CLASSIFICATION Flashcards
What are the two major contemporary classificatory systems in psychiatry?
Who produces the DSM system and who commissioned ICD-10?
What does the “operationalized approach” mean in DSM-III?
A: ICD-10 (1992) and DSM-IV (1994
DSM is produced by the American Psychiatric Association; ICD-10 was commissioned by the World Health Organization (WHO).
It uses precise clinical descriptions, inclusion/exclusion criteria, and symptom duration/intensity to diagnose disorders.
What is the difference between characteristic and discriminating symptoms?
What does the “atheoretical approach” in diagnostic classification refer to?
Characteristic symptoms are common across disorders, while discriminating symptoms are unique to a specific diagnosis.
Disorders are described based on observed phenomena, not on theoretical causes like behaviorism or psychoanalysis.
What is the difference between categorical and dimensional approaches in psychiatric diagnosis?
pros and cons of categorical?
Categorical systems classify disorders as either present or absent, while dimensional systems measure disorders on a continuum.
A: Pros: Easy to understand, communicate, and base treatment on.
Cons: Poor validity, vague categories like “psychosis-not specified.”
Dementia in Alzheimer’s disease (diagnostic criteria
5 As
Global deterioration in intellectual capacity and disturbance in higher cortical functions
Insidious onset with slow deterioration
5 As Remember
x Amnesia- Impaired ability to learn new information and to recall previously learned
information
x Aphasia -Problems with language (receptive and expressive)
x Agnosia -Failure of recognition, especially people
x Apraxia-Inability to carry out purposeful movements, even though, there is no sensory or
motor impairment
x Associated disturbance-behavioural changes, delusions, hallucinations
Vascular dementia
Cognitive decline after a cerebrovascular event, stepwise progression, focal neurological signs (e.g., hemiparesis), and emotional/personality change
What characterizes Dementia with Lewy Bodies?
Parkinsonism, fluctuating cognition, visual hallucinations, and progressive cognitive decline
If the Parkinsonian symptoms existed for more than 12
months before dementia develops then = diagnosis of Parkinson’s disease dementia.
If both motor symptoms and cognitive symptoms develop within 12 months, then = diagnosis of Lewy body dementia.
What are the main signs of Frontotemporal Dementia
Insidious onset, disinhibition, emotional blunting, speech disorders, and physical signs like rigidity and incontinence.
What are common causes of
-organic catatonia
- post-infective depression
- Encephalitis and CO poisoning cause catatonia
-influenza can cause post-infective depression.
International Pilot Study of Schizophrenia survey determined the commonest symptoms which are?
- Used 306 acute schizophrenia patients in 9 countries
Lack of insight – 97%
Auditory hallucinations - 74%
Ideas of reference – 70%
Diagnosis criteria for schizophrenia
St Louis or Feigner / Washington university
National institute of mental health research
ICD 10 = largely based off Schneiders
St Louis - 6 months + at least one delusion or hallucination or communication hard due to lack of organisation and 3 of the following present (single, poor premorbid social adjustment, fhx. absennce alcohol oro drug abuse, onset under 40)
National institute
Symptom - first rank symptoms
Duration - 2 weeks
Exclusion - meet full criteria for manic or depressive syndrome
ICD - 1 month + = schizophrenia or acute psychotic episode up to 3 months
Subtypes of schizophrenia
paranoid
hebephrenic / disorganised
Catatonic
paranoid- delusions and auditory hallucinations. Less common to have disorganised speech
Hebephrenic- disorganised speech more commoon, inappropriate affect. impaired social functioning. less common catatonic behaviour.
Catatonic- more common in developing nations and acute onset. Stupor, echolalaia or ecopraxia, posturing, extreme negativism.
Subtypes of schizophrenia
Residual
Simple
undifferentiated
Chronic
Residual- evidence full blown in past, negative syx currently or less severe forms of genetic syx
Simple -ve only, no positive. emotional blunting.
Undifferentiated = generic sux nut not falling in other categories
Chronic- persistent disability 2+ years
Schizotypal disorder
Patients with eccentric manners, social withdrawal, magical thinking, suspiciousness, and obsessive ruminations but without resistance.
The ruminations may have dysmorphophobic contents too.
At least a 2-year history with schizophrenia being never diagnosed
Persistent delusional disorders
Characterised by a persistent, often life-long, typically ‘non-bizarre’ delusion or a set of related delusions arising insidiously in mid-life or later.
Transient auditory hallucinations may occur, but NEVER ANY OF
clear and persistent voices, schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain
disease
syx1 month dsm, icd 3 months
subtype delusional disorder
What is Erotomania (de Clerambault syndrome)?
What characterizes Jealousy (Othello syndrome) and Grandiosity?
A delusion where a person believes someone of higher status is secretly in love with them. Often seen in women, but more common in males in forensic cases; may lead to stalking or assault
Jealousy: Fixed belief of partner’s infidelity, leading to possessive behaviors and violence.
Grandiosity: Belief in having special abilities or relationships, often linked to social or religious involvement.
What are the common types of delusional disorders?
Induced delusion?
- Persecutory: Belief others want to harm them.
- Somatic: Beliefs about bodily issues (e.g., infestations, deformities).
Mixed/Unspecified: Includes various delusional misidentification syndromes
Folie a deux- common in couples. usually 1 person genuine delusion, one induced
why is Schizoaffective disorder is placed with F20 (psychoses) not F30 (affective disorders).
2 subtypes
schizoaffective manic
schizoaffective depressiive -
both schizophrenic and mood symptoms are seen simultaneously in approximately equal proportion
- manic- florid, fast recovery, fhx affective disorders
- depressive- more chronic, fhx schizophrenia
Bouffée Délirante
Sudden onset psychosis with polymorphous delusions, hallucinations, clouded consciousness, and emotional instability.
No organic cause, rapid recovery, and potential for relapses separated by symptom-free intervals.
Process Schizophrenia:
Described by Langfeldt,
poor prognosis and continuous, deteriorating symptoms. I
Cycloid Psychosis:
Sudden onset psychosis with mixed affective and schizophrenic symptoms, including mood swings, confusion, delusions, and motility disturbances.
seen in severe postpartum psychiatric disorders, with high recurrence risk
difference in dsm and icd classification of depressive disorder
DSM-IV: Requires 5 or more symptoms, with at least one being depressed mood or loss of interest. duration - at least two weeks, with a specific list of symptoms, including weight changes, insomnia, and suicidal thoughts.
ICD-10: Focuses on core symptoms like depressed mood, loss of interest, and reduced energy (Criterion A).
-uses a broader description of associated symptoms
- does not specify the number of syxs, but includes ideas of guilt, self-harm, and disturbed sleep
severity grading depression ICD 10
The 4-6-8 rule for severity grading in ICD-10:
For mild depressive episode at least 2 criterion A ‘core symptoms’ with four symptoms in total is required.
For moderate depression, at least 2
criterion A with six symptoms in total is required.
To diagnose a severe episode, at least 2 criterion A symptoms with eight symptoms in total is required.
ICD vs DSM bipolar
ICD 10 needs at least 2 mood episodes before a
bipolar diagnosis can be considered, with complete recovery in between the episodes.
The depressive episode must be present at least for 2 weeks; mania for 7 days (fewer if hospitalised);
hypomania for 4 days and mixed episodes for 2 weeks before they can be diagnosed using ICD
10.
In DSM, bipolar disorder can be diagnosed even with a single manic episode.
BPAD type 1 vs type 2
BPAD is divided into two main broad types;
* Type 1 is characterised by full-blown mania or mixed mania and depression.
* Type 2 is characterised by recurrent depression and hypomania
without episodes of either mania or mixed states.
Subtypes bipolar
Rapid cycling
Postpartum onset
Seasonal pattern
When at least four episodes of bipolar disorder occur within a period of one year - 70-80% of rapid cyclers are women
Postpartum onset refers to the onset of mania, hypomania
or depression with 4 weeks of childbirth.
Seasonal pattern refers to recurrences over several years
with most episodes typically start (and end) at the same
time each year
Dysthymia/Dysthymic Disorder:
Cyclothymia
Seasonale Affective Disorder
- Chronic, mildly depressed mood lasting for at least 2 years with symptoms like low energy, poor concentration, and hopelessness.
- Double Depression* occurs when major depressive episodes occur on top of dysthymia, often with worse prognosis and treatment response.
- Cyclothymia- Mild mood swings between depression and elation, not severe or prolonged enough to meet criteria for bipolar disorder or recurrent depressive disorder. The individual perceives these fluctuations as unrelated to life events.
- SAD, ICD-10 specifies that 3 or more affective episodes must occur, with onset within the same 90
day period of the year, for 3 or more consecutive years. Remissions should occur within a defined
90-day period of the year. Seasonal episodes substantially outnumber any non-seasonal episodes
that may occur. Tx 2 hrs daily 10,000 lux
GAD
Panic disorder
ICD-10 requires duration of at least 6 months and at least 4 of the symptoms should have been present on most days during 6 months
Panic- syx must be present for one month duration. severe = 4 attacks per week in 4 week period.
Agoraphobia
Most common and incapacitating phobic disorder, often starting in early adulthood, with fear of situations where escape is difficult (e.g., crowded places).
Avoidance leads to symptom-free periods but can result in being housebound.
It can be accompanied by panic attacks. ICD-10 views agoraphobia as the primary disorder, while DSM-IV places panic attacks first.
Social phobia
Specific phobia
Social Phobia: Marked fear of social situations with scrutiny, often starting between 17-30 years. DSM emphasizes the fear of embarrassment or humiliation, distinguishing it from paranoia. The condition may be either discrete (e.g., fear of public speaking) or diffuse (e.g., fear of all social tasks). Diagnosis requires recognition of excessive fear.
Specific Phobias: Typically begin in childhood (e.g., animal phobias at age 7). DSM-IV categorizes five types (e.g., animals, blood, situational). Blood-injection phobia differs with a fainting response rather than a sympathetic-driven reaction. DSM-V now requires a 6-month duration for all ages, and no subjective recognition of irrationality is needed for adults
Obsessive compluse disorder
Obsessional thoughts/images/ideas and compulsive behaviors, often linked to anxiety and depression.
I
CD-10 criteria: Must have:
Obsessions/compulsions originating in the patient’s mind.
Repetitive, unpleasant, and excessive/unreasonable.
At least one is unsuccessfully resisted.
Actions are not intrinsically pleasurable.
Common symptoms: Checking, washing, contamination fears, doubting, counting, symmetry obsessions, aggressive thoughts.
DSM-5 update: OCD and related disorders are now in a separate chapter, with new diagnoses: Hoarding Disorder and Excoriation (skin-picking) Disorder
Acute stress reaction
Acute stress disorder
adjustment disorder
reaction - within 1 hour, resolution 8 hours or 48 hours if prolonged event, dissociative symptoms, agitation.
disorder- lasting at least 2 days, max 4 weeks. dissociation.
adjustment-relation to adapting to new circumstances and occurs in
someone who has been exposed to a psychosocial stressor. onset 1 month, ICD, 3 months dsm. last 6 months.
PTSD principles
diagnostic criteria
- Hyperarousal: Persistent anxiety, irritability, insomnia, poor concentration.
- Hypervigilance & re-experiencing: Intrusive memories, flashbacks, recurrent distressing dreams, difficulty recalling the trauma.
- Avoidance & emotional numbness: detachment, anhedonia, estrangement from others.
Both ICD-10 and DSM-IV require 2+ persistent symptoms of heightened arousal post-trauma.
Symptoms should emerge within 6 months, with chronic cases (>6 months) or delayed onset (probable PTSD).
Dissociative disorders
dissociative amnesia
dissociative fuge
Characterized by loss of integration among memories, identity, sensations, and movements, typically triggered by trauma. Symptoms start suddenly and end abruptly, but can be chronic (lasting >1 year).
Amnesia: Partial, selective loss of recent memories, usually related to trauma; no anterograde deficits.
Fugue: Amnesia with purposeful travel, often leading to the assumption of a new identity, with amnesia for past identity and the fugue episode
dissociative trance
conversion disorder
psuedoseizures
trance-Involuntary, narrow consciousness with repetitive movements; must disrupt life and occur outside cultural practices. possession trance- replced with another identity
conversion-Motor or sensory dissociative symptoms without an organic cause, often with la belle indifference (not distressed despite serious syx)
psuedoseziures- avoidance behvaiour resisting eyelid opening, emotional trigger, seizures occur only presence others
Somatoform disorders
- somatisation
somatisation = SYMPTOMS
Al = characterized by the lack of a psychological appraisal on the patient’s part + a resistance to consider presenting problems as one of ‘mental’ origin
- somatisation (a) at least 2 years of multiple and variable physical symptoms
for which no adequate physical explanation has been found; (b) persistent refusal to accept the advice and
reassurance of several doctors regarding the absence of a physical illness; (c) notable impairment of social
and family functioning due to the symptoms and the illness behaviour. The term Briquet Syndrome or St.
Louis Hysteria is sometimes applied to denote somatisation disorder
Hypochondrial disorder
hypoCondiral eg. Cancer
(1) persistent belief of harboring at least one serious physical illness
even though repeated investigations and examinations have
identified none or a persistent preoccupation with a presumed
deformity or disfigurement (body dysmorphic type);
(2) persistent refusal to accept the advice and reassurance of several
doctors regarding the absence of a physical illness
patient looks for diagnosis,
not symptom relief;
Body Dysmorphic disorder
‘subjective description of ugliness and physical defect which the
patient feels is noticeable to others’
Overvalued idea - trivial or non existent physical abnormalities
Anorexia
ICD
DSM
endocrine disturbances
atypical –>
ICD- describes the presence of low body weight as
being 15% or more below the expected norm and BMI as 17.5 or less + syx
DSM - now removed amenorrhea as a requirement.
endocrine-Amenorrhoea, reduced sexual interest, abnormal thyroid, raised GH/cortisol, and insulin secretion abnormalities due to HPA axis dysfunction.
atypyical- often older age onset, numerous somatic complaints, recurrent depression
Bulimia nervosa
icd
atypical and binge eating disorder
Includes preoccupation with eating, binge episodes, attempts to counteract food effects (vomiting, purging, starvation, appetite suppressants), and morbid fear of fatness.
Atypical bulimia may have missing features. purging and non purging types.
BED involves binge eating without extreme weight-control behaviours, often associated with obesity. men in 40s.
Sleep disorders
Kleine Levin syndrome:
Narcolepsy
Periodic episodes of hyper somnolence and hyperphagia + mood changes. Often presents in adolescent males + precipitated by fever or resp infections.
Narcolepsy -excessive daytime drowsiness accompanied by a sudden onset of REM
sleep (sleep seizure or narco lepsy) and sudden loss of muscle tone, provoked by strong emotions
(cataplexy).
Sleep Paralysis
Hypnagogic hallucinations
Divide sleep disorders into
- dyssomnias (issues falling or staying asleep)
- parasomnias (abnormal behaviours in sleep)
Inability to move occuring between wakefulness and sleep
usually auditory in nature but may be visual or tactile, occur in about 25% of patients.
Personality disorder (diagnosis cannot be made under 16/17 years)
cluster A (odd/eccentric)
Cluster B (dramatic, erratic)
icd different eupd 2 types
Cluster C (anxious, inhibitied)
A- paranoid (suspicious)
schizoid (avoid others),
schizotypal (tin hat, magical)
B- Antisocial (lack remorse, disregard rules),
(self harm, impulsive), Histrionic (dramatic, attention seek, sexually provocative)
Narcissistic (grandiose, self centred)
C- Avoidant- (socially withdrawn)
Dependent- (passive, lacks confidence)
Obsessive- Compulsive - (anakastic) (perfectionist, rigid attention to detail, workaholic)
Impulse control disorder
klepto
trichotillomania
pyromania
IED
gambling
kleptomania (steal things)
- pyromania (set fire)
-Trichotillomania (pull hair out)
- Intermittent explosive disorder (violent outbursts)
- Pathological gambling
Gender Identity Disorders (ICD-10)
3 disorders
Gender identity is established by age 3 and is resistant to change, influenced more by reared sex than biological sex.
3 = transsexualism, dual role transvestism, and gender identity disorders of childhood.
Gender dysphoria refers to incongruence between one’s gender identity and phenotypic appearance, with varying degrees of severity.
Transsexualism ICD and DSM (most severe gender dysphoria)
Dual role transvestism
Transsexualism:
Persistent discomfort with one’s sex, strong cross-gender identification, desire for sex-change surgery, and significant distress or impairment.
Has to be present for 2 years
Dual Role Transvestism: \
Wearing the opposite sex’s clothing temporarily, without sexual motivation or desire for permanent gender change.
Differentiates from fetishistic transvestism, which involves sexual arousal and is classified as a paraphilia.
Gender identity disorder in childhood
r should last at least 6 months, with a focus on ruling out chromosomal and endocrine issues.
Management involves supporting tolerance of uncertainty, with surgery not justified until adulthood.
Gender identity is separate from sexual orientation; most children with gender dysphoria do not persist as adult transsexuals.
Paraphilias (f60)
klismaphilia
necrophilia
exhibitionism
fetishism
Paedophilia
sexual masochism
sexual sadism
Fetishisitc transvestism
voyeurism
frotteurism
Klismaphilia - enemas to achieve sexual arousal
Necrophilia - arousal from death
Exhibitionism - exposing for arousal
Fetishism- inanimate objects
Paedophilia - under 13
Masochism- being humiliated for arousal
Sadism- real, not simulated act of inflicting suffering
tans- crossdressing in male to achieve arousal
Voyerusm- peeping tom
Frotteurism- rubbing against non-consenting individual
Mental retardation / intellectual disability
profound iq <20, nursing care constant
severe- speech minimal, iq 20-34
moderate - moderate supervision- iq 35-49
mild - can be guided towards social conformity. iq 50-69
Autism
Presence of abnormal and/or
impaired development evident before the age of 3 years, with
abnormal functioning in all three areas of social interaction,
communication, and restricted, repetitive behaviour.
Unlike children with autism, children with Asperger’s syndrome have normal language functions before the age of 3
Retts syndrome
Hellers Syndrome
Landau-Kleffner syndrome
Retts-apparently normal or near-normal early development is
followed by partial or complete loss of acquired hand skills and of speech, together with deceleration in
head growth, usually with an onset between 7 and 24 months of age
Hellers- dementia of childhood. normal development up til 2, then loss of skills.
LK - child loses reception and expressive skills from 3-7 but retains IQ. epilepsy temporally.
Disorder with childhood onset
Hyperkinetic (ADHD)
conduct disorder
Oppositional Defiant Disorder
hyperkinetic- must have some symptoms before 7 years old. present in 2 settings and interfere 6m+ (dsm 5 now before 12 yrs)
conduct= aggression, theft, destruction pf property, truant
Op-negative, hostile, disobedient and defiant behaviour, without serious violations of societal norms or the rights of others (less severe than conduct)
defining features
selective mutism -
social anxiety disorder-
separation anxiety disorder -
selective mutism - mute is specific situations, onset before 5 years,
social anxiety disorder- less common under 10, fear being negatively valued
separation anxiety disorder - recurrent nightmares of separation
