CE Course 10 - Figure 1

Figure 1. Mental disorders

(as defined in the Diagnostic and Statistical Manual of Mental Disorders , 4th edition, Text Revision.)

Mood Disorders

Major depressive disorder is very common, affecting 1 in 10 to as many as 1 in 4 women in their lifetime and half as many men. Those who have it are severely depressed; they lose interest or pleasure in their usual activities for two weeks or longer. They also have changes in weight, sleep patterns, or activity level, fatigue, feelings of worthlessness or guilt, difficulty thinking or making decisions, and/or recurrent thoughts of suicide. Most people with major depressive disorder, if untreated, will recover in about six months, though the pain and serious side effects of the illness warrant treatment. Depression become chronic in about 15% of patients, but with treatment, it may improve.

Dysthymic disorder is distinguished from major depressive disorder by long-lasting, less severe depressive symptoms that have been present for many years.

Bipolar disorder occurs if a person with symptoms of major depressive disorder experiences a manic or hypomanic episode as well. A manic episode markedly impairs the person’s ability to function normally, lasts at least a week, and includes such symptoms as significantly inflated self-esteem, decreased sleep, talkativeness, racing thoughts, distractibility, agitation, and excessive involvement in pleasurable, but potentially painful, activities such as unrestrained buying sprees, sexual indiscretions, or foolish business investments.

Hypomanic episodes are similar to the manic phase of bipolar disorder, but less severe.

Anxiety Disorders

• Specific phobias occur when a person has incapacitating anxiety from a specific feared object or situation.

Panic disorder is characterized by recurring, unexpected panic attacks that concern the patient.

• Panic attacks are a period of intense apprehension, or terror with shortness of breath, thumping heart, smothering sensations, and/or fear of “going crazy” or losing control.

Agoraphobia is characterized by avoidance of situations from which escape might be difficult or embarrassing in the event of a panic attack.

Post-traumatic stress disorder (PTSD) sometimes develops in individuals who have experienced severely stressful events. Those with PTSD re-experience these events as if they were happening all over again. They try to avoid reminders of the trauma.

Generalized anxiety disorder sufferers have experienced at least six months of persistent and excessive anxiety and worry.

Eating Disorders

Anorexia nervosa usually (not always) occurs in young women. They have an abnormal perception of desirable body weight or shape, are intensely afraid of gaining weight or becoming fat, and do not maintain a normal weight.

Bulimia nervosa, literally, “ox hunger,” is characterized by binge eating and purging. The patient also develops compensatory behaviors such as self-induced vomiting, and is excessively concerned about body shape and size. Anorexia nervosa and bulimia nervosa are almost exclusively seen in industrially developed countries; their occurrence is believed to be related to the unrealistic thin-body ideals prevalent in first world countries.8

Psychotic Disorders

Schizophrenia and similar mental illnesses are characterized by delusions (false beliefs, often persecutory); hallucinations (visions or sounds that other people do not see or hear, usually experienced as voices); disorganized speech; grossly disorganized behavior; and negative symptoms (including reduced emotional expressiveness, little speech, and difficulty starting and continuing goal-directed activities). Before schizophrenia can be diagnosed, these signs must continue for at least six months. Psychotic symptoms (delusions, hallucinations, negative symptoms) can also occur in psychotic depression and bipolar disorder.

Somatoform Disorders

Pain disorder is characterized by pain that causes distress or impairment that is strongly affected by psychological factors. However, one condition—pain disorder associated with a general medical condition—is not considered a mental disorder; the pain results from a medical condition. It is included in the DSM IV-TR for differential diagnosis.

Hypochondriasis is diagnosed when a person is preoccupied with unwarranted fears of a serious disease for six or more months, despite appropriate medical evaluation and reassurance.

Cognitive Disorders

Dementia is characterized by problems of memory and other cognitive disturbances. Dementia can have many causes, including Alzheimer’s disease, stroke, other neurological diseases including AIDS, or persisting effects of substance use. For a diagnosis, the problems must severely impact the person’s ability to work or function socially and represent a decline from previous ability.

Substance-Related Disorders

Substance-related disorders can be caused by exposure to any of the following substances: the DSM IV-TR uses the term substance to refer to a drug of abuse (including alcohol), a medication, or a toxin (poison). They are divided into two groups—substance-induced disorders and substance use disorders.

Substance-induced disorders include substance intoxication, substance-induced persisting dementia, and other problems due to direct physiological effects on the central nervous system.

Substance use disorders include substance abuse and substance dependence.

Substance abuse is diagnosed when a person uses a substance maladaptively and when use interferes with major role obligations like work or child care. The diagnosis of substance abuse is preempted by a diagnosis of substance dependence if tolerance, withdrawal, and/or compulsive drug-taking also occur. Most people with substance dependence experience a ‘craving’ for the substance.