Diagnosis Flashcards
- depressed mood
- loss of interest
- decreased activity
These ICD - 10 A symptoms are classic of which affective state
Depression
- reduced concentration
- reduced self-esteem
- reduced confidence
- guilt
- self-harm thoughts
- disturbed sleep
- reduced appetite
- pessimistic thoughts
These ICD - 10 B symptoms are classic of which affective state
Depression
NICE guidelines recommend
Low-intensity psycho social interventions
– individual guided self-help based on the principles
of cognitive behavioural therapy (CBT)
– computerised CBT (CCBT)1
– a structured group physical activity programme
Which condition am I? (give the severity as well)
mild depression
NICE guidelines recommend
Combination of antidepressant medication and high intensity psychological intervention (CBT / interpersonal therapy [IPT])
Which condition are these guidelines recommended for? give severity
moderate or severe depression
Which psychiatric affective disorder am I most likely to be based on these symptoms?
Pervasive elated /
expansive / irritable mood
Mania
Which psychiatric affective disorder am I most likely to be based on these symptoms?
inflated self-esteem / grandiosity - racing thoughts - more talkative - decreased need for sleep - distractibility - psychomotor agitation - excessive involvement in pleasurable activities
Mania
How is hypomania different from mania?
no psychotic symptoms
NICE guidelines recommend
I can be treated with antipsychotic (olanzapine)
BDZ (lorazepam)
mood stabilisers (lithium and carbamazepine)
Which condition am I?
Mania
Mel is in her third trimester of pregnancy and has recently suffered from an episode of mania
Which mood stabilising drug is contraindicated in pregnancy?
sodium valproate
impairment of memory, especially episodic in early stages,
language dysfunction
dyspraxia
agnosia
spatial disorientation
impaired judgement
These cognitive symptoms are classic of?
Dementia
The SCOFF screen is a quick way of identifying this condition
S - SICK
Do you ever make yourself Sick because you feel uncomfortably full?
C - CONTROL
Do you worry you’ve lost Control over how much you eat?
O - ONE STONE
Have you recently lost more than One stone in a three month period?
F - FAT
Do you believe yourself to be Fat when others say you are too thin?
F - FOOD
Would you say that Food dominates your life?
Which condition am I
Anorexia or Bulimia Nervosa
Russel's sign Swollen Salivary glands Erosion of enamel Proximal myopathy Osteoporosis
Combining all these symptoms in a young female with a BMI below 20
What is the most likely diagnosis?
Anorexia or Bulimia Nervosa
DSM - V Criteria
A - Refusal to maintain ≥85% (minimally normal) body weight
B - Fear of weight gain, even though underweight
C - ODD self-perception, ≥1 of:
Overall self-worth heavily influenced by body weight/shape
Distorted perception of shape/weight
Denies the seriousness of low body weight
Which condition am I?
Anorexia Nervosa
Which condition am I?
DSM - V Criteria
A - Recurrent binging
Vastly > others, in a similar time period and situation
lack of control ‘can’t stop once I start’
B - Recurrent purging
Fasting, over-exercise, vomiting, laxatives, diuretics, drugs
C - Binging and purging ≥1/week for 3 consecutive months
D - Overall self-worth heavily influenced by body weight/shape
E - Symptoms not exclusively of anorexic episodes
Bulimia Nervosa
Which syndrome am I?
Desire, Controlling, Withdrawal, Tolerance, Neglect, Persisting
a) a strong desire or sense of compulsion to take the substance;
b) difficulty in controlling substance taking behaviour in term of its onset, termination, or levels of use;
c) a physiological withdrawal state (see F1x.3 and F1x.4) when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
d) evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses;
e) progressive neglect or alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or taken the substance or to recover from its effects;
f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.
Dependence Syndrome
Which condition am I?
Disturbance of consciousness -
reduced awareness of environment with
decreased ability to focus, sustain or shift attention.
Change in cognition -
memory deficit, disorientation, language disturbance or
development of perceptual disturbances.
Acute onset
(hours to days) with fluctuation in severity.
Evidence from history, examination or lab findings that disturbance is caused
by direct physiological consequences of a general medical condition
Delirium
Recurrent fear of illness for >6 months due to misinterpreting bodily sensations as symptoms, despite reassurance otherwise
Hypochondriac
Characterised by the acute conversion of psychological distress into a loss or alteration of physical functioning, suggestive of a physical (often neurological) disorder
Conversion Disorder
The intentional production of physical/psychological symptoms, motivated by an identifiable external incentive
Malingering Disorder
The intentional production of physical/psychological symptoms to simulate a disease, motivated by the desire for a patient role
Factitious disorder
Epidemiology
Higher incidence in recent immigrants (e.g.
2nd generation African-Caribbean
immigrants)
DHx
Cannabis component cause but not sufficient alone
Positive Symptoms Delusions, hallucinations, thought disorder, bizarre behaviour
Which condition am I?
Schizophrenia
ONE MONTH of
Positive Symptoms
Delusions,
hallucinations,
thought disorder,
bizarre behaviour
Schizophrenia
ONE MONTH of
Negative Symptoms
Flattening of affect and volition,
Lack of motivation,
anhedonia and attentional impairment
Schizophrenia
Which condition am I?
ONE MONTH AT LEAST
ICD 10
At least one of the following:
Thought echo/ insertion / withdrawal, or thought broadcasting
Delusions of control / passivity phenomena; delusional perception
Hallucinatory voices giving running commentary or discussing patient between themselves
(3rd person), or other types of hallucinatory voices coming from some part of the body
Persistent delusions of other kinds that are culturally inappropriate and imp
Schizophrenia
Flattening, shallowness, incongruity or inappropriateness
of affect
Behaviour which is aimless and disjointed
Thought disorder
Hebephrenic
schizophrenia
For a period of at least two weeks one or more of the
following psychomotor disturbances:
(1) Stupor or mutism or (2) Excitement
(3) Posturing, (4) Negativism
(5) Rigidity or (6) Waxy flexibility
(7) Command automatism
Catatonic
Schizophrenia
Insidious and progressive negative symptoms but no overt psychotic symptoms prior
Simple
schizophrenia
Delusions or hallucinations prominent
Paranoid
schizophrenia
Delusions of ‘nothingness’ and refer to rotting death or decay
Indicate a very severe depression
What is this type of delusion?
Nihilistic delusions
A complete absence of pleasure in all things once pleasurable
Name the symptom
Anhedonia
The profound slowing of thought and movement that can accompany severe depression
Name the symptom
Psychomotor retardation
an assessment order lasting up to 28 days with a right of appeal to a tribunal
Which act and section is this referring to?
The mental health act, section 2
2 doctors and a mental health professional form the assessment team
Hypothyroidism Cushing's syndrome Parathyroid disease Renal failure Folate deficiency Cerebral tumours Alcohol or drug misuse
The above conditions are all physical causes of?
Depression
Patient Presents with signs consistent with Wernicke's encephalopathy is CAN OPEN Confusion Ataxia Nystagmus Ophthamoplegia PEripheral Neuropathy
Alcohol Abuse
Alcoholic who is dependent
decides to abstain from alcohol for 36 hours.
WHat is the riskmc
seizures
Alcoholic who is dependent
decides to abstain from alcohol for 48-72 hours.
These symptoms present coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
What is the diagnosis
delirum tremens
