Neurotic disorders Flashcards
ICD 11 classification for generalised anxiety disorder
General anxiety in multiple environments or about multiple aspects of everyday life
Anxiety accompanied by additional symptoms e.g. muscle tension, irritability, sleep disturbance
Symptoms present for several months more days than not
Not better accounted for by another condition
Result in significant distress or impairment of functioning
ICD requirement for number of months anxiety must have been present for to meet criteria for a diagnosis of generalised anxiety disorder
6 months
Physical symptoms of anxiety mentioned in ICD 10 - requirement for 4 to be present for diagnosis of GAD
- Autonomic arousal - palpitations, tachycardia, dry mouth, trembling
- Breathing difficulty, choking sensation, chest pain, abdominal pain/nausea
- Feeling dizzy, unsteady, faint, depersonalisation, derealisation
- Hot/cold flushes, numbness, tingling sensations
- Muscle tension, restlessness, lump in throat
- Exaggerated response to surprise, concentration difficulties, sleep difficulty
Types of panic attack recognised in DSM V
Expected
Unexpected
Length of time symptoms must be present to diagnose panic disorder in ICD 10
1 month
Number of panic attacks which must be present to label panic disorder as severe in ICD 10
4 attacks per week in a 4 week period
Cardinal features of a phobia
Fear is
- Out of proportion to the situation
- Cannot be explained or reasoned away
- Is beyond voluntary control
- Leads to avoidance
Difference clinically between phobic anxiety and other causes of anxiety
None
Important feature of phobias where the person becomes anxious when they feel they may encounter the object of the phobia
Anticipatory anxiety
Cognitive basis for the anxiety seen in agoraphobia
Lack of escape
Three themes that provoke anxiety in agoraphobia
Distance from home
Crowding
Confinement
Physical feature more common in social anxiety than other anxiety disorders
Blushing
Type of social anxiety seen in ICD 10 where anxiety manifests in certain situations
Discrete type
Type of social anxiety seen in ICD 10 where there is anxiety in any generic social situation
Diffuse
Five subtypes of phobia distinguished by DSM V
Animals Aspects of the natural environment Blood/injection/injury Situational Other
Definition of an obsession in the context of OCD
A repetitive and persistent thought, image or impulse/urge which is unwanted, intrusive and often associated with anxiety
Definition of a compulsion in the context of OCD
A repetitive behaviour or ritual, including a repetitive mental act, that the individual feels required to perform in response to an obsession, according to rigid rules, or to achieve a sense of ‘completeness’
Most common compulsion in OCD
Checking behaviours
Time within which an acute stress reaction usually starts
1 hour
Time by which there is usually resolution in an acute stress reaction
8 hours if there was a single stressor event
48 hours if the stressor was ongoing
Length of time an acute stress disorder should last according to DSM
Should start when the stressor is present
Should last 2 days to 4 weeks
Time frame for adjustment disorder in ICD 11
Usually starts within 1 month of the stressor
Should resolve by 6 months after the stressor has ended
Principal symptoms of PTSD
Hyperarousal - anxiety, irritability, insomnia
Hypervigilance due to re-experiencing and enhanced startle response - intrusive thoughts, distressing dreams, difficulty remembering stressful events voluntarily
Avoidance - avoidance of reminders of the event, emotional numbness, feelings of detachment
Timeframe within which PTSD should start
6 months from the trauma
Type of trauma involving a single catastrophic event
Type 1 trauma
Type of trauma involving a chronic repetitive insult
Type 2 trauma
Loss of memory for important, recent events, which is partial, patchy and selective
Dissociative amnesia
Loss of personal identity and sudden travel away from home, but maintenance of self-care
Dissociative fugue
Dissociative state where there is narrowed consciousness and limited but repeated movements, with loss of personal identity but no replacement with another identity
Dissociative trance
Dissociative state where there is narrowed consciousness and limited but repeated movements, with loss of personal identity and there is replacement with another identity
Possession trance
Disorder where someone experiences symptoms affecting the nervous system e.g. blindness, paralysis etc., that cannot be explained solely by a physical injury or illness
Conversion disorder
Absence of psychological distress sometimes seen in conversion disorder
La belle indifference
Syndrome characterised by approximate answers to simple questions e.g. on being asked how many legs a cow has the answer is given as 5. Originally described as being seen is prisoners.
Ganser syndrome
Characteristics suggestive of pseudoseizures rather then epileptic seizures
Avoidance behaviour to avoid serious injury
Eyes closing and resisting being opened
Dystonic posturing
Emotional or situational trigger
Lack of tongue biting
Movements - pelvic thrusting and side to side head movements
Longer seizures of duration 2-3 minutes
High seizure frequency but lack of injury
Lack of response or paradoxical increase in seizures with treatment
Eponymous names used to describe somatisation disorder
Briquet syndrome
St. Louis hysteria
Characteristics of somatisation disorder
At least 2 years of multiple and variable physical symptoms with no adequate physical explanation
Refusal to accept the reassurance of multiple doctors about a lack of physical cause
Impairment of social functioning
Characteristics of hypochondriacal disorder
Persistent belief that someone has at least one physical illness despite lack of evidence from investigations
Refusal to accept the advice and reassurance of several doctors
Recurrent symptoms of autonomic arousal occurring with subjective symptoms related to a specific organ despite no structural or functional deficit. Occurs with refusal to be reassured about the lack of a physical illness.
Somatoform autonomic syndrome
ICD 10 diagnosis which has been removed from ICD 11. Neurotic disorder with symptoms of increased fatigue or of bodily weakness after minimal effort. Accompanied by at least 2 of - muscular aches and pains, dizziness, tension headaches, sleep disturbance, inability to relax, irritability, dyspepsia.
Neurasthenia
The perception that someone’s feelings and/or experiences are detached, distant or not their own
Depersonalisation
The perception that someone’s surroundings seem unreal, distant, colourless or lifeless
Derealisation
Disorder where there is falsifying, feigning or deliberately inducing of medical symptoms or injuries in order to seek treatment but for no other external benefit
Factitious disorder
Group of people factitious disorder is commonly seen in
Healthcare professionals
The feigning, intentional production, or exaggerating of physical or psychological symptoms for external gain e.g. financial gain, to avoid court etc.
Malingering
Qualifier that can be used in the OCD and related disorders category in ICD 11
Poor to absent insight
Core features of neurasthenia
Duration >6 months
Easy fatiguability after minimal effort
Muscular aches and pains
Unrefreshing sleep
Type of amnesia which fugue state falls into
Global psychogenic amnesia
The inability to stand or walk in a normal manner, can be due to an organic illness or conversion disorder
Astasia-abasia
Symptoms in PTSD associated with a worse prognosis
Dissociative symptoms e.g. sense of numbness, derealisation, dissociative amnesia
Unique feature seen in psychogenic amnesia but not organic amnesia
Loss of personal identity
Term used in the early 20th century to suggest that overwhelming stress could cause mental illess
War neurosis
Code in ICD 10 for culture bound illnesses
Other specified neurotic disorders
Category of somatoform disorders globus hystericus falls into in ICD
Other somatoform disorders
Most common area perceived to be affected in body dysmorphic syndrome
Skin
Most common psychiatric diagnosis among those presenting to A&E following self harm
Adjustment disorder
Phenomena of the partner of a pregnant woman experiencing pregnancy related symptoms
Couvade syndrome
Category of syndrome couvade syndrome falls into
Conversion disorder
Lifetime prevalence of specific phobia in women
13%
Lifetime prevalence of specific phobia in men
4%
Physical condition associated with agoraphobia
Mitral valve prolapse
Sex more commonly affected by agoraphobia
Female
Ratio of females:males who suffer from OCD
1.5:1
Mean age of onset of OCD
20
Sex who have worse outcomes from OCD
Male
Prevalence of OCD in adults
1%
Phobia of fire
Pyrophobia
Phobia of being alone
Monophobia
Phobia of lightening
Astraphobia
Phobia of blood
Haematophobia
Phobia of animals or a specific type of animal
Zoophobia
Phobia of strangers
Xenophobia
Phobia of pain
Algophobia
Phobia of disease
Pathophobia
Phobia of vomiting
Emetophobia
Phobia of spiders
Arachnophobia
Phobia of heights
Acrophobia
Anxiety disorder associated with anticipation
OCD
Prevalence of social phobia
7.4%
Lifetime prevalence of anxiety disorders
10%
Class of disorders atasia-abasia is described under in ICD 10
Dissociative motor disorder
Type of image produced voluntarily in OCD in order to negate the feared effects of the obsessive images seen
Compulsive image
Type of image produced in OCD that appear with no wilful control
Obsessive image
Type of obsession where obsessional slowness is seen
Obsession of symmetry
