Psych Diagnostic Criteria/Presentations Flashcards
Depression general criteria and core symptoms
Depressive episode should last at least 2 weeks
No hypomanic or manic symptoms
2 out of 3 must be present:
- Depressed mood
- Loss of interest or pleasure
- Decreased energy/increased fatiguability
Depression additional symptoms
- Loss of confidence/self-esteem
- Unreasonable feelings of self-reproach/guilt
- Suicidal thoughts/behaviour
- Impaired concentration
- Psychomotor agitation or retardation
- Sleep disturbance
- Change in appetite
ICD moderate depressive episode criteria (using core and additional symptoms of depression)
2 core symptoms and four additional symptoms
Need total of 6 so could include 3 core and 3 additional.
ICD severe depressive episode criteria (using core and additional symptoms of depression)
All 3 core symptoms and 5 additional symptoms
Somatic syndrome (depression subtype) criteria
4 of:
- Anhedonia
- Lack of emotional response to events which normally would produce emotional response
- Waking 2 hours of more before usual time
- Depression worse in morning
- Psychomotor retardation or agitation
- Marked loss of appetite
- Weight loss (5% in one month)
- Loss of libido
Atypical depression criteria
Mood reactivity (brightens with potential or actual positive events)
2 or more of:
- significant weight gain or appetite increase
- hypersomnia
- leaden paralysis
- Long standing interpersonal rejection resulting in sig social/occupational impairment
Bipolar I diagnostic criteria
Has to have met criteria for mania at some point, although previous episodes may have been hypomanic and/or depressive
Bipolar II diagnostic criteria
Current or past hypomanic episode and current or past depressive episode
Never met criteria for manic episode
Hypomanic episode diagnostic criteria
Mood elevated or irritable to abnormal degree for the person and is sustained for at least 4 days
At least 3 of these with impairment of personal functioning:
1. Increased activity/restlessness
2. Increased talkativeness
3. Difficulty in concentration/distractability
4. Decreased need for sleep
5. Increased sexual energy
6. Mild spending sprees/impulsive reckless behaviour
Manic episode diagnostic criteria
Elevated, expansive or irritable for at least 1 week
3 of these with impairment of personal functioning:
1. Increased activity/restlessness
2. Increased talkativeness
3. Flight of ideas or thoughts racing
4. Loss of social inhibitions resulting in inappropriate behaviour
5. Decreased need for sleep
6. Inflated self-esteem/grandiosity
7. Distractability or constant changes in activity/plans
8. Reckless behaviour
9. Marked sexual energy or sexual indiscretions
Anorexia nervosa ICD-10 criteria
BMI of 17.5 or less Self-induced weight loss (strict dieting, vomiting, excessive exercise, medication) Body image disturbance Fear of fatness Amenorrhoea
High risk anorexia criteria
BMI <13, weight loss >1kg per week Prolonged QT, HR<40, BP <80 systolic Core temp <34degreesC Unable to rise from squat without using arms for leverage Cognitive impairment
Bulimia nervosa ICD-10 criteria
Persistent preoccupation with eating Irresistable craving for food Binges Attempts to counter the effects of binges (starvation, vomiting, laxatives, drug misuse) Morbid dread of fatness
PTSD DSM V criteria
Traumatic event
1 or more intrusive symptom
1 or more avoidance symptom
1 or more negative alteration in cognition and mood
2 or more increased arousal and reactivity
Duration over a month, can be delayed onset
Distress and functional impairment
Complex PTSD ICD-11 criteria
PTSD symptoms plus:
Negative self-concept
Emotional dysregulation
Chronic interpersonal difficulties
Generalised anxiety disorder criteria
Most days for at least 6 months
Not controllable
Causing significant distress/impairment of function
Generalised and persistent but not predominating in any environmental circumstance
Panic disorder criteria/symptoms
Recurrent attacks of severe anxiety Not restricted to particular situation or set of circumstances Unpredictable Other anxiety symptoms May co-occur with agoraphobia
3 types of phobia
Agoraphobia
Social phobia
Specific phobia
Phobias criteria
Typically early onset
Fear recognised as irrational
Typified by avoidance and anticipatory anxiety
Does agoraphobia usually occur on its own or secondary to another mental illness?
Usually secondary
Can be primary
Social phobia description/symptoms
The individual fears that they will act in a way/show symptoms that will be embarrassing and humiliating
Exposure to situation will cause anxiety/panic attack
Common symptoms:
Blushing or shaking
Fear of vomiting
Urgency or fear of micturition or defaecation
Describe the obessional thoughts in OCD
Ideas, images or impulses entering the mind in a stereotyped way
Recognised as the patient’s own thoughts
Unpleasant, resisted and ego-dystonic (causes sense of distress)
Describe the compulsive acts in OCD
Repeated rituals or stereotyped behaviours Not enjoyable Not functional Often viewed as "neutralising" Recognised as pointless Resistance may diminish over time
OCD diagnostic criteria
Obsessional symptoms or compulsive acts must be present for at least 2 weeks AND be a source of distress and interfere with activities Must be individuals own thoughts Resistance must be present Rituals are not pleasant Must be repetitive
Characteristics of people most at risk after deliberate self harm (DSH).
Older Male Unemployed/retired Single, separated or divorced Isolated Poor health Psych diagnosis Violent DSH Suicide note History of DSH
Schizophrenia first rank symptoms
Delusions
Hallucinations
Thought interference
Passivity
ICD-10 schizophrenia criteria
One of: Thought interference Passivity Auditory hallucinations Delusions OR Two of: Hallucinations in any modality Neologisms or breaks in train of though Catatonic behaviour Negative symptoms
Features of paranoid subtype of schizophrenia
Most common
1st rank symptoms predominate
Features of hebephrenic subtype of schizophrenia
Younger onset
Immaturity and silliness
Play pranks
Animated and giggly
Features of catatonic subtype of schizophrenia
Movement disorder predominates
Responds very well to treatment
Features of persistent delusional disorder
Delusions are only feature
Features of schizotypal disorder
Eccentricity and aloofness Social withdrawal Paranoid quasi-delusional ideas Magical thinking Transient auditory hallucinations
Features of acute and transient psychotic disorder
Schizophrenia symptoms lasting less than one months
Features of schizoaffective disorder
First rank symptoms with depression or mania
Schizophrenia negative symptoms
Reduced amount of speech Reduced motivation/drive Reduced interest/pleasure Reduced social interaction Blunting of affect
Intellectual disability criteria
Deficits in intellectual functioning (IQ<70) Deficits in adaptive functioning (moving from one thing to another) Developmental aetiology (occurs <18 years)
Intellectual disability categories based on IQ
Borderline - IQ 70 or over Mild - IQ 50-69 Moderate - IQ 35-49 Severe - IQ 20-34 Profound - IQ <20
Mild intellectual disability presentation
Mental age 9-12 years
Delayed speech (able to use everyday speech)
Full independence (self care, practical and domestic skills)
Difficulties in reading and writing
Capable of unskilled or semi-skilled work
Problems if social or emotional immaturity
Rarely organic aetiology
Moderate intellectual disability presentation
Mental age 6-9 years Slow with comprehension and language Limited achievements Delayed self care and motor skills Can do simple practical tasks often with supervision Usually fully mobile Majority organic aetiology Epilepsy and physical disability common Will likely need to be looked after
Severe intellectual disability presentation
Mental age 3-6 years
More marked impairment and more restricted achievements
Epilepsy
Profound intellectual disability presentation
Mental age <3 years Severe limitation in ability to understand or comply with requests or instructions Little or no self-care Often severe mobility restriction Basic or simple tasks may be acquired
What are the chromosomal syndromes that can result in intellectual disability? (lots of them)
Cri du chat (causes microcephaly) Angelman (maternally derived, ataxia, paroxysms of laughter) Prader-Willi (paternally derived) Velo-cardiofacial syndrome (increased risk of schizophrenia) Williams syndrome Down's syndrome Patau syndrome Edward's syndrome
What sex chromosome syndromes cause intellectual disability
Turners (XO) Trisomy X Klinefelter (XXY) XXY male may have slight lower IQ Fragile X
Schizophrenia presentation in a person with an intellectual disability
(3 times more common)
Earlier age of onset
Negative symptoms more common
Main presenting symptoms may be behaviour change
Depression presentation in a person with an intellectual disability
More likely to have somatisation
Reduced verbal expression of their feelings
Biological symptoms (sleep, appetite, energy, concentration, anhedonia)
Cluster A “odd and eccentric” personality disorders (DSM V)
Paranoid
Schizoid
Schizotypal
Cluster B “dramatic and emotional” personality disorders (DSM V)
Antisocial
Borderline
Histrionic
Narcissitic
Cluster C “anxious and avoidant” personality disorders (DSM V)
Avoidant (anxious) Dependent Obsessive compulsive (anankastic)
ICD-10 hazardous drinking description/criteria
A pattern of alcohol consumption that increases the risk of harmful consequences for the user
15-34 units a week for women
15-49 units a week
ICD-10 harmful drinking description/criteria
A pattern of alcohol drinking that is causing mental or physical damage
35 or more units a week for women
50 or more units a week for men
ICD-10 alcohol dependence description
A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and find difficulties in controlling its use
DSM-V combined name for alcohol abuse and alcohol dependence
Alcohol use disorder (mild, moderate and severe)
ADHD criteria
Triad of inattention, hyperactivity and impulsivity
Frequently co-occuring with impairing symptoms relating to self regulation e.g. executive function, emotional regulation
Need to be:
Developmentally inappropriate
Impairing functioning
Pervasive across settings
Longstanding from age of 5
ADHD children diagnostic criteria
6 or more symptoms of inattentiveness and/or 6 or more symptoms of hyperactivity and impulsiveness
Triad of impairments and one extra feature in ASD
Social communication
Social interaction
Social imagination
Repetitive behaviours (not essential but very common)
Mild cognitive impairment features and test scores
Noticeable cognitive impairment with little deterioration of function
ACE - 75-90, MOCA - 24-26 (not absolute)
Vascular dementia common presenting symptoms
Dysphasia Dyscalculia Frontal lobe and affective symptoms May have: focal neurological signs vascular risk factors step wise decline
