Psychiatric conditions - Diagnostic criteria

Question 1

Period of depressed mood or decreased interest in activities. Occurs most of the day, nearly every day for a period of > 2 weeks.

SIGNIFICANTLY AFFECTS THE INDIVIDUAL’S ABILITY TO FUNCTION.

Can be accompanied by other sx such as reduced energy, difficulty concentrating, feelings of worthlessness, excessive or inappropriate guilt, hopelessness, recurrent thoughts of death/suicide, changes in appetite or sleep, psychomotor agitation or retardation

Answer 1

Clinical features of a depressive episode

Question 2

Early morning waking (>2 hours before person’s usual time)

Depressive sx worse in morning (diurnal variation of mood)

Loss of libido

Loss of emotional reactivity

Answer 2

Other important depressive symptoms

Question 3

Marked sx of anxiety manifested by either general apprehensiveness “free floating anxiety” OR excessive worry about negative events in several aspects of life.

Accompanied by additional characteristic sx: Muscle tension/motor restlessness, sympathetic autonomic over activity, subjective experience of nervousness, being ‘on edge,’ poor concentration, irritability, sleep disturbance.

Symptoms are persistent for several months, more days than not

Sx result in significant distress or significant impairment in functioning

Answer 3

Generalised anxiety disorder, ICD-11

Question 4

Presence of persistent obsessions and/or compulsions

Obsessions or compulsions are time consuming (>1 hour/day) or result in significant distress or impairment

The sx or behaviors are not a manifestation of another medical condition/substance

Answer 4

ICD-11 diagnostic criteria for OCD (essential features)

Question 5

Course features:
Typical age of onset in the late teens and early 20’s
Younger age of onset is associated with greater genetic loading and poorer outcomes d/t interference of sx with achieving developmental milestones
Sx are often gradual
30-50% report a childhood onset of sx
Generally considered a chronic condition
Up to 30% with this condition will also experience Tourette Syndrome or another primary tic disorder during their lifetime

Answer 5

Course features of OCD

Question 6

Exposure to event/situation (short or long-lasting) or an extremely threatening or horrific nature.
Development of response is considered normal given stressor severity.
Transient emotional, somatic, cognitive or behavioural sx (daze/confusion, affective sx- anxiety, anger, sadness, despair. Overactivity/inactivity/restlessness, social withdrawal, amnesia of event, depersonalisation/derealisation, autonomic signs of anxiety)

Sx appear within hours to days after event. Usually subside within a few days (SX FOR LESS THAN ONE MONTH)
If stressor is ongoing/removal not possible- sx may persist but usually greatly reduced within 1 month

Answer 6

Acute stress reaction ICD-11

Question 7

Other criteria:
Onset: must be at least 1 month post event. Event must be extremely threatening or horrific. Onset within 3 months. Presentation may be late.

Other sx: Dissociation, somatic complaints, low mood, panic attacks, sleep disturbance, suicidal ideas

Emotions: Anger, guilt, shame, sadness, humiliation

Answer 7

PTSD

Question 8

Re-experiencing: Flashbacks, nightmare, intrusive images and memories

Avoidance: Avoidance of reminders of trauma external. Avoidance of thoughts and memories of trauma

Sense of chronic threat: hypervigilance, enhanced startle reaction

Answer 8

PTSD

Question 9

At least two of the following sx must be present most of the time for a period of ONE MONTH or more (and at least one fo the qualifying sx should be from items a-d)
a. Persistent delusions
b. Persistent hallucinations
c. Disorganised thinking (formal thought disorder)
d. Experiences of influence, passivity, or control
e. Negative sx such as affective flattening, alogia, anhedonia
f. Grossly disorganised behaviour that impedes goal-directed activity (behaviour that appears bizarre or purposeless, unpredictable)
g. Psychomotor disturbances such as catatonic restlessness or agitation, posturing, mutism, stupor

Answer 9

Schizophrenia

Question 10

The experience that one’s feelings, impulses, actions or thoughts are not generated by oneself- are being placed in one’s mind or withdrawn from one’s mind by others, or that one’s thoughts are being broadcast to others

Answer 10

Experiences of influence, passivity, or control

Question 11

An abnormal reaction to sudden stressful events. Sx are more severe and last for a longer period than in a normal stress reaction- UP TO FOUR WEEKS.

Answer 11

Acute stress reaction

Question 12

A condition where the person is inappropriately anxious in the presence of a particular object or situation, or when anticipating this encounter, and has the urge to avoid the object or situation

Answer 12

Phobia

Question 13

A persistent pattern (at least 6 months) of INATTENTION and/or HYPERACTIVITY-IMPULSIVITY that has a direct negative impact on academic, occupational or social functioning.

The onset of these symptoms occurs prior to age 12 years, typically by early- to mid-childhood. The degree of inattention and hyperactivity-impulsivity is also outside the limits of normal variation expected for age and level of intellectual functioning, and has a direct negative impact on academic, occupational, or social functioning

Answer 13

ADHD, ICD-11

Question 14

Key features of autism:
___________ _____________ and communication impairment

restricted, ___________ activities and interests

Answer 14

social interaction and communication impairment
restricted repetitive activities and interests

Question 15

What are the three key features of ADHD?

Answer 15

Hyperactivity
Impulsivity
Inattention

Question 16

This disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities.

Answer 16

Autism spectrum disorder, ICD-11

Question 17

Persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the expected range of typical functioning given the individual’s age and level of intellectual development. Specific manifestations of these deficits vary according to chronological age, verbal and intellectual ability, and disorder severity. Manifestations may include limitations in the following:
Understanding of, interest in, or inappropriate responses to the verbal or non-verbal social communications of others.
Integration of spoken language with typical complimentary non-verbal cues, such as eye contact, gestures, facial expressions and body language. These non-verbal behaviours may also be reduced in frequency or intensity.
Understanding and use of language in social contexts and ability to initiate and sustain reciprocal social conversations.
Social awareness, leading to behaviour that is not appropriately modulated according to the social context.
Ability to imagine and respond to the feelings, emotional states, and attitudes of others.
Mutual sharing of interests.
Ability to make and sustain typical peer relationships

Answer 17

Autism spectrum disorder, ICD-11

Question 18

Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. These may include:
Lack of adaptability to new experiences and circumstances, with associated distress, that can be evoked by trivial changes to a familiar environment or in response to unanticipated events.
Inflexible adherence to particular routines; for example, these may be geographic such as following familiar routes, or may require precise timing such as mealtimes or transport.
Excessive adherence to rules (e.g., when playing games).
Excessive and persistent ritualized patterns of behaviour (e.g., preoccupation with lining up or sorting objects in a particular way) that serve no apparent external purpose.
Repetitive and stereotyped motor movements, such as whole body movements (e.g., rocking), atypical gait (e.g., walking on tiptoes), unusual hand or finger movements and posturing. These behaviours are particularly common during early childhood.
Persistent preoccupation with one or more special interests, parts of objects, or specific types of stimuli (including media) or an unusually strong attachment to particular objects (excluding typical comforters).
Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus, which may include actual or anticipated sounds, light, textures (especially clothing and food), odors and tastes, heat, cold, or pain.

Answer 18

Autism spectrum disorder, ICD-11

Question 19

Key features of this condition include social interaction and communication impairment, restricted repetitive activities and interests

Answer 19

Autism spectrum disorder

Question 20

Which genetic disorders are associated with autism spectrum disorder?

Answer 20

Down’s syndrome (Trisomy 21)
Prader-Willi syndrome

Question 21

A disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains (global delay)

Answer 21

Learning disability

Question 22

Essential features:
Maladaptive reaction to identifiable psychosocial stressor or multiple stressors, usually emerges within a month of stressor.

Reaction characterised by preoccupation with stressor or consequences eg excessive worry, recurrent and distressing thoughts about stressor or constant ruminations about its implications.

Failure to adapt results in significant impairment of personal/family/social/educational/occupational functioning

Answer 22

Adjustment disorder

ICD-11 diagnostic criteria

Question 23

This is an episodic mood disorder defined by the occurrence of one or more manic or mixed episodes. A manic episode is an extreme mood state lasting at least one week unless shortened by a treatment intervention characterised by euphoria, irritability, or expansiveness, and by increased activity or a subjective experience of increased energy, accompanied by other characteristic symptoms such as rapid or pressured speech, flight of ideas, increased self-esteem or grandiosity, decreased need for sleep, distractibility, impulsive or reckless behaviour, and rapid changes among different mood states (i.e., mood lability). A mixed episode is characterised by the presence of several prominent manic and several prominent depressive symptoms consistent with those observed in manic episodes and depressive episodes, which either occur simultaneously or alternate very rapidly (from day to day or within the same day). Symptoms must include an altered mood state consistent with a manic and/or depressive episode (i.e., depressed, dysphoric, euphoric or expansive mood), and be present most of the day, nearly every day, during a period of at least 2 weeks, unless shortened by a treatment intervention. Although the diagnosis can be made based on evidence of a single manic or mixed episode, typically manic or mixed episodes alternate with depressive episodes over the course of the disorder.

Answer 23

Bipolar type I disorder

Question 24

This is an episodic mood disorder defined by the occurrence of one or more hypomanic episodes and at least one depressive episode. A hypomanic episode is a persistent mood state lasting for at least several days characterised by persistent elevation of mood or increased irritability as well as increased activity or a subjective experience of increased energy, accompanied by other characteristic symptoms such as increased talkativeness, rapid or racing thoughts, increased self-esteem, decreased need for sleep, distractability, and impulsive or reckless behavior. The symptoms represent a change from the individual’s typical mood, energy level, and behavior but are not severe enough to cause marked impairment in functioning. A depressive episode is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as changes in appetite or sleep, psychomotor agitation or retardation, fatigue, feelings of worthless or excessive or inappropriate guilt, feelings or hopelessness, difficulty concentrating, and suicidality. There is no history of manic or mixed episodes.

Answer 24

Bipolar type II disorder

Question 25

Dementia due to ______________ is the most common form of dementia. Onset is insidious with memory impairment typically reported as the initial presenting complaint. The characteristic course is a slow but steady decline from a previous level of cognitive functioning with impairment in additional cognitive domains (such as executive functions, attention, language, social cognition and judgment, psychomotor speed, visuoperceptual or visuospatial abilities) emerging with disease progression. This type of dementia may be accompanied by mental and behavioural symptoms such as depressed mood and apathy in the initial stages of the disease and may be accompanied by psychotic symptoms, irritability, aggression, confusion, abnormalities of gait and mobility, and seizures at later stages. Positive genetic testing, family history and gradual cognitive decline are suggestive of this type of dementia.

Answer 25

Alzheimer disease

Question 26

Dementia due to brain parenchyma injury resulting from cerebrovascular disease (ischemic or haemorrhagic). The onset of the cognitive deficits is temporally related to one or more vascular events. Cognitive decline is typically most prominent in speed of information processing, complex attention, and frontal-executive functioning. There is evidence of the presence of cerebrovascular disease considered to be sufficient to account for the neurocognitive deficits from history, physical examination and neuroimaging.

Answer 26

Dementia due to cerebrovascular disease

Question 27

Dementia preceding or occurring within one year after the onset of motor parkinsonian signs in the setting of _______ ________ disease. Characterized by presence of ____ bodies, which are intraneuronal inclusions containing α-synuclein and ubiquitin in the brain stem, limbic area, forebrain, and neocortex. Onset is insidious with attentional and executive functioning deficits often present. These cognitive deficits are often accompanied by visual hallucinations and symptoms of REM sleep behaviour disorder. Hallucinations in other sensory modalities, depressive symptoms, and delusions may also be present. The symptom presentation usually varies significantly over the course of days necessitating longitudinal assessment and differentiation from delirium. Spontaneous onset of Parkinsonism within approximately 1 year of the onset of cognitive symptoms is common.

Answer 27

Lewy body dementia

Question 28

This is a group of primary neurodegenerative disorders primarily affecting the frontal and temporal lobes. Onset is typically insidious with a gradual and worsening course. Several syndromic variants (some with an identified genetic basis or familiality) are described that include presentations with predominantly marked personality and behavioral changes (such as executive dysfunction, apathy, deterioration of social cognition, repetitive behaviours, and dietary changes),predominantly language deficits (that include semantic, agrammatic/nonfluent, and logopenic forms), predominantly movement-related deficits (progressive supranuclear palsy, corticobasal degeneration, multiple systems atrophy, or amyotrophic lateral sclerosis), or a combination of these deficits. Memory function, often remains relatively intact, particularly during the early stages of the disorder.

Answer 28

Frontotemporal dementia (FTD)

Question 29

Gradual decline in global cognition and day to day ability.
** Memory for recent conversations and events most prominent symptom

Answer 29

Alzheimer’s disease

Question 30

Characterised by fluctuations in cognition and alertness
Visual hallucinations
Movement sx of Parkinson’s dz
Vivid dreams/moving in sleep
Falls
Sx of anxiety/depression

Answer 30

Dementia with Lewy bodies

Question 31

Characterised by a history of stroke
History of vascular risk factors
Patch cognitive impairment (some areas of cognition preserved in unusual pattern)
“Stepwise decline” often quoted but less often seen

Answer 31

Vascular dementia

Question 32

Characterised by disinhibition, impulsivity, loss of empathy, change in food preferences (often sweet foods), change in eating habits, lack of insight, and language sx

Answer 32

Frontotemporal dementia

Question 33

This disorder is characterised by significantly low body weight for the individual’s height, age and developmental stage that is not due to another health condition or to the unavailability of food. A commonly used threshold is body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under 5th percentile in children and adolescents. Rapid weight loss (e.g. more than 20% of total body weight within 6 months) may replace the low body weight guideline as long as other diagnostic requirements are met. Children and adolescents may exhibit failure to gain weight as expected based on the individual developmental trajectory rather than weight loss. Low body weight is accompanied by a persistent pattern of behaviours to prevent restoration of normal weight, which may include behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at increasing energy expenditure (e.g. excessive exercise), typically associated with a fear of weight gain. Low body weight or shape is central to the person’s self-evaluation or is inaccurately perceived to be normal or even excessive.

Answer 33

Anorexia nervosa

Question 34

This disorder is characterised by frequent, recurrent episodes of binge eating (e.g. once a week or more over a period of at least one month). A binge eating episode is a distinct period of time during which the individual experiences a subjective loss of control over eating, eating notably more or differently than usual, and feels unable to stop eating or limit the type or amount of food eaten. Binge eating is accompanied by repeated inappropriate compensatory behaviours aimed at preventing weight gain (e.g. self-induced vomiting, misuse of laxatives or enemas, strenuous exercise). The individual is preoccupied with body shape or weight, which strongly influences self-evaluation. There is marked distress about the pattern of binge eating and inappropriate compensatory behaviour or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The individual does not meet the diagnostic requirements of Anorexia Nervosa.

Answer 34

Bulimia nervosa

Question 35

This disorder is characterised by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganisation in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one’s feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g., behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere with the organisation of behaviour). Psychomotor disturbances, including catatonia, may be present.
PERSISTENT DELUSIONS
PERSISTENT HALLUCINATIONS
THOUGHT DISORDER
EXPERIENCES OF INFLUENCE, PASSIVITY, OR CONTROL are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis to be assigned.

Answer 35

Schizophrenia

Question 36

Disorders due to substance use include disorders that result from a single occasion or repeated use of substances that have psychoactive properties, including certain medications. Disorders related to fourteen classes or groups of psychoactive substances are included. Typically, initial use of these substances produces pleasant or appealing psychoactive effects that are rewarding and reinforcing with repeated use. With continued use, many of the included substances have the capacity to produce dependence. They also have the potential to cause numerous forms of harm, both to mental and physical health. Disorders due to harmful non-medical use of non-psychoactive substances are also included in this grouping.

Answer 36

Substance use disorder

Question 37

This is an acute neuropsychiatric syndrome characterised by nystagmus, ophthalmoplegia, changes in the mental status, an uncoordinated gait and truncal ataxia. Wernicke’s encephalopathy is usually accompanied or followed by Korsakoff’s syndrome/Korsakoff’s dementia (a continuum of Wernicke’s encephalopathy characterised by severe memory defects, ataxia, apathy, disorientation, confabulations, hallucinations, paralysis of muscles controlling the eye and coma). The disorder results from a deficiency in vitamin B1, and mostly occurs in adults with a history of alcohol abuse or in patients with AIDS.

Answer 37

Wernicke’s encephalopathy

Question 38

This condition is generally defined as the tendency to experience psychological distress in the form of somatic symptoms and to seek medical help for these symptoms, which may be initiated and/or perpetuated by emotional responses such as anxiety and depression

Answer 38

Somatisation

Question 39

4 key symptoms/signs associated with Wernicke’s encephalopathy?

Answer 39

Confusion
Ataxia
Opthalmoplegia
Nystagmus

Question 40

Wernicke’s encephalopathy is due to a deficiency of which vitamin?

Answer 40

B1 (thiamine)

Question 41

Symptoms include
- clouding of consciousness
- perceptual abnormalities
- severe tremor
- paranoia (“impending doom”)
- agitation
- autonomic instability

Answer 41

Delirium tremens

Question 42

How many days after cessation of alcohol intake does delirium tremens tend to occur?

Answer 42

three days
(Peak incidence of DT’s occurs between 48-72 hours post last drink)

Question 43

Downregulation of _____ receptors in long term alcohol intake leads to symptoms of tremor, sweating, anxiety, tachycardia, insomnia, and n/v in times of withdrawl

Answer 43

GABA a

Question 44

Muscle aches, lacrimation, anxiety, diarrhoea, rhinorrhoea, tachycardia, goosebumps, sweating, and yawning are withdrawl symptoms of which class of substances?

Answer 44

Opiods

Question 45

Alcohol misuse, ICD-11
The features of dependence are usually evident over a period of at least 12 months, but the diagnosis may be made if use is CONTINUOUS (daily or almost daily) for at least ____ months

Answer 45

3

Question 46

A pattern of recurrent episodic or continuous use of alcohol with evidence of impaired regulation of alcohol use that is manifested by 2 or more of the following:
- Impaired control over etoh use (onset, frequency, intensity, duration, termination, context)
- Increasing precedence of etoh use over other aspects of life (including maintenance of health, and daily activities and responsibilities despite the occurence of harm or negative consequences)
- Physiologiical features indicative of neuroadaptation to alcohol

Answer 46

Alcohol misuse ICD-11

Question 47

1) Tolerance to the effects of etoh or a need to use increasing amounts of alcohol to achieve the same effect
2) Withdrawl sx following cessation or reduction in use of alcohol
3) Repeated use of etoh or pharmacologically similar substances to prevent or alleviate withdrawl sx

Answer 47

Physiological features indicative of neuroadaptation to alcohol

Question 48

What is the drug of choice for uncomplicated alcohol detoxification (to prevent delirium tremens and seizures)?

Answer 48

Chlordiazepoxide

Question 49

Treatment for Wernicke’s encephalopathy?

Answer 49

High dose parenteral thiamine (IM/IV Pabrinex)

Question 50

Alcohol withdrawl seizures typically occur how many hours after the last “binge?”

Answer 50

12-48 hours