cuando el opositor alegare tener derecho de posesidn; 2- cuando el opositor alegue haber presentado una peticidn ante

Episode, or a Hypomanic Episode. Note: This

exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance- or treatment-induced or are due to the direct

physiological effects of a general medical condition Features/Specifiers

 psychotic with hallucinations or delusions

 chronic - lasting 2 years or more

 catatonic - at least two of: motor immobility;

excessive motor activity;

extreme negativism or mutism; peculiarities of voluntary movement;

echolalia or echopraxia

 melancholic - quality of mood is distinctly

depressed, mood is worse in the morning, early morning

awakening, marked weight loss, excessive guilt, psychomotor retardation

 atypical - increased sleep, weight gain, leaden paralysis,

rejection hypersensitivity

 postpartum

 seasonal - pattern of onset at the same time each year (most often in the fall or winter)

Etiology biological

 genetic: 65-75% MZ twins; 14-19% DZ twins

 neurotransmitter dysfunction at level of synapse (decreased activity of serotonin, norepinephrine, dopamine)

 secondary to general medical condition psychosocial

 psychodynamic (e.g. low self-esteem)

 cognitive (e.g. negative thinking)

 environmental factors (e.g. job loss, diet (omega 3 fatty acids), bereavement, history of abuse)

 co-morbid psychiatric diagnoses (e.g. anxiety, substance abuse, mental retardation, dementia, eating disorder)

Treatment

 biological:

antidepressants, lithium, antipsychotics,

anxiolytics, electroconvulsive therapy (ECT), light therapy

 psychological o individual

therapy:

psychodynamic, interpersonal, cognitive behavioural therapy

o family therapy o group therapy

 social: vocational rehabilitation, social skills training

 experimental: deep brain stimulation, transcranial

magnetic stimulation, vagal nerve stimulation

DSM-IV-TR Criteria for Manic Episode

 A. a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting >1 week (or any duration if hospitalization is necessary)

 B. during the period of mood disturbance, >3 of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

o inflated self-esteem or grandiosity o decreased need

for sleep (e.g.

feels rested after only 3 hours of sleep)

o more talkative than usual or pressure to keep talking

o flight of ideas or subjective experience that thoughts are racing

o distractibility (i.e.

attention too easily drawn to unimportant or irrelevant external stimuli)

o increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation o excessive

involvement in pleasurable activities that have a high potential for

painful

consequences (e.g. engaging in unrestrained buying sprees, sexual

indiscretions, or foolish business investments)

 C. the symptoms do not meet criteria for a Mixed Episode (see below)

 D. the mood disturbance is sufficiently severe to cause marked

impairment in

occupational functioning or in usual social

activities or relationships with others, or to

necessitate

hospitalization to prevent harm to self or others, or there are psychotic features

 E. the symptoms are not due to the direct

physiological effects of a substance (e.g. drug of abuse, medication, or other treatment) or a general medical condition (e.g.

hyperthyroidism). Note:

Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g.

medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder

Criteria for Mania (>3): GST PAID

Grandiosity

Sleep (decreased need) Talkative

Pleasurable activities, Painful consequences

Activity

Ideas (flight of) Distractable Mixed Episode

 criterion met for both manic episode and major depressive episode (MDE) nearly every day for 1 week

 criteria D and E of manic episodes are met

Hypomanic Episode

 criterion A of a manic episode is met, but duration is >4 days

 criterion B and E of manic episodes are met

 episode associated with an uncharacteristic decline in functioning that is observable by others

 change in function is not severe enough to cause marked

impairment in social or occupational functioning or to necessitate

hospitalization

 absence of psychotic features

BIPOLAR I / BIPOLAR II DISORDER

 Bipolar I Disorder

o disorder in which at least one manic or mixed episode has occurred o commonly

accompanied by at least 1 MDE but not required for diagnosis

 Bipolar II Disorder o disorder in which

there is at least 1 MDE and at least 1 hypomanic episode

o no past manic or mixed episode

Risk Factors

 slight increase in upper socioeconomic groups

 60-65% of bipolar patients have family history of major mood disorders

Treatment

 biological: mood stabilizers, anticonvulsants, antipsychotics, antidepressants, ECT (Note: Treatment of bipolar depression must be done extremely cautiously, as a switch from depression to mania can result.

Monotherapy with antidepressants should be avoided)

 psychological: supportive and psychodynamic psychotherapy, cognitive or behavioural therapy

 social: vocational rehabilitation, leave of absence from

school/work, drug and EtOH cessation, substitute decision maker for finances, sleep hygiene, social skills training, education for family members Anxiety Disorders

Anxiety is a universal human characteristic involving tension, apprehension, or even terror, which serves as an adaptive mechanism to warn about an external threat by activating the sympathetic nervous system (fight or flight)

 manifestations of anxiety can be described along a continuum of physiology, psychology, and

behaviour

 physiology - main brain structure involved is the amygdala;

neurotransmitters involved include serotonin, cholecystokinin, epinephrine, norepinephrine, dopamine

 psychology one’s perception of a given situation is distorted which causes one to believe it is threatening in some way

 behaviour - once feeling threatened, one

responds by escaping or facing the situation, thereby causing a disruption in daily functioning

 anxiety becomes pathological when

 fear is greatly out of proportion to

risk/severity of threat

 response continues beyond existence of threat or becomes generalized to other similar/dissimilar situations

 social or occupational functioning is impaired Differential Diagnosis

 endocrine:

hyperthyroidism, pheochromocytoma, hypoglycemia, hyperadrenalism, hyperparathyroidism

 CVS: congestive heart failure, pulmonary embolus, arrhythmia, mitral valve prolapse

 respiratory: asthma, pneumonia,

hyperventilation

 metabolic: vitamin B12 deficiency, porphyria

 neurologic: neoplasm, vestibular dysfunction, encephalitis

 substance-induced:

intoxication (caffeine, amphetamines, cocaine), withdrawal

(benzodiazepines, alcohol)

Medical Workup of Anxiety Disorder

 routine screening:

physical examination, CBC, thyroid function test, electrolytes, urinalysis, urine drug screening

 additional screening:

neurological

consultation, chest x-ray, electrocardiogram (ECG), CT scan

DSM-IV-TR Diagnostic Criteria for Generalized Anxiety Disorder

A. excessive anxiety and worry (apprehensive

expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance) B. the person finds it difficult to control the worry

C. the anxiety and worry are associated with >3 of the following 6

symptoms (with at least some symptoms present for more days than not for the past 6 months).

Note: Only one item is required in children

 (1) restlessness or feeling keyed up or on edge

 (2) being easily fatigued

 (3) difficulty concentrating or mind going blank

 (4) irritability

 (5) muscle tension

 (6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. the focus of the anxiety and worry is not confined to features of an Axis I disorder, such as panic disorder, social phobia, etc.

E. the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

F. the disturbance is not due to the direct

physiological effects of a substance or a GMC and does not occur

exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder

Treatment

 psychotherapy, relaxation,

mindfulness, and CBT

 caffeine and EtOH avoidance, sleep hygiene

 pharmacotherapy:

o benzodiazepin es (short term, low dose, regular

schedule, long half-life, no prn)

o buspirone (tid dosing) o others:

SSRIs/SNRI, TCAs, beta-blockers

 combinations of above

DSM-IV-TR Diagnostic Criteria for Post-Traumatic Stress Disorder

A. the person has been exposed to a traumatic event in which both of the following were present:

 (1) the person

experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

 (2) the person's response involved intense fear, helplessness, or horror.

Note: In children, this may be expressed instead by disorganized or agitated behaviour B. the traumatic event is persistently

re-experienced in one (or more) of the following ways:

 (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed

 (2) recurrent distressing dreams of the event.

Note: In children, there may be frightening dreams without recognizable content

 (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback

episodes, including those that occur on awakening or when intoxicated) Note: In young children, trauma-specific

reenactment may occur

 (4) intense psychological distress at exposure to internal or external cues that symbolize or

resemble an aspect of the traumatic event

 (5) physiological

reactivity on exposure to internal or external cues that symbolize or

resemble an aspect of the traumatic event C. persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

 (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

 (2) efforts to avoid activities, places, or people that arouse recollections of the trauma

 (3) inability to recall an important aspect of the trauma

 (4) markedly diminished interest or participation in significant activities

 (5) feeling of detachment or estrangement from others

 (6) restricted range of affect (e.g. unable to have loving feelings)

 (7) sense of a

foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span)

D. persistent symptoms of

In document La reforma agraria en Panamá (página 78-83)