DISORDERS DURATION/ON SYMPTOMS/MANIFESTATIONS TREATMENT

SET
IQ < 70 + social adaptive deficits
Mental Retardation Onset <18y.o Causes: 1° Fetal Alcohol Sd. 2° Down Sd. 3° Fragile X Sd. Primary Prevention:
Level IQ Functioning  Genetic counseling if family hx.
Mild 50- 85%. Self-supporting. 6° grade level. Self-esteem &  Prenatal care
70 impulse control problems.
Moderat 35- Trainable, can work w/supervision. 2° grade level.
e 49 Problems conforming to social norms. Higher risk of
AD.
Severe 20- Basic self-care habits (brush teeth, comb hair). Live
34 in group home setting.
Profound <20 Dependant 24/7. Little or no speech
 Learning achievement below expectations, given pt’s age, intelligence,
Learning Disorders Onset: elementary sensory abilities & educational experience.  Special education: maximize
school  Reading, math & written expression disorders are the MC. skills, improve weak areas.
 May be present: Perceptual motor problems. Conduct disorder.  Pt & family counseling.
Oppositional Defiant disorder. ADHD. Poor self-esteem & social
immaturity
 MR (75-80%, the lower the IQ, the higher the incidence of autism)
Autism Dx: after 2° BD  Social, communication & behavioral symptoms (bizarre mannerisms)  Behavioral techniques:
 Abnormal language: pronoun reversal (everything in 1° person) shaping.
 Avoid others. Minimal eye contact. Shrink shoulders when touched.  When pt is aggressive to self &
 Doesn’t cry when mother leaves: no separation anxiety. others, give atypical
 May be aggressive towards others. antipsychotics:
 Avoid pleasure & may injure himself to calm down (head banging on Risperidone.
Pervasive the wall)
Childhood Developmental X-linked Dominant (seen almost always in girls, boys die in utero)  Behavioral techniques: teach
D. Disorder Rett’s Sd Between ages 1 &  Loss of development: it stops!  Motor/Language Regression: loss of child to communicate.
4 verbal abilities. MR. Emotional inversion.  Beta blockers for long QT Sd.
 Self-mutilating behavior. Hypotonia, dystonia, chorea, ataxia, bruxism  Pump Proton inhibitors for
 Stereotyped handwriting. reflux.
 Scoliosis, Long QT Sd, GI reflux  Antipsychotics for self-harm
behavior.
 Inattention, hyperactivity & impulsivity that interfere w/ social & Drugs  Mnemonic: “Mox Mete
Attention Deficit Hyperactivity Onset < 12y.o. academic function. Dextro”
Disorder (ADHD) Symptoms last > 6  Multiple settings: home, school, work (deficits in 2 or more areas)  atoMOXitine (most effective)
months  Difficulty controlling attention. Unable to sit still. Disruptive in the  METHYLphenidate (>6y.o)
classroom.  DEXTROamphetamine
 Easily distracted. Impulsive. Fidgets. Speaks out of turn. (>3y.o)
 Difficulty in relationship w/ others
Violation in 4 areas:  Healthy group identity & role
Conduct Disorder Dx < 18y.o  Aggression: towards people & animals, bullying, fighting, rape. model (big brother
(In >18y.o. is  Property destruction: vandalism, fire setting. programs)
Antisocial  Deceitfulness or theft  Structured living settings:
Personality  Rules: do not follow them change environment.
Disorder) Try to get parents involved.
Oppositional Defiant Disorder Onset: early Pattern of negativistic, hostile, and defiant behaviors toward adults: Family quality time (don’t
adolescence arguments, temper outburst, vindictiveness, deliberate annoyance punish behavior, & reward the
 (typical annoying teenager) desired one)
 Behavioral approach  Bell-
Childhood Enuresis Onset < 5y.o. Repeated voiding of urine into pt’s clothes or bed, when medical pad app (wet VS. dry,
conditions are ruled out. Related to stress, family hx of enuresis. reward dry days)
 Drugs: Imipramine,
desmopressin (nasal spray,
DDAVP)
Stranger Anxiety 6months – 2y.o.  Stranger Anxiety: fear of stranger in unfamiliar situations
Childho  Separation Anxiety: fear of separation from caregiver.
od Separation Anxiety 1 – 3y.o.  Physical complaints: stomach ache, malaise, unrealistic fears  Family therapy.
Anxiety 7-9yr physical (monsters), nightmares, difficulty sleeping, phobias, self mutilation  Cognitive behavioral therapy.
complaints (scratching, nail-biting, hair-pulling)
Tourette Disorder Onset < 18y.o. Vocal tics: grunts, coprolalia. Pimozide, Haloperidol,
Motor tics: twitching of face, trunk, extremities & pacing, spinning and Olanzapine,
touching. Risperidone, Clonidine,
Clonazepam.
SIGE CAPS
Major Depressive Disorder Duration of  S leep disturbances: hyper or hyposomnia.  1° secure safety: is pt suicidal?
(MDD) symptoms >2 ↓slow-wave sleep (delta) ↑REM early in sleep  Antidepressants: SSRI (the
weeks. cycle best, and > compliant), TCA,
↓REM latency ↑total REM sleep MAOi.
Duration of Repeated nighttime Early morning  Electroconvulsive therapy: in
episodes between awakenings awakenings acute situations (suicidal pt),
6m – 12m  I nterest  lost: anhedonia when drugs don’t work, or
 G uilt or feelings of worthlessness when pt is worried about SE.
 E nergy: lost Controversial use.
 C oncentration: lost (bad serial 7, serial 3)  Individual psychotherapy.
 A ppetite: ↓or↑, weight changes.
 P sychomotor agitation or retardation (stooped posture, slow
movements & speech)
 S uicidal ideas
Atypical depression MC subtype. Hypersomnia + Overeating + Mood Reactivity. Leaden  MOAi, SSRI
paralysis (pt feeling his limbs are weighed down)
 Long-term individual, insight -
Mood D. Dysthymic Disorder >2years Same as MDD but milder oriented psychotherapy.
 SSRI, MOAi, SSRI
Seasonal Affective Disorder Winter months Atypical symptoms Bright light therapy. Go to
Florida.
1 Manic episode (w/ or w/o hypomania & depression)
 Increased self-esteem, or grandiosity.
 Distractibility.  Mood stabilizers: Lithium,
Bipolar Manic symptoms  Low frustration tolerance Valproic acid (tx of choice).
Disorder BD I >1 week, cause  Erratic, uninhibited behavior  BZD: carbamazepine.
significant distress  More talkative than usual (pressured speech), flight of ideas.  Atypical Antipsychotics in
& impairment in  Excessive involvement in activities. acute manic states:
functioning.  Increased libido & sexual activity. Resperidone, olanzapine,
Onset: 30y.o  Weight loss & anorexia (bc they’re busy doing a lot of stuff, is not on clozapine
(average) purpose)  Individual psychotherapy.
BD II Recurrent depressive episodes + hypomanialike mania but mood
disturbances not severe enough to cause social impairment
 (at least one episode of each)
Cyclothymic Disorder >2 years “Milder” BD. Many periods of depressed mood & many of hypomanic  Individual psychotherapy.
mood.  If not sufficient: Lithium,
Ego - syntonic Valproic ac
Pathological Grief >6months Good and bad days. Can cause functional impairment. Return to basal  Supportive psychotherapy.
(Bereavement) level of functioning within 2 months (MDD pts don’t). If symptoms
persist, it becomes MDD.
Post Baby blues After birth – 2 Mild depression  Self-limited.
-Partum weeks
Depressi Postpartum 1m after birth, last May have thoughts of hurting baby + severe depression + psychosis  Antidepressants +
on Psychosis 4-6m  Mood stabilizers or
antipsychotics
Postpartum 1m after birth, last May have thoughts of hurting baby + severe depression  Antidepressants.
Depression 2w - 1y or >
Brief Psychotic Disorder <1month Positive symptoms  Hospitalization: stabilization
Schizophreniform Disorder 1-6 months Positive + Negative symptoms and/or safety of pt to self or
 Thought disorder that impairs: judgment behavior, ability to interpret others (e.g. suicidal, want to
reality kill someone)
>6months  PE: saccadic eye movement, hypervigilance  Atypical Antipsychotics.
 CT scan: lateral & 3° ventricles enlarged (the larger, worse px & >  If all drugs have failed:
Schizophrenia Onset negative symptoms) Clozapine (remember WBC
Schizophre
F: 25y.o.  Frontal & temporal lobe dysfunction: DECREASED metabolism count weekly bc of risk of
nia M: 15y.o. (worse Positive symptoms Negative symptoms agranulocytosis)
& Other px) Bizarre Delusions Flat (blunted) affect  Supportive psychotherapy:
Hallucinations (>>> auditory) Social withdrawal
Psychotic “ego builder”, make sure pt
Disorganized speech: loose Lack of motivation
D. trust you & is compliant with
associations medications.
Disorganized or catatonic Lack of speech or thought
behavior
Schizoaffective Disorder >2 weeks of “Schizo”  psychotic disorder; “Affective”  mood disorder.  Hospitalization?
delusions or Psychotic symptoms (positive or negative) + major depressive or  Antidepressants &/or
hallucinations w/o manic or both episodes. anticonvulsants
mood symptoms 2 subtypes: bipolar or depressive.  If not effective: atypical
antipsych.
Delusional Disorder >1 month Delusions + no impairment in level of functioning. (before: nonbizarre  Often self-limited.
delusions) Psychotherapy.
Types: erotomanic, jealous, grandiose, somatic, mixed, unespecified.  Antipsychotics.
ABRUPT onset: recurrent periods of intense fear discomfort peaking in
Panic Disorder >1 month 10 minutes with:  In acute situations:
 P alpitations, P aresthesias. Alprazolam
 A bdominal distress.  SSRI (1° choice)
 N ausea.  TCAs: Imipramine
 I ntense fear of dying, LIghth – headedness.  Clonazepam
 C hills, C hoking, disConnectedness, C hest pain.  If hyperventilation: CO2
 S weating, S haking, S hortness of breath. (breath in a paper bag)
Plus: persistent concern of additional attacks + worrying about its  Keep tx for 6-12m
consequences + related behavioral changes
Specific Phobias Anxiety when faced with identifiable object or situation. Pt tries to  Systematic desensitization.
Phobi > 6months avoid it. Disabling fear  Assertiveness training.
as Agoraphobia Fear of open or enclosed spaces from which escape would be difficult
in the event of panic symptoms
 Social Anxiety
Disorder
Obsessive Compulsive Disorder
(OCD) & related disorders.
Anxiety D.  Body Dysmorphic D.
Acute Stress Disorder &
Post-Traumatic Stress Disorder
(PTSD)
Adjustment Disorder
Generalized Anxiety Disorder
(GAD)
Former Social Phobia. Fear of embarrassment in social situations.  SSRI
Stage fright!  Beta blockers: stage fright
 Obsession: intrusive thought  1°contamination, 2°doubt, guilt,  Behavioral psychotherapy:
aggression, sex, etc. relaxation training, guided
 Compulsion: repetitive action  1°hand washing, 2°checking, imagery, exposure &
organizing, counting, praying, etc. response prevention.
 Pt is EGO – DYSTONIC (they hate doing all the rituals)  SSRI: fluoxetine, fluoxamine
 Frontal lobe: INCREASED metabolism  TCAs: Clomipramine
 Caudate nucleus: increased metabolism
Body Dysmorphic Disorder BDD
 Pt truly believes that some part is abnormal, defective, or misshapen  Individual psychotherapy
when NOT (e.g. facial flaws)  impairment in level of functioning.  Antidepressants.
 Constant mirror-checking, hide “deformity”, housebound, avoid social
events.
Severe anxiety symptoms followed by a threatening event that caused  Group therapy
Acute > 2days, feelings of fear, helplessness or horror (right after or years after event.  Constant counseling
<1month The sooner, the better the px)  SSRIs improve functional level
PTSD >1month  Re-experience of the event: recurrent dreams, flashbacks  Antidepressants
 Phobic avoidance (pt was raped in school, pt drops out of school)  BZD
 Increased anxiety. Sleep disruption or excess.  Best choice: pharmacotherapy
↑REM ↓Amount of ↓Stage
Latency REM 4
Maladaptative reactions to an identifiable psychosocial stressor
< 6months  Presence of IDENTIFIABLE STRESSOR (can’t be grief) within 3 months  Supportive psychotherapy
of onset  Anxiolytics,
 Anxiety, depression or emotional turmoil with significant social, antidepressants
academic and/or occupational IMPAIRMENT
Excessive, poorly controlled anxiety about life circumstances. Physio &
> 6months Psychological sx.  Behavioral therapy: relaxation
training, biofeedback
Physiologic component Psychologic component  SSRI
Worry that’s difficult to control Autonomic hyperactivity:  SNRI: Venlafaxine
Hypervigilance * shortness of breath  Buspirone
Restlessness * diaphoresis  BZD
Sleep disturbances * tremor
Difficulty concentrating Motor tension

Somatic  Multiple symptoms affecting multiple organs.  Single identified physician.

Symptom Months - years  Somatic symptoms + somatic symptoms plus abnormal thoughts,  Scheduled brief monthly visits
*Symptom s Disorder feelings & behaviors w or w/o a medical condition  ↑pt’s awareness of
Somatic production: psychological sx
Symptoms UNCONSCIOUS Conversio  Pt experiences 1 or > neurologic symptoms (e.g. paralysis, seizures,
*Symptom
& Related n Disorder mutism, blindness) that can’t be explained, always following an
motivation:
D. UNCONSCIOUS acute stressor.  Psychotherapy
 “La belle indifference”: pt’s not aware of impairment  Scheduled monthly visits for PE
Illness  Formerly known as hypochondriasis.
Anxiety > 6months  Pt believes to have a specific disease despite CONSTANT
Disorder REASSURANCE.
 Preoccupation for said “disease” which affects pt’s level of functioning.
  Conscious production of signs & symptoms of medical and/or
*Symptom Munchaus psychological disorders.
production:
en  Objective: assume sick role & hospitalization (they need the attention,
Factitious CONSCIOUS
& be nurtured)  Management rather than cure
*Symptom
D. motivation: Munchaus  Demand tx in hospital  negative tests  accuses & threatens Dr 
UNCONSCIOUS en by angry when confronted  goes to new hospital
proxy  By proxy: when signs & symptoms are faked by another person
(mother & kid)
Malingerin  Conscious production of signs & symptoms. NOT A MENTAL DISORDER
*Symptom production:  Objective: personal gain (drugs, money, avoid work, free bed
g D. CONSCIOUS
 Preoccupied more with rewards than with alleviation of “symptoms”
*Symptom motivation:
CONSCIOUS
 Prominent disturbances in alertness & confusion, and a short  Correction of physiologic
Delirium fluctuating course. problem.
 MCC: 1° Acute Metabolic Disorders. 2° Substance abuse behavior.  Orientation & reassurance.
 Sx: agitation or stupor, fear, emotional lability, hallucinations,  Antipsychotics & restraints if
delusions & disturbed psychomotor activity, incoordination, tremor, necessary.
asterixis, nystagmus.
 Prominent memory disturbances + other cognitive disturbances
present even in the absence of delirium.
 Abnormal neuroimaging & neuropsychiatric symptoms.
Cognitive  Sx: increasing disorientation, anxiety, depression, emotional lability,
D. personality disturbances, hallucinations & delusions.  Correction or amelioration of
 Specific dementias: underlying pathology.
Dementia  Provision of familiar
* Dementia of Alzheimer type * Lewy Body Disease surroundings, reassurance,
* Vascular (multi-infarct) dementia * HIV related and emotional support.
Dementia
* Pick Disease * Wilson Disease
* CJD * Normal Pressure
Hydrocephalus
* Huntington Disease * Pseudodementia
* Parkinson Disease

 Prominent memory impairment in the absence of disturbances in the

Amnestic Disorder
Dissociative Identity Disorder
Dissociativ Depersonalization /
Derealization Disorder
e D.
level of alertness or other cognitive problems.  Correction or amelioration of
 MCC: alcohol (bilateral diencephalic & mediotemporal damage, underlying pathology 
mammilary bodies, fornix & hippocampus due to thiamine e.g.give thiamine
deficiency, etc)
 Wernicke-Korsakoff Syndromes.
 Former Multiple Personality Disorder
 Multiple distinct personalities that controls pt’s behavior + failure to
recall important personal information
 Symptoms of disruption of identity: reported & observed.
 Gaps in the recall of daily events (not only traumatic events)  Psychotherapy.
 Persistent or recurrent feelings of being detached from one’s mental
processes or body + intact sense of reality
 Depersonalization: “out-of-body experience”
 Derealization: environment is distorted or strange + detached of
physical surroundings. “Jamais vu, déjà vu”.
  Significant episodes when pt can’t recall important & often emotionally  Rule out medical condition or
Dissociative amnesia charged memories. substance abuse.
 Dissociative fugue  It may suddenly or gradually remit, when traumatic event is resolved  Hypnosis, suggestion &
relaxation techniques.
Dissociative fugue  Psychotherapy.
 Sudden, unexpected travel + inability to remember one’s past +
confusion about personal identity or assumption of a new one.
Onset: Minutes-  Failure to resist aggressive impulses. Reaction out of proportion to the  Anticonvulsants,
Intermittent Explosive Disorder hours after stressor stressor. antipsychotics, beta-
 Result: serious assaultive acts & destruction of property blockers, SSRIs.
 Psychotherapy.
 Failure to resist impulses to steal objects that pt don’t need.  Insight-oriented therapy
Kleptomania  Anxiety prior the act. Released of anxiety after the act.  Behavioral therapy:
 Goal: stealing. conditioning & systematic
Impulse
desensitization.
Control D.  SSRIs or Anticonvulsants.
 Deliberate fire setting on more than 1 occasion.
Pyromania  Anxiety prior the act. Released of anxiety after the act, followed by  Incarceration, no tx beneficial.
gratification and fascination.
 Persistent and recurrent gambling behavior.
Pathologic Gambling  Preoccupation with gambling, need to gamble > money, attempt to  Gamblers Anonymous.
stop or gamble to win back losses, illegal acts to finance gambling.  SSRIs.
 Loss of relationships
 Pt pulls hair off, result in hair loss.  Behavior modification
Trichotillomania  Anxiety prior the act. Released of anxiety after the act. techniques.
 Scalp hair is MC. Nail-biting, head-banging, gnawing may be present  Anticonvulsants,
antipsychotics, SSRIs.
Restricting type  Self-imposed dietary limitations, self starvation. Fear of gaining weight.  Stabilizing weight.
Anorexia  Body image disturbance: “feel fat” when they’re very thin. BMI<  Family & individual therapy.
Nervosa Binge- 18.5Kg/m2  Mirtazapine: antidepressant
eating/purging  Failure to maintain normal body weight: >15-20% of ideal body weight that increase appetite.
Eating D. lost.
 Amenorrhea for 3months or more, lanugo.
Bulimia Purging type  Compulsive, rapid ingestion of food, followed by self-induced vomiting,
Nervosa (vomit, laxatives, use of laxative or exercise (binge & purge)  SSRIs
diuretics, enemas)  Low baseline serotonin: behavior of purging becomes addictive.  Imipramine
Non purging type  Sx: scars on back of hand, esophageal tears, dental cavities, enlarged  Psychodynamic psychotherapy
(fasting or parotid, minimal public eating.
exercise)
P P aranoid  Long-standing suspiciousness or mistrust of others.
 Worried w/ issues of trust. Reluctant to confide others.
e
 Lifelong pattern of social withdrawal. Disinterested in others.
r S chizoid  They love to be by themselves.
s Cluster  Seen by others as: eccentric, isolated, withdrawn. They think the same
o A of others.
Odd,  Emotionally distant: no expressions.
n
eccentric  Very odd, strange, weird, discomfort with social relationships.
a type. S chizotypal  Social anxiety (uncomfortable with others), lack of close friends.
l  Magical thinking: telepathy, illusions, ideas or reference &
i persecution.
 Odd preoccupation, speech & affect.
t
 Colorful, dramatic, extroverted.
y H istrionic  Can’t maintain long-lasting relationships.
 Attention seeking (center of the world, they do anything to get your
D attention).
 Seductive behavior.
.
Cluster If younger than 18  Inability to conform social norms: truancy, delinquency, theft,
A ntisocial Dx as Conduct running away  No treatment just long term
B
Disorder.  Aggressiveness, lack of remorse of criminal acts (serial killers). talk psychotherapy (7-10y)
Dramatic,
emotional  Disregard for the right of others.
type.  Grandiose sense of self-importance, demands constant attention.
N arcissistic  Over-concerned with issues of self-esteem, fragile self-esteem, prone
to depression.
 Criticism met with indifference or rage. “they are THE shit”
 Very unstable affect, behavior, self-image, mood swings, suicidal.
 Unstable but intense relationships, “love/hate”, dependant.
B orderline  Self detrimental impulsivity: promiscuous, gambling, overeating,
substance abuse.
 Constant state of crisis, chaos: incapable of tolerating anxiety .
 Orderliness, inflexible, perfectionist: <3 lists, rules, order.
O bsessive-Compulsive  Stubborn, no sense of humor, wants a routine.
 Unable to discard worn-out objects, doesn’t want change.
 They don’t have obsessions nor compulsions!
Cluster  Extreme sensitivity to rejection & social isolation: they want
A voidant friends but they are too shy to initiate friendship, they think the rest
 C. should change, not them.
Anxious,  They thing they’re “social inept”
fearful type.  Excessive shyness, anxiety
 Subordinates own needs to others, let others assume
D ependant responsibility.
 Don’t disagree.
 Major life decisions are needed to be taken by others.
 Great fear of having to take care of self.

Disorder of REM sleep, linked to orexin transport deficiency

Narcolepsy Onset of REM: 10 (hypocretin protein)  Tx of choice: Modafinil
Sleep D.
minutes CHAP “Moda Fina”
 C ataplexy: pathognomonic; sudden and transient episode of muscle (nonamphetamine: inhibits
weakness accompanied by full conscious awareness, typically DA re-uptake, activates
triggered by emotions such as laughing, crying, terror, etc. glutamate, inhibits GABA)
 H ypnaGOgic hallucinations: pathognomonic; hallucinations when  If cataplexy’s present: TCAs
GOing to sleep. HypnaPOMPic hallucinations (when POMPing out of (suppresses REM),
bed) can occur as well, but not pathognomonic. antidepressants.
 A ttacks: sleep attacks & excessive daytime sleepiness.
 P aralysis: sleep paralysis (REM: brain ON, body OFF)
Obstructive Middle-aged Upper airway. Rasping Pt complains/may develop:  CPAP: Continuous Positive
snoring  Dry mouth, headaches in the a.m. Airway Pressure.
Sleep Diaphragmatic. Cheyne-  Tired during the day  Weight loss if needed &
Apnea Central Elderly Stokes (60’’  Nocturnal <3 arrhythmias, BC then TC, change sleep position (beh.
hyperventilation, then by hypoxemia, pulmonary HTN, high Conditioning)
apnea) risk of sudden death during sleep.  If severe: tonsillectomy or
Central at first, but tracheostomy.
Mixed prolonged due to collapse of
airway.
Usually overweight (in all
types)
 Tx of choice: behavior therapy
Insomnia  2° to hypnotic medication abuse (tolerance, sleep fragmentation)  good sleep hygiene.
 Emotional problems: anxiety, depression, mania (BD w/insomnia: Drugs 10-14d, not more!
mania is coming) (tolerance, dependency)
 Poor sleep: habit of sleep is lost  Non-BZD, GABA receptor
 Drug or alcohol withdrawal. agonist: zaleplon,
  GABA levels ↓ zolpidem, eszopiclone
 Ramelton: melatonin receptor
ag.
Nightmares MC 3-7y.o REM Awakened Memory of Desensitization behavior
Elevated physiologic by sleep or event therapy
Night terrors MC in boys, runs in Stages 3 arousal intense No memory of
family &4 anxiety event
Parasomni Somnambulism Begins at young Stages 3 Perseverative behaviors Terminates Followed by BZD to suppress stages 3 & 4
as age &4 Performed w/o full in confusion
consciousness awakening
Somniloquy Common in All stages Sleep talking, may Not needed
children accompany
sleep terrors or walking
Enuresis Childhood Stages 3 Already discussed in childhood disorders. Desmopressin. Imipramine
&4
Gender Former Gender Identity Disorder Gender identity is  Persistent discomfort & sense of inappropriateness regarding pt’s
 Sexual Identity: based on established by the assigned sex.  Sex change.
Dysphoria
phenotype age of 3  “Born with wrong body”: children will have a preference of the  Hormonal replacement
 Gender Identity: person’s sense opposite sex, preoccupied with wearing opposite gender’s clothes, therapy.
of maleness or femaleness refuse to pee sitting down (girls) or standing up (boys)