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1

What are the two main contemporary classification systems in psychiatry?

ICD 10 and DSM IV

2

What is an operationalised approach?

the use of precise clinical descriptions of disorders, together with predefined exclusion and inclusion criteria and details of the number and duration of symptoms required for diagnosis

3

What are characteristic symptoms?

symptoms pertinent to a diagnosis, such as the symptoms of depression

4

What are discriminating symptoms?

are necessary for diagnosis since they are not found in other disorders

5

What are pathognomonic symptoms?

symptoms which strongly favour one diagnosis over another and have high specificity for the diagnosis

6

What are inclusion and exclusion criteria?

a hierarchy of symptoms, arranged in order of importance, forming the core inclusion and exclusion criteria used to establish a diagnosis

7

What is the atheoretical approach?

diseases are described according to the observed phenomenology, not an understanding of what might be causing the disease

8

What is the descriptive approach?

classification of illness based on what constitutes the illness, rather than what causes it

9

What are the advantages and disadvantages of a categorical approach?

Easy to understand
Based on existing knowledge base
Easy communication
Poor validity - vague catagories

10

What are the advantages and disadvantages of a dimensional approach?

More valid given continnum of emotional and cognitive states
Can indicate severity
Comorbid diagnosis difficult
Good for research
Unclear clinical utility

11

What is hierarchical organisation?

certain disorders take precedence over others when making a diagnosis (Jasperian theory) - ICD 10 still uses this system with organic disorders at the top of the hierarchy

12

What is a multiaxial approach?

provides a holistic assessment of the individual in terms of their disorder and functioning

13

What multi-axial approach is used in ICD-10?

Axis 1: the mental disorder
Axis 2: the degree of disability
Axis 3: current psychosocial problems

14

What multi-axial approach is used in DSM-IV?

Axis 1: Clinical disorders
Axis 2: Personality Disorders/Mental retardation
Axis 3: General Medical Conditions
Axis 4: Psychosocial and Environmental problems
Axis 5: Global Assessment of Functioning

15

What assessment instruments have been developed using the ICD10?

Schedule for clinical assessment in neuropsychiatry (SCAN)
Composite International Diagnostic Interview (CIDI)
International Personality Disorder Examination (IPDE)

16

What different versions of ICD 10 exist?

1. Clinical Descriptions and Diagnostic Guidelines (CDDG)
2. Diagnostic Criteria for Research (DCR)
3. Primary Care version
4. Clinical Coding Manual

17

What different syndromes of drug use does ICD-10 describe?

1. Acute intoxication
2. Harmful use
3. Dependence
4. Withdrawal state
5. Withdrawal delirium
6. Psychotic disorder
7. Amnesic syndrome
8. Late-onset disorders

18

What does 'harmful use' mean?

a pattern of substance misuse that is causing damage to the physical or mental health of an individual without any pattern of dependence

19

What does DSM-IV describe as substance 'abuse'?

Maladaptive use:
despite problems in social, occupational, physical and psychological domains
in hazardous situations
at least one month, usually recurring over long period
no dependence signs

20

What are the ICD-10 criteria for alcohol dependence?

In the last 12 months, at least 3 of:
1. Intense desire to drink alcohol
2. Difficulty in controlling the onset, termination and level of drinking
3. Experiencing withdrawal symptoms if alcohol is not taken
4. Use of alcohol to relieve withdrawal symptoms
5. Tolerance as evidenced by the need to escalate dose over time to achieve the same effect
6. Salience - neglecting alternate forms of leisure or pleasure in life
7. Narrowing personal repertoire of alcohol use

21

What are the DSM-IV criteria for alcohol dependence?

At least 3 of the following, lasting for at least 1 month:
1. Consuming alcohol for longer period and in larger amounts than intended
2. Unsuccessful attempts to cut down
3. Experiencing withdrawal symptoms if alcohol is not taken
4. Use of alcohol to relieve withdrawal symptoms
5. Tolerance as evidenced by the need to escalate dose over time to achieve the same effect (at least 50% increase from the start)
6. Salience - most time spent on pursuing alcohol directly or indirectly
7. Failure in role obligations and physical health
8. Giving up alternate pleasures
9. Continued use despite knowing the harm caused

22

What are the Edwards and Gross criteria for dependence?

1. Narrowed repertoire
2. Salience of alcohol seeking behaviour
3. Increased tolerance
4. Repeated withdrawals
5. Drinking to prevent or relieve withdrawals
6. Subjective awareness of compulsion
7. Reinstatement after abstinence

23

What is depressive pseudodementia?

a descriptive term, not a diagnosis, describing the presentation of depression as dementia clinically

24

What are the features of pseduodementia compared to dementia?

1. Onset can be dated more precisely
2. More rapid progression of symptoms
3. High level of complaint of cognitive impairments
4. No nocturnal increase in dysfunction
5. Attention and concentration more well preserved
6. 'Don't know' answers are common in testing
7. Memory loss for remote events more severe than recent ones

25

What are the diagnostic criteria for dementia?

1. Global deterioration in intellectual capacity and disturbance in higher cortical functions like memory, thinking, orientation, comprehension, calculation, language, learning abilities and judgement, an appreciable decline in intellectual functioning and some interference with personal activities of daily living
2. Insidious onset with slow deterioration
3. The absence of clinical evidence or findings from individual investigations suggestive of organic brain disease or other systemic abnormalities
4. Absence of sudden onset or physical/neurological signs

26

What are the 5A's associated with dementia?

1. Amnesia - Impaired ability to learn new information and to recall previously learned information
2. Aphasia - Problems with language (receptive and expressive)
3. Agnosia - Failure of recognition, especially people
4. Apraxia - Inability to carry out purposeful movements, even though, there is no sensory or motor impairment
5. Associated disturbances - behavioural changes, delusions and hallucinations

27

What are the diagnostic criteria for vascular dementia?

1. Presence of a dementia syndrome, defined by cognitive decline from a previously higher level of functioning and manifested by impairment of memory and two, or more, cognitive domains and deficits should be severe enough to interfere with ADLs, not due to the physical effects of stroke alone
2. Onset may follow a cerebrovascular event and is more acute
3. The course is usually step-wise, with periods of intervening stability
4. Focal neurological signs and symptoms or neurological evidence of cerebrovascular disease judged aetiologically related to the disturbance (hemiparesis, lower facial weakness, Babinski sign, sensory deficit, hemianopia, dysarthria) or neurological imaging
5. Emotional and personality changes are typically early, followed by cognitive deficits that are often fluctuating in severity
6. Symptoms not occurring during the course of delirium

28

What are the diagnostic criteria for dementia with Lewy Bodies?

1. Spontaneous motor features of Parkinsonism
2. Fluctuating cognition with notable variation in attention and alertness
3. Recurrent visual hallucination, which are typically well formed and detailed
4. A progressive cognitive decline that is severe enough to interfere with normal social and occupational functioning and memory loss may not be an early feature, but it is usually evident with progression
5. Supportive features: neuroleptic sensitivity and history of falls

29

What is Parkinson's disease dementia?

Parkinsonian symptoms existed for 12 months before dementia developed
If cognitive and motor symptoms develop within the same 12 month period then a diagnosis of Lewy Body dementia is given

30

What are the diagnostic criteria for frontotemporal dementia?

1. Insidious onsent and gradual progression
2. Early loss of personal and social awareness
3. Early emotional blunting, Early loss of insight
4. Behavioural features: early signs of disinhibition, decline in personal hygiene and grooming, mental rigidity, inflexibility, hyperorality, stereotyped and perseverative behaviour
5. Speech disorder: reduced output and signs such as stereotypy, echolalia and perseveration
6. Affective symptoms: anxiety, depression and frequent mood changes, emotional indifference
7. Physical signs: incontinence, primitive reflexes, akinesia, rigidity and tremor