Psychiatry and DSM-5 Overview

Psychological Disorders (Psychopathology and the DSM)

• Psychopathology is the scientific study of psychological dysfunction.
• Neural dysfunction refers to aberrant neural functioning.
• Pathophysiology describes how neural dysfunction leads to physiological changes causing psychopathology.
• Historical conceptions of psychological disorders include the supernatural tradition, psychological tradition, biological tradition, and integrative approach.
• The integrative approach considers psychological, neurobiological, sociocultural, developmental, interpersonal, and other factors.
• The DSM-5 and DSM-5 TR are diagnostic and statistical manuals used by mental health professionals.
• The DSM-5 functions to provide descriptions, symptoms, and criteria for diagnosing psychological disorders and ensures a common language for clinicians and researchers.
• The major revisions of the DSM include the elimination of the multiaxial system and a focus on neuroscience/biology/pathophysiology.
• Psychologists and psychiatrists utilize an integrative approach, often involving "combined treatment".
• Assessments for psychological disorders include clinical interviews, physical exams, psychological testing, neuropsychological testing, and behavioral observations.
• DSM-5 TR (2022) clarified criteria, updated symptoms, codes, and terms; added a new diagnosis (Prolonged grief disorder).
• Psychological disorders are characterized by behavioral, psychological, or biological dysfunctions that are culturally atypical, associated with current distress/impairment in functioning, or an increased risk of suffering, death, pain, or impairment. (4 Ds)
• The 4 Ds are: deviant (atypical), distressing (discomfort), dysfunctional (interference), and dangerous (towards self or others).

Anxiety Disorders

• Anxiety disorders are the most common type of psychological disorder.
• Generalized anxiety disorder is characterized by excessive apprehensive expectation, ongoing for more than 6 months.
• Panic disorder is characterized by recurrent episodes of fear, occurring at inappropriate times.
• Agoraphobia is often accompanied by panic disorder and involves fear or anxiety about situations like public transportation, open spaces, enclosed places, standing in line, or being in a crowd, or being outside of the home alone.
• Specific phobia features a marked fear or anxiety about a specific object or situation.
• Separation anxiety disorder is typically observed in childhood.
• Selective mutism involves consistent failure to speak in certain social situations where speaking is expected, despite the ability to speak in other situations.
• Common comorbidity with anxiety disorders includes depression and substance use disorder.

Trauma- and Stressor-Related Disorders

• Posttraumatic stress disorder (PTSD) results from a traumatic event and involves re-experiencing the trauma, avoidance of reminders, emotional numbing, impaired memory, and chronic arousal.
• Acute stress disorder shares similar features with PTSD, but the symptoms usually last less than a month.
• Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are diagnosed in childhood and involve inappropriate social interactions.

Obsessive-Compulsive and Related Disorders

• Obsessive-compulsive disorder involves intrusive, distressing thoughts (obsessions), and actions (compulsions).
• Body dysmorphic disorder centers on body image concerns.
• Hoarding disorder is characterized by persistent difficulty discarding possessions.
• Trichotillomania involves repeated pulling out of one's hair.
• Excoriation is the repeated picking at one's skin to alleviate distress.
• Substance/Medication-Induced obsessive-compulsive disorders are brought on by a substance or medication.
• Related Other and Unspecified disorders are disorders that contain patterns observed in the previous mental conditions, but do not fit into one of the main conditions.

Depressive Disorders

• Major depressive disorder is a mood disorder characterized by a persistent period of sadness, emptiness, or hopelessness; loss of interest in activities, and other significant symptoms.
• Substance/Medication-Induced depressive disorder occurs as a result of substance abuse.
• Persistent depressive disorder is a chronic pattern of depressed mood.
• Premenstrual dysphoric disorder involves changes in mood and behavior before the onset of menstruation.
• Depressive disorders due to another medical condition are caused by another medical condition.
• Other specified and unspecified depressive disorders include patterns observed in other mental conditions, but do not fit into any main condition observed.

Bipolar and Related Disorders

• Bipolar I disorder features manic episodes, distinguished by abnormally elevated moods.
• Bipolar II disorder involves hypomanic episodes and depressive episodes.
• Cyclothymic disorder involves chronic mood instability.
• Substance/Medication-Induced bipolar disorder involves moods stemming from substance abuse.
• Bipolar and Related Disorder Due to Another Medical Condition involves moods stemming from another medical condition.
• Other Specified and Unspecified Bipolar and Related Disorders involves patterns observed in other mental conditions, but do not fit into any main condition observed.

Schizophrenia Spectrum and Other Psychotic Disorders

• Schizophrenia involves a persistent disruption of thought, perception, and behavior.
• Schizotypal personality disorder shares features but is less severe and persistent.
• Substance/Medication-Induced psychotic disorders are caused by abuse of substances.
• Delusional disorder is characterized by delusions, which are persistent, false beliefs.
• Brief psychotic disorder involves brief episodes of psychosis.
• Schizophreniform disorder lasts for less than 6 months but is more acute.
• Schizoaffective disorder features features of both mood episodes and schizophrenia.
• Psychotic disorder due to another medical condition is caused by another medical condition.
• Catatonia associated with another mental illness is characterized by changes in movement.
• Prevalence 1%; 10-15 year life expectancy reduction; significant % of homelessness; late adolescence/early adulthood.
• Hallmark features: positive, negative, and disorganized symptoms.

Dissociative Disorders

• Dissociative disorders involve disruptions in memory, awareness, and identity.
• Dissociative identity disorder involves the presence of two or more distinct personalities.
• Dissociative amnesia is characterized by significant loss of episodic memory.
• Depersonalization/derealization disorder involves feelings of detachment from one's thoughts and feelings and from one's surroundings, respectively.
• Other specified and unspecified dissociative disorders contain patterns observed in other mental conditions, but do not fit into any main condition observed.

Somatic Symptom and Related Disorders

• Somatic symptom disorders are characterized by intense focus on physical symptoms or a maladaptive response.
• Etiology and influencing factors may include history of trauma in childhood, family history, or the perceived reward of being ill.
• Considerations may include associated personality disorders, psychosocial stressors, or mood disorders.
• Illness Anxiety Disorder revolves around the distress of having a serious illness with accompanying symptoms despite the lack of actual physical issues.

Personality Disorders

• Personality disorders are characterized by inflexible, enduring, and maladaptive patterns of behavior that typically impair social relationships and functioning.
• 10 personality disorders are grouped into 3 clusters (A, B, C).
• Cluster A (odd or eccentric): paranoid, schizoid, schizotypal; Cluster B (dramatic or erratic): antisocial, borderline, histrionic, narcissistic; Cluster C (anxious or fearful): avoidant, dependent, obsessive-compulsive.