Neurodevelopmental Disorders Disorder Duration

Neurodevelopmental Disorders

Disorder Duration

Intellectual Disability onset during developmental period

Autism onset during developmental period

ADHD >6 mos.; prior to age 12

Specific Learning Disorder >6 mos.

Motor Disorders

Schizophrenia Spectrum/Psychotic D/O

Disorder DurationCriterion A: Delusions: misinterpretation of experiences; false beliefs

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Symptoms

Deficits in intellectual functioning- reasoning, problem-solving, planning, abstract thinking, learning, judgement

Deficits in adaptive functioning - failure in developmental and personal independence

Deficit in social-emotional reciprocity- failure to initiate/respond to social interactions

deficits in nonverbal communicative behaviors- lack of eye contact, poor communication, lack of facial expressions/nonverbal communication

Deficits in developing relationships- inability adjust to social context, make friends, lack of interest in peers

restricted repetitive behaviors- insistence in sameness, fixated interests

inattention- e.g., fails to give close attention to details; has difficulty sustaining attention to tasks or play activities; doesn't listen when directly spoken to; fails to finish schoolwork or chores; is easily distracted by extraneous stimuli; is often forgetful in daily activities

hyperactivity-impulsivity- e.g., frequently fidgets or squirms in seat; often leaves seat at inappropriate times; frequently runs or climbs in inappropriate situations; talks excessively; has difficulty waiting his/her turn; interrupts or intrudes on others

Difficulty learning and using academic skills

Academic skills are below expected for age and cause significant interference with academic performance/DLA

Not accounted for by intellectual disabilities or other mental/neurological disorders


SymptomsCriterion A: Delusions: misinterpretation of experiences; false beliefs

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Specifiers Differential Dx

Mild, Moderate, Severe, Profound

Neurocognitive D/O

Communication D/O

Specific Learning S/O

Autism

Borderline Intellectual Functioning

with/without language impairment ADHD

with/without intellectual impairment Schizopheniaassociated w/ medical /genetic condition Intellectual Disability

Associated w/ another neurodevelopmental, mental or behavior d/o Language Disorder

w/ catatonia Stereotypic Movement

Rett Syndrome

Selective Mutism

Social Pragmatic Communication

1) Combined presentation 2) Predominantly inattentive 3) Predominantly hyperactive/impulsive

ODD; Intermittent Explosive; RAD;Specific Learning Disorder; Intellectual Disability; Autism/Stereotypic Mvt/Tourette

In partial remission depressive, Bipolar

Mild, Moderate, Severe

Disruptive Mood Dysregulation; Anxiety; Psychotic D/O; Substance Use; Borderline/Narcissistic/Personality D/O; Medication Induced; Neurocognitive

w/ impairment in reading normal variations in academic attainmentIntellectual Disability

w/impairment in written expression ADHD psychotic d/o

w/impairment in mathematics neurocognitive d/olearning difficulties due to neurological/sensory d/o


Specifiers Differential DxCriterion A: Delusions: misinterpretation of experiences; false beliefs

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Interventions

Behavior modification

Parent training Individual therapy for mild to moderate deficits Vocational Training Develop recreational interests

Family centered approach Early Interventions: special education; home health care; language stimulation; social skillsInclusion/mainstreaming into

academic settingIntegration of therapy into environment

Support Group for parent Behavior Therapy- Chaining; positive reinforcement

Psychoeducation Coloring TherapyParent Training & Support Play therapyFocus on improving language, communication skills, social skills, skills of daily living Social skills training/social skills groupBehavior Analyst Sand tray therapyRelationship Development Intervention Family Therapy

ModelingAdolescent: script fading, social stories, role-playing

Medical/Medication (repetitive behaviors, tics, anxiety, inattention)

Adult- CBT, Brainwave biofeedback, relaxation training, psychoeducation, support group

Parent Management TrainingBehavior modification Family Therapy

Appropriate accommodations at school- IEP CBTTutoring Behavioral Therapy (behavior issues)Alternative test-taking methods Play TherapyPsychoeducation Client-Centered (build rapport)Social Skills training Expressive art therapy (coping skill)Language Deficit- play/activity therapyhabit reversal technique Medication

Behavioral therapy: self-monitoring; relaxation


Interventions

Delusions: misinterpretation of experiences; false beliefs

�4

Hallucinations: altered perceptionsDisorganized Speech: loose associations; derailment; incoherentAbnormal Behaviors: agitation or catatonicNegative Symptoms flat affect; alogia (diminished speech); avolition(inability to initiate in activities); anhedonia (inability to feel pleasure); lack of motivation to engage in social interaction

Delusional D/O >1mo

Brief Psychotic Disorder Up to 1 mo

Schizophreniform 1 to 6 mos.

Schizophrenia > 6months

Schizoaffective D/O 2 wks or more of delusions outside of mood disturbance

Bipolar Disorders

Disorder Duration

Bipolar I >1 week mania or Hospitalization

Bipolar II >4days hypomania

Cyclothymic >2 yrs (>1yr Kids)

Depressive DisordersDisorder Duration

�5

altered perceptionsDisorganized Speech: loose associations; derailment; incoherentAbnormal Behaviors: agitation or catatonic

flat affect; alogia (diminished speech); avolition(inability to initiate in activities); anhedonia (inability to feel pleasure); lack of motivation to engage in social interactionPresence of >1 delusions

Criteria has not bee met for Schizophrenia

psychosocial functioning is not markedly impairedBehavior is not odd

presence of delusions, hallucination or disorganized speech

eventual return to premorbid level of functioning

at least two symptoms in Criterion A

at least two symptoms in Criterion A for at least one month with at least one symptom being delusions, hallucination, or disorganized speech.

uninterrupted period of illness during which, at some time, there are concurrent symptoms of Schizophrenia and symptoms of a major depressive or manic episode with a period of at least two weeks without prominent mood symptoms.

Bipolar Disorders

Symptoms

Distractibility; irresponsible behaviors; grandiosity; flight of ideas; activity increase; decreased need for sleep; excessive talkativeness; reckless behavior- shopping sprees; sexual indiscretions) Marked impairment in social, occupational and other important areas of functioning, or requires hospitalization to avoid harm to self or others, or the presence of psychotic features.

Major Depressive Episode w/ hypomanic episode - Note criteria E. page 125 in DSM - hypomanic episode does not affect functioning.

periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

Depressive DisordersSymptoms

depressed mood for most of the day, for more days than not. two symptoms-poor �6

altered perceptionsDisorganized Speech: loose associations; derailment; incoherent

flat affect; alogia (diminished speech); avolition(inability to initiate in activities); anhedonia (inability to feel pleasure); lack of motivation to engage in social interactionerotomanic OCD

grandiose Delirium

jealous depressive, Bipolarpersecutory Schizoaffectivesomaticmixed typeunspecified typewith marked stressor: occur in response to a stressful event depressive, Bipolar

Without marked stressor Schizophreniform; Delusional; other medical

with postpartum onset: during pregnancy or w/in 4 weeks postpartum

substance-related;personality d/omalingering/factitious

w/ good prognostic features; Brief Psychotic D/Owithout good prognostic features Delusional

depressive, Bipolar

First episode MDD; Bipolar; schizoaffective; Delusional

multiple episodes BPD; SchizotypalPTSD; Stimulant use

Bipolar type

Depressive type

Bipolar Disorders

Specifiers Differential DxMDD

w/ anxious distress Bipolar II

w/ mixed features ADHD

w/ rapid cycling GAD

w/ melancholic features Psychotic D/Ow/ atypical features Panic D/Ow/ mood-congruent or mood-incongruent psychotic features Personality D/O

w/catatonia Disorders w/ prominent irritabilityw/ peripartum onset

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MDD; Bipolar I; Cyclothymic; ADHD; Schizophrenia; Panic or other anxiety; Substance Use; Borderline

BP or depressive disorder due to medical condition, BPI and II with rapid cycling

Depressive DisordersSpecifiers Differential Dx

MDDpsychotic d/o

�7

altered perceptionsDisorganized Speech: loose associations; derailment; incoherent

Psychoeducation Medication Mgmt

Medication empathy/encouragement (supportive psychotherapy)

Avoid confrontation/power struggle Gradually and gently challenging beliefssocial skills Relaxation TechniquesCBT- Journaling Stop & Monitor: establish cues to stop and be

aware of thought processes through the day.

Medication Behavior therapy- coping skills, stress management

Supportive Psychotherapy Family-focused therapy

Psychoeducation

CBTGroup TherapyPsychoeducationReferral to PsychiatristIdentify Coping Skills

Rehabilitation; Club Houses Social Skills

Social Skills Group therapy-socializationRespite Care for families psychoeducationMedication supported employment

CBT Behavior therapy- coping skills, stress management

Family-focused group Major Role Therapy

Bipolar Disorders

Interventions

Medication CBT: behavioral contracts, self-monitoring mood, challenge faulty beliefs, activity sheets, improve social skills, stress reduction

Behavioral skills-> coping, social skillsInterpersonal and Social Rhythm Therapy Electroconvulsive Therapy Chart mood to identify triggers Life Goals programMindfulness/DBT Prodrome Detection Family-focused therapy: psychoeducation mood graph

DBT multi-family skills training group Mindfulness-based cognitive therapy (MBCT)Family-focused therapy: psychoeducation; CBT

group therapy; expressive art therapy

Depressive DisordersInterventions

Refer to Psychiatrist Psychodynamic therapyGroup therapy CBT

�8

Persistant Depressive D/O >2 yrs (>1yr Kids)

Major Depressive Disorder >2 wks

Disruptive Mood Dysregulation >3x/wk for 1 yr; age>6

Premenstrual Dysphoric Disorder most cycles in past year

Trauma and Stressor RelatedDisorder Duration/Onset

Adjustment Disorder Symptoms must develop within 3 months of stressor

Acute Stress Disorder 3 days-1 mo

PTSD >1mo

Disinhibited Social Engagement D/O Age of at least 9 mos. - present > 12 mths.

Reactive Attachment D/O age: 9 mos-5yrs - >12 months

Obsessive Compulsive Disorders

�9

depressed mood for most of the day, for more days than not. two symptoms-poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, and/or feelings of hopelessness

Sleep Disturbance, loss interest, guilt(worthless), low energy, poor concentration, Appetite, agitation or lethargic; suicidal, 5% change in body weight - up or down in 1 month period.

(a) "severe recurrent temper outbursts manifested verbally (e.g. .. verbal rages) and/or behaviorally (b) persistently irritable or angry mood between temper outbursts affective lability, irritability or anger, depressed mood or self-deprecating thoughts, or anxiety or tension *At least one symptom must be: decreased interest in usual activities, impaired concentration, lethargy, marked change in appetite, hypersomnia or insomnia, a sense of being overwhelmed or out of control, or physical symptoms (e.g., breast swelling, joint or muscle pain).

Trauma and Stressor RelatedSymptoms

marked by a psychosocial stressor that leads to functioning impairment

exposure to actual or threatened death, serious injury, or sexual violence

Intrusion: recurring memories; dreams; flashbacks/dissociation

Avoidance: avoid reminders, thoughts

Cognition/Mood: unable to recall; negative beliefs of self; blame self/others; diminished interest; withdrawn; unable to experience positive emotions

Arousal: irritability; anger; self-destructive/reckless behavior; hypervigilance; startled; poor concentration; sleep disturbance

child approaches & interacts with unfamiliar adultsimpulsivityexperienced neglect, repeated changes in caregiver

emotionally withdrawn toward caregiver: rarely seeks or responds to comfort when distressed

social/emotional disturbance: minimal response to others; limited positive affect; unexplained irritability, sadness or fearfulness with caregiver insufficient care: social/emotional neglect, repeated changes in caregiver, rearing in institution


�10

depressive/bipolar due to medicalsubstance/med induced depressive/bipolarpersonality d/o

Same as Bipolar

Mood D/O due to medicalmanic episodes w/irritable/mixed episodessubstance/med induced depressive/bipolaradjustment D/O w/ depressed moodADHD; sadness

Family Counseling, psychoeducation; parent mgt training

anger mgmt group

Trauma and Stressor RelatedSpecifiers Differential Dx

depressed mood PTSD; Normative Stress Reaction

anxiety Acute Stress D/Omixed anxiety/depressed MDDdisturbance of conduct Personality D/O

mixed disturbance of emotions and conduct Psychological factors affecting medical condition

PTSD; Adjustment; Panic

Psychotic D/ODissociative d/o; OCDTraumatic brain injury

w/ dissociative symptoms adjustment d/o

w/ delayed expression (full diagnostic criteria met at least 6 mos. after event)

acute stress disorder

anxiety d/o; OCDMDD; TBIPersonality D/O; Dissociative; Conversion

Psychotic

Persistent (>12mos)

Persistent (>12mos)

Autism

Intellectual Disability

Depressive D/O


�11

family therapy Active Listening

couples therapy BibliotherapyInvolvement in community PsychoeducationBehavioral Activation CBT

Role Play Behavior Therapy

Cognitive Restructuring group therapy

active listening

Family Counseling, psychoeducation; parent mgt training Symptom reduction: hormones, vitamins,

antidepressants

anger mgmt group; behavior plan Cognitive therapy

Trauma and Stressor RelatedInterventions

CBT, REBT, ACTRelaxation/MindfulnessStress inoculation trainingGrief- interpersonal therapy

Find an expressive outlet to process the trauma EMDR

Psychiatrist Stress InoculationIdentify support system Anxiety management trainingSupport Group Identify cognitive distortionsStrengthen coping skills Trauma-Focused CBT

Systematic DesensitizationCBT: stress inoculation, emotional processing; exposure

Guided imagery EMDRGroup therapy Mindfulness

cognitive processing therapy Anxiety Mgmtnarrative therapy to address intrusive thoughts Bibliotherapy

Tx individualized to needs Behavior Mgmtparenting training


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Disorder Duration

OCD

Body Dysmorphic Disorder

Somatic DisordersDisorder Duration

Somatic Symptom Disorders ≥ 6 months

Illness Anxiety ≥ 6 months

Conversion D/O ≥ 6 months

Psychological Factors Affecting Other Medical Conditions

Factitious

Feeding and Eating DisorderDisorder Duration

Binge Eating at least 1x/wk for 3 mos.

�13

Symptoms

obsessions, compulsions, or both that are severe time-consuming and/or cause significant impairment

preoccupation with 1 or more perceived defects or flaws in physical appearance- not observable/minor to othersRepetitive Behaviors: check mirror, excessive grooming, skin picking, reassurance seeking

Somatic DisordersSymptoms

authentic physical symptoms (ex. pain, fatigue, etc.), but no physical cause can be found for them. High levels of anxiety about health; think about the worst-case scenario when it comes to their health

preoccupation with having or acquiring a serious illness, a high level of anxiety about health; obsessed about illness; medical exams are consistently benign

sudden dramatic loss of motor or sensory function

Medical condition is present and affected by psychological/behavioral issuesFactors have altered the course of medical condition; interfere with treatment; increase health risks

Fakes an illness for psychological gain- not external reward

Feeding and Eating DisorderSymptoms

repeated episodes of out of control eatingeat in a discrete period of time, an amount of food larger than most would eatlack of control over eating;

eating rapidly, until uncomfortably full, alone due to embarrassment, feeling disgusted w/ self

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Specifiers Differential Dx

w/good or fair insight GAD; Anxiety D/O due to medical; ADHD

w/ poor insight Substance Induced Anxiety

w/ absent insight/delusional beliefs Body Dysmorphic; eating D/O

Tic related Phobia; Trichotillomania; MDDSomatic Disorder; Delusional/Psychotic

TIC/Stereotypic Mvt

w/ muscle dysmorphia

(idea body build is too small/insufficiently muscular)

Somatic DisordersSpecifiers Differential Dx

w/ predominant pain Panic; GADpersistent (>6mos) Illness Anxiety; Conversion

Body Dysmorphic; OCDDepressiveother medical condition

care-seeking type Adjustment D/Ocare-avoidant type Somatic Disorder

Anxiety; OCD; MDDPsychotic D/O

w/ weakness/paralysis Neurological D/O

w/abnormal movement Somatic Symptoms

w/swallowing symptoms Factitiousw/speech symptom Dissociative d/ow/attacks/seizures Body Dysmorphicw/anesthesia/sensory loss Depressivew/mixed symptoms Panic D/Oacute; persistent

mild; moderate;severe;extreme

single episode Somatic Symptoms

recurrent episode Malingering

Conversion D/O

Borderline

medical condition not associated with falsification

Feeding and Eating DisorderSpecifiers Differential Dx

In partial remission; in full remission Bulimiamild-1-3 ep /week BipolarModerate- 4-7 ep Depressive D/Osevere- 8-13 ep Borderlineextreme ->14 ep Obesity

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Interventions

Challenge thinking errors Rehearsal (learn new set of behaviors to replace old habits)

Medication Modeling

motivational interviewing Cognitive RestructuringBehavior Therapy- exposure and response prevention therapy

Meditation/relaxationRole-Play (hear how irrational thoughts can sound and encourage change)CBTAcceptance and Commitment

MindfulnessExposure & response prevention

Somatic DisordersInterventions

CBTMindfulnessGroup TherapyFamily Psychoeducation

Psychodynamic CBT

family therapyBrief Regressive Hypnosis-brief regressive hypnosis would be useful to rediscover thought processes, emotions, and beliefseclectic psychotherapyBrief psychodynamic therapyBiofeedbackBibliotherapyRelaxation trainingEMDR

Reinforce recovery-based behaviors RelaxationReframe feigned symptoms as a need for caring relationships Paradoxical InterventionDirect discussion away from psychological symptoms to relationship problems Clarification and goal settingGoal- Living in the community instead of the hospital Unconditional Positive Regard**Confrontation does not work** Clarification and goal setting

Empathic ListeningFeeding and Eating Disorder

InterventionsCognitive RestructuringThought JournalCognitive ReframingThought StoppingDecatastophizing

�16

Bulimia Nervosa at least 1x/wk for 3 mos.

Anorexia

Disruptive/Impulse/ConductDisorder Duration

Oppositional Defiant >6 mos.

Conduct Disorder past 12 month; one symptom in the past six months

Intermittent Explosive D/O >age 6; 2x/week for 3 mos.

Dissociative DisordersDisorder Duration

Depersonalization/ Derealization

Dissociative Amnesia

Dissociative Identity Disorder

Anxiety DisordersDisorder Duration

�17

w/ self

binge eats and then uses variety of compensatory behaviors to limit weight gain

eat in a discrete period of time, an amount of food larger than most would eat

lack of control over eating

obsessive preoccupation w/ body weight and foodlow body weight; fear of gaining weight

peculiar handling of food

distorted body image; loss of menstrual period

Disruptive/Impulse/ConductSymptoms

marked by patterned behavior that although defiant and negative, does NOT violate social norms as is the case with Conduct Disorder. angry/irritable mood: loses temper; easily annoyed; angry/resentfulargumentative/defiant: argues with authority; refuse to comply w/ requests; deliberately annoys others; blames others for misbehavior

Vindictiveness: spiteful at least 2x w/in past 6 mos.

pattern of behavior violating social norms and rights of others

aggression to people/animals; destruction of property; deceitfulness/theft; serious violations of rulesfailure to control aggressive impulsesverbal aggression; physical aggression towards property, animals, people(aggression does not result in damage or injury)3 behavioral outbursts within 1 year involving damage/destruction/injuryoutbursts are not premeditated - grossly out of proportion

Dissociative DisordersSymptoms

feelings of disengagement from one's environment, body, or social situation

Reality testing remains intactNo other mental disorder or medical condition

abnormal forgetting about personal information caused by emotional trauma

shifts between 2 or more alternate identitiesgaps in recall of everyday events, personal information, traumatic event

Anxiety DisordersSymptoms

�18

In partial remission; in full remission Anorexia

mild-1-3 ep /week Binge-Eating

Moderate- 4-7 ep MDDsevere- 8-13 ep Borderlineextreme ->14 ep Kleine-Levin Syndromerestricting type Bulimiabinge eating/purging type Body Dysmorphic

Avoidant/Restrictive Food Intake

Substance Use

OCD

Disruptive/Impulse/ConductSpecifiers Differential Dx

mild- 1 setting Conduct D/Omoderate- at least 2 settings ADHD severe- 3 or more settings depressive, Bipolar

Intermittent ExplosiveSocial Anxiety

child onset (<age10); adolescent onset; unspecified onset ODD, ADHD, Intermittent Explosivedepressive, BipolarAdjustment D/O

Dissociative DisordersSpecifiers

w/ dissociative fugue

other dissociative d/oMDD; Bipolar; PTSDPsychotic D/O; Substance InducedPersonality D/OConversion; Seizure d/ofactitious/malingering

Anxiety DisordersSpecifiers Differential Dx

�19

PsychoeducationCBT: Self-Monitoring, Disputing irrational beliefs, BibliotherapyREBT- Humor; Shame attacking (help with Self-Esteem)Interpersonal TherapyGuided Self-Help

refer to physician Journal to express feelings on eatingfamily therapy (i.e. Maudsley family) Guided imagery

Group therapy Mirror exposure

Progressive muscle relaxationComplete homework assignments involving behavioral experiments and/or exposure exercises

Establish a safety contract to ensure living safely

Disruptive/Impulse/ConductInterventions

Extracurricular activities Anger Mgt GroupMentor In-home behavior analyst

Positive reinforcementRole-Play (practice behavioral skills)ConfrontationParadoxical Intention (resistant client)assessment of alternativesContracts

Mentor Functional Family Therapyanger mgmt; behavior analyst Group TherapyExtracurricular activities Multisystemic Therapyexpressive art therapynonviolent communicationAnger Mgmt classSupport groupYoga

Dissociative DisordersInterventions

meditation or relaxation group Reducing alarm emotions through relaxation techniques

Yoga Journaling (help identify triggers)CBT: Disputing irrational beliefsBiofeedbackBibliotherapy

Hypnosis; dream analysis Free associationVisualization meditationDiary-events/emotionsPsychoeducation HypnosisYoga Expressive Arts

Supportive Therapy Learn Coping SkillsEgo-State Therapy (second Phase Tx) DBTCBT: cognitive restructuring, relaxation, education

EMDRNeurofeedback

Family therapyAnxiety Disorders

Interventions

�20

Separation Anxiety > 4 weeks- children; > 6 mos.- adults

Specific Phobia > 6 mos.

Social Anxiety Disorder > 6 mos.

Panic Disorder ≥ 1 month

Agoraphobia

> 6 mos

Generalized Anxiety ≥ 6 months (more days than not)

Substance Use DisordersDisorder Duration

Substance Use Disorders > 12 mos

Alcohol Intoxication

Alcohol Withdrawal

�21

extreme fear/anxiety about separation from attachment figurespersistent worry about harm to attachment figure; worry figure leaving and not coming back; nightmares about separationreluctance to go to school/work; refuse to sleep away from homecomplaints of physical symptomscontinual fear by an object or situation; not linked with real dangeravoidance of object/situation

fear/anxiety about social situation exposed to scrutiny by others

fear of being embarrassed, humiliated, or being judged by others

situations are avoided or endured with intense fear

abrupt surge of intense fear with symptoms of : pounding heart, chest pain, trembling, nausea, sweating, dizziness, dread, confusion, desire to flee - recurrent -unepected1 month of worrying about having another attackchange in behaviors to avoid having another attack

fear of using public transportation, open spaces, enclosed spaces, standing in line, being in a crowd, being outside of home alone

fear escape may be difficult or help not available in case of panic attack

anxious all the time over diverse issues

muscle tension, irritability, sleep disturbance, restlessness, easily fatigued, difficulty concentrating, on edge

Substance Use DisordersSymptoms

Impaired ControlUse larger amts or over longer period than intendedPersistent desire/unsuccessful efforts to cut downexcessive amt of time spent obtaining/using/recovering from useIntense craving

Pharmacological Effects

ToleranceWithdrawalSubstance Specific Syndrome (>1 of following)Slurred SpeechIncoordinationUnsteady GaitNystagmus- uncontrolled eye mvtAutonomic Hyperactivity- fluctuations in BP, HR, Respiratory,body tempHand TremorInsomnia

�22

animal Agoraphobia; Social Anxietynatural environment Trauma/Stressor related

blood-injection-injury Separation Anxiety; Panic D/O;

situational OCD; Eating D/Oother (i.e.. Choking) Schizophrenia Spectrum

performance only GAD; Panic D/O; Agoraphobia

Separation Anxiety; Specific PhobiaSchizoid; Avoidant Pervasive DepressiveAnxiety due to medical; substance InducedOther specified anxiety d/o

Specific Phobia; Separation Anxiety; Social Anxiety

Acute Stress; PTSD

Panic; MDD

Other medical conditionAnxiety due to medical; substance Induced; PanicSocial Phobia; OCD; Somatic; Separation Anxiety; PTSD; Adjustment

Substance Use DisordersSymptoms

Social ImpairmentFailure to fulfill major obligationsRecurrent social/interpersonal problemsWithdraw from social/occupational/recreational activities

Risky Use

Use in physically hazardous situationsFailure to abstain despite recurrent physical/psychological problems

Substance Specific Syndrome (>1 of following)Poor attention/memoryStupor/Coma

hallucinationsPsychomotor agitationanxiety

�23

Adjunct behavioral training group for social skills

Behavior Therapy- Role Playing, Systematic Desensitization, Assertiveness and social skills training, rehearsal (help relieve anxiety before triggering event)

Recommending 'Toast-Masters' (presentations)

Relaxation Training/anxiety management training

Meeting with a psychiatrist Guided ImageryExposure Therapy

Identify, challenge, and replace biased, fearful self-talk with positive, realistic, and empowering self-talk

Exposure Therapy

Learn and implement calming skills to reduce and manage anxiety symptoms that may emerge during phobic situations

CBT: Identify and dispute automatic thoughts

Assist the client with committing to not allow phobic fear to take control of own life

Progressive muscle relaxation

Imaginal desensitization

Replace Beliefs Relaxation therapy

Role- Playing (help with problem-solving in anxiety provoking situation)

Substance Use DisordersInterventions

motivational interviewing Improvement of communication/relationship skillsMeasurements of Change

12- Step CBT: cognitive restructuring; journaling; timeline of use; triggers; rehearsal & Role PlayStress Mgmt

Impulse control Behavior Therapy: social skills training; skill building to reduce use, replace substance with other rewarding activity; identify high-risk that trigger relapse

Group /Individual therapy

Peer SupportMindfulness- based relapse prevention

�24

Cannabis Intoxication

Cannabis Withdrawal

Caffeine Intoxication

Caffeine Withdrawal

Stimulant Intoxication

Stimulant Withdrawal

Personality DisordersDisorder Duration/ Onset

Paranoid Personality Adult

Schizoid Adult

Schizotypal Adult

Antisocial Personality D/O Adult; since age 15

Borderline Adult

�25

Nausea/vomitingSubstance Specific Syndrome (>2 of following)Conjunctival injection (red eyes)Increases appetite

Abdominal pain, tremors, sweating, fever, chills, headaches

irritabilityanxietySubstance Specific Syndrome (>5 of following)RestelessnessNervousnessrambling flow of thought/speechabnormal heart rate/beatFlushed FaceGastrointestinal disturbanceHeadacheFatigueDysphoric mood/irritability

abnormal heart ratepupillary dilationelevated blood pressureperspiration/chillsnausea/vomitingFatigueVivid DreamsInsomnia/hypersomnia

Personality DisordersSymptoms

mistrust of others, actions of other's are seen as malevolent w/o evidencebears grudges; perceives attacks on character/reputation not seen by others; quick to react angrilysuspicion of infidelity w/o evidencelacks desire for relationships, including familychooses solitary activities; lacks interest in sexual experiences; pleasure in few activitieslacks close friends, indifferent to praise or criticism, emotional coldness, detachment, flat affectinterprets minor events as highly personally significant, odd beliefs, magical thinkingbizarre/eccentric behaviors, lack of close friends

suspiciousness/paranoia

social anxiety related to paranoia-not low self-esteem3 or more:pattern of disregard and violation of rights of others; conduct disorder before age 15

breaking law, deceitfulness, impulsivity/failure to plan ahead

irritability/aggressivenessreckless disregard for safety self/others

irresponsibility-unable maintain work/meet financial obligations

lack of remorse5 or more: fear of abandonment, problems in relationships, unstable self-image/sense of selfImpulsivity- spending, sex, drugs, reckless driving, binge eating

suicidal behavior, self-mutilations

�26

seizuresSubstance Specific Syndrome (>2 of following) S, H, A intoxication

Dry Mouth Caffeine; PhencyclidineTachycardia Alcohol

restlessnesssleep disturbancedecreased appetitedepressed mood

Substance Specific Syndrome (>5 of following)DiuresisMuscle TwitchingExcitementInsomniaInexhaustibilityPsychomotor agitationimpaired concentrationflu-like symptoms

weight losspsychomotor agitationmuscular weakness

confusion, seizures, dystonias, coma

increased appetitepsychomotor retardation

Personality DisordersSpecifiers Differential Dx

Autism

SUD; personality change

other personality d/o; other mental d/o w/psychosis

neurodevelopmental d/oSUD; personality change

other personality d/o; other mental d/o w/psychosis

Schizophenia; Bipolar

Narcissistic; Histrionic; BorderlineSubstance Use DisorderCriminal behavior not associated with personality d/o

depressive, Bipolar

other personality d/opersonality change due to medical

�27

Personality DisordersInterventions

Individual Therapy Supportive PsychotherapyReality testing only after building rapport CBT

CBT

Social Skills Training

Group TherapyCBTSocial Skills TrainingSupport/EncouragementCommunication Skills- assertiveness, role-playingFocus on Low Self-Esteem

Role-Play

ModelingMotivational Interviewing (resistant clients)Reframing (helps view world realistically)

Rehearsal

DBT transference-focused psychotherapySTEPPS Narrative therapy

Mentalization-based therapy Role-Play/Rehearsal

�28

Histrionic Adult

Narcissistic Adult

Avoidant Adult

Dependent Adult

Obsessive-Compulsive Personality Disorder Adult

Personality change Due to Medical Condition

Adult

Child (change in development- 1yr)

Gender Dysphoria DisordersDisorder Duration

Gender Dysphoria >6mos

Sexual DysfunctionsDisorder Duration

Sexual Dysfunction Disorders

Factors to be considered: o Partner- health status, sexual dysfunctionso Relationship- communication, discrepancies in sexual desireso Cultural/religious- attitudes toward sexuality

o Medical- relevant to prognosis/treatment

�29

unstable affect- dissatisfaction, irritability, anxietyfeelings of emptiness, intense anger, transient stress-related paranoia/dissociation5 or more: center of attention, inappropriate sexually seductive behavior, shallow expression of emotions, use physical appearance to get attn

speech lacks details, emotion expression is dramatic, easily influenced

sees relationships to be more intimate than actually are>5: grandiose, fantasies of unlimited successbelieves being special/unique, req admirationentitled, takes advantage of others, lacks empathy, envious of others or believes others are envious of them; arrogant behaviors>4: pattern of social inhibition, feelings of inadequacy, hypersensitive to criticismavoids occupational activities-fear of criticism/disapproval; preoccupied w/ being criticized/rejectedavoid interactions w/ people unless sure of being liked; restraint w/ intimate relationshipsview self as inferior/socially inept; reluctant to take personal risks- fear of embarrassment

>5:excessive need to be taken care of--> clinging behavior, fear of separation

difficulty making decisions, needs others to take responsibility

difficulty expressing disagreement, initiating projectsexcessive lengths to obtain nurturance and support of others; helpless when alone due to fear of being unable to care for self; preoccupied with fears of being left to take care of self>4: preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. preoccupied with details, rules, lists order; rigid, stubbornnessexcessively devoted to work/productivity; unable to delegate tasks

inflexible about morality, ethics, valuesmiserly spending style; unable to discard objectsevidence from medical exam; not caused by other mental disorder or delirium

affects functioning

Gender Dysphoria DisordersSymptoms

strong feeling born the wrong gender and strong desire to become a member of the other gender;

Sexual DysfunctionsSymptoms



delay in ejaculation

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Substance UseIdentity problems

other personality d/o

personality change due to medicalSubstance Useother personality d/omania/hypomaniasubstance use d/o

Social Anxiety; AgoraphobiaDependent; paranoid personality

schizoid; schizotypal

substance use

personality change due to medical

Borderline; Histrionic other personality d/o

Avoidant personality change due to medical

Substance Use Substance Use

due to other mental D/O: depression; panic; agoraphobia

OCDHoardingother personality d/opersonality change due to medicalsubstance use d/o

labile- affective lability; Disinhibited- poor impulse; Aggressive; Apathetic; Paranoid; other Type; Combined, Unspecified

Gender Dysphoria DisordersSpecifier Differential Dx

posttransition

Nonconformity to gender roles; Transvestic; Body Dysmorphic; Schizophrenia/other psychotic d/o

Sexual DysfunctionsSpecifier Differential Dx



lifelong

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Cognitive Analytic TherapySchema-focusedconnect acts and feelings

CBT

Interpersonal Psychotherapy

Supportive TherapyCBT- systematic desensitization, cognitive restructuring, coping skills,

Psychodynamic Therapy

Coping Skills

Improve Self-EsteemAssertiveness training

social skills trainingCouples/family therapy

CBT

Psychodynamic

Gender Dysphoria DisordersInterventions

Children- individual/family o Focus on child’s feelings about their gender, behaviors, and any disturbances occurring now-not what may happen in adulthood

Adolescent- goals focus on life satisfaction, improving adjustment at home, school and work.

Supportive therapy to alleviate distress Psychoeducation Individual psychotherapy Family therapy Environmental change Group therapy Image Building

Sexual DysfunctionsInterventions

Psychoeducation Improvement of communication/relationship skillsCBTCouples therapy-when having relationship issuesArousal Issues! empty chair- help the client dialog with the part of her that does not maintain excitement during intercourse with spouse

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Delayed Ejaculation

Erectile Disorder >6mos

Female Orgasmic Disorder >6mos

Female Sexual Interest/Arousal >6mos

Genito Pelvic Pain/Pentration >6mos

Male Hypoactive Sexual Desire >6mos

Premature Ejaculation >6mos

Neurocognitive DisordersDisorder Duration

Delirium short onset- hours or days

Mild Neurocognitive

Major Neurocognitive

due to Alzheimer's subtle onset, gradual progression

due to Frontotemporal Lobar Degeneration subtle onset, gradual progression

with Lewy Bodies subtle onset, gradual progression

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infrequency/absence of ejaculation

difficulty getting or maintaining an erectioninadequate erection

difficulty is not related to relationship problems, medical or other stressor

delay or inability to have an orgasm following a normal sexual excitement phase.


lack of sexual interest, lack of minimal sexual fantasies, no initiation/unreceptive to attempts by partner, lack of associated cues to all forms of arousal


anxiety and pain around vaginal penetrationtensing/tightening of pelvic muscles

disinterest in sexual activity- disgust, boring traumatic

ejaculation occurs within 1 minute following vaginal penetration

Neurocognitive DisordersSymptoms

unable to focus; reduced orientation of surrounding; general confusion; memory deficit, cognitive disturbances

deterioration of 2 or more cognitive domains causing impairment in daily activities; Symptoms- confusion, agitation, paranoia, illusionsOLD TIMERS - genetic evidence through family history or testing; memory/learning decline and at least 1 other cognitive domain; ongoing cognitive decline ; no other etiologybehavioral variant- loss of social inhibitions, interest, sympathy/empathy, compulsive/ritualistic, putting non-food in mouth, lethargy language variant- decline in speech production, word finding, object naming, grammar, word comprehensionfluctuating cognition with variations in attention and alertnessrecurrent detailed visual hallucinations parkinsonism (tremor, rigidity, hypokinesia, postural instability) appear after cognitive declineMeet criteria for Rapid Eye Movt Sleep Behavior D/O; neuroleptic (nerve) sensitivity

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acquiredgeneralizedsituationallifelongacquiredgeneralizedsituational

lifelongacquiredgeneralized

situational

never exp an orgasmlifelongacquiredgeneralizedsituational

lifelongacquiredgeneralizedsituationallifelongacquiredgeneralizedsituationallifelongacquiredgeneralizedsituational

Neurocognitive DisordersSpecifiers

probable (genetic link); possible

probable (genetic link or neuroimaging result); possible

Possible- no evidence of gene/neuroimaging

probable, possible

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Mindfulness self-stimulation Integrative body psychotherapy journal thoughts Role-playing Sex therapy

CBT Cognitive rehearsal of past recollections of symptoms

Neurocognitive DisordersInterventions

Behavioral therapy for anxietyPrimary CareFamily CounselingStructured daily scheduleSupport Group

Refer to Neuropsychologist Maintain consistent environment

Structured daily schedule; family counseling; coordinate w/PCP; regulare f/u visits; support group; behavior symptoms for anxiety symptoms

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Vascular Neurocognitive Disorder

Due to Traumatic Brain Injury immediate after brain injury or recovery of consciousness; lasts past acute post-injury

Substance/Medication Induced

Due to HIV Infection

Due to Prion Disease rapid progression

Due to Parkinson's subtle onset, gradual progression

Due to Huntington's Disease subtle onset, gradual progression

Due to another medical condition

Due to Multiple Etiologies

Paraphilic DisordersDisorder Duration

Paraphilic Disorders >6 mos.

Voyeuristic >18 yrs

Exhibitionistic Disorder

Frotteuristic

Sexual Masochism

Sexual Sadism

Pedophilic at least 16 yrs and at least 5yrs older than childFetishistic Transvestic

V CodesDisorder Duration/ Onset

Relationship Distress w/Spouse or Intimate Partner

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onset of cognitive deficits is temporarily related to 1 or more cerebrovascular eventsDecline in ability to attend to more than 1 task and executive functionimpact to head with 1 or more: loss of consciousness, amnesia, disorientation/confusion, neurological impairment (seizures, altered vision, paralysis, muscle weakness)

not associated with intoxication, withdrawal or delirium only

HIV infection and symptoms may have a steady decline, vary over time and resolve completely or stabilizemotor symptoms (tremors, rigidity) cognitive decline, memory deficits, speech problems, vision, seizuresdiagnosis of Parkinson's; neurocognitive issues began after onset of Parkinson'sdiagnosed with disease or risk- progressive degeneration of brain functioning with decline in movement and executive functioning; depression/anxiety are common (ORGANIZING, PLANNING, CALCULATING)physical exam confirms neurocognitive dysfunctions result from another medical condition not specified in DSMphysical exam confirms neurocognitive dysfunctions result from more than 1 etiology, excluding substances

Paraphilic DisordersSymptoms

unusual sexual desires and fantasies about certain objects or towards persons; acted on fantasy

impairment in functioning

sexual arousal from observing an unsuspecting person who is naked, undressing, sexual activity impairment in functioning

sexual arousal from exposure of genitals to unsuspected person

sexual arousal from touching or rubbing against nonconsenting person

sexual arousal from being humiliated, beaten, bound or made to suffer

sexual arousal from physical/psychological suffering of another person

sexual arousal from prepubescent children (usually under 13)sexual arousal from either nonliving objects or focus on nongenital body partssexual arousal from cross-dressing

V CodesSymptoms

focus is addressing quality of the relationship, prognosis or treatment of a mental/medical disorder

conflict resolution difficulty, withdrawal

over involvement

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Possible- neuroimaging

Probable- No neuroimagingMild- Unconscious <30 minsModerate- unconscious- 30 min-24 hrsSevere- unconscious >24 hrs

Paraphilic DisordersSpecifiers Differential Dx

controlled environment (living in institution)

full remission (not acted on urges-5yrs)

controlled environment

full remission

prepubertal children; physically mature individual; both

controlled environment full remission controlled environmentfull remission

w/ asphyxiophilia

Body part; nonliving object; otherw/ fetishism(fabrics)w/autogynephilia (thoughts as female)

V CodesSpecifiers

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Paraphilic DisordersInterventions

Psychoeducation CBT- cognitive restructuring, reconditioning, social skills, Thought Stopping

Measurements of Change Behavior modification-imaginal desensitization, minimal arousal conditioning

Relapse Prevention Covert ExtinctionEmpathy training for offenders Social Skills Training

Impulse ControlStress Reduction

cognitive restructuringaversive conditioning

Behavioral Impulse ControlStress Inoculation Training

V CodesInterventions

Relaxation techniquesRole-playRehearsalModelingReflective listening (learning new ways to listen and communicate with each other)Narrative therapy (problem doesn't define a relationship but is something the relationship is experiencing, one gains a new perspective on the situation)

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Sibling-Relational Problem; Parent-Child Relational Problem

Religious or Spiritual Problem

Sexual Violence

UncomplicatedBereavment

Sleep-Wake Disorders

DiagnosisInsomniaHypersomnolenceNarcolepsyObstructive Sleep ApneaCentral Sleep ApneaSleep Related HypoventilationCircadian Rhythm Sleep-Wake Parasomnias-nightmare, sleep terror, sleepwalking

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a pattern of interaction among siblings that is associated with significant impairment in individual or family functioning

main focus of clinical attention is to address the quality of the parent-child relationship

loss or questioning of faith; problems associated with conversion to new faith; questioning spiritual values

The bereaved individual considers the depressed mood as "normal" although they may still seek treatment.Intervention§ Education- sleep hygieneo Limit caffeineo No nap during dayo Go to sleep when tiredo Sleep only in bedo Use bedroom only for sleepo After 15 mins of no sleep, get up and go to another room. Return to bed when tiredo Wake up in the morning at same time regardless of amount of sleep§ Mindfulness§ Progressive muscle relaxation§ Breathing techniques§ Healthy diet, exercise § Limit alcohol§ Regulate environment§ CBT§ Parent education-behavioral strategies

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Cognitive restructuringFamily therapy

Professional pastoral counseling Clarifying valuesValues clarification Problem-Solving SkillsProblem-Solving BibliotherapyMeaning-making Role-Play

RehearsalMaking amendsReality TherapyEmpathy Skills TrainingConfrontationCognitive Restructuring

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Documents

Neurodevelopmental Disorders Disorder Duration