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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