Concise Mental Health Notes

Mental Health

Personality Disorders

  • Borderline Personality Disorder (BPD)
    • Main Features: Unstable relationships, self-image, and impulsivity.
    • Prevalence: Begins in early adulthood, mostly affects females, with remission rates around 60%.
    • Contributing Factors:
      • Family: Economic adversities, manipulative parents, maternal BPD, dysfunctional parent-child relationship.
      • Trauma: Abuse, peer victimization.
      • Genetics: OXT receptor mutation.
      • Traits: Impulsivity, affective instability, negative affectivity, depression, anxiety, self-harm, substance use, ODD, conduct disorders.
    • Diagnostic Criteria (DSM5-TR): Instability in relationships and self-image, impulsivity, indicated by 5+ of:
      • Frantic efforts to avoid abandonment.
      • Unstable/intense relationships.
      • Unstable self-image.
      • Impulsivity in self-damaging areas.
      • Suicidal behavior or self-mutilation.
      • Affective instability.
      • Chronic emptiness.
      • Inappropriate anger.
      • Transient paranoia.
  • Narcissistic Personality Disorder (NPD)
    • Main Features: Superiority, need for admiration, lack of empathy.
    • Prevalence: Higher in males.
    • Types:
      • Grandiose: Self-importance, needs validation.
      • Communal: Presents as savior, seeks recognition.
      • Overt: Needs control, subjugates others.
      • Covert: Acts kind, unloads cruelty on close people, seeks power.
      • Malignant: Manipulative, abusive, paranoid, not accountable.
    • Diagnostic Criteria (DSM5-TR): 5+ of:
      • Grandiose self-importance.
      • Fantasies of success/power.
      • Belief of being special.
      • Needs admiration.
      • Sense of entitlement.
      • Exploitative behavior.
      • Lack of empathy.
      • Envious of others.
      • Arrogant behaviors.
  • Paranoid Personality Disorder (PPD)
    • Main Features: Distrust and suspiciousness.
    • Prevalence: More common in males with childhood abuse/neglect.
    • Diagnostic Criteria (DSM5-TR): 4+ of:
      • Suspects exploitation/harm without basis.
      • Unjustified doubts about loyalty.
      • Reluctance to confide.
      • Sees hidden meanings.
      • Bears grudges.
      • Perceives attacks.
      • Recurrent suspicions about fidelity.
      • Excludes other MH issues
  • Schizoid Personality Disorder (SPD)
    • Main Features: Detachment from social relationships.
    • Prevalence: 1-3%, more common in males with family history of schizophrenia.
    • Diagnostic Criteria (DSM5-TR): 4+ of:
      • No desire for close relationships.
      • Chooses solitary activities.
      • Little to no interest in sexual experiences.
      • Takes pleasure in few activities.
      • Lacks close friends.
      • Indifference to praise/criticism.
      • Emotional coldness.
      • Excludes other MH issues

Depressive Disorders

  • Disruptive Mood Dysregulation Disorder (DMDD)
    • Main Features: Chronic irritability, frequent temper outbursts.
    • Prevalence: Common in pediatric populations (6-18 y.o.).
    • Contributing Factors: Psychiatric history, disrupted family, parental conditions, trauma, grief, malnutrition.
    • Interaction: Strategies for parents/psychologists, stress management, boundaries, monitor anger.
    • Diagnostic Criteria (DSM5-TR):
      • Severe temper outbursts, disproportionate.
      • Inconsistent with developmental level.
      • 3+ times/week.
      • Irritable/angry mood between outbursts.
      • Present for 12+ months.
      • Present in 2+ settings.
      • Onset before age 10.
  • Major Depressive Disorder (MDD)
    • Main Features: Lack of enjoyment/interest, mood change.
    • Prevalence: Higher risk for women and LGBTQ+ community.
    • Presentation Forms:
      • Major Depression: Depressed mood or loss of interest for 2+ weeks.
      • Persistent Depressive Disorder: Less severe, lasts up to 2 years.
      • Perinatal Depression: During pregnancy or after childbirth.
      • Seasonal Affective Disorder: Symptoms start in late fall/winter.
      • Depression with Psychosis: Severe, with psychosis symptoms.
    • MDD in Teens vs. Adults: teens have issues with academic performance, somatic pain, eating disorders, substance use, self-harming behaviors, and suicidal thoughts.
    • Diagnostic Criteria (DSM5-TR): 5+ of:
      • Depressive mood.
      • Diminished interest/pleasure.
      • Weight/appetite change.
      • Insomnia/hypersomnia.
      • Psychomotor agitation/retardation.
      • Fatigue/loss of energy.
      • Worthlessness/guilt.
      • Diminished concentration.
      • Recurrent thoughts of death/suicide.
    • Significant distress/impairment.
    • Not attributed to substance/physiological event/other MH condition.
  • Perinatal Depression (PND)
    • More common than believed, often starts in the antenatal period.
    • Impact:
      • Mother: Maternal suicide, preterm delivery, reoccurrence risk, PTSD.
      • Child: Social, behavioral, and cognitive dysfunction, increased risk of MDD.
    • Physiological Changes: Stress-related disorders, genetics, HPA axis activation, DA/SE levels.
    • Environmental Factors: MH history, adverse experiences, lack of social support, unintended pregnancy, poor relationships.
    • Screening:
      • Prenatal: Sleep changes, appetite changes, fatigue, irritability, hopelessness.
      • Postnatal: Previous + difficult pregnancy, premature birth, NICU care, breastfeeding difficulties.
    • Role of Physiotherapy: recognize signs, educate, disrupt prejudice, encourage physical activity.
    • Educational resources for PND

Anxiety Disorders

  • Important Concepts:

    • Fear: Response to real threat.
    • Anxiety: Anticipation of future threat.
    • Panic Attacks: Fear response within MH conditions.
    • Symptoms include restlessness, fatigue, irritability, decreased attention, muscle tension, sleep disturbance.

  • Types:

    • Separation Anxiety Disorder
    • Specific Phobia
    • Social Anxiety Disorder
    • Selective Mutism
    • Panic Disorder
    • Agoraphobia
    • Generalized Anxiety Disorder
    • Substance/Medication-Induced Anxiety
    • Anxiety as a Symptom of other Medical Condition
    • Unspecified Anxiety Disorder

  • Generalized Anxiety Disorder (GAD)

    • Diagnostic Criteria (DSM5-TR):
      • Excessive anxiety/worry for 6+ months.
      • Difficulty controlling worry.
      • Associated with 3+ of:
        • Restlessness
        • Difficulty concentrating
        • Irritability
        • Muscle tension
        • Sleep disturbance
      • Significant distress/impairment.
      • Excludes substance effects/other MH condition.
    • GAD vs. Nonpathological Anxiety: GAD is excessive, pervasive, distressing, longer duration, and associated with somatic symptoms.
    • Adults vs. Children: Adults worry about everyday events; children worry about competence.
    • Associated Features: Muscle tension, sweating, diarrhea, exaggerated startle response.

  • Specific Phobia

    • Prevalence:
      • North America: 8-12%
      • Europe: ~6%
      • Asia, Africa, Latin America: 2-4%
    • Presented predominantly with women
    • Health-related phobias presented predominantly by men
    • Objects/Situations: Animal, situation, environment, health-related. (usually during childhood)

  • Diagnostic criteria (DSM5-TR)

    • Marked fear or anxiety about a specific object or situation
    • The phobic object or situation almost always provokes immediate fear or anxiety.
    • Actively avoided or endured with intense fear or anxiety
    • Out of proportion to the actual danger
    • The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
    • Causes clinically significant distress or ADL impairment.
    • Not better explained by another MH condition.

Trauma and Stressor-Related Disorders

  • Posttraumatic Stress Disorder (PTSD)

    • Main Features:
      • Fear-based reexperiencing.
      • Emotional/behavioral symptoms.
      • Anhedonic/dysphoric mood.
      • Dissociation/depersonalization.
    • Specific Forms:
      • With dissociative symptoms (depersonalization/derealization).
      • With delayed expression (criteria met 6+ months after event).

  • Risk Factors:

    • Pretraumatic:
      • Temperamental: Childhood emotional issues, prior MH issue, premorbid personality.
      • Environmental: Lower SES, lower education, previous trauma, ethnic discrimination, family history.
    • Peritraumatic:
      • Environmental: Severity of trauma, perceived life threat, personal injury, interpersonal violence.
    • Posttraumatic:
      • Temperamental: Negative appraisal, inappropriate coping.
      • Environmental: Exposure to reminders, adverse life events, financial losses, lack of social support.

  • Diagnostic criteria for PTSD

    • Exposure to actual or threatened death, serious injury, or sexual violence
    • Presence of at least one intrusion symptom
    • Persistent avoidance of stimuli associated with traumatic event
    • Negative alterations in cognition/mood
    • Alterations in arousal and reactivity associated with traumatic event

  • Intrusive symptoms

    • Recurrent, involuntary, and intrusive distressing memories
    • Recurrent distressing dreams
    • Dissociative reactions
    • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize traumatic events
      *Alterations in arousal and reactivity
      *Irritable behavior and angry outbursts
      *Reckless or self-destructive behavior
      *Hypervigilance
      *Exaggerated startle response
      *Problems with concentration
      *Sleep disturbance
      *Depersonalization is Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of… …one’s mental processing or body

  • Diagnostic Criteria:

    *   Duration of disturbance: More than one month.
*   Causes clinically significant distress/impairment.
*   Excludes effects of substances/other MH condition.

Schizophrenia Spectrum

  • Schizophrenia spectrum includes
    • Schizophrenia
    • Psychotic disorders
    • Schizotypal disorders
  • Definition: abnormalities in one or more of five domains
    • Delusions
    • Hallucinations
    • Disorganized thinking
    • Disorganized /abnormal motor behavior
    • Negative symptoms
  • Positive and negative symptoms:
    • Positive:
      • Hallucination
      • Delusion
      • Disorganized thinking
      • Agitation
      • Repetitive movements
    • Negative:
      • Flat affection
      • Anhedonia
      • Social withdrawl
      • Executive deficit
      • Depression