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564 sEctiON iii Psychiatry ` Psychiatry—Pathology Psychiatry ` Psychiatry—Pathology

Trauma and stress-related disorders
Adjustment disorder Emotional or behavioral symptoms (eg, anxiety, outbursts) that occur within 3 months of an
identifiable psychosocial stressor (eg, divorce, illness) lasting < 6 months once the stressor has
ended. If symptoms persist > 6 months after stressor ends, it is GAD. Symptoms do not meet
criteria for MDD. Treatment: CBT is first line; antidepressants and anxiolytics may be considered.
Post-traumatic stress Experiencing, or discovering that a loved one has experienced, a life-threatening situation (eg,
disorder serious injury, rape, witnessing death) Ž persistent Hyperarousal, Avoidance of associated stimuli,
intrusive Re-experiencing of the event (eg, nightmares, flashbacks), changes in cognition or mood
(eg, fear, horror, Distress) (having PTSD is HARD). Disturbance lasts > 1 month with significant
distress or impaired functioning. Treatment: CBT, SSRIs, and venlafaxine are first line. Prazosin
can reduce nightmares.
Acute stress disorder—lasts between 3 days and 1 month. Treatment: CBT; pharmacotherapy is
usually not indicated.

Diagnostic criteria by symptom duration

SLEEP DISORDERS
Narcolepsy > 3 m
CHILDHOOD DISORDERS Specific learning > 6 m
ADHD > 6 m

Oppositional defiant > 6 m
Selective mutism > 1 m Tourette syndrome > 1 y
Separation anxiety > 4 w Disruptive mood dysregulation > 1 y
ANXIETY DISORDERS
Panic ≥ 1 m
Acute stress ≤ 1 m Post-traumatic stress > 1 m
Phobias > 6 m

Adjustment < 6 m Generalized anxiety > 6 m 1y 2y
0 1w 2w 3w 1m 3m 6m
MOOD DISORDERS
Complicated grief > 6 m
Major depressive ≥ 2 w Dysthymic 2 y≥

Manic sx of bipolar > 1 w Cyclothymic ≥ 2 y
PSYCHOTIC DISORDERS
Schizoa‰ective > 2 w
Delusional > 1 m
Brief psychotic < 1 m Schizophreniform 1 - 6 m Schizophrenia > 6 m

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