Diagnosis Define Criteria Treatment

General Most common mental illiness • Occurring more days than not for at least 6 months 1. Cognitive Behavioral
Anxiety Combination of structural, personality, genetic, • 3+ of six symptoms Therapy
Disorder and environmental influences • Cause clinically significant distress or impairment 2. SSRI (first line)

3 months of the onset of the stressor(s) plus either or both

• Marked distress that is out of proportion to the severity or
intensity
Adjustment Emotional or behavioral symptoms develop in of the stressor
Therapy Sessions
Disorder response to identifiable stressor(s) • Significant impairment in daily activities

Acute: <6 months

Persistent: > 6 months

An abrupt surge of intense fear or physical

Thorough history & physical
discomfort and relatively brief duration • 4+ symptoms
is curcial
• <4 are considered to be a limited-symptoms attack
Panic Disorder 1. Cognitive Behavioral
MOST heritable → First-degree relatives of • Not attributable to substance, other medical conditions, and
Therapy
patients who have PD are 7x more like to have other psychiatric disorders
2. SSRI (first line)
PD

A. Exposure (1) Acute stress disorder:

B. Re-experience (1) meets criteria for PTSD but
C. Avoidance (1) has had symptoms < 1
A response to a catastrophic life experience in 1. Focused Therapy:
D. Negative alteration in mood (2) month
Post Tramatic which the pt re-experiences the trauma, avoids Exposure
E. Hyperarousal (2)
Stress Disorder reminders of the event, and experiences 2. Stress Inoculation Therapy
emotional numbing or hyperarousal 3. SSRI
1. Symptoms last for > 1 month
2. Create distress or functional impairment
3. Not due to medication, substance use, or other illness

Obsession: Recurrent and presistent thoughts AND individual

attempts to ignore or suppress
Compulsion: Repetitive behaviors AND behaviors or mental acts
are aimed at preventing or reducing anxiety or preventing some 1. Behavioral therapy
Obsessive - Chronic anxiety disorder in which a person has
dreaded event/situation 2. SSRIs
Compulsive uncontrollable, repatitive thoughts(obessions)
3. Clomipramine
Disorder and behaviors (compulsions)
• Time consuming (take more than 1 hour per day) 4. Deep Brain Stimulation

• Person is aware that the obsessions and compulsions are

unreasonable and excessive

1. Cognitive Behavioral
• Fear, anxiety, or avoidance is persistent typically lasting for 6 Therapy (first line)
Marked fear or anxiety about a specific object or
Specific Phobia months or more 2. Benzodiazepines
situation
• Out of proportion to actual danger posed 3. SSRIs
4. Beta Blockers
• Agoraphobia – fear of open spaces • Acrophobia – fear of heights
• Claustrophobia – fear of enclosed spaces • Aerophobia – fear of flying
• Social Phobia – also called social anxiety disorder – fear of • Mysophobia – fear of germs
social situations • Ophidiophobia – fear of snakes
• Arachnophobia – fear of spiders – most common specific phobia • Atichyphobia – fear of failure

The leading cause of disability.

Labs: TSH, B12, CBC, CMP Five (or more) of the following symptoms have been present 1. SSRI (first line)
DDx: Hypothyroidism, B12 deficiency, Chronic during the same 2-week period and represent a change from 2. SNRI
fatigue, DM 2, Dsythmia, Med list previous functioning; at least one of the symptoms is either: 3. Psychotherapy
1. Depressed mood 4. Complementary Drug
DEPRESSION Dysthymia: A chronic, milder mood disturbance 2. loss of interest or pleasure (Anhedonia) 5. ECT
that has been present for at least 2 years

Screening for Depression: PHQ 9 Treating depression in young adults and children we have to
ALWAYS ask about Suicide watch them and follow up with them (“2 weeks”) - Risk of
Ideation - Plan - Intention - Access suicidal thinking and behavior

Tricyclic- NEVER first line

Monoamine Oxidase Inhibitors → MUST BE ON A TYRAMINE
Depression Depression + Sucide → don't give lethal in an
FREE DIET
Medications overdose
Tyramine not getting broken down can cause a HTN crisis
Depression + Bipolar → Cause rapid cycle

Mood disturbance lasting 1 week (or any duration if

hospitalization)

During the period of mood disturbance 3 or more symptoms have

A distinct period of abnormally and persistently to be persisted BUT 4 if the mood is only irritable
Mania
elevated, expansive, or irritable mood,
The mood disturbance is sufficiently severe to cause marked
impairment in daily functions or to necessitate hospitalization 1. Lithium
to prevent harm to self or others, or there are psychotic 2. Anticonvulsants
features 3. 2nd Generation
Antipsychotic
• Mood disturbance for at least 4 days 4. Antidepressants
• During a period of mood disturbance, three 3+ symptoms

A distinct period of persistently elevated, • Unequivocal change in functioning that is uncharacteristic

Hypomania
expansive, or irritable mood, lasting throughout
• The episode is not severe enough to cause marked
impairment in daily function or to necessitate hospitalization
and no psychotic features

• Manic episodes that last at least 7 days or manic symptoms

that needs hospitalization
Bipolar I Lithium
• Women > Men • Depressive episode (can be dx by the presence of a manic
• Drug of choice in euphoric
• Age of onset is 25 years old episode alone)
mania
• Most expensive mental health disorder
• VERY narrow therapeutic
• Suicidal Attempt is up to 2x than those with
window
unipolar depression
• Anti-suicidal properties
• High rate of substance use with BD
• CHECK TSH
 • Drug of choice in euphoric
• Age of onset is 25 years old
mania
• Most expensive mental health disorder
• VERY narrow therapeutic
• Suicidal Attempt is up to 2x than those with
window
unipolar depression
1+ major depressive episode lasting at least two weeks AND • Anti-suicidal properties
• High rate of substance use with BD
Bipolar II 1+ hypomanic episode lasting at least four days • CHECK TSH
(never a manic episode)

Characterized by several alternating hypomanic and

Cyclothymic
depressive episodes lasting for at least 2 years (1 year in
Disorder
children and adolescents).
A. Pattern is mainifested in 2 (or more) of the following areas:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse Control

B. The enduring pattern is inflexible and pervasive across a

General broad rang of personal and social situations
An enduring pattern of inner experience and
Personality Therapeutical interventions
behavior C. The enduring pattern leads to clinically significant distress
Disorder
or impairment in social, occupational, or other important areas
of functioning.

D. The pattern is stable and of long duration, and its onset can
be traced back at least to adolescence or early adulthood.

Disorder Define Key Features Cluster

Distrust and suspiciouness of others and their
Paranoid Suspicious "SUSPECT"
motives
Detached from social relationships, restricted
Schizoid Cluster A
range of emotions

Social and interpersonal deficits with reduced PASS

tolerance and capacity for close relationships
Schizotypal
and with cognitive or perceptual distortions and
eccentric behavior

Unstable relationship, intense fear if

Borderline
abandonment poor impulse control

Overly emotional, need to be the center of Cluster B

Histrionic
attention

Inflated sense of self, grandiose, need for

Narcissistic
admiration, poor empathy

Disregard for the rights of others and for social

Antisocial and societal norms, lack of empathy and
remorse

Cluster C
 Socially inhibited, feelings of indequacy, fear of
Avoidant
criticism or negative evaluation
Cluster C
Inability to make decisions, need to be cared for,
Dependent
fear of losing support

Obessive- Need for order, perfectionism, rigid standards,

Complusive inflexible

A. Two (or more) of the following, each present for a significant

portion of time during a one-month period (or less if successfully Typical Antipsychotic
treated). At least one of these must be (1), (2), or (3): - Higher association with EPS
and Tardive dyskinesia
1. Delusions - better at treating positive
A thought disorder characterized by 2. Hallucinations symptoms
hallucinations, delusions, disorganized speech or 3. Disorganized Speech - blocks D2
SCHIZOPHRENIA
behavior, and decreased participation in daily 4. Grossly disorganized or catatonic behavior
activities. 5. Negative symptoms Atypical Antipsychotic
-effective for both + and -
Continuous signs of the disturbance persist for at least 6 symptoms
months. This six-month period must include at least 1 month of -blocks D2 and 5HT
symptoms (or less if successfully treated) that meet Criterion A receptors
(ie, active-phase symptoms)

Brief Psychotic
Schizophrenia-like symptoms lasting 24 hours to 1 month
Disorder

Schizophrenifor
1 month - 6 month
m

a psychiatric disorder consisting of

Schizoaffective
symptoms of both thought and mood disorder
Disorder
(depression or bipolar)

Characterized by delusions and (usually

Paranoid auditory) hallucinations that are persecutory in MOST COMMON SUBTYPE
nature

Characterized by a notably disorganized

thought processes, often with emotional
impairment and difficulty communicating
Disorganized More pronounced negative symptoms.
effectively. Hallucinations and delusions are
either absent or less pronounced than in
paranoid schizo

Characterized by a disturbances in movement,

Very rare subtype, in which people may assume odd positions or echolalia (repeating words said
Catatonic either a dramatic reduction in voluntary
by others) or echopraxia (mimicking movements).
movement. Described as “waxy flexibility"
 Undifferentiate Presence of symptoms of schizophrenia that do Undifferentiated schizophrenia may be diagnosed in people with fluctuating or atypical
d not fall into another specific subtype symptoms.

Other Delusion Disorders

Sunstance Induced Psychosis
Belief that a family member or loved one has
Capgra Syndrome
been replaced by an imposter
Unspecified Characterized by the presence of a delusion or
Delusional hallucination that does not meet criteria for
Disorder schizophrenia or another disorder
 Normal dissociation is an adaptive
Dissociative Previously known as multiple
defense used to cope with
Identity personality disorder,
overwhelming psychic trauma.

Dissociation has been defined

as a disruption
of and/or discontinuity in the
normal integration of
Believed to originate in the consciousness, memory,
context of severe trauma during identity, emotion, perception,
childhood body representation, motor
control, and behavior .
Disruption in on or more of
these areas leads to
impairment in