NEURODEVELOPMENTAL DISORDERS Mental Disorder Minimum no. of symptoms Age of onset Duration Specifier/Subtype Severity Etiology Intellectual Disabilities Intellectual Disability Global Developmental Delay Unspecified Intellectual Disability Communication Disorders Language Disorder Speech Sound Disorder Childhood Onset-Fluency Disorder (Stuttering) Social (Pragmatic) Communication Disorder Autism Spectrum Disorders Conceptual, practical, and social domains (mild, moderate, severe, profound) All 3 criteria under 5 yrs Chromosomal abnormalities ( Down syndrome fragile X syndrome) - Recessive-gene diseases - Infectious diseases - Head injuries - environmental hazards (mercury, lead) one or more with or w/out accompanying intellectual or language impairment all 3 (A) 2 or more (B) requiring support - overgrown frontal, temporal, and cerebellar areas of the brain - larger amygdalae - deficits in theory of mind Attention-Deficit/Hyperactivity Disorder 6 or more(A) 6 or more (B) - combined presentation - predominantly inattentive presentation - predominantly hyperactive/impulsive prior 12 yrs mild, moderate, severe - dopamine receptors and transporter genes - smaller dopaminergic areas of the brain: caudate nucleus, globus pallidus, and frontal lobes - perinatal and prenatal factors - environmental toxins, maternal smoking, lead poisoning - parent-child relationship mild, moderate, or severe Dyslexia - temporal, parietal, and occipital regions of the brain (phonologicall awareness) Mathematics - poor semantic memory Specific Learning Disorder 6 months despite interventions at least one - with impairment in reading - written expression -mathematics Motor Disorders Developmental Coordination Disorder - self-injurious behavior - without Stereotypic Movement Disorder mild, moderate, severe mild, moderate, severe Tic Disorders Tourette’s Disorder before 18 yrs Persistent (Chronic) Motor or Vocal Tic Disorder before 18 yrs Provisional Tic Disorder before 18 yrs Manic Episode Hypomanic Episode Major Depressive Episode Bipolar I Disorder (manic) Bipolar II Disorder (MDE + hypomanic) 3 (4 if irritable only) 3 (4 if irritable only) 5; at least one is either (1) and (2) more than1 year since first onset more than 1 year -motor tics only since first onset - vocal tics only less than 1 year since first onset EPISODES 1 week 4 days 2 weeks BIPOLAR AND RELATED DISORDERS - current or most recent episode - with psychotic features -in partial remission/full remission -in partial remission/full remission mild, moderate, severe mild, moderate, severe - very highly heritable - Selective serotonin reuptake inhibitors - less sensitive serotonin receptor - more sensitive to dopamine - cellular membrane deficits - poorly regulated cortisol system Cyclothymic Disorder (MDE symptoms + hypomanic symptoms) 2 years (1 year for children and with anxious distress adolescents) DEPRESSIVE DISORDERS Disruptive Mood Dysregulation Disorder 2 prominent clinical symptoms Major Depressive Disorder 1 major depressive episode Persistent Depressive Disorder (Dysthymia) Premenstrual Dysphoric Disorder Separation Anxiety Disorder - 6-18 yrs should diagnosis be made - age of onset is 10 yrs 2, depressed mood is a must at least 2 years (1 year in children) - onset: final week before menses - improved symptoms: a few days after menses - minimal or absent: in the week postmenses at least 5 (B & C) 2 areas (severe in one area, mild on the other) for 12 mos. 3x every week 2 weeks recurrent or single mild, moderate, severe -with pure dysthymic syndrome -with persistent MDE - with intermittent major depressive episodes a. with current episode b. w/out mild, moderate, severe provisional (no evidence) ANXIETY DISORDERS - 4 weeks (children & adolescents) - 6 weeks (adults) at least 3 Selective Mutism usually before age 5 at least 1 month Specific Phobia mean of age 10 6months or more - animal, natural environment, bloodinjection-injury, situational, others 6months or more Performance only Social Anxiety Disorder Panic Disorder at least 4 out of 13 age 22-23 Agoraphobia 2 of the 5 situations before age 35 Generalized Anxiety Disorder 3 or more Obsessive-Compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder mild, moderate, severe limited-symptom attacks 6 months or more 6 months OBSESSIVE-COMPULSIVE AND RELATED DISORDERS - with good or fair insight - with poor insight - with absentinsight/delusional beliefs - tic-related - insight specifier - with muscle dysphoria - insight specifier - with excessive acquisition - sensitivity of the “reward system” of the brain (basal ganglia) - less sensitive serotonin receptor - less sensitive to dopamine - amygdala, (overactivation) - diminished activation and diminished volume of hippocampus, prefrontal cortex, and subgenual anterior cingulate - overly active HPA axis and cortisol dysregulation Cognitive - distortion in perceiving life experiences (informationprocessing/cognitive biases) - irrational and self-defeating beliefs - hopelessness, attributions, learned helplessness Social - stressful life events and interpersonal difficulties - family’s critical or hostile comments with the person with depression; lack of social support Psychological - anger turned inward - high negative affect (neuroticism); low positive affect Risk Factors: - genetic vulnerability - increased activity in the fear circuit of the brain (amygdala) - decreased functioning of GABA and serotonin; increased norepinephrine activity - negative life events - behavioral inhibition & neuroticism - cognitive factors (attention to cues of threat and low perceived control) Specific Phobia: - behavioral (classical and operant) - prepared learning & modeling Social Anxiety Disorder: - negative self-evaluations Panic Disorder - increased activity in the locus ceruleus (source of norepiniphrine) -interoceptive conditioning (panic attack = conditioned response - catasthropizing somatic symptoms Agoraphobia - fear-of-fear hypothesis GAD - worrying to avoid more powerful emotions -difficulty accepting ambiguity - breaking down of defense mechanisms (psychoanalytic perspective) - hyperactive regions of the brain: orbitofrontal cortex, caudate nucleus, and anterior cingulate - Behavioral: compulsions as operantly conditioned responses - Cognitive: lack of satiety signal and attempts to suppress thoughts (deficit in Yedasentience) Trichotillomania (Hair-Pulling) Disorder Excoriation (Skin-Picking) Disorder Reactive Attachment Disorder Disinhibited Social Engagement Disorder 6 yrs old above Posttraumatic Stress Disorder 6 yrs old below Acute Stress Disorder A – 2/2 B – 2/3 C – 1/3 A – 2/4 C – 1/3 Intrusion – 1 Avoidance – 1 Negative Mood/Cognition – 2 Arousal -2 TRAUMA- AND STRESSOR-RELATED DISODERS 9 months – 5 persistent (present for yrs (for more than12 months) diagnosis) persistent (present for more than 12 months) more than 1 month - with dissociative symptoms - with delayed expression Intrusion – 1 Avoidance or Negative Mood- 2 Arousal – 2 more than 1 month with dissociative symptoms - with delayed expression 9/14 symptoms 3 days to 1month severe severe - with depressed mood - with anxiety - with mixed anxiety and depressed mood - with disturbance of conduct - with mixed disturbance of emotions and conduct - unspecified SCHIZOPHRENIA SPECTRUM DISORDERS - 3 months - cannot persist to additional 6 months once the stressor or its consequences have terminated Adjustment Disorder Schizotypal (Personality) Disorder SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS Delusional Disorders Brief Psychotic Disorder - 1 or more - 1,2, 3 must at least be present episode at least 1 day but less than 1 month Schizophreniform Disorder - 2 or more - 1,2, 3 must at least be present episode lasts at least 1 month but less than 6 months Schizophrenia 2 or more - 1,2, 3 must at least be present Schizoaffective Disorder Catatonia - Nature of the trauma: Severity and the type of trauma matter -smaller volume of hippocampus which is responsible for memories related to emotions - increased sensitivity of receptors to the stress hormone, cortisol - Two-Factor Model: initial fear: classical conditioning; avoidant behavior: operant conditioning - cognition and coping - serves as a coping strategy for the intolerable trauma - viewed as a defense mechanism in psychoanalytic theory early adulthood 3 or more among the 12 symptoms C L U S T E R A : Odd or Eccentric Paranoid 4 - at least 6 months (1 month of active-phase) and prodormal or residual phase (symptoms in attenuated forms or negative symptoms only ) 2 or more weeks of hallucinations and delusions in the absence of MD or manic episodes - erotomatic, grandiose, jealous, persecutory, somatic type - with bizarre content - with marked stressor - without marked stressor - with postpartum onset - with catatonia - With good prognostic features, without - with catatonia Clinician-Rated Dimensions of Psychosis Symptom Severity Clinician-Rated Dimensions of Psychosis Symptom Severity Clinician-Rated Dimensions of Psychosis Symptom Severity Clinician-Rated Dimensions of Psychosis Symptom Severity - Bipolar type - Depressive type - With catatonia Clinician-Rated Dimensions of Psychosis Symptom Severity - associated with other mental disorders - due to a general medical condition - unspecified PERSONALITY DISORDERS pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent Genetic factors - genetic heritability: strong for negative symptoms - multiple genes are involved and genetically heterogeneous Neurotransmitters Dopamine Hypothesis -excess dopamine activity - oversensitive dopamine receptors (positive symptoms) - dopamine D2 receptor, associated with the positive effectiveness of medication - mesolimbic pathway (positive symptoms) - mesocortical pathway (negative symptoms) - serotonin receptors, glutamate, and GABA transmission Brain Structure - enlarged ventricles (loss of brain cells) - deficits in executive functioning; prefrontal cortex (negative symptoms) - congenital/developmental factors - excessive pruning (loss of synapses) - reductions in hippocampal volume (disrupted HPA axis) - reduced gray matter volume Psychological Stress - stress reactivity - sociogenic hypothesis & social selection theory - schizophrenogenic mother - communication deviance (hostile and poor communication) - expressed emotion (reaction to ill behavior precipitating relapse) - appears to be highly heritable - enlarged ventricles and less temporal Schizoid 4 pattern of detachment from social relationships and restricted range of emotional expression pattern of acute discomfort in close relationships, cognitive, or perceptual distortions, and Schizotypal 5 eccentricities of behavior C L U S T E R B : Dramatic, Emotional, or Erratic Anti-Social 3 pattern of disregard for, and violation of, the rights of others Borderline 5 pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity Narcissistic 5 pattern of grandiosity, need for admiration, and lack of empathy Histrionic 5 pattern of excessive emotionality and attention seeking C L U S T E R C : Anxious or Fearful Avoidant 4 pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Dependent 5 pattern of submissive and clinging behavior related to an excessive need to be taken care of OCDP 4 pattern of preoccupation with orderliness, perfectionism, and control DISSOCIATIVE DISORDERS - pathophysiology implicated in the orbitofrontal cortex, hippocampus, parahippocampal gyrus, & amygdala - traumatic events/abuse in childhood Posttraumatic Model – People are particularly likely to use dissociation to cope with trauma Sociocognitive Model – DID is a result of learning to enact social roles (suggestions by therapists) Dissociative Identity Disorder Dissociative Amnesia lobe gray matter implicated in schizophrenia (Cluster C) - relate to early childhood experiences (perhaps through modeling; avoidant) - fear of loss of control, handled by overcompensation (psychodynamic explanation of OCDP). - DPD - overprotective and authoritarian parenting style; preventing development of self-efficacy & - disruption of early parent-child relationship with dissociative fugue Depersonalization/Derealization Disorder SOMATIC SYMPTOM AND RELATED DISORDERS Somatic Symptom Disorder - one or more somatic symptoms - at least one (excessive thoughts & behavior) - early and middle adulthood - rare in children Illness Anxiety Disorder typically more than 6 months - with predominant pain - persistent at least 6 months - care-seeking type - care-avoidant type - with paralysis - with abnormal movement - with swallowing symptoms - with speech symptom - with attacks or seizures - with anaesthesia - with special sensory symptom - with mixed symptoms Conversion Disorder (Functional Neurological Symptom Disorder) Psychological Factors Affecting Other Medical Conditions Factitious Disorder Imposed on Self Imposed on Another - acute episode / persistent - with or without psychological stressor - maladaptive personality traits - history of childhood abuse and neglect - Freud view it as a result of transfer of the psychic energy attached to repressed emotions or memories into physical symptoms - the physical symptoms represent traumas - Behavioral Theory: Symptoms are being created by an individual to gain attention or support mild, moderate, severe, extreme - single episode - recurrent episodes - brief somatic symptom disorder - brief illness anxiety disorder - illness anxiety without excessive healthrelated behaviors - pseudocyesis DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT DISORDERS Other Specified Oppositional Defiant Disorder mild, moderate, severe - catasthrophizing (attribution of normal bodily sensations to physical illness - negative affectivity (somatic symptom disorder) - paying more attention to physical symptoms - stressful life events - reinforcing factors such as illness benefits -history of childhood abuse or illness 4 symptoms usually childhood or adolescence at least 6 months * vindictiveness (at least twice within the past 6 months) Neurobiological vulnerability in general - increased sensitivity to pain -early traumatic experiences - learning (attention obtained from illness, lack of reinforcement of nonsomatic expression of distress) mild, moderate, severe -child care is disrupted by a succession of different caregivers - harsh, inconsistent, and neglectful child-rearing practices - temperamental risk factors (high levels of emotional reactivity, poor frustration tolerance) - abnormalities in the prefrontal cortex and amygdala, reduced cortisol activity Intermittent Explosive Disorder - 3 behavioral outbursts - chronological age is at least 6 years 3 out of 15 - verbal/physical aggression (2x per week for 3 months) - behavioral outbursts (12 months) past 12 months if18 years old older (criteria are not met) Conduct Disorder 1 out of 15 past 6 months - genetic influence for impulsive aggression - presence of serotonergic abnormalities specifically in the areas of the limbic system, and amygdala - child-onset - adolescent-onset - unspecified onset - with limited prosocial-emotions * lack of remorse or guilt * callous – lack of empathy) * unconcerned about performance * shallow or deficient affect mild, moderate, severe - reduced autonomic fear conditioning - autonomic nervous system abnormalities (lower arousal levels) - deficiency in moral awareness, lacing remorse for their wrong doing - modeling of aggressive behavior - harsh and inconsistent discipline and lack of monitoring - deficits in social information processing - peer influences (acceptance and rejection of peers and affiliation with deviant peers) - socioeconomic advantage Pyromania Kleptomania ELIMINATION DISORDERS at least twice a - nocturnal only at least 5 years week for at least 3 - diurnal only old consecutive - nocturnal and diurnal months - with constipation and at least once a overflow incontinence at least 4 years month for at least - without constipation old 3 months and overflow incontinence FEEDING AND EATING DISORDERS minimum age of 2 years for at least 1 month - in remission diagnosis Enuresis Encopresis Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder at least 1 month one or more (Criterion A) Binge-Eating Disorder - in remission - in remission - restricting type - binge eating/purging type -in partial remission - in full remission Anorexia Nervosa Bulimia Nervosa once a week for 3 months (compensatory behavior) 3 or more for criterion B Insomnia Disorder 1 or more / 3 Hypersomnolence 1 or more / 3 - highly heritable (anorexia nervosa and once a week for 3 months mil, moderate, severe extreme (based on BMI) - in partial remission - in full remission mild, moderate, severe, extreme (frequency of compensatory behaviors) - in partial remission - in full remission mild (1-3 episodes) moderate (4-7) severe (8-13) extreme (14 or more) SLEEP-WAKE DISORDERS - occurs at least 3 nights per week s - present for at least 3 months - at least 3 times a week for at least 3 months - episodic - persistent - recurrent - with mental disorder - with medical bulimia) Neurotransmitters - increased level endogenous opioids (reduce pain sensations, enhance mood, and suppress appetite) - underactive serotonin (binge eaters do not feel satiated; and severe food intake restriction in anorexia) - dopamine (linked to the pleasurable aspects of food) Psychodynamic View - parent-child relationship (parent’s wishes are imposed on child, thus, the child turn dieting as a means of acquiring control and identity) - Bingeing and purging represent the conflict between the need for the mother and the desire to reject her Cognitive Behavioral - Dieting and weight loss is positively reinforced by a sense of mastery or selfcontrol they create - Behaviors that maintain thinness are negatively reinforced by the reduction of anxiety about fatness - thinness ideal portrayed in media - Criticisms about being overweight Sociocultural - stigma with being overweight - cultural standards about thinness - objectification of women’s bodies Personality Influences - Perfectionism and sense of inadequacy Narcolepsy 1 or more / 3 condition - with another sleep disorder - mild - moderate - severe - mild - moderate - severe - at least 3 times a week for at least 3 months Obstructive Sleep Apnea Hypopnea - idiopathic central sleep apnea - Cheyne-stokes breathing - Central sleep apnea comorbid with opioid use - idiopathic hypoventilation - congential central alveolar hypoventilation - comorbid sleeprelated hypoventilation - delayed sleep phase type - advanced - irregular sleep-wake type - non-24-hour - shift work type - unspecified type - during sleep onset - with associated nonsleep disorder, other sleep disorder, and other medical condition -acute, subacute, persistent Central Sleep Apnea Sleep-Related Hypoventilation Circadian Rhythm Sleep-Wake Disorders Nightmare Disorder - depending on the degree of hypomexia and hypercarbia - episodic - persistent - recurrent - mild - moderate - severe Rapid Eye Movement Sleep Behavior Disorder Restless Legs Syndrome Alcohol Use Disorder at least 2 / 11 Alcohol Intoxication Alcohol Withdrawal Cannabis Use Disorder 1 or more (A) 2 or more (B) in excess of 250 mg 3 or more / 5 followed within24 hours at least 2 / 11 Cannabis Intoxication 2 or more / 4 Cannabis Withdrawal 3 or more Caffeine Intoxication Caffeine Withdrawal - at least 3 times per week and lasted 3 for 3 months SUBSTANCE-RELATED AND ADDICTIVE DISORDERS - in early remission - in sustained 12 months remission - in controlled environment 12 months within 2 hours of use approximately within1 week Phencyclidine Use Disorder at least 2 / 10 12 months Other Hallucinogen Use Disorder at least 2 / 10 12 months Phencyclidine Intoxication 2 or more / 8 within 1 hour - mild (2-3 symptoms) - moderate(4-5) - severe (6 or more) - with perceptual disturbances - in early remission - in sustained remission - in controlled environment - in early remission - in sustained remission - in controlled environment - mild - moderate - severe - mild - moderate - severe - genetic predisposition (the ability to tolerate and metabolize alcohol) Neurobiological Factors - stimulation of dopamine pathways in the brain - Incentive-sensitization theory: The dopamine system linked to reward, or liking becomes supersensitive not just to the direct effects of drugs but also to the cues associated with drugs. This sensitivity induces craving or wanting. Psychological - increase in tension or stress - expectancies about effects (cognition) - negative emotionality Sociocultural - social setting (e.g. peer-group identification) - social influence and selection model Other Hallucinogen Intoxication Hallucinogen Persisting Perception Disorder 2 or more / 8 Inhalant Use Disorder 2 or more / 10 Inhalant Intoxication 2 or more / 13 Opioid Use Disorder 2 or more/11 Opioid Intoxication 1 or more / 3 Opiod Withdrawal 3 or more / 9 12 months - with perceptual disturbances within minutes to several days 12 months Stimulant Intoxication 2 or more / 9 Stimulant Withdrawal 2 or more / 5 Tobacco Use Disorder 2 or more / 11 Tobacco Withdrawal 4 or more / 7 Erectile Disorder 12 months Female Sexual Interest/Arousal Disorder 3/6 minimum duration Lifelong/Acquired of 6 months minimum duration Lifelong/Acquired of 6 months Generalized/Situational minimum duration Lifelong/Acquired of 6 months Generalized/Situational GENDER DYSPHORIA 1 or more (A) Premature (Early) Ejaculation Gender Dysphoria in Children 6/8 one of which must be A1 Gender Dysphoria in Adolescents and Adults 2/6 2-4 years old (mean onset) at least 6 months - with a disorder of sex development - with a disorder of sex development - possttransition PARAPHILIC DISORDERS at least 6 months - mild - moderate - severe - mild - moderate - severe NON-SUBSTANCE-RELATED DISORDERS - in early remission 12 months - in sustained remission SEXUAL DYSFUNCTIONS minimum duration - Lifelong/Acquired of 6 months Generalized/Situational minimum duration - Lifelong/Acquired of 6 months Generalized/Situational - Lifelong/Acquired Generalized/Situational minimum duration - Never experienced of 6 months an orgasm under any situation Lifelong/Acquired minimum duration Generalized/Situational of 6 months either 1 of the two (A) 1 of three symptoms either 1 of the two (A) - in early remission - in sustained remission - on maintenance therapy - specify the specific intoxicant - specify the substance that causes withdrawal syndrome 12 months 4 or more / 9 Female Orgasmic Disorder Genito-Pelvic Pain/Penetration Disorder Male Hypoactive Sexual Desire Disorder - mild - moderate - severe 2 or more / 8 2 or more / 11 Delayed Ejaculation - in early remission - in sustained remission - in controlled environment 1 or more / 6 Stimulant Use Disorder Gambling Disorder - mild - moderate - severe 12 months Sedative-Hypnotic -, or Anxiolytic-Use Disorders Sedative-Hypnotic -, or Anxiolytic Intoxication Sedative-Hypnotic -, or AnxiolyticWithdrawal - the particular inhalant should be specified - in early remission - in sustained remission - in controlled environment mild, moderate, severe mild, moderate, severe mild, moderate, severe mild, moderate, severe mild, moderate, severe mild, moderate, severe mild, moderate, severe - Psychoannalytic: underlying repressed conflicts Distal and Immediate Causes - distal: fears about performance and the adoption of a spectator role - immediate: religious orthodoxy, psychosexual trauma, homosexual inclination, inadequate counseling, excessive alcohol intake, physiological problems, sociocultural factors Biological - low levels of estrogen or testosterone - substance use (alcohol, cigarette) - diseases that affect vascular and nervous system Psychosocial - poor communication - anxious about their relationships - negative cognitions (self-blame) - reinforcement of cross-gender behavior - role of hormones during gestation Voyeuristic Disorder at least 18 years old (minimum age of diagnosis) Exhibitionistic Disorder at least 6 months at least 6 months Frotteuristic Disorder at least 6 months Sexual Masochism Disorder at least 6 months Sexual Sadism Disorder at least 6 months Pedophilic Disorder at least 16 years and 5 years older than the child at least 6 months Fetishistic Disorder at least 6 months Transvestic Disorder at least 6 months - in a controlled environment - in full remission - exposing genitals to prepubertal children, physically mature individuals, or both - in a controlled environment - in full remission - in a controlled environment - in full remission - with asphxiophilia - in a controlled environment - in full remission - in a controlled environment - in full remission - exclusive or nonexclusive type - sexually attracted to males, females, or both - limited to incest - body parts, nonliving objecs - in a controlled environment - in full remission - with fetishism - with autogynephilia - in a controlled environment - in full remission Neurobiological - High level androgens (regulates sexual desire) - a dysfunction in the temporal lobe may be relevant to sadism and masochism Psychodynamic Perspective - Paraphilia is viewed as a defense, guarding the ego from dealing with repressed fears and memories - fixated at pregential stage of psychosexual development - Fetishes,voyeurism, and pedophilia are seen as manifestations of intense castration anxiety that makes heterosexual sex with adult women too threatening Psychological Factors - cause of paraphilia as classical conditioning – sexual arousal is linked with unusual or inappropriate stimuli (orgasm conditioning hypothesis) - In operant conditioning perspective, many paraphilias are considered an outcome of inadequate social skills or reinforcement of unconventionality by parents or relatives. - exposure to physical abuse, sexual abuse and poor parent-child relationships - alcohol (decreases inhibition) and negative affect - cognitive distortions (misattributing blame, denying sexual intent, debasing the victim, minimizing consequences, deflecting censure, justifying the cause
