Notes on Diagnostic and Statistical Manual IV (DSM IV)
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Notes on Psychiatry
Notes on Diagnostic and Statistical Manual IV (DSM IV)
Axis of diagnosis:
I: clinical disorders.
II: personality disorders and mental retardation.
III: physical disease.
IV: social problems.
V: GAF; global assessment of function.
Mental retardation:
• Axis II.
• Fetal alcohol syndrome is most common cause.
• Fragile X and down are most common genetic causes.
Autism:
• Axis I.
• Delayed language; social problems.
• Chromosome 15.
• Defective neural circuits; failure of apoptosis.
ADHD:
• Treatment: methylphenidate, dextroamphetamine, pemoline.
Schizophrenia:
• Causes: trinucleotide repeat amplification; birth trauma.
Types:
Paranoid: delusions, hearing voices, etc.
Catatonic: state of shock/confusion; stuck in awkward positions for long periods of time; repetitious.
Disorganized: incoherent, primitive, unorganized behavior and speech, explosive laughter.
Signs:
• Cannot follow slow moving object with the eye.
• Slower to fix impressions in short-term memory.
• Diminished amplitude of auditory P300; impaired selective attention.
• Prefrontal cortical (PFC) impairment; cannot perform complicated cognitive tasks.
• Site of primary schizophrenic pathology: limbic system.
Mood disorders:
Dysthymia:
• Chronic depression greater than 2 years.
• Changes in appetite, sleep, self-esteem, hopelessness, etc.
Cyclothymia:
• Nonpsychotic bipolar.
• Alternating states.
Seasonal affective disorder:
• Depression during winter.
• Treatment: bright light therapy.
• Abnormal melatonin metabolism.
Unipolar depression:
• Major depression greater than 2 weeks.
• Anhedonia, delusions, hallucinations, suicide risk, disturbed sleep patterns.
• Abnormally high glucose metabolism in amygdala; smaller hippocampus, increased glucocorticoids.
• Decreased NE, 5-HT, and DA.
• Early morning awakening.
Bipolar disorder:
• Unipolar disorder + mania (mood swings).
• I: more mania.
• II: more depression.
Maniac: increased self-esteem, low tolerance, flight of ideas, weight loss, increased libido.
• Increased NE, 5-HT, DA.
• Less common than unipolar.
Depression labs:
• Low MHPG.
• Dexamethasone doesn't suppress cortisol.
• TRH doesn't increase TSH.
Eating disorders:
Bulimia nervosa:
• Ingestion of food followed by self-induced vomiting.
• Treatment: imipramine, SSRIs.
Anorexia nervosa:
• Self-starvation.
• Treatment: cyproheptadine, chlorpromazine, amitriptyline.
Anxiety disorders:
• Most common psychiatric disorder in women.
Generalized anxiety disorder:
• Less than 6 months.
• Pounding heart, sweating, chest pains, hyperventilation, impatient, hyperactive, distracted.
Phobias:
Agoraphobia: open spaces.
Social: fear of social situations; treatment: phenelzine (MAO inhibitor), or paroxetine (SSRI).
Obsessive-Compulsive Disorder:
• Obsessive: focus on one thought to avoid another.
• Compulsive: repetitive actions.
• Increased frontal lobe and caudate nucleus activity.
• Treatment: fluoxetine, fluvoxamine, SSRIs, clomipramine.
Panic disorder:
• 3 attacks in 3 weeks.
• Fear, trembling, sweating, hyperventilation.
• Treatment: alprazolam, tricyclic antidepressants, clonazepam, SSRIs, CO2.
Somatoform disorders:
Somatization disorder:
• Unexplained physical symptoms without medical cause; 8 or more symptoms: 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic.
• Unconscious.
Conversion disorder:
• Unexplained physical symptoms without medical cause; 1 or more symptom.
• Unconscious.
Hypochondriasis:
• Preoccupation with illness when none is present.
• Greater than 6 months.
Somatoform pain disorder:
• Prolonged, unexplained pain.
• Looking for secondary gain.
• Unconscious.
Body dysmorphic disorder:
• Sees oneself as ugly or horrific when normal in appearance.
Malingering:
• Conscious; secondary gain.
Factitious disorder:
• Conscious and unconscious.
• Primary or secondary gain.
Post-traumatic stress disorder:
• Following a stressful situation in life.
• Flashbacks.
• Greater than 1 month.
• Less than 1 month = acute stress disorder.
Disassociative disorder:
• Triggered by emotional crisis.
• New identity, sudden travel, inability to recall past.
• Multiple personality disorder: Presence of 2 or more personalities.
• Depersonalization disorder: experienced detachment from one's body.
Personality disorders: type A:
• Paranoid: suspiciousness/mistrust of others; grudges; reads hidden meanings.
• Schizoid: social withdrawal; isolated; loner.
• Schizotypal: odd, weird, strange, magical thinking.
Personality disorders: type B:
• Histrionic: dramatic, attention-seeking, seductive behavior.
• Narcissistic: fantasy of unlimited wealth, power; fragile self-esteem; prone to depression; criticism met with rage.
• Borderline: unstable affect, behavior, self-mage; promiscuity, gambling, over-eating, drug-abuse; history of sexual abuse; self-mutilation. More in women.
• Antisocial: more in males; criminal acts; can't conform to social norm; can't hold steady job.
Personality disorders: type C:
• Avoidant: very sensitive to rejection; shy; very anxious.
• Obsessive-compulsive: orderliness, inflexible, perfectionist; rules, lists, order; stubborn; no sense of humor.
• Dependent: depends on others; assumes others to assume responsibility.
Additional Reading:
Basic Psychiatry
1. Diagnostic and Statistical Manual IV (DSM IV)
2. Organic Disorders
3. Major Depressive Disorder vs Dysthymic Disorder
Related Topics
1. Mechanics of Defense Mechanisms
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