Part II. Chief Guide in Abnormal Psychology

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Good Shepherd Professional Training Services (GSPTS) – National Review Center for Psychology and Counseling,
Psychologists and Psychometricians National Review Program 2022-2023
August 2022-February 2023, Manila, Philippines
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NEURO-DEVELOPMENTAL DISORDERS Out of these there is about 85% have mild
intellectual disability
A. Intellectual disability (intellectual
developmental disorder) • Intellectual Disability (ID): Statistics
• Prevalence = 1-3%
• It is a disorder with onset during the • 90% = mild MR
developmental period that includes • Male : Female = 1.6:1
both intellectual and adaptive • Chronic course
functioning deficits in conceptual, • Highly variable individual
social, and practical domains. The prognosis
following three criteria must be met:
Causes of Intellectual Disability (ID)
• A. Deficits in intellectual functions, such • Hundreds of known causes
as reasoning, problem solving, planning, • Environmental
abstract thinking, judgment, academic • Prenatal
learning, and learning from experience, • Perinatal
confirmed by both clinical assessment • Postnatal
and individualized, standardized
intelligence testing. Causes: Biological Contributions
• B. Deficits in adaptive functioning that
result in failure to meet developmental • Genetic Influences
and sociocultural standards for personal • Multiple genes
independence and social responsibility. • Single genes
Without ongoing support, the adaptive • Dominant
deficits limit functioning in one or more • Recessive
activities of daily life, such as • Phenylketonuria (PKU)
communication, social participation, • Lesch-Nyham syndrome
and independent living, across multiple • X-linked (males)
environments, such as home, school, • Causes: Biological Contributions
work, and community. • Chromosomal Influences
• C. Onset of intellectual and adaptive • Down syndrome
deficits during the developmental • Extra 21st chromosome:
period. Trisomy 21
• Specify Severity, according to Adaptive • Physical symptoms
Functioning if: • Increased prevalence of
Mild Alzheimer’s
Moderate • Risk increases with
Profound maternal age
Severe • Causes: Biological Contributions
• Domains include Conceptual, Social, • Fragile X syndrome
Practical Areas • Learning disabilities
• Hyperactivity
• Perseverative speech
Prevalence is approximately 1% of general • Gaze avoidance
population
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Causes: Psychological and Social Dimensions • significant limitations in
• communication
• Nearly 75% not associated with • self-care
biological cause • home living,
• Mild levels, impairments • vocational,
• Good adaptive skills • academic skills,
• Cultural-familial retardation • leisure,
• Abuse • health and safety.
• Neglect
• Social deprivation Common signs may include:
Treatment of Intellectual Disability (ID) • Delayed acquisition of milestones: the

child is late in sitting up, crawling,
Treatments walking
Early intervention may include: • Limited reasoning or conceptual
abilities
• Speech therapy • Fine/gross motor difficulties
• Occupational therapy • Poor social skills/judgment
• Physical therapy • Aggressive behavior as a coping skill
• Family counseling • Communication problems
Skill instruction C. Communication Disorders
• Productivity 1. Language Disorders

• Independence
• Education The core diagnostic features of language
• Behavioral management disorder are difficulties in the acquisition and
• Task analysis use of language due to deficits in the
• Living and self-care comprehension or production of vocabulary,
• Communication training
sentence structure, and discourse.
• Employment
• Community and supportive When a child has difficulty getting his meaning
interventions across using speech, writing, or even gestures,
we may be seeing a language disorder.
B. Global Developmental Delay
Diagnostic Criteria
 This refers to a diagnosis in which an
individual fails to meet expected A. Persistent difficulties in the
developmental milestones in several acquisition and use of language across
areas of intellectual functioning. modalities (i.e., spoken, written, sign
 A condition that occurs during the language, or other) due to deficits in
developmental period of a child's comprehension or production that
life. include the following:
1. Reduced vocabulary (word

Characterized by: knowledge and use).
• lower intellectual functioning
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2. Limited sentence structure (ability to A. Persistent difficulty with speech sound
put words and word endings together production that interferes with speech
to form sentences based on the rules of intelligibility or prevents verbal
grammar and morphology). communication of messages.
3. Impairments in discourse (ability to B. The disturbance causes limitations in

use vocabulary and connect sentences effective communication that interfere with
to explain or describe a topic or series social participation, academic achievement,
of events or have a conversation). or occupational performance, individually
or in any combination.
B. Language abilities are substantially
and quantifiably below those expected C. Onset of symptoms is in the early
for age, resulting in functional developmental period.
limitations in effective communication,
D. The difficulties are not attributable to
social participation, academic
congenital or acquired conditions, such as
achievement, or occupational
cerebral palsy, cleft palate, deafness or
performance, individually or in any
hearing loss, traumatic brain injury, or other
combination.
medical or neurological conditions.
C. Onset of symptoms is in the early
The disturbance causes limitations in effective
developmental period.
communication that interfere with
D. The difficulties are not attributable
• social participation,
to hearing or other sensory impairment,
• academic achievement, or
motor dysfunction, or another medical
• occupational performance.
or neurological condition and are not The difficulties are not attributable to
better explained by intellectual congenital or acquired conditions,
disability (intellectual developmental
disorder) or global developmental • cerebral palsy
delay. • cleft palate,
• deafness or hearing loss
When a child has difficulty getting his meaning • traumatic brain injury,
across using speech, writing, or even gestures, • other medical or neurological
we may be seeing a language disorder. conditions.
a) Expressive Language Disorder 2. Childhood-Onset Fluency Disorder

Difficulty expressing meaning to (Stuttering)
other people.
b) Receptive Language Disorder Diagnostic Criteria
Difficulty understanding other
A. Disturbances in the normal fluency and
speakers.
time patterning of speech that are
inappropriate for the individual’s age and
1. Speech Sound Disorder
language skills, persist over time, and are
characterized by frequent and marked
Diagnostic Criteria
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occurrences of one (or more) of the 1. Speech modifications: using strategies
following: for easy onset, slow easy speech, and
breathing techniques.
1. Sound and syllable repetitions. 2. Desensitization: creating awareness of
stuttering moments and how to
2. Sound prolongations of consonants as
approach them with less tension.
well as vowels.
3. Using structured activities to address
3. Broken words (e.g., pauses within a the emotions/attitudes of stuttering to
word). promote positive self-esteem.
4. Audible or silent blocking (filled or unfilled E. Social (Pragmatic) Communication Disorder

pauses in speech).
A. Persistent difficulties in the social use of
5. Circumlocutions (word substitutions to verbal and nonverbal communication as man-
avoid problematic words). ifested by all of the following:
6. Words produced with an excess of
1. Deficits in using communication for
physical tension.
social purposes, such as greeting and
7. Monosyllabic whole-word repetitions (e.g., sharing information, in a manner that is
appropriate for the social context.
“I-I-I-I see him”). 2. Impairment of the ability to change
communication to match context or the
B. The disturbance causes anxiety about
needs of the listener, such as speaking
speaking or limitations in effective differently in a classroom than on a
communication, social participation, or playground, talking differently to a child
academic or occupational performance, than to an adult, and avoiding use of
overly formal language.
individually or in any combination.
3. Difficulties following rules for
conversation and storytelling, such as
C. The onset of symptoms is in the early
taking turns in conversation, rephrasing
developmental period. (Note: Later-onset when misunderstood, and knowing how
cases are diagnosed as 307.0 [F98.5] adult- to use verbal and nonverbal signals to
onset fluency disorder.) regulate interaction.
4. Difficulties understanding what is not
D. The disturbance is not attributable to a explicitly stated (e.g., making
speech-motor or sensory deficit, dysfluency inferences) and nonliteral or ambiguous
meanings of language (e.g., idioms,
associated with neurological insult (e.g., humor, metaphors, multiple meanings
stroke, tumor, trauma), or another medical that depend on the context for
condition and is not better explained by interpretation).
another mental disorder. 5. The deficits result in functional
limitations in effective communication,
Indirect treatment: Suggestions made to the social participation, social relationships,
family to create a fluency-enhancing academic achievement, or occupational
performance, individually or in
environment and promote positive parent combination.
responses to the child’s speech. 6. The onset of the symptoms is in the
early developmental period (but deficits
Direct treatment: may not become fully manifest until
social communication demands exceed
limited capacities).
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7. Thesymptomsarenotattributabletoanothe G. Autism Spectrum Disorders
rmedicalorneurologicalconditionortolow
abilities in the domains of word structure A. Persistent deficits in social communication
and grammar, and are not better and social interaction across multiple contexts,
explained by autism spectrum disorder, as manifested by the following, currently or by
intellectual disability (intellectual
developmental disorder), global history (examples are illustrative, not
developmental delay, or another mental exhaustive;:
disorder.
1. Deficits in social-emotional reciprocity,
Risk Factors ranging, for example, from abnormal social
approach and failure of normal back-and-forth
A child is at higher risk for social communication conversation; to reduced sharing of interests,
disorder if there is a family history of autism emotions, or affect; to failure to initiate or
spectrum disorder, communication disorders, respond to social interactions.
or specific learning disorder.
2. Deficits in nonverbal communicative
• symptoms of the disorder must be behaviors used for social interaction, ranging,
present in early childhood
for example, from poorly integrated verbal and
• though they may not fully manifest until
nonverbal communication; to abnormalities in
speech, language, and communication
eye contact and body language or deficits in
demands start to exceed her pragmatic
skills. understanding and use of gestures: to a total
• Autism spectrum disorder must be lack of facial expressions and nonverbal
ruled out for a SCD diagnosis. communication.
3. Deficits in developing, maintaining, and

F. Unspecified Communication Disorder 307.9
understanding relationships, ranging, for
(F80.9)
example, from difficulties adjusting behavior to
• symptoms characteristic of suit various social contexts; to difficulties in
communication disorder that cause sharing imaginative play or in making friends; to
clinically significant distress or absence of interest in peers.
impairment in social, occupational, or
other important areas of functioning Specify current severity: Severity is based on
predominate but do not meet the full social communication impairments and
criteria for communication disorder or restricted, repetitive patterns of behavior.
for any of the disorders in the
neurodevelopmental disorders B. Restricted, repetitive patterns of behavior,
diagnostic class. interests, or activities, as manifested by at least
• It is used in situations in which the two of the following, currently or by history
clinician chooses not to specify the (examples are illustrative, not exhaustive; see
reason that the criteria are not met for text):
communication disorder or for a
specific neurodevelopmental disorder, 1. Stereotyped or repetitive motor movements,
and includes presentations in which use of objects, or speech (e.g., simple motor
there is insufficient information to stereotypies, lining up toys or flipping objects,
make a more specific diagnosis. echolalia, idiosyncratic phrases).
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2. Insistence on sameness, inflexible adherence • Autism and Intellectual Functioning
to routines, or ritualized patterns of verbal or • 40-55% with Intellectual
nonverbal behavior (e.g., extreme distress at Disability
small changes, difficulties with transitions, rigid • Indicator of prognosis
thinking patterns, greeting rituals, need to take • Language ability
same route or eat same food every day). • IQ
3. Highly restricted, fixated interests that are • Genetic influences

abnormal in intensity or focus (e.g., strong • Familial component
attachment to or preoccupation with unusual • 5-10% risk of second
objects, excessively circumscribed or child with autism
perseverative interests). • 50 to 200 fold increase
in risk
4. Hyper- or hypo reactivity to sensory input or • Polygenetic influences
unusual interest in sensory aspects of the • Oxytocin receptor genes
environment (e.g., apparent indifference to • Bonding and social
pain/temperature, adverse response to specific memory
sounds or textures, excessive smelling or
Causes of Autism: Biological
touching of objects, visual fascination with
lights or movement). • Genetic influences
• Familial component
Specify current severity: Severity is based on
• 5-10% risk of second
social communication impairments and child with autism
restricted, repetitive patterns of behavior (see • 50 to 200 fold increase
Table 2). in risk
• Polygenetic influences
C. Symptoms must be present in the early
• Oxytocin receptor genes
developmental period (but may not become
• Bonding and social
fully manifest until social demands exceed memory
limited capacities, or may be masked by learned • Neurobiological Influences
strategies in later life). • Amygdala
• Larger size at birth
D. Symptoms cause clinically significant
• Elevated cortisol
impairment in social, occupational, or other
• Neuronal damage
important areas of current functioning. • Similar size when older
Statistics • Fewer neurons
• Vaccinations?
• 1 in every 500 births • Mercury?
1 in every 150 for spectrum
• Gender and IQ interaction Causes of Autism: Psychological and Social
IQs < 35 = Females
High IQs = Males • Historical Views
• Occurs worldwide • Bad parenting
• Onset = age 3 • Lack of self-awareness
• Limited self-concept
• Behavioral correlates
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• Echolalia 1. Inattention: Six (or more) of the following
• Self-injury symptoms have persisted for at least 6
• Social deficiencies are months to a degree that is inconsistent with
primary distinguishers developmental level and that negatively
impacts directly on social and
Treatment academic/occupational activities:
There is currently no 'cure' for autism spectrum Note: The symptoms are not solely a
disorder (ASD). manifestation of oppositional behavior,
Treatment for ASD often involves a team of defiance, hostility, or failure to understand
different specialists: tasks or instructions. For older adolescents
and adults (age 17 and older), at least five
Pediatrician symptoms are required.
Psychologist
Psychiatrist a. Often fails to give close attention to
speech and language therapist details or makes careless mistakes in
occupational therapist. schoolwork, at work, or during other
activities (e.g., overlooks or misses details,
Treatment work is inaccurate).
Social-communication programs. The goal is aid b. Often has difficulty sustaining attention
individuals with ASD to communicate and in tasks or play activities (e.g., has difficulty
interact with people and make social situations
remaining focused during lectures,
easier. Depending on your child's age, these
conversations, or lengthy reading).
programs may take place at school, or with a
parent, caretaker or teacher. c. Often does not seem to listen when
Applied behaviour analysis (ABA) This involves spoken to directly (e.g., mind seems
the process of breaking down skills (such as elsewhere, even in the absence of any
communication and cognitive skills) into small
obvious distraction).
tasks and teaching those tasks in a highly
structured way, as well as rewarding and d. Often does not follow through on
reinforcing positive behaviour while instructions and fails to finish schoolwork,
discouraging inappropriate behaviour. chores, or duties in the workplace (e.g.,
starts tasks but quickly loses focus and is
G. Attention Deficit/Hyperactivity Disorder easily sidetracked).
Symptoms of ADHD in children are generally
e. Often has difficulty organizing tasks and
grouped into three categories: inattention, activities (e.g., difficulty managing
hyperactivity, and impulsiveness.
sequential tasks; difficulty keeping
DIAGNOSTIC CRITERIA materials and belongings in order; messy,
disorganized work; has poor time
A. A persistent pattern of inattention management; fails to meet deadlines).
and/or hyperactivity-impulsivity that
interferes with functioning or development, f. Often avoids, dislikes, or is reluctant to
as characterized by (1) and/or (2): engage in tasks that require sustained
mental effort (e.g., schoolwork or
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homework; for older adolescents and d. Often unable to play or engage in leisure
adults,preparing reports, completing forms, activities quietly.
reviewing lengthy papers).
e. Is often “on the go,” acting as if “driven
g. Often loses things necessary for tasks or by a motor” (e.g., is unable to be or
activities (e.g., school materials, uncomfortable being still for extended time,
pencils,books, tools, wallets, keys, as in restaurants, meetings; may be
papenwork, eyeglasses, mobile telephones). experienced by others as being restless or
difficult to keep up with).
h. Is often easily distracted by extraneous
stimuli (for older adolescents and adults, f. Often talks excessively.
may include unrelated thoughts).
g. Often blurts out an answer before a
i. Is often forgetful in daily activities (e.g., question has been completed (e.g.,
doing chores, running errands; for older completes people’s sentences; cannot wait
adolescents and adults, returning calls, for turn in conversation).
paying bills, keeping appointments).
h. Often has difficulty waiting his or her turn
2. Hyperactivity and impuisivity: Six (or (e.g., while waiting in line).
more) of the following symptoms have
i. Often interrupts or intrudes on others
persisted for at least 6 months to a degree
(e.g., butts into conversations, games, or
that is inconsistent with developmental
activities; may start using other people’s
level and that negatively impacts directly on
things without asking or receiving
social and academic/occupational activities:
permission; for adolescents and adults, may
Note: The symptoms are not solely a intrude into or take over what others are
manifestation of oppositional behavior, doing).
defiance, hostility, or a failure to
B. Several inattentive or hyperactive-
understand tasks or instructions. For older
impulsive symptoms were present prior to
adolescents and adults (age 17 and older),
age 12 years.
at least five symptoms are required.
C. Several inattentive or hyperactive-
a. Often fidgets with or taps hands or feet
impulsive symptoms are present in two or
or squirms in seat.
more settings (e.g., at home, school, or
b. Often leaves seat in situations when work; with friends or relatives; in other
remaining seated is expected (e.g., leaves activities).
his or her place in the classroom, in the
D. There is clear evidence that the
office or other workplace, or in other
symptoms interfere with, or reduce the
situations that require remaining in place).
quality of, social, academic, or occupational
c. Often runs about or climbs in situations functioning.
where it is inappropriate. (Note: In
E. The symptoms do not occur exclusively
adolescents or adults, may be limited to
during the course of schizophrenia or
feeling restless.)
another psychotic disorder and are not
better explained by another mental
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disorder (e.g., mood disorder, anxiety or any of the disorders in the
disorder, dissociative disorder, personality neurodevelopmental disorders
disorder, substance intoxication or diagnostic class.
withdrawal). • Used in situations in which the clinician
chooses to communicate the specific
Specify whether: reason that the presentation does not
meet the criteria for attention-
314.01 (F90.2) Combined presentation: If deficit/hyperactivity disorder or any
both Criterion A1 (inattention) and Criterion specific neurodevelopmental disorder.
A2 (hyperactivity-impulsivity) are met for • This is done by recording “other
the past 6 months. specified attention-deficit/hyperactivity
disorder” followed by the specific
314.00 (F90.0) Predominantly inattentive
reason (e.g., “with insufficient
presentation: If Criterion A1 (inattention) is
inattention symptoms”)
met but Criterion A2 (hyperactivity-
impulsivity) is not met for the past 6 I. Unspecified Attention Deficit/Hyperactivity
months. Disorder 314.01 (F90.8)
314.01 (F90.1) Predominantly Category applies to:
hyperactive/impulsive presentation: If
Criterion A2 (hyperactivity-impulsivity) is • symptoms characteristic of ADHD that
met and Criterion A1 (inattention) is not cause CSD or impairment in social,
met for the past 6 months. occupational, or other important areas
of functioning
Specify current severity: • DO NOT MEET full criteria for ADHD or
any of the disorders in the
Mild: Few and minor impairments in social neurodevelopmental disorders
or occupational functioning. diagnostic class.
• Used in situations in which the clinician
Moderate: Symptoms or functional
chooses not to specify the reason that
impairment between “mild” and “severe” are
the criteria are not met for
present. ADHD/specific ND, and;
Severe: Many symptoms which results in • includes presentations in which there is
marked impairment in social or insufficient information to make a more
specific diagnosis.
occupational functioning.
H. Other Specified Attention ADHD: Statistics

Deficit/Hyperactivity Disorder 314.01 (F90.8)
• Prevalence = 3-7% of school-aged
Applies to: children
• 5.2% worldwide
• Symptoms are causing clinically • Onset = age 3 or 4
significant distress or impairment in • Boys : Girls = 3:1
social, occupational or other important • Different symptom
areas of functioning predominate manifestations?
• Do not meet the full criteria for • Possible cultural construct?
attention-deficit/hyperactivity disorder • Likely not
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• ~50% have problems as adults • Peers
• Inattention persists • Adults
• Hyperactivity, impulsivity • Peer rejection
decline • Social isolation
• High comorbidity • Low self-esteem
• 80% of children • Poor self-image
• ODD
• 90% of adults
• Mood disorders What is the treatment for ADHD?
• ADHD: Causes • It cannot be cured.
• GENETICS • It can be controlled.
• Relatedness with a relative with
ADHD • Treatment for ADHD often includes a
• Polygenetic Influence combination of medication and various
• ADHD: Causes psychosocial therapies.
• Neurobiological Contributions
• Smaller brain volume • Treatment Goals of ADHD: Biological
• 3-4% • Reduce impulsivity and
• Frontal cortex and basal ganglia hyperactivity
• Inactivity • Improve attention
• Abnormal development • Stimulants
• Effective for 70%
ADHD: Causes • Example: Ritalin
• Neurochemical Contributions • Other Medications
• Dopamine D4 and D5 receptor • Strattera
gene • Imipramine
• Endophenotypes: Poor • Clonidine
inhibitory control
• ADHD: Causes • Treatment of ADHD: Biological
• The Role of Toxins
• Allergens and food additives • Effects of Medications
(food colors) • Improve compliance
• No evidence • Decrease negative behaviors
• Pregnancy complications • Do not affect learning and
• Alcohol and low birth academic performance
weight • Benefits are not lasting
• Prenatal Maternal smoking following discontinuation
• Increases risk
• Interacts with genetic • Treatment of ADHD: Behavioral and
predisposition Combined
• Behavioral Treatment
ADHD: Causes • Reinforcement programs
• Psychosocial Factors • Reward—appropriate
• Negative feedback behaviors
• Teachers
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•
Punish—inappropriate • Motivational factors
behaviors • Socioeconomic status
• Parent training • Cultural expectations
• Social skills training • Parental interactions
• Combined Treatments • Expectancies
• Recommended
• Superior to individual Specific Learning Disorder
treatments?
• different from acquired skills under
J. Specific Learning Disorder developmental milestones
• it disrupts the normal pattern of
• Learning Disorders learning academic skills
• Performance substantially • not a lack of opportunity of learning or
below expected levels inadequate instruction.
• IQ • different from intellectual disorders
• Age • have at least average intelligence but
• Education are still not able to acquire academic
• Actual vs. expected skills expected for their age, intellectual
achievement ability, experience, and education
• Learning Disorders
• Not due to sensory deficits The following describe the updated 2013 DSM-5
• Reading Disorder diagnostic subtypes of Specific Learning
• Mathematics Disorder Disorder:
• Disorder of Written Expression
1. Specific learning disorder with impairment in
• Learning Disorders: Statistics reading includes possible deficits in:
• Prevalence = 5-10% (US) • Word reading accuracy
• 1% Caucasian • Reading rate or fluency
• 2.6% African American • Reading comprehension
• 4-10% for reading difficulties 2. Specific learning disorder with impairment in
• Boys : Girls = 1:1 written expression includes possible deficits in:
• Higher drop-out rates
• Negative school experiences • Spelling accuracy
• Grammar and punctuation accuracy
Learning Disorders: Causes • Clarity or organization of written
expression
• Genetic and Neurobiological 3. Specific learning disorder with impairment in
Contributions
mathematics includes possible deficits in:
• Familial component
• Polygenetic influence • Number sense
• Cortical structure = inconclusive • Memorization of arithmetic facts
• Cortical activation = different • Accurate or fluent calculation
patterns • Accurate math reasoning
• Learning Disorders: Causes
Learning Disorders: Statistics
• Psychosocial Contributions
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• Prevalence = 5-10% (US) • Psychosocial Contributions
• 1% Caucasian • Motivational factors
• 2.6% African American • Socioeconomic status
• 4-10% for reading difficulties • Cultural expectations
• Boys : Girls = 1:1 • Diagnosed more in
• Higher drop-out rates English speaking
• Negative school experiences countries
• Parental interactions
Learning Disorders: Causes • Reading Habits at Home
(Reading Disorders)
• Genetic and Neurobiological • Expectancies
Contributions
• Familial component Treatment of Learning Disorders
• Polygenetic influence
• Genes 1,2,3,6,11,15 • Educational Interventions
and 18 • Specific skills instructions
• Areas in Brain (Dyslexia) • Vocabulary
• Broca’s area • Discerning meaning
(articulation and • Fact finding
analysis) • Strategy instruction
• Left parietotemporal • Decision making
area (word analysis) • Critical thinking
• Left occipitotemporal • Compensatory skills
area (word recognition)
• Cortical structure = inconclusive Treatment:
• Cortical activation = different
patterns • developing a learning strategy tailored
• Learning Disorders: Causes to take advantage of a child's strengths.
• Familial component • (repetition; mnemonic devices might
• Polygenetic influence make it easier to memorize a math
• Genes 1,2,3,6,11,15 formula; drawing a picture to illustrate
and 18 a word problem might help a child
• Cortical structure = inconclusive visualize what is being asked)
• Cortical activation = different • multimodal teaching
patterns
• Learning Disorders: Causes If a child has trouble comprehending a subject
• Brain Structure with his or her eyes and ears alone, other
• 3 Areas in Brain (Dyslexia) senses such as touch, taste, and even smell can
• Broca’s area play a role in the learning process. Similarly,
(articulation and learning to convert one sort of problem into
analysis) another format may help (e.g. changing a
• Left parietotemporal traditional math problem into a word problem).
area (word analysis)
• Left occipitotemporal
area (word recognition)
• Learning Disorders: Causes
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SCHIZOPHRENIA AND OTHER PSYCHOTIC • Difficulty in focusing and
DISORDERS maintaining attention
• Deficits in the working memory
• Schizophrenia (ability to hold information and
One form of psychosis manipulate it)
Persons loses touch with reality • Difficulty in keeping in touch
Develops around late teenage years or early with reality
adulthood
Devastating, not only to the patient but also to • Delusions
the family ideas that an individual believes are true but are
highly unlikely and often simply impossible.
• Schizophrenia • Hallucinations
Greek words schizein, meaning “to split,” and Unreal perceptual experiences
phren, meaning “mind.” Sensory experience in absence of
environmental stimuli or input
• Schizophrenia
Characterized by a broad spectrum of cognitive TYPES OF DELUSIONS
and emotional dysfunctions including delusions
and hallucinations, disorganized speech and • Persecutory Delusion
behavior, and inappropriate emotions • Delusion of Reference
• Grandiose Delusion
• Schizophrenia • Delusion of Being Controlled
In 1883, German psychiatrist Emil Kraepelin • Thought Broadcasting
labeled the disorder dementia praecox • Thought Insertion
(precocious dementia), because he believed • Thought Withdrawal
that the disorder results from premature • Delusion of Guilt or Sin
deterioration of the brain. • Somatic Delusion
• Disorganized thinking
CHARACTERISED Formal thought disorder
• Loosening of
• Positive Symptoms associations
• DELUSIONS • Derailment
• HALLUCINATIONS • Word Salad
• DISORGANIZED THOUGHT AND • Neologism
SPEECH • Clang Association
• DISORGANIZED OR CATATONIC
BEHAVIOR • Disorganized Behavior
• Negative Symptoms Frightening to others
• AFFECTIVE FLATTENING display unpredictable and apparently
• ALOGIA untriggered agitation—suddenly shouting,
• AVOLITION swearing, or pacing rapidly
• ASOCIALITY May be responses to hallucinations or delusions
• Cognitive Deficits • Disorganized Behavior

• Attention and Memory Trouble organizing their daily routines of
bathing, dressing properly, and eating regularly
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They may engage in socially unacceptable TYPES OF SYMPTOMS
behavior, such as public masturbation.
Many are disheveled and dirty, sometimes • PRODROMAL SYMPTOMS
wearing few clothes on a cold day or heavy are symptoms that are present before people
clothes on a very hot day go into the acute phase of schizophrenia
• RESIDUAL SYMPTOMS
• Catatonia are symptoms that are present after they
disorganized behavior that reflects emerge from it.
unresponsiveness to the world.
In catatonic excitement, the person becomes SCHIZOPHRENIA DISORDERS
wildly agitated for no apparent reason • Delusional Disorder
• Brief Psychotic Disorder
• Negative Symptoms • Schizophreniform Disorder
• Affective Flattening • Schizophrenia
• Blunted Affect • Schizoaffective Disorder
• Severe reduction or • Substance/Medical Induced
absence of affective Psychotic Disorder
responses to the
environment Delusional Disorder
• Face may remain
immobile and body DIAGNOSTIC CRITERIA
language is
unresponsive A. One (or more) delusions with a
• May reflect severe duration of 1 month or longer.
anhedonia B. Criterion A for schizophrenia has never
been met.
• Alogia Note: Hallucinations, if present, are not
Poverty of speech prominent and are related to the delusional
Reduction in speaking theme (e.g., the sensation of being infested
The person may not initiate speech with others with insects associated with delusions of
and, when asked direct questions, may give infestation).
brief, empty replies
Reflects lack of thinking or motivation to speak A. Apart from the impact of the
delusion(s) or its ramifications,
• Avolition functioning is not markedly impaired,
an inability to persist at common, goal-directed and behavior is not obviously bizarre
activities, including those at work, school, and or odd.
home B. If manic or major depressive episodes
great trouble completing tasks, is disorganized have occurred, these have been brief
and careless, and apparently is completely relative to the duration of the
unmotivated delusional periods.
He or she may sit around all day doing almost C. NOT attributable to the physiological
nothing and may withdraw and become socially effects of a substance or an other
isolated medical condition and is not better
explained by another mental disorder,
P a g e 16 | 41
such as body dysmorphic disorder or • 0.2%, in a lifetime prevalence
obsessive-compulsive disorder. • PERSECUTORY IS MOST FREQUENT
SUBTYPE
SPECIFY IF: • common in males: DELUSIONAL
DISORDER, JEALOUS TYPE
• With bizaare content • No major difference in overall
frequency of delusional disorder.
SPECIFY IF:
• First episode, currently in acute episode Dev’t & course

• First episode, currently in partial • Global function is generally better than
remission that observed in schizophrenia
• First episode, currently in full remission • Although diagnosis is generally stable:
• Multiple episodes, currently in acute some individuals go on to schizophrenia
episode • Familial relationship with both
• Multiple episodes, currently in partial schizophrenia and schizotypal
remission personality disorder
• Multiple episodes, currently in full • More in older individuals than younger
remission ones
• Continous • Delusions may be related to culture or
• Unspecified religious background
• Varies across cultural context
Specify current severity:
Each of these symptoms may be rated for its BRIEF PSYCHOTIC DISORDER
current severity (most severe in the last 7 days) Diagnostic Criteria:
on a 5-point scale ranging from 0 (not present)
to 4 (present and severe). (See Clinician-Rated • A. One (or more) of the following
Dimensions of Psychosis Symptom Severity in symptoms. At least one of these must
the chapter “Assessment Measures.”) Note: be (1), (2), or (3):
1. Delusions.
Diagnosis of delusional disorder can be made
2. Hallucinations.
without using this severity specifier.
3. Disorganized speech (e.g., frequent
ASSOCIATED FEATURES derailment or incoherence).
4. Grossly disorganized or catatonic
• Social, marital, or work problems behavior.
• irritable or dysphoric mood, which can • Note: Do not include a symptom if it is
usually be understood as a reaction to a culturally sanctioned response.
their delusional beliefs B. Episode of the disturbance is at least 1 day
• Anger and violent behavior can occur but less than 1 month, with eventual full
with persecutory jealous, and return to premorbid level of functioning.
érotomanic types
• engage in litigious or antagonistic
behavior C. NOT better explained by major depressive
or bipolar disorder with psychotic features or
PREVALENCE another psychotic disorder and IS NOT
P a g e 17 | 41
attributable to the physiological effects of a • onset can occur across the lifespan
substance or another medical condition. • MEAN ONSET AT MID-30’S
• Some may have brief psychotic
SPECIFY IF: symptoms
• With marked stressor(s)
• Preexisting personality disorders and
• Without marked stressor(s)
traits predisposes a person to the dev’t
• With postpartum onset:
of disorder:
• With catatonia
• schizotypal personality
disorder; borderline personality
SPECIFY CURRENT SEVERITY:
disorder; or traits in the
• Each of these symptoms may be rated psychoticism domain
for its current severity (most severe in • perceptual dysregulation, and
the last 7 days) on a 5-point scale the negative affectivity domain,
ranging from 0 (not present) to 4 suspiciousness
(present and severe). (See Clinician-
Rated Dim
• Distinguish symptoms from culturally
sanctioned response
ASSOCIATED FEATURES
• Consider cultural and religious
• emotional turmoil or over whelming background
confusion
• have rapid shifts from one intense
SCHIZOPHRENIFORM DISODER
affect to another
• Although disturbance is brief, the level Diagnostic Criteria:
of impairment may be severe, and
supervision may be required to ensure A. 2 (or more) of the following symptoms. At
that nutritional and hygienic needs are least one of these must be (1), (2), or (3):
met protected from the consequences
of poor judgment, cognitive 1. Delusions.
impairment, or acting on the basis of 2. Hallucinations.
delusions 3. Disorganized speech (e.g., frequent
• increased risk of suicidal behavior, derailment or incoherence).
particularly during the acute episode 4. Grossly disorganized or catatonic
behavior.
PREVALENCE
B. Episode last at least 1 month but less than 6
• 9% of cases of first-onset psychosis months. Use provisional in dianogiss if it must
• Psychotic disturbances that meet be made without waiting for recovery.
Criteria A and C, but not Criterion B, for
brief psychotic disorder – more
common in DEVELOPING COUNTRIES C. Rule out if Schizoaffective disorder and
• more common in females depressive or bipolar disorder with psychotic
features because either 1) no major depressive
DEV’T & COURSE or manic episodes have occurred concurrently
with the active-phase symptoms, or 2) if mood
• adolescence or early adulthood
P a g e 18 | 41
episodes have occurred dur ing active-phase 2. Hallucinations.
symptoms, they have been present for a 3. Disorganized speech (e.g., frequent
minority of the total duration of the active and derailment or incoherence).
residual periods of the illness. 4. Grossly disorganized or catatonic
behavior.
D. NOT attributable to the physiological effects
of a substance (e.g., a drug of abuse, a B. Level of functioning in 1 or more major areas
medication) or another medical condition. is markedly below the level achieved prior to
the onset occurs in significant portion of time
SPECIFY IF:
from onset of disturbance
• With good prognostic features
C. Disturbance persists for at least 6 months.
• Without good prognostic features
During the 6-month period, there is an inclusion
• With Catatonia
of at least 1 month of symptoms that meet
Criterion A and C. and may include prodromal
SPECIFY CURRENT SEVERITY: or residual symptoms. And on prodromal or
residual periods, the signs of the disturbance
Each of these symptoms may be rated for its
may be manifested by only negative symptoms
current severity (most severe in the last 7 days)
or by two or more symptoms listed in Criterion
on a 5-point scale ranging from 0 (not present)
A present in an attenuated form.
to 4 (present and severe). (See Clinician-Rated
Dimensions of Psychosis Symptom Severity in D. Rule out if Schizoaffective disorder and
the chapter “Assessment Measures.”) depressive or bipolar disorder with psychotic
features because either 1) no major depressive
ASSOCIATED FEATURES: Abnormalities in
or manic episodes have occurred concurrently
multiple brain regions seen in neuroimaging,
with the active-phase symptoms, or 2) if mood
neuropathological and neurophysiological
episodes have occurred during active-phase
research.
symptoms, they have been present for a
PREVALENCE: minority of the total duration of the active and
residual periods of the illness.
• Similar to schizophrenia
• Low incidence (fivefold less than schiz) E. NOT attributable to the physiological effects
• Higher incidence in developing of a substance (e.g., a drug of abuse, a
countries esp. for specifier with good medication) or another medical condition.
prognostic features
RISK & PROGNOSTIC FACTORS F. If there is a history of autism spectrum
disorder or a communication disorder of child
- Genetic and familial hood onset, the additional diagnosis of
SCHIZOPHRENIA DISODER schizophrenia is made only if prominent delu-
sions or hallucinations, in addition to the other
Diagnostic Criteria: required symptoms of schizophrenia, are also
A. 2 (or more) of the following symptoms. At present for at least 1 month (or less if
least one of these must be (1), (2), or (3): successfully treated).
1. Delusions.
P a g e 19 | 41
SPECIFY IF: • lack insight or awareness of their
disorder (predictor of non-adherence to
• First episode, currently in partial treatment—leading to higher relapse
remission rates, increased number of involuntary
• First episode, currently in full remission treatments, poorer psycho social
• Multiple episodes, currently in acute functioning, aggression, and a poorer
episode course of illness)
• Multiple episodes, currently in partial
remission PREVALENCE
• Multiple episode, currently in full
remission • 0.3%-0.7%
• W/ Catatonia • sex ratio differs
SPECIFY CURRENT SEVERITY: - Males have higher incidence on
negative symptoms and longer
Each of these symptoms may be rated for its duration
current severity (most severe in the last 7 - Females are higher in mood
days) on a 5-point scale ranging from 0 (not symptoms and briefer
present) to 4 (present and severe). (See presentation
Clinician-Rated Dimensions of Psychosis
Symptom Severity in the chapter “Assessment • Statistics
Measures.”) Generally chronic
Significant functioning in society
Associated features 85% go through prodromal phase
1-2 years before diagnosed and treated
• inappropriate affect
Children who develop them show mild physical
• dysphoric mood that can take the form
abnormalities, poor motor coordination, mild
of depression, anxiety, or anger; a
cognitive and social problems
disturbed sleep pattern
Initially they hide, recover and relapse
• lack of interest in eating or food refusal
DEVELOPMENT & COURSE
• Depersonalization, derealization, and
somatic concerns • Majority have slow and gradual
• Cognitive deficits linked with vocational development of a variety symptoms
and functional impairments • Some with depressive symptoms
• Reduced attention, declarative • Cognitive impairments may persist even
memory, working memory, language when other symptoms are in full
function, and other executive functions remission
and slow processing • Course and outcome may not be
• sensory processing and inhibitory reliably predicted
capacity • Require formal and informal daily living
• social cognition deficits, including supports
deficits in the ability to infer the • Psychotic symptoms diminish over time
intentions of other people due decline in dopamine activity
• may attend to and then inteφret • Negative symptoms may persist
irrelevant events or stimuli as • Difficult to diagnose in children
meaningful, perhaps leading to the • Delusions and hallucinations are less
generation of explanatory delusions elaborate in children
P a g e 20 | 41
• Child onset cases resemble poor- The Dopamine Hypothesis
outcome in adult cases • Agonists
• Children diagnosed may experience • Increase
nonspecific emotional-behavioral schizophrenic-
disturbances and psychopathology, like behavior
intellectual and language alterations, • Antagonists
and subtle motor delays • Reduce
• Late onset of cases in female, married schizophrenic-
status – (more psychotic symptoms like behavior
with preservation of affect and social • Ex: Neuroleptics, L-
functioning) Dopa, amphetamines
• late teens and the mid-30s; onset prior Overly simplistic
to adolescence is rare • Problematic
• peak age at onset for the first psychotic • Antagonists
ep isode is in the early- to mid-20s for don’t always
males and in the late-20s for females work
• Onset may be abrupt or insidious • Slow response
to meds
CAUSES OF DISORDER • Little impact on
negative
• Cultural Factors symptoms
Does schizophrenia even exist?
Label for difficult, unusual people
Worldwide prevalence is similar • Current Theories
Course and outcomes are different Several neurotransmitters
Higher prevalence in African Americans (U.S.) Striatial D2 receptors (excess)
Misdiagnosis Prefrontal D1 receptors (deficit)
Bias in race Glutamate
Stigma and stereotyping
• Brain Structure
• Genetic influences Enlarged ventricles
Inherited vulnerability for schizophrenia Reduced tissue volume
Polygenetic influences Hypofrontality
Risk increases with genetic relatedness Dorsolateral prefrontal cortex
Risk is transmitted independently of diagnosis
Interaction with environment
• Family Studies • Prenatal and Perinatal Influences

Parent’s severity increases likelihood for Viral Infections
children Influenza
Do inherit: general predisposition Pregnancy complications
Do not inherit: specific forms Bleeding
Good home environment reduces risk of having Rh incompatibility
schizophrenia Delivery complications
• Neurobiological Influences Anoxia
P a g e 21 | 41
Likely interact with genetics and environment • Multiple episodes, currently in partial
remission
• Psychological and Social Influences • Multiple episodes, currently in full
Stress remission
Activates vulnerability • Continuous
Increases relapse risk • Unspecified
Family and relapse
Schizophrenogenic mother SPECIFY CURRENT SEVERITY:
Double-blind communication
High Expressed emotion (EE) Each of these symptoms may be rated for its
High Criticism, hostility, intrusiveness current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not
SCHIZOAFFECTIVE DISODER present) to 4 (present and severe). (See
Clinician-Rated Dimensions of Psychosis
DIAGNOSTIC CRITERIA Symptom Severity in the chapter “Assessment
A. uninterrupted period of illness during Measures.”)
which there is a major mood episode
ASSOCIATED FEATURES
(major depressive or manic) concurrent
with Criterion A of schizophrenia. - Impaired occupational functioning
B. Delusions or hallucinations for 2 or - Restricted social contact and difficulties
more weeks in the absence of a major with self-care
mood episode (depressive or manic) - Poor insight but less than schizophrenia
during the lifetime duration of the - Inc. risked for dev. Episodes of major
illness. depressive disorder or bipolar disorder
C. Symptoms of major mood episode are -
present for the majority of the total PREVALANCE
duration of the active and residual
portions of the illness. - 1/3 as common as schizophrenia
D. NOT attributable to the effects of a - Lifetime prevalence of .3%
substance or another medical - Higher in females – due to depressive
condition. type in females
SPECIFY WHETHER:
DEV’T & COURSE
- Bipolar type
- Adult onset but can occur in between
- Depressive type
adolescent to later in life
- With Catatonia
- An ind. diagnosed with another illness
SPECIFY IF:
will initially receive schiz
• First episode, currently acute episode - Prognosis is better than schiz
• First episode, currently in partial - Variety of temporal patterns: eg. Having
remission hallucinations and delusions for 2
• Multiple episodes, currently in full months before major depressive
remission episode
• Multiple episodes, currently in acute - Depressive or manic symptoms can
episode occur before the onset of psychosis,
during acute psychotic episodes, during
P a g e 22 | 41
residual periods, and after cessation of exposure to a medication based from
psychosis history, physical examination, or
- Adult onset but can occur in between laboratory findings.
adolescent to later in life
- An ind. diagnosed with another illness 2) The involved substance/medication is
will initially receive schiz capable of producing the symptoms in
- Prognosis is better than schiz Criterion A.
- Variety of temporal patterns: eg. Having
hallucinations and delusions for 2 C. NOT explained by a psychotic disorder
months before major depressive that is not substance/ medication-induced.
episode
Such evidence of an independent psychotic
- Depressive or manic symptoms can
disorder could include the following:
occur before the onset of psychosis,
during acute psychotic episodes, during 1. The symptoms preceded the onset of
residual periods, and after cessation of the substance/medication use; the
psychosis symptoms persist for a substantial period of
- RISK & PROGNOSTIC FACTORS time after the cessation of acute
- Inc. risk among 1st degree
withdrawal or severe intoxication: or there
relatives with schiz, bipolar
is other evidence of an independent non-
disorder, or schizoaffective
disorder substance/medication-induced psychotic
- disorder.
CULTURE-RELATED DIAGNOSTIC ISSUES D. The disturbance does not occur
- Consider the cultural and exclusively during the course of a delirium.
economic factors
- Overdiagnosis occurse in
E. The disturbance causes clinically
African American and Hispanic
populations significant distress or impairment in social,
- SUICIDE RISK occupational, or other important areas of
- 5% risk of suicide functioning.
- depressive symptoms inc. risk of suicide Code if With use disorder, mild; With use
disorder, moderate or severe, without use
SUBSTANCE/MEDICATION-INDUCED disorder
PSYCHOTIC DISORDER
Here are the substances/medication examples:
DIAGNOSTIC CRITERIA
Alcohol
A. Presence of one or both of the following
symptoms: Cannabis
1. Delusions. Other Hallucinogen

2. Hallucinations. Inhalant
B. 1) Evidence that criterion A developed Sedative, Hypnotic or Anxiolytic
during or soon after a substance
intoxication or withdrawal or after Amphetamine (or other stimulant)
P a g e 23 | 41
Cocaine -hallucination of bugs/vermin can cause skin
scoriation.
Other (or unknown substance)
-cannabis can induce persecutory delusions,
SPECIFY IF
marked anxiety, emotional lability,
With onset during intoxification depersonalization
With onset during withdrawal DEV’T AND COURSE
Each of these symptoms may be rated for its -amphetamines, phencyclidinine, cocaine
current severity (most severe in the last 7 days) evokes temporary psychotic states for weeks or
on a 5-point scale ranging from 0 (not present) longer even if substance is removed.
to 4 (present and severe). (See Clinician-Rated
-medications for parkinsonism, cardiovascular
Dimensions of Psychosis Symptom Severity in
disease, and other medical disorders may be
the chap ter “Assessment Measures.”)
associated with a greater likelihood of psychosis
Psychotic disorders
PSYCHOTIC DISODER DUE TO ANOTHER
-due to intoxication of substances MEDICAL CONDITION
-due to intoxication of medication such as DIAGNOSTIC CRITERIA

anesthetics and analgesics, anticholinergic
A. Prominent hallucinations or delusions.
agents, anticonvulsants, antihistamines,
antihypertensive and cardiovascular B. Evidence shows that thedisturbance is the
medications, antimicrobial medications, direct pathophysiological consequence of
antiparkinsonian medications, another medical condition.
chemotherapeutic agents (e.g., cyclosporine,
C. NOT better explained by another mental
procarbazine), corticosteroids, gastro intestinal
disorder.
medications, muscle relaxants, nonsteroidal
anti-inflammatory medications, other over-the- D. The disturbance does not occur exclusively
counter medications (e.g., phenylephrine, during the course of a delirium.
pseudoephedrine), antidepres sant medication,
and disulfiram. E. The disturbance causes clinically significant
distress or impairment in social, occupational,
-due to anticholinesterase, organophosphate or other important areas of functioning.
insecticides, sarin and other nerve gases,
carbon monoxide, carbon dioxide, and volatile SPECIFY WHETHER:
substances such as fuel or paint. With delusions
Prevalence With hallucinations
-7% and 25% of individuals presenting with a Each of these symptoms may be rated for its
first episode of psychosis current severity (most severe in the last 7
-prolonged, heavy ingestion of alcohol days) on a 5-point scale ranging from 0 (not
present) to 4 (present and seve re). (See
-persecutory delusions after amphetamine use Clinician-Rated Dimensions of Psychosis
P a g e 24 | 41
Symptom Severity in the chapter “Assessment RISK & PROGNOSTIC FACTORS
Measures.”)
-Pre-existing central nervous system injury
PREVALENCE
SUICIDE RISK
psychotic disorder due to another medical
- epilepsy and multiple sclerosis are associated
condition are difficult to es timate given the
with increased rates of suicide
wide variety of underlying medical etiologies
Treatment: Biological Interventions
0.21% to 0.54%
• Historical Treatments—1930s and
Individuals older than 65 years have a
1940s
significantly greater prevalence of 0.74%
• Insulin coma therapy
untreated endocrine and metabolic disorders, • Psychosurgery
autoimmune disorders • Prefrontal lobotomies
• Electroconvulsive therapy
PSYCHOTIC DISODER DUE TO ANOTHER • Antipsychotic Medications
MEDICAL CONDITION (Neuroleptics)
• First line treatment
PSYCHOSIS DUE TO EPILEPSY • Began in the 1950s
• Decrease positive symptoms
HIGHER DISORDER IN FEMALES
• Side effects: common, acute,
Psychosis due to epilepsy has been further permanent
differ entiated into ictal, postictal, and interictal • Extrapyramidal
psychosis. The most common of these is • Parkinson-like
postictal psychosis, observed in 2%-7.8% of • Tardive dyskinesia
• Compliance problems
epilepsy patients.
Higher in females • Transcranial Magnetic Stimulation

• Magnetic fields
single transient state or it may be recurrent, • Possible benefits
cycling with exacerbations and remissions of • Auditory hallucinations
the underlying medical condition
• Historical Approaches
does not differ substantially in phenomenology • Focus on role of early personal
depending on age at occurrence histories
Higher prevalence in Old age • Psychodynamic
• Psychoanalytic
- more affected by stroke disease, anoxic • Little benefit, possible harm
events, and multiple sys tem comorbidities
Treatment: Psychosocial Interventions
Younger age groups
• Psychosocial Approaches
- epilepsy, head trauma, autoimmune, and • Behavioral (i.e., token
neoplastic diseases of early to mid life, economies)
• Inpatient units
• Community care programs
P a g e 25 | 41
• Social and living skills training 1. A distinct period of abnormally and
• Behavioral family therapy persistently elevated, expansive, or
• Vocational rehabilitation irritable mood
• Necessary adjunct to medication
and abnormally and persistently
• Virtual reality technology
increased goal-directed activity or
• Simulation of multiple cognitive energy, lasting at least 1 week and
tasks present most of the day, nearly every
• Diagnosis day (or any duration if hospi talization is
• Cognitive activation necessary).
• Assertive Community Treatment
• Multidisciplinary teams 2. During the period of mood disturbance
• Medication and increased energy or activity, three
management (or more) of the following symptoms
• Psychosocial treatment (four if the mood is only irritable) are
present to a sig nificant degree and
• Vocational represent a noticeable change from
rehabilitation usual behavior:
• Integrated elements increase 1. Inflated self-esteem or
efficacy grandiosity.
2. Decreased need for sleep (e.g.,
• Treatment Across Cultures feels rested after only 3 hours of
sleep).
• Adapting treatment to cultural 3. More talkative than usual or
values pressure to keep talking.
• Involving family members 4. Flight of ideas or subjective
• Adhering to beliefs experience that thoughts are
• Community-based treatments racing.
5. Distractibility (i.e., attention too
easily drawn to unimportant or
• Prevention irrelevant external stimuli), as
• Targeting at risk populations reported or observed.
• Increasing parenting skills 6. Increase in goal-directed activity
• Reducing birth complications (either socially, at work or
• Decreasing early illnesses school, or sexually) or
• Viral vaccinations psychomotor agitation (i.e.,
puφoseless non-goal-directed
activity).
BIPOLAR DISORDER and Related Disorders 7. Excessive involvement in
activities that have a high
• MANIA or Manic Episode potential for painful conse-
• HYPOMANIA or Hypomanic Episode quences (e.g., engaging in
• DEPRESSION Episode unrestrained buying sprees,
sexual indiscretions, or foolish
DIAGNOSTIC CRITERIA business investments).
It is necessary to meet the following criteria for a

manic episode. The manic episode may have
been preceded by and may be followed by hypo- 3. The mood disturbance is sufficiently
manic or major depressive episodes. severe to cause marked impairment in
social or occupational functioning or to
necessitate hospitalization to prevent
MANIC Episode
P a g e 26 | 41
harm to self or others, or there are buying sprees, sexual indiscretions, or
psychotic features. foolish business investments).
4. The episode is not attributable to the 8. Theepisodeisassociatedwithanunequivo
physiological effects of a substance calchangeinfunctioningthatisuncharac
(e.g., a drug of abuse, a medication, teristic of the individual when not
other treatment) or to another medical symptomatic.
condition. 9. The disturbance in mood and the
Note: A full manic episode that emerges change in functioning are observable by
during antidepressant treatment (e.g., others.
medi cation, electroconvulsive therapy)
but persists at a fully syndromal level C. The episode is not severe enough to
beyond the physiological effect of that cause marked impairment in social or
treatment is sufficient evidence for a occupa tional functioning or to necessitate
manic episode and, therefore, a bipolar I hospitalization. If there are psychotic
diagnosis. features, the episode is, by definition, manic.
Note: Criteria A-D constitute a manic episode. At D. The episode is not attributable to the
least one lifetime manic episode is re quired for physiological effects of a substance (e.g., a
the diagnosis of bipolar I disorder. drug of abuse, a medication, other
treatment).
Hypomanic Episode
Note: A full hypomanie episode that
A. A distinct period of abnormally and emerges during antidepressant
persistently elevated, expansive, or irritable treatment (e.g., medication,
mood and abnormally and persistently increased electroconvulsive therapy) but persists
activity or energy, lasting at least 4 consecutive at a fully syndromal level beyond the
days and present most of the day, nearly every physiological effect of that treatment is
day. sufficient evidence for a hypomanie
episode diagnosis. However, caution is
B. During the period of mood disturbance and indicated so that one or two symptoms
increased energy and activity, three (or more) of (particularly in creased irritability,
the following symptoms (four if the mood is only edginess, or agitation following
irritable) have persisted, rep resent a noticeable antidepressant use) are not taken as
change from usual behavior, and have been sufficient for diagnosis of a hypomanie
present to a significant degree: episode, nor necessarily indicative of a
bi polar diathesis.
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels Major Depressive Episode
rested after only 3 hours of sleep).
3. More talkative than usual or pressure to
keep talking. A.
4. Flight of ideas or subjective experience Five(ormore)ofthefollowingsymptomshavebeenp
that thoughts are racing. resentduringthesame2-week
5. Distractibility (i.e., attention too easily
drawn to unimportant or irrelevant period and represent a change from previous
external stimuli), as reported or functioning; at least one of the symptoms is
observed. either (1) depressed mood or (2) loss of interest
6. Increase in goal-directed activity (either or pleasure.
socially, at work or school, or sexually) Note: Do not include symptoms that are clearly
or psychomotor agitation. attributable to another medical condition.
7. Excessive involvement in activities that
have a high potential for painful conse
quences (e.g., engaging in unrestrained
P a g e 27 | 41
1. Depressed mood most of the day, Severe
nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, With psychotic features
or hopeless) or observation made by
others (e.g., appears tearful). (Note: In
In partial remission
children and adolescents, can be
irritable mood.)
2. Markedly diminished interest or pleasure In full remission
in all, or almost all, activities most of the
day, nearly every day (as indicated by Unspecified
either subjective account or
observation). Specify.
3. Significant weight loss when not dieting
or weight gain (e.g., a change of more With anxious distress
than 5% of body weight in a month), or With mixed features
decrease or increase in appetite nearly With rapid cycling
every day. (Note: In children, consider With melancholic features
failure to make expected weight gain.) With atypical features
4. Insomnia or hypersomnia nearly every With mood-congruent psychotic features
day. With mood-incongruent psychotic features
5. Psychomotor agitation or retardation With catatonia
nearly every day (observable by others;
not merely subjective feelings of With péripartum onset
restlessness or being slowed down). With seasonal pattern
6. Fatigue or loss of energy nearly every
day.
ASSOCIATED FEATURES
7. Feelings of worthlessness or excessive
or inappropriate guilt (which may be
delusional) nearly every day (not merely • Does not perceive or see need for
self-reproach or guilt about being sick). treatment; resistant
8. Diminished ability to think or • Change dress, make up or personal
concentrate, or indecisiveness, nearly appearances; sexually suggestive or
every day (either by subjective account flamboyant
or as observed by others). • Perceived sharpness in sense of smell,
9. Recurrent thoughts of death (not just hearing or vision
fear of dying), recurrent suicidal ideation • Gambling and antisocial behaviors;
with out a specific plan, or a suicide during manic episode
attempt or a specific plan for committing • May become hostile and physically
suicide. threatening
• If delusional: physically assaultive or
suicidal
B. The symptoms cause clinically significant
• Does not perceive or see need for
distress or impairment in social, occupational, or
treatment; resistant
other important areas of functioning.
• Change dress, make up or personal
appearances; sexually suggestive or
C. The episode is not attributable to the flamboyant
physiological effects of a substance or another • Perceived sharpness in sense of smell,
medical condition. hearing or vision
• Gambling and antisocial behaviors;
Codes of Bi Polar Disorder during manic episode
• May become hostile and physically
Mild threatening
• If delusional: physically assaultive or
suicidal
Moderate
P a g e 28 | 41
PREVALENCE - Females are more likely to experience
rapid cycling and mixed states; co-
• 12-month prevalence estimate in US; morbidity; eating disorders
0.6% for bipolar I disorder - Females with bipolar I or II disorder are
• 1 male: 1 female more likely to experience depressive
symptoms
- higher lifetime risk of alcohol use
Development and Course
disorder
• Mean age onset 15-18 yrs old; begin in Suicide Risk

adolescence
• Diagnosis in children is judged
according to each baseline  at least 15 times
• Onset occurs throughout the life cycle:  ¼ of all completed suicides
even 60’s or 70’s  past history of suicide attempt
• Manic episodes in late mid-life or late- and percent days spent de
life should prompt consideration of pressed in the past year are
medical conditions associated with greater risk of
• More than 90% of individuals who have suicide attempts or completions.
a single manic episode go on to have
recurrent mood episodes COMORBIDITY
• 60% of manic episodes occur
immediately before a major depressive • anxiety disorder
episode. • ¾ in individuals: ADHD, any disruptive,
• multiple (four or more) mood episodes impulse-control, or conduct disorder,
(major depressive, manic, or • ½ of individuals; any substance use
hypomanie) within 1 year receive the disorder; those with both disorders ---
specifier "with rapid cycling." inc. for suicide attempt
• high rates of serious and/or untreated
CAUSES co-occurring medical conditions
• Metabolic syndrome and migraine
Environmental.
BIPOLAR II DISORDER
- More common in high-income
- Higher rates in Separated, divorced, or For a diagnosis of bipolar II disorder, it is
widowed individuals (unclear) necessary to meet the following criteria for a cur
rent or past hypomanie episode and the following
Genetic and physiological. criteria for a current or past major de pressive
episode:
- - family history
- - 10-fold increased risk among adult Hypomanic Episode
relatives of individuals with bipolar I and
bipolar II A. A distinct period of abnormally and
- - familial co-aggregation of persistently elevated, expansive, or irritable
schizophrenia and bipolar disorder mood and abnormally and persistently increased
activity or energy, lasting at least 4 consecutive
Culture-Related Diagnostic Issues days and present most of the day, nearly every
day.
- - Little information exists on specific
cultural differences in the expression
B. During the period of mood disturbance and
Gender-Related Diagnostic Issues increased energy and activity, three (or more) of
P a g e 29 | 41
the following symptoms have persisted (four if period and represent a change from previous
the mood is only irritable), represent a no- functioning; at least one of the symptoms is
ticeable change from usual behavior, and have either (1 ) depressed mood or (2) loss of interest
been present to a significant degree: or pleasure.
Note: Do not include symptoms that are clearly
1. Inflated self-esteem or grandiosity. attributable to a medical condition.
2. Decreased need for sleep (e.g., feels
rested after only 3 hours of sleep). 2. Depressed mood most of the day,
3. More talkative than usual or pressure to nearly every day, as indicated by either
keep talking. subjec tive report (e.g., feels sad,
empty, or hopeless) or observation
4. Flight of ideas or subjective experience made by others (e.g., appears tearful).
that thoughts are racing. (Note: In children and adolescents, can
5. Distractibility (i.e., attention too easily be irritable mood.)
drawn to unimportant or irrelevant 3. Markedly diminished interest or pleasure
external in all, or almost all, activities most of the
day, nearly every day (as indicated by
either subjective account or
stimuli), as reported or obsen/ed.
observation).
6. Increase in goal-directed activity (either
4. Significant weight loss when not dieting
or weight gain (e.g., a change of more
socially, at work or school, or sexually)
than 5% of body weight in a month), or
or psychomotor agitation.
decrease or increase in appetite nearly
7. Excessive involvement in activities that
every day. (Note: In children, consider
have a high potential for painful conse-
failure to make expected weight gain.)
quences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or 5. Insomnia or hypersomnia nearly every
foolish business investments). day.
C. The episode is associated with an 6. Psychomotor agitation or retardation

unequivocal change in functioning that is nearly every day (observable by others;
uncharacteristic of the individual when not not merely subjective feelings of
symptomatic. restlessness or being slowed down).
D. The disturbance in mood and the change in 7. Fatigue or loss of energy nearly every
functioning are observable by others. day.
E. The episode is not severe enough to cause 8. Feelings of worthlessness or excessive

marked impairment in social or occupa tional or inappropriate guilt (which may be
functioning or to necessitate hospitalization. If delu sional) nearly every day (not
there are psychotic features, the episode is, by merely self-reproach or guilt about being
definition, manic. sick). Diminished ability to think or
concentrate, or indecisiveness, nearly
F. The episode is not attributable to the every day (ei ther by subjective account
physiological effects of a substance (e.g.,a drug or as observed by others).
of abuse, a medication or other treatment).
9. Recurrent thoughts of death (not just
Major Depressive Episode fear of dying), recurrent suicidal ideation
A. with out a specific plan, a suicide
Five(ormore)ofthefollowingsymptomshavebeenp attempt, or a specific plan for committing
resentduringthesame2-week suicide.
P a g e 30 | 41
C. The symptoms cause clinically significant Specify course if full criteria for a mood episode
distress or impairment in social, occupa- are not currently met: in partial remission (p. 154)
tional, or other important areas of In full remission
functioning.
Specify severity if full criteria for a mood episode
D. The episode is not attributable to the are currently met:
physiological effects of a substance or
another medical condition. Mild
Bipolar II Disorder Moderate

A. Criteria have been met for at least one Severe
hypomanic episode(CriteriaA-Funder“Hypo-
manic Episode”above) and at least one major Associate Features
depressive episode (Criteria A-C under “Major
Depressive Episode”above). • Impulsivity & substance use disorders
B. There has never been a manic episode. • heightened levels of creativity; non-linear
C. The occurrence of the hypomanie episode(s) relationship
• greater lifetime creative accomplishments
and major depressive episode(s) is not better
have been associated with milder forms of
explained by schizoaffective disorder, bipolar disorder, and higher creativity has
schizophrenia, schizophreniform disor der, been found in unaffected family members
delusional disorder, or other specified or • heightened creativity during hypomanic
unspecified schizophrenia spectrum and other episodes may contribute to ambivalence
psychotic disorder. about seeking treatment or undermine
adherence to treatment.
D. Prevalence
Thesymptomsofdepressionortheunpredictabilityc
ausedbyfrequentalternationbe tween periods of • 12 month, 0.3% in US
depression and hypomania causes clinically • Pediatric bipolar II disorder is difficult to
significant distress or im pairment in social, establish
occupational, or other important areas of
functioning. Development & Course
Specify current or most recent episode: • Higher rates in ages 12 yrs or older
HypomaniC • Age onset is mid 20’s
• Begins with depressive episode – then
hypomanic episode occurs
Depressed • Anxiety disorders, substance use or eating
disorders precedes the diagnosis
Specify if: • Lifetime episode is high than other mood
With anxious distress disorders
• Interval between mood disorders inc. as age
inc.
With rapid cycling • 5-15% have multiple episodes within 12
months – rapid cycling
with mood-congruent psychotic features • 3-year incidence rate of first-onset bipolar II
With mood-incongruent psychotic features disorder in adults older than 60 years is
With catatonia 0.34%.
With péripartum onset
Suicide Risk
With seasonal pattern
• High – 1/3 of individuals
• Lethality attempts is higher
P a g e 31 | 41
• 6.5-fold higher risk of suicide among first- social, occupa tional, or other important
degree relatives of bipolar II probands areas of functioning.
compared with those with bipolar I disorder
Specify if:
Comorbidity With anxious distress
• one or more co-occurring mental disorders, PREVALENCE

with anxiety disorders
• 60% have three or more co-occurring mental
disorders; 75% have an anxiety disorder; • Age onset 12-14 years (Goodwin &
and 37% have a substance use disorder Jamison, 2007)
• 14% of individuals with bipolar II disorder • Chronic and life long
have at least one lifetime eating disorder, • 1/3 to ½ of patients develop into full-
with binge-eating dis order being more blown bipolar disorder (Kochman et al.,
common than bulimia nervosa and anorexia
2005; Parker et al., 2012)
nervosa.
• Equal in men and women
• Higher rate of females in treatment
Cyclothymic Disorder • RISK FACTORS
• GENETIC AND
PHYSIOLOGICAL
DIAGNOSTIC CRITERIA
• First degree relatives
A. For at least 2years(at least 1 year in

children and adolescents) there have
been numerous periods with hypomanic
symptoms that do not meet criteria for a COMORBIDITY
hypomanic episode and numerous
periods with depressive symptoms that  Substance-related disorders
do not meet criteria for a major and Sleep Disorders
depressive episode.  Outpatient treatment have
B. During the above 2-year period (1 year comorbidity
in children and adolescents), the  ADHD
hypomanic and depressive periods have
been present for at least half the time Associated Features
and the individual has not been without
the symptoms for more than 2 months at
a time. • Substances/medications: Stimulant-
C. Criteria for a major depressive, manic, phencyclidine & steroids
or hypomanic episode have never been • Substance use
met.
D. The symptoms in Criterion A are not Prevalence
better explained by schizoaffective
disorder, schizophrenia, • Substances/medications: Stimulant-
schizophreniform disorder, delusional phencyclidine & steroids
disorder, or other specified or un • Substance use
specified schizophrenia spectrum and
other psychotic disorder.
Development & Course
E. The symptoms are not attributable to the
physiological effects of a substance
(e.g., a drug of abuse, a medication) or • In phencyclidine-induced mania, the
another medical condition (e.g., initial presentation may be one of a
hyperthyroidism). delirium with affective features, which
then becomes an atypically appearing
F. The symptoms cause clinically
significant distress or impairment in manic or mixed manic state. This
condition follows the ingestion or
P a g e 32 | 41
inhalation quickly, usually within hours bipolar or related disorder could include the
or, at the most, a few days. following:
• In stimulant-induced manic or
hypomanic states, the response is in The symptoms precede the onset of the
minutes to 1 hour after one or several
substance/medication use; the symptoms per
ingestions or injections. The episode is
sist for a substantial period of time (e.g., about 1
very brief and typically resolves over 1-2
days. month) after the cessation of acute withdrawal or
• With corticosteroids and some severe intoxication; or there is other evidence
immunosuppressant medications, the suggesting the existence of an independent non-
mania (or mixed or depressed state) substance/medication-induced bipolar and
usually follows several days of in related disorder (e.g., a history of recurrent non-
gestion, and the higher doses appear to substance/medication-related episodes).
have a much greater likelihood of
producing bipolar symptoms. D. The disturbance does not occur exclusively
during the course of a delirium.
Comorbidity
E. The disturbance causes clinically significant
• Use of illicit substances (stimulant, distress or impairment in social, occupational, or
phencyclidine) other important areas of functioning.
• Delirium with manic ingesting
phencyclidine/steroids
medications/immunosuppressant TYPES OF SUBSTANCES
medications
Alcohol
Substance/Medication-Induced Bipolar and
Related Disorder Phencyclidine
A. A prominent and persistent disturbance in Other hallucinogen

mood that predominates in the clinical picture
and is characterized by elevated, expansive, or Sedative, hypnotic, or anxiolytic
irritable mood, with or without depressed mood,
or markedly diminished interest or pleasure in Amphetamine (or other stimulant)
all, or almost all, activities.
Cocaine
B. There is evidence from the history, physical
examination, or laboratory findings of both Other (or unknown) substance
(1)and (2):
Specify if
1.
ThesymptomsinCriterionAdevelopedduringorsoo With onset during intoxication: If the criteria are
naftersubstanceintoxication or withdrawal or met for intoxication with the sub stance and the
after exposure to a medication. symptoms develop during intoxication.
With onset during withdrawal: If criteria are met
for withdrawal from the substance and the
2. The involved substance/medication is capable symptoms develop during, or shortly after,
of producing the symptoms in Criterion A. withdrawal.
C. Associated Features
Thedisturbanceisnotbetterexplainedbyabipolaror
relateddisorderthatisnotsub stance/medication-
induced. Such evidence of an independent
P a g e 33 | 41
• Use of illicit substances (stimulant, • lifetime history of one or more major
phencyclidine)
• Delirium with manic ingesting
depressive episodes
phencyclidine/steroids • 2 or more episodes of hypomania not
medications/immunosuppressant meeting full criteria
medications • Episodes of hypomania do Not meet
• Medical conditions are never complete
• Cushing's disease and multiple sclerosis, criteria for major depressive episodes
• Stroke and traumatic brain injuries 3. Hypomanic episode without prior major
depressive episode:
Development and Course
• one or more manic episodes
• onset acutely or sub-acutely within the first • Never meet full criteria for depressive
weeks or month of the onset of the or manic episode
associated medical condition
• worsening or later relapse of the associated • If applied to someone with Persistent
medical condition may precede the onset of depressive disorder (PDD), applied only
the manic or hypomanic syndrome; clinical during the periods when the full criteria
judgment is best in these situations
• condition may remit before or just after the
for a hypomanic episode are met.
medical condition remits, particularly when 3. Short-duration cyclothymia (less than 24
treatment of the manic/hypomanic symptoms months):
is effective.
• Multiple episodes of hypomanic
Other Specified Bipolar and Related Disorder symptoms
• Not meet criteria for depressive
• Present symptoms characteristic of a episode over less than 24 months (12
bipolar and related disorder that cause months for adolescence/children)
clinically significant distress or • Hypomanic or depressive symptoms are
impairment present for more days than not
• do not meet the full criteria of any BPD • Ind. has not been w/o symptoms for
• clinician chooses to communicate the more than 2 mos.
specific reason that the presentation
does not meet the criteria Unspecified bipolar and other related disorder
1. Other Specified Bipolar and Related • one or more co-occurring mental

Disorder: Examples of Presentation disorders, with anxiety disorders
Short-duration hypomanic episodes (2- • 60% have three or more co-occurring
3 days) and major depressive episodes: mental disorders; 75% have an anxiety
• lifetime history of one or more major disorder; and 37% have a substance use
depressive episodes disorder
• never met full criteria for a manic or - 14% of individuals with bipolar II disorder
hypomanic episode have at least one lifetime eating disorder, with
• 2 or more episodes of short duration binge-eating dis order being more common
hypomania lasting 2-3 days than bulimia nervosa and anorexia nervosa.
• Not meeting criteria for major
depressive episodes - symptoms characteristic of a bipolar
2. Hypomanic episodes with insufficient and related disorder that cause
symptoms and major depressive episodes: clinically significant distress or
impairment
P a g e 34 | 41
- do not meet the full criteria for any of • With children who
the disorders in the bipolar and related present chronic,
disorders persistent irritability
- clinician chooses not to specify the relative to children who
reason that the criteria are not met present with classic bi-
- insufficient information to make a more polar disorder.
specific diagnosis
2. Major Depressive Disorder
DEPRESSIVE DISORDERS
A. 5 or more of the following symptoms
1. Disruptive mood Dysregulation
have been present during the same 2-wek
disorder
period and represent a change from
previous functioning; at least 1 of the
DIAGNOSTIC CRITERIA
symptoms is either (1) depressed or (2) loss
A. Severe Recurrent temper outburst of iterest or pleasure. Note: Symptomvs
manifested verbally (e.g. verbal ranges) due to another medical condition is not
and or behaviorally (people/property) that includent.
are grossly out of proportion in intensity or
1. Depressed mood most of the day, nearly
duration to the situation or provocation.
every day, as indicated by either subjective
B. The temper outbursts are inconsistent report or obseved by others. [Note::
with developmental level. Children and adolescents may express this
as irritable mood.
C. The temper outburst occur, on average,
three or more times per week. 2. Markedly diminished interest or pleasure
in all, or almost all, activities most of the
E. The mood between temper outbursts is
day, nearly everyday as self-reported or
persistently irritable or angry most of the
observed by others.
day, nearly every day ad is ovservable by
others (e.g. parents, teacjhers, peers). 3. Significant weight loss when not dieting
or weight gain (e.g. change more than 5% of
E. Criteria A-D have been present for 12 or
BDI in a mo.) or decrease or increase in
more months. Througout that time, the
appetite. (Note: In children, consider failure
individual has not had a period lasting 3 or
to make expected weight gain.)
more consecuritive months without all of
the symptosm in Criteria A-D. 4. Insomia or Hypersomnia nearly everyday.
G. The diagnosis should NOT BE MADE for 5. Psychomotor agitation or reatrdation

the first time before age 6 or after age 18. nearly every day (observable by others, not
merely subjective feelings of restlness or
H. By History or observation, the age at
being slowed down).
onset of Criteria A-E is before 10 years.
6. Fatigue or loss of enery nearly every day.
• DMDD was added to address concern
about 7. Feelings of worthlessness or excessive or
– appropriate classification inappropriate guilt (which may be
– Treatment of children
P a g e 35 | 41
delusional) nearly every day (not merely PERSISTENT DEPRESSIVE DISORDER
self-reproach or guilt about being sick.) (DYSTHYMIA)
8. Diminished ability to think or This disorder represents a consolidation of

concentrate, or indecisiveness, nearly DSM-lV-defined chronic major depressive dis
everyday (either by self-report or observed order and dysthymic disorder.
by others. A. Depressed mood for most of the day, for
more days than not, as indicated by either
9. Recurrent thoughts of death (not just subjective account or observation by others, for
at least 2 years.
fear of dying), recurrent suicidal ideation
with out specifical plan, or a suicide attempt Note: In children and adolescents, mood can be
or a specific plan for committing suicide. irritable and duration must be at least 1 year.
B. The symptoms cause clinically significant B. Presence, while depressed, of two(or more)of
distress or impairment in SOCIAL, the following:
OCCUPATIONAL, OR OTHER IMPORTANT
AREAS OF FUNCTIONING. 1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
C. The episode is not attributable to 3. Low energy or fatigue.
physiological effects of a substance or to 4. Low self-esteem.
5. Poor concentration or difficulty making
another medical condition. (Note: Criteria decisions.
A-C represent a major depressive episode. 6. Feelings of hopelessness.
Responses to significant loss may be
weighed and considered if MDD is present C. Duringthe2-year period (1year for children or
adolescents) of the disturbance, the individual
vs. normal response. Consider history and
has never been without the symptoms in Criteria
cultural norms in expressing distress.) A and B for more than 2 months at a time.
D. Occurrence of MDD is not explained by
D. Criteria for a major depressive disorder may
schizoaffecive disorder, schizophrenia, be continuously present for 2 years.
schizophreniform disorder, delusional
disorder or other specified and unspecified E. There has never been a manic episode or a
schizophrenia spectrum and other psychotic hypomanic episode, and criteria have never
been met for cyclothymic disorder.
disorders.
E. No occurrence of Manic Episode or a F. The disturbance is not better explained by a

persistent schizoaffective disorder,
Hypomanic Episode. schizophrenia, delusional disorder, or other
specified or unspecified schizophrenia spectrum
Recurrence is considered with an interval of
and other psychotic disorder.
at least 2 months between separate
episodes in which criteria are not met for a G. The symptoms are not attributable to the
major depressive episode. physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical
If psychotic features are present, code condition (e.g. hypothyroidism).
“with psychotic features” specifier
irrespesctive of episode severity. H. The symptoms cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
P a g e 36 | 41
Specify if: PREMENSTRUAL DYSPHORIC DISORDER
With anxious distress
With mixed features
With melancholic features A. In the majority of menstrual cycles, at least
With atypical features five symptoms must be present in the final week
With mood-congruent psychotic features before the onset of menses, start to improve
within a few days after the onset of menses, and
With mood-incongruent psychotic features become minimal or absent in the week post
menses.
With péripartum onset
B. One (or more) of the following symptoms
Specify if: must be present:
In partial remission
1. Marked affective lability (e.g., mood
In full remission swings: feeling suddenly sad or tearful, or in
creased sensitivity to rejection).
Specify if:
Early onset: If onset is before age 21 years. Late 2. Marked irritability or anger or increased
onset: If onset is at age 21 years or older. interpersonal conflicts.
3. Marked depressed mood, feelings of
Specify if (for most recent 2 years of persistent hopelessness, or self-deprecating
depressive disorder): thoughts.
With pure dysthymic syndrome: Full criteria for a 4. Marked anxiety, tension, and/or feelings
major depressive episode have not been met in of being keyed up or on edge.
at least the preceding 2 years.
With persistent major depressive episode: Full C. One (or more) of the following symptoms
criteria for a major depressive episode have must additionally be present, to reach a total of
been met throughout the preceding 2-year five symptoms when combined with symptoms
period. from Criterion B above.
With intermittent major depressive episodes, with

current episode: Full criteria for a major
1. Decreased interest in usual activities
(e.g., work, school, friends, hobbies).
depressive episode are currently met, but there
have been periods of at least 8 weeks in at least 2. Subjective difficulty in concentration.
the preceding 2 years with symptoms below the
threshold for a full major depressive episode. 3. Lethargy, easy fatigability, or marked
With intermittent major depressive episodes, without lack of energy.
current episode: Full criteria for a major
depressive episode are not currently met, but
there has been one or more major depressive
4. Marked change in appetite; overeating;
or specific food cravings.
episodes in at least the preceding 2 years.
5. Hypersomnia or insomnia.
Specify current severity: 6. A sense of being overwhelmed or out of
control.
Mild
7. Physical symptoms such as breast
Moderate tenderness or swelling, joint or muscle
pain, a sensation of “bloating,” or weight
Severe gain.
Note: The symptoms in Criteria A-C must

have been met for most menstrual
P a g e 37 | 41
cycles that occurred in the preceding C. The disturbance is not better explained
year. by a depressive disorder that is not
substance/ medication-induced. Such
D. The symptoms are associated with clinically evidence of an independent depressive
significant distress or interference with work, disorder could include the following:
school, usual social activities, or relationships a. The symptoms preceded the
with others (e.g., avoidance of social activities; onset of the
decreased productivity and efficiency at work, substance/medication use; the
school, or home). symptoms persist for a
substantial period of time (e.g.,
about 1 month) after the
cessation of acute withdrawal or
E. The disturbance is not merely an
severe intoxication; or there is
exacerbation of the symptoms of another
disorder, such as major depressive disorder, other evidence suggesting the
panic disorder, persistent depressive disorder existence of an independent
non-substance/medication-
(dysthymia), or a personality disorder (although
induced depressive disorder
it may co-occur with any of these dis orders).
(e.g., a his tory of recurrent non-
substance/medication-related
episodes).
F. Criterion A should be confirmed by D. The disturbance does not occur
prospective daily ratings during at least two exclusively during the course of a
symptomatic cycles. (Note: The diagnosis may delirium.
be made provisionally prior to this confirmation.) E. The disturbance causes clinically
significant distress or impairment in
G. The symptoms are not attributable to the social, occupational, or other important
physiological effects of a substance (e.g., a drug areas of functioning.
of abuse, a medication, other treatment) or
another medical condition (e.g., hy- Note: This diagnosis should be made instead of
perthyroidism). a diagnosis of substance intoxication or
substance withdrawal only when the symptoms
SUBSTANCE/MEDICATION-INDUCED in Criterion A predominate in the clinical picture
DEPRESSIVE DISORDER and when they are sufficiently severe to warrant
clinical attention.
A. A prominent and persistent disturbance
in mood that predominates in the clinical TYPES OF SUBSTANCES
picture and is characterized by
depressed mood or markedly Alcohol
diminished interest or plea sure in all, or
almost all, activities.
B. There is evidence from the history, Phencyclidine
physical examination, or laboratory
findings of both (1) and (2): Other hallucinogen
a. The symptoms in Criterion A
developed during or soon after Sedative, hypnotic, or anxiolytic
substance intoxication or
withdrawal or after exposure to Amphetamine (or other stimulant)
a medication.
b. The involved
Cocaine
substance/medication is
capable of producing the
symptoms in Crite rion A. Other (or unknown) substance
P a g e 38 | 41
Specify if characteristic of a depressive disorder that
cause clinically significant distress or impairment
With onset during intoxication: If the criteria are in social, occupational, or other important areas
met for intoxication with the sub stance and the of functioning predominate but do not meet the
symptoms develop during intoxication. full criteria for any of the disorders
With onset during withdrawal: If criteria are met
for withdrawal from the substance and the clinician chooses to communicate the specific
symptoms develop during, or shortly after, reason that the presentation does not meet the
withdrawal. criteria for any specific depressive disorder
DEPRESSIVE DISORDER due to ANOTHER 1. Recurrent brief depression: Concurrent presence

MEDICAL CONDITION of depressed mood and at least
DIAGNOSTIC CRITERIA four other symptoms of depression for 2-13 days

at least once per month (not associ ated with the
A. A prominent and persistent period of menstrual cycle) for at least 12 consecutive
depressed mood or markedly months in an individual whose presentation has
diminished interest or pleasure in all, or never met criteria for any other depressive or
almost all, activities that predominates in bipolar disorder and does not currently meet
the clinical picture. active or residual criteria for any psychotic
B. Thereisevidencefromthehistory,physical disorder.
examination,orlaboratoryfindingsthatthe
disturbance is the direct
2. Short-duration depressive episode (4-13
pathophysiological consequence of
days): Depressed affect and at least four
another medical condition.
of the other eight symptoms of a major
C. The disturbance is not better explained
depressive episode associated with
by another mental disorder (e.g.,
clinically significant distress or
adjustment disorder, with depressed
impairment that persists for more than 4
mood, in which the stressor is a serious
days, but less than 14 days, in an
medical condition).
individual whose presentation has never
D. The disturbance does not occur
met criteria for any other depressive or
exclusively during the course of a
bipolar disorder, does not currently meet
delirium.
active or residual criteria for any
E. The disturbance causes clinically
psychotic dis order, and does not meet
significant distress or impairment in
criteria for recurrent brief depression.
social, occupational, or other important
3. Depressive episode with insufficient
areas of functioning.
symptoms: Depressed affect and at least
one of the other eight symptoms of a
Specify if: major depressive episode associated
(F06.31) With depressive features: Full criteria are with clinically significant distress or
not met for a major depressive episode. ' impairment tliat persist for at least 2
(F06.32) Witli major depressive-iilce episode: Full weeks in an individual whose
criteria are met (except Criterion C) for a major presentation has never met criteria for
depressive episode. any other depressive or bipolar disorder,
(F06.34) With mixed features: Symptoms of mania does not currently meet active or
or hypomania are also present but do not residual criteria for any psychotic
predominate in the clinical picture. disorder, and does not meet criteria for
mixed anxiety and depressive disorder
symptoms.
Other Specified Depressive Disorder
P a g e 39 | 41
Unspecified Depressive Disorder These neurotransmitters are found in large
concentrations in the limbic system
characteristic of a depressive dis order that depression is caused by a reduction in the
cause clinically significant distress or impairment amount of norepinephrine or serotonin in the
in social, occupational, or other im portant areas synapses between neurons
of functioning predominate but do not meet the
full criteria
• Brain Abnormalities
used in situations in which the clinician chooses (CT Scan) Neuroimaging studies have found
not to specify the reason that the criteria are not consistent abnormalities in at least four areas of
met for a specific depressive disorder the brain in people with depression: the
prefrontal cortex, anterior cingulate,
THEORIES OF DEPRESSIVE DISORDERS hippocampus, and amygdala
• Genetic Factors • Neuroendocrine factors

first-degree relatives of people with Mood HPA Axis
disorders are two to three times more likely to CRH is linked to depression
also have depression than are the first-degree Inhibited ACTH (producing Cortisol-Stress
relatives of people without the disorder hormone)
(Gershon, 1990; Klein, Lewinsohn, Rohde,
Seeley, & Durbin, 2002; Levinson, 2009). • Women’s Hormonal Cycle
Twin studies of major depression find higher Vulnerability in Depression is linked to ovarian
concordance rates for monozygotic twins than hormones (estrogen and progesterone)
for dizygotic twins, implicating genetic Premenstrual, postpartum, menopause
processes in the disorder (McGuffin et al, 2003).
Multiple genetic abnormalities • Early Stress as Vulnerability
• Serotonin transporter Adverse childhood experiences
gene – can lead to HPA Axis are exaggerated or blunted
dysfunction in the
regulation of serotonin, • Hippocampal Shrinkage
affecting the Use for Checking stress hormones and facilitate
individual’s mood cognitive processes
stability Caused by heightened levels of stress
• Low levels of serotonin hormones; long term over production causes
only cause mood lack of neurogenesis---There is connection high
disorders in relation to stress hormones and depression
other
neurotransmitters like Psychological theories of depression
norephinephrine and
dopamine (Spoont, • Behavioral Theories
1992; Thase, 2005, Depression is a reaction to stressful event (e.g.
2009). break-up, death, job loss)
Life stress leads to depression because it
• Neurotransmitter Theory reduces the positive reinforcers in a person’s
Monoamines, specifically, norepinephrine, life
serotonin, and, to a lesser extent, dopamine Learned Helplessness Theory (Seligman,1975)
P a g e 40 | 41
• Cognitive Theories PSYCHOLOGICAL TREATMENT FOR DEPRESSIVE
Aaron Beck (1967) argued that people with DISORDERS
depression look at the world through a negative
cognitive triad: • BEHAVIOR THERAPIES
They have negative views of themselves, the • INC. POSITIVE REINFORCERS.
world, and the future • REINFORCE SKILLS IN
MANAGING INTERPERSONAL
SITUATIONS AND ENV.
• Psychodynamic Theories • TEACH MOOD MANAGEMENT
Unconsciously punishing self bec. Of feeling SKILLS
abandoned not the other person; dependency
are risk factors • COGNITIVE BEHAVIORAL THERAPY
– Identify and modify negative
• Interpersonal Theories automatic thoughts
Role of relationships – Help client recognize beliefs or
Rejection sensitivity assumptions that are feeding
Reassurance seeking depression
• Sociocultural Theories • INTERPERSONAL THERAPY

Marital dissatisfaction (Davila, 2009) – (Grief, Loss) Help clients accept
Cohort Effect feelings and evaluate
Gender Differences relationship with a lost person;
Ethnicity/Race Differences invest in new relationships
Cross-Cultural Differences (industrialized vs. – (Interpersonal role disputes)
rural) Help client make decisions
Social factors influence experience of about concessions and better
depression (Beach et al, 2009). ways to communicate
– (Role Transitions) Develop more
TREATMENT realistic perspective towards
roles that lost and new ones
• Medication: Antidepressants– Selective – (Interpersonal skill deficit) help
Serotonin Re-uptake Inhibitors, Mixed client understand past
Re-uptake Inhibitors, Tricyclic relationships, teach social skills
Antidepressants and Monoamine
Oxidase Inhibitors (MAOI) • Treatment of both medication and CBT
• Lithium, Anti Convulsants, is 78% more effective (McCullough,
Antipsychotics 2000).
• Electroconvulsive Therapy • Patients treated with cognitive
• Repetitive Transcranial magnetic behavioural procedures had a
stimulation substantially lower relapse rate (35%)
• Vagus nerve stimulation than patients given the clinical
• Light Therapy management treatment (70%)
[Canestrari, 1996; Fava et al, 1998].
P a g e 41 | 41

Part II. Chief Guide in Abnormal Psychology

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Treatment of Intellectual Disability (ID) • Delayed acquisition of milestones: the

Skill instruction C. Communication Disorders

• Productivity 1. Language Disorders

1. Reduced vocabulary (word

3. Impairments in discourse (ability to B. The disturbance causes limitations in

a) Expressive Language Disorder 2. Childhood-Onset Fluency Disorder

4. Audible or silent blocking (filled or unfilled E. Social (Pragmatic) Communication Disorder

3. Deficits in developing, maintaining, and

3. Highly restricted, fixated interests that are • Genetic influences

H. Other Specified Attention ADHD: Statistics

• Cognitive Deficits • Disorganized Behavior

• First episode, currently in acute episode Dev’t & course

• Family Studies • Prenatal and Perinatal Influences

1. Delusions. Other Hallucinogen

With onset during withdrawal DEV’T AND COURSE

-due to intoxication of medication such as DIAGNOSTIC CRITERIA

Higher in females • Transcranial Magnetic Stimulation

It is necessary to meet the following criteria for a

• Mean age onset 15-18 yrs old; begin in Suicide Risk

C. The episode is associated with an 6. Psychomotor agitation or retardation

E. The episode is not severe enough to cause 8. Feelings of worthlessness or excessive

Bipolar II Disorder Moderate

• one or more co-occurring mental disorders, PREVALENCE

A. For at least 2years(at least 1 year in

A. A prominent and persistent disturbance in Other hallucinogen

1. Other Specified Bipolar and Related • one or more co-occurring mental

G. The diagnosis should NOT BE MADE for 5. Psychomotor agitation or reatrdation

8. Diminished ability to think or This disorder represents a consolidation of

E. No occurrence of Manic Episode or a F. The disturbance is not better explained by a

With intermittent major depressive episodes, with

Note: The symptoms in Criteria A-C must

DEPRESSIVE DISORDER due to ANOTHER 1. Recurrent brief depression: Concurrent presence

DIAGNOSTIC CRITERIA four other symptoms of depression for 2-13 days

• Genetic Factors • Neuroendocrine factors

• Sociocultural Theories • INTERPERSONAL THERAPY

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