Understanding Psychological Disorders, I – Notebook

Contents
Understanding Psychological Disorders, I – Notebook...........................................................................................................1

1. Issues in defining normality and abnormality.................................................................................................................2

2. Issues in diagnosis and classification:.............................................................................................................................3

3. Nature of clinical assessment..........................................................................................................................................4

4. Anxiety Disorders (any 3)...............................................................................................................................................6

a. GAD........................................................................................................................................................................... 6

b. OCD............................................................................................................................................................................8

c. Panic Disorder..........................................................................................................................................................10

d. Phobias.....................................................................................................................................................................12

5. Somatoform Disorders...................................................................................................................................................14

a. Types of somatoform disorders................................................................................................................................14

b. Hypochondriasis.......................................................................................................................................................15

c. Conversion Disorders...............................................................................................................................................17

6. Mood Disorders.............................................................................................................................................................19

a. Unipolar Depressive Disorders.................................................................................................................................19

Major Depressive Disorder............................................................................................................................................19

Persistent Depressive Disorder......................................................................................................................................21

Specifiers for MDD.......................................................................................................................................................22

b. Bipolar Disorder.......................................................................................................................................................23

7. Eating Disorders............................................................................................................................................................25

a. Anorexia, Bulimia, and Binge-eating.......................................................................................................................25

b. Causes.......................................................................................................................................................................27

8. Sexual Disorders................................................................................................................................................................29

a. Gender Identity Disorder...............................................................................................................................................29

9. Schizophrenia....................................................................................................................................................................30

10. Personality Disorders......................................................................................................................................................35

a. Anti-social personality disorder.....................................................................................................................................35

11. Disorders of Development...............................................................................................................................................38

a. Mental Retardation........................................................................................................................................................38
b.ADHD.............................................................................................................................................................................43
 1. Issues in defining normality and abnormality
Defining normality and abnormality in the context of human behavior and mental health is a complex and multifaceted
issue. There are several key issues to consider when attempting to define what is considered normal and abnormal:

1. Subjectivity: Determining what is "normal" or "abnormal" is highly subjective and influenced by various factors such
as cultural, social, and historical context. Different cultures and societies have different norms and expectations regarding
behavior, making it challenging to establish a universal definition.

2. Continuum: Human behavior exists on a continuum, ranging from what is considered typical or expected to what is
considered atypical or deviant. There is no clear dichotomy between normal and abnormal, but rather a range of behaviors
and experiences.

3. Contextual Factors: Behavior must be evaluated within the context in which it occurs. What might be considered
abnormal in one situation or culture may be completely normal in another. For example, grieving behavior can be viewed
as abnormal outside the context of a loss.

4. Cultural Relativity: Cultural norms and values heavily influence the perception of normal and abnormal behavior.
Behaviors that deviate from cultural norms may be labeled as abnormal or even pathological, while being considered
normal or acceptable in a different cultural context.

5. Evolutionary Perspective: Evolutionary psychology suggests that certain behaviors that might be labeled as abnormal
in modern society could have had adaptive functions in the past. For example, hypervigilance or anxiety may have been
beneficial in detecting and escaping from potential dangers in ancestral environments.

6. Subjective Distress and Impairment: One common criterion for defining abnormal behavior is the presence of
subjective distress and impairment in an individual's daily functioning. If a behavior causes significant distress or impairs
a person's ability to carry out their usual activities, it may be considered abnormal.

7. Statistical Rarity: Another criterion used to define abnormality is statistical rarity. Behaviors that deviate significantly
from the average or occur infrequently in a population may be considered abnormal. However, this criterion can be
problematic as it does not capture the full range of human diversity.

8. Medical Model Bias: The medical model of abnormality, influenced by the field of psychiatry, tends to view
psychological disorders as having a biological basis and focuses on symptomatology. This model may overlook
sociocultural factors and the importance of context in the definition of normal and abnormal behavior.
 2. Issues in diagnosis and classification:
The diagnosis and classification of mental disorders is a complex and evolving field that presents several challenges.
Some of the main issues include:

1. Subjectivity: Mental disorders are diagnosed based on subjective criteria, relying heavily on the interpretation of
symptoms by healthcare professionals. This subjectivity can sometimes lead to inconsistencies and variations in diagnoses
between clinicians.

2. Overlapping Symptoms: Many mental disorders share similar symptoms, making it difficult to differentiate between
them. This can result in misdiagnoses or comorbidity, where an individual may have multiple co-occurring disorders.

3. Diagnostic Criteria: The criteria for diagnosing mental disorders are based on established guidelines such as the DSM-
IV TR. However, these criteria are continuously revised and updated, which can lead to variations in diagnostic practices
over time.

4. Cultural and Contextual Factors: Cultural differences and social contexts can influence the way mental disorders
manifest and are perceived. The current diagnostic system may not adequately capture the diversity of cultural
expressions of distress and symptomatology.

5. Stigma and Labeling: The act of labeling someone with a mental disorder can have social and psychological impacts,
potentially contributing to stigma and discrimination. It is essential to consider the potential consequences of diagnostic
classifications.

6. Co-occurring Disorders: Many individuals with mental disorders often experience more than one condition
simultaneously. This can complicate the diagnostic process and require careful assessment and consideration.

7. Biological Complexity: Mental disorders are believed to have complex biological underpinnings that are not yet fully
understood. This complexity makes it challenging to establish clear diagnostic parameters solely based on biological
markers.

8. Lack of Objective Tests: Unlike many physical health conditions, there are limited objective tests, such as blood tests
or imaging, to diagnose mental disorders. Diagnosis relies primarily on observations, interviews, and symptom reports.
 3. Nature of clinical assessment
The nature of clinical assessment of mental disorders encompasses a systematic and comprehensive evaluation process
aimed at gathering information to diagnose and understand an individual's mental health condition. This process involves
various methods and techniques to assess cognitive, emotional, behavioral, and functional aspects of an individual's life.
Here are some key points to consider:

1. Purpose: The primary purpose of clinical assessment is to identify, diagnose, and understand mental disorders. It
involves assessing the nature, severity, and impact of symptoms on an individual's daily functioning.

2. Multimodal Approach: Clinical assessment typically involves using a combination of tools and techniques to gather
information. This may include interviews, psychological tests, self-report measures, behavioral observations, and
collateral information from family members or other relevant sources.

3. Diagnostic Criteria: Clinical assessment is guided by established diagnostic criteria, such as those outlined in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11).
These criteria provide a standardized framework for classifying and diagnosing mental disorders.

4. Clinical Interviews: A thorough clinical interview is a fundamental component of assessment. It involves a structured
or semi-structured conversation between the clinician and the individual, focusing on gathering information about
symptoms, personal history, and current functioning. Interviews may be conducted with the individual alone or include
collateral interviews with family members or other significant individuals.

5. Psychological Testing: Psychological tests can provide additional objective information about an individual's cognitive
abilities, personality traits, emotional functioning, and symptom severity. These tests can include intellectual assessments,
personality inventories, projective techniques, and symptom inventories.

6. Self-Report Measures: Self-report measures, such as questionnaires or rating scales, are commonly used to assess an
individual's subjective experiences, symptomatology, and quality of life. These measures allow individuals to report their
own thoughts, feelings, and behaviors.

7. Behavioral Observations: Direct observations of an individual's behavior in various settings can provide valuable
information about their functioning, social interactions, and symptom presentation. This may involve observing the
individual in therapy sessions, home, school, or work environments.

8. Cultural Considerations: Clinical assessment needs to consider cultural factors that may influence the expression and
interpretation of symptoms. Understanding an individual's cultural background and worldview is crucial for accurate
assessment and diagnosis.

9. Clinical Judgment: The assessment process also relies on the clinician's expertise, clinical judgment, and their ability to
integrate information gathered from various sources. This includes considering the context, diagnostic criteria, and
potential biases that may impact the assessment process.

10. Ethical Considerations: Ethical guidelines play a crucial role in clinical assessment to ensure the privacy,
confidentiality, and well-being of the individual being assessed. Clinicians must follow ethical standards and obtain
informed consent throughout the assessment process.
 4. Anxiety Disorders (any 3)

a. GAD
1. Definition: Generalized Anxiety Disorder is a chronic and excessive anxiety or worry about various aspects of life that
persists for at least six months.

2. Excessive Worry: Individuals with GAD experience disproportionate and uncontrollable worry about various concerns,
such as health, finances, work, relationships, and daily responsibilities.

3. Physical Symptoms: GAD is associated with a range of physical symptoms, including muscle tension, restlessness,
fatigue, irritability, sleep disturbances, and difficulty concentrating.

4. Duration and Persistence: Unlike normal worry or stress, GAD symptoms persist for an extended period, often
occurring most days over several months.

5. Interference with Daily Functioning: GAD significantly interferes with a person's ability to function in different areas
of life, such as work, school, relationships, and overall well-being.

6. Comorbidity: GAD commonly co-occurs with other mental health disorders, such as depression, panic disorder, social
anxiety disorder, and substance use disorders.

7. Prevalence: GAD is one of the most prevalent anxiety disorders, with a lifetime prevalence estimated at around 5-6%
of the general population.

8. Causes: The development of GAD is likely a result of a combination of genetic, biological, environmental, and
psychological factors. It can run in families and may be influenced by brain chemistry imbalances and life stressors.

9. Cognitive Aspects: GAD is characterized by excessive worry, often involving anticipation of worst-case scenarios.
Individuals with GAD may have difficulty controlling their worry and tend to overestimate the likelihood and severity of
negative events.

10. Treatment Options: GAD can be effectively treated through a combination of psychotherapy and medication.
Cognitive-Behavioral Therapy (CBT) is a common psychotherapy approach that helps individuals identify and challenge
irrational thoughts and develop coping strategies. Medications such as selective serotonin reuptake inhibitors (SSRIs) or
benzodiazepines may be prescribed in severe cases.

11. Lifestyle Changes: Certain lifestyle changes and self-help strategies can also help manage GAD symptoms. These
include relaxation techniques, stress management, regular exercise, adequate sleep, and a healthy diet.

12. Prognosis: With appropriate treatment and support, individuals with GAD can experience significant improvement in
symptoms and quality of life. However, long-term management may be necessary to prevent relapse.

13. Impact on Quality of Life: GAD can significantly impair an individual's overall well-being, personal relationships,
academic or occupational functioning, and physical health.

14. Seeking Professional Help: If an individual suspects they may have GAD, it is essential to seek professional help from
a mental health provider, such as a psychologist or psychiatrist, for an accurate diagnosis and appropriate treatment plan.
15. Holistic Approach: A holistic approach, encompassing both psychological and physical well-being, is crucial in the
assessment, diagnosis, and treatment of GAD, considering the multifaceted nature of the disorder.
 b. OCD
1. Definition: Obsessive-Compulsive Disorder (OCD) is a chronic mental health disorder characterized by the presence of
obsessions and/or compulsions that cause significant distress and interfere with daily life.

2. Obsessions: Obsessions are intrusive and unwanted thoughts, urges, or images that cause anxiety or distress. They can
include fears of contamination, doubts, aggressive or violent thoughts, and a need for symmetry or order.

3. Compulsions: Compulsions are repetitive behaviors or mental acts that individuals feel driven to do in response to
obsessions. These compulsions are intended to reduce anxiety or prevent a feared outcome. Examples include excessive
handwashing, checking, counting, or arranging objects.

4. Time-Consuming: OCD can be time-consuming, as individuals often feel compelled to repeat their compulsive
behaviors or mental acts until they feel a sense of relief or certainty.

5. Severity and Intensity: OCD is characterized by the severity and intensity of obsessions and compulsions, causing
significant distress and impairing daily functioning.

6. Prevalence: OCD affects approximately 1-2% of the general population, making it a relatively common mental health
disorder.

7. Onset: OCD typically begins in childhood, adolescence, or early adulthood, but it can also start in adulthood. The onset
may be gradual or sudden.

8. Causes: The exact cause of OCD is unknown, but it is believed to involve a combination of genetic, neurological, and
environmental factors. Imbalances in brain chemicals, such as serotonin, may contribute to the development of OCD.

9. Impact on Daily Life: OCD can significantly affect an individual's daily life, including relationships, work, school, and
overall well-being. It can lead to social isolation, difficulty maintaining employment, and decreased quality of life.

10. Comorbidity: Many individuals with OCD also experience other mental health disorders, such as depression, anxiety
disorders, and eating disorders.

11. Diagnosis: Diagnosing OCD involves a thorough assessment by a qualified mental health professional, including
interviews, observation of symptoms, and consideration of the impact on daily functioning.

12. Treatment Options: OCD is often treated using a combination of therapy and medication. Cognitive-Behavioral
Therapy (CBT) with Exposure and Response Prevention (ERP) is the gold standard treatment. Selective serotonin
reuptake inhibitors (SSRIs) are commonly prescribed medications for OCD.

13. Relapse Prevention: OCD is a chronic condition, and long-term management is often necessary. This may include
ongoing therapy, regular check-ins with a mental health professional, and the development of relapse prevention
strategies.

14. Support and Resources: Joining support groups, seeking guidance from mental health organizations, and accessing
reliable educational resources can provide individuals with OCD and their loved ones with valuable support and
information.
15. Recovery: With proper treatment and support, many individuals with OCD can experience significant improvement
and live fulfilling lives. Though some symptoms may persist, they can be effectively managed with appropriate
interventions and coping strategies.
 c. Panic Disorder
1. Definition: Panic Disorder is a type of anxiety disorder characterized by recurrent and unexpected panic attacks. Panic
attacks are intense episodes of fear or discomfort that reach their peak within minutes.

2. Panic Attack: Panic attacks involve sudden and overwhelming symptoms, such as rapid heartbeat, chest pain, shortness
of breath, dizziness, trembling, sweating, and a sense of impending doom or loss of control.

3. Panic Disorder with Agoraphobia: Agoraphobia often co-occurs with Panic Disorder. It involves an intense fear or
avoidance of situations or places from which escape may be difficult or embarrassing or where help may not be available
in the event of a panic attack or panic-like symptoms.

4. Panic Disorder without Agoraphobia: Some individuals experience Panic Disorder without the presence of
agoraphobia. These individuals may have panic attacks but do not necessarily fear or avoid certain situations.

5. Frequency and Duration: Panic attacks generally occur in a discrete period, often peaking within 10 minutes, but their
symptoms can last longer. Panic Disorder involves recurrent panic attacks and is associated with persistent worry about
having additional attacks.

6. Triggers and Anticipation: Panic attacks may be triggered by specific situations or occur unexpectedly without any
apparent trigger. Individuals with Panic Disorder often develop heightened anticipatory anxiety, fearing the occurrence of
future panic attacks.

7. Comorbidity: Panic Disorder frequently co-occurs with other mental health conditions, such as other anxiety disorders,
depression, and substance use disorders.

8. Impact on Daily Life: Panic Disorder can significantly impact an individual's quality of life, leading to avoidance of
certain situations, social isolation, and impairment in various domains, including work, school, and relationships.

9. Causes: The exact causes of Panic Disorder are not fully understood, but factors like genetics, brain chemistry
imbalances, and a history of life stressors may contribute to its development.

10. Diagnosis: To diagnose Panic Disorder, a qualified mental health professional conducts a comprehensive assessment,
considering the individual's reported symptoms, frequency and duration of panic attacks, and the impact on daily
functioning.

11. Treatment Options: Panic Disorder can be effectively managed with a combination of psychotherapy and medication.
Cognitive-Behavioral Therapy (CBT) is a commonly recommended therapy, which involves identifying and challenging
negative thought patterns and learning coping strategies. Selective serotonin reuptake inhibitors (SSRIs) and
benzodiazepines may be prescribed to alleviate symptoms.

12. Lifestyle Modifications: Certain lifestyle changes can help individuals manage Panic Disorder, such as practicing
stress-reduction techniques, maintaining a healthy lifestyle, engaging in regular exercise, and avoiding substances that
may exacerbate symptoms (e.g., caffeine, alcohol).

13. Support and Education: Support from mental health professionals, support groups, and loved ones can be beneficial in
managing Panic Disorder. Learning about the disorder and understanding its nature can also empower individuals to cope
effectively.
14. Relapse Prevention: Ongoing treatment and self-care practices are crucial for preventing relapse and effectively
managing Panic Disorder. This includes maintaining regular therapy sessions, adhering to medication regimens (if
prescribed), and developing coping strategies for managing symptoms.

15. Prognosis: With appropriate treatment and support, individuals with Panic Disorder can experience significant
improvement in their symptoms and overall well-being. However, long-term management may be necessary to maintain
stability and prevent relapse.
 d. Phobias
1. Phobic Disorders: Phobic disorders, also known as phobias, are a group of anxiety disorders characterized by intense
and irrational fears of specific objects, situations, or activities.

2. Agoraphobia: Agoraphobia involves a fear or avoidance of situations or places where escape or help may be difficult or
embarrassing if a panic attack or intense anxiety symptoms occur. Individuals with agoraphobia may fear being in
crowded places, using public transportation, or being outside of their home.

3. Social Phobia (Social Anxiety Disorder): Social phobia is the fear of social situations or performance situations, where
the person is excessively worried about being embarrassed, judged, or humiliated. It leads to avoidance of social
interactions, public speaking, or being the center of attention.

4. Specific Phobia: Specific phobia is characterized by a marked and persistent fear of a specific object or situation that is
excessive and unreasonable. Common specific phobias include fears of animals (e.g., spiders or snakes), flying, heights,
blood or injections, and certain situations like being in enclosed spaces.

5. Blood-Injection-Injury Phobia: Blood-injection-injury phobia is a unique subtype of specific phobia that involves an
intense fear or disgust towards blood, injections, or injury-related situations. Unlike other phobias, it can lead to a unique
physiological response, including low blood pressure and fainting.

6. Triggers and Reactions: Phobias are triggered by encounters with the feared object or situation, leading to immediate
anxiety or panic reactions. These reactions can include a rapid heartbeat, shortness of breath, trembling, sweating, nausea,
and an intense desire to escape or avoid the feared stimulus.

7. Course and Onset: Phobias can develop in childhood, adolescence, or adulthood, and their course can vary. Some
phobias may persist throughout life without treatment, while others may resolve spontaneously or with intervention.

8. Impact on Daily Life: Phobias can significantly impact an individual's daily life by causing distress, impairing
functioning, and limiting activities or experiences due to avoidance behaviors.

9. Causes: Phobias are believed to arise from a combination of genetic, biological, and environmental factors. Traumatic
experiences, learned behaviors, and cultural influences can also contribute to the development of phobias.

10. Treatment Options: Phobias can be effectively treated through psychotherapy and medication. Cognitive-Behavioral
Therapy (CBT), particularly exposure therapy, is the most common and evidence-based psychotherapy for phobias.
Medications such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may be prescribed in some cases.

11. Self-Help Strategies: Various self-help strategies can complement professional treatment for phobias. These may
include relaxation techniques, gradual exposure exercises, mindfulness, and challenging negative thoughts.

12. Prognosis: With proper treatment, many individuals with phobias can experience significant improvement, reduced
anxiety, and increased quality of life. Early intervention often leads to better outcomes.

13. Relapse Prevention: Maintaining treatment gains and preventing relapse involves ongoing practice of learned coping
skills, self-monitoring, and seeking support when needed.
14. Seeking Professional Help: If an individual suspects they have a phobia that is causing significant distress or
impacting their life, it is essential to seek professional help from a mental health provider for an accurate diagnosis and
appropriate treatment.

15. Support Networks: Engaging with support networks, such as phobia support groups or online communities, can
provide individuals with phobias with a sense of understanding, validation, and shared experiences.
 5. Somatoform Disorders

a. Types of somatoform disorders

In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), which is a widely used classification
system for mental disorders, the category of "somatoform disorders" has been replaced with a new category called
"Somatic Symptom and Related Disorders."

Under the previous classification system, DSM-IV-TR, there were several somatoform disorders. However, it's important
to note that the specific number and names of somatoform disorders may vary depending on the diagnostic criteria used.
Here are some examples of disorders that were previously classified as somatoform disorders:

1. Conversion Disorder: This involves the presence of neurological symptoms, such as paralysis, blindness, or seizures,
that are inconsistent with a known medical condition. These symptoms are believed to be related to psychological factors
rather than physiological causes.

2. Hypochondriasis: This is characterized by excessive and persistent worry about having a serious medical condition,
despite having little or no medical evidence to support the belief. Individuals often engage in excessive health-related
behaviors such as frequent doctor visits or medical tests.

3. Somatization Disorder: This is characterized by a long history of physical complaints across multiple organ systems
without any identifiable medical cause. The symptoms may be chronic and result in significant impairment in functioning.

4. Pain Disorder: This involves the presence of severe and distressing pain that is the primary focus of clinical attention.
The pain cannot be fully explained by a known physical condition or a physiological process.

5. Body Dysmorphic Disorder: Although not strictly categorized as a somatoform disorder, Body Dysmorphic Disorder
involves preoccupation with an imagined or slight defect in one's physical appearance. The individual may exhibit
repetitive behaviors (e.g., checking mirror, seeking reassurance), or avoid certain situations due to concerns about their
perceived appearance.

It's worth mentioning that the DSM-5 reorganized the classification of these disorders under the "Somatic Symptom and
Related Disorders" category, which includes disorders like Somatic Symptom Disorder, Illness Anxiety Disorder, and
Conversion Disorder (as "Functional Neurological Symptom Disorder").
 b. Hypochondriasis
1. Definition: Hypochondriasis, now known as Illness Anxiety Disorder (IAD), is a somatic symptom disorder
characterized by excessive worry and fear of having a severe medical condition, despite having little or no medical
evidence to support the belief.

2. Preoccupation with Health: Individuals with IAD have a persistent preoccupation with their health and are excessively
concerned about having a serious illness, even if they have minor or no symptoms. They may misinterpret normal bodily
sensations as signs of a severe medical condition.

3. Anxiety and Distress: The fear and worry experienced by individuals with IAD are often disproportionate to the actual
medical condition. The anxiety and distress associated with the fear of having an illness can significantly impact daily life
and functioning.

4. Excessive Checking and Doctor Shopping: Individuals with IAD may engage in excessive checking of their body for
signs of illness, repeatedly seeking reassurance from healthcare professionals, or excessively visiting doctors to seek
confirmation of their health concerns.

5. Absence of Medical Evidence: Despite limited or no medical evidence supporting their concerns, individuals with IAD
remain convinced that they have a serious illness. They may visit multiple healthcare professionals, undergo numerous
medical tests, and yet remain unsatisfied with reassurances.

6. Attentional Biases: Individuals with IAD tend to have heightened attentional biases towards bodily sensations and
symptoms, interpreting them as evidence of a severe illness. They may intensely focus on minute changes in their bodies,
leading to increased anxiety and distress.

7. Duration: The preoccupation with illness in IAD typically lasts for at least six months, and individuals often experience
persistent worry and concern about their health during this period.

8. Impact on Functioning: IAD can significantly impair an individual's daily functioning, causing distress, interfering with
relationships, and impacting occupational or academic performance. Constant health worries may lead to social isolation
and avoidance of situations perceived as potentially harmful to health.

9. Misinterpretation of Medical Information: Individuals with IAD tend to misinterpret medical information and may
selectively focus on worst-case scenarios or rare diseases. They may excessively research medical conditions, which can
further reinforce their fears and anxieties.

10. Comorbidity: IAD commonly co-occurs with other mental health conditions such as anxiety disorders, depression,
and other somatic symptom disorders.

11. Treatment Approaches: IAD can be effectively treated through a combination of psychoeducation, cognitive-
behavioral therapy (CBT), and potentially medication. CBT aims to challenge maladaptive thoughts and beliefs about
health concerns, promote healthy coping strategies, and reduce attentional biases.

12. Communication and Empathy: Healthcare professionals play a crucial role in managing IAD symptoms. Taking time
to listen, providing accurate and clear information, and offering empathetic support can help individuals with IAD feel
understood and reduce their anxiety.
13. Support Groups: Joining support groups or seeking peer support can provide individuals with IAD a sense of
validation and a platform to share experiences with others facing similar challenges.

14. Relapse Prevention: Long-term management may be necessary to prevent relapse. Regular follow-up appointments,
ongoing therapy, and the development of healthy coping mechanisms are essential in managing IAD symptoms.

15. Recovery: With appropriate treatment and support, individuals with IAD can experience significant improvement and
a better quality of life. However, some individuals may require ongoing management of their health-related worries.
 c. Conversion Disorders
1. Definition: Conversion Disorder, also known as Functional Neurological Symptom Disorder, is a psychiatric disorder
characterized by the presence of physical symptoms or deficits that cannot be explained by a known medical condition or
organic pathology.

2. Physical Symptoms: Conversion disorder manifests as physical symptoms affecting voluntary motor or sensory
functions, such as paralysis, blindness, seizures, difficulty swallowing, or voice loss. These symptoms are not
intentionally produced or consciously feigned.

3. Psychological Factors: The symptoms in conversion disorder are believed to be influenced by underlying psychological
factors, often related to stress, trauma, or unresolved emotional conflicts. The symptoms serve as a way for the individual
to express their distress or unconscious psychological conflicts.

4. Lack of Organic Basis: Medical evaluations do not reveal any physiological abnormalities or underlying medical
conditions that can account for the severity or nature of the symptoms. This distinguishes conversion disorder from other
medical or neurological conditions.

5. Emotional Distress: Conversion disorder is often accompanied by significant emotional distress, ranging from anxiety
and depression to feelings of frustration, confusion, and helplessness.

6. Relationship to Trauma: Conversion disorder is frequently associated with a history of trauma or adverse life events.
Emotional trauma, such as physical or sexual abuse, or traumatic events like accidents or combat experiences, can
increase the risk of developing conversion symptoms.

7. Diagnostic Criteria: The diagnosis of conversion disorder is made based on specific criteria outlined in the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5). These criteria include the presence of one or more symptoms
affecting voluntary motor or sensory functions, the exclusion of a known medical condition, and evidence of a
relationship between the symptoms and psychological factors.

8. Co-Occurrence of other Mental Health Conditions: Individuals with conversion disorder may also experience other
mental health conditions, such as anxiety disorders, depression, or post-traumatic stress disorder (PTSD).

9. Treatment Approaches: The treatment of conversion disorder typically involves a multidisciplinary approach, including
psychotherapy, physical therapy, and addressing any underlying psychological issues or trauma. Therapies such as
cognitive-behavioral therapy (CBT) and psychodynamic therapy may be beneficial in helping individuals understand and
cope with their symptoms.

10. Prognosis: The prognosis for conversion disorder varies from person to person. Many individuals experience
spontaneous recovery within weeks or months, while others may require longer-term treatment and support.

11. Physical Rehabilitation: Physical therapy and rehabilitation techniques may be incorporated to address functional
impairments associated with the symptoms, such as mobility issues or muscle weakness.

12. Support and Education: Providing support, psychoeducation, and reassurance to the individual and their family can be
instrumental in understanding and managing the condition.
13. Importance of Collaboration: Collaboration between mental health professionals, neurologists, and other healthcare
providers is crucial to accurately diagnose and treat conversion disorder, ruling out any organic causes and ensuring
appropriate care.

14. Cultural Influences: Cultural factors and beliefs can influence the presentation and interpretation of conversion
disorder symptoms. It is essential to consider cultural nuances when assessing and treating individuals with conversion
disorder.

15. Long-Term Management: Since conversion disorder can recur or persist, long-term management may involve regular
monitoring, therapy sessions, stress reduction techniques, and empowering the individual to develop healthy coping
strategies.
 6. Mood Disorders

a. Unipolar Depressive Disorders

Major Depressive Disorder
1. Definition: Major Depressive Disorder, often referred to as depression, is a mental health disorder characterized by
persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in activities.

2. Core Symptoms: The core symptoms of MDD include depressed mood, loss of interest or pleasure (anhedonia),
significant weight loss or gain, changes in appetite, sleep disturbances, psychomotor agitation or retardation, fatigue or
loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and recurrent thoughts of death or
suicide.

3. Duration: To be diagnosed with MDD, these symptoms must be present most of the day, nearly every day, for at least
two weeks and significantly impact daily functioning.

4. Severity: The severity of depressive symptoms can range from mild to severe, with varying degrees of impairment.

5. Comorbidity: MDD often co-occurs with other mental health disorders, such as anxiety disorders, substance use
disorders, and eating disorders.

6. Onset: The onset of MDD can occur at any age, but it often emerges in late adolescence or early adulthood. It can be
triggered by stressful life events, genetic factors, or a combination of biological, psychological, and environmental
factors.

7. Impact on Daily Life: MDD can significantly affect various aspects of an individual's life, including relationships,
work, school, and overall functioning. It can lead to social withdrawal, difficulty concentrating, decreased productivity,
impaired decision-making, and increased risk of suicide.

8. Diagnosis: The diagnosis of MDD involves a comprehensive evaluation by a mental health professional, using criteria
outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This includes a thorough assessment of
symptoms, duration, and associated impairment.

9. Treatment Options: Treatment for MDD typically includes a combination of psychotherapy and medication. Cognitive-
Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Mindfulness-Based Cognitive Therapy (MBCT) are
commonly used psychotherapeutic approaches. Antidepressant medications, such as selective serotonin reuptake
inhibitors (SSRIs), are often prescribed.

10. Recovery and Management: With appropriate treatment and support, many individuals with MDD experience
significant improvement in symptoms and quality of life. However, ongoing management may be necessary to prevent
relapse, including regular therapy sessions, medication adherence, and the development of healthy coping mechanisms.

11. Support Systems: Building a strong support system comprising friends, family, and mental health professionals can be
beneficial for individuals with MDD. Support groups and community resources can also provide valuable support and
understanding.
12. Lifestyle Modifications: Engaging in self-care activities such as maintaining a regular sleep schedule, exercising
regularly, eating a balanced diet, and engaging in pleasurable activities can help manage depressive symptoms.

13. Education and Awareness: Raising awareness about MDD, reducing stigma, and promoting understanding can
contribute to a supportive environment for those experiencing depression.

14. Relapse Prevention: Developing strategies to recognize early warning signs of relapse and implementing coping skills
learned in therapy can help individuals manage depressive episodes and prevent relapses.

15. Professional Help: Seeking help from a qualified mental health professional is crucial for accurate diagnosis,
personalized treatment, and ongoing management of MDD.
Persistent Depressive Disorder
1. Definition: Dysthymia, or Persistent Depressive Disorder (PDD), is a chronic type of depression characterized by
persistent feelings of sadness, low mood, and a lack of interest or pleasure in life.

2. Duration: Dysthymia is diagnosed when the symptoms persist for at least two years in adults (or one year in children or
adolescents) without a period of at least two months symptom-free.

3. Mild to Moderate Severity: The severity of dysthymia is typically milder than major depressive disorder, but it can still
significantly impair functioning and well-being.

4. Symptomatology: Common symptoms of dysthymia include depressed mood, loss of interest in activities, changes in
appetite, sleep disturbances, low energy or fatigue, poor concentration or difficulty making decisions, and feelings of
hopelessness.

5. Co-occurring Disorders: Dysthymia often coexists with other mental health disorders, such as anxiety disorders,
substance use disorders, or major depressive disorder.

6. Onset: Dysthymia can start in childhood, adolescence, or adulthood, and it tends to have an insidious onset, with
symptoms gradually developing over time.

7. Risk Factors: Various factors can contribute to the development of dysthymia, including a family history of depression
or other mood disorders, chronic stress, trauma, or certain personality traits.

8. Differential Diagnosis: Dysthymia needs to be differentiated from major depressive disorder, as well as other mood
disorders or medical conditions that may cause similar symptoms.

9. Impact on Daily Life: Dysthymia can significantly impair social, occupational, and educational functioning, leading to
decreased productivity, impaired relationships, and overall reduced quality of life.

10. Comorbidity: Individuals with dysthymia frequently experience comorbid conditions such as anxiety disorders,
substance use disorders, or physical health problems.

11. Treatment Options: Treatment for dysthymia typically includes a combination of psychotherapy and, in some cases,
medication. Cognitive-Behavioral Therapy (CBT) and interpersonal therapy are commonly employed therapeutic
approaches.

12. Antidepressant Medication: In some instances, selective serotonin reuptake inhibitors (SSRIs) or other antidepressant
medications may be prescribed to alleviate symptoms.

13. Prognosis: Dysthymia is a chronic condition, and long-term management is often necessary. However, with
appropriate treatment and support, many individuals can experience symptom reduction and improved functioning.

14. Suicide Risk: Dysthymia is associated with an increased risk of suicidal ideation and attempts. It is crucial to assess
and monitor individuals for potential suicidal thoughts and provide appropriate interventions and support.

15. Self-Help Strategies: In addition to professional treatment, self-help strategies such as regular exercise, engaging in
pleasurable activities, maintaining a healthy lifestyle, and seeking social support can contribute to managing symptoms
and promoting well-being in individuals with dysthymia.
Specifiers for MDD
Page 259
 b. Bipolar Disorder
1. Definition: Bipolar Disorder is a chronic mental health condition characterized by recurrent episodes of mood
disturbances, ranging from episodes of mania or hypomania to episodes of depression.

2. Bipolar I Disorder: Bipolar I Disorder is diagnosed when an individual experiences at least one manic episode, which is
a distinct period of abnormally elevated or irritable mood and increased energy or activity. The manic episodes in Bipolar
I Disorder are severe and can often lead to impairment in social or occupational functioning.

3. Bipolar II Disorder: Bipolar II Disorder is diagnosed when an individual has experienced at least one major depressive
episode and at least one hypomanic episode. Hypomania is similar to mania but has less severity and does not
significantly impair daily functioning.

4. Manic Episode: A manic episode is characterized by an elevated, expansive mood or irritable mood accompanied by
symptoms such as inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness, racing thoughts,
impulsivity, excessive involvement in pleasurable activities with a high potential for negative consequences, and
distractibility.

5. Hypomanic Episode: A hypomanic episode is similar to a manic episode but with milder symptoms. The individual
may experience increased energy, heightened creativity, elevated mood, and increased productivity. Hypomanic episodes
differ from mania in that they do not cause significant impairment or necessitate hospitalization.

6. Major Depressive Episode: A major depressive episode is characterized by a pervasive feeling of sadness, loss of
interest or pleasure in usual activities, changes in appetite or weight, sleep disturbances, decreased energy or fatigue,
difficulty concentrating, feelings of worthlessness or guilt, and recurrent thoughts of death or suicidal ideation.

7. Cyclothymic Disorder: Cyclothymic Disorder is a subtype of Bipolar Disorder that involves chronic mood fluctuations,
but the episodes are less severe than those seen in Bipolar I and II Disorders. Individuals with cyclothymic disorder
experience numerous periods of hypomanic and depressive symptoms that persist for at least two years.

8. Rapid Cycling: Some individuals with Bipolar Disorder may experience rapid cycling, wherein they experience four or
more mood episodes (manic, hypomanic, or depressive) within a 12-month period. Rapid cycling can make the disorder
more challenging to manage.

9. Neurobiological Factors: Bipolar Disorder is believed to have a neurobiological basis involving genetic, neurological,
and neurotransmitter abnormalities. Imbalances in serotonin, norepinephrine, and dopamine levels are thought to play a
role in the development and recurrence of mood episodes.

10. Treatment Options: Treatment for Bipolar Disorder typically involves a combination of medication and
psychotherapy. Mood stabilizers, such as lithium and certain anticonvulsant medications, are commonly used to reduce
the frequency and severity of mood episodes. Psychotherapy, particularly Cognitive-Behavioral Therapy (CBT) and
interpersonal therapy, can assist individuals in managing symptoms, recognizing triggers, and developing coping
strategies.

11. Prognosis and Management: Bipolar Disorder is a chronic condition that requires long-term management. With
appropriate treatment, individuals can lead fulfilling lives. Consistent medication management, psychoeducation, regular
therapy, maintaining a stable routine, and having a support system are important for managing the disorder effectively.
12. Suicide Risk: Individuals with Bipolar Disorder are at a higher risk for suicide, particularly during depressive
episodes or mixed episodes (where both manic and depressive symptoms are present). It is essential to monitor
individuals closely and provide appropriate support.

13. Impact on Daily Life: Bipolar Disorder can significantly impact various aspects of an individual's life, including
occupational functioning, relationships, and overall quality of life. It is crucial to provide support and accommodations
when necessary.

14. Co-occurring Disorders: Bipolar Disorder frequently co-occurs with other mental health conditions such as anxiety
disorders, substance use disorders, and attention-deficit/hyperactivity disorder (ADHD). The presence of comorbidities
needs to be considered in the treatment plan.

15. Individualized Treatment: Bipolar Disorder is a highly individualized condition, and treatment approaches should be
tailored to each person's specific symptoms and needs. Close collaboration between the individual, mental health
professionals, and support systems is essential for successful management of the disorder.
 7. Eating Disorders

a. Anorexia, Bulimia, and Binge-eating

1. Anorexia Nervosa:

- Definition: Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight or becoming fat,
leading to severe calorie restriction, extreme weight loss, and a distorted perception of body weight and shape.

- Key Features: Individuals with anorexia nervosa often have a significantly low body weight, engage in restrictive eating
patterns, have an intense preoccupation with food, weight, and body shape, and exhibit body dysmorphia. They may also
engage in excessive exercise, and have a strong need for control and perfectionism.

- Physical and Emotional Symptoms: Anorexia nervosa can lead to physical symptoms such as extreme thinness, fatigue,
low blood pressure, electrolyte imbalances, and disruptions in menstrual cycles. Emotional symptoms may include
anxiety, depression, social withdrawal, irritability, and a distorted self-image.

- Diagnostic Crossover: There can be diagnostic crossover of symptoms between anorexia nervosa and bulimia nervosa.
Some individuals with anorexia nervosa may engage in purging behaviors (such as self-induced vomiting or laxative
misuse) or binge eating episodes, which are typically more associated with bulimia nervosa. This crossover can
complicate the diagnosis and classification of eating disorders.

2. Bulimia Nervosa:

- Definition: Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by
compensatory behaviors to prevent weight gain, such as self-induced vomiting, excessive exercise, or the misuse of
laxatives or diuretics.

- Key Features: Individuals with bulimia nervosa often have a normal body weight or may be slightly overweight. They
experience a loss of control during binge-eating episodes and engage in secretive behaviors to compensate for the
perceived excess calories consumed during a binge. They also exhibit a preoccupation with body weight and shape.

- Physical and Emotional Symptoms: Bulimia nervosa can lead to physical symptoms such as fluctuating weight,
dehydration, electrolyte imbalances, erosion of dental enamel due to vomiting, and gastrointestinal issues. Emotional
symptoms may include low self-esteem, guilt, shame, mood swings, and anxiety.

- Diagnostic Crossover: As mentioned earlier, anorexia nervosa and bulimia nervosa can share some symptoms. For
example, individuals with bulimia nervosa may also restrict their food intake to some extent, which is more typical of
anorexia nervosa. Careful evaluation is necessary to assess the primary symptoms and determine the appropriate
diagnosis.

3. Binge Eating Disorder:

- Definition: Binge eating disorder is an eating disorder characterized by recurrent episodes of uncontrollable binge eating
without the use of compensatory behaviors.

- Key Features: Individuals with binge eating disorder often consume a large quantity of food within a discrete period,
feeling a loss of control over their eating. They may eat rapidly, until uncomfortably full, and may eat alone due to
embarrassment or shame. Unlike bulimia nervosa, they do not engage in compensatory behaviors such as vomiting or
excessive exercise.

- Physical and Emotional Symptoms: Binge eating disorder can lead to physical symptoms such as weight gain, obesity,
high blood pressure, cardiovascular issues, and type 2 diabetes. Emotional symptoms may include guilt, shame, and
distress related to the binge eating episodes.

- Diagnostic Crossover: While binge eating disorder primarily involves binge eating without compensatory behaviors, it is
possible for individuals with binge eating disorder to experience occasional purging or fasting, which can resemble
bulimia nervosa. Proper assessment is important to differentiate between the two disorders.

- Diagnostic Crossover in Anorexia Nervosa: Some individuals with anorexia nervosa may engage in binge eating or
purging behaviors, qualifying for a diagnosis of both anorexia nervosa and bulimia nervosa. This diagnostic crossover
highlights the complexity of eating disorders and the need for comprehensive evaluation and assessment.

It is worth noting that a comprehensive evaluation by a qualified healthcare professional is essential for accurate
diagnosis and individualized treatment planning for eating disorders.
 b. Causes
Biological Factors:

- Genetic predisposition: Evidence suggests that there is a genetic component to eating disorders, with certain individuals
being more vulnerable due to inherited traits.

- Neurotransmitter imbalances: Certain neurotransmitters, such as serotonin and dopamine, may play a role in the
development of eating disorders.

- Brain abnormalities: Structural and functional brain abnormalities, particularly in areas related to reward and impulse
control, have been found in individuals with eating disorders.

- Hormonal influences: Hormonal factors, such as disruptions in the hypothalamic-pituitary-adrenal (HPA) axis and
changes in leptin levels, can contribute to the development of eating disorders.

Sociocultural Factors:

- Media influence: The portrayal of idealized and unrealistic body images in the media can contribute to body
dissatisfaction and the internalization of thin beauty ideals.

- Cultural norms and values: Cultural emphasis on thinness, dieting, and appearance can significantly influence body
image dissatisfaction and disordered eating behaviors.

- Peer influence: Social pressures and the desire to fit in with peers who engage in disordered eating behaviors can
contribute to the development of eating disorders.

- Socioeconomic factors: Income disparities and social inequalities can affect access to resources and influence the
development of eating disorders.

Familial Factors:

- Family history: Having a family member with an eating disorder increases the risk of developing an eating disorder.

- Family dynamics: Dysfunctional family dynamics, such as high levels of enmeshment, overprotectiveness, or high
levels of criticism and conflict, can contribute to the development of eating disorders.

- Parental influence: Parental attitudes and behaviors related to body image, weight, and eating habits can impact the
development of disordered eating behaviors in children.

Individual Factors:

- Perfectionism: Individuals with eating disorders often have high levels of perfectionism, setting unrealistic expectations
for themselves in terms of appearance, achievement, and control.

- Low self-esteem: Poor self-esteem and negative body image play significant roles in the development and maintenance
of eating disorders.

- Psychological factors: Co-occurring mental health conditions, such as anxiety, depression, and obsessive-compulsive
disorder, can increase the risk of developing eating disorders.
- Trauma and abuse: Individuals who have experienced traumatic events or abuse may be at a higher risk for developing
eating disorders as a coping mechanism or as a way to regain control.
8. Sexual Disorders

a. Gender Identity Disorder

https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
9. Schizophrenia
Schizophrenia comes from the Greek words for “split mind”.

Individuals with schizophrenia may experience psychosis, a loss of contact with reality.

Their ability to perceive and respond to the environment becomes so disturbed that they may not be able to function at
home, with friends, in school, or at work.

They may have hallucinations (false sensory perceptions) or delusions (false beliefs).

They may withdraw into a private world.

More frequent occurrence of schizophrenia in the lower income strata of the population has led some theorists to believe
that the stress of poverty itself is a cause of the disorder. However, it could be that schizophrenia causes its victims to fall
from a higher to a lower socioeconomic level or to remain poor because they are unable to function effectively. This is
sometimes called the downward drift theory.

 Schizophrenia, a form of psychosis, is characterised by distortion to thinking and perception and inappropriate or
blunted affect.
 Schizophrenia is the most common form of psychosis with an onset that is typically early in life (15 to 35). It is a
chronic condition with a course characterised by episodes of acute psychosis.
 Symptoms that are common to psychoses are:
o Positive Symptoms of Schizophrenia:
 Hallucinations- Perceptions in the absence of external stimuli, such as auditory (e.g., hearing
voices), visual, tactile, or olfactory hallucinations.
 Delusions - False beliefs that are firmly held despite evidence to the contrary, such as paranoid
delusions or delusions of grandeur.
 Disorganized Thinking (Formal Thought Disorder) - Speech and thought patterns that are
fragmented, incoherent, or illogical, leading to difficulties in communication and understanding.
o Negative Symptoms of Schizophrenia:
 Affective Flattening or Flat Affect - Restricted range and intensity of emotional expression,
including reduced facial expressions, monotone voice, and lack of gestures.
 Alogia - Reduced speech output, manifesting as poverty of speech, or brief and empty replies to
questions.
 Avolition - Decreased motivation, difficulty initiating and sustaining goal-directed activities, and
self-care tasks.
 Anhedonia - Diminished ability to experience pleasure or interest in previously enjoyable
activities.
 Asociality or Social Withdrawal - Decreased desire for social interaction and lack of interest in
forming relationships.
o Cognitive Symptoms of Schizophrenia:
 Impaired Executive Functioning - Difficulties with planning, decision making, and cognitive
flexibility.
  Memory Impairment - Deficits in working memory and long-term memory retrieval.
 Attention Deficit - Difficulties focusing and maintaining attention on tasks, leading to
distractibility and reduced performance on cognitive tasks.

Types of Schizophrenia

 Paranoid schizophrenia: Predominant symptom is that of what are stable, normally paranoid delusions. These are
often accompanied by hallucinations (often auditory) but catatonic symptoms and those of abnormal affect,
volition and speech are normally absent.
 Hebephrenic or Disorganized schizophrenia: Affective symptoms are prominent with abnormal behaviour.
Negative symptoms are significant and social isolation may result.
 Catatonic schizophrenia: Predominant symptoms are those of psychomotor disturbance, and may exhibit both
hyperkinesis and stupor as well as automatic obedience and negativism. Other features may include episodes of
violent excitement.
 Undifferentiated schizophrenia: Those that meet the diagnostic threshold but do not fit into one of the above
categories.
 Residual Schizophrenia: This type is characterized by a past history of at least one episode of schizophrenia with
a minimization or absence of positive symptoms, but may still have negative symptoms, such as flat affect or
social withdrawal.

Risk Factors of Schizophrenia

 While there aren’t any confirmed causes of schizophrenia, there are risk factors for developing the condition:
o Environment:
 Many factors in the world around you can increase your risk of developing schizophrenia. Being
born during the winter increases your risk slightly. Certain illnesses that affect your brain,
including infections and autoimmune diseases (where your immune system attacks part of your
body), can also increase your risk. Extreme stress for long periods can also play a role in
developing it.
o Development and birth circumstances:
 How you developed before you were born plays a role in schizophrenia. The risk of having
schizophrenia goes up if your birthing parent had gestational diabetes, preeclampsia, malnutrition
or a vitamin D deficiency while pregnant with you. The risk also increases if you were
 underweight at birth or if there were complications during your birth (like if you were born via an
emergency cesarean section).
o Recreational drug use:
 Schizophrenia is linked with the use of certain recreational drugs, especially in larger amounts
and earlier in life. The connection between heavy marijuana (cannabis) use as a teenager is one of
the best-studied of these links. But experts aren’t sure if marijuana use is a direct cause of
schizophrenia or if it’s just a contributing factor.
o Experts haven’t found one specific cause of schizophrenia, so they can’t say for sure if genetics cause
schizophrenia. But if you have a family history of schizophrenia — especially a parent or sibling with it
— you have a much higher risk of developing this condition.
 How is schizophrenia diagnosed?
o According to the DSM-5, a schizophrenia diagnosis requires the following:
 At least two of the five main symptoms.
 You’ve had symptoms for at least one month.
 Your symptoms impact your ability to work or your relationships (friendly, romantic,
professional or otherwise).
o What tests will be done to diagnose this condition?
o There aren’t any diagnostic tests for schizophrenia. But healthcare providers may run tests to rule out
other conditions before diagnosing schizophrenia. The most likely types of tests include:
 Imaging tests. Healthcare providers will often use computerized tomography (CT), magnetic
resonance imaging (MRI) and other imaging tests to rule out problems like stroke, brain injuries,
tumors and other changes to your brain structure.
 Blood, urine and cerebrospinal fluid (spinal tap) tests. These tests look for chemical changes in
bodily fluids that might explain changes in your behavior. They can rule out heavy metal toxicity
or other causes of poisoning, infections and more.
 Brain activity testing. An electroencephalogram (EEG) detects and records the electrical activity
in your brain. This test can help rule out conditions like epilepsy.
 Treatment
o Antipsychotic Medications: These drugs are the primary treatment for managing symptoms of
schizophrenia. They help to alleviate hallucinations, delusions, and disordered thinking. There are two
main classes of antipsychotics: typical (first-generation) and atypical (second-generation). Examples
include risperidone, olanzapine, quetiapine, and aripiprazole.
o Psychosocial Therapies: These therapies aim to help individuals manage their symptoms, improve social
and occupational functioning, and adhere to their medication regimen. Cognitive-behavioral therapy
(CBT) and supportive therapy are commonly used to help individuals cope with the challenges of
schizophrenia.
o Family Therapy: Involving family members in the treatment process can be beneficial for both the
individual with schizophrenia and their loved ones. Family therapy can help improve communication,
reduce stress, and provide education about schizophrenia.
o Vocational Rehabilitation: Programs that assist individuals with finding and maintaining employment can
be valuable in promoting independence and self-esteem.
o Hospitalization: In severe cases or during acute psychotic episodes, hospitalization may be necessary to
ensure the individual's safety and provide stabilization.
o Community Support Services: Access to community-based services such as case management, housing
support, and peer support groups can be crucial in helping individuals with schizophrenia live
independently and reintegrate into society.
10. Personality Disorders

a. Anti-social personality disorder

 a kind of deeply ingrained and rigid dysfunctional thought process that focusses on social irresponsibility with
exploitative, delinquent, and criminal behaviour with no remorse.
 Disregard for and the violation of others' rights are common manifestations of this personality disorder, which
displays symptoms that include failure to conform to the law, inability to sustain consistent employment,
deception, manipulation for personal gain, and incapacity to form stable relationships.
 Antisocial personality disorder falls into 1 of 4 cluster-B disorders, which also includes borderline, narcissistic,
and histrionic.
 o All of these disorders characteristically present with dramatic, emotional, and unpredictable interactions
with others.
 Antisocial personality disorder is the only personality disorder that is not diagnosable in childhood.
o Before the age of 18, the patient must have been previously diagnosed with conduct disorder (CD) by the
age of 15 years old to justify diagnostic criteria for ASPD.
 Etiology/Causes:
o Although the precise etiology is unknown, both genetic and environmental factors have been found to
play a role in the development of ASPD.
o Various studies in the past have shown differing estimations of heritability, ranging from 38% to 69%.
o Environmental factors that correlate to the development of antisocial personality disorder include adverse
childhood experiences (both physical and sexual abuse, as well as neglect) along with childhood
psychopathology (Conduct Disorder and ADHD).
o Research has focused on establishing the exact gene contributing to ASPD, and much evidence is
pointing toward the 2p12 region of chromosome 2 and variation within AVPR1A.
o Interactions of specific genes with the environment have been an area of study as well, with evidence of
variation in the oxytocin receptor gene (OXTR) contributing to the broad ranges of behaviour elicited in
antisocial personality disorder due to its effect on the influence of deviant peer affiliation.
o According to this research, many environmental risk factors for ASPD are linked to experiences in
pregnancy and early childhood:
 Risk factors related to pregnancy and infancy: smoking or substance misuse during pregnancy,
experiencing stress and anxiety during pregnancy, complications during delivery, infant
malnutrition, heavy metal exposure
 Childhood trauma: negative parent-child interactions, verbal and physical abuse, inconsistent or
coercive discipline
 Social risk factors: growing up in an under-resourced community, exposure to peer groups that
engage in anti-social-like behavior, experiencing social violence.
 Epidemiology or Incidence of the disorder
o Estimated lifetime prevalence of ASPD amongst the general population falls within 1 to 4%.
o Men are 3 to 5 times more likely of being diagnosed with ASPD than females.
o Substance abuse is highly correlated to the diagnosis of ASPD.
o Education and Intelligence Displays are negatively correlated with ASPD, with a higher prevalence of
ASPD amongst those with lower IQs and reading levels.
o ASPD is lesser prevalent in criminal populations with higher ages.

 "The DSM-5 diagnostic criteria for antisocial personality disorder

o A pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three (or more) of the
following:
 Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest.
 Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit.
 Impulsivity or failure to plan.
 Irritability and aggressiveness, often with physical fights or assaults.
 Reckless disregard for the safety of self or others.
  Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations.
 Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.
o The individual is at least age 18 years.
o Evidence of conduct disorder typically with onset before age 15 years.
o The occurrence of antisocial behavior is not exclusively during schizophrenia or bipolar disorder.
11. Disorders of Development

a. Mental Retardation

 What is mental retardation?

o It is defined as an intellectual functioning level (as measured by standard tests for intelligence quotient)
well below average and significant limitations in daily living skills (adaptive functioning).
o Description of MR
 According to the ‘Centre for Disease Control and Prevention’, in the 1990s, mental retardation
occured in 2.5 to 3 percent of the general population. Mental retardation begins in childhood or
adolescence before the age of 18.
 It persists throughout adulthood. Intellectual functioning level is defined by standardized tests
(Weschsler-Intelligence Scales) that measure the ability to reason in terms of mental age
(intelligence quotient or IQ). Diagnosis of mental retardation is made if an individual has an
intellectual functioning level well below average and significant limitations in two or more
adaptive skill areas.
 Mental retardation is defined as IQ score below 70 to 75.
  Adaptive skills are the skills needed for daily life. Such skills include the ability to produce and
understand language (communication); home-living skills; use of community resources; health,
safety, leisure, self-care, and social skills; self-direction; functional academic skills (reading,
writing, and arithmetic); and work skills.
 In general, mentally retarded children reach developmental milestones such as walking and
talking much later than the general population.
 Symptoms of mental retardation may appear at birth or later in childhood. Time of onset depends
on the suspected cause of the disability.
 Some cases of mild mental retardation are not diagnosed before the child enters pre-school.
 These children typically have difficulties with social, communication, and functional academic
skills.
 Children who have a neurological disorder or illness such as encephalitis or meningitis may
suddenly show signs of cognitive impairment and adaptive difficulties.
 Categories of mental retardation
o Mild Mental Retardation
 Approximately 85 percent of the mentally retarded population is in the mildly retarded category.
Their IQ score ranges from 50 to 75 and they can often acquire academic skills up to the sixth
grade level. They can become fairly self-sufficient and in some cases live independently, with
community and social support.
o Moderate Mental Retardation
 About 10 percent of the mentally retarded population is considered moderately retarded.
Moderately retarded individuals have IQ scores ranging from 35 to 55. They can carry out work
and self-care tasks with moderate supervision. They typically acquire communication skills in
childhood and are able to live and function successfully within the community in a supervised
environment such as a group home.
o Severe Mental Retardation
 About 3 to 4 percent of the mentally retarded population is severely retarded. Severely retarded
individuals have IQ scores of 20 to 40. They may master very basic self-care skills and some
communication skills. Many severely retarded individuals are able to live in a group home.
o Profound Mental Retardation
 Only 1 to 2 percent of the mentally retarded population is classified as profoundly retarded.
Profoundly retarded individuals have IQ scores under 20 to 25. They may be able to develop
basic self-care and communication skills with appropriate support and training. Their retardation
is often caused by an accompanying neurological disorder. The profoundly retarded need a high
level of structure and supervision
 Causes of MR
o Prenatal Causes
 Chromosomal Disorders:
 Down’s syndrome,
 fragile X syndrome,
 prader wili syndrome,
  klinfelter’s syndrome
 Single Gene Disorders:
 Inborn errors of metabolism like galactosemia,
 phenyl ketonuria,
 hypothyroidism,
 muco polysaccaridoses,
 tay sachs disease
 Neuro Cutaneous Syndromes:
 Tuberous sclerosis,
 neurofibromatosis
 Dysmorphic Syndromes:
 Laurence Moon Biedl syndrome
 Brain Malformations:
 Microcephaly,
 hydrocephalus,
 myelo meningocele
o Abnormal maternal environmental influences
 Deficiencies:
 Iodine deficiency and
 folic acid deficiency,
 severe malnutrition
 Substance use:
 Alcohol,
 nicotine,
 cocaine
 Exposure to harmful chemicals:
 Pollutants,
 heavy metals,
 harmful drugs like
o thalidomide,
o phenytoin,
o warfarin sodium etc.
 Maternal infections:
 Rubella,
 toxoplasmosis,
 cytomegalovirus infection,
 syphilis,
 HIV
 Exposure to:
  Radiation and
 Rh incompatibility
 Complications of Pregnancy:
 Pregnancy induced hypertension,
 ante partum hemorrhage,
 placental dysfunction
 Maternal Disease:
 Diabetes,
 heart disease
 kidney disease
o During delivery
 Difficult and /or complicated delivery,
 severe prematurity,
 very low birth weight,
 birth asphyxia,
 birth trauma
o Neonatal period:
 Septicemia,
 jaundice,
 hypoglycemia,
 neonatal convulsions
o Infancy and childhood:
 Brain infections like tuberculosis,
 Japanese encephalitis,
 bacterial meningitis,
 Head trauma,
 chronic lead exposure,
 severe and prolonged malnutrition,
 gross under stimulation
 Symptoms of MR
o Failure to meet intellectual developmental markers
o Failure to meet developmental milestones such as sitting, crawling, walking, or talking, in a timely
manner
o Persistence of childlike behaviour, possibly demonstrated in speaking style, or by a failure to understand
social rules or consequences of behaviour
o Lack of curiosity and difficulty solving problems
o Decreased learning ability and ability to think logically
o Trouble remembering things
o An inability to meet educational demands required by school
 Treatment
o Treatment for Mental Retardation is not designed to "cure" the disorder. Rather, therapy goals include
reducing safety risks (e.g., helping an individual maintain safety at home or school) and teaching
appropriate and relevant life skills. Interventions should be based on the specific needs of individuals and
their families, with the primary goal of developing the person's potential to the fullest.
o Medications are required to treat co morbidities like aggression, mood disorders, self injurious behaviour,
other behavioral problems and convulsions which occur in 40%to 70% of cases
b.ADHD
 Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and
impulsiveness inappropriate for the child’s age that interferes with functioning or development.
o ADHD is a brain disorder that is present from birth or develops shortly after birth.
o Some children mainly have difficulty with sustained attention, concentration, and ability to complete
tasks; some children are overactive and impulsive; and some are both.
o Doctors use questionnaires completed by parents and teachers as well as observations of the child to
make the diagnosis.
o Psychostimulant or other drugs plus structured environments, routines, a school intervention plan, and
modified parenting techniques are often needed.
o Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder. Although children
who have ADHD often behave in an overactive and impulsive way, ADHD is not a behaviour disorder.
o Although there is considerable controversy about the number of children affected, it is estimated that
ADHD affects 5 to 15% of children and is twice as common among boys.
o Many features of ADHD are often noticed before age 4 and invariably before age 12, but they may not
interfere significantly with academic performance and social functioning until the middle school years.
 Overview of Attention-Deficit/Hyperactivity Disorder (ADHD)
o ADHD was previously called just attention deficit disorder (ADD). However, the common occurrence of
hyperactivity in affected children—which is really a physical extension of attention deficit and
impulsivity—led to a change to the current terminology.
o ADHD has three forms
 Inattentive
 Hyperactive/impulsive
 Combined
o The symptoms of ADHD range from mild to severe and can become exaggerated or become a problem in
certain environments, such as at home or at school. The constraints of school and organized lifestyles
make ADHD a problem, whereas in prior generations, the symptoms may not have interfered
significantly with children’s functioning because people had different expectations about normal
childhood behavior. Although some of the symptoms of ADHD can also occur in children without
ADHD, they are more frequent and severe in children with ADHD.
 ADHD in adults
o Although ADHD is considered a disorder of children and always starts during childhood, it may not be
recognized until adolescence or adulthood. The neurologic differences continue into adulthood, and about
half of people continue to have behavior symptoms in adulthood.
o In adults, symptoms include
 Difficulty concentrating
 Difficulty completing tasks (poor executive skills)
 Restlessness
 Mood swings
  Impatience
 Difficulty in maintaining relationships
o ADHD can be more difficult to diagnose during adulthood. Symptoms may be similar to those of mental
disorders, including mood disorders and anxiety disorders. Adults who abuse alcohol and recreational
drugs may also have similar symptoms. Doctors ask adults to complete questionnaires to diagnose
ADHD, but they may also need to review records from school to confirm a pattern of inattention or
impulsivity.
o Adults with ADHD may benefit from the same types of stimulant drugs as do affected children. They
may also need counseling to help them improve their time management and develop other coping skills.
 Causes of ADHD
o ADHD has no known single specific cause, but genetic (inherited) factors are often present. Research
indicates that ADHD likely involves abnormalities in neurotransmitters (substances that transmit nerve
impulses within the brain). Some other risk factors include low birth weight (under 3 pounds [1500
grams]), head injury, brain infection, iron deficiency, obstructive sleep apnea, and lead exposure, as well
as exposure to alcohol, tobacco, or cocaine before birth. ADHD also is associated with traumatic events
during childhood, for example, violence, abuse, or neglect.
o Some people have raised concerns about whether food additives and sugar may cause ADHD. Although
some children seem to become overactive or impulsive after eating foods containing sugar, studies have
confirmed that the brain differences that lead to ADHD are present at birth and that food and
environmental factors do not cause the disorder.
 Symptoms of ADHD
o ADHD is primarily a problem with sustained attention, concentration, and task persistence (ability to
finish a task). Affected children may also be overactive and impulsive. Preschool children with ADHD
may have problems with communication and appear to have social interaction problems. As children
reach school age, they may seem inattentive. They may fidget and squirm. They may be impulsive and
talk out of turn. During later childhood, such children may move their legs restlessly, move and fidget
their hands, talk impulsively, and forget easily, and they may be disorganized. They are generally not
aggressive.
 Signs of ADHD
o All signs do not have to be present for a diagnosis of attention-deficit/hyperactivity disorder (ADHD).
However, 6 or more signs of inattention or of hyperactivity and impulsivity must always be present for a
diagnosis (or 6 from each group to diagnose the combined type of ADHD). Signs must be present in two
or more situations (for example, at home and at school) and must interfere with social or academic
functioning.
 Signs of inattention:
o Often fails to pay close attention to details
o Has difficulty sustaining attention in work and play
o Does not seem to listen when spoken to directly
o Often does not follow through on instructions and fails to finish tasks
o Often has difficulty organizing tasks and activities
 o Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
o Often loses things
o Is easily distracted by extraneous stimuli
o Is often forgetful
 Signs of hyperactivity and impulsivity:
o Often fidgets with hands or feet or squirms
o Often leaves seat in classroom and elsewhere
o Often runs about or climbs excessively
o Has difficulty playing or engaging in leisure activities quietly
o Is often on the go or acts as if “driven by a motor”
o Often talks excessively
o Often blurts out answers before questions have been completed
o Often has difficulty waiting to take turns
o Often interrupts or intrudes on others
 About 20 to 60% of children with ADHD have learning disabilities affecting reading, math, or
written language, and most have academic problems such as poor grades due to disorganization
or incomplete homework (executive skills). Work may be messy, with careless mistakes and an
absence of considered thought. Affected children often behave as if their mind is elsewhere and
they are not listening. They often do not follow through on requests or complete schoolwork,
chores, or other duties. There may be frequent shifts from one incomplete task to another.
 Affected children may have issues with self-esteem, depression, anxiety, or opposition to
authority by the time they reach adolescence. About 60% of young children have such problems
as temper tantrums, and most older children have a low tolerance for frustration.
 Diagnosis of ADHD
o A doctor's evaluation
 The diagnosis of ADHD is based on the number, frequency, and severity of signs. Children must
have 6 or more signs of inattention or of hyperactivity and impulsivity (or 6 from each group to
diagnose the combined type of ADHD; see Signs of ADHD). Signs must be present in at least
two separate environments (typically, home and school) so that a child's reaction to specific
problems in one situation is not mistaken for ADHD. Occurrence of signs just at home or just at
school and nowhere else does not qualify as ADHD because such signs may be caused by the
specific situation. Signs must also be more pronounced than would be expected for the child’s
developmental level and must be present for 6 months or more. Often, diagnosis is difficult
because it depends on the judgment of the observer. Also, children who are primarily inattentive
may escape notice until their academic performance becomes adversely affected.
o There is no laboratory test for ADHD. Questionnaires about various aspects of behavior and development
can help doctors and psychologists make the diagnosis. Because learning disorders are common, many
children receive psychologic testing both to help determine whether ADHD exists and to detect the
presence of a specific learning disorder, either as a cause for inattention or as a coexisting problem.
 o A physical examination and sometimes various blood and other tests to rule out other disorders are also
done.
 ADHD: Epidemic or Over-Diagnosis?
o An increasing number of children are diagnosed with attention-deficit/hyperactivity disorder (ADHD).
However, there is concern among doctors and parents that many children are misdiagnosed. A high
activity level may be completely normal and simply an exaggeration of normal childhood temperament.
Alternatively, it may have a variety of causes, including emotional disorders or abnormalities of brain
function, such as ADHD.
o Generally, 2-year-olds are active and seldom stay still. A high activity and noise level is common up until
age 4. In these age groups, and in children functioning developmentally in this age range, such behavior
is normal. Active behavior can cause conflicts between parents and child and may worry parents. It also
can create problems for others who supervise such children, including teachers.
o Determining whether a child’s activity level is abnormally high should not simply depend on how tolerant
the annoyed person is. However, some children are clearly more active than average. If the high activity
level is combined with short attention span and impulsivity, it may be defined as hyperactivity and
considered part of ADHD.
o Scolding and punishing children for a high activity level usually backfires, increasing the child’s activity
level. Avoiding situations in which the child has to sit still for a long time or finding a teacher skilled in
coping with such children may help. If simple measures do not help, a medical or psychologic evaluation
may be useful to rule out an underlying disorder such as ADHD.
 Prognosis for ADHD
o Importantly, the vast majority of children with ADHD become creative and productive adults, and people
who have ADHD may adjust better to work than to school situations. However, if the disorder is
untreated in childhood, the risk of alcohol or substance abuse or suicide may increase.
o Children with ADHD generally do not outgrow their inattentiveness, although children with hyperactivity
tend to become somewhat less impulsive and hyperactive with age. However, most adolescents and adults
learn to adapt to their inattentiveness. About one third of people find that they continue to benefit from
the use of stimulant drugs.
o Other problems that may emerge or persist in adolescence and adulthood include poor academic
achievement, disorganization (known as poor executive skills), low self-esteem, anxiety, depression, and
difficulty in learning appropriate social behaviors.
 Treatment of ADHD
o Psychostimulant drugs
o Behavior modification
 Children are treated with both behavioral therapy and stimulant drugs. Drugs help to relieve
symptoms and allow children to participate more easily in school and other activities. Younger
children, especially, benefit from combination therapy. For preschool-aged children, behavioral
therapy alone may be all that they need.
 The federal Individuals with Disabilities Education Act (IDEA) requires public schools to
provide free and appropriate education to children and adolescents with ADHD. Education must
be provided in the least restrictive, most inclusive setting possible—that is, a setting in which the
 children have every opportunity to interact with nondisabled peers and have equal access to
community resources. The Americans with Disability Act and Section 504 of the Rehabilitation
Act also provide for accommodations in schools and other public settings.
o Drug therapy
 Psychostimulant drugs are the most effective drug treatment. Methylphenidate and other
amphetamine-like drugs are the psychostimulants most often prescribed. They are equally
effective and have similar side effects. A number of slow-release (longer-acting) preparations are
available in addition to the regular forms and allow for once-daily dosing and may help to
prevent inappropriate use.
 Side effects of psychostimulant drugs may include
o Sleep disturbances (such as insomnia)
o Appetite suppression
o Headaches
o Stomachaches
o Elevated heart rate and blood pressure
o Depression, sadness, or anxiety
 Most children have no side effects except perhaps a decreased appetite. All side effects disappear
when the drug is stopped. However, when taken in large doses for a long time, stimulants can
slow children’s growth, and this slowed growth can continue into adulthood, so doctors monitor
weight and height. If children are growing slowly or have other significant side effects, doctors
may advise drug holidays. A drug holiday is stopping the stimulant drug at times when children
do not need to be as attentive and focused, for example on weekends or during the summer.
However, some children have great difficulty functioning even outside of school and may not
tolerate drug holidays.
 A number of other drugs can be used to treat inattentiveness and behavioral symptoms. These drugs include
o Atomoxetine (a nonstimulant ADHD drug)
o Certain drugs typically used for high blood pressure such as clonidine and guanfacine
o Antidepressants
o Antianxiety drugs
o Sometimes, a combination of drugs is used.
 Behavior management
o To minimize the effects of ADHD, structures, routines, a school intervention plan, and modified parenting
techniques are often needed. Children without significant behavior challenges may benefit from drug
treatment alone. However, stimulants do not work around the clock, so adaptations may be needed to help
with organizational and other skills. Behavioral therapy conducted by a child psychologist is sometimes
combined with drug treatment.