Patients with mental complaints or concerns or disordered behavior present in a variety of clinical settings, including primary care and emergency treatment centers. Complaints or concerns may be new or a continuation of a history of mental problems. Complaints may be related to coping with a physical condition or be the direct effects of a physical condition on the central nervous system. The method of assessment depends on whether the complaints constitute an emergency or are reported in a scheduled visit. In an emergency, a physician may have to focus on more immediate history, symptoms, and behavior to be able to make a management decision. In a scheduled visit, a more thorough assessment is appropriate.
Everyone occasionally experiences a failure in the normal automatic integration of memories, perceptions, identity, and consciousness. For example, people may drive somewhere and then realize that they do not remember many aspects of the drive because they are preoccupied with personal concerns, a program on the radio, or conversation with a passenger. Typically, such a failure, referred to as nonpathologic dissociation, does not disrupt everyday activities.
Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive joyousness, or both. Mood disorders can occur in children and adolescents (see Depressive Disorders in Children and Adolescents and Bipolar Disorder in Children and Adolescents).
Obsessive-compulsive disorder (OCD) is characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images (obsessions) and/or by repetitive behaviors or mental acts that patients feel driven to do (compulsions) to try to lessen or prevent the anxiety that obsessions cause. Diagnosis is based on history. Treatment consists of psychotherapy (specifically, exposure and response prevention plus, in many cases, cognitive therapy), drug therapy (specifically, selective serotonin reuptake inhibitors [SSRIs] or clomipramine), or, especially in severe cases, both.
Paraphilic disorders are recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of oneself or the partner with the potential to cause harm.
Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors. Many gradually become less severe with age, but certain traits may persist to some degree after the acute symptoms that prompted the diagnosis of a disorder abate. Diagnosis is clinical. Treatment is with psychosocial therapies and sometimes drug therapy.
Schizophrenia and related psychotic disorders—brief psychotic disorder, delusional disorder, schizoaffective disorder, schizophreniform disorder, and schizotypal personality disorder—are characterized most prominently by psychotic symptoms and often by negative symptoms and cognitive dysfunction.
Gender dysphoria is characterized by a strong, persistent cross-gender identification associated with anxiety, depression, irritability, and often a wish to live as a gender different from the one associated with the sex assigned at birth. People with gender dysphoria often believe they are victims of a biologic accident and are cruelly imprisoned in a body incompatible with their subjective gender identity. Gender dysphoria is a diagnosis requiring specific criteria but is sometimes used more loosely for people in whom symptoms do not reach a clinical threshold. Transsexualism was once an accepted diagnosis referring to people with severe, clinically significant symptoms of gender dysphoria. While this term can still be found in the medical literature, it has fallen out of favor in modern nosology and is considered offensive or inaccurate by some people with gender dysphoria.
Somatization is the expression of mental phenomena as physical (somatic) symptoms. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously and nonvolitionally to those in which symptoms develop consciously and volitionally. This continuum includes
Suicide is death caused by an intentional act of self-harm that is designed to be lethal. Suicidal behavior encompasses a spectrum of behavior from suicide attempt and preparatory behaviors to completed suicide. Suicidal ideation refers to the process of thinking about, considering, or planning suicide.
Substance-related disorders involve drugs that directly activate the brain's reward system. The activation of the reward system typically causes feelings of pleasure; the specific pleasurable feelings evoked vary widely depending on the drug. These drugs are divided into 10 different classes that have different, although not completely distinct, pharmacologic mechanisms. The classes of drugs include