PSYCHIATRIC DISORDERS
DIAGNOSTIC CRITERIA
MOOD DISORDERS
MAJOR DEPRESSIVE DISORDER
Introduction
Fluctuation in mood or mood swings are normal. Our mood is influenced by a myriad of internal and external factors, and can change during the course of the day. Simply speaking there are periods when we may feel especially happy, or not as happy, or even unhappy, or irritable.
Idiomatic Expressions are a figurative way of expressing ones self. The origin of such terms is based on shared experience. So the expression “woke up on the wrong side of the bed” figuratively means that the person is going to be in a bad mood for the rest of the day. The fact that the expression exists in the first place and that people can relate to it simply illustrates that mood variability is normal part of our existence.
Major Depressive Disorder
Major Depressive Disorder is defined by a low or irritable mood that occurs for prolonged duration of time (more than 2 weeks). Such individuals may not be able to experience pleasure or lose interest in things they normally enjoy doing. They may also feel hopeless, helpless or worthless and experience fatigue. Typically, difficulty sleeping and loss of appetite occurs. Although atypically the inverse may occur as well i.e. sleeping more than usual, eating more than usual (comfort feeding).
It is not uncommon for one’s mental faculties to be affected. Impairment in memory and concentration are common experiences. Some individuals may forget where they leave things, experience difficulty finding words or forgetting important steps in order to complete a task and in others it can be quite pronounced where they may fail to recollect people’s names or how to go about performing a task .i.e. Pseudodementia (pseudo loosely translated as 'not actually'. This condition mimics a serious disorder i.e Dementia, which is characterized by marked memory impairment among other symptoms. Some may experience difficulty in performing tasks e.g. it takes longer to complete a task.
Suicide is not essential to make a diagnosis of Major Depressive Disorder and can range from just a thought of dying to a plan to end one’s life, or even and attempt which could be serious such as an overdose and even more severe. It does however indicate severity.
Bipolar and related disorders
It is important to keep in mind that each person will have variability in their mood. Some individuals are more marked and others less so. A depressed individual or even a stressed or anxious person can present with irritability or an unstable mood. In order for the diagnosis to be made, there are more than just mood symptoms that need to be met.
Bipolar I Disorder (Mania)
Is characterized by a clear period of an abnormally elevated or irritable mood that persists for at least a week.
Other symptoms include:
Goal directed behavior: engaging in a behavior to achieve a particular objective e.g. studying, working or even increased libido. In the case of manic individuals, it may be multiple activities that they engage in excessively which may not be sensible. Once again this is atypical of anxiety or depression which is generally associated with fatigue and poor motivation. An anxious or depressed individual however may experience insomnia and restlessness and for example may wake up at night to clean their homes in an attempt to avoid the distressing thoughts.
Self-esteem: typically enhanced. For example, a normally conservative individual will not have difficulty communicating and socializing. Sometimes they may feel a greater sense of self-importance. In contrast the opposite would be expected in a depressed or anxious individual
Talkative: they tend to talk a lot more than usual and perhaps even excessively or can’t stop talking.
Distractibility: easily losing focus or jumping from one thing to another. This may be reflected in their conversation and even in the actions.
Activities associated with potential harm: e.g. spending money they don’t have or sexual indiscretions.
It is not uncommon for such individuals to experience psychotic symptoms. Psychosis is when a person is not in touch with reality. For e.g. believing that they are a messenger of god or they have inherited large sums of money.
Bipolar II Disorder (Hypomania)
Is very much the same but the intensity and duration is much less. The duration is at least 4 day. Such individual will NOT experience psychotic episodes in which case it then becomes it would then be characterized as Mania.
ANXIETY DISORDERS
There are many forms of anxiety
Social phobia
Agoraphobia
Generalized anxiety disorder
Acute and Post Traumatic Stress Disorder
Note: Acute and Post Traumatic Stress Disorder is not characterized in the latest DSM-5 (Diagnostic and Statistical Manual as an Anxiety Disorder but rather Traum- and Stress-Related Disorders). The only reason it is included here under that category of nxiety disorder is to demonstrate the similatiries between Anxiety Disorders and Traumatic Disorder which involve very similar parts of the brain as far as the pathology is concerned.
Social phobia:
Simply a fear of being embarrassed or humiliated. The underpinnings of this disorder is associated with self-esteem or lack of confidence. There are ofcourse other causes and explanation.
Agoraphobia:
Essentially is fear of public spaces.
Generalized Anxiety Disorder:
Excessive and uncontrollable worry.
Acute and Post Truamtic Stress Disorder
Exposure to a severe traumatic event associated with disturbing recollections and hypervigilance.
Memory at is most rudimentary level allows us to remember good and bad. A good experience for example would be a safe place and where the find it. And a bad experience would be harm and how to avoid it.
If were not able to remember danger, and everything associated with danger, from how it appears, to how it sounds, to even how it smells, or anything other association for that matter with it we may not be able to identify it soon enough and jeopardies of safety, risk injury and even death. This is one of the key features of a Traumatic Disorder. The recurrent memory of the event and the reaction to that memory as if it were actually taking place whether it be triggered by something that resembles it or in theform of a dream or nightmare rather.
We are more likely to remember things if we are able to make associations or links with other memories and experiences. Memory is not purely confined to a name or a sound but rather an association.
Memory is obviously not as simple as this and there are ofcourse many other mechanisms associated with it.
However, in the context of Traumatic Disorders it is a logical (biological and psychological) process.
Indeed, there are forms of anxiety disorders such as Specific Phobias e.g. flying, hights, animals etc.
SOMATIC SYMPTOM AND RELATED DISORDERS
Somatic symptom disorder
Somatic – referring to body or physical
Basically when a person becomes preoccupied with one or more physical symptoms to such and extent that in interferes with their daily life.
The experience of the physical symptom or symptoms is in excess of what would be expted and produces exceesive and inappropriate worry or concern and much of the persons time and efforts are directed towards the condition
There may be an underlying condition or they may not be any at all.
The crucial difference is that the experience is not in keeping with what should be expected
It is most likely a manifestation of emotional agony
Conversion Disorder
Conversion = change
In this case the convertion or change is the emotional agony which manifests as a physical condition.
A person may present with problems in movement or sensation which cannot be explained by and other medical condition afterapproapitre ivestigation
Typically it has a neurological presentation (appears to be a condition associated with the brain or nervous system)
Examples can reange from stroke like symptoms to seizures
NEUROCOGNITIVE DISORDERS
Cognitive – learning, thinking, reasoning, remembering, problem solving, decision making, attention
Characterized as mild or severe depending on the degree of cognitive decline and functioning which in turn obviously would entail reliance on others for normal day to day functions.
People are more familiar with the term dementia and mostly alzheimers disease and memory impairment – forgetting peoples name or getting lost
Depending on the severity of the case – such individual would not be able to drive, or cook for that matter, or even manage their own financial affairs.
The necessary interventions would have to be put in place – revoking a license or applying for curator bonus.
SUBSTANCE USE DISORDERS
There are a number of substance which be misused, such as
Alcohol
Sedative, hypnotics, anxiolytics
Stimulants
Hallucinogen
Cannabis
Inhalants
Opiods
Each of these substances are asscoited with unique stats of intoxication and withdrawal
Substance use can predispose to
Mood
Anxiety
Neurocognitive
Psychotic
The same principles apply i.e. in order to make the diagnosis one would expect impairment in functioning
PSYCHOTIC DISORDERS
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