Can be coded for any of the disorders. Criteria involve a clinical picture that is dominated by 3 or more: stupor (no psychomotor activity), catalepsy (posture is held passively, against gravity), waxy flexibility (resistance to positioning by another), mutism (no verbal response), negativism (no response instructions or external stimuli), posturing (actively maintaining a posture against gravity), mannerism (caricature of normal actions), stereo to be repetitive non-goal directed movements, agitation, grimacing, echolalia (mimicking another's speech) or echopraxia (imitating another's movement) Manic or hypomanic includes at least three: dysphoria or depressed mood, loss of interest or pleasure, psychomotor retardation, fatigue or loss of energy, feelings of worthlessness or guilt, or recurrent bouts of death or suicidality
Depressive includes at least three: elevated or expansive mood, inflated self-esteem or grandiosity, pressured speech, flight of ideas or racing thoughts, increased energy or goal directed activity, involvement in activities that have a high likelihood of adverse consequences, or decreased need for sleep.
Onset can be at any age, although peaks in the 20s. The course is variable some rarely experience full remission, others experience isolated episodes with full return to premorbid functioning. Recovery typically begins within three months of onset for others may take up to a year. Factors associated with lower recovery rates: current episode duration, psychotic features, anxiety, personality disorders, and symptom severity. Risk of recurrence is higher when the preceding episode was severe, in younger individuals, and for persons who have had multiple episodes. Rate is Eagle and prepubertal girls and boys but one .5 to 3 times higher and females than males beginning in early adolescence. Risk factors include neuroticism (negative affectivity), adverse childhood experiences, and stressful life events. Possibility for suicide exist at all times. Depressed mood for most of the day, for more days than not, for at least two years (one year for children adolescents). While depressed two or more of the following: change in appetite, sleep difficulties, low energy or fatigue, low self esteem, poor concentration or indecisiveness, & hopelessness. Functioning is impaired or significant distress. During the two-year timeframe the person has not been without symptoms for more than two months at a time. Criteria for major depressive episode may be continuously present for two years. There's never been a manic or hypomanic episode in criteria for cyclothymia have not been met. Specifiers: early-onset (before age 21) or late onset (age 21 or older). For the most recent 2 years of of the disorder must specify: with pure dysthymia (no MDE), with persistent major depressive episode (full criteria for MDE met during preceding two years), with intermittent major depressive episode, with current episode (current MDE with periods or eight weeks or more with symptoms below threshold for MDE), and with intermittent major depressive episodes, without current episode (no current MDE but one or more in the in the preceding two years). Early and insidious onset & chronic. early onset is associated with higher likelihood of comorbid personality & substance use disorders That in the majority of menstrual cycles there are at least five symptoms present in the week before the onset of menses, symptoms start to improve within a few days after the onset of menses, and are minimal or absent in the week postmenses. At least one must be present: marked affective lability, marked irritability or increased interpersonal conflict, marked depressed mode or marked anxiety. Additionally, at least one let's be present. Decreased interest in usual activities, difficulty concentrating, lethargy or fatigue, change in appetite, sleep difficulties, feeling overwhelmed, and physical sxs. Symptoms must be present for most menstrual cycles in the preceding year. Involves a marked fear or anxiety caused by the presence or anticipation of a specific object or situation. Exposure provokes an immediate anxiety response and the phobic situation is either avoided or endured with intense distress. Fear and anxiety is out of the proportion to the actual danger and typically last for six months or more. Specifiers: animal, natural environment (heights, storms, etc.), blood injection injury, situational (planes, elevators, etc) or other (loud sounds, costumed characters, etc.). Common to have multiple specific phobias in which case multiple diagnoses are given. Expose your-based therapies are the treatment of choice. In vivo exposure usually yields the strongest results; massed exposure May result in more robust clinical improvement. Therapist assisted exposure based procedures are highly effective. Virtual-reality exposure is useful for phobias that may be difficult to treat in vivo. Systematic desensitization, which involves pairing exposure with relaxation maybe preferred by patients. However it is effective but requires more time and is less successful at decreasing avoidance. Many exposure therapies include a cognitive component which can be particularly helpful for certain phobias. An individual has been exposed to a traumatic event (actual or threatened death, serious injury, or sexual violence) in one or more ways: directly experiencing the event, witnessing the event, learning that the event has occurred to a close family member, or experiencing repeated exposure to aversive details of traumatic events. Four characteristic symptoms include: intrusive symptoms, avoidance of stimuli associated with the trauma, negative alterations in cognitions and mood, and increased arousal. Children six years and younger, the three characteristic symptoms include: intrusive symptoms, avoidance and/or negative alterations in cognitions and mood, and increased arousal. Symptoms must last for more than one month. Specifiers: with dissociative symptoms and with delayed expression if the onset of symptoms was at least six months after the event Duration of symptoms varies widely with complete recovery within three months to longer than 12 months. Risk factors for development includes severity of the trauma, perceived life threat, interpersonal violence, prior mental disorders, dissociation during and after the trauma, lack of support, female gender, younger age, lower SES, lower education, lower intelligence, & minority racial/ethnic status. more prevalent among females and is associated with suicidal ideation and attempts. Interventions include CPT, PE, seeking safety (when comorbid with SUD) and EMDR (controversial as the mechanism of change may simply be exposure). Also SIT. Psychological debriefing wasn't at first thought to prevent the development of PTSD and other trauma related symptoms but the method has been found to be ineffective and some research has indicated that it makes recovery more difficult as compared to having no treatment at all. Characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life. Evidences excessive thoughts, feelings, or behaviors related to the somatic symptoms as manifest by at least one: persistent thoughts about the seriousness of one's symptoms, persistent high levels of anxiety about health or symptoms, or excessive time and energy devoted to symptoms or health concerns. (Nutshell: somatic sxs & significant attention the sxs). Somatic sxs may not be present continuously but the worries are persistent (typically more than 6 months). Specifiers: with predominant pain (when the somatic sxs predominantly involve pain), and persistent (severe sxs, marked impairment, & long duration). Also severity is coded mild, moderate, or severe. More prevalent in females. Comorbid anxiety & depression is common. When chronic pain is prominent, evidenced-based treatments include CBT & ACT Characterized by a restriction of food intake, leading to a significantly low body weight. Intense fear of gaining weight or behavior that interferes with weight gain. There must be distortions in self image, undue influence given to body weight or shape in self-evaluation, or a denial of the seriousness of the problem. Two subtypes: restricting type and binge eating/purging type. Additional specifiers: in partial remission or in full remission. Current severity also specified: mild (BMI of 17+), moderate (BMI 16-16.99), severe (BMI 15-15.99) or extreme (BMI <15). Typically begins during adolescence or down without her. Earlier age of onset is associated with shorter duration of illness. Find more common in females associate it with cultures, settings, occupations,etc. suicide risk is increased. Bipolar, depressive, and anxiety disorders commonly cooccur. Alcohol use and other substance use disorders may also be comorbid. Treatment generally requires a multidisciplinary approach, overall family treatment is the most well-established approach. Structural family therapy most well known. CBT has modest research support Recurrent periods of an irresistible need to sleep, lapsing into sleep, or napping occurring within a given day, at least three times per week, for at least a three-month duration. Involves at least one: cataplexy (either brief episodes of sudden bilateral loss of muscle tone, typically precipitated by laughter are joking, or grimaces our job opening with tongue thrusting, without obvious emotional triggers),hypocretin deficiency, or REM indicators. Severity a specified is mild moderate or severe. Individuals commonly experience recurrent intrusion of REM sleep into the transition between sleep and wakefulness. Manifested as hypnagogic hallucinations at the onset of sleep, as hypnopompic hallucinations on awakening, or sleep paralysis at the beginning or end of sleep episodes. Central feature is a recurring pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness, which persists for at least six months. At least four symptoms must be present: angry/irritable mood as evidenced by frequent loss of temper, easily annoyed and touchy, frequently angry and resentful; argumentative/defiant behavior as evidenced by frequent arguments with authority figures/adults, deliberate defiance of rules, deliberate annoyance of others, blaming others for one's mistakes; or vindictiveness as evidenced by being spiteful and vindictive at least twice within the past six months. Severity is specified as mild (symptoms in only one setting), moderate (sxs in at least 2 settings), severe (sxs in 3+ settings). More prevalent in families in which there is inconsistency in caregiving or in families exhibiting harsh, inconsistent, or neglectful childrearing. Two most common co-occurring disorders are ADHD and CD. Have an increased risk for anxiety disorders, MDD, and SUD (in adolescents and adults). Can have onset prior to 6 A persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms and rules are violated. At least three must be present in the past 12 months and at least one in the past six months: aggression to people and animals as evidenced by bullying and threatening others, initiating physical fights, use of a weapon, physical cruelty to people, physical cruelty to animals, stealing while confronting victim, or forced sexual activity; destruction of property as evidenced by deliberate fire setting, deliberate destruction of property; deceitfulness or theft as evidence by breaking into homes or cars, lying to obtain favors, stealing without confronting the victim; or serious violation of rules as evidenced by staying out late, running away, or being truant. If the person is 18 or older criteria are not met for ASPD. Specifiers: childhood onset type (prior to age 10), adolescent onset type (after age 10), or unspecified type. Severity: mild, moderate, or severe. Additionally with limited prosocial emotions is coded when 2 or more characteristics are present over 12 months: lack of guilt or remorse, callous (lack of empathy), unconcerned about performance, or shallow or deficient affect Tendency to misperceive others intentions as hostile or threatening and thereby feeling justified in responding aggressively. Poor frustration tolerance, irritability, temper outburst, and recklessness are frequently seen. Often associated with precocious sexual behavior, drinking, smoking, use of illegal substances, and risk taking. Suicide attempts and completions are higher than average. ADHD and ODD commonly co-occur. Other concomitant dx include: specific learning disorder, anxiety disorders, depressive and bipolar disorders, and substance related disorders. A cluster of cognitive, behavioral, and physiological sxs that indicate continued use despite adverse consequences. Can occur with all substances except caffeine. Criteria include a problematic pattern of use leading to significant impairment or distress, as manifest by least two within a 12 month period: the substance is consumed in larger amounts over longer period of time than was intended; a persistent desire or unsuccessful attempts to cut down use; significant time spent in trying to get, use or recover from effects of the substance; cravings; failing to meet major role obligations; continued use despite recurrent social or interpersonal problems; other important activities are cut down; use in situations that are physically dangerous; use is continued in spite of awareness of physical or psychological problems caused or exacerbated by the substance; tolerance (need more to get effects); or withdrawal (characteristic withdrawal sxs or taking the substance to relive or avoid withdrawal). Represent four groupings: impaired control with regard to the substance, social impairment, risky use, and pharmacological criteria. Current severity is specify based on the number of symptoms endorsed: mild (2-3 symptoms), moderate (4-5 symptoms), and severe (6+ symptoms). Specifiers: in early remission (only cravings present for at least 3 months but less than 12 months), in sustained remission (no symptoms except cravings for 12 months or longer), and in a controlled environment. Characterized by five or more: restlessness, nervousness, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, rambling speech, agitation, periods of inexhaustibility, and tachycardia. Differentiated from anxiety disorder by diuresis (excessive urination). There is no use disorder in caffeine-related disorders Involves behavioral or psychological changes as well as two or more: dizziness, and coordination, nystagmus, slurred speech, unsteady gait, depressed reflexes, lethargy, muscle weakness, blurred vision, tremor, cycle motor retardation, euphoria, and stupor or coma All based on six defined cognitive domains: complex attention (sustained attention, divided attention, processing speed); executive function (planning, decision-making, responding to feedback, mental flexibility); learning and memory (immediate memory, recent memory, remote memory); expressive and receptive language (naming, word finding, grammar, comprehension); perceptual motor (visual perception, visuo-constructional, perceptual-motor, praxis, gnosis); and social cognition (recognition of emotions, theory of mind) Alzheimer's disease, frontotemporal lobar degeneration, Lewy body disease, vascular disease, TBI, substance/medication use, HIV infection, prion disease (Creutzfeldt Jakob disease), Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, or unspecified A disturbance in attention and awareness. Onset is a rapid and course tends to fluctuate. Includes a cognitive disturbance. Specifiers: substance intoxication delirium, substance withdrawal delirium, medication induced delirium, delirium due to another medical condition, and delirium due to multiple etiologies. Common causes include infections, metabolic disorders (low blood sugar, renal disease), post-operative states, and substance intoxication. The majority recover fully, with or without treatment; early intervention shortens the duration of the delirium. Untreated delirium may progress to coma, seizures, or death. Defined as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual's culture, is pervasive and inflexible has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Symptoms are evident in at least two areas: cognition, affect, interpersonal functioning, or impulse control. A diagnosis can be made in person under 18 if features of the disorder have been present for at least one year (except for ASPD which cannot be diagnosed in persons under 18). Three clusters: cluster A involves odd or eccentric presentation, cluster B involves dramatic, emotional, and erratic behavior, and cluster C involves an anxious or fearful presentation.