Psychological disorders,

DSM V
 DSM5
• Axis I: Clinical Disorders
• Axis II: Personality disorders and mental
retardation.
• Axis III: Physical condition and disorders
• Axis IV: Psychosocial and environmental
problems.
• Axis V: Global assessment of functioning
• Includes schizophrenic, affective, anxiety,
and somatoform disorders. Also includes
anorexia nervosa, bulimia nervosa, sexual
disorders, sleep disorders, and autism
• Just these two
• Any physical disorder
• Includes primary support group, social
occupation, education, housing, economics,
health care services, and legal issues
• Scored on a descending scale of l OO to 1,
where 100 represents superior
functioning, 50 represents serious
symptoms, and 1 0 represents persistent
danger of hurting self or others
 Example
• Axis 1 persistent depressive disorder
• Axis 2 Dependent personality disorder
• Axis 3 Obesity
• Axis 4 none
• Axis 5 GAF 50 defencies in getting
around, and getting along with people,
life activities
 Mental retardation
• Axis II
• FAS most common known cause
• Down and fragile x syndrome most
common genetic causes
 Autism
• Axis I
• Dx < 3 years of age
• Male to female 4:1
• Linked to ch 11, 15
• 80% IQ < 70
• Potential causes: Association with prenatal and
perinatal injury, e.g., rubella in first trimester. 2x
more likely if mother had asthma, allergies, or
psoriasis while pregnant
 Clinical Presentation
• Problems with reciprocal social interaction, decreased repetoire
of activities and interests
• Abnormal or delayed language development, impairment in verbal
and nonverbal communication
• No separation anxiety
• Oblivious to external world
• Fails to assume anticipatory posture, shrinks from touch
• Preference for inanimate objects
• Stereotyped behavior and interests
• Pronoun reversal : children refer to themselves as “he” or “she”
 Treatment
• Treatment: behavioral techniques
(shaping), risperidone reduces
agitation/aggression
 ADHD
• a. Problems with inattention, impulsivity,
hyperactivity
• b. Male-to-female ratio is 1 0: 1 .
• c. Associated with lower dopamine levels
• d. Treatment: methylphenidate,
dextroamphetamine.
 Schizophrenia
• A severe psychotic illness characterised
by delusions, hallucinations (usually
auditory), thought disorder and
behavioural disturbance
• Often deterioration in social,
occupational and cognitive function
• Occurs in Clear consciousness
 History of schizophrenia
• Kraeplin (1855 –1926) – dementia
praecox
• Bleuler (1857 – 1959) – schizophrenia
• Kraeplin suggested that aud.
Hallucinations, delusions, thought
disorder, affective falttening and
impaired insight were common to
hebephrenia, paranoia, catatonia and
dementia simplex – group of disorders
which he called dementia praecox
 History contd.
• Bleuler – the four As – abnormal thought
association, affective abnormality,
ambivalence, autism
 Prediction of good
prognosis
• Paranoid or catatonic
• Late onset –female
• Quick onset
• Positive symptoms
• No family history
• Family hx of mood disrder
• Absence of structural brain abnormalities
 Definitions
• Mood disorder: disorders that
have a disturbance in mood as
their prominent feature
• Affect: a person’s present
emotional responsiveness
• Mood: Pervasive and sustained
emotion that colours the
person’s perception of the
world
 Mood disorders
• Unipolar:
– Major depressive disorder
– Dysthymic disorder
• Bipolar:
– Bipolar I disorder
– Bipolar II disorder
– Cyclothymic disorder
• Mood disorder due to GMC
• Substance induced mood disorder
 Cont..
• Dysthymia: chronic 2 yrs, depressed mood on most
days, patient is functional, not severe for
hospitalization, prevalence 5%

• Cyclothymia: alternating states between depressed

mood and hypomania, > 2 yrs

• SAD: depressive symptoms during winter months,

caused by abnormal melatonin metabolism
 Major depression
• Symptoms 2 weeks
• Associated with; anhedonia, no
motvation, feeling of worthlesness,
decreased concentaration, wt loss or
gain, depressed mood, insomnia or
hypersomnia, psychomotor agitation or
retardation, loss of sex drive, delusions
 Suicide in Depression
• 60 % have suicidal ideation
• 15 % die by suicide
 Neurochemical changes
• Decreased norepinephrine
• Decreased serotonin
• Decreased dopamine
 Sleep correlates
• Increased REM in first half of sleep
• Decreased REM latency
• Early morning wakening
 Definition
• Anxiety is a universal human
characteristic which serves as an
adaptive mechanism to warn about
an external threat by activating
the sympathetic nervous system
(fight or flight)
• Anxiety becomes pathological
when:
– fear is greatly out-of-proportion to
risk/severity of threat
– response continues beyond absence
of threat
– social or occupational functioning is
The common anxiety
disorders
• Anxiety/phobic disorders e.g. panic
disorder, generalised anxiety
disorder (GAD), phobias
• Stress-related disorders e.g. acute
stress reactions, adjustment
disorder, post-traumatic stress
disorder (PTSD).
• Obsessive-compulsive disorder
(OCD).
• Social phobia
Eating disorders
THE END