Diagnosis Flashcards
Criteria for all DSM Dx
- Clinically significant distress or impairment in functioning
- Not attributable to another medical condition or substance/medication use
- Not better explained by another disorder
(Neurodevelopmental Disorders)
Intellectual Disability (Intellectual Development Disorder)
- Deficits in general mental abilities and adaptive functioning
- Onset during development (childhood or even in utero)
- Mild, Moderate, Severe, or Profound based on functioning
(Neurodevelopmental Disorders)
Children who can’t be assessed (temporary dx)*
- Global developmental delay if under 5 years old
- Unspecified intellectual disability if 5 or older
(Communication Disorders)
Language disorder
- Difficulty in acquisition, use of language across modalities
- Early childhood onset (toddler)
(Communication Disorders)
Speech Sounds Disorder
- Difficulty producing speech sounds impairs/prevents talking
- Early childhood onset
(Communication Disorders)
Social (Pragmatic) Communication Disorder
- Difficulty in communicating socially, including rules for conversation/storytelling
- Difficulty understanding anything that is not explicitly said
- Early childhood onset, not usually diagnosed until at least 4
Autism Spectrum Disorder
- Deficits in social communication and interaction
- Restricted, repetitive patterns of behavior
- Symptoms present in early childhood, even if not diagnosed until later
- Replaces DSM-IV Autistic Disorder, Aspergers’s Disorder, and PDD NOS
ADHD
- Inattention sys persisting for at least 6 months
- Hyperactivity/impulsivity sys persisting at least 6 months
- Sxs present in multiple settings and were present before age 12
- A lot of differential dx: ODD, IED, Autism spectrum, learning disorder, anxiety and more
Psychotic Disorders
- Delusions - fixed beliefs unchanged by conflicting evidence
- Hallucinations - perceptions w/o external stimulus
- Disorganized thinking/speech - tangential, in coherent
- Motor behavior - grossly disorganized or abnormal
- Negative sys - diminished emotion, motivated activity
- Also alogia (limited speech), anhedonia (not taking pleasure in pleasurable activities), asociality (lack of social interest)
(Psychotic Disorders)
Delusional disorder
- Delusion w/o serious impairment and w/o other schizophrenia criteria
- Sxs at least one month
- Specify type of delusion, modifiers after one year
(Psychotic Disorders)
Brief psychotic disorder
- Delusions, hallucinations, and/or disorganized speech ( negative sys not considered here)
- At least 1 day and less than one month, with return to full functioning
(Psychotic Disorders)
Schizophreniform Disorder
- Same 5 main criteria as schizophrenia
- At least 1 month, but less than 6 months
(Psychotic Disorders)
Schizophrenia
- 5 main criteria
- Continuous signs of disturbance for at least 6 months
- Specify episodes
(Psychotic Disorders)
Schizoaffective disorder
- mood episode concurrent w main criteria for schizophrenia
- psychotic symptoms persist w/o mood episode, but mood episode present more than half of the time
(Psychotic Disorders)
Substance/Medication-Induced Psychotic Disorder
- delusions or hallucinations as direct result of substance/med
- psychotic symptoms dominant, warrant clinical attention
Bipolar and Related Disorders
- For these and depressive disorders, know mood episodes - Manic episode - Hypomanic episode - Major depressive episode
- Manic episode: at least one week
- risk-taking, grandiosity, less sleep, distractible
- one+ manic episode is necessary for Bipolar I dx
- episode requires hospitalization or includes psychotic sys, even if less than a week, it is a manic episode
- Hypomanic episode: at least 4 days
- generally same symptoms, but to lesser degree (manic causes marked impairment, hypomanic does not)
- Major depressive episode
- 5+ sxs over at least a 2-week period
- at least one sxs is depressed mood (or irritable in kids) or anhedonia
- depressed mood, anhedonia, weight change, sleep change, motor activity change, fatigue, worthlessness/guilt, poor concentration
(Bipolar and Related Disorders)
Bipolar I Dx
- only requires manic episode
- differentials: substance/medication-induced bipolar, ADHD, anxiety disorders
(Bipolar and Related Disorders)
Bipolar II Dx
- requires hypomanic episode AND major depressive episode
- differentials: MDD, cyclothymic, substance, anxiety disorder
(Bipolar and Related Disorders)
Cyclothymic Disorder
- for at least 2 years, numerous periods of hypomanic sxs and depressive sxs
- Sxs present at least half the time, never 2 months sxs free
- But without EVER meeting criteria for hypomanic or depressive episode
- (less severe, but longer lasting)
- differentials: bipolar, substance, borderline
(Bipolar and Related Disorders)
Substance/Medication-Induced Bipolar
used when there is a clear link bw substance or medication use - timing and capability
(Depressive Disorders)
Major Depressive Disorder
- At least one major depressive episode
- Differentials: Mood disorder due to another medical condition, ADHD, more
(Depressive Disorders)
Disruptive Mood Dysregulation Disorder
- Frequent temper outbursts (inconsistent w developmental level and 3+ times/week), persistent angry/irritable mood in between
- Present 12 months w/o any 3 months where criteria not met
- Sxs present in at least 2 settings (e.g. school/home)
- Age of onset is less than 10 years, don’t dx under 6 or 18+
- differential: ODD, bipolar, autism spectrum. intermittent explosive disorder can be dx after 3 months. never give both dx.
(Depressive Disorders)
Persistent Depressive d/o (dysthymia)
- persistent depressed mood for at least 2 years (1 in kids), with never 2 months sxs free
- MDD, psychotic, due to AMC, substance, personality
(Depressive Disorders)
Premenstrual Dysphoric Disorder
- affective sxs in majority of cycle at least 1 year
- sxs track with menstrual cycle, become minimal or absent in week post-menses
- different from premenstrual syndrome, which is less severe
(Anxiety Disorders)
Separation Anxiety Disorder
- Sxs related to fear of being away from attachment figure
- Manifests in refusal to go places(out, school) nightmares, physical sxs, worry about losing attachment figure
- At least 4 weeks in kids/adolescents, “typically” 6 months or more in adults
- Differential: other anxiety disorder, mood, ODD, psychotic, personality
(Anxiety Disorders)
Selective Mutism
- Refusal to speak in social situations where expected for at least 1 month
- Is speaking in other situations, like at home w close family
- can’t be attributed to lack of knowledge or comfort w language
- differential: communication disorder, social anxiety, neurodevelopment disorder
(Anxiety Disorders)
Specific Phobia
- marked fear or anxiety about a specific object or situation, “typically” for 6 months or more
- fear is disproportionate to actual danger posed
- clinically significant distress or impaired functioning
- differentials: agoraphobia, social anxiety, separation anxiety, panic, OCD, trauma, psychotic
(Anxiety Disorders)
Social Anxiety Disorder (Social Phobia)
- fear that they will act in a way that will be negatively evaluated
- for kids, must apply to peer settings, not just w adults
- fear persistent “typically” for 6 months or more, fear out of proportion to threat
- differentials: lots, but first on list: normative shyness. consider whether adverse impact on important areas of functioning. Other anxiety, delusional, BDD
(Anxiety Disorders)
Panic disorder
- Recurrent, unexpected panic attacks
- 1 month or more of worry about additional attacks or consequences, or maladaptive behavior change in response to attacks (like avoidance)
- differential: other anxiety, other d/o w attacks as feature (specific phobia)
- panic attack is not a disorder by itself, but can be noted as specifier
(Anxiety Disorders)
Agoraphobia
- fear of being in public places( at least two of: public transportation, open spaces, enclosed spaces, standing in line/crowd, outside home alone)
- fear that escape not possible, help not available if panic or embarrassing behavior occurs
- fear disproportionate to danger, fear “typically” 6 months or more
- differential: social anxiety, specific phobia(situational), separation anxiety, panic
- also other medical, if realistic concern about becoming incapacitated
(Anxiety Disorders)
Generalized Anxiety Disorder
- excessive worry, difficult to control, more days than not for at least 6 months
- 3 of following (1 in kids): restless/keyed up/on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
- differentials: anxiety due to medical condition, substance/medication-induced(includes caffeine), anxiety, PTSD
(Obsessive-Compulsive and Related Disorders)
Obsessive Compulsive Disorder
- Obsessions (intrusive, unwanted thoughts, urges, images)
- Compulsions (repetitive behaviors) in response - behavior doesn’t realistically connect or is excessive
- Distress or impairment OR time consuming (1+ hour/day)
- Note no duration required in diagnostic criteria
- Differentials: Anxiety, MDD, other o/c related, tic, psychotic
(Obsessive-Compulsive and Related Disorders)
Body Dysmorphic Disorder
- Preoccupation w perceived physical defects or flaws slight/absent to others
- Repetitive behaviors(mirror checking) or mental acts(comparing) in response
- No duration requirement
- Differential: normal appearance concerns, eating disorder, illness anxiety disorder, MDD
(Obsessive-Compulsive and Related Disorders)
Hoarding Disorder
- Difficulty parting w possessions regardless of actual value
- Accumulation that congests and clutters living areas
- No duration specifier
- Differential: Other medical, neurodev, psychotic, MDD, OCD
- Don’t dx if accumulation is result of MDD-related fatigue
(Obsessive-Compulsive and Related Disorders)
Trichotillomania (Hair pulling disorder)
- Recurrent pulling out of one’s hair, resulting in hair loss
- Repeated attempts to decrease or stop
- Differential: normal grooming or hair playing, OCD
(Obsessive-Compulsive and Related Disorders)
Excoriation (Skin Picking) Disorder
- Recurrent skin picking resulting in lesions(injuries)
- Repeated attempts to decrease or stop
- Differential: Psychotic, other o/c
(Trauma and Stressor Related Disorders)
Reactive Attachment Disorder
- Inhibited, withdrawn behavior toward adult caregivers, even during nonthreatening interaction
- Rarely/minimally seeks/responds to comfort when distressed
- Child experienced “pattern of extremes of insufficient care”, presumed responsible for withdrawn behavior (timing)
- Evident bf age 5 - persistent if longer than 12 months - don’t dx after 5
- Differential: Autism spectrum disorder, depression
(Trauma and Stressor Related Disorders)
Disinhibited Social Engagement Disorder
- Child actively approaches and interacts w unfamiliar adults
- Not checking back w adult caregiver, willing to go with unfamiliar adult
- Behavior not limited to impulsivity
- Child experienced “pattern of extremes of insufficient care” presumed responsible for withdrawn behavior (timing)
- Differential: ADHD
(Trauma and Stressor Related Disorders)
Post-Traumatic Stress Disorder
- Adults and kids 6 and over
- Exposure to actual or threatened death, serious injury, or sexual violence
- One+ intrusion symptoms(flashbacks, memories)
- One+ avoidance symptoms (external reminders or thoughts/memories)
- Two or more negative changes in mood or thought after trauma
- Two or more arousal/reactivity changes
- Symptoms at least 1 month
- Differential: Adjustment disorder (differentiate by stressor), acute stress disorder (3 days to 1 month after exposure), anxiety disorder, MDD, psychosis, TBI
(Trauma and Stressor Related Disorders)
Acute Stress Disorder
- Same stressors
- Nine total sys from any of the five categories
- Duration of disturbance is 3 days to 1 month after exposure
- Differential: Adjustment (type of stressor), panic (only dx if panic unexpected), dissociative disorder, (if amnesia absent other stress sxs), TBI
(Trauma and Stressor Related Disorders)
Adjustment Disorder
- Emotional or behavioral symptoms in response to identifiable stressor within 3 months of the onset of that stressor
- Differential: MDD, PTSD, acute stress, personality d/o (review lifetime history of personality functioning), normal stress reactions
(Dissociative Disorders)
Dissociative Identity Disorder
- Two or more distinct personality states
- Recurrent gaps in recall of everyday events
- Not part of normal cultural or religious practice, or play (kids)
- Associated w overwhelming experiences, trauma, and abuse in childhood (not a diagnostic criteria)
- Differential: Depressive, bipolar, PTSD, psychotic, seizure disorder, factitious/malingering
(Dissociative Disorders)
Dissociative Amnesia
- Inability to recall important autobiographical info, usually traumatic or stressful
- Inconsistent w ordinary forgetting
- May be with or without dissociative fugue, “purposeful travel or bewildered wandering” associated w amnesia for identity or autobiographical info
- Differential: DID (DA has depersonalization, but not distinct states) PTSD
(Dissociative Disorders)
Depersonalization/Derealization Disorder
- Unreality or detachment regarding self or surroundings
- Reality testing remains intact during experience
- Differential: Illness anxiety disorder, MDD(numbers), OCD
(Somatic Symptom and Related Disorders)
Somatic Symptom Disorder
- One + somatic symptoms that are distressing or result in disruption of daily life
- Excessive thoughts, feelings, behavior associated
- Symptoms persist “typically” more than 6 months
- Differential: other medical, panic (this is more persistent), GAD
- Conversion: Symptom is loss of function, not distress
- Delusions: behavior more intense than here
(Somatic Symptom and Related Disorders)
Illness Anxiety Disorder (hypochondriac)
- Preoccupation with having or getting a serious illness
- Somatic sxs absent/mild - preoccupation disproportionate
- High anxiety about health, easily alarmed about health status
- Excessive health-related behaviors or avoidance (e.g. of MDs)
- Preoccupation present for 6+ months
- Differential: Other medical, adjustment, somatic sx disorder (when somatic sx present) anxiety, OCD
(Somatic Symptom and Related Disorders)
Conversion Disorder (Functional neurological sx disorder)
- Altered voluntary motor or sensory function
- Sxs and recognized medical conditions not compatible
- Don’t dx just bc sxs usual, unexplained
- Assessment: Different forms of testing yield different results
- Differential: Neurological disease, somatic sx d/o (that’s about distress, here incompatibility required), factitious/malingering
(Somatic Symptom and Related Disorders)
Psychological Factors Affecting other Medical Conditions
- Psychological or behavioral factors adversely affect known medical condition or interfere with treatment
- Example: Anxiety makes someone’s asthma worse
- Differential: Mental Disorders due to AMC - causality does the other way (medical causes psychological)
- Abnormal psychological or behavioral symptoms in response to medical dx: adjustment disorder
(Somatic Symptom and Related Disorders)
Factitious Disorder
- “Making shit up” - falsifying sxs, presenting to others as ill or impaired
- Present even in absence of obvious external rewards
- Can be “imposed on self” or “imposed on another”
- Differential: Somatic sxs (no evidence of falsifying)
- Malingering: doing it for personal gain or obvious rewards
- Borderline: manipulation, not deception
(Feeding and Eating Disorders)
Pica
- Eating non-nutritive non-foods for at least 1 month
- When inappropriate to developmental level and culture
- When part of another disorder, don’t dx unless warrants separate attentions
- Differential: Anorexia (ex. eating paper to control appetite), factitious, NSSI
(Feeding and Eating Disorders)
Rumination Disorder
- Repeatedly regurgitating for at least 1 month
- Regurgitated food may be chewed, re-swallowed, or spit out
- Differential: Other feeding and eating disorders
(Feeding and Eating Disorders)
Avoidant/Restrictive Food Intake Disorder
- Avoidance of lack of interest in food and eating (no duration)
- Weight loss (or in kids, fail to gain), nutritional deficiency, etc.
- Not explained by lack of available food or another disorder
- Can be applied to adolescents or adults as well as kids
- Differential: Medical(including structural/feeding), reactive attachment (caregiver trust), autism spectrum, specific phobia, anorexia
(Feeding and Eating Disorders)
Anorexia Nervosa
- Restricted intake leading to low body weight
- Intense fear of gaining weight, or persistent behavior interfering w weight gain
- Disturbance in perception of body/weight
- Specifier: binge-eating/purging type or restricting type
- Differential: Medical, MDD(no desire for weight loss or fear of gain), schizophrenia, SUD
(Feeding and Eating Disorders)
Bulimia Nervosa
- Binge eating that feels out of control + compensatory behavior, at least 1x/wk for 3 months
- Also includes self-evaluation “unduly influenced” by body shape and weight
- Differential: Anorexia binge/purge type, binge eating disorder (no compensatory behavior)
(Elimination Disorders)
Enuresis
- Repeated urinating onto bed or clothes
- 2x/week for at least 3 months or clinically significant distress or impairment
- At least 5 years old (or equivalent developmental level)
- Specify nocturnal (night only), diurnal (day only), or nocturnal and diurnal
- Differential: Medical condition, medication side effects
(Elimination Disorders)
Encopresis
- Repeated defecating in inappropriate places (bed, clothes)
- At least 1x/month for at least 3 months
- At least 4 years old (or equivalent developmental age)
- Differential: Other medical (just diagnose the medical issue)
(Sleep-Wake Disorders)
Insomnia Disorder
- Difficulty initiating or maintaining sleep, or waking too early
- At least 3 nights/week for at least 3 months
- Happens despite adequate opportunity for sleep
(Sleep-Wake Disorders)
Hypersomnolence Disorder
- Excessive sleepiness despite main sleep period of 7+ hours and at least one:
- Recurrent periods of falling asleep in the same day
- Sleep episode of 9+ hours that is non-restorative
- Difficulty being fully awake after abrupt awakening
- At least 3 times/week for at least 3 months
(Sleep-Wake Disorders)
Narcolepsy
- Irrepressible need to sleep, or falling asleep, repeatedly in day
- Quick onset of sleep
- At least 3x/week for at least 3 months
(Sleep-Wake Disorders)
Breathing Related Sleep Disorders
- All result in sleeping person not getting enough air supply
- Apneas: obstructed breathing (snoring, snorting/gasping)
- Hypoventilation can be obesity related
(Sleep-Wake Disorders)
Circadian Rhythm Sleep Wake Disorders
- Pattern of sleep disruption related to circadian rhythm disturbance
- Leads to excessive sleepiness or insomnia
- Several subtypes
(Sleep-Wake Disorders)
Non-Rapid Eye Movement(NREM) Sleep Arousal Disorders
- Parasomnia - unusual events associated w sleep
- Recurring incomplete awakening, w blank stare (sleepwalking) or panic (terrors)
- Individual is relatively unresponsive and difficult to awaken
- No dream imagery is recalled (or very little)
- Amnesia for the episodes
(Sleep-Wake Disorders)
Nightmare Disorder
- Repeated, extended, well-remembered dreams involving survival/security or “physical integrity” (serious injury, even body being torn)
- Easily awaken and recall dreams well
- Nightmares are usually during REM sleep, terrors during non-REM
- Differential: Bereavement (results in insight and reflection)
(Sleep-Wake Disorders)
Rapid Eye Movement (REM) Sleep Behavior Disorder
- Repeated arousal during sleep, with vocalization or complex motor behavior
- Typically later in sleep, not in first 90 minutes
- Awake, alert and oriented upon awakening
- Differential: Seizures, best assessed by sleep specialist or even EEG
(Sleep-Wake Disorders)
Restless Legs Syndrome
- Urge to move legs during rest or inactivity, relieved by movement, worse in evening
- At least 3x/week for at least 3 months
Sexual Dysfunctions
- Do not diagnose any of these if the issue is inadequate sexual stimulation
- Primary differential for all will be other sexual dysfunction and medical conditions
- Duration specifier for all: 6 months (most say “approximately”)
(Sexual Dysfunctions)
Female Sexual Interest/Arousal Disorder
- No or reduced sexual interest, thoughts/fantasies, pleasure during activity
- Differential (for both of these): other mental disorders, like MDD with its anhedonia
(Sexual Dysfunctions)
Male Hypoactive sexual desire disorder
- Deficient or absent sexual thoughts or fantasies, desire
- To judge “deficient”, consider age, culture, other factors
- Symptoms for at least “approximately” 6 months
- Differential: Other mental disorders, like MDD with its anhedonia
(Sexual Dysfunctions)
Erectile Disorder
-Difficulty obtaining or maintaining erection or decrease in rigidity in most/all sexual activity (note the lack of the word “partner” here)
(Sexual Dysfunctions)
Genito-Pelvic Pain/Penetration Disorder
- Recurrent or persistent difficulty with any of:
- vaginal penetration during intercourse
- vaginal/pelvic pain during vaginal intercourse or penetration attempts
- fear or anxiety about same pain, including in anticipation of
- tensing or tightening of pelvic floor during attempted penetration
(Sexual Dysfunctions)
Female Orgasmic Disorder
-Delay, infrequency, or absence of orgasm, or reduced intensity of sensations
(Sexual Dysfunctions)
Premature(Early) Ejaculation
- Ejaculation w/i about 1 minute of vaginal penetration and b/f desired in almost all or all partner sexual activity
- Duration criteria not established for other sexual activities
(Sexual Dysfunctions)
Delayed Ejaculation
-Unwanted delay/absence of ejaculation in most/all partner activity
Gender Dysphoria - only dx in category
- Different diagnostic criteria for kids, adolescents, adults
- Incongruent b/w experienced/expressed gender for assigned gender
- Strong desire to be a different gender
- Sxs present at least 6 months
- Differential: nonconformity to gender roles, transvestic disorder (cross dressing, person gets sexual excitement, but does not want to be a different gender)
(Disruptive, Impulse-Control, and Conduct Disorder)
Oppositional Defiant Disorder
- Pattern of angry/irritable mood, defiant behavior, or vindictiveness for at least 6 months
- Demonstrated w at least one person who is not a sibling
- Differential: ADHD(make sure not just in response to filing at sustained effort or attention, or sitting still), Mood disorders
(Disruptive, Impulse-Control, and Conduct Disorder)
Intermittent Explosive Disorder
- Behavior outbursts showing failure to control impulsivity:
- Verbal/physical aggression at least 2x/week for 3 months OR -3 outbursts involving damage, destruction, or injury within 12 months
- Aggression grossly disproportionate to provocation
- Aggression isn’t premeditated and is not goal-directed
- At least 6 years old
(Disruptive, Impulse-Control, and Conduct Disorder)
Conduct Disorder
- Behavior pattern violating other’s rights, major social norms:
- Aggression to people or animals
- Destruction of property
- Lies, thrift, serious rule violations
- At least one symptom present in last 6 months
- Aggression is premeditated
- In adults, may be antisocial personality disorder instead
(Disruptive, Impulse-Control, and Conduct Disorder)
One way of thinking about those 3 disorders
- IED - CD - ODD
- IED is about poorly controlled emotion
- CD is about poorly controlled behavior
- ODD is more balanced, symptoms wise, between the two
(Disruptive, Impulse-Control, and Conduct Disorder)
Pyromania
- Purposeful fire setting more than once
- Tension or arousal before, pleasure or gratification after
- Fascination or attraction to fire and its contexts
- Not done for another purpose (money, political statement, etc)
- Differential: other causes of fire-setting (ex, cover up a crime)
(Disruptive, Impulse-Control, and Conduct Disorder)
Kleptomania
- Purposeful stealing of objects that aren’t needed for personal use or financial reasons
- Tension or arousal before, pleasure or gratification after
- Not done for another purpose(anger, vengeance, hallucination)
- Differential: Ordinary theft(for object or monetary value), malingering (to avoid prosecution), manic episode
Substance Related and Addictive Disorders
- For substances, there’s use Disorder, Intoxication, and Withdrawal
- No use disorder dx for caffeine
- No withdrawal dx for hallucinogens or inhalants
- No intoxication dx for tobacco
(Substance Related and Addictive Disorders)
Drug classes (dx uses the specific drug class)
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalants
- Opioids
- Sedatives, Hypnotics, Anxiolytics
- Stimulants(cocaine, amphetamine, etc)
- Tobacco
- Other or Unknown substance
(Substance Related and Addictive Disorders)
Use Disorder
- At least 2 symptoms in 12 months:
- Tolerance, withdrawal, cravings, impact, can’t cut down
- Withdrawal - either here as a symptoms, or as its own dx - not established for hallucinogens/inhalants
- Tolerance and withdrawal criteria don’t apply to prescription medication taken under supervision
- Differentials: Accidental exposure, adolescent experimentation
(Substance Related and Addictive Disorders)
Intoxication
- Recently induced substance
- Significant, problematic psychological or behavioral changes
- Behavior consistent with intoxication for that substance
(Substance Related and Addictive Disorders)
Withdrawal
- Reducing or stopping what had been regular use
- Multiple symptoms of withdrawal for that substance (specific number and type varies by substance)
(Substance Related and Addictive Disorders)
Hallucinogen Persisting Perception Disorder
-Continuing to experience perceptual sys (usually visual) even after stopping use
(Substance Related and Addictive Disorders)
Gambling Disorder
- Only non-substance disorder in this chapter
- 4+ symptoms in 12 months, similar symptoms to substance (preoccupation, unable to stop, impact)
- Not better explained by a manic episode
- Differential: Nondisordered gambling (limited risks, disciplined)
Neurocognitive Disorders
- All are conditions where imputed cognition NOT present since birth/early life
- In many cases, exact course of the pathology can be identified
- Relies on understanding cognitive domains
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual-motor
- Social cognition
(Neurocognitive Disorders )
Delirium
- Disturbance in attention and cognition, develops fairly quickly and is variable
- Direct physiological consequence of AMC, substance, toxin, or combination
- Other specified and unspecified delirium
(Neurocognitive Disorders )
Major and Mild Neurocognitive Disorder
Specify what the disorder is due to:
- Alzheimer’s Disease - progressive, gradual cognitive decline without plateaus
- Frontotemporal Lobar Degeneration - behavioral variant or language variant
- Learning and memory, perceptual-motor function intact
- Lewy Body Disease - visual hallucinations, spontaneous parkinson symptoms
- Vascular Disease - problems in complex attention, executive function
- Traumatic Brain Injury - identifiable TBI + amnesia, disorient, confusion
- Substance/Medication Use
- HIV Infection - established through testing
- Prion Disease - (group of diseases) rapid progression, motor symptoms
- Parkinson’s Disease - established through testing
- Huntington’s Disease - established through testing or family history
- AMC/Multiple etiologies/Unspecified
- Major
- Significant cognitive decline from previous performance
- Decline interferes w indépendance in everyday tasks
- Mild
- Modest cognitive decline from previous performance
- Decline DOES NOT interfere with independence in everyday tasks
Personality Disorder
- Enduring pattern of inner experience and outward behavior inconsistent w culture
- Consistent, pervasive across social situations
- Onset can be traced at least back to adolescent or early adulthood
(Personality Disorder)
Cluster A: Primarily odd or eccentric behavior
- Paranoid: distrustful and suspicious, assuming others have ill intent
- Schizoid: doesn’t desire or enjoy social relationships (note distress/impairment criteria for dx)
- Schizotypal: discomfort w relationships, behavioral eccentricities (“weirdo”)
(Personality Disorder)
Cluster B: Dramatic, emotional, erratic
- Antisocial: disregard for and violation of other’s rights, evident bf age 15 (must be adult to dx)
- Histrionic: Excessive emotionality and attention-seeking (flamboyant)
- Borderline: Unstable relationships, “frantic efforts to avoid real or imaged abandonment”
- Narcissistic: grandiosity, lack of empathy, need for admiration
(Personality Disorder)
Cluster C: Anxious or fearful
- Avoidant: social inhibition, feelings or inadequacy, deep fear of criticism
- Dependent: submissive and clinging behavior, need to be taken care of, fears separation
- Obsessive-compulsive: orderliness, perfection (interferes w completion), control
Paraphilic Disorders
- Voyeuristic Disorder - spying on others in private activities
- Exhibitonistic Disorder - displaying genitals, usually for strangers
- Frotteuristic Disorder - touching or rubbing against consenting person
- Sexual Masochism Disorder - Undergoing humiliation, bondage, or suffering
- Sexual Sadism Disorder - Inflicting the same
- Pedophilic Disorder - sexual focus on children (patient is 16 or older and at least 5 years older than children of interest)
- Fetishistic Disorder - focus on objects or congenital body parts for arousal
- Transvestic Disorder - sexually arousing cross-dressing
Medication-Induced Disorders
- Formally, Medication-Induced Movement Disorders and Other Adverse Effects of Medication
- Neuroleptic-Induced Parkinsonism - AND - Other Med-Induced Parkinsonism
- Neuroleptic Malignant Syndrome
- Medication-Induced Acute Dystonia
- Medication-Induced Acute Akathisia
- Tardive Dyskinesia (associated w neuroleptic, must persist 8 weeks)
- Tardive Dystonia
- Tardive Akathisia
- Medication-Induced Postural Tremor
- Other Medication-Induced Movement Disorder
- Antidepressant Discontinuation Syndrome
Other Conditions (Z Codes)
- Formally, Other Conditions That May Be a Focus of Clinical Attention
- Straightforwardly named diagnostic codes for social, environmental, historical issues that may be focus of clinical attention but do not represent a mental disorder
- Can affect the dx, course, prognosis, and treatment of a disorder
- Not going to name them all here, but some examples
(Other Conditions (Z Codes))
Relational problems
- Parent-child relational problem
- Sibling relational problem
- Child affected by parental relationship distress
- Relationship distress w spouse or intimate partner
- Uncomplicated bereavement
(Other Conditions (Z Codes))
Abuse and Neglect
- Different codes when providing services to visit as opposed to perpetrator
- Child physical abuse
- Child sexual abuse
- Child psychological abuse
- Spouse or partner violence (physical, sexual, or psychological abuse)
(Other Conditions (Z Codes))
Educational and Occupational Problems
- Academic or educational problem
- Problem related to current military deployment status
(Other Conditions (Z Codes))
Housing and Economic Problems
- Homelessness
- Discord w neighbor, lodger, or landlord
- Lack of adequate food or safe drinking water
(Other Conditions (Z Codes))
Other Problems Related to the Social Environment
- Phase of life problem
- Acculturation Difficulty
- Social exclusion or rejection
- Target of perceived discrimination or persecution
(Other Conditions (Z Codes))
Problems Related to Crime or Interaction w the Legal System
- Victim of crime
- Imprisonment or Incarceration
- Problems retailed to release from prison
(Other Conditions (Z Codes))
Other Health Service Encounters for Counseling/Medical Advice
- Sex Counseling
- Other counseling or consultation (spiritual/religious, nicotine cessation)
(Other Conditions (Z Codes))
Problems Related to Other Psychosocial, Personal, and Environmental Circumstances
- Religious or spiritual problem
- Problems related to unwanted pregnancy
- Discord w social service provider
- Victim of terrorism or torture
(Other Conditions (Z Codes))
Other circumstances of personal history
- Personal history of self-harm
- Personal history of military deployment
- Problem related to lifestyle (Lack of exercise, poor sleep hygiene)
(Other Conditions (Z Codes))
Nonadherence to medical treatment
Malingering (making up symptoms for an external incentive, like $ or time off work)
