Clinical Psychiatry

106 flashcards by MentisLibrary

Diagnostic criteria and management across mood, anxiety, psychotic, substance use, neurodevelopmental, personality, neurocognitive, eating and sleep disorders, plus psychopharmacology and the core psychotherapies.

How many symptoms, and over what period, define a major depressive episode?
Five or more of nine symptoms during the same two week period, and at least one must be depressed mood or loss of interest.
What is persistent depressive disorder?
Depressed mood on most days for at least two years in adults, or one year in children and adolescents, with at least two associated symptoms.
What single feature establishes a diagnosis of bipolar I disorder?
One manic episode. A depressive episode is common but is not required.
How does bipolar II disorder differ from bipolar I?
Bipolar II requires at least one hypomanic episode and at least one major depressive episode, and a full manic episode has never occurred.
What defines cyclothymic disorder?
Two years of numerous periods of hypomanic and depressive symptoms that never meet full criteria for either episode, with symptom free intervals no longer than two months.
What does the mnemonic DIGFAST list?
The symptoms of a manic episode: Distractibility, Impulsivity or Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep need decreased, and Talkativeness.
What distinguishes premenstrual dysphoric disorder from ordinary premenstrual symptoms?
Symptoms are present in the final week before menses, begin to improve within a few days of onset of menses, and become minimal or absent in the week after, with clear functional impairment.
Postpartum blues, depression and psychosis: how do they differ?
Blues are mild, peak within the first week and resolve by about two weeks. Depression is a full major episode lasting longer with impairment. Psychosis is rare, begins within days to weeks, and is an emergency.
Which single historical factor most strongly predicts future suicide?
A previous suicide attempt.
When is electroconvulsive therapy considered?
In severe or treatment resistant depression, depression with psychotic features, catatonia, and when a rapid response is needed because of refusal to eat, high suicide risk or pregnancy.
Why is antidepressant monotherapy avoided in bipolar depression?
It can precipitate a switch into mania or hypomania and can accelerate cycling.
What is disruptive mood dysregulation disorder?
Chronic severe irritability with frequent temper outbursts out of proportion to the trigger, present in at least two settings, in a child between 6 and 18 with onset before age 10.
How long must worry persist to meet criteria for generalized anxiety disorder?
At least six months of excessive anxiety and worry occurring more days than not, about a number of events or activities.
What is required for panic disorder beyond the panic attacks themselves?
At least one month of persistent worry about further attacks or their consequences, or a maladaptive change in behavior because of them.
What is agoraphobia?
Marked fear about two or more of five situations: public transport, open spaces, enclosed spaces, queues or crowds, and being outside the home alone.
How long must a specific phobia or social anxiety disorder persist for diagnosis?
At least six months.
How are obsessions and compulsions defined in obsessive-compulsive disorder?
Obsessions are recurrent intrusive unwanted thoughts, urges or images; compulsions are repetitive behaviors or mental acts performed to reduce the resulting distress.
What is body dysmorphic disorder?
Preoccupation with a perceived defect in physical appearance that is not observable or appears slight to others, with repetitive checking, grooming or comparing.
What defines hoarding disorder?
Persistent difficulty discarding possessions regardless of value, with distress at the thought of discarding, resulting in accumulation that compromises living spaces.
Which four symptom clusters define post-traumatic stress disorder?
Intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity, all following exposure to a qualifying trauma.
How does acute stress disorder differ from post-traumatic stress disorder?
By timing. Acute stress disorder applies from three days to one month after the trauma; beyond one month the diagnosis becomes post-traumatic stress disorder.
What is adjustment disorder?
Emotional or behavioral symptoms out of proportion to an identifiable stressor, beginning within three months of it, that do not meet criteria for another disorder.
How long must separation anxiety persist in a child, and in an adult?
At least four weeks in children and adolescents, and at least six months in adults.
What is trichotillomania?
Recurrent hair pulling resulting in hair loss, with repeated attempts to stop.
What are the diagnostic requirements for schizophrenia?
Two or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms, with at least one being of the first three, present for one month, within a total disturbance of at least six months.
Positive versus negative symptoms: which respond better to antipsychotics?
Positive symptoms respond well. Negative symptoms respond poorly and drive most of the long term disability.
What is brief psychotic disorder?
Psychotic symptoms lasting at least one day and less than one month, with full return to premorbid functioning.
What is schizophreniform disorder?
The symptom picture of schizophrenia lasting between one and six months.
What is required to diagnose schizoaffective disorder?
A major mood episode concurrent with the active symptoms of schizophrenia, plus delusions or hallucinations for at least two weeks in the absence of a major mood episode.
What is delusional disorder?
One or more delusions for at least one month, with functioning not markedly impaired and behavior not obviously bizarre apart from the delusion.