DSM-5 Diagnoses Simplified

Psychotic Disorders

The Five (5) Signs of Psychosis

    1. Delusions (Positive Psychotic Symptom)
    2. Hallucinations (Positive Psychotic Symptom)
    3. Disorganized speech (Positive Disorganization Symptom)
    4. Grossly Disorganized/Catatonic behavior (Positive Disorganization Symptom)
    5. Negative Symptoms (Alogia, Flattened Affect, Anhedonia, Avolition, Attention problems, Social withdrawal)

Brief Psychotic Disorder

1, 2, or 3 are present for less than 1 month

Schizophrenia

1, 2, or 3 AND 1, 2, 3, 4, or 5 are present for greater than 6 months

Schizophreniform disorder

Same as Schizophrenia but duration is 1-6 months

Schizoaffective disorder

Schizophrenia + Manic and/or Depressive Episodes

Note: Psychotic symptoms must be present in the absence of mood symptoms for at least two weeks

Bipolar Disorder with Psychotic features

Psychotic symptoms occur exclusively during manic episodes

Depression with psychotic features

Psychotic symptoms occur exclusively during depressed episodes

Delusional disorder

Only delusions are present for at least one month. If hallucinations do occur, they are “theme congruent” or strongly related to the delusional beliefs

Substance/Medication-induced Psychotic disorder

Psychosis caused by drugs or medications

**All Psychotic Disorders are treated with Antipsychotics (atypical antipsychotics are preferred due to less side effects)**

Mood Disorders

Major Depressive Disorder (MDD)

S-I-G-E-C-A-P-S

S (Sleep Disturbance) | I (Interest is lost) | G (Guilty Feelings) | E (Energy is low) | C (Concentration is impaired) | A (Appetite changes) | P (Psychomotor changes) | S (Suicidal Thoughts) |

Major Depressive Episode: 5 of the SIGECAPS criteria must be met for at least two weeks

Therapy of choice: Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT)

Persistent Depressive Disorder (Dysthymia)

Depressive Symptoms for at least 2 years

Bipolar Disorder

D-I-G-F-A-S-T

D (Distracted) | I (Insomnia) | G (Grandiose) | F (Flight of Ideas) | A (Agitation) | S (Speech is Pressured) | T (Takes Risks) |

Mania

DIGFAST for at least one (1) week (or any duration if hospitalized)

Hypomania

DIGFAST for at least four (4) days and not hospitalized

Bipolar I Disorder

Only a Manic Episode is Required (Does not require history of major depressive episode)

Bipolar II Disorder

Requires at least one hypomanic episode AND one major depressive episode

Cyclothymia

Hypomanic Episodes + Subthreshold Major Depressive Episodes

Treatments

Unipolar Nonpsychotic Depression is managed with psychotherapy with or without antidepressants (SSRIs|SNRIs|Bupropion|Mirtazapine|Lithium)

 

Bipolar Depression is managed with Lithium, Lamotrigine, Lurasidone, Quetiapine, or [Fluoxetine + Olanzapine]

 

Bipolar Hypomania/Mania is managed with Lithium, Valproic acid, and/or atypical antipsychotics (Risperidone, Olanzapine, Asenapine, Ziprasidone, Aripiprazole) 

Trauma and Stressor-Related Disorders

Post Traumatic Stress Disorder (PTSD)

Clinical Picture: Patient has a history of some type of life threatening trauma and as a result now has flashbacks, nightmares, and hyper vigilance especially when reminded of the event and then avoids any triggers by isolating and/or avoiding “triggering” situations. Also has negative emotions or has difficulty feeling emotion (numbing). These symptoms have lasted for more than 1 month

Treatment: Prolonged Exposure Therapy, Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors, Prazosin (for nightmares)

Acute Stress Disorder

Clinical Picture: Same as PTSD but symptoms <1 month

 

Anxiety Disorders

Generalized Anxiety Disorder

Clinical Picture: Worrying about many aspects of life to a point where it causes distress [6 months]

Treatment: Cognitive Behavioral Therapy (CBT) +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors, or Clonazepam

Panic Attack

Clinical Picture: Acute onset with surge of fear and discomfort associated with somatic symptoms such as sweating, trembling, Chest pain, Choking, Palpitations, Shortness of breath, dizziness, nausea, chills, tingling, numbness, vision changes, and with a fear of dying

Treatment: Benzodiazepines (e.g., Alprazolam, Lorazepam, Diazepam, Triazolam)

Panic Disorder

Clinical Picture: Recurrent unexpected panic attacks with constant worrying that the attacks will happen again

Treatment: Cognitive Behavioral Therapy (CBT) or Exposure Therapy +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors, or Benzodiazepines

Social Anxiety Disorder (Social Phobia)

Clinical Picture: Anxiety in settings (usually social setting) where there is risk of embarrassment, humiliation, criticism, or being judged. Person avoids social situations or experiences significant distress when they do experience these situations

Treatment: Cognitive Behavioral Therapy (CBT) or Exposure Therapy or Interpersonal Therapy +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors, Benzodiazepines, or Propranolol

Obsessive Compulsive Disorder (OCD)

Clinical Picture: Obsessions (intrusive, anxiety provoking thoughts) with or without Compulsions (repetitive behaviors to ease anxiety)

Patient knows it’s ridiculous and not productive (i.e., ego dystonic)

Treatment: Exposure Response Prevention Therapy (ERP), Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT) +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors SSRIs, or Clomipramine

Trichotillomania

Clinical Picture: Compulsively pulling out hair

Treatment: Naltrexone, Exposure Response Prevention Therapy (ERP), Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT) +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors SSRIs, or Clomipramine

Skin Picking Disorder (Excoriation Disorder)

Clinical Picture: Compulsively picking at skin

Treatment: Naltrexone, Exposure Response Prevention Therapy (ERP), Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT) +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors SSRIs, or Clomipramine

Tourette’s Disorder

Clinical Picture: Impulsive outbursts + vocal or motor tics

Treatment: Antipsychotics, Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors

Hoarding Disorder

Clinical Picture: Can’t throw stuff away. “I must keep everything just in case I need it later!”

Treatment: Naltrexone, Exposure Response Prevention Therapy (ERP), Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT) +/- Selective Serotonin Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors SSRIs, or Clomipramine

 

Personality Disorders

**No approved pharmacological treatment; Mostly therapy-based treatments**

Cluster A

Schizoid: Enjoys being alone. No interest in relationships. Happy with solo life.

Schizotypal: Odd, eccentric people who have magical thinking, believe in conspiracies, and are socially awkward (but not psychotic).

Paranoid: Paranoid and mistrusting of everything. Makes mountains out of ant hills. Bad things happen to them because others can’t be trusted. Not to a delusional degree and no signs of psychosis

Cluster B

Borderline: Tumultuous and unstable interpersonal relationships, fears being abandoned, low self esteem, “quasi psychotic rages,” splitting, self-harm behaviors, makes threats or manipulates to get what he/she wants. Very manipulative.

Antisocial: Jail inmates, no empathy, no guilt, no remorse. (e.g., Ted Bundy, Serial Killers)

Narcissistic: Inflated sense of importance. Loves praise and encouragement. Low self-esteem. World revolves around them. When others don’t accommodate them they get upset. Lack insight.

Histrionic: Seductive, constantly needs attention, loves to be the life of the party (e.g., Marilyn Monroe)

Treatments: Dialectical Behavioral Therapy (DBT), Contingency-Based Treatments, Group Therapy, Lamotrigine, Fluoxetine, Atypical Antipsychotics, Lithium 

Cluster C

Avoidant: Wants to be the center of attention and life of the party but fears being rejected and then stays home and isn’t happy about staying home

Dependent: The wife who can’t leave her abusive husband. The man who needs constant reassurance before doing anything.

Obsessive Compulsive: Think OCD but the patient thinks OCD behaviors are reasonable and productive (i.e., Ego Syntonic).

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