SPMI Specifics

Question 1

Schizophrenia Criteria
According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), to be diagnosed with schizophrenia, three diagnostic criteria must be met:[70]

Answer 1

Characteristic symptoms: Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).
Delusions
Hallucinations
Disorganized speech, which is a manifestation of formal thought disorder
Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
Negative symptoms: Blunted affect (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation)
If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient’s actions or of hearing two or more voices conversing with each other, only that symptom is required above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication.
Social or occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.
Significant duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if symptoms remitted with treatment).

Question 2

Schizophrenia Paranoid Type

Answer 2

Paranoid type: Delusions or auditory hallucinations are present, but thought disorder, disorganized behavior, or affective flattening are not. Delusions are persecutory and/or grandiose, but in addition to these, other themes such as jealousy, religiosity, or somatization may also be present. (DSM code 295.3/ICD code F20.0)

Question 3

Schizophrenia Disorganized Type

Answer 3

Disorganized type: Named hebephrenic schizophrenia in the ICD. Where thought disorder and flat affect are present together. (DSM code 295.1/ICD code F20.1)

Question 4

Schizophrenia Catatonic Type

Answer 4

The subject may be almost immobile or exhibit agitated, purposeless movement. Symptoms can include catatonic stupor and waxy flexibility. (DSM code 295.2/ICD code F20.2)

Question 5

Schizophrenia Undifferentiated Type

Answer 5

Psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met. (DSM code 295.9/ICD code F20.3)

Question 6

Schizophrenia Residual Type

Answer 6

Where positive symptoms are present at a low intensity only. (DSM code 295.6/ICD code F20.5)

Question 7

BiPolar I

Answer 7

Bipolar I disorder: One or more manic episodes. Subcategories specify whether there has been more than one episode, and the type of the most recent episode.[65] A depressive or hypomanic episode is not required for diagnosis, but it frequently occurs.

Question 8

BiPolar II

Answer 8

Bipolar II disorder: No manic episodes, but one or more hypomanic episodes and one or more major depressive episode.[66] Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.

Question 9

Cyclothymia

Answer 9

Cyclothymia: A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes.[67] There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning.

Question 10

Bipolar NOS

Answer 10

Bipolar disorder NOS (not otherwise specified): This is a catchall category, diagnosed when the disorder does not fall within a specific subtype.[68] Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.

Question 11

Major Depressive Disorder

Answer 11

A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks.[6] Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features — commonly referred to as psychotic depression — is automatically rated as severe.

Question 12

Melancholic depression

Answer 12

Melancholic depression is characterized by a loss of pleasure in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.[143]

Question 13

Atypical Depression

Answer 13

Atypical depression is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite (comfort eating), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.[144]

Question 14

Catatonic Depression

Answer 14

Catatonic depression is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in schizophrenia or in manic episodes, or may be caused by neuroleptic malignant syndrome.[145]

Question 15

Dysthmic disorder

Answer 15

1.During a majority of days for two years or more, the adult patient reports depressed mood or appears depressed to others for most of the day.
2.When depressed, the patient has two or more of:
decreased or increased appetite
decreased or increased sleep (insomnia or hypersomnia)
Fatigue or low energy
Reduced self-esteem
Decreased concentration or problems making decisions
Feels hopeless or pessimistic
3. During this two-year period, the above symptoms are never absent longer than two consecutive months.
4. During the first two years of this syndrome, the patient has not had a major depressive episode.
5. The patient has not had any manic, hypomanic, or mixed episodes.
6. The patient has never fulfilled criteria for cyclothymic disorder.
7. The depression does not exist only as part of a chronic psychosis (such as schizophrenia or delusional disorder).
8. The symptoms are often not directly caused by a medical illness or by substances, including drug abuse, or other medications.
9. The symptoms may cause significant problems or distress in social, work, academic, or other major areas of life functioning.[20]

Question 16

Avoidant Personality Disorder

Answer 16

Avoidant personality disorder (AvPD), also known as anxious personality disorder,[1] is a Cluster C personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook as afflicting a person when they display a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction.[2] Individuals afflicted with the disorder tend to describe themselves as ill at ease, anxious, lonely, and generally feel unwanted and isolated from others.[3]

Question 17

Dependent Personality Type

Answer 17

The DSM-IV-TR contains a Dependent Personality Disorder diagnosis. It refers to a pervasive and excessive need to be taken care of which leads to submissive and clinging behavior and fears of separation. This begins by early adulthood and can present in a variety of contexts.:[21]

Question 18

Borderline Personality Type

Answer 18

The most distinguishing symptoms of BPD are marked sensitivity to rejection[disambiguation needed] and thinking about and feeling afraid of possible abandonment.[10] Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity. Other symptoms can include feeling unsure of one’s personal identity and values, having paranoid thoughts when feeling stressed, and severe dissociation.[10]

Question 19

Schizotypal Personality Type

Answer 19

The American Psychiatric Association defined Schizotypal Personality Disorder as a “pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts”.[6]`

Question 20

Schizoid Personality Disorder

Answer 20

Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world.[1]

Question 21

Histrionic Personality Disorder

Answer 21

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotions and attention-seeking, including inappropriately seductive behavior and an excessive need for approval, usually beginning in early adulthood. People affected by HPD are lively, dramatic, vivacious, enthusiastic, and flirtatious. HPD affects four times as many women as men.[1] It has a prevalence of 2–3% in the general population, and 10–15% in inpatient and outpatient mental health institutions.[2]

Question 22

Antisocial Personality Disorder

Answer 22

Antisocial personality disorder (ASPD), also called dissocial personality disorder, is a personality disorder characterized by a pervasive pattern of disregard for, or violation of, the rights of others. There may be an impoverished moral sense or conscience and a history of crime, legal problems, impulsive and aggressive behavior.