Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.

The DSM has attracted controversy and criticism as well as praise. There have been five revisions since it was first published in 1952, gradually including more disorders, though some have been removed and are no longer considered to be mental disorders. It initially evolved out of systems for collecting census and psychiatric hospital statistics, and from a manual developed by the US Army. The last major revision was the fourth edition ("DSM-IV"), published in 1994, although a "text revision" was produced in 2000. The fifth edition ("DSM-V") is currently in consultation, planning and preparation, due for publication in May 2012. An early draft will be released for comment in 2009. The mental disorders section of the International Statistical Classification of Diseases and Related Health Problems (ICD) is another commonly-used guide, used more often in some parts of the world. The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD, although not all codes may match at all times because the two publications are not revised synchronously.

What is attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

ADHD has three subtypes:¹

• Predominantly hyperactive-impulsive
  • Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
  • Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

• Predominantly inattentive
  • The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
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  • Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

• Combined hyperactive-impulsive and inattentive
  • Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
  • Most children have the combined type of ADHD.

Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.

Neurology

Neurology (from Greek νεῦρον, neuron, "nerve"; and -λογία, -logia) is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. corresponding surgical specialty is neurosurgery. A neurologist is a physician (not a surgeon) who specializes in neurology, and is trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research. In the United Kingdom, contributions to the field of neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialize in the technical/laboratory aspects of one of neurology's subdisciplines.

A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after graduation from medical school.

Neurologists complete, on average, at least 12 years of college education and clinical training. This training includes obtaining a four-year undergraduate degree, a medical degree, which is an additional four years, and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology. One and two year fellowships are available following completion of the neurology residency if desired.

Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke or vascular neurology, interventional neurology, epilepsy, neuromuscular, neurorehabilitation, behavioral neurology, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.

In Germany, a compulsory year of psychiatry must be done to complete a residency of neurology.

In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five to nine years of medical school and a year as a pre-registration house officer (or two years on the Foundation Programme) a neurologist must pass the examination for Membership of the Royal College of Physicians (or the Irish equivalent) before entering specialist training in neurology. A generation ago some neurologists would also spend a couple of years working in psychiatric units and obtain a Diploma in Psychological Medicine, but that became uncommon and now that a basic psychiatric qualification takes three years to obtain it is no longer practical. A period of research is essential, and obtaining a higher degree aids career progression: many found it was eased after an attachment to the Institute of Neurology at Queen Square in London. Some neurologists enter the field of rehabilitation medicine (known as physiatry in the US) to specialise in neurological rehabilitation, which may include stroke medicine as well as brain injuries.

Kleptomania -an impulse control

Kleptomania is an impulse control disorder often related to other mood disorders, such as depression, substance abuse, or eating disorders. But not everyone who shoplifts is a kleptomaniac.

Kleptomaniacs do not steal because they want a particular item and can't afford it. In fact, they often discard stolen items, or secretly return them to the store from which they were taken. Instead, kleptomaniacs are driven by an uncontrollable urge to steal things. They often feel increased anxiety when the craving hits, and this can only be relieved by taking the desired item. Often they are not even fully aware that they have stolen the item.

Ataxia-telangiectasia

Ataxia-telangiectasia (AT) (Boder-Sedgwick syndrome or Louis-Bar syndrome is a rare, neurodegenerative, inherited disease which affects many parts of the body and causes severe disability. Ataxia refers to poor coordination and telangiectasia to small dilated blood vessels, both of which are hallmarks of the disease.

AT affects the cerebellum (the body's motor coordination control center) and also weakens the immune system in about 70% of the cases, leading to respiratory disorders and increased risk of cancer. It first appears in early childhood (the toddler stage) with symptoms such as lack of balance, slurred speech, and increased infections. Because all children at this age take time to develop good walking skills, coherent speech, and an effective immune system, it may be some years before AT is properly diagnosed.

Cephalic disorders

Cephalic disasters (from the Greek word κεφάλη, meaning "head") are congenital conditions that stem from damage to, or abnormal development of, the budding nervous system. Cephalic is a term that means "head" or "head end of the body."

Cephalic disorders are not necessarily caused by a single factor, but may be influenced by hereditary or genetic conditions, nutritional deficiencies, or by environmental exposures during pregnancy, such as medication taken by the mother, maternal infection, or exposure to radiation (such disorders are more common in areas of the former Soviet Union affected by nuclear waste disposal problems, such as the area around the Mayak plant in Chelyabinsk, Russia.) Some cephalic disorders occur when the cranial sutures (the fibrous joints that connect the bones of the skull) join prematurely. Most cephalic disorders are caused by a disturbance that occurs very early in the development of the fetal nervous system.

Attention Deficit Disorders

Pervasive developmental disorders

Pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication. The pervasive developmental disorders are:

* Autism, the most commonly known,
* Rett syndrome,
* Childhood disintegrative disorder,
* Asperger syndrome, and
* Pervasive developmental disorder not otherwise specified (PDD-NOS), which includes atypical autism.

Parents may note symptoms of PDD as early as infancy and typically onset is prior to three years of age. PDD itself does not affect life expectancy.