DSM-5 Disorders (Key Features, Onset and Duration, Treatment)

Anxiety

• Apprehension over an anticipated problem (future threat)

• Increases preparedness

• Moderate Arousal

Fear

• Immediate danger

• Activates fight or flight (Triggers changes in the SNS)

• High Arousal

Criteria for each Anxiety Disorder

• Interfere with important areas of functioning

• Not caused by a drug/medical condition

• DURATION: At least 6 months; at least 1 month for panic disorder

Phobias

• Fear of objects or situations that is out of proportion to any real danger

• Recognizes that the fear is excessive but still goes to great lengths to avoid the feared object/situation

• Avoided/endured with intense anxiety

Agoraphobia

General Description

• Fear of closed spaces (In two or more situations)

• Spatial Dimension: Anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occured

• There’s a lot of people and you feel of getting trapped

DSM-5 Criteria

• Disproportionate and marked fear or anxiety about at least two situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing symptoms, or panic-like symptoms

• These situations consistently provoke fear or anxiety

• These situations are avoided, require the presence of a companion, endured with intense fear or anxiety

Acrophobia

• Fear of heights

Social Anxiety Disorder (SAD)

General Description

• Persistent, unrealistically intense fear of social situations that involve being scrutinized by/exposed to

• Social Interaction Component: Fear of Public Speaking/Speaking in Meetings or Classes/Having conversations with big groups of people

• 6 months or more

DSM-5 Criteria

• Marked and disproportionate fear triggered by exposure to potential social scrutiny

• Exposure to the triggers lead to intense anxiety about being evaluated negatively

Other notes from TOS

• Can have panic attacks cued by social situations

• Blushing: Hallmark physical response of SAD

• Paruresis: Difficulty peeing in public restrooms

• Possible Comorbidities: BDD, Avoidant PD (Adults) and ASD and Selective Mutism (Children)

Generalized Anxiety Disorder (GAD)

General Description

• Excessive, uncontrollable, unproductive and long-lasting worry about minor things

• WORRY → general feature of GAD

  • Worry continues because the person cannot settle on a solution to the problem

• Difficulty concentrating, Tiring easily, Restlessness, Irritability, and Muscle Tension

• ONSET: Begins in adolescence

DSM-5 Criteria

• Excessive Anxiety and Worry at least 50% of days about a # of events or activities

• The person finds it hard to control the worry

• Anxiety and worry are associated with at least three (or one in children of the following): restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

Other Notes from TOS

• Intense cognitive processing in the frontal lobe (left hemisphere)

• decreased GABA activity

Culturally specific Anxiety syndromes [parang may ganto sa pre-test]

1. Taijin Kyofusho - SAD in the Japan context (Fear of displeasing/embarassing others)

2. Kayak-angst - Panic Disorder of Greenland (Seal hunters who are alone at sea may experience intense fear/disorientation/concerns about drowning)

3. Susto - Belief that a severe fright has caused the soul to leave the body

4. Koro - sudden fear that one’s genitals will recede into the body

5. Shenkui - Intense anxiety and somatic symptoms attributed to the loss of semen

Panic Disorder

General Description

• Experienced one or more panic attacks

• Anxious and fearful about having future attacks

DSM-5 Criteria

• A person must experience recurrent panic attacks that are unexpected

• A person must worry about the attacks or change his or her behavior because of the attacks for at least 1 month

Other Notes from TOS

• Cannot be diagnosed unless full symptom panic attacks were experienced

• Norepinephrine activities are irregular

Panic Attack

• Person feels apprehension leading to intense fear

• Sensation of going crazy or losing control

• Physical signs of distress

• It can be cued, uncued, situationally predisposed

Treatment of Anxiety Disorders

General (Psychological)

• In general: Cognitive Behavioral Therapy (Exposure is the core component)

• Systemic Desensitization: Change the way you respond to objects, people, or situations that trigger feelings of fear and anxiety (If a person fears a bird, then show a picture of the bird).

• Virtual Reality: Simulate feared situations such as flying, heights, and social interactions

• In Vivo (real-life exposure) and imagery: Directly facing a feared object, situation, or activity in real life.

• Fear-stimulus hierarchy:

• Gradual Exposure:

General (Biological)

• Medication + Psychotherapy = best combination

• Benzodiazepines (Valium and Xanax) = preferred for general ADs

Treatment for Specific Anxiety Disorders

• Phobias:

  • Psychological: In-vivo (real life) exposure

  • Biological: Beta-adrenergic receptor antagonists

• Social Anxiety Disorder: CBT, Social Skills Training, Clarks’ Cognitive Therapy

  • Clarks’ Cognitive Therapy: Reduce internal focus of attention + Challenge negative images of how others will react

• Panic Disorder:

  • Psychological: CBT and Psychodynamic Treatment

  • Cognitive: Family oriented therapy and panic control therapy

  • Biological: Alprazolam (Xanor), Paroxetine (Paxil), SSRIs

• Agoraphobia:

  • Psychological: CBT

  • Biological: Alprazolam (Xanor), Paroxetine (Paxil), SSRIs

• GAD:

  • Cognitive: Intensive Relaxation Training, Cognitive Behavioral Methods

Obsessive-Compulsive Disorder

General Terms and DSM-5 Criteria (those italicized are indicated in the DSM-5)

• Often begins before the age of 14, some early adulthood

• Obsessions: recurring, intrusive, and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate

  • Tried to ignore, suppress, or neutralize the thoughts, images, urges

  • These are uncontrollable and irrational

    • Obsessions don’t usually involve real life concerns

• Compulsions: repetitive, clearly excessive behaviors/mental acts that the person feels driven to perform to prevent distress/dreaded event

  • Acts that are excessive/unlikely to prevent the dreaded situation

  • The compulsions are NOT PLEASURABLE

  • Feels driven to perform the behaviors/thoughts in response to obsessions or according to rigid rules

  • Tendency to repeat a ritual if they did not execute it precisely

  • Time consuming (at least one hour per day)

• Sensory Phenomena: Physical experiences that precede compulsions

• Accommodation: Involvement of family and friends in compulsive rituals

Common Compulsive Rituals of individuals diagnosed with OCD

1. Decontamination

2. Checking

3. Repeating Routine Activities (Touching a body part/repeating a word again and again)

4. Ordering/Arranging

5. Mental Rituals (Counting, Repeating a phrase)

Treatment for OCD

• Antidepressants are the most common

• Tricyclic Antidepressants:

  • Clomipramine: SNRI

• SSRI: Recommended as a first line treatment

  • Fluoxetine, Fluvoxamine, Sertraline, Paroxetine

• Last resort: Cingulotomy

• Exposure and Response Prevention

  • Exposure: Expose to situations that elicit obsessions and related anxiety

  • Prevention: Prevent them from performing compulsive ritual

• Exposure Hierarchy (From less threatening to more threatening stimuli)

Body Dysmorphic Disorder

General and TOS

• Onset: Begins in adolescence

• 3-8 hours per day

• Keyword: IMAGINED defect and ugliness

• Excessive appearance-related preoccupations and repetitive behaviors that are time-consuming

DSM-5 Criteria

• Preoccupation with one or more perceived defects in appearance

• Others find the perceived defect(s) slight or unobservable

• Performance of repetitive behaviors or mental acts (e.g., mirror checking, seeking reassurance, or excessive grooming) in response to the appearance concerns

• Preoccupation is not restricted to concerns about weight or body fat

Treatment for BDD

• Exposure and Response Prevention (ERP)

  • [Exposure to the most feared activities] Therapists might ask clients to interact with people who could be critical of their looks.

  • [Response prevention] Therapists might ask clients to avoid activities they use to reassure themselves about their appearance, such as looking in mirror

Hoarding Disorder

DSM-5 Criteria:

• Persistent difficulty discarding or parting with possessions, regardless of their actual value

• Perceived need to save items

• Distress associated with discarding

• The accumulation of a large number of possessions clutters active living spaces to the extent that their intended use is compromised unless others intervene

General

• The need to acquire is excessive + extremely attached + difficulty discarding

• Onset: Early Childhood or Early Adolescence

• With Excessive Acquisition: If difficulty discarding possessions is accompanied by excessive acquisitions of items that are not needed or for which there is not available space - other common

• Includes hoarding animals

• Unaware of the severity of the problem

• Results in squalid relationships and impacts relationships

Trichotillomania

• Excessive Hair Pulling

• triggered by feelings of anxiety of boredom, may be preceded by an increasing sense of tension or may lead to gratification, pleasure, or sense of relief when the hair is pulled out

• Hair pulling does not usually occur in the presence of other individuals, except immediate family members

Excoriation

• Excessive Skin-Picking

Onychophagia

• Excessive Nail Biting

Treatment for Hoarding Disorder

• Exposure and Response Prevention

Posttraumatic Stress Disorder and Acute Stress Disorder

OVERVIEW

• Trauma-related disorders are diagnosed only when a person develops symptoms after a traumatic event

• Trauma-related diagnoses rest on the idea that horrific life experiences can trigger serious psychological symptoms.

  • These diagnoses contrast with all other major DSM diagnoses, which are defined entirely by symptom profiles.

    No other major DSM diagnosis places emphasis squarely on the cause

Post Traumatic Stress Disorder (PTSD)

General

• Exposure to actual death, injury or sexual violence (direct experience, witness, learning that the event happened to a close family, repeated exposure)

DSM-5 Criteria

• [At least one] Intrusion/Intrusively reexperiencing the traumatic event

  • Recurrent and intrusive memories, dreams, flashbacks, dissociative reactions

• [At least one] Avoidance of stimuli associated with the event a.

  • Internal and external reminders

  • Sir’s Example: If you experienced a car accident, you might drive a different route or let go of driving

• [At least 2] Negative mood and alterations in cognitions

  • persistent negative beliefs and negative emotional states

  • Sir’s Example: Difficulty of comprehending a traumatic event → Numbness → Difficult to make sense emotionally

• [At least 2] Increased arousal and reactivity

  • Aggressiveness, hypervigilance, exaggerated startle response, poor concentration, sleep disturbance

• The symptoms began or worsened after the trauma(s) and continued for at least 1 month.

• Among children younger than 7, diagnosis criteria requires A, B, E, and F; but only one symptom from either C or D

Treatment for PTSD

Biological

• SSRIs and SNRIs

• Benzodiazepine

Psychological

• Exposure Treatment

• Exposure Hierarchy

• In Vivo

• Imaginal Exposure - person deliberately remembers the event

• Eye Movement Desensitization & Reprocessing

Acute Stress Disorder

• Symptoms are similar to PTSD, but shorter duration of symptoms

• Duration of Symptoms: 3 days to 1 month

• Diagnosis of ASD is not always predictive of who will develop PTSD

Adjustment Disorder

• Development of emotional or behavioral symptoms in response to identifiable stressors occuring within 3 months of the onset of the stressors

• Symptoms disappear when stressor ends or the person adapts

Prolonged Grief Disorder

• Death, at least 12 months, of a person close to the bereaved individual (6 months for children)

• Focused on loss and separation from a loved one rather than reflecting generalized low mood

• Distress from a deceased person

• Heightened by increased dependency on the deceased prior to death

Complex Somatic Symptom Disorder

General

• One or more symptoms cause distress and disruption of daily life

  • Distress revolved around a somatic symptom that exists!!

• Chronic, influenced by the number of symptoms, age, level of impairment, and any comorbidity

• General health services > mental health services

• Must be accompanied by excessive or disproportionate thoughts, feelings, or behavior

• Focus is on the distress that particular symptoms cause

• Individual’s belief that somatic symptoms might reflect serious underlying physical illness are not held with delusional intensity

DSM-5 Criteria

• At least one somatic symptom that is distressing/disrupts daily life

• Duration of at least 6 months

• Excessive thought, distress, and behavior related to somatic symptom(s) or health concerns as indicated by at least one of the following:

  • Health-related anxiety

  • Disproportionate and persistent concerns about the seriousness of symptoms

  • Excessive time and energy devoted to health concerns

Illness Anxiety Disorder

General

• preoccupation with fears of having a serious disease despite having no significant somatic symptoms

• Easily alarmed about one’s health

• Haunted by visual images of becoming ill/dying

• Usually minimal to no symptoms, mild intensity

• Interpret ambiguous stimuli as threatening

• Care Avoidant (Don’t seek medical care) or Care Seeking (Jump from one doctor to another)

• Hypochondriasis (Another term for IAD)

  • is common in medical students

DSM-5 Criteria

• Preoccupation with and high level of anxiety about having or acquiring a serious disease

• Preoccupation lasts at least 6 months

• No more than mild somatic symptoms are present

• Not explained by other psychological disorders

• Excessive illness behavior or maladaptive avoidance

Functional Neurological Symptom Disorder (Conversion Disorder)

General

• Symptoms are INVOLUNTARY

• Person suddenly develops neurological symptoms, such as blindness, seizures, orparalysis

• The symptoms suggest an illness related to neurological damage, but medical tests indicate that the bodily organs and nervous system are fine.

• People may experience partial or complete paralysis of arms or legs, seizures, coordination disturbances, a sensation of prickling, tingling, or creeping on the skin, insensitivity to pain

• Onset: Adolescence or Early Adulthood

Terms

• Anethesia: Loss of sensation/insensitivity to pain

• Tunnel Vision: Vision may be seriously impaired, may become partially blind

• Aphonia: Loss of the voice

• Nonepileptic Seizure Disorder: Common form of Seizure Disorder

• Glove Anesthesia: Person experiences little or no sensation in the part of the hand and lower arm that would be covered by a glove

DSM-5 Criteria

• One or more symptoms affecting voluntary motor or sensory function

• The symptoms are incompatible with recognized medical disorder

• Symptoms cause significant distress or functional impairment or warrant medical evaluation

Factitious Disorder

General

• People intentionally produce symptoms to assume the role of the patient

• They make up the symptoms and report acute pain

• Munchausen Syndrome: Internal Gains/No Motive

DSM-5

• Fabrication or induction of physical or psychological symptoms, injury to others as ill, impaired, or injured

• Deceptive behavior is present in the absence of external rewards

• Factitious Disorder Imposed on the Self: Present themselves as ill, impaired, injured

• Factitious Disorder Imposed on the Other: Fabricates/Induces symptoms in another person

Malingering Disorder

General

• Symptoms are under VOLUNTARY CONTROL

• Intentionally fakes a symptom to avoid a responsibility and to achieve a reward

Treatment for Somatic Symptom and Related Disorders

General:

• MEDICAL CARE > Mental Health Care

• Analgesics don’t benefit patients

• Antidepressants - Imipramine (Tofranil)

Somatic Symptom Disorder and Illness Anxiety Disorder

• CBT

• ACT

Conversion Disorder

• CBT

Dissociative Disorders

• Dissociation - core feature of each dissociative disorder

  • Avoidance response that protects the person from consciously experiencing stressful events

• Emotion, Memory, Experience of being inaccessible easily

• Break from reality/awareness

  • Normal: Integration of the different parts of the self

  • There is a reason why the self is breaking away

Depersonalization

• Being detached from one’s self (being an observer from one’s body)

  • You temporarily lose the sense of your own reality or there’s a detachment from one’s mental processes

• Duality of Self (It’s like I’m watching myself on a movie)

Derealization

• Sense of detachment from one’s surrounding

  • Unreality of surroundings

• Outside of their bodies, viewing themselves from a distance or looking at the world through a fog.

Depersonalization/Derealization

General

• Onset: Adolescence

DSM-5 Criteria

• Symptoms must be persistent and recurrent

  • Triggered by Stress

  • Start abruptly or gradually

• NO DISTURBANCE OF MEMORY

• Symptoms can co-occur with other disorders but should not be entirely explained by those disorders

Dissociative Amnesia

General

• Unable to recall important personal information (mostly traumatic experience)

  • Acute Trauma

• Reversible: Episode may last as briefly as several hours to as long as several years

• Disappears as it began, with complete recovery of memory + small chance of recurrence

• Loss of explicit, not implicit memory

  • Procedural Memory is intact (answering the phone/executing complex actions)

DSM-5 Criteria

• Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness

• The amnesia is not explained by substances, or by other medical or psychological conditions

• Specify fugue subtype if the amnesia is associated with bewildered or apparently purposeful wandering

Dissociative Fugue Subtype

• Fugere = to flee

• Sudden, unexpected travel away from home/place of origin, with inability to recall some or all of one’s past

• Confusion about personal identity or assumption of new identity

Dissociative Identity Disorder

General

• At least 2 separate personalities or alters

  • Each determines the person’s nature and activities when it is command

  • Primary Alter may be unaware that the other alter exists + have no memory of what those other alters do and experience when they are in control

  • Primary Alter (Host Personality) → seeks treatment

• Defining Feature: Dissociation of certain aspects of the personality

• Possession → posed character as a form of dissociation

• Psychodynamic and Unconscious → repression/splitting off from the conscious and unconscious parts of the self due to traumatic experiences

• Onset: Adulthood

DSM-5

• Recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting

• Symptoms are not part of a broadly accepted cultural or religious practice

• Symptoms are not due to drugs or a medical condition

• In children, symptoms are not better explained by an imaginary playmate/fantasy play

Treatment for Dissociative Disorders

General Treatment

• Anti-depressants

• Long term therapy

• CBT

• Psychoanalysis

Dissociative Amnesia

• Cognitive Therapy

• Hypnosis

• Somatic Therapies

• Group Psychotherapy

Depersonalization

• SSRI (Prozac) or Sertraline (Zoloft)

• Adjunct psychotherapy

Psychosis

Severe mental condition characterized by a loss of contact with reality

Delusion

• Beliefs contrary to reality and firmly held despite disconfirming evidence

Hallucination

• Sensory experiences in the absence of stimulation from the environment

• Hearing their own thoughts spoken by another voice

Types of Hallucinations

1. Auditory Hallucination - most common

2. Autoscopic Hallucination - individual experiences, all or part of the person’s own body appeared within the external space

3. Hypnagogic Hallucination - happens during sleep

4. Ictal Hallucination - associated with temporal lobe foci

5. Hypnopompic Hallucination - happens when waking up

Schizophrenia

General/Sir’s insights

• Characterized by disordered thinking: Ideas are not logically related, faulty perception and attention, lack of emotional expression, disturbances in behavior

• 6 months; 2 to 5 symptoms (positive, negative, disorganized, motor)

• Total Disintegration

  • Communication does not make sense anymore

• Dopamine and Glutamate

• Biological Aspect of Schizophrenia: Dysfunction in prefrontal cortex and temporal cortex, enlarged ventricles, excess activity of dopamine

Positive Symptoms in Schizophrenia

Excesses, Distortions, Hallucinations, and Delusions

Negative Symptoms in Schizophrenia

• Behavioral deficits in motivation, pleasure, social closeness, and emotion expression

Disorganized Symptoms in Schizophrenia

• Disorganized Speech:

  • Formal thought disorder

  • Problems in organizing ideas and in speaking (Incoherence)

• Disorganized Behavior

  • May go into inexplicable bouts of agitation, dress in unusual clothes, act in a silly manner, hoard food, or collect garbage.

  • They seem to lose the ability to organize their behavior and make it conform to community standards.

  • They also have difficulty performing the tasks of everyday living.

Thought Insertion (Type of Delusion)

• Person may believe that thoughts that are not his or her own have been placed in his or her mind by an external source

• A woman may believe that the government has inserted a computer chip in her brain so that thoughts can be inserted into her head.

Thought Broadcasting (Type of Delusion)

• Person may believe that his or her thoughts are broadcast or transmitted, so that others know what he or she is thinking.

• External force controls his/her feelings of behavior

• When walking down the street, a man may look suspiciously at passers by, thinking that they are able to hear what he is thinking even though he is not saying anything out loud.

Grandiose Delusions (Type of Delusion)

• Exaggerated sense of his/her own importance, power, knowledge, or identity

• A woman may believe that she can cause the wind to change directions just by moving her hand

Ideas of Reference (Type of Delusion)

• Incorporating unimportant events within a delusional framework and reading personal significance into the trivial activities of others.

• Belief that gestures, comments, or other cues in the environment have special meaning directed at oneself

• People with this symptom might think that overheard segments of conversations are about them

  • You are receiving secret messages from the newspaper/TV

Thought Withdrawal (Type of Delusion)

• The belief that your thoughts have been withdrawn, against your will by an outside entity

Persecutory Delusions

• Belief that one is going to be harmed, harassed and so forth

• Being followed/spied on, their house and phone are tapped, they are being drugged/conspired against

Erotomanic Delusions

• When an individual falsely believes that another person is in love with him or her (a famous/important person)

Nihilistic Delusions

• Conviction that major catastrophe will occur/reality doesn’t exist

Somatic Delusions

• Focus on preoccupations regarding health and organ function

• Feeling of bugs crawling on/inside your body, that they have a medical ailment, feeling pregnant

Cotard’s Syndrome

• The person believes someone he or she is dead

Capgras Syndrome

• Person believes someone he or she knows has been replaced by a double/imposter

Fregoli Syndrome

• Belief that a familiar person is changing their appearance due to an ulterior motive

Avolition

• Avolition is synonym with Motivation (Lack of motivation)

• Lack of motivation and a seeming absence of interest in or an inability to persist in what are usually routine activities, including work or school, hobbies, or social activities.

• Difficulty persisting at work, school, or household chores and may spend much of their time sitting around doing nothing

• Self vs Others (Motivation

  • Less motivated if related to the self (autonomy, gaining new knowledge, praise by others)

  • Equally motivated by goals that had to do with relatedness to others

Asociality

• Severe impairments in social relationships

• Few friends, poor social skills, little interest in being with others

• Not desire close relationships with family, friends, romantic partners

• When around others, people with this symptom may interact only superficially and briefly and may appear aloof or indifferent to the social interaction

Anhedonia

• Loss of interest in/lessening experience of pleasure

• Consummatory Pleasure: Amount of pleasure experienced in the moment/presence of something pleasurable

• Anticipatory Pleasure: Amount of expected/anticipated pleasure from future events/activities

  • Individuals with Schizophrenia have a deficit in this area

Blunted Affect

• Lack of outward expression of emotion

• Stare vacantly (muscles of the face are motionless, eyes are lifeless)

• When spoken to, the person may answer in a flat and toneless voice and not look at his or her conversational partner.

Alogia

• Significant reduction in the amount of speech

• A person may answer a question with one or two words and will not be likely to elaborate on an answer with additional detail.

• Ex: If you ask a person with alogia to describe a happy life experience, the person might respond “getting married” and then fail to elaborate even when asked for additional information.

Circumstantiality (Disorganized Speech)

• Excessive and Irrelevant detail in descriptions with the person eventually making his/her point

Concrete Thinking (Disorganized Speech)

• Unable to abstract and speaks in concrete + literal terms

Clang of Associations (Disorganized Speech)

• Groups of words chosen because of the catchy way they sound, not because of what they mean

Loose Association

• A loose connection between thoughts that are often unrelated

Neologism

• Creating a new word meaning only to that person

Inappropriate Affect

• Laughing/crying at improper times

Catatonia

• Gesture repeatedly, using peculiar and sometimes complex sequences of finger, hand, and arm movements, which often seem to be purposeful

• Some people manifest an unusual increase in overall level of activity (excitement/flailing of limbs/great expenditure of energy similar to mania)

• Another end of the spectrum is immobility: People adopt postures and maintain them for very long periods of time

• Catatonia Stupor: profound state of unresponsiveness, inability to speak/move, reduced reactivity to external stimuli

• Catatonia Excitement: extreme agitation and hyperactivity, exhibit erratic behavior

Schizophrenia DSM-5 Criteria

• Two or more of the following symptoms for at least 1 month. One symptom should be either 1, 2, or 3

  • [1] Delusions; [2] Hallucinations; [3] Disorganized speech; [4] Disorganized (or catatonic) behavior; [5] Negative symptoms (diminished motivation or emotional expression)

• Functioning in work, relationships, or self-care has declined since onset

• Signs of disorder for at least 6 months or, if during a prodromal or residual phase, negative symptoms or two or more of symptoms 1–4 in less severe form

• Phases of Schizophrenia:

  • Prodromal

  • Psychotic

  • Residual

Delusional Disorder

• One or more delusions for at least 1 month

• Persistent belief that is contrary to the reality in the absence of other characteristics of schizophrenia

• Types of Delusions that are present: Erotomanic delusion, Jealous delusion, Grandiose delusion, Persecutory delusion, Somatic delusion

• Shared Psychotic Disorder: Two people sharing a delusional belief (close relationship with a delusional individual)

Brief Psychotic Disorder

• Sudden onset of psychotic symptoms last from 1 day to 1 month

• Brought by extreme stress

Schizophreniform Disorder

• Same with schizophrenia

  • One time stressor/traumatic event

• Greater than 1 month but less than 6 months

Schizoaffective Disorder

• Mixture of symptoms of schizophrenia and mood disoders

• DSM-5 requires either a depressive or manic episode rather than mood disorder symptoms

Treatment of Schizophrenia

• Biopsychosocial Approach

• Medication

  • Antipsychotic Drugs

    • 1st Generation Drugs: reduce positive and disorganized symptoms/little or no effect on negative

    • 2nd Generation Drugs: more effective in reducing negative symptoms and improving cognitive functioning

• Psychological Treatment

  • Patient Outcomes Research Team

  • Social Skills Training

  • Family Therapies - Psychoeducation, Communication Skills, Blame-avoidance & reduction, Spiritual Therapy, Case Management

  • Cognitive Behavioral Therapy

Attenuated Psychosis Syndrome

• Identify young people who are at risk for developing schizophrenia

Major Depressive Disorder

General

• 5 depressive symptoms present within 2 weeks or more

• Episodic Disorder (symptoms tend to disappear)

DSM-5 Criteria

• Sad mood OR Loss of interest and pleasure

• Plus four other symptoms

  • Sleeping too much/too little

  • Feelings of worthlessness/excessive guilt

  • Psychomotor Retardation or Agitation

    • Retardation: Slow movement

    • Agitation: Not so still movements

  • Difficulty concentrating, thinking, or making decisions

  • Loss of energy

  • Recurrent thoughts of death/suicide

Persistent Depressive Disorder (Dysthymia)

DSM-5 Criteria

• Chronically depressed for at least two years

• 1 year for children or adolescents

• Plus 2 other symptoms: poor appetite/overeating, sleeping too much/too little, low energy, poor self-esteem, trouble concentrating/making decisions, feelings of hopelessness

• Symptoms do not clear for more than 2 months at a time

Double Depression

• Suffers from both MDD and PDD with fewer symptoms

Premenstrual Dysphoric Disorder

• Mood symptoms in the week before menses

Disruptive Mood Dysregulation Disorder

• 3 or more times a week; 12 or more months in at least 2 settings

• Recurrent temper outbursts (verbal and behavioral) + Persistent Mood for at least 1 year beginning before age 10

• Irritable and Angry most of the day

• Diagnosis cannot be assigned to a child who has ever experienced full-duration hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or hypomanic episode lasting more than 1 day

• Presence of severe and frequently recurrent outburst and persistent disruption in mood between outburst

• Severe in at least one setting and mild to moderate to second setting

Seasonal Affective Disorder

• Moods vary with the weather (changing seasons)

• Subtype/specifier of MDD

Mixed Anxiety/Depressive Disorder

• Both anxiety and depression are present

Mania

• State of intense elation, irritability, or activation

• During manic episodes, people will act and think in ways that are highly unusual compared to their typical selves.

  • Louder, make incessant stream of remarks, interjections about nearby stimuli

  • Extreme pleasure and joy from every activity

  • Extraordinarily active, plan excessive daily activities

  • Sleep little w/o getting tired

  • Grandiose plans to reckless behavior

  • Racing thoughts

  • Easily distracted and irritated

• Flight of Ideas

• Sociable to the point of intrusiveness

• Excessively self-confident

• A day or two

Hypomania

• Change in functioning does not cause serious problems

• Feel more social, energized, productive, and sexually alluring

• Less intense than mania with no significant impairment

Manic and Hypomanic Episodes

DSM-5 Criteria

• Distinctly elevated/irritable mood

• Abnormally increased activity/energy

• PLUS 3 other symptoms (4 if mood is irritable):

  • Increase in goal-directed activity/psychomotor agitation

  • Unusual talkativeness/rapid speech

  • Flight of Ideas/Subjective Impression that thoughts are racing

  • Excessive involvement in pleasurable activities that ae likely to have painful consequences

  • Decreased need for sleep

  • Increased self-esteem

  • Distractibility

  • Symptoms are present most of the day

Manic and Hypomanic (Duration of Episodes)

• Manic Episode:

  • Symptoms last 1 week, require hospitalization, include psychosis

  • Symptoms cause significant distress/functional impairment

• Hypomanic Episode

  • Symptoms last at least 4 days

  • Clear changes in functioning are observable to others but no impairment

Bipolar I Disorder

• At least 1 episode of Mania (at least for one week)

• Don’t have depressive episodes

Bipolar II Disorder

• Milder form of bipolar

• At least one major depressive disorder and at least one episode of hypomania

• No lifetime episode of mania

Cyclothymic Disorder

• Milder, chronic form of Bipolar Disorder

  • Fluctuations alternate between hypomania and mild depression

  • Not accompanied by the severe social or occupational problems associated with full blown manic episodes

• Symptoms last at least 2 years in adults, never without for more than 2 months

• Numerous periods with hypomanic and depressive symptoms

  • Does not meet criteria for hypomania/MDE

  • Symptoms cause significant distress/impairment

Treatment for Mood Disorders

Major Depresive Disoder

In General: Psychotherapy + Antidepressant Medications

Biological

• Electroconvulsive Therapy (ECT) - did not respond to medication

• Antidepressants (Medication)

  • Monoamine Oxidase Inhibitors, Tricyclic Antidepressants, SSRIs, SNRIs

• Transcranial Magnetic Simulation - failed to respond to antidepressants

Psychological

• Interpersonal Therapy

• Cognitive Therapy

  • Mindfulness-based cognitive therapy

• Behavioral Activation Therapy

• Behavioral Couples Therapy

Bipolar Disorder

Biological

• Mood Stabilizing Medications - reduce manic symptoms, used continually for the person’s entire life

  • Lithium - decreases severity of relapse

  • Anticonvulsants - antiseizure medications

  • Antipsychotics - calming effect

Psychological

• Psychoeducational Approaches

• Cognitive Therapy

• Family-focused Treatment

DSM-5 Criteria for General Personality Disorder

• Inflexible pattern of inner experience and behavior that is distinct from cultural expectations and influences at least two of the following:

  • Cognition about the self and others

  • Affect

  • Interpersonal Functioning

  • Impulse Control

• Onset: Adolescence or Early Adulthood

• Pattern'

  • Causes significant distress/impairment

  • Inflexible

  • Pervasive across situations

• Not explained by another medical disorder/medical condition/substance

Cluster A (General Overview, Similarities)

• Bear some similarity with Schizophrenia’s symptoms

• Presence of Bizarre thinking, Functional Impairments are less severe than Schizophrenia, Hallucinations are not present

• In terms of relationships: They are most likely to be distant, have a hard time maintaining relationships

Paranoid Personality Disorder

TLDR:

• “I cannot trust people”

• Lack of trust, suspicious of other people as they would see them as a threat. This leads to self-isolation

General/Key Words

• Suspicious of others

• Secretive + Looks out for signs of trickery and abuse

• Hostile and angry in response to perceived insults

• Social Worlds are filled with conflict

• Need to have a high degree of control over the people around them

• Rigid, critical of others, unable to collaborate

Schizoid Personality Disorder

TLDR

• “Relationships are messy and undesirable”’

• Does not exhibit lack of trust and suspiciousness, but just generally prefers solitary activities. They do not want to be around others, leading to a lack of social skills and interest in romantic or sexual relationships. They still have a few friends

General

• Do not desire/enjoy social relationships (Detachment from social relationships)

• General lack of emotionality and enjoyment

  • When interacting with people, they appear aloof + cold. Don’t show warm + tender feelings

• Rarely experience strong emotions

Schizotypal Personality Disorder

TLDR

• Eccentric thoughts and behaviors, interpersonal detachment, suspiciousness

• Alien from the Parking Lot Activity

• Schizophrenia Symptoms: Ideas of Reference, Odd beliefs/Magical Thinking, Odd thinking and speech, Odd + Eccentric + Peculiar behavior

General

• Odd beliefs/Magical Thinking: They believe that they can read people’s minds

• Recurrent Illusions: Inaccurate Sensory Perceptions

• Eccentric behavior and appearance

• Do not develop delusions, but severe psychotic symptoms