Diagnosis Differentials Pt 2 Flashcards
Delirium vs. Major Neurocognitive Disorder vs. Mild Neurocognitive Disorder
Delirium
- Most likely not on exam, but distractor answer
- Increasing confusion that occurs in the onset of hours or days
- Change in cognition and behaviors, marked shift from one’s awareness
- Typically in hospital setting, drug, or med prob that causes biochem change, e.g. memory, exec functioning cog impairment, hallucinations, talk “mamba jumbo”
Major Neurocog v. Mild Nerucog
- AKA Dementia
- Mild - precursor to major, able to maintain independence, but may need some support, e.g. spouse steps up more, can pay bills and make appointments, but notices they’re more forgetful, forgets ppl’s names
- Major - serious issues w/ attention, exec functioning, lang, memory, cog, and knowing how to interact w/ others, motor skills, significant decline from previous level of functioning, need to be in nursing home or skilled facility, e.g. can’t remember to make appointments or drive, family may struggle w/ deciding level of care
*Elderly person experiencing depression, may be having a harder time w/ their memory, but they are aware of the memory loss
Somatic Symptom Disorder vs. Illness Anxiety Disorder vs. Functional Neurological Symptom Disorder
Somatic Symptoms Dx
- AKA somatisization
- Primary focus on physical symptoms, e.g. pain, shortness of breath, or weakness
- Can lead to significant distress and problems functioning, e.g. excessive thoughts, feelings, and behaviors related to physical symptoms
- No medical cause to be found for these symptoms
- Impedes daily functioning
- Present for at least 6 mos
Illness Anxiety Dx
- AKA hypochondriosis
- Rarely have somatic symptoms, intense fear they have a disease despite reassurance they are fine
- NOT of delusional intensity
- Present for at least 6 mos
- Willingess to consider they may not have a serious illness
Functional Neurological Symptom Dx
- Psych issue turns into bio one, e.g. blind rage (so angry they turn blind), someone’s so traumatized in a situation, their arm becomes paralyzed
Factitious Disorder vs. Malingering vs. Factitious Disorder by Proxy
Factitious Dx
- Likes attention of being sick, e.g. pretends to be sick to get dr’s attention
Factitious Dx by Proxy
- e.g. parent always takes child to dr and makes them take medication when they don’t need it
Malingering
- Claiming illness in order to have some kind of gain or avoid something
Anorexia Nervosa vs. Bulimia Nervosa vs. Binge Eating Disorder
Anorexia Nervosa
- Restricts dietary intake, weighs less than normal for their weight, intense fear of gaining weight, excessively exercises and not eating enough food
- Distorted body image
- Always coordinate w/ doctor, typically needs higher level of care
Bulimia Nervosa
- Binge eating, e.g. consume larger portion than what typically eat, feels out of control, compulsive
- Recurrent purging behavior w/ idea it will prevent weight gain
Binge eating Dx
- Only engages in binge eating
- Feelings of disgust and shame after eating food
Unspecified Eating Disorder vs. Body Dysmorphic Disorder
Unspecified Eating
- Does not meet criteria for anorexia or bulimia, e.g. purging w/o binging, obsessed w/ body image
Body Dysmorphic
- Intense displeasure of specific body part, not related to weight, e.g. hates nose, Michael Jackson
Depersonalization/Derealization Disorder vs. Dissociative Amnesia vs. Dissociative Identity Disorder
Depersonalization/Derealization
- Reality is in tact, but feels out of body, feels surreal
Dissociative Amnesia
- Happens in extreme stress or shock - e.g. natural disaster, war zone
- Can’t remember personal info - e.g. SSN, address
- Can co-occur w/ acute stress dx
Dissociative Identity Dx
- AKA multiple personality dx, 2 or more distinct personality traits, e.g. Susan is very anxious and Patty is very adventurous
- Very uncommon
- Happens after extreme trauma at young age, e.g. sexual abuse
- Can’t remember their other personalities
Genito-Pelvic Pain/Penetration Disorder vs. Female Sexual Interest/Arousal Disorder
Genito-Pelvic Pain/Penetration Disorder
- Women report pain or fear during sex intercourse and displeasure towards thought of having sex
- Can happen during DV relationships or ppl w/ sexual abuse or rape
Female sexual interest arousal dx
- No sex thoughts or fantasy, decline or lack of intimacy
- May not be permanent
- Explore w/ couples
Insomnia Disorder vs. Hypersomnolence Disorder
- Opposites
- Somnia - sleepiness
- in - none
- hyper - lots
Insomnia
- Clt complains lack of sleep’s a problem - e.g. no sleep, 3x/wk, early morning wakings, multiple wakings during the evening
- Occurs more than 3+ mos
- Need to rule out manic phase, manic phase usually has reduced sleeping cycle, but there are not complaints that it’s problem and clt feels more energized
- Need to rule out major depressive or anxiety b/c both dxs impacts sleep
Hypersomnolence
- Excessive sleepiness during the day, difficulty being fully awake, tired, sluggish, sleeping excessively
- May be excessively over weight
- Need to rule out MDD or abusing substances
Nightmare Disorder vs. Non-Rapid Eye Movement Sleep Disorder
Nightmare Dx
- When person wakes up to nightmare and can recall nightmare
Non Rapid Eye Movement Sleep Disorder
- AKA sleep terror dx
- Recurrent episodes of incomplete waking and can’t remember what they were dreaming about, don’t fully wake up, sleep walking
- Occur during the first 1/3 of sleep
Central Sleep Apnea vs. Narcolepsy v. Restless Leg Syndrome
Central Sleep Apnea
- Person stops breathing while asleep, can be up to a minute
- Loud gasp or snore for air
- Disrupts quality of sleep, may report feeling tired b/c they can’t enter rem sleep due to their breathing
Narcolepsy
- Suddenly falls asleep, e.g. sleeps in middle of sentence
- Can be caused by lack of muscle tone
- Day time fatigue
Restless Leg Syndrome
- Clt reports sensations and discomfort in legs
- Moving legs helps for a little bit, but does not always fully relieve discomfort
Intermittent Explosive Disorder vs. Kleptomania vs. Trichotillomania
Intermittent Explosive Dx
- Marked aggression, assaultive, destructive, verbally abusive behavior disproportionate to stressor
- Need to rule out intoxication
Kleptomania
- Compulsive stealing, gets a rush, not related to financial needs - e.g. Winona Reider
Trichotillomania
- Compulsion to pull out hair, like arm, eyelash, or eyebrow
- Happens when someone experienced abuse or trauma
- Can be self-inflicted pain or punishment around shame, but not always the case
Substance Use Disorder vs. Substance-Induced Disorders
Substance Use Dx
- Mild or severe
- Severe - e.g. increased tolerance and use to get same effect, dependence (need drink in the morning or feel withdrawal)
- Failure to perform roles and obligations and impacts social interxns
- Made effort to stop, but can’t, use is excessive and problematic and impacts functioning
Substance-Induced
- Substance Intoxication - on substance
- Substance Withdrawal - Off substance, diff subs have diff effects
- Substance Induced Mild Neurocognitive Dx has neurocog symptoms, e.g. difficulty with learning, memory, exec functioning, Related to prolonged cocaine or meth use
Gambling Disorder
- Compulsive gambling even when damaging to life financially
- Increased amounts of money spending towards gambling
- Preoccupation w/ gambling
- Will go back for more
- Lies about gambling and jeopardizes relationships
- Need to rule out manic episodes
Trichotillomania vs. Excoriation Disorder
Trichotillomania
- Clt will pull out their hair when stressed
Excoriation Disorder
-Skin picking, clt will pick or scratch at skin to the point where damage is caused
- Often done when clt feels anxious or stressed
Kleptomania v. Unspecified Impulse-Control Disorder
Kleptomania
- Inability to refrain from stealing for reasons other than financial or personal gain
Unspecified Impulse-Control Dx
- Need to rule out other dxes, like kleptomania
