Psych

Question 1

Somatic Symptom Disorder

Answer 1

• 1 or more somatic symtpoms that are distressing and/or result in significant disruption in daily life
• one or more of: excessive thoughts, feelings, and/or behaviours related to these somatic symptoms or associated health concerns
  
  • disproportionate and persistent thoughts about the seriousness of one’s symptoms
  • persistently high level of anxiety about health or symptoms
  • excessive time and energy devoted to these symptoms or health concern
• chronicity: any one symptom may not be continuously present, the state of being symptomatic is persistent and lasts > 6 months

Question 2

Schizophrenia

Answer 2

• 2 or more of the following characteristic symptoms present for most part of 1 month: delusions hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, negative symptoms (affective flattenin, alogia, avolition); must have at least one of: delusions, hallucinations, or disorganized speech
• social/occupational dysfunction - 1 or more majour areas of functioning (self care, work, interpersonal relations) markedly below level achieved pre-illness
• continuous signs of disturbance > 6 months, including > 1 month of active phase symptoms (may include prodromal and reisdual phase)
• schizoaffective and mood disorders excluded
• the disorder is not the result of a medical condition or substance abuse
• if a history of PDD, an additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are present for > 1 month

Question 3

Bipolar Affective Disorder

Answer 3

Definition :

• A mood disorder characterized by periods of deep, prolonged, and profound depression that alternate with periods of excessively elevated and/or irritable mood known as mania.

Diagnosis :

• Requires the presence of a manic episode of at least 1 week’s duration that leads to hospitalization or other significant impairment in occupational or social functioning (Bipolar I).

Classification :

• 1) Bipolar I disorder – classic mania is required for the Dx
• 2) Bipolar II disorder – hypomanic patients
• 3) Cyclothymia – subthreshold/smoldering Sx not meeting MDE, Bipolar I or II
• 4) Other Specified Bipolar and Related Disorder

Question 4

Generalized Anxiety Disorder

Answer 4

Definition :

• The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger

Diagnosis: by clinical examination and fulfillment of DSM V criteria

• 1) Excessive anxiety and worry (apprehensive expectation) occurring for at least 6 months about several events or activities
• 2) Person finds it difficult to control the worry
• 3) The worry is associated with 3 or > of : restlessness or feeling “on the edge”, fatigue, difficulty concentrating/ mind going blank, irritability, muscle tension, or sleep disturbance
• 4) Anxiety not due to substance abuse of other medical or mental disorder
• 5) The symptoms cause significant impairment in social, occupational, or other areas function

Question 5

Panic Disorder

Answer 5

DSM V: core criteria for panic attack un changed; PD has been uncoupled from agoraphobia and their respective diagnostic criteria remain the same (ie pts with PD and agoraphobia now get two separate diagnoses)
Clinical assessment and fulfilling DSM V criteria

• 1) Recurrent unexpected panic attacks
• 2) At least one of the attacks has been followed by 1 month or more of one ore more of the following : persistent concern re more panic attacks, worry about the implications of the attack or its consequences, a significant change in behavior related to the attacks
• 3) Absence of agoraphobia
• 4) Panic attacks are not due to substance abuse or other medical disorder
• 5) Panic attacks are not due to another mental disorder

Question 6

Panic Attacks

Answer 6

Panic Attacks: defined by DSM V criteria :

• A discrete period of intense fear or discomfort in which 4 or more of the following symptoms developed abruptly and reached a peak within 10 minutes :
  
  • 1) Palpitations, pounding heart, or accelerated heart rate
  • 2) Sweating
  • 3) Trembling or shaking
  • 4) SOB or smothering sensation
  • 5) Feeling of choking
  • 6) Chest pain
  • 7) Nausea or abdominal distress
  • 8) Dizzy, unsteady, light headed or faint
  • 9) Derealization (feeling of unreality) or depersonalization (detached from ones self)
  • 10) Fear of loosing control or going crazy
  • 11) Parasthesias
  • 12) Chills or hot flushes

Question 7

Borderline Personality Disorder

Answer 7

• Impulsive
• Moody
• Paranoid under stress
• Unstable self image
• Labile intense relationships
• Suicidal
• Inappropriate anger
• Vulnerable to abandonment
• Emptiness

Question 8

Agoraphobia

Answer 8

• Marked fear or anxiety about ≥2 of the following 5 groups of situations:
  
  • Public transportation (e.g., traveling in automobiles, buses, trains, ships, or planes)
  • Open spaces (e.g., parking lots, market places, or bridges)
  • Being in shops, theatres, or cinemas
  • Standing in line or being in a crowd
  • Being outside of the home alone in other situations
• The individual fears or avoids these situations due to thoughts that escape might be difficult or help might not be available in the event of panic-like symptoms
• The agoraphobic situations almost always provoke fear or anxiety
• The situations are actively avoided, require presence of a companion, or endured with marked fear or anxiety
• The fear or anxiety is out of proportion to actual danger posed by agoraphobic situation
• The fear, anxiety, or avoidance is persistent, typically lasting ≥6 months
• The fear, anxiety, and avoidance cause clinically significant distress or functional impairment

Question 9

Specific Phobia

Answer 9

• Marked fear or anxiety about a specific object or situation (e.g., flying,seeing blood)
• The phobic object or situation almost always provokes immediate fear or anxiety and is actively avoided or endured with marked fear or anxiety
• The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation
• The fear, anxiety, or avoidance is persistent, typically ≥6 months
• There is marked distress or functional impairment
  
  • Animal: spiders, insects, dogs
  • Natural environment: heights, storms, water
  • Blood-injection-injury: needles, invasive medical procedures
  • Situational: airplanes, elevators, enclosed spaces
  • Other: choking or vomiting in children, loud sounds or costumed characters

Question 10

SAD (Specific Phobia)

Answer 10

• Marked fear or anxiety about social situations in which the person may be exposed to scrutiny by others
• Fear that actions or showing anxiety symptoms will cause negative evaluation (e.g., embarrassment, humiliation) or offend others
• The social situation:
• Almost always provokes fear or anxiety
• Is actively avoided or endured with marked fear or anxiety
• The fear, anxiety, or avoidance:
  
  • Is out of proportion to the actual threat posed by the social situation
  • Is persistent, typically ≥6 months
  • Causes significant distress or functional impairment
• If another medical condition is present (e.g., stuttering, obesity), the disturbance is unrelated or out of proportion to it
• Specify “performance only” if the fear is restricted to speaking or performing in public

Question 11

GAD

Answer 11

• Excessive anxiety and worry (apprehensive expectation) about a number of events or activities (e.g., school/work performance)
• The individual finds it difficult to control the worry
• Excessive anxiety and worry are associated with ≥3 of the following symptoms (with at least some occurring more days than not for ≥6 months): PRIME
  
  • Poor concentration
  • Restlessness or feeling keyed-up or on edge
  • Irritability & Impaired sleep
  • Muscle tension
  • Easy fatiguability
• The disturbance causes clinically significant distress or functional impairment

Question 12

OCD

Answer 12

• Presence of either obsessions, compulsions, or both
• Obsessions are defined by the following:
  
  • Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted and that cause marked anxiety or distress
  • The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with other thoughts or actions
• Compulsions are defined by the following:
  
  • Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rigid rules
• Compulsions are aimed preventing or reducing anxiety or preventing some dreaded situation or event; however, they are not connected in a realistic way with what they are designed to neutralize or are clearly excessive
• The obsessions or compulsions are time-consuming (e.g., take >1 h/day) or cause clinically significant distress or functional impairment
• Specify patient’s degree of insight as to reality of OCD beliefs:
  
  • Good or fair insight (i.e., definitely or probably not true)
  • Poor insight (i.e., probably true)
  • Absent insight (i.e., completely convinced beliefs are true)
• Specify if “tic-related” OCD

Question 13

PTSD

Answer 13

• The person has been exposed to actual or threatened death, serious injury, or sexual violation in ≥1 of the following ways:
  
  • Directly experienced or witnessed the traumatic event, learned that trauma occurred to close family member or friend (actual or threatened death must have been violent or accidental), experienced repeated exposure to aversive details of trauma
• Presence of ≥1 of the following intrusion symptoms associated with the trauma:
  
  • Recurrent, involuntary, and intrusive distressing memories, distressing dreams, dissociative reactions (e.g., flashbacks), psychological or physiological distress at reminders of traum
  • Persistent avoidance of stimuli associated with the trauma, including ≥1 of the following:
  • Avoidance of distressing memories or feelings and external reminders (e.g., people, places) of the trauma
  • Negative alterations in cognitions and mood associated with the trauma, including ≥2 of the following:
  • Inability to recall important aspect of the trauma, diminished interest or participation in activities, feeling of detachment or estrangement from others, persistent negative beliefs, distorted blame, and negative emotional state
• Marked alterations in arousal and reactivity associated with the trauma, including ≥2 of the following:
  
  • Irritable or aggressive behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance
• Duration of disturbance >1 month
• Symptoms cause clinically significant distress or impaired functioning
• Specify whether with dissociative symptoms (depersonalization or derealization) or with delayed expression (full criteria not met until at least 6 months after the event)