for markedly increased amounts of the substance

b. markedly diminished effect with continued use of the same amount of the substance

2. withdrawal

3. the substance is often taken in larger amounts or over a longer period than was intended

4. unsuccessful efforts to cut down or control substance use

5. a great deal of time is spent in activities necessary to obtain the substance

6. important social, occupational, or recreational activities are given up or reduced because of substance use

7. the substance use is continued despite knowing that substances causes psychological problems

-If someone qualifies for a substance dependence diagnosis, a substance abuse diagnosis for that particular substance is not given.

-Someone can be physiologically dependent on a substance, yet not warrant a substance dependence diagnosis. Use has to be maladaptive to warrant a diagnosis and there are people who take substances that aren’t

-A person can be psychologically dependent on a drug rather than physiologically

• Alcohol
• Sedatives, hypnotics, anxiolytics:
• Barbiturates, such as Naembutal
• Benzodiazepines, such as Athvan and Valium

• Cocaine
• gives an extremely intense high but is short acting (10-20 minutes)
• Amphetamines don’t give as intense a high as cocaine but it can last 8-10 hours.
• including methamphetamine-- Gives a very intense high that can last longer than 10 hours. 

Caffeine

Cannabis

Hallucinogens

Inhalants

PCP

-Recent ingestion of alcohol

-maladaptive behavioral or psychological changes

-One (or more) of the following signs, developing during, or shortly after, alcohol use:

1. slurred speech

2. inccordination

3. unsteady gait

4. nystagmus

5. impairment in attnetion or memory

6. stupor or coma

-Cessation of (or reduction in) alcohol use that has been heavy and prolonged

-Two (or more) of the following, developing within several hours to a few days after Criterion A:

1. auonomic hyperactivity ( e.g. sweating or pulse rate higher than 100)

2. increased hand tremor

3. insomnia

4. nausea or vomiting

5. transient visual, tactile, or auditory hallucinations or illusions

6. psychomotor agitation

7. anxiety

8. grand mal seizures

1. Recent use of a sedative, hypnotic, or anxiolytic.
2. Clinically significant maladaptive behavioral or psychological changes that developed during, or shortly after, sedative, hypnotic, or anxiolytic use.
3. One (or more) of the following signs, developing during, or shortly after, sedative, hypnotic, or anxiolytic use:
1. slurred speech
2. incoordination
3. unsteady gait
4. nystagmus
5. impairment in attention or memory
6. stupor or coma

1. Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use that has been heavy and prolonged.
2. Two (or more) of the following, developing within several hours to a few days after Criterion A:
1. autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)
2. increased hand tremor
3. insomnia
4. nausea or vomiting
5. transient visual, tactile, or auditory hallucinations or illusions
6. psychomotor agitation
7. anxiety
8. grand mal seizures

1. Recent use of cocaine.
2. Clinically significant maladaptive behavioral or psychological changes  that developed during, or shortly after, use of cocaine.
3. Two (or more) of the following, developing during, or shortly after, cocaine use:
1. tachycardia or bradycardia
2. pupillary dilation
3. elevated or lowered blood pressure
4. perspiration or chills
5. nausea or vomiting
6. evidence of weight loss
7. psychomotor agitation or retardation
8. muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
9. confusion, seizures, dyskinesias, dystonias, or coma

1. Cessation of (or reduction in) cocaine use that has been heavy and prolonged.
2. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:
1. fatigue
2. vivid, unpleasant dreams
3. insomnia or hypersomnia
4. increased appetite
5. psychomotor retardation or agitation

1. Recent use of amphetamine or a related substance (e.g., methylphenidate).
2. Clinically significant maladaptive behavioral or psychological change that developed during, or shortly after, use of amphetamine or a related substance
3. Two (or more) of the following, developing during, or shortly after, use of amphetamine or a related substance:
1. tachycardia or bradycardia
2. pupillary dilation
3. elevated or lowered blood pressure
4. perspiration or chills
5. nausea or vomiting
6. evidence of weight loss
7. psychomotor agitation or retardation
8. muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
9. confusion, seizures, dyskinesias, dystonias, or coma

1. Cessation of (or reduction in) amphetamine (or a related substance) use that has been heavy and prolonged.
2. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:
1. fatigue
2. vivid, unpleasant dreams
3. insomnia or hypersomnia
4. increased appetite
5. psychomotor retardation or agitation

1. Recent use of an opioid.
2. Clinically significant maladaptive behavioral or psychological changes that developed during, or shortly after, opioid use.
3. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use:
1. drowsiness or coma
2. slurred speech
3. impairment in attention or memory

1. Either of the following:
1. cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)
2. administration of an opioid antagonist after a period of opioid use
2. Three (or more) of the following, developing within minutes to several days after Criterion A:
1. dysphoric mood
2. nausea or vomiting
3. muscle aches
4. lacrimation or rhinorrhea
5. pupillary dilation, piloerection, or sweating
6. diarrhea
7. yawning
8. fever
9. insomnia

• Recent use of cannabis.
• Clinically significant maladaptive behavioral or psychological changes that developed during, or shortly after, cannabis use.
• Two (or more) of the following signs, developing within 2 hours of cannabis use:
• conjunctival injection
• increased appetite
• dry mouth
• tachycardia

3. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use.
4. Two (or more) of the following signs, developing during, or shortly after, hallucinogen use:
1. pupillary dilation
2. tachycardia
3. sweating
4. palpitations
5. blurring of vision
6. tremors
7. incoordination

3. Two (or more) of the following signs, developing during, or shortly after, inhalant use or exposure:
1. dizziness
2. nystagmus
3. incoordination
4. slurred speech
5. unsteady gait
6. lethargy
7. depressed reflexes
8. psychomotor retardation
9. tremor
10. generalized muscle weakness
11. blurred vision or diplopia
12. stupor or coma
13. euphoria

3. Within an hour (less when smoked, "snorted," or used intravenously), two (or more) of the following signs:
1. vertical or horizontal nystagmus
2. hypertension or tachycardia
3. numbness or diminished responsiveness to pain
4. ataxia
5. dysarthria
6. muscle rigidity
7. seizures or coma
8. hyperacusis

1. Characteristic symptoms:  Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behavior
5. negative symptoms, i.e., affective flattening, alogia, or avolition
2. Note:  Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
3. Social/occupational dysfunction
   
4. Duration:  Continuous signs of the disturbance persist for at least 6 months. This 6-month period
5. delusions do not have to be bizarre 

1. Preoccupation with one or more delusions or frequent auditory hallucinations.
2. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.
   
3. other symptoms may be present but not as prominent--people with this experience delusions/hallucinations as the predominant symptoms. Insight into it is extremely rare.

1. All of the following are prominent:
1. disorganized speech
2. disorganized behavior inappropriate behavior
3. flat or inappropriate affect
2. The criteria are not met for Catatonic Type.
   
3. hallucinations, delusion, or catatonic symptoms are not prominent.
   
4. Speech/behavior disorganization are predominent.

1. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
2. excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
3. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
4. peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
5. echolalia or echopraxia

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

1. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
2. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
3. someone was diagnosed but the positive symptoms have basically disppeared and mostly you’re just seeing negative symptoms.

-excess response or maladaption in normal behavior

-Delusions

-Hallucinations

-Disorganized speech

-Disoragnaized or catatonic behavior

• affective flattening--restricted emotional range and intensity
• alogia--poverty of thought
• avolition--impairment in goal-directed behavior
• lessening or a loss of normal functioning
  

• Differs from schizophrenia in that:
• It lasts less than six months
• social/occupational dysfunctioning not required
• Give this diagnosis is often given as provisional diagnosis and then if symptoms (+ and -) last for longer than 6 months. If longer, it’s schizophrenia (don’t forget subtype).
• An episode of the disorder (including prodromal, active, and residual phases) lasts at least 1 month but less than 6 months.

1. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.
2. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
3. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
4. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
5. Specify type:
6. Bipolar Type:  if the disturbance includes a Manic or a Mixed Episode (or a Manic or a Mixed Episode and Major Depressive Episodes)
7. Depressive Type:  if the disturbance only includes Major Depressive Episodes
8. delusions or hallucinations are present for at least two weeks with no mood disorder symptoms present. (this is what distinguishes it from a mood disorder).
   
9. If you can’t decide whether it’s schizophrenia or a mood disorder like depression or bipolar, then it’s probably Schizoaffective Disorder.

1. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration.
2. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.
3. Specify type (the following types are assigned based on the predominant delusional theme):
4. Erotomanic Type:  delusions that another person, usually of higher status, is in love with the individual
5. Grandiose Type:  delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
6. Jealous Type:  delusions that the individual's sexual partner is unfaithful
7. Persecutory Type:  delusions that the person (or someone to whom the person is close) is being malevolently treated in some way
8. Somatic Type:  delusions that the person has some physical defect or general medical condition
9. Mixed Type:  delusions characteristic of more than one of the above types but no one theme predominates
10. Unspecified Type

1. Presence of one (or more) of the following symptoms:
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behavior
2. Note:  Do not include a symptom if it is a culturally sanctioned response pattern.
3. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

1. A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion.
2. The delusion is similar in content to that of the person who already has the established delusion.
3. The disturbance is not better accounted for by another Psychotic Disorder (e.g., Schizophrenia) or a Mood Disorder With Psychotic Features and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.