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Psychiatry > Conditions > Flashcards

Conditions Flashcards

1
Q

List the possible aetiology of depression

A 
Genetics
Early life experience
Personality
Acute stress
Chronic stress
Neurobiology (early onset: decrease volume in the hippocampus, late onset: white matter intensely stained on MRI)
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2
Q

What are the main abnormalities observed in depression

A
  1. Overactivity of the hypothalamic-pituitary-adrenal axis
  2. Deficiency of monamines
    - Noradrenaline
    - Serotonin
    - Dopamine
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3
Q

Alternative causes of low mood

A

Chronic disease: MS, Parkinsons, Spinal cord injury, Cushings, Addisions, Thyroid disorders, Malignancy,Chronic pain, Rheumatoid, Renal failure

Medications: Anti-HTN, Steroids, Oral contraceptives, Levadopa, Opiates

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4
Q

Name the criteria that measure the severity of depression

A

ICD-10

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5
Q

What are the core and other symptoms of depression

A

Core:

  1. Low mood, present everyday for most of the day
  2. Anhedonia, diminished interest in all things
  3. Anergia, decrease concentration, decrease self esteem, ideas of guilt and worthlessness, bleak views of the future, ideas/acts of self harm or suicide, disturbed sleep (early waking), decrease appetite, weight loss, reduced libido

Others:
Low mood not secondary to drugs, alcohol, medication, medical disorder
Significant distress or social impairment, struggling to function

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6
Q

Define the levels of depression

A

MILD: 4+ symptoms (2 core + 2 other)
MODERATE: 5+ symptoms (2 core + 3 others) difficulty in carrying out activities of daily living
SEVERE: 7 symptoms (3 core + 4 others) unable to carry out activities of daily living

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7
Q

List the possible differentials of low mood

A

Mood disorder (depressive episodes, recurrent illness, dysthymia,bipolar affective diorder)
Schizophrenia (general medical disorder, psychoactive substance use, psychiatric disorder)
Psychotic disorder
Anxiety disorder
Adjustment disorders
Eating disorder
Dementia

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8
Q

Treatment approach to depression

A

BIOPSYCHOSOCIAL

Pharmacological:
Moderate to severe depression, first line anti depressants or for persistent sub threshold depression
SSRI’S (Sertraline, Paxoteine,Citolopram,Fluoxetine,)
Choose based on potential side effects, safety overdose, previous good results, cannot give TCA in the case of MI/arrthymias

Psychological: 
First line for mild depression or in conjunction with antidepressant for moderate depression 
CBT
Interpersonal treatment
Psychodynamic therapy
Family therapy 
Mindfullness 
Social:
Avoid alcohol/drugs 
Eat healthily 
Exercise repeatedly
Good sleep hygenie
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9
Q

Elements of substance dependence

A

Desire or compulsion to take a substance
Difficulties in controlling a substance
Withdrawal symptoms
Signs of tolerance
Persistent use despite clear harm
time spent seeking, taking recovering from substance over ADL

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10
Q

Safe units of alcohol for male and female

A

14 units a week

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11
Q

Signs of alcohol dependence

A 
Palpable liver edge
Jaundice
Spider navi
Ascites
Palmer erythema
peripheral neuropathy
ataxic gait
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12
Q

What blood test would you do if you suspected alcohol dependence in a patient and what would you expect to see

A

LFTS:

  • Increase in MCV
  • Increase in GGT
  • Increase in ALP and ASt
  • Carbohydrate deficient transferin

**Urinary ethyl-glucourinde

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13
Q

Treatment of alcohol dependence

A 
BIO
Aversive drugs (Disulfiram)
inhibits acetalehyde dehydrogenase 
Increase in acetaldehyde levels
Flushings, headaches, nausea and vomiting

800mg reduce to 100-200mg

Anti-craving: Acamprosate (Campral)
thought to work by normalising GABA neurotransmission in the brain
In RCT, patients on acamprosate have increased % remaining abstinent and double
maintanence time
-dose: 666mg td once abstinence is achieved
-indication: those wanting to remain abstinent
-side effects: GI upset, pruritis, rash, altered libido — however, usually well tolerated

PSYCHO

  • Motivational interview
  • CBT
  • Group therapy
  • AA
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14
Q

What is the pathology of Wernicke encephalopathy

A

Spectrum of disease resulting from thiamine deficiency
Haemorrhages and secondary gloss in the periventricular and the periaquaductual grey matter
Involves mammilary bodies, hypothalamus,mediodorsal thalamuc nuclei

Thiamine is the cofactor required by three enzymes in the pathway of carbohydrate metabolism

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15
Q

Signs and symptoms of Wernicke encephalopathy

A
  • Acute confusional state
  • Ocular (Ophthalmoplegia (6th nerve palsy), Nystagmus)
  • Ataxic gait
  • Peripheral neuropathy
  • Resting tachycardia
  • Nutritional deficiency
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16
Q

Ke investigations for Wernickes encephalopathy

A 
U&Es: exclude hypernatraemia,hypercalcaemia and uraemia.
LFTs
ABG: rule out hypercapnia and hypoxia
Serum thiamine levels 
Pyruvate (elevated)
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17
Q

Treatment of Wernicke Encephalopathy

A

Pharmacological:
-IV pabrinex (high potency B1 replacement)
Avoid carb loading until thiamine replacement is complete
Multivitamin to be given indefinately

Non-Pharm:
Alcohol abuse management
Assess and reassess memory and intellectual impairment
OT assessment of daily living
Mental capacitiy
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18
Q

Signs and symptoms of Korsakoff’s syndrome

A
  • Acute confusional state
  • Ocular (Ophthalmoplegia (6th nerve palsy), Nystagmus)
  • Ataxic gait
  • Peripheral neuropathy
  • Resting tachycardia
  • Nutritional deficiency

PLUS CONFABULATIONS
Falsification of memory in clear consciousness
Answer questions promptly with inaccurate and bizarre answers
Impairment to laying down new memories
Variable length of retrograde amnesia

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19
Q

Patient presents in an acute confusional state having recently started alcohol withdrawal

State the diagnosis

A

Delirium tremens

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20
Q

What are the signs and symptoms of delirium tremens

A 
Severe agitation
Confusion
Paranoid delusions 
Hallucinations (visual, auditory and tactile) 
Clouding of consciousness
Disorientation
Amnesia of recent events 
Malignant hyperthermia 
Sweating 
Tachycardia
hypertension
Tachypnoea
Tremor 
Mydriasis
CV collapse
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21
Q

Treatment of delirium tremens

A 
ABCD
Hypoglycaemia 
Sedation
Benzodiapenies 
Parbinex  500mg IV
Mg to prevent arrthymias
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22
Q

Explain alcohol dependence syndrome as per the Edwards &Cross Model?

A
  1. Narrowing of repertoire
  2. Increased salience of drinking
  3. Increased tolerance to alcohol
  4. Withdrawal of symptoms
  5. Relief or avoidance of withdrawal symptoms by further drinking
  6. Subjective awareness of the compulsion to drink
  7. Rapid reinstatement after abstinence
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23
Q

Medical management of the withdrawal of herion

A

1) Methadone: Synthetic opioid, longer half life 24 hours. Less in pregnancy
2) Lofexidine: alpha-2-adrenergic receptor agonist, relieves symptoms of withdrawal.
3) Naltrexone: Long acting opiate treatment, helps with the cravings

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24
Q

Explain the triple vulnerability model

A

1) Genetic: neurobiological ( decreased atomic nervous system response, loss of regulatory cortisol)
2) Generalised psychological vulnerability: childhood trauma/ method of parenting, attachment issues
3) Specific psychological vulnerability: traumatic event

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25
Q

List the risk factors for suicide

A 
Male 
LGBT
Prisioners
Single 
Unemployment 
Occupation 
Low socioeconomic status 
Psych illness
Previous self harm
Substance use 
Family hx of mental conditions 
Recent adverse life events
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26
Q

Measurements of suicide attempts

A

Evidence of advanced planing
Precautions taken to avoid discovery
Dangerous/lethal method used
No help sought after the act

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27
Q

List the anecdote for the following overdoses

  • Paracetamol
  • Morphine
  • TCA
A

N-acetylcysteine
Naloxone
IV sodium bicarbonate

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28
Q

Clinical features of anorexia

A

General

  • Emaciation
  • Lanugo hair
  • Brittle hair
  • Dry skin
  • Dental caries
  • Fatigue
  • Cold intolerance
  • Constipation
  • Amenorrhea

Cardio

  • Prolonged QT
  • Arrhythmias
  • Low BP

Endocrine/Metabolic

  • Low potassium
  • High amylase
  • Reduced renal function
  • Osteoporosis
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29
Q

Diagnostic criteria for anorexia

A
  1. Weight <85% less the predicated for height and weight or BMI <17.5
  2. Intense fear of gaining weight or becoming fat with persistent behaviour to prevent weight gain
  3. Feeling fat when thin

SCOFF can be used as a screening tool

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30
Q

Red flags for anorexia

A
  • BMI <13
  • Wt loss >1kg/week
  • T<34.5C
  • Vascular Bp 80/50, pulse <40, O2<92%
  • Limbs blue and cold
  • Proximal muscle weakness
  • ECG long QT, flat T waves
  • Blood K+ <2.5, Na+ <130
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31
Q

Treatment of anorexia

A 
Psychoeduction about nutrition and weight 
Nutritional and weight management 
CBT
Family therapy 
Psychodynamic psychotherapy
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32
Q

Discuss the signs and treatment of refeeding syndrome

A

Potentially fatal condition due to a fall in phosphate

Signs

  • Rhabdomyolysis
  • Resp or cardiac failure
  • Arrhythmias
  • Seizures
  • Sudden death

Treatment
- Slow referring according to a careful nutrition plan
- Monitor electrolytes ( potassium, Mg, glucose and phosphate)
Prescribe a thiamine complex

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33
Q

Define bulimia

A
  1. Recurrent episodes of binge eating characterised by uncontrolled eating
  2. Preoccupation with control of body weight
  3. Regular use of mechanisms to overcome the fattening effect of binges e.g. starvation, vomit induction
  4. BMI >17.5
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34
Q

Symptoms of bulimia

A

General

  • Fatigue
  • Lethargic
  • Feeling bloated
  • Constipation
  • Oesophagitis
  • Cardiomyopathy (laxative use)
  • Irregular menstruation
  • Erosion of dental enamel
  • Russells signs ( callouses on the back of the hands due to teeth marks from vomiting)
Metabolic alkalosis 
Metabolic acidosis ( if using laxatives)
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35
Q

List the ICD-10 criteria for diagnosing bulimia

A
  1. Binge eating
  2. Strong cravings for food
  3. Methods to counter act weight gain
  4. Overvalued idea
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36
Q

List the differential dx in a patient presenting with psychosis

A
  1. Organic disease
    - Delirium
    - Delirium tremens
    - Metabolic disease
  2. Psychoactive substance abuse
    - Cannabis
    - Mushrooms
    - LSD
  3. Schizophrenia & schizoaffective disorders & delusional disorders
  4. Affective disorders (depression and mania)
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37
Q

List the 1st rank symptoms which would lead to a diagnosis of schizophrenia

A
  • 3rd person auditory hallucinations
  • Passive delusions (figure controlling patients actions)
  • Somatic delusions
  • Thought insertion, withdrawal and broadcast.
Not 1st rank symptoms 
Negative symptoms 
- apathy
- blunting of response
- social withdrawal
- self-neglect
- anhedonia
- avolition
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38
Q

Explain the pathophysiology of schizophrenia

A

Dopamine theory
Higher occupancy of dopamine receptors
Increase mesolimbic: +ve symptoms
Increase mesocortical: -ve symptoms

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39
Q

List the types of schizophrenia

A

Paranoid: paranoid delusion
Often auditory
Per conceptual disturbance

Hebephrenic: Flattening of affect, aviolation, thought is disorganised , speech is incoherent , hallucinations are fleeting and fragment.

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40
Q

Management of schizophrenia

A
  1. Antipsychotics
  2. CBT
  3. Family intervention
  4. Art therapy
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41
Q

Define schizoaffective disorders

A

The presence of an affective disorder and schizophrenia simultaneously (during the same period)
Rx with antipsychotics

42
Q

Types of anti-psychotics and mode of action

A

**1st generation: D2 antagonist
Cause extra pyramidal side effects
Haloperidol
Chloriproniazine

**2nd generation: 5H2TA and D2 antagonist
Reduced risk of EPSE and increased risk of metabolic
Eg Olanzapine
Risperidone
Zotepine
Amsulperide

**3rd generation
Dopamine partial agonists
Aripiprazole

Clozapine
For treatment resistant schizophrenia, when a patient does not respond to 2 trials of different drugs.
Or
- patient is persistently hostile or suicidal
- a trial of each drug should last 6/52

beaware an increased risk of agranulocytosis

43
Q

Clinical features of bipolar disorder

A

ICD-10 Criteria

  • > 2 episodes of of disturbed mood or activity ( complete resolution between episodes)
  • Disturbed mood can be
    1. Elation of mood, activity and or energy ( hypomania or mania)
    2. low mood, activity or energy
  • Episode of mania lasting = 4 months
  • Episode of depression = 6 months
44
Q

Clinical features of hypomania and mania in bipolar affective disorder

A

Hypomania ( lesser degree of mania)

  • Elevation of mood, activity and energy ( not cyclothymia)
  • Symptoms for days - weeks, not so severe they disrupt work or lead to social rejection
  • Persistent wellbeing, physical and mental efficieny, increased sociability, talkativeness, sexual disinhibition.
  • Decreased need for sleep
  • Impaired concentration due to restlessness
  • Mild spending

Mania: elation unkeeping with the persons environment

  • Last of a week or more
  • Carefree joy or over excitability
  • Decreased sleep
  • Normal social inhibitions are lost
  • Distracted and attention can not be maintained
  • Self esteem massively inflated (GRANDIOSE IDEAS)
  • Perceptual disorders ) over appreciation of colours or textures)
  • Overspending

May also be accompanied by psychotic symptoms

  • Grandiose ideas ( type of delusion): I AM JESUS
  • Suspicions: nihilistic or persecutory delusions
  • Flight of ideas
  • Pressured speech
  • Hallucinations
  • Violent excitement
45
Q

Define delusion and list the types of delusions

A

An unshakeable belief, held on illogical grounds and out of keeping with the patient’s culture.

Delusions can be mood congruent ( affective disorder) or mood incongruent ( schizophrenia)

46
Q

Define persecution delusions

A

Most common type of delusion

A theme of being followed, spied on, followed.

47
Q

Define infestation delusion

A

Belief the skin is infested with parasites, causing skin itching ( formation) Common in cocaine withdrawal

48
Q

Define delusional misidentification

A

Belief that those close to them have been replaced by a double ( Capgras syndrome)
Single person is impersonating multiple people ( Fregoli syndrome)

49
Q

Define a delusion of jealousy

A

Firm belief a partner is unfaithful without proof (Othello syndrome)

50
Q

Define a delusion of reference

A

Bizarre unfeasible interpretations EG a dogs bark carries a code

51
Q

Define an hallucination

A 
A false perception which has the quality as a real perception but which occurs in the absences of any external stimulus. 
Auditory
- First person
- Third person 
- Complex 
- Elementary

Visual
- Not common in psychosis

Pseudohallucination: person knows the stimulus is in their mind

52
Q

Differential diagnosis for bipolar affective disorder

A

Substance induced mood disorder: blood test confirm high levels of substances

Major depressive disorder ( will not have any mania)

Dysthymic disorder: Depression for 2 yrs

Cyclothymic disorder: Disturbances of mood with hypomania not classifying as mania and depressive episodes not classifying for major depressive disorder.
Patient is rarely symptoms free for 2 months

Psychotic disorders: present without the severe mood symptoms

OCD

ADHD

53
Q

Treatment of acute mania in bipolar disorder

A

Assess

  • cycling speed
  • psychotic symptoms
  • suicide risk

Moderate/Severe mania

  • SGA (Olanzapine, Risperidone)
  • Valproate/ Iamotrigine
54
Q

Management of bipolar disorder

A
  1. Lithium carbonate (refer to lithium notes on prescribing)
  2. Olanzapine
  3. Aripiprazole
  4. Iamotrigine

Psychoeducation therapy: reduces relapse rates, improves therapy compliance & social functioning.
Lack sleep is key

BAD is a lifelong condition

55
Q

Risk factors for suicide in BAD

A 
Previous suicide attempt 
Family history 
Early onset of bipolar disorder
Extent of depressive symptoms 
Increasingly bad affective signs 
Rapid cycling
Abuse of alcohol or drugs
56
Q

Defining features of neurological malignant syndrome and serotonin syndrome

A 
TRIAD 
- Neuromuscular abnormalities 
- Altered consciousness
- Autonomic dysfunction 
(Hyperthermia, sweating, tachycardia, unstable blood pressure)
57
Q

List the blood results commonly found in NMS and SS

A

Increased creatine kinase
Increased WCC
Increased hepatic transaminase
METABOLIC ACIDOSIS

58
Q

List the neuromuscular abnormalities found in NMS

A

Reduced activity
Rigidity
Bradyreflexia

59
Q

List the neuromuscular abnormalities found in SS

A

Clonus
Hyperreflexia
Tremor
Slight muscular rigidity

60
Q

Treatment of NMS

A

Bromocryptine

Dantrolone

61
Q

Treatment of Serotonin Syndrome

A

Cyproheptadine

62
Q

Define depression

A

Low mood persisting for >2 weeks without the causes such as bereavement or organic disease ( hypothyroid/drug induced)

63
Q

Risk factors for depression

A 
Female 
Pregnancy/postnatal period
Asian/ Afrocarribean
Asylum seeker/ refufee descent 
Past medical history of mental health illness 
Chronic disease
64
Q

List the clinical features of depression, dividing them into core, biological and other symptoms

A

CORE

  • Low mood
  • Anhedonia
  • Low energy

BIOLOGICAL

  • Sleeplessness ( early morning waking)
  • Loss of concentration
  • Reduced appetite
  • Reduced weight
  • Constipation
  • Irritability
  • Loss of libido
  • Psychomotor retardation
  • Reduced apathy
  • Anxiety
  • Suicidal thoughts

OTHER

  • Feeling of guilt ( past)
  • Feelings of worthlessness (present)
  • Hopelessness/ Low self esteem ( future)
65
Q

Classify the levels of depression

A

Mild
- 2 core + 2 others

Moderate
- 2 core + 3 others

Severe
- 3 core + 4 others

66
Q

Differential diagnosis for depression

A

Organic disease

  • Hypothyroidism
  • Drug induced
  • Dementia
  • Bereavement

Functional psychotic disorders

  • Bipolar affective disorder
  • Depression with psychotic symptoms

Seasonal Affective Disorder

Associated disease

  • Dysthymia
  • OCD
  • Parkinsons
  • Hyperthyroid
  • Eating disorders
  • PTSD
  • Anxiety disorders
  • Personality disorders
67
Q

Management of mild- moderate depression

A

Low intensity psychological interventions
Not all patients are suitable for psychological interventions
- Sleep hygiene
- Exercise
- Self help books
- CBT ( computerised or IAPT)

Unsuccessful refer for

  • Interpersonal activation
  • Behavioural activation
  • Psychodynamic therapy

Beware of social management

  • Accommodation
  • Money
  • Relationships
68
Q

Management of moderate to severe depression

A 
Antidepressants 
Contraindicated in substance misuse 
Not suitable in adjustment disorder 
1. SSRI 
2. Different SSRI 
3. TGA/ SNRI 
4. Lithium ( recurrent or resistant depression)

Do not give TGA in suicidal people are overdose will kill.

69
Q

Diagnostic criteria for severe depression

A

Persistent low mood or anhedonia for >2 weeks

  1. Suicide plan or ideas of self harm
  2. Unexplained guilt or worthlessness
  3. Inability to function ( psychomotor retardation)
  4. Concentration impaired
  5. Decreased sleep/early waking
  6. Energy low/ unaccountable fatigue
70
Q

Criteria for ECT as a treatment for depression

A

Severe life threatening, treatment resistant depression

CONSISTS OF

  • x2 weekly ECT
  • Short acting GA and muscle relaxant
71
Q

Define self harm and suicide

A

Self harm: intentional act done with knowledge that it may be harmful

Suicide: Act of intentionally and successfully ending one’s life

72
Q

Risk factors for suicide

A 
Male 
LGBT 
Prisoners
Single 
Unemployment 
Occupation ( farmer/vet/nurse)
Poor 
Previos history of self harm 
Substance use 
Recent adverse life events
73
Q

Key areas which highlight suicide intent

A
  1. Advanced planing
  2. Precautions taken to avoid discovery
  3. Dangerous method used
  4. N help sought after the act
74
Q

Clinical features of postnatal depression

A 
Low mood 
Anhedonia
Anergia 
Preoccupying thoughts to do with the baby
 Infanticidal thoughts
75
Q

Treatment of postnatal depression

A

Low threshold for referral to hospital
CBT
Antidepressants

76
Q

Clinical features of puerperal psychosis

A 
Insomnia 
Restlessness
Suspiciousness
Marked psychosis 
Patients retain a degree of insight
77
Q

Treatment of puerperal psychosis

A 
Assess risk of infanticide and suicide 
Hospitalisation ( mother and baby unit) 
Antipsychotics 
Antidepressants 
Mood stabilisers 
If needed Benzos
78
Q

Clinical features of anxiety

A

ICD 10 >4 symptoms

Cognitive

  • Agitation
  • Feelings of impending doom
  • Poor concentration
  • Insomnia

Somatic

  • Tension
  • Trembling
  • Headache
  • Sweating
  • Palpitations
  • Vomiting

Behaviour

  • Reassurance seeking
  • Avoidance
79
Q

Treatment of anxiety

A

Symptom control

  • Listening
  • Beta blockers

Exercise

CBT

Meditation

Medication

  • Avoid benzos if possible
  • Try SSRI
80
Q

Diagnostic criteria for PTSD

A

1 month = adjustment disorder
6 months = PTSD

Avoidance 
Intrusions 
Hypersensitivity ( to stimuli) 
Stresor ( identifiable) 
Negative alteration in mood and cognition
81
Q

Management of PTSD

A

CBT
EMDR ( eye movement and desensitisation reprocessing)
SSRI (Paroxetine)

82
Q

Define obsessions and compulsions

A

Obessions: sterotyped purposeless words, ideas or phrases that come into the mind

Compulsions: senseless repeated actions/rituals.

NOT DELUSIONAL BELIEFS

83
Q

Treatment of OCD

A

CBT
SSRIs
Clomipramine ( 25mg OD) TGA

84
Q

Briquets syndrome

A

Chronic medically unexplained symptoms, affecting any body part, multiple medically unexplained symptoms.
Difficult to treat.
Psychological causes

85
Q

Hypochondrial syndrome

A

Misinterpretation of normal body sensations on illness

Refusal to accept reassurance that they are fine

86
Q

Body dysmorphic disorder

A

Patients are preoccupied with an imagined or minor defect in their physical appearance

87
Q

Diagnostic criteria for personality diorders

A

Disharmonious attitudes and behaviour, involving several areas of functioning
Chronic abnormal behaviour patterns
Present in a broad range of personal and social situations
Manifestations < 18
Considerable personal distress

88
Q

List the different types of personality disorders

A

Cluster A

  • Paranoid
  • Schizoid

Cluster B

  • Histronic
  • Narcissitic
  • Dissocial
  • Emotionally unstable personality disorder

Cluster C

  • Obessive compulsive disorder
  • Anxious
  • Dependent
89
Q

Features of a paranoid/delusional PD

A

Sensitive
Easily offended
Suspicious

90
Q

Features of a schizoid PD

A

Socially withdrawn
No pleasure from activities
Emotional coldness
Indifferent to praise or criticism

91
Q

Features of a histrionic PD

A

Self dramatisation
Easily influenced
Attention seeking

92
Q

Features of a narcissistic PD

A

Increased self importance
Lack empathy
Grandiose ideas
Need attention

93
Q

Features of a discoidal/antisocial PD

A

Agressive/ easily frustrated
Callous lack of concern for others
Cannot maintain relationships
Lack of guilt

94
Q

Features of an emotionally unstable PD

A 
Impulsive 
Irresponsible 
Impulsive 
Unable to control emotions 
Unpredictable behaviour
95
Q

Features of an OCD PD

A

Worries
Doubts
Control
Ordiness

96
Q

What does ICD-10 define as a learning disability

A

IQ <70
Onset is pre <18

Development >18 : chronic brain injury

97
Q

Downs syndrome

A 
I in 600 
Increase risk with increase maternal age 
Increase risk of Alzheimer's disease 
Extra Chromosome 
47, XX (+21)
98
Q

Foetal alcohol syndrome

A 
Smaller patients 
Pointy face 
Preventable causes of LD 
Growth retardation 
Facial dysmorphia
( small head, low nasal bridge, epicanthic fold)
99
Q

Autism spectrum disorder

A 
Affects all abilities 
Lack of social instinct 
- Social interaction 
- Communication 
- Imagination 
Inflexible thinking 
Rigid routines 
Dislikes change 
Special interests
100
Q

Aspergers syndrome

A 
Sensory distortion 
Perceptual disorientation 
Executive function difficulties 
Central coherence 
Inflexible thought/ action

Psychiatry (4 decks)

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