Upload
john-r-williams
View
293
Download
1
Tags:
Embed Size (px)
Citation preview
Review of DSM5 Mental Disorders for NCMHCE Study
1. Bipolar I Disorders2. Bipolar II Disorder3. Cyclothymic Disorder4. Substance/ Medication Induced Biolar and Related
Disorder
Diagnosis ITypically repetitive cycle of depression and mania, possibly between depressive episodesEither phase can lead to delusions and hallucinationsChronic but can have years between episodesOften begins in early 20s
1. Manic periods Abnormal high or irritable mood Increased energy and goal-
directed activity Lasts 1 week or more (less if
hospitalized) Includes 3-4 of:
Grandiosity Racing thoughts Little sleep Distractibility High risk activities Pressured speech and activity2. Sufficient intensity of episode
Diagnosis IISpecifiers include kinds and how current the episodes:
Major depression Hypomania Mania Mixed Rapid cycling (four mood episodes without break during
the last 12 month period) Mood is most of the time, nearly every dayImpairs function
Diagnosis IIICo-occurring:AnxietySubstance abuseEating DisordersADHDImpulse Control DisordersConduct DisordersAutism Tourette’s DisorderDiabetesMigraines
Rule Out:Schizophrenia & Psychotic Disorders: No psychosis except when depressed Depressive Disorders: Anti-depressants will not trigger anxiety or mania
Find OutFamily history
Clearest connection of all mental disorders
Symptomology development Affective functioningCognitive functioningSubstance historyTrauma and loss historyChart moods
Treatments 1. MedicationMood-stabilizing like Lithium (useless against mania, and toxic side effects) Anti-psychotic, like Lamotrogine, or anti-convulsants, like OlanzapineCan reduce manic phase from months to daysAvoid antidepressants, which trigger anxiety and mania
2. TherapiesCBT Cognitive
Behavioral TherapyBehavioral family
therapy IPSRT Interpersonal
Social Rhythm Therapy
Reducing expression of intense feelings
FFT Family Focused Therapy
CyclothymiaAlternating between hypomanic symptoms, and mild or moderate depressive moods, like Bipolar II Less severe, higher functioning
Bipolar II1 or more hypomanic episodes (4 days or more), and no mania1 or more major depressive episodes (2 weeks or more)
Bipolar IMore severe1 or more manic or mixed episodesLeading to:Serious problems, orHospitalization, orPsychotic features
Diagnosis More severe1 or more distinct manic episodes, or mixedOften with aggression or lack of sexual inhibitionsOften with little sleep or appetiteLeading to:Serious legal or work problems, orHospitalization to avoid harm orPsychotic features
S1. Find OutAffective functioningCognitive functioningSymptom developmentFamily historyTrauma historySubstance use
S2. Assess & ReferRefer for psychological testing
S4.Treatments 1. MedicationMood-stabilizing like Lithium (useless against mania, and toxic side effects) Anti-psychotic, like Lamotrogine, or anti-convulsants, like OlanzapineCan reduce manic phase from months to daysAvoid antidepressants, which trigger anxiety and mania
2. TherapiesPsychoeducationCBT Cognitive
Behavioral TherapyBehavioral family
therapy Interpersonal Social
Rhythm TherapyReducing expression
of intense feelings
S5. Monitoring 1. Mood charting2. Monitoring problematic behavior3. Affective functioning4. Medication compliance
S6. TerminationMedication monitoring for compliance and side effectsPsychotherapiesSupport group
Diagnosis 1 or more hypomanic episodes (4 days or more), and no mania1 or more major depressive episodes (2 weeks or more)
DiagnosisSymptomsAlternating between elevated mood (hypomanic symptoms), and mild or moderate depressive moods, like Bipolar II Less severe symptoms and higher functioning than Bipolar Disorder I or II
S1. AssessmentFamily history
Rule OutSleep problem
S5. TreatmentTherapyInterpersonal and Social Rhythm Therapy (IPSRT)Family Focused Therapy (FFT)Cognitive Behavioral TherapyGroup TherapyAlso Career counseling Interpersonal skill Group counseling
MedicationsMood stabilizers, like Lithium Anti-seizure or anticonvulsants, like DepakoteAntipsychotics, Seroquel or RisperdalAnti-anxiety, like benzodiazepinesAvoid Antidepressants, which trigger mania
S4. Goals of Treatment1.Decrease risk of developing into bipolar disorder 2.Reduce the frequency and severity of symptoms3.Prevent a relapse of symptoms, through maintenance treatment4.Treat alcohol or other substance abuse problems, since they can worsen cyclothymia symptoms