Bipolar Disorder Diagnosis (DSM)

Bipolar Disorder DSM Diagnosis

• Bipolar disorder type 1 involves at least one manic episode; major depressive episodes are typical but not required for diagnosis.
• Bipolar disorder type 2 has one hypomanic episode and one major depressive episode needed for diagnosis.
• A manic episode consist of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy
• A manic episode must last at least 1 week and be present for most of the day, nearly every day
• Manic episodes include at least three of these symptoms: grandiosity, little need for sleep, pressured speech, distractibility, engaging in multiple tasks, risky behavior, and/or racing thoughts.
• Manic symptoms must be severe enough to cause marked impairment in social or occupational function
• Hypomanic episodes also need only persist for four days and three manic episodes
• Symptoms must last four days, be present most of the day, and nearly every day
• Symptoms do not impair everyday functioning, unlike manic episodes
• Four of the symptoms must be present if the mood is only irritable, with manic and hypomanic episodes
• Cyclothymic disorder has hypomanic and depressive periods that do not fulfill the criteria for hypomania or major depression for at least two years.

Bipolar Disorder Treatment

• A distinction is made between acute and maintenance treatment.
• Acute treatment involves pharmacotherapy usually combined with individual or group psychoeducation.
• Maintenance treatment consists of pharmacotherapy and psychoeducation in euthymic states, sometimes combined with self-management skills or psychotherapy.
• Psychological treatment starts with psychoeducation (individual or group-based) aimed at self-management in both acute and stable phases.
• Second step for depressive episodes include psychoeducation, day structuring, bibliotherapy or self-help, self-management, physical relaxation or running therapy
• If not recovered, CBT, interpersonal-therapy, family-focused therapy or short psychodynamic therapy is used.
• Second step for relapse prevention utilizes social rhythm therapy or CBT, interpersonal therapy, mindfulness-based cognitive therapy if mood remains unstable
• Comorbidity is adressed in the 2nd step
• Clinical and functional recovery is the treatment's main focal point.
• Positive Psychological Treatment (PPI) includes mindfulness-based cognitive therapy (MBCT).
• Well-being therapy is used in euthymic states

Major Depressive Disorder DSM Diagnosis

• There are two major symptoms: depressed mood and/or loss of interest or pleasure
• Five or more of the symptoms present during a 2-week period must include emotional, cognitive, physical and/or behavioral presentations.
• The emotional symptoms consist of negative experiences, feeling sad, empty, and hopeless.
• The cognitive symptoms consists of diminished ability to think, concentrate or decide, diminished attention and memory skills, underestimating own abilities while overestimating the difficulty of a task, negative thoughts, and/or negative convictions about themselves and others
• Physical symptoms presented include fatigue, loss of energy, weight loss or gain, decrease or increase in appetite, insomnia/hypersomnia, and/or restlessness & psychomotor agitation or retardation.
• Behavioral symptoms presented include withdrawal from social contact, passivity, and/or loss of daily routines.

Major Depressive Disorder Treatment

• Behavioral activation diminishes passivity.
• Cognitive behavioral therapy (CBT) reduces automatic negative thoughts and prevents relapse.
• Interpersonal psychotherapy (IPT) diminishes negative thoughts by improving interpersonal functioning.
• IPT consists of a short treatment with 4 foci including bereavement (activate a grieving process), interpersonal conflict (bring the conflict in a negotiation stage), interpersonal role change (recognize losses) and interpersonal shortage (improve the social network and activate social interaction)
• The phases are divided into diagnostics and education, determine the focus and treatment.
• Positive Psychological Treatment enhances positive experiences instead of reducing symptoms:
• Mindfulness Based Cognitive Therapy (MBCT) combines mindfulness training with elements from cognitive therapy, and has relapse prevention.
• Acceptance and Commitment Therapy (ACT) diminishes experiential avoidance.

Wellbeing Therapy (WBT)

• Domains: self-acceptance, positive relations, autonomy, environmental mastery, purpose in life, and personal growth.
• Session 1 & 2 include psychoeducation about WBT, identifying episodes of wellbeing, restructuring thoughts that interrupted periods of wellbeing, and Ryffs scales of psychological wellbeing.
• Session 3-8 involves one or two dimensions of psychological wellbeing in three session modules, and focuses on positive experiences.

Generalized Anxiety Disorder (GAD)

• Excessive anxiety and worry about a variety of topics, events, or activities lasting at least six months.
• The worry is hard to control.
• It easily shifts from one topic to another in both adults and children.
• There must be accompanyment of at least three physical and/or cognitive symptoms.
• For children, only one symptom is necessary.
• Physical and/or cognitive symptoms include edginess, restlessness, fatigue, impaired concentration, feeling mind goes blank, irritability, increased muscle aches or soreness, and/or difficulty sleeping.
• Anxiety, worry, or physical symptoms cause personal distress and impairment of functioning in one or more domains (interpersonal and/or occupational).
• GAD is not better explained by another medical disorder

Generalized Anxiety Disorder (GAD) Treatment

• Metacognitive therapy including examining and changing beliefs about worry.
• CBT includes socratic dialogue, thought records and behaviour experiments, normalizing worry or worry awareness training, overcoming avoidance and accepting uncertainty
• Behavioural experiments help change beliefs about worry
• Alternative responses to worry is a method
• The worry decision can be used
• Positive Psychological Treatment involves Acceptance and Commitment Therapy.

Panic Disorder and Agoraphobia DSM Diagnosis

• Panic disorder requires recurrent unexpected panic attacks
• A panic attack is an abrupt surge of intense fear or intense discomfort that peaks within minutes and in order to be diagnosed, four or more occur from a calm or anxious state.
• Panic attack symptoms include palpitations, sweating, trembling, shortness of breath, choking feelings, chest pain or discomfort, nausea, dizziness, chills or heat sensations, paraesthesia, derealization or depersonalization, fear of losing control, and/or fear of dying
• Additional culture-specific symptoms includes, can be seen but do not count as 1 of 4 require symptoms
• Another criteria it that a Persistent is a Concern or worry about additional panic attacks or maladaptive is a change in behaviour related to the attacks
• The disturbance is not attributable to substance use or medical condition (e.g., hyperthyroidism)..
• A differential diagnosis occurs to ensure it is not another mental disorder

Panic Disorder and Agoraphobia Treatment

• First line treatment is CBT
• CBT examines catastrophic beliefs, and provides interoceptive exposure, exposure in vivo, and behavioural experiments
• Safety-behaviour is reduced
• Pharmacotherapy includes SSRI’s, TCA’s, other non-tricyclic antidepressants, MAOIs- and benzodiazepines.
• Combining CBT and pharmacotherapy improves results short term compared to either alone
• CBT is more effective than stopping pharmacotherapy
• Relapse risk is smaller when CBT is used (with or without pharmacotherapy).
• Positive Psychological Treatment involves Acceptance and Commitment Therapy.
• Agoraphobia diagnoses
• The patient is confronted with two different situations, such as using public transport, being in open spaces, being in a closed off space, being in crowded areas, and/or being alone outside of the house
• Involves thoughts that escape might be difficult or help would be limited if incapacitated by fear, panic attack or symptoms.
• Patients usually trigger fear or anxiety, they avoid the situation or require a companion

Specific Phobia and Social Anxiety DSM Diagnosis

• Specific phobia is a persistent, excessive, or unreasonable fear that occurs due to a specific object or situation.
• The phobic situation is avoided and endured with anxiety or distress
• Fear is excessive and persistent for at least six months
• It interferes with normal routine or causes marked distress.
• Is not explained by a medical condition
• Types of phobias can be related to animals, natural environment, blood injection injury, situational or other
• Social anxiety exists anxiety specific to social settings, in which a person feels noticed or scrutinised (Children must present with peers)
• Individual fears regarding anxiety display, that others will judge them and/or reject them
• Provoked distress in social interaction is intense
• Social interactions are then avoided or endured with intense fear
• the anxiety persist also for 6mths
• Can't be attributed to medical effects

Specific Phobia and Social Anxiety Treatment

• Exposure therapy, decreasing focusing on perceived threat, reducing safety behavior and adressing misinterpretation
• CBT used to refocus attention away from introspection or experiments
• inner voice is assessed

Illness Anxiety Disorder

• Involves preoccupation with having or acquiring a serious illness and somatic symptoms that are not present or only mild
• A high level of anxiety about health is present
• Display maladaptive avoidance

Illness Anxiety Disorder Treatment

• Includes testing the content of catastrophic predictions, superstitious thinking, and unhelpful related beliefs
• Reduce safety seeking behaviours
• Use theory A vs theory B
• Positive Psychological Treatment (PPI): ACT

Obsessive Compulsive Disorder (OCD) DSM Diagnosis

• The presence of obsessions, compulsions, or both, that is time consuming can cause significant distress or impairment in important areas of functioning.
• Not attributable to another medical
• Not explained by the symptoms of another medical diagnosis

Obsessive Compulsive Disorder (OCD) Treatment

• Exposure in vivo and response prevention (ERP) examines thoughts while testing unhelpful thoughts and beliefs Positive Psychological Treatment : ACT

Posttraumatic Stress Disorder (PTSD) DSM Diagnosis

• Involves death/injury exposure
• There are 4 clusters of symptoms (reExperincing, avoidance, change in cognition)
• Lasts for a month
• More distress with consciousness

Posttraumatic Stress Disorder (PTSD) Treatment

• CBT- education, confronation
• Promote post trumatic growth. Take control of life again