Classification Flashcards
As a diagnostic hierarchy is non-reflexive what does this refer to?
That diagnoses below the level may be met by the above diagnosis but not the other way round
How do ICD-10 and DSM-V differ with regards to their axes?
ICD-10
- Axis 1 (mental disorders includes PD and LD)
- Axis 2 (degree of disability)
- Axis 3 (current psychosocial problems)
DSM-V
- Axis I (clinical disorders)
- Axis II (PD and LD)
- Axis III (General medical conditions)
- Axis IV (Psychosocial stressors)
- Axis V (Global assessment of functioning)
Name four clinical instruments developed using the ICD-10
Schedule for clinical assessment in neuropsychiatry (SCAN)
Composite international Diagnostic Interview (CIDI)
International personality disorder examination (IPDE)
Present State Exam (PSE)
What four versions of the ICD-10 exist
Clinical descriptive and diagnostic guidelines (CDDG) - for clinical, educational and service use
Primary care version - broad descriptions of clinical conditions in primary care with flowcharts and recommendations
Diagnostic criteria research (DCR) - to identify homogenous patients
Clinical coding - short glossary for clinicians
How is the DSM structured
Section 1: Introduction
Section 2: Conditions and their criteria
Section 3: Conditions that need further research before their consideration as formal disorders
Name some changes from DSM-IV to DSM-V in the following conditions
a) Psychosis
b) Mood disorder
c) Developmental disorder
a) No subtypes of Schizophrenia, “bizarre delusions” removed, 3 core symptoms (delusions, hallucinations and disorganised speech), changes to Schizoaffective Criteria
b) Premenstrual dysphoric disorder, dysthymia and chronic depression are now a merged category, bereavement no longer excludes depression
c) ADHD criteria are relaxed, Asperger’s and Autism are merged into ASD
Other changes are:
- Anorexia no longer requires Ammenorrhoea
- Binging frequency is needing for Bulimia
- OCD and PTSD are in separate chapters
- Hoarding disorder, Excoriation disorder and Disruptive Mood Dysregulation Disorder are introduced
Can harmful use of substance be diagnosed if there is dependence or substance-induced psychosis? (ICD-10)
No
`What are late-onset disorders in relation to substance misuse?
Changes to the emotional, cognitive, personality or behaviour that occur beyond the expected physiological effects of the drug
The DSM-IV category of abuse refers to?
- Describes problems to occupational, social, physical and psychological domains
- Use of over at least 1 month
- Not yet dependent on alcohol
- Use is in hazardous situations
How do the ICD-10 and DSM-IV differ with respect to alcohol dependence criteria
ICD-10 - symptoms over 12 months:
1. Intense “desire” to “drink” alcohol
2. Difficulty in controlling the onset, termination and the level of drinking
3. Experiencing withdrawal symptoms if alcohol is not taken
4. Use of alcohol to relieve from withdrawal symptoms
5. Tolerance as evidenced by the need to escalate dose over time to achieve same effect
6. Salience”– neglecting”alternate”forms”of”leisure”or”pleasure”in”life
7. The”narrowing personal”repertoire”of”alcohol”use.
DSM-IV symptoms over at least a month:
1. Consuming”alcohol”for”longer”period”and”in”larger”amounts”than”intended
2. Unsuccessful”attempts”to”cut”down
3. Experiencing”withdrawal”symptoms”if”alcohol”is”not”taken
4. use”of”alcohol”to”relieve”from”withdrawal”symptoms
5. Tolerance”as”evidenced”by”the”need to”escalate”dose”over”time”to achieve”same”effect”
(at”least”50%”increase”from”start)
6. Salience”– most”time”of”life”spent”on”pursuing”alcohol”directly”or”indirectly
7. Failure”in”role”obligations”and”physical”health
8. Giving”up”alternate”pleasures
9. Continued”use”despite”knowing”the”harm”caused
What are the Edward and Gross Criteria for Alcohol Dependence?
- Narrowed repertoire
- Increased salience
- Tolerance
- Withdrawal symptoms
- Drinking to prevent withdrawals
- Reinstatement after a period of abstinence
- Subjective awareness of dependence
What are the 5As of Alzheimer’s dementia?
Aphasia
Apraxia
Agnosia
Amnesia
Associated disturbances due to behavioural changes, delusions or hallucinations
When may a diagnosis of Parkinson’s dementia be made rather than Lewy Body?
If symptoms of parkinson’s come 12-months before the dementia
What study identified the common symptoms of Schizophrenia?
International pilot study of Schizophrenia - the commonest were:
- Lack of insight (97%)
- Auditory hallucinations (74%)
Prior to the ICD-10 and DSM-IV name two criteria involved in the classification of Schizophrenia
St Louis or Feighner Criteria
National institute for health
Prior to the ICD-10 and DSM-IV name two criteria involved in the classification of Schizophrenia
St Louis or Feighner Criteria:
- A (6 months without affective disorder)
- B (sx including delusions, hallucinations or thought disorder)
- C (at least 3 manifestations i.e. FHx, single, poor premorbid social functioning, no alcohol or drug misuse, onset < 40)
National institute of mental health research criteria:
- Schneider 1st rank symptoms and formal thought disorder
- Needs to be present for 2 weeks
- Exclusion criteria of other diagnoses
What is the ICD-10 timeline for Schizophrenia?
If continuous symptoms - diagnosis can be sought after 1 month (does not include prodromal symptoms)
< 1 month - acute psychotic disorder
Persistent delusional disorder can only be diagnosed if symptoms are present after 3 months
Name the ICD-10 subtypes of Schizophrenia
Paranoid - positive symptoms
Hebephrenic or Disorganised - disorganised speech, behaviour or inappropriate affect, poor self-care, poor hygiene
Catatonic - motor immobility, excessive motor activity, catalepsy or stupor, negativisim (acting opposite to asked) or mutism, posturing, echolalia or echopraxia
Residual - past full blown episode but now either negative symptoms or two attenuated positive symptoms
Simple - slow progressing negative symptoms appears to be a deterioration of one’s personality with emotional blunting. Rare. Diagnosis supported by brief psychotic episodes. 1 year not 1 month duration.
Undifferentiated - symptoms that do not fit other categories
“Chronic schizophrenia” - descriptive label if disability for 2 years
NOTE: ICD-11 does not include descriptive categories instead there are dimensional descriptors
For post schizophrenic depression when does the depression need to have occurred? (ICD-10)
Within the last 12 months of relapse
Outline the DSM-IV criteria for Schizophrenia
One of:
- Bizarre beliefs
- 3rd person auditory hallucinations
- Running commentary
Or two of:
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised behaviour or catatonia
5. Negative symptoms
Need 1 month of symptoms but at least 6 months of disability
For DSM-V one criterion A symptoms must be one of 1-3.
Outline the ICD-10 criteria for Schizophrenia?
At least one of:
1.Thought echo, thought
insertion/withdrawal/broadcast
2.Delusions of passivity or delusional perception
3.Third person auditory hallucination, running commentary
4.Persistent bizarre delusions
OR two or more of:
1.Persistent hallucinations
2.Thought disorder
3.Catatonic behaviour
4.Negative symptoms
5.Significant behaviour change
Need at least 1 month of continuous symptoms
In Bipolar Disorder what factor related to treatment history may associate to rapid cycling?
Antidepressant use
Who coined the term Schizoaffective Psychosis?
Russian-born American psychiatrist Jacob Kasanin
Coined as a good prognosis Schizophrenia (JKing)
Is there a correlation between socioeconomic status, ethnicity and anorexia nervosa?
No
MZ concordance 65%
DZ concordance 32%
Which groups is folie a deux most commonly experienced within?
Couple (52%) then sisters (24%)
Folie a deux or induced delusional disorder is a condition where one individual induces delusional beliefs in the other
Charles Lasegne and Jules Falret coined the terms
Does ICD-11 include subtypes of Schizophrenia
No - all have been eliminated given their lack of predictive value - instead there are dimensional descriptors
Catatonia has been included a broaded diagnostic category (at hierarchical level of mood disorders, anxiety and fear disorders)
When are more severe cases of ASD identified?
< 2 years due to lack of developmentally appropriate interest in social itneraction
Can delusional disorder present with perceptual abnormalities (ICD-11)
Yes - if in keeping with delusion these include misidentification of persons, hallucination or illusion.
Other symptoms of Schz persistent and clear hallucinations, disorganised thinking, negative symptoms are not consistent with delusional disorder diagnosis
The symptom must last for 3 months
For borderline personality disorder which features are thought to decrease through adulthood?
- Impulsivity
- Self-harm
- Suicidal ideation
Other sx chronic emptiness, interpersonal difficulties, affective instability may be more resistant to reduction without treatment
For a psychotic disorder in ICD-11 to fit the label of acute and transient what time points should symptoms reach there maximum peak and resolve?
Symptoms reach peak within 2 weeks
Resolve by 3 months
In acute and transiet psychosis there are no prodromal mood symptoms
From the international pilot study of Schizophrenia which symptoms presented were most common in Schizophrenia?
Lack of insight 97%
Auditory hallucinations 74%
Ideas of reference 70%
Suspiciousness 66%
Flattened affect 66%
Name some features of paranoid PD?
Sensitive to criticism despite being very critical of others
Suspicions that others are exploiting, harming or decieving them
Reading threats from benign remarks
Long-standing grudges
Not being able to confide in people
Suspicious of infidelity
Believing others are not loyal or untrustworthy
Feel others are attacking their reputation
