9 Criteria of a Major Depressive Episode:

1)           Sad mood

2)           Loss of pleasure in usual activities

3)      Insomnia or hypersomnia

4)      Appetite/weight change

5)      Excessive guilt/worthlessness

6)      Problems concentrating

7)      Loss of energy

8)      Psychomotor retardation/agitation

9)      Thoughts of death or suicide, a suicide plan or suicide attempt

8 Criteria of a Manic Episode:

1)           Dramatically elevated, euphoric mood or irritable mood

2)      Highly inflated self-esteem (belief one can do anything without any chance of failure)

3)      Decreased need for sleep (maybe only a few hours every couple of days)

4)      Extremely talkative, much more than usual

5)      Racing thoughts

6)      Easily distracted, unable to focus attention

7)      Increased goal directed behavior (like abruptly deciding to put a new roof on the house and be finished in one day while working alone)

8)      Involvement in pleasurable activities that have painful consequences (like spending sprees, multiple, indiscriminate sexual acts)

one full-blown manic episode; may or may not have depression

·       Most recent episode manic

·       Most recent episode depressed

·       Most recent episode mixed

·       Most recent episode hypomania

one hypomania episodes never reaching FB status alternating with FB depressive episode(s)

·       Mania (NOT full blown) AND Depression

Suicide: Statistics & Conclusions

·       50-90% who commit suicide do it during a depressive episode or in the recovery phase.

·       Individuals with 2 or more mental disorders are at even greater risk than those with only 1.

·       Suicide now ranks among the 10 leading causes of death in most Western countries.

·       500,000 attempts each year

·       3% of Americans have made an attempt at some point in their lives.

·       Was most common at 22-44 years, now 18-24 years.

·       Women – 3x more likely

·       Divorcees – 3-4x higher

1)      All psychotic (therefore all schizophrenic) persons are dangerous and violent

2)      Schizophrenia and multiple personality disorder (DID) are the same disorder

3)      People who develop schizophrenia "just snap" – they are perfectly fine then they abruptly change

1)      Prevalence: about 1.5% of the general population

2)      Common onset occurs between ages of 15 and 45

3)      Average age for first hospitalization: mid 20s

4)           Accounts for 40 - 50% of all mental hospital admissions

5)      Gender ratio (male: female) is equal

1)      Distorted thinking, perception, and affect, resulting in a loss of contact with reality

2)      Social withdrawal -- either physical and or cognitive withdrawal from others

3)      Deterioration from a previous level of daily & occupational functioning

Symptoms that were not present before the onset of the illness but have now been "added" (or +).

1)      Hallucinations

2)      Bizarre Behavior

3)      Delusions

4)      Loose Association Speech

Symptoms involving abilities that have been taken away since the onset of the illness or "subtracted" (or -).

1)      Avolition - state characterized by general lack of desire, drive, or motivation to pursue meaningful goals

2)      Blunted Affect - lack of emotional reactivity on the part of an individual.

3)      Selective Mutism - most often a child, who is normally capable of speech is unable to speak in given situations

4)      Catatonic Behavior - marked motor abnormalities, generally limited to those occurring as part of a non-organic psychotic disorder

·      Paranoid Type:

system of paranoid delusions, paranoid hallucinations, OTHERWISE, SEEM NORMAL.  (NO bizarre behavior, incoherence, affect problems, loose assoc., etc...)

·     

·      has been through a full-blown, active phase of either disorganized, paranoid, catatonic or undifferentiated schizophrenia, is no longer full-blown, but continues to show some signs of the illness.

1)      Schizophreniform Disorder:

symptoms of schizophrenia, 1 – 6 months duration

2)      Schizoaffective Disorder

3)      Delusional Disorder

  non-bizarre delusions, no other psychotic symptoms

4)      Brief Psychotic Disorder:

1)      Neuropsychological

thinking, memory, psychomotor impairment

2)      Psychopathological 

1)       Memory

2)       Orientation

3)       Learning, comprehension & judgment

4)       Emotional control

5)       Apathy or emotional blunting

6)       Initiation of behavior

7)       Controls over matters of propriety and ethical conduct

8)       Receptive / expressive speech

9)       Visuospacial ability

Focal vs. Diffuse Damage

1)      Focal – focused on one part of the brain

2)      Diffuse – spread throughout the brain

1)      Delirium

memory & cognitive impairment, consciousness comes & goes, quick onset and recovery

2)      Dementia

memory impairment, plus other cognitive/motor impairments noted above and others like aphasia (language), apraxia (motor movement), ataxia (coordination), agnosia

3

1)      Amnestic Syndrome 

impairment of memory occurring in a normal state of consciousness; the most common cause is thiamine deficiency associated with alcohol abuse. Does NOT show impairment in other areas of cognition

Alzheimer’s Disease (AD / DAT)

1)      Dementia (multiple deficits, not just memory)

2)      Insidious onset, continuous deterioration

3)      Officially confirmed at death

4)      Amyloidal plaques, neurofibral tangles, granulovascular deterioration.

5)      Begins at ~ 45+ years

6)      Narrowing of social interests, lessening of alertness, intolerance of change

7)      Can diagnosis be made before death?

·       Behavioral profile

·       APO-E testing

8)      Depressive pseudo-dementia - syndrome seen in older people in which they exhibit symptoms consistent with dementia but the cause is a pre-existing psychiatric illness rather than a degenerative one.

9)      Insight -  (self-awareness)

10)    Confabulation - the creation of false memories, perceptions, or beliefs

11)    Causal factors:

·       Early-onset cases – rare genetic mutations

·       Late-onset cases – APOE (chromosome 19) gene that codes for a blood protein that helps carry cholesterol through the bloodstream.

ADHD: Clinical Picture, Causes, and Treatments

·      1985 = 500,000 vs. now = 5 – 7 million

·      Estimates = 3 – 5% of school aged children, possibly higher (16%)

·      Boys = 6 – 9x higher than girls

·      IQ scores = 7 – 15 points lower

·      Hyperactive, distractible, but not anxious

·      Often diagnosed with other disorders (ODD)

1)      Oppositional Defiant Disorder 

A distinct pattern of negativism, hostility and defiant behavior of at least 6 months or more.  Four or more of the following:  Often loses temper, often argues with adults, often defies rules of adults, often deliberately annoys others, often blames others for his/her mistakes, is often easily annoyed by others, often angry and resentful, often spiteful and vindictive.  Criteria for conduct disorder not met.

1)      Pica 

Repeated eating of non-nutritive substances for at least 1 month that is inappropriate for the developmental age of the child.

1)      Rumination Disorder

Repeated regurgitation and rechewing of food for at least 1 month.  Not associated with a gastrointestinal or other general medical condition.

1)      Feeding Disorder of Infancy & Early Childhood

Failure to eat and make age appropriate weight gains.  Not associated with a gastrointestinal or other general medical condition.

1)      Tourette's Disorder

Multiple motor and one or more vocal tics, many times a day, for 1+ year with no 3+ month tic-free interval (Onset before age 18).

1)      Chronic Vocal or Motor Tic Disorder

Chronic motor tic disorder involves quick, uncontrollable movements or vocal outbursts (but not both).

1)      Transient Tic Disorder 

multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months.

1)      Encopresis

Repeating passing of feces into inappropriate places whether involuntary or intentional.  1+ episodes each month for 3+ months.  Chronological or developmental age of 4 or more.

1)      Enuresis 

Repeated passing of urine into bed or clothes whether involuntary or intentional.  At least 2+ times a week for 3+ months.  Chronological or developmental age of 5 or more.

1)      Separation Anxiety Disorder

Developmentally inappropriate and excessive anxiety about separation from home or from parent or caregiver as indicated by stressful anticipation of separation, fearing harm or death of attachment figure, excessive fear of being lost or kidnapped, refusal to go to school, fear and refusal to be alone even at home, refusal to go to sleep without attachment figure near, nightmares with separations themes.  Disturbance of 4+ weeks.  Onset before age 18.

1)      Selective Mutism

Failure to speak in specific social situations, despite speaking in other situations.  Interferes with functioning.  At least 1+ month duration.  Has ability to speak.

1)      Reactive Attachment Disorder of Infancy or Early Childhood (RAD)

Before age 5, onset of lack of emotional connection with attachment figures and with others presumably due to lack of adequate parental care early in the development of normal human attachments.  

1)      Autistic Disorder:

persistent non-responsiveness to one's environment, deficits of language, motor skills, social interaction, perception, and reality testing. Other aspects of clinical picture:  aloof, ecolalia, prefer unchanging environment, aversion to auditory stimuli, repetitive self stimulation (head banging), work puzzles well, may have savant abilities ("autistic savant").  Causal theories vary greatly from genetic, toxin exposure, lack of bonding, etc.

1)      Rett's Disorder:

Normal prenatal and postnatal development, normal motor skills development through 5 months, normal head circumference at birth, but then after about 5 months, decelerated head growth, loss of earlier acquired skills, loss of social engagement, poor coordination, severely impaired language development.

1)      Childhood Degenerative Disorder

Normal development for 2+ years after birth, but then significant loss of earlier learned skills with onset before age 10.  Problems with language, social skills, bowel and bladder control, play and motor skills.

1)      Asperger's Disorder

Marked social impairment in areas like eye contact, facial expression, gestures.  Failure to develop age appropriate peer relations, lack of finding and sharing fun with others, lowered social and emotional reciprocity. Restricted, repetitive behavior as in preoccupation with objects, rituals, motor movements, object parts. Causes social, occupational and other impairment. But language, cognition, intellect and daily skills are intact.

1)      Expressive Language Disorder

Lowered verbal intelligence, without significantly lowered non-verbal intelligence, and can understand what is said to him/her.  Limited vocabulary, spoken grammar errors, limited spoken sentence complexity.  Criteria not met for a pervasive developmental disorder.

1)      Mixed Receptive-Expressive Language Disorder:

IQ scores indicating problems with both spoken and understood language; difficulty both using language and understanding others.  Criteria not met for a pervasive developmental disorder.

1)      Phonological Disorder:  

Problems making the correct sounds of letters and words that are considered appropriate for a given developmental age.  Interferes with academic, occupational or social interactions.

1)      Stuttering: 

Mental Retardation: 

significantly below average intellectual and adaptive functioning, begins some time during the developmental period.

IQ Level:  IQ below 70 - 75, and clear evidence of problems in daily adaptive functioning.

Causes:  can be (and most likely will be) biological, or psychosocial, or even sociocultural (or an interaction of these three)

1)      Genetic / chromosomal abnormalities    (Down's Syndrome),

2)      Prenatal infections (German Measles, syphilis, HIV),

3)      Prenatal toxin exposure (carbon monoxide, lead, alcohol) ,

4)      Premature birth,

5)      Birth trauma (hypoxia),

6)      Radiation,

7)      Malnutrition.

Onset – before the age of 17 – 18 (after age 18, likely defined as dementia)

Levels:

1)      Mild (about 51 - 70) largest group, "educable,” like an adolescent but with poor imagination and judgment.

2)      Moderate (about 36 - 50)  "trainable,” somewhat like a 4 - 7 y/o.

3)      Severe (about 20 - 35) "dependent retarded," significantly affected movement and speech.

4)      Profound (19 and under) "life-support retarded,” almost totally non-functional, usually in poor health, shortened life span.

Mood Disorders 

disorders involving an extreme of a normal mood state -- that is, when the normal moods of happy or sad become so extreme they become maladaptive -- mood disorders differ from simple normal changes in mood.

Bipolar Disorder –

Formerly called “manic-depression” – diagnosis requires the person experience at least one full-blown manic episode and will also likely (but not necessarily) involve a shift from mania to a full-blown depressive episode -- person often will fluctuate between episodes of mania and depression (over the course of several days/weeks).