Mental Health Disorders: Symptoms, Diagnosis, and Treatment Principles

Posted on Jan 4, 2025 in Psychology and Sociology

Affective Disorder Treatment Principles

Depression without Psychosis

  • I- Give Antidepressants: SSRIs (Citalopram/ Fluoxetine)
  • II- Psychotherapy
  • III- Mixed

1st line therapy is AD

If only partial response, add Lithium

Maintain: Continue therapy till the end.

If recurrence, give prophylaxis

Depression with Psychosis

  • Psychotherapy
  • Combine AD + AP
  • Olanzapine – Fluoxetine

Combination AD + AP is better

Dysthymia

  • X: SSRI, TCA, MAO
  • Psychological: Mania
  • Other X: Olanzapine/ Quetiapine/ Risperidone

Suicide: Risk Factors and Urgent Help

Risk Factors

  • Previous attempt
  • Psychiatric disorders
  • Family history
  • Substance abuse
  • History of impulse or reckless behavior
  • Age 20-28, or >60
  • Gender
  • Loss (family, job)
  • Chronic illness

Urgent Help

  • Stabilize the person in the ER
  • If patient took X, wash stomach
  • If bleeding, stop it
  • Treat life-threatening/ acute conditions
  • Patient is stable, relocate to psychiatry

Questions to Ask

  • Why now?
  • What can be solved by committing suicide?

Be direct, empathetic, don’t argue, understanding.

Check for other psychiatric conditions:

  • Depression
  • Schizophrenia
  • Check for terminal illness

Panic Disorder: Clinical Features, Principles of Treatment

Acute spontaneous fear with respiratory and ANS symptoms!

Clinical Features

  • Acute and spontaneous fear
  • Somatic symptoms (dyspnea, palpitation, abdominal pain, tremor, faintness, choking)
  • Cardinal features (fear of dying, going mad)
  • Duration <30 min, peak at min 10
  • Development of phobias

Treatment

  • I- Psychological (CBT)
  • Cognitive restructuring
  • Techniques
  • Situational

Phobic Anxiety Disorder: Main Clinical Forms and Treatment

Main Clinical Forms

  • Specific phobia
  • Agoraphobia: Fear of open or public spaces
  • Social phobias: Fear of being humiliated/ embarrassed

Treatment

  • I- Psychological (CBT) (Behavior therapy/ exposure techniques)
  • II- X:
    1. BzDz: Decreases phobia, Alprazolam 0.5 mg
    2. SSRI: Fluvoxamine (5-10 mg) for agoraphobia and social phobia
    3. MAOI – Hydrazine
    4. TCA: Clomipramine – if depressed!

Acute Reaction to Stress: Clinical Features and Diagnosis (PTSD)

Occurs in people who have experienced a traumatic event (war, sexual assault) or have themselves participated in it.

Clinical Features

  • No age dependency
  • Symptoms appear 3-6 months after trauma
  • Disrupted sleep
  • Flashbacks
  • Vivid dreams
  • Social withdrawal
  • Partial amnesia of events
  • Hyper-aroused upon re-exposure to similar situation

Diagnosis

  • Past traumatic event
  • Intrusion: Of dreams, memories, flashbacks
  • Avoidance of things similar to traumatic event
  • Negative memory of trauma/ negative emotion
  • Arousal: Irritability, aggression

Adjustment Disorder: Clinical Features and Treatment Principles

Emotional response to a stressful event.

Symptoms begin 3 months after the stressful event.

Clinical Features

  • Depression
  • Anxiety
  • Mixed depression and anxiety
  • Drinking
  • Risky behavior
  • Suicidal behavior
  • Physical symptoms

Treatment Principles

  • Psychotherapy: Group therapy with similar patients
  • Crisis intervention (hospitalization/ resolving fast by environment change)
  • Pharmacotherapy: No specific treatment, depends on main symptoms, antidepressants, anxiolytics, lithium)

Dissociative (Conversion) Disorder: Clinical Features, Treatment

Unconscious defense mechanism that involves disruption of mental function such as memory, identity, perception, consciousness.

Forms

  1. Dissociative Identity Disorder: 2 + distinct personality states with negative memory
  2. Dissociative Amnesia: Temporary loss of recall memory due to trauma
  3. Dissociative Fugue: Where basic self-care is preserved but the past is forgotten
  4. Dissociative Stupor: No voluntary movement, responds normally to external stimuli
  5. Depersonalization: Persistent feeling of detachment from oneself!

Principles of Treatment

  • Psychotherapy: CBT
  • Hypnosis
  • X: SSRI, Beta-blocker, MAO
  • ECT
  • Group psychotherapy

Obsessive-Compulsive Disorder (OCD): Diagnosis, Treatment

Diagnosis

  • More than 1 hour/day
  • Obsession: Recurrent thoughts which are supposed to be acted out
  • Compulsion: Repetitive behavior in order to neutralize obsession

Treatment

(Image of treatment options)

Diagnosis Criteria of Specific Personality Disorder

  1. Changes in one personality that is different than that of society!
  2. Stereotypic behavior that affects social and occupational function
  3. Stereotypic features begin
  4. May cause distress!

Antisocial and Emotionally Unstable Personality Disorder

Psychopathic Personality Disorder: Ignoring and Violating the Rights of Others

Symptoms

  • Apathy to others
  • Ignore social norms
  • Can’t maintain long-term relationships
  • Low threshold of frustration
  • Inability to feel guilt
  • Blame surrounding

Differential Diagnosis

  • Narcissistic Personality Disorder: No impulsiveness/ aggression
  • Histrionic Personality Disorder: Seeking attention/ psychopathic power-seeking
  • Psychotic or manic episodes: Specific trigger

Paranoid Personality Disorder: Symptoms and Differential Diagnosis

Paranoid – Constant distrust and suspicion of others!

Symptoms

  • Interpretation of other’s actions as deliberate
  • Oversensitivity, suspicion
  • Jealousy
  • Blaming others
  • Overvalue one’s ability
  • Hold grudges
  • Problems with colleagues and authority

Differential Diagnosis

  • Schizophrenia: (PPD do not lose it & have no hallucination)
  • Schizoid Personality Disorder: (PPD the speech is normal)
  • Use of X!

Schizoid Personality Disorder: Symptoms and Differential Diagnosis

Schizoid Personality Disorder

  • High dissociation from social relations
  • Poor emotional reaction

Symptoms

  • Emotional coldness
  • Limited ability to love, anger
  • Ignore criticism
  • Low interest in sex
  • No close friends
  • Ignore social norms
  • Odd speech

Differential Diagnosis

  • Schizophrenia: SPD have negative symptoms but not positive symptoms
  • Anxiety disorder: SPD no criticism fear
  • Medical disorder

Anankastic Personality Disorder: Symptoms and Differential Diagnosis

Definition

Anankastic (Obsessive-Compulsive) Personality Disorder: Pursuit of perfection

Symptoms

  • Preoccupation
  • Devotion to work activities and productivity
  • Inflexible about other opinions and thoughts
  • Unable to discard objects or money
  • Can’t work in groups

Differential Diagnosis

  • OCD: Anxiety disorder, sudden onset, no need for protection

Avoidant Personality Disorder: Symptoms and Differential Diagnosis

Definition (Anxious Personality Disorder)

  • Social discomfort
  • Self-consciousness
  • Fear of rejection
  • Negative evaluation
  • Hesitant

Symptoms

  • Restricted lifestyle
  • Avoiding activities due to fear
  • Failing to develop relationships

Differential Diagnosis

  • Dependent Personality Disorder: APD no need to have them taken care of
  • Neurotic disorder: No sudden onset, trigger
  • Schizoid Personality Disorder: Social isolation but no low self-esteem

Histrionic Personality Disorder: Symptoms and Differential Diagnosis

Histrionic Personality Disorder

  • Excessive emotional
  • Attention-seeking
  • Drama queen

Symptoms

  • Center of attention
  • Acting like a victim
  • Interpersonal relationship with a dominant partner
  • Excessive concern about physical activity

Differential Diagnosis

  • Narcissistic Personality Disorder: Desperately looking for attention