DSM 5 disorders

Intellectural Developmental disorder

Deficits in mental abilities and adaptive functioning in one or more activities, across multiple environments; level of severity based on adaptive functioning

Onset during developmental period

IQ scores two or more standard deviations below the mean

Adaptive functioning is assessed on 3 areas:

• conceptual/academic domain: memory, language, reading, writing, math reasoning, problem solving

• Social domain: empathy, interpersonal communication, friendship abilities, social judgment

• practical domain: personal care, money management, recreation, school and work task organization

Intellectual functioning MUST be determined BOTH by clinical assessment and standardized intelligence testing; adaptive functioning may be determined by clinical assessment as well as standardized testing

SPECIFIERS:

• Mild: difficulties learning academic skills and making functional use of them in everyday life; successfully maintain employment; social relationship marked by immaturity and gullibility; able to care for themselves but need support for more complex daily living tasks

• Moderate: low conceptual skills; adults achieve academic skills at elementary level; significant support needed in work settings; can achieve basic self-care and are able to complete household tasks but extended training is required

• Severe: low levels of conceptual skills and written language; speak single words or phrases; support is required for all activities of daily living

• Profound: significant motor and sensory impairments, little understanding of language; express by nonverbal language; dependent on others for virtually all aspects of daily living

Etiologies:

• Prenatal (75%), perinatal (10-15%) and postnatal (10-15%) etiologies

• Genetic factors: small influence; 5%

• Environmental factors: larger role; alterations during the embryonic stage of development (conception to 8 weeks)

  • Exposure in utero to pollutants, chemicals, toxins (alcohol consumption)

Prevalence and Comorbidity

• 1%; 85% mild specifier

• 3-4 times more comorbid mental disorders

• male- 1.5: female-1

Global Development Delay

A child under the age of 5 fails to meet expected governmental milestones and cannot be reliably assessed

Language disorder

Difficulty acquiring and using language due to deficits in comprehension or production

• Limited vocabulary, limited sentence structure and impairments in discourse

Onset in the early developmental period. Diagnosed at age 4 or later is likely to be stable over time and persist into adulthood.

Speech sound disorder

difficulty with phonology and articulation that interferes with intelligibility or prevents verbal communication

Examples include errors in sound production or use,

The difficulties improve overtime and may not be lifelong

Childhood onset, fluency disorder (stuttering)

Disturbance in normal fluency that is characterized by sound and syllable repetition, interjections, broken words, blocking, and monos Civic whole word repetitions

• Stuttering is normal until about age 2

• Onset occurs by age 6; large percentage (65 to 85%) of children recover from the dysfluency

Social communication disorder

Difficulties in the social use of verbal and nonverbal communication

• Deficits and communication for social purposes, such as greeting

• Problems changing communication to match contacts example speaking differently in a classroom then on the playground

• Difficulty following rules of conversations, such as taking turns

• Difficulty understanding, non-literal and ambiguous meanings, such as idioms, humor, and metaphor

Autism spectrum disorder

1. Persistent deficits in social communication and interaction.

   1. Present across multiple contexts

   2. Deficits in all three of the following areas: social-emotional reciprocity, nonverbal behaviours used in social interaction and development and understanding of relationships

2. Restricted, repetitive patterns of behaviour; at least two of the following:

   1. Stereotyped or repetitive motor movement or speech

   2. Inflexible adherence to routine,

   3. highly restricted, fixated interests

   4. hyper or hypo reactivity to sensory input

Symptoms must be present in the early developmental period; symptoms evident in the second year of life (12 to 24 months)

Frequency of ASD is 1-2%; absence of intellectual impairment with the presence of functional language by age 5

Male to female ratio is 3:1

Heritability estimates are high, from 35 to 90% in twin studies; 15% associated with known genetic mutation

A savant

individual with striking abilities, who otherwise exhibits severe deficits in every day, cognitive functioning and or social interactions

Rett syndrome

found exclusively in females and is a neurodevelopmental disorder characterized by normal prenatal and perinatal development, normal cycle motor development through five months and normal head circumference at birth

Between five months and 48 months, there is sudden deceleration of head growth, acquisition of stereotyped hand movements, loss of social engagement, and the appearance of poorly coordinated movements

Attention deficit/hyperactivity disorder (ADHD)

Characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity for at least 6 months, with at least some of the symptoms having been present before 12 years of age; impairment must occur in at least two settings

Criteria for inattention; six or more of the following symptoms

1. Failure to pay attention to details resulting in careless errors

2. Difficulty sustaining attention to tasks

3. Does not seem to listen when spoken to directly

4. Does not follow through or fails to finish assignments

5. Has difficulty organizing tasks

6. Avoid task task tasks, requiring sustained attention

7. Frequently loses things

8. Is easily distracted

9. Is forgetful in daily activities

Criteria for hyperactivity – impulsivity; six or more of the following symptoms:

1. Frequently fidgets or squirms

2. Stands up when remaining seated is expected

3. Runs or climbs excessively in inappropriate situations

4. Difficulty playing quietly

5. Is constantly on the go

6. Talks excessively

7. Blurt out answers before questions have been completed

8. Difficulty waiting for their turn

9. Interrupt or intrude on others

Coded as combined presentation, predominantly inattentive presentation or predominantly hyperactivity/impulsive presentation

Severity; mild, moderate or severe

Occurs in about 7% of children and 2.5% of adults

More common in males than females; ratio of 2:1

Heritability estimates are at 75%

Medications used include stimulants: Ritalin (methylphenidate), Concerta (methylphenidate), adderall (amphetamine), Dexedrine (dextroamphetamine), Vyvanse, and non-stimulant Strattera

Children treatments: Behavioural therapy, social skills training, parenting, education, and neurofeedback

Adults treatments: cognitive behaviour therapy

Disorder tends to be relatively stable through early adolescence. In adolescence and adulthood, symptoms of motoric hyperactivity decrease; difficulties with restlessness, inattention, poor planning, and impulsivity continue; 1/3 of children with ADHD remain impaired into adulthood

Frequently comorbid with oppositional defiant disorder 50% of the time or conduct disorder 25% of the time

Early adulthood is associated with increased suicide risk when comorbid with a mood, conduct or substance use disorder

Specific learning disorder

difficulties, learning and using academic skills with the presence of at least one of the following symptoms for at least six months:

1. Inaccurate or slow and effort for

2. Difficulty understanding the meaning of what

3. Difficulties with spelling

4. Difficulties with written expression

5. Difficulties, mastering number, facts or calculation

6. Difficulty with mathematical reasoning

Learning problem interferes with academic/occupational performance or activities of daily living and must be substantially below, which is achievement test scores that are at least 1.5 standard deviations below the population mean for age

All academic domains and sub skills that are in prayer should be coded

Specifiers include with impairment in reading with impairment in written expression, and with impairment in mathematics

Prevalence rate 5 to 15%

More common in males than female; 2:1 - 3:1

5 to 10 times higher in first-degree relatives

Comorbid disorders include neurodevelopmental disorders or other mental disorders

Dyslexia

problems in reading and writing

dyscalculia

problems in mathematical function

Developmental coordination disorder

individuals coordinate motor skills are significantly below those expected for their chronological age

Deficits interfere with a daily functioning and include clumsiness, slow and inaccurate motor skills

Onset during the developmental period.

Stereotypic movement disorder

Motor behaviour that is repetitive and nonfunctional (body rocking, head banging, self-biting) that interferes with normal activities or results in self-inflicted bodily injury

Cannot be diagnosed if these behaviours are due to the effects of a substance or neurological condition and is better explained by another disorder (ASD, OCD)

Tic disorder

Sudden, rapid, recurrent, non-rhythmic, stereotyped motor movements or vocalizations

1. Tourette's disorder: multiple motor and one or more vocal tics, must have been present for more than one year since the onset of the first tic.

   1. Occurs in about 5 out of every 1000 children

   2. More common in males than females; 2:1 to 4:1

   3. Prevalence rate of comorbid ADHD and OCD is greater than 50% for a person with Tourette's disorder

2. Persistent motor or vocal tic disorder: either one or more tics or one or more vocal tics, but not both motor and vocal tics

   1. Must have been present for more than one year since the onset of the first tic

3. Provisional tic disorder: motor and/or vocal tics that have been present for less than 1 year since the onset of the first tic

Text generally experienced as involuntary; they can be voluntarily suppressed for a limited time, increase under stress, and decrease during absorbing activities

Motor tics: eye blinking, neck jerking, shoulder shrugging, facial grimacing, grooming behaviours, jumping, or touching

Vocal tics: throat clearing, grunting, sniffing, barking, coprolalia (swearing) and echolalia

Medications:

• Catapres (clonidine)= antihypertensive agent,

• Haldol (Haloperidol) or Abilify (aripiprazole)= antipsychotic

• SSRIs such as Prozac (fluoxetine); occurring anxiety or OCD

Comprehensive behavioural intervention for tics; training to be more aware of their tics, encouraging competing behaviours in place of tics, and making changes to daily activity to reduce the presence of tics

Positive symptoms

A distortion or excess of normal function; these include the following:

1. Delusions: fixed, false beliefs that are unchangeable, maybe non-bizarre (situations that are possible) or bizarre (clearly impossible)

2. Hallucinations: vivid and clear perceptions that occur without external stimulus. Occur in any sensory modality; auditory hallucinations are most common in schizophrenia and related disorders (voices that are distinct from one's own thoughts)

3. Disorganized thinking: inferred from speech in which the person switches from one topic to another or provides answers that diverge from questions asked

4. Grossly disorganized or abnormal motor behaviour (including catatonia): interferes with goal-directed behaviours and activities of daily living, including a wide range of behaviours, such as childlike silliness and unexpected agitation

   1. Catatonia involves a marked decrease in reactivity to the environment. These include: negativism (resistance to instruction), odd posture, mutism, and stupor (lack of verbal responses), catatonic excitement, repeated stereotyped movements, grimacing, and echoing of speech

   2. Criterion involve a clinical picture that is dominated by three or more symptoms of category

Negative symptoms

A reduction or absence of normal function includes diminished emotional expression (facial expression, eye contact, intonations of speech), avolition (decreased in self-initiated purposeful activities)

Delusional disorder

one or more delusions of at least one month duration, and an absence of additional symptoms found and schizophrenia (hallucinations, disorganized speech, disorganized or catatonic behaviour or negative symptoms)

The person's behaviour is relatively un impaired and is not obvious odd

Specifiers:

1. Erotomanic type: delusion in which another person usually of higher status is in love with the individual

2. Grandiose type: delusions of inflated self-worth, power, knowledge or a special relationship to a deity or famous person

3. Jealous type: delusion that the person believes a sexual partner is being unfaithful

4. Persecutory type: delusion in which the person is being persecuted or ill-treated, which may trigger violent behaviour

5. Somatic type: delusions relating to body function and sensation

6. Mixed type: characteristic of more than one of the above types without any single theme predominating

7. Unspecified type: delusions whose themes are not characterized of any of the above types

8. Specifier with bizarre content is used when the delusion is bizarre

Age of onset is middle to late adulthood; can occur at a younger age

Most common subtype is persecutory

Brief psychotic disorder

One or more of the following:

1. Delusions

2. Hall

3. Disorganized speech

4. Grossly disorganized or catatonic behaviour

Episode last anywhere from one day to one month with eventual return to premorbid level of functioning.

Should be specified as with marked stressor, without marked stressor, or with postpartum onset

Schizophreniform disorder

identical, schizophrenia only by their duration; the duration of the illness is at least one month but less than six months

1/3 of individuals recover within six months

2/3 of individuals eventually are diagnosed with schizophrenia or schizoaffective disorder

Schizophrenia

Three basic conditions required:

1. Psychotic symptoms lasting at least one month

2. Some signs of disturbance lasting continuously for at least six months

3. Marked decline in overall functioning

Diagnostic criteria require the presence of two or more of the following characteristic symptoms: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour or negative symptoms

At least one of the symptoms must be delusions, hallucinations, or disorganized speech

Age of onset between late teens and early 30s; median age of onset is early to mid 20s for males and in the late 20s for females

The onset may be abrupt or gradual; most cases involved a prodromal phase; full remission is uncommon

Lifetime prevalence rate is .3- .7% equal ratio for the male to female

Prognosis is best with good prior functioning, abrupt onset, fear negative symptoms and minimal cognitive impairment

Suicide risk is high, approximately 5% dying by suicide and about 20% attempting suicide on one or more occasions

First-degree relatives have a concordance rate of about 10%, tenfold greater risk of developing schizophrenia

Identical twins have a 50% concordance rate

The risk of developing schizophrenia when both parents have the disorder is about 45%

Relatives of individuals also have an increased risk of developing other schizophrenia spectrum disorders

Measured by MRI, brains of people with schizophrenia have enlarged lateral and third ventricle, a smaller cerebral cortex and a smaller thalamus

PET scans shows they have decreased frontal lobe activity. Frontal lobe abnormalities are associated predominantly with the negative symptoms of schizophrenia.

Medication management is key and usually lifelong; commonly used are the novel/atypical antipsychotics, although traditional antipsychotics are still used

Psychosocial intervention: CBT, family education (expressed emotion by family members shown to predict relapse), social skills training (teaches skills related to communication, assertiveness, disease management, and independent living)

Schizoaffective disorder

Uninterrupted period of illness during which there has been a major mood episode, concurrent with symptoms of schizophrenia; there have been delusions or hallucinations for at least two weeks without prominent mood symptoms

Substance/medication induced psychotic disorder

Triggered by alcohol, cannabis, hallucinogens, inhaling sedatives, hypnotics, and anxiolytics and stimulants

Manic episode

Abnormally elevated, expansive or irritable mood, increased activity or energy that lasts at least one week and is present most of the day

Additionally, three or more of the following symptoms:

1. Inflated self-esteem or grandiosity

2. Decreased need for sleep

3. Pressured speech

4. Flight of ideas or racing thoughts

5. Distractibility

6. Increased goal-directed activities

7. Psycho motor agitation

8. Excessive involvement in activities that have a high likelihood of adverse consequences

Disturbances cause marked impairment in functioning or necessitate hospitalization to prevent harm to self or others or they are psychotic symptoms. Minimum duration of symptoms required when hospitalization is necessary.

Hypomanic episode

Identical to those of a manic episode however, these are less severe since they do not impair functioning, necessitate hospitalization, or include psychotic symptoms

The duration of the symptoms needs only be 4 days

Major depressive episode

Presence of five or more symptoms during a two-week period that represent a change from previous functioning:

1. Depressed mood, loss of interest or pleasure (at least one must be either of these)

2. Weight loss or gain or change in appetite

3. Insomnia or hypersomnia

4. Psychomotor agitation or retardation

5. Fatigue or loss of energy

6. Feelings of worthlessness or guilt

7. Poor concentration or indecisiveness

8. Recurrent thoughts of death or suicidal ideation, intent, or plan

Bipolar I disorder

Occurrence of at least one manic episode. This may be preceded or followed by a hypomanic or major depressive episode, but another mood episode is not necessary for diagnosis.

Prevalence rate: 1.5%

Equally common in males and females; more common in high-income than low-income countries

Has the highest heritability rate of all the major mental disorders; concordance rates are about 40 to 70% for identical, twins, and 25% for fraternal, twins, and siblings

Risk of suicide is 20 to 30 times of the general population

Medication is lifelong

1. Lithium

2. Tegretol

3. Depakene

Bipolar II disorder

There has been at least one major depressive episode and at least one hypomanic episode; there has never been a manic episode

Average age of onset is the mid-20s

More common in women than men

Risk is the highest among relatives of people with bipolar II disorder

Cyclothymic disorder

Presence of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms over the course of at least two years (one year in children and adolescents); during the two-year period, the hypomanic and depressive periods have been present at least half the time and the person has not been without symptoms for more than two months at a time.

Criteria for major depressive, manic or hypo manic episode have never been met

Disruptive mood dysregulation disorder

Recurrent verbal or physical temper outbursts occurring on average three or more times a week for over 1 year in at least two settings

Between temper outbursts, the mood is persistently irritable, or angry most of the day

The diagnosis must not be made before age 6 or after age 18 and the symptoms must have been present before age 10

Major depressive disorder

Presence of a major depressive episode characterized by five or more symptoms during a two-week period that represents a change from previous functioning:

1. Depressed mood, loss of interest or pleasure (at least one must be either of these)

2. Weight loss or gain or change in appetite

3. Insomnia or hypersomnia

4. Psychomotor agitation or retardation

5. Fatigue or loss of energy

6. Feelings of worthlessness or guilt

7. Poor concentration or indecisiveness

8. Recurrent thoughts of death or suicidal ideation, intent, or plan

9. Person has never experienced a manic or hypomanic episode

In grief, feelings of emptiness and loss predominate, while in MDE there is persistent depressed mood, and an inability to experience pleasure

In grief, the dysphoria tends to occur in waves associated with thoughts of the loss

In MDE's feelings of self-loathing and worthlessness and wanting to end one's life due to inadequacy

Can begin at any age; incidents peak in the 20s; the course is variable;

Factors associated with lower recovery rates include current episode, duration, psychotic features, prominent anxiety, personality disorders, and symptom severity

Risk of recurrence is higher when the preceding episode was severe in younger individuals or in persons who have had multiple episodes

The rate is equal in prepubertal girls and boys; two times higher in females than in males beginning in early adolescence

Concordance rate is 55 to 60% for identical twins, and approximately 20% for fraternal twins, and siblings

Risk factors include neuroticism, adverse childhood experiences, and stressful life events

The possibility of suicide exists at all times during a major depressive episode

Treatments include CBT, interpersonal therapy, behaviour therapy or behavioural activation, acceptance and commitment therapy and self-management/self control therapy,

Medications include

• SSRIs: Prozac, Zoloft, Paxil, Lexapro and Effexor

• Tricyclics (TCAs): Elavil (amitriptyline), Anafranil (clomipramine), Trofranil (imipramine), Sinequan (doxepin)

• Monoamine oxidase inhibitors: nardil, marplan, parnate, Ensam

• Others: Wellbutrin (bupropion), Desyrel (trazodone)

Postpartum depression

Peripartum onset; occur in about 10 to 15% of new mothers

Symptoms include: can continue for months if untreated

1. Severe anxiety

2. Irritability

3. Insomnia

4. Lack of interest in the infant

5. Guilt

6. Suicidal ideation

7. Poor concentration

8. Weeping and sadness

Postpartum blues

Widespread occurring in 50 to 80% of mothers

Symptoms are less severe and short-lived

1. Crying

2. Irritability

3. Poor

4. Weeping

5. In a sense of emotional vulnerability

Begin in the first week after birth and last no longer than a few weeks

Death by suicide

Top nine leading causes of death

Second leading cause of death for people ages 10 to 14 and 25 to 34

Suicide rate for males is 3 to 4 times higher than that of females, although females attempt suicide three times as often

Veterans and sexual minorities are at higher risk of death by suicide

The highest rate of suicide is found among those who are 75 and older and between 25 to 34 years; the lowest suicide rates are in age ranges 15 to 24 and 65 to 74

Suicide rate is highest among American Indian/Alaska native people and white people; much lower rates occur among black, Hispanic and Asian individuals

Many people who die by suicide have a mental disorder. The most common disorders associated with suicides are mood disorders, schizophrenia, personality disorders, and substance use disorders.

The single best predictor is a history of serious suicide attempts, with the greatest risk recurring within the days to weeks immediately following a hospitalization

Other risk factors include being male, being single or living alone, a family history of suicide, chronic pain or chronic illness and criminal and legal problems and financial loss; expressions of hopelessness is a stronger predictor of suicide than the presence and the severity of depression

Persistent depressive disorder

Depressed mood for most of the day, more days than not, for at least two years in adults.

While depressed, the person experiences two or more of the following symptoms:

1. Change in appetite

2. Insomnia or hypersomnia

3. Low energy or fatigue

4. Low self-esteem

5. Poor concentration or difficulty making decisions

6. Feelings of hopelessness

7. There have never been manic or hypo manic episodes, and criteria for cyclothymia have not been met

Early and insidious onset and a chronic course

Premenstrual dysphoric disorder

In the majority of menstrual cycles, there are symptoms present in the week before the onset of menses, symptoms start to improve within a few days after the onset of menses, and symptoms are minimal or absent in the week postmenses

Depressive disorder due to another medical condition

Caused by stroke, Huntington’s disease, Parkinson's disease, and traumatic brain injury

Neuroendocrine conditions, hypothyroidism, and Cushing's disease

Anxiety

Anticipation of future threat and associated with muscle tension, vigilance in anticipation of future danger, and avoidant behaviours

Occur more frequently in females; 2:1

Panic attacks

A discrete period of intense fear, or discomfort that develops abruptly and reaches a peak within minutes, compounded by more physical and/or cognitive symptoms:

1. Palpitations or pounding heart

2. Sweating

3. Trembling

4. Sensation of shortness of breath

5. Feeling of choking

6. Chest pain

7. Nausea or abdominal distress

8. Feeling dizzy or lightheaded

9. Chills or heat sensations

10. Numbing or tingling

11. De realization or depersonalization

12. Fear of losing control or going crazy

13. Fear of dying

Separation anxiety disorder

excessive and developmentally inappropriate anxiety concerning being away from home or away from the persons to who the individual is attached

Criteria include three or more of the following symptoms:

1. Distress one separation occurs or is anticipated

2. Worry about harm be falling one’s major attachment figure

3. Worry about getting lost or kidnapped

4. Reluctance to go out because of fear of separation

5. Reluctance/fear of being alone without the major attachment figure

6. Reluctant/refusal to go to sleep without being near one’s major attachment figure

7. Repeated nightmares about separation

8. Repeated physical complaints when separation occurs or is anticipated

Most prevalent in children younger than 12 years

Frequently developed after life stress, especially after significant loss

Treatments include CBT and family therapy

Selective mutism

Consistent failure to speak in specific social situations when speaking is expected in spite of speaking in other situations; disturbance interferes with educational or occupational achievement, or with social communication

Onset before age 5

Failure to speak in children is related to fear and anxiety

Treatments include CBT and behaviour therapy such as gradual exposure and shaping by successive approximations

Specific phobia

A marked fear or anxiety caused by the presence or anticipation of a specific object or situation. The phobic situation is either avoided or endured with intense distress.

In blood-injection injury phobia, the initial increase in heart rate is followed by a decrease in heart rate and blood pressure that leads to dizziness and fainting. Treatment is different intervention use is called applied tension where muscles are tensed in order to raise blood pressure. This tensing helps prevent fainting and allows a person to recover more quickly if they do faint.

Treatments include exposure based therapy, such as in vivo exposure. The therapist assessed exposure-based procedures and virtual reality exposure.

Systematic desensitization pairs gradual exposure with relaxation. This is effective, but requires more time and is less successful than exposure therapy at decreasing avoidance.

Social anxiety disorder.

Fear of one or more social situations in which the person is exposed to potential scrutiny by others. Examples include social interactions being observed and performing that the person fears. Their behaviour will be embarrassing, humiliating or lead to rejection.

Treatment include CBT with exposure and social skills trainings

Panic disorder.

Recurrent unexpected panic attacks. At least one of the attacks has been followed by one month or more of one or both of the following.:

1. Persistent concern about having additional panic attacks or their consequences

2. Significant change in behaviour related to the attacks

Diagnosis related to a higher rate of suicide.

Comorbid with a number of medical conditions, including cardiac arrhythmias, hyperthyroidism, asthma, chronic obstructive pulmonary disease and irritable bowel syndrome

Treatments include CBT involving psychoeducation, cognitive restructuring, in vivo exposure to situations that are avoided or give rise to panic and interoceptive exposure to aversive physiological sensations. Relaxation training, or reading or retraining.

Agoraphobia.

Intense fear or anxiety about two or more situations, using public transportation, being in open spaces, being in enclosed spaces, standing in line, being in a crowd or being outside the home.

These situations are avoided because the thought that escape might be difficult or that help might not be available when incapacitating or embarrassing symptoms occur.

The fear, anxiety or avoidance is persistent typically lasting for six months or more

Treated with CBT

Generalize anxiety disorder.

Excessive anxiety and worry about a number of events or activities occurring more days than not for at least six months

Three or more of the following six symptoms:

1. Restlessness

2. Fatigue

3. Difficulty concentrating

4. Irritability

5. Muscle tension

6. Sleep disturbance

The median age of onset is 30 years

The disorder is usually chronic, with a fluctuating course during which symptoms wax and wane.

Treatment includes:

1. CBT (relaxation training, scheduled worry, time, pleasurable activities and controlled exposure

   1. Cognitive components involve modifying catastrophic thinking patterns

2. Anxiety management training: relaxation and cognitive restructuring

Another specified anxiety disorder is ataque de nervios (attack of nerves)

Medications:

1. Anxiolytics/ benzodiazepines

   1. Xanax (alprazolam)

   2. Klonopin (clonazepam)

   3. Valium (diazepam)

   4. Ativan (lorazepam)

2. Sedative/hypnotics

   1. Restoril (temazepam)

   2. Halcion (triazolam)

3. Non-benzodiazepine anxiolytics

   1. Buspar (buspirone)

4. Non-benzodiazepine sedative/hypnotics

   1. Ambien (Zolpidem)

Obsessive compulsive disorder.(OCD)

Obsessions: recurrent thoughts, urges, or images that are experienced as intrusive and cause distress or anxiety. The person attempts to either ignore or suppress the thought or neutralize it with some other thought or action.

Compulsions: repetitive behaviour or mental acts that the person feels driven to perform to cope with an obsession or to comply with rigid rules. They aim to prevent or reduce distress or avoid a dreaded situation.

• Both are time-consuming or cause significant distress or impairment

• Males have a earlier age of onset of OCD; 25% having onset before age 10

• In adulthood females are slightly more commonly affected

• Suicide risk is high

Treatments include exposure with response prevention and cognitive therapy

Body dysmorphia disorder

A person is preoccupied with one or more perceived defects in appearance. Perceived flaws are either not observable or slight. The person performs excessive repetitive behaviours (mirror checking, grooming) or mental acts (comparing oneself to others)

Star in adolescence and occurs slightly more frequently in females

Rate of suicidal ideation and attempts are high

Major depressive disorder is a common comorbid disorder

Treatment include CBT and medications (SSRIs)

Hoarding disorder

Persistent difficulty throwing out or giving up possessions, regardless of actual value. The difficulty is due to a perceived need to save items and distress associated with discarding the items, resulting in clutter.

Trichotillomania

Recurrent pulling out of one's own hairs (the scalp, eyebrows and eyelids), resulting in noticeable hair loss, with repeated attempts to decrease or stop hair pulling

Excoriation (skin picking) disorder

Recurrent picking at one's own skin, most typically the face, arms and hands, resulting in skin lesions with repeated attempts to decrease or stop picking

Reactive attachment disorder

Consistent pattern of inhibited emotionality and withdrawn behaviour towards the caregiver that is demonstrated by the child rarely seeking or responding to comfort when distressed. The child experienced extremely insufficient care.

Disturbance is present before age 5, and the child has a developmental age of at least 9 months

Disinhibited social engagement disorder

A child actively approaches and interacts with adult strangers and exhibits at least two of the following: the child experiences extremely insufficient care and has a developmental age of at least nine months

1. Lack of hesitation in approaching unfamiliar adults

2. Overly familiar behaviour with strangers that violates cultural social boundaries

3. Lack of checking back with the adult caregiver after venturing away

4. Willingness to go off with an unfamiliar adult without hesitation

Posttraumatic stress disorder (PTSD)

The person must have been exposed to actual or threatened death, serious injury, or sexual violence. The exposure must have occurred in at least one of the following ways.:

1. Directly experiencing the event

2. Witnessing the event occurring to others

3. Learning that a traumatic event occurred to a close family member

4. Experiencing repeated exposure to aversive details of traumatic events (first responder or trauma therapist)

Symptoms must last more than 1 month

In adults PTSD, four characteristic symptoms required for diagnosis:

1. Intrusive symptoms: re-experiencing the trauma through dreams, recollections, disassociation/flashbacks

2. Avoidance of stimuli associated with the trauma: avoiding memories, thoughts, or external reminders

3. Negative alterations in cognitions and mood: inability to remember the event, distorted cognitions about the event, fear, guilt, shame)

4. Increased arousal: irritability, reckless behaviour, hypervigilance

In children 6 years and younger, only three symptoms are required:

1. Intrusive symptoms

2. Avoidance and/or negative alteration in cognition and mood

3. Increased arousal

Disorder may be specified as with delayed expression if onset of symptoms was at least six months after the event

Duration of symptoms of PTSD varies widely; 50% complete recovery within three months, while for others symptoms may last longer than 12 months and sometimes even more than 50 years

Risk factors: severity of the trauma, perceived life threat, interpersonal violence, prior mental health disorder, dissociation during and after the trauma, lack of social support, female gender, younger age, lower SES, lower education, lower intelligence, and racial/ethnic minority status.

PTSD occurs twice as often in women as in men

Associated with increased suicidal ideation and attempts

Treatment includes CBT, cognitive processing therapy, prolonged exposure, and EMDR (to change the memory of the trauma by incorporating eye movements)

Acute stress disorder

Person who has been exposed to the same type of traumatic event that causes PTSD and exhibits symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal.

Symptoms begin immediately after the trauma

The disturbance must persist for at least 3 days and last no longer than 1 month

Adjustment disorder

The presence of emotional or behavioural symptoms in response to an identifiable psychosocial stressor

Develops within three months of the onset of the stressor and remits within six months of the stressor’s termination

Experience is marked distressed in access of what would be expected or there is a significant impairment in functioning

Disorder is only diagnosed if the symptoms do not qualify for another mental disorder

Prolonged grief disorder

The diagnosis requires that at least 12 months have passed since the death of someone close to the bereaved (6 months in children and adolescents).

Must present with one or both of the following symptoms:

1. Intense yearning for the deceased person

2. Preoccupation with thoughts or memories of the deceased person

Additionally, they must exhibit 3 of the following symptoms as a result of the death:

1. Destruction of identity

2. Disbelief about the death

3. Avoidance of reminders that the person is dead

4. Intense, emotional pain related to the death

5. Difficulty in integrating into relationships and activities

6. Emotional numbness

7. Feeling that life is meaningless

8. Intense loneliness

The length and severity of the grief must exceed expected social, cultural, and religious norms for the person’s culture.

Disassociative identity disorder

The presence of two or more distinct identities or personalities.

Inability to recall every day, events, important information, personal information or traumatic events that is too extensive to be explained by ordinary forgetfulness.

Disassociative amnesia

The inability to recall important, personal information, usually of a traumatic or stressful nature, that cannot be explained by ordinary forgetfulness.

The amnesia is commonly selective for a specific event or generalized amnesia for one’s identity and life history.

The specify with dissociative fugue is used when the disorder includes purposeful travel or bewildered wandering with an inability to recall one’s past

Depersonalization and derealization disorder

persistent, or recurrent episodes of depersonalization (detachment from one’s thoughts, feelings, body or actions), and/or derealization (detachment from one's surroundings)

Reality testing (ability to distinguish one’s internal experiences from external reality) remains intact during the experience

Other specified disassociative disorder

Identity disturbance due to prolonged and intense coercive persuasion (brainwashing)

Acute dissociative reactions to stressful events that last only a few hours or days