Eppp Topics--Dsm

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Amnestic Disorder

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An impairment in the ability to learn new information or to recall previously learned
information or past events. It is caused by a general medical condition or substance use.

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Anorexia vs. Bulimia

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1. ANOREXIA NERVOSA: An Eating Disorder involving: a refusal to maintain a minimally normal body weight; an intense fear of gaining weight; a disturbed perception of one's
body shape and size; and, in females, amenorrhea. A person who also binge eats and purges during the current episode receives the diagnosis Anorexia Binge Eating/Purging Type (DSM-IV). Over 90% of anorectics are female and onset is typically in adolescence.

2. BULIMIA NERVOSA: An Eating Disorder involving: recurrent episodes of binge eating, which are accompanied by a sense of lack of control; inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, excessive exercise or
axative or diuretic use; and a self-evaluation that is unduly influenced by body shape and weight. In contrast to Anorexia, the weight loss, if any, is not life-threatening.

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Anterograde vs. Retrograde Amnesia

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1. ANTEROGRADE AMNESIA: The loss of memory for events and experiences that occur subsequent to an amnesia-causing trauma.

2. RETROGRADE AMNESIA: The loss of memory for events and experiences that
occurred in a period of time prior to an amnesia-causing trauma.

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Differential Dx of Anti-social personality disorder

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1. ANTISOCIAL PERSONALITY DISORDER: A pattern of disregard for and violation of the rights of others. There must be symptoms of Conduct Disorder before age 15 and the presence of characteristic symptoms since age 15. The person must be at least age 18.
His/her traits must be inflexible, persistent and maladaptive and impair functioning or cause subjective distress.

2. ADULT ANTISOCIAL BEHAVIOR: Criminal, aggressive or other antisocial conduct that does not meet the criteria for Antisocial Personality Disorder.

3. CONDUCT DISORDER: A persistent pattern of behaviors that violate the rights of others and/or age-appropriate social rules; i.e., aggression to people and animals;
destruction of property; deceitfulness or theft; serious violation of rules. Onset can be in Childhood (prior to age 10) or Adolescence. Childhood onset is more likely to be associated with Antisocial Personality Disorder in adulthood. Conduct Disorder may be
diagnosed in children, adolescents and adults (as long as the adult does not meet the criteria for Antisocial Personality Disorder).

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Austism and other pervasive developmental disorders

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1. AUTISTIC DISORDER: Qualitative impairment in social interaction and communication and restricted repetitive and stereotyped behaviors, interests and activities. Autism is
about 4-5 times more common in males. The developmental abnormalities are usually apparent in the first year after birth.

2. RETT'S DISORDER (a new disorder in DSM-IV): Compared to Autism, this disorder associated with a more specific pattern of deficits, which begins at age five months; i.e.,
decelerated head growth, loss of hand skills and social engagement, poor coordination, impaired language development and psychomotor retardation. This disorder has been
reported in females only.

3. CHILDHOOD DISINTEGRATIVE DISORDER (a new disorder in DSM-IV): After age two and before age ten, there is a loss of previously acquired skills in two or more areas; i.e., language, social skills, adaptive behavior, bowel/bladder control, play and motor skills. In Autism, the developmental abnormalities are evident earlier, in the first year after birth.

4. ASPERGER'S DISORDER (a new disorder in DSM-IV): Qualitative impairment in social interaction and restricted repetitive and stereotyped behaviors, interests and activities. In contrast to Autism, there is no delay in language development.

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Avoidant vs. Schizoid Personality Disorder

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1. AVOIDANT PERSONALITY DISORDER: A pervasive pattern of social inhibition,
feelings of inadequacy and hypersensitivity to negative evaluation. The person wants
relationships and feels his/her loneliness deeply.

2. SCHIZOID PERSONALITY DISORDER: A pervasive pattern of indifference to
interpersonal relationships and a restricted range of emotional expression in social settings. In contrast to the Avoidant Personality, the Schizoid Personality is content with or even prefers his/her isolation.

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Biological Causes of MR

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1. DOWN'S SYNDROME (MONGOLISM, TRISOMY 21): Caused by the presence of an
extra chromosome, and is estimated to be the cause of about 10 to 30% of all cases of moderate to severe Mental Retardation. Down's syndrome is associated with not only intellectual impairment, but also certain physical characteristics and disorders.

2. PHENYLKETONURIA (PKU): A rare recessive gene syndrome that involves an inability to metabolize the amino acid phenylalanine, which is found in high-protein foods. PKU can be detected at birth by a blood test and its symptoms prevented by a diet low in
phenylalanine. If untreated, PKU usually produces irreversible moderate to profound Mental Retardation, impaired motor and language development and unpredictable, erratic
behaviors.

3. KILINEFELTER'S SYNDROME: A disorder in males caused by the presence of an extra X chromosome, resulting in Mental Retardation, secondary female sex characteristics and small testes.

4. FRAGILE X CHROMOSOME: Genetic deficit primarily affects males and is associated with Mental Retardation and certain physical features and behaviors.

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Bipolar Disorders

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1. BIPOLAR I DISORDER: The presence of at least one or more Manic or Mixed Episodes with or without a history of a Major Depressive Episode. Lithium is usually the treatment-of-choice. This disorder is about equally common in males and females. Of the mental disorders, it most clearly has a genetic component.

2. BIPOLAR II DISORDER (a new disorder in DSM-IV): The presence of at least one Major Depressive Episode and one Hypomanic Episode. In contrast to Bipolar I Disorder, there are no Manic or Mixed Episodes. Bipolar II Disorder is more common in females than males.

3. CYCLOTHYMIC DISORDER: Fluctuating hypomanic symptoms and numerous periods of depressive symptoms for at least two years in adults or one year in children or adolescents. In contrast to Bipolar I Disorder, the hypomanic symptoms do not meet the
criteria for a Manic Episode and the periods of depression do not meet the symptom or duration criteria for a Major Depressive Episode. In contrast to Bipolar II Disorder, the periods of depression do not meet the symptom or duration criteria for a Major depressive Episode.

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Borderline vs. Narcissistic Personality Disorder

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1. BORDERLINE PERSONALITY DISORDER: A pervasive pattern of instability in
interpersonal relationships, self-image and affect and marked impulsivity.

2. NARCISSISTIC PERSONALITY DISORDER: A pervasive pattern of grandiosity, need for admiration and lack of empathy for others. Like the Borderline Personality, the
Narcissistic Personality may have angry reactions to minor stimuli. However, compared to the Borderline Personality, he/she is less self-destructive, less impulsive, less concerned about abandonment and has a more stable self-image.

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Cognitive Theory of Depression & Learned Helplessness

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1. COGNITIVE THEORY OF DEPRESSION: Beck's (1976) cognitive theory views
depression as the result of negative, illogical self-statements about oneself, the current situation and the future (the "depressive cognitive triad"). Such statements reflect certain cognitive distortions, or "depressogenic schemata," such as overgeneralization, selective abstraction, personalization, magnification and arbitrary inference.

2. LEARNED HELPLESSNESS: Seligman's theory of depression, which regards depression as the result of a belief that one cannot control the events in one's life.

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Differential Dx of Conduct Disorder

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1. CONDUCT DISORDER: A persistent pattern of behaviors that violate the rights of others and/or age-appropriate social rules; i.e., aggression to people and animals;
destruction of property; deceitfulness or theft; serious violation of rules.

2. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: Persistent, developmentally
inappropriate inattention and/or hyperactivity-impulsivity. In children, this disorder is 4-9
times more common in boys. Treatment usually involves a CNS stimulant and behavioral and cognitive-behavioral techniques. In contrast to Conduct Disorder, the hyperactive and impulsive behavior does not violate age-appropriate social norms. However, a co-diagnosis of Conduct Disorder is very common.

3. CHILD OR ADOLESCENT ANTISOCIAL BEHAVIOR: Isolated conduct problems (i.e., not a persistent pattern) that do not meet the criteria for Conduct Disorder (or an Adjustment Disorder).

4. OPPOSITIONAL DEFIANT DISORDER: A recurrent pattern of negativistic, defiant and hostile behaviors toward authority. The disruptive behaviors are of a less severe nature than those of individuals with Conduct Disorder (e.g., no theft, no aggression).

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Conversion Disorder and Primary/Secondar Gain

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Conversion Disorder is a Somatoform Disorder characterized by symptoms that suggest a serious neurological or other medical condition (e.g., paralysis, blindness, loss of pain
sensation), but for which no medical explanation can be found. Traditionally, Conversion Disorder has been traced to two etiological mechanisms: PRIMARY GAIN (keeping an
inner conflict out of consciousness) and SECONDARY GAIN (avoiding an unpleasant activity or obtaining support). Symptoms are not voluntarily produced and are usually alleviated under hypnosis or an amytal interview.

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Delirium vs. Dimentia

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1. DELIRIUM: A disturbance in consciousness accompanied by either a change in cognition (e.g., loss of memory, disorientation) and/or perceptual abnormalities. Delirium
can be caused by a general medical condition or substance use. Its symptoms usually develop rapidly and fluctuate over time.

2. DEMENTIA: A disturbance involving some degree of memory impairment and at least one other cognitive impairment (aphasia, apraxia, agnosia, disturbance in executive functioning). Dementia can be caused by a general medical condition or substance use.
Its onset is usually insidious and the course is progressive.

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Dimentia: Alzheimer vs. Vascular

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1. DEMENTIA OF THE ALZHEIMER'S TYPE: A form of dementia involving a gradual onset of symptoms and a slow, progressive decline in cognitive functioning. Early symptoms
ordinarily include deficits in recent memory and a personality change or irritability. Late onset (after 65) is more common than early onset.

2. VASCULAR DEMENTIA (formerly known as Multi-Infarct Dementia): A form of dementia caused by arteriosclerosis or other cerebrovascular disease. The course is stepwise and patchy.

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Depression vs. Dementia

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1. MAJOR DEPRESSIVE DISORDER: One or more Major Depressive Episodes without a history of Manic, Hypomanic or Mixed Episodes. Major depressive disorder is about twice as common in females as males. Treatment most commonly involves the use of an anti-depressant and/or cognitive therapy.

2. DEMENTIA: See also "Delirium vs. Dementia." The cognitive deficits in a dementia usually have a progressive course and the person denies or is unaware of the impairments. A person with Major Depressive Disorder may experience impairments in memory and cognition, but the decline is likely to be abrupt and the person is concerned (sometimes overly so) about his/her impairments.

3. DYSTHYMIC DISORDER: Chronically depressed mood, which is present most of the time for at least two years in adults or one year in children or adolescents. In contrast to Major Depressive Disorder, which includes discrete Major Depressive Episodes, the
depressed mood is more chronic (as opposed to episodic) and less severe.

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Diagnostic Uncertainty

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Diagnostic uncertainty about a person's condition can be indicated by coding one of the following on Axis I or II.
1. DIAGNOSIS (OR CONDITION) DEFERRED: Coded when there is insufficient
information to make a definite diagnosis.

2. SPECIFIC DIAGNOSIS (PROVISIONAL): Used when there is sufficient information for a tentative, but not firm, diagnosis.

3. [CLASS OF DISORDER] NOT OTHERWISE SPECIFIED (NOS): Coded when there is
adequate information to know that a disorder belongs to a particular category but insufficient information to make a specific diagnosis or when features of the disorder do not meet the criteria for a more specific diagnosis.

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Diathesis-Stress vs. Social Stress Theory

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1. DIATHESIS-STRESS THEORY: Proposes that abnormal behavior patterns are the result of an inherited vulnerability combined with a highly stressful environment and a lack of
learned skills for coping with the stress. Diathesis-stress theory is a theory for the development of schizophrenia.

2. SOCIAL STRESS THEORY: Hypothesizes that stress associated with poverty and urban living is the cause or partial cause of Schizophrenia.

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Disorders due to a General Medical Condition

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In DSM-IV, this the name for disorders that are assumed to be the direct physiological result of a general medical condition. All disorders in this category share three characteristics: (1) evidence from the history, physical exam or laboratory findings that the condition is caused by a general medical condition; (2) the disturbance is not better
explained by another mental disorder; and (3) symptoms do not occur only during the course of delirium (with the exception of delirium). These disorders include Catatonic Disorder, Personality Change Disorder, Delirium, Dementia, Amnestic Disorder, Psychotic
Disorder, Mood Disorder, Anxiety Disorder, Sexual Dysfunction and Sleep Disorder.

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Dissociative Disorders

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1. DEPERSONALIZATION DISORDER: One or more episodes of depersonalization (feeling of detachment or estrangement from oneself), with reality testing left relatively intact.

2. DISSOCIATIVE AMNESIA (formerly known as Psychogenic Amnesia): One or more episodes of an inability to recall important personal information that cannot be attributed to ordinary forgetfulness. The gaps in memory are often related to a traumatic event.

3. DISSOCIATIVE FUGUE (formerly known as Psychogenic Fugue): Abrupt, unexpected travel away from home or work with an inability to remember some or all of one's past and confusion about one's personal identity or a partial or total assumption of a new identity.

4. DISSOCIATIVE IDENTITY DISORDER (formerly known as Multiple Personality
Disorder): The existence of two or more distinct identities or personality states where each has its own pattern of perceiving, relating to and thinking about the environment and self.

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Dyssomnias

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1. DYSSOMNIAS: Sleep disorders characterized by disturbances in the amount, quality and timing of sleep. They include Primary Insomnia, Primary Hypersomnia, Narcolepsy (a new disorder in DSM-IV), Breathing-Related Sleep Disorder (a new disorder in DSM-IV) and Circadian Rhythm Sleep Disorder (formerly known as Sleep-Wake Schedule Disorder). For example, NARCOLEPSY involves irresistible attacks of restorative sleep accompanied by either cataplexy or an intrusion of REM sleep during the transition between sleep and wakefulness.

2. PARASOMNIAS: Sleep disorders involving behavioral or physiological abnormalities during sleep or in the sleep-wakefulness transition. They include Nightmare Disorder (formerly Dream Anxiety Disorder), Sleep Terror Disorder and Sleepwalking Disorder.

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Histrionic vs. Borderline vs. Narcissistic Personality Disorder

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1. HISTRIONIC PERSONALITY DISORDER: A pervasive pattern of emotionality and
attention-seeking.

2. BORDERLINE PERSONALITY DISORDER: A pervasive pattern of instability in
interpersonal relationships, self-image and affect and marked impulsivity. Like the Histrionic Personality, the Borderline Personality may seek attention, manipulate others and have rapidly shifting emotions. However, unlike the Histrionic Personality, he/she is
self-destructive and has chronic feelings of emptiness and loneliness and angry outbursts that disrupt his/her relationships.

3. NARCISSISTIC PERSONALITY DISORDER: A pervasive pattern of grandiosity, need for admiration and lack of empathy for others. Like the histrionic Personality, the
Narcissistic Personality is excessively self-centered. However, unlike the Histrionic Personality, he/she is preoccupied with a grandiose sense of self and wants praise for
his/her superiority. The Histrionic Personality is willing to appear fragile or dependent if this behavior elicits attention.

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Differential Dx of MR

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1. MENTAL RETARDATION: Significantly subaverage intellectual functioning (IQ = 70 or below); impairments in adaptive functioning; and onset before age 18. There are four subtypes: Mild, Moderate, Severe and Profound. Unless the individual is profoundly
retarded, he/she can communicate and interact with others.

2. AUTISTIC DISORDER: Qualitative impairment in social interaction and communication and restricted, repetitive and stereotyped behaviors. A person with Autism is oblivious to
others and doesn't speak or has severe speech abnormalities. 75-80% also have Mental Retardation.

3. BORDERLINE INTELLECTUAL FUNCTIONING: The person's IQ is in the 71-84 range.

4. LEARNING DISORDER (formerly known as Academic Skills Disorder): Achievement on a standard test in reading, math or language is substantially below the score on IQ test. In DSM-IV, a concurrent sensory deficit does not fully explain the problem. In a Learning Disorder, one specific area is affected; in Mental Retardation, there is generalized
impairment in intellectual development and adaptive functioning.

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Levels of Severity of MR

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1. MILD MENTAL RETARDATION: IQ 50-55 to 70. Constitutes the largest group of
individuals with this disorder. Individuals with mild mental retardation have minimal impairment in sensorimotor functioning, develop social and communication skills during the preschool years and may initially be indistinguishable from other children. With appropriate training, they can achieve academic skills up to the 6th grade level and, as adolescents
and adults, can acquire the social and vocational abilities needed to support themselves with minimal supervision or guidance.
2. MODERATE MENTAL RETARDATION: IQ 35-40 to 50-55. These individuals may
develop communication skills during childhood, can acquire academic skills up to the 2nd grade and can benefit from training in social and occupational skills. As adults, they maybe able to perform unskilled or semi-skilled tasks in supervised settings.
3. SEVERE MENTAL RETARDATION: IQ 20-25 to 35-40. These individuals may learn to talk during the school years, can acquire elementary self-care skills and may learn to count and read simple "survival" words and perform simple tasks under close supervision.
4. PROFOUND RETARDATION: IQ below 20-25. Optimal development is achieved by
providing a highly structured environment. Some can perform simple tasks under close supervision and may show improvements in self-care and communication with appropriate
training.

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Mood Episodes

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1. MAJOR DEPRESSIVE: Depressed mood and/or a loss of interest or enjoyment in usual activities that represents a change from previous functioning and persists for at least two weeks. An episode must include at least five characteristics symptoms.

2. MANIC: One week or more when the prevailing mood is abnormally and persistently elevated, expansive or irritable and when at least three characteristics symptoms are
present. There is significant impairment in functioning, the need to be hospitalized and/or psychotic features are present.

3. HYPOMANIC: A distinct period of abnormally and persistently elevated, expansive or irritable mood for at least four days and accompanied by at least three symptoms associated with a Manic Episode. The episode represents a clear change in mood and functioning, but, in contrast to a Manic Episode, it is not sufficiently severe to cause marked impairment in functioning or require hospitalization and there are no psychotic symptoms.

4. MIXED (a new criteria set in DSM-IV): Lasts for at least one week and involves rapidly alternating symptoms of Manic and Major Depressive Episodes. The disturbance is severe
enough to cause marked impairment in functioning or require hospitalization or it includes psychotic symptoms.

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Multi-axial assessment

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1. AXIS I: Used to record clinical disorders and Other Conditions That May Be a Focus of Clinical Attention (formerly known as V-Codes).
2. AXIS II: Used to code Mental Retardation, the Personality Disorders and Borderline Intellectual Functioning. Axis II may also be used to record prominent maladaptive
personality traits and habitual defense mechanisms. (In DSM-III-R, Axis II was also used to record Pervasive and Specific Developmental Disorders.)
3. AXIS III: Used to record general medical conditions that may be relevant to the understanding or management of the client's mental disorder.
4. AXIS IV: Used to code psychosocial and environmental problems that may affect the diagnosis, treatment and prognosis of the client's mental disorder. In DSM-IV, a severity
rating is not given; the problems are simply listed.
5. AXIS V: Used to note the clinician's judgment of the client's overall level of functioning. This can be done using a Global Assessment of Functioning Scale.

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OCD vs. OPD

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1. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER: A persistent preoccupation
with orderliness, perfectionism and mental and interpersonal control that has the effect of severely limiting the person's flexibility, openness and efficiency. In contrast to
Obsessive-Compulsive Disorder, there are no true obsessions or compulsions.
2. OBSESSIVE-COMPULSIVE DISORDER (OCD): An Anxiety Disorder involving recurrent obsessions and/or compulsions that are sufficiently severe to cause marked distress, to
be time-consuming or to markedly interfere with normal functioning.
OBSESSIONS are persistent thoughts, impulses or images, which are experienced as senseless and intrusive or cause marked distress. COMPULSIONS are repetitious, deliberate behaviors or mental acts, which the person feels driven to perform in response to an obsession or according to rigid rules and that reduce distress. In vivo exposure with response prevention (flooding), thought stopping and habituation are the usual treatments.

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Paranoid personality disorder vs. other paranoid disorders

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1. PARANOID PERSONALITY DISORDER: A pervasive pattern of distrust and
suspiciousness and interpreting the motives of others as malevolent.

2. DELUSIONAL DISORDER, PERSECUTORY TYPE AND SCHIZOPHRENIA, PARANOID
TYPE: These disorders include a period of persistent psychotic symptoms (e.g., delusions, hallucinations), while Paranoid Personality Disorder does not.

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Paraphilias

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A Sexual Disorder in which intense, recurrent sexual urges, fantasies or behaviors involve either (1) nonhuman objects; (2) the suffering or humiliation of oneself or one's partner; or (3) children or other nonconsenting partners. Examples include Transvestic Fetishism,
Pedophilia and Voyeurism.

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Phobias

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1. PANIC DISORDER (WITH OR WITHOUT AGORAPHOBIA): Two or more unexpected
panic attacks (discrete periods of intense apprehension, fear or terror, which develop abruptly and usually peak within 10 minutes). The symptoms may mimic a heart attack.

2. AGORAPHOBIA: Anxiety about being in situations or places from which escape might be difficult or embarrassing or in which help might not be available if a panic attack or other symptoms occur. Agoraphobia can occur with or without panic attacks, and the attacks are not limited to social situations. The treatment-of-choice is flooding.

3. SOCIAL PHOBIA: Marked, persistent fear of social or performance situations that may cause embarrassment or humiliation as the result of scrutiny or evaluation by others. Social Phobia may include situationally-bound panic attacks, but not unexpected panic attacks.

4. SPECIFIC PHOBIA (formerly known as Simple Phobia): Marked, persistent fear of a specific object or situation other than those associated with Agoraphobia or Social Phobia. Treatment involves imaginal or in vivo exposure. Specific Phobia may include
situationally-bound panic attacks, but not unexpected panic attacks.

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Differential Dx of PTSD

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1. PTSD: Development of characteristic symptoms after exposure to a traumatic event that entails actual or threatened death or serious injury to self or others. (In DSM-IV, the
phrase "outside the range of normal human experience" has been deleted.) The immediate reaction includes intense fear, helplessness or horror; this is followed by persistent reexperiencing of the trauma, avoidance of stimuli associated with the trauma and symptoms of increased arousal. The symptoms must be present for at least one month. Treatment involves crisis intervention in which the individual is encouraged to talk about the event and his feelings, followed by cognitive-behavioral techniques that facilitate habituation or extinction of symptoms.

2. ACUTE STRESS DISORDER (a new disorder in DSM-IV): Involves the same symptoms and precipitants as PTSD, but the duration is no more than four weeks. Also, Acute Stress Disorder includes dissociative symptoms, which may or may not occur in PTSD.

3. ADJUSTMENT DISORDER: A maladaptive reaction to one or more identifiable
psychosocial stressors. However, the stressor may be of any severity and, compared to PTSD and Acute Stress Disorder, a wider range of symptoms may develop.

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Schizoaffective Disorder vs. Mood w/ psychotic symptoms

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SCHIZOAFFECTIVE DISORDER: An uninterrupted period of disturbance in which there are concurrent symptoms of a Mood Disorder and the active-phase symptoms of Schizophrenia, with at least a two-week period in which hallucinations and delusions are
present without predominant mood symptoms.

2. MOOD DISORDER WITH PSYCHOTIC FEATURES: Psychotic symptoms are present only during a mood disturbance. In Schizoaffective Disorder, there is a period of two
weeks or more when delusions and hallucinations are present without mood symptoms.

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Differential Dx of Schizophrenia

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In Schizophrenia, the mood symptoms, if there are any, are brief relative to the total disturbance or they do not
meet the criteria for a Mood Episode.
2. SCHIZOPHRENIFORM DISORDER: Includes active-phase psychotic symptoms; however, in contrast to Schizophrenia, the duration is at least one month but less than six months.
3. SCHIZOAFFECTIVE DISORDER: An uninterrupted period when there are concurrent symptoms of a Mood Disorder and active-phase symptoms of Schizo, with at least two weeks when hallucinations and delusions are present without predominant mood symptoms. In contrast to schizo, the mood symptoms are present for a substantial part of the disturbance.
4. BRIEF PSYCHOTIC DISORDER (formerly known as Brief Reactive Psychosis):
Delusions, hallucinations, disorganized speech and grossly disorganized behavior. In DSM-IV, the disorder may or may not be recipitated by a severe stressor. In contrast to
Schizophrenia, the duration is from one day to one month.
5. DELUSIONAL DISORDER: Nonbizarre delusions for at least one month. Delusions in Schizophrenia are commonly bizarre. In addition, no other signs of the active phase of
Schizophrenia are present in a Delusional Disorder and there is less impairment of functioning.
6. MOOD DISORDER W/ PSYCHOTIC FEATURES: dx when the psychotic symptoms occur exclusively in the course of a mood disturbance.

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Subtypes of Schizophrenia

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Schizophrenia is a disturbance of six months or more that includes at least one month of active-phase symptoms (one week in DSM-III-R). Active phase symptoms include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and/or negative symptoms (e.g., flat affect, avolition, alogia). Rates of Schizophrenia are
about equal for males and females. Treatment usually includes a neuroleptic family therapy, and social-skills training. The subtypes are:
1. PARANOID: Preoccupation with one or more delusions and/or frequent auditory
hallucinations with relatively intact cognition and affect. The paranoid subtype is associated with the most favorable prognosis.
2. DISORGANIZED: Disorganized speech, disorganized behavior and flat or inappropriate affect. Delusions and hallucinations, if present, are fragmentary and not organized into a
coherent theme.
3. CATATONIC: At least two of the following: motoric immobility; excessive motor activity; extreme negativism or mutism; peculiarities in voluntary movement; echolalia or
echopraxia.
4. UNDIFFERENTIATED: The symptoms do not meet the criteria for a more specific subtype.
5. RESIDUAL: The individual has no current prominent delusions, hallucinations or other positive symptoms, but has had such symptoms in the past and continues to display
negative and/or attenuated positive symptoms.

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Schizotypal vs. Schizoid Personality Disorder

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1. SCHIZOTYPAL PERSONALITY DISORDER: Pervasive deficits in interpersonal
relationships, acute discomfort with and restricted capacity for close relationships and eccentricities in cognition, perception and behavior.

2. SCHIZOID PERSONALITY DISORDER: A pervasive pattern of indifference to
interpersonal relationships and a restricted range of emotional expression in social settings. In contrast to the Schizotypal Personality, there are no cognitive or perceptual distortions.

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Sexual Dysfunctions and the Sexual Response Cycle

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1. DES RE PHASE: Includes sexual fantasies and desire for sex. Associated Sexual Dysfunctions are Hypoactive Sexual Desire Disorder and Sexual Aversion Disorder.
2. EXCITEMENT PHASE: Includes physiological changes related to arousal. Associated Sexual Dysfunctions are Female Sexual Arousal Disorder and Male Erectile Disorder
(impotence).
3. ORGASM PHASE: The culmination of sexual pleasure, with release of sexual tension.

Associated Sexual Dysfunctions are Male and Female Orgasmic Disorder (most common female dysfunction) and Premature Ejaculation (most common male dysfunction).
In addition, there are two Sexual Pain Disorders: DYSPAREUNIA may occur in males or females and involves genital pain associated with sexual intercourse. VAGINISMUS occurs in females and involves involuntary spasms of the pubococyeus muscle in the
outer third of the vagina, which interfere with sexual intercourse.

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Somatoform vs. malingering vs. facticious disorder

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1. SOMATOFORM DISORDERS: Involve physical symptoms that suggest a medical condition, but that are not fully explained by a medical condition, the effects of a substance or another mental disorder. The symptoms are not voluntarily produced. For example, Hypochondriasis is characterized by an unrealistic preoccupation with a fear of having or the belief that one has a serious illness, based on a misinterpretation of bodily symptoms and Somatization Disorder involves recurrent multiple somatic complaints that begin prior to age 30 and for which no physical explanation can be found. See also
"Conversion Disorder."

2. MALINGERING: The intentional production of false or exaggerated physical or psychological symptoms motivated by external incentives (e.g., avoiding work). In contrast
to a Somatoform Disorder, the symptoms are intentionally produced. In contrast to Factitious Disorder, there is a clear external goal for the symptoms.

3. FACTITIOUS DISORDER: Characterized by the presence of physical or psychological symptoms that are intentionally produced or feigned, apparently to fulfil an intrapsychic
need to adopt the sick role. In contrast to a Somatoform Disorder, the symptoms are intentionally produced.

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Substance abuse vs. dependence

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1. SUBSTANCE ABUSE: In DSM-IV, a Substance-Use Disorder characterized by a maladaptive pattern of substance use involving clinically significant impairment or distress as manifested by the presence of at least one symptom during a 12-month period.

2. SUBSTANCE DEPENDENCE: A Substance-Use Disorder involving the continued use of a substance despite significant substance-related problems, as evidenced by the presence of at least three characteristic symptoms during a 12-month period. Dependence may or may not involve tolerance and withdrawal (physiological dependence). Substance
Dependence is more serious than Substance Abuse.

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Substance-Induced Disorders

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In DSM-IV, the "Substance-Induced Disorders" are disorders caused by the use of a drug of abuse or medication or by exposure to a toxin. Along with the Abuse and Dependence, they are classified in the section on Substance-Related Disorders. (In DSM-II-R, the
Substance-Induced Disorders were classified as Psychoactive Substance-Induced Organic Mental Disorders.)
1. INTOXICATION: Maladaptive behavior or psychological changes (e.g., aggress behave, impaired judge, emot lability), slurred speech, coordinate, unsteady gait, nystagmus, impaired att. or memory (especially anterograde amnesia or "blackouts"), stupor or coma.
2. WITHDRAWAl: Autonomic hyperact, hand tremor, insomnia, nausea or vomiting, transient illusions or hallucinations, anxiety, psychomotor agitation and/or grand mal seizures following prolonged or heavy use.
3. DEL RIUM TREMENS (A.K.A. ALCOHOL WITHDRAWAL DELIRIUM): Disturbances in
consciousness and other cognitive functions, autonomic hyperact, vivid hallucinations, delusions and/or agitation following a period of prolonged or heavy use.
4. WERNICKE-KORSAKOFF'S SYNDROME (A.K.A. ALCOHOL-INDUCED PERSISTING
AMNESTIC DISORDER): Retrograde and anterograde amnesia & confab (attempts to compensate for memory loss by fabricating memories). Wernicke-Korsakoff's syndrome is believed to be due to thiamine and other Vitamin B deficiencies.

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Suicide Risk Factors

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A high risk for suicide is associated with a warning, previous attempts, a plan (especially one involving a lethal weapon), male gender, older age and feelings of hopelessness.
While the highest completed suicide rates are among individuals aged 55 and 64, the highest rates of attempts are among people aged 24 to 44. Of the mental disorders, the highest risk is associated with depression.

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TRANSVESTISM vs. Gender Identity Disorder

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1. TRANSVESTISM: In a male, recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving cross-dressing.

2. GENDER IDENTITY DISORDER: (Classified as a Sexual Disorder in DSM-IV.) Gender Identity Disorder involves a strong, persistent cross-gender identification and discomfort
with one's sex or a sense of inappropriateness in the gender role of that sex. Males may cross-dress but, unlike in Transvestism, they do not do so for sexual excitement.