1. Enuresis:
-Continence usually develops by age 4.
-Subtypes: primary (never developed continence), secondary (learned continence and then lost it, usu between 5-8 years of age), nocturnal, diurnal
-DSM: >2 episodes of enuresis a week for at least 3 months in a child >5 years old.
-Tx: behavioral changes (alarm, no water 3 hours before bed, reward system for continence), DDAVP, imipramine
-DDx: diabetes, seizures, urethritis, small bladder.
-Encopresis: stool incontinence, >1 episode a month for 3 months in a child >5 years old. DDx: constipation with overflow, psychosocial stress, fissures/IBD.
2. Amnestic disorders
-Amnesia due to a medical condition= amnestic disorders. (Amnesia due to a psychological disorder= dissociative disorder)
-Differential:
-CNS pathology (herpes encephalitis, seizures, MS, space-occupying lesion, stroke)
-Head trauma
-Metabolic (hypoglycemia, CNS hypoxia, thiamine deficiency/wernicke-korsakoff)
-Substances: sedatives, alcohol.
3. Dissociative disorders: 
-Loss of memory, identity, sense of self 2/2 psychological trauma.
-Dissociative amnesia: patient temporarily and abruptly forgets who they are, but can remember other obscure facts, resolves after minutes or days. No other disassociative symptoms, usually aware of the memory deficit but not troubled by it. Treat by helping them retrieve memories, possibly with benzos under hypnosis.
-Dissociative fugue: patient abruptly leaves home and cannot remember their past; many assume a new identity. Predisposing factors: history of heavy alcohol use, seizures, head trauma, major depression; onset with stressful life event. Disease lasts hours to years, patients will sometimes go back to old life with no memory of the fugue.
-Dissociative identity disorder (multiple personality disorder): patient has 2+ personalities, which recurrently take control. Each personality is usually unaware of the personal information of the other. >90% female, usually history of childhood abuse, avg age of diagnosis 30 years, comorbid mood disorders and borderline personality. Treat with insight therapy, drug-assisted interview, drugs for comorbidities.
-Depersonaliziation disorder: recurrent feelings of detachment from self/environment, "out of body" experiences. People panic, feel they are going crazy, become anxious or depressed. Treat the anxiety/depression.
4. Somatization disorder:
-At least 4 pain symptoms, 2 GI symptoms, 1 neurological symptom, 1 sexual/reproductive symptom, plus onset before age 30.
-5-20x higher incidence in women
-30% concordance in identical twins, 10-20% concordance in female first degree relatives
-Increased incidence in lower SES
-Screen for other psych illnesses, commonly have comorbid anxiety/mood/personality disorders
-Tx: regular visits with PCP, since these people usually unwilling to see a psychiatrist. Medications rarely help, as they are consumed erratically.
5. Conversion disorder:
-One neurological symptom, non-pain/non-sexual. Common symptoms: blindness, shifting paralysis, mutism, paresthesias, seizures, globus hystericus (sensation of lump in throat)
-Symptom onset or exacerbation associated with psychological event.
-Patient is unconcerned-- la belle indifference
-Symptoms usually resolve in 1 month, although 25% of people will experience recurrence.
6. Other somatoform disorders:
-Hypochondriasis: >6 months of fear of serious medical condition, persists despite medical evaluation. 80% comorbid anxiety/depression
-Body dysmorphic disorder (with DSM-V now spectrum of OCD). 90% comorbid MDD, 70% comorbid anxiety, 30% comorbid psychotic. SSRIs reduce symptoms in 50% of patients.
-Pain disorder: prolonged severe pain, treat with SSRIs, transient nerve stimulation, biofeedback, hyponsis, psychotherapy.
-Factitious disorder/munchausen's syndrome: making up symptoms to play the sick role
-Malingering: making up symptoms for secondary gain (disability, a place to stay, narcotics)
7. Impulse control disorders: anxiety prior to impulse, relief on satisfaction, unable to resist impulse.
-Intermittent Explosive disorder: short bursts of aggressive behavior resulting in assault or property destruction, followed by remorse, treat with SSRIs, anticonvulsants, lithium, propanolol. Individual therapy doesn't work, group/family is better.
-Keptomania: unable to resist urge to steal, pleasure/relief assoc with stealing, occurs in <5% of shoplifters. Treat with insight-oriented psychotherapy, behavior therapy (aversive condition, systematic desensitization), SSRIs, naltrexone.
-Pyromania: >1 episode of intentional fire setting, more common in men and mentally retarded, kids recover adults don't. Treat with behavior therapy and SSRIs.
-Pathological gambling: predisposing factors- loss of parent during childhood, inappropriate parental discipline during childhood, ADHD. Treat with gamblers anonymous for 3 months, then insight-oriented psychotherapy.
-Trichotillomania: occurs usually during childhood/adolesence after stressful event, comorbid OCD, OCPD, borderline personalty. Treat with SSRIs, lithium, antipsychotics, hypnosis/relaxation, behavior therapy-- substitute another behavior for the hair pulling habit.
8. Eating disorder:
-Anorexia nervosa: BMI >15% below normal. Can be restrictive or binge/purge. Hospitalize when they are >20% below ideal body weight, or have bradycardia/electrolyte abnormalities. Treat with behavioral therapy, family therapy, weight-gaining antidepressants (mirtazapine, paroxetine)
-Bullemia: BMI normal or above normal, binge/purge occuring at least twice a week for 3 months. 50% recover fully, 50% chronic course with fluctuating symptoms. Treat with SSRIs.
-Binge eating: bingeing occurs at least 2 days a week for 6 months, no compensatory attempt to lose weight. Tx with psychotherapy and a diet/exercise program, as well as weight-loss drugs: stimulants, orlistat (inhibits panc lipase).
9. Dyssomnias: disturbances in amount/quality/timing of sleep
-Primary insomnia: difficulty initiating or maintaining sleep >3x/week for at least 1 month. Treat with sleep hygiene, short-term use of zolpidem/ambien, benadryl, zaleplon/sonata, trazodone
-Primary hypersomnia: excessive sleep, usually begins in adolescence. Treat with stimulants; SSRIs in others.
-Narcolepsy: repeated sudden daytime sleep attacks for at least 3 months, accompanied with cataplexy (70% of patients- collapse 2/2 sudden loss of muscle tone, associated with emotion), sleep paralysis upon awakening (50% of patients, resolves quickly) hypnagogic/hypnopompic hallucinations (30% of patients). Treat with timed daily naps plus stimulants (amphetamines or methyphenidate, SSRIs.
-OSA: treat with CPAP, central sleep apnea: treat with mechanical ventilation
-Melatonin for circadian rhythm disruptions: take 5.5 hours before bedtime.
10. Parasomnias: abnormal events during sleep
-Nightmare disorder: waking up with nightmares, usually in kids, worse in times of stress/illness, treat with tricyclics or other drugs that suppress REM
-Night terror: terror/fear during sleep, usually occur during first third of the night during stage 3 or 4 NREM sleep. Patients are not awake, do not remember the episodes, comorbid with sleepwalking, runs in families Tx with small dose of diazepam at bedtime.
-Sleepwalking: same as night terror.