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MRCPsych Part A - Al-Rashid Hospital > Classification > Flashcards

Classification Flashcards

1
Q

What type of classification systems are the ICD and DSM?

A

Categorical - based on clinical descriptions

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2
Q

What is an operationalised approach to diagnosis?

A

Include the use of precise clinical description of disorders, together with predefined exclusion and inclusion criteria and details of the number and duration of symptoms required for diagnosis.

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3
Q

Benefits of operationalised approach?

A

Allows algorithm-based clinical diagnosis using intensity, duration of symptoms and impairment tests.
Such as a checklist

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4
Q

What are characteristic symptoms?

A

Those which are pertinent to the diagnosis

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5
Q

What are discriminating symptoms?

A

Necessary for diagnosis since they are not found in other disorders.

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6
Q

What helps facilitate application of operationalised diagnoses?

A

Computerised scoring systems such as OPCRIT for ICD 10

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7
Q

What is the atheoretical approach?

A

Diseases are described according to observed phenomenology; classification is not based on understanding what might be causing the disturbance.
No theory forms the basis of classification; only neutral observations

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8
Q

What is the descriptive approach?

A

Classifying illness based on what constitutes it rather than what causes it.

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9
Q

What makes the descriptive approach more rational?

A

Lack of pathogenetic knowledge of psych disorders

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10
Q

Which type of psychiatric illness has it been suggested that a dimensional system is needed?

A

Personality disorders

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11
Q

Advantages of dimensional approach?

A

More valid; emotinoal and cognitive states are on a continuum
Severity can be better indicated
Prevents need for comorbid diagnoses to be considered
Research using dimensional scales have greater powert o detect differences

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12
Q

Disadvantage of dimensional approach?

A

Clinical utility is questionable as dimensions cannot be directly mapped onto clinical decisions e.g. starting or stopping an intervention

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13
Q

Advantages of categorical approach

A

Easy to understand
Can be communicated with professionals
Existing knowledge base (presentation, course, prognosis) is based on these categories

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14
Q

Disadvantage of categorical approach

A

Poor validity - e.g. Psychosis not specified needed for atypical cases

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15
Q

What is hierarchical organisation of psych disorders based on?

A

Jasperian ideas - the ladder starts from organic disorders to substance use, psychosis, affective and neurosis up to personality issues.

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16
Q

What does hierarchical organisation of psych disorders mean?

A

If a disorder at the top explains the observed symptoms then diagnoses further down should not be entertained.

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17
Q

Axes used in ICD 10

A

Axis 1 - mental disorder
Axis 2 - degree of disability
Axis 3 - current psychosocial problems

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18
Q

Axes used in DSM

A

Axis 1 - Clinical Disorders
Axis 2 - Personality Disorders/Mental retardation
Axis III - General Medical Conditions
Axis IV - Psychosocial and environmental problems
Axis V - global assessment of functioning

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19
Q

When was the first ICD done?

A

1855

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20
Q

What was the first ICD for?

A

Causes of death

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21
Q

What is the F for in the ICD?

A

Identifies the disorder as mental or behavioural

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22
Q

What is the first digit after F for in ICD?

A

Refers to broad diagnostic grouping

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23
Q

What is the second digit after F for in ICD?

A

Refers to individual diagnosis

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24
Q

What do digits after a decimal point mean in the ICD?

A

Code for additional information specific to the disorder such as sub-type, course or type of symptoms

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25
Q

Which ICD 10 is used for clinical purposes?

A

ICD-10: CDDG

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26
Q

Which ICD is used for research purposes?

A

ICD 10 DCR

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27
Q

How is the ICD 10 DCR set out

A

More restrictive and clearly defined clinical features with inclusion and exclusion criteria

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28
Q

How is ICD 10 Primary care version set out?

A

Broad clinical descriptions
Diagnostic flow charts
Treatment recommendations

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29
Q

What is ICD 10 Clinical Coding Manual used for?

A

For coding purposes

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30
Q

What are the axes in the DSM 5?

A

Psychiatric disorder
Pschosocial and environmental factors
Severity of associated disability

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31
Q

When should harmful use not be diagnosed via ICD?

A

If dependence syndrome or substance-induced psychosis are diagnosed

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32
Q

How is dependence described in CID 10?

A

Cognitive and behavioural phenomena indicating the use of the substance takes on a much higher priority for the individual than other behaviours.

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33
Q

What is harmful use code in ICD?

A

Where actual damage is caused to drinker but they have no dependence pattern

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34
Q

What is abuse in DSM?

A

Maladaptive use despite problems in social, occupational, physical and psychological domains, in hazardous situations, at least one month but not dependent on alcohol

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35
Q

What is depressive pseudodementia?

A

When depression in elderly patients initially presents as dementia

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36
Q

Typical symptoms of pseudodementia?

A

Memory impairment
Difficulty in sustaining attention and concentration
Reduced intellectual capacity

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37
Q

Difference in cognitive impairment in dementia and pseudodementia?

A

In pseudodementia patient complains about cognitive impairment; in dementia, this is rare

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38
Q

Memory loss in pseudodementia?

A

Memory loss more severe for remote events

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39
Q

Memory loss in dementia?

A

Memory loss more severe current events

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40
Q

The 5 A’s of Alzheimers

A

Amnesia
Aphasia - language difficulties
Agnosia - failure to recognise (people)
Apraxia - cannot carry out purposeful movements
Associated disturbance - behavioural, delusions, hallucinations

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41
Q

Define vascular dementia

A

Cognitive decline from previously higher level of functioning manifested by impairment of memory and of 2 or more cognitive domains and deficits severe enough to impact ADLs

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42
Q

When is onset of vascular dementia?

A

Usually after CVE

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43
Q

Deficits in Vascular dementia?

A

Emotional and personality changes are early, followed by cognitive deficits that fluctuate

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44
Q

Describe dementia with lewy bodies

A

Spontaneous motor features of parkinsonism
Fluctuating cognition - varied attention
Visual hallucinations
Cognitive decline

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45
Q

Describe the visual hallucinations in Dementia with lewy bodies?

A

Well formed

Detailed

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46
Q

Describe cognitive decline in dementia with lewy bodies

A

Progressive

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47
Q

Supportive features to diagnose dementia with lewy bodies?

A

Neuroleptic sensitivity

History of falls

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48
Q

When is Parkinsons disease dementia diagnosed?

A

If Parkinsonian symptoms exist for >12 months before dementia develops

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49
Q

Onset and progression of frontotemporal dementia

A

Insiduous onset

Gradual progression

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50
Q

Early symptoms of frontotemporal dementia

A

Early emotional blunting

Early loss of insight

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51
Q

Behavioural features of frontotemporal dementia

A 
Disinhibition
Decline in personal hygiene
Mental rigidity
Inflexibility
Hyperorality
Stereotyped and perseverative behaviour
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52
Q

Speech in frontotemporal disorder

A

Reduced output and stereotypy, echolalia and perseveration

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53
Q

Affective symptoms of frontotemporal dementia

A

Frequent mood changes

Emotional indifference

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54
Q

Physical signs of frontotemporal dementia

A 
Incontinence
Primitive reflexes
Akinesia
Rigidity
Tremor
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55
Q

How long do most cases of delirium last for?

A

4 weeks

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56
Q

Organic cause of depression?

A

Influenza

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57
Q

St Louis/Feighner criteria of Schizophrenia

A

A, B and C are needed

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58
Q

A criteria of Feighner’s criteria of Schizophrenia

A

Both needed;

  • chronic illness with at least 6 months of symptoms prior to index evaluation without return to premorbid level of psychosocial development.
  • absence of period of depressive or manic symptoms sufficient to qualify for affective disorder
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59
Q

B criteria for Feigners criteria of schizophrenia

A

At least one of the following:

  • delusions or hallucinations without significant perplexity or disorientation associated with them
  • verbal production that makes communication difficult due to lack of logical or understandable organization
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60
Q

C criteria for Feigner’s criteria of schizophrenia

A

At least 3 of the following for ‘definite’ and 2 for ‘probable’ schizophrenia

  • single
  • poor premorbid socal adjustment or work history
  • FHx of schizophrenia
  • absence of alcoholism or drug abuse within one year of onset
    Onset prior to age 40
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61
Q

NIMHR criteria for schizophrenia

A

Symptom criteria
Duration criteria
Exclusion criteria

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62
Q

What is the symptom criteria for NIMH?

A

8 symptoms; first 7 are Schneiderian first-rank, the last gives diagnostic value to formal thought disorder if accompanied by either blunted or inappropriate affect, delusinos or hallucinations or disorganized behaviour

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63
Q

What is the duration criteria for NIMHR?

A

Signs of illness have lasted at least 2 weeks from onset of a noticeable change in patients usual condition

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64
Q

What is the exclusion criteria for NIMHR?

A

Differential diagnosis with affective disorders
At no time during active period of illness being considered did patient meet full criteria for manic or depressive syndrome

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65
Q

How many patients with schizophrenia exhibit first-rank symptoms?

A

58%

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66
Q

How long are acute psychotic episodes diagnosed up to as per ICD?

A

1 month

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67
Q

How long can diagnosis of acute psychotic episode be valid for?

A

3 months

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68
Q

Subtypes of schizophrenia

A 
Paranoid
Hebephrenic
Catatonic
Residual
Simple
Undifferentiated
Chronic (not subtype but descriptive term)
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69
Q

Most prominent symptoms of paranoid schizophrenia?

A

Delusions or auditory hallucinations

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70
Q

Less prominent features of paranoid schizophrenia

A

Catatonic behaviour
Flat/inappropriate affect
Disorganized speech or behaviour

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71
Q

Which type of schizophrenia has the poorest prognosis?

A

Hebephrenic

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72
Q

Most prominent symptoms of hebephrenic schizophrenia?

A

Disorganized speech or behaviour and flat or inappropriate affect.
Impaired social and occupational functioning.
Poor self care
Extreme social behaviour
Disorganized behaviour

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73
Q

Which type of schizophrenia is most common in developing countries?

A

Catatonic; acute, episode course with complete symptom remission

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74
Q

Most prominent symptoms in catatonic schizophrenia?

A 
Motoric immobility
Excessive motor activity
Extreme negativism or mutism
Posturing, stereotypy, mannerisms, grimacing
Echolalaia or echopraxia
(Minimumum of 2 needed)
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75
Q

Less prominent features of catatonic schizophrenia

A

Oneiroid (dream life) state

Visual hallucinations

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76
Q

Most prominent features of schizophrenia

A

Full blown acute episode in past

Current negative symptoms or attenuated forms of 2 or more generic symptoms

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77
Q

What is simple schizophrenia?

A

Indsiduous development of negative symptoms without evidence of positive symptoms.
Rare.
Increasing emotional bluntness.
Occassional psychotic episodes support diagnosis.

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78
Q

What is chronic schizophrenia?

A

Persistent disability for 2 years or longer

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79
Q

Forms of catatonic schizophrenia

A
  1. excited catatonia
  2. stuporous catatonia
  3. catatonia alternating between excitement and stupor
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80
Q

What does ICD 10 recommend for confident diagnosis of hebephrenic schizophrenia?

A

Continuous observation for 2-3 months

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81
Q

What characterizes hebephrenic schizophrenia?

A

Thought disorder
Severe loosening of associations
Emotional disturbance; inappropriate affect, blunted affect or senseless giggling
Abnormal mannerisms

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82
Q

What is hebephrenic schizophrenia called in DSM IV?

A

Disorganized schizophrenia

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83
Q

Delusions and hallucinations in simple schizophrenia?

A

Absent

If present, short lasting and poorly systematised

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84
Q

Duration criteria for simple schizophrenia

A

1 year

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85
Q

In acute and transient psychotic disorders, what is described as acute?

A

Onset within 2 weeks

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86
Q

In acute and transient psychotic disorders, what is called abrupt?

A

Onset within 48 hours

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87
Q

What is the rule for recovery in acute and transient psychotic disorders?

A

Complete recovery within 2-3 months

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88
Q

What happens in acute polymorphic psychosis?

A

Several hallucinations and delusions change in both type and intensity from day to day or even same day

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89
Q

What is needed for a diagnosis of schizotypal disorder?

A

At least 2 years of never being diagnosed with schizophrenia.

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90
Q

What are the dimensions of rating severity of core symptoms of schizophrenia in DSM?

A 
Delusions
Hallucinations
Depression
Mania
Abnormal cognition
Abnormal psychomotor behaviour
Disorganized speech
Negative symptoms
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91
Q

Which core positive symptom (at least 1) is needed for a diagnosis of schizophrenia under DSM?

A

1 of
delusions
hallucinations
disorganized speech

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92
Q

What are persistent delusional disorders characterized by?

A

Persistent, often life-long, typically non-bizarre delusion arising insidiously in mid-life or later.
Transient auditory hallucinations may occur

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93
Q

How long do symptoms need to be present for diagnosis of persistent delusional disorder in both ICD and DSM?

A

ICD: 3 months
DSM: 1 month

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94
Q

Which classification system states in persistent delusional disorder the delusions cannot be bizarre?

A

ICD

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95
Q

Types of delusional disorders

A 
Erotomania (de Clerambault syndrome)
Grandiosity
Jealousy (Othello syndrome)
Persecutory
Somatic
Mixed andunspecified
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96
Q

What is Othello syndrome?

A

Delusion of infidelity; patients believe their spouse/partner has been unfaithful.

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97
Q

What is induced delusional disorder?

A

Sharing of delusions between 2 or more people who often have tight emotional bonds.
Only one has an underlying psych disorder.
The other, on separation, may give up these delusions.

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98
Q

What is folie a deux?

A

Induced delusional disorder

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99
Q

What are schizodepressive episodes associated with?

A

FHx of schizophrenia
Usually less florid
Response to treatment variable; may develop chronic negative symptoms.

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100
Q

What characterises schizomanic episodes?

A

Manic symptoms florid
Recovery within weeks
FHx of affective disorders
Respond well to mood stabilisers

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101
Q

What is Bouffee delirante?

A

Sudden onset psychosis
Polymorphous delusions and hallucinations
Clouded consciousness with emotional instability
Rapid return to premorbid level of functioning
Relapses may occur

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102
Q

What characterizes Bouffee delirante?

A

Caused by psychosocial factors which determine content and form of the disorder
People have a good tendency to recover

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103
Q

Who first described process schizophrenia?

A

Langfeldt (1939)

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104
Q

What did Langfeldt divide schizophrenia into?

A

Poor prognosis: genuinine/process schizophrenia

Good prognosis: schizophreniform psychosis

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105
Q

Who coined the term cycloid psychoses?

A

Leonhard (1957)

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106
Q

What is cycoid psychoses?

A

Endogenous psychotic syndromes characterized by sudden onset, affective symptoms and schizophrenia symptoms and a pashic course.

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107
Q

Subdivisions of cycloid psychoses?

A

Motility
Confusional
Anxiety-blissfulness

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108
Q

Who are cycloid psychoses more common in?

A

Severe postpartum psychiatric disorders

More common in women

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109
Q

How did Perris describe cycloid psychosis?

A

Good outcome
High risk of recurrence
Mood swings

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110
Q

Characteristics of cycloid psychoses according to Perris

A

Mood swings
2 of the following:
Perplexity/confusion
Delusions or hallucinations not congruent with mood
Motility disturbance (hypo or hyperkinesia)
Episodes of elation and states of overwhelming anxiety (pananxiety)

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111
Q

Duration for Major Depressive Disorder in DSM IV?

A

Most of the day nearly everyday for at least 2 weeks

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112
Q

Duration for major depressive disorder for ICD 10?

A

Duration of at least two weeks

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113
Q

Criterion of MDD for DSM IV?

A

5 or more symptoms

At least 2 symptom is either depressed mood or loss of interest or pleasure

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114
Q

Symptoms in DSM-IV MDD?

A

Depressed mood
Loss of interest
Significant weight loss (5% in one month) or gain, or decrease/increase in appetite
Insomnia/hyperosmnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Feelings of worthlessness/excessive/inappropriate guilt
Reduced ability to think/concentrate/indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation w/o plan or attempt or specific plan

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115
Q

Criterion A of Depressive Disorder for ICD 10?

A

Depressed mood, loss of interest and enjoyment, reduced energy leading to increased fatigability and diminished activity

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116
Q

Criterion B for Depressive Disorder in ICD 10?

A 
Common symptoms:
Reduced conc and attention
Reduced self-esteem and confidence
Ideas of guilt and unworthiness
Bleak and pessimistic views of future
Ideas/acts of self-harm/suicide
Disturbed sleep
Diminished appetite
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117
Q

What is the 4-6-8 rule for depression in ICD 10?

A

For mild depression, at least 2 criterion A ‘core symptoms’ with 4 symptoms in total
For moderate depression, at least 2 criterion A with 6 symptoms in total
For severe, at least 2 criterion A with 8 symptoms in total

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118
Q

What is required for diagnosis of mild depression according to ICD 10?

A

At least 2 criterion A core symptoms with 4 symptoms in total

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119
Q

What is required for diagnosis of moderate depression according to ICD 10?

A

At least 2 criterion A with 6 symptoms in total

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120
Q

What is required for diagnosis of severe depression according to ICD 10?

A

At least 2 criterion A symptoms with 8 symptoms in total

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121
Q

Definition of recurrent MDD?

A

More than 1 episode of depression

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122
Q

Define recurrent MDD for ICD10?

A

At least 1 previous MDD at least 2 months prior

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123
Q

ICD 10 criteria for Bipolar?

A

At least 2 mood episodes with complete recovery between episodes
Depressive episode must be at least for 2 weeks, mania for 7 days
Hypomania for 4 days
Mixed episode for 2 weeks

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124
Q

How can bipolar be diagnosed for DSM IV?

A

With single manic episode

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125
Q

In which type of bipolar is there mixed states?

A

Type 1 only

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126
Q

How long does mania and depression naturally last for?

A

Mania - 4 months

Depressio - 6 months

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127
Q

Natural course of bipolar in the elderly?

A

Longer episodes of mania and depression
Short periods of inter-episodic remissions
More frequent episodes

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128
Q

What is mania or manic episode according to ICD 10?

A

Abnormally and persistently elevated, expansive or irritable mood with 3 or more symptoms of mania.
Severe to impair occupational and social functioning

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129
Q

Duration for diagnosis of manic episode in DSM IV?

A

At least 1 week or less if hospitalized

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130
Q

Duration for diagnosis of manic episode for ICD 10?

A

At least one week unless in hospital

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131
Q

Criterion A for manic episode in DSM IV?

A

Abnormally and persistently elevated, expansive or irritable mood

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132
Q

Criterion B for manic episode in DSM IV?

A

3 or more symptoms persisted (4 if mood is irritable) and present to significant degree.

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133
Q

Criterion B criteria for manic episode in DSM IV?

A

Inflated self-esteem/grandiosity
Decreased need for sleep
More talkative/pressure to talk
Flight of ideas/subjective racing of thoughts
Distractability
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in pleasurable activities with high potential for painful consequences

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134
Q

Criteria for manic episode in ICD 10

A

At least 3 present (4 if mood is irritable) with interference in personal functioning:
Increased activity or physical restlessness
Increased talkativeness
Flight of ideas/thoughts racing
Loss of normal social inhibitions resulting in inappropriate behaviour
Decreased sleep
Inflated self-esteem/grandiosity
Distractability/constant change in plans
Reckless behaviour with risks patient doesn’t recognise
Marked sexual energy or sexual indiscretions

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135
Q

Types of psychotic features in manic episode?

A

Changeable in quality

Auditory hallucinations tend to be second person and consistent with persons mood

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136
Q

ICD 10 definition of hypomania

A

Similar to mania but evident to lesser degree and not severe enough to interfere with functioning or require admission to hospital or psychotic features

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137
Q

What is bipolar mixed state?

A

Manic and depressive symptoms occur simultaneously, present everyday for at least 1 week in DSM IV and 2 weeks for ICD 10

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138
Q

DSM IV or ICD 10 contains terms rapid cycling, postpartum onset and seasonal pattern?

A

DSM IV

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139
Q

What is rapid cycling?

A

At least 4 episodes of bipolar within 1 year

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140
Q

Which gender is most likely to have rapid cycling?

A

70-80% are women

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141
Q

What factors are associated with rapid cycling?

A 
TCAs
Low thyroxine
Female
Bipolar Type 2
Neurological disease
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142
Q

What is ultra-rapid cycling?

A

Fluctuations are over days or hours

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143
Q

What is postpartum onset of bipolar?

A

Onset of mania or hypomania or depression within 4 weeks of childbirth

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144
Q

What is seasonal pattern of bipolar?

A

Recurrences over several years with most episodes starting and ending at same time each year

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145
Q

What is secondary mania?

A

Due to substance misuse or drugs like levo-dopa and steroids.
Organic conditions

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146
Q

Which organic conditions can cause secondary mania?

A

Thyroid disease
MS
Lesions in cortical or subcortical areas of brain

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147
Q

What is Bipolar 3?

A

Minimal depression complicated by antidepressant-induced hypomania

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148
Q

What type of disorders are dysthymia and cyclothymia?

A

Persistent affective disorder

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149
Q

What are persistent affective disorders?

A

Ones which fail to meet criteria for severity but are of long duration and cause impairment

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150
Q

What is dysthymia?

A

Chronic, mildly depressed mood and diminished enjoyment, not severe enough to be considered depressive illness

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151
Q

Clinical features of dysthymia?

A

<2 years of depressed mood

Other symptoms as per depression

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152
Q

What is double depression?

A

Episodes of MDD superimposed on dysthymia; prognosis and treatment may be worse

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153
Q

What is cyclothymia?

A

Oscillating high and low moods without having significant manic or depressive episode
Unrelated to life events

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154
Q

Depression and seasons?

A

Reversed biological features in winter

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155
Q

Diagnosis for SAD in ICD 10?

A

3 or more affective episodes, with onset within same 90 day period of the year, for 3 or more consecutive years.
Remissions occur within defined 90 day period of the year.

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156
Q

Common onset and resolution of SAD?

A

Onset: autumn/winter
Resolution: spring/summer

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157
Q

Treatment for SAD

A

Phototherapy

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158
Q

What is phototherapy?

A 
Bright light (10,000 lux) exposure daily for 2 hours.
Maintenance treatment given for few months until usual time of remission
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159
Q

Duration for diagnosis of GAD in ICD-10?

A 
6 months (at least)
Symptoms present on most days during these 6 months
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160
Q

What is required for diagnosis of GAD re ICD 10?

A 
At least 4, with at least 1 from autonomic arousal, symptoms present:
Symptoms of autonomic arousal
Physical symptoms
Mental state symptoms
General symptoms
Symptoms of tension
Other
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161
Q

What are symptoms of autonomic arousal for GAD?

A 
Palpitations
Tachycardia
Sweating
Trembling/shaking
Dry mouth
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162
Q

What are physical symptoms of GAD?

A

Breathing difficulties
Choking sensation
CP/discomfort
Nausea/abdominal distress

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163
Q

What are mental state symptoms in GAD?

A 
Feeling dizzy
Unsteady
Faint/light headed
Derealisation/depersonalization
Fear of losing control/going crazy/passing out/dying
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164
Q

What are some general symptoms of GAD?

A

Muscle tension/aches and pains
Restlnessness/inability to relax
Feeling keyed up/on edge/mentally tense
Sensation of lump in throat/difficulty swallowing

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165
Q

What are the ‘other’ symptoms of GAD?

A

Exaggerated response to minor surprises/being startled
Concentration difficulties/mind going blank due to worry
Persistent irritability
Difficulty getting to sleep due to worrying

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166
Q

Characteristics of panic attack

A

Starts abruptly
Reaches peak within few minutes (10)
Starts to subside within 20-30 minutes
No obvious precipitants

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167
Q

Criteria for diagnosis of panic attack for DSM?

A

Specifies 13 physical symptoms of which at least 4 must be present
Also specifies different types of panic attacks

168
Q

What characterises panic disorder?

A

Recurrent panic attacks which are not secondary to substance misuse, medical conditions or another psychiatric disorder
Accompanied by persistent worry about having another attack, phobic avoidance of places or situations and significant behavioural changes related to attack

169
Q

Duration needed to diagnose panic disorder?

A

At least one month

170
Q

What is classified as severe panic disorder in ICD 10?

A

If more than 4 attacks per week in 4 week period

171
Q

What is required for definitive diagnosis of panic disorder in ICD 10?

A

Several severe panic attacks within one month where there is no danger, without being confined to known or predictable situations and with freedom from anxiety symptoms between attacks (aside from anticipatory symptoms)

172
Q

Criteria for diagnosis of panic disorder in DSM?

A

At least one of the panic attacks must be following by at least one of the following features for 1 month or more: anticipation of further attacks, worry about implications or avoidance behaviour

173
Q

In which classification can agoraphobia only be diagnosed with panic disorder?

A

DSM IV

174
Q

How can agoraphobia be classified in ICD 10?

A

Primary diagnosis, with panic disorder being a qualifier for subcategorisation or diagnostic entity on its own if no phobic disorder

175
Q

Who described the cardinal features of phobia?

A

Marks

176
Q

What are the cardinal features of phobia?

A

Fear which is out of proportion to situation, cannot be explained or reasoned away, is beyond voluntary control and leads to avoidance

177
Q

What is an important feature of phobic anxiety?

A

Anticipatory anxiety

178
Q

What is the main characteristic of phobic anxiety regarding the phobia?

A

Phobic object tends to be external and not dangerous to patient

179
Q

What is the name of phobic anxiety when the phobic object is internal?

A

Hypochondriasis

180
Q

What are the most common types of phobic syndromes?

A

Agoraphobia
Social phobia
Specific phobias

181
Q

Which phobia is noted to be the most incapacitating?

A

Agoraphobia

182
Q

Lifetime prevalence of agoraphobia?

A

6-10%

183
Q

Onset of agoraphobia?

A

Early or mid-twenties

Further period of high onset in mid-thirties

184
Q

Who is agoraphobia most common in (age and gender)?

A

Women between 15-35

185
Q

What is late onset agoraphobia often associated with?

A

May develop secondary to physical frailty, with associated fear of exacerbating medical problems or having an accident.

186
Q

When does first episode of agoraphobia typically occur?

A

When waiting for public transport or shopping in crowded supermarket and with cognitive basis of lack of immediately available exit as precipitator for anxiety

187
Q

Common themes that provoke anxiety and avoidance in agoraphobia?

A

Distance from home
Crowding
Confinement

188
Q

What is another name for agoraphobia?

A

Housebound housewife syndrome

189
Q

In which type of setting is social phobia more common?

A

Small group settings where close scrutiny is possible

190
Q

What are the two types of social phobia noted in social phobia?

A

Discrete

Diffuse

191
Q

What is discrete social phobia?

A

Anxiety manifested in specific occasions e.g. public speaking

192
Q

What is diffuse social phobia?

A

Seen with exposure to any generic social task

193
Q

Typical onset of social phobia?

A

Between ages of 17-30

First episode occurs in public place without any apparent reason

194
Q

How does DSM describe social phobia?

A

Marked, persistent fear of one or more social or performance situations where one gets exposed to unfamiliar people or possible scrutiny.
Sufferer must recognise that fear is excessive or unreasonable.

195
Q

What feature does DSM describe of social phobia which helps to differentiate it from paranoia?

A

Fear of humiliating or embarrassing oneself

196
Q

What does DSM IV specify regarding social phobia in children?

A

Difficult social situation should involve interactions with peer but an appreciation of the unreasonable or excessive nature of the fear is not required.
Duration of 6 months only for children

197
Q

Age of onset of most specific phobias?

A

Childhood

198
Q

When does phobia of animals start?

A

7

199
Q

When does phobia of blood start?

A

9

200
Q

When does dental phobia start?

A

12

201
Q

When does claustrophobia start?

A

20

202
Q

What does DSM divide specific phobias into?

A 
Animals
Aspects of natural environment
Blood/injection/injury
Situational
Other provoking agents
203
Q

Characteristic of specific phobia

A

Does not fluctuate - remains constant

204
Q

What is nosophobia?

A

Disease phobia related to situations where disease can be acquired and so avoided - this is not hypochondriasis

205
Q

What is blood injury injection?

A

Phobia in which there is a fainting response due to low BP and bradycardia.
High prevalence of condition among first-degree relatives of affected people

206
Q

Prevalence of fear of dental procedures

A

5%

207
Q

Duration for specific phobia in DSM

A

6 months only for children as irrational fears in children may be transient and developmental

208
Q

Criteria for OCD

A

Obsessions and compulsions - all must be present:

  1. Acknowledged as originating in mind of patient
  2. Repetitive and unpleasant; at least one recognised as excessive or unreasonable
  3. at least one must be unsuccessfully resisted
  4. Carrying out the obsessive thought or compulsive act is not intrinsically pleasurable
209
Q

How does obsessional slowness occur?

A

Result of obsessional doubts or compulsive rituals

210
Q

Duration criteria for OCD in ICD 10

A

Obsessions and/or compulsions must be present on most days for at least 2 successive weeks

211
Q

Common symptoms and prevalence of OCD

A 
Checking 63%
Washing 50%
Fear of contamination 45%
Doubting 42%
Bodily fears 36%
Counting 36%
Insistence on symmetry 31%
Aggressive thoughts 28%
212
Q

Describe compulsive hoarding

A

Symmetry obsessions tend to be chronic and treatment resistant
Difficult to treat

213
Q

How does DSM describe OCD?

A

Anxiety disorder along with GAD and PTSD (not on DSM V)

214
Q

What is an acute stress reaction?

A

Start in an hour, resolution begins within 8 hours (if stress is hit and run) or 48 hours if prolonged.

215
Q

What states increase risk of acute stress reaction?

A

Physical exhaustion
Organic factors
Disease states

216
Q

What are usually the characteristics of a stressor in acute stress reaction?

A

One that poses a serious threat to security, integrity and social position

217
Q

Symptoms seen in patients with acute stress reaction?

A

Initially dazed with narrowed attention, can result to disorientation
Occasional agitation and overactivity
Partial or complete amnesia
Dissociative symptoms

218
Q

In which classification is there a diagnosis of acute stress disorder rather than reaction?

A

DSM

219
Q

Definition of acute stress disorder in DSM

A

Starting while experiencing or after experiencing distressing event and lasting at least 2 days to at most 4 weeks.
Emphasis on dissociation

220
Q

Duration for diagnosis of acute stress disorder in DSM

A

Onset within 4 weeks with symptoms lasting up to 4 weeks

221
Q

What is used to treat acute stress disorder?

A

Debriefment - not found to be effective and can be counterproductive

222
Q

What category does Adjustment disorder fit into in DSM?

A

Residual category for individuals with clinically significant distress without meeting criteria for a more discrete disorder like depression/PTSD

223
Q

What is adjustment disorder due to?

A

Psychological reaction arising in relation to adapting to new circumstances and occurs in someone who has been exposed to a psychosocial stressor like divorce, separation which is not catastrophobic in nature.

224
Q

Typical presentation of adjustment disorder?

A 
Anxiety
Depression
Poor concentration
Irritability
Anger
Physical symptoms; autonomic arousal such as tremor/palpitations
225
Q

What characteristic is linked with adjustment disorder?

A

Individual vulnerability

226
Q

Link between adjustment disorder and violence?

A

Patients may feel vulnerable to become violent though rarely are violent.

227
Q

How do children present with adjustment disorder?

A

Conduct problems in adolescence; regressive phenomenon in children

228
Q

Onset and course of adjustment disorder

A

Onset more gradual than acute stress reaction
Course more prolonged
Social functioning tends to be impaired

229
Q

Onset criteria for adjustment disorder in ICD 10

A

Within month

230
Q

Onset for criteria for adjustment disorder in DSM

A

Three months

231
Q

Duration criteria for adjustment disorder

A

Cannot exceed six months except in subtype of prolonged depressive reaction, which can last up to 2 years

232
Q

Who cannot be diagnosed with adjustment disorder?

A

Patients who have experienced bereavement within last three months

233
Q

How long does a typical grief reaction last?

A

12 months

Average duration of 6 months

234
Q

What is Phase I of grief?

A

Shock and protest

235
Q

What is Phrase II of grief?

A

Preoccupation

236
Q

What is Phrase III of grief?

A

Disorganisation

237
Q

What is Phase IV of grief?

A

Resolution

238
Q

Describe Phase I of grief

A

Numbness
Disbelief
Acute dysphoria

239
Q

Describe Phase II of grief

A

Yearning
Searching
Anger

240
Q

Describe Phase III of grief

A

Despair

Acceptance of loss

241
Q

Describe of Phase IV of grief

A

Gradual return to normality

242
Q

In normal grief reaction, when is improvement expected?

A

Within 2-6 months

243
Q

Who should receive antidepressants regarding normal grief reaction?

A

Those who meet criteria for MDD and have not improved within 2-6 months

244
Q

What is abnormal grief?

A

Very intense, prolonged, delayed/absent or where symptoms are outside normal range

245
Q

What is abnormal grief reaction coded under in ICD 10?

A

Adjustment disorder

246
Q

What is adjustment disorder divided into in ICD?

A

Inhibited
Delayed
Chronic

247
Q

What is inhibited grief?

A

Absence of expected grief symptoms at any stage

248
Q

What is delayed grief?

A

Avoidance of painful symptoms within 2 weeks of loss

249
Q

What is chronic grief?

A

Continued significant grief-related symptoms six months after loss

250
Q

Causes of abnormal grief?

A

Sudden and unexpected death of deceased
Insecure survivor
Dependent or ambivalent relationship with deceased
Presence of dependent children and so cannot show grief easily
Presence of previous psychiatric disorder in the survivor

251
Q

Define PTSD

A

Intense, prolonged and sometimes delayed reaction to an intensely stressful event

252
Q

Essential features of PTSD

A

Hyperarousal

Re-experiencing of aspects of stressful event and avoidance of reminders

253
Q

What are the principal symptoms of PTSD

A

Hyperarousal
Hypervigilance due to re-experiencing and enhanced startle response
Avoidance

254
Q

Describe hyperarousal in PTSD

A

Persistent anxiety
Irritability
Insomnia
Poor conc

255
Q

Describe hypervigilance in PTSD

A

Intrusions
Recurrent distressing dreams
Intensive intrusive imagery (flashbacks, vivid memories)
Difficulty in recalling stressful events at will

256
Q

Describe avoidance in PTSD

A

Avoidance of reminders of events - efforts to avoid thoughts, conversations associated with trauma, and activities, places or people that arouse recollections.
Detachment/estrangement from others
Emotional numbness
Anhedonia

257
Q

Criteria for PTSD in ICD and DSM

A

Both require 2 or m ore persistent symptoms of increased psychological sensitivity and arousal to diagnose PTSD

258
Q

Onset criteria for PTSD

A

Within 6 months of trauma

259
Q

What is delayed PTSD?

A

Probable PTSD - after 6 months onset

260
Q

Personality changes in PTSD

A

Enduring personality changes noted following trauma

261
Q

What is criteria for chronic PTSD in DSM?

A

3 months

262
Q

What is Type 1 trauma?

A

Single, sudden catastrophic event

263
Q

What is Type 2 trauma?

A

Chronic repetitive insult against which individual has no defence

264
Q

What does dissociation refer to?

A

Loss of integration among memories, identity, sensation and movements.
Occurs closely in time with trauma.

265
Q

Onset and duration of dissociation

A

Starts and stops suddenly within weeks to months.

Treatment difficult in chronic (year) patients

266
Q

What is dissociative amnesia?

A

Loss of partial memory for important recent events. Memory is partial, patchy and selective.

267
Q

Characteristics of dissociative amnesia

A

Episodic memory loss - retrograde only
Amnesia for events that happen in discrete period of minutes to years
Complete unavailability of memories which were formed and previously accessible. Events are traumatic or stressful.

268
Q

What is dissociative fugue?

A

Purposeful journey away from home.
Self-care maintained. Sometimes new identity if formed.
No cognitive impairment, normal behaviour.

269
Q

What is trance?

A

Dissociative state where narrowed consciousness and limited but repeated movements seen.

270
Q

When is diagnosis of trance made?

A

Only if involuntary and not culturally appropriate.

Trance must be intrusive to activities of life.

271
Q

Causes of organic trance?

A

Temporal lobe epilepsy

Head injury

272
Q

What is another name for conversion/hysterical disorder?

A

Dissociative disorder of motor movement and sensations

273
Q

What is included in dissociative states in ICD 10?

A

Conversion disorder/la belle indifference
Ganser syndrome
Twilight states

274
Q

What is included under dissociative disorders in DSM?

A

Amnesia
Fugue
Dissociative identity disorder
Depersonalisation

275
Q

Symptoms of dissociative trance

A

Altered narrow consciousness
Lost personality identity with no replacement
Stereotypic movements/utterances
Amnesia

276
Q

Symptoms of possession trance

A 
Altered narrow consciousness
Lost personal identity
Replaced with another identity
Stereotypic movements/utterances
Amnesia
277
Q

Weight and BMI for diagnosis of anorexia in ICD 10?

A

Body weight 15% below expected norm

BMI 17.5 or loss

278
Q

What are some HPA axis dysfunctions of anorexia?

A 
Amenorrhoea
Reduced sexual interest
Raised GH and cortisol
Altered TFTs
Abnormal insulin secretion
Delayed or arrested puberty
279
Q

When is Quetelet’s BMI only applicable?

A

If >16 years of age

280
Q

Required minimum average frequency of compensatory behaviour/binge eating in bulimia in DSM IV and V?

A

IV: twice a week
V: once a week

281
Q

How does DSM IV define amenorrhoea?

A

At least 3 consecutive cycles being absent

282
Q

Criteria in atypical anorexia?

A

One or more of essential features may be absent or all present but to lesser degree

283
Q

Features of those with atypical anorexia?

A 
Older age of onset
Recurring depression
Numerous somatic complaints
Unmet dependency needs
Little evidence of distortion in body image
284
Q

Criteria for bulimia in ICD 10?

A

Persistent preoccupation with eating
Irresistible craving for food
Binges-episodes of overeating
Attempts to counter fattening effects of food
Morbid dread of fatness with imposed low weight threshold

285
Q

What are some of the attempts in bulimia to counter fattening effects of food?

A

Self-induced vomiting
Abuse of purgatives
Periods of starvation
Use of drugs; appetite suppressants, thyroxine, diuretics

286
Q

Criteria in atypical bulimia?

A

One or more of the features may be absent.

287
Q

What is bulimia divided into in DSM IV?

A

Purging

Non-purging

288
Q

Where is obesity coded in ICD 10?

A

Chapter E66 - not a mental disorder

289
Q

Most common ED in OP settings?

A

Eating disorder not otherwise specified

290
Q

What category does Binge eating disorder fall under in ICD 10?

A

Atypical bulimia

291
Q

What category does binge eating disorder fall under in DSM IV?

A

EDNOS

292
Q

What characterises binge eating disorder?

A

Recurrent episodes of binge eating in absence of extreme weight control behaviour

293
Q

How many patients with obesity have binge eating disorder?

A

5-10%

294
Q

Typical age of presentation of binge eating disorder?

A

40 years of age

295
Q

In ICD 10 what is considered a primary factor in non-organic sleep disorders?

A

Emotional causes

296
Q

What is dyssomnia?

A

Abnormality in amount, quality or timing of sleep

297
Q

What are parasomnias?

A

Abnormal episodic events occurring during sleep

298
Q

What should be considered if adult onset or adult persistence of sleep walking/tremors?

A

Psychological disturbance
Sometimes in early stages of dementia
REM disorders in Lewy body dementia

299
Q

Which drugs are nightmares associated with?

A

Benzos
TCAs
Thioridazine

300
Q

When does Kleine Levin syndrome tend to present?

A

Adolescent males

301
Q

Precipitating factors of Kleine Levin syndrome?

A

Excessive workload
Febrile illness
Respiratory infections

302
Q

What characterises narcolepsy?

A

Excessive daytime drowsiness accompanied by sudden onset of REM sleep and sudden loss of muscle tone, provoked by strong emotions

303
Q

What is cataplexy?

A

Sudden loss of muscle tone provoked by strong emotions

304
Q

Genetics in Narcolepsy?

A

Familial

99.5% of patients have HLA Antigen DR-2

305
Q

What are the dyssomnias?

A 
Primary insomnia
Primary hypersomnia
Circadian sleep disorders
Narcolepsy
Breathing related sleep disorders
Sleep state misperception
306
Q

What are some parasomnias that occur during NREM sleep?

A

Confusional arousals
Sleepwalking
Sleep terrors

307
Q

Another name of parasomnias which arise from NREM sleep?

A

Arousal disorders

308
Q

What are some parasomnias that occur during the sleep-wake transition?

A

Sleep starts

Sleep talking

309
Q

What are some parasomnias that occur during REM sleep?

A

REM behavioural disorder
Nightmares
Sleep paralysis

310
Q

What are some parasomnias that occur during any stage of sleep?

A

Sleep bruxism

Sleep enuresis

311
Q

Where are sexual disorders coded in ICD 10?

A

F52 group

312
Q

What are sexual disorders divided into in DSM IV?

A 
Sexual desire
Sexual arousal
Sexual pain
Orgasmic
Others
313
Q

What comes under sexual desire disorders?

A

Sexual aversion

Hypoactive sexual desire

314
Q

What comes under sexual arousal disorders?

A

Female sexual arousal disorder

Male erectile disorders

315
Q

What comes under orgasmic disorders?

A

Female and male orgasmic disorders

Premature ejaculation

316
Q

What comes under sexual pain disorder?

A

Dyspareunia

Vaginismus

317
Q

What comes under ‘Other’ sexual disorders?

A

General medicine

Substance use

318
Q

Where is puerperal disorders coded in ICD 10?

A

F53

319
Q

Which classification does not code postnatal disorders as depression or psychosis?

A

ICD 10: codes it as mild and severe

320
Q

Where is non dependence abuse coded in ICD 10?

A

F55

321
Q

When can a diagnosis of personality disorder not be made in terms of age?

A

If under 16-17 years of age

322
Q

Criteria for diagnosing PD in ICD 10

A

At least 3 traits for BPD and antisocial

At least 4 for the others

323
Q

Which PDs are in the DSM IV for research purposes?

A

Passive-aggressive PD

Depressive PD

324
Q

In which classification is there no clustering of PDs?

A

ICD 10

325
Q

In which classification is schizotypal PD a variant of psychosis under schizophrenia?

A

ICD 10

326
Q

In which classification is EUPD divided?

A

ICD 10: impulsive or borderline

327
Q

Criteria of Histronic PD

A

Extreme or over-dramatic behaviour
May form relationships quickly but be demanding
Attention-seeking
May appear to others as self-centered with shallow emotions
Being inappropriately sexually provocative

328
Q

Which PDs are under cluster C in DSM?

A

Avoidant
Dependent
OCD

329
Q

Which cluster B PD is not in ICD 10?

A

Narcissistic; mentioned in ‘other’ PD category

330
Q

Which PDs are under cluster C in ICD 10?

A

Anxious
Dependent
Anankastic

331
Q

Where is ‘habit and impulse disorders’ coded in ICD 10?

A

F63

332
Q

What does impulse disorders include?

A 
Kleptomania
Pyromania
Trichotillomania
Intermittent explosive disorder
Pathological gambling
333
Q

Which classification contains intermittent explosive disorder?

A

DSM IV

334
Q

What characterises impulse disorders?

A

Recurrent behaviours that appear irrational and result in harming patients own interests or those of others.

335
Q

What do impulsive disorders exclude?

A

Habitual excessive use of alcohol, drugs sexual or eating related compulsive acts.

336
Q

What are the disorders under Gender identity disorders in ICD 10?

A

Transsexualism
Dual role transvestism
Gender identity disorders

337
Q

By what age is gender identitiy established?

A

3 years

338
Q

What is gender identity?

A

An individual’s self-perception of being male or female and depends on reared sex rather than biological

339
Q

What is gender dysphoria?

A

Feeling of incongruence between ones gender identity and ones phenotypic appearance

340
Q

What is mild form of gender dysphoria recognised as in both ICD and DSM?

A

Dual role transvestism

341
Q

What is dual role transvestism?

A

Patients were clothes of opposite sex to experience temporary membership of that sex.
Individual experiences a sense of appropriateness by wearing these clothes.

342
Q

What is required for dual role transvestism to be diagnosed?

A

No sexual motivation

No desire for permanent change into opposite sex

343
Q

What is the severe form of gender dysphoria recognised in both ICD and DSM?

A

Transsexualism

344
Q

Criteria of transsexualism?

A

Persistent discomfort with their sex or sense of inappropriateness
Strong and persistent cross-gender identification
Disturbance not concurrent with physical intersex condition or other functional psych disorder
Disturbance causes distress or impairment in social, occupational or other areas of functioning
Present persistently for 2 years

345
Q

Duration for criteria of gender identity disorders in childhood?

A

6 months for pre-pubertal group

346
Q

What is important to rule out before diagnosing gender identity disorders in childhood?

A

Chromosomal and endocrine problems

347
Q

Main management of gender identity disorder in childhood?

A

Promoting young persons tolerance of uncertainty and resisting pressure for quick solutions
Surgical intervention not justified until adulthood

348
Q

In which gender are gender identity disorders more common?

A

Males

349
Q

When is cross-dressing behaviour more likely to occur in GID?

A

During stressful times

350
Q

Where are paraphilias, impulsive disorders and other habitual problems coded in ICD?

A

F60

351
Q

What is Klismaphilia?

A

Use of enemas to achieve sexual arousal

352
Q

What is fetishism?

A

Use of inanimate objects to achieve arousal

353
Q

Which paraphilia is a separate disorder in DSM?

A

Frotteurism

354
Q

Why does the ICD 10 advise not to use ICD rigidly when identifying mental retardation severity?

A

Problems of cross-cultural validity

355
Q

How should mental retardation be graded?

A

Based on functioning ability

356
Q

Degrees of mental retardation?

A

Mild
Moderate
Severe
Profound

357
Q

IQ for profound mental retardation?

A

<20

358
Q

IQ for severe mental retardation?

A

20-34

359
Q

IQ for moderate mental retardation?

A

35-49

360
Q

IQ for mild mental retardation?

A

50-69

361
Q

Define profound mental retardation

A

Minimal capacity for functioning; needs nursing care, constant aid and supervision

362
Q

Define severe mental retardation

A

Minimal speech, can talk or learn to communicate. No profit from training in self-help. May partially contribute to self-maintenance under complete supervision

363
Q

Define moderate mental retardation

A

Profits from training in self-help

Can be managed with moderate supervision

364
Q

Define mild mental retardation

A

Can develop social and communication skills
Minimum retardation
Can be guided towards social conformity

365
Q

What is the term for mental retardation in DSM V (not IV)?

A

Intellectual disability

366
Q

What is a statement of special educational needs?

A

Following statutory assessment by local authority, a statement of SEN will be prepared to set out what special help the child needs and to consider the views of the child and their parents.

367
Q

In which country is there a statement of special educational needs?

A

England

Wales

368
Q

How many parts in SEN?

A

6 essential parts

369
Q

Who usually organises the statutory assessment for SEN?

A

Local educational board

370
Q

importance of final statement of SEN?

A

Legally binding on local educational board

371
Q

Part 1 of SEN

A

Demographic details

List of reports gathered for statement

372
Q

Part 2 of SEN

A

Description of nature and complexity of LD

Needs listed to determine care to be provided by state

373
Q

Part 3 of SEN

A

List of arrangements and provisions to be offered by local education board, including monitoring arrangements

374
Q

Part 4 of SEn

A

Details of school placement

375
Q

Part 5 of SEN

A

Non-educational (health and social) needs

Not legally binding

376
Q

Which part of SEn is legally binding?

A

3

377
Q

Part 6 of SEN

A

Describes processes in place to meet non-educational needs

378
Q

ASD in DSM V?

A

Includes autism, aspergers, childhood disintegrative disorder and pervasive developmental disorder

379
Q

Characteristics of ASD in DSM V

A

Deficits in social communication and social interaction

Restricted repetitive behaviours, interests and activities - if none, diagnose social communication disorder

380
Q

What are the disorders of psychological development in ICD 10?

A

Disorders of speech, language, scholastic skills, motor skills and pervasive developmental disorders

381
Q

Non-pervasive vs. pervasive psychological development disorders

A

Domain showing deficit in development improves with age

382
Q

List some pervasive psychological development disorders

A 
Childhood autism
Aspergers
Rett's syndrome
Atypical autism
Other childhood disintegrative disorders
383
Q

Definition of autism in ICD 10

A

Presence of abnormal and/or impaired development evident before 3 years of age with abnormal functioning in all 3 areas of social interaction, communication and restricted, repetitive behaviour

384
Q

Difference between autism and aspergers/

A

Child with aspergers will have normal language function before 3 years of age

385
Q

Three areas of abnormal functioning required for diagnosis of autism in ICD 10?

A

Social interaction
Communication
Restricted, repetitive behaviour

386
Q

What behaviour is strongly suggestive of a pervasive developmental disorder?

A

Persistent gaze avoidance

387
Q

When is atypical autism diagnosed?

A

Autistic features seen but either age of onset not satisfied or all three setes of diagnostic criteria not fulfilled

388
Q

Definition of Rett’s syndrome in ICD 10

A

Normal early development in girls seen followed by partial or complete loss of acquired hand skills and speech, together with deceleration of head growth
Onset 7-24 months of age

389
Q

Onset of Rett’s?

A

7-24 months of age

390
Q

Signs in young children with Rett’s?

A

Hand-wringing stereotypes
Hyperventilation
Loss of purposive hand movements

391
Q

Signs of Rett’s in older children?

A

Trunk ataxia and apraxia associated with scoliosis and choreoathetoid movements

392
Q

Common feature of Rett’s?

A

Epilepsy

393
Q

What is Heller’s syndrome?

A

Dementia of childhood:

Normal development up to 2 years of age followed by loss of previously acquired skills and abnormal social functioning

394
Q

What is another name of Acquired aphasia with epilepsy?

A

Laudau-Kleffner Syndrome

395
Q

Age of onset of Laudau-Kleffner syndrome?

A

3-7 years of age

396
Q

Characteristics of Laudau-Kleffner syndrome?

A

Despite previous normal progress in language development, child loses receptive and expressive language skills but retains general intelligence

397
Q

EEG in Laudau-Kleffner syndrome?

A

Paroxysmal abnormalities, usually originating from bilateral temporal lobes

398
Q

Subdivisions of social functioning disorders in ICD?

A

Elective mutism

Reactive attachment disorder

399
Q

Subdivisions of emotional disorders specific to childhood in ICD 10?

A

Seperation anxiety
Phobias
Social anxiety
Sibling rivalry

400
Q

ADHD equivalent in ICD 10?

A

Hyperkinetic disorder

401
Q

In which classification is criteria for ADHD more strict?

A

ICD 10

402
Q

Age of onset for ADHD in DSM

A

Some symptoms must be present before 7 years of age

403
Q

What is required for diagnosis of ADHD

A

Impairment from inattention and/or hyperactivity-impulsivity observable in at least 2 settings and interfere with developmentally appropriate functioning socially, academically or in extracurricular activities for at least 6 months

404
Q

Duration of symptoms for diagnosis of ADHD

A

6 months

405
Q

When should ADHD not be diagnosed?

A

In those with pervasive developmental disorder, schizophrenia or another psychotic disorder

406
Q

Define oppositional defiant disorder?

A

Enduring pattern of negative, hostile, disobedient and defiant behaviour without serious violations of social norms or rights of others.
Symptoms persistent for 6 months.

407
Q

In which classification is oppositional disorder excluded if a patient has conduct disorder?

A

DSM

408
Q

When does reactive attachment disorder occur?

A

Infants and young children

409
Q

What happens in reactive attachment disorder?

A

Persistent abnormalities in child’s pattern of social relationships associated with emotional disturbance and reactive to changes in environment

410
Q

Describe elective mutism

A

Persistent failure to speak in selective settings (e.g. school) despite full use of language in other settings.

411
Q

When is fear of strangers a normal phenomenon?

A

Second half of first year of life

412
Q

When can social anxiety disorder of childhood be made?

A

Before age of 6 years when anxiety is to an unusual degree and accompanied by problems in social functioning

413
Q

Criteria of sibling rivalry disorder in ICD 10

A

Evidence of sibling rivalry and/or jealousy
Onset during months following birth of younger sibling
Emotional disturbance that is abnormal in degree and/or persistence and associated with psychosocial problems

414
Q

Change in age onset of ADHD in DSM V?

A

From 7 to 12

415
Q

What has been added to DSM V to reduce diagnosis of bipolar in children?

A

Disruptive mood dysregulation disorder

MRCPsych Part A - Al-Rashid Hospital (22 decks)

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