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DISORDERS

DURATION/ON
SET

Mental Retardation

Onset <18y.o

Learning Disorders

Onset: elementary
school

SYMPTOMS/MANIFESTATIONS

Childhood
D.

Pervasive
Developmental
Disorder

Autism

Dx: after 2 BD

Retts Sd

Between ages 1 &


4

Attention Deficit Hyperactivity


Disorder (ADHD)

Conduct Disorder

Oppositional Defiant Disorder

TREATMENT

IQ < 70 + social adaptive deficits


Causes: 1 Fetal Alcohol Sd. 2 Down Sd. 3 Fragile X Sd.

Level
IQ
Functioning
Mild
5085%. Self-supporting. 6 grade level. Self-esteem &
70
impulse control problems.
Moderat
35Trainable, can work w/supervision. 2 grade level.
e
49
Problems conforming to social norms. Higher risk of
AD.
Severe
20Basic self-care habits (brush teeth, comb hair). Live
34
in group home setting.
Profound <20
Dependant 24/7. Little or no speech
Learning achievement below expectations, given pts age, intelligence,

sensory abilities & educational experience.


Reading, math & written expression disorders are the MC.
May be present: Perceptual motor problems. Conduct disorder.

Oppositional Defiant disorder. ADHD. Poor self-esteem & social


immaturity
MR (75-80%, the lower the IQ, the higher the incidence of autism)

Social, communication & behavioral symptoms (bizarre mannerisms)


Abnormal language: pronoun reversal (everything in 1 person)

Avoid others. Minimal eye contact. Shrink shoulders when touched.


Doesnt cry when mother leaves: no separation anxiety.
May be aggressive towards others.
Avoid pleasure & may injure himself to calm down (head banging on
the wall)
X-linked Dominant (seen almost always in girls, boys die in utero)

Loss of development: it stops! Motor/Language Regression: loss of

verbal abilities. MR. Emotional inversion.


Self-mutilating behavior. Hypotonia, dystonia, chorea, ataxia, bruxism
Stereotyped handwriting.
Scoliosis, Long QT Sd, GI reflux

Inattention, hyperactivity & impulsivity that interfere w/ social &


Onset < 12y.o.
academic function.
Symptoms last > 6 Multiple settings: home, school, work (deficits in 2 or more areas)
months
Difficulty controlling attention. Unable to sit still. Disruptive in the
classroom.
Easily distracted. Impulsive. Fidgets. Speaks out of turn.
Difficulty in relationship w/ others
Violation in 4 areas:
Dx < 18y.o
Aggression: towards people & animals, bullying, fighting, rape.
(In >18y.o. is
Property destruction: vandalism, fire setting.
Antisocial
Deceitfulness or theft
Rules: do not follow them
Personality
Disorder)
Onset: early
Pattern of negativistic, hostile, and defiant behaviors toward adults:
adolescence
arguments, temper outburst, vindictiveness, deliberate annoyance

Primary Prevention:
Genetic counseling if family hx.
Prenatal care

Special education: maximize


skills, improve weak areas.
Pt & family counseling.

Behavioral techniques:
shaping.
When pt is aggressive to self &
others, give atypical
antipsychotics:
Risperidone.

Behavioral techniques: teach


child to communicate.
Beta blockers for long QT Sd.
Pump Proton inhibitors for
reflux.
Antipsychotics for self-harm
behavior.
Drugs Mnemonic: Mox Mete
Dextro
atoMOXitine (most effective)
METHYLphenidate (>6y.o)
DEXTROamphetamine
(>3y.o)
Healthy group identity & role
model (big brother
programs)
Structured living settings:
change environment.
Try to get parents involved.
Family quality time (dont
punish behavior, & reward the

(typical annoying teenager)


Childhood Enuresis

Childho
od
Anxiety

Onset < 5y.o.

Stranger Anxiety

6months 2y.o.

Separation Anxiety

1 3y.o.
7-9yr physical
complaints
Onset < 18y.o.

Tourette Disorder

Major Depressive Disorder


(MDD)

Duration of
symptoms >2
weeks.
Duration of
episodes between
6m 12m

Repeated voiding of urine into pts clothes or bed, when medical


conditions are ruled out. Related to stress, family hx of enuresis.

Stranger Anxiety: fear of stranger in unfamiliar situations


Separation Anxiety: fear of separation from caregiver.
Family therapy.
Physical complaints: stomach ache, malaise, unrealistic fears
(monsters), nightmares, difficulty sleeping, phobias, self mutilation Cognitive behavioral therapy.
(scratching, nail-biting, hair-pulling)
Vocal tics: grunts, coprolalia.
Pimozide, Haloperidol,
Motor tics: twitching of face, trunk, extremities & pacing, spinning and
Olanzapine,
touching.
Risperidone, Clonidine,
Clonazepam.
SIGE CAPS
1 secure safety: is pt suicidal?
S leep disturbances: hyper or hyposomnia.
Antidepressants: SSRI (the
slow-wave sleep (delta)
REM early in sleep
best, and > compliant), TCA,
cycle
MAOi.
REM latency
total REM sleep
Electroconvulsive therapy: in
Repeated nighttime
Early morning
acute situations (suicidal pt),
awakenings
awakenings
when drugs dont work, or
I nterest lost: anhedonia
when pt is worried about SE.
G uilt or feelings of worthlessness
E nergy: lost
Controversial use.
Individual psychotherapy.
C oncentration: lost (bad serial 7, serial 3)
A ppetite: or, weight changes.
P sychomotor agitation or retardation (stooped posture, slow
movements & speech)
S uicidal ideas

Atypical depression

Mood D.

MC subtype. Hypersomnia + Overeating + Mood Reactivity. Leaden


paralysis (pt feeling his limbs are weighed down)

Dysthymic Disorder

>2years

Same as MDD but milder

Seasonal Affective Disorder

Winter months

Atypical symptoms

Bipolar
Disorder

BD I

BD II

Manic symptoms
>1 week, cause
significant distress
& impairment in
functioning.
Onset: 30y.o
(average)

desired one)
Behavioral approach Bellpad app (wet VS. dry,
reward dry days)
Drugs: Imipramine,
desmopressin (nasal spray,
DDAVP)

1 Manic episode (w/ or w/o hypomania & depression)


Increased self-esteem, or grandiosity.
Distractibility.
Low frustration tolerance
Erratic, uninhibited behavior
More talkative than usual (pressured speech), flight of ideas.
Excessive involvement in activities.
Increased libido & sexual activity.
Weight loss & anorexia (bc theyre busy doing a lot of stuff, is not on
purpose)
Recurrent depressive episodes + hypomanialike mania but mood
disturbances not severe enough to cause social impairment

MOAi, SSRI
Long-term individual, insight oriented psychotherapy.
SSRI, MOAi, SSRI
Bright light therapy. Go to
Florida.
Mood stabilizers: Lithium,
Valproic acid (tx of choice).
BZD: carbamazepine.
Atypical Antipsychotics in
acute manic states:
Resperidone, olanzapine,
clozapine
Individual psychotherapy.

Cyclothymic Disorder

>2 years

Pathological Grief
(Bereavement)

>6months

Post
-Partum
Depressi
on

After birth 2
weeks
1m after birth, last
4-6m

Baby blues
Postpartum
Psychosis

Postpartum
Depression
Brief Psychotic Disorder
Schizophreniform Disorder

(at least one episode of each)


Milder BD. Many periods of depressed mood & many of hypomanic
mood.
Ego - syntonic
Good and bad days. Can cause functional impairment. Return to basal
level of functioning within 2 months (MDD pts dont). If symptoms
persist, it becomes MDD.
Mild depression
May have thoughts of hurting baby + severe depression + psychosis

1m after birth, last


2w - 1y or >
<1month
1-6 months

May have thoughts of hurting baby + severe depression

>6months

Schizophre
nia
& Other
Psychotic
D.

Schizophrenia

Onset
F: 25y.o.
M: 15y.o. (worse
px)

Schizoaffective Disorder

>2 weeks of
delusions or
hallucinations w/o
mood symptoms

Delusional Disorder

>1 month

Panic Disorder

>1 month

Delusions + no impairment in level of functioning. (before: nonbizarre


delusions)
Types: erotomanic, jealous, grandiose, somatic, mixed, unespecified.

Specific Phobias
Phobi
as

> 6months
Agoraphobia

Positive symptoms
Positive + Negative symptoms
Thought disorder that impairs: judgment behavior, ability to interpret
reality
PE: saccadic eye movement, hypervigilance
CT scan: lateral & 3 ventricles enlarged (the larger, worse px & >
negative symptoms)
Frontal & temporal lobe dysfunction: DECREASED metabolism
Positive symptoms
Negative symptoms
Bizarre Delusions
Flat (blunted) affect
Hallucinations (>>> auditory)
Social withdrawal
Disorganized speech: loose
Lack of motivation
associations
Disorganized or catatonic
Lack of speech or thought
behavior
Schizo psychotic disorder; Affective mood disorder.
Psychotic symptoms (positive or negative) + major depressive or
manic or both episodes.
2 subtypes: bipolar or depressive.

ABRUPT onset: recurrent periods of intense fear discomfort peaking in


10 minutes with:
P alpitations, P aresthesias.
A bdominal distress.
N ausea.
I ntense fear of dying, LIghth headedness.
C hills, C hoking, disConnectedness, C hest pain.
S weating, S haking, S hortness of breath.
Plus: persistent concern of additional attacks + worrying about its
consequences + related behavioral changes
Anxiety when faced with identifiable object or situation. Pt tries to
avoid it. Disabling fear
Fear of open or enclosed spaces from which escape would be difficult
in the event of panic symptoms

Individual psychotherapy.
If not sufficient: Lithium,
Valproic ac
Supportive psychotherapy.

Self-limited.
Antidepressants +
Mood stabilizers or
antipsychotics
Antidepressants.
Hospitalization: stabilization
and/or safety of pt to self or
others (e.g. suicidal, want to
kill someone)
Atypical Antipsychotics.
If all drugs have failed:
Clozapine (remember WBC
count weekly bc of risk of
agranulocytosis)
Supportive psychotherapy:
ego builder, make sure pt
trust you & is compliant with
medications.
Hospitalization?
Antidepressants &/or
anticonvulsants
If not effective: atypical
antipsych.
Often self-limited.
Psychotherapy.
Antipsychotics.
In acute situations:
Alprazolam
SSRI (1 choice)
TCAs: Imipramine
Clonazepam
If hyperventilation: CO2
(breath in a paper bag)
Keep tx for 6-12m
Systematic desensitization.
Assertiveness training.

Social Anxiety
Disorder

Anxiety D.

Obsessive Compulsive Disorder


(OCD) & related disorders.
Body Dysmorphic D.

Acute Stress Disorder &


Post-Traumatic Stress Disorder
(PTSD)

Acute > 2days,


<1month
PTSD >1month

Adjustment Disorder

< 6months

Generalized Anxiety Disorder


(GAD)

> 6months

Former Social Phobia. Fear of embarrassment in social situations.


Stage fright!
Obsession: intrusive thought 1contamination, 2doubt, guilt,
aggression, sex, etc.
Compulsion: repetitive action 1hand washing, 2checking,
organizing, counting, praying, etc.
Pt is EGO DYSTONIC (they hate doing all the rituals)
Frontal lobe: INCREASED metabolism
Caudate nucleus: increased metabolism
Body Dysmorphic Disorder
Pt truly believes that some part is abnormal, defective, or misshapen
when NOT (e.g. facial flaws) impairment in level of functioning.
Constant mirror-checking, hide deformity, housebound, avoid social
events.
Severe anxiety symptoms followed by a threatening event that caused
feelings of fear, helplessness or horror (right after or years after event.
The sooner, the better the px)
Re-experience of the event: recurrent dreams, flashbacks
Phobic avoidance (pt was raped in school, pt drops out of school)
Increased anxiety. Sleep disruption or excess.
REM
Amount of
Stage
Latency
REM
4
Maladaptative reactions to an identifiable psychosocial stressor
Presence of IDENTIFIABLE STRESSOR (cant be grief) within 3 months
of onset
Anxiety, depression or emotional turmoil with significant social,
academic and/or occupational IMPAIRMENT
Excessive, poorly controlled anxiety about life circumstances. Physio &
Psychological sx.
Physiologic component
Worry thats difficult to control
Hypervigilance
Restlessness
Sleep disturbances
Difficulty concentrating

Somatic
Symptoms
& Related
D.

*Symptom
production:
UNCONSCIOUS
*Symptom
motivation:
UNCONSCIOUS

Somatic
Symptom
s Disorder

Months - years

Conversio
n Disorder

Illness
Anxiety
Disorder

> 6months

Psychologic component
Autonomic hyperactivity:
* shortness of breath
* diaphoresis
* tremor
Motor tension

Multiple symptoms affecting multiple organs.


Somatic symptoms + somatic symptoms plus abnormal thoughts,
feelings & behaviors w or w/o a medical condition

SSRI
Beta blockers: stage fright
Behavioral psychotherapy:
relaxation training, guided
imagery, exposure &
response prevention.
SSRI: fluoxetine, fluoxamine
TCAs: Clomipramine
BDD
Individual psychotherapy
Antidepressants.

Group therapy
Constant counseling
SSRIs improve functional level
Antidepressants
BZD
Best choice: pharmacotherapy

Supportive psychotherapy
Anxiolytics,
antidepressants

Behavioral therapy: relaxation


training, biofeedback
SSRI
SNRI: Venlafaxine
Buspirone
BZD

Single identified physician.


Scheduled brief monthly visits
pts awareness of
psychological sx

Pt experiences 1 or > neurologic symptoms (e.g. paralysis, seizures,


mutism, blindness) that cant be explained, always following an
Psychotherapy
acute stressor.
La belle indifference: pts not aware of impairment
Scheduled monthly visits for PE
Formerly known as hypochondriasis.
Pt believes to have a specific disease despite CONSTANT
REASSURANCE.
Preoccupation for said disease which affects pts level of functioning.

Factitious
D.

Malingerin
g D.

*Symptom
production:
CONSCIOUS
*Symptom
motivation:
UNCONSCIOUS

Munchaus
en
&
Munchaus
en by
proxy

*Symptom production:
CONSCIOUS
*Symptom motivation:
CONSCIOUS

Delirium

Cognitive
D.

Conscious production of signs & symptoms of medical and/or


psychological disorders.
Objective: assume sick role & hospitalization (they need the attention,
Management rather than cure
be nurtured)
Demand tx in hospital negative tests accuses & threatens Dr
angry when confronted goes to new hospital
By proxy: when signs & symptoms are faked by another person
(mother & kid)
Conscious production of signs & symptoms. NOT A MENTAL DISORDER
Objective: personal gain (drugs, money, avoid work, free bed
Preoccupied more with rewards than with alleviation of symptoms
Prominent disturbances in alertness & confusion, and a short
fluctuating course.
MCC: 1 Acute Metabolic Disorders. 2 Substance abuse behavior.
Sx: agitation or stupor, fear, emotional lability, hallucinations,
delusions & disturbed psychomotor activity, incoordination, tremor,
asterixis, nystagmus.
Prominent memory disturbances + other cognitive disturbances
present even in the absence of delirium.
Abnormal neuroimaging & neuropsychiatric symptoms.
Sx: increasing disorientation, anxiety, depression, emotional lability,
personality disturbances, hallucinations & delusions.
Specific dementias:

Dementia
* Dementia of Alzheimer type
* Vascular (multi-infarct) dementia
Dementia
* Pick Disease
* CJD
Hydrocephalus
* Huntington Disease
* Parkinson Disease

Amnestic Disorder

Dissociative Identity Disorder

Dissociativ
e D.

Depersonalization /
Derealization Disorder

Correction of physiologic
problem.
Orientation & reassurance.
Antipsychotics & restraints if
necessary.

Correction or amelioration of
underlying pathology.
Provision of familiar
* Lewy Body Disease
surroundings, reassurance,
* HIV related
and emotional support.
* Wilson Disease
* Normal Pressure
* Pseudodementia

Prominent memory impairment in the absence of disturbances in the


level of alertness or other cognitive problems.
MCC: alcohol (bilateral diencephalic & mediotemporal damage,
mammilary bodies, fornix & hippocampus due to thiamine
deficiency, etc)
Wernicke-Korsakoff Syndromes.
Former Multiple Personality Disorder
Multiple distinct personalities that controls pts behavior + failure to
recall important personal information
Symptoms of disruption of identity: reported & observed.
Gaps in the recall of daily events (not only traumatic events)
Persistent or recurrent feelings of being detached from ones mental
processes or body + intact sense of reality
Depersonalization: out-of-body experience
Derealization: environment is distorted or strange + detached of
physical surroundings. Jamais vu, dj vu.

Correction or amelioration of
underlying pathology
e.g.give thiamine

Psychotherapy.

Dissociative amnesia
Dissociative fugue

Intermittent Explosive Disorder

Kleptomania

Impulse
Control D.
Pyromania

Pathologic Gambling

Trichotillomania

Restricting type
Anorexia
Nervosa

Eating D.
Bulimia
Nervosa

Bingeeating/purging

Purging type
(vomit, laxatives,
diuretics, enemas)
Non purging type
(fasting or
exercise)

Significant episodes when pt cant recall important & often emotionally Rule out medical condition or
charged memories.
substance abuse.
It may suddenly or gradually remit, when traumatic event is resolved Hypnosis, suggestion &
relaxation techniques.
Dissociative fugue
Psychotherapy.
Sudden, unexpected travel + inability to remember ones past +
confusion about personal identity or assumption of a new one.
Onset: Minutes Failure to resist aggressive impulses. Reaction out of proportion to the
hours after stressor
stressor.
Result: serious assaultive acts & destruction of property

Failure to resist impulses to steal objects that pt dont need.

Anxiety prior the act. Released of anxiety after the act.

Goal: stealing.

Anticonvulsants,
antipsychotics, betablockers, SSRIs.
Psychotherapy.
Insight-oriented therapy
Behavioral therapy:
conditioning & systematic
desensitization.
SSRIs or Anticonvulsants.

Deliberate fire setting on more than 1 occasion.


Anxiety prior the act. Released of anxiety after the act, followed by
gratification and fascination.
Persistent and recurrent gambling behavior.
Preoccupation with gambling, need to gamble > money, attempt to
stop or gamble to win back losses, illegal acts to finance gambling.
Loss of relationships
Pt pulls hair off, result in hair loss.
Anxiety prior the act. Released of anxiety after the act.
Scalp hair is MC. Nail-biting, head-banging, gnawing may be present
Self-imposed dietary limitations, self starvation. Fear of gaining weight.
Body image disturbance: feel fat when theyre very thin. BMI<
18.5Kg/m2
Failure to maintain normal body weight: >15-20% of ideal body weight
lost.
Amenorrhea for 3months or more, lanugo.
Compulsive, rapid ingestion of food, followed by self-induced vomiting,
use of laxative or exercise (binge & purge)
Low baseline serotonin: behavior of purging becomes addictive.
Sx: scars on back of hand, esophageal tears, dental cavities, enlarged
parotid, minimal public eating.

Incarceration, no tx beneficial.

Gamblers Anonymous.
SSRIs.
Behavior modification
techniques.
Anticonvulsants,
antipsychotics, SSRIs.
Stabilizing weight.
Family & individual therapy.
Mirtazapine: antidepressant
that increase appetite.

SSRIs
Imipramine
Psychodynamic psychotherapy

P
e
r
s
o
n
a
l
i
t
y
D
.

P aranoid

Cluster
A
Odd,
eccentric
type.

S chizoid

S chizotypal

H istrionic

Cluster
B
Dramatic,
emotional
type.

A ntisocial

N arcissistic

B orderline

O bsessive-Compulsive

Cluster
A voidant

If younger than 18
Dx as Conduct
Disorder.

Long-standing suspiciousness or mistrust of others.


Worried w/ issues of trust. Reluctant to confide others.
Lifelong pattern of social withdrawal. Disinterested in others.
They love to be by themselves.
Seen by others as: eccentric, isolated, withdrawn. They think the same
of others.
Emotionally distant: no expressions.
Very odd, strange, weird, discomfort with social relationships.
Social anxiety (uncomfortable with others), lack of close friends.
Magical thinking: telepathy, illusions, ideas or reference &
persecution.
Odd preoccupation, speech & affect.
Colorful, dramatic, extroverted.
Cant maintain long-lasting relationships.
Attention seeking (center of the world, they do anything to get your
attention).
Seductive behavior.
Inability to conform social norms: truancy, delinquency, theft,
running away
No treatment just long term
Aggressiveness, lack of remorse of criminal acts (serial killers).
talk psychotherapy (7-10y)
Disregard for the right of others.
Grandiose sense of self-importance, demands constant attention.
Over-concerned with issues of self-esteem, fragile self-esteem, prone
to depression.
Criticism met with indifference or rage. they are THE shit
Very unstable affect, behavior, self-image, mood swings, suicidal.
Unstable but intense relationships, love/hate, dependant.
Self detrimental impulsivity: promiscuous, gambling, overeating,
substance abuse.
Constant state of crisis, chaos: incapable of tolerating anxiety .
Orderliness, inflexible, perfectionist: <3 lists, rules, order.
Stubborn, no sense of humor, wants a routine.
Unable to discard worn-out objects, doesnt want change.
They dont have obsessions nor compulsions!
Extreme sensitivity to rejection & social isolation: they want
friends but they are too shy to initiate friendship, they think the rest

C.

should change, not them.


They thing theyre social inept
Excessive shyness, anxiety
Subordinates own needs to others, let others assume
responsibility.
Dont disagree.
Major life decisions are needed to be taken by others.
Great fear of having to take care of self.

Anxious,
fearful type.

D ependant

Sleep D.

Narcolepsy

Onset of REM: 10
minutes

Sleep
Apnea

Obstructive

Middle-aged

Central

Elderly

Mixed

Insomnia

Disorder of REM sleep, linked to orexin transport deficiency


(hypocretin protein)
CHAP
C ataplexy: pathognomonic; sudden and transient episode of muscle
weakness accompanied by full conscious awareness, typically
triggered by emotions such as laughing, crying, terror, etc.
H ypnaGOgic hallucinations: pathognomonic; hallucinations when
GOing to sleep. HypnaPOMPic hallucinations (when POMPing out of
bed) can occur as well, but not pathognomonic.
A ttacks: sleep attacks & excessive daytime sleepiness.
P aralysis: sleep paralysis (REM: brain ON, body OFF)
Upper airway. Rasping
Pt complains/may develop:
snoring
Dry mouth, headaches in the a.m.
Diaphragmatic. Cheyne Tired during the day
Stokes (60
Nocturnal <3 arrhythmias, BC then TC,
hyperventilation, then by
hypoxemia, pulmonary HTN, high
apnea)
risk of sudden death during sleep.
Central at first, but
prolonged due to collapse of
airway.
Usually overweight (in all
types)

2 to hypnotic medication abuse (tolerance, sleep fragmentation)


Emotional problems: anxiety, depression, mania (BD w/insomnia:
mania is coming)
Poor sleep: habit of sleep is lost
Drug or alcohol withdrawal.

Tx of choice: Modafinil
Moda Fina
(nonamphetamine: inhibits
DA re-uptake, activates
glutamate, inhibits GABA)
If cataplexys present: TCAs
(suppresses REM),
antidepressants.

CPAP: Continuous Positive


Airway Pressure.
Weight loss if needed &
change sleep position (beh.
Conditioning)
If severe: tonsillectomy or
tracheostomy.

Tx of choice: behavior therapy


good sleep hygiene.
Drugs 10-14d, not more!
(tolerance, dependency)
Non-BZD, GABA receptor
agonist: zaleplon,

GABA levels

Nightmares
Night terrors
Parasomni
as

Gender
Dysphoria

MC 3-7y.o

REM

MC in boys, runs in
family
Begins at young
age

Stages 3
&4
Stages 3
&4

Somniloquy

Common in
children

All stages

Enuresis

Childhood

Stages 3
&4

Somnambulism

Former Gender Identity Disorder


Sexual Identity: based on
phenotype
Gender Identity: persons sense
of maleness or femaleness

Gender identity is
established by the
age of 3

Elevated physiologic
arousal

Awakened
by sleep or
intense
anxiety
Terminates
in
awakening

Perseverative behaviors
Performed w/o full
consciousness
Sleep talking, may
accompany
sleep terrors or walking
Already discussed in childhood disorders.

Memory of
event
No memory of
event
Followed by
confusion

Persistent discomfort & sense of inappropriateness regarding pts


assigned sex.
Born with wrong body: children will have a preference of the
opposite sex, preoccupied with wearing opposite genders clothes,
refuse to pee sitting down (girls) or standing up (boys)

zolpidem, eszopiclone
Ramelton: melatonin receptor
ag.
Desensitization behavior
therapy

BZD to suppress stages 3 & 4

Not needed

Desmopressin. Imipramine

Sex change.
Hormonal replacement
therapy.