Diagnostic criteria Flashcards
Psychosis
Positive symptoms
- Delusions
- Conceptual disorganization
- Perceptual disturbances
- Catatonic symptoms
Negative symptoms
- Blunted affect
- Restricted affect
- Poor rapport
- Passive/apathetic social life or social withdrawal
- Lack of spontaneity and poverty of speech
Delusions examples
- Ideas of reference
- Grandiose
- Paranoid
- Nihilistic
- Erotomanic
Conceptual disorganization examples
- Clang association
- Loosing association
- Neologism
- Tangentiality
- Circumstantiality
- Blocking
Perceptual disturbances examples
- Hallucinations
- Illusions
Catatonic symptoms examples
Diagnosis require 3 of:
- Retarded symptoms: stupor, catalepsy, waxy flexibility, negativism, mutism
- Excited symptoms: stereotyping, agitation/grimacing, echolalia, echopraxia
- Other: mannerism
Schizophrenia
A: Two or more (one of which is 1-3), for 1 month
- 1: Delusions, 2: Hallucinations, 3: Disorganized speech, 4: Grossly disorganized or catatonic behaviour, 5: Negative symptoms
B: Decreased level of function (eg work, self-care)
C: At least 6 months of continuous signs of disturbance (must include one month of A symptoms and may include prodromal/residual symptoms)
D: Rule out schizoaffective disorder or bipolar disorder with psychotic features
E: Rule out other causes (GMC, substances)
F: If history of ASD or communication disorder of childhood onset, additional schizophrenia diagnosis is only made if hallucinations or delusions for at least 1 month
Schizophreniform disorder
- Criterion A, D, and E of schizophrenia are met
- Last 1-6 months (<1 month=brief psychotic disorder, > 6 months=schizophrenia)
Brief psychotic disorder
- Criterion A1-4, D and E of schizophrenia are met
- Last 1 day to 1 month (1-6 months=schizophreniform disorder)
Schizoaffective disorder
A: Concurrent psychotic disorder (Criterion A Schizophrenia) and major mood episode
B: Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
C: Major mood episode symptoms are present for the majority of the total duration of active and residual periods of illness
D: Not attributable to substance or other medical condition
Delusional disorder
A: The presence of one or more delusions with a duration of 1 month or longer
B: Criterion A for schizophrenia has never been met
C: Functioning is not markedly impaired and behaviour is not obviously bizarre or odd
D: If manic or major depressive episode have occured, these have been brief
E: Not attributable to substance or medical disorder
Panic disorder
A: Recurrent unexpected panic attacks: abrupt surge of intense fear/discomfort with 4 or more of “students fear the 3c´s”
B: 1 month or more of “anxiety about panic attacks”
C: Not attributable to substance or medical condition (acs, hyperthyroidism, pheochromocytoma, hypoglycemia, asthma etc)
D: Not better explained by other mental disorder
Symptoms of panic attack
Students fear the 3 c´s
- Sweating
- Trembling
- Unsteadiness, dizziness, light-headed, faint
- Depersonalization, derealization
- Excessive heart rate, palpitations
- Nausea, abdominal distress
- Tingling, paresthesias
- SOB
- Fear of dying, loosing control, going crazy
- Chest pain/discomfort
- Chills or heat sensation
- Choking
Agoraphobia
A: Marked fear or anxiety about 2 or more of:
- 1: Public transport, 2: Open spaces, 3: Enclosed spaces, 4: In line/crowd, 5: Outside home alone
B: Individuals fear or avoid these situations due to escape being difficult, help not available in case of panic or embarrassing symtoms
C: Agoraphobic situations almost always provoke fear and anxiety
D: Agoraphobic situations are actively avoided, require companion or endured with intense fear/anxiety
E: Fear/anxiety out of proportion to actual danger
F: Persistent, typically last >6 months
G: Cause clinically significant distress or impairment in social, functional or other areas of functioning
H: If another medical condition present, fear/anxiety/avoidance is clearly excessive
G: Not better explained by another mental disorder, not related exclusively to obsessions, perceived flaws in physical appearance, reminders of traumatic event or fear of separation
GAD
A: Excessive anxiety or worry (more days than not in 6 months, about a nr of events/activities)
B: Difficult to control worry
C: Associated with 3 or more of:
- 1: Concentration issues/mind going blank, 2: Fatigue, 3: Irritability, 4: Restlessness, 5: Sleep disturbance, 6: Tension (muscle)
D: Cause clinically significant distress or impairment in social, functional, other areas of functioning
E: Not attributable to medical condition or substance
F: Not better explained by another mental disorder
OCD
A: Presence of obsessions, compulsions or both
B: Obsession or compulsion are time consuming or cause clinically significant distress
C: Not attributable to substance or medical condition
D: Not better explained by another mental condition
Obsessions definition
1) Recurrent persistent thoughts, urges or images. Intrusive and unwanted. Cause marked anxiety or distress.
2) Individual attempts to ignore or suppress or neutralize them with some other thought or action (compulsions)
Compulsions definition
1) Repetitive behaviors or mental acts that individual feels driven to perform due to obsession or according to rules
2) Behaviors/mental acts are aimed at preventing or reducing anxiety/distress, or prevent dreaded event or situation
PTSD
A: Exposure to actual or threatened death, serious injury or sexual violence in one or more of:
- 1: Directly experience, 2: Witnessing, 3: Hearing about close family/friend, 4: Repeated or extreme exposure to aversive details of traumatic event
B: Presence of one or more of intrusion symptoms, beginning after trauma
- 1: Memories, 2: Dreams, 3: Flashbacks, 4: Psychologic distress when cues symbolize/resemble event, 5: same, but resemble aspect of event
C: Persistent avoidance of stimuli associated with event (internal or external reminders)
D: Negative alterations in cognitions and mood associated with event (se notes)
E: Marked alterations in arousal and reactivity associated with event (se notes)
F: Duration of disturbance (criteria B-E) is > 1 month
G: Clinically significant distress or impairment in social, occupational or other functioning
H: Not attributable to substance or medical condition
Adjustment disorder
A: Development of emotional or behavioral symptoms to identifiable stressors occurring within 3 months of onset of stressors
B: Clinically significant (either excess distress than expected or impairment in functioning)
C: Not meet criteria for another mental disorder or exacerbation of pre-existing mental disorder
D: Do not present normal bereavement
E: Once stressor has terminated, symptoms do not persist longer than 6 months
Criteria for substance use disorder
“PEC WITH MCAT”
- use despite Physical/psycholological problem
- failure in External roles (work)
- Craving
- Withdrawal
- continue despite Interpersonal problems
- Tolerance
- use in Hazardous situations
- More/for longer period than intended
- Can´t cut down
- Activities given up (social, occupational, recreational)
- excessive Time spent using/finding substance
Mild: 2-3, moderate: 4-5, severe: >6
Prochaska´s stages of change
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
Alcohol withdrawal stages
1) onset 12-18 hours after last drink
- Tremor, sweating, agitation, cramps, diarrhea, sleep disturbance
2) onset 7-48 hours
- Seizures (tonic-clonic, non-focal and brief)
3) onset 48 hours
- Visual, auditory, olfactory or tactile hallucinations
4) onset 3-5 days
- Delirium tremens, confusion, delusion, hallucination, agitation, tremor, autonomic hyperactivity (fever, tachycardia, HTN)
Delirium tremens
Alcohol withdrawal delirium
- Autonomic hyperactivity (diaphoresis, tachyc, HTN)
- Hand tremor
- Insomnia
- Psychomotor agitation
- Anxiety
- Nausea, vomiting
- Tonic-clonic seizures
- Hallucinations (visual/tactile/auditory)
- Persecutory delusions
CIWA-A score
Physical (5): n/v, tremor, agitation, paroxysmal sweats, headache/fullness
Psychological/cognitive (2): anxiety, orientation/clouding of sensorium
Perceptual (3): tactile, auditory or visual disturbances
Suicide risk factors
“SAD PERSONS”
- Sex (male)
- Age > 60 years
- Depression
- Previous attempts
- Ethanol abuse
- Rational thinking loss (delusion, hallucination, hopelessness)
- Suicide in family
- Organized plan
- No spouse/support system
- Serious illness/pain
Anorexia nervosa
A: Intake and weight
B: Fear or behavior (fear of fat, interferes with weight gain)
C: Perception (body image)
BMI severity (kg/m2)
- Mild > 17
- Moderate < 17
- Severe < 16
- Extreme: < 15
Athletic triad
1: Disordered eating
2: Amenorrhea
3: Osteoporosis
Bulimia nervosa
A: Recurrent episodes of binge-eating (short time, a lot, lack of control)
B: Recurrent inappropriate compensatory behavior (vomit, laxatives, enemas, fasting, excessive exercise)
C: A and B at least once a week for 3 months
D: Self-evaluation based on body shape and weight
E: Disturbance not exclusively during episodes of anorexia nervosa
Signs of bulimia nervosa
- Russels sign (knuckle callus)
- Tooth decay
- Perioral skin irritation
- Periocular and palatal petechiae
- Metabolic alkalosis (unless laxatives: acidosis)
- Hypokalemia
Binge-eating disorder
- Binge-eating, often alone, feeling disgusted and guilty
- At least once per week for 3 months
Delirium
A: Attention and awareness
B: Acute and fluctuating
C: Cognitive changes
D: Not better explained by neurocognitive disorder or occur in context of severely reduced arousal
E: Direct physiological cause (medical condition, substance, withdrawal etc)
CAM
Confusion assessment method Need 1 + 2 + (3 or 4): 1: Acute and fluctuating 2: Inattention 3: Disorganized thinking 4: Altered level of conciousness