Behavioral Sciences Juan Héctor M. Meléndez-Romero. MD Ciencias de la Salud
Behavioral Sciences Somatoform  & Dissociative Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660
Somatoform Disorders <ul><li>Broad group of illnesses that have bodily signs and symptoms. </li></ul><ul><ul><li>Soma  =  ...
Somatoform Disorders <ul><li>DSM-IV-TR recognizes five specific disorders: </li></ul>Modified from Kaplan & sadock`s (Nint...
Somatoform Disorders <ul><li>Somatization  </li></ul><ul><li>Characterized by many somatic </li></ul><ul><li>symptoms </li...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization </li></ul><ul><li>R...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization synonimous </li></u...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization  </li></ul><ul><li>...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization  </li></ul><ul><li>...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization etiology: </li></ul...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization Disorder Diagnosis:...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Differential Diagnosis: </li></u...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Somatization Treatment: </li></u...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Conversion   </li></ul><ul><li>D...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Conversion Disorder Definition: ...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Commmon symptoms :  </li></ul><u...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Conversion Disorder Comorbidity:...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660 <ul><li>Conversion Disorder Etiology: </...
Somatoform Disorders Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660
Tema XX <ul><li>Concepto XX </li></ul>Kaplan & sadock`s (Ninth Edition )  Chapter 17  Page 643-660
Somatoform Disorders <ul><li>Conversion Disorder Diagnosis: </li></ul><ul><li>One or more symptoms or deficitis affecting ...
Somatoform Disorders <ul><li>Conversion Disorder Treatment: </li></ul><ul><li>Psychological therapy: </li></ul><ul><ul><ul...
Somatoform Disorders <ul><li>Hypochondriasis </li></ul><ul><li>Defined as a person’s preoccupation with the fear of contra...
Somatoform Disorders <ul><li>Hypochondriasis </li></ul><ul><li>Etiology. </li></ul><ul><li>Low tolerance of,  low threshol...
Somatoform Disorders <ul><li>Diagnosis of Hypochondriasis </li></ul><ul><li>Preoccupation with fear of having, or the idea...
Somatoform Disorders <ul><li>Treatment of Hypochondriasis </li></ul><ul><li>Stress reduction </li></ul><ul><li>Medical edu...
Somatoform Disorders <ul><li>Body dhysmophic </li></ul><ul><li>Patient’s have a pervasive subjective feeling of ugliness o...
Somatoform Disorders <ul><li>Body dhysmophic </li></ul><ul><li>Location of Imagined Defects: </li></ul><ul><li>Hair Lips <...
Somatoform Disorders <ul><li>Diagnostic Criteria for Body dhysmophic </li></ul><ul><li>Preoccupation with an imagined defe...
Somatoform Disorders <ul><li>Diagnostic Criteria for Body dhysmophic </li></ul><ul><li>Relation to plastic surgery </li></...
Somatoform Disorders <ul><li>5.  Pain disorder </li></ul><ul><li>Presence of pain that is “the focus of clinical attention...
Somatoform Disorders <ul><li>5.  Etiology of Pain disorder </li></ul><ul><li>Psychodynamic factors. </li></ul><ul><ul><ul>...
Somatoform Disorders <ul><li>5.  Diagnostic Criteria for Pain disorder </li></ul><ul><li>Pain in one or more anatomical si...
Somatoform Disorders <ul><li>Diagnostic Criteria for Pain disorder </li></ul><ul><li>Medical Treatment: </li></ul><ul><ul>...
Dissociative  Disorders Dissociative  Disorders
Characteristics <ul><li>Contradictory representation of the self. </li></ul><ul><li>Produces conflicts with each other. </...
Classification  <ul><li>There are four different types: </li></ul><ul><li>Dissociative amnesia </li></ul><ul><li>Dissociat...
1. Dissociative amnesia <ul><li>Amnesia is the Key symptom in this type </li></ul><ul><li>Reffers to the inability to reca...
1. Dissociative amnesia <ul><li>Appears in war time or natural disasters. </li></ul><ul><li>Also is related with domestic ...
2.  Dissociative Fugue <ul><li>The behavior of the patient with dissociative fugue is unusual and dramatic. </li></ul><ul>...
2.  Dissociative Fugue <ul><li>Its rare. </li></ul><ul><li>Associated to alcohol  abuse </li></ul><ul><li>Desire to withdr...
3.  Dissociative Identity disorder <ul><li>Sinonimous: Multiple personality disorder </li></ul><ul><li>Chronic disease </l...
3.  Dissociative Identity disorder <ul><li>In 1800 Benjamin Rush building earlier clinical report of this problem </li></u...
3.  Dissociative Identity disorder <ul><li>Signs of multiplicity: </li></ul><ul><li>Time distorsion Change in name </li></...
4.  Depersonalization disorder <ul><li>Depersonalization disorder symptoms </li></ul><ul><li>Persistent or recurrent alter...
4.  Deprsonalization disorder <ul><li>Causes: Neurological disorders </li></ul><ul><ul><ul><ul><li>Toxic - metabolic Disor...
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01a Somatoform & Dissociative Dis

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01a Somatoform & Dissociative Dis

  1. 1. Behavioral Sciences Juan Héctor M. Meléndez-Romero. MD Ciencias de la Salud
  2. 2. Behavioral Sciences Somatoform & Dissociative Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
  3. 3. Somatoform Disorders <ul><li>Broad group of illnesses that have bodily signs and symptoms. </li></ul><ul><ul><li>Soma = body </li></ul></ul><ul><li>Encopass mind-body interactions </li></ul>Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
  4. 4. Somatoform Disorders <ul><li>DSM-IV-TR recognizes five specific disorders: </li></ul>Modified from Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 1. Somatization Disorder Physical complaints 2. Conversion Neurological complaints 3. Hypochondriasis “ Patient beliefs” 4. Body dismorphic Sx. “ Body is defective” 5. Pain Symptoms of pain Undeterminated Not otherwise specified
  5. 5. Somatoform Disorders <ul><li>Somatization </li></ul><ul><li>Characterized by many somatic </li></ul><ul><li>symptoms </li></ul><ul><li>The symptoms can not be explained on basis of the physical and laboratory examinations. </li></ul>Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
  6. 6. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization </li></ul><ul><li>Recognized by Pain, Gastrointestinal, Sexual and pseudoneurological symptoms. </li></ul><ul><li>Differs of other somotoform disorders because of the multiplicity of the complaints and the multiple organs symptoms. </li></ul>
  7. 7. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization synonimous </li></ul><ul><li>Hysteria </li></ul><ul><li>Briquet’s syndrome </li></ul><ul><li>Somatization Disorder </li></ul>
  8. 8. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization </li></ul><ul><li>Lifetime prevalence: </li></ul><ul><li>women 0.2 to 2.0 % </li></ul><ul><li>men 0.2 % </li></ul><ul><li>Begins before 30-year-old </li></ul><ul><li>Inversely related with social status </li></ul>
  9. 9. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization </li></ul><ul><li>Coexist with other mental disorders. </li></ul><ul><ul><li>2/3 patients has mental disorders: </li></ul></ul><ul><ul><ul><ul><li>avoidant </li></ul></ul></ul></ul><ul><ul><ul><ul><li>paranoid </li></ul></ul></ul></ul><ul><ul><ul><ul><li>self defeating </li></ul></ul></ul></ul><ul><ul><ul><ul><li>obssesive – compulsive symptoms </li></ul></ul></ul></ul>
  10. 10. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization etiology: </li></ul><ul><ul><li>Psychosocial Factors: </li></ul></ul><ul><ul><ul><ul><li>avoid obligations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>express emotions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>symbolized a feeling or belief </li></ul></ul></ul></ul><ul><ul><li>Biological Factors: </li></ul></ul><ul><ul><ul><li>Attention and cognitive impairments </li></ul></ul></ul><ul><ul><ul><li>Cytokines theory: IL, TNF, IF. </li></ul></ul></ul>
  11. 11. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization Disorder Diagnosis: </li></ul><ul><li>History of many physical complaints before age 30 years over a period of several years results in impairment of social and occupational functioning. </li></ul><ul><li>Individual symptoms: </li></ul><ul><ul><ul><li>Four pain symptoms (sites) </li></ul></ul></ul><ul><ul><ul><li>Two gastrointestinal symptoms </li></ul></ul></ul><ul><ul><ul><li>One sexual symptom </li></ul></ul></ul><ul><ul><ul><li>One pseudoneurological symptom </li></ul></ul></ul><ul><li>Either 1) and 2): 1) Each symptom cannot be fully explained 2) In case of medical condition, there are excessive impairment that would be explained. </li></ul><ul><li>The symptoms are not intentionally produced. </li></ul>
  12. 12. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Differential Diagnosis: </li></ul><ul><ul><ul><li>Multiple sclerosis </li></ul></ul></ul><ul><ul><ul><li>Myasthenia gravis </li></ul></ul></ul><ul><ul><ul><li>Systemic lupus erythematosus </li></ul></ul></ul><ul><ul><ul><li>AIDS </li></ul></ul></ul><ul><ul><ul><li>Hyperparathyroidism </li></ul></ul></ul><ul><ul><ul><li>Hyperthyroidism </li></ul></ul></ul><ul><ul><ul><li>Chronic Systemic Infections </li></ul></ul></ul>
  13. 13. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Somatization Treatment: </li></ul><ul><li>Primary Care: </li></ul><ul><li>Regularly scheduled visits </li></ul><ul><li>Listen to the somatic complaints and emotional expressions </li></ul><ul><li>Psychiatry evaluation: </li></ul><ul><li>Individual or group psychotherapy </li></ul><ul><li>Medication: AINEs and Placebo ? </li></ul>
  14. 14. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Conversion </li></ul><ul><li>Disturbance of bodily functioning </li></ul><ul><li>Occurrs in a setting of stress </li></ul><ul><li>Produces considerable dysfunction </li></ul>
  15. 15. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Conversion Disorder Definition: </li></ul><ul><li>Conversion disorder is characterized by the presence of one or more neurological symptoms that cannot be explain by a known neurological or medical disorder </li></ul>
  16. 16. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Commmon symptoms : </li></ul><ul><li>Motor symptoms : Sensory deficits : </li></ul><ul><li>Involuntary movements Anesthesia </li></ul><ul><li>Tics Blindness </li></ul><ul><li>Blepharospasm Tunnel vision </li></ul><ul><li>Torticolis Deafness </li></ul><ul><li>Seizures </li></ul><ul><li> Aphonia Visceral symptoms : </li></ul><ul><li>Paralysis Psychogenic vomiting </li></ul><ul><li>Weakness Pseudocyesis </li></ul><ul><li>Urinary retention </li></ul><ul><li>Diarrhea </li></ul>
  17. 17. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Conversion Disorder Comorbidity: </li></ul><ul><ul><ul><ul><li>Depressive disorder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Anxiety disorder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Somatization disorder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Schizopherina </li></ul></ul></ul></ul>
  18. 18. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 <ul><li>Conversion Disorder Etiology: </li></ul><ul><li>Psychoanalytic factors : conversion of anxiety into a medical symptom. </li></ul><ul><li>Learning theory: conditioned learning behavior. </li></ul><ul><li>Biological factors: impaired hemispheric communication. </li></ul>
  19. 19. Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
  20. 20. Tema XX <ul><li>Concepto XX </li></ul>Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
  21. 21. Somatoform Disorders <ul><li>Conversion Disorder Diagnosis: </li></ul><ul><li>One or more symptoms or deficitis affecting voluntary motor or sensory function. </li></ul><ul><li>Psychological factors are jugded to be associated with the symptoms or deficit because iniciation or exacerbation of symptoms is preceded by conflicts or other stressors. </li></ul><ul><li>Symptoms are not intentionally produces. </li></ul><ul><li>Symptoms cannot be explained by a general medical condition. </li></ul><ul><li>The symptoms causes clinically significant distress or impairment of social, occupational functioning. </li></ul><ul><li>The symtoms are no limited to pain or sexual dysfuntion. </li></ul>
  22. 22. Somatoform Disorders <ul><li>Conversion Disorder Treatment: </li></ul><ul><li>Psychological therapy: </li></ul><ul><ul><ul><li>Insight-oriented supportive or behavior therapy. </li></ul></ul></ul><ul><ul><ul><li>Hypnosis </li></ul></ul></ul><ul><ul><ul><li>Behavioral relaxation therapy </li></ul></ul></ul><ul><li>Medical Treatment: </li></ul><ul><ul><ul><li>Anxiolytic drugs </li></ul></ul></ul>
  23. 23. Somatoform Disorders <ul><li>Hypochondriasis </li></ul><ul><li>Defined as a person’s preoccupation with the fear of contracting, or belief of heaving a serious disease. </li></ul><ul><li>The person misinterpreat bodily symptoms or functions. </li></ul>
  24. 24. Somatoform Disorders <ul><li>Hypochondriasis </li></ul><ul><li>Etiology. </li></ul><ul><li>Low tolerance of, low threshold for physical discomfort </li></ul><ul><li>Understandable in terms of a social learning model </li></ul><ul><li>Variant of depressive or anxiety disorder. </li></ul>
  25. 25. Somatoform Disorders <ul><li>Diagnosis of Hypochondriasis </li></ul><ul><li>Preoccupation with fear of having, or the idea that one has a serious disease. </li></ul><ul><li>Preoccupation persist despite appropiated medical evaluation and reassurance. </li></ul><ul><li>The belief in Criterion A is not of delusional intensity. </li></ul><ul><li>The preocupation causes clinical distress or impariment of social or functioning areas. </li></ul><ul><li>Duration at least six months. </li></ul><ul><li>The preoccupation is not better accounted for by generalized anxiety disorder, separation anxiety,etc. </li></ul>
  26. 26. Somatoform Disorders <ul><li>Treatment of Hypochondriasis </li></ul><ul><li>Stress reduction </li></ul><ul><li>Medical education in chronic illness </li></ul><ul><li>Treatment of depressive or mental disorder. </li></ul>
  27. 27. Somatoform Disorders <ul><li>Body dhysmophic </li></ul><ul><li>Patient’s have a pervasive subjective feeling of ugliness of some aspecto of their appearance despite a normal or nearly normal appearance. </li></ul><ul><li>The person’s strong belief or fear that he or she is unattractive or even repulsive. </li></ul>
  28. 28. Somatoform Disorders <ul><li>Body dhysmophic </li></ul><ul><li>Location of Imagined Defects: </li></ul><ul><li>Hair Lips </li></ul><ul><li>Nose Chin </li></ul><ul><li>Skin Ears </li></ul><ul><li>Eyes Pennis </li></ul><ul><li>Head or face Buttocks </li></ul><ul><li>Body build Breast, etc. </li></ul>
  29. 29. Somatoform Disorders <ul><li>Diagnostic Criteria for Body dhysmophic </li></ul><ul><li>Preoccupation with an imagined defect in appearance. </li></ul><ul><li>The preoccupation causes clinically significant distress or impairment of social or functioning. </li></ul><ul><li>The preoccupation is not betteraccounted for by another mental disorder. </li></ul>
  30. 30. Somatoform Disorders <ul><li>Diagnostic Criteria for Body dhysmophic </li></ul><ul><li>Relation to plastic surgery </li></ul><ul><li>Medical treatment: Tryciclics </li></ul><ul><li>SSRIs </li></ul><ul><li>IMAO. </li></ul>
  31. 31. Somatoform Disorders <ul><li>5. Pain disorder </li></ul><ul><li>Presence of pain that is “the focus of clinical attention”. </li></ul><ul><li>Pain is not fully accounted for by a medical or neurological condition. </li></ul><ul><li>Synonimous: Somatoform pain disorder </li></ul><ul><li>Psychogenic pain </li></ul><ul><li>Atypical pain disorder </li></ul><ul><li>Idiopathic pain disorder </li></ul>
  32. 32. Somatoform Disorders <ul><li>5. Etiology of Pain disorder </li></ul><ul><li>Psychodynamic factors. </li></ul><ul><ul><ul><li>Intrapsychic conflic: unable to express their feelings </li></ul></ul></ul><ul><ul><ul><li>Displacing the problems to the body </li></ul></ul></ul><ul><ul><ul><li>Convinced that they have to suffer </li></ul></ul></ul><ul><li>Behavioral factors. </li></ul><ul><li>Interpersonal factors. </li></ul><ul><ul><ul><li>Means of manipulation. </li></ul></ul></ul><ul><li>Biological factors. </li></ul><ul><ul><ul><li>Endorphin deficiency. </li></ul></ul></ul>
  33. 33. Somatoform Disorders <ul><li>5. Diagnostic Criteria for Pain disorder </li></ul><ul><li>Pain in one or more anatomical sites is the predominant focus in clinical presentation. </li></ul><ul><li>Pain causes significat distress or clinical impairment. </li></ul><ul><li>Psychological factors are jugde to have an important role in onset, severity, exacerbation and maintenance of pain. </li></ul><ul><li>The symptom is not intentionally produced or feigned. </li></ul><ul><li>The pain is not better accounted for by a mood, anxiety or psychotic disorder. </li></ul>
  34. 34. Somatoform Disorders <ul><li>Diagnostic Criteria for Pain disorder </li></ul><ul><li>Medical Treatment: </li></ul><ul><ul><ul><li>Tryciclics </li></ul></ul></ul><ul><ul><ul><li>SSRI’s </li></ul></ul></ul><ul><li>Psychoterapy </li></ul><ul><li>Biofeedback </li></ul><ul><li>Pain Control Programs. </li></ul>
  35. 35. Dissociative Disorders Dissociative Disorders
  36. 36. Characteristics <ul><li>Contradictory representation of the self. </li></ul><ul><li>Produces conflicts with each other. </li></ul><ul><li>They feel that they have not identity </li></ul><ul><li>Can develops sevral identities </li></ul>
  37. 37. Classification <ul><li>There are four different types: </li></ul><ul><li>Dissociative amnesia </li></ul><ul><li>Dissociative Fugue </li></ul><ul><li>Dissociative Identity dissorder </li></ul><ul><li>Depersonalization dissorder </li></ul><ul><li>Not otherwise specified </li></ul>
  38. 38. 1. Dissociative amnesia <ul><li>Amnesia is the Key symptom in this type </li></ul><ul><li>Reffers to the inability to recall information, usually about stressful o traumatic events. </li></ul><ul><li>Affects the recall of general information </li></ul>
  39. 39. 1. Dissociative amnesia <ul><li>Appears in war time or natural disasters. </li></ul><ul><li>Also is related with domestic settings and emergency situations. </li></ul><ul><li>Most patients can not retrive stressful memories. </li></ul><ul><li>DSM-IV diagnostic criteria </li></ul>
  40. 40. 2. Dissociative Fugue <ul><li>The behavior of the patient with dissociative fugue is unusual and dramatic. </li></ul><ul><li>Fugue = The patient travel away his from their customary home and work situations. </li></ul><ul><li>Fails to remember personal data. </li></ul>
  41. 41. 2. Dissociative Fugue <ul><li>Its rare. </li></ul><ul><li>Associated to alcohol abuse </li></ul><ul><li>Desire to withdraw from emotionally painful experiences </li></ul><ul><li>DSM-IV diagnostic criteria </li></ul>
  42. 42. 3. Dissociative Identity disorder <ul><li>Sinonimous: Multiple personality disorder </li></ul><ul><li>Chronic disease </li></ul><ul><li>Associated to traumatic events: </li></ul><ul><ul><li>Child abuse </li></ul></ul><ul><ul><li>Child physical trauma </li></ul></ul><ul><li>There are two or more personalities </li></ul>
  43. 43. 3. Dissociative Identity disorder <ul><li>In 1800 Benjamin Rush building earlier clinical report of this problem </li></ul><ul><li>Freud relates with psychodynamic mechanism </li></ul><ul><li>Bleuler relates with schizophrenia. </li></ul><ul><li>The cause is unknown </li></ul>
  44. 44. 3. Dissociative Identity disorder <ul><li>Signs of multiplicity: </li></ul><ul><li>Time distorsion Change in name </li></ul><ul><li>Change behavior Use word “we” </li></ul><ul><li>Do not recognize personal objetcs </li></ul><ul><li>Auditive hallucinations </li></ul>
  45. 45. 4. Depersonalization disorder <ul><li>Depersonalization disorder symptoms </li></ul><ul><li>Persistent or recurrent alteration in the perseption of the self. </li></ul><ul><li>His personality is temporally lost. </li></ul>
  46. 46. 4. Deprsonalization disorder <ul><li>Causes: Neurological disorders </li></ul><ul><ul><ul><ul><li>Toxic - metabolic Disorders </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mental dissease </li></ul></ul></ul></ul><ul><li>DSM-IV diagnostic criteria </li></ul><ul><li>Course & Prognosis </li></ul>

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