Hi,

Does any one have a write up for Psychoneurotic, Psychosis, Character and Psychosomatic disorders?

The book I am currently following is Morgan and King, while the book is wonderful; it does not specifically different between the various disorders as required by the CSS syllabus.


Another concern of mine is that I cannot seem to fine DSM V (5) anywhere online. DSM V is Diagnostic and Statistical Manual of Mental Disorder. DSM V was Published in 2013; DSM IV in 1994 (available in Sheher Bano); DSM III is available in Morgan and King.

If anyone has any write up or knowledge relating to DSM V (5) please share.

I would be humbled by any help in this matter.

Psychoneurosis mean anxiety disorders, psychosis mean psychotic disorder, character mean personality disorders.
Better do disorders form dsm 5 than any other book, because in books disorders r describe according to dsm 4tr.

Thank you Sabeera.

Can you please guide meas to where I can get DSM 5 related information as the Internet has it all scattered in bits and pieces. I would be obliged if you could help.

Oky I will try my best to upload my dsm 5 notes of disorders, if I couldnt upload it here then mail me I will send them to you

Psychotic disorders

Schizophrenia
Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders and schizotypal personality disorder. They are defined by abnormalities in one or more of the following five domains

• Delusions
• Hellucinations
• Disorganized thinking (speech)
• Grossly disorganized motor behavior
• Negative symptoms

Delusions

Delusions are fixed beliefs, not amenable to change in the light of conflicting evidence.
Persecutory: one is going to be harmed, harassed by individual, group or organization.
Referential: certain gestures, comments, or environmental cues are directed at oneself.
Grandiose: that one has exceptional abilities, wealth or fame.
Erotomanic: one believe falsely that another person is in love with him/her.
Nihilistic: the conviction that major catastrophic events will occur.
Somatic: focus on preoccupations regarding health and organ functions.

Bizarre Delusions
Clearly implausible
Not understandable to same culture peer
Loss of control over mind
Thought withdrawal
Thought insertion
Delusion of control

Non-Bizarre Delusions
One is under surveillance of the police, without the proper evidence.

Hallucinations

Perception like experience that occur without an external stimulus.
Vivid and clear with full perception of normal perceptions.
Auditory hallucinations are common.
It must occurs in the context of a clear sensorium,
Those that occur while falling asleep (hypnogogic) or waking up (hypnopompic) are considered to be ranged in normal behaviour.

Disorganized thinking & speech
Disorganized thinking (formal thought disorder) is typically inferred from a person’s speech.
Switching from one topic to another (derailment, loose association)
Answers of the question obliquely related or unrelated (tangentially)

• Rarely, speech may be so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization {incoherence or "word salad").

• the symptom must be severe enough to substantially impair effective communication.

Grossly Disorganized or Abnormal motor Behavior(Catatonia)

• Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from childlike "silliness" to unpredictable agitation. Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living.

• Catatonic behavior is a marked decrease in reactivity to the environment. This ranges from resistance to instructions {negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses {mutism and stupor).

• It can also include purposeless and excessive motor activity without obvious cause {catatonic excitement).

Negative Symptoms

• Two negative symptoms are particularly prominent in schizophrenia:

• Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech.

• Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech.

• Alogia is manifested by diminished speech output.

• Anhedonia is the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced.

• Asociality refers to the apparent lack of interest in social interactions

Schizotypal (Personality) Disorder
Because this disorder is considered part of the schizophrenia spectrum of
disorders, and is labeled in this section of ICD-9 and ICD-10 as schizotypal disorder, it is listed in this chapter and discussed in detail in the DSM-5 chapter "Personality Disorders."



to be continue.......
tell me members if i should continue to upload or is it too much

Delusional Disorder
Diagnostic Criteria 297.1 (F22)

A. The presence of one (or more) delusions with a duration of 1 month or longer.

B. Criterion A for schizophrenia has never been met.
Note: Hallucinations, if present, are not prominent and are related to the delusional
theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.

D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Specify whether:
Erotomanie type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.
Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.

Jeaious type: This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful.

Persecutory type: This subtype applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.

Somatic type: This subtype applies when the central theme of the delusion involves
bodily functions or sensations.

Mixed type: This subtype applies when no one delusional theme predominates.
Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).

Specify if:
With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a stranger has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars).

Specify if:
The following course specifiers are only to be used after a 1 -year duration of the disorder:
First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.

First episode, currently in partial remission: Partial remission is a time period during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled.

First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.

Associated Features Supporting Diagnosis
Social, marital, or work problems can result from the delusional beliefs of delusional disorder.
Individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves (i.e., there may be "factual insight" but no true insight). Many individuals develop irritable or dysphoric mood, which can usually be understood as a reaction to their delusional beliefs. Anger and violent behavior can occur with persecutory, jealous, and erotomanie types. The individual may engage in htigious or antagonistic behavior (e.g., sending hundreds of letters of protest to the government). Legal difficulties can occur, particularly in jealous and erotomanie types.
Prevalence
The lifetime prevalence of delusional disorder has been estimated at around 0.2%, and the most frequent subtype is persecutory. Delusional disorder, jealous type, is probably more common in males than in females, but there are no major gender differences in the overall
frequency of delusional disorder.

Culture-Related Diagnostic Issues
An individual's cultural and religious background must be taken into account in evaluating the possible presence of delusional disorder. The content of delusions also varies across cultural contexts.

Functional Consequences of Delusional Disorder
The functional impairment is usually more circumscribed than that seen with other psychotic disorders, although in some cases, the impairment may be substantial and include poor occupational functioning and social isolation. When poor psychosocial functioning is present, delusional beliefs themselves often play a significant role. A common characteristic of individuals with delusional disorder is the apparent normality of their behaviour and appearance when their delusional ideas are not being discussed or acted on.

Brief Psychotic Disorder
Diagnostic Criteria 298.8 (F23)

A. Presence of one (or more) of the following symptoms. At least one of these must be
(1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specify if:
With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.

Without marited stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.

With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum.

Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder,

Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).

Associated Features Supporting Diagnosis
Individuals with brief psychotic disorder typically experience emotional turmoil or overwhelming confusion. They may have rapid shifts from one intense affect to another.
Although the disturbance is brief, the level of impairment may be severe, and supervision may be required to ensure that nutritional and hygienic needs are met and that the individual is protected from the consequences of poor judgment, cognitive impairment, or acting on the basis of delusions. There appears to be an increased risk of suicidal behavior, particularly during the acute episode.

Prevalence
In the United States, brief psychotic disorder may account for 9% of cases of first-onset psychosis.

Psychotic disturbances that meet Criteria A and C, but not Criterion B, for brief psychotic disorder (i.e., duration of active symptoms is 1-6 months as opposed to remission within 1 month) are more common in developing countries than in developed countries. Brief psychotic disorder is twofold more common in females than in males.

Development and Course
Brief psychotic disorder may appear in adolescence or early adulthood, and onset can occur across the lifespan, with the average age at onset being the mid 30s.. In some individuals, the duration of psychotic symptoms may be quite brief (e.g., a few days).

Risk and Prognostic Factors
Temperamental. Preexisting personality disorders and traits (e.g., schizotypal personality disorder; borderline personality disorder; or traits in the psychoticism domain, such as perceptual dysregulation, and the negative affectivity domain, such as suspiciousness) may predispose the individual to the development of the disorder.

Culture-Related Diagnostic issues
It is important to distinguish symptoms of brief psychotic disorder from culturally sanctioned response patterns. For example, in some religious ceremonies, an individual may report hearing voices, but these do not generally persist and are not perceived as abnormal by most members of the individual's community. In addition, cultural and religious background must be taken into account when considering whether beliefs are delusional.

Functional Consequences of Brief Psychotic Disorder
Despite high rates of relapse, for most individuals, outcome is excellent in terms of social functioning and symptomatology.

catatonia

• Catatonia is defined by the presence of three or more of 12 psychomotor features in the diagnostic criteria for catatonia associated with another mental disorder and catatonic disorder due to another medical condition.
  
• The essential feature of catatonia is a marked psychomotor disturbance that may involve decreased motor activity, decreased engagement during interview or physical examination, or excessive and peculiar motor activity.
  
• The clinical presentation of catatonia can be puzzling, as the psychomotor disturbance may range from marked unresponsiveness to marked agitation. Motoric immobility may be severe (stupor) or moderate (catalepsy and waxy flexibility). Similarly, decreased engagement may be severe (mutism) or moderate (negativism).
  
• Excessive and peculiar motor behaviors can be complex (e.g., stereotypy) or simple (agitation) and may include echolalia and echopraxia. In extreme cases, the same individual may wax and wane between decreased and excessive motor activity.
  
• During severe stages of catatonia, the individual may need careful supervision to avoid self-harm or harming others. There are potential risks from malnutrition, exhaustion, hyperpyrexia and self-inflicted injury.

Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

The clinical picture is dominated by three (or more) of the following symptoms:
1. Stupor (i.e., no psychomotor activity; not actively relating to environment).

2. Catalepsy (i.e., passive induction of a posture held against gravity).

3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).

4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).

5. Negativism (i.e., opposition or no response to instructions or external stimuli).

6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).

7. Mannerism (i.e., odd, circumstantial caricature of normal actions).

8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).

9. Agitation, not influenced by external stimuli.

10. Grimacing.

11. Echolalia (i.e., mimicking another’s speech).

12. Echopraxia (i.e., mimicking another’s movements).

Schizophreniform Disorder
Diagnostic Criteria 295.40 (F20.81)

A. Two (or more) of the following, each present for a significant portion of time during a
1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
'
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition

Specify if:
With good prognostic features: This specifier requires the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning

confusion or perplexity: good premorbid social and occupational functioning; and absence of blunted or flat affect.

Without good prognostic features: This specifier is applied if two or more of the above features have not been present.

Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder)

Associated Features Supporting Diagnosis
As with schizophrenia, currently there are no laboratory or psychometric tests for schizophreniform disorder. There are multiple brain regions where neuroimaging, neuropathological, and neurophysiological research has indicated abnormalities, but none are diagnostic.

Risk and Prognostic Factors
Genetic and physiological. Relatives of individuals with schizophreniform disorder have an increased risk for schizophrenia.

Functional Consequences of Schizophreniform Disorder
For the majority of individuals with schizophreniform disorder who eventually receive a diagnosis of schizophrenia or schizoaffective disorder, the functional consequences are similar to the consequences of those disorders. Most individuals experience dysfunction in several areas of daily functioning, such as school or work, interpersonal relationships, and self-care. Individuals who recover from schizophreniform disorder have better functional outcomes.

Schizophrenia
Diagnostic Criteria 295.90 (F20.9)

A. Two (or more) of the following, each present for a significant portion of time during a
1 -month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion

A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. have been ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria. First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.

Associated Features Supporting Diagnosis

• inappropriate affect (e.g., laughing in the absence of an appropriate stimulus);
  
• a dysphoric mood that can take the form of depression, anxiety, or anger;
  
• a disturbed sleep pattern (e.g., daytime sleeping and nighttime activity);
  
• and a lack of interest in eating or food refusal.
  
• Depersonalization, derealization, and somatic concerns may occur and sometimes reach delusional proportions.
  
• Anxiety and phobias are common.
  
• Cognitive deficits in schizophrenia are conrmion and are strongly linked to vocational and functional impairments. These deficits can include decrements in declarative memory, working memory, language function, and other executive functions, as well as slower processing speed.
  
• Abnormalities in sensory processing and inhibitory capacity, as well as reductions in attention, are also found. Some individuals with schizophrenia show social cognition deficits, including deficits in the ability to infer the intentions of other people (theory of mind), and may attend to and then inteφret irrelevant events or stimuli as meaningful, perhaps leading to the generation of explanatory delusions.
  
• These impairments frequently persist during symptomatic remission.

Prevalence
The lifetime prevalence of schizophrenia appears to be approximately 0.3%-0.7%, although there is reported variation by race/ethnicity, across countries, and by geographic origin for immigrants and children of immigrants. The sex ratio differs across samples and populations.

Development and Course
The psychotic features of schizophrenia typically emerge between the late teens and the mid-30s; onset prior to adolescence is rare. The peak age at onset for the first psychotic episode is in the early- to mid-20s for males and in the late-20s for females. The onset may be abrupt or insidious, but the majority of individuals manifest a slow and gradual development of a variety of clinically significant signs and symptoms.

Risk and Prognostic Factors

Environmental. Season of birth has been linked to the incidence of schizophrenia, including late winter/early spring in some locations and summer for the deficit form of the disease. The incidence of schizophrenia and related disorders is higher for children growing up in an urban environment and for some minority ethnic groups.

Genetic and physiological. There is a strong contribution for genetic factors in determining risk for schizophrenia, although most individuals who have been diagnosed with schizophrenia have no family history of psychosis.

Pregnancy and birth complications with hypoxia and greater paternal age are associated with a higher risk of schizophrenia for the developing fetus. In addition, other prenatal and perinatal adversities, including stress, infection, malnutrition, maternal diabetes, and other medical conditions, have been linked with schizophrenia. However, the vast majority of offspring with these risk factors do not develop schizophrenia.

Gender-Related Diagnostic Issues
A number of features distinguish the clinical expression of schizophrenia in females and males. The general incidence of schizophrenia tends to be slightly lower in females, particularly among treated cases. The age at onset is later in females, with a second mid-life peak as described earlier


Schizoaffective Disorder
Diagnostic Criteria

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion A1 : Depressed mood.

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.

C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specify whether:
Bipolar type: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur.

Depressive type: This subtype applies if only major depressive episodes
are part of the presentation.

Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder,

Prevalence
Schizoaffective disorder appears to be about one-third as common as schizophrenia. Lifetime prevalence of schizoaffective disorder is estimated to be 0.3%.

The incidence of schizoaffective disorder is higher in females than in males, mainly due to an increased incidence of the depressive type among females.

Development and Course
The typical age at onset of schizoaffective disorder is early adulthood, although onset can occur anywhere from adolescence to late in life. A significant number of individuals diagnosed with another psychotic illness initially will receive the diagnosis schizoaffective disorder later when the pattern of mood episodes has become more apparent.

Suicide Risk
The lifetime risk of suicide for schizophrenia and schizoaffective disorder is 5%, and the presence of depressive symptoms is correlated with a higher risk for suicide.

Functional Consequences of Scliizoaffective Disorder
Schizoaffective disorder is associated with social and occupational dysfunction, but dysfunction is not a diagnostic criterion (as it is for schizophrenia), and there is substantial variability between individuals diagnosed with schizoaffective disorder.

for disorders go to davison and neale 12th edition, and you will find here DSM-V too

Thank you Sabeera.

Can you kindly tell what changes have been made in DSM V in comparison to DSM IV with special focus on CSS Syllabus. Obviously there may be numerous changes but my query is only w.r.t css syllabus.

What disorders are we expected to cover under

Psychoneurotic disorders,
Psychosis,
Character disorders,
Psychosomatic disorders.

Many thanks for your post once more.