* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Diagnostic Criteria
Bipolar II disorder wikipedia , lookup
Political abuse of psychiatry wikipedia , lookup
Excoriation disorder wikipedia , lookup
Antipsychotic wikipedia , lookup
Panic disorder wikipedia , lookup
Moral treatment wikipedia , lookup
Bipolar disorder wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Mental disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Obsessive–compulsive disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Rumination syndrome wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Mental status examination wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Asperger syndrome wikipedia , lookup
Substance dependence wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Substance use disorder wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Abnormal psychology wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Eating Disorders From a Psychiatrists Perspective: Diagnostic and Treatment Considerations Preferred Provider Conference Sunday, January 31st Anna Jurec, M.D. Castlewood Treatment Center for Eating Disorders 800 Holland Road 636-386-6611 www.castlewoodtc.com [email protected] Anorexia Bulimia Diagnostic Criteria Case 1 • • • • • • The refusal to maintain body weight at or above a minimally normal weight for age and height. Maintaining a body weight less than 85% of the expected weight. An intense fear of gaining weight or becoming fat, even though the person is underweight Self-perception that is grossly distorted, excessive emphasis on body weight in self-assessment, and weight loss that is either minimized or not acknowledged completely. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In the binge-eating/purging type, the individual regularly engages in binge eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia. In the restricting type, the individual severely restricts food intake but does not regularly engage in the behaviors seen in the bingeeating type. 23 YO female with 64% IBW reports inability to maintain healthy weight because of severe preoccupation with food, its taste and “its justification” for weight restoration. She also describes intrusive fear that food, mainly its taste which she fears might be contaminated with soap, perfume, lotion, cleaning agents, etc. She compulsively evaluates its taste, brushes teeth compulsively, washes her lips, hands etc to create safe environment for consumption. 2 Obsessive Compulsive Disorder Diagnostic criteria • • • • • • The individual expresses either obsessions or compulsions At some point during the course of the disorder, the person recognizes that the obsessions or compulsions are excessive or unreasonable. This does not apply to children. The obsessions or compulsions cause marked distress; are time consuming (take >1 h/d); or significantly interfere with the person's normal routine, occupational or academic functioning, or usual social activities or relationships. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it, such as preoccupation with food and weight in the presence of an eating disorder, hair pulling in the presence of trichotillomania, concern with appearance in body dysmorphic disorder, preoccupation with drugs in substance use disorder, preoccupation with having a serious illness in hypochondriasis, preoccupation with sexual urges in paraphilia, or guilty ruminations in the presence of major depressive disorder. The disorder is not due to the direct physiologic effects of a substance or a general medical condition. The additional specification of "with poor insight" is made if, for most of the current episode, the person does not recognize that the symptoms are excessive or unreasonable. Obsessions are defined by the following 4 criteria. – Recurrent and persistent thoughts, impulses, or images are experienced at some time during the disturbance as intrusive and inappropriate and cause marked anxiety and distress. Those with this disorder recognize the craziness of these unwanted thoughts (such as fears of hurting their children) and would not act on them, but the thoughts are very disturbing and difficult to tell others about. – The thoughts, impulses, or images are not simply excessive worries about real-life problems. – The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action. – The person recognizes that the obsessional thoughts, impulses, or images are a product of his/her own mind (not imposed from without, as in thought insertion). Compulsions are defined by the following 2 criteria: – The person performs repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly. – The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are meant to neutralize or prevent or they are clearly excessive 3 Treatment Medical complications Psychiatric complications • Potential for electrolyte imbalance • Nutritional deficiencies(vitamin, mineral, protein etc.) • Cardiovascular(bradycardia, hypotension) • Amenorrhea • Risk of refeeding syndrome • • • • • Depression Suicidality Cognitive impairment Anxiety Risk of adverse reactions to medication 4 Treatment, cont. Medical goals: Psychiatric goals: • Restoration and maintenance of an appropriate nutritional status • Close monitoring for reemergence of Refeeding Syndrome • Decreasing long term health risks associated with Anorexia • Decreasing symptoms of anxiety and depression. • Improving thought process by decreasing obsessionality. • Improving ability to refrain from compulsive behaviors. • Regain appropriate insight into her illness. • Improve quality of life. 5 Pharmacological Treatment Medical • Supplements • GI • Endocrine Psychiatric: • • • • Antidepressants Anxiolytics Antipsychotics Mood stabilizers/anticonvulsants 6 Bulimia Nervosa Diagnostic Criteria A. Recurrent episodes of binge eating. B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting, or excessive exercise C. The binge eating and inappropriate compensatory behaviors occur, on average, at least twice a week for three months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa. • An episode of binge eating is characterized by both of the following: (1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. (2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). Type: Purging Type vs. Non-purging Type (exercise & fasting to compensate). 8 Case II • 25 YO female with multiple daily episodes of binging and purging as well as periods of fasting. She admits to using cocaine and stimulants to suppress appetite. She admits to binge drinking on weekends. She has significant history of sexual abuse in childhood. • She is very ashamed of her symptoms and has been feeling very guilty about her life and being a failure. She hates herself and self mutilates frequently. 9 Co-occurring Issues Substance Abuse Substance dependence • • • • • • The essential feature of abuse is a pattern of substance use that causes someone to experience harmful consequences. Clinicians diagnose substance abuse if, in a twelve-month period, a person is in one or more of the following situations related to drug use: Failure to meet obligations, such as missing work or school Engaging in reckless activities, such as driving while intoxicated Encountering legal troubles, such as getting arrested Continuing to use despite personal problems, such as a fight with a partner • • • • • • • • • Dependence is more severe. Medical professionals will look for three or more criteria from a set that includes two physiological factors and five behavioral patterns, again, over a twelve-month period. Tolerance and withdrawal alone are not enough to indicate dependence. And not all behavioral signs occur with every substance. The physiological factors are: Tolerance, in which a person needs more of a drug to achieve intoxication Withdrawal, in which they experience mental or physical symptoms after stopping drug use The behavioral patterns are: Being unable to stop once using starts Exceeding self-imposed limits Curtailing time spent on other activities Spending excessive time using or getting drugs Taking a drug despite deteriorating health 10 Borderline Personality Disorder Diagnostic criteria DSM IV TR A. An enduring pattern of inner experience and behavior deviating markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: cognition (perception and interpretation of self, others and events) • Affect (the range, intensity, lability and appropriateness of emotional response) • interpersonal functioning • impulse control B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning. D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood. E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma). 11 Treatment Medical • Stabilize and correct electrolyte imbalance • GI /GERD • Cardiovascular Psychiatric: • • • • Alcohol withdrawal Mood/anxiety/ Impulse control Self harm vs. suicide Decrease binge/purge 12 Psychological Treatment Medical • Supplements • GI medications antacids, antiemetic etc Psychiatric: • • • • • Anxiolytics Antidepressants Mood stabilizers Antipsychotics Stimulants 13 Psychological Treatment Diagnostic Criteria: • • • • • • • The EDNOS category include disorders that do not meet the criteria for a specific eating disorder. Each one of the following disorders is an example: For females, all of the criteria for anorexia nervosa are met except that the individual has regular menses. All of the criteria for anorexia nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range. All of the criteria for bulimia nervosa are met except that binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (eg; self-induced vomiting after the consumption of two cookies). Repeatedly chewing and spitting out, but not swallowing, large amounts of food. Binge eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa. Purging disorder Nighttime eating disorder Binge Eating Disorder 14 Case III • 30 year old female with BMI of 34 • She reports eating excessively trough the day and having occasional binges on food, especially sweets • She reports being very disorganized, emotional, having mood swings and being ”all over the place” • She feels that marijuana helped not to feel as overwhelmed and admits she has been self medicating her anxiety with it. 15 Treatment Considerations Medical: • Obesity • Dyslipidemias • Insulin resistance • Cardiovascular deconditioning Psychiatric: • Marijuana Abuse • Impulse Control • Affective instability 16 Pharmacological Treatment • Orlistat • Sybutramine • Lipid Lowering agents • • • • • Anxiolytics Antidepressants Stimulants Mood Stabilizers Antipsychotics 17 PTSD A. The person has been exposed to a traumatic event in which both of the following were present: the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. the person’s response involved intense fear, helplessness, or horror. B. The traumatic event is persistently reexperienced in one (or more) of the following ways: recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions recurrent distressing dreams of the event acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: efforts to avoid thoughts, feelings, or conversations associated with the trauma efforts to avoid activities, places, or people that arouse recollections of the trauma inability to recall an important aspect of the trauma markedly diminished interest or participation in significant activities feeling of detachment or estrangement from others restricted range of affect (e.g., unable to have loving feelings) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: difficulty falling or staying asleep irritability or outbursts of anger difficulty concentrating hypervigilance exaggerated startle response E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 18 PTSD Dissociative Identity Disorder • • • • The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). At least two of these identities or personality states recurrently take control of the person's behavior. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play. 19 Case IV • 36 YO female with history of severe childhood sexual abuse and periods of starvation, binge/purge. Currently at 95 % IBW, reports symptoms of depression, anxiety and inability to remember parts of the day. • She is unable to eat because of severe nausea and feeling repulsed by food. She is having frequent panic attacks especially around food. • She has profound difficulties sleeping and feels “on the edge” all the time 20