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The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies mood disorders as major depressive disorder, dysthymic disorder, bipolar I disorder, bipolar II disorder, and cyclothymic disorder, on the basis of the types of mood episodes present in the patient's history. The association between headaches and mood disorders has been demonstrated for many years across various cultures. Suicide is attempted more often when a patient has comorbid mood disorder and headache than when he or she has either alone. Suicidal intent is inversely correlated with quality of life. The treatment of depression is broadly divided into psychopharmacological and psychological therapies. The United States Food and Drug administration (USFDA) has approved the use of fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and vilazodone for the treatment of major depressive disorder. Several treatments that are effective for mood disorders also are efficacious in headache treatment.
This chapter describes the major anxiety disorders and their associations with headache, the increased burden of comorbid anxiety and headache, the mechanisms hypothesized to explain the connection between anxiety and headache, and the behavioral treatments and strategies for managing anxiety and headache. Anxiety disorders are a separate category of psychiatric disorders in The Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR), which contains six major anxiety disorders, namely generalized anxiety disorder (GAD), panic disorder, specific phobias, social anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Anxiety disorders and primary headache are commonly occurring conditions, both independently and as co-occurring conditions. The presence of anxiety and anxiety disorders in individuals with headache negatively impacts quality of life, functioning, and response to headache treatment. Effective management of headache necessitates understanding, identifying, and addressing anxiety, anxiety-related disorders, and their underlying factors that are related to headache.
Trichotillomania (TTM) is an impulse control disorder characterized by recurrent pulling out of one's hair, resulting in noticeable hair loss. The most common hair pulling sites include the scalp, eyebrows, and eyelashes, but pulling also occurs frequently on the face, abdomen, legs, arms, armpits, or chest. Early studies of functional impairment in TTM patients suggested that concealing the physical effects of pulling from friends and family, avoiding treatment because of embarrassment, low self-esteem, decreased life satisfaction, and a negative impact on day-to-day living were all common. The TTM diagnostic interview is a standardized clinician interview designed to assess the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria and can be useful. However, further questioning is needed to evaluate the additional criteria described in DSM-IV-TR. Psychotherapy for individuals with TTM typically involves a variety of techniques: habit-reversal training (HRT) and stimulus control training.
Skin picking is a common human behavior and often performed as a part of the daily grooming routine. Skin-picking disorder (SPD) is currently classified in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as an impulse control disorder not otherwise specified along with compulsive impulsive (CI) Internet usage disorder, CI sexual behaviors, and CI shopping. The differential diagnosis of SPD includes medical and psychiatric conditions that cause skin picking directly or that create the sensations, such as pruritus, that lead to skin picking. Self-monitoring techniques can be used to assess the frequency of skin-picking behavior. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) modified for psychogenic excoriation is a ten-question, semistructured, clinician-administered scale that assesses the severity of skin picking in the previous week. Trichotillomania (TTM) is the most common comorbid impulse control disorder in patients with SPD.
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