MES

Panic Disorder

Recurrent/unexpected panic attacks
Duration: \>1 month
- fear of future panic attacks OR
- significant change in behavior related to the attacks

Panic Attack

Intense fear w/ somatic/cognitive symptoms: abrupt onset w/ peak in min
- cardiac
- sweating
- trembling
- SOB
- choking
- chest pain
- GI
- feeling faint
- feeling detached
- fear of losing control
- fear of dying
- tingling/numbness
- chills/hot flushes

Agoraphobia

\>2 situations feared/avoided:
- using public transportation
- being in open spaces
- being in enclosed spaces
- standing in line/being in a crowd
- being outside of home alone

Situations are feared/avoided because of thoughts that escape might be difficult/unavailable if incapacitating/embarrassing symptoms develop

Can develop w/ or w/o PD

Specific Phobia

Excessive, persistent and disproportional fear of an object/situation
- fear invariably occurs when exposed to the stimulus OR person avoids situation
- fear causes marked distress/impairment and NOT accounted by different disorder

Social Anxiety Disorder

Excessive, persistent and unrealistic fear of social situations involving possible scrutiny by others due to fear of negative evaluation
- "Performance only": fear restricted to speaking/performing in public

Generalized Anxiety Disorder

Persistent uncontrolled anxiety about multiple events for \>6 mos w/ symptoms:
- restless, on edge
- dec conc
- muscle tension
- fatigued
- irritability
- insomnia

Separation Anxiety Disorder

Developmentally inappropriate and excessive anxiety concerning separation from major attachment figure

Experience marked distress (mental/physical):
- anticipated/actual separation
- harm befalling major attachment figure/self that leads to separation
- going out because of separation fears

Selective Mutism

Refusal to speak in specific situations despite fluent speech in other contexts
- Not due to lack of language knowledge/communication disorder
Duration: \>1 mo

Obsessive-Compulsive Disorder

1. Recurrent:
- obsessions \= intrusive recurrent thoughts/urges/images that inc distress
- compulsions \= repetitive behaviors/mental acts that dec distress

2. Obsessions/compulsions are time consuming or distressful/disruptive

3. Symptoms are not explained by another disorder

W/ absent insight (delusional beliefs): convinced that OCD beliefs are true

Hoarding Disorder

- Difficulty parting w/ possessions due to perceived need to save items or distress about discarding them
- Accumulation clutters living areas and substantially compromises their intended use
- Causes distress/impairment
- NOT better explained by another disorder

W/ absent insight (delusional beliefs): beliefs/behaviors are not problematic despite contrary evidence

Body Dysmorphic Disorder

Preoccupation w/ perceived flaw in physical appearance
- not better accounted by an eating disorder
- must cause functional impairment

Repetitive behaviors/mental acts are performed in response to appearance concerns

Specify...
- w/ muscle dysphoria: preoccupation w/ belief that one's body is too small/insufficiently muscular
- w/ absent insight (delusional beliefs): convinced beliefs are true

Excoriation Disorder

- Recurrent skin picking resulting in skin lesions
- Attempts to stop picking
- Results in distress/impairment
- ISN'T better explained by another disorder

Trichotillomania

- Recurrent pulling out of one's hair resulting in hair loss
~ any body region affected
~ episodes vary in frequency, duration, intensity of focus
- Attempts to stop hair pulling
- Causes distress/impairment
- NOT better explained by another disorder

Posttraumatic Stress Disorder

Exposure to traumatic stressor:
- actual/threatened death or serious injury or sexual violence
- include direct experience of event, witnessing event, or learning about event to close family member/friend

\>1 symptoms from each category MUST develop --\>

Intrusion:
- dreams
- recollections
- feeling event reoccur
- psychological/physiological distress when encounters symbols

Avoidance: avoid thoughts, places, conversations that are reminders of event

Negative alterations in cognition and mood:
- negative beliefs/expectations
- negative emotional states
- inability to experience positive emotion
- diminished interest/participation in activities
- detachment/estrangement from others
- dissociative amnesia

Alterations in arousal and reactivity:
- sleep disturbance
- irritable and angry outbursts
- reckless/self-destructive behavior
- concentration problems
- hypervigilance
- exaggerated startle response

Duration: \>1 mo
Onset: begin w/in 3 mo of trauma (can begin ANYTIME)
Vulnerable populations: young adults w/ sudden-onset, life-threatening medical events

Acute Stress Disorder

- Exposure to a traumatic stressor
- Numerous PTSD-like symptoms develop from 4 PTSD symptom categories

Duration: 3 days - 1 mo after trauma exposure

Adjustment Disorder

Development of significant/disproportional emotional/behavioral symptoms
- causal stressor AND no other disorder explains the symptoms

Due to an identifiable stressor:
- acute onset \= develop w/in a few months of stressor onset
- brief duration \= expected to resolve w/in several months after stressor/consequences have terminated

Subtypes:
- with depressed mood
- with anxiety
- with disturbance of conduct
- with mixed anxiety and depressed mood
- with mixed disturbances of emotion & conduct
- unspecified

Reactive Attachment Disorder

Inhibited and emotionally-withdrawn behavior towards adult caregivers

Disinhibited Social Engagement Disorder

Overly familiar behavior w/ relative strangers

Dissociation

Splitting off from conscious awareness an aspect of self usually as a coping strategy for stress

Dissociative Amnesia

Memory loss for autobiographical information, which doesn't occur due to another disorder
- localized: total loss of personal memory during a circumscribed period
- selective: some recall of personal memories during a circumscribed period of time
- generalized: loss of personal memory of entire life up to and including event

W/ dissociative fugue: purposeful travel/bewildered wandering associated w/ amnesia for identify or autobiographical information
- brief (hours to days)
- unobtrusive lifestyle during fugue
- spontaneous termination of amnesia
- rarely recurs

Dissociative Identity Disorder

Disruption of identity characterized by \> 2 distinct personality states:
- Primary (host)
- An alter

Inability to recall personal information

Depersonalization/Derealization Disorder

- Either/both depersonalization/derealization
- Reality testing remains intact
- Result in functional impairment
- Metabolic, neurologic, or pathological conditions should be eliminated as casual agents

Derealization

experiences of unreality or detachment with respect to surroundings

Depersonalization

experiences of unreality, detachment or being an outside observer with respect to one's thoughts, feelings, sensations, body or actions

Major Depressive Disorder

- Must experience \>1 MDE
- NO history of mania/hypomania (no swinging to opposite pole)

Major Depressive Episode

At least 2wks of \>5 (MUST be 1 OR 2)

Affective:
1) depressed mood
2) anhedonia

Neurovegetative:
3) significant weight change
4) insomnia/hypersomnia
5) loss of energy

Cognitive:
6) psychomotor changes
7) feeling guilty/worthless
8) decreased concentration
9) thoughts of death/suicidal ideation

SIG: "E"nergy "Cap"sules

Sleep change
Interest loss
Guilt
Energy problem
Concentration poor
Appetite change
Psychomotor changes
Suicidal ideation

MDD w/ Melancholic Features

- severe anhedonia, lack of mood reactivity, profound despondency and guilt
- depression worse in the morning
- early-morning awakenings
- significant appetite loss

MDD w/ Atypical Features

- mood reactivity
- weight and sleep inc
- leaden paralysis

MDD w/ Psychotic Features

Hallucinations and/or delusions are evident
- W/ mood-congruent psychotic features: content of delusions/hallucinations is consistent w/ typical depressive themes
- W/ mood-incongruent psychotic features: content of delusions/hallucinations does NOT involve typical depressive themes

MDD w/ Catatonia

- Mutism
- Immobility
- Waxy
- Flexibility
- Stereotypes
- Other odd posturing

MDD w/ Anxious Distress

MDE associated with feeling tense, restless, and fearful

MDD w/ Peripartum Onset

MDE onset is during pregnancy or within 4 wks post-delivery

MDD w/ Seasonal Pattern (Seasonal Affective Disorder)

Consistent temporal relationship between time of year and MDEs

Persistent Depressive Disorder

Chronic depressed mood for \>2yrs:
- long-lasting MDE
OR
- dysthymia: \>2 of following
~ poor appetite/overeating
~ insomnia/hypersomnia
~ low energy
~ low self-esteem
~ trouble concentrating or making decisions
~ feelings of hopelessness

PDD w/ Pure Dysthymic syndrome

prolonged dysthymia but no MDE occurs

PDD w/ Persistent MDE

prolonged MDE

PDD w/ Intermittent MDEs

dysthymic periods and MDEs

Premenstrual Dysphoric Disorder

MUST: cause clinically significant distress/functional impairment
- present in week before menses onset
- improve a few days after menses onset
- minimize in the week post-menses

INCLUDE:
- mood lability, irritability, dysphoria, and anxiety symptoms
- anhedonia, problems concentrating, lethargy, appetite and sleep change, physical symptoms

Validated clinical scales are used to confirm diagnosis

Disruptive Mood Dysregulation Disorder

Core features:
- severe temper outbursts at least 3x/wk
- sad, irritable or angry mood almost daily
- reaction is disproportionate to situation
- symptoms are present in multiple settings

Timelines:
- at least 6 y/o
- before age 10

Bipolar I Disorder

MUST experience at least 1 manic episode
- \>1 wk
- marked impairment in functioning
- ALSO experience MDEs

Manic Episode

Abnormally elevated mood/irritability PLUS inc energy:
- inflated self-esteem/grandiosity
- dec need for sleep
- pressured speech
- flight of ideas/ racing thoughts
- distractibility
- inc goal-directed activity / psychomotor agitation
- excessive involvement in "risky" activities

DIG FAST

Distractibility
Irresponsibility (excessive involvement in pleasurable activities)
Grandiosity, inflated self-esteem
Flight of ideas, racing thoughts

BPI w/ Rapid Cycling

experiences \>4 mood episodes/yr

BPI w/ Psychotic Features

- delusions/hallucinations are present
- specify mood-congruent/incongruent

Bipolar II Disorder

Experiences at least 1 MDE and 1 hypomanic episode

Hypomanic episode

- Different severity: mania causes "marked" impairment in functioning; hypomania does not
- Change in mood must be "unequivocal" and "uncharacteristic" of person
- Must last \>4 days

Cyclothymic Disorder

- \>2 yrs experiences periods of hypomanic symptoms that fluctuate w/ periods of depressive symptoms
- criteria for MDE have never been met

Psychotic

"a break from reality" in thinking and/or perceptions ("thought" disorders)

Psychotic symptom domains

1) Delusions
2) Hallucinations
3) Disorganized speech
4) Disorganized behavior
5) Negative symptoms

Delusions

a fixed belief that is not amenable to change, even in light of conflicting evidence

Delusion of grandeur

grandiose

Delusion of persecution

paranoid

Delusion of control

external force controlling behavior

Delusion of reference

belief that an outside action refers directly to the person or has special personal meaning to the person

Thought broadcasting delusion

thoughts being transmitted to others

Hallucinations

A sensory perception without an external stimulus:
- auditory
- single voice, voices conversing, running commentaries
- derogatory

Disorganized Thinking

"Formal thought disorder"
- tangentiality
- flight of ideas
- derailment
- clang association
- word salad

Tangentiality

Shifting to a slightly-related topic

Flight of ideas

Rapid shifting of thoughts with discernible links between ideas (extreme tangentiality)

Derailment

"loose associations" - no apparent connections between ideas

Clang association

Word association based on rhyming

Word Salad

No meaningful relationship between words

Disorganized

non-goal oriented behavior

Catatonia

multiple motor/behavioral abnormalities that reflect diminished reactivity to the environment:
- posturing
- waxy flexibility
- stereotypies
- non-responsiveness
- mutism

Negative symptoms (psychotic symptom domain)

- Diminished emotional expression: verbal/nonverbal
- Avolition: dec in self-initiated purposeful activities
- Alogia: diminished speech output
- Anhedonia
- Asociality: disinterest in social interactions

Negative symptoms (definition)

Domain 5: thoughts, behaviors, or perceptions that normally exist that are now absent or markedly diminished

Positive symptoms (definition)

Domain 1-4: thoughts, behaviors, or perceptions that are distorted or in excess of normal function

Schizophrenia

- An Active-phase for \> 1 mo at least 2 psychotic domain symptoms (1 being a core symptom)
- At least 1 symptom persists for \> 6 mo

Subtype only - with catatonia

EPS: Dystonia

Sustained muscle contractions (head, neck), often developing w/in 1st wk

EPS: Parkinsonism

Parkinsonian symptoms (tremor, shuffling), often developing in the first few months

EPS: Akathisia

Excessive movements due to "inner restlessness", often developing in the first few months

EPS: Tardive Dyskinesia

Repetitive, involuntary, purposeless movements, often of the face and extremities, developing as a long-term (yrs) side effect

Neuroleptic Malignant Syndrome

Tachycardia, HTN, rapid respiration, fever, extreme rigidity, delirium, death
- w/in first 2 wks of starting/inc dosage
- due to precipitous drop in DA affecting hypothalamic functioning

Schizophreniform Disorder

- At least 1 mo Active-Phase Symptoms
- Signs of disturbance

Brief Psychotic Disorder

- A CORE psychotic domain symptom for

Delusional Disorder

- Presence of a delusion \>1 mo
- NO OTHER psychotic domain symptoms
- No functional impairment aside from direct impact of the delusion

Delusional disorder Subtype: Persecutory

belief of malevolent treatment

Delusional disorder Subtype: Grandiose

belief of having some great talent/insight or having made some important discovery

Delusional disorder Subtype: Erotomanic

belief of somebody being in love with the individual

Delusional disorder Subtype: Jealous

belief of infidelity by partner

Delusional disorder Subtype: Somatic

belief involving bodily functions/sensations - parasitosis, malodorous, organ dysfunction

Non-bizarre delusion

belief that involves something that could occur in real life - physically possible

Bizarre delusion

belief that is clearly implausible and not derived from ordinary life experiences

Schizoaffective disorder

Active phase of schizophrenia concurrent w/ MDE/manic episode
- Active phase \>2 wks w/o mood sxs
- Mood sxs present majority of total duration

Somatic Symptom Disorder

\>1 distressing/disruptive somatic symptom

One indicator of excessive thoughts/feelings/behaviors about symptoms:
- disproportionate thoughts about seriousness of symptom
- high levels of anxiety about symptom/health
- excessive time/energy devoted to symptom

Illness Anxiety Disorder

Preoccupation w/ having/acquiring a serious illness

Somatic symptoms are NOT present (or mild):
- normal physiological sensation
- benign, self-limited dysfunction
- bodily discomfort not usually indicative of disease

Pt performs excessive health-related behaviors/maladaptively avoids health-care

Conversion Disorder

- Altered voluntary motor/sensory function
- Evidence of incompatibility between symptom and neurological conditions

Conversion Subtypes

- Weakness/paralysis
- Abnormal movement
- Swallowing symptoms
- Speech symptoms
- Attacks/seizures
- Anesthesia/sensory loss
- Special sensory symptom
- Mixed symptoms

Factitious Disorders

Fakes/induces physical or psychological symptoms (self/others) in absence of obvious "external" rewards

Factitious Disorder Imposed on Self

Pt feigns symptoms in oneself

Factitious Disorder Imposed on Another

Pt feigns symptoms in another person

Hints to facticiousness

- unexplained persistent/recurrent symptoms
- inconsistent medical history
- dramatic presentation of history & symptoms
- symptoms influenced by observation
- insistence on particular treatment
- grid abdomen

Malingering

A person fakes/induces physical or psychological symptoms in self/others for "external" rewards

Anorexia Nervosa

1) Restriction of food that leads to being significantly underweight
- adults: ~18.5
- children:

Purge

Use of vomiting, laxatives, diuretics, or enemas to eliminate calories

Anorexia Subtype: Binge-eating/purging

recurrently binges and/or purges

Anorexia Subtype: Restricting

does NOT recurrently binge/purge, weight loss through dieting, fasting, and/or exercise

Indicators of excessive thinness

- Low BMI
- Amenorrhea & loss of sex drive
- Constipation
- Hypothermia & lanugo
- Bradycardia & hypotension
- Hypercholesterolemia
- Anemia
- Leukopenia
- Low bone mineral density

Indicators of excessive vomiting

- Russell's sign \= calloused knuckles
- dental enamel erosion
- Chipmunk cheeks \= salivary gland inflammation
- subconjunctival hemorrhage
- hypokalemia