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1
Q

Acute stress reaction definition

A
  1. Transient, develops in an individual w/o any other apparent mental disorder in response to exceptional mental/physical stress
  2. Subsides within hrs/days
  3. Features:
    - initial DAZE
    - constricted field of consciousness
    - narrowed attention
    - inability to comprehend stimuli
    -disorientation
  4. severe withdrawal may manifest as stupor
  5. can become agitated and over reactive
  6. may have autonomic signs of panic
  7. complete or partial amnesia
    8 DSM-V: Sx at least 3d, if >1m consider PTSD
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2
Q

Adjustment disorder definition

A

Subjective distress and emotional disturbance
Interfering w/function
Arising in period of adaptation to life
Manifestations:
- Depressed mood
- anxiety
- worry
- unable to cope
- disability in performing daily routines
Conduct disorder association (adolescents)

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3
Q

Generalised anxiety disorder definition

A

Generalised and persistent but not restricted to one environment
>6m
Sx criteria (at least 4 including autonomic)
Common fears: self/relative illness
Doesnt meet panic/phobic anxiety, OCD or hypochondriacal dx
Not caused by organic health problem or substance
Key featues:
- apprehension
- motor tension
- autonomic overactivity

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4
Q

Sx criteria for GAD

A

at least 4 in total including 1 of:
Auto: palpitations, sweating, trembing, dry mouth
Others:
- Chest/abdo: dib, choking, pain, nausea
- Brain: dizzy, depersonalisation, fears
- General: hot/cold flushes, parasthesia
- Tension: muscle tension/ache, restless, mental tension
Other: exaggerated startle, difficulty concentrating, irritable, insomnia

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5
Q

OCD definition

A

Recurrent obsessional thoughts can be:
Ideas, Imaged, Impulses
Obsession thoughts distressing and patient tries to resist
Recognised as own thoughts despite involuntary
Compulsive rituals, not inherently enjoyable or useful
Behaviour is recognised as pointless and attempts made to resist
Anxiety almost always present and worsens if acts resisted

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6
Q

Body dysmorphic disorder definition

A

Appearance preoccupation (non-existent or slight flaw)
Repetitive behaviours (can be mental eg. comparison)
Clinical: causes distress/impairment
Specifiers:
- muscle dysmorphia (too much or too little)
- ?insight

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7
Q

Panic disorder definition

A 
Recurrent attacks not restricted to any particular situation
Are thus unpredictable
Sx:
- sudden onset palpitation
- CP
- choking sensation
- dizziness
- depersonalistion/derealisation
- fear of death/going mad
NB panic dx NOT main dx in pt w/depressive disorder at start of attacks (panic secondary)
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8
Q

Social phobia definition

A

Fear of scrutiny by others leading to avoidance of social situations
?a/w low esteem
Sx: blushing, hand tremor. nausea, urinary urgency in social situations
Can progress to panic attacks

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9
Q

Specific phobia definition

A

Restricted to highly specific situations

Can evoke panic attack

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10
Q

Agoraphobia definition

A

Cluster a/w fear of leaving home, entering crowds, travelling alone
Can have panic attacks
Avoidance prominent, so potentially can have relatively little anxiety

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11
Q

PTSD definition

A

Delayed or protracted response to exceptionally threatening/catastrophic event
Duration: >1m
RF: Hx neurotic illness or compulsive personality
Key Features
1. Re-experiencing
2. Avoidance
3. Autonomic hyperarousal
others: emotional blunting, detachment, anhedonia
?suicidal ideation
Reaction may take weeks/months
Recovery expected in most cases
Small percentage will result in enduring personality change

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12
Q

ADHD subtypes

A
  1. Predominantly inattentive
    easily distracted, forgetful, poor concentration and completion of tasks
  2. Predominantly hyperactive-impulsive: fidget, hyperactive, immature, ?destructive
  3. ADHD : combination
    Sx must have appeared by age 6-12y, occur in >1 environment, cause issues, last >6m
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13
Q

ADHD how is it subdivided?

A

Subdivision based on presence of 6+/9 Sx of inattention, hyperactivity or both lasting at least 6m

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14
Q

ADHD Sx clusters Inattention

A

Difficulty paying close attention to details
Trouble holding attention
Trouble organising tasks
Loses necessary items
Appears forgetful
Short attention span and easily distracted
Difficulty with structured school work or tasks that are complex/time consuming

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15
Q

ADHD Sx clusters Hyperactivity-Impulsivity

A 
Unable to sit still
Fidget
Leaves seat inappropriately
Takes risk w/little thought
'on the go'
talking more than others
Answers quickly
Difficulty waiting turn
Interrupts/Intrudes
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16
Q

Autistic spectrum disorder

A 
Pervasive developmental dx develops <3y
3 areas:
reciprocal social interaction
communication
restricted stereotyped repetitive behaviour
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17
Q

Aspergers syndrome definition

A

Uncertain nosological validity
Abnormalities of social interaction that typify autism
Restricted, stereotyped, repetitive repertoire of interests
NO general delay in language or cognition
Marked clumsiness
Strong tendency to persist into adult life
Psychotic episodes can occur in adult life

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18
Q

Baby blues definition

A

Tearfulness, irritability, low mood occurring within a few days of childbirth
Lasts days
Labile mood sometimes

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19
Q

Post natal depression

A

Depressive disorder w/peripartum onset (during pregnancy to 1y post)
Criteria same as non child birth depression
Most recover within a month

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20
Q

Peurperal psychosis

A

not defined by DSM-V or ICD-10
Onset of psychostic Sx after childbirth (usually around 2w)
3 Patterns:
1. Delirium
2. Affective (psychotic depression/mania)
3. Schizophreniform
Sx will deteriorate and fluctuate rapidly
Recovery 6-12w

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21
Q

Bipolar affective Dx

A

2+ episodes in which mood and activity significantly disturbed
Some occasions are (hypo)manic, some depressive
Types:
I: 1+ manic, depressive episodes common but NOT necessary
II: At least 1 hypomanic, at least 1 major depressive
Cyclothymia: Hx of hypomania w/periods of depression that are not major

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22
Q

Hypomanic episode definition

A 
Persistent mild elevation of mood, increased energy and activity, usually marked feelings of well being
Increased sociability
Increased sexual energy
Decreased need for sleep
NOT severe disruption of work
Can manifest as irritable
NO hallucinations/delusions
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23
Q

Mania w/o psychotic Sx definition

A

Mood elevated out of keeping w/circumstances (from carefree to uncontrollable excitement)
Increased energy -> overactivity, insomnia
Distractable
Inflated self esteem
Grandiose ideas
Loss of inhibition

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24
Q

Conduct disorder definition

A

Repetitive persistent dissocial/aggressive/defiant conduct
Violates age appropriate expectations
>6m
Subtypes:
- family context only
- unsocialised vs socialised (well integrated into peer group)
Oppositional-defiant disorder:
Related condition in younger children
Specific of ODD is defiance vs others (parent), NOT delinquency/aggressive

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25
Delusional Disorder
1+ delusion that are usually persistent and sometimes lifelong NOT any auditory hall., delusions of control, blunting or any other schizo sx NB. occasional or transient auditory hallucination does not rule out DD as long as it is a small part of picture
26
Depressive disorder ICD-10
Symptoms - core: low mood, anhedonia, anergia - bio: sleep/appetite disturbance, low libido, agitation - cognitive: impaired memory/concentration, guilt and worthlessness, low self esteem, bleak future MILD: 2 or 3 core, 2+ other, pt distressed but able to continue most activities MOD: 2/3 core, 3+ other, pt. reports considerable difficulty Sev: All 3 core, 4+ other, major impact on life, distress/agitation possible DURATION: >2 weeks to be major depressive episode
27
Depressive disorder definition DSM-IV
1.Depressed most of the day, nearly everyday 2.Diminished interest/pleasure in activities 3.Significant wt change or appetite change daily 4.Sleep disturbance nearly daily 5. Psychomotor agitation/retardation 6. Fatigue or low energy 7. Feeling worthless/guilty nearly daily 8. Diminished concentration ability 9. Recurrent thoughts of death SUBTHRESHOLD: <5 sx MILD: >5 Sx, minor functional impairment Moderate: symptoms and impairment mild-severe SEVERE: Most Sx, marked impairment, can present w/psychosis too
28
Dissociative disorders definition
Partial/complete loss of integration between: - memories of past, awareness of identity, control of body Tend to remit after weeks/months (particularly if a/w traumatic event) Chronic dx (paralyses) possible if a/w insoluble problems NO underlying dx NB. ONLY dx of physical function under voluntary control/loss of sensation are dissociative (pain and other ANS functions are somatisation dx)
29
Dissociative amnesia
Dissociative amnesia (loss of memory) often recent important events Dissociative stupor (pro
30
Dissociative fugue
(same features as dissociative amnesia) plus purposeful travel beyond everyday range behaviour may appear normal to outside observer who is unaware of amnesia
31
Dissociative stupor
Diminution or absence of vountary movement and normal responsiveness to external stimuli No physical cause Evidence of psychgenic causation from recent trauma/stress
32
Trance and possession disorders
Temporary loss of sense of personal identity Full awareness of surroundings ONLY trances that are involuntary and unwanted, occurring outside religion or cultural situations
33
Dissociative motor disorder
Loss of ability to move whole or part of limb | Close resemblance to any axatia/apraxia/dyskinesia
34
Dissociative convulsion
Mimic epileptic tongue biting, bruising due to fall and incontinence are rare LOC maintained or replaced by stupor/trance
35
Dissociative anaesthesia
Areas of skin w/boundaries that are not medically defined Defined by pts ideas of medicine Differential sensory modality loss not explained by any possible lesion Sensory loss a/w parathesia Loss of vision and hearing rarely total
36
Anorexia Nervosa definition
Deliberate wt loss (diet, exercise, purging, use of appetite supressants) Morbid dread of being fat Disturbed bodily funct. (endocrine/metabolic) Atypical anorexia nervosa: fulfil some criteria but overall picture not full justifying dx
37
Bulimia Nervosa definition
Repeated overeating Excessive preoccupation leading to pattern of overeating and then purging Often Hx of anorexia nervosa Atypical: some sx but not justifying dx
38
Binge eating disorder
Frequent recurrent eps of binge eating (1+/wk) over period of months inappropriate behaviour to prevent wt gain
39
Learning disability definition
Significant limitations in general mental abilities, and 1+ areas of adaptive behaviour across environments Becomes apparent in childhood/appearance IQ <70 (some discretion when sev. adaptive functioning impairment) NB. not learning difficult where general intelligence normal w/specific difficulty IQ: 50-70= mild 35-49 = mod 20-34 = severe <20 = profound
40
Personality disorder general definition
Pervasive: occurs in all/most areas of life Persistent: evident in adolescence and continues Pathological: distress to self/others, impairs function
41
Paranoid personality disorder (A)
Excessive sensitivity to setback Unforgiveness to insult Suspicious Tends to distort experiences by misconstruing neutral or friendly actions of others Recurrent suspicions regarding sexual fidelity of partner Combative and tenacious sense of personal rights Excessive self-importance and reference can occur
42
Schizoid personality disorder (A)
Withdrawal from affectional/social/other contacts Prefer fantasy, solitary activities, introspection Limited capacity to express feelings and experience pleasure
43
ICD 10 features of schizoid personality disorder (A)
Few if any activities provide pleasure Emotionally cold/detached/flattened affect Limited capacity for warm feelings and anger Indifferent to praise/criticism Little interest in sexual activity w/others Chooses solitary activities Preoccupation w/fantasy/introspection Neither desire nor have close friends/confiding relationships Marked insensitivity to norms and conventions
44
Schizotypal personality disorder (A)
Eccentric behaviour Anomalies of thinking and affect that resemble schizophrenia Cold/inappropriate affect Anhedonia Odd/eccentric behaviour Tendency to withdraw Paranoid/bizarre ideas not amounting to delusions Ruminations Thought/perceptual disturbance ?Transient quasi-psychotic moments w/intense illusions, auditory or other hallucination and delusions No definite onset or evolution
45
Dissocial (antisocial) personality disorder
Disregard for social obligations Unconcern for others Disparity between behaviour and societal norms NOT modifiable by punishment Low tolerance to frustration, low threshold for aggression/violence Tendency to blame others
46
Emotionally unstable personality disorder (B)
Tendency to act impulsively w/o considering consequences Mood unpredictable Liable to outburst of emotion incontrollable Tend to quarrel especially when impulsive acts are thwarted 2 Subtypes: Impulsive: emotionally unstable and lack control Borderline: disturbed self image, chronic emptiness, unstable interpersonal relations, self destructive behaviour
47
Histrionic personality disorder (B)
``` Shallow and labile affect Self dramatisation Theatricality Exaggerated emotional expression Suggestibility Egocentricity Self-indulgence Lack of consideration of others Easily hurt feelings Continuous seeking of appreciation, excitement, attention ```
48
Anankastic PD (C)
Feelings of doubt Perfectionism Excessive conscientiousness Checking and preoccupation w/details, stubborn, cautious, rigidity Insistent and unwelcome impulses that do not attain severity of OCD
49
Anxious (avoidant) PD (C)`
Feelings of tension/apprehension Hypersensitive to rejection/criticism Restricted personal attachments Tend to avoid certain activities by habitual exaggeration of potential dangers of everyday life
50
Dependent PD (C)
Pervasive reliance on others to make major and minor life decisions Fear of abandonment Feeling helpless and incompetent Passive compliance to wishes of others Weak response to daily demands of life Lack of vigour in intellectual/emotional sphere Transfer responsibility
51
Schizophrenia characterised by:
Fundamental and characteristic disturbance of thought/perception Affect inappropriate/blunt Clear consciousness and intellectual capacity usually maintained Negative Sx Course can be continuous or episodic
52
First Rank Sx of Schizophrenia
``` Thought insertion, withdrawal and broadcasting Delusional perceptions (and passivity phenomena) Auditory hallucinations (3rd person, thought echo, commentary) ```
53
When NOT to dx schizophrenia
presence of extensive manic or depressive Sx unless clear than schiz. Sx came first Presence of overt brain dx or during states of intox/withdrawal
54
Schiz. duration
DSM-V: 2 dx criteria met most of the time for at least 1m w/sig. impact on social/occupational function for 6m If sx present for 1-6m Dx = schizophreniform disorder Psychotic Sx <1m = brief psychotic disorder
55
Paranoid schiz. definition
Dominated by relatively stable often paranoid delusions, usually a/w hallucinations and perceptual disturbance Uncommonly; disturbance of affect, volition, speech, catatonia
56
Hebephrenic schiz. definition
Affect changes prominent Delusions/hallucinations are fleeting and fragmentary Irresponsible and unpredictable behaviour Mannerisms common Mood shallow and inappropriate Thought disorganised, speech incoherent Tendency to isolation Poor prognosis (negative sx) Should normally only be Dx in adolescent or young adult
57
Catatonic schizophrenia
psychomotor disturbances that may alternate between extremes (hyperkinesis and stupor), automatic obedience and negativism Episodes of violent excitement Catatonic phenomena may be combined w/dream like state + vivid hallucinations
58
Undiferentiated schiz
Psychotic conditions meetings general dx criteria but w/o subtyping
59
Post-schizophrenic depression
Depressive episode arises after schizophrenia some schiz sx may be present but NOT dominating clinical picture Risk of suicide If no schizophrenic sx then diagnose depressive episode
60
Residual schizophrenia
Chronic stage w/prominent negative sx long term
61
Simple schiz.
Insidious progressive development of oddities of conduct Inability to meet social demands Negative sx develop w/o preceeding by any overt psychotic sx
62
Schizoaffective Disorders
``` Episode disorders BOTH affective and schizophrenic sx prominent but do NOT jusfity schiz/depresssive/mania Dx Manic type: - schiz + manic sx Depressive type: - schiz + depressive sx Duration: Req. psychotic state for 2w w/o concurrent affective sx req. 2 episodes of psychosis (1 with and 1 without affective sx) ```
63
Substance use disorder acute intox
Condition following administration of psychoactive substances Resolve unless damage
64
SUD harmful use
Pattern of behaviour that damages health | Physical, mental
65
SUD dependence syndrome
``` Behavioural, cognitive, physiological cluster developed after repeated use Typically Includes: craving control (lack of) persistent use priority over other things tolerance withdrawal ```
66
SUD withdrawal state
Group of Sx occuring when ceasing long term use of substance Time limited Cx: convulsion
67
SUD psychotic disorder
``` during/following substance use not explained on basis of intox. and not part of withdrawal Characterised by: hallucinations perceptual distortion delusion (paranoid/persecutory) Psychomotor disturbance Abnormal affect ```
68
SUD amnestic syndrome
``` Chronic prominent impairment of recent and remote memory Immediate recall preserved Recent more disturbed than remote Disturbance of time sense and chronology Difficulty learning new material Confabulations possible ```
69
SUD residual and late onset psychotic disorder
Alcohol or other substance induce long term change in cognition, affect, personality beyond intoxication
70
Somatisation disorders
multiple recurrent and frequently changing physical sx of at least 2y duration Many have Hx of fruitless investigations Sx can be anywhere Disorder is chronic and fluctuating
71
Somatisation disorders - undifferentiated somatoform disorder
Somatoform complaints are multiple varying persistent but complete typical picture of somatisation disorder not fulfilled
72
Somatisation disorders - hypochondrial disorder
Persistent preoccupation w/one or mote serious/progressive illness Somatoform complaints or persistent concerns about appearance Normal or common sensations interpreted as distressing and attention focused on organ/system Depression/anxiety common
73
Somatisation disorders - Somatoformm autonomic dysfunction
Presented by pt as if due to physical disorder of system/organ largely under ANS control (CVS, GI, resp) 2 types: 1. based on objective signs of autonomic arousal 2. subjective complaints of burning, heaviness, bloating
74
Somatisation disorders - Persistent somatoform pain disorder
Persistent severe distressing pain cannot be explained by physiological process Occurs with emotional conflict or psychosocial problems
75
ECT Indications
Catatonia Prolonged or sev. manic episode Sev depression that is life threatening NB is effective in pregnant women
76
ECT short/ong term side effects
``` Headache, N=V Short term memory impairment memory loss of events prior to ECT Arrhythmia Long term: impaired memory ```
77
Insomnia definition
Difficulty initiating, maintaining sleep or early morning waking that leads to dissatisfaction w/sleep quality Chronic insomnia: at least 3/wk for 3mo Ix: usually based on Hx, sleep diary, polysomnography?
78
Applied relaxation therapy
Used in anxiety disorders Based on premise that they have lost ability to relax Series of exercises teach patient to: - spot sx of tension - relax muscles and relieve tension - use these techniques in stressful situations 12-15 wkly sessions
79
Mentalisation based therapy
Focus on pt ability to attend mental states in themselves and others Helps understand their and others actions Leads to more social success Used for EUPD and self harm
80
Transference focussed therapy
Based on a theory by which emotions transferred from one person to another Presumed that your feelings about certain people are transferred to therapist You then feel about and react to the therapist as you would those important people Therapist watches and helps you build healthier relationship Mainly EUPD

Psych (13 decks)

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