Paul Golden, MD Speaks; Depression & Bipolar Disorders
“Opening the Black Box on Mental Illness” Seminar, part I: Depression & Bipolar Disorders and…
This is a bipolar dictionary of common psychiatric terms.
Agoraphobia: one of the anxiety disorders characterized by feelings the environment to be unsafe, usually include unfamiliar places. The home is the only comfort zone. Age of onset is in the third decade and women outnumber men.
Attention deficit hyperactivity disorder (ADHD): difficulty focusing on a single project, excessive activity. Symptoms appear near or after puberty. It is largely more common in males. Sometimes ADHD can be subcategorized into three types. Inattentive; predominantly hyperactive; impulsive; and combined. Cause is unknown but may involve neurotransmitters.
Asperger’s syndrome in adults: a qualitative impairment in social interaction: with at least two of the following:
Autism: one end of the spectrum of autistic spectrum disorders ASDs. Childhood autism being the opposite end of the spectrum from Asperger’s. In childhood it is characterized by impaired social interaction and both verbal and non-verbal communication with repetitive behavior. Symptoms are apparent by age three. It is felt to be heritable and environmental in etiology. It is also felt to be neurodevelopmental with abnormal communication between nerve synapses. Children show less attention to social stimuli, often not smiling or looking at others. Associated is less eye contact and cannot use simple movements to express themselves. Up to half do not develop enough natural speech to establish daily communication. They are likely to repeat other’s words. They develop repetitive behavior, compulsive behavior such as stacking objects only a certain way and resist change of their patterns. Some exhibit self-injury.
Bipolar disorder: episodic episodes of major depression and mania with usual age of onset in the third decade.
Cognition: processing and acquiring knowledge, processing knowledge, attention memory, judgment and reasoning. It involves problem solving and decision making and comprehension. It generally involves areas requiring higher functioning. It can be defined as cerebral activities that lead to knowledge and information. It encompasses reasoning, memory and attention to acquire information.
Cyclothymia: a subcategory within bipolar disorder; the manic episodes are hypomanic and the depressive episodes likewise. It is characterized by numerous mood things. The mood swings may be weekly or even in the course of the same day. Although to make a diagnosis needs to meet the criteria of lasting at least two years this is not an absolute. It is usually a milder form of bipolar disease. 15 to 50% will meet the criteria of bipolar 1 or 2 in the course of a lifetime. Cyclothymia is less common than bipolar disorder itself. It is difficult to distinguish from mixed state and rapid cycling.
Depression: encompasses major depression, persistent depressive disorder, psychotic depression, postpartum depression and seasonal affective disorder. It is not melancholia or the blues due to a life event. Major depression is defined as three or more of the following symptoms lasting longer than three weeks: sadness, emptiness, pessimism, feelings of guilt and worthlessness, agitation, hopelessness, early morning awakening, obsessing, not wanting to get out of bed, gain or loss of weight, suicidal thoughts, lack of interest in hobbies, difficulty functioning and making decisions, fatigue, inability to concentrate and inability to laugh or being around others who are laughing.
ECT: electro-convulsant therapy. Formerly called shock therapy. Under general anesthesia a patient who has been given a muscle paralytic the application of a paddle on one or both temples with a brief burst of electricity causes a brief seizure only visible on an EEG (electroencephalogram). Used in unipolar depression or bipolar depression it is an alternative to drugs when combinations of the latter have not been effective. Generally in became in common use around 1960. It seems to most effective in highly cognizant or functioning individuals and is quite effective in depression in geriatric age folks. Its use for depression due to dementia is controversial. Side effects are transitory headache, nausea and amnesia prior to the treatment, so-called retrograde amnesia.
Fugue State: a rare psychiatric disorder involving reversible amnesia for personal identity including memories, personality and other identifying characteristics of self. The fugue state is usually short-lived raging from hours to days and rarely months. Upon recovery previous memories return intact but there is amnesia for the period of the fugue state itself.
Generalized anxiety disorder: GAD is an anxiety disorder marked by excessive, uncontrollable anxiety often irrational worry about events or activities. Individuals may obsess about irrational events that could have been or might begin in the future. The anxiety can interfere with daily functioning. Individuals may anticipate disaster. The anxiety may be associated with physical symptoms associated to heightened discharge of the sympathetic nervous system. It can be defined as at least six months with prominent tension, worry and feelings of apprehension about everyday events. At least four symptoms of the following list must be present: One: autonomic arousal symptoms such a palpitations, sweating trembling or dry mouth. Two: symptoms concerning chest or abdomen. Three: Symptoms concerning brain and mind. Three: general symptoms such as hot flushes or cold chills or tingling sensations. Four: Symptoms of tension such as inability to relax. Five: Non-specific symptoms: easily startled, difficulty concentrating due to worry, irritability or difficulty getting to sleep due to worry.
Histrionic personality disorder: need for attention, the teed to the center of attention, dramatic, acting out a role to others that makes keeping close sexual relationships and use of phys8cal appearance to garner attention.
Hyperthymia: a behavior type similar to hypomania but without any destructive elements. It is characterized by increased energy and productivity, self-assurance, self-confidence, strong will, talkativeness to the point of monologue in talking with others, sensation seeking, inability to tolerate boredom, cheerfulness and tireless. It is not known if hyperthymia is pathologic or whether it could be considered a personality disorder.
Hypomania: a less severe form of mania and therefore the euphoric end of bipolar 11 disorder. It is marked by euphoria with or without irritability. Other manic features include energetic, talkative, over confident and many creative ideas. In its severest form hypomania can include risky behavior.
Insomnia: difficulty falling asleep or staying asleep. It can accompany many medical or psychiatric disorders. Sleep quality is impaired and so can functioning. Primary insomnia is not associated with any other disorder. Secondary insomnia can co-exist with major depression. It can be short-lived or chronic.
Korsakoff’s syndrome: a long-term complication of alcohol abuse and is a manifestation of Wernicke’s encephalopathy. Lack of vitamin B1 (thiamine) by poor nutrition associated with alcoholism is the cause of this neurologic condition. It is often within the spectrum of Wernicke-Korsakoff syndrome. The deficit of B1 in the brain causes ophthalmoplegia, ataxia and confusion. The symptoms may often correct by thiamine supplementation IV and then PO.
Lacunar amnesia: a kind of amnesia for one particular event.
Manic depressive disorder: now called Bipolar Disorder
Major depression disorder: occurs alone and be recurrent (unifocal) or alternating with mania or hypomania as bipolar disorder. Defined in Depression above.
Mania: marked by: rapid speech, racing thoughts, aggressive behavior, irritability, risky behavior spending sprees, poor financial choices and drive to complete multiple projects.
Mixed episode: when a manic and depressive episode occur at the same time or in very short succession sometimes within the same day. A mixed state must meet the criteria for both a major depressive episode and a manic episode nearly every day for at least one week. More commonly both manic and depressive symptoms are mixed but not defining a specific manic or depressive episode.
Mood disorder: another name for affective disorders, i.e., unipolar depression and bipolar disorder
Munchausen’s syndrome: feigned disease, illness or psychological trauma to draw attention and sympathy from others. It is marked by multiple hospitalizations in multiple locales. The names from a fictional character Baron Munchausen. Munchausen syndrome by proxy refers to the abuse of another family member, usually a child, to seek attention or sympathy for the abuser. It is an obsession to relate symptoms in the proxy leading to multiple medical and surgical procedures.
Narcissistic personality disorder: increased sense of self-importance, unlimited, success, seeking constant attention, oversensitive to failure, multiple physical symptoms and exploitation of what few people with whom one is friends.
Neurotic: no longer used in psychiatric diagnosis
Obsessive Compulsive Personality Disorder: marked by high levels of aspiration, very conscientious, strive for perfection, orderly, methodical, inflexible to adapt to any change in routine, cautious, detail oriented and have difficulty completing tasks
Panic attacks: periods of intense fear of sudden onset associated with physical and cognitive symptoms including most commonly heart palpitations, chest pain as well as dizziness, breathlessness, lasting from minus to hours. Attacks begin occur abruptly and peak with 10 to 20 minutes but may last hours. When first experienced the individual may believe he/she is having a heart attack and call emergency services. Cognitive symptoms include fear of impending doom or even of sanity.
Paranoid Personality Disorder: perceiving actions of others as threatening and therefore untrusting.
Personality disorders: Schizoid personality disorder—introverted, withdrawn, cold; Paranoid personality disorder—perceiving actions of others as threatening; Schizotypal personality disorder—need for social isolation, anxiety in social situations; Anti-social personality disorder—ignore normal rules of social behavior; Narcissistic personality disorder—increased sense of self-importance; Avoidant personality disorder—hypersensitive to rejection; Dependent personality disorder—dependent behavior and relying on others to make decision s for them; Obsessive-compulsive personality disorder– orderly and strive for perfection; Histrionic personality disorder—need for attention, dramatic; borderline personality disorder– impulsive, difficulty with interpersonal relationships
Phobias: fears of certain physical items or activities. The list is enormous. Some more common phobias include: acrophobia-fear of heights; aerophobia-fear of flying; agoraphobia-fear of open spaces or crowds to the pint of rear of leaving home; arachnophobia-friar of spiders; claustrophia-fear of confined spaces; cynophobia-fear of dogs; dentophobia-fear of dentists; dishabiliophobia-fear of undressing in front of someone; felinophobia-fear of cats; xenophobia-fear of foreigners; homophobia-fear of homosexuals. The list exceeds one-hundred phobias
Psychosis: loss of contact with reality, but really a wastebasket term including everything from forms of schizophrenia, to severe mania of bipolar disorder, and at times having auditory, visual hallucinations or delusions.
Post-traumatic stress disorder (PTSD): any disabling anxiety deriving from a traumatic event such as sexual abuse, horrors of war, traffic accidents, bodily assault particularly rape. The anxiety takes the form of dreams related to the trauma, disturbing thoughts or physical distress to trauma-related cues.
Residual schizophrenia: a person is no longer experiencing delusions or hallucinations, but has no motivation or interest in life.
Retrograde amnesia: loss of memory just prior to an event or injury.
Schizoaffective disorder: features of schizophrenia and affective disorders but not strictly meeting diagnostic criteria for either alone.
Schizoid personality disorder: see personality disorders.
Schizophrenia: delusions (false beliefs) and hallucinations (auditory, visual) that lead to reduced social involvement and lack of motivation—four types include paranoid, disorganized, catatonic and residual.
Seasonal affective disorder: not a separate psychiatric disorder but rather a pattern of major depression occurring at a specific time of year and in remission at other times; most common in northern climates such as Alaska during the winter (10%) versus southern climates such as Florida (1.4%)
Self-Medication: use of medications without professional supervision; also to include use of alcohol, marijuana or opioids to treat the highs and lows of affective disorders
Tardive dyskinesia: involuntary or repetitive movements that are slow in onset and usually due to long term use of anti-psychotic drugs
Tourette syndrome: inherited neuropsychiatric disorder characterized by involuntary motor and vocal tics (often obscenity) with onset in childhood
Unifocal depression: major depression disorder without manic episodes