Common Psychiatric Disorders

Grace A. S. Gonzales, MD
Department of Psychiatry
DMC
 Definition of Terms

■ Psychosis
■ Neurosis
■ Mood
■ Affect
■ Hallucinations
■ Delusions
■ Illusions
■ Agitation
■ Restlessness
■ Ideas of reference
■ Flight of ideas
■ Looseness of association
 Case #1
■ EC a 21 yo/F/S was
brought to you by her
mother due to 5 days hx
of decreased sleep. She
doesn’t want to eat
claiming that the food is
poisoned. 3 days ago she
was seen hiding under
the table claiming that
the NPAs are after her.
She hears sounds of cars
near their house and
voices of people talking
to one another despite
the absence of such.
 Case #1
■ She refuses to go out of
the house due to fear of
being killed. 1 day PTR px
fought with neighbors,
threw stones on their
houses and became
violent, insisting they
were saying bad things
about her. Patient was
brought to you restrained
restless, poorly groomed,
angry and violent without
provocation.
 Brief Psychotic Disorder
■ Presence of 1 or more of the ff symptoms
Delusions
Hallucinations
Disorganized speech
Grossly disorganized behavior
■ Duration of an episode of the disturbance is at
least 1 day but less than 1 month
■ Not due to another psychiatric dx, effects of
substance or GMC
 Case
■ RA a 25 yo male, single was
#2
brought in by his parents
because for the past 3 mos,
he has been observed to be
always staring blankly in
space. He was noted to be
staying inside the bedroom
most of the time. He has
developed poor self care,
refuses to eat, had difficulty
in falling asleep. When
talked to, he would not
answer but was observed
mumbling incomprehensible
sounds to self.
 Case #2
■ Upon evaluation, patient
was seen poorly
groomed, poor eye
contact, answered
questions with looseness
of assocation. He was
noted with thought
blocking. He admitted to
having difficulty in falling
asleep. He denied any
forms of hallucinations
but was seen mumbling
to self. Patient denies
being sick.
■
 Schizophreniform Disorder
■ Presence of 1 or more of the ff symptoms
Delusions
Hallucinations
Disorganized speech
Grossly disorganized behavior
■ Duration of an episode of the disturbance is at
least 1 month to 6 months
■ Not due to another psychiatric dx, effects of
substance or GMC
 Schizophreniform Disorder
■ With Good Prognostic Features:
■ Onset of prominent psychotic symptoms
within 4 weeks of the 1st noticeable change in
usual behavior or functioning
■ Confusion or perplexity at the height of the
psychotic episode
■ Good premorbid, social and occupational
functioning
■ Absence of blunted or flat affect
 Case #3
■ JB is a 30yo male, single,
whom you chanced upon
in one of your visits to a
far barrio. His sister who
takes care of him has
chained him in a mango
tree for almost a year
now because of
unpredictable behavior
for more than 5 years.
She described him as
violent even without
provocation, talks to self,
cannot sleep with fair
appetite
 Case #3
■ History revealed that 7
years before their mother
died she was also noted
with same behavioral
manifestations. JB had an
older sibling who died
due to hanging and
manifested behavioral
changes prior to the
incident. He was seen
poorly groomed, spoke
irrelevantly, agitated, and
eats anything he holds.
 Schizophrenia
■ Characteristic Symptoms: Two or more of
the following during a significant time in a
one month period
■ Delusions
■ Hallucinations
■ Disorganized speech
■ Grossly disorganized or catatonic behavior
■ Negative symptoms
 Schizophrenia
■ Social or Occupational Dysfunction
■ Duration: at least 6 months
■ Schizoaffective and Mood Disorder
Exclusion
■ Substance or General Medical Condition
Exclusion
■ Relationship to Pervasive Developmental
Disorder
 Schizophrenia Subtypes

■ Paranoid – Preoccupation with 1 or more

delusions, no disorganized speech or
behavior or inappropriate affect
■ Disorganized – Prominent disorganized
speech, disorganized behavior, flat or
inappropriate affect
 Schizophrenia Subtypes
■ Catatonic – motoric immobility or excessive
motor activity, extreme negativism, echolalia or
echopraxia
■ Undifferentiated – characteristic symptoms are
present but does not meet any particular criteria
■ Residual – absence of prominent characteristic
symptoms, evidence of disturbance indicated by
presence of negative symptoms
 Treatment
■ Antipsychotic medications
■ Typical :
■ Haloperidol 5, 20mg/tab (60mg/day)
■ Chlorpromazine 50, 100, 200mg/tab (800mg/day)
■ Levomepromazine 25, 100mg/tab (800mg/day)
■ Amisulpride 200, 400mg/tab
■ Haloperidol 5mg/amp (20mg/day)
■ Atypical antipsychotics
■ Risperidone 2mg/tab
■ Olanzapine 10mg/tab
■ Quetiapine 100, 200, 400mg/tab
■ Aripiprazole 10mg/tab
■ Anticholinergics:
■ Biperiden HCL 2 mg/tab
■ Extrapyramidal Symptoms:
■ Excessive Salivation
■ Oculogyric Crisis
■ Akathisia
■ Tremors
■ dystonia
 Case #4
■ MD an 18 yo female,
single was brought to you
for consult by her mother
due to sleeplessness. 2
months ago, she was
recruited to work as a
househelp in the city
against her will. 1 ½ mos
ago she was seen by
employer dressed
inappropriately, wearing
heavy make-up at home.
She spoke of going to the
shooting and feels that
her employer has a crush
on her.
 Case #4
■ She was sent home after
police caught her dancing
and singing at the
entertainment center of
one of the malls.
■ You saw the patient
restless, euphoric to
irritable mood, talkative,
with flight of ideas, (+)
delusion of grandeur,
decreased sleep and
appetite and spoke of
questionable plans.
 Bipolar I, with PF
■ Abnormally elevated mood lasting 1 week
■ 3 or more of the ff:
■ Inflated self-esteem or grandiosity
■ Decreased need for sleep
■ Pressure to keep talking
■ Flight of ideas or feeling of racing thoughts
■ Increased goal directed activity
■ Excessive involvement in activities with potential for
self harm
 Treatment

■ Mood stabilizers:
■ Lithium Co3 450mg/tab
■ Na Divalproex 250mg/tab
■ Carbamazepine 200mg/tab
■ Antipsychotics
■ Benzodiazepines:
■ Clonazepam 2mg/tab
■ Alprazolam 250mcg, 500mcg, 1mg/tab
 Case #5
■ HP is a 68 yo widower.
His wife died almost 2
years ago and since then
has been noted to have
decreased verbal output,
concentration difficulties,
always “absent-minded”
and irritable. He was
always seen teary-eyed
and refused to join usual
family activities.
 Case #5
■ 5 days ago, he was heard
by his daughter talking
alone in the bedroom. 3
days ago, he packed all
his things and said he
was going to a journey
with his wife. AM PTr, he
was seen about to hang
himself in the bathroom.
Major Depressive Disorder with PF
■ Depressed mood
■ Diminished interest or pleasure in activities
■ Significant weight loss or weight gain
■ Insomnia or hypersomnia
■ Psychomotor agitation or retardation
■ Fatigue or loss of energy
■ Feelings of worthlessness
■ Diminished ability to think or concentrate
■ Recurrent thoughts of death
 Treatment

■ Antidepressants
■ Tricyclic antidepressants : Imipramine
■ SSRI: Sertraline, Fluoxetine
■ SNRI: Escitalopram
 Treatment

■ Antipsychotics
■ Benzodiazepines:
■ Clonazepam 2mg/tab
■ Alprazolam 250mcg, 500mcg, 1mg/tab
 Case #6
■ PB a 29 yo F, single,
teacher, was walking
home from school when 3
men grabbed her to a
bushy area and raped
her. She was found after
5 hours by the barangay
police, naked, shaking
and crying.
 Case #6
■ PB filed a case of rape
against the perpetrators.
But since the incident,
she was observed to be
always scared and always
crying. Her mother claims
that she was always
having nightmares of the
crime. PB refuses to take
the same route in going
home. Her lawyer
referred her to you
because she refuses to
talk about the incident.
 Posttraumatic Stress Disorder

■ Person has been exposed to a traumatic

event with intense fear, helplessness or
horror
■ Involved actual or threatened death,
injury, or threat to physical integrity of self
or others
■ Reexperiencing
■ Recurrent recollections
■ Recurrent dreams
■ Feeling that the event is recurring
■ Reactivity on exposure to relevant symbols
■ Avoidance
■ Efforts to avoid thoughts
■ Avoid activities
■ Inability to recall
■ Diminished interest in activities
■ Detachment
■ Sense of foreshortened future
■ Increased arousal
■ Difficulty sleeping
■ Irritability or outbursts of anger
■ Concentration difficulties
■ Hypervigilance
■ Startle response
 Treatment

■ Antidepressants
■ Benzodiazepines
 Case #7
■ NP a 27 year old female,
married was brought to
you by her husband due
to 10 days history of
sleeplessness, irrelevant
speech and talking to
self. 2 days ago, she was
seen about to throw her
1 month old child out of
the window. When
confronted, she claimed
that the infant is a
“tiyanak” and does not
want the baby.
 Post Partum Psychosis

■ History of giving birth within 6 mos

■ Presence of characteristic psychotic
symptoms
■ Treatment: Antipsychotic Medications
 Case #8
■ MJ is an 11 year old boy,
brought in by mother. He
was seen shouting
irrelevantly, hostile for no
apparent reason, cannot
sleep, for 3 days now.
Mother claimed that 4
days ago, he collapsed in
school. History revealed
that since 5 years old, he
has been having such
recurrent episodes.
 Psychosis sec to GMC

■ Presence of a General Medical Condition

■ Seizure disorder
■ Typhoid Fever
■ Malaria
■ Encephalitis
■ Meningitis
 Case #8
■ DM is a 55 year old
male, married
presenting with
auditory, tactile and
visual hallucinations
for 2 days. He went
to a fiesta 6 days ago
and went on a
drinking spree for 3
days.
 Alcohol Withdrawal

■ History of prolonged and heavy alcohol

intake with sudden withdrawal
■ Presence of characteristic psychotic
symptoms
 Treatment

■ Diazepam 5mg in tapering dosage

■ Vit. B Complex 1000mg/day
■ Vit. C 500mg/day
■ Antipsychotic Medications