Psychotic, personality, neurodevelopmental, eating and sleep disorders

AI-narrated overview made with Google NotebookLM. The written lesson below is by Dr. Andrew Wichterman.

The remaining DSM chapters the exam draws from, each with a small set of tested distinctions. Learn the signature feature of each disorder and the one or two that are most easily confused.

Schizophrenia spectrum

Schizophrenia requires two or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as flat affect, alogia and avolition, with at least one of the first three, for at least six months including one month of active symptoms, with impaired functioning. Schizophreniform disorder is the same picture lasting one to six months. Brief psychotic disorder lasts one day to one month with full return to functioning. Schizoaffective disorder combines a mood episode with schizophrenia symptoms and requires at least two weeks of psychosis without mood symptoms. Delusional disorder is one or more delusions for a month without other psychotic features and with functioning otherwise preserved. Positive symptoms add something, hallucinations and delusions; negative symptoms take something away. Antipsychotic medication is the foundation of treatment; the counselor adds psychoeducation, family work, social skills training, supported employment and CBT for psychosis, and monitors for the metabolic side effects of second-generation antipsychotics and the movement side effects, tardive dyskinesia, of first-generation ones.

Personality disorders

A personality disorder is an enduring, inflexible pattern of inner experience and behavior deviating from cultural expectations, beginning by early adulthood, stable and pervasive, causing distress or impairment. Cluster A, odd or eccentric: paranoid, schizoid, detached and indifferent to relationships, and schizotypal, odd beliefs and eccentric behavior without psychosis. Cluster B, dramatic or erratic: antisocial, disregard for others' rights, requires age eighteen and conduct disorder before fifteen; borderline, instability in relationships, self-image and affect, fear of abandonment, self-harm; histrionic, attention-seeking emotionality; narcissistic, grandiosity and need for admiration with fragile self-esteem. Cluster C, anxious or fearful: avoidant, wants relationships but fears rejection; dependent, submissive and clinging; obsessive-compulsive, perfectionism and control. Distinctions the exam tests: schizoid does not want relationships, avoidant wants them and fears them; antisocial is not diagnosed under eighteen; borderline is the one with self-harm and abandonment fear. Dialectical behavior therapy is the treatment with the strongest evidence for borderline personality disorder; personality disorders are not diagnosed from a single crisis presentation.

Neurodevelopmental disorders

Intellectual disability requires deficits in intellectual functioning, roughly two standard deviations below the mean, and in adaptive functioning, with onset in the developmental period; severity is now rated by adaptive functioning, not IQ alone. Autism spectrum disorder combines persistent deficits in social communication and interaction with restricted, repetitive patterns of behavior, interests or activities, present early, and is rated by support needs; Asperger's and PDD-NOS were folded into it. ADHD requires six or more symptoms of inattention and/or hyperactivity-impulsivity, five for those seventeen and older, present before age twelve, in two or more settings; presentations are combined, predominantly inattentive, and predominantly hyperactive-impulsive. Specific learning disorder is specified in reading, written expression or mathematics. Tourette's disorder is multiple motor and one or more vocal tics for over a year with onset before eighteen. Stimulants are first-line medication for ADHD; behavioral parent training and classroom interventions are the psychosocial treatments; applied behavior analysis is the evidence base for autism interventions.

Eating and feeding disorders

Anorexia nervosa is restriction of intake leading to significantly low weight, intense fear of gaining weight, and disturbance in the experience of body weight or shape; the restricting and binge-eating/purging types are specified, and amenorrhea is no longer required. Bulimia nervosa is recurrent binge eating with compensatory behavior, vomiting, laxatives, fasting, exercise, at least once a week for three months, at normal or above-normal weight, with self-evaluation unduly influenced by shape and weight. Binge-eating disorder is recurrent binges without compensation, with distress, at least weekly for three months. Avoidant/restrictive food intake disorder is restriction without body-image disturbance. Pica and rumination disorder are the others. Anorexia has the highest mortality of any psychiatric disorder, from medical complications and suicide; medical monitoring is part of treatment. Family-based treatment leads for adolescents with anorexia; CBT-E for bulimia and binge-eating disorder.

Sleep, dissociative and somatic disorders

Insomnia disorder is difficulty initiating or maintaining sleep three nights a week for three months with daytime impairment; cognitive behavioral therapy for insomnia, sleep restriction, stimulus control, sleep hygiene and cognitive work, is first-line over medication. Hypersomnolence, narcolepsy, obstructive sleep apnea, circadian rhythm disorders, nightmare disorder and REM sleep behavior disorder are the others named. Dissociative identity disorder is two or more distinct personality states with gaps in memory; dissociative amnesia is inability to recall autobiographical information, with or without fugue; depersonalization/derealization disorder is persistent detachment from self or surroundings with intact reality testing. Somatic symptom disorder is distressing somatic symptoms with excessive thoughts, feelings and behavior about them, whether or not medically explained; illness anxiety disorder is preoccupation with having an illness with minimal symptoms; conversion disorder, functional neurological symptom disorder, is neurological symptoms incompatible with recognized conditions; factitious disorder is deliberate falsification of illness, imposed on self or another.