dis

• Panic Disorder


  Recurrent/unexpected panic attacks

  Duration: >1 month

  - fear of future panic attacks OR

  - significant change in behavior related to the attacks
• Panic Attack


  Intense fear w/ somatic/cognitive symptoms: abrupt onset w/ peak in min

  - cardiac

  - sweating

  - trembling

  - SOB

  - choking

  - chest pain

  - GI

  - feeling faint

  - feeling detached

  - fear of losing control

  - fear of dying

  - tingling/numbness

  - chills/hot flushes
• Agoraphobia


  >2 situations feared/avoided:

  - using public transportation

  - being in open spaces

  - being in enclosed spaces

  - standing in line/being in a crowd

  - being outside of home alone

  
  

  Situations are feared/avoided because of thoughts that escape might be difficult/unavailable if incapacitating/embarrassing symptoms develop

  
  

  Can develop w/ or w/o PD
• Specific Phobia


  Excessive, persistent and disproportional fear of an object/situation

  - fear invariably occurs when exposed to the stimulus OR person avoids situation

  - fear causes marked distress/impairment and NOT accounted by different disorder
• Social Anxiety Disorder


  Excessive, persistent and unrealistic fear of social situations involving possible scrutiny by others due to fear of negative evaluation

  - "Performance only": fear restricted to speaking/performing in public
• Generalized Anxiety Disorder


  Persistent uncontrolled anxiety about multiple events for >6 mos w/ symptoms:

  - restless, on edge

  - dec conc

  - muscle tension

  - fatigued

  - irritability

  - insomnia
• Separation Anxiety Disorder


  Developmentally inappropriate and excessive anxiety concerning separation from major attachment figure

  
  

  Experience marked distress (mental/physical):

  - anticipated/actual separation

  - harm befalling major attachment figure/self that leads to separation

  - going out because of separation fears
• Selective Mutism


  Refusal to speak in specific situations despite fluent speech in other contexts

  - Not due to lack of language knowledge/communication disorder

  Duration: >1 mo
• Obsessive-Compulsive Disorder


  1. Recurrent:

  - obsessions = intrusive recurrent thoughts/urges/images that inc distress

  - compulsions = repetitive behaviors/mental acts that dec distress

  
  

  2. Obsessions/compulsions are time consuming or distressful/disruptive

  
  

  3. Symptoms are not explained by another disorder

  
  

  W/ absent insight (delusional beliefs): convinced that OCD beliefs are true
• Hoarding Disorder


  - Difficulty parting w/ possessions due to perceived need to save items or distress about discarding them

  - Accumulation clutters living areas and substantially compromises their intended use

  - Causes distress/impairment

  - NOT better explained by another disorder

  
  

  W/ absent insight (delusional beliefs): beliefs/behaviors are not problematic despite contrary evidence
• Body Dysmorphic Disorder


  Preoccupation w/ perceived flaw in physical appearance

  - not better accounted by an eating disorder

  - must cause functional impairment

  
  

  Repetitive behaviors/mental acts are performed in response to appearance concerns

  
  

  Specify...

  - w/ muscle dysphoria: preoccupation w/ belief that one's body is too small/insufficiently muscular

  - w/ absent insight (delusional beliefs): convinced beliefs are true
• Excoriation Disorder


  - Recurrent skin picking resulting in skin lesions

  - Attempts to stop picking

  - Results in distress/impairment

  - ISN'T better explained by another disorder
• Trichotillomania


  - Recurrent pulling out of one's hair resulting in hair loss

  ~ any body region affected

  ~ episodes vary in frequency, duration, intensity of focus

  - Attempts to stop hair pulling

  - Causes distress/impairment

  - NOT better explained by another disorder
• Posttraumatic Stress Disorder


  Exposure to traumatic stressor:

  - actual/threatened death or serious injury or sexual violence

  - include direct experience of event, witnessing event, or learning about event to close family member/friend

  
  

  >1 symptoms from each category MUST develop -->

  
  

  Intrusion:

  - dreams

  - recollections

  - feeling event reoccur

  - psychological/physiological distress when encounters symbols

  
  

  Avoidance: avoid thoughts, places, conversations that are reminders of event

  
  

  Negative alterations in cognition and mood:

  - negative beliefs/expectations

  - negative emotional states

  - inability to experience positive emotion

  - diminished interest/participation in activities

  - detachment/estrangement from others

  - dissociative amnesia

  
  

  Alterations in arousal and reactivity:

  - sleep disturbance

  - irritable and angry outbursts

  - reckless/self-destructive behavior

  - concentration problems

  - hypervigilance

  - exaggerated startle response

  
  

  Duration: >1 mo

  Onset: begin w/in 3 mo of trauma (can begin ANYTIME)

  Vulnerable populations: young adults w/ sudden-onset, life-threatening medical events
• Acute Stress Disorder


  - Exposure to a traumatic stressor

  - Numerous PTSD-like symptoms develop from 4 PTSD symptom categories

  
  

  Duration: 3 days - 1 mo after trauma exposure
• Adjustment Disorder


  Development of significant/disproportional emotional/behavioral symptoms

  - causal stressor AND no other disorder explains the symptoms

  
  

  Due to an identifiable stressor:

  - acute onset = develop w/in a few months of stressor onset

  - brief duration = expected to resolve w/in several months after stressor/consequences have terminated

  
  

  Subtypes:

  - with depressed mood

  - with anxiety

  - with disturbance of conduct

  - with mixed anxiety and depressed mood

  - with mixed disturbances of emotion & conduct

  - unspecified
• Reactive Attachment Disorder


  Inhibited and emotionally-withdrawn behavior towards adult caregivers
• Disinhibited Social Engagement Disorder


  Overly familiar behavior w/ relative strangers
• Dissociation


  Splitting off from conscious awareness an aspect of self usually as a coping strategy for stress
• Dissociative Amnesia


  Memory loss for autobiographical information, which doesn't occur due to another disorder

  - localized: total loss of personal memory during a circumscribed period

  - selective: some recall of personal memories during a circumscribed period of time

  - generalized: loss of personal memory of entire life up to and including event

  
  

  W/ dissociative fugue: purposeful travel/bewildered wandering associated w/ amnesia for identify or autobiographical information

  - brief (hours to days)

  - unobtrusive lifestyle during fugue

  - spontaneous termination of amnesia

  - rarely recurs
• Dissociative Identity Disorder


  Disruption of identity characterized by > 2 distinct personality states:

  - Primary (host)

  - An alter

  
  

  Inability to recall personal information
• Depersonalization/Derealization Disorder


  - Either/both depersonalization/derealization

  - Reality testing remains intact

  - Result in functional impairment

  - Metabolic, neurologic, or pathological conditions should be eliminated as casual agents
• Derealization


  experiences of unreality or detachment with respect to surroundings
• Depersonalization


  experiences of unreality, detachment or being an outside observer with respect to one's thoughts, feelings, sensations, body or actions
• Major Depressive Disorder


  - Must experience >1 MDE

  - NO history of mania/hypomania (no swinging to opposite pole)
• Major Depressive Episode


  At least 2wks of >5 (MUST be 1 OR 2)

  
  

  Affective:

  1) depressed mood

  2) anhedonia

  
  

  Neurovegetative:

  3) significant weight change

  4) insomnia/hypersomnia

  5) loss of energy

  
  

  Cognitive:

  6) psychomotor changes

  7) feeling guilty/worthless

  8) decreased concentration

  9) thoughts of death/suicidal ideation
• SIG: "E"nergy "Cap"sules


  Sleep change

  Interest loss

  Guilt

  Energy problem

  Concentration poor

  Appetite change

  Psychomotor changes

  Suicidal ideation
• MDD w/ Melancholic Features


  - severe anhedonia, lack of mood reactivity, profound despondency and guilt

  - depression worse in the morning

  - early-morning awakenings

  - significant appetite loss
• MDD w/ Atypical Features

  - mood reactivity

  - weight and sleep inc

  - leaden paralysis
• MDD w/ Psychotic Features

  Hallucinations and/or delusions are evident

  - W/ mood-congruent psychotic features: content of delusions/hallucinations is consistent w/ typical depressive themes

  - W/ mood-incongruent psychotic features: content of delusions/hallucinations does NOT involve typical depressive themes
• MDD w/ Catatonia


  - Mutism

  - Immobility

  - Waxy

  - Flexibility

  - Stereotypes

  - Other odd posturing
• MDD w/ Anxious Distress

  MDE associated with feeling tense, restless, and fearful
• MDD w/ Peripartum Onset

  MDE onset is during pregnancy or within 4 wks post-delivery
• MDD w/ Seasonal Pattern (Seasonal Affective Disorder)

  Consistent temporal relationship between time of year and MDEs
• Persistent Depressive Disorder


  Chronic depressed mood for >2yrs:

  - long-lasting MDE

  OR

  - dysthymia: >2 of following

  ~ poor appetite/overeating

  ~ insomnia/hypersomnia

  ~ low energy

  ~ low self-esteem

  ~ trouble concentrating or making decisions

  ~ feelings of hopelessness
• PDD w/ Pure Dysthymic syndrome

  prolonged dysthymia but no MDE occurs
• PDD w/ Persistent MDE

  prolonged MDE
• PDD w/ Intermittent MDEs

  dysthymic periods and MDEs
• Premenstrual Dysphoric Disorder


  MUST: cause clinically significant distress/functional impairment

  - present in week before menses onset

  - improve a few days after menses onset

  - minimize in the week post-menses

  
  

  INCLUDE:

  - mood lability, irritability, dysphoria, and anxiety symptoms

  - anhedonia, problems concentrating, lethargy, appetite and sleep change, physical symptoms

  
  

  Validated clinical scales are used to confirm diagnosis
• Disruptive Mood Dysregulation Disorder

  Core features:

  - severe temper outbursts at least 3x/wk

  - sad, irritable or angry mood almost daily

  - reaction is disproportionate to situation

  - symptoms are present in multiple settings

  
  

  Timelines:

  - at least 6 y/o

  - before age 10