ICD10 Diagnostic Criteria Flashcards
General dementia criteria
- Decline in both memory and thinking sufficient to impact ADLs
Can have
- Difficulty attending to more than one stimulus at a time
- Shifting focus
- reduction in ideas
Alzheimers Disease
Diagnosis and characteristics
Diagnosis
- Presence of dementia
- Insidious onset
- Absence of systemic/brain disease
- Absence of neurological signs sudden in onset at the start of illness
Characteristics
- Steady decline
- Neurofibrinary tangles
- Amyloid plaques
- Reduction in volume esp hipocampal, frontal and temporal lobes
Vascular Dementia
No required diagnostic criteria:
- Presence of dementia (is required)
- Uneven impairment
- Focal neurological signs
- Abrupt onset +/- stepwise deterioration
- Insight/judgement may be preserved
- Radiological evidence
Pick’s Disease
FTD
Diagnosis
- progressive dementia;
- a predominance of frontal lobe features with euphoria, emotional blunting, and coarsening of social behaviour, disinhibition, and either apathy or restlessness;
- behavioural manifestations, which commonly precede frank memory impairment
Characteristics
- earlier onset usually 50-60
- followed by impairment of intellect, memory, and language
- Atrophy of frontal and temporal lobes
Parkinsons Dementia
- Advanced Parkinsons
- Later development of dementia
HIV Dementia
HIV dementia typically presents with complaints of forgetfulness, slowness, poor concentration, and difficulties with problem-solving and reading. Apathy, reduced spontaneity, and social withdrawal are common, and in a significant minority of affected individuals the illness may present atypically as an affective disorder, psychosis, or seizures. Physical examination often reveals tremor, impaired rapid
repetitive movements, imbalance, ataxia, hypertonia, generalized hyperreflexia, positive frontal release signs, and impaired pursuit and saccadic eye movements.
Delirium
- Impairment of consciousness and attention
- Global impairment of cognition
- Psychomotor disturbances - hypo or hyperactive
- Disturbance of sleep/wake cycle
- Emotional discturbance
- Total duration
Substance - Harmful Use
Both of
- Clear evidence of physical or psychological harm
- Use for at least one month or multiple times over year
Substance - Dependence Syndrome
Three or more of
- Strong desire or compulsion to take
- impaired capacity to control (increasing amounts being taken, unsuccessful attempt to cut down or stop)
- Physiological withdrawal state
- Evidence of tolerance
- Preoccupation with substance
- Continuation despite clear evidence of harm
Schizophrenia (general)
At least one of
- Though echo, thought I/W/B
- Delusions of control, passivity or influence
- Running commentary, 3rd person hallucinations or voices from part of the patients body
- Persistent delusions that are culturally inappropriate and completely impossible.
Or at least two of
- Persistent hallucinations in any modality
- Neologisms or disorders of thought form
- catatonic behaviours
- Negative symptoms
Agoraphobia
- primary anxiety disorder (i.e. Not related to OCD or delusion)
- restricted to at least two of: crowds, public places, travelling away from home, travelling alone
- must have prominent avoidance
Social phobia
- primary anxiety (i.e. Not related to OCD, delusions etc)
- restricted to social situations (e.g. Speaking in public, eye contact, interactions with opposite sex etc)
- avoidance prominent
Panic disorder
Panic attacks where:
- there is no objective danger
- occur in unpredictable situations
- comparative freedom from anxiety symptoms between attacks
Generalised anxiety disorder
- Free floating anxiety
- no full-blown panic symptoms
OCD
Obsessional symptoms:
- must be recognised as own thoughts
- must be at least one thought or act that is still resisted unsuccessfully
- the act cannot be in itself pleasurable
- thoughts, images or impulses must be unpleasantly repetitive
Conversion disorder
Neurological condition without physical cause
- la belle indifference
Solarisation disorder
- at least 2 symptoms of concern (condition of concern would be hypochondriasis)
- persistent refusal to accept reassurances of doctors
- some degree of social impairment
Neuasthenia
A) Persistent and distressing fatigue either mental or physical after normal efforts
B) at least two of
- muscle aches and pains
- dizziness
- tension headaches
- sleep disturbance
- inability to relax
- irritability
- dyspepsia
Anorexia
- weight 15% below expected or BMI < 17.5
- weight loss is self induced
- body image distortion
- endocrine disorder: amenorrhoea in women, loss of libido/potency in males
- possible delayed puberty
Also consider primacy of thoughts about food
Acamprosate
- Start immediately
- for cravings
- TDS
- s/e nausea, vomiting, diarrhoea, not working
- Continue for 1 year
Disulfiram
- unpleasant reaction to drinking small amounts of alcohol
- only effective on days taken
- dangerous if drank large amounts
- S/E drowsiness and fatigue, n&v, rarely psychosis
- daily tablet
Parietal lobe testing
Dominant
- name finger & move specific finger
- feel item and name it
- draw letter on hand
- ask about dressing themselves
Non dom
- recognise part of the body
- intersecting pentagons
Other
- reading and writing
- ask to repeat a saying
- visual fields
- clock drawing
Temporal lobe exam
- repeat phrase
- ask for opposite of big, heavy etc
- name different objects
- ask about if can recognise faces
- hum happy birthday and ask to name
- semantic memory: e.g. Prime minister in 1980s, what was Marilyn Monroe famous for etc, famous tall building in Paris
- Apple, table, penny
- visual fields
Frontal history
- personality changes
- hyperorality
- distractability
- poor motivation
- inability to adapt
- poor problem solving
Frontal lobe exam
- FAS
- proverb
- similarities
- fist edge palm (five times then ask to do)
- cognitive estimates
- grasp reflex
- key in field
- digit span
Fitness to plead
- comprehend the course of proceedings
- know that they may challenge a juror
- comprehend the evidence
- give proper instruction to legal representative
Fitness to be interviewed
- appropriate adult must be present
- if conducting the interview could significantly harm the suspect
- can they:
- understand the questions
- understand nature and purpose of the interview
- understand the nature and significance of the caution
- understand the significance of any answers which are given
- make reasoned and rationale decisions about whether they want to say anything
- whether the condition would lead them to lie e.g. Mania
Paranoid PD
- excessive sensitivity to set backs
- bears grudges
- suspicious
- misconstrues the actions of others
- combative
- excessive self importance
- conspiracy theories
Dissocial PD
- callous
- irresponsible and no regard for social norms
- problems maintaining relationships
- low tolerance to frustration
- inability of experience guilt or profit from punishment
- blames others
- ask about conduct disorder
EUPD
Impulsive
- emotional instability
- frequent outburst, quarrelsome,
Borderline
- as above
- problems with self image
- feelings of emptiness
- intense unstable relationships
- excessive efforts to avoid abandonment
- DSH/suicidality
ASD
Problems in
- communication/language
- socialisation
- repetitive restricted behaviours
ADHD
- inattention
- hyperactive
- misbehaviour
- impulsivity
- more than one setting
