Somatoform & Anxiety Disorders.pdf

SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 5. Excessive fear or reluctance to be...

SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 5. Excessive fear or reluctance to be alone or without major attachment ANXIETY DISORDERS figures at home or in other settings. 6. Repeated physical complaints (e.g., headaches, stomachaches) when TOPIC OVERVIEW separation occurs or is anticipated. 7. Nightmares involving the theme of A. Separation Anxiety Disorder separation. B. Selective Mutism 8. Repetitive reluctance or refusal to C. Specific Phobia sleep away from home or to go to D. Social Anxiety Disorder sleep without being near a major E. Panic Disorder attachment figure. F. Agoraphobia The fear, anxiety, or avoidance is persistent, G. Generalized Anxiety Disorder lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults. A SEPARATION ANXIETY DISORDER SEPARATION ANXIETY DISORDER It is a mental health condition DURATION Children: At least 4 characterized by excessive fear or anxiety weeks. about separation from those to whom an Adults: Present for 6 individual is attached. This disorder can months or more. affect both children and adults, but it often begins in childhood. ONSET Typically begins in childhood, Developmentally inappropriate and often around ages 6 to 7. excessive fear or anxiety concerning However, it can also start in separation from those to whom the adolescence or adulthood. individual is attached, as evidenced by at least 3 of the following: COURSE It can sometimes improve with 1. Recurrent excessive distress when age, but it can persist into anticipating or experiencing adolescence and adulthood if separation from home or major untreated. attachment figures. 2. Persistent and excessive worry PREVALENCE Children and adults about losing major attachment figures or about possible harm (e.g., EXAMPLE A child with Separation Anxiety illness, injury, death) to them. Disorder might experience 3. Persistent and excessive worry significant distress when their about experiencing an untoward parents drop them off at event (e.g., getting lost, being school. They might cry, cling to kidnapped) that causes separation their parents, and have from a major attachment figure. stomach aches at the thought 4. Reluctance or refusal to go to of being away from home. They school or elsewhere because of fear might also exhibit excessive of separation. worry about something bad PAGE 1 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL happening to their parents SELECTIVE MUTISM while they are apart. Despite reassurances, the child DURATION At least 1 month (not limited to continues to be very anxious the first month of school) and might even refuse to go to school or engage in other ONSET Usually begins before the age activities away from their of 5, often when children start parents. The anxiety is school or engage in other persistent and significantly social settings where speaking impacts their daily functioning is expected. and academic performance. COURSE With early intervention, many children outgrow Selective B SELECTIVE MUTISM Mutism. If untreated, it can persist into later childhood or even adolescence. It is a childhood anxiety disorder characterized by a consistent failure to PREVALENCE Children speak in specific social situations where there is an expectation to communicate, EXAMPLE A child with Selective Mutism despite speaking in other situations. might speak freely at home Selective Mutism is defined by the with family members but following criteria: becomes completely silent ○ Consistently not speaking in when at school, despite being specific social situations (e.g., at able to understand and follow school or with playmates) where instructions. This inability to there is an expectation to speak, speak at school or during despite speaking in other playdates significantly impacts situations. their social interactions and ○ The inability to speak interferes academic performance, as the with educational or occupational child does not participate in achievement or with social class discussions or group communication. activities. The child's mutism is ○ The duration of this inability to not due to a lack of speak is at least 1 month (not understanding of the language limited to the first month of school). but rather to severe anxiety ○ The inability to speak is not due to a about speaking in specific lack of knowledge or comfort with social settings. the spoken language in the situation. ○ The communication issue is not C SPECIFIC PHOBIA exclusively linked to autism spectrum disorder, schizophrenia, or another psychotic disorder. It is a type of anxiety disorder characterized by an intense, irrational fear of a specific object or situation. This fear is disproportionate to the actual threat PAGE 2 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL posed and often leads to significant personal and professional life. distress or avoidance behaviors. ○ An overwhelming fear or anxiety about a specific object or situation D SOCIAL ANXIETY DISORDER (like flying, heights, spiders, or injections). It is an anxiety disorder characterized by an ○ The object or situation almost intense, persistent fear of social always triggers immediate fear or situations where there is a possibility of anxiety. being judged, embarrassed, or ○ The person either avoids the object humiliated. This fear often leads to or situation or endures it with great significant avoidance of social interactions. distress. A significant fear or anxiety about one or more social situations where the person is SPECIFIC PHOBIA exposed to possible scrutiny by others. ○ Examples: Public speaking, DURATION Must be present for at least 6 meeting new people, or eating in months. public. ONSET It can start in childhood, The person fears that they will be adolescence, or even negatively evaluated or humiliated in adulthood. these situations. This fear can lead to feelings of inadequacy or embarrassment. COURSE It can persist for years if not The social situation almost always triggers treated. The intensity might immediate fear or anxiety. This reaction vary, but the fear often remains if not addressed. can be in the form of physical symptoms like sweating, trembling, or a racing heart. PREVALENCE Children and adults The person either avoids these social situations or endures them with intense SPECIFIER Animal discomfort. Natural environment Blood-injection-injury SOCIAL ANXIETY DISORDER EXAMPLE Imagine a person who is terrified of flying. When they DURATION Must be present for at least 6 think about getting on an months. airplane, they feel extreme anxiety, experience a racing ONSET Often begins in childhood or heart, and avoid booking adolescence, typically between flights altogether. Their fear of ages 8 and 15. It can also flying is so intense that it develop in adulthood. affects their ability to travel for work or vacations, causing COURSE Without treatment, it can be significant problems in their chronic and persist over time. PAGE 3 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 4. Shortness of breath or a feeling of However, treatment can significantly reduce symptoms being smothered and improve quality of life. 5. Feeling of choking 6. Chest pain or discomfort PREVALENCE Children and adults 7. Nausea or abdominal stress 8. Dizziness, lightheadedness, or SPECIFIER Performance only: If the fear is feeling faint restricted to speaking or 9. Chills or hot flashes performing in public. 10. Numbness or tingling sensations EXAMPLE A person with Social Anxiety 11. Derealization (feelings of unreality) Disorder might have an or depersonalization (feeling intense fear of speaking in detached from oneself) meetings at work. They worry 12. Fear of losing control or “going that their performance will be crazy” judged harshly and that they will embarrass themselves. This 13. Fear of dying fear is so overwhelming that After having a panic attack, the person has they avoid participating in persistent worry about having additional meetings, which affects their attacks or the consequences of the attacks career advancement and social (e.g., losing control, having a heart attack) relationships at work. Even At least one of the attacks is followed by when they do attend meetings, at least 1 month of one or both of the they experience significant distress and physical following: symptoms, such as sweating 1. Persistent concern or worry about and trembling, due to their fear having more panic attacks or their of being evaluated negatively. consequences (e.g., losing control, having a heart attack) 2. Significant maladaptive changes in E PANIC DISORDER behavior related to the attacks (e.g., avoiding situations that might It is a mental health condition trigger an attack). characterized by recurrent and unexpected panic attacks– sudden PANIC DISORDER episodes of intense fear or discomfort that peak within minutes. These attacks DURATION Involves ongoing worry or often lead to ongoing worry about having behavioral changes lasting at more attacks or their consequences. least one month after a panic Must include at least 4 of the following attack. symptoms: ONSET Can develop at any age, but it 1. Palpitations or a pounding heart typically begins in late 2. Sweating adolescence to early adulthood 3. Trembling or shaking (ages 20-24) PAGE 4 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 2. Being in open spaces (e.g., parking COURSE It can vary in its course. Some people may have frequent lots, marketplaces, bridges) attacks for months, followed by 3. Being in enclosed spaces (e.g., periods of remission. Others shops, theaters, cinemas) might experience a more 4. Standing in line or being in a crowd. continuous course with 5. Being outside of the home alone. frequent panic attacks over a The person fears or avoids these situations longer period. because they think escape might be PREVALENCE It is more common in women difficult, or help might not be available if than in men. they develop panic-like symptoms or become incapacitated. EXAMPLE Imagine someone is at the These situations almost always provoke grocery store, and suddenly fear or anxiety and are actively avoided, they feel an overwhelming require the presence of a companion, or sense of fear and doom, as if are endured with intense fear or anxiety. something terrible is about to happen. Their heart starts The fear or anxiety is out of proportion to racing, they sweat, feel dizzy, the actual danger posed by the situations and have trouble breathing. and to the sociocultural context. Even though there is no real danger, this experience is terrifying, and afterward, they AGORAPHOBIA worry about when it might happen again. This worry DURATION The symptoms must be might lead them to avoid persistent, usually lasting for 6 grocery stores altogether, months or more. fearing another panic attack. ONSET Often begins in late adolescence to early adulthood F AGORAPHOBIA (usually before the age of 35), but it can occur at any age. It is characterized by an intense fear of COURSE It often has a chronic course if situations where escape might be left untreated. difficult, or help might not be available PREVALENCE It is more common in women in the event of developing panic-like than in men. symptoms or other incapacitating or embarrassing symptoms. This fear often EXAMPLE Imagine a person who is afraid leads to the avoidance of various places or to go to a shopping mall situations. because they worry they might Marked fear or anxiety about two (or have a panic attack and be unable to escape or get help. more) of the following five situations: They might avoid shopping 1. Using public transportation (e.g., malls altogether, only go with a buses, trains, planes) PAGE 5 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL f. Sleep disturbance (difficulty trusted friend, or feel extreme anxiety when they must go falling or staying asleep, or alone. This avoidance can restless, unsatisfying sleep) extend to other situations, such Note: only one item is required in children as using public transportation or being in crowded places, significantly limiting their daily GENERALIZED ANXIETY DISORDER activities. DURATION The symptoms must be present for at least 6 months and occur on more days than G GENERALIZED ANXIETY DISORDER not during this period. It is characterized by excessive and ONSET It can begin at any age, but it uncontrollable worry about various often starts in childhood or adolescence and can persist aspects of life, such as work, health, into adulthood. social interactions, and daily routines. This worry is often difficult to control and is COURSE Typically chronic, with accompanied by physical and symptoms that can fluctuate in psychological symptoms. intensity. Many people with The following criteria must be met: GAD experience symptoms that are persistent over time, 1. Excessive anxiety and worry though the severity may vary. (apprehensive expectation) occurring more days than not for at PREVALENCE It is more common in women least 6 months, about a number of than in men. events or activities (such as work or school performance) EXAMPLE Imagine a person who 2. The individual finds it difficult to constantly worries about their job performance, even when control the worry. there is no reason to believe 3. The anxiety and worry are there is a problem. They might associated with three (or more) of also worry excessively about the following six symptoms (with their health, finances, and the at least some symptoms present well-being of their family. This for more days than not for the person may find it hard to control their worries and feels past 6 months): tense, restless, and irritable a. Restlessness or feeling most of the time. They might keyed up or on edge experience muscle tension, b. Being easily fatigued have trouble sleeping, and find c. Difficulty concentrating or it difficult to concentrate at mind going blank work or in social situations due d. Irritability to their constant worrying. e. Muscle tension PAGE 6 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL Quetiapine: Second-line for GAD, RX TREATMENTS especially when other treatments fail. Buspirone: Used for GAD, often as GENERAL APPROACH an adjunct to antidepressants. Most patients show significant improvement with treatment. C. BENZODIAZEPINES TREATMENT OPTIONS Effective for short-term use, ○ Pharmacologic treatments especially for rapid symptom relief (medication) ○ e.g., Lorazepam, ○ Psychological treatments Alprazolam (therapy) Should be limited to short-term ○ Combined treatments (both) due to risks of dependence and cognitive side effects. HOSPITALIZATION Long-term use is discouraged unless other options fail. Rarely required unless there are complications like medical issues, D. OTHER MEDICATIONS substance use, or suicidal behavior. β-Blockers (Propranolol): Sometimes used for performance PHARMACOTHERAPY anxiety but lack strong evidence for general anxiety use. Antihistamines (Hydroxyzine): A. FIRST-LINE TREATMENTS Used as an alternative for 1. SSRIs (Selective Serotonin short-term treatment, especially in Reuptake Inhibitors) GAD. Effective for panic disorder, Antipsychotics and generalized anxiety Anticonvulsants: Not disorder (GAD), social recommended for initial therapy anxiety disorder. but may help treatment-resistant Common SSRIs: Sertraline, patients. Fluoxetine 2. SNRIs (Serotonin-Norepinephrine DISORDER-SPECIFIC TREATMENTS Reuptake Inhibitors) Example: Venlafaxine (used for panic disorder, GAD, A. PANIC DISORDER social anxiety) First-line: SSRIs, SNRIs (Venlafaxine) B. SECOND-LINE OPTIONS Second-line: Tricyclic Tricyclic Antidepressants (TCAs) antidepressants (TCAs), MAOIs ○ Effective for panic disorder, Benzodiazepines for short-term but less common due to use during acute attacks side effects. Long-term antidepressant therapy Mirtazapine: Useful due to sedative recommended to prevent relapse effects but limited studies. PAGE 7 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL B. GENERALIZED ANXIETY DISORDER (GAD) BEHAVIORAL THERAPY First-line: SSRIs, SNRIs TECHNIQUES Alternatives: Agomelatine, ○ Assumes that behavioral Pregabalin, Buspirone, Quetiapine changes can occur without insight into the C. SOCIAL ANXIETY DISORDER psychological causes. First-line: SSRIs, SNRIs ○ Techniques include: Alternatives: Pregabalin, Systematic Clonazepam (for short-term use) Desensitization: β-Blockers: For performance Gradual exposure to anxiety only. feared stimuli while using relaxation D. SPECIFIC PHOBIA techniques. First-line: Behavioral therapies (e.g., Flooding and exposure therapy). graded exposure: SSRIs may help, but limited Direct exposure to research is available. feared situations Relaxation E. AGORAPHOBIA techniques, thought Treat panic attacks, which are stopping, and panic usually comorbid with agoraphobia. control therapy Limited research on medications Used extensively for for "pure" agoraphobia. specific phobias (e.g., gradual PSYCHOSOCIAL THERAPIES exposure to heights for someone with acrophobia) 1. COGNITIVE-BEHAVIORAL THERAPY (CBT) Substantial evidence supports CBT 2. INTERPERSONAL PSYCHOTHERAPY (IPT) for generalized anxiety disorder Effective, especially for social (GAD), panic disorder, and social anxiety disorder anxiety disorder. Focuses on improving CBT is often considered a first-line interpersonal skills and addressing treatment, especially for social deficits that may contribute to anxiety disorder. social anxiety Group CBT is also effective, Helps patients increase positive particularly in treating social experiences in social interactions anxiety disorder. and reduce negative consequences COGNITIVE THERAPY FOCUS (social punishments) ○ Panic Disorder: Focuses on correcting false beliefs 3. VIRTUAL THERAPY about bodily sensations (e.g., Uses virtual environments to help teaching patients that patients practice exposure therapy panic attacks are in a controlled setting. time-limited and not ○ Effective for disorders like life-threatening) agoraphobia, specific PAGE 8 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL phobia, and social anxiety Q&A ANXIETY | REVIEW QUESTIONS! disorder ○ Example: Simulating a crowded supermarket to 1. A 9-year-old child cries and clings to her help an agoraphobic patient mother every morning before school and gradually confront their frequently complains of stomach aches, fears. ○ Particularly useful for begging to stay home. This has been phobias or situations that occurring daily for over a month. Which are hard to replicate in a disorder does this best describe? clinical environment (e.g., A. Generalized Anxiety Disorder flying) B. Separation Anxiety Disorder C. Social Anxiety Disorder 4. SUPPORTIVE PSYCHOTHERAPY D. Specific Phobia Psychodynamic concepts and the therapeutic alliance are used to promote adaptive coping. 2. A 7-year-old boy speaks comfortably at Therapists help with reality testing, home but remains silent at school and offer behavioral advice, and around peers, even though he encourage the use of adaptive understands the questions being asked. defenses. This behavior has persisted for over 6 Frequently used as an adjunct to months. Which disorder is being medication but lacks substantial empirical evidence. described? A. Specific Phobia 5. INSIGHT-ORIENTED PSYCHOTHERAPY B. Social Anxiety Disorder Focuses on developing insight into C. Selective Mutism underlying psychological conflicts D. Generalized Anxiety Disorder that may manifest as anxiety Historically, it was the classic treatment for anxiety, with the 3. A woman avoids visiting her friend who assumption that unresolved has a dog because she is intensely afraid psychodynamic conflicts caused of dogs, even small and friendly ones. anxiety This fear has been present since Some studies suggest it may childhood and significantly affects her reduce anxiety symptoms, but the social life. Which disorder does this research has methodological scenario most likely represent? limitations, and larger studies are needed to confirm its efficacy. A. Agoraphobia B. Social Anxiety Disorder 6. OTHER TECHNIQUES C. Specific Phobia In vivo exposure therapy: The D. Panic Disorder treatment of choice for specific phobia. It involves exposing the 4. A college student avoids speaking in patient to the feared object or class and declines invitations to social situation in real life until the fear diminishes. gatherings due to a persistent fear of PAGE 9 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL being judged or embarrassed. This fear is persisted for over 6 months. What so intense that it affects her academic disorder is he likely experiencing? performance and social life. What A. Social Anxiety Disorder disorder does this scenario best B. Generalized Anxiety Disorder describe? C. Panic Disorder A. Panic Disorder D. Specific Phobia B. Generalized Anxiety Disorder C. Agoraphobia 8. A 10-year-old girl becomes extremely D. Social Anxiety Disorder upset whenever her parents leave her at a friend's house or at school, fearing 5. A man experiences sudden, intense something bad will happen to them. This episodes of fear, including heart has been ongoing for several months palpitations, sweating, and a sense of and affects her daily activities. Which impending doom, without any clear anxiety disorder does this situation best trigger. These episodes occur describe? unexpectedly and cause him to worry A. Panic Disorder constantly about having another attack. B. Separation Anxiety Disorder Which disorder does this best describe? C. Selective Mutism A. Generalized Anxiety Disorder D. Agoraphobia B. Panic Disorder C. Agoraphobia 9. A child who speaks fluently at home but D. Social Anxiety Disorder refuses to talk in social settings like school or playgrounds for months is 6. A woman refuses to use public likely experiencing which disorder? transportation, avoids crowded places, A. Social Anxiety Disorder and won't leave her home without a B. Specific Phobia trusted companion because she fears C. Selective Mutism being unable to escape or get help if she D. Separation Anxiety Disorder has a panic attack. Which disorder does this scenario best fit? 10. An adult avoids attending work A. Panic Disorder meetings or speaking up in social B. Agoraphobia settings due to intense fear of C. Specific Phobia embarrassment, criticism, or being D. Generalized Anxiety Disorder scrutinized by others. This avoidance significantly interferes with their career 7. A 35-year-old man frequently feels and social relationships. Which disorder restless, fatigued, and tense. He does this situation most likely describe? constantly worries about various aspects A. Generalized Anxiety Disorder of his life, such as his job, finances, and B. Social Anxiety Disorder health, even when there is little or no C. Panic Disorder reason to worry. These symptoms have D. Agoraphobia PAGE 10 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL  SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 11. What is the general outcome of anxiety C. Venlafaxine disorder treatments for most patients? D. Buspirone A. No improvement B. Worsening of symptoms 17. Why are Tricyclic Antidepressants (TCAs) C. Significant improvement considered second-line treatment? D. Full recovery A. They are ineffective B. They cause severe withdrawal symptoms 12. Which treatment option is most likely to be C. They have more side effects compared effective for anxiety disorders? to SSRIs A. Psychological treatment D. They are more expensive B. Pharmacologic treatments C. Combined treatments 18. Which medication is often used for its D. Hospitalization sedative effects but has limited research backing for anxiety? 13. When is hospitalization typically required for A. Mirtazapine anxiety disorder patients? B. Sertraline A. For every patient diagnosed C. Buspirone B. Only when there are complications like D. Propranolol substance use or suicidal behavior C. During initial treatment phases 19. What is the primary concern with long-term D. When starting pharmacotherapy use of benzodiazepines for anxiety disorders? A. Cost 14. Which class of medication is considered B. Risk of dependence and cognitive side first-line treatment for anxiety disorders? effects A. Tricyclic Antidepressants (TCAs) C. Poor effectiveness B. SSRIs (Selective Serotonin Reuptake D. Difficulty in prescribing Inhibitors) C. Benzodiazepines 20. Which medication class is often used for D. Antipsychotics short-term, rapid relief of anxiety symptoms? A. SNRIs 15. What is an example of an SSRI used to treat B. Benzodiazepines panic disorder and GAD? C. Antihistamines A. Sertraline D. Anticonvulsants B. Mirtazapine C. Propranolol 21. Which β-blocker is sometimes used for D. Hydroxyzine performance anxiety? A. Propranolol 16. Which of the following is a commonly used B. Alprazolam SNRI for anxiety disorders? C. Quetiapine A. Fluoxetine D. Buspirone B. Lorazepam PAGE 11 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL  SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 22. Which of the following is a potential alternative for short-term treatment of GAD? A. Antipsychotics B. Hydroxyzine C. Fluoxetine D. Mirtazapine 23. Why are antipsychotics not recommended as first-line therapy for anxiety disorders? A. They are too expensive B. They are only effective for treatment-resistant cases C. They cause increased anxiety D. They are unavailable 24. Which medication is often used as an adjunct to antidepressants for GAD? A. Quetiapine B. Buspirone C. Propranolol D. Venlafaxine 25. Which of the following medications is not commonly used as a first-line treatment for generalized anxiety disorder (GAD)? A. Sertraline B. Venlafaxine C. Alprazolam D. Mirtazapine PAGE 12 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL b. High levels of anxiety about SOMATIC SYMPTOM their health or symptoms. AND RELATED DISORDERS c. Excessive time and energy devoted to these symptoms or health concerns. TOPIC OVERVIEW A. Somatic Symptom Disorder SOMATIC SYMPTOM DISORDER B. Illness Anxiety Disorder C. Functional Neurological Symptom DURATION The condition must last for at Disorder (Conversion Disorder least 6 months, even if the D. Factitious Disorder specific physical symptoms a. Imposed on Self may change over time. b. Imposed on Others ONSET SSD can begin at any age, but it often starts in adolescence A SOMATIC SYMPTOM DISORDER or early adulthood. People with a history of anxiety, depression, or chronic pain are It is a mental health condition where a more likely to develop SSD. person experiences one or more physical symptoms (such as pain, fatigue, or other COURSE The course of SSD is typically bodily complaints) that are distressing or chronic but fluctuating. The significantly disrupt daily life. severity of symptoms may These symptoms cannot be fully explained increase or decrease over time, by a medical condition, and the person’s and the person may excessive thoughts, feelings, or behaviors experience different types of about these symptoms cause significant physical complaints. distress or dysfunction. The following criteria must be met: PREVALENCE Somatic Symptom Disorder is 1. The person has one (1) or more estimated to affect about 5-7% somatic (physical) symptoms that of the general population. It is are distressing or cause significant more common in women than disruption in daily life. men. These symptoms can include pain, SPECIFIERS 1. With Predominant gastrointestinal problems, Pain: This specifier is fatigue, or other used if the somatic unexplained physical issues. symptoms primarily 2. The person has excessive and involve pain. disproportionate thoughts, 2. Persistent: The disorder feelings, or behaviors related to is considered persistent their physical symptoms. This can if the symptoms last for include: more than 6 months a. Persistent thoughts about with high levels of the seriousness of their distress or impairment. symptoms. 3. Severity Specifiers PAGE 13 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL a. Mild: Only one of B ILLNESS ANXIETY DISORDER the Criteria B (Excessive It is a mental health condition where a Thoughts, person is excessively worried about Feelings, or having or developing a serious illness. Behaviors) is Despite little to no physical symptoms or present. medical reassurance, the person remains b. Moderate: Two preoccupied with their health, often or more of the misinterprets normal bodily sensations as Criteria B is signs of a severe medical condition. present. The following criteria must be met: c. Severe: Two or 1. The person is overly worried or more of the preoccupied with the idea that Criteria B are they have, or will develop, a present, and serious medical condition. This there are fear persists even after medical multiple somatic evaluation and reassurance. complaints (or 2. Minimal or no somatic symptoms. one very severe Physical symptoms, if present, are somatic mild, and the preoccupation with symptom) health is not proportional to any actual health problem EXAMPLE A 40-year-old woman 3. The individual has excessive frequently visits her doctor health-related anxiety, frequently with complaints of fatigue, checks their body for signs of back pain, and stomach issues. illness, or avoids medical care due Despite undergoing multiple to fear of finding something wrong. medical tests that do not 4. The preoccupation with illness reveal any significant health must last for at least 6 months. problems, she remains The specific illness the person fears convinced that something is may change during this time, but seriously wrong with her. She the anxiety about health persists. constantly worries about her 5. The symptoms are not better symptoms, spends hours accounted for by another mental researching her condition health disorder, such as somatic online, and frequently misses symptom disorder or generalized work due to her health anxiety disorder. concerns. Her doctors have reassured her that she does not have a serious illness, but she remains anxious and distressed, believing that her symptoms are signs of a major health problem. PAGE 14 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL ILLNESS ANXIETY DISORDER convinced that he has a serious heart condition after feeling DURATION The preoccupation with health occasional chest pain, despite must last for at least 6 multiple tests confirming that months, even if the specific his heart is healthy. He feared illness may change over frequently checks his pulse, time. avoids physical activities out of fear of triggering a heart ONSET The onset of IAD can occur at attack, and visits different any age but is more common doctors seeking confirmation in early adulthood. It often of a diagnosis. Even after begins after the individual or repeated reassurances, he someone close to them has remains anxious about his had a significant health event health and believes that his or after exposure to a serious symptoms have been illness. overlooked. COURSE The course is typically chronic and fluctuating. Periods of C FUNCTIONAL NEUROLOGICAL intense anxiety about health SYMPTOM DISORDER (CONVERSION may be followed by periods of DISORDER) less concern, but the preoccupation tends to return. It is also known as Conversion Disorder. PREVALENCE Illness Anxiety Disorder affects It is a mental health condition in which a approximately 1-10% of the person experiences neurological population, and it is equally symptoms (such as paralysis, blindness, common in men and women. seizures, or difficulty walking) that cannot be explained by medical SPECIFIERS 1. Care-Seeking Type: conditions. The individual These symptoms cause significant distress frequently seeks or impairment, and there is no clear medical attention, physical or medical reason behind them. going to doctors, The following criteria must be met: undergoing tests, and 1. The individual has symptoms that searching for affect movement (such as confirmation of their paralysis, tremors, or gait illness fears. abnormalities) or sensory function 2. Care-Avoidant Type: (such as blindness, numbness, or The individual avoids loss of hearing) medical care, fearing 2. Medical evaluations do not reveal a that they will be neurological or medical cause for diagnosed with a the symptoms. The symptoms are serious illness. inconsistent with medical tests or findings. EXAMPLE A 30-year-old man becomes 3. The symptoms cause significant distress in social, occupational, or PAGE 15 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL other important areas of symptoms involve functioning. difficulty moving, 4. The symptoms are not better weakness, or paralysis of accounted for by another medical part of the body. condition, mental disorder, or 2. With Abnormal substance use. Movement: The symptoms involve CONVERSION DISORDER abnormal movements such as tremors, DURATION There is no specific duration dystonia, or gait requirement in the DSM-5 for abnormalities. this disorder. The symptoms 3. With Swallowing may come on suddenly and Symptoms: The person can last for variable periods of has difficulty time, from short-term episodes swallowing or a to chronic conditions. lump-in-the-throat sensation (globus). ONSET Onset can occur at any age but 4. With Speech often begins in adolescence or Symptoms: The person early adulthood, especially experiences problems during times of stress. Women with speech, such as are more likely to be diagnosed slurred speech or with conversion disorder than aphonia (loss of voice) men. 5. With Seizures or Attacks: The person has COURSE The course is often acute (with seizures, convulsions, or sudden onset) but can also similar episodes become chronic if not treated. without a neurological Symptoms may fluctuate in cause (also known as severity and often worsen with nonepileptic seizures) stress or emotional trauma. In 6. With Anesthesia or some cases, symptoms resolve Sensory Loss: The quickly, while in others, they person experiences may persist or recur. sensory deficits, such as numbness or blindness. PREVALENCE Functional Neurological 7. With Special Sensory Symptom Disorder is rare, Symptoms: The person affecting approximately 2-5 experiences symptoms people per 100,000 annually. It involving vision, is more common in women hearing, or olfaction. and often linked to 8. With Mixed psychological stress. Symptoms: The person has multiple types of SPECIFIERS Specify if: conversion symptoms 1. With Weakness or (e.g., motor and Paralysis: The sensory) PAGE 16 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL Specify if: D FACTITIOUS DISORDER 1. Acute Episode: Symptoms present for less than 6 months. D1 IMPOSED ON SELF 2. Persistent Episode: Symptoms present for 6 months or more. Formerly known as Munchausen Specify if: Syndrome. 1. With Psychological It is a mental health condition in which a Stressor: The disorder is person deliberately falsifies, related to an exaggerates, or induces physical or identifiable psychological symptoms in themselves. psychological stressor. The primary motivation is to assume the The specific stressor role of a sick person and gain attention, should be specified care, or sympathy, without any external (e.g., recent loss of a incentives like financial gain or avoiding loved one, work-related responsibilities. stress, etc.) The following criteria must be met: 2. Without Psychological 1. The person intentionally fabricates Stressor: The or exaggerates physical or symptoms are not psychological signs of illness, or associated with a clear they induce injury or disease in psychological stressor. themselves (e.g., contaminating wounds, injecting substances) EXAMPLE A 25-year-old woman suddenly 2. The individual presents loses the ability to move her themselves to others as being legs after experiencing sick, injured, or impaired, often extreme emotional stress seeking medical care, related to her job. Medical tests hospitalization, or treatment. show no neurological damage 3. The behavior is not motivated by or physical cause for the external rewards such as financial paralysis. Her symptoms compensation, avoiding work, or worsen when she is anxious, legal obligations. The individual’s but she does not consciously goal is to assume the sick role. fake or exaggerate the 4. The behavior cannot be better problem. After working with a explained by another condition, therapist, her symptoms such as delusional disorder or gradually improve as she learns another psychotic disorder. to manage her stress and emotional triggers. FACTITIOUS DISORDER IMPOSED ON SELF DURATION There is no specific duration for diagnosis. The behavior can be episodic, occurring when the person is in a health care setting or when they believe PAGE 17 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL their condition is being repeatedly visits emergency questioned. rooms, claiming to have severe abdominal pain and vomiting. ONSET Onset typically occurs in early Despite undergoing multiple adulthood but can begin at tests that show no any age. It is often linked to abnormalities, she insists on past experiences with illness or additional procedures. She has hospitalization, either in the been hospitalized several person or a family member. times, often exaggerating or lying about her symptoms. COURSE The course is usually chronic Medical staff begin to notice and fluctuating. Individuals that she deliberately with factitious disorder may contaminates her IV site, repeatedly seek medical causing infections. She denies attention and undergo any external motives such as numerous tests or procedures financial gain or avoiding despite being physically responsibilities and appears healthy. Symptoms may primarily motivated by the worsen or become more attention and care she complex over time as the receives. individual becomes more skilled at faking or inducing illness. D2 IMPOSED ON ANOTHER PREVALENCE Factitious Disorder is relatively rare, though exact prevalence It is previously known as Munchausen is difficult to determine due to Syndrome by Proxy the deceptive nature of the It is a mental health condition in which a condition. It is thought to occur person deliberately induces, more frequently in women and exaggerates, or fabricates symptoms of individuals with healthcare illness in someone else, typically a child knowledge. or dependent, with the intention of assuming the role of a caregiver and SPECIFIERS 1. Single Episode: The receiving attention or sympathy. behavior occurs only The following criteria must be met: once, in a single 1. The person deliberately fabricates episode where the or exaggerates physical or person falsifies illness or psychological symptoms in injury. another individual under their 2. Recurrent Episodes: care (e.g., a child, elderly person, The person engages in or dependent) repeated episodes of 2. The caregiver presents the person falsifying illness or as being sick, injured, or impaired, injury. often seeking medical care or attention for the fabricated EXAMPLE A 35-year-old woman symptoms. PAGE 18 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL 3. The falsification or induction of Most victims are young symptoms is done without children, though it can affect external rewards such as financial other dependents like the gain, avoiding legal elderly. consequences, or other tangible benefits. The motivation is to gain SPECIFIERS 1. Single Episode: The empathy or attention as the behavior occurs only dedicated caregiver. once, involving a single 4. The behavior is not better episode of falsifying accounted for by another condition, illness in the such as a delusional or psychotic dependent. disorder. 2. Recurrent Episodes: The individual engages FACTITIOUS DISORDER IMPOSED ON OTHERS in repeated episodes of falsifying or inducing DURATION There is no specific duration for illness in the diagnosis. The deceptive dependent. behavior can occur repeatedly over time, often continuing as EXAMPLE A mother takes her 5-year-old long as the individual is in a daughter to multiple doctors, caregiving role or until they are reporting symptoms such as caught. severe vomiting, seizures, and unusual behavior. Despite ONSET Onset is usually in adulthood, numerous medical tests that particularly among caregivers, show no underlying health and it often involves individuals condition, she continues to who have previous experience push for further medical or knowledge of the medical evaluations and treatments. field. The mother is highly involved and praised by medical staff for COURSE The course is typically chronic her dedication to her child’s and can continue as long as care. It is later discovered that the caregiver has access to the the mother has been inducing dependent. The disorder can the child’s symptoms by giving result in serious harm to the her medication she doesn't victim, as the individual may need and falsifying medical undergo unnecessary medical records. procedures or treatments based on fabricated symptoms. PREVALENCE The exact prevalence is unknown, but it is considered rare. However, it is more commonly found in women, particularly mothers who present their children as ill. PAGE 19 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL ○ Medications are generally RX TREATMENTS avoided unless treating comorbid anxiety, 1. SOMATIC SYMPTOM DISORDER (SSD) depression, or psychosis Treatment Goals ○ There is no substantial ○ Initial goals should be evidence supporting a modest, focusing on purely pharmacological reducing medical visits and approach for somatic unnecessary procedures. symptom disorder. ○ Encourage patients to commit to a single primary 2. ILLNESS ANXIETY DISORDER (IAD) care physician to avoid Cognitive-Behavioral Therapy is overuse of specialists and the first-line treatment, focusing tests. on addressing health anxiety and ○ Physicians must be reducing catastrophic prepared for long-term interpretations of bodily sensations. management and ○ Mindfulness training, incorporate CBT elements exposure therapy, and such as diary-keeping into acceptance and treatment. commitment therapy have Psychological Interventions also shown efficacy. ○ Cognitive-Behavioral Pharmacological Interventions Therapy is highly effective in ○ SSRIs have shown some managing somatic benefit in treating illness symptoms by helping anxiety disorder, though patients recognize data is limited. catastrophic thinking and ○ Studies suggest fluoxetine modify behaviors. may be effective when ○ Techniques such as combined with CBT. relaxation training and graded increases in activity 3. CONVERSION DISORDER (FUNCTIONAL are used to combat the NEUROLOGICAL SYMPTOM DISORDER) cycle of inactivity and health Acute Conversion Symptoms concerns. ○ Many conversion symptoms Additional Interventions resolve spontaneously with ○ Recommendations for understanding and exercise, yoga, relaxation, support meditation, and massage ○ Early intervention can may be well-received. prevent chronicity and the ○ The use of a consultation development of entrenched letter to guide primary care somatization physicians in managing Chronic Conversion Symptoms these patients has shown ○ Treatment may include improvements in patient hospitalization, behavioral outcomes. techniques, hypnosis, and Medication Use physical therapy for muscle symptoms or balance issues. PAGE 20 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL SUMMARY OF DSM-5 DISORDERS DSM-V BLOCK 6 | 1ST SEMESTER | PASCUAL, H. REVIEWER FOR CLINICAL ○ Reassurance is critical, as implying that the patient is malingering can worsen the condition. 4. FACTITIOUS DISORDER Management, not cure ○ Treatment focuses on reducing the risk of comorbidity and addressing underlying emotional needs rather than curing the disorder. ○ Physicians need to recognize the disorder early to avoid unnecessary diagnostic procedures and treatments. Key Interventions ○ Establish a working alliance with the patient while managing the balance between skepticism and trust. ○ The physician should avoid any “unmasking” ceremony that may lead to the patient abruptly leaving treatment. Factitious Disorder Imposed on Another ○ Legal interventions are sometimes necessary, especially in cases involving children. Monitoring and collaboration with child welfare agencies are crucial. PAGE 21 DSM-V TR SUMMARY/REVIEWER FOR CLINICAL | PREPARED BY HYDEE PASCUAL