Mental Retardation: Diagnostic Criteria

1. Subaverage IQ (below 70)

2. Adaptive deficits in at least two areas

3. Diagnosis prior to the age of 18

Mental Retardation: Associated Features

More mental disorders:

* ADHD

* Mood disorders

* PDD

* Sterotypic Movement D/O

* Mental Disorder due to Medical Condition

Mental Retardation: Course/Prognosis

Delayed Motor Development

Lack of interest in environment

Mental Retardation: Etiology/Treatment

5% Heredity

30% Embryonic development

10% perinatal/pregnancy issues

5% Medical

15-20% Environment and mental disorder

30-40% unknown

Learning Disorders: Diagnostic Criteria

"Substantially below" achievement score for age/schooling/intelligence

Three types:

Reading

Mathematics

Written Expression

Learning Disorders: Associated Features

Most co-morbid with ADHD - 25%

Delays in language and motor development

Average or higher IQ

Attention, memory deficits, low self-esteem

Learning Disorders: Course/Prognosis

Continues through adulthood

1.5 times drop out rate

Adults have problems in work and social situations

Learning Disorders: Etiology/Treatment

Multiple causes

Cerebellar-bestibular dysfunction (otitis media)

 Incomplete dominance

Exposure to lead

Communication Disorders: Diagnostic Criteria

Expressive Language Disorder

Mixed Receptive-Expressive Language Disorder

Phonological Disorder

Stuttering

Stuttering: Diagnostic Criteria

Age inappropriate disturbance in normal fluency and time patterning of speech.

Stuttering: Course/Prognosis

Begins age 2-7

 Stuttering: Etiology/Treatment

Treatment: 60% remit spontaneously

Regulated breathing method

Autistic Disorder: Diagnostic Criteria

Total of 6 symptoms - at least 2 from category 1 and at least 1 from the other categories:

1. Qualitative impairment in social interaction

2. Qualitative impairment in communication

3. Restricted, repetitive, and stereotyped behavior, interests and activities.

Autistic Disorder: Associated Features

75% qualify as Mentally Retarded

Uneven cognitive skills

Some are savant

20-35% have epilepsy

Autistic Disorder: Course/Prognosis

Early sign: Not responsive to caregivers

Refuse to cuddle

Look through people

Often misinterpret as hearing disorder.

Poor prognosis

Autistic Disorder: Etiology and Treatment

Reduced cerebellum

Reduced ventricles

Abnormal levels of norepinepherine, dopamine

Increased serotonin (40% more)

Genetics 50-100 times higher in siblings

Treatment: Behavioral, visual structures and cues.

Autistic Disorder: Comments and Gender Issues

4-5:1 (more males)

Best outcome: verbal communication by age of 5; IQ >70, Late onset

Rett's Disorder: Diagnostic Criteria

Period of normal development (> 5 months) the onset of sxs

Head growth deceleration

Loss of purposive hand skills

hand wringing

Loss of social interst

impaired coordination of gait or trunk

Severe language impairment

Psychomotor retardation

Only in females

Asperger's Disorder: Diagnostic Criteria

Severe social impairment

No delay in language, self-help curiosity in environment or cognitive development

Normal IQ, good verbal skills

ADHD: Diagnostic Criteria

Persistent developmentally inappropriate pattern of inattention and/or hyperactivity

onset prior to age 7

at least 6 month duration

impairment in at least 2 settings

>/= 6 symptoms of inattention and/or hyperactivity

ADHD: Associated Features

Average or higher IQ but test lower

academic problems: 25-30% have LD

Social Adjustment: peer rejection/peer neglect

Common co-disorder: conduct disorder

ADHD: Course/Prognosis

Not diagnosed until school age

hyperactivity declines in adolescence

Adulthood: 60% have sxs in adulthood

Problems with divorce, jobs, accidents, depression, substance abuse and Antisocial Personality Disorder

Poorest Prognosis: conduct disorder, low IQ, parents with severe mental disorders

ADHD: Etiology and Treatment

Genetic

Brain: lack of activity in frontal lobe and basal ganglia; impaired right hemisphere, small caudate nucleus, globus pallidus and prefrontal cortex

Treatment: Ritalin, TCAs, Clonidine

Conduct Disorder: Diagnostic Criteria

Persistent pattern of behaviors that violate rights of others and/or age-appropriate social rules

3 symptoms for the past 12 months

4 categories of symptoms:

Aggression to people and animals

destruction of property

deceitfulness or theft

serious violation of rules

If age >18, must not meet criteria for APD

Conduct Disorder: Etiology/Treatment

Moffitt: Life course persistent type: begins early, symptoms by age 3, increasing transgression that continues into adulthood - neuro impairments, difficult temperament and adverse environment.

Treatment: Better for preadolescents + family therapy

Paremtn management training

multisystemic treatment

Oppositional Defiant Disorder: Diagnostic Criteria

Recurrent pattern of negativistic, defiant and hostile behaviors toward authority figures.

Tourette's Syndrome: Diagnostic Criteria

>/= 1 vocal tic and many motor tics

Onset prior to age 18

Tourette's Syndrome: Associated Features

Obsessions and compulsions

hyperactivity

impulsivity

distractibility

Tourette's Syndrome: Etiology and Treatment

Antipsychotics: Haldol & Pimozide (80% effective)

caused by excessive dopamine; so treat hyperactive not with stimulant but clonidine or desipramine

Separation Anxiety Disorder: Diagnostic Criteria

Developmentally inappropriate, excessive anxiety related to separation from home or attachment figures

Duration: at least 4 weeks

Onset prior to age 18

>/= 3 sxs: persistent fear of being alone, frequent physical complaints when separated.

Separation Anxiety Disorder: Associated Features

Usually from close, warm families

Precipitated from major life stress

sometimes manifest as school refusal

happens at 3 different ages.

Reactive Attachment Disorder: Diagnostic Criteria

Marked disturbed and developmentally inappropriate social relatedness in many setting

Onset prior to age 5

Evidence of pathogenic care

 Reactive Attachment Disorder: Associated Features

Inhibited Type: inhibited, hypervigilant, highly ambivalent

Disinhibited Type: indiscriminate socialbility, lack of selectivity

Delirium: Diagnostic Criteria

Distrubance in consciousness (less aware of environment, attention, distractibility)

Change in cognition or perceptual abnormalities (delusions, hallucinations, etc)

Delirium: Etiology/Treatment

5 Groups high risk:

elderlyl, decreased cerebral reserve, postcardiotomy patients, burn patients, drug dependence

Risk: elderly followed by young children

Treatment: can use antipsychotic but not sedatives; sedatives have side effects and mask sxs.

Dementia: Diagnostic Criteria

Multiple cognitive deficits:

1. Memory impairment

2. aphasia, apraxia, agnosia, and/or impaired executive functioning.

Dementia: Associated Features

Usually progressive and irreversible

 Both anteriograde and retrograde amnesia

Anteriograde is more evident in early phase

Many associated features

Usually not aware of cognitive deficits

 Dementia: Etiology/Treatment

Alzheimers, Picks, Parkinsons, Huntingtons, head trauma, brain tumor, anoxia, hydrocephalus, etc.

Substances: alcohol, inhalants, sedatives, hypnotics

Substance Dependence: Diagnostic Criteria

3 symptoms in 12 months

Tolerance

Withdrawal

larger amounts needed

failed attempts to quit

Impairment

Continued use even with increased problems

Substance Dependence: Etiology/Treatment

Aversion therapy: Covert sensitization

Self control techniques

Substance Dependence: Other Comments

Marlatt & Gordon

- Overlearned habit pattern

- Abstinence violation effect

Relapse is the result of negative affect

Substance Abuse: Diagnostic Criteria

Clinically significant impairment or distress

At least 1 symptom for 12 months:

Recurrent substance use resulting in a failure to fulfill major role obligations

Use is physically hazardous

USe even with legal problems

Use even with socal problems

Alcohol Withdrawal: Diagnostic Criteria

Autonomic hyperactivity; hand tremor; insomnia; nausia/vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; grand mal seizures

Alcohol Withdrawal Delirium (DT): Diagnostic Criteria

Distrubances in consciousness and other cognitive functions; autonomic hyperactivity; vivid hallucinations; delusions; agitation

Alcohol-induced Dementia: Diagnostic Criteria

Dementia with more visuospatial memory. Some improvements after 5 years of sobriety

Alcohol-Induced Persisiting Amnestic Disorder (Korsakoffs): Diagnostic Criteria

Retrograde/Anteriograde amnesia, confabulation, ataxia; abnormal eye movements; confusion.

Anterograde severe for declarative memories

Retrograde effects recent long-term more than remote.

Schizophrenia: Diagnostic Criteria

Continuous disturbance > 6 months

at least 1 month of 2 or more active symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms.

Impariments in major area of functioning

5 types:

paranoid, disorganized, catatonic, undifferentiated, residual

Schizophrenia: Associated Features

Dysphoric mood, anhedonia, etc.

Higher suicide risk

Not more violent

Common co-disorder: substance dependence

Schizophrenia: Course/Prognosis

Chronic

Overtime, positive symptoms decrease and negative symptoms increase.

Schizophrenia: Etiology/Treatment

Genetic: 10% sibling, 17% fraternal twin, 48% identical twin

Dopamine hypothesis

Treatment: Neuroleptics, Atypical: Clozapine - less TD; better for hostility and negative symptoms.

Schizophrenia: Comments

Crow:

Type I: positive symptoms, good premorbid functioning, response to antipsychotics, due to neurotransmitters

Type II: negative symptoms, poor premorbidity, poor response to drugs, structural brain damage.

Later onset for females, females have more positive symptoms

Schizophreniform Disorder: Diagnostic Criteria

Same as schizophrenia, but less than 6 months with symptoms.

2/3 of people receive a diagnosis of schizophrenia eventually

Delusional Disorder: Diagnostic Criteria

Presence of 1 or more nonbizzare (plausible) delusions that last at least 1 month

Types: Grandiose, erotomanic, jealous, persecutory, somatic, mixed, unspecified

Major Depressive Disorder: Diagnostic Criteria

>/= 1 major depressive episode without history of manic, hypomanic or mixed episodes

Specifiers: w/ psychotic features, catatonic features, melancholic features, postpartum onset

Major Depressive Disorder: Associated Features

Double Depression: MDD and Dysthymia

Masked Depression: primarily physical symptoms

Major Depressive Disorder: Course/Prognosis

Symptoms vary with age

Untreated: Most last for >/= 6 months

20-30% symptoms remain for months or years

50% experience more than 1 episode

First two episodes may be triggered by severe stressors.

Major Depressive Disorder: Etiology (Physiological)

Catecholamine hypothesis: lower norepinepherine

Indolamine hypothesis: lower serotonin

Permissive Theory: serotonin + norepinepherine + dopamine produce depression and other mood disorders

Cortisol theory: increase cortisol = decreased serotonin.

Lack of new cell growth in subgenual prefrontal cortex and hippocampus

Major Depressive Disorder: Etiology (Therapeutic)

Learned helplessness model: negative event + attribution of internal, negative, global factors

Rehm self control model: depression = self-monitoring + self-evaluation + self-reinforcement

Beck's Cognitive Theory: depressive negative triad (self, current situation, future), cognitive errors, depressogenic schemas

Major Depressive Disorder: Treatment

Combined treatment of meds and therapy is best for severe or reccurent.

Medication: TCA, SSRI, MAOI

Therapy: Beck's cognitive therapy: identify automatic thoughts, distancing, neutralize

Dysthymic Disorder: Diagnostic Criteria

Chronically depressed mood

>/= 2 years for adults

>/= 1 year for children

Not meet criteria for major depressive episode

Bipolar I Disorder: Diagnostic Criteria

>/= 1 manic or mixed episode

History of Major Depressive Episode is optional

Specifiers:

Single manic episode, most recent episode manic, most recent episode hypomanic, most recent episode mixed, most recent episode depressed.

Bipolar I Disorder: Course/Prognosis

Usually recurrent with full return to premorbid functioning.

Rapid cylcing equals poorer prognosis

Average age for mania is 20s

Bipolar I Disorder: Etiology/Treatment

Most genetically linked disorder

65% identical twins

14% dizygotic twins

Stress can precipitate first 2 episodes

Treatment: Lithium - 60-90% effective

Antiseizure meds: carbamazepine, divalproex sodium

Bipolar II Disorder: Diagnostic Criteria

>/= 1 Major Depressive Episode and 1 Hypomanic Episode

No history of manic/mixed episodes

Cyclothymic Disorder

Fluctuating hypomanic symptoms and numerous depressive episodes

Do not meet criteria for Major Depressive Episode

>/= 2 years for adults

>/= 1 year for children/adolescents

Panic Disorder with or without Agoraphobia: Diagnostic Criteria

>/= 2 unexpected panic attacks and 1 month of concern of having another attack in between attacks

4 symptoms required:

palpitations, sweating, accelerated heart beat, chest pains, nausea, dizziness, derealization, parasthesia

Agoraphobia

>/= 1 spontaneous uncued attack

 Panic Disorder with or without Agoraphobia: Associated Features

Differential Diagnosis: Social phobia - panic disorder in agoraphobia are sometimes unexpected; with friends, the anxiety is decreased.

Rule out Medical: hyperthyroidism, hypoglycemia, cardiac arrhythmia, mitral valve relapse

Panic Disorder with or without Agoraphobia: Course/Prognosis

Starts in adolescence to mid 30s

Prepubertal children have physical sxs but rarely get diagnosis - one theory says its because children cannot make catastrophic interpretations of internal sensations.

 Panic Disorder with or without Agoraphobia: Etiology/Treatment

Flooding: In vivo exposure with response prevention.  60-70% effective.

Panic Control Treatments: target panic symptoms

Drugs: TCAs - imipramine, SSRIs, Benzos, anticonvulsants...there is a high relapse with drugs alone.

 Specific Phobia: Diagnostic Criteria

Marked or persistent fear of a specific object or situation. 

5 types:

Animal, natural environment, situational (fear of flying, etc.), blood-injection-injury (increases heart rate and blood pressure then quickly drops - faint), other 

Specific Phobia: Etiology/Treatment

Mowrer's 2 Factor Theory:

Avoidance conditioning = phobias; classical conditioning + operant conditioning

Treatment: in vivo exposure is the best

in vivo desensitization + participant modeling

Cognitive self-control

Treatment for blood-injection-type treatment uses tesning not relaxing.

Social Phobia: Diagnostic Criteria

Marked and persistent fear of social or performance situations that may cause embarrassment or humiliation as result of scrutiny or evaluation by others.

Social Phobia: Etiology/Treatment

Treatment:

Exposure

Exposure + social skills or cognitive techniques

Cognitive-behavioral group therapy

Meds: MAOI effective, SSRIs, SNRI, Beta-blocker for somatic symptoms

Obsessive-Compulsive Disorder: Diagnostic Criteria

Recurrent obsessions and/or compulsions that cause significant distress

For adults, need awareness that it is excessive.

Obsessive-Compulsive Disorder: Etiology/Treatment

Caused by decrease in serotonin

Decreased activity in right caudate nucleus

Treatment: Exposure with response prevention + meds is best.  90% reduction in symptoms

Supplement with thought stopping

Do not use drugs alone, relapse is high.

Posttraumatic Stress Disorder: Diagnostic Criteria

Characteristic symptoms after exposure to extreme trauma.

1. Persistent re-experiencing of trauma (Children: repetitive play, omen formation)

2. Persistent avoidance of stimuli associated with trauma.

3. Persistent symptoms of increased arousal.

Symptoms must be present >/= 1 month after trauma.

Posttraumatic Stress Disorder: Treatment

Treatment depends on the stage

- Acute stage: debriefing

- Chronic PTSD: cognitive-behavioral + stress inoculation or anxiety manangement training

Meds:

TCA, EMDR is controversial.

Acute Stress Disorder: Diagnostic Criteria

Same as PTSD, but symptoms must onset within 4 weeks and last for at least 2 days but less than 4 weeks

3 or more dissociative symptoms:

sense of numbness, emotional detachment, derealization, dissociative amnesia

Generalized Anxiety Disorder: Diagnostic Criteria

Excessive anxiety and worry about multiple events or activities.

 Constant for >/= 1 month

Person finds it hard to control

Need 3 symptoms:

restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.

Generalized Anxiety Disorder: Associated Features

Differential Diagnosis:

Normal anxiety - with normal anxiety, the anxiety they feel is controllable to some degree.  This is not the case with GAD.

Generalized Anxiety Disorder: Treatment

Multicomponent cognitive-behavioral intervention

Beck's CBT is superior to behavioral therapy and benzos

Meds:

SSRIs, Anxioleptic: Buspar

 Somatoform Disorders: Diagnostic Criteria

Physical symptoms that suggest a medical disorder but:

1. are not fully explained by medical, substance use, or other mental disorder.

2. Distress and impairment

3. not intentionally produced.

Somatization Disorder: Diagnostic Criteria

Recurrent multiple somatic complaints, before the age of 30. 

Persistent for several years; sought medical help but no physical explanation found.

Must include:

4 pain sxs, 2 GI sxs, 1 sexual sx, 1 pseudoneuro

Somatization Disorder: Associated Features

People describe complaints dramatically

May see several MDs at once.

May undergo many surgeries and other medical procedures.

May have substance use.

Conversion Disorder: Diagnostic Criteria

Symptoms that involve voluntary motor or sensory functioning and that suggest a serious meuro or other medical condition.

Eg: paralysis, blindness

Conversion Disorder: Associated Features

La belle indifference or overly dramatic

Differential Diagnosis: Factitious and malingering have similar symptoms but are voluntarily produced or feigned.

Conversion Disorder: Etiology/Treatment

Etiology:

Primary gain (keep conflict out of consciousness)

Secondary gain (avoid unpleasant activity or support)

Treatment:

symptoms clear with hypnosis or sodium amytal

Suggest to patient symptoms will remit.

Hypocondriasis: Diagnostic Criteria

Unrealistic pre-occupation with a serious illness.

Persists despite lack of medical evidence.

Doctor shopping

Detailed symptom descriptions

Resists mental health referrals

Facticious Disorders: Diagnostic Criteria

Intentionally produced or feigned physical or psychological symptoms. Goal is to adopt the sick role.

Facticious disorder by proxy (Munchausen) - keep your child sick for attention.

Facticious Disorder: Associated Features

Overly dramatic history presentation

vague, inconsistent details

history of many surgeries

Differential Diagnosis: Malingering; also feigning, but want external reward.

Dissociative Disorders: Diagnostic Criteria

Disruption in consciousness, identity, memory or perception of the environment not due to a medical condition or substance use.

Dissociative Amnesia: Diagnostic Criteria

1 or more episodes of an inability to recall important personal information.  There are usually gaps in memory due to trauma.

Types:

Localized (all events), Selective (some events), Generalized (whole life), Continuous (before a certain time)

Dissociative Fugue: Diagnostic Criteria

Abrupt, unexpected travel away from home or work with an inability to recall some or all of one's past.

Confused about identity

The person takes on a whole new identity

 Dissociative Identity Disorder: Diagnostic Criteria

Presence of 2 or more distinct identities or personality states.

Each has its own pattern of perceiving, relating to, and thinking about the environment and self.

Depersonalization Disorder

1 or more episode of depersonalization, which involves feeling of detachment or estrangement from one's mental processes or body.

Reality testing is intact. There must be significant impairment.

Sexual Dysfunctions: Diagnostic Criteria

Disturbance in sexual response cycle or pain related to sexual intercourse that results in marked distress or interpersonal difficulty.

Types:

Lifelong or acquired, generalized or situational, primary or secondary

 Sexual Dysfunctions: Etiology/Treatment

Master & Johnson: successful for premature ejaculation and vaginismus.  Treat couple not individual

Dysfunctional behaviors: performance anxiety, faulty attitudes and beliefs, deficient knowledge and skills.

Sensate focus: reduce performance anxiety and increase sexual excitement.  start with graded exercises then to genital stimulation but no orgasm and finally intercourse.

Male Erectile Disorder: Diagnostic Criteria and Associated Features

 Cannot attain or maintain an adequate erection.

Physical factors: Diabetes mellitus, liver/kidney disease, multiple sclerosis, antipsychotic/antidepressants/hypertensive meds

Male Erectile Disorder: Etiology/Treatment

No erection during REM sleep = an organic problem

Treatment: Viagra (does not effect desire, just the erection.) Side effects are facial flushing, indigestion, headache.

Female/Male Orgasmic Disorder: Diagnostic Criteria

Delay in or absence of an orgasm following a normal sexual excitement phase.

Female/Male Orgasmic Disorder: Treatment

Start-stop/Squeeze

Kegel exercises

 Premature Ejaculation

Orgasm and ejaculation with minimal sexual stimulation.  Before, or after, penetration; before the person desires.

Paraphilias: Diagnostic Criteria

Intense, recurrent sexual urges, fantasies or behaviors involving nonhuman objects, the suffering or humiliation of oneself or one's partner or children or other nonconsenting partners.

Usually claim sexual behaviors as non-disturbing; some claim shame, guilt and depression.

Types: fetishism, transvestic fetishism, pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, frotteurism.

Paraphilias: Treatment

PReviously in vivo aversion therapy, now convertion sensitization (aversive condition in imagination)

Satiation therapy

Others: orgasmic reorientation - substitute appropriate stiumulus while masturbating.

Meds: DepoProvera (must continue to take it)

Gender Identity Disorder: Diagnostic Criteria

Strong, persistent cross-gender identification and discomfort with one's sex or a sense of inappropriateness in the gender role of that sex.

Gender Identity Disorder: Course/Prognosis

Onset ate 2 to 4

75% by adulthood report homosexual or bisexual orientation.

 Narcolepsy: Diagnostic Criteria

Irresistable attacks of restorative sleep and cataplexy (loss of muscle tone)

And/or REM intrusion between sleep and wakefulness

Narcolepsy: Associated Features

Cataplexy triggered by strong emotion

Differential Diagnosis: substance-induced sleep disorder, hypersomnia Type (similar symptoms but due to substance)

Nightmare Disorder: Diagnostic Criteria

Repeated awakening from sleep with detail recollection of frightening dreams.

Wake up fully alert; feel anxious and fearful

Sleep Terror Disorder: Diagnostic Criteria

Repeated abrupt awakenings from sleep - usually with panicky scream or crying

Difficult to wake up or comfort

Maybe confused upon awakening during episode

In morning, does not remember episode

Sleepwalking Disorder: Diagnostic Criteria

Rise from bed and walk around

Usually cannot wake up and has blank stare

May talk during episode, inarticulate

Happens during non-REM sleep, usually during the first third of the night.

Anorexia Nervosa: Diagnostic Criteria

1. Refuse to maintain weight (<85% ideal weight)

2. Fear of gaining weight

3. Significant disturbance in perception of the shape or size of one's body

4. In females, amenorrhea

2 subtypes:

Restrictive type: dieting, fasting, exessive exercise

Binge/Purge type: binge eating and/or purging during anorectic episode

Anorexia Nervosa: Associated Features

Deny their disorder

Physical Symptoms: constipation, cold intolerance, lethargy, bradycardia

If purging also: anemia, impaired renal functioning, cardiac abnormalities, dental problems, osteoporosis.

Anorexia Nervosa: Course/Prognosis

Onset mid- to late adolescence; usually associated with a stressful life event.

Anorexia Nervosa: Etiology/Treatment

Family Characteristics: Usually middle or upper class; outwardly calm family but competitive and overly concerned with approval and success.

Mother is overbearing

Father is distant

Treatment: put on weight first; Minuchin "family lunch sessions"

Bulimia Nervosa: Diagnostic Criteria

Recurrent episodes of binge eating; accompanied by sense of lack of control

Inappropriate compensatory behavior to prevent weight gain - self-vomiting, laxxatives, diuretics, fasting, excessive exercise

Bulimia Nervosa: Associated Features

Between binges - counting calories

Weight = normal usually

Co-Diagnosis: Dysthymic Disorder, Major Depression

Medical Problems: metabolic alkalosis from vomiting, metabolic acidosis from laxatives, dental problems, menstrual abnormalities.

Bulimia Nervosa: Course/Prognosis

Begin in late adolescence or early adulthood; begins after a period of dieting.

Bulimia Nervosa: Etiology/Treatment

Genetics = runs in families

Low levels of endogenous opiod beta-endorphin

Low serotonin and low norepinepherine

Treatment: nutritional counseling, CBT

Meds: not as good long term - Imipramine, Prozac

Adjustment Disorder: Diagnostic Criteria

Maladaptive reactions to one or more identifiable psychosocial stressors

Symptom onset within 3 months of stressor

Impairment and/or distress in excess

Types: Depressed mood, anxiety, mixed anxiety and depressed mood, disturbances of conduct, disturbances of emotions and conduct

Adjustment Disorder: Associated Features

Differential Diagnosis:

PTSD, Acute Stress Disorder, Bereavement (excessive bereavement becomes adjustment disorder)

Personality Disorders: Diagnostic Criteria

Rigid maladaptive traits

Cause personal distress, impairment

If under 18, symptoms present for at least one year (APD cannot be diagnosed before age of 18)

APD = decreased neuroticism, agreeableness, and conscientiousness

Avoidant = decreased extraversion and increased neuroticism

Paranoid PD: Diagnostic Criteria

Distrust and suspiciousness

>/= 4 characteristic symptoms:

suspects others are exploiting, harming or deceiving

does not confide in others

sees benign comments as demeaning

suspicious without justification about spouse fidelity

Schizoid PD: Diagnostic Criteria

Indifference to interpersonal relationships

Restricted emotions in social settings

>/=4 symptoms:

no desire for close relationships

chooses solitary activities

no interest in sexual relationships

few pleasurable activities

indifferent to praise or criticism

emotional detachment/coldness

Schizotypal PD: Diagnostic Criteria

Social and interpersonal deficits, eccentric

>/= 5 symptoms

ideas of reference

odd beliefs or magical thinking

bodily illusions

odd thinking and speech

suspiciousness

inappropriate or constricted affect

Antisocial PD: Diagnostic Criteria

Disregard for and violation of the rights of others

>18 years; history of conduct disorder before 15

>/= 3 symptoms

failure to conform to norms

deceitfulness

impulsivity

reckless disregard for safety of self/others

consistent irresponsibility, lack of remorse

Borderline PD: Diagnostic Criteria

Instability in interpersonal relationships, self-image, affect and marked impulsivity

>/= 5 symptoms

frantic efforts to avoid abandonment

pattern of unstable, intense relationships (ideal-devalue)

instable sense of self, impulsivity, recurrent suicide threats, affective instability, chronic feelings of emptiness.

Borderline PD: Treatment

Linnehan's DBT = CBT + Rogerian

Reduces permature termination and suicidal threats

DBT Techniques:

group skills, individual outpatient, telephone consultation

Beck's CBT: Focus on transferences

Histrionic PD: Diagnostic Criteria

Emotionality and attention seeking

>/= 5 symptoms

discomfort when not center of attention

seductive inappropriately

shallow shifting emotions

excessively impressionistic speech lacking in detail

exaggerated expression of emotion, easily influenced by others, considers relationships to be more intimate than they are.

Narcissistic PD: Diagnostic Criteria

Grandiosity, need for admiration, and lack of empathy

>/= 5 symptoms

grandiosity

preoccupied with fantasies of unlimited success, power, etc., believe to be unique, requires admiration, sense of entitlement, interpersonally exploitative, lacks empathy

 Avoidant PD: Diagnostic Criteria

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation

>/= 4 symptoms

avoids work or school involving interpersonal contact due to fear of criticism, rejection or disapproval, unwilling to engage people unless they will be liked, preoccupied with criticism and rejection, sees self as socially inept.

Obsessive-Compulsive PD: Diagnostic Criteria

Preoccupation with orderliness, perfectionism, and mental and interpersonal control

>/=4 symptoms

preoccupied with details

perfectionism

too devoted to work

overconscientious

inflexible morality