Disorder - University of Arizona



Disorder |Description |Occurrence/ Etiology |Treatment/ Prognosis | |

|Mood Disorders |

|Major Depressive Disorder |- 1 (+) major depressive episode (5/9: ↓ Sleep, ↓ |Lifetime: |SSRIs, |

| |Interest/ pleasure, Guilt/ worthlessness, ↓ Energy/ |♂ 5-12% |Heterocyclic |

| |fatigue, ↓ Concentration, |♀ 10-20% |antidepressants, |

| |↓ Appetite, Psychomotor agitation/ retardation, SI | |MAOIs, |

| |and depressed mood) |- ↓ serotonin/ NE/ |Electro-convulsive |

| |Atypical depression: ↑ sleep/appetite |dopamine |therapy, |

| |- No mania |- genetic component |psychotherapy, |

| |- possible confused thinking, mild memory problems, |- left sided strokes, | |

| |delusions, hallucinations |chronic disorders |usu. self-limiting |

| | |- medications |6-10 m. |

| | |-early loss, child | |

| | |abuse, learned | |

| | |helplessness, loss | |

|Post Partum Depression | | |Same as MDD |

|Seasonal Affective Disorder |- major depressive disorder associated with winter/ | |Full spectrum light |

| |short days | |exposure |

|Masked Depression |- Pt unaware of depression | |Same as MDD |

| |- headaches, body aches, vague symptoms with no | | |

| |organic cause (tend to see PCP) | | |

| |- 15% commit suicide | | |

|Dysthymic Disorder |- mild depression for 2 (+) yrs |Lifetime: 6% |Same as MDD |

| |- nonepisodic, no psychosis | | |

|Bereavement |- dysthymia or MDD up to 2 m. after of loss of | | |

| |loved one | | |

|Adjustment Disorder with |- dysthymia following within 2 m. of significant | | |

|Depressed Mood |stressor lasting up to 6 m. after stressor | | |

|Bipolar Disorder I |- Mania (3/7 for 1 (+) week: ↑ self esteem/ |1% |Lithium (citrate or |

| |grandiosity, ↓ Sleep, talkativeness, flight of | |carbonate), |

| |ideas, distractibility, ↑ activity/ agitation, | |anticonvulsants, |

| |activities with negative consequences) | |Sedatives |

| |- depression | | |

| | | |(antidepressants may |

| | | |provoke mania) |

| | | | |

| | | |Therapy over chronic |

| | | |course |

|Bipolar Disorder II |- hypomania (mild mania for 4 (+) days) | | |

| |- depression | | |

|Cyclothymic Disorder |- dysthymia & hypomania for |Lifetime: 1% |Same as bipolar |

| |2 (+) yrs | |disorder |

| |- nonepisodic, no psychosis | | |

|Mood Disorder due to medical |- mood symptoms from endocrine problem, neurologic | | |

|condition |lesion | | |

|Substance-Induced Mood Disorder |- mood symptoms from drug use/abuse | | |

| |- reserpine, antihypertensives, antineoplastic, | | |

| |steroids, stimulants | | |

|Suicide |Increased risk: serious prior attempt, > 45 yo, |USA 12 per 100,000 |Hospitalize pt. if: pt|

| |substance abuse, violent history, male, white, | |has means, has plan, |

| |isolated, close relative committed suicide, jewish, |8th leading cause of |acute intoxication, |

| |protestant, professional, psychotic symptoms, |death |“out of control”, |

| |recession, low job satisfaction | |repeated attempts, |

| | | |psychotic symptoms, no|

| | | |social support, |

| | | |unreliable |

|Anxiety Disorders |

|Panic Disorder |- episodic panic attacks (~30min: sudden onset, |Lifetime: |SSRI & BZ, |

| |extreme apprehension, tachycardia, sweating, |3.5% |β adrenergic |

| |dyspnea, pt thinks she will die) 2x wk |♂ 2% |antagonist (for |

| |-between attacks- anticipatory anxiety (fear of |♀ 5% |automatic symptoms) |

| |panic attack) | | |

| | |Onset 25 yo |Systemic |

| | | |desensitization / |

| | |Inducible with IV |cognitive-behavioral |

| | |sodium lactate or |therapy |

| | |hyperventilation or | |

| | |CO2 inhalation | |

|Agoraphobia |- panic attacks associated with fear/ avoidance of |♂ 2% | |

| |public places/ situations with no escape |♀ 4% | |

|Social Phobia (= social anxiety |- fear of embarrassment in social/ performance |3% |SSRI, MAOI, β |

|disorder) |settings | |adrenergic antagonist |

| | | |, |

| | | |Assertiveness or group|

| | | |therapy |

|Specific Phobia |- irrational fear of certain things/ situations |♂ 5% |Cognitive- behavioral |

| | |♀ 10% |therapy, systematic |

| | | |desensitization, |

| | | |behavioral therapy, |

| | | |hypnosis |

|Obsessive Compulsive Disorder |- recurrent, unwanted, intrusive feelings/thoughts/ |2-3% |SSRI, Clomipramine, |

| |images (obsessions) and anxiety | |Behavior therapy, |

| |- anxiety relieved by repetitive actions |Genetic relation to |supportive |

| |(compulsions) or obsessive thinking |Tourette’s |psychotherapy |

| |- ex: hand washing, door locking | | |

| |- pts have insight (realize behaviors are irrational| | |

| |and want to eliminate them) | | |

|Generalized Anxiety Disorder |- persistent symptoms of anxiety (hyperarousal, |3-5% |Buspirone, |

| |excessive worrying) x 6 m. | |Venlafaxine, Doxepin, |

| | |commonly comorbid with|BZ, β adrenergic |

| | |MDD |antagonist, cognitive |

| | | |–behavorial therapy, |

| | | |behavioral therapy |

|Stress/Adjustment Disorders |

|Post-Traumatic Stress Disorder |- exposure to life threatening event affecting pt or|Any point in time: |SSRI, anticonvulsant, |

| |someone close |1-2% |antipsychotic, β |

| |- re-experiencing – flashbacks, nightmares | |adrenergic antagonist |

| |- hyperarousal – anxiety, ↑ startle response, sleep |Lifetime: | |

| |trouble, hypervigilience |1-14% |33%- w/in 3 m. full |

| |- emotional numbing - ↓ emotionality, anhedonia, | |recovery |

| |difficulty connecting to others |In at risk population:| |

| |- avoidance – guilt, dissociation, withdrawal, being|3-58% (book) |33% - symptoms persist|

| |overwhelmed |10-20% (notes) |after 10 yrs |

| | | | |

| | |33% comorbid for MDD |PTSD worsened by |

| | | |alcohol abuse, trauma |

| | | |in childhood |

|Adjustment Disorder |- emotional symptoms – anxiety, depression, conduct | | |

| |problems, mixed emotional symptoms | | |

| |- social, school, work impairment within 3 months | | |

| |and lasting less than 6 months after stressor | | |

|Acute Stress Disorder |- response to traumatic event | | |

| |- dissociation (numbing, amnesia, derealization, , | | |

| |depersonalization) | | |

| |- re-experiencing | | |

| |- avoidance | | |

| |- ↑ arousal | | |

| |- 2 days to 4 wks | | |

|Dissociative Disorders |

|Dissociative Amnesia |- can’t remember important info about self |♂ < ♀ |Usu. resolves in |

| | |Young > old |minutes-days, may last|

| | | |years |

| | | | |

| | | |Hypnosis, drug |

| | | |assisted interviews, |

| | | |psychoanalysis, |

| | | |antidepressants, |

| | | |antiaxiety meds, |

| | | |anticonvulsants |

|Dissociative Fugue |- can’t remember pertinent info about self | |Hypnosis, drug |

| |- wanders from home and adopts a new identity | |assisted interviews, |

| | | |psychoanalysis, |

| | | |antidepressants, |

| | | |antiaxiety meds, |

| | | |anticonvulsants |

|Depersonalization Disorder |- recurrent, persistent feelings of detachment and | |Hypnosis, drug |

| |unreality about ones body/ social situation/ | |assisted interviews, |

| |environment | |psychoanalysis, |

| |- normal reality testing (insight) | |antidepressants, |

| |-often follows acute stressor | |antiaxiety meds, |

| | | |anticonvulsants |

|Dissociative Identity Disorder |- at least 2 distinct personalities (= alters) in |♂ < < ♀ |Hypnosis, drug |

|(= Multiple Personality |one individual | |assisted interviews, |

|Disorder) |- usu. 5-10 personalities |Often comorbid with |psychoanalysis, |

| |- usu. one personality rules |depression & anxiety |antidepressants, |

| | | |antiaxiety meds, |

| | | |anticonvulsants |

|Somatoform Disorders |

|Somatization Disorder |- history of 8(+) symptoms (pain, GI, sexual, | | |

| |neurological, etc) with no or inadequate cause, usu.| | |

| |chronic | | |

| |- symptoms begin before 30 yo | | |

|Conversion Disorder |- sudden, dramatic loss of motor or sensory function| | |

| |(commonly shifting paralysis, globus hystericus, | | |

| |pseudoseizures, paresthesias, anesthesias, visual | | |

| |problems) | | |

| |- preceded by stressor | | |

| |- “la belle indifference” | | |

|Hypochondriasis |- fear of having a serious illness based on | |SSRIs |

| |misinterpretation of bodily symptoms | | |

|Body Dysmorphic Disorder |- normal appearing pt focused on minor or imagined | | |

| |defect | | |

|Somatoform Pain Disorder |- protracted, intense pain not adequately explained |Onset: 30-40s | |

| |by physical cause | | |

|Chronic Fatigue Syndrome |- unexplained fatigue lasting 6+ months | |Please note that these|

| | | |disorders are not |

| | | |psycho-pathologica, |

| | | |but differential |

| | | |diagnoses |

|Fibromyalgia |- unexplained widespread musculoskeletal pain & | | |

| |multiple tenderpoints | | |

|Cognitive Disorders |

|Delirium |- impaired consciousness | | |

| |- acute, disorientation, ↓ awareness | | |

| |- illusions, delusions, hallucinations | | |

|Dementia |- loss of intellectual ability |In people over 80 yo: | |

| |- gradual, can’t register/retrieve new info. |20% | |

| |- preserved consciousness | | |

|Amnestic Disorder |- loss of memory (esp. recent) |Thiamine deficiency | |

| |- acute or gradual |(Korsakoff) | |

| |-preserved demeanor, language, personality | | |

| |- commonly, pt. fabricates forgotten info to cover |Temporal lobe injury | |

| |up mem. Loss (confabulation) |(herpes simplex | |

| | |encephalitis) | |

|Mild Cognitive Impairment | | | |

|Alzheimer’s Disease | | | |

|Personality Disorders |

|A Paranoid Personality Disorder |- distrustful, suspicious, litigious, blames others | | |

| |for own problems | | |

|A Schizoid Personality Disorder |- longstanding pattern of voluntary social |1% | |

| |withdrawal without psychosis | | |

| |- detached | | |

| |- restricted emotions | | |

|A Schizotypal Personality |- peculiar appearance |2-3% | |

|Disorder |- magical thinking | | |

| |- odd thought patterns & behavior without psychosis | | |

|B Histrionic |- attention seeking |2-3% | |

| |- extroverted, emotional, vain, shallow, sexually | | |

| |provocative (♂: “Don Juan” dress) | | |

| |- can’t maintain intimate relationships | | |

|B Antisocial |- refuses to conform to social norms, dishonest |2-3% | |

|(= psychopaths = sociopaths) |- no concern for others, fails to learn from | | |

| |experience | | |

| |- associated with conduct disorder in childhood and | | |

| |criminality in adulthood | | |

|B Narcissitic |- pompous, sense of entitlement, lacks empathy, |1% | |

| |feels superior | | |

|B Borderline Personality |- erratic, unstable behavior/mood |2-3% | |

| |- boredom, feels alone, impulsive, suicide attempts,| | |

| |self-injury |Often comorbid with: | |

| | |mood & eating | |

| | |disorders | |

|C Avoidant |- timid, sensitive to rejection, socially withdrawn,|1% | |

| |feelings of inferiority | | |

|C Dependent |- poor self confidence, allows others to make their |2-3% | |

| |decisions/assume their responsibility | | |

| |- may end up as abused spouse | | |

|C Obcessive-Compulsive |- conscious need for perfection may result in |1% | |

| |repetitive behaviors | | |

| |- rituals are not common | | |

| |-orderly, stubborn, indecisive, ultimately | | |

| |inefficient | | |

|Passive-Aggressive |- procrastinates, inefficient, sullen, outwardly | | |

| |compliant but inwardly defiant | | |

|Intermittent Explosive Disorder |- episodes where pt loses self-control and attacks |♂ > ♀ | |

|(= amok) |others | | |

| |- soft neuro signs | | |

|Kleptomania |- impulse to take things without paying despite the | | |

| |fact that the things are affordable | | |

|Pathologic Gambling |- overwhelming need to gamble despite negative |1-3% |Gambler’s anonymous |

| |effect on family/work | | |

|Pyromania |- repetitive fire setting, overwhelming interest in |♂ > ♀ | |

| |fire |Young > old | |

| |- associated with conduct disorder | | |

|Trichotillomania |- strong need to pull out own hair | | |

|Factitious Disorder (= |- pt fakes or induces medical/emotional symptoms for| | |

|Munchausen’s Syndrome) |attention and care | | |

| |- pts usu. don’t know why they do this | | |

|Malingering |- conscious simulation or exaggeration of medical | | |

| |condition for obvious gain (avoid work/ get money) | | |

|Schizophrenia |

|Schizophrenia |(+): delusions, hallucinations, disorganized speech,| | |

| |disorganized/ catatonic behavior | | |

| |(-): affective flattening, alogia, avolition | | |

| |- signs for 6+ months | | |

|Subtype: Paranoid | | | |

|Subtype: Disorganized | | | |

|Subtype: Catatonic | | | |

|Subtype: Residual | | | |

|Subtype: Undifferentiated | | | |

|Childhood & Adolescent Disorders |

|Depression |- may present as irritability and failure |Prepubertal: 2% | |

| | |Adolescents: 5% | |

|Simple Phobias | | |Desensitization, |

| | | |medication, |

| | | |individual/group |

| | | |therapy |

|Separation Anxiety Disorder | | | |

|Generalized Anxeity Disorder | | | |

|Obsessive Compulsive Disorder | | | |

|Schizophreinia |- visual hallucinations more common |1 in 2,000 |MUST do comprehensive |

| | | |physical workup |

|Eating Disorders | |25% of non-referred | |

| | |adolescents | |

|Mental Retardation |- IQ 70 or below, onset before 18 yo |4-5 in 10,000 | |

|Tourette’s Disorder |- multiple motor tics and one or more vocal tics |♂ > ♀ | |

| |- may have obsessions, compulsions, hyperactivity, | | |

| |distractibility, impulsivity | | |

|Substance Abuse | | | |

|Elimination Disorders | | | |

|ADHD |- inattentive, hyperactive, impulsive |Preschool/ | |

| |- soft neurological signs (↓ fluidity) |kindergarten | |

| | |boys: 14-20% | |

|Conduct Disorder |- repetitive violation of the basic rights of | | |

| |others, stealing, run away, lie, firesetting, | | |

| |truancy, vandalism, animal cruelty, aggession | | |

|Oppositional Defiant Disorder |- stubborn, negative, provocative, hostile, defiant | | |

|Autism |- impairment in social relation, language & | | |

| |restricted/repetitive areas of interest | | |

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