Psiquiatría Toronto Notes

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5creen|ng uesI|ons lor Major
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Fsych|aIric FuncI|onaI |nquiry
MAF5
Mood
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nx|aty
Fsychos|s
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Insightandudgmant
Logn|tion
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DA dopmiâ NAO| moôm|naoxiJsai^|ibito| ODD opposit|oâlJa||^tJ|sorda|
ECT alactroconvulsiva tha|py NOD m|o|Japrassivadisorda| O pa|so^lityd|sorJa|
EPS axt|py|m|dlsymptoms NOE m|o| JaprassivaapisoJa OD pa|vsivadavalopmant|d|sorJa|
EtOH at|ô||cohol NSE mantlsttcsaxmiât|o^ ISD post-t|cmticst|assd|sorJa|
OAD gaâr||tadnxiatyd|sorJa| NOS notot|am |saspac|liaJ SNRl sa|otoî^^dnorap|naphr|na|acpt<ai^hibitors
OVC gaâr| maJiclco^d|tion OCD obsassiva-compcls|vaJiso|Jar SSR| sa|activasa|oton|nraupt|ai^|ibito|
|TP intarpa|so^lt|arpy OCPD obsassiva-compcls|vaparso^lityd|sorJa| TCA tr|cycl|cnt|Jap|ass^t
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Hstory
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whomIhcyarcIvIng,rcIcrraIsourcc
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maynccdcoIIatcraIsourcc c.g.parcnI,Icachcr)IIpaIIcnIunabIc/unwIIIIngIoco-opcraIc
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InpaIIcnI`sownwords
duraIIon
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supporIs,IuncIIonaIsIaIus,rcIcvantassocaIcdsympIomspcrIIncnIpostvcsandncgaIIvcs)
saIcIyscrccn:!sIhcpaIIcnIcndangcrIngscIIoroIhcrscpcndcnIsaIhomcc.g.chIdrcn,pcIs),
abiIiIyIodrivc saIcIy, abiIiIyIocarcIorscIIc.g.caIing,hygicnc,IakingmcdicaIions)
5yCutlC uDCtODul DQuly
mood: dcprcsscd,manc
anxIcIy:worrIcs, obscssIons, compuIsons,pancaIIacks,phobIas,hIsIoryoIIrauma
psychoss: haIIucInaIIons,dcIusons,IhoughIIorm dIsordcrs
suIcIdc/homcIdc:IdcaIIon,pIan,InIcnI,hIsIoryoIatIcmpIs
organIc: LIH/druguscorwIIhdrawaI,IIIncss,dcmcnIIa
u5t 5yCutlC H5tOly
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aIsoIncIudcpasIsuIcIdcaIIcmpIs,subsIanccusc/abusc,andIcgaIprobIcms
u5t Ne0CululgCul H5tOly
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mcdIcaIIons,aIIcrgIcs
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rcIaIIonshIpswIIhparcnts/sbIIngs
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physIcaIorscxuaIabuscIn chIIdhood/adoIcsccncc
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pcrsonaItybcIorccurrcnIIIIncss,rcccnIchangcsInpcrsonaIty
Nental 8tatus Exam {N8E}
eDelul PeuluDCe uD0 euvOUl
drcss,groomIng,posturc,gaII,physIcaIcharacIcrIsIcs,bodyhabIIus, apparcnIvs.chronoIogIcaI
agc,IacIaIcxprcsson c.g. sad, suspIcIous)
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psychomoIoracIIvIIyagIIaIIon,rcIardaIIon),abnormaImovcmcnIsorIackIhcrcoIIrcmors,
akaIhIsIa,IardIvcdyskIncsIa,paraIysIs), aIIcnIIonIcvcIandcycconIacI,aIIIudcIoward
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anccI- objccIIvc cmoIIonaI sIaIc,InIcrrcdIromcmoIIonaIrcsponscsIosIImuII,dcscrIbcdIn
Icrms oI.
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rangc nII, rcsIrIcIcd, IIaI,bIunIcd)
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moodcongrucncc InIcrrcdbyrcadcrbycomparIngmoodandaBccIdcscrIpIIons)
approprIaIcncssIoIhoughIconIcnI
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cohcrcncc- cohcrcnI,IncohcrcnI
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sIrcam
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crcumsIanIaI- spccchIhaIIs ndIrccIanddcIaycdnrcachIngIIsgoaI,cvcnIuaIIycomcs
backIo IhcponI
IangcnIIaI- spccchsobIIqucorIrrcIcvanI, docsnoIcomcbackIo IhcorIgInaIpoInI
IooscnIngoIassocIaIIons- IIIogIcaIshIhIngbcIwccnIopIcs
BghIoIIdcas- quIckIyskIppIngIromoncIdcaIoanoIhcrwhcrcIhc IdcasarcmargnaIIy
connccIcd,assocIaIcdwIhmanIa
wordsaIad- jumbIcoIwordsIackIngmcanngorIogIcaIcohcrcncc
pcrscvcraIon - rcpcIIIIonoIIhc samcvcrbaIormoIorrcsponscIo sIImuII
cchoIaIIa- rcpcIIIIonoIphrascsorwordsspokcnbysomconccIsc
IhoughIbIockIng- suddcnccssaIIonoIowoIIhoughIandspccch
cIangassocIaIIons- spccchbascdonsoundsuchasrhymIngorpunnIng
ncoIogism- uscoInovcIwordsoroIcxsIingwordsn anovcIIashion
Ougt LODteDt
suIcIdaIIdcaIIon/homIcIdaIIdcaIIon
Iow- ccIIngIhoughIs,noIormuIaIcdpIan,nonIcnI
InIcrmcdIaIc- morcIrcqucnIIdcaIon,wcIIIormuIaIcdpIan,noacIIvcInIcnI
hgh- pcrsIsIcnIIdcaIIonandproIoundhopcIcssncss/angcr,wcIIIormuIaIcdpIan,acIIvc
InIcnI,bcIcvcssucIdc/homIcIdcsIhc onIyhcIpIuIopIIonavaIIabIc
prc-occupaIIons,rumInaIIons- rcIIccIIons/IhoughIsaIIcngIh, noIncdorIaIsc
obscsson-rccurrcnIandpcrsIsIcnIIhoughI,ImpuIscorImagcwhchIsInIrusIvcorInapproprIaIc
cannoIbcsIoppcdbyIogIcorrcason
causcsmarkcdanxIcIyanddIsIrcss
commonIhcmcs- conIamInaIIon,ordcrIIncss,scxuaI,paIhoIogIcaIdoubI/worry/guIII
magIcaIIhInkIng- bcIIcIIhaIIhInkIngsomcIhIngwIIImakcIIhappcn, normaIInkIds
Idcas oIrcIcrcncc- sImIIarIodcIusIonoIrcIcrcnccbuIIhcrcaItyoIIhc bcIcIIsqucsIoncd
ovcrvaIucdIdcas- unusuaI/oddbcIIcIsIhaIarcnoIoIdcIusIonaIproporIIons
rsIranksympIomsoIschIzophrcnIa- IhoughInscrIIon/wIIhdrawaI/broadcasIIng
dcIusIon- ahxcdIaIscbcIcIIhaIIsouIoIkccpIngwIIhapcrson'scuIIuraIorrcIIgIous
backgroundandIshrmIyhcIddcspIIcInconIrovcrIIbIcprooIIoIhcconIrary
progrcssIonoIIncrcasIngpaIhoIogy, dccrcasIngInsghI:Idcas/Ihcmcs~ prcoccupaIIons
~ rumInaIIons~ obscssIons~ magIcaIIhInkIng~ IdcasoIrcIcrcncc~ ovcrvaIucdIdcas
~ nrsIranksympIoms ~ dcIusIons
elCetOD
haIIucInaIIon- scnsorypcrccpIonIn Ihc abscnccoIcxIcrnaIsIImuIIIhaIIssImIarInquaIIIyIo
aIrucpcrccpIon,audIorymosIcommon),vIsuaI,gusIaIory, oIIacIory,IacIIIc
IIIusIon- mIspcrccpIIonoIarcaIcxIcrnaIsIImuIus
dcpcrsonaIIzaIIon- changcInscII-awarcncsssuchIhaIIhcpcrson IccIs unrcaI, dcIachcdIrom
hsorhcrbody, and/orunabIcIoIccIcmoIIon
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InIcIIccIuaInncIIons- aIIcnIIon,conccnIraIIon,caIcuIaIon,absIracIIon provcrb
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IIsImpIIcaIIons
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Ins|ghI
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andpat|cnt'sappcaranccandactions.
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0illerenI|a| 0|agnos|s ol Fsychos|s

A5PP
Eene|a|med|ca|conditon
|lectivediso|de|s
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Fsychot|cd|so|ders
Fe|sona|ityd|sorde|s
ManagemenI ol AcuIe Psychosis and
Man|a
Ensu|esaletyo|se||, pat|entand
othe|pat|ents
haveanex|tstrategy
ecreasest|mu|aI|on
A88um0non-th|0!0n|ng8tnc0
lMmed|cat|ons|benzodiazepine
ant|psychotic}o|tenneededaspat|ent
may|e|useoralmeds
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onotuseantidep|essantso|
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NultuXul P55e55DeDt
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AX8111
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gIobaIasscssmcnIoI IuncIIonIng G^F,0Io 00) IncorporaIIngcnccIsoIaxcs!Io !V
OlDulutOD
adIagramouIIInIngcurrcnIssucsandInIcrrcIaIIonsbcIwccnanIndIvIduaI'sbIoIogIcaI,
psychoIogIcaI,and socIaIIacIors
IorcachcaIcgory. prcdIsposIng, prccIpIIaIIng,pcrpcIuaIIng,andproIccIIngIacIors
PlOuC tO NuDugeDeDt
IbIoIogIcaIc.g.pharmacoIhcrapy)
2.psychoIogIcaIc.g. C8J)
J. socIaIc.g.supporIgroup)
HSg0HOI0 SOtOBtS
eDtOD
characIcrIzcdbyasIgnIcanIImpaIrmcnIInrcaIIIyIcsIIng
dcIusIonsorhaIIucInaIIonswIIh/wIIhouIInsIghIInIoIhcrpaIhoIogIcaInaIurc)
bchavIoursodIsorganIzcdIhaIIIsrcasonabIcIo nIcrIhaIrcaIIIyIcsIIngIsdIsIurbcd
Dfferental Dagnoss of Psychoss
prImarypsychoIIcdIsordcrs. schIzophrcnIa, schIzophrcnIIorm,brcIpsychoIIc, schIzoanccIIvc,
dcIusIonaIdsordcr
mooddsordcrs.dcprcssonwIhpsychoIIcIcaIurcs,bIpoIardIsordcrmanIccpIsodcwIIh
psychoIIcIcaIurcs)
pcrsonaItydIsordcrs. schIzoIypaI,schIzoId,bordcrIInc,paranoId, obscssIvc-compuIsIvc
gcncraImcdIcaI condIIons.Iumour,hcadIrauma, dcmcnIIa, dcIIrum,mcIaboIc
subsIancc-InduccdpsychosIs.InIoxIcaIIonorwIhdrawaI
8chzophrena
N-V-H ugDO5tC Lltelu Ol C2OleDu
Hep|inted with perm|ssion |rom the 0agnost|c and Stat|st|cal Mandal ol Mental 0|so|ders, 1ext Hev|s|on, |od|1h Ld|t|on, (Lopy|ight 2UUU}.
Ame|ican |sychiatric Associatiou.
^. characIcrIsIIcsympIoms acIIvc phasc). <2 oIIhcIoIIowIng, cachprcscnIIorasIgnhcanI
porIIonoIIImcdurnga1-muu!H gctuu orIcssIIsucccssIuIIyIrcaIcd)
dcIusIons
haIIucInaIIons
dIsorganIzcd spccch c.g.IrcqucnIdcraIImcnIorIncohcrcncc)
grossIydIsorganIzcdorcaIaIonIcbchavIour
ncgaIIvcsympIoms,c.g.anccIvcIaIIcnIng, aIogIa InabIIIIyIospcak),oravoIIIIon nabIIIy
IoInIIIaIcandpcrsIsIIn goaI-dIrccIcdacIvIIIcs)
u!c: onIy `sympIomIs rcqurcdIIdcIusonsarcbIzarrcorhaIIucnaIIonsconsIsIoIavoIcc
kccpIngarunnIngcommcnIaryonIhcpcrson
'
sbchavIourorIhoughIs,or2ormorcvoIccs
convcrsIngwIIhcachoIhcr
8. socIaI/occupaIIonaIdysIuncIon. z majorarcasoIIuncIIonIngwork,InIcrpcrsonaIrcIaIIons,
scII-carc)markcdIybcIowIhcIcvcIachIcvcdprIorIoIhconscIoIsympIoms
C. conIInuoussIgnsoIdIsIurbanccIor<muu!H8, IncIudIng <1 muu!H oIacIIvcphascsympIoms,
mayncIudcprodromaIorrcsIduaIphascs
. schzoanccIIvcandmooddIsordcrscxcIudcd
L. IhcdIsIurbanccIsnoIducIoIhcdIrccIphysIoIogIcaIcnccIsoIasubsIanccoraGMC
t IhsIoryoIpcrvasvcdcvcIopmcnIaIdIsordcr,addIIIonaIdIagnosIsoIschIzophrcnIaIsmadc
onIyIpromncnIdcIusIonsorhaIIucInaIIonsarcaIsoprcscnIIoraIIcasI I monIh
Jutuu!uu!c8212
uDtye5
paranoId
V8jcHu!cL8utuct8
prcoccupaIIonwIIhoncormorcdcIusIonsIypIcaIIypcrsccuIoryorgrandIosc)orIrcqucnI
audIIoryhaIIucInaIIons
rcIaIIvcprcscrvaIIonoIcognIIIvcluncIIonIngandadccI,onscIIcndsIo bcIaIcrIn IIIc,
bcIIcvcdIohavcIhcbcsIprognosIs
caIaIonIc
aIIcasIIwooI.moIorImmobIIIIycaIaIcpsyorsIupor), cxccssIvcmoIoracIIvIIypurposcIcss,
noIInIIucnccdbycxIcrnaIsIImuII),cxIrcmcncgaIIvIsmrcsIsIanccIoInsIrucIIons/aIIcmpIs
Iobcmovcd) ormuIIsm, pccuIIarvoIunIarymovcmcnIposIurIng, sIcrcoIypcd movcmcnIs,
promIncnImanncrIsms),cchoIaIIarcpcaIIngwords/phrascsoIanoIhcr'sspccch) or
cchopraxIaImIIaIIvcrcpcIIIIonoIanoIhcr'smovcmcnIs,gcsIurcsorposIurc)
dIsorganIzcd
dIsorganIzcdspccchandbchavIour,aIorInapproprIaIcadccI
poorprcmorbIdpcrsonaIIIy, carIyand InsIdIousonscI, and conIInuouscourscwIIhouI
sIgnIcanIrcmIssIons
undIdcrcnIIaIcd
sympIomsolcrIIcrIa^mcI,buIdocs noIIaIIInIoIhcJ prcvIoussubIypcs
rcsIduaI
abscnccoIpromIncnIdcIusIons,haIIucInaIIons,dIsorganIzcdspccch,grossIydIsorganIzcdor
caIaIonIcbchavIour
conIInuIngcvIdcnccoldIsIurbanccIndIcaIcdbyIhc prcscnccoIncgaIIvcsympIomsorIwo
or morc sympIomsincriIcria^prcscnIinaIIcnuaIcdIorm
L0eDOlOgy
prcvaIcncc.0.5%- %,M.I " 1:1
mcanagcoIonscI.IcmaIcs ~27,maIcs~21
LtOlOgy
muIIIIacIorIaI.dIsordcrIsarcsuIIoIInIcracIIonbcIwccnboIhbIoIogIcaIandcnvIronmcnIaI
IacIors
gcncIIc- 50%concordanccInmonozygoIIcMZ)IwIns,40% IIboIhparcnIshavc
schIzophrcnIa, I0%oldIzygoIIc Z)IwIns, sIbIIngs,chIIdrcnadccIcd
ncurochcmIsIry- "dopamInchypoIhcsIsIhcory.cxccssacIIvIIyInIhcmcsoIImbIc
dopamIncpaIhwaymaymcdIaIcIhcposIIIvcsympIomsoIpsychosIsI.c.dcIusIons,
haIIucInaIIons,dIsorganIzcdspccchandbchavIour, and agIIaIIon)
ncuroanaIomy- dccrcascd IronIaIIobcIuncIIon,asymmcIrIcIcmporaI/IImbIcIuncIIon,
dccrcascdbasaIgangIIaIuncIIon,subIIcchangcsInIhaIamus,corIcx,corpuscaIIosum,and
vcnIrIcIcs,cyIoarchIIccIuraIabnormaIIIIcs
ncurocndocrInoIogy- abnormaIgrowIhhormonc,proIacIIn, corIIsoI, and
adrcnocorIIcoIropIchormonc
ncuropsychoIogy- gIobaIdcIccIssccnIn aIIcnIIon,Ianguagc,andmcmorysuggcsIIackol
connccIIvIIyolncuraIncIworks
IndIrccIcvIdcnccoIgcographIcaIvarIancc,wInIcrscason oIbIrIh,andprcnaIaIvIraIcxposurc
utHOhy5OlOgy
ncurodcgcncraIIvcIhcory
naIuraIhIsIorymaybcrapIdorgraduaIdccIIncInIuncIIonandabIIIIyIocommunIcaIc
gIuIamaIcsysIcmmaymcdIaIcprogrcssIvcdcgcncraIIonbycxcIIoIoxIcmcchanIsmwhIch
Icads IoproducIIonoIlrccradIcaIs
ncurodcvcIopmcnIaIIhcory.abnormaIdcvcIopmcnIoIIhcbraInlromprcnaIaIIIIc
ncuronslaIIIomIgraIccorrccIIy, makcInapproprIaIcconnccIIons,andbrcakdown InIaIcr
IIIc
InapproprIaIcapopIosIsdurIngncurodcvcIopmcnIrcsuIIIngIn IauIIyconnccIIonsbcIwccn
ncurons
NuugeDeDt O Ch2OhleDu
bIoIogIcaI
acuIcIrcaImcnIandmaInIcnanccwIIhanIIpsychoIIcs anIIconvuIsanIs anxIoIyIIcs
managcmcnIoIsIdccdccIs
psychosocIaI
psychoIhcrapyIndIvIduaI,IamIIy, group).supporIIvc, C8J
asscrIIvc communIIyIrcaImcnI^CJ)
socIaIskIIIsIraInIng,cmpIoymcnIprograms,dIsabIIIIybcnchIs
housInggrouphomc,boardInghomc,IransIIIonaIhomc)
V8jcHa!tj Vbb
5uggesIed 6r|Ier|a lor Prodroma|
5yndromes
Attcnuatcdpos|t|vcsymptom
synd|omc.Abno|ma/unusualthought
contcnt,susp|c|ousncss,g|andiosity,
pc|ccptua|abnormalitics, and/o|
o|gan|zat|ono|communicat|on,onsct
o|wo|scn|nginpastyca|
br|c| |ntc|m|ttcnt psychot|c
synd|omc: ||an<lypsychotic,unusua|
thoughtcontcnt, susp|c|ousncss,
g|and|os|ty, pc|ccptualabno|ma||t|cs,
and/oro|gan|zat|ono|commun|cat|on,
onsctinpastth|ccmonths
cnctic|is<p|us|unctiona|
dctc|io|at|on:|||st-dcg|cc|c|at|vc
withh|stoqol anypsychot|cdiso|dcr
o|sch|zotypa|pc|sona||tydiso|dcr|n
pat|cnt, substantia| |unct|ona| dcc||nc
inpastyca|
1pI1 l|om S1oc\, B1.11 S1ocK V.
Kp|1 h1 S1oc\`s L0ml0h00|r0 0u|
0l /jchl/'y, I| L1|I|o1. ||pp||coII W||||ms 8
W||\|1s, ZJJa.
Bc|a||60sh| Bc|wcc0 00ta6 6! U0|tca|c1
Psyc|6s|s |0UP} a1 00!c6Mc |h ||ts!-c|s61c
Sc||t6|tc|a
m. /jchl/'j ZJJa, !cZ. ! !a!J1
P0t6sc. 1o |v|w I1e ssoc|I|o| Iw1 UU|
11 sympIom sv||Iy I l|sI I|"hI co1IcI,
11 m1 UU| 11 I|Im1I ouIcoms.
S!01y 0|atac|ct|s||cs. U||I|c| |v|w h1 mI
1|ys|s ol 1J sI1|s w|I1 1!!! pI|hIs.
Patc|ab. |I||Is w|I1 1o1llcI|v psyc|oI|c
1|so|1|s I o| c|os Io l||sI I|Im1I.
Bcs0||s. S1o|1| UU| ws ssoc|I1 w|I| g|I|
|spo1s Io hI|psyc|0I|c I|ImhI, s ms|1
y g|o| psyc1opI|o|ogy, pos|I|v sympIoms,
1gI|v sympIoms, |1 lu1cI|o1| oIcoms. I
I1 I|m ol I|Im1I |1|I|I|o1, |o|g| UU| ws
ssoc|I1 w|I1 I1 sv||Iy ol hgI|v sympIoms
uI hoI w|I1 I1 sv||Iy ol pos|I|v sympIoms,
g|o| psyc1opI|o|ogy, o| h|ocogh|I|v lhcI|oh.
060c|0s|6s: UU| my poI1I|||y mo1|l||
p|og1osI|c lcIo|.
5uppor||ve Fvidence lor 0opam|ne
hypoIhes|s
Aagon|sts cxacc|batcschizoph|cn|a
Ant|psychoticd|ugsactbyb|oc<|ng
post-synapt|cUA|cccpto|s
|otcncyo|manyant|psychot|cd|ugs
co||c|atcsw|th0Zb|oc<adc olpost-
synapt|crcccptors
Ant|psychotic d|ugs a|cassoc|atcd
withaninc|cascinthcnumbcrol 0Z
and04post-synaptic|cccpto|s
Vb V8jcHa!tj
ood PrognosI|c FacIors
Acutc onsct
||cc|p|tating |actors
oodcogn|t|vc|unct|on|ng
oodp|cmo|b|d|unct|on|ng
No|am||yhisto|y
||cscnccola||cctlvcsymptoms
Abscncco|st|uctu|a|b|ain
abnormalitics
ood|csponsctod|ugs
oodsuppoi1systcm
Non-b|za|rcdc|uslons|nvo|vcs|tuat|ons
thatcou|doccu|in|cal |||c|c.g.bcing
lol|owcd, po|soncd,lovcdatad|stancc}.
V8jcHu!c L8utuct8 Jutuu!uu!c8212
lOgDO55
IhcmajorIIyoIIndIvIduaIs dIspIaysomcIypcoIprodromaIphasc
courscsvarIabIc. somcIndIvIduaIshavccxaccrbaIIonsandrcmIssIonsandoIhcrsrcmaIn
chronIcaIIyIII, accuraIc prcdIcIIon oIIhcIongIcrmouIcomcIsnoIpossIbIc
carIyIn IhcIIIncss,ncgaIIvcsympIomsmaybcpromncnI,posIIvcsympIoms appcarand
IypIcaIIydImInIshwIIhIrcaImcnI,ncgaIvcsympIomsmaybccomcmorcpromIncnIandmorc
dIsabIIng
ovcrIImc, I/J Improvc, I/J rcmanIhcsamc, I/J worscn
8chzophrenform Dsorder
ua_uu88: crIIcrIa^, andLoIschIzophrcnIaarcmcI,an cpIsodcoIIhcdIsordcrIasIsIrom
1-muu!H8. !IIhcsympIomshavccxIcndcdpasI6monIhsIhcdIagnosIsbccomcsschIzophrcnIa
!tca!mcu!: smIIarIoacuIcschzophrcnIa
gtu_uu88: bcIIcrIhanschIzophrcna,bcgInsandcndsmorcabrupIIy, goodprc- andposI-
morbIdIuncIIon
Bref Psychotc Dsorder
ua_uu88:acuIcpsychosIs(prcscnccoII ormorcposIIIvcsympIomsIncrIIcrIaÎ-4 oI
schzophrcnIa) IasIIngIrom 1uaj!u 1 muu!H, wIIhcvcnIuaIIuIIrcIurnIoprcmorbIdIcvcIoI
IuncIIonIng
can occuraI|crasIrcssIuIcvcnIorposIparIum (scc1u5I0rIum uud !t5urdcr5, PSO)
!tca!mcu!: sccurccnvronmcnI,anIpsychoIIcs,anxIoIyIIcs
gtu_uu88: good,scII-ImIIng,shouIdrcIurnIo prc-morbIdnncIIonIn abouI I monIh
8chzoaffectve Dsorder
N-V-H ugDO5tC Ltt0tu Ot C2OuH0Ctv0 5Ot00t
Hep|inted with perm|ssion |rom the 0|agnost|c and Stat|st|cal Mandal o| Mental 0|so|ders, 1ext Hev|s|on, |od|lh Ld|t|on, (Lopy|ight 2UUU}.
^. unInIcrrupIcdpcrIodoIIIIncssduringwhIchIhcrcscIIhcraML ML), manIccpIsodc,ora
mIxcdcpIsodcconcurrcnIwIIhsympIomsmccIIngcrIIcraÎorschIzophrcnIa
8. nIhcsamcpcrIod,dcIusIonsorhaIIucInaIIonsIorZ2WccK8nIhcabscnccoIpromIncnImood
sympIoms
C. sympIomsIhaImccIcrIIcrIaIoramoodcpIsodcarcprcscnIIor asubsIanIaIporIIonoIIoIaI
duraIIonoIacIIvcandrcsduaIpcrIodsoIIhcIIncss
. IhcdIsIurbanccIsnoIducIoIhcdIrccIphysIoIogIcaIcdccIsoIasubsIanccorGMC
!tca!mcu!: anIIpsychoIcs, mood sIabUIzcrs, anIdcprcssanIs
gtu_uu88: bcIwccnIhaIoIschIzophrcnIaandoImooddsordcr
Delusonal Dsorder
N-V-H ugDO5tC Llt0lu Ol 0lu5ODul 5Ol00l
Hep|inted with perm|ssion |rom the 0|agnost|c and Stat|st|cal Mandal o| Mental 0|so|ders, 1ext Hev|s|on, |od|1h Ld|t|on, (Lopy|ight 2UUU}.
^. non-bzarrcdcIusIonsIorZ1 muu!H
8. crIIcrIonÎor schIzophrcnIahasncvcrbccnmcI (IhoughpaIIcnImayhavcIacIIIcoroIIacIory
haIIucInaIIonsIIIhcyarcrcIaIcdIo IhcdcIusIonaIIhcmc)
C. IuncIIonIngnoImarkcdIyImpaIrcd,bchavIournoIobvIousIyoddorbIzarrc
. ImoodcpIsodcs occurconcurrcnIIywIhdcIusons,IoIaIduraIIonhasbccnbrIcIrcIaIIvcIo
duraIIonoIIhcdcIusIonaIpcrIods
L. IhcdIsIurbanccIsnoIducIoIhcdIrccIphysIoIogIcaIcdccIsoIasubsIanccorGMC
8uD!jgc8: croIomanIc,grandosc,jcaIous,pcrsccuIory,somaIIc,mIxcd, unspccIhcd
!tca!mcu!:psychoIhcrapy, anIIpsychoIIcs, anIdcprcssanIs
gtu_uu88: chronIc,unrcmIIIIngcourscbuIhIghIcvcIoIIuncIIonIng
8hared Psychotc Dsorder {Fole Deux}
ua_uu88: dcIusIonIhaIdcvcIopsInanIndIvIduaIwhoIsInacIoscrcIaIIonshpwIIh anoIhcr
pcrsonwhoaIrcadyhasapsychoIIcdIsordcrwIIhpromncnIdcIusIons,IhcdcIusIons sImIIarIn
conIcnIIoIhaIoIIhcoIhcrpcrson
!tca!mcu!: scparaIIonoIIhcIwopcopIcrcsuIIsInIhcdIsappcaranccoIIhcdcIusIonInIhc
hcaIIhIcrmcmbcr,anIIpsychoIIcsmaypIay aroIc
gtu_uu88: good
Jutuu!uu!c8212 V8jcHu!cL18utuct8luuu L8utuct8
100 T . 0f00tt0g 6y0hut0 6ufd0f6
0|sorJct Psychot|c 5yptos 0utat|oa Mood 5yptos
Br.eI psyc|aI|c 4.sar4er > pas|!|ve sypIas aI cr|Ier.aa A < aaI |I preseaI, Z
Sc|.tap|rea|Iar 4.sar4er Or|!er|aa A I - aaI|s |I preseaI, Z
Sc|.tap|rea|a Or|!er|aa A > aaIs |I preseaI, Z
Sc|.taaI|ecI.ve 4|sar4er >Z w\s w|I| aa aa4 sypIasj > aaI PreseaI
e|cs.aaa| 4|sar4er Maa-a|tarre 4e|as|aas, |a||cc|aaI.aas > aaI |I preseaI, Z
Z Ia suas!aace Or|Ier|aa A cr.a |aIax |caI|aa ar Var.aa|e
|aIax .caI.aa/w|!|4rawa| sl aaI| afIer w.I|4rawa|
Z Ia aa4 4|sar4er e|cs.aas/|a||cc|aaI.aas aa4 caaraeaIj Uaspec.I.e4 I
NOOO SOtOBtS
eDtOD5
mooddIsordcrsarcdchncdbyIhcprcscnccoImoodcpIsodcs
moodcpIsodcsrcprcscnIacombInaIIonoIsympIomscomprIsIngaprcdomInanImoodsIaIcIhaI
Is abnormaIIn quaIIIyorduraIIon, c.g. majordcprcssIvc, manIc, mIxcd,hypomanIc
IypcsoImooddIsordcrsIncIudc
dcprcssivc majordcprcssvcdsordcr,dysIhymia)
bIpoIarbIpoIar!l!!dIsordcr, cycIoIhymIa)
sccondaryIo GMC,subsIanccs,mcdIcaIIons
100 Z. b00u0dfy u606 u Nuud 6ufd0f6
0atcgoty
Vasca|ar
|aIecI.aas
W Neap|asI|c
0 eeaera!|ve
|a!ax.caI|aa/ras/
eI.c.eac|es
0 Oaaea.Ia|
A AaIa|aae
1 TraaaI.c
E c a4acr|ae/VeIaaa||c
Exap|cs
Oar4.ayapa!|y, OH|, V|, OVA
c acep|a||I.s/e^|a|t|s, epaI|I|s, paeaaa|a, TB, syp|||s
PaacreaI|c caacer, carc.aa|4, peac|raacyIaa
HaaI.aIaa's 4|sease, a|I.p|e sc|eras|s, Iaaeraas sc|eras|s, 4eeaeraI.ve vasca|ar, A|t|e.er's
4eeaI.aj
AaI|ype|feas|ves, aaI.par|.asaa|aa, araaes, sIera|4s, aaI.Iaaercc|aas, |aIeneraa, aaI.aeap|asI.c
e4|ca!|aas, v|Ia.a 4eI|c|eac.es Wera|c\e's eacep|a|apaI|y, aer.aer|, pe||ara, pera.c.acs aae|a
S|c, pa|ya|fer|I|s aa4asa
HypaIyra|4|s, |ypedyra|4|s, |ypap.Ia|Iar|s, SlAH, parp|yr|a, W||saa's 4.sease, 4|aaeIes
Ne0Cul VOlkU O NOO0 5Ol0el
rouIIncscrccnIng
physIcaIcxamInaIIon
compIcIcbIoodcounI
IhyroIdIuncIIonIcsI
cIccIroIyIcs
urInaIysIs,urIncdrugscrccn
addIIIonaIscrccnIng.
ncuroIogIcaIconsuIIaIIon
chcsIx-ray
cIccIrocardIogram
C1scan
Nood Epsodes
N-V-H Lltelu Ol Nu[Ol ele55ve L5O0e
Hep|inted with perm|ssion Irom the 0agnost|c and Statist|cal Manda| Menta| 0|so|ders, 1ext Hev|s|on, |od|lh Ld|t|on, (Lopy|ight 2UUU}.
American |sychiatric Associatiou.
^. z 5oIIhcIoIIowIngsympIomshavcbccnprcscnIdurIngIhcsamc2-WccKpcrIodandrcprcscnI
achangcIromprcvIousIuncIIonIng,aIIcasIoncoIIhcsympIomsIscIIhcr I) ucgtc88cu muuu
or2)u88uu!ctc8! utgca8utc (auHcuuua)
u!c: onoIIncIudcsympIomsIhaIarccIcarIyducIo aGMC,mood-IncongrucnIdcIusIonsor
haIIucInaIIons
dcprcsscd moodmosIoIIhcday, ncarIycvcryday, asIndIcaIcdbycIIhcrsubjccIIvc rcporIor
obscrvaIIonmadcbyoIhcrs
markcdIydImInIshcdInIcrcsIorpIcasurcIn aII,oraImosIaII,acIIvIIIcsmosIoIIhcday,
ncarIycvcryday
V8jcHa!tj Vb
0uraI|on ol Time 0illerenI|aIes Ihe
lo||ow|ng JFsychoIic 0|sorders
b|iclpsychot|c diso|dc| < I month
Schizoph|cn||ormd|sordcrI-b months
Schizoph|cn|a >6months
k
6r|Ier|a lor 0epress|on (5[
M5IELLF5
Mood- dcp|csscd
5|ccp- |nc|cascd/dccrcascd
Intcrcst- dccrcascd
Euilt
Lnc|gy- dcc|cascd
Lonccnt|ation- dcc|cascd
ppct|tc- |nc|cascd/dccrcascd
Fsychomoto|- ag|tat|on/rctardat|on
5u|c|da||dcation
Vb V8jcHa!tj
l.
6riIeria lor Man|a (zJ]
E5TFI0
Erand|osity
5leep|dec|easedneed)
Ta||at|ve
Fleasu|ableact|vites,Fa|nlul
consequences
ct|vity
Ideas(|lighto|}
b|8t|c!|b|0
n examp|eo|am|xed episodewould
bemanicbehaviou|,|ac|ngthoughts
withdep|esslveo|n|h||Ist|ccontent.
uuuL8utucF8 Jutuu!uu!c8212
sIgnhcanIwcIghIIosswhcnnotdIcIIngorwcIghIgaIn,ordccrcascorIncrcascInappcIItc
ncarIycvcryday
InsomnIaorhypcrsomnIancarIy cvcryday
psychomotoragIIaIIonorrcIardaIIon ncarIycvcryday
IatIgucor IossoIcncrgyncarIycvcryday
IccIIngs oIworIhIcssncssorcxccssIvcorInappropratcguIIt (whchmaybcdcIusIonaI)ncarIy
cvcryday(notmcrcIyscII-rcproachorguIIIabouIbcIngsIck)
dImInIshcdabIItyIo IhInkorconccnIraIc,orIndccsIvcncss,ncarIycvcryday
rccurrcnIIhoughIsoIdcaIh (noIjustIcaroIdyIng),rccurrcnIsuIcIdaIIdcaIIonwIIhouIa
spccIcpIan,orasuIcIdcaIIcmptoraspccIhcpIanIorcommIIIngsuIcdc
8. IhcsympIoms donoImccIcrIIcrIaIoraMIxcdLpIsodc(sccbcIow)
C. IhcsympIomscausccIInIcaIIysgnIcanIdIsIrcssorImpaIrmcnInsocIaI,occupaIIonaI,or
oIhcrmportantarcasoIIuncIIonng
. IhcsympIomsarcnoIducIoIhcdIrccIphysIoIogIcaIcnccIsoIasubsIanccoraGMC
L. IhcsympIomsarcnoIbcIIcraccounIcdIorbybcrcavcmcnI,IhcsympIomspcrssIIorIongcr
Ihan2monIhs, sympIomsarccharacIcrIzcdbymarkcdIuncIonaIImpaIrmcnI,morbId
prcoccupaIIonwIIhworIhIcssncss, suIcIdaIIdcaIIon,psychoIIcsympIoms,orpsychomotor
rcIardaIIon
N-V-H Lltelu Ol NuDC L5O0e
^. adIsIIncIpcrIodoIabnormaIIyandpcrsIsIcnIIycIcvaIcd, cxpansIvc, orIrrIIabIcmood,IasIng
21 WccK (oranyduraIonIIhospIIaIIzaIIonIsncccssary)
8. durIngIhcpcrIodoImooddIsIurbancc, 2 oIIhcIoIIowIngsympIomshavcpcrsIsIcd
(4 IIIhcmoodIsonIyIrrIIabIc) andhavcbccnprcscnIIoasgnIcanIdcgrcc.
InIIaIcdscII-csIccmorgrandIosIIy
dccrcascdnccdIorsIccp (c.g.IccIs rcsIcdahcronIyJ hoIsIccp)
morcIaIkatIvcIhanusuaIor prcssurcIokccpIaIkng
IghtoIIdcasorsubjccIIvc cxpcrIcnccIhaIIhoughtsarcracIng
dIsIracIIbIIIy(.c.aIIcnIIonIoocasIydrawnIounImporIantorIrrcIcvanIcxIcrnaIsIImuII)
IncrcascngoaI-dIrccIcdactIvIIy (cIIhcrsocIaIIy, aIworkor schooI,orscxuaIIy)or
psychomoIoragIIaIIon
cxccssIvcInvoIvcmcnIIn pIcasurabIcacIIvIIIcsIhathavcahIghpoIcnIIaIIorpanIuI
conscqucnccs(c.g.cngagngInunrcsIrancdbuyIngsprccs,scxuaIIndIscrctIons,orIooIIsh
busIncss InvcsImcnts)
C. IhcsympIomsdonotmccIcrtcraIoraMIxcdLpIsodc(sccbcIow)
. IhcmooddIsIurbanccIssumcIcntIyscvcrcIo causcmarkcdImpaIrmcntIn occupatonaI
IuncIIonIngorInusuaIsocIaIacIIvIIcsorrcIaIIonshIpswIIhoIhcrs,orIoncccssIIaIc
hospIIaIIzaIIontoprcvcnIharmIo scIIorothcrs,orthcrcarcpsychoIIcIcaIurcs
L. IhcsympIomsarcnoIductothcdIrccIphysoIogcaIcnccIsoIasubsIancc (c.g.drugoIabusc,
mcdIcatIon, oroIhcrIrcaImcnI)or aGMC (c.g.hypcrIhyroIdIsm).u!c. Manc-IkccpIsodcs
IhaIarccIcarIycauscdbysomaIIcanIIdcprcssanIIrcatmcnI (c.g.mcdIcaIIon,LCJthcrapy, IIghI
Ihcrapy)shouIdnotcounIIowardadIagnosIsoI8poIar!sordcr
NXe0 L5O0e
crIIcrIonmcIIorbothmanIccpIsodcandMLncarIycvcrydayIorI wcck
crIIcrIaandLoImanIccpIsodcsarcmcI
HyOnuDC L5O0e
crIIcrIonôIamanccpIsodcIsmcI,buIduraIIonIs2+uaj8
crIIcrIa8 andLoImanIccpIsodcs arcmcI
cpIsodcassocIatcdwIIhanuncharactcrIsIIcdccIIncIn IuncIonIngIhaIIsobscrvabIcbyoIhcrs
changcnIuncIIonIsnoIscvcrccnoughIocauscmarkcdmparmcnIInsocIaIoroccupaIIonaI
IuncIIonIngorto ncccsstaIchosptaIIzaIon
abscnccoIpsychoIcIcaIurcs
Depressve Dsorders
NPJLH LHLVL LHLH
N-V-H ugDO5tC Lltelu Ol Nu[Ol ele55ve 5Ol0el [N],
Dgle L5O0e [v5. HeCulleDt]
^. prcscnccoIasIngIcML (vs.RccurrcnI,whIchrcquIrcsprcscnccoItwoormorcMLs, Io
bcconsIdcrcdscparaIccpIsodcs,IhcrcmusIbcan ntcrvaIoIaIIcast2consccuIIvcmonIhsIn
whIchcrIcrIaarcnoImcIIoraML)
Jutuu!uu!c8212 uuuL8utuct8
8. IhcMLIsnoIbcIIcraccounIcdIorby SchIzoadccIIvc IsordcrandIsnoIsupcrImposcdon
SchIzophrcnIa,SchIzophrcnIIorm Isordcr,cIusIonaIIsordcr, orPsychoIIcIsordcrnot
oIhcrwIscspccIhcd
C. IhcrchasncvcrbccnaManIcLpIsodc, aMIxcdLpIsodc,oraHypomanIcLpIsodc
u!c. JIIscxcIusIondocsnotappIyIIaIIolIhcmanIc-IIkc,mixcd-IIkc,orhypomanIc-IIkc
cpIsodcsarc substanccorIrcaImcnI-InduccdorarcducIothc dIrccIphysIoIogIcaIcdcctsoIa
GMC
eutule5eCel5
g8jcHu!c wIthhaIIucInaIIonsordcIusIons
cHtuuc IasIIng2yrsormorc
ca!a!uuc aIIcastIwool.moIorImmobIIIIy, cxccssIvcmoIoracIIvIIy, cxtrcmcncgatIvIsmor
muIIsm,pccuIIarItIcsoIvoIunIarymovcmcnI,cchoIaIIaorcchopraxIa
mcaucHuc quaIIIyolmood IsdIsIIncIIydcprcsscd, mood IsworscInIhcmornIng,carIy
mornIngawakcnIng,markcdwcIghtIoss,cxccssIvc guIII, psychomoIorrcIardaIIon
a!jgca IncrcascdsIccp,wcIghIgaIn, IcadcnparaIysIs, rcjccIIonhypcrscnsItIvIIy
gu8!gat!um scc1u5I0rIum uud !t5urdcr5, PSI0)
8ca8uua paIIcrnoIonscIaIthc samctImccachycarmosIohcnInIhcIaIIorwInIcr)
L0eDOlOgy
prcvaIcncc.maIc5- 2%,IcmaIc 0-25% M.I " . 2)
mcanagcoIonscI. ~J0yrs
LtOlOgy
bIoIogIcaI
gcncIIc. 65-75%MZIwIns, I4-%ZIwIns
ncuroIransmItIcrdysIuncIIonaIIcvcIoIsynapsc dccrcascdacIIvItyoIscroIonIn,
norcpIncphrInc,dopamInc)
sccondaryIoGMC
psychosocIaI
psychodynamIc c.g.IowscII-csIccm)
cognIIIvc c.g.ncgaIIvcIhInkIng)
cnvIronmcnIaIlacIorsc.g.job Ioss, dIcI,bcrcavcmcnI, hIsIoryoIabusc)
co-morbIdpsychIaIrIcdIagnoscs c.g. anxIcIy,subsIanccabusc,mcnIaIrctardaIIon,
dcmcnIIa, caIIngdIsordcr)
H5k uCtOl5
scx. IcmaIc >maIc
agc.onsctbcIwccn25-50yrsoIagc
IamIIyhIstory. dcprcssIon,aIcohoIabusc, socIopaIhy
chIIdhoodcxpcrIcnccs.IossoIparcnIbcIorcagc I ,ncgaIIvchomccnvronmcnIabusc,ncgIcct)
pcrsonaIIty. Insccurc,dcpcndcnI, obscssIonaI
rcccnIsIrcssors. IIIncss,hnancIaI,IcgaI
posIpartum<6monIhs
IackoIInIImaIc,condIngrcIaIIonshIpsorsocIaIIsoIatIon
ete55OD D te Ll0elly
accounIsIorabouI50%oIacuIcpsychIaIrIcadmIssIonsIn IhccIdcrIy
adccIsabouI5%oIcommunIIyrcsIdcnIs >65 yrs oId
hIghsuIcIdc rIskducIosocIaI IsoIaIIon,chronIcmcdIcaIIIIncss
suIcIdcpcak. maIcsagcd80-0,IcmaIcsagcd50-65
ohcnprcscnIwIthsomaIIccompIaInIsc.g.changcsInwcIghI,sIccp,cncrgy)oranxIcIysympIoms
rclcrto1abIc4 scc!cmchIt0, PSI)tocomparcwIIhdcIIrIumanddcmcnIIa
leutDeDt
bIoIogIcaI.anIIdcprcssanIs,IIIhIum, anIIpsychoIIcs,anxIoIyIIcs,LCJ,IIghIIhcrapy
psychoIogIcaI
IndIvIduaIthcrapy.psychodynamIc,InIcrpcrsonaI,C81
IamIIyIhcrapy
group Ihcrapy
socIaI:vocatIonaIrchabIIIIaIIon, socIaIskIIsIraInIng
cxpcrImcnIaI. dccpbraInsIImuIaIIon, transcranIaI magncIIc sIImuIaIIon,vagaIncrvc
sIImuIaIIon
lOgDO55
oncycarahcrdIagnosIsoIaMLwIIhouItrcatmcnI,40%oIIndIvIduaIsstIIIhavcsympIoms
IhaIarcsumcIcnIIyscvcrcIomccIcrItcrIaIor aIuIIML,20%conIInuctohavcsomcsympIoms
IhaInoIongcrmccIcrIIcrIaIoraML, 40%havcno mooddIsordcr
V8jcHa!tj VbV
k01ctcssa6b !ot 0cptcss|60 | Nc1|ca|
|||0css
L0ch|00 0!0 0l j!0mc h0r'0w ZJ! U,
|ssu J
1||s sysImI|c |v|w 11 mI-h|ys|s ol a!
HU1s JcUJ pI|hIs} comp|1 hI|1p|sshIs
Io p|co |1 pI|1Is w|I1 p|ys|c| 1|so|1| g.
U1c|, N| w1o 1v 1 1|ghos1 s 1p|ss1
|1c|u1|hg N|o| Up|ss|oh, 1|usIm1I U|so|1|,
11 UysI1ym|.
060c|0s|os: 1I|1p|sshIs, |1c|u1|1g SSB|s 11
1Us, cus s|gh|l|chI |mp|ovm1I |h pI|1Is
w|I1 p1ys|c| |||hss, s comp|1 Io p|co.
S!. Jo|s Wod l6t Naj6t 0ctcss|o6
L0ch/000!0 0l j h0r ZUU, |ssu J
S!01y: SysImI|c |v|w ol I|||s I1I w| !J
|h1om|t1, 1ou|-o||h11 Z w|I1 pI|1Is w|I1
m|o| 1p|ss|oh J comp||hg SI. Jo11`s wo|l
1yp||cum xI|cIs w|I1 p|coo o| sI11|1
1I|1p|ss1Is 11 1 |hc|d11 c||h|c| odIcoms.
Pa||c0|s: a19 pI|hIs w|I1 m|o| 1p|ss|o1.
00|coMcs: !. Ll|cI|vhss. I|Im1I |spo1s
msu|1 y 1p|ss|oh sc| Z. SlIy. I|
p|opo|l|o1 ol pI|1Is w|o 1|opp1 odI 1u Io
1v|s cIs.
|6!cNc||6: SI. Jo|1`s wo|l vs. p|co, SI.
Jo1hs wo|I vs. sI11|1 1I|1p|ss1Is.
Bcs0||s: Z9 I|||s, a19 pIhIs, w|I| !
comp||so1s w|I1 p|co 11 ! ! w|I|
1I|1p|ss1Is. SI Jo|1`s wo|l |s mo| llcI|v
I11 p|coo |spohs |I |I|o= !.!, 9a"
U|, 11 s|m||||y cl|v s 1I|1p|sshIs
BHH= ! .UZ, 9a"U|. |ess 1v|s llcIs w|I1
1yp||cdm xI|cIs. Howv|, I| llcI s|t |s
1ph1hI o1 I1 cou0I|y ol o||g|1.
06g0|vc 1hctapy W. Nc1|ca||60s | ||c
Ttcawc| dNo1ctatc !o Scvctc 0ctcss|o
/ch G00 /jch!|j ZuJa, cZ.1J9-1!c
S!01y: B11om|t1 conI|o| I|||.
Pa||c0|s: Z1J ouIpI|1Is w|T mo1|I Io sv|
NUU, g1 ! !J.
|6!cNc||6: ! c w\s ol p|oxI|1 w|I1 o| w|I1ouI
ugm1II|o1 w|I| ||I||dm c|ohI o| 1s|p|m|h
1y1|oc1|o||1 h= !ZJ) v|sus cog1|I|v 1v|od||
I1|py h=cU}. Hspo1s up Io w\s ws
cohI|o||1 y p||| p|cbo 1=cJ
Na|0 00!c6Mcs: 11 hm||Io1 Up|ss|o1 HI|1g
sc| ws us1 Io 1I|m|h |spohs Io I|ImhI.
Bcs0||s: I w\s, aJ" 9a"U| 1! -a9"} elpI|hIs
oh m1|cI|oh 11 1J1 9a"U| J!-ac" ol pI|1Is
oh UH1 |1 |spo111 |1 comp||so1 Io Za"
9a"U| !c-J"} ol pI|1Is o1 p||| p|co. 11|
ws 1o s|g1|l|c1I 1|ll|hc Iw1 m1|cI|o1
11 UHJ I ! c w\s, 16" ol pI|1Is o1 m1|cI|o1
11 1J" !pI|hIs o0 UH1 c1|v1 |m|ss|oh.
S0MMaty: 11| |s 1o 1||1c |h ll|ccy
Iwh UHl vs. p|oxI|1 |h I| I|Im1I ol
mo1|I Io sv| 1p|ss|o1.
Vb1 V8jcHa!tj
dca|!h 0a6a1a k1v|scs 6! P6|c6!|a| k1vctsc
tmcb 6! SSB|s a61 Wct k6||1cptcssa0|s 66
Wcw06t6s
gsI J, ZUU1
H1| U11 ws cohcT1 I1I 1woTs
xpos1 Io SSB|s 11 oI|| 1I|1p|ss1Is 1d||1g
I1 I1||1 I||TsI| ol p|g1hcy Ty 1v|s|y
l|tI1, t ol |poN ol toTp||t!|o1 I
||l| ||||1g |o1g| 1osp|I|CI|o1, |I1|1g
sdppo|| h1 I l1|1g. 1v|so|{ pp||1
Io. p|op|o1 |ds1 lo| 1p|ss|o1 o| sTo\|hg
cssI|o1}, c|I|op|T, IoxI|1, IvoxT|1,
T||ltp|h, p|oxI|1, s|l|||1 11 v1|lx|1.
066c|0s|66s. |1ys|c|hs h1 pI||Is s1ou|1
c|l||y co1s|1| ||s\s, 1l|Is 11 opI|ohs lo|
oI1 I1 ToI1| h1 u1oT y w11 I|I|hg
1p|ss|o1 |1 p|gh1I woTh. Uohs|1| Ip||hg
|h I| I|||1 I1TsI|. WoTh s1ou|1 cohsu|I I1||
1ocIo|s lo| sIopp|hg I1s T1|cI|o1s.
uuuL8utucF8 Jutuu!uu!c8212
YHYNlP
N-V-H ugDO5tC Lltelu Ol y5tyDC 5Ol0el
Hep|inted with perm|ssion |rom the 0|agnost|c and Stat|st|cal Mandal o| Mental 0|so|ders, 1exl Hev|s|on, |od|1h Ld|t|on, (Lopy|ight 2UUU}.
^. dcprcsscdmoodIormosIoIIhcday, IormorcdaysIhannoI,asIndcaIcdcIIhcrbysubjccIIvc
accounIorobscrvaIIonbyoIhcrs,Iora2jcat8
u!c: !nchIIdrcn and adoIcsccnIs,moodcanbc IrrIIabIcand duraIIon musIbcaIIcasI Iycar
8. prcscncc, whIIcdcprcsscd,oI a2oIIhcIoIIowIng
poorappcIIIcorovcrcaIIng
InsomnIaorhypcrsomna
IowcncrgyorIaIIguc
IowscII-csIccm
poorconccnIraIIonordImcuIIymakngdccsIons
IccIIngs oIhopcIcssncss
C. durIngIhc2-ycarpcrIod IycarIorchIdrcnoradoIcsccnIs)oIIhcdIsIurbancc,Ihcpcrsonhas
ncvcrbccnwIhouIIhcsympIomsncrIIcrIaând8IormorcIhan2monIhsaIaIImc
. no MLhasbccnprcscnIdurngIhcrsI2yrsoIIhc dIsIurbancc I ycarIorchIIdrcnand
adoIcsccnIs),.c.IhcdIsIurbanccs noIbcIIcraccounIcdIorby chronIcM,orM In
parIIaIrcmssIon
L. IhcrchasncvcrbccnaManIcLpIsodc,aMIxcdLpIsodc,oraHypomanIcLpIsodc,andcrIcra
havcncvcrbccnmcIIor CycIoIhymIcIsordcr
t IhcdIsIurbanccdocsnoIoccurcxcIusIvcIydurngIhccourscoIachronIcpsychoIIcdIsordcr,
suchasSchIzophrcnIaorcIusonaIIsordcr
G. IhcsympIomsarcnoIducIoIhcdIrccIphysoIogcaIcnccIsoIasubsIanccoraGMC
H.IhcsympIomscausccIInIcaIIysgnIcanIdIsIrcssorImpaIrmcnIn socIaI, occupaIIonaI, or
oIhcrImporIanIarcasoIIuncIIonIng
L0eDOlOgy
poInIprcvaIcncc. J%, IIIcprcvaIcncc.6%, M.I " I. 2-J
leutDeDt
psychoIogcaI
prIncIpIcIrcaImcnIIordysIhymIa
IndIvIduaI,group,andIamIIyIhcrapy
bIoIogIcaI
anIIdcprcssanIIhcrapySSR!s/SNR!s)asan ouIpaIcnI
Postpartum Nood Dsorders
O5tultuD lue5
IransIcnIpcrIodoImIIddcprcssIon,moodInsIabIIIIy,anxIcIy, dccrcascdconccnIraIIon,
IncrcascdconccrnovcrownhcaIIhandhcaIIhoIbaby- consIdcrcdIobcnormaIcmoIIonaI
changcsrcIaIcdIoIhcpucrpcrIum
occursIn 50-80%oImoIhcrs,bcgIns2-4dposIparIum,usuaIIyIasIs48h, canIasIupIo 0 d
docsnoIrcquIrcpsychoIropIcmcdcaIIon
paIIcnIaIIncrcascdrIskoIdcvcIopIngposIparIumdcprcssIon
O5tultuD ele55OD []
ua_uu88: ML, onscIwIIhIn4wksposIparIum
cucagtc8cu!a!uu
IypIcaIIyIasIs2Io 6monIhs,rcsIduaIsympIomscanIasIup Io ycar
mayprcscnIwIIhpsychosIs - rarc0.2%),usuaIIyassocaIcdwIIhmanIa,buIcanbcML
scvcrcsympIomsIncIudccxIrcmcdIsnIcrcsInbaby, suIcIdaIandInIanIcIdaIIdcaIIon
cgucmuu_j: occurs n 0%oImoIhcrs,rIskoIrccurrcncc50%
t8Kac!ut8
prcvIoushIsIoryoIamooddIsordcrposIparIumoroIhcrwIsc)
psychosocIaIIacIors. sIrcssIuIIIIccvcnIs,uncmpIoymcnI,marIIaIconIcI,IackoIsocIaI
supporI,unwanIcdprcgnancy,coIIckyorsIckInIanI
!tca!mcu!
psychoIhcrapy
shorI-IcrmsaIcIyoImaIcrnaISSR!sIorbrcasIIccdIngInIanIscsIabIIshcd, Iong-Icrm cnccIs
unknown
supporIIvc,non-dIrccIIvccounscIIIngbyIraIncdhomcvIsIIors
IIdcprcssIonscvcrc, consIdcrLCJ
gtu_uu88: ImpacIonchIIddcvcIopmcnI- IncrcascdrIskoIcognIvcdcIay,Insccurc
aIIachmcnI,bchavIouraIdIsordcrs,IrcaImcnIoImoIhcrImprovcsouIcomcIorchIIdaI8monIhs
IhroughIncrcascdmoIhcr-chIIdnIcracIIon
Jutuu!uu!c8202 uuuL8utuct8luXc!jL8utuct8
Bpolar Dsorders
LLPH l LLPH LHLH
eDtOD
8IpoIar!Isordcr
dIsordcrInwhchaIIcasIoncmanIcormxcdcpIsodchasoccurrcd
commonIyaccompanIcdbyaIIcasI I MLbuInoIrcquIrcdIordagnoss
8IpoIar!!Isordcr
dIsordcrInwhchIhcrcIsaIIcasIMLandaIIcasI hypomanIccpIsodc
nopasImanIcormIxcdcpIsodcs
L0eDOlOgy
prcvaIcncc.0.6-0.%,M.I" .
agcoIonscI.IccnsIo 20's
H5k uCtOl5
sIIghtncrcascInuppcrsocIocconomIcgroups
60-65%oIbIpoIarpaIIcnIshavcIamIIyhIstoryoImajormooddIsordcrs
Llu55CutOD
cIassIhcaIIonoIbpoIardIsordcrnvoIvcsdcscrIbIngIhccurrcnIormosIrcccnImoodcpIsodcas
ciIhcrmanic,hypomanic,mxcdordcprcsscd
IhccurrcnIormostrcccnIcpsodccanbcIurthcr cIasshcd aswIIhouIpsychotIcIcaIurcs,wIIh
psychoIIcIcaIurcs,wIIhcaIaIonIcIcaIurcs,wIIhposIpartumonscI,wIIhscasonaIpaIIcrn,wIIh
rapIdcycIIngaIIcasI4cpIsodcsolamooddIsIurbanccIn IhcprcvIous I2 monIhsthaImcct
crItcrIaIoraMajorcprcssIvc, ManIc,MIxcd,orHypomancLpIsodc)
leutDeDt
bIoIogIcaI. moodsIabIIzcrs,anIconvuIsants,antIpsychoIIcs, anIIdcprcssants,LCJ
0!ct JrcatmcnIolbipoIardcprcssionmusIbcdonccxtrcmcIycauIiousIy, asaswiIchIrom
dcprcssonIomanIacanrcsuII.MonoIhcrapywIIhantdcprcssanIsshouIdbcavoIdcd
psychoIogcaI.supporIvcandpsychodynamIcpsychoIhcrapy,cognIIIvcorbchavIouraIIhcrapy
socIaI.vocatIonaIrchabIIIIaIIon,IcavcoIabscnccIromschooI/work,drugandLIH ccssaIIon,
subsIIIuIcdccsIonmakcrIornanccs,sIccphygIcnc, socIaIskIIIsIraInIng,cducaIIonIorIamIIy
mcmbcrs
LYLLLHYNlP
ugDO55
prcscnccoInumcrouspcrodsoIhypomancanddcprcssIvcsympIoms noImccIIng
crItcrIaIorML) Ior z2jt8, ncvcrwIIhouIsympIomslor>2muu!H8
no ML,mancormIxcdcpIsodcs, nocvIdcnccoIpsychosIs
sympIomsarcnoIductoIhcdIrccIphysoIogcaIcnccIsoIasubsIanccorGMC
sympIomscausccIInIcaIIysIgnhcantdIsIrcssorImpaIrmcnIIn socIaI, occupatIonaI, or
oIhcrImporIanIarcasolIuncIIonIng
leutDeDt
sImIIarIo8poIar!
antconvuIsanIspsychoIhcrapy
HXBIg SOtOBtS
eDtOD
anxIcIyIsaunvcrsaIhumancharacIcrIsIIcInvoIvngIcnsIon,apprchcnsIon,orcvcnIcrror,
which scrvcs asanadapIivc mcchansm Io warnabouIancxtcrnaIIhrcaIbyacIivaIingIhc
sympathcIIc ncrvous sysIcm ghIorIghI)
manIIcsIaIIonsoIanxIcIycanbcdcscrIbcdaIongaconIInuum oIphysoIogy,psychoIogy,and
bchavIour
physIoIogy- maInbraInsIrucIurcInvoIvcdIsIhcamygdaIa,ncuroIransmIIIcrsnvoIvcd
IncIudcscroIonIn,choIccystokInIn, cpIncphrInc,norcpIncphrnc,dopamInc
psychoIogy- onc'spcrccpIIonoIagvcnsIIuaIonsdIsIorIcdwhIchcauscsoncIobcIIcvcII
IsIhrcaIcnIngIn somcway
bchavIour- onccIccIIngIhrcatcncd,oncrcspondsbycscapIngorIacIngIhcstuaIon,
IhcrcbycausIngadsruptonIndaIIyIuncIIonIng
anxIcIybccomcspaIhoIogIcaIwhcn.
IcarsgrcaIIyouIoIproporIIon IorIsk/scvcrIIyoIIhrcaI
rcsponscconIInucsbcyondcxsIcnccolIhrcaIorbccomcsgcncraIIzcdIooIhcrsImIIaror
dIssImIIarsIIuaIIons
socaIoroccupaIIonaIIuncIIonIngsImpaIrcd
V8jcHa!tj Vb1 1
k B1oM|tc1 0oo||c1 Tt|| ol 0og|!|vc
T|cty lot B|o|t U|sot1ct: Focs o |og-
!ctM 0hgc
J L#0,chl!ly ZUUc |o, c!|Z|.Z!!c
S!1y. B|1oT|t1, o|||11 c||h|c| I|||.
P!|c!s. aZ pI||Is w|Ik USY-|V o|po|| o| Z
1|so|1|.
|!cNc!|o. |I||Is ||ocI1 Io |Ik| c
To|Ik I||| ol co||I|va I1|py |U1} w|I1 ToI|v
Ick||us o| I|IT1I s s|. UoIk |oups
|c|v1 Too1 sIo|||t|s.
N| 00!cocs. H|ps |Is, 1ysl|cI|o||
U|Iu1s, psyc1osoc|| lhcI|oh||, kop|sshss,
sK-co|I|o|, T1|cI|o1 11||c. |I|hIs
w| ssss1 oy |r1p|1|I |I|s o|||11 Io
I|IT|I |oup.
Bcs0ks. I c To|Iks, U1 pI||Is xp|||c1
lw| 1p|ss|v syTpIoTs |1 lw|
1yslhcI|o|| II|I1s. 1k| ws ho|-s|h|l|c|I
p=.Uc| I||1 Io |I| I|T Io 1p|ss|v ||ps.
I !Z To|Ik lo||ow-up, U1 pI|hIs 11 |ow| Yo|
Y|| BI|| sco|s |1 |Tp|ov1 o1v|ou||
sK-co|I|o|. I ! TohIks, U1 pI||Is |po|l1 |ss
sv||Iy ol ||||ss.
0oc|0s|os. U1 pp|s Io p|ov|1 o|l|Is || I1
!Z To|Iks l|| coTp|I|o| ol Ik|py.
Vb12 V8jcHa!tj
S|tuat|o t||gge| Pan|cUac|
lnc|easedanx|ety Mental|y
andgenera||zation Q assoc|atedw|th
toothe|situat|ons situat|on
guf0 T . 00 H0k
\
LrItcrIaf0rFan|c 0Isordcr(>4[
5Tb0LNT5FLt0cd Ls
5weating
T|emb||ng
Unstead|ness,d|zz|ness
0epe|sona||zation,0e|eal|zat|on
Lxcessivehea||rate,pa|p|tat|ons
Nausea
Ting||ng
5ho||nesso|breath
Fear o|dy|ng,|osingcontrol,go|ngc|azy
d L's.Lhestpa|n, Lhi||s, Lho||ng
Fan|c Anack VS. Fan|c 0Is0rdcr
|an|cd|so|de|cons|stsolpan|cattac|s.
|an|cattac|isnotacodab|ed|sorde|
andcanoccu||nthe context o|many
d|||e|entd|sorders.
AuXc!jL8utuct8 Jutuu!u u!c8 212
eleDtul ugDO55
100 . 0f00t g0u66 u 0X0ty 6ufd0f6
0atd|ovascu|ar PasI-V|, arr|y!|.a, caaesI|ve |earI Ia||are, pa|aaaq e|a|cs, |Ira| va|ve pra|apse
8csp|ratory As!|a, OOPO, paeaaa|a, |yperveaI||a!|aa
Eadocr|ac Hype|tyra|4.s, p|eac|raacyIaa, |ypa|yce|a, |ypera4reaa||s, |yperparaI|yra.4|s
Mctabo||c V.Ia|a B 4eI|c.eocy, parpyr.a
Wcuto|og|c Meap|as, ves!|aa|ar 4ysfaacI|aa, eacep|a||I|s
5ubstaacc-|aduccd |aIax .caI.aa ca1e|oe, ap|e!a|aes, caca.ae, I|yra|4 preparaI.aas, OTO far ca|4s/4ecaaesIaaIs,
w|I|4rawa| |eata4|atep.aes, a|ca|a|j
0thcr Psych|atr|c 0|sordcrs PsycaI.c 4.sar4ers, aa4 4|sar4ers, persaaa||Iy 4.sar4ers OOPOj, saaIaIar 4.sar4ers
Ne0Cul VOlkU O PDXety 5Ot0et
rouIIncscrccnIng.physcaIcxamInatIon, C8C,IhyroIdIuncIIonIcsI,cIccIroIyIcs,urInaIysIs,
urIncdrugscrccnIng
addIIIonaIscrccnng.ncuroIogIcaIconsuIIaIIon,chcsIx-ray, LCG, C1
Panc Dsorder
N-V-H ugO5tC Lttetu Ot uC 5Ot0et WtHOUt PgOtuHODu
Hep|inted with perm|ssion |rom the 0|agnost|c and Stat|st|cal Mandal o| Mental 0|so|ders, 1ext Hev|s|on, |od|lh Ld|t|on, (Lopy|ight 2UUU.
^. boIh ) and(2)
)rccurrcnIuncxpccIcdpanIcaIIacks.adIscrcIcpcrIodoInIcnscIcarordIscomIorI, In
whIch?+oIIhcIoIIowIngsympIomsdcvcIopabrupIIyandrcachapcakwIIhIn 0mInuIcs
" paIpIIaIons,poundInghcarI,oracccIcraIcdhcarIraIc
" swcaIng
" IrcmbIingorshakIng
" scnsaIIonsoIshorIncssoIbrcaIhorsmoIhcrIng
" IccIIngoIchokng
" chcsIpaInordscomIorI
" nauscaorabdomInaIdIsIrcss
" IccIIngdIzzy, unsIcady, IIghIhcadcd,orIaInI
" dcrcaIIzaIIon (IccIIngsoIunrcaIIy)ordcpcrsonaIIzaIIon(bcngdcIachcdIromoncscII)
" IcaroIIosIngconIroIorgongcrazy
" IcaroIdyIng
" parcsIhcsIas(numbncssorIIngIIngscnsaIIons),chIIIs orhoIushcs
(2)aIIcasIoncoIIhcaIIackshasbccnIoIIowcdbymuu!H(ormorc)oI aoIIhcIoIIowng
" pcrsIsIcnIconccrnabouIhavIngaddIIIonaIaIIacks
" worryabouIIhcImpIIcaIIonsoIIhc aIIackorIsconscqucnccs (c.g. IosIng conIroI, havng
ahcarIaIIack, "gongcrazy)
" asIgnIhcanIchangcInbchavIourrcIaIcdIo IhcaIIacks
8. abscnccoIagoraphobIa
C. IhcpanIcaIIacksarcnoIducIo IhcdIrccIphysIoIogIcaIcnccIsoIasubsIanccorGMC
. IhcpanIcaIIacksarcnoIbcIIcraccounIcdIorbyanoIhcrmcnIaIdIsordcr,suchasSocaI
PhobIa, SpcchcPhobIa,bscssIvc-CompuIsIvcsordcr, PosI-1raumaIIc SIrcss sordcr,
ScparaIIon ^nxIcIyIsordcr
L0eDOlOgy
prcvaIcncc. . 5-5%(oncoIIhcIophvcmosIcommonrcasonsIosccaIamIIydocIor),M:I" :2-J
onscI.avcragcIaIc 20`s,IamIIIaIpaIIcrn
teutDeDt
psychoIogIcaI
supporIIvc psychoIhcrapy, rcIaxaIIonIcchnIqucs(vIsuaIIzaIIon,box-brcaIhIng),C8J (corrccI
dIsIorIcdIhInkIng, dcscnsIIIzaIIon/cxposurcIhcrapy)
bIoIogIcaI
SSR!s.uoxcIInc,cIIaIopram,paroxcIInc,uvoxamInc,scrIraIInc
SNR!.vcnIaIaxInc
wIIhSSR!/SNR!ssIarIIow,go sIow,aImhIghIo prcvcnInon-compIanccducIophysIcaIsIdc
cnccIs,cxpIaIn sympIoms Io cxpccIprIorIoInIIIaIIon
oIhcr anIIdcprcssanIs (1C^s, mIrIazapInc, M^!s)
" consdcravodIngbupropIonducIosImuIaIIngcdccIs
bcnzodIazcpIncs (shorI Icrm, Iowdosc,rcguIarschcduIc,IonghaII-IIIc,nopm)
Jutuu!uu!c8212 AuXc!yL8utuct8
lOgDO55
6- I0yrsposI-trcaImcnI: J0%wcII,40-50%Improvcd,20-J0%nochangc orworsc
cIInIcaIcoursc.chronIc,buIcpIsodIcwIIhpsychosocIaIsIrcssors
uDC 5Ol0el Wt PgOluODu
agoraphobIa
anxIctyabouIbcIngInpIaccsorsIIuatIonsIromwhIchcscapcmIghIbcdImcuII(or
cmbarrassIng)orwhcrchcIpmaynoIbc avaIIabIcInIhccvcnIoIhavIngan uncxpccIcd
panIcaIIack
Icars commonIyInvoIvcsIIuaIIons suchasbcIngouI aIonc, bcIngIn acrowd,standIngIna
IInc,orIravcIIIngonabus
sIIuaIIonsarcavoIdcd,cndurcdwIIhanxIcIyorpanIc,orrcquIrccompanIon
IrcaImcnI.aspcrpanIcdIsordcr
GeneraIzed nxety Dsorder {GD}
N-V-H ugDO5tC Lltelu Ol eDelul2e0 PDXety 5Ol0el
Hep|inted with perm|ssion |rom the 0agnost|c and Statist|cal Mandal o| Mental 0|so|ders, 1ext Hev|s|on, |od|lh Ld|t|on, (Lopy|ight 2UUU}.
^. cxccssIvc anxIctyandworry(apprchcnsIvccxpccIaIIon),occurrIngmorcdaysthannoIIoraI
Icastmuu!H8, abouIanumbcroIcvcnIsoracIIvIIIcs(suchasworkorschooIpcrIormancc)
8. IhcpcrsonhndsIIdImcuIIIo controIthcworry
C. IhcanxIcIyandworryarc assocIaIcdwIIh? oIIhcloIIowIng6sympIoms (wIIh aIIcast somc
sympIomsprcscnIIormorcdaysthannoIlor IhcpasI muu!H8)
u!c. nIyoncIIcmIsrcquIrcdInchIIdrcn
1. rcsIIcssncssorIccIIngkcycdup oroncdgc
2. bcIngcasIIyIaIIgucd
J. dImcuIIyconccntraIIngormIndgoIngbIank
4. IrrIIabIIIIy
5. muscIcIcnsIon
6. sIccpdIsIurbancc(dImcuIIyIaIIIngorsIayngasIccp, orrcsIIcssunsaIIsfyIngsIccp)
. IhclocusoIIhcanxIcIyandworryIsnoIconhncdIo IcaIurcsolan^xIs!dIsordcr,suchas
panIc dIsordcr, socIaIphobIa,cIc.
L. IhcanxIcIy,worry, orphysIcaIsympIomscausccIInIcaIIysIgnIcanIdIsIrcssorImpaIrmcnIIn
socIaI,occupaIIonaI,oroIhcrImporIanIarcasoIfuncIIonIng
t IhcdIsIurbanccIs notducIoIhcdIrcctphysIoIogIcaIcnccIsoIasubstanccoraGMCand
docsnoI occurcxcIusIvcIy durIngaMoodIsordcr,aPsychoIIcIsordcr,oraPcrvasIvc
cvcIopmcntaIIsordcr
L0eDOlOgy
-yrprcvaIcncc.J-8%,M.I " I.2
IIconsIdcrIngonIythoscrcccIvIngInpaIIcnIIrcatmcnI,raIIoIs .
mostcommonIyprcscnIsIn carIyaduIIhood
leutDeDt
IIIcsIyIc. cancIncandLIHavoIdancc,sIccphygIcnc
psychoIogIcaI.psychoIhcrapy, rcIaxaIIon,mIndIuIncss,andC8J
bIoIogIcaI
bcnzodIazcpIncs (shortIcrm,Iowdosc,rcguIarschcduIc,IonghaII-IIIc, nopm)
buspIronc(IIddosIng)
oIhcrs: SSR!s/SNR!, JC^s, p-bIockcrs
avoIdbupropIonducIo sIImuIatIngcnccIs
combInaIIonsoIabovc
lOgDO55
chroncaIIyanxIousaduIIsbccomcIcsssowIhagc
dcpcndsonprc-morbIdpcrsonaIItyluncIIonIng, sIabIIItyoIrcIatIonshIps,work, andscvcrIIyoI
cnvIronmcnIaIsIrcss
dImcuIIIotrcat
Phobc Dsorders
eCC ODu
dcLnIIIon.markcdandpcrsIsIcnIIcarIhaIIscxccssIvcorunrcasonabIc,cucdbyprcscnccor
anIIcIpaIIonoIaspccIhcobjccIorsIIuaIIon
IIIcIImcprcvaIcncc 2-6%, M.I ratIovarIabIc
Iypcs:anImaI/InsccI, cnvIronmcnI (hcIghIs,sIorms),bIood/InjcctIon/Injury, sIIuaIIonaI
(aIrpIanc, cIoscd spaccs),othcr(Ioud noIsc, cIowns)
V8jcHa!tj Vb1

6riIcrIalor A (aJ|
L58IM
|an|m|nd
Las|lylatigued
5|eepd|stu|bance
eyedup
I|||tabi||ty
Muscletens|on
Vb1+ V8jcHa!tj AuXc!j L8utuct8 Jutuu!uu!c8J1J
OCul ODu [OCul PDXety 5Ol0el]
ucu!uu: markcdandpcrsIsIcnIIcaroIsocIaIorpcrIormanccsIIuaIIonsInwhIchpcrsonIs
cxposcdIounIamIIIarpcopIcortopossIbIcscrutInybyoIhcrs,pcrsonIcarshc/shcwIIIacIIn
awayIhaImaybchumIIIaIIngorcmbarrassng(c.g. pubIIcspcakng,nIatngormaInIaInIng
convcrsatIon,datIng, caIIngnpubIIc)
IIIctImcprcvaIcnccmaybcashIghas J-I6%,M<I
ugDO5tC Lltelu Ol ODC 5Ol0el5
cxposurcIostImuIusaImosInvarabIyprovokcsan ImmcdIatcanxcIyrcsponsc,mayprcscnIas
apancaItack
pcrson rccognIzcsIcarascxccssIvc orunrcasonabIc
sIIuaIIonsarcavoIdcdorcndurcdwIIhanxIcIy/dIsIrcss
sIgnIhcanIInIcrIcrcnccwIIhdaIIyroutInc,occupaIIonaIl socIaIIuncIIonIng,and/ormarkcddIsIrcss
IIpcrson Is < 8yrs,duratIonIsaIIcasI6monIhs
leutDeDt
psychoIogIcaI
cxposurcIhcrapy/dcscnstIzaIIon,InsIghI-orIcnIcdpsychoIhcrapy
bchavouraIIhcrapyIsmorccmcacousIhanmcdIcaIon
bIoIogIcaI
p-bIockcrs orbcnzodIazcpIncsIn acuIcsIIuaIIons(c.g.pubIIcspcakIng)
SSR!s,M^!s, cIompramInc
lOgDO55
chronIc
Obsessve-Compulsve Dsorder {OCD}
N-V-H ugDO5tC Lltelu Ol LD5e55ve LODul5ve 5Ol0el
Am0|i0n |8y0hiIri0 A8800iIi0u.
^. cIIhcrobscssIonsorcompuIsIons.
uD8c88uu8 asdchncdby(), (2), (J),and(4)
() rccurrcnIandpcrsIstcnIIhoughIs,ImpuIscs,ormagcsIhaIarccxpcrIcnccd,aIsomcIImc
durIngIhcdIsturbancc,asInIrusvcandInappropraIcandthaIcauscmarkcdanxIcIyor
dsIrcss
(2) IhcIhoughIs,ImpuIscs,ormagcsarcnoIsImpIycxccssIvcworrIcsabouIrcaI-IIIcprobIcms
(J) Ihc pcrsonaIIcmpIsIo IgnorcorsupprcsssuchIhoughIs,ImpuIscs,orImagcs, orIo
ncuIraIIzcIhcmwIIh somcoIhcrIhoughIoracIIon
(4) IhcpcrsonrccognIzcsthaIIhcobscssIonaIIhoughIs,mpuIscs,orImagcsarcaproducIoI
hIsorhcrownmInd (noI ImposcdIromwIIhouIasnIhoughIInscrIIon)
cumgu8uu8asdchncdby ( ) and (2)
() rcpcIIIIvcbchavIoursormcnIaIacIsthaIIhcpcrsonIccIsdrIvcnIopcrIormInrcsponscIo
anobscsson,oraccordIngIoruIcsthaImusIbcappIIcdrIgIdIy
(2) Ihc bchavIours ormcnIaI acts arc aImcdaIprcvcntIngorrcducng dIsIrcss orprcvcnIng
somcdrcadcdcvcnIorsIIuaIIon,howcvcr,IhcscbchavIoursormcnIaIactscIIhcrarcnoI
connccIcdInarcaIIstIcwaywIIhwhaIthcyarcdcsIgncdIo ncuIraIIzcorprcvcnIorarc
cIcarIycxccssIvc
8. atsomc poInIdurngthc courscoIIhcdIsordcr,IhcpcrsonhasrccognIzcdIhatIhcobscssIons
orcompuIsIonsarc cxccssIvc orunrcasonabIc(cgo-dystonc)
u!c:JhsdocsnotappIyIo chIIdrcn
C. IhcobscssIonsor compuIsIons causcmarkcddIsIrcss,arcIImc-consumIng(Iakc Z1Huut a
day),orsIgnIhcanIIyInIcrIcrcwIIhIhcpcrsonsnormaIrouIInc,occupaIIonaI(oracadcmIc)
luncIIonIng,orusuaIsocIaIacIIvIIIcsorrcIaIIonshIps
. IanoIhcr^xs!dIsordcrIsprcscnI, IhcconIcnIoIIhcobscssIonsorcompuIsIonsIsnoI
rcsIrIcIcdIoII(c.g.prcoccupaIIonwIIhIoodInIhcprcscnccoIanLaIIngsordcr)
L. IhcdIsIurbanccIsnoIducIoIhcdIrcctphysIoIogIcaIcnccIsoIasubstanccoraGMC
L0eDOlOgy
IIIcImcprcvaIcnccraIcs2-J%,M=I
ratcoICInhrst-dcgrccrcIaIIvcs IshIghcrIhanIn IhcgcncraIpopuIaIIon
leutDeDt
C8J.dcscnsIIIzaIIon,oodIng,thoughIsIoppIng,ImpIosIonIhcrapy,avcrsIvccondIIIonIng
pharmacoIhcrapy
cIomIpramInc,SSR!s (hIghcr doscsandIongcr IrcaImcnInccdcdthanlorIrcaImcnI oI
dcprcssIon,I.c.up Io8-2wks)
aIypcaIandtypIcaIanIIpsychoIcs- rIspcrIdonc,haIopcrIdoI
lOgDO55
IcndsIobcrcIracIoryandchronIc
Jutuu!uu!c8212 AuXc!yL8utuct8
Post-Traumatc 8tress Dsorder {PT8D}
N-V-H ugDO5tC Lltelu Ol O5t-luuDutC tle55 5Ol0el
Hep|inted with perm|ssion |rom the 0iagnost|c and Statist|cal Mandal o| Mental 0|so|ders, 1exl Hev|s|on, |odnh Ld|t|on, (Lopy|ight 2UUU}.
^. IhcpcrsonhasbccncXgu8cu!u a!tauma!ccVcu1InwhIchboIholIhcIoIIowngwcrcprcscnI
( ) IhcpcrsoncxpcrIcnccd,wIIncsscd,orwasconIronIcdwIIhan cvcnIorcvcnIsIhaI
InvoIvcdacIuaIorIhrcaIcncddcaIh orscrIousInjury,oraIhrcaIIoIhcphysIcaInIcgrIIy
olscIlor oIhcrs
(2) Ihc pcrsons rcsponscInvoIvcdInIcnscIcar,hcIpIcssncss,orhorror.
u!c: !n chIIdrcn,IhIsmaybccxprcsscdInsIcadbydIsorganIzcdoragIIaIcdbchavIour
8. !Hc!tauma!ccVcu!8 gct88!cu!jtc-cXgctcuccuInonc (or morc) oIIhcIoIIowIngways.
( ) rccurrcnIandInIrusivcdIsIrcssIngrccoIIccIIonsoIIhccvcnI, IncIudngImagcs, IhoughIs,
orpcrccpIIons
u!c: !nyoungchIIdrcn, rcpcIIIvcpIaymayoccurInwhIchIhcmcsoraspccIsoIIhc
Iraumaarccxprcsscd
(2) rccurrcnIdIsIrcssngdrcamsolIhc cvcnI
u!c: !n chIIdrcn, IhcrcmaybcIrghIcnIng drcamswIIhouIrccognIzabIcconIcnI
(J) acIIngorlccIIngasIIIhcIraumaIIccvcnIwcrcrccurrIng(IncIudcsascnscoIrcIIvIngIhc
cxpcrcncc,IIIusons,haIIucnaIons,anddIssocIaIIvc ashbackcpIsodcs,IncIudIngIhosc
IhaIoccuronawakcnIngorwhcnInIoxIcaIcd)
u!c: !nyoungchIIdrcn,Irauma-spcchcrccnacImcnImayoccur
4) InIcnscpsychoIogIcaIdIsIrcssaIcxposurcIoInIcrnaIorcxIcrnaIcucsIhaIsymboIIzcor
rcscmbIcanaspccIolIhcIraumaIIccvcnI
(5) physoIogcaIrcacIIvIIy oncxposurcIo InIcrnaIorcxIcrnaIcucs IhaIsymboIIzcor
rcscmbIcanaspccIolIhcIraumaIIccvcnI
L pcrsIsIcnIaVuuauccu 8!mu associaIcdwIIhIhcIraumaand numbIngoIgcncraI
rcsponsIvcncss(noIprcscnIbcIorcIhcIrauma),asIndIcaIcdbyZ oIIhcIoIIowIng.
( ) cdorIsIoavoIdIhoughIs,IccIIngs,orconvcrsaIIons assocIaIcdwIhIhcIrauma
(2) cdorIsIoavoIdacIIvIIIcs, pIaccs, orpcopIc IhaIarouscrccoIIccIIonsoIIhcIrauma
(J) InabIIIIyIorccaIIanImporIanIaspccIoIIhcIrauma
4) markcdIydImInIshcdInIcrcsIorparIIcpaIIonInsIgnIhcanIacIIvIIcs
(5) IccIngoIdcIachmcnIorcsIrangcmcnIIromoIhcrs
(6) rcsIrIcIcdrangcoIadccI(c.g.unabIc IohavcIovInglccIIngs)
(7) scnscoIaIorcshorIcncdIuIurc (c.g.docsnoIcxpccIIohavcacarccr,marrIagc, chIIdrcn,
oranormaIIIIcspan)
.pcrsIsIcnI8jmg!um8 uuctca8cuatuu8a(noIprcscnIbcIorcIhcIrauma),asIndIcaIcdbyZ2
oIIhcIoIIowIng.
( ) dmcuIIyIaIIIngorsIayngasIccp
(2) IrrIIabIItyorouIbursIsoIangcr
(J) dmcuIIyconccnIraIIng
4) hypcrvIgIIancc
(5) cxaggcraIcdsIarIIcrcsponsc
L. duraIIonoIIhcdIsIurbancc(sympIomsn CrIIcrIa8,C,and)Is Z1 muu!H
t IhcdIsIurbancccauscscIInIcaIIysIgnIhcanIdIsIrcssorImparmcnIInsocIaI,occupaIIonaI,or
oIhcrImporIanIarcasoIIuncIonIng
L0eDOlOgy
prcvaIcnccIngcncraIpopuIaIIon. 7%
mcn
'
sIraumaIsmosIcommonIycombaIcxpcrIcncc,womcn
'
sIraumaIsusuaIIyphysIcaIor
scxuaIassauII
leutDeDt
C8J.sysIcmaIcdcscnsIzaIIon,rcIaxaIIonIcchnIqucs,IhoughIsIoppng
bIoIogIcaI
SSR!s
bcnzodIazcpIncs(loracuIcanxcIy)
rsI-IInc adjuncI - aIypIcaIanIpsychoIIcs(qucIapInc, oIanzapInc, rIspcrdonc)
LycMovcmcnIcscnsIIIzaIIonandRcproccssIng(LMR).ancxpcrImcnIaImcIhodoI
rcproccssIngmcmorcsoIdIsIrcssngcvcnIsbyrccounIIngIhcmwhIIcusIngaIormolduaI
aIIcnIIonsIImuIaIIonsuch ascycmovcmcnIs,bIIaIcraIsound, orbIIaIcraIIacIIcsIImuIaIIon
LODlCutOD5
subsIanccabusc,rcIaIonshIpdmcuIIIcs,dcprcssIon,ImpaIrcdsocIaIandoccupaIIonaI
IuncIIonIng,^xIs!!dIsordcrs
V8jcHa!tj Vb1b
AcuIe 5Iress |sorder
Maybeap|ecursortoPTS
6riIer|a.
Exposu|e to traumatic event
|ssoc|at|ve symptoms
Event|spers|stent|y|e-exper|enced
Avo|danceo|stimuli
Symptomsolanxietyor|nc|eased
arousal
Uausesclinica||ys|gni|icantd|stress
o||mpai|ment|nsoc|al,occupat|onal
o|other|mpo|1anta|easo|lunction|ng
Symptoms|ast Zdto4w|sand
occu|w|thin4w|so|event
6riIer|a lor FosI-Iraumatic 5Iress
|sorder
TUM
Traumat|cevent
e-exper|enceth0event
vo|danceo|st|mu||assoc|atedwith
thetrauma
Unableto|unct|on
Mo|ethanaMonth
|ousa|increased
Vb1 V8jcHa!tj Au|u8!mcu!L8utuctlLu_u!VcL8utuct8 Jutuu!uu!c8J1J
OgUSIHBHI SOtOBt
N-V-H ugDO5tC Lltelu Ol P0[u5tDeDt 5Ol0el
^. IhcdcvcIopmcnIoIcmoIIonaIorbchavIouraIsympIomsInrcsponscIo an IdcnIIhabIc
sIrcssor(s)occurrIngW!Hu muu!H8 oIIhconscIoIIhcsIrcssor(s)
8. IhcscsympIoms orbchavIoursarccIInIcaIIysIgnIhcanIas cvdcnccdbycIIhcroIIhcIoIIowng
()markcddIsIrcssIhaIIsIncxccssoIwhaIwouIdbccxpccIcdIromcxposurcIo IhcsIrcssor
(2)sgnIhcanImpaIrmcnIInsocIaIoroccupaIIonaI(acadcmc)IuncIIonng
C. IhcsIrcss-rcIaIcddIsIurbanccdocsnoImccIcrIIcrIaIor anoIhcr^xs!dIsordcrandIsnoI
mcrcIyancxaccrbaIIonoIaprc-cxIsIng^xIs!or^xIs!!dsordcr
. IhcsympIomsdo noIrcprcscnIbcrcavcmcnI
L. onccIhc sIrcssor (orIIsconscqucnccs)hasIcrmInaIcd,IhcsympIomsdonoIpcrssIIormorc
IhananaddIIIonaI6monIhs
spcciIyII
" acu!c.IIIhcdIsIurbanccIasIsIcssIhan6monIhs
" cHtuuc. IIhcdIsIurbanccIasIsIor6monIhsorIongcr
adjusImcnIdIsordcrsarccodcdbascd onIhc subIypc,whIchIsscIccIcdaccordIngIoIhc
prcdomInanIsympIoms
Llu55CutOD
IypcsoIsIrcssors
sngIc (c.g.IcrmInaIIonoIromanIIcrcIaIIonshIp)
muIIpIc (c.g.markcdbusIncssdmcuIIcsandmarIIaIprobIcms)
rccurrcnI(c.g. scasonaIbusIncss crIscs)
conIInuous(c.g.IIvIngInacrmc-rIddcnncIghbourhood)
dcvcIopmcnIaIcvcnIs (c.g.goIngIo schooI,IcavIngparcnIaIhomc,gcIIIngmarrIcd,
bccomIngaparcnI,IaIIngIo aIIaInoccupaIIonaIgoaIs,rcIIrcmcnI)
u!c! IhcspccihcsIrcssorisspccihcdon^xisV
8uD!_c8, adjusImcnIdIsordcrwIh.
dcprcsscdmood
anxIcty
mIxcdanxIcIyanddcprcsscdmood
dIsIurbanccoIconducI
mIxcddIsIurbanccoIcmoIonsandconducI
unspccIhcd
L0eDOlOgy
M=I
leutDeDt
brIcIpsychoIhcrapy(group,IndIvIduaI),crIsIsInIcrvcnIIon
bIoIogIcaI
bcnzodIazcpIncsmaybcuscdIorIhoscwIIhanxcIysympIoms(shorI-Icrm,Iow-dosc,
rcguIarschcduIc,IonghaII-IIIc,nopm)
SSR!sIorboIhdcprcsscdandanxIcIysympIoms
LO@HIVB SOtOBtS
Delrum
sccNcuroIo__,N!
N-V-H ugDO5tC Lltelu Ol elluD 0ue tO u NL
^. u8!utDauccucuu8cuu8uc88 (.c. rcduccdcIarIIyoIawarcncssoIIhccnvIronmcnI)wIh
rcduccd abIIIIyIoIocus, susIaIn, orshIIIaIIcnIIon
8. acHau_cu cu_u!uu (suchasmcmorydchcI,dIsorIcnIaIIon,Ianguagc dIsIurbancc)or Ihc
dcvcIopmcnIoIapcrccpIuaIdIsIurbanccIhaIIsnoIbcIIcraccounIcdIorbyaprc-cxIsIng,
csIabIIshcd,orcvoIvngdcmcnIIa
C. IhcdIsIurbanccdcvcIopsovcrashorIpcrIodoIIImc (usuaIIyHuut8!uuaj8)andIcndsIo
ucIuaIc durIngIhccourscoIIhc day
. Ihcrc IscvIdcncc IromIhchIsIory,physIcaIcxamInaIIon,orIaboraIoryhndIngs IhaIIhc
dIsIurbanccIscauscdbyIhcdIrccIphysoIogIcaIconscqucnccsoIaGMC
Jutuu!uu!c8212
LlDCul le5eDtutOD uD0 P55e55DeDt
commonsympIoms
wandcrIngaIIcnIIon
dIsIracIIbIIIIy
dIsorIcnIaIIon (IImc, pIacc,rarcIypcrson)
mIsInIcrprcIaIIons,IIIusIons,haIIucInaIIons
Lu_u!Vc L18utuct8
spccch/IanguagcdIsIurbanccs(dysarIhrIa,dysnomIa,dysgraphIa)
anccIIvc sympIoms (anxIcIy, Icar, dcprcssIon, IrrIIabIIIIy,angcr,cuphorIa,apaIhy)
shIhsInpsychomoIoracIIvIIy(gropIng/pIckIngaIcIoIhcs, aIIcmpIsIogcIouIoIbcdwhcn
unsaIc, suddcnmovcmcnIs,sIuggIshncss,IcIhargy)
IoIsIcInMInIMcntaISIaIusLxamIshcIpIuIIo asscss bascIIncoIaItcrcdmcnIaIsIatc- I.c. scorc
wIIIImprovcassympIomsrcsoIvc
H5k uCtOl5
hospIIaIIzaIIon(IncIdcncc0-40%)
nursInghomcrcsIdcnIs(IncIdcncc60%)
chIIdhood(c.g.IcbrIIc IIIncss,anIIchoIIncrgIcusc)
oIdagc(cspccIaIIymaIcs)
scvcrcIIIncss(c.g. canccr,^!S)
prc-cxIsIIngcognIIIvcImpaIrmcnIorbraInpaIhoIogy
rcccnIancsIhcsIa
subsIanccabusc
LtOlOgy
nIccIIous(cnccphaIIIIs,mcnIngIIIs,\J!,pncumonIa)
YIIhdrawaI (aIcohoI,barbIIuraIcs,bcnzodIazcpIncs)
AcuIcmcIaboIIcdIsordcr(cIccIroIyIcImbaIancc,hcpaIIcorrcnaIIaIIurc)
Trauma (hcadInjury,posIopcraIIvc)
CNS pathoIogy(sIrokc,hcmorrhagc,Iumour, scIzurc dIsordcr, ParkInson's)
HypoxIa (ancmIa, cardIacIaIIurc,puImonarycmboIus)
DchcIcncIcs(vItamIn8,IoIIcacId,IhIamInc)
ndocrInopaIhIcs(IhyroId,gIucosc,paraIhyroId,adrcnaI)
AcuIcvascuIar(shock,vascuIIIIs,hypcrIcnsIvccnccphaIopaIhy)
ToxIns.subsIanccusc,aIcohoIwIthdrawaI,scdaIIvcsorscdaIIvcwIIhdrawaI, opIoIds(cspccIaIIy
morphInc),ancsIhcIIcs,anIIchoIIncrgIcs,anIIconvuIsanIs,dopamIncrgIcagcnIs,sIcroIds,
InsuIIn,gIyburIdc,anIIbIoIIcs(cspccIaIIyquInoIoncs),NS^!s
HcavymcIaIs (arscnIc,Icad,mcrcury)
Dve5tgutOD5
sIandard. C8CanddIncrcnIIaI,cIccIroIyIcs,Ca
.
, P,Mg
.
',gIucosc,LSR,II1sCr,8\N,
JSH,vIIamIn8,IoIaIc,aIbumIn,urIncC&S,R&M
asIndIcaIcd.LCG,CXR,CJhcad,IoxIcoIogy/hcavymcIaIscrccn,VRI,H!V, IP,LLG
(IypIcaIIyabnormaI.gcncraIIzcdsIowIngorIasIacIIvIIy),bIoodcuIIurcs
IndIcaIIonsIorCJhcad. IocaIncuroIogIcaIdchcII,acuIcchangcIn sIaIus,anIIcoaguIanIusc,
acuIcInconIIncncc,gaIIabnormaIIIy,hIstoryoIcanccr
NuDugeDeDt
InIrInsIc
IdcnII[andIrcaIundcrIyIngcauscImmcdIaIcIy
sIop aIInon-csscnIIaImcdIcaIIons
maInIaInnuIrIIIon,hydraIIon,cIccIroIyIcbaIanccandmonIIorvIIaIs
cxIrInsIc
cnvIronmcnIshouIdbc quIcIandwcIIIII
opIImIzchcarIngandvIsIon
roomncarnursIngsIaIIonIor cIoscrobscrvaIIon,consIanIcarcIIpaIIcnIjumpIngouIoIbcd,
puIIIngouIIIncs
IamIIymcmbcrprcscnIIorrcassuranccandrc-orIcnIaIIon
caIcndar, cIockIororIcnIaIIoncucs
bIoIogIcaI
haIopcrIdoIorrIspcrIdonc(Iowdosc)
Iorazcpam
physIcaIrcsIraInIsIIpaIIcnIbccomcsvIoIcnI
lOgDO55
upIo 50% yrmorIaIIIyraIcahcrcpIsodcoIdcIIrIum
0c|IrI0m
IWTLh0LTh
In|ect|ous
V8jcHa!tj Vb1
W|thdrawa|||omd|ugs
cutemetabo||cdiso|de|
Trauma
LNSpatho|ogy
hypox|a
0e||cencies|nv|tam|ns
Lndocrinopathies
cutevascu|ar|nsults
Tox|ns
heavymeta|s
Vb1 V8jcHa!tj
MosI 6ommon Iypes ol emenI|a
Alzheime|'s dement|a
Vascu|ardement|a
Lewy-bodydement|a
||onto-tempo|a|dementia
B|sK ol Uca!h w|!h k!y|ca| ksycho!|c Utg
Ttca!Mc! !ot UcMc!|a
JM ZUUa, Z91 !a|.! 9J1!91J
Ptosc. 1o ssss I1 v|1hc lo| |hc|s1
mo||||Iy l|om Iyp|c| |I|psyc1oI|c 1| I|Im|I
lo| 1|us|ohs, |ss|o| |1 |II|o| || 1mhI|.
Sl1y O|rrtrr|tt|ct.Y!-||y| ! !a HU1
w|I1 a! ! U pI|hIs.
Pad|c|a!s. |I|hIs w|I1 |t1|m|`s 1|ss
o| 1mhI|.
Bcs||s. UI1 occd||1 mo| ol|| moh
pI|hIs |h1om|t1 Io 1|us ( ! ! jJ.a"| vs. 1U
[Z.J"|. 11 o11s |I|o oy mIh|ys|s ws ! .a1,
Ja" co|I1|c |hI|\| jU||, ! .UcZ.ZJ, |=U.UZ|.
S|s|I|v|Iy h|yss 1|1 |oI s|ow v|1hc lo|
1|l|||I|| ||s\s lo| ||1|v|1u| 1|us o| 1|hos|s.
Uoc|0s|os: Iyp|c| hI|psyc1oI|c 1|s my
ssoc|I1 w|Ik sm|| ||c|s1 ||s\ ol
1I1 comp|1 Io p|co. 11|s ||s\ s1ou|1
cohs|1|1 w|I1|| I1 cohIxI ol m1|c| |1 lo|
I1 1|s, l1ccy v|1|c, m1|c| como|b|1|Iy,
|1 Ik l1ccy |1 slIy ol 1mI|vs.
Lu_u!Vc L8utuct8 Jutuu!uu!c8J1J
Dementa
sccNcuroI_N20
N-V-H ugDO5tC Lltelu Ol eDeDtu [Pl2eDel5 ye]
Hep|inted with perm|ssion |rom the 0|agnost|c and Stat|st|cal Mandal ol Mental 0|so|ders, 1ext Hev|s|on, |od|lh Ld|t|on, (Lopy|ight 2UUU}.
^. IhcdcvcIopmcnIoImuIIIpIccognIIIvcdchcIIsmanIIcsIcdbyboIh
I mcmutjmgatmcu! (ImpaIrcdabIIIyIoIcarnncwInIormaIIonorIorccaIIprcvIousIy
IcarncdInIormaIIon)
2. Z1 oIIhcIoIIowIngcu_u!Vc u8!utDaucc8.
" aphasa(IanguagcdsIurbancc)
" apraxa(ImpaIrcdabIIIIyIo carryouImoIoracIIvIcsdcspIIcInIacImoIorfuncIon)
" agnosa(IaIurcIorccognIzcorIdcnIIfyobjccIsdcspIcInIacIscnsoryfuncIIon)
" dIsIurbanccIncxccuIvcfuncIIonIng(I.c.pIannIng,organIzIng,scqucncng,absIracIIng)
8. IhccognIvcdchcIsInCrIIcrIa^ and^2cachcauscsIgnIhcanIImpaIrmcnInsocIaI
oroccupaIIonaIluncIIonIngandrcprcscnIasIgnIhcanIdccIIncIromaprcvIousIcvcIoI
luncIIonIng
C. IhccourscIscharacIcrzcdbygraduaIonscIandconIInuIngcognIIIvcdccIInc
. IhccognIIvcdchcIsIn CrIIcrIa^ and^2arcnoI ducIoanyoIIhcIoIIowIng.
I oIhcrccnIraIncrvous sysIcm condIIIons IhaIcauscprogrcssIvc dchcIIsIn mcmoryand
cognIIon
2. sysIcmIccondIIonsIhaIarcknownIocauscdcmcnIIa
J. subsIancc-InduccdcondIons
L. IhcdchcIIsdonoIoccurcxcIusIvcIydurIngIhc courscoladcIIrIum
IhcdIsIurbanccIsnoIbcIIcr accounIcdIorbyanoIhcr^xIs!dIsordcr
L0eDOlOgy
prcvaIcnccIncrcascswIhagc. 0%InpaIcnIsovcr65yrsoIagc,25%In paIcnIsovcr85yrsoI
agc
prcvaIcnccIsncrcascdInpcopIcwIIhownsyndromcandhcadIrauma
ÎzhcImcr'sdcmcnIIacomprIscs>50%oIcascs,vascuIar causcs comprIscapproxmaIcIy5%oI
cascs (oIhcrcauscsoIdcmcnIIa- sccNcuroIo_N2I)
avcragc duraIIon oIIIIncssIromonscIoIsympIomsIodcaIhIs8- 0yrs
uDtye5
wIIh orwIIhouIbchavouraIdIsIurbancc(c.g. wandcrng,agIIaIIon)
carIyonscI.agcoIonscI<65yrs
IaIconscI.agcoIonscI >65 yrs
Dve5tgutOD5 [lule Out level5De Cuu5e5]
sIandard.scc!c/trtum, PS6
asIndIcaIcd.VRI,H!VSPLC1,CJhcadIndcmcnIIa
IndIcaIIonsIor C1hcad. samcasIor dcIIrIum,pIus.agc<60,rapIdonscI(uncxpIaIncddccInc
IncognIIIonorfuncIonovcr-2monIhs),dcmcnIIaoIrcIaIIvcIyshorIduraIIon ( 2 yrs),rcccnI
sIgnIhcanIhcadIrauma,uncxpIaIncdncuroIogcaIsympIoms (ncwonscIoIscvcrchcadachc/
scIzurcs)
NuDugeDeDt
IrcaImcdIcaIprobIcmsandprcvcnIoIhcrs
provIdcorIcnIaIoncucs (c.g. cIock,caIcndar)
provIdccducaIIonandsupporIIorpaIIcnIandlamIy(dayprograms,rcspIccarc, supporI
groups,homccarc)
consIdcrIong-IcrmcarcpIan(nursInghomc) andpowcroIaIIorncy/IIvngwIII
InIormMInIsIryoI1ransporIaIIonabouIpaIIcnI'sInabIIIIyIodrIvcsaIcIy
consIdcrpharmacoIogIcaIIhcrapy
choIIncsIcrascInhIbIIors c.g.doncpczII(^rccpI)]lormIIdIoscvcrc dIscasc
NM^rcccpIoranIagonIsI(c.g. mcmanIInc)IormodcraIcIoscvcrcdIscasc
Iow-doscncuroIcpIcs(haIopcrIdoI,rspcrIdonc)andanIIdcprcssanIsIbchavouraIor
cmoIonaIsympIomspromIncnI- sIarIIowandgosIow
rcasscsspharmacoIogIcaIIhcrapycvcryJmonIhs
Jutuu!uu!c8212 Lu_u!Vc L8utuct8lbuD8!aucc-Vca!cuL8utuct8
100 9. umf6u0 u 0m00t, 0fum 0d 60udud0m00t u 0f066u0
0ccat|a 0c||t|a Pscadodccat|a ol 0cprcss|oa
0asct Ora4aaJsIep-w.se 4ec|.ae Aca!e |-4j Sa|aca!e
00rat|oa VaI|s-yrs 4-w\s Var.a||e
Wat0ta| h|story Praress.ve ||ccIaaI|a, revers|||e RecarreaI
Usaa||y .rrevers|||e H|| ar||4|Iy/ada||Iy Usaa||y revers|||e
|a very a|4
|cvc| ol 0oasc|oasacss Mara| ||ccIaaI|a aver Z1 | Mara|
Attcat|oa MaI |a|I.a||y aIIec!e4 Oecrease4 O|I||cc|Iy caaceaIraI|a
waa4er.a, easy 4|sIracI|aa
0r|catat|oa |!acI |a|I|a||y |pa.re4 asca||y Ia I.e laIacI
aa4 p|acej, I|acIaaIes
8chav|oat O.s.a|||.I.aa, |pa.reaI |a Severe a|!a!|aa/reIar4aI|aa lpadaa|a, se|I-|ar/sa.c.4e
AO||AO|, persaaa||Iy c|aae,
|ass aI sac|a| races
Psychootot Mara| ||ccIaaIes |eIwee exIrees S|aw|a
5|ccp Wakc 0yc|c |raeIe4 s|eep aI a||I Reverse4 s|eep wa|e cyc|e Ear|y ara.a awa|ea|a
Mood aad Alfcct |a|||e |aI aaI asaa||y aax.aas Aax.acs, |rr.Ia||e, f|acIaa!|a Oepresse4, sIa||e
0oga|t|oa Oecrease4 execaI|ve IaacI.a|a, ||ccIaaI|a prece4e4 |y aa4 ||ccIaa!|a
pacc|Iy af I|aa|I c|aes
Mcoq |oss ReceaI, eveaIaa||y reaIe Var\e4 receaI Recea!
|aagaagc Aaas|a, ap|as.a, 4ecrease4 Oysaa|a, 4ysrap||a, speec MaI aI|ecIe4
capreeas|aa, repe!|!|aa, ra|||a, .rre|evaoI, |aca|erea!,
speec| ec|a|a||a, pa|||a|.a l sa||ecI c|aaes
0c|as|oas OapeasaIary M|!ar.s aa4 paar|y Iare4 M||.||sI|c, saaI|c
haI|ac|aat|oas Var.a||e V|saa| caaa less taaa, aa4|Iaq
pre4a|aaIes
0a||ty of ha||ac|aat|oas Vacaacs/||aa4 |r||Iea|a/|.tarre Se|f-4eprecaIaq
Mcd|ca| 5tatas Var.a||e Aca!e .||aess, 4rc Iax|c|!y R/O sysIe.c |||aess, e4s
UDSIBH0B-B BIBO SOtOBtS
L0eDOlOgy
47%oIIhoscwIIhsubsIanccabuschavcmcnIaIhcaIIhprobIcms
2%oIIhoscwIIhamcnIaIhcaIIhdIsordcrhavcasubsIanccuscdIsordcr
47%oIIhoscwIIhschIzophrcnIa,25%oIIhoscwIIhananxIcIydIsordcr
ye5 O uD5tuDCe 5Ol0el5
. buD8!aucc-u8cu8utuct8
I 8uD8!auccaDu8c.maIadapIvcpaIIcrnoIsubsIancc uscIcadIngIocIIncaIIysIgnhcanI
ImpaIrmcnIordIsIrcss,asmanIcsIcdby21 oIIhcIoIIowIngoccurrngwIIhIna 12muu!H
pcrIod
" rccurrcnIuscrcsuIIIngInIaIIurcIoIuIhBmajorroIcobIIgaIIon
" rccurrcnIuscIn sIIuaIIonsInwhIchIIIsphysIcaIIyhazardous (c.g.drIvIng)
" rccurrcnIsubsIancc-rcIaIcdIcgaIprobIcms
" conIInucduscdcspIcInIcrIcrcnccwIIh socIaIornIcrpcrsonaIIuncIIon
2. 8uD8!auccucgcuucucc.maIadapIIvcpaIIcrnolsubsIanccuscIcadIngIocInIcaIIysIgnIhcanI
ImpaIrmcnIordIsIrcssasmanIIcsIcdbyZ occurrIngaIanyIImcIn Ihcsamc 12muu!H
pcrIod
" IoIcrancc(nccdIorncrcascdamounIIo achIcvcInIoxIcaIIonordImInshcdcnccIwIIh
samc amounIoIsubsIancc)
" wIIhdrawaI/uscIoavoIdwIIhdrawaI
" IakcnInIargcr amounIorovcrIongcrpcrIodIhan nIcndcd
" pcrssIcnIdcsIrcorunsucccssIuIcdorIsIocuIdown
" cxccssIvcIImcIo procurc, uscsubsIancc, orrccovcr IromIIscnccIs
" ImporIanIInIcrcsIs/acIIvIIcsgIvcnup orrcduccd
" conIInucduscdcspIcphyscaI/psychoIogIcaIprobIcmcauscd/cxaccrbaIcdbysubsIancc
U. buD8!aucc-uuuccuu8utuct8
I 8uD8!aucc u!uXca!uu. rcvcrsbIcphysoIogcaIandbchavIouraIchangcsducIo rcccnI
cxposurcIo psychoacIIvc subsIancc
2. 8uD8!auccW!HutaWa. subsIancc-spccIcsyndromcIhaIdcvcIopsloIIowIngccssaIIon oIor
rcducIIonndosagcolrcguIarIyuscd subsIanccs
V8jcHa!tj Vb1V
L
5ubsIance ependence
Ihe JL8
Lompu|s|veuse
Losso|Lont|o|
Lonsequencesol use
Vb2 V8jcHa!tj
A "5Iandard 0r|nk"
Spir|t|4U7} - I .boz.o|4mL
Tab|eW|ne| I Z7} - boz.o|I 4ZmL
|o|||||edWine | I 87} - oz. o|8bmL
Hegu|a|bee||b7} - !Zoz. or4I mL
h
I p|nto|bee| I . bS
I bot|leo|wine bSU
I m|c|ey 8S
Zb-er I 7 S
4Uoz. Z7S
Ma<esuretoas<aboutothe|a|coho|s:
mouthwash,|ubbinga|coho|,methanol,
ethy|eneglycol,a|te|shave|maybe
ase4 as a ceaper a|teroaI|vej
Alcoho| abuse canon|y be diagnosed |n
theabsenceola|coholdependence.1he
c||te||a|o|abuseanddependencea|e
outlinedunde|substanceusediso|ders.
0eI|r|um Iremens
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tachyca|d|a,inc|easedrespirat|on}
handt|emor
lnsomnia
|sychomoto|ag|tat|on
Anx|ety
Nauseao|vomiting
Tonic-c|on|cse|zu|es
V|sua|/tacti|e/audito|yha|luc|nat|ons
|e|secuto|yde|usions
buD8!aucc-Vca!cu L18utuct8
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sccIamII_ McdIcInc,./cuhu/, IM0andLmcr_cnc_ McdcInc,LR48
H5tOly
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C cvcrIcIIIhcnccdIo CuIdownondrInkng
A cvcrIcIIAnnoycdaIcrIIcIsmoIyourdrInkng
G cvcrIccI GuIIyabouIyourdrnkng
cvcrnccdadrInkrsIIhIngInmornIng (ycopcncr)
Jutuu!u u!c8 212
Ior mcn,ascorcoI2Isapostvcscrccn,Iorwomcn,ascorcoIIsaposIIIvcscrccn
IIposIIIvcC^GL,Ihcn asscssIurIhcrIodIsIInguIshbcIwccnprobIcmdrInkIngandaIcohoI
dcpcndcncc
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WhcnwasyourIasIdrInk
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HowmuchIImcandcnorIdoyoupuIInIoobIaInIngaIcohoI
HasyourdrInkInganccIcdyourabIIIIyIowork,goto schooI,orhavcrcIaIIonshIps
HavcyousuncrcdanyIcgaIconscqucnccs
HasyourdrInkIngcauscdanymcdcaIprobIcms
100 b. 0f00tt0g Nud0ft0 f0kBg fum f0k0g fu00m
Modcratc 0r|ak|ag
Or.a||a w|I|a I|e recaea4e4 a|4e||aes
U.S. OeparIeaI aI Hea|I aa4
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Vea. Z ar |ess/4 s!1/w|
Waea. I ar |ess/4 s9/w|
E|4er|y. I ar |ess/4
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sIccpdIsIurbancc
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coursc. InyoungaImosIcompIcIcIyrcvcrsIbIc,cIdcrIyohcnIchwIIhcognIIIvc dchcIts
morIaItyraIc20% IunIrcatcd
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sysIcm
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" trcmor " anxIcIy
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" agtaton " orIcnIaton andcIoudIngoIscnsorIum
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dIazcpam20mgPqI -2hprnunIIIC!W^-^<I0ponts, IapcrIngdoscnoIrcqurcd
obscrvc -2hahcrIasIdosc andrc-asscssonC!W^-^scaIc
IhIamInc 00mgIMIhcn 00mgPIor Jd
supporIIvc carc(hydraIonandnutrIIIon)
IIhsIoryoIwIIhdrawaIscIzurcs
dIazcpam20mgPqIhIor mInImumoIIhrcc doscs rcgardIcssoIsubscqucnIC!W^scorcs
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mcdIcaIIon (c.g. IIanIIn")
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dIazcpam2-5mg!V/mIn- maxImum I0-20mg qh, orIorazcpamSI
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bcnzodIazcpInc
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admIIIohospIaII
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dcIIrIumIrcmcns,rccurrcnIarrhyIhmIas,ormuIIpIcscIzurcs
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conIusIon
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leutDeDt O PlCOOl eeD0eDCe
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opcranIcondtonIng
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psychoIhcrapy,moIIvaIIonaIInIcrvIcwng
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aIcohoI,modcraIcIycdcctIvcIn rcducIng cravIngs,IrcqucncyorntcnsIIyoIaIcohoIbIngcs
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aIcohoIconsumpIIon,accIaIdchydcaccumuIaIcsIocauscaIoxIcrcacIIon(vomtIng,IachycardIa,
dcaIh),IIpaIIcnIrcIapscs,mustwaI48hbcIorc rcstarIIng^nIabusc
Opods
IypcsoIopIoIds.hcroIn,morphInc,oxycodonc,JyIcnoI#J(codcInc)
majorrIsksassocIaIcdwIIhIhc uscoIconIamnaIcdnccdIcs,IncrcascdrIskoIhcpaIIIIs8 andC,
bacIcrIaIcndocardIIIs, H!V
PCuIe DtOXCutOD
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scxdrvc,nausca/vomIIng,dccrcascdG!moIIIIy(constIpatIonandanorcxa),andrcspIraIory
dcprcsson
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IcvcIoIconscIousncss
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naIoxonchydrochIorIdc(Narcan). 0. 4mgupIo2mg!VIordagnoss
IrcaImcnI.InIubaIIonandmcchanIcaIvcnIIIaIIon,naIoxoncdrIp,untIpaIIcnIaIcrI
wIIhouInaIoxonc(upIo 48+ hwIIh Iong-acIngopods)
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V8jcHa!tj Vb21
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ehyd|ogenase
Acetaldehyde
Aceta|dehyde
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Na|trexone|Hev|a
}
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pedo|mance
Med|caI uses ol Mar|juana
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(cIondInc)
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cuphorIa),norcpncphrIncandcpIncphrnc (causIngvasospasm,hypcrIcnson)
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proIongcduscmayrcsuItIn paranoIa andpsychoss
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arrhyIhmIas
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hypcrtcnsIonandarrhyIhmIas
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InsomnIaorhypcrsomnIa, psychomoIoragItatIonorrcIardaIIon
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managcmcnI:supporIIvc managcmcnI
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psychoIhcrapy,groupIhcrapy, andbchavIourmodIcaIIonuscIuIIn maInIaInIngabsIIncncc
sIudIcsoIdopamIncagonIsIsIobIockcravIngs shownconsIstcnIrcsuIIs
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ncuroIogIc.scIzurcs
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marIjuanaIsthcmosIohcnuscdIIIIcItdrug
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schzophrcnIaIIprcdIsposcd
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hypcracIIvIIyandaIhIgh doscs can causccoma
chroncusccanproduccaparanodpsychosIsdIagnosIIcaIIysImIIarIoschIzophrcnIawIIh
agIIaIIon,paranoIa, dcIusIonsandhaIIucInaIIons
wIIhdrawaIsympIomsIncIudcdysphorIa,IaIguc,andrcsIIcssncss
IrcaImcnIoIsImuIanIpsychosIs.anIIpsychoIIcs
Hallucnogens
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ISIsahIghIypotcnIdrug, InIoxIcaIIoncharactcrzcdbyIachycardIa, H1N, mydrIasIs,Ircmor,
hypcrpyrcxIa, andavarIctyoIpcrccptuaIand mood changcs
hghdoscscancauscdcpcrsonaIIzaIIon,paranoIa,andanxcIy
no spcchcwIthdrawaIsyndromccharacIcrIzcd
IrcaImcnIoIagIIaIIonandpsychoss. supporI,rcassurancc,dImInIshcdsIImuIaIIon,
bcnzodIazcpIncsorhIghpoIcncyantIpsychoIIcsscIdomrcquIrcd
"Club Drugs''
100 b. h0 N00h06m 0d c00t6 u ummu0 u0 fug6
0rug
M0MA
|"Ecstasy", ,"E"|
6aa
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spass espec|a||y jaw c|ec|.aj,
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aa4 4.s!ar|aace, sa|c.4a| aa4 |a|c|4a|
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cohI|o| sId1|s |sI1 w|Ik|h |o||Iu1||| 1s|hs.
Bcsks. 11| ws h ||c|s1 ||s\ ol hy
psyc1oI|c oIcoT |h |h1|v|1|s w1o 11 v| s1
c|ho|s poo|1 1|sI1 o11s |I|o "! .1!, Ja" U|
! .ZU-! .ca}. |||1|hs w| co|s|sI|I w|I1 1os
|spo|s llcI, w|I1 |I| ||s\ || pop| wko
s1 c|ho|s To| l|ed|I|y |Z.JJ, Ja" U|, !.a1-
Z.1}. ||h1|hs lo| 1p|ss|oh, s|c|1| I1o1Is
|1 hx|Iy ouIcoTs w| |ss co|s|sIhI. ||
ooI1 css psyckoI|c h1 l|cI|v oIcoTs|
sdosIhl|| co|lod|1|h llcI ws p|s|I.
Uoc|0s|os: 11 l||1|hs | cohs|sIhI w|Ik
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oIcoTs |h1ph1hl ol I|hs|hI ||Iox|cI|o|
l|cIs, |I|od| v|1hc |s |ss sI|oh lo|
l|cI|v oIcoTs. |1o1 c||o|s us |1 I|
1v|opThI ol psyc10s|s | sI|o||y ssoc|I1,
|I |s 1|ll|cu1 Io 1I|T|h cds||Iy h1 |I |s poss|o|
I1I Ik ssoc|I|o| |ss l|oT cohloh1||
llcl0| o| |. 11 lulko| 1|1 co|c|u1 Ikl
I1| |s sl||c|hI v|1a|c Io w1 yoh pop|
I1I s|| ch|o|s co|1 ||c|s Ik|| ||s\ ol
1v|op|h psyckoI|c |||hss |I| |h |!.
0aIe 8ape 0rugs
hb
||unitrazcpam|Hohypnol
}
Kctam|nc
|o|m|cat|on- tact||chal|uc|natlonthat
inscctsorsnakcs a|c c|aw||ng ovcr o|
undc|thcskin. Espccia|lyassoc|atcd
w|thc|ysta|mcth usc.
Vb2+ V8jcHa!tj
5u|cide 8isk FacIors

50 FL50N5
5ex|male}
ge >bUy|so|d
0ep|ess|on
F|ev|ousattempts
Lthano|abuse
ationalth|n|ing|oss(de|usions,
ha|lucinat|ons,hopelessness}
5u|c|dein|am|ly
0|gan|zedplan
Nospouse|nosuppo||systems}
5er|ous|||ness, int|actablepain
FharmacoIherapy and 5u|c|de 8|sk
nceant|depressantthe|apy|s|n|tiated,
patlentsshou|dbe|o||owed||equent|y
asthe|esasulc|dewlndow|nwhich
thepat|entmaysti||be depressed, but
nowhasenoughene|gytoca||yout
su|cide.Avo|dtr|cyclicant|depressants
(TLAs} becauseo|high|etha||ty|n
ove|dose!
As||ngpat|entsaboutsuic|dew||lnot
g|vethemthe|deaorthe|ncentlveto
comm|tsuicide.
Thebestp|ed|ctorolcompleted
su|c|deisahisto|yofattempted
su|c|de.
Themostcommonpsychiat||c
d|sorde|sassociatedwithcompleted
su|c|dea|emooddiso|de|sand
a|coholabuse.
bucuc Jutuu!uu!c8212
U0OB
L0eDOlOgy
aIIcmpIcd.compIcIcd" 20.
M.I " J. IorcompIcIcd,I .4IoraIIcmpIs
H5k uCtOl5
cpIdcmoIogIclacIors
agc. Incrcascsahcragc I4, sccond mosIcommoncauscoIdcaIhIoragcs I5-24,hIghcsIraIcs
In pcrsons >65yrs
scx.maIc
racc/cIhnIcbackground.whIIcornatIvcCanadIansonrcscrvcs
marIIaIsIaIus:wIdowcd/dIvorccd
IIvIngsIIuaIIon.aIonc,nochIIdrcn<8yrsoIdInIhchouschoId
oIhcr.sIrcssluIIIIccvcnIs,acccssIo hrcarms
psychIatrIcdIsordcrs
mooddIsordcrs( 5%IIIcIImcrIskn dcprcssIon,hIghcrnbIpoIar)
anxIctydIsordcrs (cspccIaIIypanIcdIsordcr)
schIzophrcnIa(0- 5%rIsk)
subsIanccabusc (cspccIaIIyaIcohoI - 5%IIIcImcrsk)
caIIng dIsordcrs (5%IIIcIImcrIsk)
adjusImcnIdIsordcr
conducIdsordcr
pcrsonaIIIydIsordcrs(bordcrInc,anIIsocIaI)
pasIhIsIory
prIorsuIcdcaIIcmpI
IamIIyhIsIoryoIsucIdc aIIcmpI/compIcIIon
LlDCul le5eDtutOD
sympIomsassocIaIcdwIhsucIdc
hopcIcssncss
anhcdona
InsomnIa
scvcrcanxIcIy
ImpaIrcd conccnIraIIon
psychomoIoragIIaIIon
panIcaIIacks
PlOuC
LVctj Va1cu!. 1aVcjuuHauauj!Huu_H!8 uWau1u_1uHut!lKjuut8c:
IdcaIIon- "oyouhavc thoughIsabouIcndIngyourIlc, commIItngsuIcdc
passIvc - wouIdrathcrnoIbcaIIvcbuIdocsnoIadmtIoIdcaIhaIInvoIvcsactoInIIIaIIon
" c.g. ``!C raIhcrnoIwakcup,' "!wouIdn'ImIndIIacarhIImc
acIvc
" c.g."!IhnkabouIkIIIIngmyscII
pIan- "oyouhavcapIanasIo howyouwouIdcndyourIIIc
InIcnI- "YouIaIkabouIwanIIngtodIc,buIarcyoupIannngIodoIhIs`,"WhaIhassIoppcd
youIromcndngyourIIIc
pasIatIcmpIs- hIghcsIrIskIIprcvIousaIIcmpIInpasIycar
askabouIIcIhaIIIy,ouIcomc,mcdIcaIInIcrvcnIIon
88c88mcu!ubucua1uca!uu
onscIandIrcqucncyoIthoughIs- "WhcndIdthIssIartHowohcndoyouhavcIhcscthoughIs
conIroIovcrsuIcdaIIdcaIIon- "CanyousIopIhcIhoughIsorcaIIsomconcIorhcIp
IcIhaIity- "oyouwanIIocndyourIiIcrgcIa`rcIcascÌromyourcmoIionaIpain
acccssIomcans- "HowwIIIyougcIagun"WhIchbrIdgcdoyouIhInkyouwouIdgoIo
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provocaIvcIacIors- "WhaImakcsyouIccIworsc(c.g.bcIngaIonc)
proIccIIvcIacIors- "WhaIkccpsyouaIIvc (c.g. lrIcnds,IamIIy,pcIs,IaIIh,IhcrapIsI)
hnaIarrangcmcnIs- "HavcyouwrIItcnasuIcdcnoIcMadcawIIIGvcnawayyour
bcIongIngs
pracIIccdsuIcdcoraborIcdaItcmpIs- "HavcyouputIhcguntoyourhcadHcIdIhc
mcdIcaIIonsInyourhand SIoodaIIhcbrIdgc
ambIvaIcncc- "JcrcmusIbcapartoIyouIhaIwanIsIoIIvc- youcamchcrcIorhcIp
Jutuu!uu!c8212 bucuclbuma!uutm L8utuct8
A88c88mcu!ubucucA!!cmg!
scItIng- soIaIcdvs. oIhcrsprcscnI, chancc oIdIscovcry
pIanncdvs. mpuIsIvcaIIcmpI, IrIggcrs/sIrcssors
InIoxIcatIon
mcdIcaI aIIcnIIon - broughIInbyanoIhcr pcrsonvs.broughIInbyscIIIo LR
IImcIagIromsuIcIdcaIIcmpIIoLRarrIvaI
cxpccIaIIonoIIcIhaIIIy, dyIng
rcactIonIosurvIvaI- guII/rcmorscvs. dsappoIntmcnI/scII-bIamc
aua_cmcu!
dcpcndsonIhcIcvcIoIrIskIdcnIIhcd
hghcrrIsk
patIcnIswIIhapIan, acccssIoIcIhaImcans,rcccnIsocIaI sIrcssors, andsympIomssuggcsIIvc
oIapsychIaIrIcdIsordcrshouIdbc hosptaIIzcdImmcdIaIcIy
donoIIcavcpaIIcnIaIonc, rcmovcpotcnIIaIIydangcrousobjccIsIromroom
IIpaIIcnIrcIuscsIobchospIIaIIzcd,compIcIcIormIorinvoIuntaryadmIssIon
IowcrrIsk
patIcnIswhoarcnoIacIIvcIysuIcIdaI,wIthnopIanoracccssIoIcIhaImcans
dIscuss proIccIIvcIacIorsandsupportsIn IhcIrIIc,rcmIndIhcmoIwhaIIhcyIIvclor,
promoIcsurvIvaIskIIsIhaIhcIpcdIhcmIhroughprcvIoussuIcdcaIIcmpIs
makcasaIctypIan- an agrccmcnIIhatIhcywIInoIharmIhcmscIvcs, avoIdaIcohoI, drugs,
andsIIuaIIonsIhaImayIrIggcrsuIcIdaIIhoughIs,IoIIow-upwIIhyouaIadcsIgnaIcdIImc,
andconIacIahcaIIhcarcworkcr, caIIacrIsIsIncorgo IoancmcrgcncydcparImcntilIhcy
IccIunsaIcorIIthcIrsuIcIdaIIccIIngsrcIurnorInIcnsIIy
dcprcsson.hospIIaIIzc IscvcrcorIlpsychoIIcIcaIurcsarc prcscnI, oIhcrwsc ouIpaIIcnI
IrcaImcnIwth good supporIs and SSR!s/SNR!s
aIcohoI-rcIatcd.usuaIIyrcsoIvcswIIhabstIncnccIor aIcwdays,IInoI,suspccIdcprcssIon
pcrsonaItydIsordcrs. crIsIsInIcrvcnIIon/conIronIaIIon,may ormaynoIhospIIaIIzc
schzophrcnIa/psychoss.hospIIaIIzaIIon
parasucIdc/scII-mutiIaIIon.Iong-IcrmpsychoIhcrapywIIhbrIcIcrIsIsInIcrvcntIonwhcnncccssary
propcrdocumcnIationolthccIinicaIcncounIcrandraIionaIclormanagcmcnIIscsscnIiaI
OHBIOOtH SOtOBtS
eDelul LuluCtel5tC5
physIcaIsIgnsandsympIomsIackingaknownmcdIcaIbasIsInIhcprcscnccoIpsychoIogIcaI
IacIorsIhatarcjudgcdIobcImporIanIInIhcnIIaIIon,cxaccrbaIIon,ormantcnanccolIhc
dIsIurbancc
causcsIgnIhcantdIsIrcssorImpaIrmcnIIn IuncIIonIng
sympIomsarcproduccd unconscIousIy
sympIomsarcnoIIhc rcsuIIoImaIIngcrIngorIacIIIIousdIsordcrwhIcharcundcrconscous
conIroI
prImarygan.somaIIcsympIomrcprcscnIsasymboIIcrcsoIuIIonoIanunconscIous
psychoIogIcaIconIcI,scrvcsIorcduccanxIcIyandconIct,nocxIcrnaIInccntIvc
sccondarygaIn.IhcsckroIc,cxIcrnaIbcnchtsobtaIncd or unpIcasanIdutIcsavoIdcd(c.g.work)
NuugeDeDt O ODutOOlD 5Ol0el5
brIcIIrcqucnIvIsts
IImIInumbcroIphysIcansInvoIvcdIn carc
IocusonpsychosocaInoIphysIcaIsymptoms
mInImIzc mcdIcaIInvcsIIgatIons, coordnatcncccssaryInvcsIIgaIIons
bIoIccdback
psychoIhcrapy. conIcI rcsoIuIIon
mInImIzc psychoIropc drugs. anxIoIyIIcsIn shorIIcrmonIy,anIIdcprcssanIsIordcprcssvc
sympIoms
aIIcndIoIransIcrcnccand counIcrtransIcrcncc
Converson Dsorder
oncormorcsympIomsordchcItsaBccIngvoIunIarymoIororscnsoryIuncIIonIhaImImIca
ncuroIogcaIorGMC (c.g.ImpaIrcdco-ordnaIIon,IocaIparaIysIs,doubIcvIsIon, sczurcsor
convuIsons)
psychoIogIcaIIactorsthoughItobccIIoIogIcaIIyrcIaIcdto thcsympIomsasIhcInIIIaIonoI
sympIomsIsprcccdcdbyconIcIsoroIhcrsIrcssors
-J00/I00,000ngcncraIpopuIaton,IocusoIIrcaImcnIIn -J%oIouIpaIIcnIrcIcrraIsIo
mcnIaIhcaIIhcInIcs
morccommonInruraIpopuIaIIonsandnIndIvIduaIswIIhIIIIIcmcdIcaIknowIcdgc
sponIancous rcmIssIon In 5%oIacuIccascs, 50% oIchronIc cascs (>6monIhs)
V8jcHa!tj Vb2b
Ma||nger|ng -|ntent|ona|product|ono|
la|seo|g|oss|yexaggeratedphys|ca|
o| psycho|ogica|symptoms,motivated
byexte|nal |ewa|d |e.g. avoid|ng wor|,
obta|n|ngl|nanc|a| compensat|ono|
obta|n|ngd|ugs}
FacI|I|ous d|sorder -|ntent|ona|
product|ono|leign|ng olphysica|o|
psycho|og|calsignso|symptomsin
o|de|toassumethes|c||o|ewhe|e
exte|na||ncentives|e.g. econom|cga|n}
a|eabsent
Vb2 V8jcHa!tj buma1uutm L8utuct8lL88uca1Vc L8utuct8 Jutuu!uu!c8212
8omatzaton Dsorder
rccurrIng,muIIIpIc, cIIncaIIysIgnhcanIphysIcaIcompIaInIswhchrcsuItnpatcnIscckIng
IrcaImcnIorhavIngImpaIrcdIuncIIonng
ZgHj8ca8jmg!um8IhaIhavcuuut_aucga!Huu_jIncIudIngcachoI.
IourpaInsympIomsrcIaIcdIoaIIcasIIourdIdcrcnIsIcsornncIIons
IwogasIroInIcsIInaIsympIoms,noIIncIudIngpaIn
oncscxuaIsympIom,notIncIudIngpaIn
oncpscudo-ncuroIogIcaIsympIom,noIIncIudngpaIn c.g. numbncss,parcsthcsIa)
onscIbcIorcagc J0,cxIcndsovcrapcrIodoIycars
IIIcImcprcvaIcncc0.2-2%amongwomcnand0. 2%amongmcn
cuIIuraIIacIorsmayInucnccscxrato
compIIcaIIons. anxIcIy,dcprcssIon,unncccssarymcdIcaIIonsorsurgcry
ohcnamsdagnossIoran nsIdIousIIIncsssoruIcouIaIIorganIc IIIncsscs c.g.muIIIpIc
scIcrosIs)
Pan Dsorder
paInIsprImarysympIomandIsoIsumcIcnIscvcrIIyIowarranImcdcaIaIIcnIIon
usuaIIynoorganIcpaIhoIogybuIwhcnI cxsIs,rcacIIonIs cxccssIvc
IIIcImcprcvaIcncc 2%
psychIatrIcdIsordcrsmood,anxIcIy, substancc)mayprcccdc,co-cxIsIorrcsuIIIrompaIn
dIsordcr
Hypochondrass
prcoccupaIIonwIIhIcaroIhavng,orthcIdcathaIonchas,ascrousdIscascbascdona
mIsInIcrprcIaIonoIoncormorcbodIIysIgnsorsympIoms
cvIdcnccdocs noIsupporIdagnossolaphysIcaIdIsordcr
IcaroIhavIngadscascdcsptcmcdicaIrcassurancc
bcIIcIsnoIoIdcIusIonaInIcnsIIyasIn dcIusIonaIdIsordcr,somaIIcIypc) as pcrson
acknowIcdgcsunrcaIsIIcInIcrprctaIIon
duraIIonIsZ muu!H8, onscIn Jrd-4Ih dccadcoIIIIc
communIIyprcvaIcncc I . I -4.5%,prcvaIcnccIngcncraImcdIcaIpracIIcc4-%,hIghcrn
psychIatrIcscIIIngs
Body Dysmorphc Dsorder
prcoccupaIIonwIIhImagIncddcIccIIn appcaranccorcxccssconccrnaroundsIIghIanomaIy
usuaIIyrcIaIcdIoIacc
M=I,prcvaIcncc I-2. 2%nIhccommunIy,6-5%IndcrmatoIogy/cosmcIIcsurgcrycIInIcs
mayIcadIo avoIdanccoIworkorsocIaIsIIuaIIons
SSO0BIVB SOtOBtS
eDtOD
dIssocIaIIonsoscvcrcIhatIhcusuaIlynIcgraIcdluncIIonsoIconscIousncssandpcrccptIonol
scIIbrcakdown
suddcnorgraduaIonscI,IransIcnIorchronIccoursc
sympIomscauscdIsIrcssorImpaIrcdIuncIIonng
NuDe5tutOD5
dIssocIaIIvc amncsIa,dIssocIaIIvcIuguc,dIssocaIIvcIdcnIIIydIsordcr,anddcpcrsonaIIzaIIon
dIsordcr
dIdcrcnIIaIdIagnosIs. P1S,acuIcstrcssdsordcr,somatzaIIondIsordcr,subsIanccabusc,GMC
c.g. compIcx/parIaIscIzurcs)
Jutuu!uu!c8212 L88uca!Vc L8utuct8lbccg L8utuct8
100 . 66u0tV0 6ufd0f6
Aacs|a |agac |dcat|ty 0|sordcr
0|aga0s|s |a|.||Iy Ia reca|| |parIaaI persaaa| Sa44ea, aaexpecIe4 Irave| away Ira Twa ar are 4|sI.acI persaaa||!|es
|aIaraI|aa, csaa||y af a IraaaI|c |ae ar war|p|ace w|!| |aa|||.Iy Ia I|aI Ia\e ca!ra| aI aa .a4|v|4aa|'s
ar s!ressfa| aaIare, ay |e |aca|.te4, reca|| sae ar a|| aI aoe's pasI, |eav|aar, aes.a rear4|a
se|ecI|ve ar eera|.te4 ay assae aew .4eoI.Iy persaa| ||sIary a.\.a. Va|I|p|e
Persaa|.Iy O.sar4erj
Ep|dc|o|ogy preva|eace 0.Z preva|eace .3 preva|eace, V.|= l .J. 9
|crease4 | san.vars af Iraaa Vay acccr a4er IracaI.c Vay |ave |.sIa|y aI p|ys|ca|
war, a|asej c|rcasIaaces ca|aI, rape, ar sexaa| a|cse
aa!cra| 4|sas!ersj
Trcatcat Psyc|aI|erapy, ypas|s Usaa||y spaIaaeaas recaveq Tree sIaes. sypIa s!a|.|.taI.a,
Ma pravea ra|e far |ar||Iara!es/ Psyc|aI|erapy, ypas|s aI|ea!|aa Ia !raca, re.a!eraI|aa
paraca|a.ca||y-ass|sIe4 Esare sIa||||Iy aa4 safeIy PsycaI|erapy, ypaas|s
|aIerv.ew|a Ma pravea ra|e Iar |ar|.Iara!es/ SypIa-ar.eaIe4 a4|avaaIs
paraca|a.ca||y-ass|sIe4 aaI|4epressa!s, aax.a|yI.csj
.aIen.ew.a Ma pravea ra|e far |ar||Iara!es/
p|araca|a. ca||y-ass|sIe4
|aIen.ew|a
BBQ SOtOBtS
Lltelu Ol ugDO55
causcssIgnIcanIdIstrcssorImpaIrmcnIIn IuncIIonng
notduc Io mcdIcaIIons,drugs,oraGMC
Nocturnal Nyoclonus
mIddIc-agcdandcIdcrIy
myocIonIcj crkscvcry20-40scc
bcd partncrcompIaInIs
IrcaImcnI.bcnzodazcpIncs (cIonazcpam, nIIrazcpam)
Narcolepsy
IrrcsIsIIbIcsIccpaIIacks(upIoJ0mIn)andpcrsIsIcnIdaytImcdrowsIncssoccurrng
daIIylor Z muu!H8
catapIc(suddcnIcmporarycpIsodcsoIparaIysIswIIhIossoImuscIcIonc)
sIccpparaIysIs
hypnogogc(whIIcIaIIIngasIccp)/hypnopompIc(whIcwakIng)haIIucInaIIons arc
manIIcsIaIIonsoIrccurrcnIInvasIonsoIrapId cycmovcmcnI(RLM)sIccp InIo Ihc IransIIon
bcIwccnsIccpandwakcnIncss
IncIdcncc4In 0,000cascs, M=I
IrcaImcnI. stImuIanIs(mcthyIphcnIdaIc,-amphctamInc),JC^s,SSR!s
Hl NPHY NLNNP
sccIamIIMcdIcInc,IM46
LLL PNLP
scc RcsroI_RJ2
V8jcHa!tj Vb2
0cpcrsoaa||tat|oa 0|sotdcr
Pers|sIea! ar recarreaI exper|eaces aI
Iee|.a 4e!ac|e4 Ira aae's eIa|
pracesses ar |a4y |.e. |.\e |e. .a a
4reaj
Rare 4|sar4er
Apprax|a!e|y a0 aI a4a|Is |ave
exper.eace4 a s|a|e |r|ef ep|sa4e
aI 4epersaaa||ta!|aa, prec|p.IaIe4 |y
exIree sIress
Psyc|aI|erapy
P|aracaIerapy. c|aaatepa,
I|caxeI.e, c|a.pra.ae
L
5ymptoms ol NarcoIepsy
LhF
Latap|exy
ha||uc|nat|ons
ttac|so|S|eep
Fa|a|ys|sonwa|ing
Vb2 V8jcHa!tj bcXua!yauu LcuuctLa!u_L8utuct8 Jutuu!uu!c8212
BXUBIg BHO BHOBt
Paraphlas
ucu!uu. scxuaIarousaI,IanIasIcs, scxuaIurgcsorbchavIourInvoIvIngnon-humanobjccIs,
suncrIngorhumIIIaIIonoIoncscIIoronc`sparIncr, chIIdrcnoroIhcrnon-conscnIIngpcrson
8uD!jgc8. cxhIbIIIonIsm,IcIIshIsm,lroIIcurIsm,voycurIsm,pcdophIIIa,scxuaImasochIsm,
scxuaIsadIsm,IransvcsIIIclcIIshIsm,notoIhcrwIscspccIhcd(NS)
rarcIyscII-rcIcrrcd,comcIomcdIcaIaIIcnIIonIhroughInIcrpcrsonaIorIcgaIconIcI
pcrsonusuaIIyhasmorcIhanoncparaphIIIa,onIy5% oIparaphIIIadIagnoscsaItrIbuIcdIo
womcn
!ygca gtc8cu!a!uu
bcgInsIn chIIdhoodorcarIyadoIcsccncc, IncrcasIng In compIcxIIyandsIabIIIIywIIhagc
chronIc, dccrcascswIIh advancIngagc
mayIncrcascwIIhpsychosocIaIsIrcssors
!tca!mcu!
anII-androgcndrugs
bchavIourmodIhcaIIon
psychoIhcrapy
Gender ldentty Dsorder
gcndcrIdcnIItyIssctaIapproxImaIcIyJyrsoIagc
!ygcagtc8cu!a!uu
sIrongandpcrsIsIcnIcross-gcndcrIdcntIhcaIIon
rcpcaIcdsIatcddcsIrcorInsIsIcncc thaIoncIs oIthcopposItc scx
prclcrcncclorcross-drcssIng,cross-gcndcrroIcs In makc-bcIIcvcpIayIng
InIcnsc dcsIrc Io parIIcIpaIcIn IhcsIcrcotypIcaIgamcsandpasIImcsoIIhcopposIIcscx
sIrongprcIcrcncclorpIaymaIcs oIIhcopposIIcscx
sIgnIhcanIdIsIrcssorImpaIrmcnIIn luncIIonIngandpcrsIsIcnIdIscomIorIwIIhhIsorhcr
scxorgcndcrroIc
!tca!mcu!
psychoIhcrapy
hormonaIIhcrapy
scxuaIrcassIgnmcnIsurgcry
LAOPL YONLLN
sccG_ccoIog_, GYJ2and\roIo__, \J0
bBIH@ SOtOBtS
L0eDOlOgy
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Developmental Concepts
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PNlL LHLH
dIagnosIIccrtcrIasamcasaduIts (scc10htc !t5urdcr, PSI2)
gcnctc/parcnIaImodcIIng/IdcnIIcaIIonhypoIhcsIzcdascausc
oIIcn parcnIwIIhpanIcordcprcssIvcdIsordcr
LNLHPLZL PNALY LHLH
dIagnosIIccrIIcrIasamcasaduIIs (sccL.!, PSJ)
ohcnrcdoIasks, showdIssaIIsIacIIonwIIhIhcIrworkandIcndIobcpcrIccIIonsIIc
ohcnrcquIrcrcassuranccandsupporIIoIakconncwIasks
LLL HLP
commonphobasIn chIIdhoodIncIudcaIcarolhcIghIs,smaIIanImaIs,docIors,dcnIIsIs,
darkncss,IoudnoIscs, IhundcrandIIghInIng
ChIdhood 8chzophrena
L0eDOlOgy
/2,000In chIIdhood,IncrcascsahcrpubcrIyIoaduIIraIcs (%)InIaIcadoIcsccncc
dIagnosIIccrIIcrIasamcasInaduIIs(sccOchtZuhrcht0, PS4)
<6yrsoIdmayprcscnIInsImIIarIashIonIoauIsmprIorIoonscIolcorcsympIoms
prognosspoorascognIIvc, Ianguagc, socIaIandpcrsonaIIydcvcIopmcnI arc dIsrupIcd
leutDeDt
psychoIhcrapy,IamIycducaIIon
Iowdosc anIIpsychoIIcsIorpsychoIcsympIoms(c.g.haIIucInaIIons)andIargcIbchavours
(c.g. aggrcssIon,hypcracIIvIIy, mpuIsIvcncss)
hospIIaIIzaIIonorrcsIdcnIIaIpIaccmcnI,Iscvcrc
Pervasve Developmental Dsorders
IncIudcauIIsm, ^spcrgcr's,chIIdhooddIsInIcgraIIvcdIsordcr,RcII'sdIsordcr,andPNS
M. I" J-4. I (cxccpIIorRcII`swIIhIcmaIcprcdomInancc)
HeleDtul ugDO55
mcnIaIrcIardaIon,chIIdhoodschIzophrcnIa,socIaIphobIa,C,communIcaIIondIsordcr,
non-vcrbaIIcarnIngdIsordcr, ^H, abusc,hcarIngorvIsuaIImpaIrmcnI, scIzurcdIsordcr,
moIor ImpaIrmcnI
NuugeDeDt
hcarIngIcsIIoruIcouIImparmcnI
psychoIogcaIIcsIngIoasscssnIcIIccIuaIIuncIIonIngandIcarnIng
chromosomaIanaIysIsIo ruIcouIabnormaIIIIcs(c.g.IrIsomy2, IragIIcXsyndromc)
ruIcouIpsychoIIcdIsordcrs, socaIprobIcms,dcprcssIon,anxIcIy, abusc
leutDeDt
Icam-bascd. schooI,psychoIogIsI,occupaIIonaIIhcrapsI,physIoIhcrapIsI,spccchandIanguagc
Ihcrapy,audIoIogy,pcdIaIrcs, psychIaIry
IamIIycducaIIonandsupporI
IrcaIconcomIanIdIsordcrssuchasIIcs, C, anxIcIy, dcprcssIon, andsczurcdIsordcr
bchavIourmanagcmcnI,schooIprogrammIng
pharmacoIhcrapy. aIypIcaIanIIpsychoIIcs(IoraggrcssIon,agIIaIIon, scII-muIIIaIIon, IIcs), SSR!s
(loranxIcIy,dcprcssIon),sImuIanIs(lorassocaIcdInaIIcnIIonandhypcracIIvIy)
lOgDO55
varabIc,buIImprovcswIIh carIyInIcrvcnIIon
bcIIcrII!Q >60andabIcIocommunIcaIc
PUN
prcvaIcncc /,000
abnormaIIIIcsInIhrcc arcas
8ucau!ctac!uu ImpaIrcdnon-vcrbaIbchavIours(cycconIacI,lacaIcxprcssIon,
handgcsIurcs),IaIurc Io dcvcIopappropraIcpccrrcIaIIonshIps,IackoIsocIaI/cmoIIonaI
rccprocIIy
cummuuca!uu dcIaycdorabscnIspccchormarkcdImpaIrmcnIIoInIIaIcorsusIaIna
convcrsaIIon, sIcrcoIypcd/rcpcIIIIvc orIdIosyncraIIcuscoIIanguagc,abscnccolappropraIc
makc-bcIIcvcpIay
tc8!tc!cuauutcgc!!VcDcHaVuut8, u!ctc8!8, auu ac!V!c8 InIIcxIbIcadhcrcnccIo
spcchc,non-IuncIIonaIrouIIncs, sIcrcoIypcdhandorbodymovcmcnIs (c.g. rockng)
aIIcasI6IcaIurcsbcIorcJyrsoId (aIIcasI2Irom socIaIInIcracIonand IromoIhcr
2caIcgorIcs)
V8jcHa!tj Vbb
Vb V8jcHa!tj
Bc!|'s 00
Uv|opm|I Ao|m| Ao|m|
||c|1|c
Ul|c|Is
L
1v|opm1I |1 1v|opmrI
k1 s|t u|0| lo| zZ y|s
za morIks
!/! UJ,UJU
lm|s
!/!UJ,JJU
ooys>g|0s
Uc|s1 Uc|s1
k1 g|owI|, s\|||s
k|1 movm|Is, ||gug,
s\|||s |soc||, soc||, moIo||,
coo|1|rI|o|, oow|o|11|
|rgdg| co|I|o|, p|y
bse|vecH||d lor
TLNTINIeaIcres.
nnoy|ng
Tempe|amenta|
LnetgeI| c
No|sy
Tas<| ncomp|eI|on
Inattent|ve
pposit|ona|
Negativ|sm
k 4-o!h Ba1o|tc1 0||0|ca| 1t|a| o!
Ttca!c! S!ta!cg|cs !ot kc!|o-0ctc|l
dyctac!|v||y 0|sot1ct
cb G00 /jcbltj ! 999, t.! J!J!JB
P0tosc. 1o |rvsI|gI Ik |org-I| l|ccy ol
pk|coIk|py |1 okv|o| Ik|py, s w|| s
Ik|| como||I|o|.
S!01y 0hatac!ct|s!|cs. S|rg| o||r11 BU1 w|Ik
t!9 ck||1||, |1 !1 mo|Ik lo||ow-up.
Pad|c|pa!s. g !9.9 w|Ik ck|cI||sI|cs Iyp|c|
ol oI1| UHU smp|s.
|!ctvc6!|o6. ! 1 mo|Iks ol o1 ol lod|
||I|v|I|ors. I m1|c| m|gm|I, w|Ik
mIky|pk||1I s1 s l||sI ||| grI, lo||ow1
oy oIk| 1|gs s |u||1, |1 mo|Ik|y lo||ow-p,
Z| ||I|s|v okv|ou|| Ik|py |p||I, sckoo|,
|1 ck||1}, J| Ik Iwo como|r1, o| 1} sI|1|1
commu||Iy c|.
Na| 00!cocs. UHU sympIoms, oppos|I|o||
gg|ss|v sympIoms, soc|| s\|||s, |rIm||t||g
sympIoms rx|Iy |1 1p|ss|or|, p||I-ck||1
||I|o|, |1 c1m|c ck|vm|I
Bcs|!s. || g|odps skow1 |1cI|o| ||
sympIoms ov| I|m. N1|cI|o| ws lo|1 Io
o sp||o| Io okv|ou|| I|Im|I lo| UHU
sympIoms, ouI |o oIk| oIcoms. Uomo|r1
I|Im|I |1 m1|cI|or 1|1 |oI 1|lI| s|gr|l|c|I|y
c|oss ry 1om|r || 1||cI c0mp||sor.
Y1|cI|o| I|Im|Is w| sup||o| Io commd||Iy
c|, 1sp|I Ik lcI IkI Iwo-Ik||1s ol commr|Iy
I|I1 suo|cIs |c|v1 m1|cI|o| 1d|||g Ik
sIu1y p||o1.
0oc|0s|o6s: Us ol psycko sI|md||I m1|cI|o|s
|s sp||o| Io okv|o|| ||I|\rI|o|s o|
commu||q c| || I|I||g HU sympIoms.
Uomo||1 m1|c| |1 okv|o|| I|Im|I |s |oI
mo| l||cc|os Ik| m1|cI|o| |o| || I|I||g
UHU sympIoms.
LHuV8jcHa1Fj Jutuu!u u!c8 J1J
PLHLH lLHLH
prcvaIcnccJ/,000
no carIyspccchandIanguagcdcIay, nocognIIIvcdchcIIs,normaIIohIghInIcIIIgcncc
ImpaIrcd socIaI InIcracIIonwIIh2oI
nonvcrbaIInIcracIIons,pccr rcIatIonshIps, sponIancoussharIngoIcnjoymcnI/acIIvIIIcs,
socIaI/ cmoIIonaIrccIprocIIy
rcstrIctcdrcpcIIIIvcpaIIcrnsoIbchavour/InIcrcsIswIth >IoI
rcstrIcIcdInIcrcsIwIIhhIgh InIcnsIIy, IncxIbIcnonIuncIIonaIrouIIncs,rcpcIIIIvc
manncrIsms,prcoccupaIIonwIthparts
causcsImpaIrmcnI,no dcIayInIanguagcorcognIIIvcdcvcIopmcnI,not causcdbyanoIhcrPDD
LHLHLL lN1LHP1VL LHLH [L]
sImIIarIo auIIsm,buIIhcrcmusIbcapcrIodoIaIIcast2yrs(andupIoI0yrs)oInormaI
dcvcIopmcnI
ruIcouIdcgcncratIvcbraIn dIscasc, schIzophrcnIa
HL11 LHLH
X-IInkcddomInanIdIsordcr,IhcrcIorcprcdomInanIIyIngIrIs
rcsIrIcIIonoIbraIngrowIhbcgInnIngInhrstycarolIIIc
normaIdcvcIopmcnIbcIwccn6monIhsIo4yrs,IhcnrcgrcssIon(IossolpurposcIuIhand
movcmcnIs,mcnIaIrcIardaIIon,scIzurcs,ncuroIogIcaI,rcspIratoryandmoIordchcts)
NL
markcd dchcItsInabovcarcas,buIdocsnoImcctIuIIcrIIcrIaIoranoIhcrP
ttentIon Defct HyperactIvty DIsorder
prcvaIcncc.5-2%oIschooI-agcdchIIdrcn,M:I" 4. , aIthoughgIrIsmaybcundcr-dIagnoscd
gIrIsIcndIohavcInaItcnIIvc/dIsIracIIbIcsympIoms,boyshavcImpuIsIvc/hypcracIIvc sympIoms
LtOlOgy
gcncIIc- dopamInccandIdaIcgcncs,caIcchoIamInc/ncuroanaIomIcaIhypoIhcsIs
cognIIIvc- mcntaIrcIardatIon,InhIbIIoryconIroIandoIhcrcrrorsoIcxccutIvcIuncIIon
arousaI- aIIcraIIonsIn Ihc scnsorysystcmhIIcrs
ugDO55
dIdcrcnIIaI.IcarnIngdIsordcrs,hcarIng/vIsuaIdcIccts,IhyroId, atopIccondItIons,congcnIIaI
probIcms(lctaIaIcohoIsyndromc,IragIIcX),IcadpoIsonIng,hIsIoryolhcadInjury,IraumaIIc
IIIc cvcnIs (abusc)
dIagnosIs(JsubIypcs).
LumDucuJygc 6ormorcsymptomsolInaIIcnIIonand6ormorcsympIomsoI
hypcractIvIIy-ImpuIsIvIy
Vtcuumuau!j1ua!!cu!Vc Jygc 6ormorcsymptomsolInaIIcnIIon
Vtcuumuau!j1ygctac!Vc-1mgu8VcJjgc 6ormorcsympIomsoIhypcracIIvIIy-
ImpuIsIvIty
symptomspcrsIsIIor>muu!H8
onscIDcutca_c
symptomsprcscntIn aIIcast!Wu 8c!!u_8 (I.c. homc,schooI,work)
InIcrIcrcswIthacadcmIc,IamIIy, andsocIaIIuncIIonIng
docsnoIoccurcxcIusIvcIydurIngIhc courscoIanoIhcrpsychIatrIcdIsordcr
100 T T . uf0 bymtum6 u h |bN-V)
|aattcat|oa
Oare|ess |sIa|es
Oaaaa! sas!a|a aI!eaI.aa |a !as|s ar p|ay
Oaes aaI ||sIea w|ea spa|ea Ia 4|recI|y
|a||s Ia cap|eIe Ias|s
O.saraa|te4
Ava|4s, 4.s|||es Ias|s !|aI rea.re
sasIa|ae4 eaIa| eIfad
|ases I|.as aecessaq Iar Ias|s ar ac!|v.I.es
O.sIrac!|||e
|areIIa|
hypctact|v|ty
|.4eIs, sa|rs |a sea!
|eaves seaI w|ea expecIe4 !a rea|a
seaIe4
Raas aa4 c|||s excess.ve|y
Oaaoa! p|ay a.eI|y
Oa !he a, 4r.vea |y a aIar
Ta||s excess|ve|y
|p0|s|v|ty
B|arIs aaI aaswers |eIare aesI|aas
cap|eIe4
O.fI.ca|Iy awa|I|a !ara
|a!errapIs/.a!ra4es aa aI|ers
eutule5
avcragconscIJyrsoId
IdcnIIhcaIIonupon schooIcntry
ruIcouIdcvcIopmcnIaIdcIay, gcncIIcsyndromcs,cnccphaIopaIhIcsortoxns (aIcohoI, Icad)
rskoIsubstanccabusc,parIIcuIarIycannabsandcocanc,dcprcsson,anxIcIy,acadcmIclaIIurc,
poorsocaIskIIs, rskoIcomorbd C and/or , rIskoIaduIt^SP
assocIaIcdwthlamIIyhIsIoryol^H,dImcuIIIcmpcramcnIaIcharacIcrIsIIcs
leutDeDt
non-pharmacoIogIcaI.parcnImanagcmcnI,angcrconIroIsIraIcgcs,posIIvcrcInIorccmcnI,
socaIskIIIsIraInIng,IndIvIduaI/IamIIyIhcrapy, rcsourccroom,IuIors, cIassroomInIcrvcnIIon,
cxcrcIsc rouIIncs, cxIracurrcuIaracIIvIIIcs
pharmacoIogIcaI
sIandardIrcaImcnI:sIImuIanIs (mcIhyIphcnIdaIc- RIIaIn",Conccrta" jIong-acIIng],
8IphcnIn",dcxIroamphcIamnc,mIxcdamphcIamIncsaIIs- ^ddcraII",IsdcxamIcIamInc -
Vyvansc"SNR(aIomoxcIInc- SIraIIcra")
IorcomorbdsympIoms. anIIdcprcssanIs,antIpsychoIIcs
lOgDO55
65%conIInucntoaduIIhood,sccondarypcrsonaItydIsordcrsandcompcnsaIoryanxIcIy
dsordcrsarc IdcntabIc
70-80%conIInucInIo adoIcsccncc,buIhypcractIvc sympIomsusuaIIyabaIc
Oppostonal Defant Dsorder
prcvaIcncc.2-6%
ugDO55
paIIcrnoIncgatvIsIIc/hosIIIcanddcanIbchavIourIor < muu!H8wIIh< + oI.
IoscsIcmpcr, argucswiIh aduRs,dcncsaduIIruIcs, dcIibcraIcIyannoys,bIamcsoIhcrs,
Iouchy/casIIyannoycd,angryandrcscnIIuI, spIIcIuIorvIndcIIvc
bchavIour causcs sIgnIhcanI ImpaIrmcnIn socIaI, acadcmcoroccupaIIonaIIuncIonIng
bchavIoursdo noIoccurcxcIusIvcIydurIngIhccourscoIapsychoIIcormooddIsordcr
crItcrIanoImcIIorconductdIsordcr(C),II8yrsoroIdcr,crIIcrIanoImcIIor^SP
IcaIurcsthaIIypcaIIydIncrcnIatclromIranscnIdcvcIopmcntaIsIagc:onscI<8yrs,
chroncduraIIon(>6monIhs),lrcqucnIInIrusIvcbchavIour
ImpacIoI.poorschooIpcrIormancc,lcwlrIcnds, sIraIncdparcnt/chIdrcIaIIonshIps
mayprogrcssIoC
leutDeDt
csIabIIshboundarIcs
parcnImanagcmcnIIranIngandpsychocducaIIon
IndvIduaI/lamIyIhcrapy
pharmacoIhcrapyIorcomorbIddIsordcrs
schooI/daycarcInIcrvcnIIonsIohcIpwIIhbchavIourmanagcmcnt
Conduct Dsorder
prcvaIcncc. .5-J.4%(M.I " 4-2. )
LtOlOgy
parcnIaI/IamIIIaIIacIors- parcnIaIpsychopaIhoIogy(c.g.^SP,subsIanccabusc),chIdrcarng
pracIIccs (c.g. chIIdabusc,dscIpInc),Iowsoco-cconomIcstatus(SLS),IamIIyvIoIcncc
chIdIactors- dImcuIIIcmpcramcnt, ,IcarnngprobIcms, ncurobIoIogy
ugDO55
dIncrcnIIaI.^H,dcprcssIon,hcadInjury, substanccabusc
dIagnosIs.uscmuIIIpIcsourccs(^chcnbachChIId8chavIouraIChcckIIsI,Jcachcr`sRcporIIorm)
patIcrnoIbchavIourIhaIvIoIaIcsrIghIsoIoIhcrsandagcapproprIaIcsocIaInormswIIh
JInpasI 12 muu!H8 and nga8! muu!H8.
" aggrcssIonIopcopIcandanImaIs(buIIyng,physIcaIhghIs,uscoIwcapons,Iorccdscx)
" dcsIrucIIonoIpropcrIy,rcscttIngwIIhInIcnIIo damagc
" dcccIIluIncssorIhch (brcakIngandcnIcrIng,carIhch)
" vIoIaIIonoIruIcs(ouIaIInIghIbcIorcagc J, runaway 2IImcsorIorIongpcrIodsoI
Imc,ohcnIruanIIromschooIbcIorcagc IJ)
dIsIurbancccauscscIInIcaIIysgnIcanImpaIrmcnIIn socIaI,acadcmIcoroccupatIonaI
IuncIIonng
IIIndvduaIIs I8 yrsoroIdcr,crIIcrIanoImcIIor^SP
V8jcHa!tj Vb
00 kids LT5:
nnoy|ng
esent|u|
Lasilyannoyed
|amesothe|s
ulebrea<e|
|guesw|thadu|ts
Tempe|
5pite|ulvind|ctive
L
6onducI 0|sorder 0iagnos|s
TF
The|t- b|ea||ngandente||ng,dece|ving,
non-conl|ontationa|stea|ing
ulebrea<|ng- runn|ngaway,s<|pp|ng
schoo|,out|ate
gg|esson- people, an|ma|s,weapons,
lo|cedsex
F|ope||ydest|uct|on
Vb V8jcHa!tj
T|c Bo|c ol !hc 1hctac0c k|||acc |
Psycho!hctay a1 Phataco!|ctay 00!coc.
||1|6gs | !hc Wa!|oa| |6s!10!c o! Nc!a|
dca|!h 1tca!c6! o! 0ctcss|o6 0o||a|ota!|vc
Bcscatch Ptogta
J L0001l0 |cb0l I 99b, b1|J|.bJZ9
S!01y. B|1om|t1 c||||c| I|||.
Pamc|a6b. Zbb m| |1 lam| 11s lul||||hg
|s|c1 c||I|| lo| HD||1 w1o comp|I1
lo||owup |IoI| ol bI9 sss|o0s}.
|6!cNc!|o. |o| I|ImhI |ms. Ud1, lP,
|m|p|m|| p|s c||||cl m|gm|I |1 p|coo
p|s c||||c| mhgm|I.
Nc!|o1s. U||||c| |I|s sco|1 v|1oIps ol ||y,
m|11| |1 |I Ik|py sss|oh.
0!cocs. |I|hIs' |1 c||||c||s p|spcI|vs
|1 1p|ss|v sympIomIo|ogy.
Bcs0|!s. 1k|pI|c ||||c ws lo|1 Io 1v
s|g||l|c|I l|cI o| oIcom |h || I|Im|I |ms.
|I|hI co|I||oI|o| Io l|||c 11 s|g||l|chI
l|cI o| oIcoms, w1|s Ik|p|sI cohI||ouI|oh
Io ||||c 11 ho s|g||l|c|I llcI.
0oc|0s|o6s. 11|pI|c |l||c |s commo|
lcIo| wk|ck s|g||l|chIy |hl|hcs odIcom.
LHuV8jcHa!tjlV8jcHu!Hctagj
dIagnosIIcIypcs
chIIdhoodonscI.aIIcasIonccrIIcrIonprIorIoagc0
" poorprognosIs. assocIaIcdwIIh,aggrcssIvcncss,mpuIsIvcncss
adoIcsccnIonscI. abscnccoIanycrIIcrIaunIIIagc I0
" bcIIcrprognosIs,IcasIaggrcssIvc,gang-rcIaIcddcIInqucncy
mIId,modcraIc,scvcrc
leutneDt
Jutuu!u u!c8 J1J
carIyInIcrvcnIonncccssaryandmorccnccIIvc, Iong-IcrmIoIIow-uprcquIrcd
parcnImanagcmcnIIranng,angcrrcpIaccmcnIIraInIng, C8J,IamIIyIhcrapy, cducaIIon/
cmpIoymcnIprograms, socIaIskIIIsIraInIng,mcdIcaIIonsIoraggrcssIvcncssorcomorbd
dIsordcrs
pharmacoIhcrapyIsInsumcIcnI,manIyuscdlorIrcaImcnIoIcomorbIddIsordcrs
lOgDO55
poorprognosIIcIndIcaIorsIncIudccarIy-agconscI,hIghIrcqucncyandvarIcIyoIbchavIours,
pcrvasIvcncss(I.c.nhomc, schooI,communIIy),comorbId^H, carIyscxuaIacIvIIy,
subsIanccabusc
5O%oICchIIdrcnbccomc aduII^SP
sccVcua!tc8.
Lht/d /bu5c, PI5
Lhruhtc !ccurrchI /bdumth0/ 10th, P42
!cvc/umchI0/ !c/0, P26
!/tmth0Ituh !t5urdcr5, PI2
!c0rhth_ !t50bt/tI, P28
1hIc//ccIu0/ !t50bt/tI, P26
O/cc !t5Iurb0hcc5, PJ
HSg0HOIHBtBQg
Ihcory.onc'sprcscnIouIIookIsshapcdbyonc'spasIandunconscIouspsychoIogcaIIorccs
InsIghIaIIowschangcnpcrsonaIIIyandbchavIour
conIIcI- IhrccsIagcs
non-rcsoIvabIcconIIIcI
aIIcmpIIorcprcss
rcIurnoIconIcIn dsguIscdIorm(sympIomorcharacIcrIraII)
cmphasIsoncarIyInIcracIIonwIIhcarcgIvcr
sourccs oIInIormaIon
pasIandprcscnIcxpcrIcnccsandrcIaIIonshIps
rcIaIIonshIpwIIhIhcrapIsI
" !tau8ctcucc. unconscIousrccnacImcnIoIcarIyInIcrpcrsonaIpaIIcrnsIn rcIaIIonshIp
wIhIhcrapIsI
" cuuu!ct!tau8ctcucc. IhcrapIsI'sIransIcrcnccIopaIIcnI
" tc88!aucc: cIcmcnIsIn IhcpaIcnIwhIchopposcIrcaImcnI
IcchnIqucs
IrccassocIaIIon.paIIcnIsayswhaIcvcrcomcsIomInd
drcamanaIysIs
sIagcoIchangcImporIanIIoraIIconIIcIrcsoIuIons
Jutuu!uu!c8212 V8jcHu!Hctagj
Defense Nechansms
dcIcnscmcchanIsmsarcunconscIousIyacIIvaIcdbyIhcpaIIcnIInrcsponscIoanxIcIyprovokng
cvcnIsandIccIIngs
100 T Z. 00060 N00h06m6
|cvc| ! . Psychot|c 0cfcascs
Oaaa | jsyc|as.s,
ara||y see I|raa|aa!
c|||4|aaJ a4 .a Jreas
|cvc| t.|aturc 0cfcascs
Oaaa | jersaa||Iy
J.sar4ers, severe
Jejress|aa. Mara||y
seea Iaraa|aaI
aJa|esceace
|cvc| 1.Wcarot|c 0cfcascs
Oaaa | a4a|Is
|cvc| 0Matarc 0cfcac
Oaaa | ea!.aa||y
|ea|!|y a4a|!s
0ca|a|. rej|ac.a exIeraa| rea||Iy w|I| w|s|Ia| IaIasy
0|storl|oa. res|aj. aI rea||!y Ia eeI |aer |e|.efs, resa|I.a | aarea|.sI|c a4 ave|va|ae4 |4eas
Pto|cct|oa. |a!erjreI| .a!era| |ja|ses as !|aa| I|ey are aaIs|4e se", | jsyc|as|s see as Ira\
4e|as.aa a|aaI rea|.Iy e.. jerseca!aq 4e|as.asj
Act|ag oat. exjress aacasc|aas w|s| I|raa| .ja|s.ve acI|aa, raI|er I|a ||.||I .I
B|ock|ag. aI !||\|, aIIec!, ar |ja|se
hypochoadr|as|s. exaeraI.aa af .||aess | arJer Ia ava|4 ax.eIy-jrava\.a s|Iaa!.as
|atrojcct|oa. |Ieraa||t|a aa||!.es af aa a|jecI |.e. v|cI| |Jea!.fy.a w|I| aressarj
Pass|vc-aggrcss|vc bchav|oar. exjress aress|ar I|raa| jass|v.!y aJ asac||s
8cgrcss|oa. reIar| Ia a ear||er sIae aI 4eve|ajeI Ia ava|4 jreseI s!ressars
5oat|tat|oa. acaasc|aas exjress.a aI jsyc|.c ja|/Ies|a as j|ys.ca| syjIas
0oatro|||ag. aaa|a eveIs Ia reJace .aer caI|.cI
0|sp|acccat. s||fI|a eaI|aaa| resjase !a a aa|ecv|4ea rese||| I|a! w|.c| .s aax|e!y jrava\|
Exlctaa||tat|oa. aI!r||a!.a jersaa| asjec!s e. aaJs, aII|Ia4es, caaf||c!sj Ia exIera| war|J aaJ a||ecIs
|ah|b|t|oa. |||I| Iaac!.a !a ava.J aax.eIy jraJac.a |Ieraa| caf|.c!s
|atc||cctua||tat|oa. as. .a!e||ec!aa| jracess|a Ia ava|4 exjer|ec|a aI|ec!
|so|at|oa. sejaraI| a|jecIJ|4eas fra !|e.r assac.aIe4 aI|ecI w|.c| .s rejresse4j
8at|oaa||tat|oa. as| raI.aaa| exj|aaI|aas !a jas!.fy |e|av.aars I|a! are aaaccej!a||e
0|ssoc|at|oa. !ejaraq a4.I.ca!.a af sese af se|I !a ava.J eaI|aaa| 4.sIress
8cact|oa forat|oa. !rasfar.a aa aaccejIa||e |ja|se .a!a .!s ajjas.!e
8cprcss|oa. w|I||a|4|a ar reav| Ira caasc|acsaess aa .4ea/ee|.
5cxaa||tat|oa. |es!aw|a sexaa| |jar!ace Ia a||ec!s
A|tra|s. caasIrac!.ve se.ce !a aI|ers !a exjer|ece eja!|y
Aat|c|pat|oa. j|aa. Iar fa!are 4.scaIarI
Ascct|c|s. 4eay.a j|easara||e efIecIs af aa exjer|eace . . e. raI|I|caI|aa Ira reacac.aI.aaj
haoar. averI exjress.aa af Iee||as | a a ca|c Ias|.aa
5upprcss|oa. jasIjaae aIIeaI|aa Ia |ja|se ar caaI|.cI
Psychodynamc Therapy
g8jcHuauaj88 (cxpIoraIorypsychoIhcrapy)
orIgnaIIhcrapydcvcIopcdbyIrcud,goaIs scII-rcvcIaIIonandInsIghI
IhccxpIoraIonoIIhcmcanIngoIcarIycxpcrIcnccsandhowIhcyanccIcmoIIonsand
paIIcrnsoIbchavIourprcscnIIy
IImc InIcnsIvc (c.g. 4-5 Imcs/wkIorJ-7yrs)
IorIndIvIduaIswhocanIoIcraIcambgutyIncxpIoraIonsoIIccIngsandIrcaImcnI
8uggut!Vcg8jcHu!Hctagj
goaIIsnoIInsIghIbuI rcducIIon olanxIcIy
sIrcngIhcn hcaIIhydclcnscmcchanIsmsIo assIsI day-Io-dayfuncIonIng
IcchnIqucsIncIudc. cnhancIngscII-csIccm,cIarIhcaIIon,conlronIaIIon,raIIonaIzaIIon,
rcIramIng,cncouragcmcnI,rchcarsaI/anIIcIpaIIon,dc-caIasIrophIzIng,aIIowIng"vcnIIngoI
IrusIraIIons
8Hut!!ctmtcg8jcHu!Hctagj
rcsoIuIIonoIparIIcuIar cmoIonaIprobIcms, oracuIccrIsIs
numbcroIscssIonsagrccdonaIouIscI(6-20)
u!ctgct8uuag8jcHu!Hctagj
shorI-IcrmIrcaImcnIIookIngaI rcIaIIonshIp paIIcrns andIcachIngcopng mcchanIsms
IocusonpcrsonaIsocIaIroIcsandrcIaIIonshIpsIohcIpdcaIwIIhprobIcmsIncurrcnInncIIonIng
Behavour Therapy
modhcaIIonoIInIcrnaIorcxIcrnaIcvcnIswhIchprccIpIIaIcormaInIaIn cmoIIonaI dIsIrcss,
uscIuIIn IhcIrcaImcnIoIanxcIydIsordcrs,subsIanccabusc,paraphIIIas
8j8!cma!cuc8cu8!2a!uu: masIcrInganxIcty-provokIngsIIuaIIonsbyapproachIngIhcm
graduaIIyandIn arcIaxcdsIaIcIhaIIImIIsanxIcty
uuuu_: conlronIngIcarcdsIImuIusIorproIongcdpcrIodsunIIIIIIsnoIongcr IrIghIcnIng
gu8!Vc tcuutccmcu!: sIrcngIhcnngbchavIourand causIngIIIooccurmorcIrcqucnIIyby
rcwardIngII
uc_a!Vctcuutccmcu!: causngbchavIourIo occurmorcIrcqucnIIybyrcmovInganoxIous
sIImuIuswhcndcsIrcdbchavIouroccurs
cX!uc!uu: causIngabchavIourIodImInshbynoIrcwardngII
guu8Hmcu! (avcrsonIhcrapy).causIngabchavourIo dImInIshbyappIyInganoxoussIImuIus
V8jcHa!tj VbV
Vb+ V8jcHa!tj
Two-ycat Ba1o|tc1 0o!ro||c1 1t|a| a1
o||ow- o 0a|ccca| Bckav|ot 1hctay W.
Thctay |y txcns !ot S0|c|1a| Bchav|ots a1
Bot1ct||c Pctsoa|||y 0|sot1ct
/ch G F,ch|ll, ZJJc, cJ(!}.!a!-cc
0|jccl|vc. 1o 1I1r|h |ow UH1 coTp|s w|I1
|o|-1v|ou|| psyc1oI||py.
S!01y. Uh-y| ||1oT|t1 cohI|o||1 I|||
lo||ow1 y oh y| lo||ow-p p||o1.
Pa!|c!s: !JJ womh w|I| |c|I su|c|1| h1
s|l-|h|||os o|v|ou|s mI|| USY c||I|| |1
mIc11 Io v||ous 1To|p1|c 1I.
|!ctvc!|o. Uh y| ol UH1 o| oh y| ol |oh
|v|o|| I||py.
0!cocs. 1||msI| ssssT|Is ol s|c|1|
|v|o|, m||cy s|\|cs us, |||
psyc|o|o|c| w||-||.
Bcs0|!s. |I|hIs |c|v|| UU1 w| ||l s ||\|y
Io IImpI s|c|1, |q||1 |ss 1osp|I|I|o| lo|
su|c|1| |1I|o|, 11 |ow| m1|c| ||s\ lo| su|c|1
UmpIs, w| |ss ||\|y Io d|op oI ol I||py
|1 11 lw| T|hcy |ooT v|s|Is lo| su|c|1|
|1I|o|.
0oc|0s|os: UH1 |s cI|va || |1uc|h su|c|1|
|v|o| |h pI||Is w|I| o|1|||h p|soh||Iy
1|so|1|.
V8jcHu!HctagjlVHatmacu!Hctagj Jutuu!u u!c8 J1J
Cogntve Therapy
Ihcory. moods andIccIIngsarcnucnccdbyonc`sIhoughIs
psychIatrIcdIsIurbanccsarcIrcqucnIIycauscdbyhabIIuaIcrrorsInIhInkIng
goaIIsIohcIppaIIcnIbccomcawarcoIautomatIcIhoughIsandcorrccIassumpIonswIIhamorc
baIanccdvIcw
uscIuIIordcprcssIon,anxIcIydsordcrs, scII-csIccmprobIcms
uscoIIhIsIhcrapyprcsupposcsasIgnhcanIIcvcIoIIuncIIonIng
paIIcnIsaskcdIo kccpIhoughIjournaI(ohcnn charIIorm,wIIhcoIumnhcadngs"stuaton`,
"IccIng`,"thoughI and"cognItvcdsIortIon )IomonIorIhcIrIhoughIs,whcn/whcrcIhcy
IhInkIhcscIhoughts,howthcthoughIsmakcIhcmIccIandwhaIIhcIrundcrIyngcrrorIn
IhInkngmIghIbc
Cogntve Behavour Therapy {CBT}
combIncscognIIvcandbchavourIhcrapIcsIotcachIhcpaIIcnItowcakcnconnccIIonsbcIwccn
IhInkngpatIcrns,habtuaIbchavIoursandmood/anxIcIyprobIcms
goodIortrcaImcnIoImIId/modcratcdcprcssIon/anxIcIy
Dalectcal Behavour Therapy {DBT}
IhcrapyIhaIcombIncsC81IcchnIqucswIhapproachcsdcrIvcdIrom8uddhsImcdIIaIon
pracIIccs
orIgInaIIydcvcIopcdIorbordcrIIncpaIIcnIsbuIsnccIoundIo bccnccIIvcIorIhctrcatmcnIoI
scvcraIoIhcrdsordcrs
IocuscsonIourtypcsoIskIIIs.mIndIuIncss,cmoIIonrcguIaIIon,InIcrpcrsonaIcnccIIvcncss,and
dIsIrcsstoIcrancc
IndIvIduaIandgroup IhcrapyscIIIngs
Other Therapes
_tuugg8jcHu!Hctagj
goaIs: scII-undcrsIandIng, acccpIancc,socIaIskIIIs
crcaIcsamIcrocosmoIsocIcty
amj!Hctagj
IamIIysysIcmconsIdcrcdmorcnucnIIaIIhanIndIvIduaI
Iocuson
" hcrcandnow, rc-csIabIshIngparcnIaIauIhorIIy,sIrcngIhcnngnormaIboundarIcs and
rcarrangIngaIIanccs
Hjguu88: mxcdcvdcnccIorIhcIrcaImcntoIpaIn,phobIas,anxIcIy,andsmokngccssatIon
muuuuc88-Da8cucu_u!1Vc !Hctagj:dcrIvcdIrom8uddhIsImcdtaIIvcpracIIccs,aImsto
hcIppcopIcaIIcndIoIhoughIs,bchavIoursandcmoIIonsnon-judgmcnIaIIyandInIhcmomcnI
usIngguIdcdbrcaIhIngcxcrcIscs
HHBtHB0OIHBtBQg
ntpsychotcs
"anIIpsychoIIcsand"ncuroIcpIIcsarctcrmsuscdInIcrchangcabIy
uuca!uu8: schIzophrcnIaandoIhcr psychoIIc dsordcrs,mooddIsordcrswthorwIthouI
psychoss,vIoIcnIbchavour, auIsm,JourcIIc's,somaIoIorm dIsordcrs, dcmcnIIa, C
uu8c!: ImmcdIaIccaImIngcnccIand dccrcascInagItaIIon,IhoughtdIsordcrrcspondsm2-4wks
ta!uuau8c.
norcasonIocombncantIpsychoIIcs
choosIngan anIIpsychoIIc.
" aIIanIpsychoIIcsarccquaIIycncctvc
" aIypIcaI antIpsychoIIcsarcas cnccIIvcasIypIcaIanIIpsychoIIcsbuIhavc bcttcr sIdccnccI
prohIcs
" choosc adrugIhaIIhcpaIIcnthas rcspondcdIoInIhcpasIorIhaIwasuscdsucccssIuIIy
InaIamIIymcmbcr
rouIc. P, shorI-actngorIong-acIIngdcpoI!MInjcctIons,subIInguaI
duraIIon.mInImum6monIhs,usuaIIyIorIIIc
Jutuu!uu!c8212 VHatmacu!Hctagj
LODg-PCtDg leulutOD5
anIIpsychoIIcsIormuIaIcdInoIIIor dccpIMInjccIIon scc 1abIc 4)
rcccIvcdonanouIpaIIcnIbasIs
IndIcaIIons.IndIvIduaIswIIhschIzophrcnIaoroIhcrchronIcpsychosIswhorcIapscbccauscoI
non-adhcrcncc
dosIng. sIarIaIIowdosagcs,andIhcnIIIraIccvcry2Io 4wksIomaxImIzcsaIcIyandmInImIzc
sIdccnccIs
shouIdbccxposcdIooraIIormprIorIohrsIInjccIIon
sIdccnccIs.rIskoILPS, parkInsonIsm, IncrcascdrIskoIncuroIcpIIcmaIIgnanIsyndromc
LuDu0uD u0elDe5 Ol te leutDeDt O PCute 5yCO55 D te LDelgeDCy ettDg
haIopcrIdoI5mgIM 2mgIMIorazcpam
oIanzapInc2.5- I0mg P, !M,quIckdIssoIvc)
rIspcrIdonc2mg M-Iab,IIquId)
100 T . thuhy6uugy u b0h2uhf00 V6. N00h06m u 0tu0 u 0t6y0hut06
8ra|a Atca
||b|c 5ystc
Froata| 0oncx
Pathophys|o|ogy |a 5ch|tophtca|a
Excess OA
+ve sypIas |a||ac|aaI.aas,
4e|as|aas
Typ|ca| Aat|psychot|c
OZ a|ac|a4e
TreaIs ve syp!as
Oecrease4 OA OZ a|ac|a4e
Atyp|ca| Aat|psychot|c
Wea| a-HT a|ac|,
OZ/I a|ac|a4e a.aIa.ae4
TreaIs +ve sypIas
-ve sypIas I|aI afIecI, aa|e4aa.a, Vay warsea -ve sypIas
RaaasI a-HT a|ac| |acreases
OA Iraas.ss|aa
ava||I.aa, caa.I.ve |pa.reaI aa4 caa|I|ve |pa|reaI Teare!|ca| |praveea! |a
aeaI.ve/caa.I.ve syp!as
aa|y aasene4 w|I| c|atap|ae
8asa| 6aag||a Uac|aae4
1ubct0|afaad|bu|at Ttact Uac|aae4
OZ a|ac|a4e
Re|aI.ve AO| excess cacses
EPS syp!as
OZ a|ac|a4e
Hyperpra|ac!|ae.a
RaaasI a-HT a|ac| |acreases
OA Iraas.ss|aa
Oecrease4 EPS |ac|4eace
a-HT a|ac| .acreases OA
|ess |yperpra|ac!|ae.a
U " 1opT||, aH1 " s|oIo|||, Uk " cIy|cko|||, L|S " xI|py|T|1| syTpIoTs
MoI. spac|l|c "Iyp|c| |1 "Iyp|c| |I|psyc1oI|cs v|y || I|Ts ol ||1|| Io 1||||c, aH1 c1o||h||c |1 1|sIT|h||c s|Is |1|| Io 1|l||hI s|1 llcI p|ol||s
100 T 9. ummu0 0t6y0hut0 g00t6
5tan|ag 0osc Ma|atcaaacc Max|a 8c|at|vc
Potcacy
|g|
Typ|ca|s
|a ar4er aI paIeacy Ira ||| Ia |aw
P.at|4e Orap' 0.a-I PO a|4 Z-IZ /4 PO Z0 /4 PO
Ha|aper.4a| Ha|4a|' Z-a lV 1-&| Base4 aa c||a.ca| eI|ecI Z0 g4 PO Z
0.a-a PO a/I.4
0.Z g|/4 PO
||ap|eaat|ae eaaaIa!e Z.a-I 0 /4 PO I-a PO s Z0 /4 PO Z
Va4|!ea', Va4eca!e'
Iar lV Iarc|a!|aa Za |V/SO ! -Jw|s
Zac|apea!|.xa| HO| O|ap|xa|' Z0-J0 /4 PO Z0-10 /4 PO I 00 /4 PO 1
Zac|apeaI|xa| aceIaIe a0-Ia0 |V 1&-7Z 100 |V Zw|s
Acapaase'
Zcc|apeaI|.xa| 4ecaaaaIe I 00 |V I -1w|s I a0-J00 |V Zw|s 00 lV/w|
O|ax|pa| OepaI'
Tr|I|caperat|ae SIe|at|ae' Z-a PO a.4 Z-I a PO a.4 0 /4 PO
Perp|eaat|ae Tr||aIaa' &-I PO a/!|4 1-& PO (|4 1 /4 PO 0
|axap|oe HO| |ax|Iaae' I0 PO I.4 0-I00 g4 PO Za0 /4 PO 0
I Z.a-a0 | V 1-|
T||ar.4at.ae Ve||ar||' Za- 00 PO !|4 I 00-100 PO a.4 &00 /4 PO I 00
O||arpraat|ae |aracI|| ' I 0-Ia PO a}. 4 100 /4 PO I 000 /4 PO I 00
V8jcHa!tj Vb+1
t!lcc!|vccss o! k!|syc|o!|c 0tgs |6 Pac6b
wN 0|to|c Sc||to|tc6|a
At.MZJUa,JaJ.!ZJ9-ZJ
S!1y: B|1oT|t1, 10| ||h1, cI|vcoH|o|
I||| w|I1 T1|| lo||owp ol c TohI1s.
Pa!|c!s: ! 1JZ pI|hls w|I1 1||os|s ol
sc1|top1||| |s p| 0SY|V c1I||| h1 |
Io I| |I|psyc|oI|c m1|cI|o|s |s 1I|T|h1
y sI1y 1ocIo|s}. Nh 1!, !1" T|, Zc"
lT|.
|6!cNc!|o. ! Io 1 caps|s 1||y ol o||tp||
ZJ.! T}, qI|p|h (a1J.1 T}, ||sp||1o| |J.J
T}, p|p1|t|| ZU. T}, o| t|p|s|1oh | ! ! Z.
T}, w|I1 1os I Ih 1|sc|I|o| o| Ik sI1y
1ocIo|. Nh To1| 1oss |h p|hI1ss.
N|6 0!coc: U|sco|I|huI|oh ol I|IThI lo|
|y cs
Bcs0k. U||tp|| |op k1 sII|sI|c||y
s|||l|c|I |ow| |I ol 1|sco|I||I|o| lo| |y
cs c1"} l|oT || oI1|s |dI|p|| Z",
||sp||1o| !1", p|pk|t|| - !a", t|p|s|1o|
" !9"}. 11| w| |o s|h|l|c|I 1|ll||cs ||
I|T |I|| 1|sco|I||I|o| 1 Io |hIo||| s|1
||cIs, 1owv|, o|htp|| ws ssoc|I1 w|I1
s|||l|c|I|y k|1| |aI ol TIo||c s|1 l|cIs.
Vb+2 V8jcHa!tj
AIyp|ca| AnI|psychotics
|ewe|E|Sthantyp|ca|s[except
rspe||doneabove8mg/d}
H|spe||done,o|anzapIne, quet|ap|ne
a|ethe|i|st|ineatyp|ca|
ant| psychotics"
Nos|gni|icantd|l|erence|ne||icacy,
speedo||esponse and stab||ityol
rem|ss|onbetween|||st||neatyp|ca|s
sadvantages. expens|ve,metabo|ic
s|deel|ects
L
6ommon|y used AIypica|
AnI|psychot|cs
865
|sper|done
0|anzap|ne
L|ozap|ne
5eroque| [quetiap|ne}
L
AnI|cho||nergic Fllects
8ed asa beet
hoI asa ha|e
0ry asa bone
8||nd asa bat
Mad asa hatte|
MeIaboI|c 5yndrome
Atypica|ant| psychoticshavebeen||n<ed
towe|ghtga|n,hype|g|ycem|a,and
|ip|dabno|ma||t|esandareassociated
withan|nc|eased||s|o|metabo|ic
synd|ome[ aco||ect|ono|c|in|ca|and
|abo|atoi abno|ma||t|es |nc|uding
abdom|na|obesity,|nsu|n|esistance,
hyper|enson,|ow|eve|so| high-density
|ipoproteincho|este|o|, andh|gh|eve|s
olt||g|yce||des}.
5|de FllecIs ol Iyp|cal AnI|psychoI|cs
Low potency. ant|cho||nergic,
ant|ad|energic,ant|-H|stam|nicside
e||ects
h|ghpotency.||s<o|movement
d|sorde|sidee||ects[ext|apyram|da|
s|deel|ects}andneu|o|ept|c
mal|gnantsynd|ome
VHatmacu!Hctagj
100 T 9. ummu0 0t6ychutc g00t6 |cont| nucd}
Atyp|ca|s
R|sper|4aae R|sper4a|', I -Z OOl||4 +-& /4 PO & /4 PO
R|sper4a| Oaas!a'
Iar |V |aa acI|a prepara!|aaj Za |V Zw|s
O|aatap.ae Zyprexa', Zy4.s'j a /4 PO I 0-Z0 /4 PO J0 /4 PO
Ar.p|prata|e A||.|Iy'j I 0- I a /4 PO I 0-I a /4 PO J0 /4 PO
Z.pras.4aae Ze|4ax'j +0 /4 |V &0-0 /4 |V I 0 /4 | V
O|atap|ae O|atar||'j Za PO ||4 J00-00 /4 PO 900 /4 PO
OaeI.ap|ae Serace|'j Za PO |.4 +00-&00 /4 PO &00 /4 PO
100 T b. ummu0y U60d tyc 0t6ychutc6
Mcchaa|s
Advaatagcs
8|spcr|doac
[8|spctda|"|
B|ac|s a-HT, OZ aa4
a4reaer.c recep!ars
|aw |ac|4eace af EPS aI
|awer 4ases & j
0|aatap|ac [yprcxa",
yd|s'|
B|ac|s a-HT_, O -O+,
cscar|a|c,
gg
reaer.c,
|sIa.aer.c recepIars
BeI!er avera|| eff.cacy
capare4 Ia a|aper.4a|
We|| !a|eraIe4
|aw |rc|4eace af EPS
aa4T0
0|sadvaatagcs SE. .asaa|a, a.IaI.aa, SE. ||4 se4aI|aa,
EPS, H/A, aax|e!y, .asaa|a, 4|tt.aess,
pra|ac!|a, pasIara| |a|a| aa!|ca||aer|c,
|ypa!eas|aa, caasI|pa!|aa, ear|y AST aa4 A|T
4|n.aess, we||! a|a e|evaI|aa, resI|essaess
We|aI a.a assac|aIe4
w.I| .ocrease4 r|s| aI
4|a|etes e|||!as aa4
yper||p|4e.a
0ocats Oa|c| 4|ssa|ve V-Ia|sj, Oa|c| 4.ssa|ve Iara|aI.aa
aa4 |aa-acI|a OaasIa'j Zy4|s'j ase4 caaa|y
fara|aI|aas ava.|a||e |a ER seII.a far |eIIer
cap||aace
| V Iar ava||a||e
MoI. H|s\ ol w|1I ||. U|otp||lU||tp|| > H|sp||1o|/UueI|p||
100 Tb. bd0 c0ct6 u 0t6ychutc6
5ystc 5|dc Ehccts
0act|ap|ac [5ctoguc|"|
B|ac|s a-HT, OI -Z,
a4reaer|c aa4 |.sIa|aer|c
recep!ars
Assac.aIe4 w|I |ess we||I
a|a capare4 Ia c|atap|ae
aa4 a|aatap.ae
SE. H/A, se4aI.aa, 4.n|aess,
caasI.paI|aa
VasI se4aI|a af I.rs! |.ae
aIyp|ca|s
Jutuu!u u!c8 212
H.| pa!eacy
|aw pa!eacy
0|otap|ac [0|otat||'|
B|ac|s a-HT _, OI -+,
ascar.a.c,
g
.sIa|aer|c
recep!ars
VasI eIIecI|ve far
IreaIeaI-res|s!aaI
sc||tap|rea.a
Oaes aa! warsea Iar4.ve
sypIas, ay Irea!
I|e
Apprax|aIe|y a0 aI
paI.ea!s |eaef.I, espec.a||y
paraaa.4 paI.eaIs aa4
I|ase w|!| aaseI aIIer
Z0 yrs
SE. 4raws|aess/se4aI|aa,
|ypersa||va!|aa,
Iac|ycar4.a, 4.n.aess,
EPS, MVS
araaa|acy!as.s
Wee||y ||aa4 caaaIs far
aI |eas! I aaI, Iea
Zw|s
Oc aaI ase w|!| 4ras
w|.c| ay cacse |aae
arraw sappress|ao 4ae
Ia r|s| af araaa|acyIas|s
Aat|cho||acrg|c
o-adtcactg|c b|ockadc
0opa|acrg|c b|ockadc
Ory aaI, 4|1.ca|Iy ar|aaI|a, caasI|pa!|aa, ||arre4 v|s|aa, Iax|c-caaIas|aaa| sIaIes
On|as!aI|c |ypaIeas|aa, .pa!eace, Ia||are Ia ejaca|a!e
Aat|-h|sta|ac
hcato|og|c
ExIrapyra|4a| sya4raes 4ysIaa|a, a|aI|s.a, psea4a par||asaa.s, 4ys|.aes|aj, a|ac!arr|ea,
aeaarr|ea, .paIeace, we.|I a|a
Se4a!|aa
Araaa|acy!as.s c|atap|aej
hypcrscas|t|v|ty rcact|oas ||ver 4ysIaac!|aa
B|aa4 4yscras.as
S||a ras|es
Mecra|epI|c a|.aaa! sya4rae
A|Iere4 IeperaIare rea|a!|aa |ypaI|er|a ar |yperI|er.aj
Eadoct|ac VeIa|a||c sya4rae see s|4e |arj
NeutOletC NBlgDBDt yD0lODe [NN]
g8jcHa!tccmct_cucj
ducIo massIvc dopamIncbIockadc, ncrcascd IncIdcnccwIIhhIghpoIcncyanddcpoI
ncuroIcpIIcs
t8Kac!ut8
mcdIcaIIonIacIors
" suddcnIncrcascIndosagc,orsIarIIngancwdrug
paIIcnIIacIors
" mcdIcaIIIIncss
" dchydraIIon
" cxhausIon
" poornuIrIIIon
" cxIcrnaIhcaIIoad
" scx:maIc
" agc.youngaduIIs
cucagtc8cu!a!uu
Icvcr,auIonomIcrcacIIvIIy, rIgIdIIy, mcnIaIsIaIuschangcs(usuaIIyoccurrsI)
dcvcIopsovcr24-72h
Iabs.IncrcascdcrcaIIncphosphokInasc,IcukocytosIs,myogIobInurIa
!tca!mcu!. dIsconIInucdrug,hydraIIon, cooIIngbIankcIs, danIroIcnc(hydranIoIndcrIvaIIvc,
uscdasamuscIc rcIaxanI),bromocrpIInc(âgonIsI)
mut!a!y. 5%
LXtlBylBD0Bl yDtOD5 [L]
IncIdcnccrcIaIcdIoIncrcascddoscandpoIcncy
acuIc(carIy-onscI,rcvcrsIbIc)vs. IardIvc (IaIc-onscI,oIIcn IrrcvcrsIbIc)
100 T 1. cXtfyfmd bymtum6
0ystoa|a Akath|s|a Pscadopatk|asoa|s
Acatc or BaI BaI| AcaIe
1ard|vc
8|sk 6roap AcaIe. E|4er|y fema|es
Yaaa As|aa
aa4 B|ac| ma|es
Ptcscatat|oa SasIa|ae4 aaaarma| VaIar resI|essaess, Tremar
pasIare, Iars|aas, Oraw||a seasaI|aa |a 8.|4.Iy (caw|ee|.aj
Iw|sI.a, caaIracI.aa |es re|.eve4 ay wa||.a, k|.aes|a
aI mcsc|e raaps, ve|y 4|sIress.a, .acrease4 PasIara| |asIaa||.Iy
masc|e spasms r|s| aI sa.c.4e aa4 paar 4ecrease4/aaseaI
e.. aca|ayr.c cr.s.s, a4|ereace arm-sw|a, sIaape4
|a|yaaspasm, pasIare, s|aIf||a a.I,
Ian|ca|||sj 4|I||cc|!y p.vaI.aj
0asct AcaIe. w|I|a a 4 AccIe. w|I||a I0 4 AcaIe. w|I|a J0 4
Tar4|ve. >90 4 Tar4.ve. > 90 4
1rcatmcat AcaIe. aeatIrap|ae ar AccIe. |aratepam, AcaIe. aeatIrap|ae
4.p|ea|y4ram|ae prapaaa|a| ar ar aeata4.atep|ae |I
4|p|ea|y4ram|ae, s.4e eIfecIs, re4cce ar
re4ace ar c|aae c|aae oeara|ep!|c Ia
aeara|epI|c !a |awer |awer paIeacy
pa!eacy
PDtBlkD5ODBD PgeDt5 [PDtCOlDelgC PgeDt5]
Iypcs
bcnzIropInc(CogcnIn") 2mgP,IMor!VO( ~-6mg)
amanIadInc(SymmcIrcI") 00mgPbd(00-400mg)
diphcnhydraminc(8cnadryI") 25-50 mgP/!Mqid
donoIaIwaysprcscrIbcwIIhncuroIcpIIcs
gIvconIyIIaIhIghrIskIoracuIcLPSorIIacuIcLPSdcvcIops
0ysk|acs|a
Tar4|ve
E|4er|y Iema|es
Parpase|ess, caasIaaI
mavemeaIs, .ava|v|a Iac|a|
aa4 maa!| masca|aIare, ar |ess
cammaa|y, Ie |.mas
Tar4|ve. >90 4
Tar4|ve. aa aa4 !reaImeaI,
may I|y c|atap|ae, 4.scaaI|aae
4ra ar re4ace 4ase
donoIgIvc IhcscIorIardIvcsyndromcsbccauscIhcyworscnIhccondIIIon
V8jcHa!tj Vb+
FeaIures ol Neuro|epI|c Ma||gnanI
5yndrome
FA8M
feve|
utonom|c changes|e.g.|nc|easedhH/
b|sweat|ng}
igld|tyo|musc|es
Menta|statuschanges|e.g.con|us|on}
|AHMsymptomsa|ea|soseenin
Se|otoninSyndrome|SS}.
SScanbed|stinguished||omNMSby
the|o|lowing.
55 NM5
Tw|tchy,sh|ver|ng, Seve|eg|oba|
|est|ess r|gid|ty
||ushed,sweaty |a||o|
Vom|ting,d|ar|hea, Nolsymptoms
abdomina|pa|n
Tardive ysk|nesia may|nc|ude
gr|macing, tongue prot|usion, lip
smac|ing, and|aldeye movement.
Vb+ V8jcHa!tj
Sc|cc!|vc Scto!o| Bc0!akc |||||!ots |SSB|s|
vctss 0!|ct k1ctcssa6b !ot 0cptcss|6
|0oc|tac Bcv|cw}
L0cb/00 0!0 0l \0mc NWn ZJJ1,
|ss 3
1k|s sysITI|c |v|w ol 9 HU1s coTp|1
I1 l||ccy ol SSH|s w|I1 oIk| \||1s ol
|I|1p|ss|Is |h Ik I|IT|I ol pI||Is w|I1
1p|ss|v 1|so|1|s.
Uoc|0s|o6s. 11| |s |o s|||l|c|I 1|l|||c |h
I1 l|cI|vhss elSSH|s v|ss 1Us. Uohs|1|
||I|v pI|hI ccpI|||Iy, Iox|c|Iy |1 cosI
w1| ckoos||g.
I|ps n 6hoosing AnI|depressants
A||SSH|shaves|m|la|e!!ectiveness,
butcons|ders|deel|ectp|o!||esand
ha|!-l|ves.
bup|op|oncauses|esssexua|
dyslunction,we|ghtga|n,and
sedat|onbutis contra|ndicated!o|
pat|ents w|th h|story olse|zure,
st|o<e, b|aintumou|, b|ainsu|ge|yor
c|ase4 h0dinu|y.A|sa cse4 Ia IreaI
eating diso|de|s.Not|ecommended
!o|anx|etybecauseo!st|mu|at|ng
e!!ects.
M||tazap|neuse!u|i!|nsomn|ao|
ag|tat|onarep|om|nent,ortot|eat
dep|ess|onwithcachexia.
T|azodonema|n|yusedasad|unct!or
SSHl-|nduceds|eepdistu|bances.
Sen|a||ne,citalop|am,and
esc|talop|amhave the |east
inte|act|onswith otherd|ugsanda|e
sleep-wa|eneut|a|.
|luoxet|neandparoxet|nea|ethe
mostact|vat|ngd|ugsandshou|dbe
ta<en|nthemo|n|ng.
|luvoxam|ne|sa|wayssedat|ngand
shou|dbeta|en|n theeven|ng.
how Long Io Ireat!
b-Z monIhs. |l l||sto|secondep|sode
Z yrs. |!thi|dep|sode,e|de|ly,psychot|c
leatures,|elracto|ydep|ess|on,
>Zep|sodes|nby|s
Fsychopharmaco|ogy ol 558Is
FosI-5ynapt|c FllecU5ide Fllect
5eroIon|n
8ecepIor
5I|muIaIed
bhTAce^t|a||y Hel|e!o!1p|ss|o0
Anxio|yt|cel|ect
bhTZAinsp|â| Sexua|1yslu|cI|o0.
co|1 1|y1 |c0|I|o|,
0o|gs^|, 1c|s1
|0I|sJ||b| 1o
bhTZU}ahTZA Act|vat|on.|x|Iy,
inbrai^ |nsomn|a
Worst w|t| llcoxetiê,
proxeI||
Wa|^pI||Is anx|eIy
ayworse^|^!||st
I -Zw<s o! treatme^t
bhT3A || gut L| upset. nausea,
vom|t|ng,b|oat|ng
Ta<ew|thlood
VHatmacu!Hctagj Jutuu!u u!c8 J1J
ntdepressants
onscIoIcdccI
ncurovcgcIaIIvcsympIoms I-Jwks
cmoIIonaI/cognIIIvc sympIoms 2-6wks
mayusc mIIdsIImuIanI (c.g.mcIhyIphcnIdaIc)IorscvcrcncurovcgcIaIIvcsympIomsbrIcyand
IapcrdownasanIIdcprcssanIcdccIIncrcascs
IapcrJC^ssIowIy(ovcrwccks-monIhs)bccauscIhcycancauscwIIhdrawaIrcacIIons
IapcrIngoIanykIndoIanIIdcprcssanImaybcrcquIrcdbascdonIhchaII-IIIcoIIhcmcdIcaIIon
andIhcpaIIcnI'sIndIvIduaIscnsIIIvIIy
IIIs ImporIanIIobcparIIcuIarIyvIgIIanIovcrIhchrsI2wksoIIhcrapyasncurovcgcIaIIvc
sympIomsmaysIarIIo rcsoIvcwhIIccmoIIonaIandcognIIIvcsympIomsmaynoI (paIIcnIs may
bcparIIcuIarIyaIrIskIorsuIcIdaIbchavIourdurIng IhIsIImc)
IrcaImcnIoIbIpoIardcprcssIon.monoIhcrapywIIhanIIdcprcssanIsIsnoIadvIsabIcasaswIIch
Irom dcprcssIonIomanIacanoccur.!IIhcpaIIcnI Is mcdIcaIIon-navc, InIIIaIcIhcrapywIIh
amoodsIabIIIzcrpIusan SSR! orbuproprIon. IorpaIIcnIsIakIng mood sIabIIIzcrs, consIdcr
addIngorswIIchIngIoIIIhIumorIamoIrIgInc,oraddInganSSR!orbuproprIon
100 T . ummu0 0td0f0660t6
0|ass 0tag 0a||y 5tatt|ag 0osc |g| Thctapcut|c 0osc |g|
558| I|aaxeI|ae Pratac'j Z0 Z0-&0
I|avaxa.ae |avax'j a0- I 00 ! a0-J00
paraxeI|ae Pax||'j I 0 Z0-0
ser!ra||ae Za|aI!'j a0 a0-Z00
c|Ia|apra Oe|exa'j Z0 Z0-0
esc|!a|apra O|pra|ex'j I 0 0-Z0
5W8| vea|afax|ae EIfexarj J7.a-7a 7a-ZZa
4a|axeI|ae Oyaa|!a'j 10 10-0
W08| aaprap|aa We||aaIr.a'j I 00 J00-1a0
T0A 1A|acs| a|Ir.p!y||ae E|av||'j 7a-00 I a0-J00
||pra|ae TaIraa.|'j 7a- 00 I a0-J00
10A tA|acs| aa|tr|pIy||ae AveaIy|'j 7a-!00 7a-Ia0
4es|pra|ae Marpra|a'j I 00-Z00 a0-J00
MA0| p|eae|t|ae Mar4||'j 1a 0-90
Iraay|cypra.ae ParaaIe'j J0 I 0-0
8|MA ac|aae.4e Vaaer|x'j J00 J00-00
WA55A |rIatap.ae Reeraa'j I a I a-1a
SSH|=s|cI|v s|oIo||| |pI\ ||1|o|s, Sh| =s|oIoh|h 01 ho|p||p1||h |pI\ ||k|o|Io|s, hUH|=|o|p|hpk||| |1 1opT|| |pI| |h1||Io|s,
1U=I||cyc||c |I|1p|sshIs, YU|= To|oT|| ox|1s ||1|1o|s, H|Y=|v|s|| ||k||I|oh ol YU-, MSS=|o|1|||g|c |1 spc|lc s|oIo||| |Io||sIs|
leutneDt tlutege5 Ol HeluCtOly ele55OD seeIigure2)
ug!m2a!uu. cnsurIngadcquaIc drugdoscsIor IhcIndIvIduaI
au_mcu!a!uu. Ihc addIIIon oIamcdIcaIIon IhaIIsnoIconsIdcrcdan anIIdcprcssanIIoan
anIIdcprcssanIrcgImcn(c.g. IhyroIdhormonc,IIIhIum,aIypIcaIanIIpsychoIIcs)
cumDua!uu. IhcaddIIIonoIanoIhcranIIdcprcssanIIoancxIsIIngIrcaImcnIrcgImcn(c.g. Ihc
addIIIon oIbupropIon Io an SSR! orSNR!)
8uD8!!u!c: changcInIhcprImaryanIIdcprcssanI(wIIhInorouIsIdcacIass).NoIc.IIIs
ImporIanIIoIuIIyIrcaIIhcsympIomsoIdcprcssIonInordcrIo dccrcascraIcs andscvcrIIyoI
rcIa scs
StanSSHlo|othe|lirst|ineagent
HeassesseveryI -Zw<sl0| -4w|s

I
+
|u|l|esponse Noo|pa|||a|response

Uont|nue pI|m|zedose

Heassessregu||ylo|4-8w|s

+
|u|||esponse Par||a|response No|esponse
Uomb|ne
guf0 Z. f0tm00t u 0f066u0
I

Augment Switch
Jutuu!uu!c8212
100 T S. ummu0y U60d 0td0f0660t6
10A
0oas|Jctat|oas OOO c|a|pra|aej
Ve|aac|a|.c 4epress|aa
Modc ol Act|oa B|ac| aarep|aepr|ae aa4 sera!aa|a
reapIa\e
VHatmacu!Hctagj V8jcHa!tj Vb+b
558| MA0| 5W8|
Aax|eIy sIaIes, OOO, eaI.a 4.sar4ers, |ar a4eraIe/severe 4epress|aa I|aI Oepress.aa, aax|eIy 4.sar4ers
seasaaa| 4epress.aa, !yp.ca| aa4 4aes aaI respaa4 Ia SSR|
a!yp.ca| 4epress|aa
AIyp.ca| 4epress.aa
B|ac| sera!aa|a reapta|e aa|y |rrevers.a|e .a|a.I.aa aI aaaa|ae
ax|4ase A aa4 B
|ea4s Ia 4 aarep|aep|r.ae aa4
seraIaa.a
B|ac| aarep.aep|r|ae aa4 seraIaa.a
reapIa|e
5|dc Ellccts AaI.ca||aer|c eI|ecIs. see Taa|e I |ewer I|aa TOA, !|ereIare .acrease4 Hypeneas|ve cr.ses w.I !yra.ae r|c |aw 4ase s.4e eI|ecIs .ac|a4e |asaa|a
Mara4reaer|c eI|ecIs. Irears,
Iac|ycar4.a, sweaI|a, |asaa|a,
erecI.|e aa4 e|aca|aI.aa praa|es
o-I a4reaer|c eI|ecIs. arIas!a!|c
|ypaIeas.aa
AaI.|sIa.ae eI|ecIs. se4aI.aa,
we|! a.a
OMS. se4aI.aa, s!|a|aI|aa,
+se|tcre I|res|a|4
OVS. 4 HR, caa4acI.aa 4e|ay
8|sk |n 0vctdosc Tax.c |a OO
J !|es I|erapea!|c 4ase |s |eI|a|
PreseaIaI|aa. aaI.c|a|.aer.c eIIecIs,
OMS sI|a|aI|aa, I|ea 4epress|aa aa4
se.tares
EOO. 44araI|aa reI|ec!s sever.Iyj
TreaIea!. ac!|vaIe4 c|arcaa|,
caI|an|cs, sapparI.ve !reaIea!, |V
4|atepa Iar se|tare, p|ysas!||ae
sa||cy|aIe Iar caa
Oa aaI |ve .pecac, as caa caase rap|4
aeara|a|c 4eIer|araI|aa aa4 se|tares
0tug |ntctact|oas VAO|, SSR|
EIOH
W08|
0oas|Jctat|oas Oepress|aa, seasaaa| 4epress|aa
Modc ol Act|oa B|ac| aarep|aepr|ae aa4 4apa|ae
reapIa\e
5|dc El|ccts OMS. 4|n|aess, |ea4ace, Irear,
|asaa|a
OVS. 4ysr|yI||a, |ypeneas.aa
O|. 4q aa!, NcaasI|paI.aa,
4appeI|Ie
O!|er. a|!a!|aa, aax.eIy,
aaap|y|acIa.4 reac!|aa
8|sk |n 0vctdosc Trears aa4 se|tcres seea |a acaIe
aver4ase
0tug |ntctact|oas VAO|
Oras I|aI re4ace se|tare !|resa|4.
aaI.psyc|aI.cs, sys!e.c sIera|4s,
c|aa|aae aaI|a.aI|cs, aaI|a|ar|a|
4rcs
cap|.aace
OMS. resI|essaess, Irear, .asaa|a,
|ea4ac|e, 4raws|aess
Ol. N4|arr|ea, aaJa|aa| craps,
we||I |ass
Sexaa| 4ysIcac!|aa. . paIeace,
aaaras|a
OVS. |acrease4 HR, caa4acI.aa 4e|ay
Sera!aa|a sya4rae, EPS, S|AOH
Re|aI.ve|y saIe |a OO
Iaa4s e.. w|ae, ceese |,|ea4ac|e, seraIaaer|cj
I|as|es, pa|p|!aI|aas, MN, p|a!apaa|a
H||er 4ase s.4e efecIs .ac|a4e.
O|n|aess, ref|ex !ac|ycar4|a, pas!cra| !rears, Iac|ycar4|a, sweaI|a,
ypa!eas|aa, se4a!|aa, |asaa|a |asaa.a, 4ase- 4epea4eaI .acrease |a
We|I a.a
4.asIa|.c BP aara4reaer|cj
Sac|a| 4ysfaacI.aa
Eaer|t|a
V.a|a| aaI|ca||aer|c aa4
aa!||sIa|ae effecIs
Tax|c .a OO, aaI w.4er ar|a aI
saIeIy I|aa TOA
Tacycar4|a aad MN seea .a acaIe
aver4ase
SSR|s .a||a|I P1a0 eotyes, I|ereIare E!OH VAO |, SSR|
w||| 4|eve|s af 4ras e!aaa||te4 ay
Hypeneas|ve cr.ses w|I Oaes aaI see !a |a|.a|I P1a0 sysIe
P1a0 sysIe
aara4reaer.c e4|ca!|aas e.. TOA,
4ecaaes!aaIs, ap|eIa|aesj
8|MA
Oepress|aa aarespaos|ve Ia aI|er
!|erap|es
Revers|a|e |a|.a|!ar aI aaaa|ae
ax|4ase A
|ea4s !a 4aarep.aep|r|ae aa4
sera!aa|a
OMS. 4.n|aess, |ea4ac|e, Irear,
|asaa.a
OVS. 4ysr|yI||a, |ypaIeas.aa
Ol. 4q aaI|, MN, 4|arr|ea,
aa4a.aa| pa.a, 4yspeps|a
OU. 4e|aye4 ejaca|aI.aa
OIer. 4.ap|ares.s
R.s| af faIa| aver4ase w|ea caa|ae4
w|I c|!a|apra ar c|a|pra|ae
VAO|, SSR|, TOA
Op|a|4s
SeraIaa|a sya4rae w.I|
seraIaaer.c 4rcs e.. SSR|,
IqpIapaa, 4exIraeI|arp|aaj
WA55A
UseIa| |a paI|eaIs w.I |asaa.a, a.IaI.aa ar 4epress.ar w|I cac|ex|a
Ea|aace ceaIra| aara4reaer|c aa4 seraIaaer|c acI|v.Iy ay .a|.a|I|a
presyaapI|c o-Z a4reaer.c recep!ars
OMS. saaa|eace, 4.n|aess, se|tare rarej
Ea4acr.ae. Jc|a|esIera|, J!r||ycer.4es
O|. caasI.pa!|aa, 4A|T
V||4 syp!as w.I| aver4ase
VAO|, SSR|, SMR|, R|VA
Vb+ V8jcHa!tj
L
5ympIoms ol AnIidepressanI
0isconI|nuaI|on
fINI5h
flu-li|esymptoms
Insomn|a
Nausea
Imba|ance
5ensorydistu|bances
hypera|ousal|anxlety/ag|tation}
Scqc6cc1 T|etnetk|te|0t|vettoBc||v
0ctcss|o
Ju00l ul |chuucll A0l8ln ZJJ, 1c.Z!-Z1
S!1y. ||ospcI|v ||1oT|t1 |I|-1p|ss|I
I|Im|I I|||.
PI|hIs. 1JJU pI|hIs w|I1 m|o| 1p|ss|v
1|so|1|.
Jo|cl|vc: 1o coTp| I1 ll|ccy |1 Io|||||Iy
oI v||ous |I|1p|ss|I I||p|s I1|og1 lo|
sqhI|| I|ImhI |v|s.
|hlnhl|6h. |v| l-c|I|op|m |l ||ps
|v| Z-c|I|op|m * p|op|o| SB, s|I|||h,
v||lx|| XB, 0| t0gh|l|v pyt10l1|py. |vl
Z-sw|Ic1 Io op|op|o| o| v1|lx|| XB. |v|
J-|I1| T||Itp|| o| |o||||ply||h ||I||dm,
13. |v| 1-I||y|cyp|oT|| o| v||lx|h XB *
m||ltp|h.
Bcs||s. Bm|ss|o| |Is w| Z" lo| |v| l ,
!!" lo| |v| Z, ! Z-Za" lo| |av| J, |1 !-!1" lo|
|v| 1. W|| mo| I|Imhl sIps | |q||1,
|ow| |m|ss|oh |Is, g|I| 1g|s ol Io||hc,
|1 1|g1| |Is ol ||ps.
Longte|m l|th|um use can |eadtoa
neph|opathyand diabetes|nslp|dus|n
somepat|ents.
f_
UIhium 5ide Fl|ecIs
LIThIVM
Leu|ocytos|s
Ins|p|dus|dlabetes}
Tremo|, teratogen|c|ty
hypothy|o|dism
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esp|teongoingstigmat|zat|on,ECTas
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