CLASSIFICATION

Question 1

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?

Answer 1

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.

Question 2

What is the difference between characteristic and discriminating symptoms?

What does the “atheoretical approach” in diagnostic classification refer to?

Answer 2

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.

Question 3

What is the difference between categorical and dimensional approaches in psychiatric diagnosis?

pros and cons of categorical?

Answer 3

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.”

Question 4

Dementia in Alzheimer’s disease (diagnostic criteria

5 As

Answer 4

Global deterioration in intellectual capacity and disturbance in higher cortical functions
Insidious onset with slow deterioration

5 AsRemember
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

Question 5

Vascular dementia

Answer 5

Cognitive decline after a cerebrovascular event, stepwise progression, focal neurological signs (e.g., hemiparesis), and emotional/personality change

Question 6

What characterizes Dementia with Lewy Bodies?

Answer 6

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.

Question 7

What are the main signs of Frontotemporal Dementia

Answer 7

Insidious onset, disinhibition, emotional blunting, speech disorders, and physical signs like rigidity and incontinence.

Question 8

What are common causes of
-organic catatonia
- post-infective depression

Answer 8

• Encephalitis and CO poisoning cause catatonia
  -influenza can cause post-infective depression.

Question 9

International Pilot Study of Schizophrenia survey determined the commonest symptoms which are?

• Used 306 acute schizophrenia patients in 9 countries

Answer 9

Lack of insight – 97%
Auditory hallucinations - 74%
Ideas of reference – 70%
Suspiciousness – 66%
Flatness of affect – 66%
Second person hallucinations – 65% Delusional mood – 64%
Delusions of
persecution – 64%
Thought alienation – 52%
echo De Pensee,
Gedankenlautwerden- 50%

Question 10

Diagnosis criteria for schizophrenia

St Louis or Feigner / washington university

National institiute of mental health research

ICD 10 = largely based off Schneiders

Answer 10

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

Question 11

Subtypes of schizophrenia

paranoid

hebephrenic / disorganised

Catatonic

Answer 11

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.

Question 12

Subtypes of schizophrenia
Residual

Simple

undifferentiated

Chronic

Answer 12

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

Question 13

Schizotypal disorder

Answer 13

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

Question 14

Persistent delusional disorders

Answer 14

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

Question 15

subtype delusional disorder

What is Erotomania (de Clerambault syndrome)?

What characterizes Jealousy (Othello syndrome) and Grandiosity?

Answer 15

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.

Question 16

What are the common types of delusional disorders?

Induced delusion?

Answer 16

• 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

Question 17

why is Schizoaffective disorder is placed with F20 (psychoses) not F30
(affective disorders).

2 subtypes
schizoaffective manic
schizoaffective depressiive -

Answer 17

both schizophrenic and mood symptoms are seen simultaneously in approximately equal proportion

• manic- florid, fast recovery, fhx affective disorders
• depressive- more chronic, fhx schizophrenia

Question 18

Bouffée Délirante

Answer 18

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.

Question 19

Process Schizophrenia:

Answer 19

Described by Langfeldt, it refers to schizophrenia with poor prognosis and continuous, deteriorating symptoms. It contrasts with “schizophreniform” psychosis, which has a better prognosis, often now considered affective disorders with psychotic features.

Question 20

Cycloid Psychosis:

Answer 20

Sudden onset psychosis with mixed affective and schizophrenic symptoms, including mood swings, confusion, delusions, and motility disturbances. Predominantly seen in severe postpartum psychiatric disorders, with high recurrence risk and episodic mood changes.

Question 21

difference in dsm and icd classification of depressive disorder

Answer 21

DSM-IV: Requires 5 or more symptoms, with at least one being depressed mood or loss of interest. The duration must be 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). It uses a broader description of associated symptoms and does not specify the number of symptoms, but includes ideas of guilt, self-harm, and disturbed sleep

Question 22

severity grading depression ICD 10

Answer 22

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.

Question 23

ICD vs DSM bipolar

Answer 23

ICD 10 needs at least two 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 hospitalized);
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.

Question 24

BPAD type 1 vs type 2

Answer 24

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.

Question 25

Subtypes bipolar
Rapid cycling

Postpartum onset

Seasonal pattern

Answer 25

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

Question 26

Dysthymia/Dysthymic Disorder:

Cyclothymia

Seasonale Affective Disorder

Answer 26

• 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

Question 27

GAD

Panic disorder

Answer 27

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.

Question 28

Agoraphobia

Answer 28

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.

Question 29

Social phobia

Specific phobia

Answer 29

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

Question 30

Obsessive compluse disorder

Answer 30

Characterized by: Obsessional thoughts/images/ideas and compulsive behaviors, often linked to anxiety and depression.
ICD-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

Question 31

Acute stress reaction

Acute stress disorder

adjustment disorder

Answer 31

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.

Question 32

PTSD principles

diagnostic criteria

Answer 32

• 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).

Question 33

Dissociative disorders

dissociative amnesia
dissociative fuge

Answer 33

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

Question 34

dissociative trance

conversion disorder

psuedoseizures

Answer 34

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

Question 35

Somatoform disorders

1. somatisation

somatisation = SYMPTOMS

Answer 35

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

1. 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

Question 36

Hypochondrial disorder
hypoCondiral eg. Cancer

Answer 36

(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;

Question 37

Body Dysmorphic disorder

Answer 37

‘subjective description of ugliness and physical defect which the
patient feels is noticeable to others’
Overvalued idea - trivial or non existent physical abnormalities

Question 38

Anorexia
ICD

DSM

endocrine disturbances

atypical –>

Answer 38

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

Question 39

Bulimia nervosa
icd

atypical and binge eating disorder

Answer 39

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.

Question 40

Sleep disorders
Kleine Levin syndrome:

Narcolepsy

Answer 40

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).

Question 41

Sleep Paralysis

Hypnagogic hallucinations

Divide sleep disorders into
- dyssomnias (issues falling or staying asleep)
- parasomnias (abnormal behaviours in sleep)

Answer 41

Inability to move occuring between wakefulness and sleep

usually auditory in nature but may be visual or tactile, occur in about 25% of patients.

Question 42

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)

Answer 42

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)

Question 43

Impulse control disorder
klepto
trichotillomania
pyromania
IED
gambling

Answer 43

kleptomania (steal things)
- pyromania (set fire)
-Trichotillomania (pull hair out)
- Intermittent explosive disorder (violent outbursts)
- Pathological gambling

Question 44

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.

Answer 44

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.

Question 45

Transsexualism ICD and DSM (most severe gender dysphoria)

Dual role transvestism

Answer 45

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.

Question 46

Gender identity disorder in childhood

Answer 46

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.

Question 47

Paraphilias (f60)
klismaphilia
necrophilia
exhibitionism

fetishism
Paedophilia
sexual masochism
sexual sadism
Fetishisitc transvestism
voyeurism
frotteurism

Answer 47

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

Question 48

Mental retardation / intellectual disability

Answer 48

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

Question 49

Autism

Answer 49

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

Question 50

Retts syndrome

Hellers Syndrome

Landau-Kleffner syndrome

Answer 50

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.

Question 51

Disorder with childhood onset

Hyperkinetic (ADHD)

conduct disorder

Oppositional Defiant Disorder

Answer 51

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)