Specificity of Psychosis, Mania and Major Depression in A
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First Episode Psychosis an Information Guide Revised Edition
First episode psychosis An information guide revised edition Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) i First episode psychosis An information guide Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) A Pan American Health Organization / World Health Organization Collaborating Centre ii Library and Archives Canada Cataloguing in Publication Bromley, Sarah, 1969-, author First episode psychosis : an information guide : a guide for people with psychosis and their families / Sarah Bromley, OT Reg (Ont), Monica Choi, MD, Sabiha Faruqui, MSc (OT). -- Revised edition. Revised edition of: First episode psychosis / Donna Czuchta, Kathryn Ryan. 1999. Includes bibliographical references. Issued in print and electronic formats. ISBN 978-1-77052-595-5 (PRINT).--ISBN 978-1-77052-596-2 (PDF).-- ISBN 978-1-77052-597-9 (HTML).--ISBN 978-1-77052-598-6 (ePUB).-- ISBN 978-1-77114-224-3 (Kindle) 1. Psychoses--Popular works. I. Choi, Monica Arrina, 1978-, author II. Faruqui, Sabiha, 1983-, author III. Centre for Addiction and Mental Health, issuing body IV. Title. RC512.B76 2015 616.89 C2015-901241-4 C2015-901242-2 Printed in Canada Copyright © 1999, 2007, 2015 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work. This publication may be available in other formats. For information about alterna- tive formats or other CAMH publications, or to place an order, please contact Sales and Distribution: Toll-free: 1 800 661-1111 Toronto: 416 595-6059 E-mail: [email protected] Online store: http://store.camh.ca Website: www.camh.ca Disponible en français sous le titre : Le premier épisode psychotique : Guide pour les personnes atteintes de psychose et leur famille This guide was produced by CAMH Publications. -
Autism Practice Parameters
American Academy of Child and Adolescent Psychiatry AACAP is pleased to offer Practice Parameters as soon as they are approved by the AACAP Council, but prior to their publication in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). This article may be revised during the JAACAP copyediting, author query, and proof reading processes. Any final changes in the document will be made at the time of print publication and will be reflected in the final electronic version of the Practice Parameter. AACAP and JAACAP, and its respective employees, are not responsible or liable for the use of any such inaccurate or misleading data, opinion, or information contained in this iteration of this Practice Parameter. PRACTICE PARAMETER FOR THE ASSESSMENT AND TREATMENT OF CHILDREN AND ADOLESCENTS WITH AUTISM SPECTRUM DISORDER ABSTRACT Autism spectrum disorder (ASD) is characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills which arise in the first years of life. Although frequently associated with intellectual disability, this condition is distinctive in terms of its course, impact, and treatment. ASD has a wide range of syndrome expression and its management presents particular challenges for clinicians. Individuals with an ASD can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with this condition necessitate multidisciplinary care, coordination of services, and advocacy for individuals and their families. Early, sustained intervention and the use of multiple treatment modalities are indicated. Key Words: autism, practice parameters, guidelines, developmental disorders, pervasive developmental disorders. ATTRIBUTION This parameter was developed by Fred Volkmar, M.D., Matthew Siegel, M.D., Marc Woodbury-Smith, M.D., Bryan King, M.D., James McCracken, M.D., Matthew State, M.D., Ph.D. -
Is Your Depressed Patient Bipolar?
J Am Board Fam Pract: first published as 10.3122/jabfm.18.4.271 on 29 June 2005. Downloaded from EVIDENCE-BASED CLINICAL MEDICINE Is Your Depressed Patient Bipolar? Neil S. Kaye, MD, DFAPA Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essen- tial, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treat- ment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdi- agnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive fea- tures and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifi- cally on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physi- cian can easily perform this assessment. Tools to assist the physician in daily practice with the evalua- tion and recognition of bipolar disorders and bipolar depression are presented and discussed. (J Am Board Fam Pract 2005;18:271–81.) Studies have demonstrated that a large proportion orders than in major depression, and the psychiat- of patients in primary care settings have both med- ric treatments of the 2 disorders are distinctly dif- ical and psychiatric diagnoses and require dual ferent.3–5 Whereas antidepressants are the treatment.1 It is thus the responsibility of the pri- treatment of choice for major depression, current mary care physician, in many instances, to correctly guidelines recommend that antidepressants not be diagnose mental illnesses and to treat or make ap- used in the absence of mood stabilizers in patients propriate referrals. -
Types of Bipolar Disorder Toms Are Evident
MOOD DISORDERS ASSOCIATION OF BRITISH COLUmbIA T Y P E S O F b i p o l a r d i s o r d e r Bipolar disorder is a class of mood disorders that is marked by dramatic changes in mood, energy and behaviour. The key characteristic is that people with bipolar disorder alternate be- tween episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months. The mood distur- bances are severe enough to cause marked impairment in the person’s func- tioning. The experience of mania is not pleasant and can be very frightening to The Diagnotistic Statisti- the person. It can lead to impulsive behaviour that has serious consequences cal Manual (DSM- IV-TR) is a for the person and their family. A depressive episode makes it difficult or -im manual used by doctors to possible for a person to function in their daily life. determine the specific type of bipolar disorder. People with bipolar disorder vary in how often they experience an episode of either mania or depression. Mood changes with bipolar disorder typically occur gradually. For some individuals there may be periods of wellness between the different mood episodes. Some people may also experience multiple episodes within a 12 month period, a week, or even a single day (referred to as “rapid cycling”). The severity of the mood can also range from mild to severe. Establishing the particular type of bipolar disorder can greatly aid in determin- ing the best type of treatment to manage the symptoms. -
Pharmacogenomic Characterization in Bipolar Spectrum Disorders
pharmaceutics Review Pharmacogenomic Characterization in Bipolar Spectrum Disorders Stefano Fortinguerra 1,2 , Vincenzo Sorrenti 1,2,3 , Pietro Giusti 2, Morena Zusso 2 and Alessandro Buriani 1,2,* 1 Maria Paola Belloni Center for Personalized Medicine, Data Medica Group (Synlab Limited), 35131 Padova, Italy; [email protected] (S.F.); [email protected] (V.S.) 2 Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; [email protected] (P.G.); [email protected] (M.Z.) 3 Bendessere™ Study Center, Solgar Italia Multinutrient S.p.A., 35131 Padova, Italy * Correspondence: [email protected] Received: 25 November 2019; Accepted: 19 December 2019; Published: 21 December 2019 Abstract: The holistic approach of personalized medicine, merging clinical and molecular characteristics to tailor the diagnostic and therapeutic path to each individual, is steadily spreading in clinical practice. Psychiatric disorders represent one of the most difficult diagnostic challenges, given their frequent mixed nature and intrinsic variability, as in bipolar disorders and depression. Patients misdiagnosed as depressed are often initially prescribed serotonergic antidepressants, a treatment that can exacerbate a previously unrecognized bipolar condition. Thanks to the use of the patient’s genomic profile, it is possible to recognize such risk and at the same time characterize specific genetic assets specifically associated with bipolar spectrum disorder, as well as with the individual response to the various therapeutic options. This provides the basis for molecular diagnosis and the definition of pharmacogenomic profiles, thus guiding therapeutic choices and allowing a safer and more effective use of psychotropic drugs. Here, we report the pharmacogenomics state of the art in bipolar disorders and suggest an algorithm for therapeutic regimen choice. -
2021 Psychiatry CERT Content Specifications
CERTIFICATION EXAMINATION IN PSYCHIATRY Beginning in 2017, the American Board of Psychiatry and Neurology, Inc. (ABPN) issued two- dimensional content specifications for the psychiatry, neurology and child neurology certification examinations. Questions for the September 2021 psychiatry, neurology and child neurology certification examinations will conform to these content specifications. Within the two-dimensional format, one dimension is comprised of disorders and topics while the other is comprised of competencies and mechanisms that cut across the various disorders of the first dimension. By design, the two dimensions are interrelated and not independent of each other. All of the questions on the examination will fall into one of the disorders/topics and will be aligned with a competency/mechanism. For example, an item on substance use could focus on treatment, or it could focus on systems-based practice. The psychiatry, neurology and child neurology content specifications can be accessed from the specialty certification section of our website. Candidates should use the detailed content specifications as a guide to prepare for a certification examination. Scores for these examinations will be reported in a standardized format rather than the previous percent correct format. Starting in 2018, all future examinations given by the ABPN will gradually conform to the two- dimensional content specification. The American Board of Psychiatry and Neurology, Inc. is a not-for-profit corporation dedicated to serving the public interest and the professions of psychiatry and neurology by promoting excellence in practice through certification and continuing certification processes. For more information, please contact us at [email protected] or visit our website at www.abpn.com. -
Bordering on the Bipolar: a Review of Criteria for ICD-11 and DSM-5 Persistent Mood Disorders Jason Luty
BJPsych Advances (2020), vol. 26, 50–57 doi: 10.1192/bja.2019.54 ARTICLE Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders Jason Luty Jason Luty, MB, ChB, PhD, SUMMARY MRCPsych, is a consultant in addic- Persistent low mood with lack of enjoyment (‘anhe- tions, liaison and general psychiatry The principal manuals for psychiatric diagnosis donia’) is common and often hard to treat in psychi- in south-east England. He trained at have recently been updated (ICD-11 was released atric practice. Recent changes in the two major the Maudsley Hospital, London, and in June 2018 and DSM-5 was published in 2013). spent 8 years as a consultant in diagnostic classification systems – ICD-11 released A common diagnostic quandary is the classification addictions with the South Essex in June 2018 (World Health Organization 2018) Partnership NHS Trust. He has a PhD of people with chronic low mood, especially those in pharmacology, following a study of with repeated self-harm (‘emotionally unstable’ or and DSM-5 (American Psychiatric Association the molecular mechanisms of recep- ‘borderline’ personality disorder). There has been 2013) – make the time apposite to review the diag- tor desensitisation and tolerance, and a great interest in use of type II bipolar affective dis- nostic categories relevant to persistent mood has published in the addictions field. order (‘bipolar II disorder’) as a less pejorative diag- disorders. Correspondence Dr Jason Luty, nostic alternative to ‘personality disorder’,despite fi Consultant Psychiatrist, Athona There is signi cant diagnostic overlap with emo- Recruitment Ltd, 1st Floor, Juniper the radically different treatment options for these tionally unstable/borderline personality disorder, House, Warley Hill Business Park, disorders. -
Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders
J Autism Dev Disord (2006) 36:849–861 DOI 10.1007/s10803-006-0123-0 ORIGINAL PAPER Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders Ovsanna T. Leyfer Æ Susan E. Folstein Æ Susan Bacalman Æ Naomi O. Davis Æ Elena Dinh Æ Jubel Morgan Æ Helen Tager-Flusberg Æ Janet E. Lainhart Published online: 15 July 2006 Ó Springer Science+Business Media, Inc. 2006 Abstract The Kiddie Schedule for Affective Disorders sample demonstrated a high prevalence of specific phobia, and Schizophrenia was modified for use in children and obsessive compulsive disorder, and ADHD. The rates of adolescents with autism by developing additional screening psychiatric disorder in autism are high and are associated questions and coding options that reflect the presentation of with functional impairment. psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview- Keywords Psychopathology Æ Autism Æ Psychiatric Present and Lifetime Version (ACI-PL), was piloted and interview Æ Comorbidity frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The Children with autism frequently have problematic emo- tional reactions and behaviors along with the features that O. T. Leyfer Department of Psychological and Brain Sciences, University define autism. Disturbances of emotion, attention, activity, of Louisville, Louisville, KY, USA and thought, and associated behavioral problems occur in children with autism of all ages (Lainhart, 1999). It is not S. E. Folstein yet known how often these additional difficulties are due to Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA comorbid psychiatric disorders. -
Depression and Anxiety: a Review
DEPRESSION AND ANXIETY: A REVIEW Clifton Titcomb, MD OTR Medical Consultant Medical Director Hannover Life Reassurance Company of America Denver, CO [email protected] epression and anxiety are common problems Executive Summary This article reviews the in the population and are frequently encoun- overall spectrum of depressive and anxiety disor- tered in the underwriting environment. What D ders including major depressive disorder, chronic makes these conditions diffi cult to evaluate is the wide depression, minor depression, dysthymia and the range of fi ndings associated with the conditions and variety of anxiety disorders, with some special at- the signifi cant number of comorbid factors that come tention to post-traumatic stress disorder (PTSD). into play in assessing the mortality risk associated It includes a review of the epidemiology and risk with them. Thus, more than with many other medical factors for each condition. Some of the rating conditions, there is a true “art” to evaluating the risk scales that can be used to assess the severity of associated with anxiety and depression. Underwriters depression are discussed. The various forms of really need to understand and synthesize all of the therapy for depression are reviewed, including key elements contributing to outcomes and develop the overall therapeutic philosophy, rationale a composite picture for each individual to adequately for the choice of different medications, the usual assess the mortality risk. duration of treatment, causes for resistance to therapy, and the alternative approaches that The Spectrum of Depression may be employed in those situations where re- Depression represents a spectrum from dysthymia to sistance occurs. -
First-Episode Psychosis: a Clinical Approach
J Am Board Fam Pract: first published as 10.3122/15572625-13-6-430 on 1 November 2000. Downloaded from First-Episode Psychosis: A Clinical Approach S. Charles Schulz, MD, Deanna Bass, MD, and Cynthia S. Vrabel, MD Background: Psychotic illnesses, such as schizophrenia and bipolar illness, are relatively common and clearly devastating diseases. Most scientific literature focuses on research and care of patients suffering from psychotic illnesses in the middle age-group; subsequently, the first episode or early stages of psy chotic illnesses have been relatively ignored, especially the issues of early diagnosis and inten-ention. The purpose of this article is to highlight issues of first-episode schizophrenia for the family physician and to discuss (1) diagnosis, (2) neuropsychiatry research, (3) new medications, and (4) family issues. Methods: To approach the issues of first-episode schizophrenia, we describe a case of a young woman who suffered her first episode of psychosis. Relevant literature related to the early stages of psychosis, including new pharmacologic treatments, is addressed. Results: This report of our patient, a 19-year-old woman, illustrates the problems of a long prodro mal phase of her illness, the use of medications that might have worsened her condition, and the suc cessful use of new antipsychotic medications. Her family's issues as the patient went through this phase of her illness and recovery are reviewed. Conclusions: Patients at the outset of a psychotic illness are frequently first seen by a family physi cian. Familiarity with current diagnostic criteria and effectiveness of new treatments can lead to im proved detection and overall outcome. -
The Trauma of First Episode Psychosis: the Role of Cognitive Mediation
The trauma of first episode psychosis: the role of cognitive mediation Chris Jackson, Claire Knott, Amanda Skeate, Max Birchwood Objective: First episode psychosis can be a distressing and traumatic event which has been linked to comorbid symptomatology, including anxiety, depression and PTSD symp- toms (intrusions, avoidance, etc.). However, the link between events surrounding a first episode psychosis (i.e. police involve- ment, admission, use of Mental Health Act, etc.) and PTSD symptoms remains unproven. In the PTSD literature, attention has now turned to the patient’s appraisal of the traumatic event as a key mediator. In this study we aim to evaluate the diagnostic status of first episode psychosis as a PTSD-triggering event and to determine the extent to which cognitive factors such as appraisals and coping mechanisms can mediate the expression of PTSD (traumatic) symptomatology. Method: Approximately 1.5 years after their first episode of psychosis, patients were assessed for traumatic symptoms, conformity to DSM-IV criteria for posttraumatic stress disorder (PTSD), and their appraisals of the traumatic events and coping strategies. Psychotic symptomatology was also measured. Results: 31% of the sample of 35 patients who agreed to participate reported symptoms consistent with a diagnosis of PTSD. Although no relationship was found between PTSD (traumatic) symptoms and potentially traumatic aspects of the first episode (including place of treatment, detention under the MHA etc.), intrusions and avoidance were positively related to retrospective appraisals of stressfulness of the ward (i.e. the more stressful they rated it the greater the number of PTSD symptoms) and the patient’s coping style (sealers were less likely to report intrusive re-experiencing but more likely to report avoidance). -
Chapter 7 Mood Disorders
An Overview of Mood Disorders • Gross Deviations in Mood • 2 Fundamental states: Depression & Mania Chapter 7 • Depression: “The Low” – Major Depressive Episode •The most commonly diagnosed & most severe Mood Disorders depression •Depressed (or in children, irritable) mood state that lasts at least 2 weeks –Cognitive symptoms •Feelings of worthlessness or inappropriate guilt •Diminished ability to concentrate or indecisiveness – Dysthymic Disorder –Disturbed physical functions (vegetative •Similar symptoms to Major Depressive Episode, symptoms) (central to the disorder) but milder •Insomnia or hypersomnia nearly every day –Also fewer symptoms: need only 2 of the •Significant weight loss or gain or change in symptoms, as opposed to 5 in Major Depressive appetite Episode •Fatigue or loss of energy nearly every day •A persistently depressed (or, in children & •Psychomotor agitation or retardation adolescents, irritable) mood that continues for at –Nearly always accompanied by markedly least 2 years diminished interest or ability to experience pleasure –During those 2 years, the individual has never been (anhedonia) from life without the symptoms for more than 2 months at a • Average duration if untreated: 9 months time •Most people with Dysthymia eventually experience a major depressive episode • Mania: “The High” –Abnormally exaggerated elation, joy, or euphoria OR irritability (common toward the –Behavioral symptoms end of the episode) lasting at least 1 week •More talkative / pressured speech –Cognitive symptoms •Psychomotor agitation