Mental Health Treatments

Understanding Mental Health Conditions and Treatments: This guide provides an overview of common mental health conditions, their symptoms, and the most effective treatments, including psychotherapies and medications. We follow national guidelines to outline first, second, and third-line treatments, ensuring you receive evidence-based care. For conditions where ketamine therapy (IV or nasal) is appropriate, we’ve noted its role in treating treatment-resistant cases.

Symptoms: Challenges with social interaction, communication, and repetitive behaviors.

Common Psychotherapies:

Applied Behavior Analysis (ABA): Structured intervention to improve social, communication, and behavioral skills.

Social Skills Training: Enhances interpersonal interactions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety or emotional regulation.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability: Risperidone or Aripiprazole (FDA-approved ASD).

Second-Line: SSRIs (e.g., Fluoxetine) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms.
Symptoms: Inattention, hyperactivity, impulsivity inappropriate for age.

Common Psychotherapies:

Behavioral Therapy: Teaches organizational and coping skills.

Parent Training: Equips caregivers to manage behaviors.

CBT: Improves time management and emotional regulation in adults.

Medication Treatments:

First-Line: Stimulants (Methylphenidate, Amphetamine-based like Adderall).

Second-Line: Non-stimulants (Atomoxetine, Guanfacine).

Third-Line: Bupropion or Tricyclic Antidepressants for adults with co-occurring depression.
Symptoms: Significant limitations in intellectual functioning (e.g., reasoning, problem-solving) and adaptive behavior (e.g., daily living skills, communication), typically identified before age 18.

Common Psychotherapies:

Behavioral Interventions: Tailored strategies to teach adaptive skills and reduce challenging behaviors.

Skills Training: Focuses on improving daily living, communication, and social skills.

Family Therapy: Supports caregivers in managing behaviors and fostering independence.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring behavioral issues (e.g., aggression): Risperidone or Aripiprazole (may be considered).

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) or non-stimulants (e.g., Atomoxetine) for co-occurring ADHD symptoms.
Symptoms: Difficulties with speech, language, or social communication, including articulation issues, fluency disorders (e.g., stuttering), or challenges understanding/expressing language.

Common Psychotherapies:

Speech-Language Therapy: Tailored interventions to improve articulation, language comprehension, and expression.

Social Communication Training: Enhances pragmatic language skills for better social interactions.

Cognitive-Behavioral Therapy (CBT): Addresses anxiety or emotional challenges related to communication difficulties.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety related to communication: SSRIs (e.g., Sertraline or Fluoxetine) may be considered.

Second-Line: Beta-blockers (e.g., Propranolol) for performance anxiety in specific situations (e.g., public speaking).

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting communication focus.
Symptoms: Involuntary tics, both motor (e.g., blinking, head jerking) and vocal (e.g., grunting, throat clearing), typically starting in childhood, often accompanied by co-occurring conditions like ADHD or OCD.

Common Psychotherapies:

Comprehensive Behavioral Intervention for Tics (CBIT): Teaches strategies to manage and reduce tics through habit reversal training.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, OCD, or emotional challenges.

Psychoeducation and Supportive Therapy: Helps individuals and families understand and cope with tics.

Medication Treatments:

First-Line: For significant tics: Alpha-2 agonists (e.g., Clonidine or Guanfacine) to reduce tic severity.

Second-Line: Antipsychotics (e.g., Risperidone, Aripiprazole) for severe tics not responding to first-line treatments.

Third-Line: SSRIs (e.g., Fluoxetine) for co-occurring OCD or anxiety; stimulants (e.g., Methylphenidate) for co-occurring ADHD, with caution due to potential tic exacerbation.
Symptoms: Hallucinations (e.g., hearing voices), delusions, disorganized thinking, negative symptoms (e.g., reduced emotions, motivation), and impaired social or occupational functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage hallucinations, delusions, and improves coping strategies.

Social Skills Training: Enhances interpersonal and daily living skills.

Family Therapy: Supports family education and communication to reduce stress and improve outcomes.

Medication Treatments:

First-Line: Antipsychotics (e.g., Risperidone, Olanzapine, Aripiprazole) to reduce positive symptoms like hallucinations and delusions.

Second-Line: Clozapine for treatment-resistant schizophrenia or severe symptoms not responding to other antipsychotics.

Third-Line: Adjunctive treatments like SSRIs (e.g., Sertraline) for co-occurring depression or anxiety; mood stabilizers (e.g., Lithium) for affective symptoms.
Symptoms: Extreme mood swings including manic episodes (e.g., elevated mood, increased energy, impulsivity) and depressive episodes (e.g., sadness, low energy, hopelessness), with potential for mixed episodes or rapid cycling.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage mood swings, identify triggers, and develop coping strategies.

Interpersonal and Social Rhythm Therapy (IPSRT): Stabilizes daily routines and improves interpersonal relationships to prevent mood episodes.

Family-Focused Therapy: Educates and supports families to enhance communication and reduce relapse risk.

Medication Treatments:

First-Line: Mood stabilizers (e.g., Lithium, Valproate, Carbamazepine) to prevent manic and depressive episodes; atypical antipsychotics (e.g., Quetiapine, Olanzapine) for acute mania or mixed episodes.

Second-Line: Antidepressants (e.g., Fluoxetine, Sertraline) for depressive episodes, typically combined with a mood stabilizer to prevent mania.

Third-Line: Adjunctive treatments like Lamotrigine for bipolar depression or Benzodiazepines (e.g., Lorazepam) for short-term management of agitation or insomnia.
Symptoms: Persistent sadness, loss of interest or pleasure, fatigue, feelings of worthlessness, difficulty concentrating, changes in sleep or appetite, and possible suicidal thoughts.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets negative thought patterns and behaviors to improve mood and coping skills.

Interpersonal Therapy (IPT): Focuses on improving relationships and addressing interpersonal issues contributing to depression.

Behavioral Activation: Encourages engagement in meaningful activities to counteract withdrawal and low motivation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) to alleviate depressive symptoms.

Second-Line: Atypical antidepressants (e.g., Bupropion, Mirtazapine) or tricyclic antidepressants (e.g., Amitriptyline) for non-responders to first-line treatments.

Third-Line: Monoamine oxidase inhibitors (MAOIs) (e.g., Phenelzine) or adjunctive treatments like Lithium or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant depression.

Treatment Resistant: Ketamine
Symptoms: Severe mood changes, sadness, irritability, anxiety, or hopelessness occurring in the luteal phase of the menstrual cycle (typically the week before menstruation) and resolving shortly after menstruation begins.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage negative thoughts and emotional responses tied to menstrual cycle changes.

Interpersonal Therapy (IPT): Addresses interpersonal conflicts or stressors that may exacerbate symptoms.

Mindfulness-Based Therapy: Promotes relaxation and emotional regulation to reduce symptom severity.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) taken continuously or during the luteal phase to alleviate depressive and anxiety symptoms.

Second-Line: Oral contraceptives (e.g., Ethinyl Estradiol/Drospirenone) to stabilize hormonal fluctuations and reduce mood symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) for anxiety or adjunctive treatments like Calcium supplements or Vitamin B6 for mild symptom relief.
Symptoms: Excessive, persistent worry about various aspects of life (e.g., work, health, relationships), accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets anxious thought patterns and behaviors to reduce worry and improve coping skills.

Acceptance and Commitment Therapy (ACT): Promotes mindfulness and value-based actions to manage anxiety.

Mindfulness-Based Stress Reduction (MBSR): Uses mindfulness techniques to reduce anxiety and enhance emotional regulation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) to reduce anxiety symptoms.

Second-Line: Buspirone for persistent anxiety or benzodiazepines (e.g., Lorazepam) for short-term relief of acute symptoms.

Third-Line: Tricyclic antidepressants (e.g., Imipramine) or adjunctive treatments like Pregabalin for treatment-resistant cases.
Symptoms: Recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety, often causing significant distress or interference with daily life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP): Gradually exposes individuals to obsessional triggers while preventing compulsive responses to reduce anxiety.

Acceptance and Commitment Therapy (ACT): Encourages acceptance of intrusive thoughts while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Promotes awareness and non-judgmental acceptance of thoughts to reduce compulsive behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) at higher doses to reduce obsessions and compulsions.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Risperidone, Aripiprazole) for treatment-resistant OCD or augmentation with glutamate modulators (e.g., Memantine).
Symptoms: Preoccupation with perceived flaws or defects in physical appearance (often minor or unnoticeable to others), leading to repetitive behaviors (e.g., mirror checking, excessive grooming) or mental acts (e.g., comparing appearance), causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about appearance and reduces compulsive behaviors through exposure and response prevention.

Acceptance and Commitment Therapy (ACT): Promotes acceptance of body image concerns while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Encourages non-judgmental awareness to reduce preoccupation with perceived flaws.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, Sertraline) to reduce obsessive thoughts and compulsive behaviors.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Aripiprazole, Risperidone) for treatment-resistant cases or severe symptoms.
Symptoms: Intrusive memories, flashbacks, or nightmares of a traumatic event, avoidance of trauma-related triggers, negative changes in mood or thinking (e.g., guilt, detachment), and heightened arousal (e.g., hypervigilance, irritability).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses trauma-related thoughts and behaviors through cognitive restructuring and exposure techniques.

Eye Movement Desensitization and Reprocessing (EMDR): Uses guided eye movements to process traumatic memories and reduce distress.

Prolonged Exposure Therapy (PE): Encourages gradual confrontation of trauma-related memories and situations to reduce avoidance.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Paroxetine) to reduce anxiety, depression, and intrusive symptoms.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) or atypical antidepressants (e.g., Mirtazapine) for non-responders.

Third-Line: Prazosin for trauma-related nightmares or adjunctive antipsychotics (e.g., Risperidone) for severe hyperarousal or treatment-resistant symptoms.
Symptoms: Emotional and behavioral symptoms (e.g., sadness, anxiety, irritability, or reckless behavior) in response to a specific stressor (e.g., life changes, loss, or trauma), occurring within three months of the stressor and causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps reframe negative thoughts and develop coping strategies to manage stress.

Solution-Focused Brief Therapy (SFBT): Focuses on identifying solutions and goals to address the specific stressor.

Supportive Psychotherapy: Provides emotional support and guidance to enhance resilience and problem-solving.

Medication Treatments:

First-Line: No medications specifically treat adjustment disorders. For significant anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) may be considered.

Second-Line: Benzodiazepines (e.g., Lorazepam) for short-term relief of acute anxiety, used cautiously due to dependency risk.

Third-Line: Atypical antidepressants (e.g., Trazodone) for sleep disturbances or mild depressive symptoms.
Symptoms: Disruptions in memory, identity, consciousness, or perception, including dissociative amnesia (inability to recall important personal information), depersonalization/derealization (feeling detached from self or reality), or dissociative identity disorder (presence of multiple distinct identities).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses underlying trauma and helps integrate dissociated experiences.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and grounding techniques to manage dissociative episodes.

Psychodynamic Psychotherapy: Explores unconscious conflicts and past trauma to foster integration of self and memories.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) may be considered.

Second-Line: Anxiolytics (e.g., Clonazepam) for short-term relief of acute anxiety or dissociative episodes, used cautiously.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe co-occurring symptoms like agitation or mood instability.
Symptoms: Excessive focus on physical symptoms (e.g., pain, fatigue) causing significant distress or impairment, often with disproportionate worry about their seriousness, despite minimal or no medical explanation.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses maladaptive thoughts about physical symptoms and reduces health-related anxiety.

Mindfulness-Based Therapy: Promotes acceptance of physical sensations and reduces symptom preoccupation.

Psychodynamic Psychotherapy: Explores underlying emotional conflicts contributing to physical complaints.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring anxiety or depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for persistent symptoms or pain-related complaints.

Third-Line: Low-dose tricyclic antidepressants (e.g., Amitriptyline) for somatic pain or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Anorexia Nervosa

Symptoms: Extreme weight loss, intense fear of gaining weight, distorted body image, and restrictive eating behaviors, often leading to severe physical complications (e.g., malnutrition, amenorrhea).

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about body image and food, promoting healthy eating behaviors.

Family-Based Therapy (FBT): Engages family to support weight restoration and healthy eating, particularly for adolescents.

Maudsley Approach: A family-based treatment focusing on parental involvement to restore weight and address psychological factors.

Medication Treatments:

First-Line: No medications directly treat core symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Atypical antipsychotics (e.g., Olanzapine) to address severe body image distortions or promote weight gain.

Third-Line: Anxiolytics (e.g., Lorazepam) for short-term management of anxiety related to eating or weight gain.

Bulimia Nervosa

Symptoms: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxative use, excessive exercise), with a preoccupation with body shape and weight.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on reducing binge-purge cycles and addressing distorted body image.

Interpersonal Psychotherapy (IPT): Targets interpersonal issues contributing to binge eating and purging behaviors.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation to reduce impulsive eating behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, FDA-approved for bulimia) to reduce binge-purge frequency.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for co-occurring depression or anxiety.

Third-Line: Anticonvulsants (e.g., Topiramate) to reduce binge eating or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Insomnia Disorder

Symptoms: Difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue, irritability, or impaired functioning, persisting for at least three nights per week for three months.

Common Psychotherapies:

Cognitive-Behavioral Therapy for Insomnia (CBT-I): Targets sleep-related thoughts and behaviors to improve sleep quality and duration.

Mindfulness-Based Therapy: Promotes relaxation and reduces pre-sleep anxiety.

Sleep Hygiene Education: Teaches habits to enhance sleep environment and routines.

Medication Treatments:

First-Line: Non-benzodiazepine hypnotics (e.g., Zolpidem, Eszopiclone) for short-term use to improve sleep onset or maintenance.

Second-Line: Melatonin receptor agonists (e.g., Ramelteon) or low-dose sedating antidepressants (e.g., Trazodone) for chronic insomnia.

Third-Line: Benzodiazepines (e.g., Lorazepam) for short-term use, cautiously due to dependency risk, or orexin receptor antagonists (e.g., Suvorexant).

Hypersomnolence Disorder

Symptoms: Excessive daytime sleepiness despite adequate sleep, with frequent naps that are unrefreshing, causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses behaviors and thoughts contributing to excessive sleepiness and improves sleep regulation.

Behavioral Activation: Encourages structured daily activities to reduce daytime napping.

Sleep Scheduling: Promotes consistent sleep-wake cycles to optimize alertness.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) to promote wakefulness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) for non-responders to first-line treatments.

Third-Line: Sodium oxybate for severe cases or adjunctive antidepressants (e.g., Bupropion) for co-occurring depression.

Narcolepsy

Symptoms: Excessive daytime sleepiness, sudden sleep attacks, and possible cataplexy (sudden muscle weakness triggered by emotions), hypnagogic hallucinations, or sleep paralysis.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Supports coping with symptoms and improves sleep-wake regulation.

Psychoeducation: Educates patients on managing narcolepsy and maintaining structured sleep schedules.

Supportive Therapy: Addresses emotional and social impacts of narcolepsy.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) for daytime sleepiness; sodium oxybate for cataplexy and sleepiness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) or antidepressants (e.g., Venlafaxine) for cataplexy.

Third-Line: Pitolisant (histamine H3 receptor antagonist) or solriamfetol for refractory sleepiness.

Restless Legs Syndrome

Symptoms: Uncomfortable sensations in the legs (e.g., crawling, tingling) with an urge to move, worsening at rest or at night, leading to sleep disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Manages stress and anxiety that may exacerbate symptoms.

Sleep Hygiene Education: Promotes routines to minimize sleep disruption.

Relaxation Techniques: Includes progressive muscle relaxation to reduce leg discomfort.

Medication Treatments:

First-Line: Dopamine agonists (e.g., Pramipexole, Ropinirole) to reduce leg sensations and improve sleep.

Second-Line: Gabapentinoids (e.g., Gabapentin, Pregabalin) for symptom relief, especially in painful cases.

Third-Line: Opioids (e.g., Oxycodone) for severe, refractory cases or iron supplementation for patients with low ferritin levels.
Symptoms: Significant distress or discomfort due to a mismatch between one’s gender identity and their assigned sex at birth, often accompanied by a desire to transition socially, physically, or legally to align with their gender identity.

Common Psychotherapies:

Gender-Affirming Psychotherapy: Supports exploration of gender identity, coping with distress, and navigating social or medical transitions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, depression, or social stressors related to gender dysphoria.

Supportive Therapy: Provides emotional support and guidance for individuals and families to foster acceptance and resilience.

Medication Treatments:

First-Line: Hormone Replacement Therapy (HRT) (e.g., Estrogen, Testosterone) for adults or adolescents (with consent and evaluation) to align physical characteristics with gender identity.

Second-Line: Gonadotropin-releasing hormone (GnRH) analogs (e.g., Leuprolide) for pubertal suppression in adolescents to delay puberty-related changes.

Third-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring depression or anxiety.
Oppositional Defiant Disorder

Symptoms: Persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures, causing significant impairment in social, academic, or family functioning.

Common Psychotherapies:

Parent Management Training (PMT): Teaches parents strategies to manage defiant behaviors and reinforce positive interactions.

Cognitive-Behavioral Therapy (CBT): Helps children develop anger management and problem-solving skills.

Family Therapy: Improves communication and reduces conflict within the family.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability or aggression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting behavior.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe aggression or irritability, used cautiously.

Intermittent Explosive Disorder

Symptoms: Recurrent, impulsive aggressive outbursts (verbal or physical) disproportionate to the situation, not explained by other disorders, causing distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on impulse control, anger management, and coping strategies.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and distress tolerance to reduce outbursts.

Group Therapy: Provides peer support and practice in managing aggressive impulses.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) to reduce impulsivity and aggression.

Second-Line: Mood stabilizers (e.g., Valproate, Carbamazepine) for severe outbursts.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant aggression.

Conduct Disorder

Symptoms: Persistent pattern of violating societal norms or others’ rights, including aggression toward people or animals, property destruction, deceitfulness, or serious rule-breaking, often before age 18.

Common Psychotherapies:

Multisystemic Therapy (MST): Addresses behavior across family, school, and community settings.

Cognitive-Behavioral Therapy (CBT): Targets antisocial behaviors and improves moral reasoning and impulse control.

Family Therapy: Enhances family dynamics and parental supervision to reduce delinquent behavior.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring aggression: Atypical antipsychotics (e.g., Risperidone) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD or mood stabilizers (e.g., Lithium) for severe aggression.

Third-Line: SSRIs (e.g., Sertraline) for co-occurring depression or impulsivity.

Pyromania

Symptoms: Deliberate and repeated fire-setting driven by fascination or gratification, not for monetary gain, revenge, or other motives, causing distress or risk.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses impulses to set fires and develops alternative coping mechanisms.

Behavioral Therapy: Uses reinforcement strategies to reduce fire-setting behaviors.

Psychodynamic Psychotherapy: Explores underlying emotional triggers for fire-setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring impulsivity or anxiety.

Second-Line: Mood stabilizers (e.g., Valproate) to reduce impulsive behaviors.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe impulsivity or co-occurring conditions.

Kleptomania

Symptoms: Recurrent, irresistible urges to steal items not needed for personal use or monetary value, followed by guilt or relief, not motivated by anger or delusions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets stealing impulses and develops strategies to resist urges.

Covert Sensitization: Pairs stealing impulses with negative imagery to reduce behavior.

Supportive Therapy: Addresses shame and guilt while fostering impulse control.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) to reduce impulsivity and obsessive urges.

Second-Line: Opioid antagonists (e.g., Naltrexone) to decrease urge-driven behaviors.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant impulsivity.
Cannabis Use Disorder

Symptoms: Problematic cannabis use leading to tolerance, withdrawal, unsuccessful attempts to quit, and significant impairment in social, occupational, or other functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets triggers for use and develops coping strategies to prevent relapse.

Motivational Enhancement Therapy (MET): Increases motivation to reduce or stop cannabis use.

Contingency Management: Provides rewards for abstinence to reinforce sobriety.

Medication Treatments:

First-Line: No FDA-approved medications for cannabis use disorder. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Off-label use of N-acetylcysteine or Gabapentin to reduce cravings.

Third-Line: Anxiolytics (e.g., Buspirone) for withdrawal-related anxiety or mood stabilizers (e.g., Valproate) for co-occurring mood instability.

Opioid Use Disorder

Symptoms: Compulsive opioid use, tolerance, withdrawal symptoms (e.g., nausea, muscle aches), and continued use despite harmful consequences.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses triggers and builds relapse prevention skills.

Motivational Interviewing: Enhances commitment to recovery and treatment adherence.

12-Step Facilitation Therapy: Supports engagement with programs like Narcotics Anonymous.

Medication Treatments:

First-Line: Medication-Assisted Treatment (MAT) with Methadone or Buprenorphine to reduce cravings and withdrawal.

Second-Line: Naltrexone (oral or injectable) to block opioid effects and prevent relapse.

Third-Line: Adjunctive SSRIs (e.g., Fluoxetine) for co-occurring depression or clonidine for acute withdrawal symptoms.

Stimulant Use Disorder

Symptoms: Problematic use of stimulants (e.g., cocaine, methamphetamine), leading to tolerance, cravings, withdrawal (e.g., fatigue, depression), and significant life disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on managing cravings and avoiding high-risk situations.

Contingency Management: Rewards abstinence to promote sustained recovery.

Matrix Model: Combines CBT, family education, and support groups for intensive treatment.

Medication Treatments:

First-Line: No FDA-approved medications. For co-occurring depression: SSRIs (e.g., Sertraline).

Second-Line: Off-label use of Bupropion or Modafinil to reduce cravings or improve energy during withdrawal.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for co-occurring agitation or psychosis.

Substance-Induced Disorders (e.g., Intoxication, Withdrawal)

Symptoms:

Intoxication: Reversible substance-specific effects (e.g., euphoria, sedation, agitation) varying by substance (e.g., alcohol, opioids, cannabis).

Withdrawal: Substance-specific symptoms (e.g., anxiety, tremors, seizures for alcohol; nausea, aches for opioids) after cessation or reduction of use.

Common Psychotherapies:

Supportive Therapy: Provides emotional support during acute intoxication or withdrawal phases.

Cognitive-Behavioral Therapy (CBT): Helps manage withdrawal-related distress and prevents relapse.

Motivational Enhancement Therapy (MET): Encourages commitment to detoxification and recovery.

Medication Treatments:

First-Line:

Alcohol Withdrawal: Benzodiazepines (e.g., Lorazepam, Diazepam) to manage seizures and agitation.

Opioid Withdrawal: Buprenorphine or Clonidine to alleviate symptoms.

Cannabis Withdrawal: Symptomatic treatment with anxiolytics (e.g., Buspirone).

Second-Line: Anticonvulsants (e.g., Carbamazepine) for alcohol withdrawal or beta-blockers (e.g., Propranolol) for stimulant withdrawal-related tachycardia.

Third-Line: Adjunctive antipsychotics (e.g., Quetiapine) for severe agitation or psychosis during intoxication/withdrawal.

Gambling Disorder

Symptoms: Persistent, problematic gambling behavior leading to preoccupation, increased risk-taking, chasing losses, and significant distress or impairment in personal, social, or occupational life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted beliefs about gambling and builds impulse control strategies.

Motivational Interviewing: Enhances motivation to reduce or stop gambling.

12-Step Facilitation (e.g., Gamblers Anonymous): Supports recovery through peer support and structured steps.

Medication Treatments:

First-Line: No FDA-approved medications. SSRIs (e.g., Fluvoxamine, Sertraline) for co-occurring anxiety or obsessive thoughts.

Second-Line: Opioid antagonists (e.g., Naltrexone) to reduce gambling urges.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Olanzapine) for co-occurring mood instability or impulsivity.
Delirium

Symptoms: Acute, fluctuating disturbances in attention, awareness, and cognition (e.g., memory deficits, disorientation), often developing rapidly and caused by underlying medical conditions, substance intoxication/withdrawal, or medication side effects.

Common Psychotherapies:

Supportive Therapy: Provides reassurance and orientation to reduce confusion and anxiety during acute episodes.

Environmental Interventions: Promotes a calm, structured environment with consistent cues to improve orientation.

Family Education: Supports caregivers in understanding and managing delirium behaviors.

Medication Treatments:

First-Line: Treat underlying cause (e.g., infection, electrolyte imbalance). For severe agitation: Low-dose antipsychotics (e.g., Haloperidol, Risperidone) used cautiously.

Second-Line: Benzodiazepines (e.g., Lorazepam) for delirium due to alcohol/sedative withdrawal, used sparingly.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for persistent agitation or when typical antipsychotics are contraindicated.

Major Neurocognitive Disorder (e.g., due to Alzheimer’s, Parkinson’s, etc.)

Symptoms: Significant cognitive decline in one or more domains (e.g., memory, executive function, language) interfering with independence in daily activities, caused by conditions like Alzheimer’s disease, Parkinson’s disease, or vascular dementia.

Common Psychotherapies:

Cognitive Stimulation Therapy (CST): Engages patients in structured activities to maintain cognitive function.

Behavioral Therapy: Manages behavioral and psychological symptoms (e.g., agitation, depression) through environmental and behavioral strategies.

Caregiver Support and Psychoeducation: Helps families manage symptoms and plan for long-term care.

Medication Treatments:

First-Line:

Alzheimer’s: Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine) or NMDA receptor antagonists (e.g., Memantine) to slow cognitive decline.

Parkinson’s-related dementia: Rivastigmine for cognitive symptoms.

Second-Line: SSRIs (e.g., Sertraline, Citalopram) for co-occurring depression or anxiety.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe agitation or psychosis, used cautiously due to risk in dementia patients.

Mild Neurocognitive Disorder

Symptoms: Modest cognitive decline in one or more domains (e.g., memory, attention) noticeable but not significantly interfering with independence, often a precursor to major neurocognitive disorders.

Common Psychotherapies:

Cognitive Training: Targets specific cognitive skills (e.g., memory, problem-solving) to maintain function.

Lifestyle Interventions: Promotes physical exercise, healthy diet, and social engagement to slow cognitive decline.

Psychoeducation: Educates patients and families on managing symptoms and reducing risk factors.

Medication Treatments:

First-Line: No medications specifically approved. For co-occurring depression or anxiety: SSRIs (e.g., Sertraline, Escitalopram).

Second-Line: Cholinesterase inhibitors (e.g., Donepezil) may be considered off-label in some cases, though evidence is limited.

Third-Line: Supplements (e.g., Vitamin E, Omega-3 fatty acids) or cognitive enhancers (e.g., Ginkgo biloba) for symptom management, with limited evidence.
Cluster A Personality Disorders

Paranoid Personality Disorder

Symptoms: Pervasive distrust and suspicion of others, interpreting motives as malevolent, leading to guardedness, hypervigilance, and reluctance to confide in others.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges mistrustful thoughts and builds coping strategies for interpersonal interactions.

Supportive Therapy: Fosters trust in therapeutic relationships to reduce paranoia.

Schema Therapy: Addresses deep-seated beliefs about others’ intentions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Low-dose antipsychotics (e.g., Risperidone) for severe paranoia or agitation, used cautiously.

Third-Line: Anxiolytics (e.g., Buspirone) for persistent anxiety.

Schizoid Personality Disorder

Symptoms: Detachment from social relationships, limited emotional expression, preference for solitary activities, and indifference to praise or criticism.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Enhances social skills and addresses barriers to forming relationships.

Psychodynamic Psychotherapy: Explores underlying reasons for emotional detachment.

Social Skills Training: Improves interpersonal engagement and communication.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring depression: SSRIs (e.g., Fluoxetine).

Second-Line: Atypical antipsychotics (e.g., Olanzapine) for co-occurring mild psychotic-like symptoms, if present.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring apathy or low energy, with limited evidence.

Schizotypal Personality Disorder

Symptoms: Eccentric behavior, odd beliefs or magical thinking, social anxiety, and perceptual distortions, with discomfort in close relationships and reduced capacity for social connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses distorted thinking and improves social functioning.

Social Skills Training: Enhances interpersonal interactions and reduces social anxiety.

Supportive Psychotherapy: Builds trust and helps manage eccentric behaviors.

Medication Treatments:

First-Line: Low-dose antipsychotics (e.g., Risperidone, Aripiprazole) for perceptual distortions or quasi-psychotic symptoms.

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Mood stabilizers (e.g., Lamotrigine) for emotional dysregulation or adjunctive anxiolytics (e.g., Clonazepam).

Cluster B Personality Disorders

Antisocial Personality Disorder

Symptoms: Disregard for and violation of others’ rights, impulsivity, deceitfulness, lack of remorse, and persistent rule-breaking, often beginning in adolescence.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets impulsivity and antisocial behaviors, promoting prosocial alternatives.

Mentalization-Based Therapy (MBT): Enhances empathy and understanding of others’ perspectives.

Contingency Management: Reinforces positive behaviors to reduce criminal or harmful actions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For aggression: Mood stabilizers (e.g., Lithium, Valproate).

Second-Line: SSRIs (e.g., Fluoxetine) for impulsivity or co-occurring depression.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe aggression or irritability.

Borderline Personality Disorder

Symptoms: Instability in relationships, self-image, and emotions, with impulsivity, fear of abandonment, recurrent suicidal behaviors, and intense anger or mood swings.

Common Psychotherapies:

Dialectical Behavior Therapy (DBT): Focuses on emotional regulation, distress tolerance, and interpersonal effectiveness.

Mentalization-Based Therapy (MBT): Improves understanding of self and others’ mental states.

Schema Therapy: Addresses maladaptive patterns rooted in early experiences.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Sertraline) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lamotrigine, Valproate) for emotional instability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for severe mood swings or paranoia.

Histrionic Personality Disorder

Symptoms: Excessive emotionality and attention-seeking behavior, discomfort when not the center of attention, and overly dramatic or sexually provocative interactions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges attention-seeking behaviors and promotes healthier emotional expression.

Psychodynamic Psychotherapy: Explores underlying needs for approval and attention.

Group Therapy: Provides feedback on interpersonal behaviors in a supportive setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Mood stabilizers (e.g., Carbamazepine) for emotional lability.

Third-Line: Low-dose antipsychotics (e.g., Olanzapine) for severe emotional dysregulation, used cautiously.

Narcissistic Personality Disorder

Symptoms: Grandiosity, need for admiration, lack of empathy, and hypersensitivity to criticism, often leading to arrogant behavior and exploitative relationships.

Common Psychotherapies:

Psychodynamic Psychotherapy: Explores underlying insecurities and need for admiration.

Cognitive-Behavioral Therapy (CBT): Challenges grandiose beliefs and promotes empathy.

Schema Therapy: Addresses maladaptive schemas related to self-worth and entitlement.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lithium) for irritability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe grandiosity or paranoia, used sparingly.

Cluster C Personality Disorders

Avoidant Personality Disorder

Symptoms: Extreme social inhibition, feelings of inadequacy, and hypersensitivity to rejection, leading to avoidance of social interactions despite a desire for connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets fears of rejection and builds social confidence.

Social Skills Training: Improves interpersonal interactions and reduces social anxiety.

Schema Therapy: Addresses core beliefs about inadequacy and rejection.

Medication Treatments:

First-Line: SSRIs (e.g., Sertraline, Paroxetine) to reduce social anxiety and depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) for persistent symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) or beta-blockers (e.g., Propranolol) for situational anxiety.

Dependent Personality Disorder

Symptoms: Excessive need to be cared for, submissive behavior, fear of separation, and difficulty making decisions without reassurance, leading to clingy or overly compliant relationships.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Promotes independence and challenges dependency-related thoughts.

Assertiveness Training: Enhances self-confidence and decision-making skills.

Psychodynamic Psychotherapy: Explores underlying fears of abandonment or autonomy.

Medication Treatments:

First-Line: SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Anxiolytics (e.g., Clonazepam) for severe anxiety, used short-term.

Third-Line: SNRIs (e.g., Duloxetine) for persistent depressive symptoms.

Obsessive-Compulsive Personality Disorder

Symptoms: Preoccupation with orderliness, perfectionism, and control, leading to rigidity, excessive devotion to work, and inflexibility, often at the expense of relationships or leisure.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges perfectionistic and rigid thinking patterns.

Psychodynamic Psychotherapy: Explores underlying needs for control and fear of mistakes.

Mindfulness-Based Therapy: Promotes flexibility and acceptance of imperfection.

Medication Treatments:

First-Line: SSRIs (e.g., Fluoxetine, Sertraline) for co-occurring anxiety or obsessive tendencies.

Second-Line: Clomipramine for severe perfectionism or obsessive traits.

Third-Line: Anxiolytics (e.g., Buspirone) or mood stabilizers (e.g., Lamotrigine) for emotional rigidity or irritability.

Symptoms: Challenges with social interaction, communication, and repetitive behaviors.

Common Psychotherapies:

Applied Behavior Analysis (ABA): Structured intervention to improve social, communication, and behavioral skills.

Social Skills Training: Enhances interpersonal interactions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety or emotional regulation.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability: Risperidone or Aripiprazole (FDA-approved ASD).

Second-Line: SSRIs (e.g., Fluoxetine) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms.
Symptoms: Inattention, hyperactivity, impulsivity inappropriate for age.

Common Psychotherapies:

Behavioral Therapy: Teaches organizational and coping skills.

Parent Training: Equips caregivers to manage behaviors.

CBT: Improves time management and emotional regulation in adults.

Medication Treatments:

First-Line: Stimulants (Methylphenidate, Amphetamine-based like Adderall).

Second-Line: Non-stimulants (Atomoxetine, Guanfacine).

Third-Line: Bupropion or Tricyclic Antidepressants for adults with co-occurring depression.
Symptoms: Vary by disorder; include cognitive limitations, speech/language difficulties, academic struggles, or motor tics.

Common Psychotherapies:

Behavioral Interventions: Tailored to specific deficits (e.g., speech therapy for communication disorders).

Educational Support: Individualized education plans (IEPs) for learning disorders.

Habit Reversal Training: For tic disorders.

Medication Treatments:

First-Line: Varies; e.g., Clonidine or Aripiprazole for tics; no primary medications for intellectual or learning disorders.

Second-Line: SSRIs for co-occurring anxiety (e.g., Sertraline).

Third-Line: Antipsychotics (e.g., Haloperidol) for severe tics.

Symptoms: Challenges with social interaction, communication, and repetitive behaviors.

Common Psychotherapies:

Applied Behavior Analysis (ABA): Structured intervention to improve social, communication, and behavioral skills.

Social Skills Training: Enhances interpersonal interactions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety or emotional regulation.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability: Risperidone or Aripiprazole (FDA-approved ASD).

Second-Line: SSRIs (e.g., Fluoxetine) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms.
Symptoms: Inattention, hyperactivity, impulsivity inappropriate for age.

Common Psychotherapies:

Behavioral Therapy: Teaches organizational and coping skills.

Parent Training: Equips caregivers to manage behaviors.

CBT: Improves time management and emotional regulation in adults.

Medication Treatments:

First-Line: Stimulants (Methylphenidate, Amphetamine-based like Adderall).

Second-Line: Non-stimulants (Atomoxetine, Guanfacine).

Third-Line: Bupropion or Tricyclic Antidepressants for adults with co-occurring depression.
Symptoms: Significant limitations in intellectual functioning (e.g., reasoning, problem-solving) and adaptive behavior (e.g., daily living skills, communication), typically identified before age 18.

Common Psychotherapies:

Behavioral Interventions: Tailored strategies to teach adaptive skills and reduce challenging behaviors.

Skills Training: Focuses on improving daily living, communication, and social skills.

Family Therapy: Supports caregivers in managing behaviors and fostering independence.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring behavioral issues (e.g., aggression): Risperidone or Aripiprazole (may be considered).

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) or non-stimulants (e.g., Atomoxetine) for co-occurring ADHD symptoms.
Symptoms: Difficulties with speech, language, or social communication, including articulation issues, fluency disorders (e.g., stuttering), or challenges understanding/expressing language.

Common Psychotherapies:

Speech-Language Therapy: Tailored interventions to improve articulation, language comprehension, and expression.

Social Communication Training: Enhances pragmatic language skills for better social interactions.

Cognitive-Behavioral Therapy (CBT): Addresses anxiety or emotional challenges related to communication difficulties.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety related to communication: SSRIs (e.g., Sertraline or Fluoxetine) may be considered.

Second-Line: Beta-blockers (e.g., Propranolol) for performance anxiety in specific situations (e.g., public speaking).

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting communication focus.
Symptoms: Involuntary tics, both motor (e.g., blinking, head jerking) and vocal (e.g., grunting, throat clearing), typically starting in childhood, often accompanied by co-occurring conditions like ADHD or OCD.

Common Psychotherapies:

Comprehensive Behavioral Intervention for Tics (CBIT): Teaches strategies to manage and reduce tics through habit reversal training.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, OCD, or emotional challenges.

Psychoeducation and Supportive Therapy: Helps individuals and families understand and cope with tics.

Medication Treatments:

First-Line: For significant tics: Alpha-2 agonists (e.g., Clonidine or Guanfacine) to reduce tic severity.

Second-Line: Antipsychotics (e.g., Risperidone, Aripiprazole) for severe tics not responding to first-line treatments.

Third-Line: SSRIs (e.g., Fluoxetine) for co-occurring OCD or anxiety; stimulants (e.g., Methylphenidate) for co-occurring ADHD, with caution due to potential tic exacerbation.
Symptoms: Hallucinations (e.g., hearing voices), delusions, disorganized thinking, negative symptoms (e.g., reduced emotions, motivation), and impaired social or occupational functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage hallucinations, delusions, and improves coping strategies.

Social Skills Training: Enhances interpersonal and daily living skills.

Family Therapy: Supports family education and communication to reduce stress and improve outcomes.

Medication Treatments:

First-Line: Antipsychotics (e.g., Risperidone, Olanzapine, Aripiprazole) to reduce positive symptoms like hallucinations and delusions.

Second-Line: Clozapine for treatment-resistant schizophrenia or severe symptoms not responding to other antipsychotics.

Third-Line: Adjunctive treatments like SSRIs (e.g., Sertraline) for co-occurring depression or anxiety; mood stabilizers (e.g., Lithium) for affective symptoms.
Symptoms: Extreme mood swings including manic episodes (e.g., elevated mood, increased energy, impulsivity) and depressive episodes (e.g., sadness, low energy, hopelessness), with potential for mixed episodes or rapid cycling.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage mood swings, identify triggers, and develop coping strategies.

Interpersonal and Social Rhythm Therapy (IPSRT): Stabilizes daily routines and improves interpersonal relationships to prevent mood episodes.

Family-Focused Therapy: Educates and supports families to enhance communication and reduce relapse risk.

Medication Treatments:

First-Line: Mood stabilizers (e.g., Lithium, Valproate, Carbamazepine) to prevent manic and depressive episodes; atypical antipsychotics (e.g., Quetiapine, Olanzapine) for acute mania or mixed episodes.

Second-Line: Antidepressants (e.g., Fluoxetine, Sertraline) for depressive episodes, typically combined with a mood stabilizer to prevent mania.

Third-Line: Adjunctive treatments like Lamotrigine for bipolar depression or Benzodiazepines (e.g., Lorazepam) for short-term management of agitation or insomnia.
Symptoms: Persistent sadness, loss of interest or pleasure, fatigue, feelings of worthlessness, difficulty concentrating, changes in sleep or appetite, and possible suicidal thoughts.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets negative thought patterns and behaviors to improve mood and coping skills.

Interpersonal Therapy (IPT): Focuses on improving relationships and addressing interpersonal issues contributing to depression.

Behavioral Activation: Encourages engagement in meaningful activities to counteract withdrawal and low motivation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) to alleviate depressive symptoms.

Second-Line: Atypical antidepressants (e.g., Bupropion, Mirtazapine) or tricyclic antidepressants (e.g., Amitriptyline) for non-responders to first-line treatments.

Third-Line: Monoamine oxidase inhibitors (MAOIs) (e.g., Phenelzine) or adjunctive treatments like Lithium or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant depression.

Treatment Resistant: Ketamine
Symptoms: Severe mood changes, sadness, irritability, anxiety, or hopelessness occurring in the luteal phase of the menstrual cycle (typically the week before menstruation) and resolving shortly after menstruation begins.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage negative thoughts and emotional responses tied to menstrual cycle changes.

Interpersonal Therapy (IPT): Addresses interpersonal conflicts or stressors that may exacerbate symptoms.

Mindfulness-Based Therapy: Promotes relaxation and emotional regulation to reduce symptom severity.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) taken continuously or during the luteal phase to alleviate depressive and anxiety symptoms.

Second-Line: Oral contraceptives (e.g., Ethinyl Estradiol/Drospirenone) to stabilize hormonal fluctuations and reduce mood symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) for anxiety or adjunctive treatments like Calcium supplements or Vitamin B6 for mild symptom relief.
Symptoms: Excessive, persistent worry about various aspects of life (e.g., work, health, relationships), accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets anxious thought patterns and behaviors to reduce worry and improve coping skills.

Acceptance and Commitment Therapy (ACT): Promotes mindfulness and value-based actions to manage anxiety.

Mindfulness-Based Stress Reduction (MBSR): Uses mindfulness techniques to reduce anxiety and enhance emotional regulation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) to reduce anxiety symptoms.

Second-Line: Buspirone for persistent anxiety or benzodiazepines (e.g., Lorazepam) for short-term relief of acute symptoms.

Third-Line: Tricyclic antidepressants (e.g., Imipramine) or adjunctive treatments like Pregabalin for treatment-resistant cases.
Symptoms: Recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety, often causing significant distress or interference with daily life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP): Gradually exposes individuals to obsessional triggers while preventing compulsive responses to reduce anxiety.

Acceptance and Commitment Therapy (ACT): Encourages acceptance of intrusive thoughts while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Promotes awareness and non-judgmental acceptance of thoughts to reduce compulsive behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) at higher doses to reduce obsessions and compulsions.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Risperidone, Aripiprazole) for treatment-resistant OCD or augmentation with glutamate modulators (e.g., Memantine).
Symptoms: Preoccupation with perceived flaws or defects in physical appearance (often minor or unnoticeable to others), leading to repetitive behaviors (e.g., mirror checking, excessive grooming) or mental acts (e.g., comparing appearance), causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about appearance and reduces compulsive behaviors through exposure and response prevention.

Acceptance and Commitment Therapy (ACT): Promotes acceptance of body image concerns while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Encourages non-judgmental awareness to reduce preoccupation with perceived flaws.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, Sertraline) to reduce obsessive thoughts and compulsive behaviors.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Aripiprazole, Risperidone) for treatment-resistant cases or severe symptoms.
Symptoms: Intrusive memories, flashbacks, or nightmares of a traumatic event, avoidance of trauma-related triggers, negative changes in mood or thinking (e.g., guilt, detachment), and heightened arousal (e.g., hypervigilance, irritability).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses trauma-related thoughts and behaviors through cognitive restructuring and exposure techniques.

Eye Movement Desensitization and Reprocessing (EMDR): Uses guided eye movements to process traumatic memories and reduce distress.

Prolonged Exposure Therapy (PE): Encourages gradual confrontation of trauma-related memories and situations to reduce avoidance.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Paroxetine) to reduce anxiety, depression, and intrusive symptoms.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) or atypical antidepressants (e.g., Mirtazapine) for non-responders.

Third-Line: Prazosin for trauma-related nightmares or adjunctive antipsychotics (e.g., Risperidone) for severe hyperarousal or treatment-resistant symptoms.
Symptoms: Emotional and behavioral symptoms (e.g., sadness, anxiety, irritability, or reckless behavior) in response to a specific stressor (e.g., life changes, loss, or trauma), occurring within three months of the stressor and causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps reframe negative thoughts and develop coping strategies to manage stress.

Solution-Focused Brief Therapy (SFBT): Focuses on identifying solutions and goals to address the specific stressor.

Supportive Psychotherapy: Provides emotional support and guidance to enhance resilience and problem-solving.

Medication Treatments:

First-Line: No medications specifically treat adjustment disorders. For significant anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) may be considered.

Second-Line: Benzodiazepines (e.g., Lorazepam) for short-term relief of acute anxiety, used cautiously due to dependency risk.

Third-Line: Atypical antidepressants (e.g., Trazodone) for sleep disturbances or mild depressive symptoms.
Symptoms: Disruptions in memory, identity, consciousness, or perception, including dissociative amnesia (inability to recall important personal information), depersonalization/derealization (feeling detached from self or reality), or dissociative identity disorder (presence of multiple distinct identities).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses underlying trauma and helps integrate dissociated experiences.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and grounding techniques to manage dissociative episodes.

Psychodynamic Psychotherapy: Explores unconscious conflicts and past trauma to foster integration of self and memories.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) may be considered.

Second-Line: Anxiolytics (e.g., Clonazepam) for short-term relief of acute anxiety or dissociative episodes, used cautiously.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe co-occurring symptoms like agitation or mood instability.
Symptoms: Excessive focus on physical symptoms (e.g., pain, fatigue) causing significant distress or impairment, often with disproportionate worry about their seriousness, despite minimal or no medical explanation.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses maladaptive thoughts about physical symptoms and reduces health-related anxiety.

Mindfulness-Based Therapy: Promotes acceptance of physical sensations and reduces symptom preoccupation.

Psychodynamic Psychotherapy: Explores underlying emotional conflicts contributing to physical complaints.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring anxiety or depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for persistent symptoms or pain-related complaints.

Third-Line: Low-dose tricyclic antidepressants (e.g., Amitriptyline) for somatic pain or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Anorexia Nervosa

Symptoms: Extreme weight loss, intense fear of gaining weight, distorted body image, and restrictive eating behaviors, often leading to severe physical complications (e.g., malnutrition, amenorrhea).

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about body image and food, promoting healthy eating behaviors.

Family-Based Therapy (FBT): Engages family to support weight restoration and healthy eating, particularly for adolescents.

Maudsley Approach: A family-based treatment focusing on parental involvement to restore weight and address psychological factors.

Medication Treatments:

First-Line: No medications directly treat core symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Atypical antipsychotics (e.g., Olanzapine) to address severe body image distortions or promote weight gain.

Third-Line: Anxiolytics (e.g., Lorazepam) for short-term management of anxiety related to eating or weight gain.

Bulimia Nervosa

Symptoms: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxative use, excessive exercise), with a preoccupation with body shape and weight.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on reducing binge-purge cycles and addressing distorted body image.

Interpersonal Psychotherapy (IPT): Targets interpersonal issues contributing to binge eating and purging behaviors.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation to reduce impulsive eating behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, FDA-approved for bulimia) to reduce binge-purge frequency.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for co-occurring depression or anxiety.

Third-Line: Anticonvulsants (e.g., Topiramate) to reduce binge eating or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Insomnia Disorder

Symptoms: Difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue, irritability, or impaired functioning, persisting for at least three nights per week for three months.

Common Psychotherapies:

Cognitive-Behavioral Therapy for Insomnia (CBT-I): Targets sleep-related thoughts and behaviors to improve sleep quality and duration.

Mindfulness-Based Therapy: Promotes relaxation and reduces pre-sleep anxiety.

Sleep Hygiene Education: Teaches habits to enhance sleep environment and routines.

Medication Treatments:

First-Line: Non-benzodiazepine hypnotics (e.g., Zolpidem, Eszopiclone) for short-term use to improve sleep onset or maintenance.

Second-Line: Melatonin receptor agonists (e.g., Ramelteon) or low-dose sedating antidepressants (e.g., Trazodone) for chronic insomnia.

Third-Line: Benzodiazepines (e.g., Lorazepam) for short-term use, cautiously due to dependency risk, or orexin receptor antagonists (e.g., Suvorexant).

Hypersomnolence Disorder

Symptoms: Excessive daytime sleepiness despite adequate sleep, with frequent naps that are unrefreshing, causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses behaviors and thoughts contributing to excessive sleepiness and improves sleep regulation.

Behavioral Activation: Encourages structured daily activities to reduce daytime napping.

Sleep Scheduling: Promotes consistent sleep-wake cycles to optimize alertness.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) to promote wakefulness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) for non-responders to first-line treatments.

Third-Line: Sodium oxybate for severe cases or adjunctive antidepressants (e.g., Bupropion) for co-occurring depression.

Narcolepsy

Symptoms: Excessive daytime sleepiness, sudden sleep attacks, and possible cataplexy (sudden muscle weakness triggered by emotions), hypnagogic hallucinations, or sleep paralysis.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Supports coping with symptoms and improves sleep-wake regulation.

Psychoeducation: Educates patients on managing narcolepsy and maintaining structured sleep schedules.

Supportive Therapy: Addresses emotional and social impacts of narcolepsy.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) for daytime sleepiness; sodium oxybate for cataplexy and sleepiness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) or antidepressants (e.g., Venlafaxine) for cataplexy.

Third-Line: Pitolisant (histamine H3 receptor antagonist) or solriamfetol for refractory sleepiness.

Restless Legs Syndrome

Symptoms: Uncomfortable sensations in the legs (e.g., crawling, tingling) with an urge to move, worsening at rest or at night, leading to sleep disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Manages stress and anxiety that may exacerbate symptoms.

Sleep Hygiene Education: Promotes routines to minimize sleep disruption.

Relaxation Techniques: Includes progressive muscle relaxation to reduce leg discomfort.

Medication Treatments:

First-Line: Dopamine agonists (e.g., Pramipexole, Ropinirole) to reduce leg sensations and improve sleep.

Second-Line: Gabapentinoids (e.g., Gabapentin, Pregabalin) for symptom relief, especially in painful cases.

Third-Line: Opioids (e.g., Oxycodone) for severe, refractory cases or iron supplementation for patients with low ferritin levels.
Symptoms: Significant distress or discomfort due to a mismatch between one’s gender identity and their assigned sex at birth, often accompanied by a desire to transition socially, physically, or legally to align with their gender identity.

Common Psychotherapies:

Gender-Affirming Psychotherapy: Supports exploration of gender identity, coping with distress, and navigating social or medical transitions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, depression, or social stressors related to gender dysphoria.

Supportive Therapy: Provides emotional support and guidance for individuals and families to foster acceptance and resilience.

Medication Treatments:

First-Line: Hormone Replacement Therapy (HRT) (e.g., Estrogen, Testosterone) for adults or adolescents (with consent and evaluation) to align physical characteristics with gender identity.

Second-Line: Gonadotropin-releasing hormone (GnRH) analogs (e.g., Leuprolide) for pubertal suppression in adolescents to delay puberty-related changes.

Third-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring depression or anxiety.
Oppositional Defiant Disorder

Symptoms: Persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures, causing significant impairment in social, academic, or family functioning.

Common Psychotherapies:

Parent Management Training (PMT): Teaches parents strategies to manage defiant behaviors and reinforce positive interactions.

Cognitive-Behavioral Therapy (CBT): Helps children develop anger management and problem-solving skills.

Family Therapy: Improves communication and reduces conflict within the family.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability or aggression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting behavior.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe aggression or irritability, used cautiously.

Intermittent Explosive Disorder

Symptoms: Recurrent, impulsive aggressive outbursts (verbal or physical) disproportionate to the situation, not explained by other disorders, causing distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on impulse control, anger management, and coping strategies.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and distress tolerance to reduce outbursts.

Group Therapy: Provides peer support and practice in managing aggressive impulses.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) to reduce impulsivity and aggression.

Second-Line: Mood stabilizers (e.g., Valproate, Carbamazepine) for severe outbursts.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant aggression.

Conduct Disorder

Symptoms: Persistent pattern of violating societal norms or others’ rights, including aggression toward people or animals, property destruction, deceitfulness, or serious rule-breaking, often before age 18.

Common Psychotherapies:

Multisystemic Therapy (MST): Addresses behavior across family, school, and community settings.

Cognitive-Behavioral Therapy (CBT): Targets antisocial behaviors and improves moral reasoning and impulse control.

Family Therapy: Enhances family dynamics and parental supervision to reduce delinquent behavior.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring aggression: Atypical antipsychotics (e.g., Risperidone) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD or mood stabilizers (e.g., Lithium) for severe aggression.

Third-Line: SSRIs (e.g., Sertraline) for co-occurring depression or impulsivity.

Pyromania

Symptoms: Deliberate and repeated fire-setting driven by fascination or gratification, not for monetary gain, revenge, or other motives, causing distress or risk.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses impulses to set fires and develops alternative coping mechanisms.

Behavioral Therapy: Uses reinforcement strategies to reduce fire-setting behaviors.

Psychodynamic Psychotherapy: Explores underlying emotional triggers for fire-setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring impulsivity or anxiety.

Second-Line: Mood stabilizers (e.g., Valproate) to reduce impulsive behaviors.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe impulsivity or co-occurring conditions.

Kleptomania

Symptoms: Recurrent, irresistible urges to steal items not needed for personal use or monetary value, followed by guilt or relief, not motivated by anger or delusions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets stealing impulses and develops strategies to resist urges.

Covert Sensitization: Pairs stealing impulses with negative imagery to reduce behavior.

Supportive Therapy: Addresses shame and guilt while fostering impulse control.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) to reduce impulsivity and obsessive urges.

Second-Line: Opioid antagonists (e.g., Naltrexone) to decrease urge-driven behaviors.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant impulsivity.
Cannabis Use Disorder

Symptoms: Problematic cannabis use leading to tolerance, withdrawal, unsuccessful attempts to quit, and significant impairment in social, occupational, or other functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets triggers for use and develops coping strategies to prevent relapse.

Motivational Enhancement Therapy (MET): Increases motivation to reduce or stop cannabis use.

Contingency Management: Provides rewards for abstinence to reinforce sobriety.

Medication Treatments:

First-Line: No FDA-approved medications for cannabis use disorder. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Off-label use of N-acetylcysteine or Gabapentin to reduce cravings.

Third-Line: Anxiolytics (e.g., Buspirone) for withdrawal-related anxiety or mood stabilizers (e.g., Valproate) for co-occurring mood instability.

Opioid Use Disorder

Symptoms: Compulsive opioid use, tolerance, withdrawal symptoms (e.g., nausea, muscle aches), and continued use despite harmful consequences.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses triggers and builds relapse prevention skills.

Motivational Interviewing: Enhances commitment to recovery and treatment adherence.

12-Step Facilitation Therapy: Supports engagement with programs like Narcotics Anonymous.

Medication Treatments:

First-Line: Medication-Assisted Treatment (MAT) with Methadone or Buprenorphine to reduce cravings and withdrawal.

Second-Line: Naltrexone (oral or injectable) to block opioid effects and prevent relapse.

Third-Line: Adjunctive SSRIs (e.g., Fluoxetine) for co-occurring depression or clonidine for acute withdrawal symptoms.

Stimulant Use Disorder

Symptoms: Problematic use of stimulants (e.g., cocaine, methamphetamine), leading to tolerance, cravings, withdrawal (e.g., fatigue, depression), and significant life disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on managing cravings and avoiding high-risk situations.

Contingency Management: Rewards abstinence to promote sustained recovery.

Matrix Model: Combines CBT, family education, and support groups for intensive treatment.

Medication Treatments:

First-Line: No FDA-approved medications. For co-occurring depression: SSRIs (e.g., Sertraline).

Second-Line: Off-label use of Bupropion or Modafinil to reduce cravings or improve energy during withdrawal.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for co-occurring agitation or psychosis.

Substance-Induced Disorders (e.g., Intoxication, Withdrawal)

Symptoms:

Intoxication: Reversible substance-specific effects (e.g., euphoria, sedation, agitation) varying by substance (e.g., alcohol, opioids, cannabis).

Withdrawal: Substance-specific symptoms (e.g., anxiety, tremors, seizures for alcohol; nausea, aches for opioids) after cessation or reduction of use.

Common Psychotherapies:

Supportive Therapy: Provides emotional support during acute intoxication or withdrawal phases.

Cognitive-Behavioral Therapy (CBT): Helps manage withdrawal-related distress and prevents relapse.

Motivational Enhancement Therapy (MET): Encourages commitment to detoxification and recovery.

Medication Treatments:

First-Line:

Alcohol Withdrawal: Benzodiazepines (e.g., Lorazepam, Diazepam) to manage seizures and agitation.

Opioid Withdrawal: Buprenorphine or Clonidine to alleviate symptoms.

Cannabis Withdrawal: Symptomatic treatment with anxiolytics (e.g., Buspirone).

Second-Line: Anticonvulsants (e.g., Carbamazepine) for alcohol withdrawal or beta-blockers (e.g., Propranolol) for stimulant withdrawal-related tachycardia.

Third-Line: Adjunctive antipsychotics (e.g., Quetiapine) for severe agitation or psychosis during intoxication/withdrawal.

Gambling Disorder

Symptoms: Persistent, problematic gambling behavior leading to preoccupation, increased risk-taking, chasing losses, and significant distress or impairment in personal, social, or occupational life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted beliefs about gambling and builds impulse control strategies.

Motivational Interviewing: Enhances motivation to reduce or stop gambling.

12-Step Facilitation (e.g., Gamblers Anonymous): Supports recovery through peer support and structured steps.

Medication Treatments:

First-Line: No FDA-approved medications. SSRIs (e.g., Fluvoxamine, Sertraline) for co-occurring anxiety or obsessive thoughts.

Second-Line: Opioid antagonists (e.g., Naltrexone) to reduce gambling urges.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Olanzapine) for co-occurring mood instability or impulsivity.
Delirium

Symptoms: Acute, fluctuating disturbances in attention, awareness, and cognition (e.g., memory deficits, disorientation), often developing rapidly and caused by underlying medical conditions, substance intoxication/withdrawal, or medication side effects.

Common Psychotherapies:

Supportive Therapy: Provides reassurance and orientation to reduce confusion and anxiety during acute episodes.

Environmental Interventions: Promotes a calm, structured environment with consistent cues to improve orientation.

Family Education: Supports caregivers in understanding and managing delirium behaviors.

Medication Treatments:

First-Line: Treat underlying cause (e.g., infection, electrolyte imbalance). For severe agitation: Low-dose antipsychotics (e.g., Haloperidol, Risperidone) used cautiously.

Second-Line: Benzodiazepines (e.g., Lorazepam) for delirium due to alcohol/sedative withdrawal, used sparingly.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for persistent agitation or when typical antipsychotics are contraindicated.

Major Neurocognitive Disorder (e.g., due to Alzheimer’s, Parkinson’s, etc.)

Symptoms: Significant cognitive decline in one or more domains (e.g., memory, executive function, language) interfering with independence in daily activities, caused by conditions like Alzheimer’s disease, Parkinson’s disease, or vascular dementia.

Common Psychotherapies:

Cognitive Stimulation Therapy (CST): Engages patients in structured activities to maintain cognitive function.

Behavioral Therapy: Manages behavioral and psychological symptoms (e.g., agitation, depression) through environmental and behavioral strategies.

Caregiver Support and Psychoeducation: Helps families manage symptoms and plan for long-term care.

Medication Treatments:

First-Line:

Alzheimer’s: Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine) or NMDA receptor antagonists (e.g., Memantine) to slow cognitive decline.

Parkinson’s-related dementia: Rivastigmine for cognitive symptoms.

Second-Line: SSRIs (e.g., Sertraline, Citalopram) for co-occurring depression or anxiety.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe agitation or psychosis, used cautiously due to risk in dementia patients.

Mild Neurocognitive Disorder

Symptoms: Modest cognitive decline in one or more domains (e.g., memory, attention) noticeable but not significantly interfering with independence, often a precursor to major neurocognitive disorders.

Common Psychotherapies:

Cognitive Training: Targets specific cognitive skills (e.g., memory, problem-solving) to maintain function.

Lifestyle Interventions: Promotes physical exercise, healthy diet, and social engagement to slow cognitive decline.

Psychoeducation: Educates patients and families on managing symptoms and reducing risk factors.

Medication Treatments:

First-Line: No medications specifically approved. For co-occurring depression or anxiety: SSRIs (e.g., Sertraline, Escitalopram).

Second-Line: Cholinesterase inhibitors (e.g., Donepezil) may be considered off-label in some cases, though evidence is limited.

Third-Line: Supplements (e.g., Vitamin E, Omega-3 fatty acids) or cognitive enhancers (e.g., Ginkgo biloba) for symptom management, with limited evidence.
Cluster A Personality Disorders

Paranoid Personality Disorder

Symptoms: Pervasive distrust and suspicion of others, interpreting motives as malevolent, leading to guardedness, hypervigilance, and reluctance to confide in others.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges mistrustful thoughts and builds coping strategies for interpersonal interactions.

Supportive Therapy: Fosters trust in therapeutic relationships to reduce paranoia.

Schema Therapy: Addresses deep-seated beliefs about others’ intentions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Low-dose antipsychotics (e.g., Risperidone) for severe paranoia or agitation, used cautiously.

Third-Line: Anxiolytics (e.g., Buspirone) for persistent anxiety.

Schizoid Personality Disorder

Symptoms: Detachment from social relationships, limited emotional expression, preference for solitary activities, and indifference to praise or criticism.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Enhances social skills and addresses barriers to forming relationships.

Psychodynamic Psychotherapy: Explores underlying reasons for emotional detachment.

Social Skills Training: Improves interpersonal engagement and communication.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring depression: SSRIs (e.g., Fluoxetine).

Second-Line: Atypical antipsychotics (e.g., Olanzapine) for co-occurring mild psychotic-like symptoms, if present.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring apathy or low energy, with limited evidence.

Schizotypal Personality Disorder

Symptoms: Eccentric behavior, odd beliefs or magical thinking, social anxiety, and perceptual distortions, with discomfort in close relationships and reduced capacity for social connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses distorted thinking and improves social functioning.

Social Skills Training: Enhances interpersonal interactions and reduces social anxiety.

Supportive Psychotherapy: Builds trust and helps manage eccentric behaviors.

Medication Treatments:

First-Line: Low-dose antipsychotics (e.g., Risperidone, Aripiprazole) for perceptual distortions or quasi-psychotic symptoms.

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Mood stabilizers (e.g., Lamotrigine) for emotional dysregulation or adjunctive anxiolytics (e.g., Clonazepam).

Cluster B Personality Disorders

Antisocial Personality Disorder

Symptoms: Disregard for and violation of others’ rights, impulsivity, deceitfulness, lack of remorse, and persistent rule-breaking, often beginning in adolescence.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets impulsivity and antisocial behaviors, promoting prosocial alternatives.

Mentalization-Based Therapy (MBT): Enhances empathy and understanding of others’ perspectives.

Contingency Management: Reinforces positive behaviors to reduce criminal or harmful actions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For aggression: Mood stabilizers (e.g., Lithium, Valproate).

Second-Line: SSRIs (e.g., Fluoxetine) for impulsivity or co-occurring depression.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe aggression or irritability.

Borderline Personality Disorder

Symptoms: Instability in relationships, self-image, and emotions, with impulsivity, fear of abandonment, recurrent suicidal behaviors, and intense anger or mood swings.

Common Psychotherapies:

Dialectical Behavior Therapy (DBT): Focuses on emotional regulation, distress tolerance, and interpersonal effectiveness.

Mentalization-Based Therapy (MBT): Improves understanding of self and others’ mental states.

Schema Therapy: Addresses maladaptive patterns rooted in early experiences.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Sertraline) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lamotrigine, Valproate) for emotional instability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for severe mood swings or paranoia.

Histrionic Personality Disorder

Symptoms: Excessive emotionality and attention-seeking behavior, discomfort when not the center of attention, and overly dramatic or sexually provocative interactions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges attention-seeking behaviors and promotes healthier emotional expression.

Psychodynamic Psychotherapy: Explores underlying needs for approval and attention.

Group Therapy: Provides feedback on interpersonal behaviors in a supportive setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Mood stabilizers (e.g., Carbamazepine) for emotional lability.

Third-Line: Low-dose antipsychotics (e.g., Olanzapine) for severe emotional dysregulation, used cautiously.

Narcissistic Personality Disorder

Symptoms: Grandiosity, need for admiration, lack of empathy, and hypersensitivity to criticism, often leading to arrogant behavior and exploitative relationships.

Common Psychotherapies:

Psychodynamic Psychotherapy: Explores underlying insecurities and need for admiration.

Cognitive-Behavioral Therapy (CBT): Challenges grandiose beliefs and promotes empathy.

Schema Therapy: Addresses maladaptive schemas related to self-worth and entitlement.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lithium) for irritability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe grandiosity or paranoia, used sparingly.

Cluster C Personality Disorders

Avoidant Personality Disorder

Symptoms: Extreme social inhibition, feelings of inadequacy, and hypersensitivity to rejection, leading to avoidance of social interactions despite a desire for connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets fears of rejection and builds social confidence.

Social Skills Training: Improves interpersonal interactions and reduces social anxiety.

Schema Therapy: Addresses core beliefs about inadequacy and rejection.

Medication Treatments:

First-Line: SSRIs (e.g., Sertraline, Paroxetine) to reduce social anxiety and depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) for persistent symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) or beta-blockers (e.g., Propranolol) for situational anxiety.

Dependent Personality Disorder

Symptoms: Excessive need to be cared for, submissive behavior, fear of separation, and difficulty making decisions without reassurance, leading to clingy or overly compliant relationships.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Promotes independence and challenges dependency-related thoughts.

Assertiveness Training: Enhances self-confidence and decision-making skills.

Psychodynamic Psychotherapy: Explores underlying fears of abandonment or autonomy.

Medication Treatments:

First-Line: SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Anxiolytics (e.g., Clonazepam) for severe anxiety, used short-term.

Third-Line: SNRIs (e.g., Duloxetine) for persistent depressive symptoms.

Obsessive-Compulsive Personality Disorder

Symptoms: Preoccupation with orderliness, perfectionism, and control, leading to rigidity, excessive devotion to work, and inflexibility, often at the expense of relationships or leisure.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges perfectionistic and rigid thinking patterns.

Psychodynamic Psychotherapy: Explores underlying needs for control and fear of mistakes.

Mindfulness-Based Therapy: Promotes flexibility and acceptance of imperfection.

Medication Treatments:

First-Line: SSRIs (e.g., Fluoxetine, Sertraline) for co-occurring anxiety or obsessive tendencies.

Second-Line: Clomipramine for severe perfectionism or obsessive traits.

Third-Line: Anxiolytics (e.g., Buspirone) or mood stabilizers (e.g., Lamotrigine) for emotional rigidity or irritability.

Symptoms: Challenges with social interaction, communication, and repetitive behaviors.

Common Psychotherapies:

Applied Behavior Analysis (ABA): Structured intervention to improve social, communication, and behavioral skills.

Social Skills Training: Enhances interpersonal interactions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety or emotional regulation.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability: Risperidone or Aripiprazole (FDA-approved ASD).

Second-Line: SSRIs (e.g., Fluoxetine) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms.
Symptoms: Inattention, hyperactivity, impulsivity inappropriate for age.

Common Psychotherapies:

Behavioral Therapy: Teaches organizational and coping skills.

Parent Training: Equips caregivers to manage behaviors.

CBT: Improves time management and emotional regulation in adults.

Medication Treatments:

First-Line: Stimulants (Methylphenidate, Amphetamine-based like Adderall).

Second-Line: Non-stimulants (Atomoxetine, Guanfacine).

Third-Line: Bupropion or Tricyclic Antidepressants for adults with co-occurring depression.
Symptoms: Vary by disorder; include cognitive limitations, speech/language difficulties, academic struggles, or motor tics.

Common Psychotherapies:

Behavioral Interventions: Tailored to specific deficits (e.g., speech therapy for communication disorders).

Educational Support: Individualized education plans (IEPs) for learning disorders.

Habit Reversal Training: For tic disorders.

Medication Treatments:

First-Line: Varies; e.g., Clonidine or Aripiprazole for tics; no primary medications for intellectual or learning disorders.

Second-Line: SSRIs for co-occurring anxiety (e.g., Sertraline).

Third-Line: Antipsychotics (e.g., Haloperidol) for severe tics.

Symptoms: Challenges with social interaction, communication, and repetitive behaviors.

Common Psychotherapies:

Applied Behavior Analysis (ABA): Structured intervention to improve social, communication, and behavioral skills.

Social Skills Training: Enhances interpersonal interactions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety or emotional regulation.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability: Risperidone or Aripiprazole (FDA-approved ASD).

Second-Line: SSRIs (e.g., Fluoxetine) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms.
Symptoms: Inattention, hyperactivity, impulsivity inappropriate for age.

Common Psychotherapies:

Behavioral Therapy: Teaches organizational and coping skills.

Parent Training: Equips caregivers to manage behaviors.

CBT: Improves time management and emotional regulation in adults.

Medication Treatments:

First-Line: Stimulants (Methylphenidate, Amphetamine-based like Adderall).

Second-Line: Non-stimulants (Atomoxetine, Guanfacine).

Third-Line: Bupropion or Tricyclic Antidepressants for adults with co-occurring depression.
Symptoms: Significant limitations in intellectual functioning (e.g., reasoning, problem-solving) and adaptive behavior (e.g., daily living skills, communication), typically identified before age 18.

Common Psychotherapies:

Behavioral Interventions: Tailored strategies to teach adaptive skills and reduce challenging behaviors.

Skills Training: Focuses on improving daily living, communication, and social skills.

Family Therapy: Supports caregivers in managing behaviors and fostering independence.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring behavioral issues (e.g., aggression): Risperidone or Aripiprazole (may be considered).

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) or non-stimulants (e.g., Atomoxetine) for co-occurring ADHD symptoms.
Symptoms: Difficulties with speech, language, or social communication, including articulation issues, fluency disorders (e.g., stuttering), or challenges understanding/expressing language.

Common Psychotherapies:

Speech-Language Therapy: Tailored interventions to improve articulation, language comprehension, and expression.

Social Communication Training: Enhances pragmatic language skills for better social interactions.

Cognitive-Behavioral Therapy (CBT): Addresses anxiety or emotional challenges related to communication difficulties.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety related to communication: SSRIs (e.g., Sertraline or Fluoxetine) may be considered.

Second-Line: Beta-blockers (e.g., Propranolol) for performance anxiety in specific situations (e.g., public speaking).

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting communication focus.
Symptoms: Involuntary tics, both motor (e.g., blinking, head jerking) and vocal (e.g., grunting, throat clearing), typically starting in childhood, often accompanied by co-occurring conditions like ADHD or OCD.

Common Psychotherapies:

Comprehensive Behavioral Intervention for Tics (CBIT): Teaches strategies to manage and reduce tics through habit reversal training.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, OCD, or emotional challenges.

Psychoeducation and Supportive Therapy: Helps individuals and families understand and cope with tics.

Medication Treatments:

First-Line: For significant tics: Alpha-2 agonists (e.g., Clonidine or Guanfacine) to reduce tic severity.

Second-Line: Antipsychotics (e.g., Risperidone, Aripiprazole) for severe tics not responding to first-line treatments.

Third-Line: SSRIs (e.g., Fluoxetine) for co-occurring OCD or anxiety; stimulants (e.g., Methylphenidate) for co-occurring ADHD, with caution due to potential tic exacerbation.
Symptoms: Hallucinations (e.g., hearing voices), delusions, disorganized thinking, negative symptoms (e.g., reduced emotions, motivation), and impaired social or occupational functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage hallucinations, delusions, and improves coping strategies.

Social Skills Training: Enhances interpersonal and daily living skills.

Family Therapy: Supports family education and communication to reduce stress and improve outcomes.

Medication Treatments:

First-Line: Antipsychotics (e.g., Risperidone, Olanzapine, Aripiprazole) to reduce positive symptoms like hallucinations and delusions.

Second-Line: Clozapine for treatment-resistant schizophrenia or severe symptoms not responding to other antipsychotics.

Third-Line: Adjunctive treatments like SSRIs (e.g., Sertraline) for co-occurring depression or anxiety; mood stabilizers (e.g., Lithium) for affective symptoms.
Symptoms: Extreme mood swings including manic episodes (e.g., elevated mood, increased energy, impulsivity) and depressive episodes (e.g., sadness, low energy, hopelessness), with potential for mixed episodes or rapid cycling.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage mood swings, identify triggers, and develop coping strategies.

Interpersonal and Social Rhythm Therapy (IPSRT): Stabilizes daily routines and improves interpersonal relationships to prevent mood episodes.

Family-Focused Therapy: Educates and supports families to enhance communication and reduce relapse risk.

Medication Treatments:

First-Line: Mood stabilizers (e.g., Lithium, Valproate, Carbamazepine) to prevent manic and depressive episodes; atypical antipsychotics (e.g., Quetiapine, Olanzapine) for acute mania or mixed episodes.

Second-Line: Antidepressants (e.g., Fluoxetine, Sertraline) for depressive episodes, typically combined with a mood stabilizer to prevent mania.

Third-Line: Adjunctive treatments like Lamotrigine for bipolar depression or Benzodiazepines (e.g., Lorazepam) for short-term management of agitation or insomnia.
Symptoms: Persistent sadness, loss of interest or pleasure, fatigue, feelings of worthlessness, difficulty concentrating, changes in sleep or appetite, and possible suicidal thoughts.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets negative thought patterns and behaviors to improve mood and coping skills.

Interpersonal Therapy (IPT): Focuses on improving relationships and addressing interpersonal issues contributing to depression.

Behavioral Activation: Encourages engagement in meaningful activities to counteract withdrawal and low motivation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) to alleviate depressive symptoms.

Second-Line: Atypical antidepressants (e.g., Bupropion, Mirtazapine) or tricyclic antidepressants (e.g., Amitriptyline) for non-responders to first-line treatments.

Third-Line: Monoamine oxidase inhibitors (MAOIs) (e.g., Phenelzine) or adjunctive treatments like Lithium or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant depression.

Treatment Resistant: Ketamine
Symptoms: Severe mood changes, sadness, irritability, anxiety, or hopelessness occurring in the luteal phase of the menstrual cycle (typically the week before menstruation) and resolving shortly after menstruation begins.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage negative thoughts and emotional responses tied to menstrual cycle changes.

Interpersonal Therapy (IPT): Addresses interpersonal conflicts or stressors that may exacerbate symptoms.

Mindfulness-Based Therapy: Promotes relaxation and emotional regulation to reduce symptom severity.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) taken continuously or during the luteal phase to alleviate depressive and anxiety symptoms.

Second-Line: Oral contraceptives (e.g., Ethinyl Estradiol/Drospirenone) to stabilize hormonal fluctuations and reduce mood symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) for anxiety or adjunctive treatments like Calcium supplements or Vitamin B6 for mild symptom relief.
Symptoms: Excessive, persistent worry about various aspects of life (e.g., work, health, relationships), accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets anxious thought patterns and behaviors to reduce worry and improve coping skills.

Acceptance and Commitment Therapy (ACT): Promotes mindfulness and value-based actions to manage anxiety.

Mindfulness-Based Stress Reduction (MBSR): Uses mindfulness techniques to reduce anxiety and enhance emotional regulation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) to reduce anxiety symptoms.

Second-Line: Buspirone for persistent anxiety or benzodiazepines (e.g., Lorazepam) for short-term relief of acute symptoms.

Third-Line: Tricyclic antidepressants (e.g., Imipramine) or adjunctive treatments like Pregabalin for treatment-resistant cases.
Symptoms: Recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety, often causing significant distress or interference with daily life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP): Gradually exposes individuals to obsessional triggers while preventing compulsive responses to reduce anxiety.

Acceptance and Commitment Therapy (ACT): Encourages acceptance of intrusive thoughts while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Promotes awareness and non-judgmental acceptance of thoughts to reduce compulsive behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) at higher doses to reduce obsessions and compulsions.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Risperidone, Aripiprazole) for treatment-resistant OCD or augmentation with glutamate modulators (e.g., Memantine).
Symptoms: Preoccupation with perceived flaws or defects in physical appearance (often minor or unnoticeable to others), leading to repetitive behaviors (e.g., mirror checking, excessive grooming) or mental acts (e.g., comparing appearance), causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about appearance and reduces compulsive behaviors through exposure and response prevention.

Acceptance and Commitment Therapy (ACT): Promotes acceptance of body image concerns while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Encourages non-judgmental awareness to reduce preoccupation with perceived flaws.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, Sertraline) to reduce obsessive thoughts and compulsive behaviors.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Aripiprazole, Risperidone) for treatment-resistant cases or severe symptoms.
Symptoms: Intrusive memories, flashbacks, or nightmares of a traumatic event, avoidance of trauma-related triggers, negative changes in mood or thinking (e.g., guilt, detachment), and heightened arousal (e.g., hypervigilance, irritability).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses trauma-related thoughts and behaviors through cognitive restructuring and exposure techniques.

Eye Movement Desensitization and Reprocessing (EMDR): Uses guided eye movements to process traumatic memories and reduce distress.

Prolonged Exposure Therapy (PE): Encourages gradual confrontation of trauma-related memories and situations to reduce avoidance.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Paroxetine) to reduce anxiety, depression, and intrusive symptoms.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) or atypical antidepressants (e.g., Mirtazapine) for non-responders.

Third-Line: Prazosin for trauma-related nightmares or adjunctive antipsychotics (e.g., Risperidone) for severe hyperarousal or treatment-resistant symptoms.
Symptoms: Emotional and behavioral symptoms (e.g., sadness, anxiety, irritability, or reckless behavior) in response to a specific stressor (e.g., life changes, loss, or trauma), occurring within three months of the stressor and causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps reframe negative thoughts and develop coping strategies to manage stress.

Solution-Focused Brief Therapy (SFBT): Focuses on identifying solutions and goals to address the specific stressor.

Supportive Psychotherapy: Provides emotional support and guidance to enhance resilience and problem-solving.

Medication Treatments:

First-Line: No medications specifically treat adjustment disorders. For significant anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) may be considered.

Second-Line: Benzodiazepines (e.g., Lorazepam) for short-term relief of acute anxiety, used cautiously due to dependency risk.

Third-Line: Atypical antidepressants (e.g., Trazodone) for sleep disturbances or mild depressive symptoms.
Symptoms: Disruptions in memory, identity, consciousness, or perception, including dissociative amnesia (inability to recall important personal information), depersonalization/derealization (feeling detached from self or reality), or dissociative identity disorder (presence of multiple distinct identities).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses underlying trauma and helps integrate dissociated experiences.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and grounding techniques to manage dissociative episodes.

Psychodynamic Psychotherapy: Explores unconscious conflicts and past trauma to foster integration of self and memories.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) may be considered.

Second-Line: Anxiolytics (e.g., Clonazepam) for short-term relief of acute anxiety or dissociative episodes, used cautiously.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe co-occurring symptoms like agitation or mood instability.
Symptoms: Excessive focus on physical symptoms (e.g., pain, fatigue) causing significant distress or impairment, often with disproportionate worry about their seriousness, despite minimal or no medical explanation.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses maladaptive thoughts about physical symptoms and reduces health-related anxiety.

Mindfulness-Based Therapy: Promotes acceptance of physical sensations and reduces symptom preoccupation.

Psychodynamic Psychotherapy: Explores underlying emotional conflicts contributing to physical complaints.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring anxiety or depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for persistent symptoms or pain-related complaints.

Third-Line: Low-dose tricyclic antidepressants (e.g., Amitriptyline) for somatic pain or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Anorexia Nervosa

Symptoms: Extreme weight loss, intense fear of gaining weight, distorted body image, and restrictive eating behaviors, often leading to severe physical complications (e.g., malnutrition, amenorrhea).

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about body image and food, promoting healthy eating behaviors.

Family-Based Therapy (FBT): Engages family to support weight restoration and healthy eating, particularly for adolescents.

Maudsley Approach: A family-based treatment focusing on parental involvement to restore weight and address psychological factors.

Medication Treatments:

First-Line: No medications directly treat core symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Atypical antipsychotics (e.g., Olanzapine) to address severe body image distortions or promote weight gain.

Third-Line: Anxiolytics (e.g., Lorazepam) for short-term management of anxiety related to eating or weight gain.

Bulimia Nervosa

Symptoms: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxative use, excessive exercise), with a preoccupation with body shape and weight.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on reducing binge-purge cycles and addressing distorted body image.

Interpersonal Psychotherapy (IPT): Targets interpersonal issues contributing to binge eating and purging behaviors.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation to reduce impulsive eating behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, FDA-approved for bulimia) to reduce binge-purge frequency.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for co-occurring depression or anxiety.

Third-Line: Anticonvulsants (e.g., Topiramate) to reduce binge eating or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Insomnia Disorder

Symptoms: Difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue, irritability, or impaired functioning, persisting for at least three nights per week for three months.

Common Psychotherapies:

Cognitive-Behavioral Therapy for Insomnia (CBT-I): Targets sleep-related thoughts and behaviors to improve sleep quality and duration.

Mindfulness-Based Therapy: Promotes relaxation and reduces pre-sleep anxiety.

Sleep Hygiene Education: Teaches habits to enhance sleep environment and routines.

Medication Treatments:

First-Line: Non-benzodiazepine hypnotics (e.g., Zolpidem, Eszopiclone) for short-term use to improve sleep onset or maintenance.

Second-Line: Melatonin receptor agonists (e.g., Ramelteon) or low-dose sedating antidepressants (e.g., Trazodone) for chronic insomnia.

Third-Line: Benzodiazepines (e.g., Lorazepam) for short-term use, cautiously due to dependency risk, or orexin receptor antagonists (e.g., Suvorexant).

Hypersomnolence Disorder

Symptoms: Excessive daytime sleepiness despite adequate sleep, with frequent naps that are unrefreshing, causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses behaviors and thoughts contributing to excessive sleepiness and improves sleep regulation.

Behavioral Activation: Encourages structured daily activities to reduce daytime napping.

Sleep Scheduling: Promotes consistent sleep-wake cycles to optimize alertness.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) to promote wakefulness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) for non-responders to first-line treatments.

Third-Line: Sodium oxybate for severe cases or adjunctive antidepressants (e.g., Bupropion) for co-occurring depression.

Narcolepsy

Symptoms: Excessive daytime sleepiness, sudden sleep attacks, and possible cataplexy (sudden muscle weakness triggered by emotions), hypnagogic hallucinations, or sleep paralysis.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Supports coping with symptoms and improves sleep-wake regulation.

Psychoeducation: Educates patients on managing narcolepsy and maintaining structured sleep schedules.

Supportive Therapy: Addresses emotional and social impacts of narcolepsy.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) for daytime sleepiness; sodium oxybate for cataplexy and sleepiness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) or antidepressants (e.g., Venlafaxine) for cataplexy.

Third-Line: Pitolisant (histamine H3 receptor antagonist) or solriamfetol for refractory sleepiness.

Restless Legs Syndrome

Symptoms: Uncomfortable sensations in the legs (e.g., crawling, tingling) with an urge to move, worsening at rest or at night, leading to sleep disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Manages stress and anxiety that may exacerbate symptoms.

Sleep Hygiene Education: Promotes routines to minimize sleep disruption.

Relaxation Techniques: Includes progressive muscle relaxation to reduce leg discomfort.

Medication Treatments:

First-Line: Dopamine agonists (e.g., Pramipexole, Ropinirole) to reduce leg sensations and improve sleep.

Second-Line: Gabapentinoids (e.g., Gabapentin, Pregabalin) for symptom relief, especially in painful cases.

Third-Line: Opioids (e.g., Oxycodone) for severe, refractory cases or iron supplementation for patients with low ferritin levels.
Symptoms: Significant distress or discomfort due to a mismatch between one’s gender identity and their assigned sex at birth, often accompanied by a desire to transition socially, physically, or legally to align with their gender identity.

Common Psychotherapies:

Gender-Affirming Psychotherapy: Supports exploration of gender identity, coping with distress, and navigating social or medical transitions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, depression, or social stressors related to gender dysphoria.

Supportive Therapy: Provides emotional support and guidance for individuals and families to foster acceptance and resilience.

Medication Treatments:

First-Line: Hormone Replacement Therapy (HRT) (e.g., Estrogen, Testosterone) for adults or adolescents (with consent and evaluation) to align physical characteristics with gender identity.

Second-Line: Gonadotropin-releasing hormone (GnRH) analogs (e.g., Leuprolide) for pubertal suppression in adolescents to delay puberty-related changes.

Third-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring depression or anxiety.
Oppositional Defiant Disorder

Symptoms: Persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures, causing significant impairment in social, academic, or family functioning.

Common Psychotherapies:

Parent Management Training (PMT): Teaches parents strategies to manage defiant behaviors and reinforce positive interactions.

Cognitive-Behavioral Therapy (CBT): Helps children develop anger management and problem-solving skills.

Family Therapy: Improves communication and reduces conflict within the family.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability or aggression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting behavior.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe aggression or irritability, used cautiously.

Intermittent Explosive Disorder

Symptoms: Recurrent, impulsive aggressive outbursts (verbal or physical) disproportionate to the situation, not explained by other disorders, causing distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on impulse control, anger management, and coping strategies.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and distress tolerance to reduce outbursts.

Group Therapy: Provides peer support and practice in managing aggressive impulses.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) to reduce impulsivity and aggression.

Second-Line: Mood stabilizers (e.g., Valproate, Carbamazepine) for severe outbursts.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant aggression.

Conduct Disorder

Symptoms: Persistent pattern of violating societal norms or others’ rights, including aggression toward people or animals, property destruction, deceitfulness, or serious rule-breaking, often before age 18.

Common Psychotherapies:

Multisystemic Therapy (MST): Addresses behavior across family, school, and community settings.

Cognitive-Behavioral Therapy (CBT): Targets antisocial behaviors and improves moral reasoning and impulse control.

Family Therapy: Enhances family dynamics and parental supervision to reduce delinquent behavior.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring aggression: Atypical antipsychotics (e.g., Risperidone) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD or mood stabilizers (e.g., Lithium) for severe aggression.

Third-Line: SSRIs (e.g., Sertraline) for co-occurring depression or impulsivity.

Pyromania

Symptoms: Deliberate and repeated fire-setting driven by fascination or gratification, not for monetary gain, revenge, or other motives, causing distress or risk.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses impulses to set fires and develops alternative coping mechanisms.

Behavioral Therapy: Uses reinforcement strategies to reduce fire-setting behaviors.

Psychodynamic Psychotherapy: Explores underlying emotional triggers for fire-setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring impulsivity or anxiety.

Second-Line: Mood stabilizers (e.g., Valproate) to reduce impulsive behaviors.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe impulsivity or co-occurring conditions.

Kleptomania

Symptoms: Recurrent, irresistible urges to steal items not needed for personal use or monetary value, followed by guilt or relief, not motivated by anger or delusions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets stealing impulses and develops strategies to resist urges.

Covert Sensitization: Pairs stealing impulses with negative imagery to reduce behavior.

Supportive Therapy: Addresses shame and guilt while fostering impulse control.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) to reduce impulsivity and obsessive urges.

Second-Line: Opioid antagonists (e.g., Naltrexone) to decrease urge-driven behaviors.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant impulsivity.
Cannabis Use Disorder

Symptoms: Problematic cannabis use leading to tolerance, withdrawal, unsuccessful attempts to quit, and significant impairment in social, occupational, or other functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets triggers for use and develops coping strategies to prevent relapse.

Motivational Enhancement Therapy (MET): Increases motivation to reduce or stop cannabis use.

Contingency Management: Provides rewards for abstinence to reinforce sobriety.

Medication Treatments:

First-Line: No FDA-approved medications for cannabis use disorder. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Off-label use of N-acetylcysteine or Gabapentin to reduce cravings.

Third-Line: Anxiolytics (e.g., Buspirone) for withdrawal-related anxiety or mood stabilizers (e.g., Valproate) for co-occurring mood instability.

Opioid Use Disorder

Symptoms: Compulsive opioid use, tolerance, withdrawal symptoms (e.g., nausea, muscle aches), and continued use despite harmful consequences.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses triggers and builds relapse prevention skills.

Motivational Interviewing: Enhances commitment to recovery and treatment adherence.

12-Step Facilitation Therapy: Supports engagement with programs like Narcotics Anonymous.

Medication Treatments:

First-Line: Medication-Assisted Treatment (MAT) with Methadone or Buprenorphine to reduce cravings and withdrawal.

Second-Line: Naltrexone (oral or injectable) to block opioid effects and prevent relapse.

Third-Line: Adjunctive SSRIs (e.g., Fluoxetine) for co-occurring depression or clonidine for acute withdrawal symptoms.

Stimulant Use Disorder

Symptoms: Problematic use of stimulants (e.g., cocaine, methamphetamine), leading to tolerance, cravings, withdrawal (e.g., fatigue, depression), and significant life disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on managing cravings and avoiding high-risk situations.

Contingency Management: Rewards abstinence to promote sustained recovery.

Matrix Model: Combines CBT, family education, and support groups for intensive treatment.

Medication Treatments:

First-Line: No FDA-approved medications. For co-occurring depression: SSRIs (e.g., Sertraline).

Second-Line: Off-label use of Bupropion or Modafinil to reduce cravings or improve energy during withdrawal.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for co-occurring agitation or psychosis.

Substance-Induced Disorders (e.g., Intoxication, Withdrawal)

Symptoms:

Intoxication: Reversible substance-specific effects (e.g., euphoria, sedation, agitation) varying by substance (e.g., alcohol, opioids, cannabis).

Withdrawal: Substance-specific symptoms (e.g., anxiety, tremors, seizures for alcohol; nausea, aches for opioids) after cessation or reduction of use.

Common Psychotherapies:

Supportive Therapy: Provides emotional support during acute intoxication or withdrawal phases.

Cognitive-Behavioral Therapy (CBT): Helps manage withdrawal-related distress and prevents relapse.

Motivational Enhancement Therapy (MET): Encourages commitment to detoxification and recovery.

Medication Treatments:

First-Line:

Alcohol Withdrawal: Benzodiazepines (e.g., Lorazepam, Diazepam) to manage seizures and agitation.

Opioid Withdrawal: Buprenorphine or Clonidine to alleviate symptoms.

Cannabis Withdrawal: Symptomatic treatment with anxiolytics (e.g., Buspirone).

Second-Line: Anticonvulsants (e.g., Carbamazepine) for alcohol withdrawal or beta-blockers (e.g., Propranolol) for stimulant withdrawal-related tachycardia.

Third-Line: Adjunctive antipsychotics (e.g., Quetiapine) for severe agitation or psychosis during intoxication/withdrawal.

Gambling Disorder

Symptoms: Persistent, problematic gambling behavior leading to preoccupation, increased risk-taking, chasing losses, and significant distress or impairment in personal, social, or occupational life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted beliefs about gambling and builds impulse control strategies.

Motivational Interviewing: Enhances motivation to reduce or stop gambling.

12-Step Facilitation (e.g., Gamblers Anonymous): Supports recovery through peer support and structured steps.

Medication Treatments:

First-Line: No FDA-approved medications. SSRIs (e.g., Fluvoxamine, Sertraline) for co-occurring anxiety or obsessive thoughts.

Second-Line: Opioid antagonists (e.g., Naltrexone) to reduce gambling urges.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Olanzapine) for co-occurring mood instability or impulsivity.
Delirium

Symptoms: Acute, fluctuating disturbances in attention, awareness, and cognition (e.g., memory deficits, disorientation), often developing rapidly and caused by underlying medical conditions, substance intoxication/withdrawal, or medication side effects.

Common Psychotherapies:

Supportive Therapy: Provides reassurance and orientation to reduce confusion and anxiety during acute episodes.

Environmental Interventions: Promotes a calm, structured environment with consistent cues to improve orientation.

Family Education: Supports caregivers in understanding and managing delirium behaviors.

Medication Treatments:

First-Line: Treat underlying cause (e.g., infection, electrolyte imbalance). For severe agitation: Low-dose antipsychotics (e.g., Haloperidol, Risperidone) used cautiously.

Second-Line: Benzodiazepines (e.g., Lorazepam) for delirium due to alcohol/sedative withdrawal, used sparingly.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for persistent agitation or when typical antipsychotics are contraindicated.

Major Neurocognitive Disorder (e.g., due to Alzheimer’s, Parkinson’s, etc.)

Symptoms: Significant cognitive decline in one or more domains (e.g., memory, executive function, language) interfering with independence in daily activities, caused by conditions like Alzheimer’s disease, Parkinson’s disease, or vascular dementia.

Common Psychotherapies:

Cognitive Stimulation Therapy (CST): Engages patients in structured activities to maintain cognitive function.

Behavioral Therapy: Manages behavioral and psychological symptoms (e.g., agitation, depression) through environmental and behavioral strategies.

Caregiver Support and Psychoeducation: Helps families manage symptoms and plan for long-term care.

Medication Treatments:

First-Line:

Alzheimer’s: Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine) or NMDA receptor antagonists (e.g., Memantine) to slow cognitive decline.

Parkinson’s-related dementia: Rivastigmine for cognitive symptoms.

Second-Line: SSRIs (e.g., Sertraline, Citalopram) for co-occurring depression or anxiety.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe agitation or psychosis, used cautiously due to risk in dementia patients.

Mild Neurocognitive Disorder

Symptoms: Modest cognitive decline in one or more domains (e.g., memory, attention) noticeable but not significantly interfering with independence, often a precursor to major neurocognitive disorders.

Common Psychotherapies:

Cognitive Training: Targets specific cognitive skills (e.g., memory, problem-solving) to maintain function.

Lifestyle Interventions: Promotes physical exercise, healthy diet, and social engagement to slow cognitive decline.

Psychoeducation: Educates patients and families on managing symptoms and reducing risk factors.

Medication Treatments:

First-Line: No medications specifically approved. For co-occurring depression or anxiety: SSRIs (e.g., Sertraline, Escitalopram).

Second-Line: Cholinesterase inhibitors (e.g., Donepezil) may be considered off-label in some cases, though evidence is limited.

Third-Line: Supplements (e.g., Vitamin E, Omega-3 fatty acids) or cognitive enhancers (e.g., Ginkgo biloba) for symptom management, with limited evidence.
Cluster A Personality Disorders

Paranoid Personality Disorder

Symptoms: Pervasive distrust and suspicion of others, interpreting motives as malevolent, leading to guardedness, hypervigilance, and reluctance to confide in others.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges mistrustful thoughts and builds coping strategies for interpersonal interactions.

Supportive Therapy: Fosters trust in therapeutic relationships to reduce paranoia.

Schema Therapy: Addresses deep-seated beliefs about others’ intentions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Low-dose antipsychotics (e.g., Risperidone) for severe paranoia or agitation, used cautiously.

Third-Line: Anxiolytics (e.g., Buspirone) for persistent anxiety.

Schizoid Personality Disorder

Symptoms: Detachment from social relationships, limited emotional expression, preference for solitary activities, and indifference to praise or criticism.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Enhances social skills and addresses barriers to forming relationships.

Psychodynamic Psychotherapy: Explores underlying reasons for emotional detachment.

Social Skills Training: Improves interpersonal engagement and communication.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring depression: SSRIs (e.g., Fluoxetine).

Second-Line: Atypical antipsychotics (e.g., Olanzapine) for co-occurring mild psychotic-like symptoms, if present.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring apathy or low energy, with limited evidence.

Schizotypal Personality Disorder

Symptoms: Eccentric behavior, odd beliefs or magical thinking, social anxiety, and perceptual distortions, with discomfort in close relationships and reduced capacity for social connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses distorted thinking and improves social functioning.

Social Skills Training: Enhances interpersonal interactions and reduces social anxiety.

Supportive Psychotherapy: Builds trust and helps manage eccentric behaviors.

Medication Treatments:

First-Line: Low-dose antipsychotics (e.g., Risperidone, Aripiprazole) for perceptual distortions or quasi-psychotic symptoms.

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Mood stabilizers (e.g., Lamotrigine) for emotional dysregulation or adjunctive anxiolytics (e.g., Clonazepam).

Cluster B Personality Disorders

Antisocial Personality Disorder

Symptoms: Disregard for and violation of others’ rights, impulsivity, deceitfulness, lack of remorse, and persistent rule-breaking, often beginning in adolescence.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets impulsivity and antisocial behaviors, promoting prosocial alternatives.

Mentalization-Based Therapy (MBT): Enhances empathy and understanding of others’ perspectives.

Contingency Management: Reinforces positive behaviors to reduce criminal or harmful actions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For aggression: Mood stabilizers (e.g., Lithium, Valproate).

Second-Line: SSRIs (e.g., Fluoxetine) for impulsivity or co-occurring depression.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe aggression or irritability.

Borderline Personality Disorder

Symptoms: Instability in relationships, self-image, and emotions, with impulsivity, fear of abandonment, recurrent suicidal behaviors, and intense anger or mood swings.

Common Psychotherapies:

Dialectical Behavior Therapy (DBT): Focuses on emotional regulation, distress tolerance, and interpersonal effectiveness.

Mentalization-Based Therapy (MBT): Improves understanding of self and others’ mental states.

Schema Therapy: Addresses maladaptive patterns rooted in early experiences.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Sertraline) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lamotrigine, Valproate) for emotional instability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for severe mood swings or paranoia.

Histrionic Personality Disorder

Symptoms: Excessive emotionality and attention-seeking behavior, discomfort when not the center of attention, and overly dramatic or sexually provocative interactions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges attention-seeking behaviors and promotes healthier emotional expression.

Psychodynamic Psychotherapy: Explores underlying needs for approval and attention.

Group Therapy: Provides feedback on interpersonal behaviors in a supportive setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Mood stabilizers (e.g., Carbamazepine) for emotional lability.

Third-Line: Low-dose antipsychotics (e.g., Olanzapine) for severe emotional dysregulation, used cautiously.

Narcissistic Personality Disorder

Symptoms: Grandiosity, need for admiration, lack of empathy, and hypersensitivity to criticism, often leading to arrogant behavior and exploitative relationships.

Common Psychotherapies:

Psychodynamic Psychotherapy: Explores underlying insecurities and need for admiration.

Cognitive-Behavioral Therapy (CBT): Challenges grandiose beliefs and promotes empathy.

Schema Therapy: Addresses maladaptive schemas related to self-worth and entitlement.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lithium) for irritability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe grandiosity or paranoia, used sparingly.

Cluster C Personality Disorders

Avoidant Personality Disorder

Symptoms: Extreme social inhibition, feelings of inadequacy, and hypersensitivity to rejection, leading to avoidance of social interactions despite a desire for connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets fears of rejection and builds social confidence.

Social Skills Training: Improves interpersonal interactions and reduces social anxiety.

Schema Therapy: Addresses core beliefs about inadequacy and rejection.

Medication Treatments:

First-Line: SSRIs (e.g., Sertraline, Paroxetine) to reduce social anxiety and depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) for persistent symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) or beta-blockers (e.g., Propranolol) for situational anxiety.

Dependent Personality Disorder

Symptoms: Excessive need to be cared for, submissive behavior, fear of separation, and difficulty making decisions without reassurance, leading to clingy or overly compliant relationships.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Promotes independence and challenges dependency-related thoughts.

Assertiveness Training: Enhances self-confidence and decision-making skills.

Psychodynamic Psychotherapy: Explores underlying fears of abandonment or autonomy.

Medication Treatments:

First-Line: SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Anxiolytics (e.g., Clonazepam) for severe anxiety, used short-term.

Third-Line: SNRIs (e.g., Duloxetine) for persistent depressive symptoms.

Obsessive-Compulsive Personality Disorder

Symptoms: Preoccupation with orderliness, perfectionism, and control, leading to rigidity, excessive devotion to work, and inflexibility, often at the expense of relationships or leisure.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges perfectionistic and rigid thinking patterns.

Psychodynamic Psychotherapy: Explores underlying needs for control and fear of mistakes.

Mindfulness-Based Therapy: Promotes flexibility and acceptance of imperfection.

Medication Treatments:

First-Line: SSRIs (e.g., Fluoxetine, Sertraline) for co-occurring anxiety or obsessive tendencies.

Second-Line: Clomipramine for severe perfectionism or obsessive traits.

Third-Line: Anxiolytics (e.g., Buspirone) or mood stabilizers (e.g., Lamotrigine) for emotional rigidity or irritability.

Symptoms: Challenges with social interaction, communication, and repetitive behaviors.

Common Psychotherapies:

Applied Behavior Analysis (ABA): Structured intervention to improve social, communication, and behavioral skills.

Social Skills Training: Enhances interpersonal interactions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety or emotional regulation.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability: Risperidone or Aripiprazole (FDA-approved ASD).

Second-Line: SSRIs (e.g., Fluoxetine) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms.
Symptoms: Inattention, hyperactivity, impulsivity inappropriate for age.

Common Psychotherapies:

Behavioral Therapy: Teaches organizational and coping skills.

Parent Training: Equips caregivers to manage behaviors.

CBT: Improves time management and emotional regulation in adults.

Medication Treatments:

First-Line: Stimulants (Methylphenidate, Amphetamine-based like Adderall).

Second-Line: Non-stimulants (Atomoxetine, Guanfacine).

Third-Line: Bupropion or Tricyclic Antidepressants for adults with co-occurring depression.
Symptoms: Significant limitations in intellectual functioning (e.g., reasoning, problem-solving) and adaptive behavior (e.g., daily living skills, communication), typically identified before age 18.

Common Psychotherapies:

Behavioral Interventions: Tailored strategies to teach adaptive skills and reduce challenging behaviors.

Skills Training: Focuses on improving daily living, communication, and social skills.

Family Therapy: Supports caregivers in managing behaviors and fostering independence.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring behavioral issues (e.g., aggression): Risperidone or Aripiprazole (may be considered).

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) or non-stimulants (e.g., Atomoxetine) for co-occurring ADHD symptoms.
Symptoms: Difficulties with speech, language, or social communication, including articulation issues, fluency disorders (e.g., stuttering), or challenges understanding/expressing language.

Common Psychotherapies:

Speech-Language Therapy: Tailored interventions to improve articulation, language comprehension, and expression.

Social Communication Training: Enhances pragmatic language skills for better social interactions.

Cognitive-Behavioral Therapy (CBT): Addresses anxiety or emotional challenges related to communication difficulties.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety related to communication: SSRIs (e.g., Sertraline or Fluoxetine) may be considered.

Second-Line: Beta-blockers (e.g., Propranolol) for performance anxiety in specific situations (e.g., public speaking).

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting communication focus.
Symptoms: Involuntary tics, both motor (e.g., blinking, head jerking) and vocal (e.g., grunting, throat clearing), typically starting in childhood, often accompanied by co-occurring conditions like ADHD or OCD.

Common Psychotherapies:

Comprehensive Behavioral Intervention for Tics (CBIT): Teaches strategies to manage and reduce tics through habit reversal training.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, OCD, or emotional challenges.

Psychoeducation and Supportive Therapy: Helps individuals and families understand and cope with tics.

Medication Treatments:

First-Line: For significant tics: Alpha-2 agonists (e.g., Clonidine or Guanfacine) to reduce tic severity.

Second-Line: Antipsychotics (e.g., Risperidone, Aripiprazole) for severe tics not responding to first-line treatments.

Third-Line: SSRIs (e.g., Fluoxetine) for co-occurring OCD or anxiety; stimulants (e.g., Methylphenidate) for co-occurring ADHD, with caution due to potential tic exacerbation.
Symptoms: Hallucinations (e.g., hearing voices), delusions, disorganized thinking, negative symptoms (e.g., reduced emotions, motivation), and impaired social or occupational functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage hallucinations, delusions, and improves coping strategies.

Social Skills Training: Enhances interpersonal and daily living skills.

Family Therapy: Supports family education and communication to reduce stress and improve outcomes.

Medication Treatments:

First-Line: Antipsychotics (e.g., Risperidone, Olanzapine, Aripiprazole) to reduce positive symptoms like hallucinations and delusions.

Second-Line: Clozapine for treatment-resistant schizophrenia or severe symptoms not responding to other antipsychotics.

Third-Line: Adjunctive treatments like SSRIs (e.g., Sertraline) for co-occurring depression or anxiety; mood stabilizers (e.g., Lithium) for affective symptoms.
Symptoms: Extreme mood swings including manic episodes (e.g., elevated mood, increased energy, impulsivity) and depressive episodes (e.g., sadness, low energy, hopelessness), with potential for mixed episodes or rapid cycling.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage mood swings, identify triggers, and develop coping strategies.

Interpersonal and Social Rhythm Therapy (IPSRT): Stabilizes daily routines and improves interpersonal relationships to prevent mood episodes.

Family-Focused Therapy: Educates and supports families to enhance communication and reduce relapse risk.

Medication Treatments:

First-Line: Mood stabilizers (e.g., Lithium, Valproate, Carbamazepine) to prevent manic and depressive episodes; atypical antipsychotics (e.g., Quetiapine, Olanzapine) for acute mania or mixed episodes.

Second-Line: Antidepressants (e.g., Fluoxetine, Sertraline) for depressive episodes, typically combined with a mood stabilizer to prevent mania.

Third-Line: Adjunctive treatments like Lamotrigine for bipolar depression or Benzodiazepines (e.g., Lorazepam) for short-term management of agitation or insomnia.
Symptoms: Persistent sadness, loss of interest or pleasure, fatigue, feelings of worthlessness, difficulty concentrating, changes in sleep or appetite, and possible suicidal thoughts.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets negative thought patterns and behaviors to improve mood and coping skills.

Interpersonal Therapy (IPT): Focuses on improving relationships and addressing interpersonal issues contributing to depression.

Behavioral Activation: Encourages engagement in meaningful activities to counteract withdrawal and low motivation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) to alleviate depressive symptoms.

Second-Line: Atypical antidepressants (e.g., Bupropion, Mirtazapine) or tricyclic antidepressants (e.g., Amitriptyline) for non-responders to first-line treatments.

Third-Line: Monoamine oxidase inhibitors (MAOIs) (e.g., Phenelzine) or adjunctive treatments like Lithium or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant depression.

Treatment Resistant: Ketamine
Symptoms: Severe mood changes, sadness, irritability, anxiety, or hopelessness occurring in the luteal phase of the menstrual cycle (typically the week before menstruation) and resolving shortly after menstruation begins.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage negative thoughts and emotional responses tied to menstrual cycle changes.

Interpersonal Therapy (IPT): Addresses interpersonal conflicts or stressors that may exacerbate symptoms.

Mindfulness-Based Therapy: Promotes relaxation and emotional regulation to reduce symptom severity.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) taken continuously or during the luteal phase to alleviate depressive and anxiety symptoms.

Second-Line: Oral contraceptives (e.g., Ethinyl Estradiol/Drospirenone) to stabilize hormonal fluctuations and reduce mood symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) for anxiety or adjunctive treatments like Calcium supplements or Vitamin B6 for mild symptom relief.
Symptoms: Excessive, persistent worry about various aspects of life (e.g., work, health, relationships), accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets anxious thought patterns and behaviors to reduce worry and improve coping skills.

Acceptance and Commitment Therapy (ACT): Promotes mindfulness and value-based actions to manage anxiety.

Mindfulness-Based Stress Reduction (MBSR): Uses mindfulness techniques to reduce anxiety and enhance emotional regulation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) to reduce anxiety symptoms.

Second-Line: Buspirone for persistent anxiety or benzodiazepines (e.g., Lorazepam) for short-term relief of acute symptoms.

Third-Line: Tricyclic antidepressants (e.g., Imipramine) or adjunctive treatments like Pregabalin for treatment-resistant cases.
Symptoms: Recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety, often causing significant distress or interference with daily life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP): Gradually exposes individuals to obsessional triggers while preventing compulsive responses to reduce anxiety.

Acceptance and Commitment Therapy (ACT): Encourages acceptance of intrusive thoughts while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Promotes awareness and non-judgmental acceptance of thoughts to reduce compulsive behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) at higher doses to reduce obsessions and compulsions.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Risperidone, Aripiprazole) for treatment-resistant OCD or augmentation with glutamate modulators (e.g., Memantine).
Symptoms: Preoccupation with perceived flaws or defects in physical appearance (often minor or unnoticeable to others), leading to repetitive behaviors (e.g., mirror checking, excessive grooming) or mental acts (e.g., comparing appearance), causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about appearance and reduces compulsive behaviors through exposure and response prevention.

Acceptance and Commitment Therapy (ACT): Promotes acceptance of body image concerns while focusing on value-driven actions.

Mindfulness-Based Cognitive Therapy (MBCT): Encourages non-judgmental awareness to reduce preoccupation with perceived flaws.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, Sertraline) to reduce obsessive thoughts and compulsive behaviors.

Second-Line: Clomipramine (a tricyclic antidepressant) for individuals not responding to SSRIs.

Third-Line: Adjunctive antipsychotics (e.g., Aripiprazole, Risperidone) for treatment-resistant cases or severe symptoms.
Symptoms: Intrusive memories, flashbacks, or nightmares of a traumatic event, avoidance of trauma-related triggers, negative changes in mood or thinking (e.g., guilt, detachment), and heightened arousal (e.g., hypervigilance, irritability).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses trauma-related thoughts and behaviors through cognitive restructuring and exposure techniques.

Eye Movement Desensitization and Reprocessing (EMDR): Uses guided eye movements to process traumatic memories and reduce distress.

Prolonged Exposure Therapy (PE): Encourages gradual confrontation of trauma-related memories and situations to reduce avoidance.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Paroxetine) to reduce anxiety, depression, and intrusive symptoms.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) or atypical antidepressants (e.g., Mirtazapine) for non-responders.

Third-Line: Prazosin for trauma-related nightmares or adjunctive antipsychotics (e.g., Risperidone) for severe hyperarousal or treatment-resistant symptoms.
Symptoms: Emotional and behavioral symptoms (e.g., sadness, anxiety, irritability, or reckless behavior) in response to a specific stressor (e.g., life changes, loss, or trauma), occurring within three months of the stressor and causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps reframe negative thoughts and develop coping strategies to manage stress.

Solution-Focused Brief Therapy (SFBT): Focuses on identifying solutions and goals to address the specific stressor.

Supportive Psychotherapy: Provides emotional support and guidance to enhance resilience and problem-solving.

Medication Treatments:

First-Line: No medications specifically treat adjustment disorders. For significant anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Escitalopram) may be considered.

Second-Line: Benzodiazepines (e.g., Lorazepam) for short-term relief of acute anxiety, used cautiously due to dependency risk.

Third-Line: Atypical antidepressants (e.g., Trazodone) for sleep disturbances or mild depressive symptoms.
Symptoms: Disruptions in memory, identity, consciousness, or perception, including dissociative amnesia (inability to recall important personal information), depersonalization/derealization (feeling detached from self or reality), or dissociative identity disorder (presence of multiple distinct identities).

Common Psychotherapies:

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Addresses underlying trauma and helps integrate dissociated experiences.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and grounding techniques to manage dissociative episodes.

Psychodynamic Psychotherapy: Explores unconscious conflicts and past trauma to foster integration of self and memories.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) may be considered.

Second-Line: Anxiolytics (e.g., Clonazepam) for short-term relief of acute anxiety or dissociative episodes, used cautiously.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe co-occurring symptoms like agitation or mood instability.
Symptoms: Excessive focus on physical symptoms (e.g., pain, fatigue) causing significant distress or impairment, often with disproportionate worry about their seriousness, despite minimal or no medical explanation.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses maladaptive thoughts about physical symptoms and reduces health-related anxiety.

Mindfulness-Based Therapy: Promotes acceptance of physical sensations and reduces symptom preoccupation.

Psychodynamic Psychotherapy: Explores underlying emotional conflicts contributing to physical complaints.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring anxiety or depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for persistent symptoms or pain-related complaints.

Third-Line: Low-dose tricyclic antidepressants (e.g., Amitriptyline) for somatic pain or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Anorexia Nervosa

Symptoms: Extreme weight loss, intense fear of gaining weight, distorted body image, and restrictive eating behaviors, often leading to severe physical complications (e.g., malnutrition, amenorrhea).

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about body image and food, promoting healthy eating behaviors.

Family-Based Therapy (FBT): Engages family to support weight restoration and healthy eating, particularly for adolescents.

Maudsley Approach: A family-based treatment focusing on parental involvement to restore weight and address psychological factors.

Medication Treatments:

First-Line: No medications directly treat core symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Atypical antipsychotics (e.g., Olanzapine) to address severe body image distortions or promote weight gain.

Third-Line: Anxiolytics (e.g., Lorazepam) for short-term management of anxiety related to eating or weight gain.

Bulimia Nervosa

Symptoms: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxative use, excessive exercise), with a preoccupation with body shape and weight.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on reducing binge-purge cycles and addressing distorted body image.

Interpersonal Psychotherapy (IPT): Targets interpersonal issues contributing to binge eating and purging behaviors.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation to reduce impulsive eating behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, FDA-approved for bulimia) to reduce binge-purge frequency.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for co-occurring depression or anxiety.

Third-Line: Anticonvulsants (e.g., Topiramate) to reduce binge eating or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.
Insomnia Disorder

Symptoms: Difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue, irritability, or impaired functioning, persisting for at least three nights per week for three months.

Common Psychotherapies:

Cognitive-Behavioral Therapy for Insomnia (CBT-I): Targets sleep-related thoughts and behaviors to improve sleep quality and duration.

Mindfulness-Based Therapy: Promotes relaxation and reduces pre-sleep anxiety.

Sleep Hygiene Education: Teaches habits to enhance sleep environment and routines.

Medication Treatments:

First-Line: Non-benzodiazepine hypnotics (e.g., Zolpidem, Eszopiclone) for short-term use to improve sleep onset or maintenance.

Second-Line: Melatonin receptor agonists (e.g., Ramelteon) or low-dose sedating antidepressants (e.g., Trazodone) for chronic insomnia.

Third-Line: Benzodiazepines (e.g., Lorazepam) for short-term use, cautiously due to dependency risk, or orexin receptor antagonists (e.g., Suvorexant).

Hypersomnolence Disorder

Symptoms: Excessive daytime sleepiness despite adequate sleep, with frequent naps that are unrefreshing, causing significant distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses behaviors and thoughts contributing to excessive sleepiness and improves sleep regulation.

Behavioral Activation: Encourages structured daily activities to reduce daytime napping.

Sleep Scheduling: Promotes consistent sleep-wake cycles to optimize alertness.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) to promote wakefulness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) for non-responders to first-line treatments.

Third-Line: Sodium oxybate for severe cases or adjunctive antidepressants (e.g., Bupropion) for co-occurring depression.

Narcolepsy

Symptoms: Excessive daytime sleepiness, sudden sleep attacks, and possible cataplexy (sudden muscle weakness triggered by emotions), hypnagogic hallucinations, or sleep paralysis.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Supports coping with symptoms and improves sleep-wake regulation.

Psychoeducation: Educates patients on managing narcolepsy and maintaining structured sleep schedules.

Supportive Therapy: Addresses emotional and social impacts of narcolepsy.

Medication Treatments:

First-Line: Stimulants (e.g., Modafinil, Armodafinil) for daytime sleepiness; sodium oxybate for cataplexy and sleepiness.

Second-Line: Amphetamine-based stimulants (e.g., Methylphenidate) or antidepressants (e.g., Venlafaxine) for cataplexy.

Third-Line: Pitolisant (histamine H3 receptor antagonist) or solriamfetol for refractory sleepiness.

Restless Legs Syndrome

Symptoms: Uncomfortable sensations in the legs (e.g., crawling, tingling) with an urge to move, worsening at rest or at night, leading to sleep disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Manages stress and anxiety that may exacerbate symptoms.

Sleep Hygiene Education: Promotes routines to minimize sleep disruption.

Relaxation Techniques: Includes progressive muscle relaxation to reduce leg discomfort.

Medication Treatments:

First-Line: Dopamine agonists (e.g., Pramipexole, Ropinirole) to reduce leg sensations and improve sleep.

Second-Line: Gabapentinoids (e.g., Gabapentin, Pregabalin) for symptom relief, especially in painful cases.

Third-Line: Opioids (e.g., Oxycodone) for severe, refractory cases or iron supplementation for patients with low ferritin levels.
Symptoms: Significant distress or discomfort due to a mismatch between one’s gender identity and their assigned sex at birth, often accompanied by a desire to transition socially, physically, or legally to align with their gender identity.

Common Psychotherapies:

Gender-Affirming Psychotherapy: Supports exploration of gender identity, coping with distress, and navigating social or medical transitions.

Cognitive-Behavioral Therapy (CBT): Addresses co-occurring anxiety, depression, or social stressors related to gender dysphoria.

Supportive Therapy: Provides emotional support and guidance for individuals and families to foster acceptance and resilience.

Medication Treatments:

First-Line: Hormone Replacement Therapy (HRT) (e.g., Estrogen, Testosterone) for adults or adolescents (with consent and evaluation) to align physical characteristics with gender identity.

Second-Line: Gonadotropin-releasing hormone (GnRH) analogs (e.g., Leuprolide) for pubertal suppression in adolescents to delay puberty-related changes.

Third-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) for co-occurring depression or anxiety.
Oppositional Defiant Disorder

Symptoms: Persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures, causing significant impairment in social, academic, or family functioning.

Common Psychotherapies:

Parent Management Training (PMT): Teaches parents strategies to manage defiant behaviors and reinforce positive interactions.

Cognitive-Behavioral Therapy (CBT): Helps children develop anger management and problem-solving skills.

Family Therapy: Improves communication and reduces conflict within the family.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring irritability or aggression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD symptoms impacting behavior.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe aggression or irritability, used cautiously.

Intermittent Explosive Disorder

Symptoms: Recurrent, impulsive aggressive outbursts (verbal or physical) disproportionate to the situation, not explained by other disorders, causing distress or impairment.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on impulse control, anger management, and coping strategies.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation and distress tolerance to reduce outbursts.

Group Therapy: Provides peer support and practice in managing aggressive impulses.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) to reduce impulsivity and aggression.

Second-Line: Mood stabilizers (e.g., Valproate, Carbamazepine) for severe outbursts.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant aggression.

Conduct Disorder

Symptoms: Persistent pattern of violating societal norms or others’ rights, including aggression toward people or animals, property destruction, deceitfulness, or serious rule-breaking, often before age 18.

Common Psychotherapies:

Multisystemic Therapy (MST): Addresses behavior across family, school, and community settings.

Cognitive-Behavioral Therapy (CBT): Targets antisocial behaviors and improves moral reasoning and impulse control.

Family Therapy: Enhances family dynamics and parental supervision to reduce delinquent behavior.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring aggression: Atypical antipsychotics (e.g., Risperidone) may be considered.

Second-Line: Stimulants (e.g., Methylphenidate) for co-occurring ADHD or mood stabilizers (e.g., Lithium) for severe aggression.

Third-Line: SSRIs (e.g., Sertraline) for co-occurring depression or impulsivity.

Pyromania

Symptoms: Deliberate and repeated fire-setting driven by fascination or gratification, not for monetary gain, revenge, or other motives, causing distress or risk.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses impulses to set fires and develops alternative coping mechanisms.

Behavioral Therapy: Uses reinforcement strategies to reduce fire-setting behaviors.

Psychodynamic Psychotherapy: Explores underlying emotional triggers for fire-setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring impulsivity or anxiety.

Second-Line: Mood stabilizers (e.g., Valproate) to reduce impulsive behaviors.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe impulsivity or co-occurring conditions.

Kleptomania

Symptoms: Recurrent, irresistible urges to steal items not needed for personal use or monetary value, followed by guilt or relief, not motivated by anger or delusions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets stealing impulses and develops strategies to resist urges.

Covert Sensitization: Pairs stealing impulses with negative imagery to reduce behavior.

Supportive Therapy: Addresses shame and guilt while fostering impulse control.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline) to reduce impulsivity and obsessive urges.

Second-Line: Opioid antagonists (e.g., Naltrexone) to decrease urge-driven behaviors.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant impulsivity.
Cannabis Use Disorder

Symptoms: Problematic cannabis use leading to tolerance, withdrawal, unsuccessful attempts to quit, and significant impairment in social, occupational, or other functioning.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets triggers for use and develops coping strategies to prevent relapse.

Motivational Enhancement Therapy (MET): Increases motivation to reduce or stop cannabis use.

Contingency Management: Provides rewards for abstinence to reinforce sobriety.

Medication Treatments:

First-Line: No FDA-approved medications for cannabis use disorder. For co-occurring anxiety or depression: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Off-label use of N-acetylcysteine or Gabapentin to reduce cravings.

Third-Line: Anxiolytics (e.g., Buspirone) for withdrawal-related anxiety or mood stabilizers (e.g., Valproate) for co-occurring mood instability.

Opioid Use Disorder

Symptoms: Compulsive opioid use, tolerance, withdrawal symptoms (e.g., nausea, muscle aches), and continued use despite harmful consequences.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses triggers and builds relapse prevention skills.

Motivational Interviewing: Enhances commitment to recovery and treatment adherence.

12-Step Facilitation Therapy: Supports engagement with programs like Narcotics Anonymous.

Medication Treatments:

First-Line: Medication-Assisted Treatment (MAT) with Methadone or Buprenorphine to reduce cravings and withdrawal.

Second-Line: Naltrexone (oral or injectable) to block opioid effects and prevent relapse.

Third-Line: Adjunctive SSRIs (e.g., Fluoxetine) for co-occurring depression or clonidine for acute withdrawal symptoms.

Stimulant Use Disorder

Symptoms: Problematic use of stimulants (e.g., cocaine, methamphetamine), leading to tolerance, cravings, withdrawal (e.g., fatigue, depression), and significant life disruption.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on managing cravings and avoiding high-risk situations.

Contingency Management: Rewards abstinence to promote sustained recovery.

Matrix Model: Combines CBT, family education, and support groups for intensive treatment.

Medication Treatments:

First-Line: No FDA-approved medications. For co-occurring depression: SSRIs (e.g., Sertraline).

Second-Line: Off-label use of Bupropion or Modafinil to reduce cravings or improve energy during withdrawal.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for co-occurring agitation or psychosis.

Substance-Induced Disorders (e.g., Intoxication, Withdrawal)

Symptoms:

Intoxication: Reversible substance-specific effects (e.g., euphoria, sedation, agitation) varying by substance (e.g., alcohol, opioids, cannabis).

Withdrawal: Substance-specific symptoms (e.g., anxiety, tremors, seizures for alcohol; nausea, aches for opioids) after cessation or reduction of use.

Common Psychotherapies:

Supportive Therapy: Provides emotional support during acute intoxication or withdrawal phases.

Cognitive-Behavioral Therapy (CBT): Helps manage withdrawal-related distress and prevents relapse.

Motivational Enhancement Therapy (MET): Encourages commitment to detoxification and recovery.

Medication Treatments:

First-Line:

Alcohol Withdrawal: Benzodiazepines (e.g., Lorazepam, Diazepam) to manage seizures and agitation.

Opioid Withdrawal: Buprenorphine or Clonidine to alleviate symptoms.

Cannabis Withdrawal: Symptomatic treatment with anxiolytics (e.g., Buspirone).

Second-Line: Anticonvulsants (e.g., Carbamazepine) for alcohol withdrawal or beta-blockers (e.g., Propranolol) for stimulant withdrawal-related tachycardia.

Third-Line: Adjunctive antipsychotics (e.g., Quetiapine) for severe agitation or psychosis during intoxication/withdrawal.

Gambling Disorder

Symptoms: Persistent, problematic gambling behavior leading to preoccupation, increased risk-taking, chasing losses, and significant distress or impairment in personal, social, or occupational life.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted beliefs about gambling and builds impulse control strategies.

Motivational Interviewing: Enhances motivation to reduce or stop gambling.

12-Step Facilitation (e.g., Gamblers Anonymous): Supports recovery through peer support and structured steps.

Medication Treatments:

First-Line: No FDA-approved medications. SSRIs (e.g., Fluvoxamine, Sertraline) for co-occurring anxiety or obsessive thoughts.

Second-Line: Opioid antagonists (e.g., Naltrexone) to reduce gambling urges.

Third-Line: Mood stabilizers (e.g., Lithium) or atypical antipsychotics (e.g., Olanzapine) for co-occurring mood instability or impulsivity.
Delirium

Symptoms: Acute, fluctuating disturbances in attention, awareness, and cognition (e.g., memory deficits, disorientation), often developing rapidly and caused by underlying medical conditions, substance intoxication/withdrawal, or medication side effects.

Common Psychotherapies:

Supportive Therapy: Provides reassurance and orientation to reduce confusion and anxiety during acute episodes.

Environmental Interventions: Promotes a calm, structured environment with consistent cues to improve orientation.

Family Education: Supports caregivers in understanding and managing delirium behaviors.

Medication Treatments:

First-Line: Treat underlying cause (e.g., infection, electrolyte imbalance). For severe agitation: Low-dose antipsychotics (e.g., Haloperidol, Risperidone) used cautiously.

Second-Line: Benzodiazepines (e.g., Lorazepam) for delirium due to alcohol/sedative withdrawal, used sparingly.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for persistent agitation or when typical antipsychotics are contraindicated.

Major Neurocognitive Disorder (e.g., due to Alzheimer’s, Parkinson’s, etc.)

Symptoms: Significant cognitive decline in one or more domains (e.g., memory, executive function, language) interfering with independence in daily activities, caused by conditions like Alzheimer’s disease, Parkinson’s disease, or vascular dementia.

Common Psychotherapies:

Cognitive Stimulation Therapy (CST): Engages patients in structured activities to maintain cognitive function.

Behavioral Therapy: Manages behavioral and psychological symptoms (e.g., agitation, depression) through environmental and behavioral strategies.

Caregiver Support and Psychoeducation: Helps families manage symptoms and plan for long-term care.

Medication Treatments:

First-Line:

Alzheimer’s: Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine) or NMDA receptor antagonists (e.g., Memantine) to slow cognitive decline.

Parkinson’s-related dementia: Rivastigmine for cognitive symptoms.

Second-Line: SSRIs (e.g., Sertraline, Citalopram) for co-occurring depression or anxiety.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe agitation or psychosis, used cautiously due to risk in dementia patients.

Mild Neurocognitive Disorder

Symptoms: Modest cognitive decline in one or more domains (e.g., memory, attention) noticeable but not significantly interfering with independence, often a precursor to major neurocognitive disorders.

Common Psychotherapies:

Cognitive Training: Targets specific cognitive skills (e.g., memory, problem-solving) to maintain function.

Lifestyle Interventions: Promotes physical exercise, healthy diet, and social engagement to slow cognitive decline.

Psychoeducation: Educates patients and families on managing symptoms and reducing risk factors.

Medication Treatments:

First-Line: No medications specifically approved. For co-occurring depression or anxiety: SSRIs (e.g., Sertraline, Escitalopram).

Second-Line: Cholinesterase inhibitors (e.g., Donepezil) may be considered off-label in some cases, though evidence is limited.

Third-Line: Supplements (e.g., Vitamin E, Omega-3 fatty acids) or cognitive enhancers (e.g., Ginkgo biloba) for symptom management, with limited evidence.
Cluster A Personality Disorders

Paranoid Personality Disorder

Symptoms: Pervasive distrust and suspicion of others, interpreting motives as malevolent, leading to guardedness, hypervigilance, and reluctance to confide in others.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges mistrustful thoughts and builds coping strategies for interpersonal interactions.

Supportive Therapy: Fosters trust in therapeutic relationships to reduce paranoia.

Schema Therapy: Addresses deep-seated beliefs about others’ intentions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring anxiety: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline).

Second-Line: Low-dose antipsychotics (e.g., Risperidone) for severe paranoia or agitation, used cautiously.

Third-Line: Anxiolytics (e.g., Buspirone) for persistent anxiety.

Schizoid Personality Disorder

Symptoms: Detachment from social relationships, limited emotional expression, preference for solitary activities, and indifference to praise or criticism.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Enhances social skills and addresses barriers to forming relationships.

Psychodynamic Psychotherapy: Explores underlying reasons for emotional detachment.

Social Skills Training: Improves interpersonal engagement and communication.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring depression: SSRIs (e.g., Fluoxetine).

Second-Line: Atypical antipsychotics (e.g., Olanzapine) for co-occurring mild psychotic-like symptoms, if present.

Third-Line: Stimulants (e.g., Methylphenidate) for co-occurring apathy or low energy, with limited evidence.

Schizotypal Personality Disorder

Symptoms: Eccentric behavior, odd beliefs or magical thinking, social anxiety, and perceptual distortions, with discomfort in close relationships and reduced capacity for social connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Addresses distorted thinking and improves social functioning.

Social Skills Training: Enhances interpersonal interactions and reduces social anxiety.

Supportive Psychotherapy: Builds trust and helps manage eccentric behaviors.

Medication Treatments:

First-Line: Low-dose antipsychotics (e.g., Risperidone, Aripiprazole) for perceptual distortions or quasi-psychotic symptoms.

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Mood stabilizers (e.g., Lamotrigine) for emotional dysregulation or adjunctive anxiolytics (e.g., Clonazepam).

Cluster B Personality Disorders

Antisocial Personality Disorder

Symptoms: Disregard for and violation of others’ rights, impulsivity, deceitfulness, lack of remorse, and persistent rule-breaking, often beginning in adolescence.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets impulsivity and antisocial behaviors, promoting prosocial alternatives.

Mentalization-Based Therapy (MBT): Enhances empathy and understanding of others’ perspectives.

Contingency Management: Reinforces positive behaviors to reduce criminal or harmful actions.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For aggression: Mood stabilizers (e.g., Lithium, Valproate).

Second-Line: SSRIs (e.g., Fluoxetine) for impulsivity or co-occurring depression.

Third-Line: Atypical antipsychotics (e.g., Quetiapine) for severe aggression or irritability.

Borderline Personality Disorder

Symptoms: Instability in relationships, self-image, and emotions, with impulsivity, fear of abandonment, recurrent suicidal behaviors, and intense anger or mood swings.

Common Psychotherapies:

Dialectical Behavior Therapy (DBT): Focuses on emotional regulation, distress tolerance, and interpersonal effectiveness.

Mentalization-Based Therapy (MBT): Improves understanding of self and others’ mental states.

Schema Therapy: Addresses maladaptive patterns rooted in early experiences.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Sertraline) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lamotrigine, Valproate) for emotional instability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Aripiprazole) for severe mood swings or paranoia.

Histrionic Personality Disorder

Symptoms: Excessive emotionality and attention-seeking behavior, discomfort when not the center of attention, and overly dramatic or sexually provocative interactions.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges attention-seeking behaviors and promotes healthier emotional expression.

Psychodynamic Psychotherapy: Explores underlying needs for approval and attention.

Group Therapy: Provides feedback on interpersonal behaviors in a supportive setting.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Mood stabilizers (e.g., Carbamazepine) for emotional lability.

Third-Line: Low-dose antipsychotics (e.g., Olanzapine) for severe emotional dysregulation, used cautiously.

Narcissistic Personality Disorder

Symptoms: Grandiosity, need for admiration, lack of empathy, and hypersensitivity to criticism, often leading to arrogant behavior and exploitative relationships.

Common Psychotherapies:

Psychodynamic Psychotherapy: Explores underlying insecurities and need for admiration.

Cognitive-Behavioral Therapy (CBT): Challenges grandiose beliefs and promotes empathy.

Schema Therapy: Addresses maladaptive schemas related to self-worth and entitlement.

Medication Treatments:

First-Line: No medications directly treat core symptoms. SSRIs (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Mood stabilizers (e.g., Lithium) for irritability or impulsivity.

Third-Line: Atypical antipsychotics (e.g., Risperidone) for severe grandiosity or paranoia, used sparingly.

Cluster C Personality Disorders

Avoidant Personality Disorder

Symptoms: Extreme social inhibition, feelings of inadequacy, and hypersensitivity to rejection, leading to avoidance of social interactions despite a desire for connection.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets fears of rejection and builds social confidence.

Social Skills Training: Improves interpersonal interactions and reduces social anxiety.

Schema Therapy: Addresses core beliefs about inadequacy and rejection.

Medication Treatments:

First-Line: SSRIs (e.g., Sertraline, Paroxetine) to reduce social anxiety and depression.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) for persistent symptoms.

Third-Line: Anxiolytics (e.g., Buspirone) or beta-blockers (e.g., Propranolol) for situational anxiety.

Dependent Personality Disorder

Symptoms: Excessive need to be cared for, submissive behavior, fear of separation, and difficulty making decisions without reassurance, leading to clingy or overly compliant relationships.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Promotes independence and challenges dependency-related thoughts.

Assertiveness Training: Enhances self-confidence and decision-making skills.

Psychodynamic Psychotherapy: Explores underlying fears of abandonment or autonomy.

Medication Treatments:

First-Line: SSRIs (e.g., Escitalopram) for co-occurring anxiety or depression.

Second-Line: Anxiolytics (e.g., Clonazepam) for severe anxiety, used short-term.

Third-Line: SNRIs (e.g., Duloxetine) for persistent depressive symptoms.

Obsessive-Compulsive Personality Disorder

Symptoms: Preoccupation with orderliness, perfectionism, and control, leading to rigidity, excessive devotion to work, and inflexibility, often at the expense of relationships or leisure.

Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Challenges perfectionistic and rigid thinking patterns.

Psychodynamic Psychotherapy: Explores underlying needs for control and fear of mistakes.

Mindfulness-Based Therapy: Promotes flexibility and acceptance of imperfection.

Medication Treatments:

First-Line: SSRIs (e.g., Fluoxetine, Sertraline) for co-occurring anxiety or obsessive tendencies.

Second-Line: Clomipramine for severe perfectionism or obsessive traits.

Third-Line: Anxiolytics (e.g., Buspirone) or mood stabilizers (e.g., Lamotrigine) for emotional rigidity or irritability.

Mental Health Treatments

Symptoms: Significant limitations in intellectual functioning (e.g., reasoning, problem-solving) and adaptive behavior (e.g., daily living skills, communication), typically identified before age 18. Common Psychotherapies:

Behavioral Interventions: Tailored strategies to teach adaptive skills and reduce challenging behaviors.

Skills Training: Focuses on improving daily living, communication, and social skills.

Family Therapy: Supports caregivers in managing behaviors and fostering independence.

Medication Treatments:

First-Line: No medications directly treat core symptoms. For co-occurring behavioral issues (e.g., aggression): Risperidone or Aripiprazole (may be considered).

Second-Line: SSRIs (e.g., Sertraline) for co-occurring anxiety or depression.

Third-Line: Stimulants (e.g., Methylphenidate) or non-stimulants (e.g., Atomoxetine) for co-occurring ADHD symptoms.

Symptoms: Difficulties with speech, language, or social communication, including articulation issues, fluency disorders (e.g., stuttering), or challenges understanding/expressing language.

Common Psychotherapies:

Medication Treatments:

Symptoms: Involuntary tics, both motor (e.g., blinking, head jerking) and vocal (e.g., grunting, throat clearing), typically starting in childhood, often accompanied by co-occurring conditions like ADHD or OCD.

Common Psychotherapies:

Medication Treatments:

Symptoms: Hallucinations (e.g., hearing voices), delusions, disorganized thinking, negative symptoms (e.g., reduced emotions, motivation), and impaired social or occupational functioning.

Common Psychotherapies:

Medication Treatments:

Symptoms: Extreme mood swings including manic episodes (e.g., elevated mood, increased energy, impulsivity) and depressive episodes (e.g., sadness, low energy, hopelessness), with potential for mixed episodes or rapid cycling. Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Helps manage mood swings, identify triggers, and develop coping strategies.

Interpersonal and Social Rhythm Therapy (IPSRT): Stabilizes daily routines and improves interpersonal relationships to prevent mood episodes.

Family-Focused Therapy: Educates and supports families to enhance communication and reduce relapse risk.

Medication Treatments:

First-Line: Mood stabilizers (e.g., Lithium, Valproate, Carbamazepine) to prevent manic and depressive episodes; atypical antipsychotics (e.g., Quetiapine, Olanzapine) for acute mania or mixed episodes.

Second-Line: Antidepressants (e.g., Fluoxetine, Sertraline) for depressive episodes, typically combined with a mood stabilizer to prevent mania.

Third-Line: Adjunctive treatments like Lamotrigine for bipolar depression or Benzodiazepines (e.g., Lorazepam) for short-term management of agitation or insomnia.

Symptoms: Persistent sadness, loss of interest or pleasure, fatigue, feelings of worthlessness, difficulty concentrating, changes in sleep or appetite, and possible suicidal thoughts. Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets negative thought patterns and behaviors to improve mood and coping skills.

Interpersonal Therapy (IPT): Focuses on improving relationships and addressing interpersonal issues contributing to depression.

Behavioral Activation: Encourages engagement in meaningful activities to counteract withdrawal and low motivation.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Venlafaxine) to alleviate depressive symptoms.

Second-Line: Atypical antidepressants (e.g., Bupropion, Mirtazapine) or tricyclic antidepressants (e.g., Amitriptyline) for non-responders to first-line treatments.

Third-Line: Monoamine oxidase inhibitors (MAOIs) (e.g., Phenelzine) or adjunctive treatments like Lithium or atypical antipsychotics (e.g., Aripiprazole) for treatment-resistant depression.

Treatment Resistant: Ketamine

Symptoms: Severe mood changes, sadness, irritability, anxiety, or hopelessness occurring in the luteal phase of the menstrual cycle (typically the week before menstruation) and resolving shortly after menstruation begins.

Common Psychotherapies:

Medication Treatments:

Symptoms: Excessive, persistent worry about various aspects of life (e.g., work, health, relationships), accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances.

Common Psychotherapies:

Medication Treatments:

Symptoms: Recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety, often causing significant distress or interference with daily life.

Common Psychotherapies:

Medication Treatments:

Symptoms: Preoccupation with perceived flaws or defects in physical appearance (often minor or unnoticeable to others), leading to repetitive behaviors (e.g., mirror checking, excessive grooming) or mental acts (e.g., comparing appearance), causing significant distress or impairment.

Common Psychotherapies:

Medication Treatments:

Symptoms: Intrusive memories, flashbacks, or nightmares of a traumatic event, avoidance of trauma-related triggers, negative changes in mood or thinking (e.g., guilt, detachment), and heightened arousal (e.g., hypervigilance, irritability).

Common Psychotherapies:

Medication Treatments:

Symptoms: Emotional and behavioral symptoms (e.g., sadness, anxiety, irritability, or reckless behavior) in response to a specific stressor (e.g., life changes, loss, or trauma), occurring within three months of the stressor and causing significant distress or impairment.

Common Psychotherapies:

Medication Treatments:

Common Psychotherapies:

Medication Treatments:

Symptoms: Excessive focus on physical symptoms (e.g., pain, fatigue) causing significant distress or impairment, often with disproportionate worry about their seriousness, despite minimal or no medical explanation.

Common Psychotherapies:

Medication Treatments:

Anorexia Nervosa Symptoms: Extreme weight loss, intense fear of gaining weight, distorted body image, and restrictive eating behaviors, often leading to severe physical complications (e.g., malnutrition, amenorrhea). Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Targets distorted thoughts about body image and food, promoting healthy eating behaviors.

Family-Based Therapy (FBT): Engages family to support weight restoration and healthy eating, particularly for adolescents.

Maudsley Approach: A family-based treatment focusing on parental involvement to restore weight and address psychological factors.

Medication Treatments:

First-Line: No medications directly treat core symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine) for co-occurring depression or anxiety.

Second-Line: Atypical antipsychotics (e.g., Olanzapine) to address severe body image distortions or promote weight gain.

Third-Line: Anxiolytics (e.g., Lorazepam) for short-term management of anxiety related to eating or weight gain.

Bulimia Nervosa Symptoms: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxative use, excessive exercise), with a preoccupation with body shape and weight. Common Psychotherapies:

Cognitive-Behavioral Therapy (CBT): Focuses on reducing binge-purge cycles and addressing distorted body image.

Interpersonal Psychotherapy (IPT): Targets interpersonal issues contributing to binge eating and purging behaviors.

Dialectical Behavior Therapy (DBT): Enhances emotional regulation to reduce impulsive eating behaviors.

Medication Treatments:

First-Line: Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Fluoxetine, FDA-approved for bulimia) to reduce binge-purge frequency.

Second-Line: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., Duloxetine) for co-occurring depression or anxiety.

Third-Line: Anticonvulsants (e.g., Topiramate) to reduce binge eating or adjunctive anxiolytics (e.g., Buspirone) for anxiety management.

Insomnia Disorder Symptoms: Difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue, irritability, or impaired functioning, persisting for at least three nights per week for three months. Common Psychotherapies:

Cognitive-Behavioral Therapy for Insomnia (CBT-I): Targets sleep-related thoughts and behaviors to improve sleep quality and duration.

Mindfulness-Based Therapy: Promotes relaxation and reduces pre-sleep anxiety.

Sleep Hygiene Education: Teaches habits to enhance sleep environment and routines.

Medication Treatments:

First-Line: Non-benzodiazepine hypnotics (e.g., Zolpidem, Eszopiclone) for short-term use to improve sleep onset or maintenance.

Symptoms: Significant limitations in intellectual functioning (e.g., reasoning, problem-solving) and adaptive behavior (e.g., daily living skills, communication), typically identified before age 18.

Common Psychotherapies:

Symptoms: Extreme mood swings including manic episodes (e.g., elevated mood, increased energy, impulsivity) and depressive episodes (e.g., sadness, low energy, hopelessness), with potential for mixed episodes or rapid cycling.

Common Psychotherapies:

Symptoms: Persistent sadness, loss of interest or pleasure, fatigue, feelings of worthlessness, difficulty concentrating, changes in sleep or appetite, and possible suicidal thoughts.

Common Psychotherapies:

Anorexia Nervosa

Symptoms: Extreme weight loss, intense fear of gaining weight, distorted body image, and restrictive eating behaviors, often leading to severe physical complications (e.g., malnutrition, amenorrhea).

Common Psychotherapies:

Bulimia Nervosa

Symptoms: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxative use, excessive exercise), with a preoccupation with body shape and weight.

Common Psychotherapies:

Insomnia Disorder

Symptoms: Difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue, irritability, or impaired functioning, persisting for at least three nights per week for three months.

Common Psychotherapies:

Hypersomnolence Disorder

Symptoms: Excessive daytime sleepiness despite adequate sleep, with frequent naps that are unrefreshing, causing significant distress or impairment.

Common Psychotherapies:

Narcolepsy

Symptoms: Excessive daytime sleepiness, sudden sleep attacks, and possible cataplexy (sudden muscle weakness triggered by emotions), hypnagogic hallucinations, or sleep paralysis.

Common Psychotherapies:

Restless Legs Syndrome

Symptoms: Uncomfortable sensations in the legs (e.g., crawling, tingling) with an urge to move, worsening at rest or at night, leading to sleep disruption.

Common Psychotherapies:

Oppositional Defiant Disorder

Symptoms: Persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures, causing significant impairment in social, academic, or family functioning.

Common Psychotherapies:

Intermittent Explosive Disorder

Symptoms: Recurrent, impulsive aggressive outbursts (verbal or physical) disproportionate to the situation, not explained by other disorders, causing distress or impairment.

Common Psychotherapies:

Conduct Disorder

Symptoms: Persistent pattern of violating societal norms or others’ rights, including aggression toward people or animals, property destruction, deceitfulness, or serious rule-breaking, often before age 18.

Common Psychotherapies:

Pyromania

Symptoms: Deliberate and repeated fire-setting driven by fascination or gratification, not for monetary gain, revenge, or other motives, causing distress or risk.

Common Psychotherapies:

Kleptomania

Symptoms: Recurrent, irresistible urges to steal items not needed for personal use or monetary value, followed by guilt or relief, not motivated by anger or delusions.

Common Psychotherapies: