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Antipsychotic Availability (Other Than Pill/Capsule) Notes Paliperidone Antipsychotic Availability Notes (other than pill/capsule) Paliperidone long acting injectable Good for hepatically (Invega) (Sustenna) impaired; Extended Release Quetiapine Extended release Sedating (Seroquel) Risperidone Liquid Increases (Risperdal) Dissolvable Prolactin IM Long acting injectable (Consta) Ziprasidone Liquid Monitor EKG (Geodon) IM Supportive Psychotherapy Club House ACT services NAMI Vocational Rehab Nicotine counseling 1 (or more ) delusions Duration: 1 month or longer Criterion A for Schizophrenia has never been met. Functioning is not markedly impaired Behavior is not obviously odd or bizarre Features: Differential Diagnosis Prevalence: Obsessive-compulsive and ◦ lifetime 0.2 % related disorders ◦ Most frequent is persecutory Delirium • Males > females for Jealous major neurocognitive d/o type psychotic disorder due to • Function is generally better another medical condition than in schizophrenia substance-medication- • Familiar relationship with induced psychotic disorder schizophrenia and Schizophrenia & schizotypal Schizophreniform Depressive and bipolar d/o Schizoaffective Disorder Delusion types Erotomanic Grandiose Jealous Persecutory Somatic Mixed Unspecified • Substance Abuse • Dependence • Withdrawal ◦ Alcohol Divided into 2 ◦ Caffeine groups: ◦ Cannabis ◦ Hallucinogens (with separate ◦ Substance use categories for phencyclidine and other disorders hallucinogens) ◦ Substance-induced ◦ Inhalants disorders ◦ Opioids ◦ Sedatives, hypnotics, and anxiolytics ◦ Stimulants (amphetamine-type substances, cocaine, and other stimulants) ◦ Tobacco ◦ Other or unknown substances Continue using the substance despite significant substance-related problems Repeated relapses and intense drug craving Taken in larger amounts or over a longerior period than was originally intended Express persistent desire to cut down Spend a great deal of time obtaining the substance, using the substance, or recovering from its effects Tolerance Withdrawal Reversible Disturbances in: After ingestion Not attributable to ◦ Perception another medical condition or another ◦ Wakefulness mental disorder ◦ Attention ◦ Thinking Can occur in individuals without a ◦ Judgment substance use ◦ Psychomotor behavior disorder ◦ Interpersonal behavior Does not apply to tobacco Cessation of or reduction in heavy and prolonged substance use Clinically significant distress or impairment Not due to another medical condition or another mental disorder Not always associated with a substance use disorder Most have an urge to re-adminster the substance to reduce the symptoms Psycho Bipolar Depressive Anxiety OCD Sleep tic D/O D/o D/o D/o D/o Alcohol I/W I/W I/W I/W I/W Caffeine I I/W Cannabis I I I/W Hallucinogens I I I I Inhalants I I I Opioids I/W W I/W Sedative, I/W I/W I/W W I/W hypnotics, or anxiolytics Stimulants I I/W I/W I/W I/W I/W Tobacco W Sexual Delirium Neurology Substance Sub- Substance Dys- D/o Use D/o stance Withdrawal function Intoxi- cation Alcohol I/W I/W I/W I/W I/W Caffeine I I/W Cannabis I I I/W Hallucinogens I I I I Inhalants I I I Opioids I/W W I/W Sedative, I/W I/W I/W W I/W Hypnotics, or anxiolytics Stimulants I I/W I/W I/W I/W I/W Tobacco W Evaluation Treatment Suboxone Evaluation by Vivitrol LCAS/Psychiatrist Antabuse CAGE SAIOP Treat underlying disorder SBIRT (e.g. antidepressants for LFTS depression) UDS Opiate withdrawal – clonidine, Loperamide, Hepatitis panel Flexaril, Ibuprofen STD’s Alcohol withdrawal – Lorazepam; CIWA Physical exam – pupils protocols; GI evaluations Enduring pattern Applied to children/adolescents if present for at least 1 year CLUSTERS A, B, C Gender Differences: ◦ Antisocial M > F ◦ Borderline: F > M Differential Diagnosis: Psychotic disorders, Anxiety/depressive Disorders, PTSD, Substance use, medical condition Paranoid: other’s motives Treatment: are interpreted as malevolent ◦ Group therapy Schizoid: pattern of detachment, restricted ◦ Psychotherapy range of emotional expression ◦ low dose antipsychotics Shizotypal: cognitive or perceptual distortions, and ◦ SSRI’s for mood eccentricities of behavior symptoms Antisocial: disregard for and violation of the rights for others ◦ Males > females Histrionic: excessive ◦ Treatment: therapy, emotionality and valproate, atypical attention seeking antipsychotics ◦ Therapy ◦ Antidepressants Borderline: instability in interpersonal Narcissistic: grandiosity, relationships, self-image, need for admiration, and affects, and marked lack of empathy impulsivity ◦ Males > females ◦ Females > males ◦ Treatment: psychotherapy ◦ Treatment: Antipsychotics, ◦ Consider SSRI’s/Lithium Lithium, SSRI’s ◦ Dialectical Behavior therapy Avoidant: social inhibition, feelings of inadequacy, and hypersensitivity to Obsessive- negative evaluation ◦ Treatment: compulsive: psychotherapy; social preoccupation with skills; B-blockers; SSRI’s ( sertraline, excitalopram, orderliness, paroxetime);Benzos prn perfectionism, and Dependent: submissive control. and clinging behavior ◦ Treatment: first-line: related to an excessive need to be taken care of psychotherapy; SSRI’s; ◦ Treatment: Second-line: psychotherapy; Family (Clomipramine) therapy; SSRI’s if anxiety Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder (functional neurological symptoms disorder) Psychological factors affecting other medical conditions Factitious disorder Other Specified somatic symptoms and related disorder Unspecified somatic symptom and related disorder Very distressing Result in significant disruption of functioning Excessive and disproportionate thoughts typically at least for 6 months The DSM-IV disorders of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed Does not require a specific number of complaints from among four symptom groups. Does not require that the somatic symptoms are medically unexplained. A. One or more somatic symptoms that are distressing B. Excessive thoughts, feelings, or behaviors manifested by 1 of: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms 2. Persistently high level of anxiety about health or symptoms 3. Excessive time and energy devoted to these symptoms C. the state of being symptomatic is persistent (typically more than 6 months) A. Preoccupation with having or acquiring a serious illness. B.Somatic symptoms are not present or, if present, are only mild in intensity C. High level of anxiety about health.. D. Individual performs excessive health-related behaviors E. Present 6 months, but specific illness that is feared may change over that period of time F. Not better explained by another mental disorder A. 1 or more symptoms of altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between symptom and recognized condition. C. not better explained D. Causes clinically significant distress 1. Temporal association between the psychological factors and the development or exacerbation of or delayed recovery from the medical condition 2. Interfere with the treatment of the medical condition (e.g., poor adherence) 3. Health risks for the individual Moved into Somatic Key criteria: Symptom and Related Disorders from its own chapter ◦ Present self as ill, impaired, or injured No motivation included in DSM 5 criteria ◦ evident even in the absence of obvious external rewards Divided into: ◦ Imposed on Self ◦ Imposed on another (previously by proxy) Factitious Disorder Conversion Disorder • Early Recognition • Psychotherapy • Non-threatening • Hypnosis confrontation • Short-term anxiolytics • Relaxation therapy • SSRI’s to reduce • Regular visits impulsive • Referral to mental tendencies or health care provider anxiety • Minimize unnecessary • Regular visits medications Obesity Anorexia Nervosa Bulimia Nervosa 1/3 of U.S. adults Obesity-related conditions: heart disease, stroke, type 2 diabetes, cancer Higher medical costs Higher in minorities Higher among middle age adults distorted body image Prevalence: females 0.4% excessive dieting Development: adolescence pathological fear of becoming fat. Risk/Prognostic: ◦ anxiety Restricting type: The person restricts their food intake on their own and ◦ displace obsession traits does not engage in binge-eating or purging behavior. Comorbidity: Bipolar, Depressive, and anxiety Binge eating/purging type: The disorders person self-induces vomiting or misuses laxatives, diuretics, or enemas. Suicide risk: 12 per 100,000 Treatment: ◦ Inpatient ◦ Partial hospitalization DSM changes: ◦ Outpatient ◦ Word “refusal” not included in terms ◦ CBT of weight maintenance ◦ Nutritionist ◦ amenorrhea deleted ◦ Medications: SSRI’s (Prozac), Zyprexa, benzos, bowel regimen ◦ avoid Wellbutrin, TCA’s Diagnostic Markers: Leukopenia Elevated BUN Hypercholesterolemia Elevated LFT’s Hypomagnesmia Hypozincemia Hypophophatemia Hyperamulasemia Metabolic alkalosis Serum T4 levels low range T3 decreased Low estrogen and testosterone Sinus Bradycardia Prolonged QYC Low bone mineral denisty EEG – diffuse abnormalities Emaciation Binge eating followed by Associated features: inappropriate behaviors ◦ Usually normal weight ◦ Menstrual irregularity to avoid weight gain Prevalence females 1 to Lack of control 5% ◦ Peaks in older DSM-5 criteria reduced adolescence and the frequency of binge to adulthood ◦ Crude mortality rate is once a week for 3 months nearly 2% per decade
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