Childhood Disintegrative Disorder: Clinical Features and Diagnostic Criteria Waleed Ahmad Published online by MRCPsych UK: Tuesday, 03 May 2022 Introduction There is a loss of skills in several areas of development and deficits in social, communicative, and behavioural functioning that follow normal development in this condition. Often the condition follows a prodromic period during which children develop obscure symptoms; they become restive, irritable, anxious, and overactive. Impoverishment follows this and then loss of speech and language, accompanied by behavioural disintegration. Sometimes the loss of skills is persistently progressive (especially if there is an underlying progressive neurological condition), but more often, the decline over some months and then a slight improvement. The prognosis is usually abysmal, and it leaves most individuals with severe intellectual disability. There is uncertainty about the extent to which this condition differs from autism. Sometimes, th

A 16-year-old girl presents with multiple unconsciousness. These started about six months ago and have become progressively worse. During the episodes, there is the jerky movement of the body but no urinary or faecal incontinence. These symptoms last for a few minutes and are followed by drowsiness. Neurological examination is normal. What differential diagnoses would you consider in this case? What other information would you enquire from the family about the episodes? Which specific investigations would you like to order? Differential Diagnosis Conversion disorder (F44.5 Dissociative convulsions) suggested by the episodes of unconsciousness and lack of findings on neurological examination and absence of incontinence. Epilepsy suggested by the recurrent brief episodes of unconsciousness, accompanied by jerky movements and followed by drowsiness Vasovagal syncope suggested by the brief episodes of unconsciousness, jerky movements (may occur) and normal physical examination Paroxysmal a

In multi-axial diagnosis, a patient’s problems are viewed within a broader context, which includes clinical diagnosis, assessment of disability, and psychosocial factors. In ICD-10, multi-axial diagnoses are made along three axes, as follows: Axis I: clinical diagnoses This includes all disorders, both psychiatric and physical, including learning disability and personality disorders.  Axis II: disabilities Conceptualized in line with WHO definitions of impairments, disabilities, and handicaps, this covers a number of specific areas of functioning that are rated on a scale of 0–5 (‘no disability’ to ‘gross disability’): Personal care: personal hygiene, dressing, feeding, etc. Occupation: expected functioning in paid activities, studying, homemaking, etc. Family and household: participation in family life. Functioning in a broader social context: participation in the wider community, including contact with friends, leisure, and other social activities.  Axis III: contextual factors The

Classification of Depression According to the International Classification Diseases, Tenth Revision (ICD-10) Waleed Ahmad The ICD-10 has comprehensively sub-classified into various categories based on the clinical profile of symptoms and the course of symptoms.  Based on the course, it may be a depressive episode, recurrent (major) depressive disorder, persistent depressive disorder or dysthymia, recurrent brief depression, etc. Depression may also be either unipolar or bipolar or it may occur in   A first depressive episode, duration of at least15 days, is classified as a  depressive episode (F32).  If the first depressive episode severe and rapid onset, duration less than 15 days still depressive episode (F32).   A depressive episode can be mild (2 core symptoms, 2 other symptoms from the list) (32.0) moderate (2 core symptoms, 3 or preferably 4 other symptoms) (32.1) Severe (3 core symptoms, 4 other symptoms) without psychotic symptoms (32.2) (no delusion, hallucination or stupor)