Psychiatry Flashcards
What are the diagnostic criteria for Avoidant Restrictive Food Intake Disorder (ARFID)?
- An eating or feeding disturbance manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
1. Significant weight loss or faltering growth
2. Significant nutritional deficiency
3. Dependence on enteral feeding or oral nutritional supplements
4. Marked interference with psychosocial functioning - The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice
- The eating disturbance does not occur due to AN or BN, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced
- The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder
What is the diagnostic criteria of Antisocial Personality Disorder?
- Must be 18+yo
- Evidence of conduct disorder <15yo (see CD criteria)
- Pattern of irresponsible & antisocial behaviour since 15yo, indicated by 4+ of:
- Unable to do consistent work
- Fails to confirm to social norms re: lawful behaviour
- Irritable and aggressive
- Doesn’t honour financial obligations
- Fails to plan ahead/impulsive
- Has no regard for the truth, reckless
- Can’t function as a parent
- Has never sustained monogamous relationship >1yr
- Lacks remorse
Diagnostic Criteria of Bipolar Disorder
A person must have experienced at least one episode of mania or hypomania.
○ Abnormally and persistently elevated, expansive or irritable mood with goal-directed activity or increased energy for at least 1wk
○ 3+ of the following symptoms:
§ Inflated self-esteem, grandiosity
§ Goal directed activity
○ Excessive involvement in potentially painful consequence activities
“DIGFAST”
D = Distractibility, I = Irresponsibility, G = Grandiosity, F = Flight of ideas, A = Activity increase, S = Sleep deficit, T = Talkativeness.
Diagnostic criteria of Canabanoid Hyperemesis Syndrome
• History of regular cannabis use
• Major clinical features
○ severe nausea and vomiting
○ vomiting that recurs in a cyclic pattern over months
○ resolution of symptoms after stopping cannabis use
• Supportive Features
○ compulsive hot baths with symptom relief
○ colicky abdominal pain
○ no evidence of gallbladder or pancreatic inflammation
Diagnostic Criteria for Schizophrenia
• At least 1 of the following for at least 1 month of time:
○ Delusions
○ Hallucinations
○ Disorganized speech
• May also see grossly disorganized or catatonic behaviour or negative symptoms (i.e. diminished emotional expression or avolition)
• Level of functioning in 1 or more major areas such as work, interpersonal relations or self-care is markedly below that of present at time of symptom onset
• Signs of disturbance must persist for at least 6 months and symptoms (including prodromal or mild symptoms)
• Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
• The disturbance is not attributable to any substances or other medical conditions
• If there is ASD, schizophrenia can only be diagnosed if symptoms have been present for at least a month
What are some non-psychiatric causes of acute psychosis?
- hypoglycemia
- cerebral hypoxia
- brain tumour
- head trauma
- CNS infection (meningitis, encephalitis)
- stroke
- temporal lobe epilepsy
- acute intermittent porphyria
- Wilson disease
- subacute sclerosing panencephalitis
- hepatic failure
- postpartum psychosis
- Hashimoto encephalopathy (as a result of thyroiditis)
- antiphospholipid syndrome
- substance use (anticholinergic, hallucinogens such as LSD, PCP or ketamine, marijuana)
- steroids
Diagnostic criteria for Intermittent Explosive Disorder
• Recurrent behavioural outbursts representing a failure to control aggressive impulses as manifested by either of the following:
○ Verbal aggression or physical aggression toward property, animals or other individuals at least twice weekly for 2 months (aggression does not result in damage or destruction)
○ At least 3 behavioural outbursts involving damage or destruction of property and/or physical assault within a 12 month period
• The magnitude of aggressiveness is grossly out of proportion to the provocation
• The recurrent aggressive outbursts are not premeditated or done to achieve a tangible objective
• The outbursts either cause marked distress to the individual or impair their day-to-day functioning
• (developmental) age is at least 6 years
• The outbursts are not better explained by another mental disorder
• The diagnosis can be made in addition to ADHD, conduct disorder, ODD or ASD
Treatment for Intermittent Explosive Disorder
- Cognitive Behavioural Therapy (cognitive restructuring, relaxation techniques, coping skills training and relapse prevention)
- SSRI - Fluoxetine
- Phenytoin
- Oxcarbazepine
- Lithium
- VPA
A child on Risperidone was recently seen by their psychiatrist. 3 days later they develop fever, rigidity, increased HR, confusion and ‘lead-pip’ rigidity. What complication have they developed?
Neuroleptic Malignant Syndrome
How do you distinguish Neuroleptic Malignant Syndrome from Serotonin Syndrome?
- NMS develops over 1-3 days rather than <12 hours
- NMS has ‘lead pipe’ rigidity in all muscle groups where as SS will have increased tone primarily in the lower extremities
- NMS will have hyporeflexia instead of hyperrflexia
- There is no clonus
- Pupils are normal
- Normal or decreased bowel sounds are found
Diagnostic Criteria for Obsessive Compulsive Disorder
• Presence of obsessions, compulsions or both
○ Obsession:
- Recurrent or persistent thoughts, urges or images that are intrusive and unwanted such that the patient has marked distress or anxiety
- The patient attempts to ignore/suppress these obsessions
○ Compulsion:
- Repetitive behaviours that the patient feels driven to do in response to the obsession
- The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or to prevent a situation even if they are not connected in a realistic way or are clearly excessive
• Obsessions or compulsions are time consuming or cause clinically significant distress or impairment in social, occupational or other areas of functioning
• the condition is not attributable to a substance or other medical condition
How to best manage a child with OCD?
- CBT alone or CBT with SSRI
* SSRI: fluoxetine, sertraline, fluvoxamine, clomipramine (only if failed 2+ SSRI trials)
What is PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcus
- prepubertal onset
- abrupt onset and episodic course
- Tics, OCD or both
- Proven GADHS infection
- neurologic abnormalities i.e. tics, hyperactivity, choreaform movements
What are the diagnostic criteria for Oppositional Defiant Disorder?
• At least 6 months of angry, irritable mood, argumentative/defiant behaviour or vindictiveness exhibited during interaction with at least 1 individual who is not a sibling
• At least 4 symptoms from the following:
○ Angry/irritable mood: often loses temper, is often touchy or easily annoyed, is often angry and resentful
○ Argumentative/defiant behaviour: with authority figures/adults, defies or refuses to comply with requests from authority, deliberately annoys others, often blames otherse for their mistakes/misbehaviour
○ Vindictiveness: spiteful or vindictive at least twice withein the past 6 months
Treatment for ODD
- Parental training
- Anger management programs for youth
- Medication: methylphenidate, risperidone
