The Diagnostic and Statistical Manual of Mental Disorders (DSM).

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Psychiatric

Stages Psychiatric interview

• Per-orientation

• Orientation

• Working

• Termination

Mental Health Team

• Psychiatric nurse

• Psychiatric social worker

• Psychiatrist

• Psychologist

• Psychiatric technician

 

  • Axis I: Clinical disorders, including major mental disorders, and learning disorders : Common Axis I disorders include depression, anxiety disorders, bipolar disorder,  anorexia nervosa, bulimia nervosa, and schizophrenia.
  • Axis II: Personality disorders and intellectual disabilities (although developmental disorders, such as Autism, were coded on Axis II in the previous edition, these disorders are now included on Axis I)
  • Axis III: Acute medical conditions and physical disorders
  • Axis IV: Psychosocial and environmental factors contributing to the disorder
  • Global Assessment of Functioning or Children’s Global Assessment Scale for children and teens under the age of 18

Definitions

1. Delusion : A false belief based on incorrect inference about external reality.

Per security delusion , references delusion , passivity delusion , grandiosity delusion

2. Hallucination: An abnormal sensory experience that arises in the absence of a direct external stimulus, and which has the qualities of a normal percept and is experienced as real and usually in external space. Hallucinations may occur in any sensory modality.

Visual Hallucination , auditory , tactile , olfactory ,gustatory

3. Illusion: An abnormal perception caused by a sensory misinterpretation of and actual stimulus, sometimes precipitated by strong emotion, e.g. fear provoking a person to imagine they have seen an intruder in the shadows.

 

Anxiety

  • An uncomfortable feeling that occurs in response to the fear of being hurt or losing something valued.

Types of Anxiety Disorders :

1.General Anxiety Disorder- GAD

  • Persistent anxiety without phobias or panic attacks
  • Worry excessively about everyday concerns
  • May become preoccupied with catastrophic thoughts

2. Panic Attack

  • The highest level of anxiety, characterized by disorganized thinking, feelings of terror and helplessness, and non purposeful behavior
  • Intense feel like they are about to die, lose control, or go crazy.

3. Panic disorder

  • Recurrent panic attacks
  • Usually affects young adults
  • Can occur with or without agoraphobia
  • Sudden onset, unexpected, intense fear, a feeling of doom, catastrophic thinking
  • May manifest in respiratory, cardiovascular symptoms

4. Phobic disorders

  • Fear of Losing Control
  • Behavioral patterns that develop as a defense against anxiety
  • Underlying anxiety is displaced on to something concrete that can identified and then avoided
  • The feared object may or may not be symbolic of the underlying anxiety

 

Phobia

Phobia : An obsessive, persistent, unrealistic fear of an object or situation.

Some common phobias are:

1. Social phobia (fear from public speaking , meeting new people )

2. Agoraphobia (fear from outside)

3. Specific (Simple) phobia

examples:

  • acrophobia – fear of heights;
  • claustrophobia – fear of closed places;
  • xenophobia – fear of strangers.

 

OCD

OCD: Obsessive-Compulsive Disorder : is an anxiety disorder characterized by intense, recurrent, unwanted thoughts and rituals to release tension or relive anxiety.

Examples:

  • endless hand washing ,
  • checking rechecking doors to be sure they are locked.
  • elaborate dressing rituals.

Treatment

  • Drugs: Anfranil (Clomipramin)
  • Behavioral therapy :
  • Desensitization thought stopping flooding and implosion therapy aversive conditioning : means giving a painful shock or loud noise when the thought occurs
  • Exposure response preventing (ERP)

 

  • Psychodynamic psychoanalytic therapy

 

 

Post Traumatic Stress Disorder

  • Post Traumatic Stress Disorder : A psychological disorder that develops in some individuals after a major traumatic experience such as war, rape, domestic violence, or accident.
  • PTSD is an anxiety disorder characterized by a terrifying physical or emotional event (trauma) causing the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal. Persons with PTSD often feel chronically, emotionally numb.

 

Eating Disorders

1. Anorexia Nervosa

Anorexia nervosa define as “an aversion to food” or desired to avoid food, a condition that can cause death from malnutrition , anorexia is usually manifested initially in adolescence but can see in young as 8 year old. patient refuse to eat.

Treatment of Anorexia Nervosa

  • Complete Physical examination
  • Correct the nutrition
  • Admission in moderate and severe condition Treatment
  • Drugs ( anti depression, anti psychotic if symptoms appear)
  • Psychotherapy
  • ECT .

 

2. Bulimia Nervosa

Bulimia is” binge eating” those with bulimia consume huge amount of food . the binge eating is followed by forced vomiting. usually manifested initially in adolescence

Treatment

– psychotherapy

 

Somatoform Disorders

Types of DSM-IV Somatoform Disorders

A. Pain disorder

B. Somatization disorder

C. Body dysmorphic disorder

D. Conversion disorder ( Hysterical neurosis )

E. Hypochondriasis

 

A. Pain disorder

The predominant focus of the clinical presentation in pain in one or more anatomical sites.

B. Somatization disorder:

Frequently seeking and obtaining medical treatment for multiple clinically significant somatic complaints.

C. Body dysmorphic disorder : Dysmorphophbia

Dysmorphophbia the onset is generally in the teens through the 30s. include excessive preoccupation with imagined defect in one’s physical appearance (usually facial) and obsessive and or compulsive behavior

D. Conversion Disorder ( Hysterical neurosis )

Loss or change in body functioning that can not be explained by any medical disorder, and occurs in response to psychological stress.

E. Hypochondriasis:

There are six major criteria associated with Hypochondriasis;

1- The individual is preoccupied with fears of having a serious medical disorder based on his interpretation.

2- The misinterpretation of bodily symptoms persists despite appropriate medical evaluation and reassurance.

3- The individual’s preoccupation with symptoms is not as intense or distorted as found in body dysmorphic disorder.

4- The preoccupation causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

5- The duration of disturbance must be at least six months.

6- The condition is not better accounted for by another anxiety disorder

 

PERSONILITY DISORER

1.Cluster A – Odd or eccentric cluster

2.Cluster B – Dramatic, emotional, erratic cluster

3.Cluster C – Fearful or anxious cluster

Cluster (A) P.D: (Odd or eccentric)

  • Paranoid
  • Schizoid P.D
  • Schizotypal P.D

Cluster B: Dramatic, emotional, erratic cluster

  • Antisocial P.D
  • borderline personality
  • Histrionic P.D
  • Narcissistic P.D

Cluster C:  Fearful or anxious cluster

  • Avoidant PD
  • Dependant P.D
  • Obsessive – Compulsive P.D
  • Passive-Aggressive

 

Schizophrenia

Schizophrenia is the most severe of all mental illnesses, it is characterized by disturbances in thought, affect, and perception. The personality is disintegrated and the patient functioning deteriorates in all fields. He becomes burden his family and society.

Etiology:

Main cause is unknown “Idiopathic” but there are theories and factor may contribute in occurrence of disease.

  • Genetic factors:
  • Neurotransmitters and the dopamine hypothesis:
  • Psychosocial factors:
  • Psychoanalytic theory:
  • Family theory:

Clinical features of schizophrenia :

  • talkative and hyperactive or mute and very quiet.
  • disorganized hyperactivity.
  • lack of self care and hygiene.
  • Inappropriate affect: the pt. affective response is not going with his experience.
  • Ambivalence: some pt.s show contradicting affects to the same experience, like feeling love and hate to the same person at the same time.
  • Auditory hallucinations
  • Visual hallucination
  • Disorders in the content of thought
  • Delusions of Reference: are beliefs that others talk about him e.g. TV news about him or hearing his name in the Radio.
  • Grandiose delusions: are beliefs of great abilities or wealth. The pt. may think that he is president or a prophet.
  • Passivity delusions: the beliefs of being influenced by others, e.g. others can read his thoughts or a computer is directing his actions.
  • Loose associations:
  • Neologism:
  • Flight of ideas:
  • Thought blocking
  • Abstract- Concrete thinking:
  • Poor control over his actions, he may be aggressive or intrusive.
  • Little or no insight into their condition.

 

Types Of Schizophrenia

1- Paranoid schizophrenia ( persecution delusion or auditory hallucination)

2- Disorganized Schizophrenia (hebephrenic , early onset and silly, childish affect is characterized by a severe disintegration of the personality

3- Catatonic schizophrenia:

4- Undifferentiated schizophrenia  It does not clearly meet the criteria necessary for a diagnosis in other types of schizophrenia (paranoid, catatonic, or disorganized), has some aspects of each type.

5- Residual schizophrenia

 

Positive symptoms Of Schizophrenia

  • Delusions,
  • Hallucinations,
  • Bizarre Dress,
  • Thought Disorganization,
  • Aggression,
  • Agitated Behavior,
  • Pressured Speech,
  • Suicidal Ideation.

 

Negative symptoms Of Schizophrenia :

  • lack of emotion – the inability to enjoy regular activities (visiting with friends, etc.) as much as before.
  • Flat or inappropriate affect poor eye contact, anhedonia attitude, withdrawal, poor grooming and hygiene, lack of expressive gestures, apathy, and inattentiveness.
  • Low energy – the person tends to sit around and sleep much more than normal lack of interest in life, low motivation.
  • Alogia (difficulty or inability to speak).
  • Inappropriate social skills or lack of interest.
  • Social isolation – person spends most of day alone or only with close family.
  • Sleep patterns are disturbed by nightmares and early morning awakening

 

Management of schizophrenia

1- Hospitalization:

2- Medications:

Anti-psychotic or major tranquilizers. They are used to treat psychotic and schizophrenia symptoms not schizophrenia.

• Chlopromazine (largactil): is the drug of choice in acute stage. It acts by blocking the dopamine receptors.

• Dose 50 – 1200mg daily.

• Haloperidol ( Haldol ): Dose 2 – 100 mg daily.

Anti cholinergic: help return balance among dopamine

3. Psychotherapy therapy

4. Electro convulsive therapy (ECT)

 

Types of Mood Disorder

1. Major Depression (Unipolar Depression)

Loss of interest or pleasure in usual activities, impaired social and occupational functioning has existed for at least 2 weeks

2. Dysthymic Disorder Depression

• Dysthymia is defined as mild (low grade) depression for at least 2 years for adult and at least 1 year for adolescence and younger children.

3. Bipolar Depression (Manic – Depressive Disorder)

Manic Episode

• The main feature of mania (manic episode ) is a period of elevated, expansive or irritable mood.

Hypomanic Episode

• Manic and hypomanic episode share symptom criteria and are differentiated primarily by their severity and duration.

– Bipolar I disorder (manic –depression disorder )

Mania or mixed symptoms ( one episode of mania of life – depression)

– Bipolar II disorder (major depression –episode of hypomania )

4. Cyclothymic Disorder

• Is chronic mood disturbance of at least 2 years’ duration ( 1 year for children and adolescence).

• Many episode of hypomanic symptoms depressed mood and anhedonia

• The symptom are less severe or intense than those in major depressive

Other Types of Mood Disorder

• Melancholic Depression . Atypical Depression

• Seasonal Affective Disorder . Post partum mood disorder

 

 

Symptoms of Major Depression

  • Loss of pleasure in usually pleasurable things (anhedonia)
  • No hallucination or delusion and four of the following for at least 2 consecutive weeks:

1. weight loss or gain result from increased or decreased appetite

2. sleep pattern disturbances

3. increased fatigue

4. increased agitation

5. increased or decreased in normal activity; lowered pleasured for life, including sexual activity

6. feelings of guilt or worthlessness

7. decreased ability to think, remember or concentrate

8. suicidal thoughts

 

Management and Treatment For People With Mood Disorder

• Hospitalization

• Medication Evaluation and Management

Examples

– Tricyclic Anti Depressant

–  Monoamine Oxidase Inhibitor (MAOI)

Mood Stabilizing Medications

– Lithium carbonate (Antipsychotic)

– Anticonvutsants

– Verapamil (Calcium channel blocker)

• Electroconvulsive Therapy

• Psychosocial therapy

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