brife overview of disorders in DSM V

1. An Overview of Common
Mental Disorders.
Ramkumar G S MD
Psychiatry Specialist
Caritas Hospital
Thallekom, Kottayam.

2.  What are the common mental disorders?
 What is a mental disorder?
 Overview of mental disorders.
 Definition
 Characteristics of disorder

3. What are the common mental disorders?
 Epidemiological
studies ascertain
prevalence.

4.  prevalence rates for psychiatric disorders from 9.5
to 370/1000 populations in India from 16 studies (
Indian J Med Res. 2007 Sep;126(3):183-92. ), Indian J Psychiatry. 2010 Jan;52(Suppl 1)
 A meta-analysis of 13 psychiatric epidemiological
studies yielded an estimate prevalence rate of 58.2
per thousand population Indian Journal of Psychiatry. 1998 vol. 40 (2) p. 149
 The national prevalence rates for 'all mental
disorders' arrived at are 70.5 (rural), 73 (urban) and
73 (rural + urban) per 1000 population.(15 studies)
Indian Journal of Psychiatry. 2000 vol. 42 (1) p. 14

5. Mental illness http://www.mayoclinic.org/
 Mental illness refers to a wide range of mental health conditions
— disorders that affect your mood, thinking and behavior.
Examples of mental illness include depression, anxiety disorders,
schizophrenia, eating disorders and addictive behaviors.
 Many people have mental health concerns from time to time. But
a mental health concern becomes a mental illness when ongoing
signs and symptoms cause frequent stress and affect your ability
to function.
 A mental illness can make you miserable and can cause
problems in your daily life, such as at work or in relationships. In
most cases, symptoms can be managed with a combination of
medications and counseling (psychotherapy).

7. Mental disorder DSM 5
 "A mental disorder is a syndrome characterized by clinically
significant disturbance in an individual's cognition,
emotion regulation, or behavior that reflects a dysfunction in the
psychological, biological, or developmental processes underlying
mental functioning.
 Mental disorders are usually associated with significant distress
in social, occupational, or other important activities.
 An expectable or culturally approved response to a common
stressor or loss, such as the death of a loved one, is not a mental
disorder. Socially deviant behavior (e.g., political, religious, or
sexual) and conflicts that are primarily between the individual and
society are not mental disorders unless the deviance or conflict
results from a dysfunction in the individual, as described above."

8.  Severe Mental illness…Psychosis
 Minor mental illness….Neurosis

9. Indian Journal of Psychiatry. 1998 vol. 40 (2) p. 149
 Organic psychosis (0.4),
 Schizophrenia (2.7),
 Affective disorders (12.3)
contributed a rate of 15.4 for psychoses. (severe
mental illness)
 Mental retardation (6.9),
 epilepsy (4.4),
 neurotic disorders (20.7),
 alcohol/drug addiction (6.9)
 and miscellaneous group (3.9)

10. Affective disorders (Bipolar and related
disorders)
 Manic depressive disorder.
 Mania. Distinct period of abnormally and
persistently elevated, expansive or irritable
mood…. inflated self esteem, decreased
need for sleep, more talkative, flight of ideas,
distractibility, increase in goal directed
activities, excessive involvement in activities
that have a high potential for painful
consequences.

11. Depression
 Depressed mood.
 Diminished interest or pleasure.
 Significant wt loss.
 Insomnia/hypersomnia
 Psychomotor/ agitation or retardation.
 Fatigue.
 Felling of worthlessness and inappropriate guilt.
 Diminished ability to think or concentrate.
 Recurrent thoughts of death.

12.  Responses to significant loss, Grief etc may
have feelings of intense sadness, rumination
about loss, insomnia, poor appetite and
weight loss which may resemble a
depressive episode.
 Different types of Biplor disorders.

13. Schizophrenia Spectrum and other
Psychotic Disorders
 Schizophrenia.
Abnormalities in one or more of the five
domains:
 Delusions,
 Hallucinations,
 Disorganised thinking (speech)
 Grossly disorganised or abnormal motor
behaviour (including catatonia),
 Negative symptoms.

14.  Delusions are fixed beliefs that are not
amenable to change in light of conflicting
evidence. (Delusion vs a strongly held idea)
 Hallucinations are perception-like
experiences that occur without an external
stimuli.

15. Delusional disorders
 Apart from the impact of the delusion(s) or its
ramifications, functioning is not markedly
impaired, and behavior is not obviously
bizarre of odd.
 Erotomaniac type, grandiose type, jealous
type, Persecutory type, Somatic type…

16. Childhood disorders
(Neurodevelopmental disorders)
 Intellectual disability.
 Autism spectrum disorder.
 Specific learning disorder.
 ADHD.
 Oppositional Defiant disorder.
 Conduct disorder.

17. Intellectual disability (intellectual
development disorder)
 Intellectual and adapt function deficits in
conceptual, social, and practical domains.
 Clinical assessment with standardized
testing.

18. Autism spectrum disorder
 Deficits in social communication and social
interaction
 Restricted, Repetitive pattern of behavior,
interests, activities.

19. Attention-Deficit/Hyperactivity disorder
 Persistent pattern of inattention and/or
hyperactivity-implusivity

20. Specific Learning disorder (SLD)
 Difficulties learning and using academic
skills.
 School reports and psychoeducational
assessment in addition to clinical
assessment.

21. Oppositional defiant disorder.
 Angry/irritable mood.
 Argumentative/defiant behavior.
 Vindictiveness.

22. Conduct disorder
 Persistent pattern of behavior in which basic
rights of others or major age-appropriate
societal norms or rules are violated.
 Aggression to people or animals.
 Destruction to property.
 Deceitfulness or theft.
 Serious violation of rules.

23. Late life disorders
 Dementia (neurocognitive disorders).
 Behavioral and psychological symptom of
dementia (BPSD)
 Delirium.

24. Neurotic disorders.
 Anxiety.
 Depression.
 OCD
 Adjustment disorder.
 Somatic symptom disorder.
 Dissociative disorder

25. Depressive disorders.
 Major depressive disorder.
 Persistent depressive disorder (dysthymia)
 Premenstrual dysphoric disorder.
 Depressive disorder due to medical condition.

26. Anxiety disorders
 Share features of excessive fear, anxiety and
related behavioral disturbances.
 Fear is an emotional response to real or
perceived imminent threat.( autonomic
arousal of fight or flight, thoughts of
immediate danger and escape behavior)
 Anxiety is anticipation of future threat.
(muscle tension, vigilance in preparation of
future danger and cautious or avoidant
behavior)

27.  Social phobia.
 Panic disorder.
 Generalized anxiety disorder.
 Specific phobia.
 Separation anxiety disorder and elective
mutism in children

28. Genealised Anxiety Disorder
 Excessive anxiety and worry (apprehensive
expectation)
 Difficult to control worry
 Restlessness or feeling on the edge, Being
easily fatigued, Difficulty concentrating,
Irritability, Muscle tension, sleep disturbance.
 Cause clinically significant distress or
impairment in social, occupational or other
important areas of functioning.

29. Obsessive-Compulsive and Related
Disorder.
 Obsessions are persistent unwanted
thoughts.
 Compulsions are repetitive behaviors
 Cleaning , symmetry, forbidden or taboo
thoughts, harm thoughts.

30.  Acute stress disorder.
 Adjustment disorder.
 Dissociative disorder.
 Somatic symptom disorder/ hypocondriasis.
 Illness anxiety disorder/ health anxiety.
 Sexual dysfunctions…delayed ejaculation,
premature ejaculation, erectile disorder,
Genito-pelvic/penetration disorder

31. Conversion disorder (Functional
Neurological symptom disorder)
 Symptoms of altered voluntary motor or
sensory function.
 Incompatibility between the symptom and
recognized neurological or medical
conditions.
 Psychogenic

32. Substance Use Disorders.
 Cluster of cognitive, behavioral, and
physiological symptoms indicating that the
individual continues using the substance
despite significant substance-related
problems.
 Underlying change in brain circuits.

33. Symptom cluster in substance use
disorders.
 Impaired control,
 social impairment,
 risky use,
 pharmacological
criteria.

34. Alcohol use disorder
 Alcohol taken in large amounts over longer period.
 Persistent desire or unsuccessful efforts to cut down or control
 A great deal of time spent in activities related to alcohol.
 Craving or strong desire.
 Failure to fulfill major role obligations
 Continues use despite harm in social or interpersonal sphere
 Other activities given up for alcohol related activities.
 Continued use despite physical or psychological harm
 Tolerance
 Withdrawal

35.  Personality disorders.
 Other conditions that may be a focus of
clinical attention like relational problems,
abuse, neglect, Partner violence, educational
and occupational problems

36.  Mental healthcare priorities need to be shifted from
psychotic disorders to common mental disorders
 and from mental hospitals to primary health centers.
 Increase in invisible mental problems such as
suicidal attempts, aggression and violence,
widespread use of substances, increasing marital
discord and divorce rates emphasize on the need to
prioritize and make a paradigm shift in the strategies
to promote and provide appropriate mental health
services in the community.
Indian J Psychiatry. 2010 Jan;52(Suppl 1)