Education- Psychiatric Illness

Major Depressive Disorder (MDD)

Characterized by presence or history of at least one major depressive episode: Depressed mood or significant loss of interest or pleasure in many or all activities for at least two weeks.  Additionally, four or more of the following must have been present during the same two week period: Significant change in appetite or weight, fatigue or loss of energy present nearly every day, feelings of worthlessness or excessive guilt, recurrent thoughts of death or suicidal thought, difficulty concentrating or making decisions, insomnia or sleeping excessively, physical agitation or physically slowing.

Melancholia is a severe sub-type of a major depressive episode where there is a complete loss of pleasure in almost all activities

and/or a lack of reactivity to pleasurable experiences. The depression is usually worse in the morning with undesired early morning awakening. There tends to be excessive guilty feelings, significant loss of appetite or weight loss and psychomotor slowing or agitation.

In contrast with melancholia, the "atypical" sub-type of depressive episode presents with mood reactivity, increased appetite or weight gain, excessive sleep or feeling sleepy during the day, leaden paralysis (heavy feeling in the arms or legs) and excessive sensitivity to interpersonal rejection.

Bipolar Disorder

Characterized by the presence or history of at least one manic or hypomanic episode: A one week period of abnormally and persistently elevated, irritable, or expansive mood. May be less than one week if hospitalization is required. During this period of mood disturbance, three or more of the following symptoms must be present: inflated self-esteem, decreased need for sleep, excessive speech, flight of ideas or racing thoughts, distractability, increase in goal directed activity, excessive involvement in pleasurable activities that have potentially negative consequences.

Bipolar II is characterized by all the above symptoms though not sufficiently severe to cause impairment in occupational, or social/relationship settings. With bipolar II disorder the above group of symptoms would be classifieds as hypomania instead of mania. One with bipolar II would not require hospitalization for hypomanic symptoms or experience psychotic symptoms, i.e., hallucinations or delusions, as part of the hypomania.

 

While not necessary for the diagnosis, bipolar disorder is also characterized by major depressive episodes, hence the previous name "manic-depression".

Generalized Anxiety Disorder (GAD)

Excessive anxiety or worry present more days than not concerning more than one event or activity for six months. Three or more of the following are also present: restlessness or feeling on edge, fatigue, difficulty concentrating or thinking, irritability, muscle tension, disturbed sleep.

 

Anxiety, worry, or physical symptoms are sufficiently severe to cause impairment in occupational, or social/relationship settings.

Obsessive Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder is characterized by inappropriate and intrusive thoughts, impulses, compulsions and behaviors that interfere with one's functioning or take up excessive time.  A person will generally realize the obsessions and/or compulsions are excessive or unreasonable. Common compulsions:  Hand washing, counting, checking, repeating behaviors (rituals).

Schizophrenia

The diagnosis of schizophrenia is often made when psychotic symptoms last for at least six months in the absence or relative absence of mood involvement.

Symptoms fall into two categories: positive symptoms and negative symptoms. Positive symptoms tend to be distortions of otherwise normal functions i.e., delusions and hallucinations. Negative symptoms exhibit a loss or diminishing of normal functions.  Some examples are: loss of range or intensity of emotion expression or "relatedness" to a situation. Loss of the fluency or productivity of thoughts or speech. Loss of the ability to initiate goal-directed behavior. Social withdrawal.

 

Schizophrenia is divided into five sub-types: paranoid, disorganized, catatonic, undifferentiated, and residual. In the paranoid type, positive symptoms predominate and negative symptoms are less apparent. Delusions and hallucinations are apparent with a relative preservation of affect and cognition. ​Disorganized type tends to display a preponderance of negative symptoms such as disorganized speech and behavior, social withdrawal and inappropriate or unrelated affect. The hallmark of catatonic type is psychomotor disturbance characterized by immobility, mutism, echolalia, and posturing. 

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