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q DSM-IV and Models of Psychopathology § Axis I § Axis II § Axis III § Axis IV § Axis V § V codes § Pathological Gambling
q Psychotherapeutic Treatment § Psychoanalysis o Freud o Jung o Adler § Cognitive-Behavioral o Rational-Emotive Therapy (Ellis) o Cognitive Restructuring (Beck) o Self-Instructional Training (Meichenbaum) o Stress Inoculation o Self-Control Techniques o Biofeedback § Humanistic o Client-Centered Therapy o Gestalt Therapy o Transactional Analysis o Reality Therapy (Glasser) § Group and Family Therapy o Group Therapy (Yalom) o Extended Family Systems Therapy (Bowen) o Structured Family Therapy (Minuchin/Haley)
q Psychiatric Nomenclature and Mental Status Exam § MSE Components o General appearance, behavior, attitude o Mood o Affect · Range · Appropriateness o Speech · Rate, rhythm, tone o Thought process · Goal-directed · Circumstantial · Tangential · Loose associates · Echolalia, perseveration, clanging, neologisms o Thought content · Illusions · Hallucinations · Delusions · Suicidal/homicidal ideation · Reucurring themes, obsessions, compulsions o Sensorium and Cognition · Orientation · Memory (immediate, recent, long-term) · Calculations · Concentration · Insight · Judgement (hypothetical, real life)
q Cognitive Disorders § Delirium o Reduced ability to focus, sustain, shift attention o Anything that makes you sick can cause delirium o Prognosis parallels medical recovery o Treat underlying etiology § Dementia o Memory impairment (with possible aphasia, apraxia, agnosia) o Alzheimer’s disease accounts for 60% o Vascular dementia accounts for 15% o Mixed AD + vascular accounts for another 15% o CJD o Pick’s disease o Secondary Dementias § Amnestic Syndrome o Can’t learn new information o Can’t recall old information o Thiamine deficiency (EtOH abuse), hypoxia, trauma, HSV encephalitis o Anything that damages mammillary bodies, hippocampus, medial temporal lobe
q Psychiatric Disorders Due to Medical Conditions § Psychotic Disorder o Drugs o Sensory deficits o Seizures o Brain lesions (neoplasm, stroke) § Mood Disorder o Steroids, thyroid medication, reserpine, B-blockers, tranquilizers, EtOH o Endocrinopathies o Tumors (esp. pancreatic) o CNS (Parkinson’s, strokes, dememtia) o Viral syndromes § Anxiety o Stimulants, xanthines, thyroid medications, THC o Hyperthyroidism, pheochromocytoma o Withdrawal from sedatives o MVP, arrhythmias, CHF o PE, COPD (hypoxia) o Hypoglycemia § Personality Changes o Neoplasms o Head trauma o Seizures o Stroke o Anabolic steroids § Catatonic Disorder o CNS trauma, tumors, infection, stroke o Hypercalcemia o Major organ failure o Medications or substances
q Anxiety Disorders § Panic Disorder o Panic attacks o Women 3:1 o 30% MZ twin concordance o Neurochemistry (NE, GABA, 5HT, CCK, opiates) o Behavioral theories § Social Phobia o 14% lifetime prevalence o Fear of scrutiny, embarrassment, humiliation o Shyness o Hypersensitive to criticism o Post-synaptic 5HT receptor supersensitivity o Blunted GH response to clonidine § Specific Phobia o 12% lifetime prevalence o Cued fear, excessive o Avoidance § Obsessive-Compulsive Disorder o 2-3% lifetime prevalence o Comorbidities: Depression, panic disorder, eating disorders, tourette’s, schizophrenia o Obsessions = recurrent impulses, thoughts, images that are intrusive o Compulsions = repetitive behaviors aimed at preventing some dreaded event o MZ twin corcordance 75% o DA and 5HT involved o Caudate, globus pallitus, orbital gyri, orbital-frontal cortex § Post-Traumatic Stress Disorder o Men = combat effects o Women = exposure to trauma o Impact of triggering events o Alpha-2 adrenergic dysfn o urine catecholamines o Locus ceruleus, amygdala, hippocampus, prefrontal cortex § Generalized Anxiety Disorder o Excessive anxiety for 6 months o Restlessness, irritability, fatigue, muscle tension, sleep disturbance o Genetic = clustered in families o Behavioral theories = conditioned responses § Anxiety due to General Medical Condition § Substance-Induced Anxiety Disorder § Agoraphobia o Afraid of being outside home o Situations are avoided or endured with marked distress
q Affective Disorders § Depression o SIG E CAPS o Medical inpatients 10-14% o Outpatients 9-16% o 10% die by suicide (elderly 25%) o mortality rates 4X o Watch for comorbid substance abuse o Pharmacotherapy, ECT o At least six months of wellness before tapering off anti-depressant medication § Dysthymia o Depressed mood for 2 years § Cyclothymia o Dysthymia + hypomania § Bipolar I o Major depression + manic episodes § Bipolar II o Major depression + hypomania o Treatments · Lithium · Valproic acid · Olanzapine (for mania) § Substance-induced mood disorders § Mood disorders due to general medical conditions § Post-partum depression § Perimenopausal depressin § Premenstrual dysphoric disorder § Seasonal affective disorder § Adjustment Disorder
q Suicide and Violence § 9th leading COD § Decreased CSF 5-HIAA § Meninger’s triad: wish to kill, wish to be killed, wish to die § Previous suicide attempt best predictor of future suicidality § 90% of attempters have diagnosable mental disorder, esp. cluster B personality disorders § Substance abuse increases risk § Single best predictor of future violence is past violence
q Schizophrenia and Psychotic Disorders § Category A symptoms, present for 6 months o Hallucinations, delusions o Disorganized speech, catatonia o Negative symptoms § Schniederian symptoms = first rank o Hearing thoughts spoken aloud o Auditory hallucinations that comment on behavior o Somatic hallucinations o Thought control o Projecting one’s thoughts o Having actions controlled from outside § Male = female, 1% if population § 40-60% MZ twin concordance § Good prognosis = late and acute onset (> age 18), mood disorder symptoms during the acute illness, family history of mood disorders, positive symptoms § Schizophreniform = 1 month – 6 months § Schizoaffective disorder = Mood disorder + schizophrenia § Brief psychotic disorder = less than one mo |
