Classification Flashcards
1
Q
What type of classification systems are the ICD and DSM?
A
Categorical - based on clinical descriptions
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.
3
Q
Benefits of operationalised approach?
A
Allows algorithm-based clinical diagnosis using intensity, duration of symptoms and impairment tests.
Such as a checklist
4
Q
What are characteristic symptoms?
A
Those which are pertinent to the diagnosis
5
Q
What are discriminating symptoms?
A
Necessary for diagnosis since they are not found in other disorders.
6
Q
What helps facilitate application of operationalised diagnoses?
A
Computerised scoring systems such as OPCRIT for ICD 10
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
8
Q
What is the descriptive approach?
A
Classifying illness based on what constitutes it rather than what causes it.
9
Q
What makes the descriptive approach more rational?
A
Lack of pathogenetic knowledge of psych disorders
10
Q
Which type of psychiatric illness has it been suggested that a dimensional system is needed?
A
Personality disorders
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
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
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
14
Q
Disadvantage of categorical approach
A
Poor validity - e.g. Psychosis not specified needed for atypical cases
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.
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.
17
Q
Axes used in ICD 10
A
Axis 1 - mental disorder
Axis 2 - degree of disability
Axis 3 - current psychosocial problems
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
19
Q
When was the first ICD done?
A
1855
20
Q
What was the first ICD for?
A
Causes of death
21
Q
What is the F for in the ICD?
A
Identifies the disorder as mental or behavioural
22
Q
What is the first digit after F for in ICD?
A
Refers to broad diagnostic grouping
23
Q
What is the second digit after F for in ICD?
A
Refers to individual diagnosis
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
25
Which ICD 10 is used for clinical purposes?
ICD-10: CDDG
26
Which ICD is used for research purposes?
ICD 10 DCR
27
How is the ICD 10 DCR set out
More restrictive and clearly defined clinical features with inclusion and exclusion criteria
28
How is ICD 10 Primary care version set out?
Broad clinical descriptions
Diagnostic flow charts
Treatment recommendations
29
What is ICD 10 Clinical Coding Manual used for?
For coding purposes
30
What are the axes in the DSM 5?
Psychiatric disorder
Pschosocial and environmental factors
Severity of associated disability
31
When should harmful use not be diagnosed via ICD?
If dependence syndrome or substance-induced psychosis are diagnosed
32
How is dependence described in CID 10?
Cognitive and behavioural phenomena indicating the use of the substance takes on a much higher priority for the individual than other behaviours.
33
What is harmful use code in ICD?
Where actual damage is caused to drinker but they have no dependence pattern
34
What is abuse in DSM?
Maladaptive use despite problems in social, occupational, physical and psychological domains, in hazardous situations, at least one month but not dependent on alcohol
35
What is depressive pseudodementia?
When depression in elderly patients initially presents as dementia
36
Typical symptoms of pseudodementia?
Memory impairment
Difficulty in sustaining attention and concentration
Reduced intellectual capacity
37
Difference in cognitive impairment in dementia and pseudodementia?
In pseudodementia patient complains about cognitive impairment; in dementia, this is rare
38
Memory loss in pseudodementia?
Memory loss more severe for remote events
39
Memory loss in dementia?
Memory loss more severe current events
40
The 5 A's of Alzheimers
Amnesia
Aphasia - language difficulties
Agnosia - failure to recognise (people)
Apraxia - cannot carry out purposeful movements
Associated disturbance - behavioural, delusions, hallucinations
41
Define vascular dementia
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
42
When is onset of vascular dementia?
Usually after CVE
43
Deficits in Vascular dementia?
Emotional and personality changes are early, followed by cognitive deficits that fluctuate
44
Describe dementia with lewy bodies
Spontaneous motor features of parkinsonism
Fluctuating cognition - varied attention
Visual hallucinations
Cognitive decline
45
Describe the visual hallucinations in Dementia with lewy bodies?
Well formed
| Detailed
46
Describe cognitive decline in dementia with lewy bodies
Progressive
47
Supportive features to diagnose dementia with lewy bodies?
Neuroleptic sensitivity
| History of falls
48
When is Parkinsons disease dementia diagnosed?
If Parkinsonian symptoms exist for >12 months before dementia develops
49
Onset and progression of frontotemporal dementia
Insiduous onset
| Gradual progression
50
Early symptoms of frontotemporal dementia
Early emotional blunting
| Early loss of insight
51
Behavioural features of frontotemporal dementia
```
Disinhibition
Decline in personal hygiene
Mental rigidity
Inflexibility
Hyperorality
Stereotyped and perseverative behaviour
```
52
Speech in frontotemporal disorder
Reduced output and stereotypy, echolalia and perseveration
53
Affective symptoms of frontotemporal dementia
Frequent mood changes
| Emotional indifference
54
Physical signs of frontotemporal dementia
```
Incontinence
Primitive reflexes
Akinesia
Rigidity
Tremor
```
55
How long do most cases of delirium last for?
4 weeks
56
Organic cause of depression?
Influenza
57
St Louis/Feighner criteria of Schizophrenia
A, B and C are needed
58
A criteria of Feighner's criteria of Schizophrenia
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
59
B criteria for Feigners criteria of schizophrenia
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
60
C criteria for Feigner's criteria of schizophrenia
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 of drug abuse within one year of onset
Onset prior to age 40
61
NIMHR criteria for schizophrenia
Symptom criteria
Duration criteria
Exclusion criteria
62
What is the symptom criteria for NIMH?
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
63
What is the duration criteria for NIMHR?
Signs of illness have lasted at least 2 weeks from onset of a noticeable change in patients usual condition
64
What is the exclusion criteria for NIMHR?
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
65
How many patients with schizophrenia exhibit first-rank symptoms?
58%
66
How long are acute psychotic episodes diagnosed up to as per ICD?
1 month
67
How long can diagnosis of acute psychotic episode be valid for?
3 months
68
Subtypes of schizophrenia
```
Paranoid
Hebephrenic
Catatonic
Residual
Simple
Undifferentiated
Chronic (not subtype but descriptive term)
```
69
Most prominent symptoms of paranoid schizophrenia?
Delusions or auditory hallucinations
70
Less prominent features of paranoid schizophrenia
Catatonic behaviour
Flat/inappropriate affect
Disorganized speech or behaviour
71
Which type of schizophrenia has the poorest prognosis?
Hebephrenic
72
Most prominent symptoms of hebephrenic schizophrenia?
Disorganized speech or behaviour and flat or inappropriate affect.
Impaired social and occupational functioning.
Poor self care
Extreme social behaviour
Disorganized behaviour
73
Which type of schizophrenia is most common in developing countries?
Catatonic; acute, episode course with complete symptom remission
74
Most prominent symptoms in catatonic schizophrenia?
```
Motoric immobility
Excessive motor activity
Extreme negativism or mutism
Posturing, stereotypy, mannerisms, grimacing
Echolalaia or echopraxia
(Minimumum of 2 needed)
```
75
Less prominent features of catatonic schizophrenia
Oneiroid (dream life) state
| Visual hallucinations
76
Most prominent features of schizophrenia
Full blown acute episode in past
| Current negative symptoms or attenuated forms of 2 or more generic symptoms
77
What is simple schizophrenia?
Indsiduous development of negative symptoms without evidence of positive symptoms.
Rare.
Increasing emotional bluntness.
Occassional psychotic episodes support diagnosis.
78
What is chronic schizophrenia?
Persistent disability for 2 years or longer
79
Forms of catatonic schizophrenia
1. excited catatonia
2. stuporous catatonia
3. catatonia alternating between excitement and stupor
80
What does ICD 10 recommend for confident diagnosis of hebephrenic schizophrenia?
Continuous observation for 2-3 months
81
What characterizes hebephrenic schizophrenia?
Thought disorder
Severe loosening of associations
Emotional disturbance; inappropriate affect, blunted affect or senseless giggling
Abnormal mannerisms
82
What is hebephrenic schizophrenia called in DSM IV?
Disorganized schizophrenia
83
Delusions and hallucinations in simple schizophrenia?
Absent
| If present, short lasting and poorly systematised
84
Duration criteria for simple schizophrenia
1 year
85
In acute and transient psychotic disorders, what is described as acute?
Onset within 2 weeks
86
In acute and transient psychotic disorders, what is called abrupt?
Onset within 48 hours
87
What is the rule for recovery in acute and transient psychotic disorders?
Complete recovery within 2-3 months
88
What happens in acute polymorphic psychosis?
Several hallucinations and delusions change in both type and intensity from day to day or even same day
89
What is needed for a diagnosis of schizotypal disorder?
At least 2 years of never being diagnosed with schizophrenia.
90
What are the dimensions of rating severity of core symptoms of schizophrenia in DSM?
```
Delusions
Hallucinations
Depression
Mania
Abnormal cognition
Abnormal psychomotor behaviour
Disorganized speech
Negative symptoms
```
91
Which core positive symptom (at least 1) is needed for a diagnosis of schizophrenia under DSM?
1 of
delusions
hallucinations
disorganized speech
92
What are persistent delusional disorders characterized by?
Persistent, often life-long, typically non-bizarre delusion arising insidiously in mid-life or later.
Transient auditory hallucinations may occur
93
How long do symptoms need to be present for diagnosis of persistent delusional disorder in both ICD and DSM?
ICD: 3 months
DSM: 1 month
94
Which classification system states in persistent delusional disorder the delusions cannot be bizarre?
ICD
95
Types of delusional disorders
```
Erotomania (de Clerambault syndrome)
Grandiosity
Jealousy (Othello syndrome)
Persecutory
Somatic
Mixed andunspecified
```
96
What is Othello syndrome?
Delusion of infidelity; patients believe their spouse/partner has been unfaithful.
97
What is induced delusional disorder?
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.
98
What is folie a deux?
Induced delusional disorder
99
What are schizodepressive episodes associated with?
FHx of schizophrenia
Usually less florid
Response to treatment variable; may develop chronic negative symptoms.
100
What characterises schizomanic episodes?
Manic symptoms florid
Recovery within weeks
FHx of affective disorders
Respond well to mood stabilisers
101
What is Bouffee delirante?
Sudden onset psychosis
Polymorphous delusions and hallucinations
Clouded consciousness with emotional instability
Rapid return to premorbid level of functioning
Relapses may occur
102
What characterizes Bouffee delirante?
Caused by psychosocial factors which determine content and form of the disorder
People have a good tendency to recover
103
Who first described process schizophrenia?
Langfeldt (1939)
104
What did Langfeldt divide schizophrenia into?
Poor prognosis: genuinine/process schizophrenia
| Good prognosis: schizophreniform psychosis
105
Who coined the term cycloid psychoses?
Leonhard (1957)
106
What is cycoid psychoses?
Endogenous psychotic syndromes characterized by sudden onset, affective symptoms and schizophrenia symptoms and a pashic course.
107
Subdivisions of cycloid psychoses?
Motility
Confusional
Anxiety-blissfulness
108
Who are cycloid psychoses more common in?
Severe postpartum psychiatric disorders
| More common in women
109
How did Perris describe cycloid psychosis?
Good outcome
High risk of recurrence
Mood swings
110
Characteristics of cycloid psychoses according to Perris
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)
111
Duration for Major Depressive Disorder in DSM IV?
Most of the day nearly everyday for at least 2 weeks
112
Duration for major depressive disorder for ICD 10?
Duration of at least two weeks
113
Criterion of MDD for DSM IV?
5 or more symptoms
| At least 2 symptom is either depressed mood or loss of interest or pleasure
114
Symptoms in DSM-IV MDD?
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
115
Criterion A of Depressive Disorder for ICD 10?
Depressed mood, loss of interest and enjoyment, reduced energy leading to increased fatigability and diminished activity
116
Criterion B for Depressive Disorder in ICD 10?
```
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
```
117
What is the 4-6-8 rule for depression in ICD 10?
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
118
What is required for diagnosis of mild depression according to ICD 10?
At least 2 criterion A core symptoms with 4 symptoms in total
119
What is required for diagnosis of moderate depression according to ICD 10?
At least 2 criterion A with 6 symptoms in total
120
What is required for diagnosis of severe depression according to ICD 10?
At least 2 criterion A symptoms with 8 symptoms in total
121
Definition of recurrent MDD?
More than 1 episode of depression
122
Define recurrent MDD for ICD10?
At least 1 previous MDD at least 2 months prior
123
ICD 10 criteria for Bipolar?
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
124
How can bipolar be diagnosed for DSM IV?
With single manic episode
125
In which type of bipolar is there mixed states?
Type 1 only
126
How long does mania and depression naturally last for?
Mania - 4 months
| Depressio - 6 months
127
Natural course of bipolar in the elderly?
Longer episodes of mania and depression
Short periods of inter-episodic remissions
More frequent episodes
128
What is mania or manic episode according to ICD 10?
Abnormally and persistently elevated, expansive or irritable mood with 3 or more symptoms of mania.
Severe to impair occupational and social functioning
129
Duration for diagnosis of manic episode in DSM IV?
At least 1 week or less if hospitalized
130
Duration for diagnosis of manic episode for ICD 10?
At least one week unless in hospital
131
Criterion A for manic episode in DSM IV?
Abnormally and persistently elevated, expansive or irritable mood
132
Criterion B for manic episode in DSM IV?
3 or more symptoms persisted (4 if mood is irritable) and present to significant degree.
133
Criterion B criteria for manic episode in DSM IV?
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
134
Criteria for manic episode in ICD 10
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
135
Types of psychotic features in manic episode?
Changeable in quality
| Auditory hallucinations tend to be second person and consistent with persons mood
136
ICD 10 definition of hypomania
Similar to mania but evident to lesser degree and not severe enough to interfere with functioning or require admission to hospital or psychotic features
137
What is bipolar mixed state?
Manic and depressive symptoms occur simultaneously, present everyday for at least 1 week in DSM IV and 2 weeks for ICD 10
138
DSM IV or ICD 10 contains terms rapid cycling, postpartum onset and seasonal pattern?
DSM IV
139
What is rapid cycling?
At least 4 episodes of bipolar within 1 year
140
Which gender is most likely to have rapid cycling?
70-80% are women
141
What factors are associated with rapid cycling?
```
TCAs
Low thyroxine
Female
Bipolar Type 2
Neurological disease
```
142
What is ultra-rapid cycling?
Fluctuations are over days or hours
143
What is postpartum onset of bipolar?
Onset of mania or hypomania or depression within 4 weeks of childbirth
144
What is seasonal pattern of bipolar?
Recurrences over several years with most episodes starting and ending at same time each year
145
What is secondary mania?
Due to substance misuse or drugs like levo-dopa and steroids.
Organic conditions
146
Which organic conditions can cause secondary mania?
Thyroid disease
MS
Lesions in cortical or subcortical areas of brain
147
What is Bipolar 3?
Minimal depression complicated by antidepressant-induced hypomania
148
What type of disorders are dysthymia and cyclothymia?
Persistent affective disorder
149
What are persistent affective disorders?
Ones which fail to meet criteria for severity but are of long duration and cause impairment
150
What is dysthymia?
Chronic, mildly depressed mood and diminished enjoyment, not severe enough to be considered depressive illness
151
Clinical features of dysthymia?
<2 years of depressed mood
| Other symptoms as per depression
152
What is double depression?
Episodes of MDD superimposed on dysthymia; prognosis and treatment may be worse
153
What is cyclothymia?
Oscillating high and low moods without having significant manic or depressive episode
Unrelated to life events
154
Depression and seasons?
Reversed biological features in winter
155
Diagnosis for SAD in ICD 10?
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.
156
Common onset and resolution of SAD?
Onset: autumn/winter
Resolution: spring/summer
157
Treatment for SAD
Phototherapy
158
What is phototherapy?
```
Bright light (10,000 lux) exposure daily for 2 hours.
Maintenance treatment given for few months until usual time of remission
```
159
Duration for diagnosis of GAD in ICD-10?
```
6 months (at least)
Symptoms present on most days during these 6 months
```
160
What is required for diagnosis of GAD re ICD 10?
```
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
```
161
What are symptoms of autonomic arousal for GAD?
```
Palpitations
Tachycardia
Sweating
Trembling/shaking
Dry mouth
```
162
What are physical symptoms of GAD?
Breathing difficulties
Choking sensation
CP/discomfort
Nausea/abdominal distress
163
What are mental state symptoms in GAD?
```
Feeling dizzy
Unsteady
Faint/light headed
Derealisation/depersonalization
Fear of losing control/going crazy/passing out/dying
```
164
What are some general symptoms of GAD?
Muscle tension/aches and pains
Restlnessness/inability to relax
Feeling keyed up/on edge/mentally tense
Sensation of lump in throat/difficulty swallowing
165
What are the 'other' symptoms of GAD?
Exaggerated response to minor surprises/being startled
Concentration difficulties/mind going blank due to worry
Persistent irritability
Difficulty getting to sleep due to worrying
166
Characteristics of panic attack
Starts abruptly
Reaches peak within few minutes (10)
Starts to subside within 20-30 minutes
No obvious precipitants
167
Criteria for diagnosis of panic attack for DSM?
Specifies 13 physical symptoms of which at least 4 must be present
Also specifies different types of panic attacks
168
What characterises panic disorder?
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
Duration needed to diagnose panic disorder?
At least one month
170
What is classified as severe panic disorder in ICD 10?
If more than 4 attacks per week in 4 week period
171
What is required for definitive diagnosis of panic disorder in ICD 10?
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
Criteria for diagnosis of panic disorder in DSM?
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
In which classification can agoraphobia only be diagnosed with panic disorder?
DSM IV
174
How can agoraphobia be classified in ICD 10?
Primary diagnosis, with panic disorder being a qualifier for subcategorisation or diagnostic entity on its own if no phobic disorder
175
Who described the cardinal features of phobia?
Marks
176
What are the cardinal features of phobia?
Fear which is out of proportion to situation, cannot be explained or reasoned away, is beyond voluntary control and leads to avoidance
177
What is an important feature of phobic anxiety?
Anticipatory anxiety
178
What is the main characteristic of phobic anxiety regarding the phobia?
Phobic object tends to be external and not dangerous to patient
179
What is the name of phobic anxiety when the phobic object is internal?
Hypochondriasis
180
What are the most common types of phobic syndromes?
Agoraphobia
Social phobia
Specific phobias
181
Which phobia is noted to be the most incapacitating?
Agoraphobia
182
Lifetime prevalence of agoraphobia?
6-10%
183
Onset of agoraphobia?
Early or mid-twenties
| Further period of high onset in mid-thirties
184
Who is agoraphobia most common in (age and gender)?
Women between 15-35
185
What is late onset agoraphobia often associated with?
May develop secondary to physical frailty, with associated fear of exacerbating medical problems or having an accident.
186
When does first episode of agoraphobia typically occur?
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
Common themes that provoke anxiety and avoidance in agoraphobia?
Distance from home
Crowding
Confinement
188
What is another name for agoraphobia?
Housebound housewife syndrome
189
In which type of setting is social phobia more common?
Small group settings where close scrutiny is possible
190
What are the two types of social phobia noted in social phobia?
Discrete
| Diffuse
191
What is discrete social phobia?
Anxiety manifested in specific occasions e.g. public speaking
192
What is diffuse social phobia?
Seen with exposure to any generic social task
193
Typical onset of social phobia?
Between ages of 17-30
| First episode occurs in public place without any apparent reason
194
How does DSM describe social phobia?
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
What feature does DSM describe of social phobia which helps to differentiate it from paranoia?
Fear of humiliating or embarrassing oneself
196
What does DSM IV specify regarding social phobia in children?
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
Age of onset of most specific phobias?
Childhood
198
When does phobia of animals start?
7
199
When does phobia of blood start?
9
200
When does dental phobia start?
12
201
When does claustrophobia start?
20
202
What does DSM divide specific phobias into?
```
Animals
Aspects of natural environment
Blood/injection/injury
Situational
Other provoking agents
```
203
Characteristic of specific phobia
Does not fluctuate - remains constant
204
What is nosophobia?
Disease phobia related to situations where disease can be acquired and so avoided - this is not hypochondriasis
205
What is blood injury injection?
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
Prevalence of fear of dental procedures
5%
207
Duration for specific phobia in DSM
6 months only for children as irrational fears in children may be transient and developmental
208
Criteria for OCD
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
How does obsessional slowness occur?
Result of obsessional doubts or compulsive rituals
210
Duration criteria for OCD in ICD 10
Obsessions and/or compulsions must be present on most days for at least 2 successive weeks
211
Common symptoms and prevalence of OCD
```
Checking 63%
Washing 50%
Fear of contamination 45%
Doubting 42%
Bodily fears 36%
Counting 36%
Insistence on symmetry 31%
Aggressive thoughts 28%
```
212
Describe compulsive hoarding
Symmetry obsessions tend to be chronic and treatment resistant
Difficult to treat
213
How does DSM describe OCD?
Anxiety disorder along with GAD and PTSD (not on DSM V)
214
What is an acute stress reaction?
Start in an hour, resolution begins within 8 hours (if stress is hit and run) or 48 hours if prolonged.
215
What states increase risk of acute stress reaction?
Physical exhaustion
Organic factors
Disease states
216
What are usually the characteristics of a stressor in acute stress reaction?
One that poses a serious threat to security, integrity and social position
217
Symptoms seen in patients with acute stress reaction?
Initially dazed with narrowed attention, can result to disorientation
Occasional agitation and overactivity
Partial or complete amnesia
Dissociative symptoms
218
In which classification is there a diagnosis of acute stress disorder rather than reaction?
DSM
219
Definition of acute stress disorder in DSM
Starting while experiencing or after experiencing distressing event and lasting at least 2 days to at most 4 weeks.
Emphasis on dissociation
220
Duration for diagnosis of acute stress disorder in DSM
Onset within 4 weeks with symptoms lasting up to 4 weeks
221
What is used to treat acute stress disorder?
Debriefment - not found to be effective and can be counterproductive
222
What category does Adjustment disorder fit into in DSM?
Residual category for individuals with clinically significant distress without meeting criteria for a more discrete disorder like depression/PTSD
223
What is adjustment disorder due to?
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
Typical presentation of adjustment disorder?
```
Anxiety
Depression
Poor concentration
Irritability
Anger
Physical symptoms; autonomic arousal such as tremor/palpitations
```
225
What characteristic is linked with adjustment disorder?
Individual vulnerability
226
Link between adjustment disorder and violence?
Patients may feel vulnerable to become violent though rarely are violent.
227
How do children present with adjustment disorder?
Conduct problems in adolescence; regressive phenomenon in children
228
Onset and course of adjustment disorder
Onset more gradual than acute stress reaction
Course more prolonged
Social functioning tends to be impaired
229
Onset criteria for adjustment disorder in ICD 10
Within month
230
Onset for criteria for adjustment disorder in DSM
Three months
231
Duration criteria for adjustment disorder
Cannot exceed six months except in subtype of prolonged depressive reaction, which can last up to 2 years
232
Who cannot be diagnosed with adjustment disorder?
Patients who have experienced bereavement within last three months
233
How long does a typical grief reaction last?
12 months
| Average duration of 6 months
234
What is Phase I of grief?
Shock and protest
235
What is Phrase II of grief?
Preoccupation
236
What is Phrase III of grief?
Disorganisation
237
What is Phase IV of grief?
Resolution
238
Describe Phase I of grief
Numbness
Disbelief
Acute dysphoria
239
Describe Phase II of grief
Yearning
Searching
Anger
240
Describe Phase III of grief
Despair
| Acceptance of loss
241
Describe of Phase IV of grief
Gradual return to normality
242
In normal grief reaction, when is improvement expected?
Within 2-6 months
243
Who should receive antidepressants regarding normal grief reaction?
Those who meet criteria for MDD and have not improved within 2-6 months
244
What is abnormal grief?
Very intense, prolonged, delayed/absent or where symptoms are outside normal range
245
What is abnormal grief reaction coded under in ICD 10?
Adjustment disorder
246
What is adjustment disorder divided into in ICD?
Inhibited
Delayed
Chronic
247
What is inhibited grief?
Absence of expected grief symptoms at any stage
248
What is delayed grief?
Avoidance of painful symptoms within 2 weeks of loss
249
What is chronic grief?
Continued significant grief-related symptoms six months after loss
250
Causes of abnormal grief?
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
Define PTSD
Intense, prolonged and sometimes delayed reaction to an intensely stressful event
252
Essential features of PTSD
Hyperarousal
| Re-experiencing of aspects of stressful event and avoidance of reminders
253
What are the principal symptoms of PTSD
Hyperarousal
Hypervigilance due to re-experiencing and enhanced startle response
Avoidance
254
Describe hyperarousal in PTSD
Persistent anxiety
Irritability
Insomnia
Poor conc
255
Describe hypervigilance in PTSD
Intrusions
Recurrent distressing dreams
Intensive intrusive imagery (flashbacks, vivid memories)
Difficulty in recalling stressful events at will
256
Describe avoidance in PTSD
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
Criteria for PTSD in ICD and DSM
Both require 2 or m ore persistent symptoms of increased psychological sensitivity and arousal to diagnose PTSD
258
Onset criteria for PTSD
Within 6 months of trauma
259
What is delayed PTSD?
Probable PTSD - after 6 months onset
260
Personality changes in PTSD
Enduring personality changes noted following trauma
261
What is criteria for chronic PTSD in DSM?
3 months
262
What is Type 1 trauma?
Single, sudden catastrophic event
263
What is Type 2 trauma?
Chronic repetitive insult against which individual has no defence
264
What does dissociation refer to?
Loss of integration among memories, identity, sensation and movements.
Occurs closely in time with trauma.
265
Onset and duration of dissociation
Starts and stops suddenly within weeks to months.
| Treatment difficult in chronic (year) patients
266
What is dissociative amnesia?
Loss of partial memory for important recent events. Memory is partial, patchy and selective.
267
Characteristics of dissociative amnesia
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
What is dissociative fugue?
Purposeful journey away from home.
Self-care maintained. Sometimes new identity if formed.
No cognitive impairment, normal behaviour.
269
What is trance?
Dissociative state where narrowed consciousness and limited but repeated movements seen.
270
When is diagnosis of trance made?
Only if involuntary and not culturally appropriate.
| Trance must be intrusive to activities of life.
271
Causes of organic trance?
Temporal lobe epilepsy
| Head injury
272
What is another name for conversion/hysterical disorder?
Dissociative disorder of motor movement and sensations
273
What is included in dissociative states in ICD 10?
Conversion disorder/la belle indifference
Ganser syndrome
Twilight states
274
What is included under dissociative disorders in DSM?
Amnesia
Fugue
Dissociative identity disorder
Depersonalisation
275
Symptoms of dissociative trance
Altered narrow consciousness
Lost personality identity with no replacement
Stereotypic movements/utterances
Amnesia
276
Symptoms of possession trance
```
Altered narrow consciousness
Lost personal identity
Replaced with another identity
Stereotypic movements/utterances
Amnesia
```
277
Weight and BMI for diagnosis of anorexia in ICD 10?
Body weight 15% below expected norm
| BMI 17.5 or loss
278
What are some HPA axis dysfunctions of anorexia?
```
Amenorrhoea
Reduced sexual interest
Raised GH and cortisol
Altered TFTs
Abnormal insulin secretion
Delayed or arrested puberty
```
279
When is Quetelet's BMI only applicable?
If >16 years of age
280
Required minimum average frequency of compensatory behaviour/binge eating in bulimia in DSM IV and V?
IV: twice a week
V: once a week
281
How does DSM IV define amenorrhoea?
At least 3 consecutive cycles being absent
282
Criteria in atypical anorexia?
One or more of essential features may be absent or all present but to lesser degree
283
Features of those with atypical anorexia?
```
Older age of onset
Recurring depression
Numerous somatic complaints
Unmet dependency needs
Little evidence of distortion in body image
```
284
Criteria for bulimia in ICD 10?
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
What are some of the attempts in bulimia to counter fattening effects of food?
Self-induced vomiting
Abuse of purgatives
Periods of starvation
Use of drugs; appetite suppressants, thyroxine, diuretics
286
Criteria in atypical bulimia?
One or more of the features may be absent.
287
What is bulimia divided into in DSM IV?
Purging
| Non-purging
288
Where is obesity coded in ICD 10?
Chapter E66 - not a mental disorder
289
Most common ED in OP settings?
EDNOS
290
What category does Binge eating disorder fall under in ICD 10?
Atypical bulimia
291
What category does binge eating disorder fall under in DSM IV?
EDNOS
292
What characterises binge eating disorder?
Recurrent episodes of binge eating in absence of extreme weight control behaviour
293
How many patients with obesity have binge eating disorder?
5-10%
294
Typical age of presentation of binge eating disorder?
40 years of age
295
In ICD 10 what is considered a primary factor in non-organic sleep disorders?
Emotional causes
296
What is dyssomnia?
Abnormality in amount, quality or timing of sleep
297
What are parasomnias?
Abnormal episodic events occurring during sleep
298
What should be considered if adult onset or adult persistence of sleep walking/tremors?
Psychological disturbance
Sometimes in early stages of dementia
REM disorders in Lewy body dementia
299
Which drugs are nightmares associated with?
Benzos
TCAs
Thioridazine
300
When does Kleine Levin syndrome tend to present?
Adolescent males
301
Precipitating factors of Kleine Levin syndrome?
Excessive workload
Febrile illness
Respiratory infections
302
What characterises narcolepsy?
Excessive daytime drowsiness accompanied by sudden onset of REM sleep and sudden loss of muscle tone, provoked by strong emotions
303
What is cataplexy?
Sudden loss of muscle tone provoked by strong emotions
304
Genetics in Narcolepsy?
Familial
| 99.5% of patients have HLA Antigen DR-2
305
What are the dyssomnias?
```
Primary insomnia
Primary hypersomnia
Circadian sleep disorders
Narcolepsy
Breathing related sleep disorders
Sleep state misperception
```
306
What are some parasomnias that occur during NREM sleep?
Confusional arousals
Sleepwalking
Sleep terrors
307
Another name of parasomnias which arise from NREM sleep?
Arousal disorders
308
What are some parasomnias that occur during the sleep-wake transition?
Sleep starts
| Sleep talking
309
What are some parasomnias that occur during REM sleep?
REM behavioural disorder
Nightmares
Sleep paralysis
310
What are some parasomnias that occur during any stage of sleep?
Sleep bruxism
| Sleep enuresis
311
Where are sexual disorders coded in ICD 10?
F52 group
312
What are sexual disorders divided into in DSM IV?
```
Sexual desire
Sexual arousal
Orgasmic
Sexual pain
Others
```
313
What comes under sexual desire disorders?
Sexual aversion
| Hypoactive sexual desire
314
What comes under sexual arousal disorders?
Female sexual arousal disorder
| Male erectile disorders
315
What comes under orgasmic disorders?
Female and male orgasmic disorders
| Premature ejaculation
316
What comes under sexual pain disorder?
Dyspareunia
| Vaginismus
317
What comes under 'Other' sexual disorders?
General medicine
| Substance use
318
Where is puerperal disorders coded in ICD 10?
F53
319
Which classification does not code postnatal disorders as depression or psychosis?
ICD 10: codes it as mild and severe
320
Where is non dependence abuse coded in ICD 10?
F55
321
When can a diagnosis of personality disorder not be made in terms of age?
If under 16-17 years of age
322
Criteria for diagnosing PD in ICD 10
At least 3 traits for BPD and antisocial
| At least 4 for the others
323
Which PDs are in the DSM IV for research purposes?
Passive-aggressive PD
| Depressive PD
324
In which classification is there no clustering of PDs?
ICD 10
325
In which classification is schizotypal PD a variant of psychosis under schizophrenia?
ICD 10
326
In which classification is EUPD divided?
ICD 10: impulsive or borderline
327
Criteria of Histronic PD
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
Which PDs are under cluster C in DSM?
Avoidant
Dependent
OCD
329
Which cluster B PD is not in ICD 10?
Narcissistic; mentioned in 'other' PD category
330
Which PDs are under cluster C in ICD 10?
Anxious
Dependent
Anankastic
331
Where is 'habit and impulse disorders' coded in ICD 10?
F63
332
What does impulse disorders include?
```
Kleptomania
Pyromania
Trichotillomania
Intermittent explosive disorder
Pathological gambling
```
333
Which classification contains intermittent explosive disorder?
DSM IV
334
What characterises impulse disorders?
Recurrent behaviours that appear irrational and result in harming patients own interests or those of others.
335
What do impulsive disorders exclude?
Habitual excessive use of alcohol, drugs sexual or eating related compulsive acts.
336
What are the disorders under Gender identity disorders in ICD 10?
Transsexualism
Dual role transvestism
Gender identity disorders
337
By what age is gender identitiy established?
3 years
338
What is gender identity?
An individual's self-perception of being male or female and depends on reared sex rather than biological
339
What is gender dysphoria?
Feeling of incongruence between ones gender identity and ones phenotypic appearance
340
What is mild form of gender dysphoria recognised as in both ICD and DSM?
Dual role transvestism
341
What is dual role transvestism?
Patients were clothes of opposite sex to experience temporary membership of that sex.
Individual experiences a sense of appropriateness by wearing these clothes.
342
What is required for dual role transvestism to be diagnosed?
No sexual motivation
| No desire for permanent change into opposite sex
343
What is the severe form of gender dysphoria recognised in both ICD and DSM?
Transsexualism
344
Criteria of transsexualism?
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
Duration for criteria of gender identity disorders in childhood?
6 months for pre-pubertal group
346
What is important to rule out before diagnosing gender identity disorders in childhood?
Chromosomal and endocrine problems
347
Main management of gender identity disorder in childhood?
Promoting young persons tolerance of uncertainty and resisting pressure for quick solutions
Surgical intervention not justified until adulthood
348
In which gender are gender identity disorders more common?
Males
349
When is cross-dressing behaviour more likely to occur in GID?
During stressful times
350
Where are paraphilias, impulsive disorders and other habitual problems coded in ICD?
F60
351
What is Klismaphilia?
Use of enemas to achieve sexual arousal
352
What is fetishism?
Use of inanimate objects to achieve arousal
353
Which paraphilia is a separate disorder in DSM?
Frotteurism
354
Why does the ICD 10 advise not to use ICD rigidly when identifying mental retardation severity?
Problems of cross-cultural validity
355
How should mental retardation be graded?
Based on functioning ability
356
Degrees of mental retardation?
Mild
Moderate
Severe
Profound
357
IQ for profound mental retardation?
<20
358
IQ for severe mental retardation?
20-34
359
IQ for moderate mental retardation?
35-49
360
IQ for mild mental retardation?
50-69
361
Define profound mental retardation
Minimal capacity for functioning; needs nursing care, constant aid and supervision
362
Define severe mental retardation
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
Define moderate mental retardation
Profits from training in self-help
| Can be managed with moderate supervision
364
Define mild mental retardation
Can develop social and communication skills
Minimum retardation
Can be guided towards social conformity
365
What is the term for mental retardation in DSM V (not IV)?
Intellectual disability
366
What is a statement of special educational needs?
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
In which country is there a statement of special educational needs?
England
| Wales
368
How many parts in SEN?
6 essential parts
369
Who usually organises the statutory assessment for SEN?
Local educational board
370
importance of final statement of SEN?
Legally binding on local educational board
371
Part 1 of SEN
Demographic details
| List of reports gathered for statement
372
Part 2 of SEN
Description of nature and complexity of LD
| Needs listed to determine care to be provided by state
373
Part 3 of SEN
List of arrangements and provisions to be offered by local education board, including monitoring arrangements
374
Part 4 of SEn
Details of school placement
375
Part 5 of SEN
Non-educational (health and social) needs
| Not legally binding
376
Which part of SEn is legally binding?
3
377
Part 6 of SEN
Describes processes in place to meet non-educational needs
378
ASD in DSM V?
Includes autism, aspergers, childhood disintegrative disorder and pervasive developmental disorder
379
Characteristics of ASD in DSM V
Deficits in social communication and social interaction
| Restricted repetitive behaviours, interests and activities - if none, diagnose social communication disorder
380
What are the disorders of psychological development in ICD 10?
Disorders of speech, language, scholastic skills, motor skills and pervasive developmental disorders
381
Non-pervasive vs. pervasive psychological development disorders
Domain showing deficit in development improves with age
382
List some pervasive psychological development disorders
```
Childhood autism
Aspergers
Rett's syndrome
Atypical autism
Other childhood disintegrative disorders
```
383
Definition of autism in ICD 10
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
Difference between autism and aspergers/
Child with aspergers will have normal language function before 3 years of age
385
Three areas of abnormal functioning required for diagnosis of autism in ICD 10?
Social interaction
Communication
Restricted, repetitive behaviour
386
What behaviour is strongly suggestive of a pervasive developmental disorder?
Persistent gaze avoidance
387
When is atypical autism diagnosed?
Autistic features seen but either age of onset not satisfied or all three setes of diagnostic criteria not fulfilled
388
Definition of Rett's syndrome in ICD 10
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
Onset of Rett's?
7-24 months of age
390
Signs in young children with Rett's?
Hand-wringing stereotypes
Hyperventilation
Loss of purposive hand movements
391
Signs of Rett's in older children?
Trunk ataxia and apraxia associated with scoliosis and choreoathetoid movements
392
Common feature of Rett's?
Epilepsy
393
What is Heller's syndrome?
Dementia of childhood:
| Normal development up to 2 years of age followed by loss of previously acquired skills and abnormal social functioning
394
What is another name of Acquired aphasia with epilepsy?
Laudau-Kleffner Syndrome
395
Age of onset of Laudau-Kleffner syndrome?
3-7 years of age
396
Characteristics of Laudau-Kleffner syndrome?
Despite previous normal progress in language development, child loses receptive and expressive language skills but retains general intelligence
397
EEG in Laudau-Kleffner syndrome?
Paroxysmal abnormalities, usually originating from bilateral temporal lobes
398
Subdivisions of social functioning disorders in ICD?
Elective mutism
| Reactive attachment disorder
399
Subdivisions of emotional disorders specific to childhood in ICD 10?
Seperation anxiety
Phobias
Social anxiety
Sibling rivalry
400
ADHD equivalent in ICD 10?
Hyperkinetic disorder
401
In which classification is criteria for ADHD more strict?
ICD 10
402
Age of onset for ADHD in DSM
Some symptoms must be present before 7 years of age
403
What is required for diagnosis of ADHD
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
Duration of symptoms for diagnosis of ADHD
6 months
405
When should ADHD not be diagnosed?
In those with pervasive developmental disorder, schizophrenia or another psychotic disorder
406
Define oppositional defiant disorder?
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
In which classification is oppositional disorder excluded if a patient has conduct disorder?
DSM
408
When does reactive attachment disorder occur?
Infants and young children
409
What happens in reactive attachment disorder?
Persistent abnormalities in child's pattern of social relationships associated with emotional disturbance and reactive to changes in environment
410
Describe elective mutism
Persistent failure to speak in selective settings (e.g. school) despite full use of language in other settings.
411
When is fear of strangers a normal phenomenon?
Second half of first year of life
412
When can social anxiety disorder of childhood be made?
Before age of 6 years when anxiety is to an unusual degree and accompanied by problems in social functioning
413
Criteria of sibling rivalry disorder in ICD 10
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
Change in age onset of ADHD in DSM V?
From 7 to 12
415
What has been added to DSM V to reduce diagnosis of bipolar in children?
Disruptive mood dysregulation disorder
