Mentally STRONG with Dr. B

Dr. B here with our series on Demystifying the DSM and today I'm talking about PMDD, and if there's men listening, this is a real disorder, and it should be treated. Oftentimes many, many women experience PMS symptoms. But PMDD is to a point of really needing treatment. And even PMS, I want to empower women that even PMS can be treated. I personally take birth control pills on a constant to stop ovulation so that I do not experience those PMS symptoms. That is one of the treatments that we use for PMDD. But oftentimes we also have to add in an antidepressant, sometimes just in those two weeks prior to menses. But oftentimes we have to do it all the time. It's very important that we distinguish PMDD from bipolar type mood, right? It's very specific around the hormone level one week prior to menses. The individual needs to be documenting when they start their menses and where they are in their cycle. Because if there's fluctuations in different times in the cycle, it's likely not PMDD. It's likely more in that bipolar type of mood disorder or mood disorder unspecified. For PMDD it's very specifically in that week prior to the menses is the most severe and actually upon starting menses and the week following menses, the symptoms are improving slowly. It’s very important. You cannot diagnose PMDD without having a clear record of those cycles. And they must have at least five of these symptoms in a dysfunctional manner. Mood swings, suddenly tearful. Severe irritability or anger. Depressed mood or anxiety. A decrease in interests of usual activities. Difficulty concentrating. Severely fatigued. Changes in appetite. Hypersomnia or insomnia. Feeling out of control, and oftentimes they also have physical symptoms. You know, their breasts hurt, they feel inflamed, bloated, and so there's a clear physical component to this hormonal physical component that we often do recommend birth control and again you know we have to look at the history of the person and there are certain kinds of breast cancers and female cancers that can worsen with birth control. So, this is a choice that's made with your doctor. But super important, if you meet criteria for PMDD that you don't just shrug it off as you know this is something we have to deal with as a woman, right? You don't have to. Again, my whole thing is like you deserve to be happy. You deserve to not have to do this half of your life. I remember before myself getting on birth control, I don't have PMDD, but I have PMS, and two weeks out of my month I'm not feeling well, right? I'm having these symptoms of PMS. That's half of my life and as I got older, my cycle shortened. So instead of having a 28-to-36-day menses cycle, I was going to 20-24 day cycle so I'm almost always feeling the symptoms of PMS. I want to empower women that there are safe and effective ways to treat this and that we don't have to endure it just because we're women, right? Because you deserve to be happy.
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

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Dr. B here with our series on Demystifying the DSM. So, the next depressive disorder in the series is called persistent depressive disorder or dysthymia. In the clinic environment we often don't see people with Dysthymia. But maybe they've gotten into their late 20s, early 30s, and now they're going, “Gosh, I just, I've been depressed or down my whole life.” But don't meet criteria for major depressive disorder, have never had any severe depression where they felt like they needed treatment. But oftentimes, when we see them present, it’s in their late 20s and just Gosh I really can't get motivated to do things I've just had a poor appetite my whole life, low energy, fatigue, low self-esteem. I'm just getting through life. I'm not actually excelling. Life coaches might see Dysthymia disorder or people who are, you know, trying to motivate a crowd of people or individuals in the workplace. This is someone who is just kind of skating through life. Never really happy, but never really depressed either. A cartoon character would be like Eeyore in Winnie the Pooh. He would go out with his friends; he would do things. But he was never happy. And like I often tell people; you deserve to be happy. If you are listening to this and you're like, that's me, I've never really had like, truly happy moments, but I don't meet criteria for depression. I don't want to hurt myself, I'm functioning, I go to work, I do what I'm supposed to do. That could be a persistent depressive disorder, and oftentimes that is very well treated with just a low dose of an antidepressant, because theoretically, you have low neurotransmission, low serotonin, norepinephrine, and dopamine going on in your brain. And so, a low dose antidepressant is very successful with dysthymia. Again, you deserve to be happy.
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
mentally_strong_
@MentallySTRONG4
https://www.youtube.com/c/drbmentallystrong
https://www.linkedin.com/company/mentallystrong

Dr. B here with our series on Demystifying the DSM. Today I'm going to talk about Major Depressive Disorder and it's kind of ironic to only be doing a 5-minute video on what is the most prevalent diagnosis that we see in our clinic. So many people are struggling with depressive symptoms, and so I want to really help our listeners differentiate the depressive symptoms in Major Depressive Disorder. We all experience symptoms of depression, of extreme sadness, and we often use depression as an adjective on how you feel, like, I feel depressed. If you follow my story, you know that I'm personally grieving the loss of my daughter recently and I have moments where I am depressed. I have not recently met criteria for Major Depressive Disorder. What I want to do here is help distinguish when you meet criteria for Major Depressive Disorder, that there is treatment, and oftentimes people will say, well, I don't want to take medication, I don't necessarily need it. Some of the previous disorders that we've talked about in this series probably need medication, right? There's a biochemical problem in schizophrenia. There's a biochemical problem in bipolar, one that really needs to be addressed from a chemical standpoint. There's also a biochemical component, and some people are predisposed to that and have it come without stress. But then there is this threshold that we can all get to, that puts us to the point where our neurotransmitters are not functioning well enough, right? So, it's okay to, even if you don't have this predisposition, even if you feel like maybe your depression is not bad enough, to need medication. Just think, what if there was something that would help you to be able to choose happiness more often and to get out of bed on a Saturday and do something fun, right? So, there is a strong cognitive behavioral therapy component to treating depression. It's okay to also take medication when you get to the point of meeting criteria for Major Depressive Disorder. I do want you to consider taking medication. Some of the symptoms: depressed mood most days or nearly every day. A market diminished interest in things that typically were pleasurable for you. Any significant weight loss, insomnia or hypersomnia like sleeping too much. Feeling agitated or excessively fatigued. Feelings of worthlessness, hopelessness, helplessness. If you have five or more of those symptoms please consider medication treatment, or at least getting an evaluation for that. So, those are some of the symptoms for Major Depressive Disorder, and one of the things that we talk about as well is that point of feeling like you want to hurt yourself or even kill yourself, feeling suicidal. If you are at that point, if you feel like hurting yourself, if you're cutting yourself, burning yourself. Doing some other kind of self-mutilation or you feel like you want to die. That is the point that is non-negotiable for me. You must consider medication. Your neurotransmitters are too low, and you need to bring those up. That is specifically major depressive disorder and the how we treat it as Mentally STRONG is you'll come in and get a full psychiatric assessment. We would set you up with a counselor that would do the Mentally STRONG Method. If we change the way we think, we can change our choices. Sometimes that depression is coming from this negative internal dialogue, the way that you're talking to yourself, and we're going to help you reframe that and find those positives so that you can make the choice to go out for a walk on a sunny day, or you can make the choice to exercise, which would naturally bring up those neurotransmitters, right? Find that balance, but if you meet criteria for Major Depressive Disorder, please get an evaluation and get some treatment. You deserve to be happy.
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that hav

Dr. B here, with our series on Demystifying the DSM. Now I'm going to sum up the other bipolar type of diagnosis. I don't personally study the DSM, and so it's kind of funny that I'm doing this Demystifying the DSM series. I personally study Dr. Stahl and his symptoms and receptors, and any professionals out there, that's who I recommend that you study from. These videos are more for our clients to understand these diagnosis, and when I'm talking to my clients, I'm very specific about “don't own this”, right? This is just a cluster of symptoms, we can work with this, The Mentally STRONG Method and the cognitive behavioral approach to get your thinking and your choices in line with what you want, and if there is a neurobiology symptoms and receptor, we can treat that with medication. So, I'm going to quickly go through some of these other bipolar types. Cyclothymia is the next one here in the DSM, and it's basically a milder bipolar II. Right, so you don't really meet criteria for hypomania. You don't really meet criteria for major depressive disorder, but you still have these pretty significant fluctuations in mood and I would challenge that maybe that we can do that with therapy. Or is there a borderline personality or some other personality disorder contributing to that fluctuation. So that's one of the differential diagnosis with Cyclothymia. The other thing that we often see is substance use. And substance use can often look like bipolar, but it can also mask true bipolar. So really, when there's substance abuse going on, the number one goal is sobriety, and there's several mental health clinics that won't treat someone's mental illness until they have become sober. I actually will treat the mental illness while I'm trying to encourage sobriety, because I think it would be very difficult if I'm severely depressed to stop using my substance if I can't get treatment for my depression, right? So, there are two schools of thought on that, but substance abuse can always, always, always complicate the diagnosis and often can look like bipolar. Also, you can have a fluctuating mood disorder secondary to a medical condition. The first thing I tell people, especially if they're coming in at 50 years or older with their first significant mood disorder symptoms, I'm really looking hard at, Is there a medical reason for this? Because most mental health conditions start in childhood, teens, 20s, rarely, early 30s. After that, if there's no mental health history and then someone has significant problems, let's look closely at medication that they've been prescribed. Steroids are a big culprit. I've had several people who have post steroid mood disorder that looks like bipolar and sometimes we do have to treat that for a period of time and sometimes it can take six months to a year post steroid use to feel stabilized from that. So, anytime someone is presenting with some other medical conditions, look at the medications that they're on, as well as any kind of neurological or inflammatory conditions can actually present as mood problems. Then we have the bucket of unspecified bipolar, I use this diagnosis frequently because I don't know the client well enough to say for sure If it’s bipolar I or bipolar II. We haven't been able to really pinpoint it yet, and that's there in the DSM and then it goes through trying to show you all these little boxes of additional modifiers on that bipolar: bipolar with psychotic features. Bipolar with melancholic features. Bipolar with catatonic features. And we like to get to that point, but I can tell you typically in the first three to six months, I can't be that specific, and often it doesn't matter to be that specific because mood disorders can change, the presentation can change. 

Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depress

Dr. B here with our series on demystifying the DSM and today I'm going to be talking about Bipolar 2 which is significantly harder to diagnose and I'm very cautious and conservative in giving this diagnosis. I feel like, sometimes people have been told that they're moody, that they're bipolar by their friends or their significant other because they have extreme fluctuations in mood. But depression can cause extreme fluctuations in mood. Anxiety can cause that, and PTSD is known for causing significant mood fluctuations. So, I'm very careful. I always tell my clients I'm considering bipolar for you, but I'd like to get to know you better. I would like to see how you respond to certain medications before I tell you for sure that I think Bipolar 2 is your diagnosis. And this is very important because people get diagnosed and then own it and I want to be very diligent, specifically with this one, that I'm not over diagnosing. Someone who maybe has depression, PTSD and they are presenting with fluctuating mood and we give them a bipolar diagnosis and they own that. So, I am always very conservative in giving this diagnosis. But when you're looking at the DSM you have to have one, at least, hypomanic episode in your lifetime. And these are periods of time where you have elated mood or elated self-esteem, maybe shopping sprees, but you feel like you're in control. So, hypomania: hypo means lower. So this is kind of a softer mania, one that looks functional. Most people with bipolar 2 are functioning. They go on a shopping spree and then they feel guilty. Then they budget their money and they pay off their bills so there's some compensation type behaviors. And it impedes function, because that's a DSM criteria, but not to the point of severity that mania does. And so, this is very hidden. I mean, many people with hypomania do not seek treatment during this time. This is when they're super productive. But the depressive episodes become so debilitating that they must begin to treat it like bipolar, because, unfortunately, in bipolar, although oftentimes they're only seeking treatment during the depressive episode, they feel like they want to keep that hypomania. They don't want to let that go. They only want to treat the depression, but the depression, when we try to treat it like major depressive disorder, it doesn't work, or it could cause problems of what we call activating. So, you could give someone with bipolar 2 an antidepressant and it would actually cause a hypomania. And they would think, this antidepressant is working so great because they got to their hypomania, but the crash will likely be quick and a significant crash back into the depression. So, watching for those kinds of things over time. It's not clinically appropriate to give antidepressants when we think it's bipolar 2. We used to do that 20-30 years ago, but we need to be watching very closely. If there's any indication of this bipolar 2 that we're looking more for mood stabilizing agents rather than just antidepressants. In both bipolar one and bipolar 2, you are likely seeing them for the first, second, third time in their depressive episode. Sometimes in that bipolar one they are hospitalized or arrested or something severe but typically in bipolar 2 you do not see them in their hypomanic state because this is productivity. For them, they feel very good and happy, and so it's very important to watch your client over time, to make sure that we have that right diagnosis, but that we don't do it right off the bat either, right? At Mentally STRONG we do frequent follow ups and we coordinate the counseling with the medication follow up so that we can begin to really look at those patterns and treat it accordingly. Because if we're just trying to treat the depression, we will not actually be successful long term. Again, bipolar 2 is significantly harder to diagnose. But much higher functioning people can typically be stabilized with a mild anticonvulsant. Some of t

Dr. B here with our series on demystifying the DSM. Today I'm going to be talking about Bipolar I. This is the most severe type of bipolar. Although the DSM clearly distinguishes bipolar 1, bipolar 2 and cyclothymia, I see clinically that this is more like a continuum. Bipolar diagnosis does not necessarily mean a severe mental illness, but Bipolar I - severe can be very, very debilitating and cause disability. So, it's really on this continuum. When we talk about bipolar one, this is the classic manic depressive that people think about when they think about bipolar. This is someone who has clearly had at least one manic episode in their life. A true manic episode, and possibly some additional hypomanic episodes with depressive episodes. So, how do we determine the difference there? A true manic episode? Clearly, if you're looking at it clinically, it clearly looks abnormal, right? You can even have psychotic features in a true manic episode. So many people have insomnia and insomnia can be a symptom of depression, anxiety, lots of things. So, it's not the diagnostic criteria for bipolar, but often it's not that they're complaining of not being able to sleep, they don't need a lot of sleep, they'll sleep for two hours and be fine and function. So that's a true manic episode of having this elated energy that they don't actually need sleep is one of the main things that we see in that true bipolar one is not very common. Less than 1% of the population have true bipolar one. In the next video when we talk about Bipolar 2, that's a different story, and it's harder to diagnose. Because you have mania, you have hypomania, and you have depression. And many times, people are only seeking treatment during that depressive episode. Manic episodes are often high-risk behavior. Things that are out of character. I have had several clients tell me that they become hypersexual during their manic episode. They could, you know, go on shopping sprees. There are risk taking behavior like drinking and driving things that are out of their character during those manic episodes, and they can identify it afterwards as being completely out of character for them. And so, making sure to when giving that true bipolar 1 diagnosis that there is clearly evidence of a true manic episode with the depressive episodes. Unfortunately, bipolar one clients are the most likely to complete suicide because the extremes go so quickly from, you know, being on top of the world to literally wanting to die within 24 hours. So, the. You know, it just goes very quickly. Unlike someone with depression or the depressed mood, it takes a long time to get to that feeling of suicidality. Bipolar one is truly a biochemical problem and likely will need medication. So, it's important to make sure that we clearly identify those bipolar 1 diagnosis in really looking for the suicidality, protecting them from that piece, and talking very seriously in the beginning about long term. Medication compliance, so that is bipolar 1 diagnosis.
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
mentally_strong_
@MentallySTRONG4
https://www.youtube.com/c/drbmentallystrong
https://www.linkedin.com/company/mentallystrong

Hi! Dr. B here demystifying the DSM and finishing up the psychotic disorders. So, we've been going over all the different psychotic disorders and the last you know 7 disorders here in this cluster are really not specifically psychotic disorders treated by psychiatrist. We have the substance abuse psychotic disorder, so this means that somebody is intoxicated, and they come in, and they're psychotic because they're intoxicated or someone who is going through withdrawal and has psychotic symptoms during withdrawal. Now we you can with long term use or sometimes if you don't come out of this psychotic episode, it could be a brief psychotic episode that turns into schizophrenia with long term use. So, this is that diagnosis that's given if somebody is intoxicated and they're psychotic, right? But if they continue with psychotic symptoms, and this is where it can start to get personal again. My brother, who I've talked about in other videos has had a substance abuse problem most of his life. Started with alcohol, then to cocaine and in the last five years he's been using meth and about two years ago he had a substance abuse psychotic episode. I told him please stop, please stop. I mean obviously I've been trying to get him to stop using for years. Everybody has this threshold for psychosis and, uh, a substance can throw you over that and you are not able to come back. And that's kind of where he is now. Five years of abusing meth and he meets criteria for schizophrenia and likely even with sobriety, will not go back to complete normalcy so. Obviously don't do drugs, but this is one of the diagnoses that you may see. The other is psychosis due to a medical condition, so you could have someone with Alzheimer's ALS, other kinds of dementias that are beginning to have psychotic symptoms. They're not schizophrenic. Their brain is changing, and it can't compensate, can't adjust and therefore they have this secondary psychosis due to their medical condition and it's important to differentiate that. For the family's sake and for the person's sake that this is not schizophrenia, it is due to their medical condition. A known neurological problem and the then you start to have psychotic symptoms then that is psychosis related to your neurological condition. But if you are completely normal, have no known diagnosis and abruptly start having psychotic symptoms that delirium needs to be ruled out, right? Because this is a delirium is like psychotic symptoms related to an acute medical condition, right? Something that can be treated. We see this a lot in elderly. They will be fine and then suddenly, it's like they have, you know dementia and psychosis. That is likely delirium. Go to the emergency room, get a medical work up. The most common reason is a UTI, which you wouldn't connect those two symptoms, right? So important that if it comes on acutely you get a full medical work up. If you don't have a diagnosis, you get a full medical work up. If somebody comes in my office at 65 or 70 years old, with psychotic symptoms and never having any mental health concerns. Maybe some depression but never any major psychotic concerns in their entire life. We need to do an MRI. We need to work that up medically because there likely is a dementia diagnosis now too. Providers out there, sometimes somebody will come in and tell me they have no history. And I will do the whole medical work up to find out when their brother calls me that they've been diagnosed with schizophrenia since they were 20. So, a good history is super important. But if it comes on late in life, schizophrenia, and other psychotic disorders are usually in the 20s. So, if they come up in an older aged person, you have somebody there to confirm that they have no psychotic history that needs to be worked up medically, acutely or long term. So that is the end of our psychotic series. The last couple are ones that we don't use very often and are very specific to specialties so thank you and

Dr. B here in our series demystifying the DSM and we are on psychotic disorders. Today I'm going to be talking about schizoaffective disorder, so if you came across this just in like a search for schizoaffective disorders, it's going to be important to also look at the schizophrenia video and either the bipolar or depressive videos. Because Schizoaffective brings in those symptoms. And if I'm talking to practitioners the differential diagnosis here sometimes gets confusing, and I have seen people putting schizoaffective and I might have said bipolar with psychotic features. You will see differences in diagnosis among providers and to our clients that are listening. That's OK, right? Unfortunately, mental health is not as black and white as other symptoms in the body, right? Our neurological system and how we present has a lot to do with our environment, how we're raised Our culture You know, Schizoaffective is basically saying that you meet that first criteria for schizophrenia, so go back and look at that That's where you have two of these five symptoms, delusions, hallucinations, disorganized speech, you must have at least two of those. So, you're meeting those basic criteria for schizophrenia, but then there's this concurrent mood piece, right? So affective means mood and schizo means schizophrenia and affective means mood. So schizoaffective means you are meeting those basic criteria for schizophrenia, but maybe not the negative symptoms or the severe functional decline that you see in schizophrenia. But there's this strong affective component that is there even when we get the psychotic piece in remission. So, when we're treating someone with schizoaffective, we are treating the psychosis first and then the mood second. So oftentimes you'll see the psychotic symptoms decrease and then we have to maybe add an antidepressant or do something specific like an anticonvulsant or a mood stabilizer to treat the affective part. So, in schizoaffective we have two types, we have the bipolar type. Go and look at the bipolar video, which I haven't done yet, but it'll be in the series and the depressive type. Ok, so that means that they're meeting criteria for schizophrenia part A and they are meeting criteria for either bipolar or depression. And that's how we get that schizoaffective diagnosis. But don't be discouraged if you are someone who is diagnosed with that and you're like well, but somebody else said I was bipolar. The reality is here at Mentally STRONG, we treat symptoms and receptors, not DSM diagnosis because DSM diagnosis are really just a cluster of symptoms that don't necessarily go with our neurological circuits. And remember when we're talking about psychotic disorders, we are likely going to have to treat it with medication. Here at Mentally STRONG we are going to take that schizoaffective diagnosis and look at you personally and say what symptoms are you presenting with and how can we treat those. And honestly, we might treat someone with you know, bipolar psychotic features with some of the same medications so don't own your diagnosis as who you are. Just know that these are the symptoms that you are presenting, and psychotic symptoms need to be treated with medication. The affective part of what's going on in the bipolar depression. The maybe you've experienced trauma. That's going to be treated with the Mentally STRONG Method and those with a schizoaffective diagnosis can come learn to function You know, especially with medication and therapy. Function and get control of those symptoms. So that's how we do it here. At Mentally STRONG we treat with medication and counseling.

Dr. B here Demystifying the DSM and we are in the series on psychotic disorders. I don't want to lose some of my followers. Psychotic disorders are our least common diagnosed mental health concern. However, they are the most catastrophic and life changing as far as function and that really brings me to the diagnosis of schizophrenia. When somebody is diagnosed with schizophrenia, they have had psychotic symptoms for longer than six months and actively in a 30-day period. The main criteria are that they must have at least two symptoms over that period of time, and one of those must be a positive symptom. We separate psychotic symptoms into two categories, positive symptoms and negative symptoms. Positive symptoms, and this is politically incorrect, but this means you are positively psychotic, right? This is delusions hallucinations, disorganized speech and the negative symptoms are things like grossly disorganized or just negative symptoms of things that you might also see in depression like not taking care of themselves not being able to function. Those kinds of things. Not taking a shower, you can see all of those You can see negative symptoms in other disorders, but positive symptoms are just in psychotic disorders, so you must have at least two psychotic symptoms over that period of time with a significant impairment in function. Some of those functional things are work, interpersonal relationships, self-care. So, schizophrenia is not taken lightly. When someone is diagnosed with schizophrenia, we are saying that this is a chronic lifetime condition that we really need you to be on medication for. 

Schizophrenia is also a very hard thing to treat. If you know someone with schizophrenia medication compliance is the number one thing that the support person in their life can be doing. It's because the likelihood of having another major psychotic break if you come off the meds is very high. 

How do we treat that here and Mentally STRONG? Medication management. If it's truly schizophrenia, there is not wiggle room to say they don't need medication. Here at Mentally STRONG we strongly encourage compliance with an antipsychotic medication. Antipsychotics are a big class we use them in bipolar and sometimes as an adjunct in depression, but they are the very specific treatment for schizophrenia and that's what we're going to recommend. 

Schizophrenia does not have to be a progressive disorder. This is where it's very important. If you are the support person for someone with schizophrenia, it does not have to be a progressive disorder. But oftentimes it is because people come off their medication, they have another psychotic break and with each psychotic break it becomes more difficult to get them back to what we call their previous level of function, right? 

Again, the biggest thing for someone who is a support person or someone with schizophrenia is medication compliance. And getting them to a practitioner, a specialist that knows how to treat specifically those psychotic symptoms. So, it's not necessarily a counselor, it needs to be someone who can prescribe medications.  
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
mentally_strong_
@MentallySTRONG4
https://www.youtube.com/c/drbmentallystrong
https://www.linkedin.com/company/mentallystrong

Dr. B here with demystifying the DSM and we're in the series on psychotic disorders and I'm going to clump the next two together. Brief psychotic disorder and schizophreniform. So, brief psychotic disorder, say someone presents to the emergency room or a psychiatric hospital, or even in the outpatient psychiatric center and they are meeting criteria for psychosis. They have maybe delusions and hallucinations, but it's very important, and one of the criteria for having some of the other disorders is a significant impairment in function and a period of time of those symptoms. So oftentimes we'll put as the treating diagnosis, brief psychotic disorder, really hoping that it's brief. Some doctors will put psychotic disorder unspecified. If you think that you might be able to bring this person out of it, maybe they ingested a substance, or they had a traumatic event, or something happened that you think that this is brief. It's short lived. We're going to be able to treat them and they're not going to have a chronic condition. Schizophreniform is when there's been a period of time where they have had these symptoms and we are concerned that they are going to eventually meet criteria for schizophrenia, and schizophrenia is a chronic long-term diagnosis that can go into remission, but likely will never go back to baseline. Brief psychotic disorder is kind of that diagnosis that we put on anybody coming in with no mental health history and they are having a psychotic episode and we are hoping that it is brief. So that's what brief psychotic disorder is. Schizophreniform is when they don't quite meet criteria for schizophrenia right now, but the likelihood is high, and this happens when somebody young comes in right at that age where schizophrenia typically develops, and we have not been able to put them into remission quickly. So, we put schizophreniform disorder there. You don't see these chronically. You'll see these diagnosis often if you work in a crisis center or an emergency room where there's not time. Sometimes we need time. A lot of people read this book and they say, oh, you know, if someone meets these criteria, they are this. I tell this to my students all the time, we need time. This diagnostic interview that you can sit with somebody for one hour and know their chronic long-term diagnosis is not fair to you as a practitioner, nor is it fair to the patient, right? So, these are diagnosis that we can treat because we must put a diagnosis in. To patients listening or clients listening. Your doctor had to continue treating you. They must put something otherwise your insurance will not cover it. And so, these are diagnosis that we can use to say we hope this is brief, but these are the symptoms that we are treating. 
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Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depression, anxiety, anger, & overwhelming stress. 
However, she has developed a new pathway to becoming Mentally Strong & Choosing to be Happy.  With purpose, Dr. B has developed the phases that were refined within the Mentally STRONG Method that she created and wants to share with you.

https://www.facebook.com/Mentallystronginc
https://www.mentallystrong.com
mentally_strong_
@MentallySTRONG4
https://www.youtube.com/c/drbmentallystrong
https://www.linkedin.com/company/mentallystrong