Diagnostic criteria

Question 1

Schizophrenia

Answer 1

One of: thought control, passivity phenomena, auditory hallucinations, delusions OR
Two of : persistent hallucinations + fleeting delusions; though disorganisation, catatonia, negative symptoms
Duration of over a month

Question 2

Bipolar Affective disorder

Answer 2

Bipolar I: ≥1 manic episode +/- ≥1 depressive episode

Bipolar II: ≥1 hypomanic episode +/- ≥1 depressive episode

Question 3

Manic episode

Answer 3

A. Distinct period of abnormally and persistently elevated, expansive or irritable mood ≥ 1 week or requiring hospital admission.

B. 3 or more of:

1. Inflated self-esteem (grandiosity)
2. Decreased need for sleep
3. More talkative than usual
4. Flight of ideas
5. Distractability
6. Increase in goal directed activity
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences.

C. Symptoms do not meet the criteria for a mixed episode.

D. Marked impairment in occupational/social functioning.

E. Not due to drugs or general medical condition.

Question 4

Hypomanic episode

Answer 4

• As above but ≥4 days
• Not requiring hospital admission
• Not severe enough to cause social/occupational dysfunction

Question 5

Mixed bipolar episode

Answer 5

• Occurrence of both manic/hypomanic & depressive symptoms in single episode, present every day for ≥1 week:
o Depression and overactivity
o Mania and reduced energy/libido
o Rapid cycling – fluctuating between mania and depression - ≥4 episodes/year.

Question 6

Depression

Answer 6

Core symptoms, psychological symptoms, biological symptoms. Impaire quality of life. Not due to drugs or medical condition
Duration of 2 weeks
Mild - at least 2 core, 1-2 other symptoms
Moderate - at least 2 core, at least 3 other symptoms
Severe - all 3 core, 5 other core, or psychotic or psychomotor retardation

Question 7

Generalised anxiety disorder

Answer 7

Prominent tension, worry and apprehension about everyday events and problems, as well as at least 4 of the symptoms below (including at least 1 autonomic symptom):
• Autonomic arousal: Palpitations/tachycardia, sweating, trembling, dry mouth not due to medication/dehydration
• Chest/abdo symptoms: Breathing difficulties, choking sensation, chest pain/discomfort, nausea/abdo distress
• Mental state symptoms: Feeling dizzy/unsteady/faint, derealisation/depersonalization, fear of losing control/going crazy/passing out, fear of dying
• General: Hot flushes/cold chills, numbness/tingling, muscle tension, restlessness, feeling on edge, sensation of a lump in the throat
• Non-specific: Exaggerated response to minor surprises, difficulty concentrating, persistent irritability, difficulty getting to sleep
At least 6 months

Question 8

Anorexia Nervosa

Answer 8

1. Maintenance of underweight BMI (<17.5 in adults), or 15% below expected
2. Self-induced weight loss
   a. Exercise, appetite suppressants, starvation, laxatives
3. Body image distortion
   a. Intrusive, overvalued ideas
   b. (Overvalued idea = idea with emphasis, not a delusion, shaping some behaviour/significant portion of their life, inaccurate, exaggerated)
4. Endocrine disorders (amenorrhoea, decreases libido/impotence)
5. Delayed/arrested puberty

Question 9

Alcohol dependence

Answer 9

Dependence syndrome (DSM-IV requires 3/7 in a 12 months period):

1. Compulsion to drink
2. Primacy of drink over other activities
3. Stereotyped pattern of drinking (e.g. narrowing of drinking repertoire)
4. Increased alcohol tolerance
5. Repeated withdrawal symptoms (e.g. anxiety, sweating, tremor, nausea, fits, delirium tremens)
6. Relief drinking to avoid withdrawal symptoms
7. Reinstatement after abstinence

Question 10

Panic disorder

Answer 10

Physical symptoms/signs related to autonomic arousal (e.g. tremor, tachycardia, tachypnoea, hypertension, sweating, GI upset), often compounded by HVS (in 50–60% of cases, see Anxiety and stress-related disorders [link]).

• Concerns of death from cardiac or respiratory problems may be a major focus, leading to patients presenting (often repeatedly) to emergency medical services.

Question 11

Somatisation disorder

Answer 11

ICD-10: At least 2 years of multiple physical symptoms with no physical explanation.
Key diagnostic features = multiple, atypical, and inconsistent medically unexplained symptoms in a patient under the age of 40

Question 12

Conversion disorder

Answer 12

Usually suspected due to the non-anatomical or clinically inconsistent nature of the signs. Established by:

1. Excluding underlying organic disease or demonstrating minor disorder insufficient to account for the symptoms
2. Finding of ‘positive sings’ (ie demonstration of function thought to be absent)
3. A convincing psychological explanation for the deficit

Question 13

Bulimia nervosa

Answer 13

Persistent preoccupation with eating

• Irresistible craving for food
• ‘Binges’—episodes of overeating
• Attempts to counter the ‘fattening’ effects of food (self-induced vomiting, abuse of purgatives, periods of starvation, use of drugs, e.g. appetite suppressants, thyroxine, diuretics)
• Morbid dread of fatness, with imposed ‘low weight threshold’

Question 14

Impulsive EUPD

Answer 14

Characterised predominantly by emotional instability and lack of impulsive control.
• Marked tendency to act unexpectedly and without consideration of the consequences
• Marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts thwarted or criticised
• Liability to outbursts of anger with inability to control the resulting behavioural explosions
• Difficulty maintaining any course of action that offers no immediate reward
• Unstable and capricious mood

Question 15

Borderline EUPD

Answer 15

At least 3 of the impulsive criteria plus:

1. Self-image: characterised in addition by disturbances in self-image, aims and internal preferences
2. Mood: chronic feelings of emptiness and fears of abandonment
3. Relationships: intense and unstable interpersonal relationships
4. Behaviour: tendency to self-destructive behaviour, including suicide gestures and attempts

Question 16

Dysthymia

Answer 16

Depressed mood (>2yrs).

• Reduced/increased appetite.
• Insomnia/hypersomnia.
• Reduced energy/fatigue.
• Low self-esteem.
• Poor concentration.
• Difficulties making decisions.
• Thoughts of hopelessness.

Question 17

Acute stress reaction

Answer 17

re-experiencing of events, avoidance, and hyperarousal (but lasting no more than 4wks).

Question 18

PTSD

Answer 18

Symptoms arise within 6mths of the traumatic event (delayed onset in ~10% of cases) or are present for at least 1mth, with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• 2 or more ‘persistent symptoms of increased psychological sensitivity and arousal’ (not present before exposure to the stressor): difficulty falling or staying asleep; irritability or outbursts of anger; reckless or self-destructive behaviour (DSM-5); difficulty in concentrating; hypervigilance; exaggerated startle response.
• Persistent remembering/‘reliving’ of the stressor in intrusive flashbacks, vivid memories, or recurring dreams; and distress when exposed to circumstances resembling or associated with the stressor.
• Actual/preferred avoidance of circumstances resembling/associated with the stressor (not present before exposure to the stressor).
• Inability to recall, either partially or completely, some important aspects or the period of exposure to the stressor.

Question 19

Learning disability

Answer 19

ICD-10 defines ‘mental retardation’ as ‘a condition of arrested or incomplete development of the mind, characterized by impairments of skills manifested in the developmental period, i.e. cognitive, language, motor and social abilities’.

IQ below 70

Mild 50-69
Delay in acquiring speech, but eventual ability to use everyday speech; generally able to independently self-care; main problems in academic settings (e.g. reading, writing); potentially capable of working; variable degree of emotional and social immaturity; problems more like the normal population. Minority with clear organic aetiology, variable associated problems (autism, developmental disorders, epilepsy, conduct disorders, neurological and physical disabilities).

Moderate 35-49
Delay in acquiring speech, with ultimate deficits in use of language and comprehension; few acquire numeracy and literacy; occasionally capable of simple supervised work. Majority have an identifiable organic aetiology, a substantial minority have associated problems (autism, developmental disorders, epilepsy, conduct disorders, neurological and physical disabilities).

Severe 20-34
Similar to moderate, but with lower levels of achievement of visuospatial, language, or social skills. Marked motor impairment and associated deficits.

Profound Below 20
Comprehension and use of language very limited; basic skills limited at best; organic aetiology clear in most cases; severe neurological and physical disabilities affecting mobility common; associated problems (atypical autism, pervasive developmental disorders, epilepsy, visual and hearing impairment) more common.

Question 20

Antisocial behavioural disorder

Answer 20

1. Callous unconcern for the feeling of others
2. Disregard for and violation of social rules, obligations and the rights of others.
3. Irresponsibility and impulsivity
4. Irritability and aggression
5. Lack of guilt and failure to learn from experience
6. No difficulty in finding relationships (superficially charming) but relationships are usually fiery, turbulent and short-lived.