-
What are the criteria for a manic episode
for at least one week
- abnormal elevated, expansive (all encompassing) or irritable mood
- increase goal directed activity or energy
presence of three or more symptoms
- pressured speech
- flight of ideas
- distractability
- psychomotor agitation
- Excessive involvement in things that could have painful consequences
- grandiosity
- decreased need for sleep
severe enough to cause marked impairment in function or require hospitalization
-
what is the difference between bipolar 1 and 2?
bipolar 1 has full blown manic episodes
-
what are the criteria for a hypomanic episode?
for at least four consecutive days
- abnormal elevated, expansive (all encompassing) or irritable mood
- increase goal directed activity or energy
presence of three or more symptoms
- pressured speech
- flight of ideas
- distractability
- psychomotor agitation
- Excessive involvement in things that could have painful consequences
- grandiosity
- decreased need for sleep
Not severe enough to cause marked impairment in function or require hospitalization
If there is a history of a full manic episode then diagnose a full manic episode
-
What is necessary for a depressive episode?
For a two week period, five or more of the following
- depressed mood
- anhedonia
- significant weight loss or gain
- sleep disturbance
- psychomotor agitation or retardation
- fatigue
- worthlessness or inappropriate guilt
- diminished ability to concentrate
- recurrent suicidal ideation/suicide attempt
-
What is needed for a Bipolar 1 Disorder diagnosis?
- manic episode (1 in history)
- depressive episode is not needed
- average age is 18
- not caused by drug addiction capable of producing symptoms
-
Bipolar specifier: with anxious distress
- restless and have a hard time concentrating
- afraid some awful might happen or they might loose control of themselves
-
Bipolar specifier: with rapid cycling
at least 4 manic episodes in the past 12 months
-
Bipolar specifier: with melancholic features
- a loss of pleasure
- depression is worse in the morning
- feel guilty
- weight loss
- loss of sleep
-
Bipolar specifier: with atypical features
- mood is very reactive (can actually cheer up in conversation)
- excessively sleepy
- sensitive to rejection
- weight gain
-
Bipolar specifier: with mood-congruent psychotic features
- consistent with the mood the person is presenting
- if person is manic, the delusions are cheerful. If person is depressed, so are the delusions
-
Bipolar specifier: with mood-incongruent psychotic features
delusions are not persistent with presenting mood
-
Bipolar specifier: with catatonia
psycho-motor hyper activity or inactivity
-
Bipolar specifier: with peripartum onset
symptoms happen during or 1 month after pregnancy
-
Bipolar specifier: with seasonal onset
mood changes with seasons or with absence of light
-
Criteria for Bipolar II Disorder
- Hypomanic episode + major depressive episode
- no previous manic episode
- onset is usually in 20's
- treatment is usually about the depressive episode
- do not usually see flight of ideas or pressured speech
- will not require hospitalization for manic episode
-
requirements of Cyclothymic Disorder
- symptoms do not qualify for manic, depressive, or hypomanic episodes
- onset is usually early adulthood
- 15-50% go on to develop Bipolar I or II
-
Criteria for substance/medication induced Bipolar and Related Disorder
disturbed mood symptoms develop during or soon after
- substance intoxication
- substance withdrawal
- exposure to medication
substance/medication is capable of producing disturbed mood symptoms
-
Criteria for Bipolar and Related Disorder due to Another Medical Condition
prominent, persistent abnormally elevated, expansive, or irritable mood
- evidence that disturbance is direct consequence of another medical condition
- clinically significant distress or social, occupational impairment
-
Bipolar Disorder risk factors: Gender
- women are more like to manifest depressive symptoms, more rapid cycling, and more Bipolar II diagnosis
- Men and women are equally diagnosed with Bipolar I
-
Bipolar Disorder risk factors: culture
- African Americans are more likely to attempt suicide
- more likely to be prescribed antipsychotics
- shows cultural bias in psychiatry
- African Americans adolescents tend to be in treatment longer
- less likely to have follow up treatment
-
Bipolar Disorder risk factors: age-related
- 1/2-2/3 develop by age 18
- the earlier the onset, the worse the prognosis
-
Bipolar Disorder risk factors: suicide
- rates of suicide or 12-15 times higher than general population and 4 times higher than people with recurrent depression
- 50% will attempt suicide in their lifetime
- comorbid with substance abuse elevates risk
-
Bipolar Disorder risk factors: recurrence
- almost all will have recurrent episodes
- there is a biological component
-
Bipolar Disorders treatment
- Needs to be stabilized with mood stabilizers
- atypical antipsychotics and antidepressents are used sometimes
- problems with people staying on meds
- abrupt cessation of meds can lead to suicide attempts
- High EE contributes to relapse rates
- CBT is used sometimes to work on problem solving skills and cognitive restructuring
- Interpersonal and social rhythm therapy -- sleep/wake cycles are targeted as well as daily routines
- taught to avoid drugs and alcohol
- always target compliance with meds
-
Criteria for Major Depressive Disorder
Have to have a history of at least 1 major depressive episode
-
Criteria for Persistent Depressive Disorder
chronic depressive symptoms for at least 2 years
Depressed mood for most of the day + two of the following
- poor appetite
- insomnia/hypersomnia
- low energy
- low self-esteem
- difficulty concentrating or making decisions
- feelings of hoplessness
-
criteria for substance/medication-induced depressive disorder
prominent, persistent depressive mood disturbance and symptoms develop during or soon after
- Substance intoxication
- substance withdrawal
- exposure to medication
-
Criteria for Depressive Disorder due to Another Medical Condition
Prominent, persistent depressed mood or diminished interest or pleasure
- evidence that disturbance is direct consequence of another medical condition
- clinically significant distress or social, occupational impairment
-
Criteria for Other Specified Depressive Disorder
does not meet full criteria for any of the disorders in the depressive disorders class
-
Criteria for Unspecified Depressive Disorder
To be used in situations
- in which the clinician chooses not to specify the reason criteria are not met for a specific disorder
- in which there is insufficient information to make a more specific diagnosis (emergency rooms)
-
suicide attempters vs. completers: gender
- attempt: majority female
- complete: majority male
-
suicide attempters vs. completers: age
- attempt: mostly young
- complete: risk increases with age
-
suicide attempters vs. completers: method
- attempt: low lethality (pills, cutting)
- complete: more violent (guns, jumping)
-
suicide attempters vs. completers: common Dx
- attempt: dysthymic disorder, borderline, schizophrenia
- complete: major mood disorder, alcoholism
-
suicide attempters vs. completers: dominant emotion
- attempt: depression with anger
- complete: depression with hoplessness
-
suicide attempters vs. completers: motivation
- attempt: change in situation/cry for help
- complete: death
-
What is the single best predictor of a suicide attempt?
previous attempts
-
Suicide risk assessment: Ideation
just thinking about it
-
Suicide risk assessment: plans/means
person has thought about it in some detail
-
Suicide risk assessment: history of attempts
best single indicator
-
Suicide risk assessment: impulse control
- have to evaluate through behavior
- use of drugs and alcohol are a bad sign
-
Suicide risk assessment: hoplessness
- life will not be better in the future
- common in depression
- can elevate risk by up to 4 times
-
What is the negativistic thinking triad?
negative thinking about the self, future, and world
-
Depression subtype: typical (melancholic or endogenous)
tends to be more responsive to medications and might be a biochemical issue
-
depression subtype: Atypical
- sometimes caused by a stressful event
- see a temporary brightness in mood
- can see hypersomnia and weight gain
- heaviness in arms and legs
- highly sensitive to rejection
- more responsive to psychotherapy
-
Effects of CBT on depression
- very effective
- depression sits on three points -- negative views of self, world, and future
- targets distortions in people's thinking
- taught new ways to think in specific situations
-
When are depressive actions more prevalent?
summer and spring because of increased energy levels
-
Define fear
emotional and physiological response to recognized external threat
-
define anxiety
- unpleasant emotional state -- source is less readily defined; frequently accompanied by physiological symptoms
- not always recognizable
-
define a specific phobia
- marked fear of specific object or situation
- provokes immediate fear or anxiety
- is actively avoided
- fear is out of proportion to actual danger
- last longer than 6 months
-
What is an effective treatment for a most phobias?
CBT
-
Define Social Anxiety Disorder
- marked fear or anxiety in social situations where a person is exposed to scrutiny by others
- fear of negative evaluations
- almost always provokes anxiety
- avoided or endured with great fear/anxiety
- fear/anxiety is out of proportion
- persists over time
-
What is the 3rd most common disorder in the US?
Social Anxiety Disorder
-
Define derealization
- the sense of things around seeming unreal/different
- sometimes things feel like they are slowed down
-
define depersonalization
the odd sense of being detached from yourself
-
Define agoraphobia
marked fear or anxiety about two or more
- using public transportation
- open spaces
- enclosed spaces
- standing in line, being in a crowd
- being outside of the home alone
fear and avoidance of these situations
- escape might be difficult
- help might not be available
-
Define Generalized Anxiety Disorder
- excessive anxiety and worry about a number of events or activities
- difficult to control worry
with three or more of the following
- restlessness
- easily fatigued
- difficulty concentrating, mind going blank
- irritability
- muscle tension
- sleep disturbance
Sometimes have a history of traumatic experiences
-
Anxiety Disorders treatment approaches: psychological treatments
- confronting fear is central
- cognitive-behavioral approaches have been found helpful
-
Anxiety Disorders treatment approaches: medications
- Benzodiazepines
- Anti-depressants -- SSRI's currently treatment of choice
-
Define obession
A thought, urge, or image that is persistent and recurrent that is unwanted causing the person a great deal of distress or anxiety
-
Define compulsion
- a behavior that is repetitive that a person is DRIVEN to perform in response to an obsession
- the action is intended to reduce stress or prevent disaster
- not realistically connected to the obsession
-
Define ego-syntonic
something is comfortable to the self
-
define ego-dystonic
when something is uncomfortable to the self (OCD Disorder)
-
Define Body Dysmorphic Disorder
- preoccupation with perceived deficits or flaws in physical appearance that are not observable or appear slight to others
- person has performed repetitive behaviors or mental acts in response to the appearance concerns
- a possible link to depression
- generally a poor quality of life
-
Define Hoarding Disorder
- persistent difficulty discarding possessions, regardless of their actual value
- difficulty due to perceived need to save items and to the distress associated with discarding them
- results in accumulation of possessions that congest and clutter active living areas and compromises their intended use
-
What are the characteristics of hoarders
- Core vulnerabilities: depression, anxiety, family history and high levels of perfectionism
- difficulties processing information: attention, memory, categorization, and decision making
- intense emotional control to objects
- beliefs about necessity of not wasting objects
-
define trichotillomania
- repeated pulling out one's hair
- repeated attempts to decrease or stop hair pulling
-
Define Excoriation Disorder
- recurrent skin picking -- resulting in skin lesions
- repeated attempts to decrease of stop skin picking
-
Criteria for PTSD
Exposure to traumatic event (that terrifies the person)
One or more intrusion symptom
- recurrent, involuntary, intrusive distressing memory of event
- recurrent distressing dreams
- dissociative reactions (flash backs)
- distress when exposed to internal/external cues
- physiological reactions
Avoidance symptoms (one or both)
- avoidance of distressing memories related to the event
- avoidance of external reminders related to the event
Negative alterations in cognitions and mood (at least 1)
- issues with recalling aspects of event
- negative beliefs/expectations of others
- persistent negative emotional state
- inability to experience positive emotions
- etc...
- Arousal and reactivity
- symptoms (at least 1)
- irritability/angry outbusrts
- hypervigilance
- sleep disturbance
- reckless behavior
- etc...
-
What is the difference between PTSD and Complex PTSD?
- associated with long-term trauma in which an individual is held in captivity
- kept under control of the perpetrator without escape options
- additional symptoms make diagnosis and treatment more difficult
- involves dysregulation: inability to regulate emotionality or be preoccupied with revenge, sometimes develop personality disorders
- much more chronic than PTSD
-
Non-combat PTSD vs. combat PTSD
evidence shows that combat PTSD had
- more severe symptoms
- less apt to experience remission of symptoms
- less likely to seek mental health treatment
-
Treatment of PTSD: goals
- regaining a sense of control over one's life
- developing and maintaining coping strategies
-
Treatment of PTSD: medications
- antipsychotics
- antidepressants
- anti-anxiety meds
- prazosin -- helpful with insomnia and nightmare
-
Treatment of PTSD: psychological
- trauma focused CBT: cognitive restructuring, stress inoculation therapy, exposure therapy
- Family therapy
- EMDR
-
Things to keep in mind about PTSD
- powerful biochemical process occurs
- Brain damage can occur with trauma
- its not just an issue of the mind
-
Criteria for Acute Stress Disorder
- Same as PTSD but symptoms pattern must happen within a month of the traumatic event
- 9 or more symptoms needed from the remaining categories
- dissociative is a symptom, not a specifier
-
Criteria for Adjustment Disorder
- development of emotional or behavioral symptoms in response to an identifiable stressor (within 3 months)
- distress out of proportion to the severity or intensity pf the stressor
- significant impairment
- not life threatening
- must rule out other diagnoses first
|
|