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Differential Dx

From ANCC Review

QuestionAnswer
MDD Depressed mood/loss of interest +5 symptoms for at least 2 weeks, has significant distress or impairment - not related to substance or general medical condition, not bereavement.
Dysthymic Disorder depressed mood for at least 2 years - 1 for children or adolescents. Cannot be without symptoms for >2 months + 2 following
Bipolar I disorder persistently elevated expansive or irritable mood lasting at least a week. 3 if expansive/elevated, 4 if irritable - no depressive episode necessary, marked impairment, hospitalization or psychotic features
Bipolar II disorder at least 1 depressive episode AND 1 hypomanic episode. Persistent elevated, expansive or irritable mood lasting at least 4 days. +3/4 Has s/s uncharacteristic. Seen by others, never needed hospitalization, NO psychotic s/s never had manic or mixed episode
Cyclothymic disorder hypomanic and depressive symptoms that don't meet criteria for MDD or BP. Symptoms last at least 2 years, 1 in kids. Not without s/s for >2 months
Time frame for MDD 2 weeks
Time frame for Dysthymic d/o 2 years, 1 for children
Time frame for Bipolar I at least 1 week
Time frame for Bipolar II at least 4 days must have both depressive/hypomanic
Time frame for Cyclothymic 2 years, 1 for kids - just doesn't meet criteria for BP
Panic Disorder period of intense fear/discomfort+4 physical/behavioral s/s develop abruptly & reach peak within 10 min. Must have 1 or more months of at least 1 of these: concern about attacks, worry about implications, change in behavior r/t attacks. +/- agoraphobia
Specific phobia excessive or unreasonable persistent fear caused by presence or anticipation of specific object or situation. Exposure to stimuli provokes immediate anxiety response. Pt. Recognized fear as excessive/unreasonable. Avoid sitch. Significant interference.
Subtypes of specific phobia animal type, natural environment type, blood injection injury type, situational type, other
Social Phobia is also known as Social Anxiety Disorder
Social Anxiety Disorder is also known as Social Phobia
Social Phobia persistent fear of one or more social or performance situations where person is exposed to unfamiliar people or scrutiny by others. exposure to feared situation provokes anxiety, recognize distress is excessive, sitch is avoided or endured w high stress
For kids, social phobia must occur in both adult and peer situations, last at least 6 months. Kid might be refusing
OCD must have either obsessions or compulsions. Person recognizes that obsessions/compulsions may be excessive/unreasonable, marked distress, time consuming and significant interference.
OCD time consuming = at least 1 hour/day
PTSD exposure to traumatic event with threatened or actual injury or death. Response is extreme fear, horrpr, helplessness. Re-experiencing symptoms, increased arousal symptoms, avoidance symptoms. Symptoms must last greater than 1 month.
This is diagnosed if PTSD symptoms last <1month acute stress disorder
PTSD symptoms must last at least 1 month
GAD excessive anxiety and worry on most days for at least 6 months, difficulty controlling worry. 3 + symptoms (fatigue, restlessness, keyed up/on edge, difficulty concentrating, irritability, muscle tension, sleep disturbance).
For GAD to be diagnosed, the time frame is most days for at least 6 months.
Dementia, Alzheimer's Type memory impairment, 2 or more of aphasia, apraxia, agnosia, executive functioning problems. Decline from previous function, significant impairment. Gradual onset and continuing cog decline
Per the ANCC Reviewer, those with a higher SES are better confabulaters
Schizophrenia 2 of the s/s for at least 1 month or 1 if bixare delusions or hallucinations consisting of a voice keeping a running commentary or 2 or more voices conversing with each other.
Schizophrenia dx 5 hallucinations, delusions, disorganized speech, disorganized behavior, negative s/s (flat affect, alogia, volition etc. )
Subtypes of Schizophrenia Paranoid, Disorganized, Catatonic, Undifferentiated, Residual
schizophreniform disorder same as schizophrenia - symptoms present for 1-6 months only.
duration of schizophrenia at least 6 months with 1 month of frank psychosis
schizoaffective disorder schizophrenia + mdd. delusions/hallucinations present for at least 2 wks without mood s/s. Mood s/s must be present.
brief psychotic disorder 1 or more s/s - delusions, halluc., disorganized speech/ behavior or catatonic. with a duration of at least 1 day but less than a month with full return to premorbid functioning level. Specifiers : w marked stressor, without, with postpartum onset.
delusional disorder non-bizarre delus. for at least 1 month. Criteria for schizophrenia not met. Functioning not impaired, not obviously odd, if mood episodes occurred, duration is shorter. Subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified
substance dependence maladaptive pattern of use leading to impairment/distress with 3 of these in the same 12 month period
substance dependence criteria tolerance, withdrawal, substance taken in larger amounts/over longer period than intended, persistent desire/unsuccessful efforts to cut down, lg amt of time spent obtaining/ using/ recovery, activities given up d/t substance use, used despite conseq.
alcohol withdrawal cessation of or decrease in ETOH use that has been heavy & prolonged
alcohol withdrawal criteria 2 or more of these within several hours to a few days after decrease: autonomic hyperactivity, inc. hand tremor, insomnia, N/V, transient halluc/illusions, psychomotor agitation, anxiety, GM seizures
use this to assess for withdrawal clinical institute for withdrawal assessment for alcohol (CIWA - Ar). 10 parameters score 0-7
Score on CIWA-Ar 0-9 absent or minimal wd 10-19 mild to mod withd 20+ severe withdrawal
S/S of withdrawal from opioid 3 or more within minutes to several days of decreasing opiate: dysphoric mood, N/V/D, lacrimation or rhinorrhea, pupillary dilation, piloerection, diaphoresis, yawning, fever, insomnia, distress or impairment
do people die from opioid withdrawal? no, unless cardiac disease concominant
residual symptoms of opioid withdrawal insomnia, bradycardia, temp dysreg., craving - can persist for months after
Personality Disorder Clusters A,B, C
Cluster A Personality Disorders Paranoid, Schizotypal, Schizoid
Cluster B Personality Disorders Antisocial, Borderline, Histrionic, Narcissistic
Cluster C Personality Disorders Obsessive Compulsive, Dependent, Avoidant
Personality d/o usually presents during crisis
Cluster A Characteristics odd, eccentric, loner, emotionally distant
Cluster A Tx prolonged intensive psychotherapy, pharm tx of dysphoric symptoms. caution group therapy
Cluster B Characteristics dramatic, erratic, egocentric, lack of appreciation for concerns of others
Cluster B Tx CBT/DBT , self help groups, be aware of transference/counter transference, limit setting, pharm - valproate for impulsiveness/rage. Symptom minimization.
Cluster C Characteristics avoidant, anxious, fearful. Preoccupied with rules or reactions of others.
Cluster C Tx psychotherapy, pharm; symptomatic - usually anxiety or depression
Poor behavioral adaptation requires early intervention for preventing maladaptation
Maladaptive outcomes result from continuous dysfunctionality in the caretaking environment
conduct disorder is a persistent pattern of conduct in which the child violates the basic rights of others. onset of aggressive behavior is observed in toddler
Formal dx of conduct disorder can be made from age 7-18.
treatment for conduct disorder problem solving skills training, pharm - for explosive aggression, 8887888 therapy
ODD Defiant and negativistic behavior that is more severe than seen in most children of the same mental age. precursors 3-7 years disorder:age 8
treatment for ODD therapy, accept responsibility for own behavior, increase self esteem, improve social interaction, family - positive parenting strategies, enforce consistency in discipline.
rett's disorder neurodegenerative disease that affects only females. cease to gain developmental milestones, loss of skills already acquired, stereotypic hand movements, seizures, scoliosis, hypertonicity. mgmt. preserve functional abilitiews
onset of rett's disorder females at 1 year old
aspergers males and females more males affected, females exhibit more severe form. aspergers is autism but speech not affected.
mental retardation is coded on axis ii
MR is intellectual impairment that affects functioning and self care.
IQ test cut off for MR less than 70
MR can be concurrent with ODD
Mild MR range 50-70
Mod MR range 35-50
Severe MR range 20-35
Profound MR range below 20
Fetal Alcohol Syndrome is coded on axis III
Characteristics of FAS skin folds in corner of eyes, low nasal bridge, short nose, indistinct philtrum, thin upper lip, small head circumference, small midface.
The philtrum is the grove between nose and upper lip
Separation Anxiety Disorder occurs with fam disposition, stressful life events, occurs in small families, higher SES, eldest child, parents place importance on achievement, overprotective parents, child models parents fears/anxieties.
Tx issues r/t separation anxiety d/o improve social interactions, develop adaptive coping strategies. affects 4% of all kids
Separation Anxiety disorder is coded on Axis I
Depression in childhood and adolescents usually presents angry. more commonly irritable.
Eating d/o. Suicide is more likely in bulimia
This lab value is associated with bulimia hypokalemia
Russel's sign scars on knuckles with bulimia
Neuroendocrine abnormalities associated with eating disorders hypothalamic dysfunction in AN, increased CSF cortisol levels, dopaminergic dysregulation.
Created by: jonquil