Disorder DSM Risk Factors Epidemiology Cours

MDD Change in mood or affect plus 5 or more Family History— Age: 34 No dr

of the following everyday for most of the correlated to age of 2x F:M month
day for at least two weeks: onset Very recurrent drugs
1. S = sleep disturbance (Younger age of
2. I = irritability onset of the parent, Males 9% lifetime;
3. G= guilt higher chance you females 17%; total 13%
4. E = Decrease in energy will inherit it; if they
5. C = Concentration problems got it when older,
6. A = change in appetite might just be
7. P = Psychomotor (increased or vascular)
decreased)
8. S = suicidal thoughts/ideations

Sleep Changes:
1. Prolonged patency
2. Decreased stage 3 and 4 sleep
3. Decreased REM latency
4. Increased REM activity
5. Increased duration of REM early in
night
Disorder DSM Risk Factors Epidemiology Cours
Agoraphobia 1. Marked fear or anxiety of >2 (out of 2-5% of population
5): open spaces, enclosed spaces, Onset 17-19
public transport, lines/crowds, being
outside alone
2. Anxiety in places where escape
might be difficult
3. Situations almost always provoke
fear or anxiety
4. Situations actively avoided or
approached w/ distress
5. Fear out of proportion to real
danger
6. Present for >6 months
Delirium 1. Disturbance of consciousness Age >65 Incidence 10-85% (10%
2. Change in cognition or perceptual Pre-existing on medicine floors, 85%
disturbance (hallucinations) dementia in cancer care)
3. Onset is acute/fluctuating Severe underlying
4. Disturbance is caused by an illness
underlying medical condition Electrolyte
abnormalities
Associated w/ increased morbidity and Dehydration
mortality Malnutrition
Medications cause
40% of cases**
Bipolar Criteria for Manic Episode: 1st degree relative = 1% prevalence; M=F Episod
Disorder 1. Distinct period of abnormally and 10-15% drugs
Disorder DSM Risk Factors Epidemiology Cours
persistently elevated, irritable, or Mean age of onset: 18
expansive mood lasting > 1 week Monozygotic twins years
2. Three or more present to a certain = 40-70%
degree and deviate from normal:
grandiosity, decreased need for
sleep, flight of ideas, more talkative,
distractibility, increased goal
oriented activity, high consequence
behavior
3. Sufficiently causes marked
impairment
4. Not attributed to substance or
another med condition

Bipolar I: One manic episode sufficient for

diagnosis
(Bipolar I depression = same criteria for
MDD)

Bipolar II/Hypomania: similar manic

episode criteria as above, but lasts 4 days
and typically can continue to be
functional
Schizophreni 1. Two more of the following present Risk if sibling or 1-2% of population; M=F Wome
a most of the time for a 1 month parent has it, ↑ better
period (at least one must be one of more if multiple Onset: later a
the first three): Delusions, family members Earlier in males (10-25) acute
Disorder DSM Risk Factors Epidemiology Cours
Hallucinations, Disorganized have it; than females (25-35) better
speech, catatonic/disorganized
behavior, negative symptoms Most
2. Markedly diminished level of >1 rel
functioning Patien
3. Continuous signs of disturbance unma
lasting 6 months (including the unem
month in #1) educa
4. Must rule out substance abuse, negati
schizoaffective disorder, other = wor
mood disorders w/ psychotic
features
Generalized a. Recurrent unexpected panic attacks Genetics Women > men (2 times) Often
Panic b. At least 1 attack followed by 1 month Onset: late teens early can be
Disorder of: twenties (second peak in increa
i. Persistent concern about having 30s-50s) suicid
additional attacks 30-60
ii. a significant change in behavior ~ 5% of the general 50% im
related to the attacks population (though 30% 30% u
c. Attacks are not accounted for by will have a panic attack) worse
another mental disorder (ex: simple
phobia, PTSD, etc)
d. Attacks are not directly substance-
induced
Panic Attack 1. Starts abruptly and spontaneously (if
situational, points to another disorder)
Disorder DSM Risk Factors Epidemiology Cours
2. Discrete period of intense fear or
discomfort
3. Reaches a peak in 10 minutes (can last
up to 30 minutes & then dissipate) (if
>1hr, consider other dx’s)
4. At least 4 (of 13) co-occurring anxiety
sx (somatic or cognitive)
a. palpitations or tachy
b. sweating
c. trembling/shaking
d. SOB or smothering
sensations
e. choking sensation
f. feeling dizzy, unsteady,
lightheaded, faint
g. nausea or abdominal
distress
h. derealization or
depersonalization
i. Fear of losing control or
going crazy
j. fear of dying
k. paresthesias
l. chills/hot flashes
m. CP or discomfort
Disorder DSM Risk Factors Epidemiology Cours
Social Anxiety 1. Marked fear or anxiety about >1 Genetics Women > Men Chron
Disorder situation which involves exposure to signifi
scrutiny by others Overall 13% (15% impai
2. Fear that actions or anxiety women, 11% men) chang
symptoms will be negatively Most common anxiety morbi
evaluated disorder proble
3. Exposure to social situations proba
provokes fear/anxiety Median age onset ~ 15- abuse
4. Interferes w/ function 16
5. Symptoms present > 6 months

Ultimately afraid of embarrassment in a

social situation (vs. agoraphobia where
they are afraid they will have a panic
attack in a place they can’t get help,
which makes them socially isolated)
Generalized 1. Excessive anxiety and worry Genetics; share Women > men Chron
Anxiety occurring for >6 months, on more genes with panic Prevalence: 5% sympt
Disorder days than not disorder and ADD Median onset 30 fluctu
2. Worry is difficult to control respo
3. Worry or anxiety is associated with: and b
restlessness/on edge, muscle therap
tension, irritability, fatigue, trouble maint
concentrating, sleep disturbance overti
4. Symptoms cause marked distress or
impair function
Disorder DSM Risk Factors Epidemiology Cours
Note: these people generally don’t have
panic attacks

OCD 1. Obsessions (realization that they are Genetics Prevalance 2-3% 1. Tx

excessive) F=M (40-60
a. thoughts, impulses, or images that Late teens/early 20’s impro
are: in gen
i. intrusive 2. stu
ii. recurrent varied
iii. inappropriate impro
iv. excessive/unreasonable full re
v. induce anxiety recognized as subcli
one’s own thoughts. impro
vi. resisted clinica
2. Compulsions worse
a. Repetitive behaviors or mental acts uncha
usually done on response to obsession 3. wo
b. Aimed at reducing distress or hoard
preventing dreaded event 4. Sx
w/ str
over ti
Personality 1. Enduring pattern of inner Genetics/epigenetics 30% have maladaptive a. anti
Disorder experience or behavior that Social environment trait’s borde
deviates markedly from person’s Synergistic 15% have Personality schizo
culture Disorder STABL
a. ii. problems in at > 2 areas Think of as M=F overall b. Bor
“adaptation”
Disorder DSM Risk Factors Epidemiology Cours
i. cognition (ways of perceiving disorders—don’t M >> in ASP, OCPD, comp
& interpreting self, other adapt well cluster A c. ASP
people, & events) F >> borderline ↑ unti
ii. emotional Starts in ↓ SES
response/affectivity-range, childhood/adolescence; d. “bu
intensity, lability, tendency for burn out in age (m
appropriateness of affect 30’s ASP &
iii. interpersonal functioning
iv. impulse control w/ ma
b. Pattern is enduring, inflexible, & religio
pervasive across broad range of better
personal & social situations & across somet
time. value
c. Clinically significant distress or to lose
impaired function e. PD
2. d. stable, long duration (onset by at w/ str
least adolescence or early adulthood) I exac
impro
Diagnosis: amelio
Look at character (failed adaptation)- if
yes, then they fulfill the criteria for
personality disorder
---Character = adaptive core of
personality
Look at the temperament for the specific
type of personality disorder
Disorder DSM Risk Factors Epidemiology Cours
---Temperament = early and heritable
disposition to primary emotions
Disorder DSM Risk Factors Epidemiology Cours

Substance A maladaptive pattern of substance used Genetics (family Nicotine: Alcoh

Abuse defined as 2 or more in the span of one Hx=2-10x risk)— 20-25% of population is Lifetim
year: younger age of addicted, M>F 24%, M
1. Tolerance onset=more risk to MOA: binds to nACh Highe
2. Withdrawal family members receptor in VTA to lower
3. Substance taken in larger amounts 2x M to F increased dopaminergic laws
than desired Onset of substance firing Herita
4. Persistent desire or unsuccessful use: 11-14 years Withdrawal: Withd
attempts to cut down Age of onset of Acute = Irritability, Early (
5. Significant energy spent obtaining, dependence: 20 restlessness, poor tremo
using or recovering from the years concentration, anxiety diaph
substance depression heada
6. Reduction in important social, Chronic = cravings, Middl
occupational, or recreational increased appetite, = hallu
activities depression seizur
7. Continued use despite knowing the Detox: Late (
physical/psycholocial problems it Varenicline: partial a4b2 Deliriu
causes nACh receptor agonist; waxin
8. Craving take for 2 weeks then consc
9. Recurrent use in physically attempt to quit, black box severe
dangerous ways warning for suicides tremo
10. Failure to fulfill major Bupropion auton
Disorder DSM Risk Factors Epidemiology Cours
obligations at work, school or home NRT instab
11. Social or interpersonal Detox
conflicts related to substance use Long a
Disulf
Specifiers: mild (2-3), moderate (4-5), aldeh
severe (>6) dehyd
blocke
Naltre
decre
of drin
Acam
NMDA
no be
placeb
Topira
enhan
cause
acidos
Autism 1. Clinically significant, persistent Genetic: 4:1 M:F, 1/42 boys has it Most
Spectrum defects in social communication - MZ concordance = prese
Disorder that meet all of the three: 80-90% langua
a. Deficits in verbal and -Other single gene the ag
nonverbal communication causes: Rett, Fragile
b. Lack of social reciprocity X, TS, Angelman Diagn
c. Failure to develop and -7q11.23; too much devel
maintain peer relationships = Williams, too little histor
Disorder DSM Risk Factors Epidemiology Cours
appropriate to developmental = ASD behav
level docto
2. Restricted, repetitive patterns of
behavior as manifested by at least Best p
TWO of the following: factor
a. Stereotyped motor or unusual develo
sensory IQ)
b. Excessive adherence to routine
c. Restricted, fixed interests
3. Symptoms must be present in early
childhood (but may not manifest
until later)

Specifiers: w/ or w/o intellectual

impairment, w/ or w/o language
impairment, associated w/ another
neurodevelopmental disorder, w/
catatonia; severity levels = requiring
support (this used to be Asperger’s),
requiring substantial support, requiring
very substantial support
Intellectual More severe is more -dev delay: 5-10% Progn
Disability Impairments that affect adaptive likely to be genetic -mental retardation: 1-4% on sev
functioning in three domains: Maternal - severe MR 0.3% work
1. Conceptual domain: skills in exposures/age— M>F begin
reading, writing, language alcohol and hearin
Disorder DSM Risk Factors Epidemiology Cours
2. Social domain: empathy, judgment, teratogens MOST if susp
interpersonal communication skills COMMON CAUSE IN somet
3. Practical domain: self management, US tailor
personal care, job responsibilities Nutrition that
Environmental
Severity now based on function in these deprivation
three domains, NOT just IQ
Conduct 1. Deliberate violation of Low socioeconomic M > F (boys w/ it also Predic
Disorder others/societal norms by three or status most more likely to commit social
more in a one year period: predictive crimes) disord
a. Aggression to people/animals Genetics play role 4% of population adulth
b. Property destruction progr
c. Deceitfulness/theft espec
d. Serious violation of rules the la
emoti
Childhood vs. adolescent onset specifi
(childhood <10 years old; important for
prognosis) Stable
Specifiers: lack of emotion/guilt, lack of overti
empathy, unconcerned about
performance, shallow or deficient affect

Anorexia 1. Significantly low body weight Polygenic, F>>M 9:1 Highly

Nervosa 2. Fear of gaining weight somewhat heritable 0.5-1% in females most
3. Lack of recognition of low weight or Tryptophan theory: Highest in industrialized develo
disturbance in self image Abnormal 5HT1A societies bingin
Specifiers: receptor binding
Disorder DSM Risk Factors Epidemiology Cours
Restricting (no binging/purging) causes increased Morta
Binge eating/purging anxiety; reducing highe
Remission tryptophan intake psych
Severity (based on current BMI; Mild <17, decreases anxiety to disord
Extreme <15) mask these suicid
abnormalities
Early
and sh
durati
progn
70% r
15 yrs
Bulimia 1. Recurrent episodes of binge eating F > M (90% female) Binge
(binge eating = eating more than 1-2% lifetime prevalence after e
most people would eat w/ loss of Begins late dietin
self control) adolescence/early adult Persis
2. Recurrent inappropriate life years
compensatory behavior to prevent perce
weight gain clinica
3. Once per week for >3 months Better
4. Self evaluation is influenced by body respo
shape and weight better
5. Episodes don’t exclusively occur (70%
during episodes of AN

Specifiers:
Partial vs. Full remission
Disorder DSM Risk Factors Epidemiology Cours
Severity (mild = 1-3 times/week;
moderate = 4-7 times/week; severe = 8-
13 times/week; extreme >14 times/week)
Binge Eating 1. Recurrent episodes of binge eating F>M; age 40s (though Cours
Disorder with at least three indicators of loss more equal male and histor
of self control female than BN) weigh
a. Eating more rapidly than Typically more progra
normal overweight, less anxiety say it
b. Eating until uncomfortably full than BN some
c. Eating large amounts when 2-3% lifetime in women remit
not hungry
d. Eating alone due to
embarrassment
e. Feeling disgusted w/ self or
guilty after
2. Marked distress about binge eating
3. Occurs at least once a week for at
least three months
4. Does not occur during episodes of
BN or AN

Same specifiers as BN

Linked to overweight and obesity (as

opposed to BN)
Tourette’s 1. Motor and vocal tics that begin Strong genetics M > F (5:1) Most
Syndrome before adulthood (< 18 years old) (maybe AD w/ Age of onset: 7 norma
Disorder DSM Risk Factors Epidemiology Cours
2. Not due to another illness reduced penetrance morbi
3. Chronic (but symptoms and severity in females?) 3% of children will have a impul
change over time, can have bouts) Secondary: low birth chronic tic disorder inatte
weight, maternal 10-50% of kids will have a
smoking, transient tic disorder Sever
PANDAS 11, th
regres

Somatization 1. One or more somatic symptoms Men w/ ASPD or Women: 2% 1. Chr

Disorder that are distressing or result in a alcohol abuse have Hospital Inpatients (psych fluctu
significant disruption of daily life female pro band w/ and med): 10% sympt
2. Excessive thoughts, feelings or higher rates of IBS patients: 15-48% show
behaviors related to that symptom somatization on 10
or associated health concern disorder Virtually all women
3. The state of symptomatology is Decade following puberty 2. Soc
Somatization (diagnosis requires onset
Disorder DSM Risk Factors Epidemiology Cours
consistently present (>6 months) disorder pro band < 30 years old) comp
though the symptoms may change have higher rates of Occup
SD, ASPD and impai
alcohol abuse (men) interp
relatio
marita
family
paren
proble
proble

3. Disa
Confin
suicid
hospit
greate
costs.

4. "Bu
age (m
Conversion medically unexplained Sx or deficits a. 20-25% lifetime rate of 1. 20-
Disorder relating to voluntary motor or sensory conversion Sxs in general patien
fxn=pseudoneurological population. unexp
1. Do NOT dx if also fit criteria for neuro
somatization d/o: somatization d/o b. 10-15% of hospital sympt
subsumes conversion Sx’s med/surg inpatients. found
Disorder DSM Risk Factors Epidemiology Cours
2. 4 types of conversion sx medic
a. Motor deficits 75-90% female which
b. sensory deficit Age: 10-35 accou
c. seizures/convulsions sympt
d. mixed Sx 10% if
somati
disord
prese
 2. Pro
conve
disord
(60-85
conve
sympt
later)
 3. Pro
depen
como
(wors
como
somati
disord
Post- 1. Exposure to threat: directly Women > Men Prevalence: Women 10%; Starts
Traumatic experiencing, witnessing it person Early separation Men 5% event
Stress occurring to someone else, learning from parents one w
Disorder about it happening to a close Pre-existing anxiety Note resilience is the after o
Disorder DSM Risk Factors Epidemiology Cours
friend/family, experiencing and depression rule, NOT the exception and te
repeated exposure (healthcare Family history of chron
workers, firefighters, etc) anxiety/ASPD years,
2. Presence of intrusive symptoms: Previous more
distressing memories or dreams, trauma**they are years)
flashbacks, psychological and additive!
physiological distress to cues
3. Persistent avoidance of stimuli
associated w/ the event: avoidance
of memories, thoughts, feelings;
external reminder avoidance
4. Negative cognition/mood: inability
to remember, negative beliefs about
self/world, personal blame,
disinterst, detachment, negative
emotional state, can’t have positive
emotion
5. Hyperarousal/hyperactivity:
irritable outbursts, destructive
behavior, hypervigilence,
exaggerated startle response,
concentration problems, sleep
disturbance

These all occurring for > 1 month, they

impair functioning, and they are not due
Disorder DSM Risk Factors Epidemiology Cours
to substance abuse

Specifiers: dissociative symptoms,

delayed expression
ADHD 6+ of 9 inattentive symptoms Heritability – 80% M > F (about 3:1) 70-80
1. Poor attention to Lead exposure in chil
details/careless OB complications Preschool: 3% (most still ha
2. Can’t sustain attention in Premature common = hyperactive adole
task/play Alcohol exposure subtype)
3. Fails to listen Maternal smoking School: 4-12% 45-65
4. Poor follow-through Psychosocial Adult: 4-7% have i
5. Poor organization adversity
6. Avoids difficult tasks
7. Often loses things
8. Easily distracted
9. Forgetful
6+ of 9 hyperactive/impulsive symptoms
1. Fidgets/squirms
2. Leaves seat
3. Runs/climbs
4. Can’t play quietly
5. Talks excessively
6. Blurts out
7. Can’t wait turn
8. Interrupts
Some impairing symptoms prior to age 12
Disorder DSM Risk Factors Epidemiology Cours
Three types: inattentive, hyperactive, NOS
(combo of the two)
Oppositional 4 or more behavior variants apparent Males > Females 70% s
Defiant over 6 months: (especially prepubertal) remit
Disorder 1. Loses temper often Average prevalence ~ 3% adulth
2. Argues w/ adults course
3. Actively defies rules 1/3 pr
4. Deliberately annoys 1/10 p
5. Blames others ASPD
6. Easily annoyed
7. Angry and resentful Predic
8. Spiteful and vindictive depre
anxiet
Make sure this is apparent in ALL aspects
of life, not just situational