A. At least 2 attacks fulfilling criterion B
B. Migraine aura fulfilling criteria B and C for one of the subforms
C. Not attributed to another disorder1
Thursday, December 27, 2007
Diagnostic Parameter, Migraine without aura
Diagnostic criteria:
At least 5 attacks1 fulfilling criteria B-D
Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)2;3;4
Headache has at least two of the following characteristics:
unilateral location5;6
pulsating quality7
moderate or severe pain intensity
aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
During headache at least one of the following:
nausea and/or vomiting
photophobia and phonophobia8
Not attributed to another disorder9
At least 5 attacks1 fulfilling criteria B-D
Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)2;3;4
Headache has at least two of the following characteristics:
unilateral location5;6
pulsating quality7
moderate or severe pain intensity
aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
During headache at least one of the following:
nausea and/or vomiting
photophobia and phonophobia8
Not attributed to another disorder9
Diagnostic Parameter, Dementia with Lewy Bodies
Dementia
Gait/Balance Disorder
Prominent Hallucinations and Delusions
Sensitivity to traditional Psychotics
Fluctuations in alertness
Gait/Balance Disorder
Prominent Hallucinations and Delusions
Sensitivity to traditional Psychotics
Fluctuations in alertness
Diagnostic Parameter, Dementia
The American Psychiatric Association has established two generally accepted criteria for the diagnosis of dementia: (1) erosion of recent and remote memory and (2) impairment of one or more of the following functions:
Language misuse of words or inability to remember and use words correctly (i.e., aphasia)
Motor activity unable to perform motor activities even though physical ability remains intact (i.e., apraxia)
Recognition unable to recognize objects, even though sensory function is intact (i.e., agnosia)
Executive function unable to plan, organize, think abstractly
Symptoms often develop gradually and show a progressive deterioration in function.
Language misuse of words or inability to remember and use words correctly (i.e., aphasia)
Motor activity unable to perform motor activities even though physical ability remains intact (i.e., apraxia)
Recognition unable to recognize objects, even though sensory function is intact (i.e., agnosia)
Executive function unable to plan, organize, think abstractly
Symptoms often develop gradually and show a progressive deterioration in function.
Diagnostic Parameter, Parkinson's Disease
Parkinson's Diaease
Loss of Smell or lack thereof may be an initial presenting feature
Cardinal symptoms
Resting, pill rolling tremor
Bradykinesia
Rigidity
Postural instability seen later as the disease progresses
Loss of Smell or lack thereof may be an initial presenting feature
Cardinal symptoms
Resting, pill rolling tremor
Bradykinesia
Rigidity
Postural instability seen later as the disease progresses
Wednesday, December 26, 2007
Diagnostic Parameter, Paranoid Personality Disorder
Paranoid Personality Disorder
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
Reads hidden demeaning or threatening meanings into benign remarks or events persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights.
Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.
Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid)."
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
Reads hidden demeaning or threatening meanings into benign remarks or events persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights.
Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.
Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid)."
Diagnostic Parameter, Borderline Personality Disorder
Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment.
Apattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance
abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment.
Apattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance
abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Diagnostic Parameter, Narcissistic Personality Disorder
Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
Requires excessive admiration.
Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
Is often envious of others or believes that others are envious of him or her.
Shows arrogant, haughty behaviors or attitudes.
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
Requires excessive admiration.
Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
Is often envious of others or believes that others are envious of him or her.
Shows arrogant, haughty behaviors or attitudes.
Diagnostic Parameter, Histronic Personality Disorder
Histrionic Personality Disorder
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
is uncomfortable in situations in which he or she is not the center of attention
Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
Displays rapidly shifting and shallow expression of emotions.
consistently uses physical appearance to draw attention to self.
Has a style of speech that is excessively impressionistic and lacking in detail.
Shows self-dramatization, theatricality, and exaggerated expression of emotion.
Is suggestible, i.e., easily influenced by others or circumstances.
Considers relationships to be more intimate than they actually are.
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
is uncomfortable in situations in which he or she is not the center of attention
Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
Displays rapidly shifting and shallow expression of emotions.
consistently uses physical appearance to draw attention to self.
Has a style of speech that is excessively impressionistic and lacking in detail.
Shows self-dramatization, theatricality, and exaggerated expression of emotion.
Is suggestible, i.e., easily influenced by others or circumstances.
Considers relationships to be more intimate than they actually are.
Diagnostic Parameter, Borderline Personality Disorder
Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment.
Apattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance
abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment.
Apattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance
abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Diagnostic Parameter, Panic Disorder
Panic Disorder
People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They cannot predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next attack will strike.
Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.
Panic Attack
The person suddenly develops a severe fear or discomfort that peaks within 10 minutes.
During this discrete episode, 4 or more of the following symptoms occur:
Chest pain or other chest discomfort
Chills or hot flashes
Choking sensation
Derealization (feeling unreal) or depersonalization (feeling detached from self)
Dizzy, lightheaded, faint or unsteady
Fear of dying
Fears of loss of control or becoming insane
Heart pounds, races or skips beats
Nausea or other abdominal discomfort
Numbness or tingling
Sweating
Shortness of breath or smothering sensation
Trembling
Panic Disorder With Agoraphobia
The person has recurrent panic attacks that are not expected.
For a month or more after at least 1 of these attacks, the person has had 1 or more of:
Ongoing concern that there will be more attacks.
Worry as to the significance of the attack or its consequences.
Material change in behavior, such as doing something to avoidance.
The patient also has agoraphobia.
The panic attacks are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
The panic attacks are not better explained by another Anxiety or Mental Disorder.
Panic Disorder Without Agoraphobia
The person has recurrent panic attacks that are not expected.
For a month or more after at least 1 of these attacks, the patient has had 1 or more of:
Ongoing concern that there will be more attacks.
Worry as to the significance of the attack or its consequences.
Material change in behavior, such as avoidance.
The person does not have agoraphobia.
The panic attacks are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
The panic attacks are not better explained by another Anxiety or Mental Disorder.
People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They cannot predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next attack will strike.
Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.
Panic Attack
The person suddenly develops a severe fear or discomfort that peaks within 10 minutes.
During this discrete episode, 4 or more of the following symptoms occur:
Chest pain or other chest discomfort
Chills or hot flashes
Choking sensation
Derealization (feeling unreal) or depersonalization (feeling detached from self)
Dizzy, lightheaded, faint or unsteady
Fear of dying
Fears of loss of control or becoming insane
Heart pounds, races or skips beats
Nausea or other abdominal discomfort
Numbness or tingling
Sweating
Shortness of breath or smothering sensation
Trembling
Panic Disorder With Agoraphobia
The person has recurrent panic attacks that are not expected.
For a month or more after at least 1 of these attacks, the person has had 1 or more of:
Ongoing concern that there will be more attacks.
Worry as to the significance of the attack or its consequences.
Material change in behavior, such as doing something to avoidance.
The patient also has agoraphobia.
The panic attacks are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
The panic attacks are not better explained by another Anxiety or Mental Disorder.
Panic Disorder Without Agoraphobia
The person has recurrent panic attacks that are not expected.
For a month or more after at least 1 of these attacks, the patient has had 1 or more of:
Ongoing concern that there will be more attacks.
Worry as to the significance of the attack or its consequences.
Material change in behavior, such as avoidance.
The person does not have agoraphobia.
The panic attacks are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
The panic attacks are not better explained by another Anxiety or Mental Disorder.
Diagnostic Parameter, Dependant / Co-Dependant Personality Disorder
Dependent / Co-Dependent Personality Disorder
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of his or her life.
Has difficulty expressing disagreement with others because of fear of loss of support or approval.
Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
Urgently seeks another relationship as a source of care and support when a close relationship ends.
Is unrealistically preoccupied with fears of being left to take care of himself or herself.
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of his or her life.
Has difficulty expressing disagreement with others because of fear of loss of support or approval.
Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
Urgently seeks another relationship as a source of care and support when a close relationship ends.
Is unrealistically preoccupied with fears of being left to take care of himself or herself.
Diagnostic Parameter, Generalized Anxiety Disorder
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is a relatively common anxiety problem, affecting 3 - 4% of the population, Generalized anxiety disorder is much more than the normal anxiety people experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. The diagnostic criteria for GAD is as follows:
For more than half the days in at least 6 months, the patient experiences excessive anxiety and worry about several events or activities.
The person has trouble controlling these feelings.
Associated with this anxiety and worry, the patient has 3 or more of the following symptoms, some of which are present for over half the days in the past 6 months:
Feels restless, edgy, keyed up.
Tires easily.
Trouble concentrating.
Irritability.
Increased muscle tension.
Trouble sleeping (initial insomnia or restless, unrefreshing sleep).
The symptoms cause clinically important distress or impair work, social or personal functioning.
The disorder is not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
It does not occur only during a Mood Disorder, Psychotic Disorder, Posttraumatic Stress Disorder or Pervasive Developmental Disorder.
Generalized anxiety disorder (GAD) is a relatively common anxiety problem, affecting 3 - 4% of the population, Generalized anxiety disorder is much more than the normal anxiety people experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. The diagnostic criteria for GAD is as follows:
For more than half the days in at least 6 months, the patient experiences excessive anxiety and worry about several events or activities.
The person has trouble controlling these feelings.
Associated with this anxiety and worry, the patient has 3 or more of the following symptoms, some of which are present for over half the days in the past 6 months:
Feels restless, edgy, keyed up.
Tires easily.
Trouble concentrating.
Irritability.
Increased muscle tension.
Trouble sleeping (initial insomnia or restless, unrefreshing sleep).
The symptoms cause clinically important distress or impair work, social or personal functioning.
The disorder is not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
It does not occur only during a Mood Disorder, Psychotic Disorder, Posttraumatic Stress Disorder or Pervasive Developmental Disorder.
Diagnostic Parameter, Conversion Disorder
Conversion Disorder
Whilst "hysterical" blindness, paralysis, anesthesia, dysphagia, and gait disturbance have been described for many years, This patient confronts an acute stressor that creates a psychic conflict, and the physical symptom(s) serve as the resolution for the conflict. The patient may repress the stressor or be unaware of its impact. Failure to recognize and treat this early in the course may lead to symptoms which eventually become harder or impossible to cure. This disorder may occur at any age, either gender, any personality. A conversion disorder is characterized by the loss of a bodily function, for example blindness , paralysis, or the inability to speak . The loss of physical function is involuntary, but diagnostic testing does not show a physical cause for the dysfunction.
At least one symptom or deficit of sensory or voluntary motor function suggests a neurological or general medical condition.
It is not limited to pain or sexual dysfunction.
Appropriate investigation does not identify a neurological or general medical condition or the direct effects of substance use that can fully explain it.
Conflicts or other stressors that precede the onset or worsening of this symptom suggest that psychological factors are related to it.
The patient doesn't consciously feign the symptoms for material gain (Factitious Disorder) or to occupy the sick role (Malingering).
It is not a culturally sanctioned behavior or experience.
It is serious enough to produce at least 1 of:
warrants medical evaluation, or
causes distress that is clinically important, or
impairs social, occupational or personal functioning
It does not occur solely during Somatization Disorder, and no other mental disorder better explains it.
Symptom Groupings:
Sensory Symptoms: These include anesthesia, excessive sensitivity to strong simulation (hyperanesthesia), loss of sense of pain (analgesia), and unusual symptoms such as tingling or crawling sensations.
Motor Symptoms: In motor symptoms, any of the body's muscle groups may be involved: arms, legs, vocal chords. Included are tremors, tics (involuntary twitches), and disorganized mobility or paralysis.
Visceral Symptoms: Examples are trouble swallowing, frequent belching, spells of coughing or vomiting, all carried to an uncommon extreme. In both sensory and motor symptoms, the areas affected may not correspond at all to the nerve distribution in the area.
Specify type of symptom or deficit:
With Motor Symptom or Deficit.
With Seizures or Convulsions.
With Sensory Symptom or Deficit.
With Mixed Presentation.
Whilst "hysterical" blindness, paralysis, anesthesia, dysphagia, and gait disturbance have been described for many years, This patient confronts an acute stressor that creates a psychic conflict, and the physical symptom(s) serve as the resolution for the conflict. The patient may repress the stressor or be unaware of its impact. Failure to recognize and treat this early in the course may lead to symptoms which eventually become harder or impossible to cure. This disorder may occur at any age, either gender, any personality. A conversion disorder is characterized by the loss of a bodily function, for example blindness , paralysis, or the inability to speak . The loss of physical function is involuntary, but diagnostic testing does not show a physical cause for the dysfunction.
At least one symptom or deficit of sensory or voluntary motor function suggests a neurological or general medical condition.
It is not limited to pain or sexual dysfunction.
Appropriate investigation does not identify a neurological or general medical condition or the direct effects of substance use that can fully explain it.
Conflicts or other stressors that precede the onset or worsening of this symptom suggest that psychological factors are related to it.
The patient doesn't consciously feign the symptoms for material gain (Factitious Disorder) or to occupy the sick role (Malingering).
It is not a culturally sanctioned behavior or experience.
It is serious enough to produce at least 1 of:
warrants medical evaluation, or
causes distress that is clinically important, or
impairs social, occupational or personal functioning
It does not occur solely during Somatization Disorder, and no other mental disorder better explains it.
Symptom Groupings:
Sensory Symptoms: These include anesthesia, excessive sensitivity to strong simulation (hyperanesthesia), loss of sense of pain (analgesia), and unusual symptoms such as tingling or crawling sensations.
Motor Symptoms: In motor symptoms, any of the body's muscle groups may be involved: arms, legs, vocal chords. Included are tremors, tics (involuntary twitches), and disorganized mobility or paralysis.
Visceral Symptoms: Examples are trouble swallowing, frequent belching, spells of coughing or vomiting, all carried to an uncommon extreme. In both sensory and motor symptoms, the areas affected may not correspond at all to the nerve distribution in the area.
Specify type of symptom or deficit:
With Motor Symptom or Deficit.
With Seizures or Convulsions.
With Sensory Symptom or Deficit.
With Mixed Presentation.
Diagnostic Parameter, Bereavement
Bereavement (Symptoms)
Individuals present symptoms which are characteristic of a Major Depressive Episode. The bereaved individual typically regards the depressed mood as "normal," although the person may seek professional help for relief of associated symptoms such as insomnia. The duration and expression of "normal" bereavement vary considerably among different cultural groups. The diagnosis of Major Depressive Disorder is generally not given unless the symptoms are still present 2 months after the loss. However, the presence of certain symptoms that are not characteristic of a "normal" grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode. These include:
Guilt about things other than actions taken or not taken by the survivor at the time of the death.
Thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person.
Morbid preoccupation with worthlessness.
Marked psychomotor retardation.
Prolonged and marked functional impairment.
Hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.
Individuals present symptoms which are characteristic of a Major Depressive Episode. The bereaved individual typically regards the depressed mood as "normal," although the person may seek professional help for relief of associated symptoms such as insomnia. The duration and expression of "normal" bereavement vary considerably among different cultural groups. The diagnosis of Major Depressive Disorder is generally not given unless the symptoms are still present 2 months after the loss. However, the presence of certain symptoms that are not characteristic of a "normal" grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode. These include:
Guilt about things other than actions taken or not taken by the survivor at the time of the death.
Thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person.
Morbid preoccupation with worthlessness.
Marked psychomotor retardation.
Prolonged and marked functional impairment.
Hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.
Diagnostic Parameter, Major Depressive Episode
Major Depressive Episode
Depression, which affects people of all ages, income, race, and cultures, is a disturbance of mood and is characterized by a loss of interest or pleasure in normal everyday activities. People who are depressed may feel "down in the dumps" for weeks, months, or even years at a time.
in the same 2 weeks, the patient has had 5 or more of the following symptoms, which are a definite change from usual functioning. Either depressed mood or decreased interest or pleasure must be one of the five:
Mood. For most of nearly every day, the patient reports depressed mood or appears depressed to others.
Interests. For most of nearly every day, interest or pleasure is markedly decreased in nearly all activities (noted by the patient or by others).
Eating and weight. Although not dieting, there is a marked loss or gain of weight (such as five percent in one month) or appetite is markedly decreased or increased nearly every day.
Sleep. Nearly every day the patient sleeps excessively or not enough.
Motor activity. Nearly every day others can see that the patient's activity is agitated or retarded.
Fatigue. Nearly every day there is fatigue or loss of energy.
Self-worth. Nearly every day the patient feels worthless or inappropriately guilty. These feelings are not just about being sick; they may be delusional.
Concentration. Noted by the patient or by others, nearly every day the patient is indecisive or has trouble thinking or concentrating.
Death. The patient has had repeated thoughts about death (other than the fear of dying), suicide (with or without a plan) or has made a suicide attempt.
These symptoms cause clinically important distress or impair work, social or personal functioning.
They don't fulfill criteria for Mixed Episode
This disorder is not directly caused by a general medical condition or the use of substances, including prescription medications.
Unless the symptoms are severe (defined as severely impaired functioning, severe preoccupation with worthlessness, ideas of suicide, delusions or hallucinations or psychomotor retardation), the episode has not begun within two months of the loss of a loved one.
Use the following codes (including Chronic) for the current or most recent Major Depressive Episode in Major Depressive, Bipolar I or Bipolar II Disorders.
Fifth Digit Severity Code for Major Depressive Episode.
.1 Mild. Symptoms barely meet criteria for major depression and result in little distress or interference with the patient's ability to work, study or socialize.
.2 Moderate. Intermediate between Mild and Severe.
.3 Severe without Psychotic Features. The number of symptoms well exceeds the minimum for diagnosis, and they markedly interfere with patient's work, social or personal functioning.
.4 With Psychotic Features. The patient has delusions or hallucinations, which may be mood-congruent or mood-incongruent. Specify, if possible:
Severe With Mood-congruent Psychotic Features. The content of the patient's delusions or hallucinations is completely consistent with the typical themes of depression: death, disease, guilt, nihilism, personal inadequacy or punishment that is deserved.
Severe With Mood-incongruent Psychotic Features. The content of the patient's delusions or hallucinations is not consistent with the typical themes of depression. Mood incongruent themes include delusions of control, persecution, thought broadcasting and thought insertion.
.5 In Partial Remission. Use this code for patients who formerly met full criteria for Major Depressive Episode and now either (1) have fewer than five symptoms or (2) have had no symptoms for less than two months.
.6 In Full Remission. The patient has had no material evidence of Major Depressive Episode during the past 2 months.
.0 Unspecified.
Chronicity Specifier: Chronic. All the criteria for a Major Depressive Episode have been met without interruption for the previous 2 years or longer.
Psychomotor Agitation and Psychomotor Retardation
Psychomotor agitation and retardation occur in depression, producing states of over activity and under activity respectively. Agitation and retardation can lead to impaired cognition, judgment, reason, and decision making, which often further isolates depressed people and prolongs symptoms. Psychomotor agitation can also lead to generalized restlessness.
Motor agitation is rarer than motor retardation and is often occurs in the elderly. Over activity in this sense does not mean mania. The agitated state in major depressive disorder should not be confused with the manic episode that occurs in bipolar disorder, when mood is temporarily elevated by a transient sense of hope and elation.
Psychomotor activities are the physical gestures that result from mental processes and are a product of the psyche. Many psychomotor behaviors associated with mental disorder affect impulses, cravings, instincts, and wishes. The spectrum of agitated behavior includes the following:
Incoherent conversation
Expansive gesturing
Pacing and hair twirling
Psychomotor retardation manifests as a slowing of coordination, speech, and impaired articulation. In this state, a person appears sluggish and seems hesitant or confused in speech and intention.
Essentially Features:
Physical illness, alcohol, medication, or street drug use.
Normal bereavement.
Bipolar Disorder
Mood-incongruent psychosis (e.g., Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified).
Major Depressive Disorder causes the following mood symptoms:
Abnormal depressed mood:
Sadness is usually a normal reaction to loss. However, in Major Depressive Disorder, sadness is abnormal because it:
Persists continuously for at least 2 weeks.
Causes marked functional impairment.
Causes disabling physical symptoms (e.g., disturbances in sleep,
appetite, weight, energy, and psychomotor activity).
Causes disabling psychological symptoms (e.g., apathy, morbid
preoccupation with worthlessness, suicidal ideation, or psychotic
symptoms).
The sadness in this disorder is often described as a depressed, hopeless, discouraged, "down in the dumps," "blah," or empty. This sadness may be denied at first. Many complain of bodily aches and pains, rather than admitting to their true feelings of sadness.
Abnormal loss of interest and pleasure mood:
The loss of interest and pleasure in this disorder is a reduced capacity to experience pleasure which in its most extreme form is called anhedonia.
The resulting lack of motivation can be quite crippling.
Abnormal irritable mood:
This disorder may present primarily with irritable, rather than depressed or apathetic mood. This is not officially recognized yet for adults, but it is recognized for children and adolescents.
Unfortunately, irritable depressed individuals often alienate their loved ones with their cranky mood and constant criticisms.
Major Depressive Disorder causes the following physical symptoms:
Abnormal appetite: Most depressed patients experience loss of appetite and weight loss. The opposite, excessive eating and weight gain, occurs in a minority of depressed patients. Changes in weight can be significant.
Abnormal sleep: Most depressed patients experience difficulty falling asleep, frequent awakenings during the night or very early morning awakening. The opposite, excessive sleeping, occurs in a minority of depressed patients.
Fatigue or loss of energy: Profound fatigue and lack of energy usually is very prominent and disabling.
Agitation or slowing: Psychomotor retardation (an actual physical slowing of speech, movement and thinking) or psychomotor agitation (observable pacing and physical restlessness) often are present in severe Major Depressive Disorder.
Major Depressive Disorder causes the following cognitive symptoms:
Abnormal self-reproach or inappropriate guilt:
This disorder usually causes a marked lowering of self-esteem and self-confidence with increased thoughts of pessimism, hopelessness, and helplessness. In the extreme, the person may feel excessively and unreasonably guilty.
The "negative thinking" caused by depression can become extremely dangerous as it can eventually lead to extremely self-defeating or suicidal behavior.
Abnormal poor concentration or indecisiveness:
Poor concentration is often an early symptom of this disorder. The depressed person quickly becomes mentally fatigued when asked to read, study, or solve complicated problems.
Marked forgetfulness often accompanies this disorder. As it worsens, this memory loss can be easily mistaken for early senility (dementia).
Abnormal morbid thoughts of death (not just fear of dying) or suicide:
The symptom most highly correlated with suicidal behavior in depression is hopelessness
Depression, which affects people of all ages, income, race, and cultures, is a disturbance of mood and is characterized by a loss of interest or pleasure in normal everyday activities. People who are depressed may feel "down in the dumps" for weeks, months, or even years at a time.
in the same 2 weeks, the patient has had 5 or more of the following symptoms, which are a definite change from usual functioning. Either depressed mood or decreased interest or pleasure must be one of the five:
Mood. For most of nearly every day, the patient reports depressed mood or appears depressed to others.
Interests. For most of nearly every day, interest or pleasure is markedly decreased in nearly all activities (noted by the patient or by others).
Eating and weight. Although not dieting, there is a marked loss or gain of weight (such as five percent in one month) or appetite is markedly decreased or increased nearly every day.
Sleep. Nearly every day the patient sleeps excessively or not enough.
Motor activity. Nearly every day others can see that the patient's activity is agitated or retarded.
Fatigue. Nearly every day there is fatigue or loss of energy.
Self-worth. Nearly every day the patient feels worthless or inappropriately guilty. These feelings are not just about being sick; they may be delusional.
Concentration. Noted by the patient or by others, nearly every day the patient is indecisive or has trouble thinking or concentrating.
Death. The patient has had repeated thoughts about death (other than the fear of dying), suicide (with or without a plan) or has made a suicide attempt.
These symptoms cause clinically important distress or impair work, social or personal functioning.
They don't fulfill criteria for Mixed Episode
This disorder is not directly caused by a general medical condition or the use of substances, including prescription medications.
Unless the symptoms are severe (defined as severely impaired functioning, severe preoccupation with worthlessness, ideas of suicide, delusions or hallucinations or psychomotor retardation), the episode has not begun within two months of the loss of a loved one.
Use the following codes (including Chronic) for the current or most recent Major Depressive Episode in Major Depressive, Bipolar I or Bipolar II Disorders.
Fifth Digit Severity Code for Major Depressive Episode.
.1 Mild. Symptoms barely meet criteria for major depression and result in little distress or interference with the patient's ability to work, study or socialize.
.2 Moderate. Intermediate between Mild and Severe.
.3 Severe without Psychotic Features. The number of symptoms well exceeds the minimum for diagnosis, and they markedly interfere with patient's work, social or personal functioning.
.4 With Psychotic Features. The patient has delusions or hallucinations, which may be mood-congruent or mood-incongruent. Specify, if possible:
Severe With Mood-congruent Psychotic Features. The content of the patient's delusions or hallucinations is completely consistent with the typical themes of depression: death, disease, guilt, nihilism, personal inadequacy or punishment that is deserved.
Severe With Mood-incongruent Psychotic Features. The content of the patient's delusions or hallucinations is not consistent with the typical themes of depression. Mood incongruent themes include delusions of control, persecution, thought broadcasting and thought insertion.
.5 In Partial Remission. Use this code for patients who formerly met full criteria for Major Depressive Episode and now either (1) have fewer than five symptoms or (2) have had no symptoms for less than two months.
.6 In Full Remission. The patient has had no material evidence of Major Depressive Episode during the past 2 months.
.0 Unspecified.
Chronicity Specifier: Chronic. All the criteria for a Major Depressive Episode have been met without interruption for the previous 2 years or longer.
Psychomotor Agitation and Psychomotor Retardation
Psychomotor agitation and retardation occur in depression, producing states of over activity and under activity respectively. Agitation and retardation can lead to impaired cognition, judgment, reason, and decision making, which often further isolates depressed people and prolongs symptoms. Psychomotor agitation can also lead to generalized restlessness.
Motor agitation is rarer than motor retardation and is often occurs in the elderly. Over activity in this sense does not mean mania. The agitated state in major depressive disorder should not be confused with the manic episode that occurs in bipolar disorder, when mood is temporarily elevated by a transient sense of hope and elation.
Psychomotor activities are the physical gestures that result from mental processes and are a product of the psyche. Many psychomotor behaviors associated with mental disorder affect impulses, cravings, instincts, and wishes. The spectrum of agitated behavior includes the following:
Incoherent conversation
Expansive gesturing
Pacing and hair twirling
Psychomotor retardation manifests as a slowing of coordination, speech, and impaired articulation. In this state, a person appears sluggish and seems hesitant or confused in speech and intention.
Essentially Features:
Physical illness, alcohol, medication, or street drug use.
Normal bereavement.
Bipolar Disorder
Mood-incongruent psychosis (e.g., Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified).
Major Depressive Disorder causes the following mood symptoms:
Abnormal depressed mood:
Sadness is usually a normal reaction to loss. However, in Major Depressive Disorder, sadness is abnormal because it:
Persists continuously for at least 2 weeks.
Causes marked functional impairment.
Causes disabling physical symptoms (e.g., disturbances in sleep,
appetite, weight, energy, and psychomotor activity).
Causes disabling psychological symptoms (e.g., apathy, morbid
preoccupation with worthlessness, suicidal ideation, or psychotic
symptoms).
The sadness in this disorder is often described as a depressed, hopeless, discouraged, "down in the dumps," "blah," or empty. This sadness may be denied at first. Many complain of bodily aches and pains, rather than admitting to their true feelings of sadness.
Abnormal loss of interest and pleasure mood:
The loss of interest and pleasure in this disorder is a reduced capacity to experience pleasure which in its most extreme form is called anhedonia.
The resulting lack of motivation can be quite crippling.
Abnormal irritable mood:
This disorder may present primarily with irritable, rather than depressed or apathetic mood. This is not officially recognized yet for adults, but it is recognized for children and adolescents.
Unfortunately, irritable depressed individuals often alienate their loved ones with their cranky mood and constant criticisms.
Major Depressive Disorder causes the following physical symptoms:
Abnormal appetite: Most depressed patients experience loss of appetite and weight loss. The opposite, excessive eating and weight gain, occurs in a minority of depressed patients. Changes in weight can be significant.
Abnormal sleep: Most depressed patients experience difficulty falling asleep, frequent awakenings during the night or very early morning awakening. The opposite, excessive sleeping, occurs in a minority of depressed patients.
Fatigue or loss of energy: Profound fatigue and lack of energy usually is very prominent and disabling.
Agitation or slowing: Psychomotor retardation (an actual physical slowing of speech, movement and thinking) or psychomotor agitation (observable pacing and physical restlessness) often are present in severe Major Depressive Disorder.
Major Depressive Disorder causes the following cognitive symptoms:
Abnormal self-reproach or inappropriate guilt:
This disorder usually causes a marked lowering of self-esteem and self-confidence with increased thoughts of pessimism, hopelessness, and helplessness. In the extreme, the person may feel excessively and unreasonably guilty.
The "negative thinking" caused by depression can become extremely dangerous as it can eventually lead to extremely self-defeating or suicidal behavior.
Abnormal poor concentration or indecisiveness:
Poor concentration is often an early symptom of this disorder. The depressed person quickly becomes mentally fatigued when asked to read, study, or solve complicated problems.
Marked forgetfulness often accompanies this disorder. As it worsens, this memory loss can be easily mistaken for early senility (dementia).
Abnormal morbid thoughts of death (not just fear of dying) or suicide:
The symptom most highly correlated with suicidal behavior in depression is hopelessness
Diagnostic Parameter, Bipolar Disorder
Bipolar I Disorder
Sometimes individuals experience severe mood swings from periods of extreme depression to periods of exaggerated happiness. This is known as bipolar disorder or manic-depressive illness, an illness that involves episodes of serious mania and depression. The individual's mood usually swings from overly "high" and irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal moods interspersed.
Bipolar I Disorder, Single Manic Episode
The patient has had just one Manic Episode and no Major Depressive Episodes.
Schizoaffective disorder doesn't explain the Manic Episode better, and it isn't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Specify Mixed: If a single episode meets the criteria for Mixed Episode, it would be recorded, for example:
Bipolar I Disorder, Single Manic Episode, Mixed, Moderate
Include any specifiers that apply to this Manic Episode.
Bipolar I Disorder, Most Recent Episode Manic
The patient's most recent episode is of mania.
The patient has had at least one Major Depressive, Manic or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to this Manic Episode or to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Hypomanic
The patient's most recent episode is Hypomanic.
The patient has previously had one or more Manic or Mixed Episodes.
The symptoms cause clinically important distress or impair work, social or personal functioning.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Mixed
The patient's most recent episode is of mixed mania and depression.
The patient has had at least one Major Depressive, Manic or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to this Mixed Episode or to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Depressed
The patient's most recent episode is Major Depressive.
The patient has had at least one previous Manic or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to this Major Depressive Episode or to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Unspecified
Other than duration, the patient currently or recently meets criteria for Major Depressive, Manic, Mixed, or Hypomanic episode.
The patient has had at least one previous Manic or Mixed Episode.
These symptoms cause clinically important distress or impair work, social or personal functioning.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
The symptoms are not directly caused by a general medical condition or the use substances, including prescription medications.
Include any specifiers that apply to the overall course of the disorder.
Sometimes individuals experience severe mood swings from periods of extreme depression to periods of exaggerated happiness. This is known as bipolar disorder or manic-depressive illness, an illness that involves episodes of serious mania and depression. The individual's mood usually swings from overly "high" and irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal moods interspersed.
Bipolar I Disorder, Single Manic Episode
The patient has had just one Manic Episode and no Major Depressive Episodes.
Schizoaffective disorder doesn't explain the Manic Episode better, and it isn't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Specify Mixed: If a single episode meets the criteria for Mixed Episode, it would be recorded, for example:
Bipolar I Disorder, Single Manic Episode, Mixed, Moderate
Include any specifiers that apply to this Manic Episode.
Bipolar I Disorder, Most Recent Episode Manic
The patient's most recent episode is of mania.
The patient has had at least one Major Depressive, Manic or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to this Manic Episode or to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Hypomanic
The patient's most recent episode is Hypomanic.
The patient has previously had one or more Manic or Mixed Episodes.
The symptoms cause clinically important distress or impair work, social or personal functioning.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Mixed
The patient's most recent episode is of mixed mania and depression.
The patient has had at least one Major Depressive, Manic or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to this Mixed Episode or to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Depressed
The patient's most recent episode is Major Depressive.
The patient has had at least one previous Manic or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
Include any specifiers that apply to this Major Depressive Episode or to the overall course of the disorder.
Bipolar I Disorder, Most Recent Episode Unspecified
Other than duration, the patient currently or recently meets criteria for Major Depressive, Manic, Mixed, or Hypomanic episode.
The patient has had at least one previous Manic or Mixed Episode.
These symptoms cause clinically important distress or impair work, social or personal functioning.
Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
The symptoms are not directly caused by a general medical condition or the use substances, including prescription medications.
Include any specifiers that apply to the overall course of the disorder.
Diagnostic Parameter, Male Erectile Disorder
Male Erectile Disorder
Is the recurrent inability to achieve or maintain an adequate erection until completion of sexual activity. It is not considered male erectile disorder if it is merely an occasional problem or if it does not create distress and interpersonal difficulty.
Chronically or repeatedly, the patient cannot get or keep an erection sufficient to complete the sexual activity.
Except for another Sexual Dysfunction.
It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.
It causes marked distress or interpersonal problems.
Is the recurrent inability to achieve or maintain an adequate erection until completion of sexual activity. It is not considered male erectile disorder if it is merely an occasional problem or if it does not create distress and interpersonal difficulty.
Chronically or repeatedly, the patient cannot get or keep an erection sufficient to complete the sexual activity.
Except for another Sexual Dysfunction.
It is not directly caused by substance use (medication or drug of abuse) or by a general medical condition.
It causes marked distress or interpersonal problems.
Diagnostic Parameter, Selective Mutism
Selective Mutism
Is a rare condition occurring in childhood. Selective Mutism is characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking. Children with this disorder have the ability to both speak and understand language, but fail to use this ability. Most children who experience selective mutism function normally in other areas of their lives. Selective mutism is not a communications disorder and is not part of a developmental disorder. Therefore by definition, the disorder does not include children with conduct disorders, oppositional defiant behavior, and/or attention-deficit hyperactivity disorder. The main characteristics are:
Does not speak in certain places; such as school or other social events.
Can speak normally in other settings such as in their home or in places where they are comfortable and relaxed.
The child's inability to speak interferes with their ability to function in educational and/or social settings.
Mutism has persisted for at least one month.
Is a rare condition occurring in childhood. Selective Mutism is characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking. Children with this disorder have the ability to both speak and understand language, but fail to use this ability. Most children who experience selective mutism function normally in other areas of their lives. Selective mutism is not a communications disorder and is not part of a developmental disorder. Therefore by definition, the disorder does not include children with conduct disorders, oppositional defiant behavior, and/or attention-deficit hyperactivity disorder. The main characteristics are:
Does not speak in certain places; such as school or other social events.
Can speak normally in other settings such as in their home or in places where they are comfortable and relaxed.
The child's inability to speak interferes with their ability to function in educational and/or social settings.
Mutism has persisted for at least one month.
Diagnostic Parameter, Expressive Language Disorder
Expressive Language Disorder
The scores obtained from standardized individually administered measures of expressive language development are substantially below those obtained from standardized measures of both nonverbal intellectual capacity and receptive language development. The disturbance may be manifest clinically by symptoms that include having a markedly limited vocabulary, making errors in tense, or having difficulty recalling words or producing sentences with developmentally appropriate length or complexity. The disorders main features are:
Using standardized measures, the patient's scores of expressive language development are materially lower than those of both nonverbal intellectual capacity and receptive language development. Clinically, the patient may have severely limited vocabulary, make errors of tense, recall words poorly or produce sentences that are shorter or less complex than is developmentally appropriate.
This disorder interferes with educational or occupational achievement or with social communication.
It does not fulfill criteria for a Mixed Receptive-Expressive Language Disorder or a Pervasive Developmental Disorder.
If the patient also has Mental Retardation, environmental deprivation or a speech-motor or sensory deficit, the problems with language are worse than you would expect with these problems.
The scores obtained from standardized individually administered measures of expressive language development are substantially below those obtained from standardized measures of both nonverbal intellectual capacity and receptive language development. The disturbance may be manifest clinically by symptoms that include having a markedly limited vocabulary, making errors in tense, or having difficulty recalling words or producing sentences with developmentally appropriate length or complexity. The disorders main features are:
Using standardized measures, the patient's scores of expressive language development are materially lower than those of both nonverbal intellectual capacity and receptive language development. Clinically, the patient may have severely limited vocabulary, make errors of tense, recall words poorly or produce sentences that are shorter or less complex than is developmentally appropriate.
This disorder interferes with educational or occupational achievement or with social communication.
It does not fulfill criteria for a Mixed Receptive-Expressive Language Disorder or a Pervasive Developmental Disorder.
If the patient also has Mental Retardation, environmental deprivation or a speech-motor or sensory deficit, the problems with language are worse than you would expect with these problems.
Diagnostic Parameter, Stereotypic Movement Disorder
Stereotypic Movement Disorder
The child's motor behavior seems driven, repetitive and nonfunctional. Examples include biting or hitting self, body rocking, hand shaking or waving, head banging, mouthing of objects, picking at skin or body openings.
This behavior seriously interferes with normal activities or causes physical injury that requires medical treatment. Main characteristics are:
If the patient also has Mental Retardation, the stereotypic behavior is serious enough to be a focus of treatment. The behavior is not better explained by a compulsion (as in Obsessive-Compulsive Disorder), a tic (Tic Disorder), hair pulling (Trichotillomania) or a Pervasive Developmental Disorder.
It is not directly caused by a general medical condition or the effects of substance use.
The behavior has persisted for at least 4 weeks.
Specify if With Self-Injurious Behavior. The behavior causes bodily injury that requires medical treatment (or would, if the child were not interfered with).
The child's motor behavior seems driven, repetitive and nonfunctional. Examples include biting or hitting self, body rocking, hand shaking or waving, head banging, mouthing of objects, picking at skin or body openings.
This behavior seriously interferes with normal activities or causes physical injury that requires medical treatment. Main characteristics are:
If the patient also has Mental Retardation, the stereotypic behavior is serious enough to be a focus of treatment. The behavior is not better explained by a compulsion (as in Obsessive-Compulsive Disorder), a tic (Tic Disorder), hair pulling (Trichotillomania) or a Pervasive Developmental Disorder.
It is not directly caused by a general medical condition or the effects of substance use.
The behavior has persisted for at least 4 weeks.
Specify if With Self-Injurious Behavior. The behavior causes bodily injury that requires medical treatment (or would, if the child were not interfered with).
Diagnostic Parameter, Mental Retardation
Mental Retardation
According to the American Association on Mental Retardation (AAMR), an individual is considered to have mental retardation based on the following three criteria:
Intellectual functioning level (IQ) is below 70-75.
Significant limitations exist in two or more adaptive skill areas and the condition is present from childhood (defined as age 18 or less.).
The person's intellectual functioning is markedly below average (IQ of 70 or less on a standard, individually administered test).
In 2 or more of the following areas, the patient has more trouble functioning than would be expected for age and cultural group:
Communication
Self-care
Home living
Social and interpersonal skills
Using community resources
Self-direction
Academic ability
Work
Free time
Health
Safety
Starts before age 18.
According to the American Association on Mental Retardation (AAMR), an individual is considered to have mental retardation based on the following three criteria:
Intellectual functioning level (IQ) is below 70-75.
Significant limitations exist in two or more adaptive skill areas and the condition is present from childhood (defined as age 18 or less.).
The person's intellectual functioning is markedly below average (IQ of 70 or less on a standard, individually administered test).
In 2 or more of the following areas, the patient has more trouble functioning than would be expected for age and cultural group:
Communication
Self-care
Home living
Social and interpersonal skills
Using community resources
Self-direction
Academic ability
Work
Free time
Health
Safety
Starts before age 18.
Diagnostic Parameter, Selective Mutism
Selective Mutism
Is a rare condition occurring in childhood. Selective Mutism is characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking. Children with this disorder have the ability to both speak and understand language, but fail to use this ability. Most children who experience selective mutism function normally in other areas of their lives. Selective mutism is not a communications disorder and is not part of a developmental disorder. Therefore by definition, the disorder does not include children with conduct disorders, oppositional defiant behavior, and/or attention-deficit hyperactivity disorder. The main characteristics are:
Does not speak in certain places; such as school or other social events.
Can speak normally in other settings such as in their home or in places where they are comfortable and relaxed.
The child's inability to speak interferes with their ability to function in educational and/or social settings.
Mutism has persisted for at least one month.
Associated Features:
Psychological trauma or stressors may be apparent particularly during the time of speech development.
A particular mother profile and mother-child relationship (maternal anxiety, depression, dependence and a domineering and overprotective approach to the child).
Minimal brain dysfunction.
History of developmental delays and speech and language disabilities.
Neuropsychological social cue processing disorder.
Anxious temperament: shyness, worry, social avoidance,fearful, social withdrawal clinging, Negativism
Is a rare condition occurring in childhood. Selective Mutism is characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking. Children with this disorder have the ability to both speak and understand language, but fail to use this ability. Most children who experience selective mutism function normally in other areas of their lives. Selective mutism is not a communications disorder and is not part of a developmental disorder. Therefore by definition, the disorder does not include children with conduct disorders, oppositional defiant behavior, and/or attention-deficit hyperactivity disorder. The main characteristics are:
Does not speak in certain places; such as school or other social events.
Can speak normally in other settings such as in their home or in places where they are comfortable and relaxed.
The child's inability to speak interferes with their ability to function in educational and/or social settings.
Mutism has persisted for at least one month.
Associated Features:
Psychological trauma or stressors may be apparent particularly during the time of speech development.
A particular mother profile and mother-child relationship (maternal anxiety, depression, dependence and a domineering and overprotective approach to the child).
Minimal brain dysfunction.
History of developmental delays and speech and language disabilities.
Neuropsychological social cue processing disorder.
Anxious temperament: shyness, worry, social avoidance,fearful, social withdrawal clinging, Negativism
Diagnostic Parameter, Childhood Disintegrative Disorder
Childhood Disintegrative Disorder
A condition occurring in 3 to 4 year olds which is characterized by a deterioration, over several months of intellectual, social, and language functioning. Also known as; disintegrative psychosis or Heller's syndrome. This rather rare condition was described many years before autism but has only recently been 'officially' recognized. With CDD children develop a condition which resembles autism but only after a relatively prolonged period of clearly normal development. This condition apparently differs from autism in the pattern of onset, course, and outcome. Although apparently rare the condition probably has frequently been incorrectly diagnosed. The following is prominent with the condition:
Loss of social skills.
Loss of bowel and bladder control.
Loss of expressive or receptive language.
Loss of motor skills.
Lack of play.
Failure to develop peer relationships.
Impairment in nonverbal behaviors.
Delay or lack of spoken language.
Inability to initiate or sustain a conversation.
A condition occurring in 3 to 4 year olds which is characterized by a deterioration, over several months of intellectual, social, and language functioning. Also known as; disintegrative psychosis or Heller's syndrome. This rather rare condition was described many years before autism but has only recently been 'officially' recognized. With CDD children develop a condition which resembles autism but only after a relatively prolonged period of clearly normal development. This condition apparently differs from autism in the pattern of onset, course, and outcome. Although apparently rare the condition probably has frequently been incorrectly diagnosed. The following is prominent with the condition:
Loss of social skills.
Loss of bowel and bladder control.
Loss of expressive or receptive language.
Loss of motor skills.
Lack of play.
Failure to develop peer relationships.
Impairment in nonverbal behaviors.
Delay or lack of spoken language.
Inability to initiate or sustain a conversation.
Diagnostic Parameter, Rett's Disorder
Rett's Disorder
An inherited disorder that affects only females, the syndrome causes mental retardation and developmental degeneration. The following suggest normal early development:
Prenatal and perinatal development appear normal.
Psychomotor development appears normal at least until month 6 old.
Head circumference is normal at birth.
After this period of normal development, all of:
Head growth slows abnormally between 5 and 48 months.
Between 5 and 30 months, the child loses already acquired purposeful hand movements and develops stereotyped hand movements such as handwashing or handwringing.
Early in the course, the child loses interest in the social environment. However, social interaction often develops later.
Gait or movements of trunk are poorly coordinated.
Severe psychomotor retardation and impairment of expressive and receptive language.
An inherited disorder that affects only females, the syndrome causes mental retardation and developmental degeneration. The following suggest normal early development:
Prenatal and perinatal development appear normal.
Psychomotor development appears normal at least until month 6 old.
Head circumference is normal at birth.
After this period of normal development, all of:
Head growth slows abnormally between 5 and 48 months.
Between 5 and 30 months, the child loses already acquired purposeful hand movements and develops stereotyped hand movements such as handwashing or handwringing.
Early in the course, the child loses interest in the social environment. However, social interaction often develops later.
Gait or movements of trunk are poorly coordinated.
Severe psychomotor retardation and impairment of expressive and receptive language.
Diagnostic Parameter, Austic Disorder
Autistic Disorder
Autism is a developmental disorder that typically appears during the first three years of life and may be the result of a neurological disorder that affects the brain. Autism is classified by the American Psychiatric Association as a Pervasive Development Disorder (APA, 1994). It is defined by symptoms that appear before the age of three which reflect delayed or abnormal development in Language, Social Skills and Behavioral Repertoire.
Autistic disorder symptoms manifest themselves as follows:
The person fulfills a total of at least 6 criteria from the following 3 lists, distributed as indicated:
Impaired social interaction (at least 2):
Markedly deficient regulation of social interaction by using multiple non-verbal behaviors such as eye contact, facial expression, body posture and gestures.
Lack of peer relationships that are appropriate to the developmental level.
Doesn't seek to share achievements, interests or pleasure with others.
Lacks social or emotional reciprocity.
Impaired communication (at least 1):
Delayed or absent development of spoken language for which the patient doesn't try to compensate with gestures.
In person's who can speak, inadequate attempts to begin or sustain a conversation.
Language that is repetitive, stereotyped or idiosyncratic.
Appropriate to developmental stage, absence of social imitative play or spontaneous, make-believe play.
Activities, behavior and interests that are repetitive, restricted and stereotyped (at least 1 of):
Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
Rigidly sticks to routines or rituals that don't appear to have a function.
Has stereotyped, repetitive motor mannerisms, such as hand flapping.
Persistently preoccupied with parts of objects.
Before age three, the person shows delayed or abnormal functioning in 1 or more of these areas:
Social interaction.
Language used in social communication.
Imaginative or symbolic play.
These symptoms are not better explained by Childhood Disintegrative Disorder or Rett's Disorder.
Autism is a developmental disorder that typically appears during the first three years of life and may be the result of a neurological disorder that affects the brain. Autism is classified by the American Psychiatric Association as a Pervasive Development Disorder (APA, 1994). It is defined by symptoms that appear before the age of three which reflect delayed or abnormal development in Language, Social Skills and Behavioral Repertoire.
Autistic disorder symptoms manifest themselves as follows:
The person fulfills a total of at least 6 criteria from the following 3 lists, distributed as indicated:
Impaired social interaction (at least 2):
Markedly deficient regulation of social interaction by using multiple non-verbal behaviors such as eye contact, facial expression, body posture and gestures.
Lack of peer relationships that are appropriate to the developmental level.
Doesn't seek to share achievements, interests or pleasure with others.
Lacks social or emotional reciprocity.
Impaired communication (at least 1):
Delayed or absent development of spoken language for which the patient doesn't try to compensate with gestures.
In person's who can speak, inadequate attempts to begin or sustain a conversation.
Language that is repetitive, stereotyped or idiosyncratic.
Appropriate to developmental stage, absence of social imitative play or spontaneous, make-believe play.
Activities, behavior and interests that are repetitive, restricted and stereotyped (at least 1 of):
Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
Rigidly sticks to routines or rituals that don't appear to have a function.
Has stereotyped, repetitive motor mannerisms, such as hand flapping.
Persistently preoccupied with parts of objects.
Before age three, the person shows delayed or abnormal functioning in 1 or more of these areas:
Social interaction.
Language used in social communication.
Imaginative or symbolic play.
These symptoms are not better explained by Childhood Disintegrative Disorder or Rett's Disorder.
Diagnostic Parameter, Aaperger Syndrome
Asperger's Disorder
Asperger Syndrome is a neurobiological disorder named after the Viennese physician, Hans Asperger, who in 1944 published a research paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. It wasn't until 1994 that Asperger Syndrome was recognised a a unique disorder.
Qualitative impairment in social interaction with at least two demonstrations of impaired social interaction. The person:
Shows a marked inability to regulate social interaction by using multiple non-verbal behaviors such as body posture and gestures, eye contact and facial expression.
Doesn't develop peer relationships that are appropriate to the developmental level.
Doesn't seek to share achievements, interests or pleasure with others.
Lacks social or emotional reciprocity.
Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
Rigidly sticks to routines or rituals that don't appear to have a function.
Has stereotyped, repetitive motor mannerisms (such as hand flapping).
Persistently preoccupied with parts of objects.
The symptoms cause clinically important impairment in social, occupational or personal functioning.
There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
The patient doesn't fulfill criteria for Schizophrenia or another specific Pervasive Developmental Disorder.
Asperger Syndrome is a neurobiological disorder named after the Viennese physician, Hans Asperger, who in 1944 published a research paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. It wasn't until 1994 that Asperger Syndrome was recognised a a unique disorder.
Qualitative impairment in social interaction with at least two demonstrations of impaired social interaction. The person:
Shows a marked inability to regulate social interaction by using multiple non-verbal behaviors such as body posture and gestures, eye contact and facial expression.
Doesn't develop peer relationships that are appropriate to the developmental level.
Doesn't seek to share achievements, interests or pleasure with others.
Lacks social or emotional reciprocity.
Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
Rigidly sticks to routines or rituals that don't appear to have a function.
Has stereotyped, repetitive motor mannerisms (such as hand flapping).
Persistently preoccupied with parts of objects.
The symptoms cause clinically important impairment in social, occupational or personal functioning.
There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
The patient doesn't fulfill criteria for Schizophrenia or another specific Pervasive Developmental Disorder.
Diagnostic Parameter, Schizoaffective Disorder
Schizoaffective Disorder
Occasionally, clinicians are confronted with a client whose disorder of mood is equal of anything seen in the major or bipolar disorders but whose mental and cognitive processes are so deranged as to suggest the presence of Schizophrenia. The often severe disturbances of psychological functioning seen in these conditions, such as mood-incongruent delusions and hallucinations are indeed reminiscent of a schizophrenic episode. Unlike schizophrenia, the schizoaffective pattern tends to be episodic, with a good prognosis for individual attacks, with lucid periods between episodes.
During a continuous period of illness, for a material part of at least one month (or less, if effectively treated) the patient has had 2 or more of the following symptoms:
Delusions (only one symptom is required if a delusion is bizarre, such as being abducted in a space ship from the sun).
Hallucinations (only one symptom is required if hallucinations include at least two voices are talking to one another or of a voice that keeps up a running commentary on the patient's thoughts or actions).
Speech that shows incoherence, derailment or other disorganization.
Severely disorganized or catatonic behavior.
Any negative symptom such as flat affect, muteness, lack of volition.
During this same continuous period of illness the patient has either:
A major depressive episode that includes depressed mood, or
A manic episode.
For at least 2 weeks of this period there have been delusions or hallucinations and no prominent mood symptoms.
The mood episode symptoms have been present during a substantial part of the active and residual portions of the illness. This disorder is not caused directly by a general medical condition or the use of substances, including prescription medications.
Criteria for Major Depressive Episode
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms do not meet criteria for a Mixed Episode The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Criteria for Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
The symptoms do not meet criteria for a Mixed Episode.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Criteria for Mixed Episode
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Criterion A for Schizophrenia
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
Delusions.
Hallucinations.
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior.
Negative symptoms, i.e., affective flattening, alogia, or avolition.
Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Occasionally, clinicians are confronted with a client whose disorder of mood is equal of anything seen in the major or bipolar disorders but whose mental and cognitive processes are so deranged as to suggest the presence of Schizophrenia. The often severe disturbances of psychological functioning seen in these conditions, such as mood-incongruent delusions and hallucinations are indeed reminiscent of a schizophrenic episode. Unlike schizophrenia, the schizoaffective pattern tends to be episodic, with a good prognosis for individual attacks, with lucid periods between episodes.
During a continuous period of illness, for a material part of at least one month (or less, if effectively treated) the patient has had 2 or more of the following symptoms:
Delusions (only one symptom is required if a delusion is bizarre, such as being abducted in a space ship from the sun).
Hallucinations (only one symptom is required if hallucinations include at least two voices are talking to one another or of a voice that keeps up a running commentary on the patient's thoughts or actions).
Speech that shows incoherence, derailment or other disorganization.
Severely disorganized or catatonic behavior.
Any negative symptom such as flat affect, muteness, lack of volition.
During this same continuous period of illness the patient has either:
A major depressive episode that includes depressed mood, or
A manic episode.
For at least 2 weeks of this period there have been delusions or hallucinations and no prominent mood symptoms.
The mood episode symptoms have been present during a substantial part of the active and residual portions of the illness. This disorder is not caused directly by a general medical condition or the use of substances, including prescription medications.
Criteria for Major Depressive Episode
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms do not meet criteria for a Mixed Episode The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Criteria for Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
The symptoms do not meet criteria for a Mixed Episode.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Criteria for Mixed Episode
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Criterion A for Schizophrenia
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
Delusions.
Hallucinations.
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior.
Negative symptoms, i.e., affective flattening, alogia, or avolition.
Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Diagnostic Parameter, Mood Disorder with Physchotic Episode
Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
Presence, while depressed, of two (or more) of the following:
Poor appetite or overeating.
Insomnia or hypersomnia.
Low energy or fatigue.
Low self-esteem.
Poor concentration or difficulty making decisions.
Feelings of hopelessness.
Psychomotor agitation or retardation nearly every day.
During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Major Depressive Episode:
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms do not meet criteria for a Mixed Episode
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Manic Episode:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
The symptoms do not meet criteria for a Mixed Episode
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Mixed Episode:
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Hypomanic Episode:
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
The episode is associated with an unequivocal change in functioning that is
uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Presence, while depressed, of two (or more) of the following:
Poor appetite or overeating.
Insomnia or hypersomnia.
Low energy or fatigue.
Low self-esteem.
Poor concentration or difficulty making decisions.
Feelings of hopelessness.
Psychomotor agitation or retardation nearly every day.
During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Major Depressive Episode:
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms do not meet criteria for a Mixed Episode
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Manic Episode:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
The symptoms do not meet criteria for a Mixed Episode
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Mixed Episode:
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Hypomanic Episode:
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli).
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
The episode is associated with an unequivocal change in functioning that is
uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Diagnostic Parameter, Schizophrenia
Schizophrenia
A group of psychotic disorders characterized by disturbances in thought, perception, affect, behavior, and communication that last longer than 6 months.
Symptoms. For a material part of at least one month (or less, if effectively treated) the patient has had 2 or more of:
Delusions (only one symptom is required if a delusion is bizarre, such as being abducted in a space ship from the sun)
Hallucinations (only one symptom is required if hallucinations are of at least two voices talking to one another or of a voice that keeps up a running commentary on the patient's thoughts or actions).
Speech that shows incoherence, derailment or other disorganization
Severely disorganized or catatonic behavior Any negative symptom such as flat affect, reduced speech or lack of volition.
Duration. For at least 6 continuous months the patient has shown some evidence of the disorder. At least one month must include the symptoms of frank psychosis mentioned above. During the balance of this time (either as a prodrome or residual of the illness), the patient must show either or both:
Negative symptoms as mentioned above.
In attenuated form, at least 2 of the other symptoms mentioned above (example: deteriorating personal hygiene plus an increasing suspicion that people are talking behind one's back).
Dysfunction. For much of this time, the disorder has materially impaired the patient's ability to work, study, socialize or provide self-care.
Mood exclusions. Mood and schizoaffective disorders have been ruled out, because the duration of any depressive or manic episodes that have occurred during the psychotic phase has been brief.
Other exclusions. This disorder is not directly caused by a general medical condition or the use of substances, including prescription medications.
Developmental Disorder exclusion. If the patient has a history of any Pervasive Developmental Disorder (such as Autistic Disorder), only diagnose Schizophrenia if prominent hallucinations or delusions are also present for a month or more (less, if treated).
After at least 1 year as passed since onset, classify the course of psychosis. Until a year has passed, you cannot assign any of these course specifiers.
Continuous. There has been no remission of "A" symptoms (first bullet). If negative symptoms stand out, you can also add "With Prominent Negative Symptoms."
Episodic With Interepisode Residual Symptoms. During episodes, "A" criteria are met. Between episodes the patient has clinically important residual symptoms. If negative symptoms stand out, you can also add "With Prominent Negative Symptoms."
Episodic With No Interepisode Residual Symptoms. During episodes, "A" criteria are met. Between episodes the patient has remissions with no clinically important symptoms.
Single Episode in Partial Remission. There has been one episode during which "A" criteria are met. Now there are some clinically important residual symptoms. If negative symptoms stand out, you can also add "With Prominent Negative Symptoms."
Single Episode in Full Remission. No clinically important symptoms remain.
Other or Unspecified Pattern.
Clinical Types
| Paranoid Type | Disorganized Type | Catatonic Type | Undifferentiated Type | Residual Type |
Paranoid type
The patient meets the basic criteria for Schizophrenia.
The patient is preoccupied with delusions or frequent auditory hallucinations.
None of these symptoms is prominent:
Disorganized speech
Disorganized behavior
Inappropriate or flat affect
Catatonic behavior
Disorganized type
The patient meets the basic criteria for Schizophrenia
All of these symptoms are prominent:
Disorganized behavior
Disorganized speech
Affect that is flat or inappropriate
The patient does not fulfill criteria for Catatonic Schizophrenia
Catatonic Type
The patient meets the basic criteria for Schizophrenia
At least 2 catatonic symptoms predominate:
Stupor or motor immobility (catalepsy or waxy flexibility)
Hyperactivity that has no apparent purpose and is not influenced by external stimuli
Mutism or marked negativism
Peculiar behavior such as posturing, stereotypes, mannerisms or grimacing
Echolalia or echopraxia
Undifferentiated Type
The patient meets the basic criteria for Schizophrenia
The patient does not meet criteria for Paranoid, Disorganized, or Catatonic types.
Residual Type
The patient at one time met criteria for Catatonic, Disorganized, Paranoid or Undifferentiated Schizophrenia.
The patient no longer has pronounced catatonic behavior, delusions, hallucinations or disorganized speech or behavior.
The patient is still ill, as indicated by either:
1) Negative symptoms such as flattened affect, reduced speech output or lack of volition, or
2) An attenuated form of at least 2 characteristic symptoms of schizophrenia, such as odd beliefs (related to delusions), distorted perceptions or illusions (hallucinations), odd speech (disorganized speech) or peculiarities of behavior (disorganized behavior).
A group of psychotic disorders characterized by disturbances in thought, perception, affect, behavior, and communication that last longer than 6 months.
Symptoms. For a material part of at least one month (or less, if effectively treated) the patient has had 2 or more of:
Delusions (only one symptom is required if a delusion is bizarre, such as being abducted in a space ship from the sun)
Hallucinations (only one symptom is required if hallucinations are of at least two voices talking to one another or of a voice that keeps up a running commentary on the patient's thoughts or actions).
Speech that shows incoherence, derailment or other disorganization
Severely disorganized or catatonic behavior Any negative symptom such as flat affect, reduced speech or lack of volition.
Duration. For at least 6 continuous months the patient has shown some evidence of the disorder. At least one month must include the symptoms of frank psychosis mentioned above. During the balance of this time (either as a prodrome or residual of the illness), the patient must show either or both:
Negative symptoms as mentioned above.
In attenuated form, at least 2 of the other symptoms mentioned above (example: deteriorating personal hygiene plus an increasing suspicion that people are talking behind one's back).
Dysfunction. For much of this time, the disorder has materially impaired the patient's ability to work, study, socialize or provide self-care.
Mood exclusions. Mood and schizoaffective disorders have been ruled out, because the duration of any depressive or manic episodes that have occurred during the psychotic phase has been brief.
Other exclusions. This disorder is not directly caused by a general medical condition or the use of substances, including prescription medications.
Developmental Disorder exclusion. If the patient has a history of any Pervasive Developmental Disorder (such as Autistic Disorder), only diagnose Schizophrenia if prominent hallucinations or delusions are also present for a month or more (less, if treated).
After at least 1 year as passed since onset, classify the course of psychosis. Until a year has passed, you cannot assign any of these course specifiers.
Continuous. There has been no remission of "A" symptoms (first bullet). If negative symptoms stand out, you can also add "With Prominent Negative Symptoms."
Episodic With Interepisode Residual Symptoms. During episodes, "A" criteria are met. Between episodes the patient has clinically important residual symptoms. If negative symptoms stand out, you can also add "With Prominent Negative Symptoms."
Episodic With No Interepisode Residual Symptoms. During episodes, "A" criteria are met. Between episodes the patient has remissions with no clinically important symptoms.
Single Episode in Partial Remission. There has been one episode during which "A" criteria are met. Now there are some clinically important residual symptoms. If negative symptoms stand out, you can also add "With Prominent Negative Symptoms."
Single Episode in Full Remission. No clinically important symptoms remain.
Other or Unspecified Pattern.
Clinical Types
| Paranoid Type | Disorganized Type | Catatonic Type | Undifferentiated Type | Residual Type |
Paranoid type
The patient meets the basic criteria for Schizophrenia.
The patient is preoccupied with delusions or frequent auditory hallucinations.
None of these symptoms is prominent:
Disorganized speech
Disorganized behavior
Inappropriate or flat affect
Catatonic behavior
Disorganized type
The patient meets the basic criteria for Schizophrenia
All of these symptoms are prominent:
Disorganized behavior
Disorganized speech
Affect that is flat or inappropriate
The patient does not fulfill criteria for Catatonic Schizophrenia
Catatonic Type
The patient meets the basic criteria for Schizophrenia
At least 2 catatonic symptoms predominate:
Stupor or motor immobility (catalepsy or waxy flexibility)
Hyperactivity that has no apparent purpose and is not influenced by external stimuli
Mutism or marked negativism
Peculiar behavior such as posturing, stereotypes, mannerisms or grimacing
Echolalia or echopraxia
Undifferentiated Type
The patient meets the basic criteria for Schizophrenia
The patient does not meet criteria for Paranoid, Disorganized, or Catatonic types.
Residual Type
The patient at one time met criteria for Catatonic, Disorganized, Paranoid or Undifferentiated Schizophrenia.
The patient no longer has pronounced catatonic behavior, delusions, hallucinations or disorganized speech or behavior.
The patient is still ill, as indicated by either:
1) Negative symptoms such as flattened affect, reduced speech output or lack of volition, or
2) An attenuated form of at least 2 characteristic symptoms of schizophrenia, such as odd beliefs (related to delusions), distorted perceptions or illusions (hallucinations), odd speech (disorganized speech) or peculiarities of behavior (disorganized behavior).
Diagnostic Parameter, Antisocial Personality Disorder
Antisocial Personality Disorder
There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 18 years, as indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
impulsivity or failure to plan ahead.
Irritability and aggressiveness, as indicated by repeated physical fights or assaults
reckless disregard for safety of self or others.
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
The individual is at least 18 years old (under 18 see Conduct Disorder ). There is evidence of Conduct Disorder with onset before age 15 years and the occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode
Associated Features:
Depressed Mood.
Addiction.
Dramatic or Erratic or Antisocial Personality.
There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 18 years, as indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
impulsivity or failure to plan ahead.
Irritability and aggressiveness, as indicated by repeated physical fights or assaults
reckless disregard for safety of self or others.
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
The individual is at least 18 years old (under 18 see Conduct Disorder ). There is evidence of Conduct Disorder with onset before age 15 years and the occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode
Associated Features:
Depressed Mood.
Addiction.
Dramatic or Erratic or Antisocial Personality.
Diagnostic Parameter, Adjustment Disorders
Adjustment Disorders
An adjustment disorder is a debilitating reaction, usually lasting less than six months, to a stressful event or situation. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
These symptoms or behaviors are clinically significant as evidenced by either of the following:
Distress that is in excess of what would be expected from exposure to the stressor.
Significant impairment in social, occupational or educational functioning.
The symptoms are not caused by Bereavement.
The stress-related disturbance does not meet the criteria for another specific disorder. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Adjustment Disorders Subtypes:
With Depressed Mood
With Anxiety
With Mixed Anxiety and Depressed Mood
With Disturbance of Conduct
With Mixed Disturbance of Emotions and Conduct
Unspecified
An adjustment disorder is a debilitating reaction, usually lasting less than six months, to a stressful event or situation. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
These symptoms or behaviors are clinically significant as evidenced by either of the following:
Distress that is in excess of what would be expected from exposure to the stressor.
Significant impairment in social, occupational or educational functioning.
The symptoms are not caused by Bereavement.
The stress-related disturbance does not meet the criteria for another specific disorder. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Adjustment Disorders Subtypes:
With Depressed Mood
With Anxiety
With Mixed Anxiety and Depressed Mood
With Disturbance of Conduct
With Mixed Disturbance of Emotions and Conduct
Unspecified
Diagnostic Parameter, Conduct Disorder
Conduct Disorder
A pattern of repetitive behavior where the rights of others or the social norms are violated and in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:
Aggression to people and animals:
Often bullies, threatens, or intimidates others.
Often initiates physical fights.
Has used a weapon that can cause serious physical harm to others.
Has been physically cruel to people.
Has been physically cruel to animals.
Has stolen while confronting a victim.
Has forced someone into sexual activity.
Destruction of property:
Has deliberately engaged in fire setting with the intention of causing serious damage.
Has deliberately destroyed others' property (other than by fire setting).
Deceitfulness or theft:
Has broken into someone else's house, building, or car.
Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).
Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Serious violations of rules:
Often stays out at night despite parental prohibitions, beginning before age 13 years.
Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).
Is often truant from school, beginning before age 13 years.
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.
Specify Type based on age at onset:
1. Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years.
2. Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years.
Specify Severity:
1. Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others.
2. Moderate: number of conduct problems and effect on others intermediate between "mild" and "severe".
3. Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others.
A pattern of repetitive behavior where the rights of others or the social norms are violated and in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:
Aggression to people and animals:
Often bullies, threatens, or intimidates others.
Often initiates physical fights.
Has used a weapon that can cause serious physical harm to others.
Has been physically cruel to people.
Has been physically cruel to animals.
Has stolen while confronting a victim.
Has forced someone into sexual activity.
Destruction of property:
Has deliberately engaged in fire setting with the intention of causing serious damage.
Has deliberately destroyed others' property (other than by fire setting).
Deceitfulness or theft:
Has broken into someone else's house, building, or car.
Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).
Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Serious violations of rules:
Often stays out at night despite parental prohibitions, beginning before age 13 years.
Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).
Is often truant from school, beginning before age 13 years.
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.
Specify Type based on age at onset:
1. Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years.
2. Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years.
Specify Severity:
1. Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others.
2. Moderate: number of conduct problems and effect on others intermediate between "mild" and "severe".
3. Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others.
Diagnostic Parameter, Oppositional Defiant Disorder Mental REtardation
Oppositional Defiant Disorder
Oppositional Defiant Disorder is defined as an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures that does not involve major antisocial violations, is not accounted for by the child's developmental stage, and results in significant functional impairment. A certain level of oppositional behavior is common in children and adolescents.
It should be considered a disorder only when the behaviors are more frequent and intense than in unaffected peers and when they cause dysfunction in social, academic, or work-related oppositional defiant disorder, oppositional disorder, defiant.
For at least 6 months, these person's show defiant, hostile, negativistic behavior; 4 or more of the following often apply:-
Losing temper.
Arguing with adults.
Actively defying or refusing to carry out the rules or requests of adults.
Deliberately doing things that annoy others.
Blaming others for own mistakes or misbehavior.
Being touchy or easily annoyed by others.
Being angry and resentful.
Being spiteful or vindictive.
The symptoms cause clinically important distress or impair work, school or social functioning.
The symptoms do not occur in the course of a Mood or Psychotic Disorder.
The symptoms do not fulfill criteria for Conduct Disorder.
If older than age 18, the patient does not meet criteria for Antisocial Personality Disorder.
Oppositional Defiant Disorder is defined as an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures that does not involve major antisocial violations, is not accounted for by the child's developmental stage, and results in significant functional impairment. A certain level of oppositional behavior is common in children and adolescents.
It should be considered a disorder only when the behaviors are more frequent and intense than in unaffected peers and when they cause dysfunction in social, academic, or work-related oppositional defiant disorder, oppositional disorder, defiant.
For at least 6 months, these person's show defiant, hostile, negativistic behavior; 4 or more of the following often apply:-
Losing temper.
Arguing with adults.
Actively defying or refusing to carry out the rules or requests of adults.
Deliberately doing things that annoy others.
Blaming others for own mistakes or misbehavior.
Being touchy or easily annoyed by others.
Being angry and resentful.
Being spiteful or vindictive.
The symptoms cause clinically important distress or impair work, school or social functioning.
The symptoms do not occur in the course of a Mood or Psychotic Disorder.
The symptoms do not fulfill criteria for Conduct Disorder.
If older than age 18, the patient does not meet criteria for Antisocial Personality Disorder.
Diagnostic Parameter, Mental REtardation
Mental Retardation
According to the American Association on Mental Retardation (AAMR), an individual is considered to have mental retardation based on the following three criteria:
Intellectual functioning level (IQ) is below 70-75.
Significant limitations exist in two or more adaptive skill areas and the condition is present from childhood (defined as age 18 or less.).
The person's intellectual functioning is markedly below average (IQ of 70 or less on a standard, individually administered test).
In 2 or more of the following areas, the patient has more trouble functioning than would be expected for age and cultural group:
Communication
Self-care
Home living
Social and interpersonal skills
Using community resources
Self-direction
Academic ability
Work
Free time
Health
Safety
Starts before age 18.
According to the American Association on Mental Retardation (AAMR), an individual is considered to have mental retardation based on the following three criteria:
Intellectual functioning level (IQ) is below 70-75.
Significant limitations exist in two or more adaptive skill areas and the condition is present from childhood (defined as age 18 or less.).
The person's intellectual functioning is markedly below average (IQ of 70 or less on a standard, individually administered test).
In 2 or more of the following areas, the patient has more trouble functioning than would be expected for age and cultural group:
Communication
Self-care
Home living
Social and interpersonal skills
Using community resources
Self-direction
Academic ability
Work
Free time
Health
Safety
Starts before age 18.
Asperger's Disorder
Asperger Syndrome is a neurobiological disorder named after the Viennese physician, Hans Asperger, who in 1944 published a research paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. It wasn't until 1994 that Asperger Syndrome was recognised a a unique disorder.
Qualitative impairment in social interaction with at least two demonstrations of impaired social interaction. The person:
Shows a marked inability to regulate social interaction by using multiple non-verbal behaviors such as body posture and gestures, eye contact and facial expression.
Doesn't develop peer relationships that are appropriate to the developmental level.
Doesn't seek to share achievements, interests or pleasure with others.
Lacks social or emotional reciprocity.
Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
Rigidly sticks to routines or rituals that don't appear to have a function.
Has stereotyped, repetitive motor mannerisms (such as hand flapping).
Persistently preoccupied with parts of objects.
The symptoms cause clinically important impairment in social, occupational or personal functioning.
There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
The patient doesn't fulfill criteria for Schizophrenia or another specific Pervasive Developmental Disorder.
Asperger Syndrome is a neurobiological disorder named after the Viennese physician, Hans Asperger, who in 1944 published a research paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. It wasn't until 1994 that Asperger Syndrome was recognised a a unique disorder.
Qualitative impairment in social interaction with at least two demonstrations of impaired social interaction. The person:
Shows a marked inability to regulate social interaction by using multiple non-verbal behaviors such as body posture and gestures, eye contact and facial expression.
Doesn't develop peer relationships that are appropriate to the developmental level.
Doesn't seek to share achievements, interests or pleasure with others.
Lacks social or emotional reciprocity.
Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
Rigidly sticks to routines or rituals that don't appear to have a function.
Has stereotyped, repetitive motor mannerisms (such as hand flapping).
Persistently preoccupied with parts of objects.
The symptoms cause clinically important impairment in social, occupational or personal functioning.
There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
The patient doesn't fulfill criteria for Schizophrenia or another specific Pervasive Developmental Disorder.
Diagnostic Parameter, Obsessive-Compulsive Disorderr Vocal Tics
Obsessive-Compulsive Disorder
A person with obsessive-compulsive disorder have either obsessions, or compulsions, or both. The obsessions and/or compulsions are strong enough to cause significant distress in their employment, schoolwork, or personal and social relationships. This includes: anankastic neurosis, obsessional neurosis and obsessive-compulsive neurosis
The person has obsessions or compulsions, or both.
Obsessions. The patient must have all of:
Recurring, persisting thoughts, impulses or images inappropriately intrude into
awareness and cause marked distress or anxiety.
These ideas are not just excessive worries about ordinary problems.
The person tries to ignore or suppress these ideas or to neutralize them by thoughts
or behavior.
There is insight that these ideas are a product of the patient's own mind.
Compulsions. The person must have all of:
The person feels the need to repeat physical behaviors (checking the stove to be sure it is off, hand washing) or mental behaviors (counting things, silently repeating words).
These behaviors occur as a response to an obsession or in accordance with strictly applied rules.
The aim of these behaviors is to reduce or eliminate distress or to prevent something that is dreaded.
These behaviors are either not realistically related to the events they are supposed to
counteract or they are clearly excessive for that purpose.
During some part of the illness the patient recognizes that the obsessions or compulsions are unreasonable or excessive.
The obsessions and/or compulsions are associated with at least 1 of:
Cause severe distress.
Take up time (more than an hour per day).
Interfere with the patient's usual routine or social, work or personal functioning.
The symptoms are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
A person with obsessive-compulsive disorder have either obsessions, or compulsions, or both. The obsessions and/or compulsions are strong enough to cause significant distress in their employment, schoolwork, or personal and social relationships. This includes: anankastic neurosis, obsessional neurosis and obsessive-compulsive neurosis
The person has obsessions or compulsions, or both.
Obsessions. The patient must have all of:
Recurring, persisting thoughts, impulses or images inappropriately intrude into
awareness and cause marked distress or anxiety.
These ideas are not just excessive worries about ordinary problems.
The person tries to ignore or suppress these ideas or to neutralize them by thoughts
or behavior.
There is insight that these ideas are a product of the patient's own mind.
Compulsions. The person must have all of:
The person feels the need to repeat physical behaviors (checking the stove to be sure it is off, hand washing) or mental behaviors (counting things, silently repeating words).
These behaviors occur as a response to an obsession or in accordance with strictly applied rules.
The aim of these behaviors is to reduce or eliminate distress or to prevent something that is dreaded.
These behaviors are either not realistically related to the events they are supposed to
counteract or they are clearly excessive for that purpose.
During some part of the illness the patient recognizes that the obsessions or compulsions are unreasonable or excessive.
The obsessions and/or compulsions are associated with at least 1 of:
Cause severe distress.
Take up time (more than an hour per day).
Interfere with the patient's usual routine or social, work or personal functioning.
The symptoms are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
Diagnostic Parameter, Chronic moter or Vocal Tics
Chronic Motor or Vocal Tic Disorder
This disorder is characterized either by rapid, recurrent, uncontrollable movements or by vocal outbursts, but not both, that have been present nearly daily for more than a year without a period free of the problem longer than three months. These repeated uncontrollable bursts of activity or speech are called tics.
This Tic Disorder is diagnosed when either motor (Rapid, recurrent movement of the arms, legs, or other areas) or vocal (Vocalizations) grunts, abdominal ar diaphragmatic contractions. But not both - see Tourette's tics (sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization) are experienced persistently.
Single or multiple motor or vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations), but not both, have been present at some time during the illness.
The tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.
The onset is before age 18 years.
The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).
Criteria have never been met for Tourette's Disorder.
This disorder is characterized either by rapid, recurrent, uncontrollable movements or by vocal outbursts, but not both, that have been present nearly daily for more than a year without a period free of the problem longer than three months. These repeated uncontrollable bursts of activity or speech are called tics.
This Tic Disorder is diagnosed when either motor (Rapid, recurrent movement of the arms, legs, or other areas) or vocal (Vocalizations) grunts, abdominal ar diaphragmatic contractions. But not both - see Tourette's tics (sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization) are experienced persistently.
Single or multiple motor or vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations), but not both, have been present at some time during the illness.
The tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.
The onset is before age 18 years.
The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).
Criteria have never been met for Tourette's Disorder.
Diagnostic Parameter, Tourette's syndrome
Tourette's Disorder
This is a rare disorder characterized by repetitive muscle movements and vocal outbursts. The main diagnostic criteria is as follows:
At some time during the illness, though not necessarily at the same time, the patient has had both of:
At least one vocal tic (A tic is a motor movement or vocalization that is nonrhythmic, rapid, repeated, stereotyped and sudden) and
Multiple motor tics:
For longer than 1 year, these tics have occurred many times each day, nearly every day or at intervals.
During this time, the patient never goes longer than 3 months without the tics.
These symptoms cause marked distress or materially impair work, social or personal functioning.
The symptoms begin before age 18. Approximately 1% of mainstream schoolchildren may be affected. Onset occurs with motor tics usually followed by vocal tics.
The symptoms are not directly caused by the effects of a general medical condition (such as Huntington's disease or a postviral encephalitis) or substance use (such as a CNS stimulant).
This is a rare disorder characterized by repetitive muscle movements and vocal outbursts. The main diagnostic criteria is as follows:
At some time during the illness, though not necessarily at the same time, the patient has had both of:
At least one vocal tic (A tic is a motor movement or vocalization that is nonrhythmic, rapid, repeated, stereotyped and sudden) and
Multiple motor tics:
For longer than 1 year, these tics have occurred many times each day, nearly every day or at intervals.
During this time, the patient never goes longer than 3 months without the tics.
These symptoms cause marked distress or materially impair work, social or personal functioning.
The symptoms begin before age 18. Approximately 1% of mainstream schoolchildren may be affected. Onset occurs with motor tics usually followed by vocal tics.
The symptoms are not directly caused by the effects of a general medical condition (such as Huntington's disease or a postviral encephalitis) or substance use (such as a CNS stimulant).
Diagnostic Parameters , Transient Tic Disorder
Transient Tic Disorder
A tic is a problem in which a part of the body moves repeatedly, quickly, suddenly and uncontrollably. Tics can occur in any body part, such as the face, shoulders, hands or legs.
Sounds that are made involuntarily (such as throat clearing) are called vocal tics. Most tics are mild and hardly noticeable. However, in some cases they are frequent and severe, and can affect many areas of a child's life.
The patient has vocal or motor tics,or both. They can be single or multiple.
For at least 4 weeks but no longer than 12 consecutive months, these tics have occurred many times each day, nearly every day.
These symptoms cause marked distress or materially impair work, social or personal functioning.
They began before age 18.
The symptoms are not directly caused by a general medical condition (such as Huntington's disease or a postviral encephalitis) or to substance use (such as a CNS stimulant).
The patient has never fulfilled criteria for Tourette's Disorder or Chronic Motor or Vocal Tic Disorder.
A tic is a problem in which a part of the body moves repeatedly, quickly, suddenly and uncontrollably. Tics can occur in any body part, such as the face, shoulders, hands or legs.
Sounds that are made involuntarily (such as throat clearing) are called vocal tics. Most tics are mild and hardly noticeable. However, in some cases they are frequent and severe, and can affect many areas of a child's life.
The patient has vocal or motor tics,or both. They can be single or multiple.
For at least 4 weeks but no longer than 12 consecutive months, these tics have occurred many times each day, nearly every day.
These symptoms cause marked distress or materially impair work, social or personal functioning.
They began before age 18.
The symptoms are not directly caused by a general medical condition (such as Huntington's disease or a postviral encephalitis) or to substance use (such as a CNS stimulant).
The patient has never fulfilled criteria for Tourette's Disorder or Chronic Motor or Vocal Tic Disorder.
Diagnostic Parameters Amyotrophic Lateral Sclerosis
The diagnosis of Amyotrophic Lateral Sclerosis [ALS] requires:
A - the presence of:
(A:1) evidence of lower motor neuron (LMN) degeneration
by clinical, electrophysiological or neuropathologic examination,
(A:2) evidence of upper motor neuron (UMN) degeneration
by clinical examination, and
(A:3) progressive spread of symptoms or signs within a region or to other regions,
as determined by history or examination,
together with
B - the absence of:
(B:1) electrophysiological and pathological evidence of other disease
processes that might explain the signs of LMN and/or UMN degeneration, and
(B:2) neuroimaging evidence of other disease processes that might explain the
observed clinical and electrophysiological signs.Diagnostic
A - the presence of:
(A:1) evidence of lower motor neuron (LMN) degeneration
by clinical, electrophysiological or neuropathologic examination,
(A:2) evidence of upper motor neuron (UMN) degeneration
by clinical examination, and
(A:3) progressive spread of symptoms or signs within a region or to other regions,
as determined by history or examination,
together with
B - the absence of:
(B:1) electrophysiological and pathological evidence of other disease
processes that might explain the signs of LMN and/or UMN degeneration, and
(B:2) neuroimaging evidence of other disease processes that might explain the
observed clinical and electrophysiological signs.Diagnostic
Diagnostic criteria for ADHD
DSM-IV Criteria for ADHD
I. Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted.
Often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Often fidgets with hands or feet or squirms in seat.
Often gets up from seat when remaining in seat is expected.
Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
Often has trouble playing or enjoying leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively.
Impulsiveness
Often blurts out answers before questions have been finished.
Often has trouble waiting one's turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
I. Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted.
Often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Often fidgets with hands or feet or squirms in seat.
Often gets up from seat when remaining in seat is expected.
Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
Often has trouble playing or enjoying leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively.
Impulsiveness
Often blurts out answers before questions have been finished.
Often has trouble waiting one's turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Tuesday, December 25, 2007
diagnostic Parameters for Multiple Sclerosis
Diagnostic Criteria for Multiple Sclerosis
In April, 2001, an international panel in association with the NMSS of America recommended revised diagnostic criteria for multiple sclerosis. These new criteria have become known as the McDonald criteria after their lead author. They make use of advances in MRI imaging techniques and are intended to replace the Poser Criteria and the older Schumacher Criteria. The new revised criteria are as follows:
Clinical Presentation Additional Data Needed
2 or more attacks (relapses)
2 or more objective clinical lesions
None; clinical evidence will suffice
(additional evidence desirable but must be consistent with MS)
2 or more attacks
1 objective clinical lesion
Dissemination in space, demonstrated by:
MRI
or a positive CSF and 2 or more MRI lesions consistent with MS
or further clinical attack involving different site
1 attack
2 or more objective clinical lesions
Dissemination in time, demonstrated by:
MRI
or second clinical attack
1 attack
1 objective clinical lesion
(monosymptomatic presentation) Dissemination in space by demonstrated by:
MRI
or positive CSF and 2 or more MRI lesions consistent with MS
and
Dissemination in time demonstrated by:
MRI
or second clinical attack
Insidious neurological progression
suggestive of MS
(primary progressive MS) Positive CSF
and
Dissemination in space demonstrated by:
MRI evidence of 9 or more T2 brain lesions
or 2 or more spinal cord lesions
or 4-8 brain and 1 spinal cord lesion
or positive VEP with 4-8 MRI lesions
or positive VEP with <4 brain lesions plus 1 spinal cord lesion
and
Dissemination in time demonstrated by:
MRI
or continued progression for 1 year
In April, 2001, an international panel in association with the NMSS of America recommended revised diagnostic criteria for multiple sclerosis. These new criteria have become known as the McDonald criteria after their lead author. They make use of advances in MRI imaging techniques and are intended to replace the Poser Criteria and the older Schumacher Criteria. The new revised criteria are as follows:
Clinical Presentation Additional Data Needed
2 or more attacks (relapses)
2 or more objective clinical lesions
None; clinical evidence will suffice
(additional evidence desirable but must be consistent with MS)
2 or more attacks
1 objective clinical lesion
Dissemination in space, demonstrated by:
MRI
or a positive CSF and 2 or more MRI lesions consistent with MS
or further clinical attack involving different site
1 attack
2 or more objective clinical lesions
Dissemination in time, demonstrated by:
MRI
or second clinical attack
1 attack
1 objective clinical lesion
(monosymptomatic presentation) Dissemination in space by demonstrated by:
MRI
or positive CSF and 2 or more MRI lesions consistent with MS
and
Dissemination in time demonstrated by:
MRI
or second clinical attack
Insidious neurological progression
suggestive of MS
(primary progressive MS) Positive CSF
and
Dissemination in space demonstrated by:
MRI evidence of 9 or more T2 brain lesions
or 2 or more spinal cord lesions
or 4-8 brain and 1 spinal cord lesion
or positive VEP with 4-8 MRI lesions
or positive VEP with <4 brain lesions plus 1 spinal cord lesion
and
Dissemination in time demonstrated by:
MRI
or continued progression for 1 year
Diagnostic Parameters for Restless Leg Syndrome (RLS)
The International Restless Legs Syndrome Study Group described the following symptoms of restless legs syndrome (RLS):
Strange itching, tingling, or "crawling" sensations occurring deep within the legs. These sensations sometimes occur in the arms.
A compelling urge to move the limbs to relieve these sensations
Restlessness - Floor pacing, tossing and turning in bed, rubbing the legs
Symptoms may occur only with lying or sitting. Sometimes persistent symptoms occur that are worse with lying or sitting and better with activity. In very severe cases, the symptoms may not improve with activity.
Strange itching, tingling, or "crawling" sensations occurring deep within the legs. These sensations sometimes occur in the arms.
A compelling urge to move the limbs to relieve these sensations
Restlessness - Floor pacing, tossing and turning in bed, rubbing the legs
Symptoms may occur only with lying or sitting. Sometimes persistent symptoms occur that are worse with lying or sitting and better with activity. In very severe cases, the symptoms may not improve with activity.
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