Introduction to Psychiatry
MUDr. Eliška Bartečková, Ph.D.
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1 Psychiatry and mental disorders
Psychiatry is a medical specialty focused on the diagnosis, treatment, and prevention of mental,
emotional, and behavioral disorders. As a field of medicine, psychiatrists are trained physicians who can
prescribe medication, and they often use a combination of medical and psychotherapeutic techniques.
Psychology, in contrast, primarily deals with the study of the mind and behavior. Psychologists use
various therapeutic techniques to help individuals cope with and overcome emotional and behavioral
challenges, but they typically cannot prescribe medications unless they're specifically licensed to do so
in certain jurisdictions.
While both fields aim to understand the mind and improve mental well-being, psychiatry has its roots in
medicine and medical interventions, whereas psychology is rooted in understanding cognitive,
emotional, and behavioral processes.
A Mental Disorder is a syndrome characterized by a clinically significant disturbance in an
individual's cognition, emotion regulation, or behavior. This disturbance reflects a dysfunction in the
psychological, biological, or developmental processes underlying mental functioning and is usually
associated with significant distress or disability in social, occupational, or other essential activities.
Mental Health, on the other hand, refers to a state of well-being in which an individual realizes their own
abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to their community. It's not just the absence of mental disorders but encompasses
emotional, psychological, and social well-being.
2 Diagnosis in psychiatry
2.1 Outline of the diagnostic process in psychiatry
The diagnostic process in psychiatry follows this workflow: Symptoms are gathered from various
sources: direct interviews with the patient, observations during consultations, third-party information
(family, close friends), and occasionally from indirect mediums (creative activities, diaries, messages,
suicide notes). Once these symptoms are collected, they are matched to known syndromes or patterns;
for instance, depressive symptoms can be present in conditions like bipolar or depressive disorders.
Understanding the context is paramount, considering factors such as age of onset, duration, and the
course of the symptoms. In psychiatry, paraclinical examinations play a pivotal role in differentiating
psychiatric symptoms from those caused by underlying medical conditions. For instance, delirium or
acute confusional state often has a physical etiology. First-line investigations may involve blood tests,
urine tests, and toxicological screenings. Brain imaging techniques such as CT and MRI are also used,
with further insights gained from EEG. In rare cases, advanced functional brain imaging like SPECT,
PET, and PET MR may be employed. These examinations ensure accurate diagnosis and appropriate
management, highlighting their crucial importance in psychiatric practice.
2.2 Basics of psychopathology
Psychopathology serves as the bedrock of psychiatric diagnostics, emphasizing the meticulous
delineation of symptoms. These symptoms are typically organized and described across specific
domains, offering a structured insight into an individual's mental state.
Consciousness plays a pivotal role in our understanding of the world. When there's disorientation, an
individual struggles to identify time, place, or even persons accurately. A more profound disturbance in
consciousness are somnolence, stupor (sopor in the Czech context) and coma.
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In the realm of psychomotorics, akinesia represents the absence or impairment of voluntary
movements. Meanwhile, catatonic symptoms like waxy flexibility (where individuals maintain
positions that are externally imposed), motoric stereotypies (repetitive, purposeless movements), and
echophenomena (mimicking another's actions or speech) come to the fore. Agitation signifies
excessive, often purposeless motor activity accompanied by feelings of inner unrest. The term stupor
in the Czech terminology describes a noticeable lack of movement or response without necessarily
indicating a decrease in alertness. Furthermore, behavioral manifestations can escalate to aggression,
where there's a potential for physical harm to oneself or others.
Moving to the domain of volitional behavior, abulia stands out as a deficit in willpower, making it hard
for individuals to act decisively. On the other hand, compulsions manifest as repetitive behaviors or
mental acts that individuals feel driven to perform, often stemming from obsessions.
In the emotional sphere, the distinction between affect and mood is crucial. While affect pertains to
immediate emotional expressions, mood denotes a prolonged emotional state, such as the pervasive
sadness in a depressive mood or the elevated feelings in a manic mood. Feelings of anxiety and
anhedonia further elaborate on this spectrum, signifying an overwhelming sense of fear or impending
doom and a loss of interest or pleasure in activities, respectively.
Our perception molds our reality. Here, hallucinations emerge as sensory experiences without any
external stimuli, such as hearing non-existent voices. Conversely, illusions are misinterpretations of
real external stimuli.
Diving into the intricacies of thought, the speed can range from slowed down processes, termed
bradyphrenia, to heightened, racing thoughts. The formal structure of thought can sometimes be
disorganized, leading to incoherence. The content of one's thoughts can sometimes be dominated by
delusions, which are false yet firmly held beliefs or by obsessions, which are recurrent and intrusive
unwanted thoughts.
A significant component of our daily function is attention, and disruptions (hypoprosexia) here can
cause difficulties in maintaining focus or lead to distractions by irrelevant stimuli. Our innate appetite
can also fluctuate, manifesting as an increased or decreased desire for food.
Sleep disturbances, such as insomnia or hypersomnia, can severely impact health and well-being.
Insomnia denotes difficulties in falling or maintaining sleep, while hypersomnia is characterized by
excessive sleepiness.
In more severe manifestations, suicidality embodies thoughts, plans, or actions related to selfdestruction.
A related yet distinct phenomenon is NSSI (Non-Suicidal Self-Injury), where individuals
harm themselves without the intention to die.
Lastly, insight is pivotal for understanding and managing disorders. A significant lack of insight
(anosognosia), especially prevalent in psychotic disorders, means an unawareness or denial of a
disorder and its ramifications.
2.3 Syndromes in psychiatry
A syndrome is a group of symptoms that consistently occur together and represent a particular medical
condition or disorder. In psychiatry, symptoms, syndromes, and diagnoses are distinct entities:
symptoms cluster into syndromes, and when a syndrome is combined with context, it forms a
diagnosis. Currently, these clusters of symptoms and contextual information are codified in diagnostic
manuals. However, from a didactic perspective, it's valuable to understand that certain symptoms tend
to cluster in similar ways across various diagnoses, highlighting shared features or underlying
mechanisms.
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Here are some notable examples of psychiatric syndromes, each representing a characteristic cluster
of symptoms:
Dementia Syndrome: Characterized by cognitive deficits, memory impairment, and challenges in daily
functioning. It's seen in conditions like Alzheimer's disease.
Delirium: A sudden disturbance in attention and cognition, often reversible. It is often accompanied with
paranoidity, paranoid delusions and hallucinations. Commonly arises due to medical conditions,
substance intoxication, or withdrawal.
Catatonic Syndrome: Catatonia is a neuropsychiatric condition marked by motor disturbances, ranging
from immobility (stupor) to excessive movement (hyperkinesia). Symptoms can include posturing,
stereotypy, and echolalia. Once predominantly linked with schizophrenia, it's now known to appear in
other disorders, such as mood disorders and can arise from physical illnesses like limbic encephalitis
as well.
Withdrawal Syndrome: Symptoms that emerge when reducing or discontinuing a substance that the
body has become dependent upon, such as alcohol or certain drugs. Its clinical presentation depends
on substance.
Paranoid Syndrome: Dominated by paranoid delusions of persecution or grandeur, often without
hallucinations.
Hallucinatory Syndrome: Mainly characterized by persistent hallucinations, most commonly auditory,
without pronounced delusional content.
Paranoid-Hallucinatory Syndrome: A combination of delusions, primarily of persecution or grandeur,
and persistent hallucinations. This syndrome is frequently seen in conditions like schizophrenia.
Depressive Syndrome: Symptoms like persistent sadness, lack of interest, weight changes, and
feelings of hopelessness. Often seen in major depressive disorder.
Manic Syndrome: Features include elevated mood, increased energy, and impulsivity, commonly
associated with bipolar disorder.
Obsessive Syndrome: Marked by persistent, intrusive thoughts (obsessions) and repetitive behaviors
or mental acts (compulsions).
These represent just a few syndromes within psychiatry, providing a glimpse into the diverse
manifestations of psychiatric symptoms.
2.4 Context
In psychiatric diagnoses, several contextual factors are essential for differentiation.
The age of onset often hints at specific disorders, such as ADHD in childhood or late-life depression in
the elderly.
The course of a disorder is another important feature. The remitting course sees symptoms come and
go with recovery periods in between (major depressive disorder). Remitting with deterioration involves
episodes with a decline in baseline function after each (schizophrenia, bipolar disorder). Chronic
disorders persist without significant remissions (generalized anxiety disorder). Chronic with
exacerbations are ongoing conditions punctuated by periods of worsening symptoms (schizophrenia,
bipolar disorder, generalized anxiety disorder). Single episode disorders occur once in a lifetime without
recurrence (acute psychotic disorder). The chronic with diminishing symptoms over time course sees
a significant reduction in symptoms over years (ADHD, Borderline personality disorder). Lastly, chronic
with deterioration conditions present symptoms that progressively worsen over time (dementia).
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The severity of symptoms helps gauge the intensity and urgency of the condition, while the duration
reveals if symptoms are short-lived or persistent. By considering these factors, clinicians can ensure a
nuanced and accurate diagnosis, leading to targeted treatment strategies.
Temporal sequence or progression of symptoms can provide valuable clues in distinguishing among
disorders with overlapping symptomatology. For example in a patient presenting with both depressive
symptoms and delusions, the chronology can be revealing - in depression with psychotic features
depressive symptoms usually appear first, before onset of psychotic symptoms.
2.5 Diagnostic manuals
The purpose of diagnostic manuals in psychiatry is to standardize and categorize mental health
conditions, ensuring consistent understanding and treatment across the medical community. These
manuals provide diagnostic criteria, which are sets of symptoms (clustering into syndromes) and
characteristics (context) that must be present for a specific diagnosis to be made. By following these
criteria, psychiatrists can ensure accurate and consistent diagnoses. These manuals are periodically
updated to reflect new knowledge and research, resulting in different versions over time. The most
commonly used diagnostic manuals include ICD-10 (International Classification of Disorders 10th
Revision, prevalent in Europe), DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, widely used in the USA and for research purposes), and ICD-11, which is currently being
implemented.
3 Etiopathogenesis of psychiatric disorders
3.1 Biopsychosocial model
The biopsychosocial model presents a matrix-like understanding of mental health, considering both
distinct domains and the sequence of events influencing mental well-being. Central are the three primary
domains: Biological factors (e.g., genetics, brain chemistry, physical health), Psychological factors
(e.g., personal experiences, emotions, coping mechanisms), and Social factors (e.g., societal
structures, relationships, cultural norms). Interwoven with these are the "Three P's": Predisposing
factors which increase vulnerability, Precipitating factors that trigger onset, and Perpetuating factors
that maintain or exacerbate a disorder. While specific mental disorders often align with a set of
recognized factors, the exact interplay can differ remarkably between individuals. This variation
underscores the importance of individualized assessment and care, ensuring treatments are tailored to
each person's unique constellation of influences. Following table shows examples of combinations of
factors:
Biological Psychological Social
Predisposing Factors genetics, other
congenital diseases
early life trauma,
personality traits
growing up in an
impoverished
environment, cultural
norms favoring
maladaptive strategies
Precipitating Factors physical illness, injury,
medication with
psychiatric side effects
significant life
stressors, other
psychiatric disorder
loss of social support,
moving to a new
country or city
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(corticosteroids)
Perpetuating Factors chronic pain or
disability
substance abuse
maladaptive coping
strategies (e.g.
avoidance in phobias)
ongoing social
isolation, stigmatization
3.2 Relevance of neurotransmitter systems in psychiatry
In the realm of biological psychiatry, neurotransmitter systems are of paramount importance.
Neurotransmitters are chemical messengers that transmit signals across nerve endings, facilitating
communication throughout the brain and body. Dysregulation in these systems can lead to a myriad of
psychiatric symptoms. Consequently, many psychiatric treatments aim to modulate neurotransmitter
activity to restore balance and alleviate symptoms.
Major symptoms often associated with neurotransmitter imbalances include mood fluctuations, anxiety,
psychosis, and cognitive disturbances. Key regulatory neurotransmitters include:
Neurotransmitter Examples of relevant
symptom domains
Examples of relevant disorders
Serotonin (5-HT) mood, appetite, sleep mood disorders, anxiety
disorders, obsessive-compulsive
disorder
Dopamine (DA) salience signaling, reward,
motivation, volition
primary psychotic disorders,
mood disorders, catatonia
Norepinephrine (NE) alertness, energy mood disorders, attention deficit
and hyperactivity disorder
(ADHD)
Gamma-Aminobutyric Acid
(GABA)
primary inhibitory
neurotransmitter
anxiety disorders, catatonia
Glutamate main excitatory
neurotransmitter, learning,
memory
cognitive disturbances,
depressive disorder, primary
psychotic disorders
Acetylcholine cognitive processes,
especially memory and
attention
Alzheimer’s disease
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4 Basic epidemiology of psychiatric disorders
Epidemiology is the study of the distribution, determinants, and frequency of disease conditions within
a population. In the realm of psychiatry, understanding epidemiology is pivotal for grasping the
prevalence (how common a disorder is in a population), incidence (the rate of new cases over a given
time), and risk factors (elements that increase the likelihood of developing a disorder) associated with
different psychiatric conditions. For instance:
Common disorders include major depressive disorder (MDD), anxiety disorders, and substancerelated
disorders. These inflict a significant burden as measured by Years Lived with Disability (YLD).
Less common disorders might encompass bipolar disorder or obsessive-compulsive disorder.
Rare disorders could be conditions like Dissociative Identity Disorder or rare variants of early-onset
psychosis.
Factors influencing the epidemiology of these disorders can range from genetics and personal history
to environmental triggers like trauma or societal stressors. Comprehensive epidemiological studies aid
in shaping public health policies, tailoring interventions, and allocating resources effectively to address
the mental health needs of a population.
5 Basics of treatment in Psychiatry
The treatment of psychiatric disorders is multifaceted and aims to alleviate symptoms, improve quality
of life, and enhance the patient's ability to function in daily life. Depending on the nature and cause of
the disorder, interventions can range from addressing underlying medical conditions to modulating brain
functions and providing coping and adaptive strategies through psychotherapy. The comprehensive
approach in psychiatry often requires a combination of these modalities tailored to the individual needs
of the patient.
5.1 Causal Treatment of Underlying Cause
For psychiatric symptoms stemming from identifiable and treatable medical conditions, the primary
approach is to address that underlying cause. Such cases are often termed as secondary psychiatric
conditions. A classic example is delirium, a common occurrence in the general hospital setting, where
rapid-onset confusion can arise from various causes such as infections, metabolic imbalances, or drug
side effects. Treating the root cause – be it an infection, correcting the metabolic imbalance, or
discontinuing the offending drug – leads to resolution of the psychiatric symptoms.
5.2 Biological Treatments
5.2.1 Pharmacotherapy
Psychotropic medications play a pivotal role in the management of numerous psychiatric disorders.
They work by influencing the brain's neurotransmitter systems and include antidepressants,
antipsychotics, mood stabilizers, anxiolytics, and stimulants among others.
5.2.1.1 Anxiolytics and Sedatives
Benzodiazepines: Enhance GABA-A receptor activity. (e.g., diazepam, clonazepam)
Z-compounds: Act on specific GABA-A receptor sites; primarily for insomnia. (e.g., zolpidem,
zopiclone)
Pregabalin: Modulates calcium channels, leading to anxiolytic effects.
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5.2.1.2 Antidepressants
MAOI (Monoamine oxidase inhibitors): Increase monoamine neurotransmitter availability by inhibiting
monoamine oxidase. (e.g., moclobemide)
Tricyclic: Increase serotonin and norepinephrine; known for more side effects due to wide receptor
activity. (e.g., amitriptyline, imipramine)
Selective serotonin reuptake inhibitors (SSRI): Increase serotonin levels; typically fewer side effects
than tricyclics. (e.g., fluoxetine, paroxetine)
Serotonin and norepinephrine reuptake inhibitors (SNRI): Boost serotonin and norepinephrine; can
be more activating. (e.g., duloxetine, venlafaxine)
Serotonin antagonists and reuptake inhibitors (SARI): Affect serotonin receptors and reuptake. Can
be sedating. (e.g., trazodone)
DNRI: Elevate dopamine and norepinephrine. (e.g., bupropion)
NaSSA: Affect specific serotonin pathways; often sedative. (e.g., mirtazapine)
Melatonin Agonist and Selective Serotonin Antagonist (MASSA): Affect melatonine and serotonine
receptors (e.g. agomelatine)
SMS: Modulate serotonin receptors based on the body's current levels. (e.g., vortioxetine)
5.2.1.3 Antipsychotics
Typical
Sedative: Block dopamine receptors; tranquilizing. (e.g., chlorpromazine)
Incisive: Strong dopamine antagonists; more motor side effects. (e.g., haloperidol)
Atypical
D2/D3 antagonists: Affect dopamine (e.g. sulpiride, amisulpride)
Serotonin and dopamine antagonists (SDA): Affect dopamine and serotonin receptors. (e.g.,
risperidone, olanzapine)
Multi receptor antagonists (MARTA): Multimodal action, often less extrapyramidal sie effects (e.g.,
clozapine, olanzapine, quetiapine)
Partial dopamine agonists: Modulate dopamine activity based on the situation. (e.g., aripiprazole,
brexpiprazole, cariprazine)
5.2.1.4 Mood Stabilizers
Lithium: Modulates neurotransmitters; exact mechanism complex.
Anticonvulsants: Influence ion channels and enhance GABA neurotransmission. (e.g., valproate,
carbamazepine, lamotrigine)
5.2.1.5 Cognitives
Acetylcholinesterase inhibitors: Increase acetylcholine by inhibiting its breakdown. (e.g., donepezil,
rivastigmine)
Glutamate antagonists: Modulate glutamatergic neurotransmission by blocking NMDA receptors.
(e.g., memantine)
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5.2.1.6 Stimulants and ADHD medication
Stimulants: Boost dopamine and norepinephrine. (e.g., methylphenidate,
amphetamine/dextroamphetamine)
Atomoxetine: Increases norepinephrine and dopamine in prefrontal cortex.
5.2.2 Stimulation Methods
Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic Stimulation (rTMS) are
therapeutic modalities that use electrical or magnetic fields to stimulate certain brain areas.
Electroconvulsive Therapy (ECT): ECT is a highly effective treatment method, especially notable for
producing rapid relief of severe symptoms. It's particularly beneficial for patients with severe depression
accompanied by psychotic symptoms or those with catatonia. In some of these cases, due to its
effectiveness and rapid onset of action, ECT may even be considered as a first-line treatment. The
procedure involves passing a controlled electric current through the brain, inducing a therapeutic
seizure. Despite misconceptions and historical stigmas associated with ECT, it is a safe and welltolerated
treatment when conducted under appropriate medical supervision.
Repetitive Transcranial Magnetic Stimulation (rTMS): This non-invasive procedure uses magnetic
fields to stimulate nerve cells in the brain, primarily used for treating depression when other treatments
haven't been effective.
5.2.3 Other
Other biological interventions such as bright-light therapy can be used for conditions like Seasonal
Affective Disorder. Nutritional support, ensuring adequate vitamins and minerals, can also play a role in
the holistic treatment of some psychiatric conditions.
5.3 Psychotherapy
Also termed as "talk therapy", psychotherapy is a method where mental health professionals help
patients by talking through strategies for understanding and dealing with their disorder. Types include
Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), psychodynamic therapy,
interpersonal therapy, and others. It can be applied in individual, couple, family, or group settings.
It's worth noting that many patients benefit from a combination of these treatments, especially for
complex or chronic disorders. The choice of treatment depends on the nature of the disorder, its severity,
the patient's preference, and other individual factors.
6 Basic legal aspects in Psychiatry
Hospitalization and treatment are usually performed with the informed consent of the patient. However,
psychiatric disorders can influence the judgment of patients and their behavior. In some situations, the
patient or his surroundings can be in danger due to psychiatric conditions. In such cases, the patient's
autonomy is impaired and psychiatric hospitalization and treatment aim to return this autonomy. In the
Czech Republic, there are several situations when hospitalization without a patient's consent is
permitted. These situations are described in Act 372/2011 on Health Services and on Conditions of their
Provision. The most relevant situations are as follows:
The patient may be hospitalized without their consent if:
1. they endanger themselves or others in the imminent and serious manner and shows signs
of mental disorder or suffers from it, or is under the influence of an addictive substance
unless the threat to the patient or to others can be avoided otherwise, or
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2. their health condition requires the provision of urgent care and at the same time, it does
not allow them to provide consent.
Furthermore, the patient may only be provided urgent care without his/her consent, in the case:
1. where the health condition does not allow the patient to provide this consent
2. of a treatment of serious mental disorder if, in the absence of treatment, it is likely to cause
serious damage to the patient’s health.
7 Basic groups of psychiatric disorders
This section includes a list of major diagnostic groups of psychiatric disorders according to ICD-11
together with the most common age of onset, course type and treatment. Of note is that while this
information pertains to “average” patients, there are possibilities of other course types and may vary
between specific diagnoses inside the group and between individuals.
7.1 Neurodevelopmental disorders
Description: Developmental deficits that cause impairments in personal, social, academic, or
occupational functioning.
Examples: Autism, ADHD.
Age of Onset: Early childhood.
Course: Chronic with some symptoms possibly improving with age and intervention.
Treatment: Behavioral therapy, stimulant medications for ADHD, and tailored educational interventions.
7.2 Primary psychotic disorders
Description: Disorders characterized by a distorted sense of reality, including hallucinations and
delusions.
Examples: Schizophrenia, delusional disorder.
Age of Onset: Late teens to early 30s.
Course: Remitting with deterioration, chronic with exacerbations
Treatment: Antipsychotic medications and psychosocial interventions.
7.3 Catatonia
Description: Behavioral syndrome marked by an inability to move normally. It is associated with other
psychiatric disorders or medical conditions.
Examples: Catatonic schizophrenia, mood disorder with catatonic features.
Age of Onset: Can vary widely.
Course: Depends on underlying cause.
Treatment: Benzodiazepines, ECT for severe cases.
7.4 Mood disorders
Description: Disorders that influence mood regulation and can lead to emotional distress.
Examples: Depressive disorder, bipolar disorder (with episodes of mania).
Age of Onset: Late teens to early adulthood.
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Course: Remitting, chronic
Treatment: Antidepressants, mood stabilizers, antipsychotics, and psychotherapy.
7.5 Anxiety disorders
Description: Excessive fear or anxiety which can be situational or generalized.
Examples: Panic disorder, GAD, phobic disorders.
Age of Onset: Childhood to adulthood.
Course: Chronic with exacerbations, remitting
Treatment: Psychotherapy (especially CBT), anxiolytics, and antidepressants.
7.6 Obsessive-compulsive disorders
Description: Characterized by obsessive thoughts and compulsive behaviors.
Examples: OCD.
Age of Onset: Adolescence or early adulthood.
Course: Chronic with exacerbations, remitting
Treatment: CBT, SSRIs.
7.7 Stress-related disorders
Description: A reaction to acute or chronic stressors.
Examples: Acute stress reaction, adjustment disorder, PTSD.
Age of Onset: Any age following a traumatic or stressful event.
Course: Varies; PTSD can be chronic if untreated.
Treatment: Psychotherapy, medication for comorbid symptoms.
7.8 Dissociative disorders
Description: Disruption and discontinuity in the normal integration of consciousness, memory, identity,
or emotions.
Examples: Dissociative identity disorder, functional neurological disorders.
Age of Onset: Most commonly in childhood.
Course: Chronic, can improve with therapy.
Treatment: Psychotherapy is the mainstay.
7.9 Eating disorders
Description: Disorders marked by unhealthy relationships with food and body image.
Examples: Anorexia nervosa, bulimia.
Age of Onset: Adolescence or early adulthood.
Course: Chronic, with potential for recovery with treatment.
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Treatment: Multimodal with nutritional, psychotherapeutic, and sometimes pharmacological
interventions.
7.10 Disorders of bodily distress or bodily experience
Description: Primarily medically unexplained bodily symptoms that cause distress.
Examples: Somatic symptom disorder, illness anxiety disorder.
Age of Onset: Varies.
Course: Typically chronic.
Treatment: Psychotherapy, physical rehabilitation approaches.
7.11 Substance-related disorders
Description: Problems related to the use of alcohol, caffeine, cannabis, hallucinogens, inhalants,
opioids, sedatives, stimulants, tobacco, or other substances.
Examples: Acute intoxication, withdrawal, addiction.
Age of Onset: Typically adolescence or early adulthood.
Course: Chronic, remitting
Treatment: Detoxification, counseling, medications to reduce craving or withdrawal symptoms.
7.12 Neurocognitive disorders
Description: Disorders that affect cognitive function.
Examples: Dementia, delirium.
Age of Onset: Dementia in older age; delirium can occur at any age, more often in elderly.
Course: Dementia is progressive; delirium is acute and often reversible.
Treatment: Address underlying cause for delirium, symptomatic treatment, and support for dementia.
7.13 Personality disorders
Description: Enduring patterns of behavior, cognition, and inner experience that deviate from cultural
expectations.
Examples: Borderline personality disorder.
Age of Onset: Symptoms often begin in adolescence.
Course: Chronic, chronic with diminishing symptoms (BPD)
Treatment: Psychotherapy, especially DBT for BPD.