We treat patients suffering from the following condition :

A.  Marked fear or anxiety about 2+:

  1. Using public transportation
  2. Being in open spaces
  3. Being in enclosed spaces
  4. Standing in line or being in a crowd
  5. Being outside of the home alone

B. Individual fears or avoids these situations because of the thoughts escape will be difficult or help is not available in the event of developing panic like symptoms, or other incapacitating or embarrassing moments

C.  Situations almost always provoke fear or anxiety

D.  Actively avoided or endured with great fear and anxiety

E.  Out of proportion to actual danger posed

F.  Persistent, lasting for 6 months or more

strong>G.  Clinically significant distress or impairment in social, occupational and other important areas of functioning

H. If another medical condition is present, the fear, anxiety, or avoidance is clearly excessive

I. Not better explained by another mental disorder

Differential Diagnosis: SP, OCD, BDD, SAD

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

Anorexia Nervosa

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

B.  Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Coding: restricting type, binge-eating/purging type

Bulimia Nervosa

A. recurrent episodes of binge eating. characterized by both:

  1. eating, in a discrete period of time an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
  2. sense of lack of control over eating during the episode

B. recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting misuse of laxatives, diuretics, or other medications; fasting or excessive exercise

C.  the binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months

D.  self-evaluation is unduly influenced by body shape and weight

E.  the disturbance does not occur exclusively during episodes of Anorexia Nervosa

Generalized Anxiety Disorder

A. Excessive anxiety or worry occurring more days than not for 6+ mos

B. Difficulty controlling worry

C. 3+ Sx:

  1. Restlessness or feeling keyed up or on edge
  2. Being easily faigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance

D. Distress or impairment

Differential Diagnosis: PD, SAD, OCD, PTSD, Anorexia Nervosa, Somatic Symptom Disorder, BDD, Illness Anxiety Disorder, Schizophrenia, Delusional Disorder

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

Bipolar I Disorder

A. Meet criteria for a manic episode. Manic episode may or may not have been preceded by or followed by a hypomanic or major depressive episode.

B. Not better explained by schizoaffective disorder, any other psychotic disorder

Specifiers:

with anxious distress, with mixed features, with rapid cycling, with melancholic features, with atypical features, with mood-(in)congruent psychotic features, with catatonia, with peripartum onset, with seasonal pattern.

Bipolar II Disorder

A. Current or past hypomanic episode and a current or past major depressive episode

B. Never had a manic episode

C. Not better explained by psychotic disorder

D. Symptoms of depression or unpredictability of alteration between periods of depression and hypomania causes distress or impairement

Specifiers:
anxious distress, mixed features, rapid cycling, melancholic features, atypical features, mood-(in)congruent psychotic features, catatonia, peripartum onset, seasonal pattern, partial/full remission, Mild/moderate/severe

A.  Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains*:

  • Learning and memory
  • Language
  • Executive function
  • Complex attention
  • Perceptual-motor

B.  The cognitive deficits interfere with independence in everyday activities. At a minimum, assistance should be required with complex instrumental activities of daily living, such as paying bills or managing medications.Social cognition

C.  The cognitive deficits do not occur exclusively in the context of a delirium

D.  The cognitive deficits are not better explained by another mental disorder (eg, major depressive disorder, schizophrenia)

A. 5+ of the following during the same 2 week period and represent a change in fx (at least 1 = 1 or 2)

  1. depressed mood most of the day, nearly every day
  2. markedly diminished interest or pleasure in all, or almost all, activities
  3. significant weight loss when not dieting or weight gain or decrease/increase in appetite
  4. insomnia or hypersomnia
  5. psychomotor agitation or retardation
  6. fatigue or loss of energy
  7. feelings of worthlessness or excessive or inappropriate guilt
  8. diminished ability to think or concentrate or indecisiveness
  9. recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan

B. Causes distress or impairment

C. Not due to a substance or medical condition

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

B. Presence, while depressed, of two (or more) of the following:

  1. Poor appetite or overeating.
  2. Insomnia or hypersomnia.
  3. Low energy or fatigue.
  4. Low self-esteem.
  5. Poor concentration or difficulty making decisions.
  6. Feelings of hopelessness.

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.

D. Criteria for a major depressive disorder may be continuously present for 2 years.

E. There has never been a manic episode or a hypomanie episode, and criteria have never been met for cyclothymic disorder.

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

G.The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).

H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

B.  One (or more) of the following symptoms must be present:

  1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
  2. Marked irritability or anger or increased interpersonal conflicts.
  3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C.  One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.

  1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
  2. Subjective difficulty in concentration.
  3. Lethargy, easy fatigability, or marked lack of energy.
  4. Marked change in appetite; overeating; or specific food cravings.
  5. Hypersomnia or insomnia.
  6. A sense of being ovenwhelmed or out of control.
  7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.

D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A. A predominant complaint of dissatisfaction witli sleep quantity or quality, associated with one (or more) of the following symptoms:

  1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
  2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
  3. Early-morning awakening with inability to return to sleep.

B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.

C. The sleep difficulty occurs at least 3 nights per week.

D. The sleep difficulty is present for at least 3 months.

E. The sleep difficulty occurs despite adequate opportunity for sleep.

F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).

G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

 

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

Menopause is the permanent cessation of menstruation resulting in the loss of ovarian follicle development. It is considered to occur when 12 menstrual cycles are missed.Menopausal transition, or perimenopause, is the period between the onset of irregular menstrual cycles and the last menstrual period. This period is marked by fluctuations in reproductive hormones 3 and is characterized by the following:

  • Menstrual irregularities
  • Prolonged and heavy menstruation intermixed with episodes of amenorrhea
  • Decreased fertility
  • Vasomotor symptoms
  • Insomnia

Some of these symptoms may emerge 4 years before menses cease, with a perimenopausal mean age of onset of 47.5 years.During the menopausal transition, estrogen levels decline and levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) increase.
Postmenopause is the phase following the last menstrual period.

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

Mood Disorder Due to a General Medical Condition.

1. At least one of the following:

A. Mark lack of interest in all or almost all,activities.( A depressed mood state. )
B. Heighten or irritable mood.

2. Evidence condition is from a general medical condition.

3. Symptoms not from another disorder.

4. Symptoms not from delirium.

5. Clinically significant distress from symptoms, or impairment in work, social,or other areas of important functioning.

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

ONSET:

Early adulthood and with a variety of contexts

A. presence of obsessions, compulsions, or both
Obsessions:
1. recurrent and persistent thoughts, urges, or images that are intrusive and unwanted and that cause anxiety or distress
2. attempts to ignore or suppress such thoughts, urges, or images or to neutralize them

Compulsions:
1. repetitive behaviors or mental acts that you feel driven to do in response to an obsession or rules
2. aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation

B. o/c are time-consuming or cause distress or impairment
C. not due to substances or a medical disorder
D. not better explained by another mental disorder

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A. recurrent unexpected panic attacks. Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and has 4+:
1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feelings of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. chills or heat sensations
9. paresthesias (numbness or tingling)
10. derealization or depersonalization
12. fear of losing control or going crazy
13. fear of dying
B. at least one of the attacks followed by a month of 1. persistent concern or worry about additional panic attacks
2. significant maladaptive change in behavior related to the attacks and designed to avoid having panic attacks
C. not due to substance or medical condition
D. not better explained by another mental disorder

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

B. One (or more) of the following symptoms must be present:

  1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
  2. Marked irritability or anger or increased interpersonal conflicts.
  3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.

  1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
  2. Subjective difficulty in concentration.
  3. Lethargy, easy fatigability, or marked lack of energy.
  4. Marked change in appetite; overeating; or specific food cravings.
  5. Hypersomnia or insomnia.
  6. A sense of being ovenwhelmed or out of control.
  7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.

D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.) G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).

 

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A. 2+ for 1 month (1, 2, or 3)

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms

B. Level of fx in one or more major life areas is below premorbid level.

C. Continuous signs of disturbance for 6 months (must include 1 month of criterion A symptoms, may include prodromal or residual phases)
Specifiers: First episode/acute, partial remission, full remission, Multiple edisodes/acute, partial remission, full remission, With catatonia
Differential Diagnosis: Schizoaffective disorder, Depressive/Bipolar with psychotic features, Substance abuse, Medical condition, Autis Spectrum/Communication Disorder (Additional diagnosis of Schizophrenia only made if prominent delusions or hallucinations are present for 1 month).

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

Sexual dysfunctions include:

delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, substance/medicationinduced sexual dysfunction, other specified sexual dysfunction, and unspecified sexual dysfunction.

Sexual dysfunctions are a heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure. An individual may have several sexual dysfunctions at the same time. In such cases, all of the dysfunctions should be diagnosed

 

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

A.  A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.

B.  Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.

C.  The person recognizes that this fear is unreasonable or excessive.

D.  The feared situations are avoided or else are endured with intense anxiety and distress.

E.  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F.  In individuals under age 18 years, the duration is at least 6 months.

G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.

 

Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.

Cyclothymia (Thyroid Disorders)

A. At least 2 years numerous periods of hypomanic sx that don’t meet criteria for episode and numerous periods with depressive sx that don’t meet criteria for episode

B. Present at least half the time and not been without for more than 2 months at a time

C.  Criteria for MD, manic, or hypomanic episode never met.
Specifiers: with anxious distressComorbidity of diabetes and psychiatric disorders can present in different patterns.

  1. The two can present as independent conditions with no apparent direct connection. In such a scenario both are an outcome of independent and parallel pathogenic pathways.
  2. The course of diabetes can be complicated by emergence of psychiatric disorders. In such cases, diabetes contributes to the pathogenesis of psychiatric disorders. Various biological and psychological factors mediate the emergence of psychiatric disorders in such context.
  3. Certain psychiatric disorders like depression and schizophrenia act as significant independent risk factors for the development of diabetes.
  4.  There could be an overlap between the clinical presentation of hypoglycemic and ketoacidosis episodes and conditions such as panic attacks.
  5. Impaired glucose tolerance and diabetes could emerge as a side effect of the medications used for psychiatric disorders. Treatment of psychiatric disorders could influence diabetes care in other ways also as discussed in subsequent sections.Speak to your psychiatrist about symptoms and work closely with your psychiatrist to find the best treatment for you.