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
What are the characteristic symptoms of narcolepsy?
Hypnopompic hallucinations
Hypnogogic hallucinations
Sleep paralysis
Cataplexy - loss of muscle tone and rigidity when awake (note catalepsy is when this occurs during sleep)
What condition associates to selective mutism?
Social anxiety disorder - in selective mutism there is failure to speak in certain settings despite full use of language elsewhere
The condition develops after an individual has learnt how to speak
Can dissociative neurological symptom disorder include speech disturbance?
Yes - it can present with difficulty with speaking (dysphonia), loss of ability to speech (aphonia) or dysarthria
Outline how the severity of LD is classified?
Mild - capable of self-care. Can find employment but may need support to live independently. May struggle with academic skills or complex language comprehension.
Moderate - capacity for some academic skills and language comprehension but usually limited to basic ability. Most need ongoing support to live or work independently. Some can manage basic self-care.
Severe - Daily support in a supervised environment. With training some may develop basic self-care skills. Usually motor impairments
Profound - Motor and sensory impairment, may have basic language skills. Daily support in supervised care environment.
Outline the dimensional symptoms domain descriptors in the ICD-10
+ve symptoms
-ve symptoms
Depressive mood symptoms
Manic mood symptoms
Psychomotor symptoms
Cognitive symptoms
What is la belle indifference?
Lack of concern or denial of a severe functional disability.
What is DeClerambault syndrome?
Delusional disorder where one believes that they are in love/relationship with a individual of higher class (erotomanic delusions)
May be associated with persecutory delusions that individuals are trying to keep them apart
Wilhem Griesenger felt all mental disorders were…
Diseases of the brain!
Anti-social aggressive or defiant behaviours that do not align with age appropriate norms may refer to a CAMHs diagnosis of?
Conduct disorder
Behaviour could include:
- Fire-setting
- Cruelty to animals
- Lying/deceitful
- Aggression to others
- Running away from home
- Truancy
- Use of a weapon
- Forced sexual activity
How much does smoking cannabis during adolescent increase the risk of developing Schz?
2-4 x
Outline some features of histrionic personality disorder?
Feeling relationships are more intimate than they are
Dramatic and flamboyant behaviour
Being suggestible and easily influenced
Having shallow or shifting emotions
Being inappropriately sexually provocative
Are bizarre delusions allowed in a delusional disorder?
Generally no (DSM-V does allow for with bizarre content descriptor) however mostly delusions are not bizarre.
In delusional disorders there may be transient olfactory or tactile hallucinations however these are related to the delusional content
DSM-IV and V subtypes include:
- grandiose, jealous (othello), erotomanic (de clerambault), somatic, persecutory
Outline some poor prognostic factors in Schizophrenia?
Male
Young onset
Cognitive impairment
Insidious onset
Negative symptoms (note mood symptoms may be a positive predictor)
What is the most common symptoms seen in OCD?
Checking (63%)
Followed by washing (53%) and fear of contamination (45%)
How does Schizotypal and Schizoid disorders differ?
Schizotypal:
- Odd and eccentric behaviour
- Suspiciousness
- Magical thinking
- More common in family of Schz patients
- 2 years without Schz diagnosed
- May have illusions or transient hallucinations
- Ruminations without resistance
Schizoid:
- Difficulty expressing emotions particularly warmth
- Spend time alone, may be aloof
- Unresponsive to praise
- Unaware of social trends
Describe how Schizoaffective disorder presents?
Criterion A of Schizophrenia fulfilled
However during illness episodes there are symptoms that fulfill the criteria for mania/depression
B. During lifetime illness hallucinations or delusions are present for at least 2 weeks outside of mood symptoms
C. Most illness episodes schizophrenia and mood symptoms co-occur
What psychotic variant conditions did the following people coin?
a) Legrain
b) Leonhard
c) Langfeldt
d) Perris
a) La Boufee Delirante - sudden onset out of the blue with rapid recovery
b) Cycloid Schizophrenia - endogenous psychosis akin to postpartum cases
c) Process schizophrenia - separated schizophrenia cases to affective psychosis (schizophreniform psychosis)
d) Sudden onset psychotic symptoms unrelated to stress high onset of recurrence with mood swings - pananxiety and hyper/hypokinesia
What does 4-6-8 relate to severity of depression in ICD-10?
4 - mild severity i.e. 2 core symptoms with 4 extras
6 - moderate severity i.e 2 core symptoms with 6 extras
8 - severe severity i.e. 2 core symptoms with 8 extra symptoms
Note iCD-11 has scrapped this and refers to severity/global burden of symptoms and degree of functioning
Outline the 9 DSM-V depression symptoms?
1) Low mood *
2) Anhedonia *
3) Reduced energy/fatigue
4) Loss of appetite/increased appetite
5) Reduced sleep/increased sleep
6) Negative cognitions - guilt/worthlessness
7) Suicidal ideation
8) Psychomotor agitation/slowing
9) Reduced ability to concentrate
Note in ICD-10 core symptoms of depression were - low mood, anhedonia, low energy however in ICD-11 the core symptoms are just depressed mood and anhedonia
How do associated symptoms of depression in ICD-10 vary to DSM-V
ICD-10 (10 total symptoms):
- No psychomotor agitation/retardation (present in DSM-V)
- Additional - low confidence/self-esteem
- Additional - thoughts of pessimism of the future
Note both require 5 total symptoms
What is the natural length of depression and manic episodes in bipolar I?
Depression - 6 months
Mania - 4 months
Outline the associated symptoms (Criterion B) of mania in DSM-V and ICD-10?
Presence of 3 (or 4 if only irritable mood):
DSM-V:
1. Increased self-esteem or grandiosity
2. Talkative or pressure of speech
3. Racing thoughts or flight of ideas
4. Distractability
5. Decreased need for sleep
6. Increase goal directed activity
7. Risk behaviour - engaging in behaviour that has capacity for painful consequences
ICD-10:
1. Increased self-esteem or grandiosity
2. Talkative or pressure of speech
3. Racing thoughts or flight of ideas
4. Distractability
5. Decreased need for sleep
6. Increased activity/restless
7. Foolish or risky behaviour
8. Loss of social inhibition
9. Increased sexual activity or sexual interest.
For the ICD-10 SAD outline the criteria that describes episode frequency/improvement?
3 or more episodes with onset within the same 90 day period of the year
Occurs for 3 or more years
Remissions also occur with a set 90 day window
How long does GAD have to be present for to reach a diagnosis in ICD-10?
6 months
Outline the 6 criteria for GAD in ICD-10?
- Symptoms of autonomic arousal
- Physical symptoms - chest pain, nausea, SOB
- Mental state symptoms - feeling like going crazy, fear of losing control, fear of passing out/dying
- General symptoms - hot flushes/chills or numbness/tingling
- Symptoms of tension
- Other - difficulty sleeping, difficulty concentrating/mind going blank, irritability
For panic disorder what do DSM and ICD specify with regards to length of duration?
Be present for at least 1 month
In ICD-10 for severe the patient requires 4 panic attacks per week over the 4 weeks
What are the cardinal features of phobia according to Marks?
- Fear out of proportion
- Cannot be rationalised away
- Is beyond voluntary control
- Leads to avoidance
In DSM-IV and DSM-V how long does phobia need to be present?
6 months - for DSM-IV this was only the case for children (however both in DSM-V)
Also now no need for insight that fear us excessive
What is nosophobia?
Fear of contracting an illness typically chronic in nature - may lead to avoidance of healthcare settings etc.
In ICD-10 on how many days do obsessions and compulsions need to be present to consider a diagnosis of OCD?
14 days
What does the ICD-10 specify for all obsessions and compulsions?
(1) Acknowledged as originating in the mind of the patient
(2) Repetitive and unpleasant; at least one recognised as excessive or unreasonable
(3) At least one must be unsuccessfully resisted (although resistance may be minimal in some cases)
4) Carrying out the obsessive thought or compulsive act is not intrinsically pleasurable
When does adjustment disorder need to start and end?
DSM-IV within 3 months start
ICD-10 within 1 month start
Resolves within 6 months the termination of stressor
(note prolonged subtype may last up to 2 years)
–> Vulnerability to adjustment disorder plays a more significant role than other neurotic disorders
What are the differences between type I and type II trauma (DSM-IV)?
Type I - single life-threatening
Type II - repetitive events
When should PTSD start?
Within 6 months of trauma
If > 6 months termed probably PTSD
Define dissociation
Loss of integration of memories, identity, sensation and movement
How does dissociative trance differ to possession trance?
In possession trance personal identity is lost and replaced with another identity (does not occur with dissociative).
Both have narrow consciousness, amnesia, stereotypic or repeated movements and loss of personal identity
What is ganser syndrome?
Type of dissociative disorder
Dissociation symptoms inc. amnesia, fugue, narrowed consciousness, conversion symptoms
Approximate answers to questions
Visual pseudohallucinations
What is Somnambulism
Sleep walking
Broadly define the criteria for a hypochondriacal disorder?
- Belief a person has a disease
- Belief part of the body is disfigured (BDD type)
AND
- Refusal to accept reassurance or negative medical test results
- Needs to last for 6 months
Includes: nosophobia and nondelusional dysmorphophobia
Where is Body Dysmorphic Disorder included in DSM-IV and DSM-V?
DSM-IV –> somatoform disorders
DSM-V –> OCD related disorders (includes with muscle dysmorphobia specifier)
Note - a if the belief of disfigurement or changing appearance is delusional > overvalued it is a delusional disorder
How do factitious disorder and malingering differ?
Malingering there are clear secondary gains i.e. money/housing
Factitious disorder (munchosens) in extreme form) is just seeking medical role
What are dysomnias and parasomnias?
Dysomnia - abnormal timing, quality of sleep
Parasomnia - abnormal events occuring during sleep
When is gender identity established?
By 3 years - dependent on reared sex > biological sex and is resistant to change
What is dual role transvestitsm?
Where an individual wears clothes of the opposite sex and feels more appropriate doing this.
Can occur if theres is incongruity between an individuals biological sex and gender identity
- Note fetishistic transvestitism is different and refers to when an individual gains sexual pleasure from wearing clothes of the other sex - paraphillic disorder
What is gender dysphoria?
When there is incongruity between gender identity and phenotypic appearance
Define the following:
a) Fetishism
b) Paedophilia
c) Sexual masochism
d) Sexual sadism
e) Fetishistic transvestism
f) Voyeurism
g) Frotteurism
Exhibitionism Expose genitals to achieve arousal
Fetishism Use of inanimate objects to achieve arousal
Paedophilia Sex with prepubescent child (<13)
Sexual masochism Real, not simulated act of being humiliated, beaten or bound to achieve arousal
Sexual sadism Real, not simulated act of inflicting psychological or physical suffering including
humiliation of victim to achieve arousal
Fetishistic transvestism Crossdressing in heterosexual male to achieve arousal
Voyeurism ‘Peeping-toms.’
Frotteurism Touching and rubbing against non-consenting individual
How does IQ differ with the severity of LD?
Mild: 50-69:
- Can develop social and communication skills
Moderate: 35-49
- Profits from training
Severe: 20-34
- May have self-maintenance but under complete supervision later in life
- Does not profit from training
- Speech minimal but can talk/communicate a little
Profound: < 20:
- Needs constant supervision aid and care
Outline the 3 symptoms domains in Autism?
Social interaction
Communication/language development
Restrictive/repetitive behaviours
Symptoms arise < age 3 but child is not mute
In what pervasive developmental conditions is there loss of previous abilities?
Heller’s syndrome - normal until 2 than loss of acquired skills and functioning
Rett’s - normal development then loss of hand and communication skills - normally between 7 and 24 months. Children have hand wriggling stereotypes, hyperventilation and loss of purposeful hand movements. Scoliosis and choreoathetoid movements.
Acquired Aphasia with Epilepsy / Landau-Kleffner syndrome. Normal development then receptive and expressive aphasia but with general intelligence. Develop seizures with focal EEG abnormalities
How does DSM-V describe ADHD criteria?
If < 17:
- 6 of 9 inattentive symptoms (5 of 9 if 17 or over)
AND
- 6 of 9 impulsive/hyperactive symptoms (5 of 9 if 17 or over)
Most of symptoms need to have been present from < 12 years
Need to occur in at least 2 settings
Need to be present for 6 months
Must be a degree of occupational/social/emotional impairment
