Psychiatry Flashcards
What are the core symptoms of depressive disorder?
- Anhedonia- Lack of interests in things which were previously enjoyable to the patient
- Low Mood- Present for ≥2 wks
- Lack of Energy - AKA anergia
What are the cognitive symptoms of depressive disorder?
- Lack of Concentration - ↓ Ability to think / concentrate
(Nearly everyday) - Negative Thoughts
Beck’s cognitive triad:
i. Negative views about oneself (Feels worthless)
ii. Negative views of the world (Unfair world)
iii. Negative views of the future (Hopeless future) - Excessive Guilt - Feeling of worthlessness / excessive or inappropriate guilt (Nearly everyday)
- Suicidal Ideation
Recurrent:
i. Thoughts of death
ii. Suicidal ideation without a specific plan
What are the biological symptoms of depressive disorder?
- Diurnal Variation in Mood (DVM) - Low mood more pronounced during certain times of the day (Usually morning)
- Early Morning Wakening (EMW)- Wakening up to 2 hrs earlier than usual
* May have hypersomnia (Excessive sleep) in atypical depression - Loss of Libido - ↓ Sexual drive
- Psychomotor Retardation - Slow speech + Slow movement
- Weight Loss & Loss of Appetite-
i. Sig. weight lost (When not dieting)
/↓ Appetite nearly everydayii. In atypical depression; may have:
↑ Weight
↑ Appetite
What are the psychotic symptoms of depressive disorder?
- Hallucinations - Usually second person auditory hallucinations
2. Delusions - Usually: o Hypochondrical o Guilt o Nihilistic o Persecutory
What is the criteria to fulfil for positive diagnosis fo depressive disorder?
- Present for ≥2 wks and represent a change from normal
2. NOT secondary to: Effects of drug / alcohol misuse Medication Medical disorder Bereavement
- Significant distress and/or impairment of social, occupational or general functioning
What is the ICD-10 classification of depression?
Mild depression = 2 core symptoms + 2 other symptoms
Moderate depression = 2 core symptoms + 3–4 other symptoms
Severe depression = 3 core symptoms + ≥4 other symptoms
Severe depression with psychosis = 3 core symptoms + ≥4 other symptoms + psychosis
What is recurrent depressive disorder?
A recurrent depressive episode = When a patient has another depressive episode after their first
What is seasonal affective disorder?
Characterized by depressive episodes recurring annually at the same time each year:
o Usually during the winter months!!!
What is masked depression?
• A state in which depressed mood NOT particularly prominent
• But other features are prominent; eg:
o Sleep disturbance
o DVM
What is dysthymia?
Depressive state for ≥2 yrs
+ BUT DOESN’T meet the criteria for:
Mild depressive disorder
/Moderate depressive disorder
/Severe depressive disorder
+ NOT the result of a partially treated depressive illness!!!
What is cyclothymia?
Chronic mood fluctuation over ≥2 yrs
With episodes of elation & depression
BUT these episodes DON’T fulfill criteria of hypomanic / depressive disorder
What are the differentials for depression?
- Other mood disorder - BPD
- secondary - Hypothyroidism , anaemia, diabetes (anergia)
- secondary to Substance abuse
- Secondary to psychiatric disorder
Recurrent depressive disorder
Masked depression
Dysthymia
What is the broad approach for the management of depressive disoder?
A bio-psychosocial approach
How is mild-moderate depression managed?
- Watchful waiting (reassess patient in 2wks)
- Self- help programs
- Computerised cognitive behavioural therapy (CBT)
- Physical activity programme
Antidepressants - not the 1st line for mild depression unless:
i. Depression has lasted a long time ii. Past Hx of moderate - severe depression iii. Failure of other interventions iv. Depression complicates care of other physical health problems
What are the circumstances where antidepressants are prescribed in mild-moderate depression?
Antidepressants - not the 1st line for mild depression unless:
i. Depression has lasted a long time typically at least 2 years ii. Past Hx of moderate - severe depression iii. Failure of other interventions iv. Depression complicates care of other physical health problems
How is moderate-severe depression managed?
• Suicide risk assessment (Performed on ALL patients)
• Psychiatry referral if: o High suicidal risk o /Severe depression o /Recurrent depression o /Unresponsive to initial Rx
• Antidepressants: o 1st line = SSRI (Eg: Citalopram) o Other choices include: TCAs SNRIs MAOIs (Only prescribed by specialist)
• Adjuvants; may be augmented with:
o Lithium
o /Antipsychotics
- Psychotherapy (CBT or IPT)
- Social support
- ECT
How long do antidepressants need to taken for depression?
1st episode - Continue for 6mths after resolution
2nd episode - Continue for 2 yrs after resolution
Have had multiple severe episodes - Long term
What are the indications for electro-convulsive therapy for depression?
o Acute Rx of severe depression which is life-threatening
o Rapid response required
o Depression + Psychotic features
o Severe psychomotor retardation / Stupor
o Failure of other Rx
What is Cotard syndrome and what is it usually associated with?
• Affected patients believe that they (/Some parts of their body) is dead / non-existent
Associated with -
• Severe depression
• Psychotic disorders
How is depression diagnosed?
Diagnostic questionnaires-
• PHQ-9
• HADS (Hospital Anxiety and Depression Scale)
• Beck’s depression inventory
What tests are required to rule out secondary causes of depression?
Blood tests: o FBC (Anaemia?) o TFTs (Hypothyroidism?) o U&Es (Biochemical abnormalities?) o LFTs (Biochemical abnormalities?) o Ca2+ (Biochemical abnormalities?) o Glucose (Diabetes? – Can cause anergia)
Imaging:
MRI/Ct scan required when -
1. Atypical presentation or examination
2. Features suggest intracranial lesion - unexplained headache, personality change
What are the diagnostic clinical features of mania and how is it diagnosed?
- Grandiosity (↑ Self-esteem)
- ↓ Sleep
- Pressure of speech
- Flight of ideas
- Distractibility
- Psychomotor agitation (Restlessness)
- Reckless behaviour (Eg: Spending sprees, reckless driving)
- Loss of social inhibitions (Hence inappropriate behaviour)
- ↑ Sexual energy
Mania / Hypomania requires presence of 3 out of 9 symptoms of above
What is the criteria for hypomania?
- Mildly elevated mood / irritable mood for ≥4 d
- Symptoms of mania (BUT < severe)
- NO severe disruption of work & social life:
But may have considerable disruption - Partial insight may be preserved
What is the criteria for mania without psychosis?
- Symptoms present for >1 wk
- Symptoms of mania (BUT > severe than hypomania)
- Complete disruption of work & social activities
- May have:
- Grandiose ideas (NOT delusion yet!)
- Excessive spending (Lead to debts)
- Sexual disinhibition
- ↓ Sleep (Exhaustion)
What is the criteria for mania with psychosis?
- Severely elevated / Suspicious mood
+ Psychotic features; eg:
o Grandiose delusion
o Persecutory delusion
o Auditory hallucinations (Mood congruent)
- May have signs of aggression
What is the criteria for diagnosing bipolar affective disorder?
To diagnose bipolar affective disorder:
≥2 Episodes of a person’s mood disorder (Depressive / Mania / Hypomania)
\+
One of the episode MUST be mania / Hypomania
What is Bipolar I ?
Involves periods of severe mood episode from mania to depression
Mania
+
Depression
What is Bipolar II ?
Milder form of mood elevation
Involves milder episodes of hypomania that alternate with periods of severe depression
Hypomania
+
Severe Depression
What is Rapid cycling?
> 4 mood swings in 12mth period (With NO intervening asymptomatic period)
Poor prognosis
What are the differentials for BPAD?
- Mood disorders: hypomania, mania, mixed episode, cyclothymia.
- Psychotic disorders: schizophrenia, schizoaffective disorder.
- Secondary to medical condition: hyper/hypothyroidism, Cushing’s disease, cerebral tumour (e.g. frontal lobe lesion with disinhibition), stroke.
- Drug related: illicit drug ingestion (e.g. amphetamines, cocaine), acute drug withdrawal, side effect of corticosteroid use.
- Personality disorders: histrionic, emotionally unstable
What are the tests done for Mania/BPAD?
• Self-rating scales (Eg: Mood Disorder Questionnaire)
Blood Tests
• FBC (Routine)
• TFTs:
o Hyper/hypothyroidism
• U&Es (Baseline renal Fx with view to starting Li)
• LFTs (Baseline hepatic Fx with view to starting mood stabilizers)
• Glucose
• Ca2+ (Biochemical disturbances can cause mood symptoms)
- Urine drug test (Illicit drugs can cause manic symptoms)
- CT Head (To rule out SOL that may cause manic symptoms eg: Disinhibitions)
What does the management of BPAD other than drugs and pshysocial mx involve?
• Full risk assessment:
Suicidal ideation
Risk to self (Eg: Financial ruin from overspending)
• Driving:
o DVLA has clear guideliens abt driving when manic / hypomanic / severely depressed
• Mental Health Act; needed if:
o Patient is violent
o /Pose a risk to self
• Hospitalization will be required if: o Reckless behaviour causing risk to patient or others o Sig. psychotic symptoms o Impaired judgement o Psychomotor agitation
What is the management of acute manic episode/ mixed episode
• Consider stopping Antidepressants + Offer antipsychotics
• 1st line = An antipsychotic; eg: o Olanzapine o Risperidone o Quetiapine (Haloperidol also effective)
Offer 2nd antipsychotic if the 1st one:
NOT effective
/Poorly tolerated
Antipsychotics have rapid onset of action (Compared to mood stabilizers): - So used in severe mania
• If 2nd antipsychotic doesn’t work: Add Mood stabilizer (2nd line): o Lithium (Preferred) o If Li not suitable = Valproate
• ECT (For severe mania that doesn’t respond to other Rx)
Benzodiazepines may be required to:
Aid sleep and ↓ Agitation
• Rapid transquilization may be required with:
o Haloperidol
+//Lorazepam
DONT OFFER LAMOTRIGINE!
When are lithium levels to be measured in BPAD pateints?
Sample should be taken 12hrs post dose, after that weekly for 4 weeks
once level established, lithium blood level should ‘normally’ be checked every 3 months
What are the features of psychosis?
Reality is distorted with:
- Delusions
- Hallucinations
- Thought disorder
What are the non-organic causes of psychosis?
- Schizophrenia
- Schizotypal disorder
- Schizoaffective disorder
- Acute psychotic episode
- Mood disorders with psychosis
- Drug-induced psychosis
- Delusional disorder
- Induced delusional disorder
- Puerperal psychosis
What are the non-organic causes of psychosis?
- Drug-induced psychosis -Alcohol, cocaine, amphetamine, methamphetamine, MDMA, mephedrone, cannabis, LSD, psilocybins (e.g. magic mushrooms), ketamine
- Iatrogenic (medication) -levodopa, methyldopa, steroids, antimalarials.
- Complex partial epilepsy
- Delirium
- Dementia
- Huntington’s disease
- Systemic lupus erythematosus
- Syphilis
- Endocrine disturbance, e.g. Cushing’s syndrome Metabolic disorders including vitamin B12 deficiency and porphyria
What is the most common type of schizophrenia?
Paranoid schizophrenia
What are the 5 positive symptoms (the acute syndrome) of schizophrenia?
- Delusions - persecutory, grandiose, nihilistic, reference, or religious
- Hallucination - Third person running commentary
- Formal thought disorder
- Thought interference - thought insertion, withdrawal and broadcast
- Passivity phenomenon - action and feeling influenced by external force
Mnemonic: Delusions Held Firmly Think Psychosis
What are Schnieder’s first rank symptoms of schizophrenia?
- Delusional perception - A new delusion that forms in response to a real perception without any logical sense, e.g. ‘the traffic light turned red so I am the chosen one.’
- Third person auditory hallucinations: usually a running commentary.
- Thought interference - thought insertion, withdrawal and broadcast
- Passivity phenomenon
If one or more are present, are strongly suggestive of schizophrenia
What are the negative symptoms (the chronic syndrome) of schizophrenia?
- Avolition (↓ motivation): Reduced ability (or inability) to initiate and persist in goal-directed behaviour.
- Asocial behaviour: Loss of drive for any social engagements.
- Anhedonia: Lack of pleasure in activities that were previously enjoyable to the patient.
- Alogia (poverty of speech): A quantitative and qualitative decrease in speech.
- Affect blunted: Diminished or absent capacity to express feelings.
- Attention (cognitive) deficits: May experience problems with attention, language, memory
How is schizophrenia diagnosed according to ICD10?
Group A:
A. Thought echo/insertion/withdrawal/ broadcast.
B. Delusions of control, influence or passivity phenomenon.
C. Running commentary auditory hallucinations.
D. Bizarre persistent delusions.
Group B:
E. Hallucinations in other modalities that are persistent.
F. Thought disorganization (loosening of associations, neologisms, incoherence).
G. Catatonic symptoms.
H. Negative symptoms.
At least one very clear symptom from Group A (A–D) or two or more from Group B (E–H) for at least 1 month or more
What are the investigations to perform for schizophrenia?
Blood tests:
- FBC (anaemia, infection)
- TFTs (thyroid dysfunction can present with psychosis)
- Glucose or HbA1c (as atypical antipsychotics can cause metabolic syndrome)
- Serum calcium (hypercalcaemia can present with psychosis)
- U&Es and LFTs (assess renal and liver function before giving antipsychotics)
- Cholesterol (as atypical antipsychotics cause metabolic syndrome)
- Vitamin B12 and folate (deficiencies can cause psychosis).
Urine drug test: Illicit drugs can cause and exacerbate psychosis
ECG: Antipsychotics cause prolonged QT interval
CT scan: To rule out organic causes such as space-occupying lesions
EEG: To rule out temporal lobe epilepsy as possible cause of psychosis
How is schizophrenia managed biologically ?
1st line : Second generation/ atypical antipsychotics - Risperidone or Olanzapine
Interchange drug if not tolerated or effective after 2-3 weeks of assessing
2nd line : If not effective - Clozapine - treatment resistant schizo
Compliance issues - use depot formulations (1st or 2nd line)
Adjuvants:
1. Benzodiazepines can provide short-term relief of behavioural disturbance, insomnia, aggression and agitation.
- Antidepressants and lithium can be used to augment antipsychotics.
ECT - patients who are resistant to pharmacological agents. Effective for catatonic schizophrenia.
How is schizophrenia managed phycologically and socially ?
Psychologically:
- CBT
- Family intervention - to reduce high levels of expressed emotions
- Art therapy
- Social skill training
Socially:
- National support groups - Rethink and SANE - rehabilitation back into the community.
- Peer support - peer support worker -recovered from psychosis or schizo
- Supported employment programmes
What is schizotypal disorder?
Also known as latent schizophrenia
it is characterized by eccentric behaviour, suspiciousness, unusual speech and deviations of thinking and affect that is similar to those suffering from schizophrenia.
These individuals however, do not suffer from hallucinations or delusions.
There is an increased risk of schizotypal disorder in those who have first-degree relatives with schizophrenia.
What is acute and transient psychotic disorders?
A psychotic episode presenting very similarly to schizophrenia but lasting <1 month and so not meeting the criteria for schizophrenia.
What is schizoaffective disorder?
- Characterized by both symptoms of schizophrenia and a mood disorder (depression or mania) in the same episode of illness
- The mood symptoms should meet the criteria for either a depressive illness or a manic episode together with one or two typical symptoms of schizophrenia.
Schizophrenia + depression/mania
What is persistent delusional disorder?
The development of a single or set of delusions for a period of
at least 3 months in which the delusion is the only, or the most prominent, symptom with other areas of thinking and functioning well preserved, unlike in schizophrenia
The content of the delusion is often persecutory, grandiose or hypochondriacal in nature. The onset and content of the delusion is often related to the patient’s life situation.
Symptoms often respond well to antipsychotics.
How do you manage an acute case of schizophrenia?
Non-pharmacological de-escalation therapy
IM/Oral lorazapam
What is the diagnostic criteria for general anxiety disorder?
A. A period of atleast 6mths with prominent tension, worry and feelings of apprehension about everyday events and problems
B. Atleast four of the following symptoms with at aleast one symptoms of autonomic arousal: palpitation, sweating, shaking/tremor, dry mouth
Other symptoms: tension in muscles, tremors, concentration difficulty, headache, energy loss, restlessness, startled easily, sleep disturbances
What is the management of general anxiety disorder involve?
NICE suggest a step-wise approach:
step 1: education about GAD + active monitoring
step 2: low intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment.
step 4: highly specialist input e.g. Multi agency teams
Which step is drug intervention used in general anxiety disorder and what drugs are used?
Step 3: high intensity psychological interventions (CBT/ applied relaxation) or drug treatment
1st line - SSRI (sertaline)
2nd line - SNRI (venflexine or duloxetine) - if sertaline ineffective
3rd line - Pregabalin - if SSRI or SNRI are ineffective or not tolerated
What are the questionnaries used for GAD?
GAD-2, GAD7, Beck’s anxiety inventory, hospital anxiety and depression scale
What is agoraphobia?
A fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack.
What is the diagnostic criteria for agoraphobia?
A. Marked and consistently manifest fear in, or avoidance of, at least two of the following:
- Crowds
- Public spaces
- Travelling alone
- Travelling away from home
B. Symptoms of anxiety in the feared situation with at least two symptoms present together (and at least one symptom of autonomic arousal).
C. Significant emotional distress due to the avoidance, or anxiety symptoms. Recognized as excessive or unreasonable.
D. Symptoms restricted to (or predominate in) feared situation.
What is the diagnostic criteria for social phobia?
A. Marked fear (or marked avoidance) of being the focus of attention, or fear of acting in a way that will be embarrassing or humiliating.
B. At least two symptoms of anxiety in the feared situation plus one of the following: 1. Blushing 2. Fear of vomiting 3. Urgency or fear of micturition/defecation
C. Significant emotional distress due to the avoidance or anxiety symptoms.
D. Recognized as excessive or unreasonable.
E. Symptoms restricted to (or predominate in) feared situation.
What is the diagnostic criteria for specific phobia?
A. Marked fear (or avoidance) of a specific object or situation that is not agoraphobia or social phobia.
B. Symptoms of anxiety in the feared situation
C. Significant emotional distress due to the avoidance or anxiety symptoms. Recognised as excessive or unreasonable
D. Symptoms restricted to the feared situation.
What is the management of agoraphobia?
- CBT - graduated exposure and desensitization. Graduated exposure techniques such as walking increased distances from home day by day
- SSRIs are the first-line .
What is the management of social phobia?
CBT (individual or group) specifically designed for social phobia - graduated exposure to feared situations
Pharmacological interventions - SSRIs (escitalopram, sertaline), SNRIs (venlafaxine) or MAOI (moclobemide)
Psychodynamic psychotherapy - for those who decline CBT or medication
What is the management of specific phobia?
- The mainstay of treatment is exposure either using self-help methods or more formally through CBT.
- Benzodiazepines may be used as anxiolytics in the short term (due to risk of dependence) for instance if a patient needs an urgent CT scan and they are claustrophobic.
What are the causes of panic disorder?
Mostly inherited
Neurochemical - post synaptic hypersensitivity to serotonin and adrenaline
Sympathetic nervous system (SNS) - fear or worry stimulates the SNS –> increased cardiac output which can lead to further anxiety
What questionnaires are used for phobic anxiety disorder?
Social Phobia Inventory and Liebowitz Social Anxiety Scale.
What is the important clinical feature of panic disorder and what is the diagnostic criteria?
Panic symptoms usually peak within 10 minutes and rarely persist beyond an hour
Diagnostic criteria:
A. Recurrent panic attacks that are not consistently associated with a specific situation or object and often occur spontaneously.
B. Characterised by:
1. Discrete episode of intense fear or discomfort
2. Starts abruptly
3. Reaches a cresendo within a few minutes and atleast some minutes
4. At least one symptoms of autonomic arousal
5. Other symptoms of GAD
What are the differentials for panic disorder?
- Psychiatry - other anxiety disorders - GAD, phobic anxiety disorder, dissociative disorder, BPAD, depression, schizophrenia
- Organic - pheochromocytoma, hyperthyroidism, hypoglycaemia, carcinoid syndorme, alcohol/substance withdrawal
What is the management of panic disorder?
step 1: recognition and diagnosis
step 2: treatment in primary care - CBT and SSRI, then TCA
step 3: review and consideration of alternative treatments
step 4: review and referral to specialist mental health services
step 5: care in specialist mental health services
What are the drugs used in the management of panic disorder?
SSRIs are first-line but if they are not suitable, or there is no improvement after 12 weeks
TCA, e.g. imipramine or clomipramine - need to be considered
* Benzodiazepines should not be prescribed!
What is PTSD? What are the causes or situations that can lead to it?
Post-traumatic stress disorder (PTSD): Is an intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event.
Genetic vulnerability has been suggested.
traumatic events - Severe assault Major natural disaster Observer/survivor of civilian disaster Involvement in wars Freak
What is abnormal bereavement
Loss of a loved one
Delayed onset, is more intense and prolonged (>6 mths). the impact of their loss overwhelms the individual’s coping capacity
What is acute stress reaction ?
Exposure to an exceptional physical or mental stressor - phsycial assault or RTA
followed by an immediate onset of symptoms - within an hour
Symptoms - anxiety symptoms, narrowing of attention, apparent disorientation, anger or verbal aggression, despair or hopelessness, uncontrollable or excessive grief.
Symptoms begin to diminish within 8hrs or 48hrs
What is adjustment disorder?
Identifiable (non-catastrophic) psychosocial stressor (e.g. redundancy, divorce) within one month of onset of symptoms.
The symptoms must be present for less than 6 months.
What is the clinical features of PTSD?
PTSD symptoms must occur within 6 months of the event and can be divided into four categories:
- Reliving the situation - Persistent, intrusive, involuntary - flashbacks, vivid memories, nightmares, distress when exposed to similar circumstances as the stressors
- Avoidance - Avoiding reminders of trauma - excessive rumination about the trauma, inability to recall aspects of the trauma
- Hyperarousal - irritability or outbursts, difficulty with concentration, sleep, hyper vigilance, exaggerated startle response
- Emotional numbing - negative thoughts about oneself, difficulty experiencing emotions
What is the diagnostic criteria for PTSD?
A. Exposure to a stressful event or situation of extremely threatening or catastrophic nature (would likely cause distress in almost anyone).
B. Persistent remembering (‘reliving’) of the stressful situation.
C. Actual or preferred avoidance of similar situations resembling or associated with the stressor.
D. Either (1) or (2)
- Inability to recall some important aspects of the period of exposure to the stressor.
- Persistent symptoms of increased psychological sensitivity and arousal.
E. Criteria B, C & D all occur within 6 months of the stressful event, or the end of a period of stress.
What are the questionnaries used for PTSD?
Trauma Screening Questionnaire
(TSQ), Post-traumatic diagnostic scale.
How is PTSD within 3mths of trauma managed?
- Watchful waiting may be used for mild symptoms lasting <4 weeks.
- Military personnel have access to treatment provided by the armed forces.
- Trauma-focused CBT should be given at least once a week for 8–12 sessions.
- Short-term drug treatment may be considered in the acute phase for management of sleep disturbance (e.g. zopiclone - GABA agonist).
- Risk assessment is important to assess risk for neglect or suicide.
How is PTSD after 3mths of trauma managed?
Course on trauma-focused psychological intervention
Psychological interventions - CBT and eye movement desensitisation and reprocessing (EMDR)
Drug treatment - 1. little benefit from psychological therapy, 2. patient preference not to engage in psychological therapy 3. Co-morbid depression or severe hyperarousal
Paroxetine, mirtazapine, amitriptyline and phenelzine - Paroxetine is the weakest
What are obsessions?
Unwanted intrusive thoughts, images or urges that repeatedly enter the individual’s mind. They are distressing for the individual who attempts to resist them and recognizes them as absurd (egodystonic) and a product of their own mind.
What are compulsions?
Repetitive, stereotyped behaviours or mental acts that a person feels driven into performing. They are overt (observable by others) or covert (mental acts not observable).
What the causes of OCD?
- Biological - reduced serotonin in the frontal cortex and basal ganglia.
- Genetic contribution - paediatric onset
- Childhood group A beta-haemolytic streptococcal infection - role in causing OCD symptoms
- Psychoanalytic - filling the mind with obsessional thoughts in order to prevent undesirable ideas from entering consciousness
- Behavioural - compulsive behaviour is learned and maintained by operant conditioning.
Strong association with - depression, schizophrenia, syndenham’s chorea, Tourette’s syndrome and anorexia nervosa
What is the criteria for the diagnosis of OCD?
A. Either obsessions or compulsions (or both) present on most days for a period of at least 2 weeks.
B. Obsessions (thoughts, ideas or images) or compulsions (acts) share a number of features
ALL of which must be present: (FORD Car)
1. Failure to resist - at least one obsession or compulsion is present which is unsucessfully resisted
2. Originate from the patient's mind - acknowledges that the obsessions are all from their own mind and not imposed by outside persons or influences
3. Repetitive and Distressing - at least one obsession or compulsion must be preset which is acknowledged by the patient as excessive or unreasonable
4. Carrying out the obsessive thoughts/act is not in itself pleasurable but reduces anxiety levels
C. The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.
NOTE: The diagnosis can be specified as ‘predominantly obsessional thoughts or ruminations’, ‘predominantly compulsive acts’, or ‘mixed obsessional thoughts and acts’.
