Psychiatry Osmosis HY Pathology Notes ATF - ATF

PSYCHIATRY
High-Yield
Notes
by
AfraTafreeh.com
PATHOLOGY
Table of Contents
Anxiety Disorders 1
Agoraphobia 2
Generalized Anxiety Disorder 3
Panic Disorder 4
Phobias 5
Separation Anxiety Disorder 6
Social Anxiety Disorder 6
Cognitive And Dissociative Disorders 8

Amneisa 8
Delirium 9
Dissociative Disorders 10
Depressive and Bipolar Disorders 12

Bipolar 1 Disorder 13
Bipolar 2 Disorder 14
Major Depressive Disorder 14
Premenstrual Dysphoric Disorder 15
Seasonal Affective Disorder 16
Elimination Disorder 17
Encopresis 17
Enuresis 18
Factitious Disorder 19
Manchausen Syndrome 19
Feeding and Eating Disorders 20

Anorexia Nervosa 21
Bulimia Nervosa 22
Neurodevelopmental Disorders 23
Attention Deficit Hyperactivity Disorder ADHD 23
Autism Spectrum Disorder 24
Disruptive, Impulse Control and Conduct Disorders 25
Learning Disability 27
Tourette Syndrome 28
Obsessive-Compulsive Disorders 29
Body Dysmorphic Disorder 30
Body Focused Repetitive Disorders 30
Obsessive-Compulsive Disorder 31
Personality Disorders Cluster A 32

Paranoid Personality Disorder 33
Schizoid Personality Disorder 34
Table of Contents
Schizotypal Personality Disorder 35
Personality Disorders Cluster B 36

Antisocial Personality Disorder 37
Borderline Personality Disorder 38
Histrionic Personality Disorder 39
Narcissitic Personality Disorder 40
Personality Disorders Cluster C 41

Avoidant Personality Disorder 42
Obsessive-Compulsive Personality Disorder 43
Dependant Personality Disorder 44
Schizophrenia and Psychotic Disorders 45

Delusional Disorder 46
Schizoaffective Disorder 47
Schizophrenia 48
Schizophreniform Disorder 49
Schizo-Pathologies 50
Sexual Dysfunction 51
Female Sexual Interest/ Arousal Disorder 52
Genito-Pelvic Pain and/or Penetration Disorder 52
Male Hypoactive Sexual Desire Disorder 53
Orgasmic Dysfuntion 54
Sleep and Sleep-Wake Disorders 55

Insomnia 56
Narcolepsy 57
Night Terror 58
Nocturnal Enuresis 58
Substance Use and Related Disorders 60

Alcohol Use Disorder 61
Cannabis Dependence 63
Cocaine Dependence 64
Opioid Dependance 66
Tobacco Dependance 68
Substance Abuse Acute Intoxication 70
Trauma and Abuse Related Disorders 71

Physical And Sexual Abuse 71
Post traumatic Stress Disorder PTSD 72
Somatic System Disorder 73
NOTES
GENERALLY,WHAT ARE THEY?

( PATHOLOGY & CAUSES ) ( D_IA_GN_o_s,_s __ )
• Mental disorders characterized by • Excessive, unreasonable fear/distress
excessive, unreasonable fear, distress • Struggle to control symptoms
• May be omnipresent/in response to • Lasts > six months
particular stimulus • Affects day-to-day functioning
• Awareness of condition often causes more • Not explained by other condition/substance
distress
CAUSES ( T_R_E~_~_M_EN_T
__ )
• May be genetic, environmental
• Often associated with other mental MEDICATIONS
disorders (mood, substance-related) • Selective serotonin reuptake inhibitors
(SSRls), other antidepressants,
benzodiazepines
( SIGNS & SYMPTOMS )
PSYCHOTHERAPY
• Persistent fear/distress • E.g. cognitive behavioral therapy
• Nausea, difficulty sleeping, headache O Identify, explain thoughts/feelings,
change flawed ones
O Better long-term prognosis; no side
effects. no dependency
1
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AGORAPHOBIA
osmsJl/ e1g0Te1pho\>ie1
( PATHOLOGY & CAUSES ) (..____ D_IA_GN_O_s,_s)

• Fear, avoidance of public places • Unreasonable fear/anxiety associated with
• Individuals refuse to leave "safety" of home public places
• Caused by underlying fear of feeling
trapped, unable to receive help
CAUSES
• Resulting avoidance of public places
• Lasts > six months
• Associated with other anxiety disorders,
• Distress affects day-to-day functioning
e.g. panic disorder
• Not explained by other condition/substance
(__ s,_G_NS_&_SY_M_PT_O_M_s )
(..____ T_R_E~_iT_M_EN_T
)
• Fast heartbeat, dizziness, trembling
• Thinking about/avoidance of public places
MEDICATIONS
causes distress • SSRls, benzodiazepines
PSYCHOTHERAPY
• E.g. cognitive behavioral therapy,
systematic desensitization
PANIC DISORDER [
end.uT'e o.Ho.cks]
a.lone
AVOIDANCE AVOID PLACES
'>I J,
~ -lemporar~ relief AGORAPHOBIA
~ makes d.ail~ life hard.
* ANTICIPATORY ANXIETY *
Figure 90.1 Illustration showing how other disorders can lead to agoraphobia. If someone with
panic disorder has panic attacks outside frequently, they may develop agoraphobia and avoid
going outdoors altogether.
2
GENERALIZED ANXIETY
DISORDER
osms.i"l/ ge neTo.li2ed-o.nxie-l14-disoTdeT
( PATHOLOGY & CAUSES ) (.______ D_IA_GN_O_SI_S __ )

• Excessive, unreasonable, persistent fear, • Excessive, unreasonable anxiety
distress • Struggle to control anxiety
• Persistent fear/distress, nausea, difficulty
CAUSES sleeping, headache
• May be genetic, environmental; higher in • > three symptoms listed above (children>
some groups one year old)
• Associated with depressive disorders • Lasts > six months
(__ SI_G_NS_&_S_Y_M_PT_O_M_s_)
• Restlessness, difficulty concentrating, (.______ T_R_E~_;,-_M_EN_T__ )
irritability
• Muscle tension (- aching and soreness), MEDICATIONS
fatigue, insomnia (- chronic fatigue) • SSRls, antidepressants, benzodiazepines
PSYCHOTHERAPY
• E.g. cognitive behavioral therapy
~;~ C.E.SS \\I l ,.,_ ..,.,. o'fe. h,o.v, ~or.to.,c. t.\Sc.

P~ ~S\S1£ Ni ,._ k<s.;1;. ~o (),J..,J"''c}
\)~'2.EJ\~OtJA%\.~ "'- °!,\'\ov..lo.i-~ ~ '-'Otr~ul..
~\Lt) ~(."~'""
(.o.,.flicTU,'1'
Fu~cno 1-1 !.o'-•IIL'-'I'
P~n.1t1t,'TU
"°'~ +
011wtJ "Jo\
Figure 90.2 Illustration of the different levels of anxiety.
3
PANIC DISORDER
osmsJl/po.nie-disoTdeT
( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s

__ )
• Recurrent panic attacks-« sudden periods • Recurrent, unpredictable panic attacks (>
of intense fear/discomfort two)
• Attacks unpredictable • Distress affects day-to-day functioning
• Behavioral changes to avoid further attacks
CAUSES • Presence of> four symptoms
• May be genetic, environmental; higher in • Not explained by other condition/substance
some groups
• Associated with major depressive disorder,
social and generalized anxiety disorders, ( T_R_E~_iT_M_EN_T
__ )
obsessive-compulsive disorder
MEDICATIONS
• SSRls and other antidepressants,
(__ s,_G_NS_&_SY_M_PT_O_M_s_) benzodiazepines
• Antiseizure medications
• Feelings of choking, derealization. fear of
losing control/dying
PSYCHOTHERAPY
• Elevated heart rate. chest pain/discomfort,
sweating, trembling, shortness of breath,
nausea, dizziness, chills, numbness
,.,.,?MJlC..
..... ~ ....D,~o~PE.9-
~,....,,,.,..
-* Gt1.1tn<.
l.,, ~Vt\\ 1 ... {on-i\i&S
'* ~~c.'v\..W,C.r4\>'j
\....:.,, LO!"'~~Vt. 'c)& .... &UI Of" tl,,U'Qfj
1. . Lf;.Ap. ....
a , t,,\O~l"fO(l.
1. 6UATI4UJ~ i.- il~V,.,t~"TlOµ
~. CAA\!~ BEl.l~FS
Ii. E,tp~u~E:
t ,-4i\<.0~0V\..
Figure 90.3 Illustration showing possible causes for panic disorder, and avenues to treatment.
4
PHOBIAS
osms.tl/ pho\>io.
( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s)

• Excessive, unreasonable, persistent fear • Unreasonable fear/anxiety associated with
resulting in avoidance of particular object/ phobic stimulus
situations (phobic stimulus) • Resulting avoidance (which may itself
cause distress) of phobic stimulus
TYPES • Lasts > six months
• As listed in the DSM-5 • Distress affects day-to-day functioning
° Fear of animals • Not explained by other condition/substance
° Fear of natural environment
Fear of blood, needles
°
( T_R_E~_iT_M_EN_T
)
O Situational fears
0 "Other" fears (AKA none of the above) MEDICATIONS
• SSRls, benzodiazepines
CAUSES
• May be genetic, environmental PSYCHOTHERAPY
• Associated with anxiety, mood, substance • E.g. cognitive behavioral therapy,
use disorders systematic desensitization
• Response to phobic stimulus: elevated
heartbeat, dizziness, trembling
• Excessive thinking about/avoidance of
phobic stimulus causes distress
Y:,ro11',,0•'1.a.
~i'llac.ip"'o'eiia.
\)\lo'i1~S
.~:....
• 111~11-ltnII'·~\..
• t,1<l<a\.u~
• ,.,.•••EM•'•,..
Figure 90.4 Illustration of different specific phobias making someone feel powerless.
5
SEPARATION ANXIETY DISORDER
osms.i"l/ sepe1Te1-l:ion-e1nxie-l:14-disoTdeT
( PATHOLOGY & CAUSES ) ( D_IA_GN_o_s,_s__ )

• Excessive, unreasonable, persistent fear of • Excessive, unreasonable, persistent fear of
being separated from individual/location being separated from individual/location
• Adults: lasts > six months
CAUSES • Children: lasts > four weeks
• May be genetic, environmental • Not explained by other condition/substance
• Associated with all other anxiety disorders
( T_R_E~_~_M_EN_T__ )
(__ SI_G_NS_&_SY_M_PT_O_M_s_)
MEDICATIONS
• Distress caused by thought of experiencing • SSRls, benzodiazepines
separation
• Nightmares, headaches, nausea PSYCHOTHERAPY
SOCIAL ANXIETY DISORDER

osms.i-1:/soeie1l-e1nxie-l:14-disoTdeT
( PATHOLOGY & CAUSES )

( s,_G_NS_&_S_Y_M_PT_O_M_
• Excessive, unreasonable, persistent fear of
• Trembling, blushing, derealization
being judged
• Avoidance of social situations • Excessive thinking about/avoidance of
social situations/circumstances, associated
distress
CAUSES
• May be genetic, environmental; higher in
some groups ( D_IA_GN_O_s,_s
__ )
• Associated with mood disorders,
substance-related disorders, eating • Excessive, unreasonable, persistent fear of
disorders, obsessive-compulsive disorders being judged
• Avoidance of social situations/
circumstances, associated distress
• Fear of others judging anxious feelings
• Lasts > six months
6
( T_R_E~_~_M_EN_T
)
MEDICATIONS
• SSRls, antidepressants, benzodiazepines
PSYCHOTHERAPY
CRUSE.. - Ul'JC.LE:AR
',ti (loSQ. rtlc.h11t wl.trt

Sou(ll onxlt\j d1~0,der
D5M-5
_. lndl'11duGll> fto.r athn..7 vi Gt wo.'J -\vull mLjnt mo.~ -thcrv1 9tl JU06E,O,
'f l"~trfett> wl.{n NORMAL IZ.OUTll'JE: S. R~LA1lOl"JSHlP.S.
11 PeRSISTE.rJT ( > bMOfltns.)
Figure 90.5 Illustration of the possible causes of social anxiety disorder, which are still unclear,
as well as the DSM-5's criteria for a diagnosis of the condition.
7
NOTES

(__ s,_G_NS_&_S_Y_M_PT_O_M_s_)
(__ P_~_;TH_O_l_OG_Y_&_CA_U_S_E_S
_)
• See individual disorders
• Cognitive disorders: involve cognitive
decline
• Dissociative disorders: involve detachment ( D_IA_G_N_os_,s )
from past/present versions of oneself/the
world • See individual disorders
CAUSES
• Past trauma/stress may cause/worsen
( T_R_E_AT_M_E_N_T
__ )
condition
COMPLICATIONS
• Personality changes, depression
AMNESIA
osms.i-l:/ C1mnesiC1
• Associated with storage and retrieval

( PATHOLOGY & CAUSES ) phases of memory
• Usually involves damage to cortex
• Acute loss of memory
CAUSES
TYPES • Head trauma, infection, neurodegenerative
Anterograde amnesia diseases (e.g. dementia/Alzheimer's),
brain tumours. thiamine deficiency
• Inability to form new memories
(causing Wernicke-Korsakoff syndrome),
• Associated with encoding and
benzodiazepines, electroconvulsive therapy
consolidation phases of memory
• Usually involves damage to prefrontal
cortex/hippocampus COMPLICATIONS
• Range of potential complications (e.g.
Retrograde amnesia confusion, loss of identity)
• Inability to recall old memories (may result
in creation of false memories)
8
(
(..___s,_G_Ns_&_s_v_M_PT_O_M_s
) T_R_E~_~_M_EN_T
)
• Acute memory loss, affects memories PSYCHOTHERAPY
created before/after an event (or onset of • Occupational and cognitive therapies to
illness) enhance memory
( D_IA_GN_O_SI_S) OTHER INTERVENTIONS

• Often temporary (address cause)
DIAGNOSTIC IMAGING • Mobile phones and digital devices as
workarounds to memory loss
MRI/CT scan
• Brain damage/abnormalities
LAB RESULTS
• Nutritional deficiencies/infections
DELIRIUM
osmsJl/deliTium
( PATHOLOGY & CAUSES ) C__s,_G_Ns_&_sv_M_PT_O_M_s_)

• Fast decline in attention/consciousness, • Difficulties with attention span,
thinking concentration, remaining conscious
• Sometimes accompanied by symptoms of • Disorganized/delayed thinking
hyper/hypoactivity • Hyperactive symptoms
O Agitated/aggressive
RISI( FACTORS O Delusions/hallucinations
• Disease (e.g. dementia, constipation, • Hypoactive symptoms
pneumonia, UTls) O Sluggish, drowsy
• Post-surgical complications O Less reactive, withdrawn
O Medications (e.g. narcotic pain
medications. benzodiazepines,
hypnotics, anticholinergics) C D_IA_GN_O_SI_S
__ )
O Altered metabolic homeostasis (e.g.
electrolyte or imbalance), chronic fatigue • Issues with attention/consciousness and
• Increases risk of falling over----> broken cognition, developing over short time
bones, head injuries, bruises, bleeds=- (several days or fewer)
longer hospitalizations. more complications, O Difficulties with attention span,
higher mortality rates concentration, remaining conscious
O Disorganized/delayed thinking
• Not explained by pre-existing
neurocognitive condition
• Explained by other medical condition and/or
exposure to/withdrawal from a substance
9
OTHER INTERVENTIONS
(..__ __ T_R_E~_~_M_EN_T
)
Preventative
MEDICATIONS • Make high-risk targets feel oriented,
comfortable (reducing excess noise/
Severe symptoms
stimulation; make sure glasses, hearing aids
• Haloperidol/second generation are used if needed; encourage daily routine)
antipsychotics
• Avoid opiates. other causative medications;
avoid restraints
DISSOCIATIVE DISORDERS
osmsJl/dissoeio.-1:ive-disoTdeTs
• Worsens under stress
High severity: dissociativeidentity disorder
• Characterized by disruptions or • Feeling of having multiple identities which
breakdowns of memory, awareness, act/think/perceive differently, thus impairing
identity, or perception. ability to recall everyday/important
information about oneself
TYPES • Two categories of dissociative identity
• Three types on scale of severity disorder
= Covert: individual aware of identity
Low severity: depersonalization/derealiza- shifts, struggles to manage them
tion disorder = Overt: individual completely assumes
• Depersonalization: feeling detached from different identities while unaware
own body/mind (e.g. feeling one's body is a • Can involve dissociative fugue (individual
robot/ feeling of watching self) becomes confused about identity, starts
• Derealization: feeling of world not being sudden travel/ wandering)
fully real (e.g. feeling outside world not real/
lacks lucidity)
CAUSES
Middle severity: dissociativeamnesia • Thought to be primarily caused by
• Inability to recall significant information psychological trauma; associated with
about oneself (e.g. location of childhood sexual abuse. post-traumatic stress
home, what mother looked like) disorder, depression, substance abuse.
borderline personality, somatoform
• Four categories of amnesia
conditions
O Localized: trouble recalling traumatic
• More common in biologically-female
event (and surrounding period)
indiviudals
O Generalized: trouble recalling significant
portion of one's past
O Systematized: trouble recalling
category of information
specific ( SIGNS & SYMPTOMS )
°Continuous: trouble recalling events Depersonalization
/derealization disorder
after they occur • Explicit thoughts/behaviors related to
• Can involve dissociative fugue (individual depersonalization/derealization
becomes confused about identity, starts
• Emotional/physical numbness; weak sense
sudden travel/ wandering) of self
10
• Deadpan speech
• Altered sense of time
( T_R_E~_~_M_EN_T )
• Brain fog/lightheadedness MEDICATIONS
• Prone to rumination, anxiety • Antidepressants (like selective serotonin
• Severe symptoms: difficulty recognizing reuptake inhibitors)
familiar places, people, objects • Mood stabilizers
Dissociativeamnesia & Dissociativeidenti- • Neuroleptics
ty disorder
• Inability to recall significant information PSYCHOTHERAPY
about oneself • E.g., psychodynamic, cognitive, cognitive
• Altered consciousness (e.g. behavioral, supportive
depersonalization, derealization)
• Depression, suicidal ideation
OTHER INTERVENTIONS
• Memory aids: alarms, reminders, media
( D_IA_GN_o_s,_s__ ) (e.g. photos/videos/recordings)
• Occupational therapy
Depersonalization/derealizationdisorder
• Presence of depersonalization/derealization
• Symptoms affect day-to-day functioning
• Not caused by other condition/substance
Dissociativeamnesia
• Inability to recall significant information
about oneself, beyond everyday forgetting
Dissociativeidentity disorder
• Feeling of having multiple identities which
act/think/ perceive differently
• Inability to recall significant information
about oneself, beyond everyday forgetting
• Not described by cultural/religious practices,
nor by play (e.g. imaginary friends)
11
NOTES
GENERALLY, WHAT ARE THEY?

__ )
Mental disorders involving mood changes • Excessive, unreasonable fear/distress
• Often involve depression, sometimes • Struggle to control symptoms
mania/hypomania (see below) • Lasts > six months
• Affects day-to-day functioning
CAUSES • Not explained by other condition/substance
• Genetic (especially between close relatives)
• Linked to neurotransmitter regulation
(norepinephrine, serotonin, dopamine) (.._____ T_R_EA_~_M_EN_T
__ )
• High comorbidity with other mental
disorders
MEDICATIONS
• Antidepressants, lithium
COMPLICATIONS
• Self-harm/suicide
PSYCHOTHERAPY
• Social consequences (e.g. losing friends)
OTHER INTERVENTIONS
(__ s,_G_NS_&_SY_M_PT_O_M_s_) • Lifestyle changes
, Improved diet, more exercise, more
• Manic episodes featuring a mood sunlight
disturbance, increased energy/activity,
and z three of following for z one week,
affecting day-to-day functioning
• Hypomanic ("less than manic") episodes
featuring a mood disturbance, increased
energy/activity, and ;;:: three of the above
during a period > four days, not affecting
day-to-day functioning
• Major depressive episodes featuring ;;:: five
of following in a two week period
• Other mood changes, including more mild
depression; see individual disorders
12
BIPOLAR I DISORDER
osms.tl/\,ipolo.,--1
( PATHOLOGY & CAUSES ) (__ SI_G_NS_&_S_Y_M_PT_O_M_s_)

Bipolar disorder characterized by extreme • Mood swings
mood swings with combination of manic, • Manic episodes
hypomanic, depressive episodes • Usually, hypomanic and depressive
episodes
CAUSES
• Medications (e.g. SSRls)
(.____ D_IA_GN_O_SI_S
__ )
• Often no particular trigger • 2:: one manic episode
• High comorbidity with other mental • Symptoms affect day-to-day functioning
disorders
\ I MNEMONIC: DIG FAST

(.____ T_R_E~_;,-_M_EN_T
__ )
i
Characteristics of manic
episode
Distractibility MEDICATIONS
Indiscretion: excessive • Atypical antipsychotics (e.g. olanzapine).
involvement in pleasurable in combination with mood stabilizers (esp.
activities lithium)
Grandiosity
Flight of ideas PSYCHOTHERAPY
Activity increase • E.g. cognitive behavioral therapy,
Sleep deficit/decreased need interpersonal
for sleep
Talkativeness/pressured OTHER INTERVENTIONS
speech
• Electroconvulsive therapy (ECT)
13
BIPOLAR 11 DISORDER
osms.i-l/\>ipolo.T-11

__ )
Bipolar disorder characterized by mood • ~ one hypomanic episode
swings with hypomanic, depressive episodes. • ~ one major depressive episode
CAUSES • Not caused by other condition/substance
• Medications (e.g. SSRls)
• Often no particular trigger
( T_R_E~_~_M_EN_T
__ )
• High comorbidity with other mental MEDICATIONS
disorders
• Atypical antipsychotics (e.g. olanzapine),
in combination with mood stabilizers (esp.
( SIGNS & SYMPTOMS ) lithium)
• Mood swings PSYCHOTHERAPY

• Hypomanic, depressive episodes • E.g. cognitive behavioral therapy,
interpersonal
MAJ"OR DEPRESSIVE DISORDER

osms.i-l/ mojoT-depTessive-disoTdeT
( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_S_Y_M_PT_O_M_

)
Depressive disorder characterized by one or • Major depressive episodes
more episodes of a strongly depressed mood
• Episodes interfere with day-to-day life
in activities such as eating, working, and (..____ D_IA_GN_O_s,_s)
sleeping
• One or more major depressive episodes
• The symptoms cause distress in other
CAUSES areas of life
• Exact cause unknown; runs in families.
• The disturbance is not better explained
especially between close relatives;
by or accounted for by another medical
linked to neurotransmitter regulation
condition or substance
(norepinephrine, serotonin, dopamine); high
comorbidity with other mental disorders , There has not been a manic or
hypomanic episode
14
\ MNEMONIC: SIG ED CAPS
Diagnostic criteria for Major
( T_R_E~_~_M_EN_T
)
depressive disorder
MEDICATIONS
Sleep: increased or decreased
• Antidepressants (SSRls, SNRls, NDRls)
Interest: decreased
Guilt/worthlessness
Energy: decreased or fatigued PSYCHOTHERAPY
• E.g., cognitive behavioral therapy,
Depressed mood most of the
interpersonal
day
Concentration/difficulty making
decisions OTHER INTERVENTIONS
Appetite and/or weight • Improved diet, more exercise, more sunlight
increase or decrease
Psychomotor activity:
increased or decreased
Suicidal ideation/ thoughts of
death
PREMENSTRUAL DYSPHORIC
DISORDER
osmsJl/ pTeme ns-lTue1l-cJ.14sphoTie-disoTdeT
= Inabilityto sleep/oversleeping
( PATHOLOGY & CAUSES ) • Feelings of being overwhelmed
= Mild physical symptoms (e.g.
• Depressive disorder characterized by mood
tenderness/swelling)
changes during menstrual cycle
CAUSES ( D_IA_GN_O_s,_s __ )
• Unknown; possible sensitivity to hormonal
changes • Mood changes s one week before menses,
as evidenced by presence of z five of
symptoms (;;:: one from each category),
(__ s,_G_NS_&_S_Y_M_PT_O_M_s_) resolving within one week post-menses
• Must occur during majority of menstrual
• Emotional cycles over past year
O Affective !ability
• Symptoms affect day-to-day life
O Irritability/anger • Not caused by other condition/substance
O Anxiety/angst
• Other symptoms
O Diminished interest/pleasure
O Decreased concentration
° Fatigue
o Weight loss/gain
15
PSYCHOTHERAPY
(..____ T_R_E~_~_M_EN_T
) • E.g. cognitive behavioral therapy,
interpersonal
MEDICATIONS
• SSRls, oral contraceptives
OTHER INTERVENTIONS
• Lifestyle changes: improved diet, more
exercise, more sunlight
SEASONAL AFFECTIVEDISORDER
osmsJl/seo.sono.1-o.ffee-live-disoTdeT
( PATHOLOGY & CAUSES ) C D_IA_GN_O_SI_S __ )

• Depressive disorder characterized by one • One or more major depressive episodes
or more episodes of a strongly depressed • The symptoms cause distress in other
mood areas of life
• Episodes interfere with day-to-day life • The disturbance is not better explained
in activities such as eating, working, and by or accounted for by another medical
sleeping condition or substance
• Occurs most commonly in seasons of lower , There has not been a manic or
light, like winter hypomanic episode
CAUSES
• Exact cause unknown; runs in families,
C T_R_E~_~_M_EN_T__ )
especially between close relatives;
linked to neurotransmitter regulation
MEDICATIONS
(norepinephrine, serotonin, dopamine); high • Antidepressants (SSRls, SNRls, NDRls)
comorbidity with other mental disorders
PSYCHOTHERAPY
C__s,_G_Ns_&_s_v_M_PT_O_M_s_) • E.g. cognitive
interpersonal
behavioral therapy,
• Major depressive episodes

OTHER INTERVENTIONS
• Improved diet, more exercise, more sunlight
16
NOTES

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s __ )
• Repeated voluntary/involuntary passage of • Repeated voluntary/involuntary passage of
feces/urine into inappropriate places feces/urine into inappropriate places
O Encopresis: feces • > five years old
O Enuresis: urine • Not caused by other condition/substance
• Disorders can be functional; often explained
by/causing distress
( T_R_E~_~_M_EN_T__ )
CAUSES MEDICATIONS
• Genetic, environmental • Laxatives, desmopressin, to manage
elimination
(__ SI_G_NS_&_S_Y_M_PT_O_M_s
)
PSYCHOTHERAPY
• Repeated voluntary/involuntary passage of • E.g. cognitive behavioral therapy
feces/urine into inappropriate places
ENCOPRESIS
osms.i"l/ e nee Tes is
( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_S_Y_M_PT_O_M_s_)

• Repeated voluntary/involuntary passage of • Repeated passage, voluntary or
feces into inappropriate places uncontrolled, of feces into inappropriate
• Often functional, caused by overflow due to places
withholding feces (e.g. fear of defecation);
constipation-related
• When feces deposited in abnormal places,
( D_IA_GN_o_s,_s __ )
may be neurodevelopmental/induced by
fear of toilets • Repeated passage, voluntary or
uncontrolled, of feces into inappropriate
places
CAUSES • Occurs at least once a month for three
• Genetic, environmental months in a row
• Often associated with psychiatric
comorbidities
17
• Age: > four years old OTHER INTERVENTIONS
Dietary
(except constipation)
• Avoid constipating foods
• Adequate hydration
(..____ T_R_EA_~_M_EN_T__ ) • Increase fiber intake; fiber tablets
MEDICATIONS Remove fecal impaction

• Daily laxatives (stool softeners: lg/kg • Polyethylene glycol/mineral oil
polyethylene glycol per day) • Rectal enema
PSYCHOTHERAPY
• Behavioral therapy
O Encourage toilet usage, normalize bowel
movements
ENURESIS
osms.i"l/enuTesis

__ )
• Repeated voluntary/involuntary passage of • Repeated voluntary/involuntary passage of
urine into inappropriate places urine into inappropriate places
• Can be nocturnal, diurnal, both • "Clinically significant": occurs > two times
• Can involve poor bladder control per week for> three consecutive months or
(physiological developmental reasons)/ affects day-to-day life
exceeding bladder capacity • Age: > five years old
• Not caused by other substance
CAUSES
• Genetic, environmental; stress-related
( T_R_EA_~_M_EN_T
__ )
O Often associated with psychiatric
comorbidities MEDICATIONS
O More common in biological males • Desmopressin (reduce urine production)
PSYCHOTHERAPY
(__ SI_G_NS_&_SY_M_PT_O_M_s
)
• Behavioral therapy (e.g. bedtime alarm
• Repeated voluntary/involuntary passage of therapy), bladder program
urine into inappropriate places
18
NOTES
MUNCHAUSENSYNDROME
osms.i"l/muneho.usen-s14ndTome
( PATHOLOGY & CAUSES ) (..____ D_IA_GN_o_s,_s__ )

• Fabricating/exaggerating physical/ Munchausen syndrome
psychological symptoms in oneself/another • Fabricating/exaggerating physical/
• Both types motivated by desire for psychological symptoms
sympathy/attention • Seeks self to be treated as ill/impaired/
injured
TYPES Munchausen syndrome by proxy
Munchausen syndrome • Purposefully inducing symptoms in another
• Faking/exaggerating symptoms in oneself • Seeks victim to be treated as ill/impaired/
injured
O AKA factitious disorder
• Diagnosis for perpetrator, not victim
Munchausen syndrome by proxy
Both
• Purposefully inducing symptoms in another
(e.g. a child, elder, family member, pet) • Behavior occurs even without obvious
rewards (e.g. insurance claim)
O AKA factitious disorder by proxy/
factitious disorder imposed on another • Not caused by other condition
• Can occur once, multiple times
CAUSES
• High comorbidity with mood/personality (..____ T_R_EA_:T_M_EN_T__ )
disorders
PSYCHOTHERAPY
• Various psychotherapy methods
(_~SI_G_NS_&~SY_M_P_TO_M_S~)
Munchausen syndrome by proxy
Munchausen syndrome • Family therapy helpful
• Feigned symptoms • Separate perpetrator, victim
Munchausen syndrome by proxy • Treat victim for induced illness/injury/
emotional trauma
• Purposefully inducing symptoms in another
• High level of perceived interest in victim/
victim's condition (if applicable)
Both types
• Limited but highly-relevant medical
knowledge
19
NOTES afratafreeh.com exclusive

( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_S_Y_M_PT_O_M_s_)
• Psychological disorders causing unhealthy • Unhealthy relationship with food
relationship with food, body image (physically, mentally)
• Often begin in teens/early adulthood • Distorted view of body, belief that body
weight/appearance crucial for self-worth
• Restrictive food intake/compensatory
CAUSES
behaviors (purging/excessive exercise)
• Genetic, environmental
• High comorbidity with obsessive-
compulsive disorder, depression, anxiety ( D_IA_GN_O_s,_s __ )
COMPLICATIONS • See individual disorders
• Refeeding syndrome (refeeding -
secretion of insulin - cells take in
electrolytes from already low serum levels ( T_R_EA_:l"_M_EN_T__ )
- even lower serum electrolyte levels -
cardiac arrhythmia/death) PSYCHOTHERAPY
OTHER INTERVENTIONS
• Careful weight gain
20
ANOREXIA NERVOSA
osmsJl/e1noTexie1-neTvose1
hair falls out, menstruation stops, difficulty
( PATHOLOGY & CAUSES ) breathing, slow heartbeat, hypotension,
congestive heart failure, edema (especially
• Eating disorder characterized by restrictive in feet), bone marrow shuts down (---->
food intake (leading to significantly low dampened immune response, low energy
body weight), fear of weight gain, distorted levels, easier bleeding/bruising)
view of body • If purging by vomiting: enamel erosion,
• Often begins in teens/early adulthood parotid gland swelling, bad breath, bruised/
calloused knuckles (Russell's sign), stomach
TYPES tearing, fast heartbeat, depletion of
electrolytes
Atypical anorexia nervosa
• Label for individuals with anorexia
symptoms without significantly low body (..____ D_IA_GN_O_SI_S
__ )
weight
• Restrictive food intake (leading to
Restricting anorexia nervosa significantly low body weight)
• Individual loses weight only by via highly • If body weight cannot be described as
restricted food intake/excessive exercise significantly low, diagnosis = atypical
anorexia nervosa
Binge-eating/purging anorexia nervosa
• Fear of weight gain
• Individual loses weight by purging (e.g.
• Distorted view of body
vomiting, use of laxatives/diuretics/enemas)
• Restricting type: individual has not
repeatedly binge-eaten or purged over s
CAUSES three months (instead, attempts to lose
• Genetic (e.g. abnormalities in hunger weight by restricting food intake/exercising
signals). environmental (e.g. peer pressure/ excessively)
forces of popular culture) • Binge-eating/purging anorexia nervosa:
• High comorbidity with obsessive- repeated binge-eating/purging over s three
compulsive disorder, depression, anxiety months
Specify severity
COMPLICATIONS • Mild: BMI > 17
• Refeeding syndrome. difficulty breathing,
• Moderate: BMI 16-17
heart failure, brain damage, suicidal
• Severe: BMI 15-16
ideation. death
• Extreme: BMI < 15
)
(..____ T_R_E~_~_M_EN_T
__ )
• Fear of weight gain----> restrictive food
behaviors, purging, excessive exercise. PSYCHOTHERAPY
weight checks. food rituals • E.g. cognitive behavioral therapy
• Restrictive food intake ----> electrolyte
abnormalities. vitamin deficiencies, muscle OTHER INTERVENTIONS
loss. low creatinine levels. fatigue----> brain • Careful weight gain
damage, weakened bones. dry/scaly skin,
21
BULIMIA NERVOSA
osms.i"l/\,u limio.-neY-voso.
• Compensatory behaviors to prevent weight
( PATHOLOGY & CAUSES ) gain, concurrent with binge-eating
• Distorted view of body, belief that body
• Eating disorder characterized by repeated weight/appearance crucial for self-worth
binge-eating, compensatory behaviors
to prevent weight gain, belief that body Specify severity
weight/appearance crucial for self-worth • Mild: 1-3 compensatory behaviors/week
• Compensatory behaviors/"purges": • Moderate: 4-7 compensatory behaviors/
vomiting, use of laxatives/diuretics/enemas week
• Attempts to conceal behaviors • Severe: 8-13 compensatory behaviors/
• Often begins in teens/early adulthood week
• Extreme: > 14 compensatory behaviors/
CAUSES week
• Genetic (e.g. abnormalities in hunger
signals), environmental (e.g. peer pressure/
forces of popular culture) (.._____ T_R_E~_~_M_EN_T
)
• High comorbidity with obsessive-
compulsive disorder, depression, anxiety
MEDICATIONS
• Antidepressants (e.g. selective serotonin
reuptake inhibitors)
COMPLICATIONS
• Refeeding syndrome, diabetes mellitus, fast
heartbeat, suicidal ideation, death
PSYCHOTHERAPY
(.___s,_G_NS_&_S_Y_M_PT_O_M_s_)
OTHER INTERVENTIONS
• Careful weight gain
• Binge-eating, compensatory behaviors
(usually purposeful vomiting)
• Endocrine changes----. menstruation stops/
never starts, increased risk of diabetes
mellitus
• If purging by vomiting: enamel erosion,
parotid gland swelling, bad breath, bruised/
calloused knuckles (Russell's sign), stomach
tearing, fast heartbeat, depletion of
electrolytes
(.._____ D_IA_GN_O_s,_s)
• Must occur exclusive of anorexia nervosa
• Repeated binge-eating over s three Figure 95.1 Erosion of the enamel of the
months mandibular teeth of an individual with bulimia
• Binge-eating classification requires sense nervosa.
of loss of control
22
NOTES

( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_SY_M_PT_O_M_s_)
• Mental disorders causing difficulties • See individual disorders
in everyday activities/skills (e.g.
communication, learning), occurring over
an extended period, beginning during ( D_IA_GN_O_s,_s __ )
development
• Often causes social lsolation/anxletv -e • See individual disorders
depression
( T_R_E~_~_M_EN_T__ )
CAUSES
• Genetic, environmental • Not curative
COMPLICATIONS
• Reduced success in various areas of life
(esp. social, academic)
ATTENTION DEFICIT
HYPERACTIVITY DISORDER (ADHD)
osms.ll/ ADMD
CAUSES
( PATHOLOGY & CAUSES ) • Genetic, environmental
• Associated with neurotransmitter activity
• Developmental disorder characterized by
(low amounts of dopamine/norepinephrine)
inattentiveness/hyperactivity/impulsiveness,
lasting for> six months
COMPLIC ATIONS
TYPES • Reduced success in various areas of life
(esp. social, academic)
• Inattentive. hyperactive/impulsive, or both
23
( SIGNS & SYMPTOMS ) , Struggles to stay seated
, Restless
, Struggles to keep quiet
• Inattentiveness (careless mistakes, not
listening, easily distracted) , Likes to keep moving
• Hyperactivity/impulsiveness (restlessness) , Talks before others have finished
• Developmental delay (e.g. in linguistid , Doesn't like waiting
social/ motor skills) , Interrupts/bothers others
• Symptoms for either category must
, Persist > six months
(..____ D_IA_GN_O_SI_S
) , Present< 12 years old
, Present in multiple settings
• For inattentive dtaqnosisz six of following
(;;:: five if age > 16) , Affect day-to-day functioning
O Makes careless mistakes/overlooks , Not caused by other condition
details
O Struggles to stay focused
O Doesn't appear to listen
(..____ T_R_EA_~_M_EN_T )
O Doesn't follow instructions MEDICATIONS
O Has poor organizational skills • Stimulants to slowly release
O Avoids mentally-engaging tasks neurotransmitter (e.g. amphetamines =
O Often loses things Adderall/ methylphenidate = Ritalin)
O Is easily distracted
O Is forgetful PSYCHOTHERAPY
• For a hyperactive/impulsive diaqnosis.a six • Behavioral therapy focused on decreasing
of following (;;:: five if age > 16) distractions/improving time management,
O Often fidgets organizational skills
AUTISM SPECTRUM
DISORDER (ASD)
osms.i"l/ cu-lism
CAUSES
( PATHOLOGY & CAUSES ) • Genetic, environmental
• Developmental disorder characterized

by difficulties with social interaction/ COMPLI CATIONS
communication as well as restricted/ • Reduced success in various areas of life
repetitive behaviors, interests, activities (esp. social, academic)
• Encompasses autism, Asperger syndrome,
childhood disintegrative disorder, and PDD-
NOS (pervasive developmental disorder not
otherwise specified)
24
• Restricted/repetitive behaviors, interests, or
activities, with 2:: two of following
O Repetition of particular movements/
• Difficulties with social interaction,
phrases
communication (doesn't understand others'
O Specific routines/rituals, resistant to
emotions/respond to them, struggles to
change
make friends)
O Restricted interests (e.g. highly specific
• Restricted/repetitive nature regarding
knowledge in a subject)
particular behaviors/interests/activities
O Highly sensitive to/interested in
surroundings
( D_IA_GN_O_s,_s
__ ) • Symptoms must have been present in
development, and affect day-to-day
• Struggles with social interaction/ functioning
communication • Not caused by other condition
O Poor emotional reciprocity (doesn't
respond to/communicate emotions,
thoughts) ( T_R_EA_:T_M_EN_T__ )
O Poor non-verbal communication
(especially poor understanding thereof) PSYCHOTHERAPY
O Impaired joint attention (doesn't share • Educational programs, behavioral therapy
interests with others) tailored to individual
O Difficulty in developing/maintaining
relationships
DISRUPTIVE, IMPULSE CONTROL,

AND CONDUCT DISORDERS
osmsJI:/ eondue-1:-dlsoTdeT
CAUSES
( PATHOLOGY & CAUSES ) • Generally unknown (genetic+
environmental); tend to run in families
• Mental disorders characterized by impulsive
behaviors or a general lack of self-control
• No underlying motives for resulting MNEMONIC
behaviors Conduct disorders are seen in
• Tend to start in childhood and persist into Children
adulthood Antisocial personality disorder
• Includes is seen in Adults
° Conduct disorders
O Intermittent explosive disorder

O Oppositional defiant disorder
o Pyromania
° Kleptomania
25
) C..____ T_R_EA_~_M_EN_T
)
• Persistent, aggressive or harmful behaviors PSYCHOTHERAPHY
O May involve aggression or harm towards • Focused on therapy, not medications
other individuals or animals • Cognitive behavioral therapy, social skills
O May involve damage to or stealing training, anger management, parent
physical property management training
(..____ D_IA_GN_o_s,_s)
• Multiple impulsive behaviors observed over
an extended period of time
Inattentiveness. hyperactivity, restlessness, impulsive Present> 6 months, multiple

Social/motor/linguistic developmental delay settings. distresses daily life
Present > 6 months:

Willful defiance
distresses daily life
Present 12 months
(continuous) in individuals
Willful aggression
< 18 years old: distresses
daily life
Repeated self-control loss (may involve aggression).

6 years/older, unprovoked,
otherwise normal daily temperament
distresses daily life
Feels post-outbreak guilt/remorse
26
LEARNING DISABILITY
osmsJl:/leo.Tning-diso.\>ili-l:14

__ )
• Difficulty with learning/developing certain • 2:: one of following for at 2:: six months
skills • Poor reading skills
= Poor reading comprehension
TYPES = Difficulties with spelling
• Dyslexia: difficulty reading • Other difficulties with written language
• Dysgraphia: difficulty writing • Trouble with mathematics
• Dyscalculia: difficulty with mathematics • Trouble with mathematical reasoning
• Academic skills significantly lower than
what would otherwise be expected, as
CAUSES
confirmed by testing
• Learning difficulties must begin during
• Not due to lack of intelligence/desire to
school years but may not be problematic
learn/education
until later
• Not caused by other condition/
COMPLICATIONS environmental factor
• Reduced success in various areas of life
(esp. academic)
( T_R_E~_~_M_EN_T
__ )
(__ s,_G_NS_&_S_Y_M_PT_O_M_s_) OTHER INTERVENTIONS
• Modified approaches to education (e.g. one
• Difficulty with learning/developing certain on one tutoring)
skills • Specific techniques/workarounds
O Dyslexia: slow, effortful reading/poor dependent on symptoms (e.g. using specific
understanding fonts to alleviate dyslexia)
O Dysgraphia: poor spelling, grammar,
handwriting
O Dyscalculia: poor arithmetic
• Often comorbid with anxiety, depression
27
TOURETTESYNDROME
osmsJl/-louTe-He-s14nd Tome
( PATHOLOGY & CAUSES ) (......___ D_IA_GN_O_s,_s)

• Developmental disorder characterized by • ;;;: two motor ticsa one vocal tic
tics (rapid, repeated, involuntary, often • Must last z one year from first tic
inappropriate movements/vocalizations) • Must start< 18 years old
O Simple: short, involving particular body • Not caused by other condition/substance
part
° Complex: comprised of multiple
simultaneous tics (......___ T_R_E~_iT_M_EN_T
)
TYPES MEDICATIONS
• Motor tics: repeating movements of others • Antipsychotics/epilepsy medications (only
(echopraxia), making obscene gestures in severe cases)
(copropraxia) • Botox injections may decrease appearance
• Vocal tics: repeating same words/ of facial tics
phrases (echolalia, palilalia), blurting out
inappropriate language (coprolalia) PSYCHOTHERAPY
• Cognitive behavioral therapy
CAUSES • Habit reversal training
COMPLICATIONS
• Often comorbid with anxiety, depression
• Simple/complex tics of either/both types
28
NOTES

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_SI_S
)
• Mental disorders characterized by • Presence of obsessions, compulsions
obsessions and/or compulsions • Not caused by other condition/substance
• Obsessions: recurrent, intrusive thoughts
(often causing anxiety)
• Compulsions: repeated, purposeful, ( T_R_E~_~_M_EN_T
)
ritualistic behaviors (often attempts to
alleviate anxiety from obsessions) MEDICATIONS
• Obsessions/compulsions give feelings of • Selective serotonin reuptake inhibitors
gratification but affect day-to-day life (SSRls), other antidepressants
CAUSES PSYCHOTHERAPY
• Genetic, often associated with psychiatric • E.g. cognitive behavioral therapy
comorbidities
• Can lead to depressive/substance use
disorders
• Obsessions, compulsions causing distress
29
BODY DYSMORPHIC DISORDER
osms.i"l/BDD
( PATHOLOGY & CAUSES ) (.._____ D_IA_GN_O_s,_s)
• Characterized by an obsessive belief that • Not caused by other condition/substance
one's appearance is flawed
• Can cause compulsive behaviors (e.g.
excessive grooming) (.._____ T_R_E~_~_M_EN_T
)
• No consensus on optimal treatment
CAUSES
• Genetic, environmental; linked to issues
with serotonin neurotransmitters MEDICATIONS
• SSRls and other antidepressants
(__ s,_G_NS_&_SY_M_PT_O_M_s_) PSYCHOTHERAPY

• Obsessive belief that one's appearance is
flawed
• Compulsive behaviors in response
BODY FOCUSED REPETITIVE

DISORDERS
osms.i{/ Tepe{i{ive-disoTdeTs
( PATHOLOGY & CAUSES ) (__ SI_G_NS_&_S_Y_M_PT_O_M_

TYPES • Purposeful skin-picking (excoriation)
or hair-pulling (trichotillomania) with
Excoriationdisorder associated damage
• Characterized by compulsive skin-picking • Causes distress in other areas of life
• Can lead to infection/tissue damage
Trichotillomania
• Characterized by compulsive hair-pulling
( D_IA_GN_O_s,_s
__ )
• Not explained by any other condition/
CAUSES substance
• High comorbidity with other mood
disorders; stress-related
• Trichotillomania: genetic
30
( T_R_E~_~_M_EN_T
)
• No consensus on optimal treatment
MEDICATIONS
• SSRls and other antidepressants
PSYCHOTHERAPY
OTHER INTERVENTIONS
• Physical prevention (e.g. covering exposed Figure 97.1 An individual with excoriation
skin or hair) syndrome and numerous, small skin sores
caused by constant skin scratching and
picking.
OBSESSIVE-COMPULSIVE
DISORDER
osmsJl/OC,D

__ )
• Characterized by obsessions and/or • Obsessions and/or compulsions
compulsions O Must be time consuming (affecting day-
• Obsessions, compulsions vary in scope, to-day life)
type O Must not be caused by effects of a
substance or other medical condition
CAUSES • Not explained by other condition/substance
• Genetic, environmental; linked to issues
with serotonin neurotransmitters
( T_R_E~_~_M_EN_T
__ )
(__ s,_G_NS_&_S_Y_M_PT_O_M_s_) MEDICATIONS
• SSRls, other antidepressants
• Obsessions (e.g. with germs, unsafeness)
and/or compulsions (e.g. repeated hand- PSYCHOTHERAPY
washing, checking stove burner)
• E.g. cognitive behavioral therapy (exposure
• Distress affects day-to-day functioning and response therapy)
31
NOTES

( PATHOLOGY & CAUSES ) ( T_R_EA_:l"_M_EN_T__ )
• Deviations from cultural expectations - PSYCHOTHERAPY
worsens day-to-day life, relationships. • Focused on supporting individual, not
• Paranoid, schizoid, schizotypal personality challenging beliefs
disorders , Challenging beliefs often elicits negative
responses, affects treatment
CAUSES
• Linked to schizophrenia (esp. schizotypal)
PERSONALITY
(__ s,_G_NS_&_SY_M_PT_O_M_s_) DISORDERS
Paranoid
• Unusual behavior CLUSTER A Schizoid
• Poor relationships Schizotypal
Borderline
Antisocial
( D_IA_GN_o_s,_s __ ) CLUSTER 8 Histrionic
Narcissistic
• Unusual behaviors/traits Avoidant

• Not explained by other condition/substance CLUSTER C Obsessive-compulsive
Dependent
U.U~TE~ A
PAJZ"~'t> S,~\~O\t)
PH-SotJAl..11'( t)1SOII-Pll(
SC.lo\\~c:>1''\'PA\.
\'<:'1-'>oi,i p,1..nt 'i)1So1<\lli
PE~SOtJALIT'( 01SollOEfl
ti \I
f\(C.U5A1"0'2'( ''Aloof"
Figure 98.1 Illustration depicting different types of cluster A personality disorders.
32
PARANOID PERSONALITY
DISORDER
osmsJl/po.To.noid-peTsono.li-l:14-disoTdeT

• Overlaps with schizotypal personality • 2:: four of following
disorder O Irrational belief that others are harmful/
• Generally distrustful of others; demands deceptive
loyalty of family, friends O Doubts trustworthiness of close
• Individual harbors grudges if feeling lied to/ individuals
slighted O Reluctance to confide in others, fearing
• Suspiciousness damages relationships it may be used against oneself
O Sees hidden threats in everyday
scenarios
CAUSES
O Holds prolonged grudges
° Constantly feels attacked
O Suspicion of partner's fidelity
Not explained O by other condition/
substance
• Excessive distrust of others
• Prolonged grudges, superficial
relationships, isolation ( T_R_E~_~_M_EN_T
)
PSYCHOTHERAPY
• Aimed at improving social understanding;
can be challenging due to trust issues
A~~UM(S 01HEIZS / C:, UJ£(l N.A..'t DI ST !Z-VST FU L

WILL... "-.,
a, sust>1c.1ous
L D1S.SAP1'01~r
L MAt..11PvlAT£
L Tllll' BEHlµD -.....~iS S£ve:iELY 1r
8AC.l( fE£LS i~E.'1'1Vf. \)U..,-i •.•
Ci
L L\ED iO
0 " L SL\b\-tT~t>
H 0L9S (a~uo~~~
Figure 98.2 Illustration depicting thoughts and symptoms of paranoid personality disorder.
33
SCHIZOID PERSONALITY
DISORDER
osmsJl/ schizoid- eTsono.li-l14-disordeT

• Overlaps with negative symptoms of • 2: four of following
schizophrenia (blunted emotions/flat affect) , Does not want/enjoy close relationships
• Disinterested in, avoids social interaction , Prefers solitude
O Not caused by paranoia/social anxiety , Lack of interest in sexual activities
• Dislikes physical contact , Hard to please
, Lacks close friends
CAUSES , Un bothered by others' comments
• May be genetic, environmental , Flat affect/emotional blunting
, Not explained by other condition/
substance
)
• Flat affect/blunted emotions (..____ T_R_EA_~_M_EN_T
)
• Lack of desire for intimacy
• Chooses solitary activities PSYCHOTHERAPY
• Takes pleasure in few activities • Aimed at improving social understanding;
can be challenging due to trust issues
PH'tSIC.Al (ONTA<.T
LESS PLcASVf!ABl-E °"-.
e,_j, SfXVA L AC.TIVITi
e..,j, ~oLOU.J<. HAt'l>S
'-- _)
L k,s l1r.e..1::i to
See\£ ou.t
)
... \SO\.I\TIOtJ
\)\':)T\ ucr yoM
f.t."OTIONAL 6W~1'1~'1
L l)otJ't Sttow Pos,,-1vf ~ 1.JtC>11T1\/£. PA~t:\WOIA &. ~~\~~v
Figure 98.3 Illustration depicting thoughts and symptoms of schizoid personality disorder.
34
SCHIZOTYPAL PERSONALITY
DISORDER
osmsJl/ sehi20-l:14po.l-peTsono.li-l:14-disoTdeT

• Overlaps with paranoid personality disorder • 2:: five of following
• Excessive magical thinking (linking O Ideas of reference
unrelated events) O Magical thinking that changes behavior
• Ideas of reference (believes everything O Altered perception
relates to personal destiny) O Unusual thinking/talking
• Beliefs cause overconfidence, self-centered O Suspiciousness/paranoia
thinking O Inappropriate/flat affect
• Poor at gauging how others perceive them O Eccentridunusual behavior
• Maintain desire for relationships (unlike O Lack of close friends
schizoid)
O Social anxiety (related to paranoia, not
O schizoiD = "Distant"
fear of judgment)
O schizoTypal = "magical Thinking"
CAUSES
• May be genetic, environmental ( T_R_E~_~_M_EN_T
)
• Linked to schizophrenia
PSYCHOTHERAPY
• Aimed at improving social understanding;
(__ SI_G_NS_&_S_Y_M_PT_O_M_s_) can be challenging due to trust issues
• Ideas of reference
• Altered perception
• Unusual thinking/talking (vague, not
incoherent)
• Paranoia/anxiety
"IOEAS of ,.,..,- MA~1£.AI. 11m..1ir.1~

~f£fZU1'€ --.....
l-l2A1Jl>01'A £vt1-1TS
L f.v6!1'f1i-111-'C:i 1'19-E. L1)JKcO
(2ElA1£'.> re 0£'iTI\J't
Figure 98.4 Illustration depicting thoughts and symptoms of schizotypal personality disorder.
35
NOTES

( PATHOLOGY & CAUSES ) ( D_IA_GN_o_s,_s
__ )
• Antisocial, borderline, histrionic, narcissistic • Unusual behaviors/traits
personality disorders • Not explained by other condition/substance
• Deviations from cultural expectations -
affects day-to-day life, relationships
• Linked to depressive, substance use ( T_R_EA_:l"_M_EN_T
__ )
disorders
MEDICATIONS
• Antidepressants
CAUSES
PSYCHOTHERAPY
• Unusual behavior
• Poor relationships
AtJ Tl SOC.IAl SOltl)l1l\Nt H\ST~\OtJlC NAltUSS\ST\L

f>Efl.SCt,1A\.fT'I' Pt,s(),-,Alll't ~lf!SO~llT't
'\)\~OP.~~ ~l~OIIIAl\1'(
OISo~l)(\< 0~01'1>€~ 01':.0~0E:~
Figure 99.1 Illustration depicting the four cluster B personality disorders: antisocial personality
disorder, borderline personality disorder. histrionic personality disorder. and narcissistic
personality disorder.
36
ANTISOCIAL PERSONALITY
DISORDER
osms.i"l/ o.n-l.isoeio.l-persono.li-l.14-disorder

__ )
• Uses charisma to manipulate others. • 2:: three of following
• Disregard for moral values, societal norms, O Does not conform to societal norms
rights of others • Deceitful
• Poor impulse control, lacks empathy • Impulsive
• Willing to hurt others for own benefit=. O Irritable/aggressive
aggressive, unlawful behavlor=-. often • Reckless
given "sociopath"/"psychopath" label O Irresponsible
• Associated with substance use disorders, O Unremorseful

overrepresented in prisons
• Age> 18, conduct disorder since age< 15
• Not explained by other condition
CAUSES
• May be genetic, environmental; more
common in biological males MNEMONIC: CC/AA
Conduct disorder/antisocial
personality disorder
(__ SI_G_NS_&_S_Y_M_PT_O_M_s_)Conduct disorder is seen in
children
• Outwardly normal behavior
Antisocial personality disorder
• Hidden hostility, callousness, disregard for is seen in adults
others
( T_R_EA_:l"_M_EN_T__ )
PSYCHOTHERAPY
• E.g. self help groups
t)1~U~A~D fo' 1
'"'"" """"'t
!"\Of.Al.. VI\W~S
~ C.HAit.A1tJ~
L used. to MAIJIPvtAlE
LITTlE EM\>AT~'( ......--' t( JO' l'f\?'i,OIJI\\. C.1111.l
P()Of- 'IM~
CP~l10\..
J-
.)
......_ NO (ZEVIO~t/ C,ul~T
l \)o~l 0<«9t Yc~Vlll'o<li~
5,,, "l\\?M
l,JlllllJC. "Tl>
Hun onu:ll.\ ~bitss,vt "'=>0L1ovl\-ttt"
lf tr --- ..~ i<U,..LA\Alf\JL--+ 0'
\.\UPS l\UM 8EttAv1e1t "~~tl\ol'Anl"
Figure 99.2 Illustration depicting thoughts and symptoms of antisocial personality disorder.
37
BORDERLINE PERSONALITY
DISORDER
osms.i"l/\>oTdeTline- eTsono.li"l14-disoTdeT

• Unstable moods (intense joy+--- - rage) • 2: five of following
• Intense relationships that sour over time , Frantic avoidance of abandonment
• "Stable instability" (consistent pattern of , Unstable, intense relationships
instability) , Unstable self-image
• Splitting (extreme perspectives: things seen , Self-destructive impulsivity
as completely good/completely bad) , Suicidal/self-harming behavior
• Fear of abandonment , Emotional instability
, Feeling empty
CAUSES , Anger management issues
• May be genetic, environmental , Transient paranoid thinking
, Not explained by other condition

(..____ T_R_EA_:T_M_EN_T
)
• Unstable mood
• Fear of abandonment (real/imagined) MEDICATIONS
• Splitting • Antipsychotics, antidepressants
• Suicidal/self-harming behavior
PSYCHOTHERAPY
• E.g. dialectical behavior therapy,
mentalization-based therapy, transference-
focused therapy
t)tFEOJS( r-\lOAl<ISM
S9llTTHJ~ --- I~rt:JJS.f
1 So-"~ Wot-.Jt>E~FvL
lMl'O~IIN11'111~<,S~-~ 'joe)
~ELA110..iS\-\1PS
~~
UOOO or 6AO
c. TEJ.~lflEO oj A6A .... 01)W~EtJT'
L ~to'l'Y\e. o~,w.,._,·v..
11.
L i-A•g,,t ae ~,<tf~M< ~•"'3S to !'.ee.p

5ou9- o./tf -\-'IMt
j,oM \eov1V1~
Figure 99.3 Illustration depicting thoughts and symptoms of borderline personality disorder.
38
HISTRIONIC PERSONALITY
DISORDER
osms.i-l/his-lrionie-persono.li-l'4-disorder

• Attention-seeking, excessive emotionality. • 2:: five of following
• Manipulative tendencies O Must be center of attention
• Superficial relationships O Inappropriate (e.g. provocative)
• Shallow, flighty, egocentric interactions
° Fast changing, shallow emotions
Uses appearance to draw attention
CAUSES O
O Vague speech
O Exaggerated manner
O Easily affected by others/situations
Mistakes relationships O as more intimate
• Not explained by other condition
• Exaggerated thoughts, feelings (e.g.
tantrums)
• Superficial relationships ( T_R_E~_~_M_EN_T
__ )
• Excessively seductive behavior
• Attention-seeking behavior PSYCHOTHERAPY
• Psychoanalytic therapy
ATT€Ul'IO~-SE£tt1~4
£'1.(.ESSIVE "'
f MOTIO>JAUTV --......_
l
Figure 99.4 Illustration depicting thoughts and symptoms of histrionic personality disorder.
39
NARCISSISTIC PERSONALITY
DISORDER
osms.i"l/ ne1Teissis-lie-persone1li-l14-disorder
( PATHOLOGY & CAUSES ) ( D_IA_GN_o_s,_s

__ )
• Grandiose self-image • 2:: five of following
• Demands special treatment O Grandiose self-image
• Thinks ideas are best, should be supported n Fantasies of grandiosity
• Fragile self-esteem, lashes out if slighted O Believes they are "special"
• Lacks empathy O Seeks admiration
• Exploitative of others O Entitled
• Only involved in what advances personal O Exploitative
agenda O Thoughtless
O Envious/jealous
CAUSES O Arrogant
• May be genetic, environmental • Not explained by other condition
(__ SI_G_NS_&_SY_M_PT_O_M_s_) C T_R_E~_~_M_EN_T

__ )
• Sense of entitlement MEDICATIONS
• Arrogant behavior • Lithium, SSRls, other antidepressants
• Vulnerable to criticism
• Exploitative of others PSYCHOTHERAPY
• Psychoanalytic therapy, group therapy
u~~WDIOSE
5Hf-1MA6£ D
o
~ f ~llf SHF-(St££M
LvuLtJEl!ABLc To
C~\TlllS,M
LL11~£~ our
W'M.V\ .fu.\1V,&
Sl.1<.~'tl-1)
Figure 99.5 Illustration depicting thoughts and symptoms of narcissistic personality disorder.
40
NOTES

__ )
• Avoidant, obsessive-compulsive and • Unusual behaviors/traits
dependent personality disorder • Not explained by other condition/substance
• Deviations from cultural expectations e-
worsens day-to-day life and relationships
( T_R_E~_~_M_EN_T
__ )
CAUSES MEDICATIONS
• Antidepressants
• Linked to anxiety disorders
PSYCHOTHERAPY
(__ s,_G_NS_&_S_Y_M_PT_O_M_s_) • E.g. behavioral therapy, group therapy,
assertiveness training
• Unusual behavior
• Poor relationships
A\IO\'i>AW1 ogse.~S\\IE-LON\9ULS\Vt Of PE.)JO~tJT

j>E;~50Nf>.LH ',( Pt~SCNI\L\1'( ~t~~P.\..HY
0\CSo1D~\2 t),soiof.i \)\$0~6~
Figure 100.1 Illustration depicting the three cluster C personality disorders: avoidant personality
disorder, obsessive-compulsive personality disorder, and dependent personality disorder.
41
AVOIDANT PERSONALITY
DISORDER
osms.i"l/ o.voido.n-l-peTsono.ltt:14-disoTdeT

__ )
• Shyness, social inhibition, low self-esteem • ;;;: four of following
• Wants close relationships, but doesn't take , Avoids social situations
social risks , Unwillingness to interact
• Hypersensitive to rejection, criticism , Limits intimate relationships
• Overlap with dependent personality , Preoccupation with rejection, criticism
disorder, others from clusters A, B , Low self-esteem
, Fears embarrassment associated with
social risk-taking
• Hypersensitivity to rejection, criticism

• Resulting timidness
( T_R_E~_~_M_EN_T__ )
• Desire for relationships
MEDICATIONS
• Beta blockers, selective serotonin reuptake
inhibitors (SSRls)
PSYCHOTHERAPY
• E.g. group therapy, assertiveness training
SHV
1
WS\tJ'fS C..LOS(
itt.ri.110N~\11PS.Bvr ...
il~\l) ..::::::
.,.___...,...,... • ro.rel~to.I<(~ sow~l
S«>llAU.'1' V'IS~
'1.,iH191T£D - * o.vo1d..S ~o,;al
s',tualtOVIS
Low _,,,,,-
SfLF--£51(£~
1.M So ... ~\.WP(~$E\.J!>IT\V( ,tp
.. l'I\UlfO.',,\t
J2EJH,T10µ ~ tJfl:iATI~ fEt08AC.J(.
: ~:~;~nlt
C~\;It.
~ Xle.lO'!Yle~ ~~ u,ihldro.Vh\..
Figure 100.2 Illustration depicting thoughts/symptoms typical of avoidant personality disorder.
42
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
osms.i-l/ o\>essive-complusive

__ )
• Obsessed with orderliness, perfection, • ;;:: four of following
need to be in control , Preoccupation with details
• Inflexible, easily stressed, inefficient , Disruptive perfectionism
(because of excessive planning) , Work eclipses personal life
• Rigid beliefs----. "stubborn" label , Rigid, loud beliefs (religious, ethical)
• OCD ego-dystonic; OCPD ego-syntonic , Tendency to hoard possessions
, Refuses to delegate
, Excessively frugal
, Stubbornness
• Preoccupation with rules, details, perfection
• Rigid, inflexible behavior
• Lacking sense of humor (..____ T_R_EA_:T_M_EN_T
__ )
• Indecisive (for fear of making wrong
decision) MEDICATIONS
PSYCHOTHERAPY
• Cognitive behavioral therapy, group therapy
0% S.E~S.l\JE.- (Ot,.\\l\Jl.~\\1£. os~,s.~\\JE.- C.l>M9ULS\VE.

\)\~C~Off!.. ~(;iZ-SONALI T~ Dl~Oll-1)£\l
(OU>) lOC.Pl)J
• ~tJ1\t"f'1 'D1!>0iVf.~ •
\.... ?c,\>(-'atiOYI Dy E.uo -5'fWTOtJI(.
i'1tl.lo.1is~k o.c..-t>~f\'> l..\l\o.?~'a o,:,"1tli\. ~OUJ -ti/\~ O.~
£C..O-D'lSTOtJ\C.. , ._, u:,wa..
l>JISv,e!:. -h\e~
Sitl p
\... ~011-\:. IIJO.(I\;. "tO CVIO.'l\~e
Figure 100.3 Illustration depicting differences between obsessive compulsive disorder and
obsessive compulsive personality disorder.
43
DEPENDENT PERSONALITY
DISORDER
osms.i"l/ depe nde n-l-pel9sono.li-l14-disol9del9

__ )
• Excessive fear of separation/rejection • ;;;: five of following
• Overly dependent on others , Can't make everyday decisions
• Lack self-confidence , Overly dependent on others
• Overly indecisive , Scared to disagree with others
• Possessive of individuals they depend on , Lack of self-motivation
• Overlap with avoidant personality disorder, , Craves approval
others from clusters A, B , Uncomfortable/afraid of being alone
, Quick to replace lost relationships
• Dependent, submissive ( T_R_EA_~_M_EN_T
__ )
• Overly indecisive
• Clings onto others MEDICATIONS
PSYCHOTHERAPY
• E.g. insight oriented, behavioral, family,
group, assertiveness training
LACJ:S
1~1ttJ5.E. Jeo.r 1· .. / SEt.f~ (ONFll>UJc.£
~ SEPAAATlOW
• ieJtc:noN
Figure 100.4 Illustration depicting thoughts/symptoms typical of dependent personality disorder.
44
NOTES

Negative symptoms
( PATHOLOGY & CAUSES ) • Impairment of normal functioning in
emotional expression, communication,
• Mental disorders characterized by purposeful activities
fragmented patterns of thinking
• Flat affect (less emotional response)
• Feature positive, negative symptoms
• Alogia (lack of content in speech)
• Avolition (decrease in motivation)
CAUSES
• Multiple factors: genetic vulnerability, Cognitive symptoms
physiological/biochemical dysfunction, • Difficulties with memory, learning,
psychosocial stressors understanding
Mood-related symptoms
• Sometimes
Positive (psychotic) symptoms

• Delusions
( D_IA_GN_o_s,_s
__ )
° False beliefs remaining even when
• Based on symptoms' presence over certain
opposing evidence presented (e.g.
time period (varies by disorder)
delusions of control/reference)
• Affects day-to-day functioning (e.g. social,
• Hallucinations
occupational, academic)
O Perceptual experiences occurring
without sensory stimuli (e.g. visual,
auditory, tactile hallucinations)
• Disorganized speech (e.g. word salad)
( T_R_E~_~_M_EN_T__ )
• Disorganized behavior (e.g. wearing warm
clothes on a hot day; may include catatonic MEDICATIONS
behavior; e.g. resistant movement/
• Antipsychotics
unresponsiveness)
PSYCHOTHERAPY
• E.g. individual/group therapy, rehabilitation
45
~C.\i\l.O 9\.\\2.fNI f4 \o~ ~ Sj'l\l\ftt""\
' SY~l.OM6, 1 d,.',~(Nlt' v~httlH "-clifftrtnt 'j~P~o .... ,
• ?!o~~O"ti'- Sj~pttl\l'~ 'l

* '(t~~~\ of 'f\O'ttl\t.\ -If o.~eLtt
• 9(\.USIO~S ~'#Ot.t.s,t\
\_.,, 'Mt.WI Dr~
L- r>f" (.o't\\r, \ ., ,1, '-W\Qt\ot\'> \..-,\t4,a\v,3
Lot nfue.-n<.e. .,.. \,ass 6f \'trt~rtS~ \...,, VIIIO.l.-\t.f\O. 1111j
• "AL"U'INf\TIOlJS • FLAT M'fl<..T .. s"~+1c. iJ.Hfi,u.lt

L Stn\otio~ V\Ol ~rt L 1no.pprof1'i•tt +e V\O tit.t.
'1"C.S\>on\C.
• l)1S«.1lEiA~\'l~O ~'Pt«.\\
L ~ O't"ck Sa.\o.cl. • ALO~\A
• \)\SOP.tal\tJl~~b it\'\Pl\1101>- L 9ovtr~ at
'- 'o\i~rrt. , -no ~,.\>Ole. ~vt.td,\.
, (PITl'iON\l iE~A\J&Ol • ~\IOl.lT\CHJ
\...'t'l'olle.MtM} &,.. ftSV01\~t.~ L ~ 'Motiv."10"'-
Figure 101.1 Illustration depicting positive, negative, and cognitive syjmptoms.
DELUSIONAL DISORDER
osms.i"l/ cJ.elusione1l-cJ.isorcJ.er
Non-bizarre delusions
( PATHOLOGY & CAUSES ) • Persecutory
, Others conspiring against/following
• Mental disorder characterized by persistent
oneself
delusions
• Jealous
• Delusions may be bizarre (impossible)/non-
bizarre (possible, but still wrong) , One's partner unfaithful
• Delusions remain even when opposing • Of guilt/sin

evidence presented , One wrongly feels guilty
• Of reference
, One believes messages directed at
( s,_G_NS_&_SY_M_PT_O_M_s_) them/are especially significant
• Somatic
Delusions
, One's body is diseased/changed
• Of control
• Erotomanic
O Others control one's actions/thoughts
, Another is in love with oneself
• Of thought broadcasting
• Grandiose
O Others can hear one's thoughts
' One believes they have special talents/
• Of thought withdrawal abilities
O One's thoughts are being stolen • Religious
• Nihilistic , Involving spiritual aspect
O World/self doesn't exist
46
( D_IA_GN_O_s,_s __ ) ( T_R_E~_~_M_EN_T__ )
• ~ one delusion, over ~ one month MEDICATIONS
period, without meeting other criteria for • Antipsychotics, antidepressants
schizophrenia
O Hallucinations may occur in some cases
PSYCHOTHERAPY
of delusional disorder
SCHIZOAFFECTIVE DISORDER
osms.i"l/ sehizoo.ff ee-l.ive-disoTdeT
( PATHOLOGY & CAUSES ) ( T_R_E~_~_M_EN_T

__ )
• Mental disorder characterized by symptoms • Treat depressive, schizophrenic symptoms
of schizophrenia + a mood disorder separately
MEDICATIONS
(__ s,_G_NS_&_S_Y_M_PT_O_M_s_) • Antipsychotics, antidepressants
• Positive symptoms
O Delusions, hallucinations, disorganized PSYCHOTHERAPY
speech, disorganized behavior • Dialectical behavior therapy, mentalization-
• Negative symptoms based therapy, transference-focused
° Flat affect, alogia, avolition therapy
• Mood-related symptoms
O Depression, suicidal ideation
O Manic episodes (e.g. euphoria,
grandiosity, hyperactivity)
( D_IA_GN_o_s,_s __ )
• ~ two of following (+ at least one of first
three) + a mood disorder
o Delusions
O Hallucinations
O Disorganized speech
O Disorganized or catatonic behavior
O Negative symptoms
• Delusions/hallucinations last z two weeks
beyond mood episode
47
SCHIZOPHRENIA
osmsJl/ sehizophTenio.

__ )
• Mental disorder characterized by • 2:: two of fol lowing ( + at least one offirst
fragmented patterns of thinking for> six three), over one month
months , Delusions
• Individuals cycle through three phases, , Hallucinations
normally in order , Disorganized speech
O Prodromal phase: socially withdrawn; , Disorganized or catatonic behavior
blunted affect
, Negative symptoms
O Active phase: severe positive, negative
• Other signs of disturbance (with prodromal,
symptoms
residual symptoms) persist 2:: six months
O Residual phase: cognitive symptoms;
periods of remission
CAUSES
• Success of treatment with dopamine ( T_R_E~_~_M_EN_T
__ )
antagonists suggests link to increased
dopamine levels MEDICATIONS
• Genetic; more common in biological males • Antipsychotics
RISI( FACTORS PSYCHOTHERAPY

• Suicidal ideation - death • E.g. individual/group therapy, rehabilitation
(__ s,_G_NS_&_SY_M_PT_O_M_s_)
• Positive symptoms
O Delusions, hallucinations, disorganized
speech, disorganized behavior
• Negative symptoms
° Flat affect, alogia, avolition
• Cognitive symptoms
O Difficulties with memory, learning,
understanding
48
Sc.H\c.0 9\\(lfNI"
P~ASlS
0>~oOlOIW\A~ - • (Ac.TIU€ j
• wi#tdrelk.111\ • SEvE.IU: S'1fWl~To~S
-k111sio111~
_ 1,.alli.tcl~tto~I
• . 1
- 4/.l~oy1can 1~u-
so~,,~
r ,
- ,l.1\1 ,,i,..iv"- 'o<t..l,,,cav••r
_ tOl\cHofl•L .._,.,,ca"4°""
"
\.__ \ ~SIOUA\. /
Figure 101.1 Illustration depicting positive, negative, and cognitive syjmptoms.
SCHIZOPHRENIFORM DISORDER
osms.i-1:/sehizophTenifoTm-cJ.isoTdeT
( PATHOLOGY & CAUSES ) ( D_IA_G_N_OS_IS)

• Mental disorder characterized by • ;;;: two of fol lowing (+ at least one of first
fragmented patterns of thinking over three), over one month
reduced period (1-6 months) O Delusions
• Similar to active phase of schizophrenia O Hallucinations
(severe positive, negative symptoms), O Disorganized speech
minus prodromal phase O Disorganized or catatonic behavior
O Negative symptoms
( SIGNS & SYMPTOMS ) • Other signs of disturbance (with prodromal,
residual symptoms) do not persist ;;;: six
• Positive symptoms months (if 2: six months, diagnosis=
O Delusions,
schizophrenia)
hallucinations, disorganized
speech, disorganized behavior • Affects day-to-day functioning
• Negative symptoms • Not caused by other condition/substance

° Flat affect, alogia, avolition
• Cognitive symptoms ( TR_E_AT_M_E_N_T
)
O Difficulties with memory, learning,
understanding MEDICATIONS
• Antipsychotics
PSYCHOTHERAPY
49
Avoid social interaction, lack friends, flat affect, lack of sexual interest. "Lone wolf'';
Not caused by paranoia or social anxiety
(Overlaps with Negative symptoms of Schizophrenia)
Excessive magical thinking (linking unrelated events. fixation on personal destiny).

beliefs cause overconfidence, poor social perception, still want to maintain relationships
Positive symptoms: Delusions. hallucinotions. disorganized speech

or catatonic behavior;
Negative symptoms: Flat affect, alogia, avolition
Persists ,= 6 months
Symptoms of schizophrenia for 1-6 months
Symptoms of schizophrenia for < 1 month
Symptoms of schizophrenia with addition of a mood disorder (Depression, Bipolar)
"Fixed false belief'' that lasts > 1 month without other schizophrenia criteria
50
NOTES
GENERALLY.WHAT IS IT?
( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_SY_M_P_TO_M_s_)
• Sexual function disturbances, often causing • Sexual dysfunction
distress , E.g. I/absent orgasmic function, altered
• May be lifelong/acquired, mild/moderate/ libido
severe, generalized/situational • Anxiety, distress
Associated factors
• Medical diagnoses ( D_IA_GN_O_s,_s __ )
O E.g. diabetes mellitus, thyroid
dysfunction OTHER DIAGNOSTICS
• Relationship issues • Based on specific sexual-disturbance
O E.g. impaired interpersonal presence
communication, intimate partner ° Causing individual distress
violence O Not better explained/accounted for by
• Cultural/religious factors another medical condition, non-sexual
O E.g. negative attitudes/prohibitions psychological disorder, interpersonal
regarding sexual activity stress, substance
• Individual vulnerabilities
OE.g. history of abuse, psychiatric
comorbidity-anxiety, depression, ( T_R_E~_~_M_EN_T__ )
intrapsychic conflict, psychosocial
st res so rs
MEDICATIONS
• Partner issues
O E.g. mental, physical. sexual health
issues PSYCHOTHERAPY
51
FEMALE SEXUAL INTEREST I
AROUSAL DISORDER
osms.i-l/f emC1le-C1TousC1l-disoTdeT
, Sexual/erotic thoughts
( PATHOLOGY & CAUSES ) , Sexual activity initiation; partner
initiation receptivity
• Disorder characterized by either absence
, Pleasure/excitement durinq a 75% of
or! frequency/intensity of sexual/erotic
sexual encounters
activity or thoughts in biological females
, Interest/arousal in sexual/erotic-cue
settings
(__ SI_G_NS_&_SY_M_P_TO_M_s_) , Genital/non-genital sensation during ;;::
75% of sexual encounters
• Self-reported !/absent sexual pleasure,
genital/nongenital sensations, ! vaginal
lubrication - anxiety/distress (..____ T_R_E~_iT_M_EN_T
)
MEDICATIONS
( D_IA_GN_O_s,_s __ ) • Flibanserin, bupropion
OTHER DIAGNOSTICS PSYCHOTHERAPY

• Absence of/] frequency/intensity of at
• Cognitive-behavioral and/or psychosexual
least three of following; persisting for z six
therapy
months - distress; not better explained by
non-sexual factors
O Interest in sexual activity
GENITO-PELVIC PAIN AND/OR

PENETRATION DISORDER
osmsJl/ genl"lo-pelvie-pe1in
(gynecological exams. tampon insertion)
Associated factors
• Disorder characterized by difficulty with • Medical conditions
intercourse due to vulvovaginal/pelvic pain. OE.g. anatomic anomalies. atrophic
anticipatory fear of pain during penetration. vaginitis, obstetric perinea! injury (e.g.
pelvic floor muscle tension during episiotomy)
penetration
• Sexually-transmitted disease history
• Penetration concerns may be related
• Vulvodynia (persistent idiopathic vu Ivar
to vaginal intercourse/other situations
pain)
52
• Low estrogen levels intercourse/penetration attempts
, Fear/anxiety in anticipation of, during,
after penetration
( SIGNS & SYMPTOMS ) , Pelvic floor muscle tensing during
penetration attempts
• Dyspareunia
O Pain described as superficial/deep;
throbbing, shooting, burning ( TREATMENT )
• Pelvic floor muscle guarding, reflexive
spasms PSYCHOTHERAPY
• Avoidance of intimate sexual activity/ • Cognitive-behavioral and/or psychosexual
recommended gynecological exams therapy
• Resulting anxiety/distress
OTHER INTERVENTIONS
• Pelvic physical therapy
(.____ D_IA_GN_O_s,_s __ ) • Address underlying cause
OTHER DIAGNOSTICS • E.g. ospemifene for dyspareunia
(vulvovaginal atrophy)
• Recurring one/more difficulties persisting
for ~ six months ----. distress, not better
explained by non-sexual factors
O Vaginal penetration during intercourse
O Vulvovaginal/pelvic pain during
MALE HYPOACTIVE SEXUAL

DESIRE DISORDER
osmsJl/male-h14poad:ive-desiTe

• !/non-existent sexual desire, interest, • Persistent, !/non-existent sexual desire,
arousal in biological males, persisting for z interest, arousal ----. anxiety/distress
six months ----. distress, not better explained
by non-sexual factors
( D_IA_GN_O_SI_S __ )
Associated factors
• Medical conditions OTHER DIAGNOSTICS
O E.g. impaired erectile/ejaculatory • Absence of/] frequency/intensity of sexual
function; diabetes mellitus; desire or sexual/erotic thoughts; persisting
hyperprolactinemia; low testosterone for ~ six months ----. distress; not better
levels explained by non-sexual factor
• Psychological/social conditions
O E.g. depression, stress, substance abuse
53
(..__ __ T_R_E~_~_M_EN_T
)
MEDICATIONS
• Bupropion
PSYCHOTHERAPY
• Cognitive-behavioral/psychosexual therapy
ORGASMIC DYSFUNCTION
osmsJf:/ 0Tge1smie-d14sfunelion
Male
( PATHOLOGY & CAUSES ) • ED: presence of one of following symptoms
experienced during 2: 75% of sexual
• Orgasmic sensation absence, infrequency,
activity; persisting for 2: six months -
! intensity, delay distress; not better explained by nonsexual
Female cause
, Difficulty obtaining erection
• Female orgasmic disorder: difficulty
experiencing normal orgasmic function , Difficulty maintaining erection
, ! erectile rigidity
Male • Abnormal ejaculation
• Erectile dysfunction (ED): persistent , Delayed ejaculation
inability to obtain/maintain erection
, Ejaculation infrequency/absence
• Abnormal ejaculation (premature, delayed)
, Premature ejaculation
( T_R_E~_~_M_EN_T
)
• Reported impaired orgasmic function
during sexual activity
MEDICATIONS
• Sildenafil
• Low self-esteem, ! sense of sexual self -
depressed affect
PSYCHOTHERAPY
• Cognitive-behavioral/psychosexual therapy
)
OTHER DIAGNOSTICS
Female
• Presence of one of following symptoms
experienced during 2: 75% of sexual
activity; persisting for 2: six months -
distress: not better explained by nonsexual
cause
O Orgasm delay, infrequency, absence
(specify if orgasm never experienced)
0 ! orgasmic intensity
54
NOTES

( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_SY_M_PT_O_M_s_)
• Mental disorders impacting normal sleep • See individual disorders
CAUSES ( D_IA_GN_O_s,_s __ )
• Stress, substance use, medical conditions
COMPLICATIONS
• Affects quantity/quality of sleep, causing
lack of restorative sleep ----> irritability, ( T_R_E~_~_M_EN_T__ )
anxiety, depression
BRUXISM
osms.i"l/\>Tuxlsm
( PATHOLOGY & CAUSES ) (__ SI_G_NS_&_S_Y_M_PT_O_M_S_)

• Repeated teeth grinding/clenching • Dental abfraction/attrition ---->
• Nocturnal (sleep bruxism) or diurnal (awake hypersensitivity

bruxism) • Tooth fractures/loosening/loss
• Awake variant more associated with stress • Tongue biting ----> crenated/scalloped tongue
• Cheek biting ----> canker sores
CAUSES • Sleep bruxism: jaw pain in morning
• Obstructive sleep apnea, misaligned teeth, • Awake bruxism: jaw pain increases
stress, dehydration, medication side effects, throughout day
illicit drugs
( D_IA_G_N_OS_IS)
COMPLICATIONS
• Can cause temporomandibular joint OTHER DIAGNOSTICS
disorder • Persistent grinding/clenching of teeth
• Not caused by other condition
55
(..____ T_R_E~_~_M_EN_T
)
MEDICATIONS
• Avoid stimulants, depressants
OTHER INTERVENTIONS
• Sleep bruxism: mouth guards, occlusal
splints, dental plates, muscle relaxants, oral
surgery
• Awake bruxism: behavior modification
Figure 103.1 Bruxismcauses flattening of the • Minimize chewing
occlusal surfaces as seen here.
INSOMNIA
osms.i"l/insomnio.
( PATHOLOGY & CAUSES ) (..____ D_IA_GN_O_SI_S

)
• Repeated difficulty falling asleep, waking OTHER DIAGNOSTICS
up throughout night, waking up too early • Poor sleep quantity/quality, associated with
• Affects quantity/quality of sleep, causing , Difficulty falling asleep
lack of restorative sleep , Difficulty maintaining sleep (waking up/
• Individuals often self-medicate with being unable to fall back to sleep)
alcohol/benzodiazepines , Waking up too early, being unable to fall
back to sleep
CAUSES • Affects day-to-day functioning
• Stress. stimulants. depressants. psychiatric/ • Difficulty with sleep ~ three nights a week
physical conditions (e.g. pulmonary disease) for z three months
• Must have sufficient opportunity to sleep
RISI( FACTORS
• Heightened cortisol levels/ sensitivity
( T_R_E~_~_M_EN_T
)
• Reduced levels of estrogen/progesterone
• Increases with age MEDICATIONS
• Melatonin agonists. non-benzodiazepine
sedatives, occasionally benzodiazepines
(__ SI_G_NS_&_SY_M_PT_O_M_s )
• Excessive time spent falling asleep OTHER INTERVENTIONS
• Repeated waking up during night • Improve sleep hygiene
• Daytime sleepiness, fatigue - irritability, , Regular sleep schedule. exercise; reduce
anxiety, depression alcohol. caffeine. smoking (esp. in
evening); avoid daytime naps and going
to sleep hungry
• Stimulus control
O Use bed only to sleep; remove bright
56
lights, minimize noise
• Don't force sleep (try for 20 min, then stop)
• Behavior therapy
NARCOLEPSY
osms.i"l/ ne1Teoleps14

__ )
• Recurrent sleep phenomena (e.g. OTHER DIAGNOSTICS
sleepiness/dreaming) during wakefulness • Recurrent feelings of sleepiness during
• Associated with a lack of orexin daytime > three times/week ::::: three
(neuropeptide) months
• Orexin (A and BJ increases state • ::::: one of following
of wakefulness when binding with • Cataplexy
postsynaptic neurons O Hypocretin deficiency
• Individuals fall asleep faster and enter REM O Short rapid eye movement (REM) sleep
faster
CAUSES
• Damage to orexin-transporting neurons ( T_R_E~_~_M_EN_T
__ )
O By autoimmune process/injury)
MEDICATIONS
• Selective serotonin reuptake inhibitors
RISI( FACTORS (SSRls), stimulants (e.g. modafinil)
• Genetic factors, low levels of histamine,
infections, autoimmune diseases
• Daytime sleepiness
• Cataplexy (strong emotions cause muscle
weakness)
• Hallucinations
O Hypnagogic: happen when falling
asleep
O Hypnopompic: happen when waking up
• Sleep paralysis
O Regaining consciousness while body's
muscles are paralyzed during sleep
57
NIGHT TERROR
osms.i"l/ nigh-l--leTToT
( PATHOLOGY & CAUSES ) (......___ D_IA_GN_O_s,_s)

• Repeated night/sleep terrors OTHER DIAGNOSTICS
O Periods of intense fear occurring at night • Presence of night terrors
• Usually occur during deep non-REM sleep • No recollection of imagery during episode
• Incomplete/absent memory of episode
CAUSES • Affects day-to-day life
• Linked to past traumatic events, sleep • Not caused by other condition/substance
deprivation
(......___ T_R_E~_iT_M_EN_T
)
RISI( FACTORS
• Most common in children (3-8 years old) OTHER INTERVENTIONS
• Reduce stress, follow nighttime routine
• Often resolves spontaneously (esp. in
children)
• Night terrors
O Begins with sharp scream - individual
sits up - unresponsive - when
awoken, individual confused, has no
memory of episode
NOCTURNAL ENURESIS
osms.i-l/ noe-luTno.1-enuTesis
( PATHOLOGY & CAUSES ) C__s,_G_Ns_&_s_Y_M_PT_O_M_

• Repeated, uncontrolled passage of urine • Repeated, uncontrolled passage of urine
into bed/clothes. during nighttime into bed/clothes during the nighttime
• Often occurs during REM sleep
CAUSES
C D_IA_GN_o_s,_s
__ )
• Poor bladder control (for physiological OTHER DIAGNOSTICS
developmental reasons)/simply exceeding • Repeated, uncontrolled passage of urine
bladder capacity into bed/clothes during the nighttime
• Genetic, environmental • "Clinically significant"
° Comorbid with other mental disorders , Occurs z two times/week for z three
O More common in biological males consecutive months or affects day-to-
58
day functioning
• ;:=: five years old
( T_R_E~_~_M_EN_T__ )
• Often resolves spontaneously
MEDICATIONS
• Desmopressin - reduces urine production
PSYCHOTHERAPY
• Behavioral therapy
O Esp. bedwetting alarm therapy
O Moisture-detecting alarm wakes
individual up during enuresis
OTHER INTERVENTIONS
• Bladder program
O To build good habits
59
NOTES afratafreeh.com exclusive

( PATHOLOGY & CAUSES ) ( D_IA_GN_o_s,_s __ )
• Maladaptive pattern of substance use OTHER DIAGNOSTICS
• Dependence: inability to feel "normal" • ;;;: two of fol lowing
without using substance , Consuming more of a substance than
• Addiction: compulsive substance use to intended
achieve reward stimuli, despite negative , Inability to cut down
effects , Use takes up a lot of time
• Continued consumption causes tolerance , Cravings
O Receptors become less sensitive, , Use affects responsibilities
or neurons have fewer receptors
, Using in spite of social problems caused
(downregulation)
, Use replaces important activities
O Must consume more of substance to feel
, Using in physically dangerous situations
desired effect (positive reinforcement)
, Using even if it worsens a problem
• Stopping use causes withdrawal
, Developing tolerance
O Body predictively counters consumption
symptoms; no consumption = nothing to , Feeling withdrawal symptoms
counter • Mild = 2-3 symptoms, moderate = 4-5
O Must consume more to avoid discomfort symptoms, severe = ;;;: 6 symptoms
(negative reinforcement)
• Possibly fatal complications (e.g. cancer,
heart attack, overdose) ( T_R_EA_~_M_EN_T__ )
MEDICATIONS
(__ s,_G_NS_&_SY_M_PT_O_M_s_) • To reduce cravings, mimic substance, or
change its effects
• Increased tolerance
• Upon withdrawal PSYCHOTHERAPY
O Anxiety, depression, irritability, fatigue, • E.g. motivational interviewing, cognitive
tremors. palpitations, clammy skin. behavioral therapy, peer-support programs
dilated pupils, sweating, headaches.
difficulty sleeping. vomiting, seizures,
changes in vital signs
60
ALCOHOL USE DISORDER
osmsJl/ e1leohol-use-clisoTcleT
( PATHOLOGY & CAUSES ) (.____ D_IA_GN_O_SI_S

)
• Inability to feel "normal" without alcohol OTHER DIAGNOSTICS
• Alcohol use disorder: maladaptive pattern • 2:: two of fol lowing
of alcohol consumption n Consuming more alcohol than intended
• Alcohol = depressant O Inability to cut down
• Develop alcohol tolerance O Alcohol use takes up a lot of time
O GABA, glutamate, dopamine, serotonin ° Cravings to use alcohol
receptors become less sensitive/neurons O Alcohol use affects responsibilities
have fewer receptors (downregulation) O Using alcohol despite social problems
O Must drink more to feel euphoric O Giving up important activities for alcohol
(positive reinforcement)
O Using alcohol in dangerous situations
• Withdrawal
O Using alcohol even if worsens a problem
O Becoming tolerant to alcohol
COMPLICATIONS O Withdrawal symptoms
• Heart damage (dilated cardiomyopathy,
• Mild = 2-3 symptoms, moderate = 4-5
arrhythmias, stroke), liver damage
symptoms, severe = 2:: six symptoms
(steatosis, steatohepatosis, fibrosis,
cirrhosis), pancreatitis, cancers (mouth,
esophagus, throat, liver, breast), death by
overdose (cardiac, respiratory depression)
(.____ T_R_E~_~_M_EN_T
)
MEDICATIONS
( SIGNS & SYMPTOMS ) • Naltrexone (reduces cravings), acamprosate
(stabilizes withdrawal), disulfiram
(increases ethanol sensitivity)
• Increased alcohol tolerance
• Upon withdrawal
O Anxiety, depression, irritability, fatigue. PSYCHOTHERAPY
tremors, palpitations, clammy skin. • Motivational interviewing, cognitive
dilated pupils, sweating, headaches, behavioral therapy, peer-support programs
difficulty sleeping, vomiting, seizures
O Delirium tremens {high fever,
hallucinations, intense agitation) MNEMONIC: COAT RACK
Wernicke's encephalopathy
Confusion
\ MNEMONIC: CANs of heer Ophthalmoplegia
Wernicke-Korsakoff triad Ataxia
Confusion Thiamine tx.
Ataxia
Nystagmus Korsakoff's psychosis
Retrograde amnesia
Anterograde amnesia
Confabulation
Korsakoff's psychosis
61
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Figure 104.1 Illustration showing alcohol's effects on the hypothalamus, pituitary glands, and
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Figure 104.2 Illustration showing the effects of alcohol withdrawal.
CANNABIS DEPENDENCE
osms.i"l/ eo.nno.\>is_de endenee
• Continued cannabis use causes tolerance
( PATHOLOGY & CAUSES ) , Cannabinoid receptors become less
sensitive/neurons have fewer receptors
• Inability to feel "normal" without cannabis (downregulation)
• Cannabis use disorder: maladaptive pattern , Must consume more to feel euphoric
of cannabis use (positive reinforcement)
• Cannabis = depressant/stimulant • Withdrawal
62
COMPLICATIONS O Giving up important activities for
• Anxiety, depression, psychotic disorders cannabis
(e.g. schizophrenia), hyper-inflated O Using cannabis in dangerous situations
lungs (when smoking cannabis), chronic O Using cannabis even if it worsens a
bronchitis, respiratory infections, heart problem
attacks, strokes O Becoming tolerant to cannabis
• Teenagers at higher risk (developing brain O Withdrawal symptoms
more sensitive)
symptoms, severe=::::: six symptoms
• Increased cannabis tolerance
( T_R_EA_:T_M_EN_T__ )
• Upon withdrawal PSYCHOTHERAPY
, Cravings, irritability, anxiety, difficulty • Motivational interviewing
sleeping
( D_IA_GN_O_s,_s __ )
OTHER DIAGNOSTICS
• ::::: two of following
, Consuming more cannabis than
intended
, Inability to cut down
, Cannabis use takes up a lot of time
= Cravings to use cannabis
, Cannabis use affects responsibilities
, Using cannabis despite social problems
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Figure 104.3 Illustration showing the stimulant effects of tetrahydrocannabinol (THC) versus the
depressant effects of cannabidiol (CBD). CBD's properties mean it can be used medicinally in
some cases.
63
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Figure 104.4 Illustration showing the potential physical and mental effects of severe cannabis
dependence.
COCAINE DEPENDENCE
osmsJl/ eoee1ine-dependenee

)
• Inability to feel "normal" without cocaine • Increased cocaine tolerance
• Stimulant use disorder: maladaptive • Upon withdrawal
pattern of stimulant use , Depression, anxiety, fatigue, reduced
• Cocaine = stimulant concentration, cravings, tiredness,
• Continued cocaine use causes tolerance increased appetite, excessive sleeping,
vivid dreaming, suicidal ideation,
O Dopaminergic receptors become less
nausea, vomiting, hallucinations
(downregulation)
Must consume more to feel euphoric
O
(positive reinforcement)
)
• Withdrawal OTHER DIAGNOSTICS
• ;;,: two of fol lowing
COMPLICATIONS , Consuming more stimulants than
• Hyperthermia, seizures, stroke, brain intended
hemorrhage, heart attack, death by , Inability to cut down
overdose , Stimulant use takes up a lot of time
, Cravings to use stimulants
, Stimulant use affects responsibilities
64
O Using stimulants despite social
problems
O Giving up important activities for
stimulants
O Using stimulants in dangerous situations
O Using stimulants even if they worsen a
problem
O Becoming tolerant to stimulants
O Withdrawal symptoms
symptoms, severe::::: six symptoms
(...____ T_R_E~_~_M_EN_T__ )
MEDICATIONS
• Modafinil (stimulates, reduces cravings) Figure 104.6 An individual with a perforated
nasal septum secondary to cocaine abuse.
Cocaine causes vasoconstriction and
PSYCHOTHERAPY ischemic necrosis. The hole has been closed
• Motivational interviewing, peer-support with a translucent silicone button to provie
programs structural support.
WITHDRAWAL SYMPTOMS
M\LD SYMPTOMS WORST S'l'MPTOMS
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Figure 104.5 Illustration showing the symptoms of cocaine withdrawal.
65
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PROTE.CT THE.IR AIRWAY
MAKE. $URE. SU>OD '' CIRCUI..A1'\I\)(.

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Figure 104.7 Illustration showing some of the recommended approaches to immediate treatment
of someone experiencing a cocaine overdose.
OPIOID DEPENDENCE
osms.tl/o ioid-de endenee

• Inability to feel "normal" without opioid use • Increased opioid tolerance
• Opioid use disorder: maladaptive pattern of • Upon withdrawal
opioid use , Anxiety, shivering, tremors, yawning,
• Opioids = depressants body aches, sweating, runny nose,
• Continued opioid use causes tolerance abdominal cramps, diarrhea, vomiting,
increased heart rate, blood pressure
O Opioid receptors become less sensitive,
/neurons have fewer receptors
(downregulation)
( D_IA_GN_o_s,_s __ )
O Must use more to feel euphoric (positive
reinforcement)
OTHER DIAGNOSTICS
• Withdrawal
• ;;:: two of following
, Consuming more opioids than intended
COMPLICATIONS , Inability to cut down
• Disease transmission from shared needles, , Opioid use takes up a lot of time
death by overdose (cardiac, respiratory
, Cravings to use opioids
depression)
, Opioid use affects responsibilities
66
O Using opioids despite social problems
O Giving up important activities for opioids
( T_R_E~_~_M_EN_T
)
Using opioids in dangerous situations
O
MEDICATIONS
O Using opioids even if they worsen a • Naloxone (blocks opioids), naltrexone,
problem methadone (opioid for maintenance/
O Becoming tolerant to opioids tapering consumption), buprenorphine
O Withdrawal symptoms
• Mild = 2-3 symptoms, moderate = 4-5 PSYCHOTHERAPY
symptoms, severe=::::: six symptoms
• Motivational interviewing, peer-support
programs, cognitive behavioral therapy
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Figure 104.8 Illustration with examples of endogenous and exogenous opioids.
SLOl,Jf.ST lNuE.STION
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Figure 104.9 Illustration showing the ways opioids are most commonly self-administered by
people with opioid use disorder.
67
TOBACCO DEPENDENCE
osmsJl/ -lo \>o.eeo-depe nde nee
, Using tobacco in dangerous situations
( PATHOLOGY & CAUSES ) , Using tobacco even if it worsens a
problem
• Inability to feel "normal" without tobacco
, Becoming tolerant to tobacco
use (nicotine)
, Withdrawal symptoms
• Tobacco use disorder: maladaptive pattern
of tobacco use • Mild = 2-3 symptoms, moderate = 4-5
symptoms, severe = ~ six symptoms
• Tobacco= depressant, stimulant
• Continued tobacco use causes tolerance
O Nicotinic receptors become less
(downregulation)
O Must use more to feel euphoric (positive
reinforcement)
• Withdrawal
COMPLICATIONS
• Heart attack, stroke, peripheral vascular
disease, pulmonary disease, cancer (mouth,
throat, lungs, bladder, pancreas, uterus)
• Increased tobacco tolerance
• Upon withdrawal
° Cravings, irritability, anxiety, anger, poor
concentration, restlessness, impatience,
increased appetite, weight gain,
insomnia
Figure 104.10 An individual with tar stained

( D_IA_GN_O_SI_S
__ ) fingers caused by tobacco smoking.
OTHER DIAGNOSTICS
• ~ two of following
° Consuming more tobacco than intended ( T_R_E~_~_M_EN_T
__ )
O Inability to cut down
O Tobacco use takes up a lot of time
MEDICATIONS
• Nicotine replacement therapies (gum,
° Cravings to use tobacco
sprays, patches) to taper dose
O Tobacco use affects responsibilities
• Bupropion (antidepressant; reduces
O Using tobacco despite social problems cravings, withdrawal symptoms),
O Giving up important activities for varenicline (reduces cravings, enjoyment of
tobacco tobacco)
68
PSYCHOTHERAPY
• Motivational interviewing, peer-support
programs
OTHER 1NTERVENT10NS
• Switch to electronic cigarettes
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Figure 104.12 Illustration showing the half-life of nicotine, which can lead to chain smoking.
69
Severe confusion, stupor. lapses of consciousness.
vomiting, seizures, respiratory depression, Fomepizole
bluish, cold, clammy skin
Conjunctival inject,011, drowsiness, euphoria, nausea,

hyperlension, tschvcardia. tachvpnea, tremors,
slurred speech. acute psychosis. agitation,
urinary retention
Altered mental status. seizure. hypertension. chest pain.

dyspnea, epistaxis, mydriasis, blurring vision, restless, Benzodiazepines
severe agitation
Triad of: CNS depression.respiratory depression.

Naloxone
pupillary miosls
Abdominal pain. pallor. sweating. hypertension.

tachycardia. ataxia, tremor, headache, fasciculations,
Activated charcoal
seizures; then depressorstate of CNS depression.
respiratory failure, bradycardia
"Bad trip": panic reaction. self aggression,

suicidaVhomicidal ideation, hallucinations. mydriasis.
hypertension, tachycardia, flushing, sweating
Violent, Ruclualing behavior, nystagmus,

motor disturbence,autonomic stimulation; nystagmus. Activated charcoal.
tachycardia,tachypnea. salivation. Benzodiazepines
flushing. diaphoresis
Nystagmus. hallucinations. slurred speech. ataxia,

Activated charcoal,
coma. respiratory depression.hyPotension.
Flumazenil
paradoxical agitation
70
NOTES

__ )
• Mental disorders caused by/associated with • See individual disorders
past traumatidstressful event
• Abuse: intentional mistreatment of others;
may be directed at anyone; often features ( T_R_E~_~_M_EN_T
__ )
children or the elderly
O Increases risk of the target developing MEDICATIONS
a mental disorder; generally results in • See individual disorders
depression or aggressiveness; may
incite posttraumatic stress disorder PSYCHOTHERAPY
• Psychological symptoms - behavioral • Abuse-related: cognitive behavioral
changes therapy
• Individuals might self-medicate with
substance use
OTHER INTERVENTIONS
• Manage substance use
• Anxiety/fear associated with traumatic/
stressful stimuli
• Reduced pleasure, self-acceptance;
depression; anger, aggressiveness;
dissociation (detachment from present in
cognitive/sensory capacity); etc.
PHYSICAL & SEXUAL ABUSE

osms.i"l/ph14sieo.l_o.nd_sexuo.l_o.buse
COMPLICATIONS
( PATHOLOGY & CAUSES ) • Increases risk of the target developing
a mental disorder; generally results in
• Intentional injuring of others. which may depression or aggressiveness; may incite
include hitting, burning, or even poisoning posttraumatic stress disorder
• Sexual abuse: forced or otherwise • Severe abuse may cause prolonged or
inappropriate (e.g. in age difference) sexual irreversible damage to the body
behavior with others
71
c SIGNS & SYMPTOMS ) c
MEDICATIONS
TREATMENT )
• Bruising, cuts, sores, burns or rashes;
fractured or broken bones; damage to • Sexual abuse: may require emergency
internal organs; failure to thrive contraceptives or STD prophylactics
• Anxiety related to the abuse
• Dissociative reactions PSYCHOTHERAPY
• Depression • Focus on screening and prevention;
• Aggressiveness may include symptomatic treatment or
• PTSD psychotherapy (esp. cognitive behavioral
• Sexual abuse therapy)
° Fear of or anxiety towards sexual
activity OTHER INTERVENTIONS
O Increased risk of suicide • Medical intervention, as needed
O If appropriate, physical symptoms (e.g. • Referral to protective services for legal/
physical trauma, STls, UTls) social support
c
OTHER DIAGNOSTICS
DIAGNOSIS )
• Based on individual history and presence of
above symptoms
POSTTRAUMATIC STRESS
DISORDER (PTSD)
osmsJl/PTSD
• Memory of past traumatic event ----. • Psychological
recurrent mental, physical stress , Nightmares, flashbacks, intrusive
O E.g. car crashes; sexual abuse; military thoughts
service; natural disasters • Behavioral
• Psychological svrnptoms e- behavioral • Avoidance of situations/environments,
changes hypervigilance, hyperarousal ----. trouble
• Individuals might self-medicate with sleeping, general irritability, emotional
substance use outbursts
• Neurological factors • Children less likely to show distress; often
O Dysfunctions in hypothalamic-pituitary- use play to express memories
adrenal axis/endogenous opioid system;
deficits in arousal, sleep regulation;
family history
72
• Disturbance cannot be better explained by
( D_IA_GN_O_s,_s) another condition/substance
OTHER DIAGNOSTICS
• Exposure to traumatic event (..____ T_R_E~_~_M_EN_T )
• Intrusive symptoms
O Recurrent, distressful memories, dreams MEDICATIONS
O Dissociative reactions • Antidepressants, esp. selective serotonin
reuptake inhibitors (SSRls); anti-anxiety;
O Distress/physiological reactions in
sleep aids
response to stimuli
• Avoidance of associated stimuli,
psychological (e.g. memories)/tangible (e.g. PSYCHOTHERAPY
places) • Exposure, group therapy
• Negative changes in thoughts, feelings
• Increased sensitivity to event, associated OTHER INTERVENTIONS
stimuli
• Manage substance use
• Disturbance lasts> one montb -e distress
in other areas of life
SOMATIC SYMPTOM DISORDER

osms.i"l/somo.-lie-s14mp-lom-disoTdeT
( PATHOLOGY & CAUSES ) ( D_IA_GN_O_SI_S

)
• Extended periods of unexplainable physical OTHER DIAGNOSTICS
symptoms • 2: one somatic symptoms ----. distress in
• Individuals not faking symptoms (unlike other areas of life, last > six months
factitious disorder) • Changes in behavior/thinking, related to
• Thinking about physical svrnptoms=- somatic symptoms
cognitive symptoms (e.g. stress/anxiety) O Excessive thought about severity of
• Cause unknown; affected individuals symptoms
sensitive to physical changes ----. everyday O Anxiety about symptoms/health
experiences misinterpreted O Devotion of time/energy to symptoms/
• High comorbidity with depressive, anxiety health
disorders • Severity determined by changes in
behavior/thinking
Mild = one change O
) Moderate = ;;;: two changes O
O Severe= ;;;: two changes + multiple

• Somatic symptoms (e.g. pain, sexual,
gastrointestinal problems); change over physical symptoms/one severe symptom
time
• Cognitive symptoms (e.g. worry, anxiety)
( T_R_E~_~_M_EN_T
)
PSYCHOTHERAPY
• Improve cognitive symptoms (e.g.
cognitive-behavioral/group therapy) 73

Psychiatry Osmosis HY Pathology Notes ATF - ATF

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Psychiatry Osmosis HY Pathology Notes ATF - ATF

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Copyright:

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PSYCHIATRY

Cognitive And Dissociative Disorders 8

Depressive and Bipolar Disorders 12

Feeding and Eating Disorders 20

Personality Disorders Cluster A 32

Personality Disorders Cluster B 36

Personality Disorders Cluster C 41

Schizophrenia and Psychotic Disorders 45

Sleep and Sleep-Wake Disorders 55

Substance Use and Related Disorders 60

Trauma and Abuse Related Disorders 71

GENERALLY,WHAT ARE THEY?

( PATHOLOGY & CAUSES ) (..____ D_IA_GN_O_s,_s)

( PATHOLOGY & CAUSES ) (.______ D_IA_GN_O_SI_S __ )

~;~ C.E.SS \\I l ,.,_ ..,.,. o'fe. h,o.v, ~or.to.,c. t.\Sc.

Figure 90.2 Illustration of the different levels of anxiety.

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s)

( PATHOLOGY & CAUSES ) ( D_IA_GN_o_s,_s__ )

SOCIAL ANXIETY DISORDER

( PATHOLOGY & CAUSES )

',ti (loSQ. rtlc.h11t wl.trt

11 PeRSISTE.rJT ( > bMOfltns.)

GENERALLY,WHAT ARE THEY?

• Associated with storage and retrieval

( D_IA_GN_O_SI_S) OTHER INTERVENTIONS

( PATHOLOGY & CAUSES ) C__s,_G_Ns_&_sv_M_PT_O_M_s_)

GENERALLY, WHAT ARE THEY?

( PATHOLOGY & CAUSES ) (__ SI_G_NS_&_S_Y_M_PT_O_M_s_)

\ I MNEMONIC: DIG FAST

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s

( SIGNS & SYMPTOMS ) lithium)

• Mood swings PSYCHOTHERAPY

MAJ"OR DEPRESSIVE DISORDER

( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_S_Y_M_PT_O_M_

( PATHOLOGY & CAUSES ) C D_IA_GN_O_SI_S __ )

• Major depressive episodes

GENERALLY,WHAT ARE THEY?

( PATHOLOGY & CAUSES ) (__ s,_G_NS_&_S_Y_M_PT_O_M_s_)

MEDICATIONS Remove fecal impaction

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s

( PATHOLOGY & CAUSES ) (..____ D_IA_GN_o_s,_s__ )

GENERALLY, WHAT ARE THEY?

GENERALLY,WHAT ARE THEY?

• Developmental disorder characterized

DISRUPTIVE, IMPULSE CONTROL,

O Intermittent explosive disorder

Inattentiveness. hyperactivity, restlessness, impulsive Present> 6 months, multiple

Present > 6 months:

Repeated self-control loss (may involve aggression).

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s

( PATHOLOGY & CAUSES ) (......___ D_IA_GN_O_s,_s)

GENERALLY,WHAT ARE THEY?

(__ s,_G_NS_&_SY_M_PT_O_M_s_) PSYCHOTHERAPY

BODY FOCUSED REPETITIVE

( PATHOLOGY & CAUSES ) (__ SI_G_NS_&_S_Y_M_PT_O_M_

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s

GENERALLY, WHAT ARE THEY?

• Unusual behaviors/traits Avoidant

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s)

A~~UM(S 01HEIZS / C:, UJ£(l N.A..'t DI ST !Z-VST FU L

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s)

( PATHOLOGY & CAUSES ) ( D_IA_GN_O_s,_s)

"IOEAS of ,.,..,- MA~1£.AI. 11m..1ir.1~