Definitions Flashcards
Acute stress reaction definition
- Transient, develops in an individual w/o any other apparent mental disorder in response to exceptional mental/physical stress
- Subsides within hrs/days
- Features:
- initial DAZE
- constricted field of consciousness
- narrowed attention
- inability to comprehend stimuli
-disorientation - severe withdrawal may manifest as stupor
- can become agitated and over reactive
- may have autonomic signs of panic
- complete or partial amnesia
8 DSM-V: Sx at least 3d, if >1m consider PTSD
Adjustment disorder definition
Subjective distress and emotional disturbance
Interfering w/function
Arising in period of adaptation to life
Manifestations:
- Depressed mood
- anxiety
- worry
- unable to cope
- disability in performing daily routines
Conduct disorder association (adolescents)
Generalised anxiety disorder definition
Generalised and persistent but not restricted to one environment
>6m
Sx criteria (at least 4 including autonomic)
Common fears: self/relative illness
Doesnt meet panic/phobic anxiety, OCD or hypochondriacal dx
Not caused by organic health problem or substance
Key featues:
- apprehension
- motor tension
- autonomic overactivity
Sx criteria for GAD
at least 4 in total including 1 of:
Auto: palpitations, sweating, trembing, dry mouth
Others:
- Chest/abdo: dib, choking, pain, nausea
- Brain: dizzy, depersonalisation, fears
- General: hot/cold flushes, parasthesia
- Tension: muscle tension/ache, restless, mental tension
Other: exaggerated startle, difficulty concentrating, irritable, insomnia
OCD definition
Recurrent obsessional thoughts can be:
Ideas, Imaged, Impulses
Obsession thoughts distressing and patient tries to resist
Recognised as own thoughts despite involuntary
Compulsive rituals, not inherently enjoyable or useful
Behaviour is recognised as pointless and attempts made to resist
Anxiety almost always present and worsens if acts resisted
Body dysmorphic disorder definition
Appearance preoccupation (non-existent or slight flaw)
Repetitive behaviours (can be mental eg. comparison)
Clinical: causes distress/impairment
Specifiers:
- muscle dysmorphia (too much or too little)
- ?insight
Panic disorder definition
Recurrent attacks not restricted to any particular situation Are thus unpredictable Sx: - sudden onset palpitation - CP - choking sensation - dizziness - depersonalistion/derealisation - fear of death/going mad NB panic dx NOT main dx in pt w/depressive disorder at start of attacks (panic secondary)
Social phobia definition
Fear of scrutiny by others leading to avoidance of social situations
?a/w low esteem
Sx: blushing, hand tremor. nausea, urinary urgency in social situations
Can progress to panic attacks
Specific phobia definition
Restricted to highly specific situations
Can evoke panic attack
Agoraphobia definition
Cluster a/w fear of leaving home, entering crowds, travelling alone
Can have panic attacks
Avoidance prominent, so potentially can have relatively little anxiety
PTSD definition
Delayed or protracted response to exceptionally threatening/catastrophic event
Duration: >1m
RF: Hx neurotic illness or compulsive personality
Key Features
1. Re-experiencing
2. Avoidance
3. Autonomic hyperarousal
others: emotional blunting, detachment, anhedonia
?suicidal ideation
Reaction may take weeks/months
Recovery expected in most cases
Small percentage will result in enduring personality change
ADHD subtypes
- Predominantly inattentive
easily distracted, forgetful, poor concentration and completion of tasks - Predominantly hyperactive-impulsive: fidget, hyperactive, immature, ?destructive
- ADHD : combination
Sx must have appeared by age 6-12y, occur in >1 environment, cause issues, last >6m
ADHD how is it subdivided?
Subdivision based on presence of 6+/9 Sx of inattention, hyperactivity or both lasting at least 6m
ADHD Sx clusters Inattention
Difficulty paying close attention to details
Trouble holding attention
Trouble organising tasks
Loses necessary items
Appears forgetful
Short attention span and easily distracted
Difficulty with structured school work or tasks that are complex/time consuming
ADHD Sx clusters Hyperactivity-Impulsivity
Unable to sit still Fidget Leaves seat inappropriately Takes risk w/little thought 'on the go' talking more than others Answers quickly Difficulty waiting turn Interrupts/Intrudes
Autistic spectrum disorder
Pervasive developmental dx develops <3y 3 areas: reciprocal social interaction communication restricted stereotyped repetitive behaviour
Aspergers syndrome definition
Uncertain nosological validity
Abnormalities of social interaction that typify autism
Restricted, stereotyped, repetitive repertoire of interests
NO general delay in language or cognition
Marked clumsiness
Strong tendency to persist into adult life
Psychotic episodes can occur in adult life
Baby blues definition
Tearfulness, irritability, low mood occurring within a few days of childbirth
Lasts days
Labile mood sometimes
Post natal depression
Depressive disorder w/peripartum onset (during pregnancy to 1y post)
Criteria same as non child birth depression
Most recover within a month
Peurperal psychosis
not defined by DSM-V or ICD-10
Onset of psychostic Sx after childbirth (usually around 2w)
3 Patterns:
1. Delirium
2. Affective (psychotic depression/mania)
3. Schizophreniform
Sx will deteriorate and fluctuate rapidly
Recovery 6-12w
Bipolar affective Dx
2+ episodes in which mood and activity significantly disturbed
Some occasions are (hypo)manic, some depressive
Types:
I: 1+ manic, depressive episodes common but NOT necessary
II: At least 1 hypomanic, at least 1 major depressive
Cyclothymia: Hx of hypomania w/periods of depression that are not major
Hypomanic episode definition
Persistent mild elevation of mood, increased energy and activity, usually marked feelings of well being Increased sociability Increased sexual energy Decreased need for sleep NOT severe disruption of work Can manifest as irritable NO hallucinations/delusions
Mania w/o psychotic Sx definition
Mood elevated out of keeping w/circumstances (from carefree to uncontrollable excitement)
Increased energy -> overactivity, insomnia
Distractable
Inflated self esteem
Grandiose ideas
Loss of inhibition
Conduct disorder definition
Repetitive persistent dissocial/aggressive/defiant conduct
Violates age appropriate expectations
>6m
Subtypes:
- family context only
- unsocialised vs socialised (well integrated into peer group)
Oppositional-defiant disorder:
Related condition in younger children
Specific of ODD is defiance vs others (parent), NOT delinquency/aggressive
Delusional Disorder
1+ delusion that are usually persistent and sometimes lifelong
NOT any auditory hall., delusions of control, blunting or any other schizo sx
NB. occasional or transient auditory hallucination does not rule out DD as long as it is a small part of picture
Depressive disorder ICD-10
Symptoms
- core: low mood, anhedonia, anergia
- bio: sleep/appetite disturbance, low libido, agitation
- cognitive: impaired memory/concentration, guilt and worthlessness, low self esteem, bleak future
MILD: 2 or 3 core, 2+ other, pt distressed but able to continue most activities
MOD: 2/3 core, 3+ other, pt. reports considerable difficulty
Sev: All 3 core, 4+ other, major impact on life, distress/agitation possible
DURATION: >2 weeks to be major depressive episode
Depressive disorder definition DSM-IV
1.Depressed most of the day, nearly everyday
2.Diminished interest/pleasure in activities
3.Significant wt change or appetite change daily
4.Sleep disturbance nearly daily
5. Psychomotor agitation/retardation
6. Fatigue or low energy
7. Feeling worthless/guilty nearly daily
8. Diminished concentration ability
9. Recurrent thoughts of death
SUBTHRESHOLD: <5 sx
MILD: >5 Sx, minor functional impairment
Moderate: symptoms and impairment mild-severe
SEVERE: Most Sx, marked impairment, can present w/psychosis too
Dissociative disorders definition
Partial/complete loss of integration between:
- memories of past, awareness of identity, control of body
Tend to remit after weeks/months (particularly if a/w traumatic event)
Chronic dx (paralyses) possible if a/w insoluble problems
NO underlying dx
NB. ONLY dx of physical function under voluntary control/loss of sensation are dissociative (pain and other ANS functions are somatisation dx)
Dissociative amnesia
Dissociative amnesia (loss of memory) often recent important events
Dissociative stupor (pro
Dissociative fugue
(same features as dissociative amnesia) plus purposeful travel beyond everyday range
behaviour may appear normal to outside observer who is unaware of amnesia
Dissociative stupor
Diminution or absence of vountary movement and normal responsiveness to external stimuli
No physical cause
Evidence of psychgenic causation from recent trauma/stress
Trance and possession disorders
Temporary loss of sense of personal identity
Full awareness of surroundings
ONLY trances that are involuntary and unwanted, occurring outside religion or cultural situations
Dissociative motor disorder
Loss of ability to move whole or part of limb
Close resemblance to any axatia/apraxia/dyskinesia
Dissociative convulsion
Mimic epileptic
tongue biting, bruising due to fall and incontinence are rare
LOC maintained or replaced by stupor/trance
Dissociative anaesthesia
Areas of skin w/boundaries that are not medically defined
Defined by pts ideas of medicine
Differential sensory modality loss not explained by any possible lesion
Sensory loss a/w parathesia
Loss of vision and hearing rarely total
Anorexia Nervosa definition
Deliberate wt loss (diet, exercise, purging, use of appetite supressants)
Morbid dread of being fat
Disturbed bodily funct. (endocrine/metabolic)
Atypical anorexia nervosa:
fulfil some criteria but overall picture not full justifying dx
Bulimia Nervosa definition
Repeated overeating
Excessive preoccupation leading to pattern of overeating and then purging
Often Hx of anorexia nervosa
Atypical: some sx but not justifying dx
Binge eating disorder
Frequent recurrent eps of binge eating (1+/wk) over period of months
inappropriate behaviour to prevent wt gain
Learning disability definition
Significant limitations in general mental abilities, and 1+ areas of adaptive behaviour across environments
Becomes apparent in childhood/appearance
IQ <70 (some discretion when sev. adaptive functioning impairment)
NB. not learning difficult where general intelligence normal w/specific difficulty
IQ:
50-70= mild
35-49 = mod
20-34 = severe
<20 = profound
Personality disorder general definition
Pervasive: occurs in all/most areas of life
Persistent: evident in adolescence and continues
Pathological: distress to self/others, impairs function
Paranoid personality disorder (A)
Excessive sensitivity to setback
Unforgiveness to insult
Suspicious
Tends to distort experiences by misconstruing neutral or friendly actions of others
Recurrent suspicions regarding sexual fidelity of partner
Combative and tenacious sense of personal rights
Excessive self-importance and reference can occur
Schizoid personality disorder (A)
Withdrawal from affectional/social/other contacts
Prefer fantasy, solitary activities, introspection
Limited capacity to express feelings and experience pleasure
ICD 10 features of schizoid personality disorder (A)
Few if any activities provide pleasure
Emotionally cold/detached/flattened affect
Limited capacity for warm feelings and anger
Indifferent to praise/criticism
Little interest in sexual activity w/others
Chooses solitary activities
Preoccupation w/fantasy/introspection
Neither desire nor have close friends/confiding relationships
Marked insensitivity to norms and conventions
Schizotypal personality disorder (A)
Eccentric behaviour
Anomalies of thinking and affect that resemble schizophrenia
Cold/inappropriate affect
Anhedonia
Odd/eccentric behaviour
Tendency to withdraw
Paranoid/bizarre ideas not amounting to delusions
Ruminations
Thought/perceptual disturbance
?Transient quasi-psychotic moments w/intense illusions, auditory or other hallucination and delusions
No definite onset or evolution
Dissocial (antisocial) personality disorder
Disregard for social obligations
Unconcern for others
Disparity between behaviour and societal norms
NOT modifiable by punishment
Low tolerance to frustration, low threshold for aggression/violence
Tendency to blame others
Emotionally unstable personality disorder (B)
Tendency to act impulsively w/o considering consequences
Mood unpredictable
Liable to outburst of emotion incontrollable
Tend to quarrel especially when impulsive acts are thwarted
2 Subtypes:
Impulsive: emotionally unstable and lack control
Borderline: disturbed self image, chronic emptiness, unstable interpersonal relations, self destructive behaviour
Histrionic personality disorder (B)
Shallow and labile affect Self dramatisation Theatricality Exaggerated emotional expression Suggestibility Egocentricity Self-indulgence Lack of consideration of others Easily hurt feelings Continuous seeking of appreciation, excitement, attention
Anankastic PD (C)
Feelings of doubt
Perfectionism
Excessive conscientiousness
Checking and preoccupation w/details, stubborn, cautious, rigidity
Insistent and unwelcome impulses that do not attain severity of OCD
Anxious (avoidant) PD (C)`
Feelings of tension/apprehension
Hypersensitive to rejection/criticism
Restricted personal attachments
Tend to avoid certain activities by habitual exaggeration of potential dangers of everyday life
Dependent PD (C)
Pervasive reliance on others to make major and minor life decisions
Fear of abandonment
Feeling helpless and incompetent
Passive compliance to wishes of others
Weak response to daily demands of life
Lack of vigour in intellectual/emotional sphere
Transfer responsibility
Schizophrenia characterised by:
Fundamental and characteristic disturbance of thought/perception
Affect inappropriate/blunt
Clear consciousness and intellectual capacity usually maintained
Negative Sx
Course can be continuous or episodic
First Rank Sx of Schizophrenia
Thought insertion, withdrawal and broadcasting Delusional perceptions (and passivity phenomena) Auditory hallucinations (3rd person, thought echo, commentary)
When NOT to dx schizophrenia
presence of extensive manic or depressive Sx unless clear than schiz. Sx came first
Presence of overt brain dx or during states of intox/withdrawal
Schiz. duration
DSM-V:
2 dx criteria met most of the time for at least 1m w/sig. impact on social/occupational function for 6m
If sx present for 1-6m Dx = schizophreniform disorder
Psychotic Sx <1m = brief psychotic disorder
Paranoid schiz. definition
Dominated by relatively stable often paranoid delusions, usually a/w hallucinations and perceptual disturbance
Uncommonly; disturbance of affect, volition, speech, catatonia
Hebephrenic schiz. definition
Affect changes prominent
Delusions/hallucinations are fleeting and fragmentary
Irresponsible and unpredictable behaviour
Mannerisms common
Mood shallow and inappropriate
Thought disorganised, speech incoherent
Tendency to isolation
Poor prognosis (negative sx)
Should normally only be Dx in adolescent or young adult
Catatonic schizophrenia
psychomotor disturbances that may alternate between extremes (hyperkinesis and stupor), automatic obedience and negativism
Episodes of violent excitement
Catatonic phenomena may be combined w/dream like state + vivid hallucinations
Undiferentiated schiz
Psychotic conditions meetings general dx criteria but w/o subtyping
Post-schizophrenic depression
Depressive episode arises after schizophrenia
some schiz sx may be present but NOT dominating clinical picture
Risk of suicide
If no schizophrenic sx then diagnose depressive episode
Residual schizophrenia
Chronic stage w/prominent negative sx long term
Simple schiz.
Insidious progressive development of oddities of conduct
Inability to meet social demands
Negative sx develop w/o preceeding by any overt psychotic sx
Schizoaffective Disorders
Episode disorders BOTH affective and schizophrenic sx prominent but do NOT jusfity schiz/depresssive/mania Dx Manic type: - schiz + manic sx Depressive type: - schiz + depressive sx Duration: Req. psychotic state for 2w w/o concurrent affective sx req. 2 episodes of psychosis (1 with and 1 without affective sx)
Substance use disorder acute intox
Condition following administration of psychoactive substances
Resolve unless damage
SUD harmful use
Pattern of behaviour that damages health
Physical, mental
SUD dependence syndrome
Behavioural, cognitive, physiological cluster developed after repeated use Typically Includes: craving control (lack of) persistent use priority over other things tolerance withdrawal
SUD withdrawal state
Group of Sx occuring when ceasing long term use of substance
Time limited
Cx: convulsion
SUD psychotic disorder
during/following substance use not explained on basis of intox. and not part of withdrawal Characterised by: hallucinations perceptual distortion delusion (paranoid/persecutory) Psychomotor disturbance Abnormal affect
SUD amnestic syndrome
Chronic prominent impairment of recent and remote memory Immediate recall preserved Recent more disturbed than remote Disturbance of time sense and chronology Difficulty learning new material Confabulations possible
SUD residual and late onset psychotic disorder
Alcohol or other substance induce long term change in cognition, affect, personality beyond intoxication
Somatisation disorders
multiple recurrent and frequently changing physical sx of at least 2y duration
Many have Hx of fruitless investigations
Sx can be anywhere
Disorder is chronic and fluctuating
Somatisation disorders - undifferentiated somatoform disorder
Somatoform complaints are multiple varying persistent but complete typical picture of somatisation disorder not fulfilled
Somatisation disorders - hypochondrial disorder
Persistent preoccupation w/one or mote serious/progressive illness
Somatoform complaints or persistent concerns about appearance
Normal or common sensations interpreted as distressing and attention focused on organ/system
Depression/anxiety common
Somatisation disorders - Somatoformm autonomic dysfunction
Presented by pt as if due to physical disorder of system/organ largely under ANS control (CVS, GI, resp)
2 types:
1. based on objective signs of autonomic arousal
2. subjective complaints of burning, heaviness, bloating
Somatisation disorders - Persistent somatoform pain disorder
Persistent severe distressing pain
cannot be explained by physiological process
Occurs with emotional conflict or psychosocial problems
ECT Indications
Catatonia
Prolonged or sev. manic episode
Sev depression that is life threatening
NB is effective in pregnant women
ECT short/ong term side effects
Headache, N=V Short term memory impairment memory loss of events prior to ECT Arrhythmia Long term: impaired memory
Insomnia definition
Difficulty initiating, maintaining sleep or early morning waking that leads to dissatisfaction w/sleep quality
Chronic insomnia: at least 3/wk for 3mo
Ix: usually based on Hx, sleep diary, polysomnography?
Applied relaxation therapy
Used in anxiety disorders
Based on premise that they have lost ability to relax
Series of exercises teach patient to:
- spot sx of tension
- relax muscles and relieve tension
- use these techniques in stressful situations
12-15 wkly sessions
Mentalisation based therapy
Focus on pt ability to attend mental states in themselves and others
Helps understand their and others actions
Leads to more social success
Used for EUPD and self harm
Transference focussed therapy
Based on a theory by which emotions transferred from one person to another
Presumed that your feelings about certain people are transferred to therapist
You then feel about and react to the therapist as you would those important people
Therapist watches and helps you build healthier relationship
Mainly EUPD
