F 5.....schizophrenia....mania....hypomania .pptx

Psychiatry

1. THEME: F50-F59 BEHAVIOURAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS

2. Main features of the chapter F5 Etiology : complex factors – social, psychological, biological Borderline level of disturbances, but may be reach psychotic level ( puerperium disorders) Progressive development is absent Excepted physical diseases Drug abused are excluded

3. F50.0 Anorexia nervosa Anorexia nervosa is a disorder characterized by deliberate weight loss, induced and/or sustained by the patient. The disorder occurs most commonly in adolescent girls and young women, but adolescent boys and young men may be affected more rarely, as may children approaching puberty and older women up to the menopause.

4. For a definite diagnosis, all the following are required Body weight is maintained at least 15% below that expected (either lost or never achieved), or Quetelet's body-mass index4 is 17.5 or less. Prepubertal patients may show failure to make the expected weight gain during the period of growth. The weight loss is self-induced by avoidance of "fattening foods". One or more of the following may also be present: self-induced vomiting; self-induced purging ; excessive exercise; use of appetite suppressants and/or diuretics. There is body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself. A widespread endocrine disorder involving the hypothalamic - pituitary -gonadal axis is manifest in women as amenorrhea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are receiving replacement hormonal therapy, most commonly taken as a contraceptive pill.) There may also be elevated levels of growth hormone, raised levels of cortisol, changes in the peripheral metabolism of the thyroid hormone, and abnormalities of insulin secretion.

5. F50.1 Atypical anorexia nervosa This term should be used for those individuals in whom one or more of the key features of anorexia nervosa (F50.0), such as amenorrhea or significant weight loss, is absent, but who otherwise present a fairly typical clinical picture. Such people are usually encountered in psychiatric liaison services in general hospitals or in primary care. Patients who have all the key symptoms but to only a mild degree may also be best described by this term. This term should not be used for eating disorders that resemble anorexia nervosa but that are due to known physical illness.

6. F50.2 Bulimia nervosa Bulimia nervosa is a syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading the patient to adopt extreme measures so as to mitigate the "fattening" effects of ingested food. The disorder may be viewed as a sequel to persistent anorexia nervosa (although the reverse sequence may also occur). A previously anorexic patient may first appear to improve as a result of weight gain and possibly a return of menstruation, but a pernicious pattern of overeating and vomiting then becomes established.

7. For a definite diagnosis, all the following are required There is a persistent preoccupation with eating, and an irresistible craving for food; the patient succumbs to episodes of overeating in which large amounts of food are consumed in short periods of time. The patient attempts to counteract the "fattening" effects of food by one or more of the following: self-induced vomiting; purgative abuse, alternating periods of starvation; use of drugs such as appetite suppressants, thyroid preparations or diuretics. When bulimia occurs in diabetic patients they may choose to neglect their insulin treatment. The psychopathology consists of a morbid dread of fatness and the patient sets herself or himself a sharply defined weight threshold, well below the premorbid weight that constitutes the optimum or healthy weight in the opinion of the physician. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval between the two disorders ranging from a few months to several years. This earlier episode may have been fully expressed, or may have assumed a minor cryptic form with a moderate loss of weight and/or a transient phase of amenorrhea.

8. F50.3 Atypical bulimia nervosa This term should be used for those individuals in whom one or more of the keyfeatures listed for bulimia nervosa (F50.2) is absent, but who otherwise present a fairly typical clinical picture. Most commonly this applies to people with normal or even excessive weight but with typical periods of overeating followed by vomiting or purging. Partial syndromes together with depressive symptoms are also not uncommon, but if the depressive symptoms justify a separate diagnosis of a depressive disorder two separate diagnoses should be made.

9. F50.4 Overeating associated with other psychological disturbances Overeating that has led to obesity as a reaction to distressing events should be coded here. Bereavements , accidents, surgical operations, and emotionally distressing events may be followed by a "reactive obesity", especially in individuals predisposed to weight gain. Obesity as a cause of psychological disturbance should not be coded here. Obesity may cause the individual to feel sensitive about his or her appearance and give rise to a lack of confidence in personal relationships; the subjective appraisal of body size may be exaggerated.

10. F51 Nonorganic sleep disorders This group of disorders includes: dissomnias : primarily psychogenic conditions in which the predominant disturbance is in the amount, quality, or timing of sleep due to emotional causes, i.e. insomnia, hypersomnia, and disorder of sleep - wake schedule; and parasomnias : abnormal episodic events occurring during sleep; in childhood these are related mainly to the child's development, while in adulthood they are predominantly psychogenic, i.e. sleepwalking, sleep terrors, and nightmares.

11. F51.0 Nonorganic insomnia Diagnostic guidelines The following are essential clinical features for a definite diagnosis: the complaint is either of difficulty falling asleep or maintaining sleep, or of poor quality of sleep; the sleep disturbance has occurred at least three times per week for at least 1month; there is preoccupation with the sleeplessness and excessive concern over its consequences at night and during the day; the unsatisfactory quantity and/or quality of sleep either causes marked distress or interferes with ordinary activities in daily living.

12. F51.1 Nonorganic hypersomnia excessive daytime sleepiness or sleep attacks, not accounted for by an inadequate amount of sleep, and/or prolonged transition to the fully aroused state upon awakening (sleep drunkenness); sleep disturbance occurring daily for more than 1 month or for recurrent periods of shorter duration, causing either marked distress or interference with ordinary activities in daily living; absence of auxiliary symptoms of narcolepsy (cataplexy, sleep paralysis, hypnagogic hallucinations) or of clinical evidence for sleep apnoea (nocturnal breath cessation, typical intermittent snorting sounds, etc.); absence of any neurological or medical condition of which daytime somnolence may be symptomatic.

13. F51.2 Nonorganic disorder of the sleep-wake schedule the individual's sleep-wake pattern is out of synchrony with the sleep-wake schedule that is normal for a particular society and shared by most people in the same cultural environment; insomnia during the major sleep period and hypersomnia during the waking period are experienced nearly every day for at least 1 month or recurrently for shorter periods of time; the unsatisfactory quantity, quality, and timing of sleep cause marked distress or interfere with ordinary activities in daily living.

14. F51.3 Sleepwalking [somnambulism] - the predominant symptom is one or more episodes of rising from bed, usually during the first third of nocturnal sleep, and walking about; -during an episode, the individual has a blank, staring face, is relatively unresponsive to the efforts of others to influence the event or to communicate with him or her, and can be awakened only with considerable difficulty; -upon awakening (either from an episode or the next morning), the individual has no recollection of the episode; -within several minutes of awakening from the episode, there is no impairment of mental activity or behavior, although there may initially be a short period of some confusion and disorientation; -there is no evidence of an organic mental disorder such as dementia, or a physical disorder such as epilepsy.

15. F51.4 Sleep terrors [night terrors] the predominant symptom is that one or more episodes of awakening from sleep begin with a panicky scream, and are characterized by intense anxiety, body motility, and autonomic hyperactivity, such as tachycardia, rapid breathing, dilated pupils, and sweating; these repeated episodes typically last 1-10 minutes and usually occur during the first third of nocturnal sleep; there is relative unresponsiveness to efforts of others to influence the sleep terror event and such efforts are almost invariably followed by at least several minutes of disorientation and perseverative movements; recall of the event, if any, is minimal (usually limited to one or two fragmentary mental images); there is no evidence of a physical disorder, such as brain tumor or epilepsy.

16. F51.5 Nightmares awakening from nocturnal sleep or naps with detailed and vivid recall of intensely frightening dreams, usually involving threats to survival, security, or self-esteem; the awakening may occur at any time during the sleep period, but typically during the second half; upon awakening from the frightening dreams, the individual rapidly becomes oriented and alert; the dream experience itself, and the resulting disturbance of sleep, cause marked distress to the individual.

17. F52 Sexual dysfunction, not caused by organic disorder or disease F52.0 Lack or loss of sexual desire F52.1 Sexual aversion and lack of sexual enjoyment F52.2 Failure of genital response F52.3 Orgasmic dysfunction F52.4 Premature ejaculation F52.5 Nonorganic veganism's F52.6 Nonorganic dyspareunia F52.7 Excessive sexual drive