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DURATION/ON
SET
Mental Retardation
Onset <18y.o
Learning Disorders
Onset: elementary
school
SYMPTOMS/MANIFESTATIONS
Childhood
D.
Pervasive
Developmental
Disorder
Autism
Dx: after 2 BD
Retts Sd
Conduct Disorder
TREATMENT
Level
IQ
Functioning
Mild
5085%. Self-supporting. 6 grade level. Self-esteem &
70
impulse control problems.
Moderat
35Trainable, can work w/supervision. 2 grade level.
e
49
Problems conforming to social norms. Higher risk of
AD.
Severe
20Basic self-care habits (brush teeth, comb hair). Live
34
in group home setting.
Profound <20
Dependant 24/7. Little or no speech
Learning achievement below expectations, given pts age, intelligence,
Primary Prevention:
Genetic counseling if family hx.
Prenatal care
Behavioral techniques:
shaping.
When pt is aggressive to self &
others, give atypical
antipsychotics:
Risperidone.
Childho
od
Anxiety
Stranger Anxiety
6months 2y.o.
Separation Anxiety
1 3y.o.
7-9yr physical
complaints
Onset < 18y.o.
Tourette Disorder
Duration of
symptoms >2
weeks.
Duration of
episodes between
6m 12m
Atypical depression
Mood D.
Dysthymic Disorder
>2years
Winter months
Atypical symptoms
Bipolar
Disorder
BD I
BD II
Manic symptoms
>1 week, cause
significant distress
& impairment in
functioning.
Onset: 30y.o
(average)
desired one)
Behavioral approach Bellpad app (wet VS. dry,
reward dry days)
Drugs: Imipramine,
desmopressin (nasal spray,
DDAVP)
MOAi, SSRI
Long-term individual, insight oriented psychotherapy.
SSRI, MOAi, SSRI
Bright light therapy. Go to
Florida.
Mood stabilizers: Lithium,
Valproic acid (tx of choice).
BZD: carbamazepine.
Atypical Antipsychotics in
acute manic states:
Resperidone, olanzapine,
clozapine
Individual psychotherapy.
Cyclothymic Disorder
>2 years
Pathological Grief
(Bereavement)
>6months
Post
-Partum
Depressi
on
After birth 2
weeks
1m after birth, last
4-6m
Baby blues
Postpartum
Psychosis
Postpartum
Depression
Brief Psychotic Disorder
Schizophreniform Disorder
>6months
Schizophre
nia
& Other
Psychotic
D.
Schizophrenia
Onset
F: 25y.o.
M: 15y.o. (worse
px)
Schizoaffective Disorder
>2 weeks of
delusions or
hallucinations w/o
mood symptoms
Delusional Disorder
>1 month
Panic Disorder
>1 month
Specific Phobias
Phobi
as
> 6months
Agoraphobia
Positive symptoms
Positive + Negative symptoms
Thought disorder that impairs: judgment behavior, ability to interpret
reality
PE: saccadic eye movement, hypervigilance
CT scan: lateral & 3 ventricles enlarged (the larger, worse px & >
negative symptoms)
Frontal & temporal lobe dysfunction: DECREASED metabolism
Positive symptoms
Negative symptoms
Bizarre Delusions
Flat (blunted) affect
Hallucinations (>>> auditory)
Social withdrawal
Disorganized speech: loose
Lack of motivation
associations
Disorganized or catatonic
Lack of speech or thought
behavior
Schizo psychotic disorder; Affective mood disorder.
Psychotic symptoms (positive or negative) + major depressive or
manic or both episodes.
2 subtypes: bipolar or depressive.
Individual psychotherapy.
If not sufficient: Lithium,
Valproic ac
Supportive psychotherapy.
Self-limited.
Antidepressants +
Mood stabilizers or
antipsychotics
Antidepressants.
Hospitalization: stabilization
and/or safety of pt to self or
others (e.g. suicidal, want to
kill someone)
Atypical Antipsychotics.
If all drugs have failed:
Clozapine (remember WBC
count weekly bc of risk of
agranulocytosis)
Supportive psychotherapy:
ego builder, make sure pt
trust you & is compliant with
medications.
Hospitalization?
Antidepressants &/or
anticonvulsants
If not effective: atypical
antipsych.
Often self-limited.
Psychotherapy.
Antipsychotics.
In acute situations:
Alprazolam
SSRI (1 choice)
TCAs: Imipramine
Clonazepam
If hyperventilation: CO2
(breath in a paper bag)
Keep tx for 6-12m
Systematic desensitization.
Assertiveness training.
Social Anxiety
Disorder
Anxiety D.
Adjustment Disorder
< 6months
> 6months
Somatic
Symptoms
& Related
D.
*Symptom
production:
UNCONSCIOUS
*Symptom
motivation:
UNCONSCIOUS
Somatic
Symptom
s Disorder
Months - years
Conversio
n Disorder
Illness
Anxiety
Disorder
> 6months
Psychologic component
Autonomic hyperactivity:
* shortness of breath
* diaphoresis
* tremor
Motor tension
SSRI
Beta blockers: stage fright
Behavioral psychotherapy:
relaxation training, guided
imagery, exposure &
response prevention.
SSRI: fluoxetine, fluoxamine
TCAs: Clomipramine
BDD
Individual psychotherapy
Antidepressants.
Group therapy
Constant counseling
SSRIs improve functional level
Antidepressants
BZD
Best choice: pharmacotherapy
Supportive psychotherapy
Anxiolytics,
antidepressants
Factitious
D.
Malingerin
g D.
*Symptom
production:
CONSCIOUS
*Symptom
motivation:
UNCONSCIOUS
Munchaus
en
&
Munchaus
en by
proxy
*Symptom production:
CONSCIOUS
*Symptom motivation:
CONSCIOUS
Delirium
Cognitive
D.
Dementia
* Dementia of Alzheimer type
* Vascular (multi-infarct) dementia
Dementia
* Pick Disease
* CJD
Hydrocephalus
* Huntington Disease
* Parkinson Disease
Amnestic Disorder
Dissociativ
e D.
Depersonalization /
Derealization Disorder
Correction of physiologic
problem.
Orientation & reassurance.
Antipsychotics & restraints if
necessary.
Correction or amelioration of
underlying pathology.
Provision of familiar
* Lewy Body Disease
surroundings, reassurance,
* HIV related
and emotional support.
* Wilson Disease
* Normal Pressure
* Pseudodementia
Correction or amelioration of
underlying pathology
e.g.give thiamine
Psychotherapy.
Dissociative amnesia
Dissociative fugue
Kleptomania
Impulse
Control D.
Pyromania
Pathologic Gambling
Trichotillomania
Restricting type
Anorexia
Nervosa
Eating D.
Bulimia
Nervosa
Bingeeating/purging
Purging type
(vomit, laxatives,
diuretics, enemas)
Non purging type
(fasting or
exercise)
Significant episodes when pt cant recall important & often emotionally Rule out medical condition or
charged memories.
substance abuse.
It may suddenly or gradually remit, when traumatic event is resolved Hypnosis, suggestion &
relaxation techniques.
Dissociative fugue
Psychotherapy.
Sudden, unexpected travel + inability to remember ones past +
confusion about personal identity or assumption of a new one.
Onset: Minutes Failure to resist aggressive impulses. Reaction out of proportion to the
hours after stressor
stressor.
Result: serious assaultive acts & destruction of property
Goal: stealing.
Anticonvulsants,
antipsychotics, betablockers, SSRIs.
Psychotherapy.
Insight-oriented therapy
Behavioral therapy:
conditioning & systematic
desensitization.
SSRIs or Anticonvulsants.
Incarceration, no tx beneficial.
Gamblers Anonymous.
SSRIs.
Behavior modification
techniques.
Anticonvulsants,
antipsychotics, SSRIs.
Stabilizing weight.
Family & individual therapy.
Mirtazapine: antidepressant
that increase appetite.
SSRIs
Imipramine
Psychodynamic psychotherapy
P
e
r
s
o
n
a
l
i
t
y
D
.
P aranoid
Cluster
A
Odd,
eccentric
type.
S chizoid
S chizotypal
H istrionic
Cluster
B
Dramatic,
emotional
type.
A ntisocial
N arcissistic
B orderline
O bsessive-Compulsive
Cluster
A voidant
If younger than 18
Dx as Conduct
Disorder.
C.
Anxious,
fearful type.
D ependant
Sleep D.
Narcolepsy
Onset of REM: 10
minutes
Sleep
Apnea
Obstructive
Middle-aged
Central
Elderly
Mixed
Insomnia
Tx of choice: Modafinil
Moda Fina
(nonamphetamine: inhibits
DA re-uptake, activates
glutamate, inhibits GABA)
If cataplexys present: TCAs
(suppresses REM),
antidepressants.
GABA levels
Nightmares
Night terrors
Parasomni
as
Gender
Dysphoria
MC 3-7y.o
REM
MC in boys, runs in
family
Begins at young
age
Stages 3
&4
Stages 3
&4
Somniloquy
Common in
children
All stages
Enuresis
Childhood
Stages 3
&4
Somnambulism
Gender identity is
established by the
age of 3
Elevated physiologic
arousal
Awakened
by sleep or
intense
anxiety
Terminates
in
awakening
Perseverative behaviors
Performed w/o full
consciousness
Sleep talking, may
accompany
sleep terrors or walking
Already discussed in childhood disorders.
Memory of
event
No memory of
event
Followed by
confusion
zolpidem, eszopiclone
Ramelton: melatonin receptor
ag.
Desensitization behavior
therapy
Not needed
Desmopressin. Imipramine
Sex change.
Hormonal replacement
therapy.