Cards Flashcards
Medication-Induced Movement Disorders and other Adverse Effects
Neuroleptic-induced Parkisonism
G21.19 Other medication-induced Parkisonism
· Tremor, muscular rigidity, loss of movement or slowed movement
G21.0 Neuroleptic malignant syndrome
· Rare; raises body temperature
G24.02 Medication-induced acute dystonia
· Involuntary muscle contractions
G25.71 Medication-induced acute akathisia
Tardive dystonia
G25.71 Tardive akathisia
· Symptoms are permanent, and do resolve after antipsychotic is discontinued
G25.1 Medication-induced postural tremor
· Similar to tremors of anxiety, caffeine, stimulants
G25.79 Medication-induced movement disorder
T43.205X Antidepressant discontinuation syndrome
Somatic symptom disorder
One or more somatic symptoms that are distressing or result in significant disruption
of daily life.
Excessive thoughts, feelings, and behaviors related to somatic symptoms or
health concerns. At least one of the following:
o Persistent thoughts about seriousness of sx
o High anxiety about health/sx
o Excessive time/energy devoted to sx
§ Duration: symptomatic for ≥6 months
§ Genuine health conditions can occur, though do not by themselves account for
the client’s distress
o Example: minor myocardial infarction results in client fears of making
condition worse; client becomes disabled by fear
Illness anxiety disorder
Formerly hypochondria
· Preoccupation with having/acquiring illness
· Somatic sx must be mild, if present
· High level of anxiety (hypersensitive) about health
· Excessive health-related behaviors; checking every day for cancer, for example
· Duration: ≥6 months
· Specifier: care-seeking and care-avoiding types (care-seeking = frequent use of
medical care)
Conversion Disorder
Altered motor or sensory function (inc. seizures) that tests indicate do not have a medical cause
o Seizure example: resistance to opening eyes
Specifier: Acute (<6 months), persistent (≥6 months)
Psychological factors affecting other medical conditions
§ Can be life threatening
§ Directly affects prognosis of medical condition
§ Not better accounted for by mental disorder
§ Severity
o Mild: increases medical risk (e.g., inconsistent adherence to
antihypertensive tx)
o Moderate: Aggravates underlying medical condition (e.g., anxiety
aggravating asthma)
o Severe: Results in trip to ER or hospitalization
o Extreme: Results in severe, life threatening risk (e.g., ignoring heart
attack symptoms)
Factitious disorder
Commonly known as Munchhausen’s syndrome
§ Like malingering, the mental disorder does not really exist. The person is aware
and deceptively presents themselves to others as ill, impaired, injured
§ Usually paired with treatment-seeking behavior
§ Unlike malingering, the person does not have a secondary gain or motive
§ Must r/o delusional or psychotic d/o first
Major & Mild Neurocognitive disorder
· Formerly dementia.
· Key symptom: cognitive decline
· Major: significant. Minor: modest
· In major NCD, this decline interferes with daily activities.
· In minor NCD, this decline does not interfere.
Rates of major NCD dramatically increase after age 65 (1-2%); at age 85, the rate
is nearly 30%
Delirium
Disturbance in attention and awareness/orientation
§ With additional disturbance in cognition
§ Disturbance develops quickly, and fluctuates during the day
§ There is evidence the disturbance is caused by a medical condition or substance
use
Insomnia disorder
· Difficulty initiating sleep, maintaining sleep, or awakening early
· Causes distress or impairment
· Occurs ≥ 3x per week, for ≥ 3 months
· There is adequate opportunity for sleep
· Not caused by drugs or meds
Hypersomnolence disorder
§ Excessive fatigue after sleeping ≥ 7 hours
§ Sleep lapses during the day
§ Can sleep >9 hours, but nonrestorative
§ Difficulty staying awake after abrupt awakening
Narcolepsy
§ Lapsing into sleep/napping during day
§ Occurs ≥ 3x per week, for ≥ 3 months
§ At least one of:
o Presence of cataplexy, grimaces
o Hypocretin deficiency
o Reduced length of REM sleep
Obstructive Sleep Apnea Hypopnea
Uses polysomnography scans to detect nocturnal sleeping difficulties with
breathing
· Daytime sleepiness and fatigue
· Note relationship with obesity; CPAP
Circadian Rhythm Sleep-Wake disorder
· Disruption to circadian rhythm and sleep schedule
· Resulting in sleepiness or insomnia
· Causes distress or impairment
Non-REM sleep arousal disorder
F51.3 Sleepwalking type
o With sleep-related eating
o With sleep-related sexual behavior
§ F51.4 Sleep terror type
Nightmare disorder
Dysphoric dreams: threats to survival Individual is rapidly alert upon waking
REM Sleep behavior disorder
· “Dream enacting behaviors”
· Vocalizations or complex motor behaviors
Diagnoses on the Mood Spectrum (in order of increased severity)
· Episodic subthreshold depression symptoms (premenstrual dysphoric disorder, disruptive mood
dysregulation disorder, other specified)
· Episodic subthreshold depression symptoms + minor hypomanic symptoms (cyclothymic
disorder)
· Major depressive episode (major depressive disorder)
· Minor depressive symptoms or major depressive episode, two years duration (persistent
depressive disorder, or dysthymia)
· Major depressive episode + hypomanic episode (bipolar II)
· Major depressive episode + manic episode (bipolar I)
Manic Episode definition
Period (≥ 7 days*) of elevated, expansive, or irritable mood and increased energy/activity, most of the
day, nearly every day, with at least 3 of the following sx:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (rested in < 3 hrs)
3. More talkative than usual, pressured
4. Flight of ideas or racing thoughts
5. Distractibility
6. Increased goal-directed activity or agitation
7. Excessive activities associated with painful consequences (spending sprees, sexual indiscretions,
foolish business investments)
Hypomanic Episode definition
Same as manic episode, except symptoms are not as severe (does not cause major impairments to
functioning such as employment, and does not include psychosis or usually precipitate
hospitalization)
Major Depressive Episode definition
Five or more symptoms in 2-week period, most of the day, nearly every day, causing distress/impairment:
- Depressed mood
- Loss of interest or pleasure in activities
- Significant change in weight or appetite
- Significant change in sleep
- Motor agitation or hypoactivation
- Fatigue or loss of energy
- Worthlessness or excessive guilt
- Difficulty concentrating, or indecisiveness
- Recurrent thoughts of death and SI
Bipolar I
Must have lifetime occurrence of both manic and major depressive episodes
Bipolar II
Must have lifetime occurrence of both hypomanic and major depressive episodes
Major depression
- Can be single major depressive episode or recurrent episodes
- Not better explained by psychotic disorder
- No hx of manic or hypomanic episodes
Cyclothymic disorder
Sub-threshold symptoms of major depressive and hypomanic episode for ≥ 2
years (1 year in child/adolescent)
· No hx of major depressive, manic or hypomanic episodes
- R/O schizophrenia spectrum, medical and substance use
Dysthymia (persistent depression)
· Does not need to meet threshold of major depressive episode, but can
· No hx of hypomanic episodes
- Depressive symptoms present for 2 years (Adult) or 1 year (child and adolescent, mood may also be irritable)
Disruptive mood dysregulation disorder
· Persistent irritability
- Severe recurrent temper outbursts, 3+ times/week
· Sx present for at least 12 months
· Child is aged 6-18 years; onset before 10 y.o.
· Present in 2-3 settings (home, school, peers)
· No manic or hypomanic episode - rule out ASD, PTSD, separation anxiety
- r/o substance, neurological or medical conditions
Premenstrual dysphoric disorder
· Mood sx usually occur in week before menses, improve during menses, and are
minimal after menses
· Sx: Mood lability, irritability and interpersonal conflicts, depressed mood,
hopelessness, self-deprecation, anxiety or tension, anhedonia, difficulty
concentrating, lack of energy, change in appetite and/or sleep, feeling
overwhelmed and out of control, physical sx such as breast tenderness or bloating
· Two symptomatic cycles
Diagnoses on the Mood-Psychosis Spectrum (in order of increased severity)
· Short-lasting (schizophreniform or brief psychotic disorder) or persistent subthreshold psychosis
(schizotypal personality, delusional disorder)
· Psychosis only during mood disorder (major depressive disorder, bipolar disorder with psychotic
features)
· Psychosis during mood disorder and also outside mood disorder (schizoaffective)
· Psychosis without mood symptoms (schizophrenia)
Schizophrenia
2+ Symptoms for ≥ 1 month, with 6 months of prodromal or residual sx (e.g.,
odd beliefs, unusual perceptual experiences).
o Delusions
o Hallucinations
o Disorganized speech
o Grossly disorganized or catatonic behavior
o Negative symptoms (flat affect, avolition)
o Marked decline in functioning
o Mood disorders have been ruled out
Schizophreniform disorder
· Same symptoms as schizophrenia
· But only lasts 1-6 months
Brief Psychotic Disorder
· Similar to schizophreniform, but symptoms last \< 1 month and do not include negative symptoms (flat affect, avolition). Has better prognosis
Schizoaffective disorder
· Concurrent major mood episode (major depressive or manic) with two of the five
key sx of Schizophrenia
· Delusions or hallucinations for 2 weeks outside of major mood episode
· Mood episode lasts for majority of duration of active and residual psychotic sx (note: if not, diagnose
schizophrenia)
· Less severe compared to Schizophrenia (e.g., less occupational impairment)
Schizotypal personality disorder
· Acute discomfort in close relationships
· Perceptual and cognitive distortions
· Eccentric behavior
o Ideas of reference
o Odd ideas or magical thinking
o Unusual perceptual experiences
o Odd thinking and speech
o Paranoia
o Flat affect
o Lack of close friends
o Social anxiety
Delusional disorder
· ≥ 1 delusion for duration of ≥ 1 month
· Criteria A for Schizophrenia has never been met
· Functioning is not impaired, behavior is not bizarre or odd
· Mood episodes are brief relative to delusional periods
Separation Anxiety (child and adult)
· Most prevalent anxiety disorder for children < 12 y.o.
· Decreases in prevalence with age
· Attachment related
· Sx lasting 4 weeks (children) or ≥ 6 months (adults), causing distress or impairment:
o Distress when anticipating or experiencing separation from home or major attachment figures (MAF)
o Excessive worry about loss of MAF
o Excessive worry about event causing separation from MAF
o Staying home for fear of separation
o Fear/reluctance to be alone, without MAF
o Reluctance/refusal to sleep away from home or without MAF
o Repeated nightmares with theme of separation
o Repeated c/o physical sx with separation
Selective Mutism
· For ≥ 1 month, does not speak in social situations when speaking is expected
· despite speaking in other situations
· Interferes with occupational/educational achievement or social communication
· Not attributable to language barriers
Specific Phobia
· For ≥ 6 months, fear/anxiety about object or situation
· Avoided or endured with intense fear/anxiety
Social Anxiety Disorder (Social Phobia)
· For ≥ 6 months, fear/anxiety about exposure to scrutiny in social situations
· Fear of anxiety sx being negatively evaluated, causing humiliation,
embarrassment, rejection
· Fear is out of proportion to threat
· In children, must occur with peers (not just adults)
Agoraphobia
· For ≥ 6 months, fearful avoidance of difficult-to-escape situations in event of
panic or incapacitating, embarassing symptoms
· Person may require presence of companion
· Fear occurs in ≥ 2 of 5 situations:
1. Using public transportation
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in line, being in a crowd
5. Outside of home alone.
Panic Disorder
· Recurrent unexpected panic attacks*
· ≥ 1 attack is followed by ≥ 1 month of…
o Persistent concern or worry about additional attacks
o Significant maladaptive bx change (e.g., avoidance of antecedents)
o (i.e., attempt to organize life around prevention of panic attacks)
Can occur in context of anxiety, depression, PTSD, SUDs, medical conditions;
add “with panic attacks”
· If Panic Disorder is coded, do not add “with panic attacks” to other dx
· Four or more Symptoms:
1. Palpitations, increased heart rate
2. Sweating
3. Trembling or shaking
4. Shortness of breath; smothering sensation
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feel dizzy, unsteady, light-headed, faint
9. Chills or heat sensations
10. Paresthesias (numbness, tingling sensations)
11. Derealization or depersonalization
12. Fear of losing control, “going crazy”
13. Fear of dying
Generalized Anxiety Disorder
· For ≥ 6 months, excessive anxiety and worry occuring more days than not about
a number of events/activities
· Anxiety is difficult to control
· ≥ 3 of 6 symptoms (1 in children)
o Restlessness, “keyed up,” on edge
o Easily fatigued
o Difficulty concentrating, mind going blank
o Irritability
o Muscle tension
o Sleep disturbance (DFA, DSA, restless, unsatisfying sleep)
Obsessive-Compulsive Disorder
· Either obsessions, compulsions, or both, that are time consuming or cause
distress/impairment
· Obsessions:
o Recurrent, persistent, intrusive, unwanted thoughts, urges, images that
cause anxiety or distress in most individuals
o Attempts at ignoring or suppressing them, often by neutralizing them
(i.e., compulsion)
· Compulsions:
o Repetitive behaviors or mental acts that individual feels driven to
perform, where rules must be applied rigidly
o Behaviors or mental acts are meant to prevent or reduce anxiety, though
seem disconnected
· i.e., compulsions are attempts to control obsessions
· Insight: Good/fair, poor, absent/delusional
Hoarding disorder
· Difficulty discarding items, regardless of value
· Discarding items causes distress
· Accumulation clutters and congests living space
Trichitillomania
Recurrent hair-pulling, resulting in hair loss. Can lead to feelings of shame
Excoriation Disorder
Recurrent skin-picking, lesions
Rule out substance use, medical cause, dysmorphia, psychotic
Body Dysmorphic Disorder
· Preoccupation with perceived flaws in physical appearance that unobservable or
seem slight to others
· Repetitive behaviors or mental acts are connected with preoccupation
· Appearance preoccupation is different from eating disorder
Posttraumatic Stress Disorder
· Two criteria depending on client age (≤ 6 years old, > 6 years). For the latter:
· Traumatic event: Experiencing, witnessing, learning it happened to family
member or close friend, repeated or extreme exposure to aversive details
· For ≥ 1 month duration…
o Distress: memories, dreams, dissociative reactions such as
flashbacks, intense or prolonged distress at exposure to symbols/
resemblances, physiological reactions
o Avoidance: of memories, thoughts, feelings; external reminders
o Change in cognition/mood: dissociative amnesia of event, negative
beliefs about self or the world, distorted cognitions resulting in
blaming self/others, negative emotional state, anhedonia,
detachment/estrangement from others, flat/dulled positive emotions
o Arousal/reactivity: irritability and outbursts, reckless or self-destructive bx, hypervigilance, hyperstartle response, problems
concentrating, sleep disturbance
Acute Stress Disorder
Symptoms must begin within 3 days to 1 month of traumatic event, and
resolve in 1 month
Adjustment Disorder
stres· Emotional/behavioral sx in response to an identifiable stressor occurring
within past 3 months
· Causes distress or impairment
· Does not meet criteria for another mental disorder, is not an exacerbation of
mental disorder
· Not normal bereavement
· Once stressor/consequences have terminated, symptoms cease within 6 months
Reactive Attachment Disorder
· I conceptualize this as attachment trauma
· History of “insufficient care” (traumatic events). My experience of
Eastern adoptions
· Symptomatic response:
o Consistent pattern of inhibited, withdrawn behavior toward adult
caregivers
o Minimally seeks or responds to comfort when distressed
o Persistent social and emotional disturbance
§ limited positive affect,
§ social/emotional response to others,
§ unexplained negative emotions during nonthreatening
interactions with caregivers
