Bipolar disorder in children

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Main article: Medicine:Bipolar disorder

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Comparison of bipolar disorder subtypes: Bipolar I, Bipolar II, and cyclothymia

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder similar to bipolar disorder in adults. The diagnosis of bipolar disorder in children has been heavily debated for many reasons, including the potential harmful effects of adult bipolar medication on children.

PBD has been proposed as an explanation for periods of extreme shifts in mood, called mood episodes.[1][2] These shifts alternate between periods of depression or irritability and periods of abnormally elevated moods, called manic or hypomanic episodes.[1] Mixed mood episodes can occur when someone with PBD experiences depressive and manic symptoms simultaneously.[2] PBD mood episodes are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time (i.e. days, weeks, or years) and cause severe disruptions to an individual's life.[2]

There are three known forms of PBD: bipolar I, bipolar II, and bipolar disorder not otherwise specified (BD-NOS).[2] The average age of onset of PBD remains unclear, but the reported age of onset ranges from 5 to 19 years old.[3] PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late adolescence or adulthood.[4]

Since 1980, the DSM has specified that the criteria for bipolar disorder in adults can also be applied to children with some adjustments based on developmental differences.[5] Genetics and environment are considered risk factors for the development of bipolar disorder, but the exact cause is currently unknown. Diagnosis of bipolar disorder requires evaluation by a professional, and diagnosis of PBD typically requires more in-depth observation due to children's inability to report symptoms properly.

## Contents

* 1 Causes
* 2 Diagnosis
* 2.1 Signs and symptoms
* 2.1.1 Manic episodes include
* 2.1.2 Depressive episodes include
* 2.2 Subtypes
* 2.3 Controversy
* 3 Management
* 3.1 Medication
* 3.2 Psychotherapy
* 4 Prognosis
* 5 Comorbid conditions
* 6 Epidemiology
* 7 History
* 8 References
* 9 External links

## Causes

While there is limited understanding of the development of bipolar disorder, research shows that there are many environmental and biological risk factors.[2] Family history is a strong predictor of childhood development of bipolar disorder, with genetics contributing to risk by up to 50%.[2][6][7] However, family history does not lead to a certain diagnosis of PBD in a child. Only 6% of children with parents diagnosed with bipolar disorder also have bipolar disorder.[2] Still, children of parents with bipolar disorder should be monitored, especially if they exhibit sleep disturbances and symptoms of anxiety disorders early on.[6] Other factors that can contribute to PBD include substance use disorder and childhood adversity, such as abuse or school trauma.[8][9]

## Diagnosis

Diagnosis is made based on a clinical interview by a licensed mental health professional. There are no blood tests or imaging to diagnose bipolar disorder.[10] PBD can be difficult to diagnose, especially in children under 11–12 years, as they may be unable to self-assess and communicate symptoms properly.[11] Therefore, it is helpful to obtain information from multiple sources, such as family members and teachers, and use questionnaires and checklists for a more accurate diagnosis.[6] Commonly used assessment tools include the K-SADS (Kiddie Schedule for Affective Disorders and Schizophrenia), the Diagnostic Interview Schedule for Children (DISC), and the Child Mania Rating Scale (CMRS).[5] It is important to assess the child's baseline mood and behavior and determine if symptoms present episodically. Parents are often encouraged to keep mood logs to assist with this.[5] Family history is also important to obtain, as bipolar disorder is heritable. Medication, substance use, and other medical problems should be ruled out to diagnose bipolar disorder accurately.[6]

Early diagnosis and treatment of PBD lead to better outcomes. Anxiety disorders and sleep disturbances often precede mood symptoms.[6][7] If a child presents with these symptoms alongside major changes in energy and deterioration of function, especially in school, this may warrant evaluation for PBD.[8]

It can be difficult to distinguish PBD due to overlapping symptoms with other conditions such as ADHD, OCD, autism spectrum disorder, depression, anxiety, and conduct disorders.[12][13] Common symptoms of PBD and ADHD include irritability, distractibility, and poor judgment. Elated mood and decreased need for sleep can be specifically diagnostic of PBD.[6]

### Signs and symptoms

The American Psychiatric Association's DSM-5 and the World Health Organization's ICD-10 use the same criteria to diagnose bipolar disorder in adults and children, with some adjustments to account for differences in age and developmental stage, particularly with depressive episodes.[5][14] For example, the DSM-5 specifies that children may exhibit persistently irritable moods instead of a depressed mood.[1] Additionally, children will more than likely fail to meet their expected body weight instead of presenting with weight loss.[8]

In diagnosing manic episodes, it is important to compare the changes in mood and behavior to the child's baseline mood and behaviors instead of to other children or adults.[6] For example, grandiosity, which is an unrealistic overestimation of one's intelligence, talent, or abilities, can occur at varying degrees during childhood and adolescence. Therefore, grandiosity is only considered symptomatic of mania in children when the beliefs are held despite being presented with concrete evidence otherwise or when they lead to a child attempting activities that are clearly dangerous, and most importantly, when the beliefs are an obvious change from a child's baseline self-image.[1]

It is important to distinguish if irritability is related to bipolar disorder or another condition, as it is common in other childhood disorders.[5] If irritability is persistent, it is important to differentiate it from chronic irritability seen in disruptive mood dysregulation disorder (DMDD).[8]

PBD and ADHD, in particular, have many overlapping symptoms, such as the hyperactivity characteristic of manic episodes.[15] Many children and adolescents with PBD are misdiagnosed with ADHD.[15] Misdiagnosis can lead to complications, as some medications for other disorders can exacerbate symptoms of PBD.[16]

#### Manic episodes include

* Elevated mood (or increased silliness in children)
* Rapid speech that is difficult to interrupt
* Decreased need for sleep
* Racing thoughts
* Increased interests/participation in activities (especially those considered more reckless)
* Inflated sense of ability[10]

#### Depressive episodes include

* Frequent and unprovoked sadness
* Physical pain (stomach aches, headaches)
* Sleeping more
* Difficulty concentrating
* Feelings of worthlessness/hopelessness
* Changes in eating habits[10]

### Subtypes

According to the DSM-5, there are three subtypes of bipolar disorder: bipolar I, bipolar II, and bipolar disorder not otherwise specified (BD-NOS).[1][2] Just as in adults, bipolar I is the most severe form of PBD, can impair sleep and general function, and can lead to hospitalization.[2] BD-NOS is the mildest form of PBD.[2] The criteria for distinguishing subtypes is the same as that for bipolar disorder in adults.

### Controversy

The diagnosis of childhood bipolar disorder has been heavily debated.[5] It is recognized that the typical symptoms of bipolar disorder are dysfunctional and have negative consequences for minors with the condition.[17] The main discussion is centered on whether what is called bipolar disorder in children is the same as adult bipolar disorder[18] and whether the criteria for adult diagnosis are useful and accurate for children.[5] There are also questions about how mania differs between children and adults.[12]

There are significant differences in how commonly PBD is diagnosed across clinics and in different countries. In the United States, there were concerns about overdiagnosis and misdiagnosis of PBD.[5][19] More understanding and research led to a decrease in PBD diagnosis from the mid-2000s to 2010.[20] This decreased diagnosis is likely due to the various challenges of identifying bipolar disorders in youth. PBD has many[which?] overlapping symptoms with other[which?] childhood conditions.

## Management

A combination of medication and psychosocial intervention is recommended for most children with PBD. This combination has been proven to lead to improved prognosis.[13][7][9] Choosing the best treatment involves considering the child's age, psycho-social environment, presentation and severity of symptoms, and family history.[7]

### Medication

Mood stabilizers, which help manage manic episodes, and atypical antipsychotics, which help manage both manic and depressive episodes, have been demonstrated to be the safest and most effective for treating PBD.[8][13] Mood stabilizers used for the treatment of PBD include lithium, valproic acid, divalproex sodium, carbamazepine, and lamotrigine.[21] Lithium is FDA approved for those 12 years and older and appears to be particularly effective in children with a family history of mood disorders, especially if family members have been successfully treated with lithium.[5][9] Atypical antipsychotics FDA-approved for the treatment of PBD include risperidone, cariprazine, lurasidone, olanzapine-fluoxetine combination, and quetiapine.[21] Risperidone has been approved for use in children 10 and older.[5] Medications have also proved effective when combined, whether that is multiple mood stabilizers or a mood stabilizer with an atypical antipsychotic.[5]

Medications for the treatment of PBD can produce significant side effects, so it is recommended that families of patients be informed.[18] Although atypical antipsychotics are more effective in treating PBD than mood stabilizers, they can lead to more side effects.[17][22] Typical antipsychotics may cause weight gain and other metabolic problems, including diabetes mellitus type 2 and hyperlipidemia. Extrapyramidal secondary effects may occur with the use of these medications, including tardive dyskinesia, a movement disorder that is difficult to treat.[23] Liver and kidney damage may occur as a result of the use of mood stabilizers.[18] Lithium overdose can also occur in individuals with low sodium levels.[21] Pediatric populations often struggle with medication adherence for PBD, which can be improved with motivational interviewing techniques.[13]

### Psychotherapy

Psychological treatment for PBD can take on several different forms, such as psychoeducation, psychotherapy, and alternative treatments.[24] One form of psychotherapy is psychoeducation, in which children with bipolar disorder and their families are informed, in ways according to their age and family role, about the different aspects of bipolar disorder and its management, including causes, signs and symptoms, and treatments.[21] Similarly, family-focused therapy (FFT) is therapy for both individuals with PBD and their caregivers, in which families take part in communication improvement training and problem-solving skills training.[21] Group therapy aims to improve social skills and manage group conflicts, with role-playing as a critical tool. Another type of therapy used in individuals with PBD is chronotherapy, which helps children and adolescents form a healthy sleep pattern, as sleep is often disrupted by PBD symptoms.[21] Finally, cognitive-behavioral therapy (CBT) aims to give participants better understanding and control of their emotions and behaviors.[12]

Psychotherapy can be tailored to each individual and address needs that medication alone cannot to help improve lifestyle and functionality. Additionally, psychotherapy improves medication adherence.[7]

Alternative treatments are currently being developed for pediatric populations with PBD in which medication and psychotherapy have proven to be ineffective. Currently, interventions involving dialectical behavioral therapy (DBT) are being explored due to the focus on mindfulness and distress tolerance skill building. According to the APA, studies have indicated that DBT may lead to decreased suicidal ideation compared to typical psychosocial treatments. Nutritional interventions are also currently undergoing further research along with other lifestyle modifications, including exercise and proper sleep habits.[13][9]

## Prognosis

Bipolar disorder is a chronic condition that requires lifelong care and treatment.[2] Without proper treatment, PBD often has a poor prognosis.[21] Chronic adherence to medication is often needed, with relapses of individuals reaching rates over 90% in those not following medication indications and almost 40% in those complying with medication regimens in some studies.[12] Other risk factors for poor outcomes of PBD and increased severity of symptoms are comorbid pathologies and early onset of disease.[6][8][18][9]

Children with PBD, especially early onset, are more likely to commit suicide than other children, as well as misuse alcohol and/or other drugs.[5][6][8][21] Studies have shown that among adolescents with PBD, 44% report a lifetime suicide rate, twice as much compared to teens diagnosed with major depressive disorder.[25] Children and adolescents with PBD are also at an increased risk for behavior that can result in incarceration.[21]

Hypomanic episodes in adolescents have been shown to not always progress into adult bipolar disorder.[26] However, research surrounding PBD emphasizes the importance of early diagnosis of PBD for improved prognosis.[26]

## Comorbid conditions

The most common comorbidities seen with PBD are ADHD (80%) and oppositional defiant disorder (47%).[27] Anywhere between 13.2% and 29% of patients with bipolar disorder are diagnosed with conduct disorder, substance use disorders, anxiety disorders, or borderline personality disorder.[6][8][27]

Comorbid ADHD can be diagnosed if symptoms such as hyperactivity and distractibility are present persistently. If they are only episodic, this is likely a symptom of PBD.[6] Therefore, it is important to carefully evaluate the onset of symptoms and the course of the time present. While difficulty with sleep can be present in both, patients with bipolar disorder typically have a decreased need for sleep during manic episodes, whereas children with ADHD will have sleep problems with increased fatigue. Grandiosity is also a distinguishing factor: mania typically presents with increased self-esteem, while children with ADHD may have lower self-esteem.[15]

## Epidemiology

Globally, the prevalence of PBD is estimated at 3.9% as of 2019.[21][26] However, 5 surveys (from Brazil, England, Turkey, and the United States) have reported pre-adolescence rates of PBD as zero or close to zero.[26]

The increase in PBD in the United States is attributed to the cohort effect (shared circumstances of more recently born children) as well as the anticipation effect (the earlier onset of genetic conditions in later generations).[28]

## History

Descriptions of children with symptoms similar to contemporary concepts of mania date back to the 18th century. In 1898, a detailed psychiatric case history was published about a 13-year-old that met Jean-Pierre Falret and Jules Baillarger's criteria for folie circulaire, which is congruent to the modern conception of bipolar I disorder.[29]

In Emil Kraepelin's descriptions of bipolar disorder in the 1920s, which he called "manic depressive insanity," he noted the rare possibility that it could occur in children. In addition to Kraepelin, Adolf Meyer, Karl Abraham, and Melanie Klein were some of the first to document bipolar disorder symptoms in children in the first half of the 20th century.[30] It was not mentioned much in English literature until the 1970s, when interest in researching the subject increased. It became more accepted as a diagnosis in children in the 1980s after the DSM-III (1980) specified that the same criteria for diagnosing bipolar disorder in adults could also be applied to children.[5]

Recognition came twenty years after, with epidemiological studies showing that approximately 20% of adults with bipolar disorder already had symptoms in childhood or adolescence. Nevertheless, onset before age 10 was thought to be rare, below 0.5% of the cases. During the second half of the century, misdiagnosis with schizophrenia was common in the non-adult population due to the common co-occurrence of psychosis and mania. This issue diminished with an increased following of the DSM criteria in the last part of the 20th century.[18][31]

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Fifth ed.). American Psychiatric Pub. pp. 272–288. ISBN 978-0-89042-557-2. https://books.google.com/books?id=-JivBAAAQBAJ&pg=PT272.
2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 "Bipolar Disorder | Boston Children's Hospital". https://www.childrenshospital.org/conditions/bipolar-disorder#:~:text=Bipolar disorder has been diagnosed,What are mood episodes?.
3. ↑ "Early stages of pediatric bipolar disorder: retrospective analysis of a Czech inpatient sample". Neuropsychiatric Disease and Treatment 11: 2855–2864. November 2015. doi:10.2147/NDT.S79586. PMID 26604770.
4. ↑ "Mood Disorders: Pediatric Bipolar Disorder", Collection of Evidence-based Practices for Children and Adolescents with Mental Health Treatment Needs, 5th Edition, Commonwealth of Virginia Commission on Youth, 2013, House Document No. 7, http://vcoy.virginia.gov/pdf/documents/collection/Pediatric_Bipolar_Disorder0413.pdf, retrieved January 10, 2017
5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 "Bipolar disorder in children". Psychiatry Journal 2014. 2014. doi:10.1155/2014/928685. PMID 24800202.
6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 "Progress in diagnosis and treatment of bipolar disorder among children and adolescents: an international perspective". Evidence-Based Mental Health 21 (4): 177–181. November 2018. doi:10.1136/eb-2018-102912. PMID 30327338.
7. ↑ 7.0 7.1 7.2 7.3 7.4 "Psychosocial Treatments for Bipolar Disorder in Children and Adolescents". Annual Review of Clinical Psychology 18 (1): 291–327. May 2022. doi:10.1146/annurev-clinpsy-072220-021237. PMID 35216522.
8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 "Clinical picture and treatment of bipolar affective disorder in children and adolescents". Psychiatria Polska 54 (1): 35–50. March 2020. doi:10.12740/PP/OnlineFirst/92740. PMID 32447355.
9. ↑ 9.0 9.1 9.2 9.3 9.4 "The Challenges of Children with Bipolar Disorder". Medicina 57 (6): 601. June 2021. doi:10.3390/medicina57060601. PMID 34207966.
10. ↑ 10.0 10.1 10.2 "NIMH: Bipolar Disorder in Children and Teens". National Institutes of Health. 2015. https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens.
11. ↑ "The diagnosis of bipolar disorder in children and adolescents: Past, present and future". Bipolar Disorders 25 (6): 469–477. September 2023. doi:10.1111/bdi.13367. PMID 37433682.
12. ↑ 12.0 12.1 12.2 12.3 "Pediatric bipolar disorder". Annual Review of Clinical Psychology 4 (1): 163–187. 2008. doi:10.1146/annurev.clinpsy.4.022007.141216. PMID 17716034.
13. ↑ 13.0 13.1 13.2 13.3 13.4 "Treating bipolar disorder in kids and teens". October 1, 2020. https://www.apa.org/monitor/2020/10/ce-corner-bipolar.
14. ↑ "Stark discrepancy in pediatric bipolar diagnoses between the US and UK/Australia". Journal of the American Academy of Child and Adolescent Psychiatry 53 (11): 1234–1235. November 2014. doi:10.1016/j.jaac.2014.08.012. PMID 25440313. https://zenodo.org/record/897827.
15. ↑ 15.0 15.1 15.2 "Can Bipolar Disorder Be Misdiagnosed as ADHD?" (in en). 2022-03-23. https://psychcentral.com/bipolar/adhd-misdiagnosed-as-bipolar.
16. ↑ "Treatment of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review". Journal of Affective Disorders 166: 258–263. September 2014. doi:10.1016/j.jad.2014.05.026. PMID 25012439.
17. ↑ 17.0 17.1 "Pharmacotherapy of bipolar disorder in children and adolescents: an update". Revista Brasileira de Psiquiatria 35 (4): 393–405. 2013. doi:10.1590/1516-4446-2012-0999. PMID 24402215.
18. ↑ 18.0 18.1 18.2 18.3 18.4 "Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder". Journal of the American Academy of Child and Adolescent Psychiatry 46 (1): 107–125. January 2007. doi:10.1097/01.chi.0000242240.69678.c4. PMID 17195735.
19. ↑ "Overdiagnosis of bipolar disorder: a critical analysis of the literature". TheScientificWorldJournal 2013. November 2013. doi:10.1155/2013/297087. PMID 24348150.
20. ↑ "Decreasing rate of inpatient pediatric bipolar disorder diagnosis in the US between 2004 and 2010". Bipolar Disorders 24 (2): 149–160. March 2022. doi:10.1111/bdi.13145. PMID 34664344.
21. ↑ 21.00 21.01 21.02 21.03 21.04 21.05 21.06 21.07 21.08 21.09 "Bipolar Disorder in Children: Symptoms, Diagnosis & Treatment" (in en). https://my.clevelandclinic.org/health/diseases/14669-bipolar-disorder-in-children.
22. ↑ "Valproate for acute mania". The Cochrane Database of Systematic Reviews 2019 (10). October 2019. doi:10.1002/14651858.CD004052.pub2. PMID 31621892.
23. ↑ "What Is Tardive Dyskinesia?" (in en). https://www.webmd.com/mental-health/tardive-dyskinesia.
24. ↑ "Treating bipolar disorder in kids and teens". https://www.apa.org/monitor/2020/10/ce-corner-bipolar?.
25. ↑ "History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk". Bipolar Disorders 7 (6): 525–535. December 2005. doi:10.1111/j.1399-5618.2005.00263.x. PMID 16403178.
26. ↑ 26.0 26.1 26.2 26.3 "'Pediatric Bipolar Disorder' rates are still lower than claimed: a re-examination of eight epidemiological surveys used by an updated meta-analysis". International Journal of Bipolar Disorders 9 (1). June 2021. doi:10.1186/s40345-021-00225-5. PMID 34170440.
27. ↑ 27.0 27.1 "Psychiatric comorbidity in patients with pediatric bipolar disorder - A systematic review". Acta Psychiatrica Scandinavica 148 (2): 110–132. August 2023. doi:10.1111/acps.13548. PMID 36941106.
28. ↑ "Further Evidence of a Cohort Effect in Bipolar Disorder: More Early Onsets and Family History of Psychiatric Illness in More Recent Epochs". https://www.psychiatrist.com/jcp/cohort-effect-in-bipolar-disorder/.
29. ↑ "Historical Underpinnings of Bipolar Disorder Diagnostic Criteria". Behavioral Sciences 6 (3): 14. July 2016. doi:10.3390/bs6030014. PMID 27429010.
30. ↑ "Bipolar disorder in children". Psychiatry Journal 2014. 2014. doi:10.1155/2014/928685. PMID 24800202.
31. ↑ "Manic-depressive psychosis in childhood". Journal of Child Psychology and Psychiatry 1 (1): 53–72. 1960. doi:10.1111/j.1469-7610.1960.tb01979.x.

## External links

* International Society for Bipolar Disorders Task Force report on current knowledge in pediatric bipolar disorder and future directions

* v
* t
* e

Mood disorder (F30–F39, 296)

History|

* Emil Kraepelin
* Karl Leonhard
* John Cade
* Mogens Schou
* Frederick K. Goodwin
* Kay Redfield Jamison

Symptoms|

* Hallucination
* Delusion
* Emotional dysregulation
* Anhedonia
* Dysphoria
* Suicidal ideation
* Mood swing
* Sleep disorder
* Hypersomnia
* Insomnia
* Psychosis
* Racing thoughts
* Reduced affect display
* Depression (differential diagnoses)

Spectrum|

* Bipolar disorder
* Bipolar I
* Bipolar II
* Cyclothymia
* Bipolar NOS
* Depression
* Major depressive disorder
* Dysthymia
* Seasonal affective disorder
* Atypical depression
* Melancholic depression
* Schizoaffective disorder
* Mania
* Mixed affective state
* Hypomania
* Major depressive episode
* Rapid cycling

Treatment|

| Anticonvulsants|

* Carbamazepine
* Lamotrigine
* Oxcarbazepine
* Valproate
* Sodium valproate
* Valproate semisodium

|

Sympathomimetics,
SSRIs & similar|

* Dextroamphetamine
* Methylphenidate
* Bupropion
* Sertraline
* Fluoxetine
* Escitalopram

Other mood stabilizers|

* Antipsychotics
* Lithium
* Lithium carbonate
* Lithium citrate
* Lithium sulfate
* Lithium toxicity
* Atypical antipsychotics

Non-pharmaceutical|

* Clinical psychology
* Electroconvulsive therapy
* Involuntary commitment
* Light therapy
* Psychotherapy
* Transcranial magnetic stimulation
* Cognitive behavioral therapy
* Dialectical behavior therapy

* v
* t
* e

Mental and behavioral disorders (F00–F99 & 290–319)

Adult personality and behavior

| Gender dysphoria|

* Ego-dystonic sexual orientation
* Paraphilia
* Fetishism
* Voyeurism
* Sexual maturation disorder
* Sexual relationship disorder

|

Other|

* Factitious disorder
* Munchausen syndrome
* Impulse control disorder
* Dermatillomania
* Kleptomania
* Pyromania
* Trichotillomania
* Personality disorder

Childhood and learning

| Emotional and behavioral|

* ADHD
* Conduct disorder
* ODD
* Emotional and behavioral disorders
* Separation anxiety disorder
* Movement disorders
* Stereotypic
* Social functioning
* DAD
* RAD
* Selective mutism
* Speech
* Stuttering
* Cluttering
* Tic disorder
* Tourette syndrome

|

Intellectual disability|

* X-linked intellectual disability
* Lujan–Fryns syndrome

Psychological development
(developmental disabilities)|

* Pervasive
* Specific

Mood (affective)

* Bipolar
* Bipolar I
* Bipolar II
* Bipolar NOS
* Cyclothymia
* Depression
* Atypical depression
* Dysthymia
* Major depressive disorder
* Melancholic depression
* Seasonal affective disorder
* Mania

Neurological and symptomatic

| Autism spectrum|

* Autism
* Asperger syndrome
* High-functioning autism
* PDD-NOS
* Savant syndrome

|

Dementia|

* AIDS dementia complex
* Alzheimer's disease
* Creutzfeldt–Jakob disease
* Frontotemporal dementia
* Huntington's disease
* Mild cognitive impairment
* Parkinson's disease
* Pick's disease
* Sundowning
* Vascular dementia
* Wandering

Other|

* Delirium
* Organic brain syndrome
* Post-concussion syndrome

Neurotic, stress-related and somatoform

| Adjustment|

* Adjustment disorder with depressed mood

|

Anxiety|

| Phobia|

* Agoraphobia
* Social anxiety
* Social phobia
* Anthropophobia
* Specific social phobia
* Specific phobia
* Claustrophobia

|

Other|

* Generalized anxiety disorder
* OCD
* Panic attack
* Panic disorder
* Stress
* Acute stress reaction
* PTSD

Dissociative|

* Depersonalization disorder
* Dissociative identity disorder
* Fugue state
* Psychogenic amnesia

Somatic symptom|

* Body dysmorphic disorder
* Conversion disorder
* Ganser syndrome
* Globus pharyngis
* Da Costa's syndrome
* Hypochondriasis
* Mass psychogenic illness
* Neurasthenia
* Nosophobia
* Psychalgia
* Somatization disorder

Physiological and physical behavior

| Eating|

* Anorexia nervosa
* Bulimia nervosa
* Rumination syndrome
* Other specified feeding or eating disorder

|

Nonorganic
sleep|

* Hypersomnia
* Insomnia
* Parasomnia
* Night terror
* Nightmare
* REM sleep behavior disorder

Postnatal|

* Postpartum depression
* Postpartum psychosis

Sexual dysfunction|

| Arousal|

* Erectile dysfunction
* Female sexual arousal disorder

|

Desire|

* Hypersexuality
* Hypoactive sexual desire disorder

Orgasm|

* Anorgasmia
* Delayed ejaculation
* Premature ejaculation
* Sexual anhedonia

Pain|

* Nonorganic dyspareunia
* Nonorganic vaginismus

Psychoactive substances, substance abuse and substance-related

* Drug overdose
* Intoxication
* Physical dependence
* Rebound effect
* Stimulant psychosis
* Substance dependence
* Withdrawal

Schizophrenia, schizotypal and delusional

| Delusional|

* Delusional disorder
* Folie à deux

|

Psychosis and
schizophrenia-like|

* Brief reactive psychosis
* Schizoaffective disorder
* Schizophreniform disorder

Schizophrenia|

* Childhood schizophrenia
* Disorganized (hebephrenic) schizophrenia
* Paranoid schizophrenia
* Pseudoneurotic schizophrenia
* Simple-type schizophrenia

Symptoms and uncategorized

* Catatonia
* False pregnancy
* Intermittent explosive disorder
* Klüver–Bucy syndrome
* Psychogenic non-epileptic seizures
* Psychomotor agitation
* Stereotypy

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