Gaba Telepsychiatry

We Treat

We treat patients suffering from the following conditions:

ADD/ADHD Childhood

According to the DSM V criteria, there are two main categories of childhood attention-deficit/hyperactivity disorder (ADHD) – inattention and hyperactivity.

Inattention:
Children who exhibit inattention may frequently:

a. make careless mistakes in schoolwork or fail to pay close attention to details.
b. Have difficulty staying focused on tasks or other activities.
c. not appear to listen even when spoken to directly.
d. struggle with following instructions and completing schoolwork or chores.
e. have trouble organizing tasks and activities.
f. avoid or dislike tasks that require mental effort, such as homework
g. lose items needed for tasks or activities, such as toys or pencils
h. be easily distracted
i. forget to do daily activities, such as chores.

Hyperactivity and impulsivity:
Children who exhibit hyperactivity and impulsivity may frequently:

a. fidget with hands or feet, or squirm in their seat.
b. have difficulty staying seated in the classroom or other situations.
c. constantly be on the go or in motion.
d. run around or climb in situations where it’s not appropriate.
e. have difficulty playing or engaging in activities quietly.
f. talk excessively.
g. blurt out answers, interrupting others.
h. have difficulty waiting for their turn.
i. interrupt or intrude on others’ conversations, games, or activities.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

ADD/ADHD Adult

According to the DSM V criteria for adults (over 17 years of age), ADD/ADHD is characterized by the following symptoms, where at least 6 of them persist for 6 months or more:

Inattention symptoms:

a. Often making careless mistakes in academic work, paid work, or other activities due to lack of attention to detail.
b. Struggling with sustaining attention.
c. Appearing not to listen when directly spoken to.
d. Failure to follow through on instructions and complete schoolwork, chores, or workplace duties.
e. Difficulty in organizing tasks and activities.
f. Avoidance or dislike of tasks that require sustained concentration and mental effort.
g. Losing things necessary for tasks or activities.
h. Being easily distracted by extraneous stimuli.
i. Often forgetting things.

Hyperactivity and impulsivity symptoms:

a. Fidgeting with or tapping hands or feet, or squirming in their seat.
b. Leaving their seat in situations where remaining seated is expected.
c. Moving around in situations where it is considered inappropriate.
d. Inability to do things quietly.
e. Always being “on the go,” as if driven by a motor.
f. Talking excessively.
g. Blurting out answers or responding before questions are completed.
h. Having difficulty waiting for his or her turn.
i. Interrupting or intruding on others.

Other criteria include the presence of several inattentive or hyperactive-impulsive symptoms before 12 years of age, clear evidence that the symptoms interfere with social, academic, or occupational functioning, and exclusion of symptoms occurring exclusively during the course of schizophrenia or another psychotic disorder, or being better explained by another mental disorder.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Agoraphobia

The DSM V criteria for Agoraphobia include:

A. Marked fear or anxiety about two or more of the following situations:

  • Using public transport.
  • Being in open spaces.
  • Being in enclosed spaces.
  • Standing in line or being in a crowd.
  • Being outside of the home alone.

B. The individual avoids or fears the situations above, because they believe that escape would be difficult, help would not be available if they experience panic-like symptoms, or other incapacitating or embarrassing moments may occur.
C. The fear or anxiety is almost always provoked by these situations.
D. The individual actively avoids or endures these situations with intense fear and anxiety.
E. The fear or anxiety is excessive in proportion to the actual risk.
F. The symptoms persist for at least six months or longer.
G. The fear or anxiety causes significant distress or impairment in social, occupational, or other important situations.
H. If another medical condition is present, the fear, anxiety or avoidance is excessive.
I. The symptoms are not better explained by another mental disorder.

Differential Diagnosis: Other potential conditions to consider in the differential diagnosis include Specific Phobia (SP), Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), and Social Anxiety Disorder (SAD).

It’s important to speak to your psychiatrist about your symptoms and work closely with them to determine the most suitable treatment.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Anorexia Nervosa

The DSM V criteria for Anorexia Nervosa include the following symptoms:

A. Limited food intake that does not meet the body’s nutritional requirements, resulting in a significantly low body weight considering factors such as age, sex, developmental trajectory and physical health.
B. Intense fear of gaining weight or becoming fat, or persistent behaviors that interfere with weight gain, even when the individual’s body weight is already very low.
C. Disturbance in the individual’s perception of their own body weight or shape, with an excessive influence of body weight or shape on their self-evaluation, or persistent lack of recognition of the seriousness of their current low body weight.

Coding: The condition can be classified as either restricting type or binge-eating/purging type.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Bipolar I Disorder

DSM V criteria for bipolar disorder includes:

Bipolar disorders are characterized by mood episodes, the highs are known as manic episodes and the lows as depressive episodes.

The key difference between the two types is the severity of the episodes experienced and the prevalence of depressive episodes.

Bipolar I sufferers will experience a manic episode as defined below. This may or may not be followed by hypomanic (less severe) or major depressive episodes. Not all bipolar I sufferers will experience depressive episodes.

Bipolar II sufferers will experience hypomanic (less severe than manic) episodes (defined below) and major depressive episodes.

Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least a week and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from the usual behavior:

  1. Inflated self-esteem or grandiosity.
  2. Decreased need for sleep.
  3. More talkative than usual or pressure to keep talking.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Increased distractibility, as reported or observed.
  6. Increase in goal-directed activity or psychomotor agitation.
  7. Significantly increased involvement in activities that have a high risk of causing physical pain or injury.

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:

  1. Inflated self-esteem or grandiosity.
  2. Decreased need for sleep.
  3. More talkative than usual or pressure to keep talking.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Distractibility, as reported or observed.
  6. Increase in goal-directed activity or psychomotor agitation.
  7. Excessive involvement in activities that have a high risk of causing injury or physical pain.

C. The episode is associated with a clear change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance.

Major Depressive Episode
A. At least 5 of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure and symptoms last most of the day, nearly every day.

  1. Depressed mood, noticed by themselves or others.
  2. Markedly diminished interest or pleasure in all, or almost all, activities.
  3. Significant weight loss or gain without dieting, or major change (decrease or 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 for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.

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

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Bulimia Nervosa

The DSM V criteria for diagnosing binge eating disorder includes the following:

A. Recurrent episodes of binge eating, characterized by eating an amount of food in a discrete period of time that is significantly larger than what most people would eat in a similar situation, and a sense of lack of control over eating during the episode.
B. Recurrent inappropriate compensatory behaviors 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 occur, on average, at least once a week for a period of 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.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Dementia

The DSM V criteria for diagnosing cognitive decline includes the following:

A. There must be evidence of a significant decrease in cognitive function compared to a person’s previous level of performance in one or more cognitive domains (such as attention, executive function, memory, language, perceptual-motor skills, or social cognition). This should be based on the person’s own concerns, observations from a knowledgeable informant or assessment by a clinician. Additionally, there should be substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or other quantified clinical assessment.
B. The cognitive deficits must interfere with the person’s ability to carry out everyday activities independently, such as needing help with complex tasks like managing finances or medication.
C. The cognitive deficits should not be solely attributable to a delirium, which is a temporary state of confusion often caused by a medical condition or medication.
D. The cognitive deficits cannot be better explained by another condition or disorder.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Depressive Disorders

DSM V criteria includes:

The DSM V criteria for diagnosing major depressive episode includes:

A. During a 2-week period, five or more of the following symptoms must be present and represent a change from previous functioning, with at least one of the symptoms being either depressed mood or loss of interest or pleasure. Symptoms must be present most of the day, nearly every day. Note: Symptoms should not be attributable to another medical condition.

  1. Depressed mood, observed by themselves or others. In children and adolescents, this can also be an irritable mood.
  2. Markedly diminished interest or pleasure in almost all activities as indicated by self-report or observation.
  3. Significant weight loss or weight gain, or change in appetite. In children, failure to make expected weight gain should also be considered.
  4. Insomnia or hypersomnia.
  5. Psychomotor agitation or retardation, observable by others.
  6. Fatigue or loss of energy.
  7. Feelings of worthlessness or excessive guilt, not merely self-reproach or guilt about being sick. These feelings may be delusional.
  8. Diminished ability to think, concentrate, or make decisions, as reported by self or observed by others.
  9. Recurrent thoughts of death, suicidal ideation without a specific plan, or a suicide attempt or plan.

B. The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode must not be attributable to the physiological effects of a substance or another medical condition.
D. The major depressive episode cannot be better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There must never have been a manic episode or a hypomanic episode.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Gender Dysmorphic Disorder

Some transgender individuals suffer because of conflicted gender identity , and struggles with acceptance. Many transgender individuals are comfortable with their identify but need help with hormone replacement, and other issues associated with a smooth male to female, or female to male transition.

Generalized Anxiety Disorder

A. Persistent excessive anxiety and worry (apprehensive expectation) occurring on most days for at least 6 months, related to multiple events or activities such as work or school performance.
B. Difficulty in controlling the worry.
C. Presence of three or more of the following six symptoms, with some symptoms being present for most days in the past 6 months:

  • Restlessness, feeling on edge, or being nervous.
  • Becoming easily fatigued.
  • Difficulty concentrating or experiencing mind blanks.
  • Irritability.
  • Muscle tension.
  • Sleep disturbance, including difficulty falling or staying asleep, or restless and unsatisfying sleep.

D. Clinically significant distress or impairment in social, occupational, or other important areas of functioning due to anxiety, worry, or physical symptoms.
E. The disturbance is not caused by the physiological effects of a substance or another medical condition, such as hyperthyroidism.
F. The disturbance is not better explained by another mental disorder, such as

  • Panic disorder
  • Social anxiety disorder
  • Obsessive-compulsive disorder
  • Separation anxiety disorder
  • Posttraumatic stress disorder
  • Anorexia nervosa
  • Somatic symptom disorder
  • Body dysmorphic disorder
  • Illness anxiety disorder, or schizophrenia or delusional disorder.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Hormonal imbalance

Frequently, this situation can result in mental health concerns, including anxiety, depression, and insomnia. Due to the daily fluctuations in hormone levels, individuals may experience a combination of these symptoms.

The fluctuations in mood and sleep can contribute to a cycle where patients feel unsteady and emotionally vulnerable, leading to increased anxiety and depression.

Various hormones, such as estrogen, progesterone, testosterone, thyroid hormone, insulin, growth hormone, and cortisol can impact mood.

Therefore, any type of hormone replacement should be approached with caution to ensure proper care.

Hypochondria Somatization

The DSM V criteria for illness anxiety disorder include the following:

A. Persistent preoccupation with the fear of having a serious illness.
B. Absence or mildness of somatic symptoms. If other medical conditions are present or if there is a high risk for developing a medical condition, the preoccupation is excessive or disproportionate.
C. High levels of anxiety about personal health status, and being easily alarmed about health.
D. Engaging in excessive health-related behaviors (e.g., repeatedly checking the body for signs of illness) or maladaptive avoidance (e.g. avoiding doctor appointments and hospitals).
E. The preoccupation with illness has been present for at least 6 months, although the specific illness feared may change over time.
F. The illness-related preoccupation cannot be better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, delusional disorder, or somatic type.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Impulse Control Disorder

In the DSM V, Disruptive, Impulse-control and Conduct disorders are a group of disorders that encompass conditions such as oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania and pyromania.

These disorders can result in individuals behaving angrily or aggressively towards people or property. They may struggle with controlling their emotions and behavior, and may exhibit a tendency to break rules or laws.

Insomnia and other sleep disorders

The DSM V criteria for insomnia includes:

A. The main complaint of dissatisfaction with sleep quantity or quality, accompanied by one or more of the following symptoms:

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

B. The sleep disturbance causes significant distress or impairment in various areas of functioning, such as social, occupational, educational, academic or behavioral.
C. The sleep difficulty occurs on at least 3 nights per week.
D. The sleep difficulty has been present for at least 3 months.
E. The sleep difficulty persists despite adequate opportunity for sleep.
F. The insomnia is not better explained by, and does not exclusively occur during the course of, another sleep-wake disorder (e.g. narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g., drug of abuse, medication).
H. Coexisting mental disorders and medical conditions do not sufficiently explain the primary complaint of insomnia.

It’s important to discuss these symptoms with your psychiatrist and work closely with them to determine the best treatment approach for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

LGBT Issues

LGBT individuals face higher rates of mental health challenges compared to the general population. This may include struggles with depression, anxiety, trauma, and self-acceptance, which can arise from experiencing discrimination. LGBT youth are about three to four times more likely to attempt suicide compared to their peers.

Research suggests that these elevated rates of mental health challenges are a result of prolonged exposure to societal and institutional prejudice and discrimination that many LGBT individuals face. Discrimination can have similar effects on mental health and coping mechanisms in response to stress.

However, it’s important to acknowledge that not all LGBT individuals have the same experiences, and people may respond to similar experiences in different ways.

Additionally, it’s important to note that sexual orientation (lesbian, gay, and bisexual) and gender identity (transgender) are distinct issues with unique challenges.

Menopause & PCOS Related Mood Disorders

Menopause refers to the permanent cessation of menstruation, which occurs when a woman has missed 12 menstrual cycles. The period leading up to menopause, known as perimenopause or menopausal transition, is marked by irregular menstrual cycles and fluctuations in reproductive hormones.

This can result in symptoms such as

  • Menstrual irregularities
  • Heavy bleeding mixed with episodes of missed periods (amenorrhea)
  • Decreased fertility
  • Vasomotor symptoms (such as hot flashes)
  • Insomnia

Some of these symptoms may begin to emerge up to 4 years before menstruation ceases, with an average age of onset for perimenopause being 47.5 years. During this transition, estrogen levels decline while follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels increase. Postmenopause follows the last menstrual period.

If you’re experiencing symptoms related to menopause, it’s important to speak with your healthcare provider, such as a psychiatrist, and work closely with them to determine the best treatment options for you.

Menstrual Disorders

The DSM V criteria for diagnosing premenstrual syndrome (PMS) includes the following:

A. In the majority of menstrual cycles, at least five symptoms must be present in the week before menstruation, start to improve within a few days after menstruation begins, and become minimal or absent in the week after menstruation.
B. One or more of the following symptoms must be present:

  • Marked mood swings, such as sudden sadness or increased sensitivity to rejection.
  • Marked irritability, anger, or increased conflicts in interpersonal relationships.
  • Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  • Marked anxiety, tension, or feeling on edge.

C. One or more of the following symptoms must also be present, in addition to symptoms from Criterion B, to reach a total of five symptoms:

  • Decreased interest in usual activities, such as work, school, friends, or hobbies.
  • Subjective difficulty in concentration.
  • Lethargy, easy fatigability, or marked lack of energy.
  • Marked change in appetite, overeating, or food cravings.
  • Hypersomnia or insomnia.
  • Feeling overwhelmed or out of control.
  • Physical symptoms such as breast tenderness, joint or muscle pain, bloating, or weight gain.

Note: Criteria A-C must have been met for most menstrual cycles in the preceding year.

D. The symptoms cause clinically significant distress or interference with work, school, social activities, or relationships.
E. The disturbance is not solely due to another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder, although it may co-occur with these disorders.
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles, although a provisional diagnosis may be made prior to this confirmation.
G. The symptoms are not caused by the physiological effects of a substance or another medical condition, such as hyperthyroidism.

It’s important to speak with a psychiatrist about your symptoms and work closely with them to determine the best treatment options for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Mood D-O Related to other Medical Conditions

The DSM V criteria for diagnosing a manic episode includes:

A. The presence of a persistent period of abnormally elevated, expansive, or irritable mood, along with increased activity or energy that is prominent in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is directly caused by another medical condition.
C. The disturbance cannot be better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, or requires hospitalization to prevent harm to self or others, or involves psychotic features.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Obsessive Compulsive Disorder

The DSM V criteria for diagnosing obsessive-compulsive disorder (OCD) includes the following:

A. Presence of obsessions, compulsions, or both:
Obsessions are characterized by (1) and (2):

  1. Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, and typically cause marked anxiety or distress.
  2. The individual tries to ignore or suppress these thoughts, urges, or images, or neutralize them with other thoughts or actions (i.e. compulsions).

Compulsions are characterized by (1) and (2):

  1. Repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels compelled to perform in response to an obsession or according to rigid rules.
  2. These behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, but are not realistically connected to what they are meant to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to explain the aims of these behaviors or mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The symptoms of OCD are not caused by the physiological effects of a substance (e.g. drug of abuse, medication) or another medical condition.
D. The symptoms of OCD are not better explained by the symptoms of another mental disorder (e.g. excessive worries in generalized anxiety disorder; preoccupation with appearance in body dysmorphic disorder; difficulty discarding possessions in hoarding disorder; hair pulling in trichotillomania [hair-pulling disorder]; skin picking in excoriation [skin-picking] disorder; stereotypies in stereotypic movement disorder; ritualized eating behavior in eating disorders; preoccupation with substances or gambling in substance-related and addictive disorders; preoccupation with having an illness in illness anxiety disorder; sexual urges or fantasies in paraphilic disorders; impulses in disruptive, impulse-control, and conduct disorders; guilty ruminations in major depressive disorder; thought insertion or delusional preoccupations in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior in autism spectrum disorder).

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Panic Disorder

The DSM V criteria for panic disorder includes the following:

A. Recurrent unexpected panic attacks, which are sudden episodes of intense fear or discomfort that peak within minutes and have four or more of the following symptoms:

  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.
  11. Fear of losing control or going crazy.
  12. Fear of dying.

B. At least one of the panic attacks is followed by one month or more of either:

  1. Persistent concern or worry about additional panic attacks.
  2. Significant maladaptive changes in behavior aimed at avoiding panic attacks.

C. The panic attacks are not due to substance use or a medical condition.
D. The symptoms are not better explained by another mental disorder.

It is important to discuss these symptoms with your psychiatrist and work closely with them to determine the best treatment approach for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Peripartum disoder (formerly known as postpartum disorder)

Peripartum depression refers to the occurrence of depression during pregnancy or after childbirth.

The term “peripartum” acknowledges that depression related to childbirth often starts during pregnancy.

Peripartum depression is a significant medical illness that can be treated and involves experiencing intense feelings of sadness, indifference, and/or anxiety, as well as changes in energy levels, sleep patterns, and appetite.

It poses risks to both the mother and the child.

Persistent Depressive Disorder / Dysthymia

According to DSM V criteria for Persistent Depressive Disorder/Dysthymia:

A. The individual must have experienced a depressed mood for most of the day, for more days than not, for at least 2 years, as indicated by subjective account or observation by others. Note: In children and adolescents, the mood can be irritable and the duration must be at least 1 year.
B. While experiencing depression, the individual must have at least two of the following symptoms:

  • Poor appetite or overeating.
  • Insomnia or hypersomnia.
  • Low energy or fatigue.
  • Low self-esteem.
  • Poor concentration or difficulty making decisions.
  • Feelings of hopelessness.

C. During the 2-year period (1 year for children or adolescents), the individual must not have been without the symptoms mentioned in Criteria A and B for more than 2 months at a time.
D. The individual may have met the criteria for a major depressive disorder continuously for 2 years.
E. There must be no history of a manic episode or a hypomanic episode, and criteria must not have been met for cyclothymic disorder.
F. The disturbance cannot be better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms must not be 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 must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It is recommended to speak to a psychiatrist about the symptoms and work closely with them to determine the best treatment approach.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Premenstrual Dysphoric Disorder

The DSM V criteria for diagnosing a menstrual-related mood disorder include the following:

A. For most menstrual cycles, at least five symptoms must be present in the week before the onset of menstruation, improve within a few days after the onset of menstruation, and become minimal or absent in the week after menstruation.
B. One or more of the following symptoms must be present:

  • Marked mood swings, such as sudden sadness or increased sensitivity to rejection.
  • Marked irritability, anger, or increased conflicts in interpersonal relationships.
  • Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  • Marked anxiety, tension, or feelings of being on edge.

C. Additionally, one or more of the following symptoms must be present, along with symptoms from Criterion B, to reach a total of five symptoms:

  • Decreased interest in usual activities, such as work, school, friends, or hobbies.
  • Subjective difficulty in concentration.
  • Lethargy, easy fatigability, or marked lack of energy.
  • Marked change in appetite, overeating, or specific food cravings.
  • Hypersomnia or insomnia.
  • A sense of being overwhelmed or out of control.
  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. Note: These symptoms must have been present for most menstrual cycles in the preceding year.

D. The symptoms must be associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others, such as avoidance of social activities or decreased productivity and efficiency at work, school, or home.
E. The disturbance is not simply 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, such as a drug of abuse, a medication, or other treatment, or another medical condition, such as hyperthyroidism.

It is important to speak to a psychiatrist about these symptoms and work closely with them to find the best treatment for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Schizophrenia

A. In order to meet criteria for schizophrenia, two or more of the following symptoms must be present for at least one month (1, 2, or 3):

  • Delusions (false beliefs not based in reality).
  • Hallucinations (perceiving things that are not there).
  • Disorganized speech.
  • Grossly disorganized or catatonic behavior (unusual motor behaviors).
  • Negative symptoms (lack of normal emotional expression or motivation).

B. The level of functioning in one or more major areas of life (such as work, relationships, or self-care) is lower than the person’s previous level of functioning before the onset of symptoms.
C. Continuous signs of disturbance are present for at least six months, which must include at least one month of the symptoms described in criterion A. The signs of disturbance may also include prodromal (early warning) or residual (lingering) phases. Additional specifiers include: first episode/acute, partial remission, full remission, multiple episodes/acute, partial remission, full remission, with catatonia.
D. Other possible diagnoses that need to be ruled out include: schizoaffective disorder, depressive/bipolar disorder with psychotic features, substance abuse, medical conditions, and autism spectrum/communication disorder. A diagnosis of schizophrenia should only be made if prominent delusions or hallucinations are present for at least one month.

It is important to discuss these symptoms with your psychiatrist and work closely with them to determine the best treatment approach for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Sexual Dysfunction

The DSM V criteria for sexual dysfunctions include the following:

  1. Delayed ejaculation (difficulty or inability to ejaculate).
  2. Erectile disorder (difficulty achieving or maintaining an erection).
  3. Female orgasmic disorder (difficulty or inability to reach orgasm).
  4. Female sexual interest/arousal disorder (lack of interest or arousal in sexual activities).
  5. Genito-pelvic pain/penetration disorder (pain or discomfort during intercourse).
  6. Male hypoactive sexual desire disorder (lack of sexual desire or interest in men).
  7. Premature (early) ejaculation (ejaculation that occurs too quickly).
  8. Substance/medication-induced sexual dysfunction (sexual dysfunction caused by substance use or medication).
  9. Other specified sexual dysfunction (sexual dysfunction that does not fit into any specific category).
  10. Unspecified sexual dysfunction (sexual dysfunction that is not specified or diagnosed).

Sexual dysfunctions are a diverse group of disorders that involve clinically significant disturbances in a person’s ability to respond sexually or experience sexual pleasure. It is possible for an individual to experience multiple sexual dysfunctions simultaneously, in which case all the relevant dysfunctions should be diagnosed.

It is important to discuss any symptoms related to sexual dysfunctions with your psychiatrist and work closely with them to determine the most appropriate treatment for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Social Phobia

The DSM V criteria for social anxiety disorder include:

A. A persistent and excessive fear of one or more social or performance situations where the individual may be exposed to unfamiliar people or possible scrutiny by others. The person fears that they will behave in a way that is embarrassing or humiliating, or that they will exhibit symptoms of anxiety.
B. The feared situation almost always triggers anxiety, which may manifest as a situationally bound or situationally predisposed panic attack.
C. The person recognizes that their fear is unreasonable or excessive.
D. The feared situations are avoided or endured with intense anxiety and distress.
E. The avoidance, anxious anticipation, or distress related to the feared social or performance situations significantly interferes with the person’s normal routine, occupational (or academic) functioning, social activities, or relationships, or causes marked distress about having the phobia.
F. In individuals under the age of 18 years, the duration of symptoms is at least 6 months.
G. The fear or avoidance is not due to the direct physiological effects of a substance (such as drugs or medications) or a general medical condition, and is not better accounted for by another mental disorder.

It is important to discuss any symptoms related to social anxiety disorder with your psychiatrist and work closely with them to determine the most appropriate treatment for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

Thyroid and Diabetes Related Mood Disorders

The DSM V criteria for Cyclothymia (Thyroid Disorders) include:

A. The presence of numerous periods of hypomanic symptoms that do not meet the criteria for a full manic or hypomanic episode, and numerous periods of depressive symptoms that do not meet the criteria for a full major depressive episode, lasting for at least 2 years.
B. These symptoms are present at least half of the time and have not been absent for more than 2 months at a time.
C. The criteria for a major depressive episode, manic episode, or hypomanic episode have never been met.
Specifiers: With anxious distress.

Comorbidity of diabetes and psychiatric disorders can manifest in various patterns. In some cases, they may appear as independent conditions with no apparent direct connection, where both are outcomes of independent and parallel pathogenic pathways. The course of diabetes may be complicated by the emergence of psychiatric disorders, where diabetes contributes to the pathogenesis of psychiatric disorders. Factors such as biological and psychological influences can mediate the emergence of psychiatric disorders in the context of diabetes.

Certain psychiatric disorders, such as depression and schizophrenia, can act as significant independent risk factors for the development of diabetes. There may be an overlap between the clinical presentation of episodes of hypoglycemia and ketoacidosis and conditions such as panic attacks.Impaired glucose tolerance and diabetes may also emerge as side effects of medications used for psychiatric disorders. Treatment of psychiatric disorders can also have an impact on diabetes care in other ways, as discussed in subsequent sections.

It is important to discuss any symptoms with your psychiatrist and work closely with them to determine the best treatment approach for you.

Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Publisher.
Text citation: (American Psychiatric Association, 2013).

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