DSM 5

Child psychological abuse

Child psychological abuse, confirmed; child psychological abuse, suspected; and other circumstances related to child psychological abuse

Child sexual abuse

Child sexual abuse, confirmed; child sexual abuse, suspected; and other circumstances related to child sexual abuse

Genito-Pelvic Pain/Penetration Disorder

(Pain with sex or attempts at sex) Characterized by recurrent difficulties with one or more: penetration during intercourse; pain during intercourse or penetration attempts; fear or anxiety about pain before, during, or after intercourse; tensing or tightening of the pelvis during attempted penetration. Symptoms have persisted for minimum of six months

Cluster A: paranoid personality disorder

A pervasive distrust and suspiciousness of others and tendency to interpret actions of others as deliberately demeaning, threatening, and malevolent as evidence by four or more: suspects that others are exploiting, harming or deceiving them; is preoccupied with doubts about trustworthiness of others; reluctant to confide in othets because of concerns that information will be used against them; interprets benign comments/events as demeaning or threatening; hold grudges; perceives attacks on their character, and respond with anger or counterattacks; belief that partner is unfaithful (extreme distrust and suspicion of others - impaired cognition & interpersonal functioning)

Substance Use Disorders (SUD)

A cluster of cognitive, behavioral, and physiological sxs that indicate continued use despite adverse consequences. Can occur with all substances except caffeine. Criteria include a problematic pattern of use leading to significant impairment or distress, as manifest by least two within a 12 month period: the substance is consumed in larger amounts over longer period of time than was intended; a persistent desire or unsuccessful attempts to cut down use; significant time spent in trying to get, use or recover from effects of the substance; cravings; failing to meet major role obligations; continued use despite recurrent social or interpersonal problems; other important activities are cut down; use in situations that are physically dangerous; use is continued in spite of awareness of physical or psychological problems caused or exacerbated by the substance; tolerance (need more to get effects); or withdrawal (characteristic withdrawal sxs or taking the substance to relive or avoid withdrawal). Represent four groupings: impaired control with regard to the substance, social impairment, risky use, and pharmacological criteria. Current severity is specify based on the number of symptoms endorsed: mild (2-3 symptoms), moderate (4-5 symptoms), and severe (6+ symptoms). Specifiers: in early remission (only cravings present for at least 3 months but less than 12 months), in sustained remission (no symptoms except cravings for 12 months or longer), and in a controlled environment.

Panic attacks

A discrete period of intense fear or discomfort that come on abruptly and reach a peak within 10 minutes accompanied by four or more physical and/or cognitive symptoms. May be expected or unexpected. Limited-symptom panic attacks have fewer than four symptoms. Can be used as a specifier for anything Zaidi disorder as well as other mental disorders. Those that are co occur with another mental disorder are associated with increased symptom severity, higher rates of suicide, and poorer treatment response.

Delirium

A disturbance in attention and awareness. Onset is a rapid and course tends to fluctuate. Includes a cognitive disturbance. Specifiers: substance intoxication delirium, substance withdrawal delirium, medication induced delirium, delirium due to another medical condition, and delirium due to multiple etiologies. Common causes include infections, metabolic disorders (low blood sugar, renal disease), post-operative states, and substance intoxication. The majority recover fully, with or without treatment; early intervention shortens the duration of the delirium. Untreated delirium may progress to coma, seizures, or death.

Cluster A: schizoid personality disorder

A pattern of detachment from an indifference to social relationships and a restricted range of emotions as evidenced by: neither desires nor enjoys close relationships; usually chooses solitary activities; has minimal interest in sexual experiences; experiences little pleasure in activities; lacks close friends; appears indifferent to praise; is cold, detached or affectively flat. (Doesn't want relationships & has no emotion- impaired affect & interpersonal functioning)

Cluster B: BPD

A pattern of instability of mood, interpersonal relationships, and self image, as well as significant impulsivity as indicated by five or more: efforts to avoid abandonment; intense, unstable relationships characterized by idealization and evaluation; unstable self image; impulsivity in two areas that are potentially damaging (spending, sex, substance abuse); recurrent suicidal or self mutilating behavior; have affective instability; chronic feelings of emptiness; inappropriate anger; transient paranoid ideation or dissociative symptoms (stress related)

Cluster C: avoidant personality disorder

A pattern of social inhibition, feelings inadequacy, and hypersensitivity to negative evaluation by four more: avoids occupational activities due to fear of criticism, disapproval, or rejection; generally unwilling to get involved with others unless certain of being like; restrained in intimate relationship due to fear or shame you; preoccupied with concerns of rejection and criticism and social situations; inhibited in new situations due to a sense of inadequacy; views self as social inept or inferior; reluctant to take risks or trying to things because of potential embarrassment.

Hypomanic episode

A period of elevated, expensive, or irritable mood as well as increased activity or energy that lasts at least four days and is present most days nearly every day. Three or more of the following symptoms: inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased go directed activity or psycho motor agitation and involvement in activities that have a high likelihood of adverse consequences. Distinct from a manic episode in that it is not severe enough to impaired functioning or require hospitalization

Conduct Disorder (CD)

A persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms and rules are violated. At least three must be present in the past 12 months and at least one in the past six months: aggression to people and animals as evidenced by bullying and threatening others, initiating physical fights, use of a weapon, physical cruelty to people, physical cruelty to animals, stealing while confronting victim, or forced sexual activity; destruction of property as evidenced by deliberate fire setting, deliberate destruction of property; deceitfulness or theft as evidence by breaking into homes or cars, lying to obtain favors, stealing without confronting the victim; or serious violation of rules as evidenced by staying out late, running away, or being truant. If the person is 18 or older criteria are not met for ASPD. Specifiers: childhood onset type (prior to age 10), adolescent onset type (after age 10), or unspecified type. Severity: mild, moderate, or severe. Additionally with limited prosocial emotions is coded when 2 or more characteristics are present over 12 months: lack of guilt or remorse, callous (lack of empathy), unconcerned about performance, or shallow or deficient affect

Personality change due to another disorder

A persistent personality disturbance that represents a change from the person's previous personality with evidence that the disturbance is a direct physiological result of a general medical condition. The disorders coded in Longwood medical condition

Educational problems

Academic or educational problem

Adult abuse by nonspouse or nonpartner

Adult physical abuse by nonspouse or non-partner, confirmed; adult physical abuse by nonspouse or nonpartner, suspected; adult sexual abuse by nonspouse or nonpartner, confirmed; adult sexual abuse by nonspouse or nonpartner, suspected; adult psychological abuse by nonspouse or nonpartner, confirmed; adult psychological abuse by nonspouse or nonpartner, suspected; and other circumstances related to adult abuse by nonspouse or nonpartner

Criteria for NCDs

All based on six defined cognitive domains: complex attention (sustained attention, divided attention, processing speed); executive function (planning, decision-making, responding to feedback, mental flexibility); learning and memory (immediate memory, recent memory, remote memory); expressive and receptive language (naming, word finding, grammar, comprehension); perceptual motor (visual perception, visuo-constructional, perceptual-motor, praxis, gnosis); and social cognition (recognition of emotions, theory of mind)

Trauma and Stressor Related Disorders

All include the diagnostic criteria of exposure to a traumatic or stressful event. Symptoms of psychological distress following exposure vary and many manifest as anxiety or fear-based symptoms, anhedonic and dysphoric symptoms, externalizing and aggressive symptoms or dissociative symptoms

Disruptive, Impulse-Control, and Conduct Disorders

All involve problems regulating emotions and behavior, behaviors that violate the rights of others and/or that involve conflict with societal norms or persons of authority. Tend to be more common in males.

Depressive Disorders

All involve sad, empty, or irritable mood plus somatic & cognitive changes that significantly affect functioning

Specifiers for NCDs

Alzheimer's disease, frontotemporal lobar degeneration, Lewy body disease, vascular disease, TBI, substance/medication use, HIV infection, prion disease (Creutzfeldt Jakob disease), Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, or unspecified

Manic episode

An abnormally elevated, expensive, or irritable mood with increased goal directed activity or energy that lasts at least one week and is present most of the day nearly every day. Three or more symptoms: inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal directed activity, psychomotor agitation and excessive involvement in activities that have a high likelihood of adverse consequences. Either causes significant impairment in functioning or necessitates hospitalization (no minimum duration of symptoms required when hospitalization is necessary)

Other specified/unspecified elimination disorder

An example is low-frequency enuresis

Other specified/unspecified sexual dysfunction

An example is sexual aversion

Posttraumatic stress disorder

An individual has been exposed to a traumatic event (actual or threatened death, serious injury, or sexual violence) in one or more ways: directly experiencing the event, witnessing the event, learning that the event has occurred to a close family member, or experiencing repeated exposure to aversive details of traumatic events. Four characteristic symptoms include: intrusive symptoms, avoidance of stimuli associated with the trauma, negative alterations in cognitions and mood, and increased arousal. Children six years and younger, the three characteristic symptoms include: intrusive symptoms, avoidance and/or negative alterations in cognitions and mood, and increased arousal. Symptoms must last for more than one month. Specifiers: with dissociative symptoms and with delayed expression if the onset of symptoms was at least six months after the event

Dissociative amnesia

And inability to recall important personal information, usually of a traumatic or stressful nature, that cannot be explained by ordinary forgetfulness. Most commonly selective for a specific event or events, rather than generalized amnesia. Specifier with dissociative fugue is used when it includes purposeful travel or bewildered wandering with an inability to recall one's past.

Other specified/unspecified mental disorder due to another medical condition

Applies to presentations in which symptom of disorder due to a medical condition predominate but the full criteria are not met for any specific mental disorder due to a medical condition. Dissociative symptoms due to complex partial seizures are an example

Other specified/unspecified mental disorder

Applies to presentations in which symptoms characteristic of a mental disorder predominate but the full criteria are not met for any mental disorder

Child physical abuse

Child physical abuse, confirmed; child physical abuse, suspected; and other circumstances related to child physical abuse

Disinhibited social engagement disorder

Behavior in which a child actively approaches and interacts with adult strangers and exhibits at least two: lack of hesitation in approaching unfamiliar adults, overly familiar behavior with strangers that violate cultural social boundaries, lack of checking back with caregiver after venturing away, and willingness to go off with an unfamiliar adult without hesitation. Mikell has also experienced extremely insufficient care and has a developmental age of at least nine months. Specifier of persistent is to be given when the disorder is present for more than 12 months and severe when all symptoms are present, with each symptom at a high-level.

Specifier w/catatonia

Can be coded for any of the disorders. Criteria involve a clinical picture that is dominated by 3 or more: stupor (no psychomotor activity), catalepsy (posture is held passively, against gravity), waxy flexibility (resistance to positioning by another), mutism (no verbal response), negativism (no response instructions or external stimuli), posturing (actively maintaining a posture against gravity), mannerism (caricature of normal actions), stereo to be repetitive non-goal directed movements, agitation, grimacing, echolalia (mimicking another's speech) or echopraxia (imitating another's movement)

Factitious disorder

Can be either imposed on self or imposed on another (factitious disorder by proxy). Characterized by intentional feigning of physical or psychological symptoms or by creation of injury or disease (for instance swallow bleach to get sick). Individual presents self or other as ill, impaired, or injured and there is an absence of external incentives for the behavior (attention seeking isn't considered an incentive). Specify: single episode or recurrent episode.

Oppositional Defiant Disorder (ODD) (Bx is prominent)

Central feature is a recurring pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness, which persists for at least six months. At least four symptoms must be present: angry/irritable mood as evidenced by frequent loss of temper, easily annoyed and touchy, frequently angry and resentful; argumentative/defiant behavior as evidenced by frequent arguments with authority figures/adults, deliberate defiance of rules, deliberate annoyance of others, blaming others for one's mistakes; or vindictiveness as evidenced by being spiteful and vindictive at least twice within the past six months. Severity is specified as mild (symptoms in only one setting), moderate (sxs in at least 2 settings), severe (sxs in 3+ settings). More prevalent in families in which there is inconsistency in caregiving or in families exhibiting harsh, inconsistent, or neglectful childrearing. Two most common co-occurring disorders are ADHD and CD. Have an increased risk for anxiety disorders, MDD, and SUD (in adolescents and adults). Can have onset prior to 6

Separation Anxiety Disorder

Characterized by a developmentally inappropriate and excessive anxiety concerning being away from home or away from the person(s) to whom the individual is attached. Need three or more: distress when separation occurs/anticipated, worry about harm befalling the major attachment figure, worry about getting lost or kidnapped, reluctance to go out because of fear of separation, reluctance/fear of being alone without the major attachment figure, reluctant/refusal to go to sleep without being near the major attachment figure, repeated nightmares about separation, repeated physical complaints when separation occurs/anticipated. duration must be at least 4 weeks in children and adolescents & 6 months+ in adults. Frequently develops after life stress, especially after a significant loss, the most common evidence-based treatment is CBT and family therapy is also used.

Avoidant/Restrictive Food Intake Disorder

Characterized by a failure to eat adequately with one or more: significant weight loss or failure to achieve expected weight gain, significant nutritional deficiency, dependence on a feeding tube or nutritional supplements, or marked interference with psychosocial functioning. Only diagnosed when there is no medical condition that accounts for the symptoms. Is associated with failure to thrive syndrome.

Cluster C: dependent personality disorder

Characterized by a pervasive and excessive need to be taken care of that results in submissive and clinging behaviors, difficulty making decisions, and fears of separation as evidenced by five or more: difficulty making decisions without advice and reassurance from others; needs others to assume responsibility for most major areas; have difficulty expressing disagreement due to fear of loss of approval; difficulty doing things on their own; excessive attempts to obtain support from others; Uncomfortable when alone due to not being self-sufficient; urgently seeks a new relationship when a close relationship ends; preoccupied with fears of being left alone

Circadian rhythm sleep wake disorder

Characterized by a recurrent pattern of sleep disruption caused by an alteration of the circadian system, or a mismatch in the sleep wake schedule required by the person's environment and circadian sleep wake cycle. The mismatch results in insomnia or excessive sleepiness. Specifiers: delayed sleep phase type, advanced sleep phase type, irregular sleep wake type, non-24 hour sleep wake type, shiftwork type, and unspecified type. Also episodic, persistent, or recurrent

Anorexia Nervosa

Characterized by a restriction of food intake, leading to a significantly low body weight. Intense fear of gaining weight or behavior that interferes with weight gain. There must be distortions in self image, undue influence given to body weight or shape in self-evaluation, or a denial of the seriousness of the problem. Two subtypes: restricting type and binge eating/purging type. Additional specifiers: in partial remission or in full remission. Current severity also specified: mild (BMI of 17+), moderate (BMI 16-16.99), severe (BMI 15-15.99) or extreme (BMI <15). Typically begins during adolescence or down without her. Earlier age of onset is associated with shorter duration of illness. Find more common in females associate it with cultures, settings, occupations,etc. suicide risk is increased. Bipolar, depressive, and anxiety disorders commonly cooccur. Alcohol use and other substance use disorders may also be comorbid. Treatment generally requires a multidisciplinary approach, overall family treatment is the most well-established approach. Structural family therapy most well known. CBT has modest research support

Medication Induced Acute Dystonia (muscle spasms)

Characterized by abnormal & prolonged contractions (spasms) of the muscle of the eyes (oculogyric crisis), head, neck, limbs, or trunk

Schizophrenia Spectrum & Psychotic Other Disorders

Characterized by abnormalities of one or more: delusions,hallucinations, disorganized thinking (speech), disorganized or abnormal motor (including catatonia) & negative symptoms. Severity is rated by assessing the primary symptoms of psychosis on a 5point scale for each so based on presence & strength of the screen from 0 (not present) to 4 (present & severe). Disorders presented in order of severity.

PCP Intoxication

Characterized by behavior changes and two or more: nystagmus, hypertension or tachycardia, diminished response to pain, ataxia (difficulty coordinating voluntary movement), dysarthria (articulation difficulties), muscle rigidity, seizures or coma, and hyperacusis (oversensitivity to sound)

Alcohol Intoxication

Characterized by behavioral or physiological changes and one or more: slurred speech, incoordination, unsteady gait, nystagmus rapid oscillation of eyes), impaired memory and concentration, & stupor or coma.

Cannabis Intoxication

Characterized by behavioral or psychological changes and 2 or more: conjunctival injection (redness of the eye), increased appetite, dry mouth, and tachycardia

Other Hallucinogen Intoxication

Characterized by behavioral or psychological changes and perceptual changes and two or more: sweating, cardio, palpitations, pupillary dilation, tremors, blurred vision, and incoordination.

Stimulant Intoxication

Characterized by behavioral or psychological changes and two or more: psychomotor agitation or retardation, tachycardia or bradycardia (slowed heart rate), changes in blood pressure, nausea or vomiting, muscular weakness or chest pain, pupillary dilation, perspiration or chills, respiratory problems, weight loss, seizures or coma

Sedative, Hypnotic, or Anxiolytic intoxication

Characterized by behavioral or psychological changes, and one or more: slurred speech, incoordination, unsteady gait, nystagmus, impaired memory and concentration as well as possible stupor or coma

Opioid intoxication

Characterized by behavioral or psychological changes, pupillary constriction, and one or more: drowsiness or coma, slurred speech, and impairment and attention or memory

Male Hypoactive Sexual Desire Disorder

Characterized by deficiency or absence of sexual thoughts or fantasies and desire for sexual activity. Symptoms have persisted for minimum of six months

Persecutory type

Characterized by delusions in which the person is being persecuted or ill treated, which may trigger violent behavior

Grandiose type

Characterized by delusions of inflated self-worth, power, knowledge, or a special relationship to a deity or famous person

Stimulant withdrawal

Characterized by dysphoria and two or more: fatigue, unpleasant dreams, increased appetite, psychomotor agitation or retardation, and insomnia or hypersomnia

Hypersomnolence disorder

Characterized by excessive sleepiness in spite of sleeping at least seven hours with at least one of the following: recurrent daytime sleep episodes, prolonged sleep for more than nine hours that is non-restorative, or difficulty being fully awake after abrupt awakening. Occurs at least three times a week for at least three months. Specifiers: with mental comorbidity, with medical condition, and with another sleep disorder. Additional specifiers: acute, subacute, and persistent. Severity is specified based on the frequency of difficulty maintaining daytime alertness: mild moderate and severe.

Pedophilic Disorder

Characterized by fantasies, urges, or behavior involving sexual contact with a prepubescent child (age 13 or under), over a period of at least six months. The individual must be at least 16 years old and at least five years older than the child being fantasized about. (Difference in child abuse is sex with a minor of any age under 18)

Caffeine Intoxication

Characterized by five or more: restlessness, nervousness, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, rambling speech, agitation, periods of inexhaustibility, and tachycardia. Differentiated from anxiety disorder by diuresis (excessive urination). There is no use disorder in caffeine-related disorders

Tobacco withdrawal

Characterized by four more: depressed mood, insomnia, irritability or anger, anxiety, difficulty concentrating, restlessness, and increased appetite.

Gender Dysphoria in children

Characterized by marked incongruence between one's assigned gender and the gender experienced or expressed, of at least 6 months duration, manifested by a strong desire to be of the other gender or insistence that one is the other gender and at least 5: A strong preference for cross-dressing; a strong preference for cross gender roles in play; a strong preference for activities, toys, or games that are stereotypically of the other gender; a strong preference for playmates of the other gender; and rejection of toys games and activities that are stereotypically of the same gender; a strong dislike of one's sexual anatomy; and a strong desire for sex characteristics of the opposite gender

Gender Dysphoria in adolescents/adults

Characterized by marked incongruence between one's assigned gender and the gender experienced or expressed, of at least six months duration, manifested by at least two: a marked incongruence between one's experienced/expressed gender and sex characteristics; a strong desire to be rid of one's sex characteristics; strong desire for the sex characteristics of the other gender; a strong desire to be of the other gender; a strong desire to be treated as the other gender; a strong conviction that one has the feelings and reactions that are typical of the other gender. Specifier posttransition is coded if the person is living as the other gender and has undergone or is preparing to undergo at least one cross sex medical procedure or treatment regimen. More commonly in natal males. Onset among children is between 2-4 and typically persists into adolescence or adulthood. Late onset occurs around puberty or much later in life and is extremely rare in natal females

Sedative, Hypnotic, or Anxiolytic withdrawal

Characterized by two or more: autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, anxiety, psychomotor agitation, and seizures. Withdrawal can be fatal.

Somatic Symptom Disorders

Characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life. Evidences excessive thoughts, feelings, or behaviors related to the somatic symptoms as manifest by at least one: persistent thoughts about the seriousness of one's symptoms, persistent high levels of anxiety about health or symptoms, or excessive time and energy devoted to symptoms or health concerns. (Nutshell: somatic sxs & significant attention the sxs). Somatic sxs may not be present continuously but the worries are persistent (typically more than 6 months). Specifiers: with predominant pain (when the somatic sxs predominantly involve pain), and persistent (severe sxs, marked impairment, & long duration). Also severity is coded mild, moderate, or severe. More prevalent in females. Comorbid anxiety & depression is common. When chronic pain is prominent, evidenced-based treatments include CBT & ACT

Brief Psychotic Disorder

Characterized by one or more: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. The episode lasts from one day to one month with eventual return to premorbid level of functioning. Specifiers: with Mark stressor, without marked stressor, or with postpartum onset. With catatonia is also used.

Non-Substance-Related Disorders: Gambling Disorder

Characterized by persistent and recurrent gambling behavior that is maladaptive and causes disruption in the person's life as indicated by four more: needs to gamble with increasing amounts of money to achieve the desired excitement, is restless or irritable when attempting to cut down our stop, has made repeated unsuccessful attempt to cut back or stop, is often preoccupied with gambling, often gambles when feeling distressed, returns another day in hopes of winning after losing money, lies to conceal the excitement of involvement, has jeopardized or lost a significant relationship or job because of gambling, or relies on others for money to relieve the desperate financial situation caused by gambling.

Feeding & Eating Disorders

Characterized by persistent disturbance of eating behavior, leading to altered consumption or absorption of food that significantly impairs physical health and/or psychosocial functioning

Premature (Early) Ejaculation

Characterized by recurrent ejaculation during partnered sexual activity within approximately one minute following penetration and before the person wishes it, occurs on almost all or all occasions. Symptoms have persisted for a minimum of six months. Treatments include the squeeze and stop-start techniques, the female superior position is recommended, SSRIs, and topical desensitizing agents

Bulimia Nervosa

Characterized by recurrent episodes of binge eating followed by inappropriate compensatory behavior to prevent weight gain. Episodes occur at least once a week for three months. Binge eating is eating an amount definitely larger than most would within a discrete time period or a sense of lack of control over eating during the episode. The specifiers in partial remission or in full should be used. Current severity is based on the average number of episodes each week mild (1-3), moderate (4-7), severe (8-13), or extreme (14+). Commonly begins in adolescence or young adulthood far more common in females associated with childhood obesity and early pubertal maturation, low self-esteem, and childhood sexual or physical abuse. Suicide risk is increased. Bipolar, depressive, anxiety, and personality disorders (especially BPD) commonly cooccur. Alcohol use disorder and stimulant use disorder may also be comorbid. Treatment includes CBT and interpersonal therapy antidepressants are also highly effective as serotonin is believed to be the primary neurotransmitter involved.

Panic Disorder

Characterized by recurrent unexpected panic attacks. At least one of the attacks has been followed by one month or more of a one or both of the following: persistent concern about having additional panic attacks or the consequences of the attacks or a significant change in behavior related to the attacks. Panic attacks and a diagnosis of panic disorder are related to higher rates of suicide. Prevalence is higher in individuals with other anxiety disorders especially Agoura phobia, major depression, bipolar disorder, and possible alcohol use disorder. Comorbid with a number of medical symptoms and conditions. Cognitive behavioral therapy is considered the evidence-based treatment of choice - includes psychoeducation, cognitive restructuring, in vivo exposure, and interoceptive exposure to aversive psychological sensations. Relaxation training or breathing retraining is sometimes included as well.

Rapid Eye Movement (REM) Sleep Behavior Disorder

Characterized by repeated episodes of arousal (moving) during sleep associated with vocalization and/or complex motor behaviors that occur during REM sleep. Behavior may involve injury to self or bed partner.

Transvestic Disorder

Characterized by sexual fantasies, urges, or behavior that involves cross dressing for sexual arousal, over a period of at least six months. (If cross dressing is for gender identity then not dx, must be for sexual arousal)

Opioid withdrawal

Characterized by three or more of the following: dysphoric mood, nausea or vomiting, muscle aches, diarrhea, fever, yawning, insomnia, pupillary dilation or sweating, and weepiness or runny nose

Cannabis Withdrawal

Characterized by three or more: irritability or aggression, nervousness or anxiety, sleep difficulty, decreased appetite or weight loss, restlessness, depressed mood or physical symptoms.

Neuroleptic-induced Parkinsonism/medication-induced Parkinsonism

Characterized by tremor, muscular rigidity, akinesia (difficulty initiating movement), or bradykinesia (slowed movement)

Alcohol Withdrawal

Characterized by two or more: automatic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, anxiety, psychomotor agitation, and seizures. Can potentially be fatal

Child neglect

Child neglect, confirmed; child neglect, suspected; and other circumstances related to child neglect

Treatment for MDD

Cognitive therapy, interpersonal therapy, behavior therapy/behavior activation, self-management/self-control therapy. Behavior activation shown to be just as effective as medication and more effective than cognitive therapy when treating severe depression.

Somatic Symptoms and Related Disorders

Common feature is the prominence of somatic symptoms associated with significant distress and impairment. These individuals are more commonly encountered in primary care and other medical settings. Highlights distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to symptoms.

Reactive attachment disorder

Consistent pattern of inhibited, emotionally withdrawn behavior toward the caregiver, as manifested by the child rarely seeking nor responding to comfort when distressed. Exhibits at least two: minimally responsive to others, limited positive affect, or episodes of unexplained sadness, fear or irritation. Child has also experienced grossly insufficient care. Present before five and the child has a developmental age of at least nine months. Specifier of persistent is to be given when the disorder is present for more than 12 months and severe when all symptoms are present, with each symptom at a high-level.

Other opiate induced disorders

May include a depressive disorder, anxiety disorder, sleep - wake disorder, sexual dysfunction, as well as intoxication and withdrawal delirium

Due to HIV infection

Criteria met for major or minor NCD and documented HIV infection; the NCD is not attributable to another medical condition

Personality disorders

Defined as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual's culture, is pervasive and inflexible has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Symptoms are evident in at least two areas: cognition, affect, interpersonal functioning, or impulse control. A diagnosis can be made in person under 18 if features of the disorder have been present for at least one year (except for ASPD which cannot be diagnosed in persons under 18). Three clusters: cluster A involves odd or eccentric presentation, cluster B involves dramatic, emotional, and erratic behavior, and cluster C involves an anxious or fearful presentation.

Unspecified type

Delusions who's themes are not characteristic of any of the types

Persistent Depressive Disorder (Dysthymia)

Depressed mood for most of the day, for more days than not, for at least two years (one year for children adolescents). While depressed two or more of the following: change in appetite, sleep difficulties, low energy or fatigue, low self esteem, poor concentration or indecisiveness, & hopelessness. Functioning is impaired or significant distress. During the two-year timeframe the person has not been without symptoms for more than two months at a time. Criteria for major depressive episode may be continuously present for two years. There's never been a manic or hypomanic episode in criteria for cyclothymia have not been met. Specifiers: early-onset (before age 21) or late onset (age 21 or older). For the most recent 2 years of of the disorder must specify: with pure dysthymia (no MDE), with persistent major depressive episode (full criteria for MDE met during preceding two years), with intermittent major depressive episode, with current episode (current MDE with periods or eight weeks or more with symptoms below threshold for MDE), and with intermittent major depressive episodes, without current episode (no current MDE but one or more in the in the preceding two years). Early and insidious onset & chronic. early onset is associated with higher likelihood of comorbid personality & substance use disorders

Cyclothymic disorder

Diagnosed when the presence of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms have occurred for at least two years (one year in children adolescents). During the 2 year period, symptoms have been present at least half the time and have never been absent for more than two months at a time. Criteria for mood episodes have never been. Symptoms must cause significant distress or impairment. The specifier with anxious distress is available for use

Bipolar II disorder

Diagnosed when there has been at least one major depressive episode and at least one hypomanic episode and there has never been a manic episode. The average age of onset is in mid 20s and appears to be more common in women. The risk of the disorder is highest among relatives of people with the disorder

Generalized Anxiety Disorder

Diagnosed when there is excessive anxiety and worry about a number of events or activities, occurring more days than not for at least six months. Requires three or more: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Only one symptom is required in children. The median age of onset is 30 years, which is later then for all the other anxiety disorders. Disorders usually chronic, with the fluctuating course during which symptoms wax and wane. CBT or anxiety management training may be best treatment approaches. Anxiety management training is a combination of relaxation and cognitive restructuring.

Mild Neurocognitive Disorder

Diagnosed when there is modest cognitive decline from prior level of functioning in one or more domains. The decline is noticed by the individual or others and documented by standardized testing or quantify clinical assessment. The deficits do not interfere with independent functioning and every day activities.

Enuresis

Diagnosed when there is repeated voiding of urine into the bed or clothes, whether intentionally or involuntarily. Considered clinically significant either when it occurs twice a week for at least three months or results in significant distress or impairment in functioning. Minimum chronological and mental age is five years. Not diagnosed if due to a medical disorder. subtypes: nocturnal only, diurnal only, or nocturnal and diurnal. Characterized as either primary, in which the child is age 5 and has never established continence, or secondary in which the disturbance develops after a period of continence. Usually remits by adulthood. Most effective treatment for primary is the urine alarm (aka bell & pad technique; based on principles of classical conditioning), medication (high relapse rate once stopped). Family and/or individual therapy is often used to treat secondary associated with the stressor

Major Neurocognitive Disorder

Diagnosed when there is significant cognitive decline from a prior level of function in one or more domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition). The decline is noticed by the individual or others and documented by standardized testing or quantified clinical assessment. Deficits interfere with independent functioning and every day activities.

Problems related to family upbringing

Diagnoses in this category: parent-child relational problem, sibling relational problem, upbringing away from parents, and child affected by parental relationship distress

Other problems related to primary support group

Diagnoses in this category: relationship distress with spouse or intimate partner, disruption of family by separation or divorce, high expressed emotion level within family, and uncomplicated bereavement

Schizophrenia

Diagnostic criteria require the presence of two or more sx of psychosis each for a significant time during a 1 month period. At least one sx must be hallucinations, disorganized speech, or delusions. Since onset the person must be functioning at a level markedly below previous functioning for a significant portion of time in areas such as work, personal relations or self-care. Signs must persist for at least 6 months with at least 1 month of active sx. During prodromal or residual periods, the signs of disturbance May include only negative symptoms or two or more symptoms in attenuated (weakened) forms.

PTSD course & treatment

Duration of symptoms varies widely with complete recovery within three months to longer than 12 months. Risk factors for development includes severity of the trauma, perceived life threat, interpersonal violence, prior mental disorders, dissociation during and after the trauma, lack of support, female gender, younger age, lower SES, lower education, lower intelligence, & minority racial/ethnic status. more prevalent among females and is associated with suicidal ideation and attempts. Interventions include CPT, PE, seeking safety (when comorbid with SUD) and EMDR (controversial as the mechanism of change may simply be exposure). Also SIT. Psychological debriefing wasn't at first thought to prevent the development of PTSD and other trauma related symptoms but the method has been found to be ineffective and some research has indicated that it makes recovery more difficult as compared to having no treatment at all.

Encopresis

Dx when there is repeated passage of feces into inappropriate places, intentionally or involuntarily. Must occur at least once a month got a minimum of 3 months. Child must be chronologically & mentally age 4. Specifiers: with constipation and overflow incontinence and without constipation and overflow incontinence. Can be primary in which person has never established continence or secondary in which the problem develops after a period of continence. No evidence-based treatments. Medical management is often used successfully when constipation is the underlying problem. When clearly deliberate, features of ODD and/or CD may also be present. Treatment typically involves a behavioral approach in order to promote appropriate continent. Family therapy may be indicated especially if the symptoms are secondary to family conflict.

Psychological factors affecting other medical conditions

Essential feature is a medical symptom or condition is present, and psychological or behavior factors adversely affect the medical condition in one or more ways: factors have influenced the course or pathophysiology of the medical condition (exacerbation or delayed recovery), the factors interfere with treatment (poor adherence), or the factors create an additional health risk. Specify: mild moderate severe or extreme.

Other Cannabis-Induced Disorders

May include a psychotic disorder, anxiety disorder, sleep-wake disorder as well as intoxication delirium

Bipolar I disorder

Essential features that occurrence of it one manic episode, other episodes may proceed or follow that are not necessary for the diagnosis. The current or most recent episode should specified as manic, hypomanic, depressed, or u specified. Equally common in males & females, more common in high-income than low-income countries. Has the highest concordance (heredity) rates of all the major mental disorders. Risk of suicide is at least 15 times that of the general population. Mean age of onset for first mood episode is 18. Typically recurrent, those who have one manic episode have future mood episodes. Research a shown the stressors play more of a role in precipitating the first and/or second episode of the disorder then subsequent episodes. Medication management is typically lifelong and commonly prescribed meds include lithium, Tegretol, or Depakene. Psychoeducation about the disorder with the goal of improving adherence to medication has strong research support.

Due to TBI

Evidence of TBI; one or more of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, neurological signs (seizures, hemiparesis); persists past the acute post injury period

Other specified/unspecified feeding or eating disorder

Examples include atypical anorexia (criteria for anorexia met but no significant weight loss or weight is within or above normal range), bulimia nervosa of low frequency and/or limited duration, purging disorder (absence of binge eating), and night eating syndrome (recurrent episodes of night eating either after awakening from sleep or after the evening meal)

Other Specified/Unspecified Obsessive-Compulsive and Related Disorder

Examples include body dysmorphic like disorder without repetitive behaviors, obsessional jealousy, and koro (intense anxiety that the penis or vulva/nipples will recede into the body, possibly leading to death)

Other specified/unspecified somatic symptom and related disorder

Examples include brief somatic symptom disorder (duration of symptoms less than six months), pseudocyesis (false belief of being pregnant associated with objective signs and symptoms of pregnancy), malingering (intentional production of symptoms motivated by clear external incentives; not a mental disorder but is a diagnosis)

Other specified/unspecified dissociative disorder

Examples include identity disturbance due to prolonged and intense coercive persuasion, or acute dissociative reactions to stressful events (sometimes lasting only a few hours or days)

Other Specified/Unspecified Paraphilic Disorder

Examples include necrophilia (corpse), zoophilia (animals) and telephone scatologia (obscene phone calls)

Other stimulant induced disorders

May include a psychotic disorder, bipolar disorder, depressive disorder, anxiety disorder, OCD, sleep wake disorder, sexual dysfunction, neurocognitive disorder, as well as an intoxication delirium

Cluster B: histrionic personality disorder

Excessive emotionality and attention seeking as evidenced by five or more: uncomfortable when not the center of attention; sexually seductive/provocative behavior; rapidly shifting and shallow expressions of emotion; uses physical appearance to draw attention; speaks dramatically but without substance; exaggerates of motion; is easily influenced by others; considers relationship closer than they actually are.

Sexual Sadism Disorder

Fantasies, urges, or behavior involving sexual excitement resulting from the physical or psychological suffering of another, for at least 6 months.(SS- Stuff done to Someone; man in 50 shades)

Sexual Masochism Disorder

Fantasies, urges, or behavior involving the act of being humiliated, beaten, bound, or made to suffer, over a period of at least 6 months (SM - Stuff done to Me)

Voyeuristic Disorder

Fantasies, urges, or behavior that involves watching an unsuspecting person who is naked, undressing, or engaged in sexual activity. Must be for a period of at least 6 months and individual is at least 18. (Peeping Tom)

Schizophrenia & genes

First-degree relatives have a concordance rate of 10% and have a greater risk of developing schizophrenia than the general population. Identical twins have a 50% concordance rate, the risk of developing schizophrenia when both parents have the disorder is about 45%. Relatives of individuals with schizophrenia havoc increased risk of developing other schizophrenia spectrum disorders including schizotypal and paranoid personality disorders and delusional disorder

Delusions (thinking)

Fixed, false beliefs that are unchangeable. Content varies and can be bizarre or non-bizarre. Non-bizarre are situations that are possible and bizarre are those that are clearly implausible

Sexual Dysfunction

Heterogeneous group of disorders characterized by disturbance in sexual response or sexual experience of pleasure. Specifiers: lifelong (the disturbance has been present since the individual became sexually active) or acquired (the disturbance began after a period of normal sexual functioning; and generalized (occurs with all types of stimulation, situations, or partners) or specific (occurs only with certain types of stimulation, situations, or partners). Current severity coded based on distress over the symptoms: mild moderate or severe

Housing problems

Homelessness, in adequate housing, discord with neighbor or landlord, and problems related to living in a residential institution

Other specified/unspecified trauma and stressor related disorder

Include adjustment-like disorders with late onset of symptoms that occur more than three months after the stressor, persistent complex bereavement disorder, or ataque de nervios

Substance/medication induced

Impairment persist beyond intoxication and withdrawal; can produce neurocognitive impairment; for alcohol, the subtype amnestic - confabulatory is coded if appropriate

Neurocognitive Disorders (NCDs)

Include delirium, as well as major NCDs, mild in NCDs, and their subtypes. The primary clinical deficit is in cognitive functioning, and the disorders are acquired rather than developmental. The impaired cognition has not been present since birth nor in early life, and represents a decline from a prior level of functioning. For many NCDs the underlying pathology & etiology can be determined. The term dementia is assumed under major neurocognitive disorder. Dementia is still use for disorders involving degenerative processes typically in order adults, neurocognitive disorder is preferred for conditions affecting younger persons. Individuals with a decline in a single domain can receive the diagnosis.

Negative Symptoms

Include diminished emotional expression and avolition (decrease in self-initiated purposeful activities), alogia (reduced speech output), anhedonia (diminished pleasure) & asociality (lack of interest in social interactions)

Substance-Related and Addictive Disorders

Include substance-related disorders as well as gambling disorder. All drugs taken in excess activate the brain's reward system, involved in reinforcement of behaviors and production of memories. Gambling found to activate reward systems too. Normal activities may be neglected and individuals with lower levels of self-control (possibly reflecting impairment in the brain's inhibitory mechanisms) may be predisposed to develop a disorder. Divided into two groups: substance use disorders and substance-induced disorders

Breathing related sleep disorders

Include three distinct disorders: obstructive sleep apnea hypopnea (characterized by snoring, snorting/gasping, or breathing pauses during sleep); central sleep apnea (no evidence of obstruction); sleep related hypoventilation (decreased respiration associated with elevated carbon dioxide levels). Obstructive sleep apnea hypopnea is the most common. Apnea refers to a temporary cessation of breathing; hypopnea is abnormally slow or shallow breathing.

Good prognostic features

Include two or more: onset of prominent psychotic symptoms within four weeks of the first noticeable change in behavior (acute onset), confusion or perplexity, good premorbid social and occupational functioning, and absence of flat or blunted affect.

ASPD

Included in this section because it is closely connected to the spectrum of externalizing disorders of conduct

Stimulant related disorders

Includes amphetamines, cocaine, or other stimulants (narcotics too)

Gender Dysphoria

Includes one diagnosis for gender dysphoria with separate criteria sets for children & adolescents/adults

Due to frontotemporal disorder

Insidious onset and gradual progression of impairment; either behavioral variant with decline in social cognition and/executive functioning, or language variant; relative sparing of learning, memory, and perceptual-motor function. (Gradual steady and apparent onset and progression with behavior problems AND decline in social cognition and/or executive functioning OR language problems)

Due to Alzheimer's Disease

Insidious onset and gradual progression of impairment; either evidence of a causative Alzheimer's disease genetic mutation or clear evidence of a decline in memory & learning and at least one other cognitive domain; no extended plateaus; no evidence of mixed etiology (gradual steady & apparent onset and progression)

Due to Huntington's disease

Insidious onset and gradual progression of impairment; occurs in the context of a diagnosed Huntington's disease, or risk for the disease (abnormaloties can predate motor symptoms by 15 years)

Due to Parkinson's disease

Insidious onset and gradual progression of impairment; occurs in the context of a diagnosed Parkinson's disease

With Lewy bodies

Insidious onset and gradual progression of impairment; several of the following: fluctuating technician with variations and attention/alertness, visual hallucinations, parkinsonian is him, REM sleep behavior disorder, and severe neuroleptic sensitivity.

Due to prion (mad cow) disease

Insidious onset and rapid progression of impairment; there are motor features such as myoclonus (jerky muscle contractions) or ataxia, or biomarker evidence. Creutzfeldt-Jakob disease is the most common typically progresses very rapidly to major impairment over several months

Economic problems

Lack of adequate food are safe drinking water, extreme poverty, low income, insufficient social insurance or welfare support, and unspecified housing or economic problem

Agoraphobia

Intense fear or anxiety about two or more situations: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside the home. Situations are avoided because of thoughts that escape might be difficult or that help might not be available when incapacitating or embarrassing symptoms occur. The fear, anxiety, or avoidance is persistent and typically last six months or more. Individuals also have comorbid mental disorders most common co occurring diagnoses include other anxiety disorders, depressive disorders,PTSD, and alcohol use disorder. Usually treated with CBT very similar to the treatment of panic disorder

Sedative, Hypnotic, or Anxiolytic related disorders

Intoxication and withdrawal results in symptoms identical to alcohol intoxication and withdrawal

Dissociative Disorders

Involve a disturbance or alteration in the normally integrative functions of consciousness, identity, memory, perception, emotion, body representation, motor control, and behavior. May be experienced as intrusions into awareness and behavior (positive sxs such as derealization) and/or as an inability to access information (negative sxs such as amnesia). Frequently occur following a trauma

Elimination disorders

Involve inappropriate elimination of urine or feces; usually first diagnosed in childhood.

Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders

Involve recurrent episodes of incomplete awakening from sleep, usually during the first third of the night accompanied by either sleepwalking or sleep terrors. There's total amnesia for the event and no dream recollection.

With mood congruent or mood incongruent psychotic features

Involve the presence of delusions or hallucinations at any time in the episode. Mood congruent features delusions and hallucinations consistent with the mood. Mood incongruent features delusions and hallucinations that are not consistent with the mood.

Adjustment disorders

Involve the presence of emotional or behavioral symptoms in response to an identifiable psychosocial stressor. The disorder develops within three months of the onset of the stressor and remits within six months of the stressors termination. Person experiences marked distress in excess of what would be expected or there is significant impairment in functioning. Only diagnosed if the stress related disturbance does not qualify for another mental disorder nor is it an exacerbation of a pre-existing mental disorder. Specifiers: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, and unspecified

Somatic type

Involved illusion relating to body functions and sensations

Selective mutism

Involves a consistent failure to speak in specific social situations when speaking is expected, in spite of speaking in other situations. A minimum of one month duration is required for the diagnosis. Onset is usually before age 5. In children it is related to fear and anxiety not disobedience. Treatment includes combination of behavioral therapy and cognitive therapy- desensitization, relaxation protocols to include guided imagery.

Medication induced postural tremor

Involves a fine tremor occurring while trying to maintain posture

Specific Phobia

Involves a marked fear or anxiety caused by the presence or anticipation of a specific object or situation. Exposure provokes an immediate anxiety response and the phobic situation is either avoided or endured with intense distress. Fear and anxiety is out of the proportion to the actual danger and typically last for six months or more. Specifiers: animal, natural environment (heights, storms, etc.), blood injection injury, situational (planes, elevators, etc) or other (loud sounds, costumed characters, etc.). Common to have multiple specific phobias in which case multiple diagnoses are given. Expose your-based therapies are the treatment of choice. In vivo exposure usually yields the strongest results; massed exposure May result in more robust clinical improvement. Therapist assisted exposure based procedures are highly effective. Virtual-reality exposure is useful for phobias that may be difficult to treat in vivo. Systematic desensitization, which involves pairing exposure with relaxation maybe preferred by patients. However it is effective but requires more time and is less successful at decreasing avoidance. Many exposure therapies include a cognitive component which can be particularly helpful for certain phobias.

Other medication induced movement disorder

Involves a medication induced movement disorder not captured by any other specific disorder

Cluster B: narcissistic personality disorder

Involves a pattern grandiosity, need for admiration, and lack of empathy as indicated by five or more: grandiose sense of self importance; preoccupied with fantasies of greatness; believes they are special; needs excessive admiration; has a sense of entitlement; is interpersonally exploitative; lacks empathy; is envious of others, or thinks others are envious of them; is arrogant and haughty

Illness Anxiety Disorder

Involves a preoccupation with having or developing a serious illness. Somatic sxs or mild or not present and there is significant anxiety about health. Either performs excessive health-related behaviors or demonstrates maladaptive avoidance. Illness preoccupation lasts at least 6 months.prevalence is similar in both men and women (nutshell: anxiety about developing an illness)

Antidepressant discontinuation syndrome

Involves a set of symptoms that can occur after abrupt cessation of antidepressants, and may include sensory and somatic symptoms, as well as nonspecific anxiety and feelings of dread

Tardive dyskinesia

Involves athetoid (writhing) or choreiform (jerky) movements of the tongue, jaw, and extremities

Inhalant intoxication

Involves behavioral or psychological changes as well as two or more: dizziness, and coordination, nystagmus, slurred speech, unsteady gait, depressed reflexes, lethargy, muscle weakness, blurred vision, tremor, cycle motor retardation, euphoria, and stupor or coma

Mixed type

Involves characteristics of more than one of the types of without any single theme predominating

Medication induced acute akathisia (restlessness)

Involves complaints of restlessness accompanied by excessive movement (fidgeting, rocking, pacing, inability to sit still)

Pyromania

Involves deliberate and purposeful fire setting on more than one occasion. Tension or affective of arousal is experience before the act, fascination with or attraction to fire, and pleasure or relief on setting fires or witnessing their aftermath.

Erotomanic type

Involves delusions and which another person, usually of higher status, is in love with the individual

Jealous type

Involves delusions in which the person believes that a sexual partner is being unfaithful

Delayed ejaculation

Involves either marked delay in ejaculation or marked infrequency or absence of ejaculation, occurring on almost all or all occasions. Symptoms present for a minimum of six months

Female Orgasmic Disorder

Involves either marked delay, infrequency, or absence of orgasm, or reduced intensity of sensations of orgasm, occurring on almost all or all occasions for a minimum of six months.

Obsessive-Compulsive Disorder

Involves either obsessions and/or compulsions. Obsessions are recurrent thoughts, urges, or images that are experienced as intrusive and cause distress or anxiety. The person attempts to either ignore or suppress the thoughts or to neutralize them with some other thought or action. Compulsions are repetitive behaviors or mental acts the person feels driven to perform as an attempt to prevent or reduce distress or prevent some dreaded situation. Obsessions or compulsions take more than one hour per day or cause significant distress or impairment. Specifiers: with good or fair insight, with poor insight, and with absent insight/delusional beliefs. Tic-related it's coded if the individual has a current or past history of a tic disorder.

Erectile disorder

Involves either the inability to achieve an erection, difficulty maintaining erection, or decrease erectile rigidity, occurring on almost all or all occasions for a minimum of six months.

Kleptomania

Involves failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. Their is tension immediately before committing the theft and pleasure or relief at the time of the theft

Frotteuristic Disorder

Involves fantasies, urges, or behavior that involve rubbing or touching an unconsenting person, over a period of at least 6 months. (Crowd in Vegas on NYE or molestation)

Exhibitionistic Disorder

Involves fantasies, urges, or behavior that involves exposing one's genitals to a stranger, over a period of 6 months (flashers)

Social Anxiety Disorder (Social Phobia)

Involves fear of one or more social situations in which the person is exposed to potential scrutiny by others, for example social interactions, being observed, and performing. Person fears their behavior will be embarrassing, humiliating, or lead to rejection. Fear, anxiety, or avoidance is persistent, typically lasts six months or more. If the fear is restricted to speaking or performing in public the specifier performance only should be used. Strong support for treating with cognitive therapy and with behavioral approaches (including exposure & relaxation). Combining cognitive and behavioral therapy seems to yield the best results.

Conversion Disorder (functional neurological symptom disorder)

Involves one or more symptoms or deficits affecting voluntary motor or sensory function. Symptoms are not intentionally produced but are incompatible with recognized neurological or medical conditions (nutshell: have sxs but don't match any known neuro or med condition). Specifiers: with weakness or paralysis, with abnormal movement, with swallowing symptoms, with speech symptoms, with attacks of seizures, and with anesthesia or sensory loss, with special sensory symptom, or with mixed symptoms. Must also specify if: acute episode (sxs present less than 6 months), or persistent (sxs present more than six months), and with psychological stressor (stressor needs to be specified) or without psychological stressor. Occurs 2 to 3 times more frequently in women.

Hoarding Disorder

Involves persistent difficulty throwing out or giving up possessions, regardless of actual value. There is a perceived need to save items and distress associated with discarding items, which results in a cluttered living space. Specifiers: with good or fair insight, with poor insight, and with absent insight/delusional beliefs. With excessive accusation is coded if in addition to difficultly discarding there is an excessive acquisition of items that are not needed or for which there is no space.

Disruptive Mood Dysregulation Disorder

Involves recurrent temper outbursts (verbal or physical) three or more times a week for over one year in at least two settings. Between outbursts the mood is persistently irritable or angry most of the day nearly every day. Diagnosis must be made between ages 6-18 but sxs must have been present before age 10. There has never been a period of more than one day in which the symptoms of a manic or hypomanic episode have been present.

Neuroleptic Malignant Syndrome

Involves severe muscle rigidity, elevated temperature, and other symptoms, such as labile blood pressure and changes in consciousness

Fetishistic Disorder

Involves sexual fantasies, urges, or behavior involving either the use of nonliving objects or a highly specific focus on a non genital body part, over a period of at least six months (foot fetish)

Female Sexual Interest/Arousal Disorder

Involves the lack of or reduced sexual interest/arousal as evidenced by at least three: absent/reduced sexual interests, absent/reduced sexual thoughts or fantasies, lack of or reduced initiation of sexual activity and lack of receptivity to partner's initiation, absent/reduced sexual pleasure (most often), absent/reduced interest/arousal in response to internal or external sexual cues, and absent/reduced sensations during sexual activity (most often). Sxs have persisted for at least 6 months

Rumination disorder

Involves the repeated regurgitation of food for at least one month. Food maybe re-chewed, re-swallowed, or spit out. Not attributable to a medical disorder. Age of onset is usually between 3-12 months. Neglect, stressful life situations, and parent-child problem may be predisposing factors.

Caffeine Withdrawal

Involves three or more: headache, fatigue/drowsiness, dysphoric mood or irritability, difficulty concentrating, and flulike symptoms.

Schizotypal Personality Disorder

Is considered part of the schizophrenia spectrum and is also in the personality disorders.

Substance-Induced Disorders - Substance/Medication-Induced Mental Disorders

May be induced by any of the 10 classes of substances that produce SUD or by medication used in medical treatment.

Schizophrenia & brain

MRI of the brain the persons with schizophrenia showing enlargement of the lateral and third ventricles, a smaller cerebral cortex, and a smaller thalamus (the filter for sensory input). PET scans indicate decreased frontal lobe activity which have been associated with the negative symptoms

OCD course & treatment

Males have an earlier age of onset than females, usually before age 10 as a result males are more commonly affected in childhood and also more likely to have a comorbid tic disorder. In adulthood females are slightly more commonly Fectig. Suicide risk is high. Evidenced based treatments include exposure with response prevention and cognitive therapy. The two approaches are often combined.

With mixed features specifier

Manic or hypomanic includes at least three: dysphoria or depressed mood, loss of interest or pleasure, psychomotor retardation, fatigue or loss of energy, feelings of worthlessness or guilt, or recurrent bouts of death or suicidality Depressive includes at least three: elevated or expansive mood, inflated self-esteem or grandiosity, pressured speech, flight of ideas or racing thoughts, increased energy or goal directed activity, involvement in activities that have a high likelihood of adverse consequences, or decreased need for sleep.

Other Sedative, Hypnotic, or Anxiolytic induced disorders

May include a psychotic disorder, bipolar disorder, depressive disorder, anxiety disorder, sleep wake disorder, sexual dysfunction, neurocognitive disorder, as well as an intoxication delirium

Other inhalant induced disorders

May include a psychotic disorder, depressive disorder, anxiety disorder, neurocognitive disorder, as well as an intoxication delirium

Other tobacco induced disorders

May include a sleep-wake disorder

Other Caffeine-Induced Disorders

May include an anxiety disorder or sleep-wake disorder

Other Phencyclidine-Induced/Hallucinogen-Induced Disorders

May include psychotic, bipolar, depression, anxiety disorders as well as an intoxication delirium

Other Alcohol-Induced Disorders

May include the following disorders psychotic, bipolar, depressive, sleep-wake, neurocognitive, sexual dysfunction, as well as intoxication and withdrawal delirium.

Grossly Disorganized or Abnormal Motor Behavior (including catatonia)

May range from childlike silliness to unexpected agitation, typically interfering with goal-directed behaviors and activities of daily living. Catatonia is a marked decrease I reactivity that ranges from resistance to instructions (negativism), to maintaining odd posture,to lack of verbal or motor response (mutism and stupor). Can also involve excessive motor activity (catatonic excitement) repeated stereotype movement, grimacing, and echoing of speech.

Catatonic disorder due to another medical condition

Medical conditions that are known to manifest with catatonia including neurological conditions and metabolic conditions

Psychotic disorder due to another medical condition

Medical conditions that are known to manifest with delusions or hallucinations include neurological conditions, in the kindest orders, and metabolic condition. Specifiers include with delusions or with hallucinations

Obsessive-Compulsive and Related Disorder due to Another Medical Condition

Medical conditions that are known to manifest with symptoms include Sydenham's chorea and pediatric acute-onset neuropsychiatric syndrome (PANS)

Anxiety disorder due to another medical condition

Medical conditions that are known to manifest with symptoms of anxiety include endocrine disorders, cardiovascular disorders, respiratory illness, metabolic disturbances, and neurological illness

Depressive disorder due to another medical condition

Medical conditions that are known to manifest with symptoms of depression include stroke, Huntington's disease, Parkinson's disease, & TBI. The neuroendocrine conditions of hypothyroidism and Cushing's disease are also associated with depression

Bipolar and related disorder due to another medical condition

Medical conditions that may cause a bipolar manic or hypomanic condition include Cushing's disease, multiple sclerosis, stroke, TBI

Treatment for Schizophrenia

Medication management is a key component and typically life long. Most common are antipsychotics. Psychosocial interventions such as CBT and family psychoeducation. Expressed emotion by family members has been shown to predict relapse many family approaches work to decrease expressed emotion and focus on strength and resiliency. Social skills training teach skills related to communication, service, disease management and independent living.

Other health service encounters for counseling and medical advice

Sex counseling and other counseling or consultation

Nonadherence to medical treatment

Non-adherence to medical treatment, overweight or obesity, malingering, wandering associated with a mental disorder, and borderline intellectual functioning

Sedative, Hypnotic, or Anxiolytic use disorder

Occurs when an individual's use meets criteria for substance use disorder

Alcohol Use Disorder

Occurs when individuals use of alcohol meet the criteria for theft disorder

Cannabis Use Disorder

Occurs when the individuals use of cannabis meets the criteria for substance use disorder

Inhalant use disorder

Occurs when the use of inhalant meets the criteria for a substance use disorder (No with drawl category for inhalant-related disorders)

Hallucinogen-Related Disorders - PCP Use Disorder

Occurs when the use of phencyclidine meets the criteria for substance use disorder (no withdrawal category with hallucinogen-related disorder)

Tobacco use disorder

Occurs when the use of tobacco meets criteria for a substance use disorder. No intoxication with tobacco related disorders. Quitting smoking is very difficult, and many require multiple attempts before they are ultimately successful. Counseling and medication both effective for treating dependence, but using them together is more effective. Pharmacological treatments include Zyban (the antidepressant bupropion) and the nicotine patch.

Other Hallucinogen Use Disorder

Occurs when use of a hallucinogen other than PCP (LSD, peyote, psilocybin) meets the criteria for a SUD

Delusional Disorder

One or more delusions for at least one month with no additional symptoms found in schizophrenia. The person's behavior is relatively unimpaired and is not obviously. If manic or major depressive episodes occur concur with the delusions, the duration of the moon episode is brief relative to the duration of the delusion. Specifiers include erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, and unspecified type. Specifier with bizarre content if bizarre. Onset is typically in middle to late adulthood & the most common subtype is persecutory

MDD & treatment/course

Onset can be at any age, although peaks in the 20s. The course is variable some rarely experience full remission, others experience isolated episodes with full return to premorbid functioning. Recovery typically begins within three months of onset for others may take up to a year. Factors associated with lower recovery rates: current episode duration, psychotic features, anxiety, personality disorders, and symptom severity. Risk of recurrence is higher when the preceding episode was severe, in younger individuals, and for persons who have had multiple episodes. Rate is Eagle and prepubertal girls and boys but one .5 to 3 times higher and females than males beginning in early adolescence. Risk factors include neuroticism (negative affectivity), adverse childhood experiences, and stressful life events. Possibility for suicide exist at all times.

DSM 5

Organized based on developmental and lifestyle considerations, as well as the clustering of disorders based on internalizing and externalizing factors. (Begins with disorders that manifest early in life, then those that are more common in adolescence and young adulthood that are internalizing, then those that are externalizing, ending with those related to later life). Nonaxial documentation with separate notation for important social and contextual factors and disabilities

Other circumstances of personal history

Other personal history of psychological trauma, personal history of self harm, personal history of military deployment, other personal risk factors, problems related to,ifestyle, adult antisocial behavior, and child or adolescent antisocial behavior

Paraphilic Disorders

Paraphilia's are intense and persistent sexual urges, benefits, or behaviors that involve nonhuman objects, the suffering or humiliation of oneself apartment, or children or other nonconsenting person. Considered a disorder if it causes distress or impairment to the individual, or if satisfaction involves personal harm or risk of harm to others. Specifiers: in a controlled environment and in full remission if the person has not acted on the urges and there has not been distress or functioning for at least five years, while in an uncontrolled environment. With the exception of sexual masochism, these disorders occur almost exclusively in men

Cluster A: Schizotypal personality disorder

Pattern of deficits in social and interpersonal functioning marked by discomfort with and reduced capacity for close relationships, peculiarities in cognition, perception, ideation, appearance and behavior as evidenced by five or more: ideas of reference; beliefs; unusual perceptual experiences; odd thinking and speech; suspiciousness/paranoia; inappropriate or constricted affect; odd behavior or appearance; lack of close friends; social anxiety associated with paranoid fears (want relationships but doesn't know how to interact socially, overall weird (impaired - cognition & interpersonal functioning)

Pica

Persistent eating oven on the trip to, non-food substances for a period of at least one month. It's commonly seen in young children and occasionally in pregnant women. In individuals with intellectual disability, the prevalence increases with the severity of the disorder. Can be life-threatening.

Depersonalization/Derealization disorder

Persistent or recurrent episodes of depersonalization (a sense of unreality or detachment from one's thoughts, feelings, body, or actions) or derealization (a sense of unreality or detachment from one's surroundings). Reality testing remains intact.

Cluster B: ASPD

Pervasive pattern of disregard for and violation of the rights of others since at least 15 as indicated by three or more: repeatedly committing unlawful acts; deceitfulness; impulsivity and failure to plan ahead; repeated physical fight/assaults; disregard for the safety of others or self; irresponsibility; lack of remorse. Must be at least 18 and evidence of conduct disorder before 15

Other problems related to the social environment

Phase of life problem, probably related to living alone, alteration difficulty, social exclusion or rejection, target of (perceived) adverse discrimination or persecution, and unspecified problem related to social environment

CD course & treatment

Poor prognosis is associated with early onset. Typically symptoms remit by adulthood although some continue to exhibit symptoms and meet criteria for ASPD in adulthood. Predisposing factors include: difficult infant temperament, parental rejection and neglect, inconsistent child-rearing with harsh discipline, physical or sexual abuse, lack of supervision, change in caregivers or institutional living, large family size in association with the delinquent peer group. Parent management training, a form of behavior therapy, has most success. Severe cases may warrant a residential or inpatient treatment

Insomnia disorder

Predominant complaint of dissatisfaction with sleep quality or quantity associated with one or more: difficulty initiating sweet, difficulty maintaining sleep, or early-morning awakening with inability to go back to sleep. Occurs at least three nights each week for at least three months. Specifiers with a non-sleep disorder mental comorbidity, with other medical comorbidity, and with other sleep disorder. Additional specifiers: episodic (symptoms last at least one month for less than three months), persistent (symptoms last three months or longer), and recurrent (two or more episodes within one year). CBT is most effective, component techniques there also use independently to successfully treat including sleep restriction therapy, stimulus control therapy, and relaxation training. Dx when this is the focus of tx.

Body Dysmorphic Disorder

Preoccupation with one or more perceived defects in appearance. The perceived flaws are either not observable or slight. Excessive repetitive behaviors or mental acts are performed. Usually begins in adolescence and occurs slightly more frequently in women. Suicidal ideation and attempts are high. Major depressive disorder is the most common comorbid disorder also social anxiety disorder and substance related disorders are common. Treatment typically includes CBT and medication. Specifiers: with good or fair insight, with poor insight, and with absent insight/delusional beliefs. With muscle dysmorphia is coded if the individual is preoccupied with the idea that their body build is too small or not muscular enough.

Clauses C: Obsessive-Compulsive Personality Disorder

Preoccupation with orderliness, perfectionism, and control which results in inflexibility and inefficiency as evidence by four more: preoccupation with details, rules, or schedules such that the major point of activity is lost; perfectionism that interferes with task completion; excessive focus on work and productivity to the exclusion of friendship and leisure over conscientiousness and inflexibility about morals and values; inability to discard worn out and worthless objects; reluctance to delegate tasks to others; stingy with money; rigid and stubborn

Major Depressive Disorder

Presence of a major depressive episode characterized by five in two weeks. One of the symptoms must be either depressed mood or loss of interest or pleasure. Other symptoms include: weight loss or gain, change in appetite: insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or guilt; poor concentration or indecisiveness; our current thoughts of death or suicidal ideation, intent, or plan. There has never been a manic or hypomanic episode present.

With rapid cycling

Presence of at least 4 mood episodes in the previous 12 months that are demarcated by a partial or full remission of at least two months or a switch to an episode of the opposite pole.

Occupational problems

Problem related to current military deployment status and other problems related to employment

Schizophrenia prognosis

Prognosis is best with good prior functioning, abrupt onset, fewer negative symptoms, minimal cognitive impairment & female gender (females tend to have fewer negative symptoms). Later on that has been associated with better prognosis however the effect of age on onset on prognosis is likely related to gender as females have a later age of onset. Suicide risk is high.

Other specified/unspecified schizophrenia spectrum and other psychotic disorder

Psychotic like symptoms below threshold for full psychosis

Sleep terrors (NREM Sleep Arousal Dis)

Recurrent episodes of abrupt awakening that begin with a panicky scream. Episodes last from 1-10 minutes at which time the person evidences intense fear and autonomic arousal, is generally unresponsive to efforts to be comforted and hard to wake up

Binge eating disorder

Recurrent episodes of binge eating associated with three or more: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone out of embarrassment by the amount one is eating, or feeling disgusted or guilty afterwards. The binge on average last at least once a week for three months.(no compensatory behaviors as seen in bulimia nervosa). The specifiers in partial remission or in full should be used. Current severity is based on the average number of episodes each week mild (1-3), moderate (4-7), severe (8-13), or extreme (14+)

Intermittent Explosive Disorder (Impulses are prominent)

Recurrent outburst resulting from a failure to control aggressive impulses as manifested by either verbal aggression or physical aggression toward animals, property, or people, occurring twice weekly for a period of three months in which the physical aggression does not cause property damage or physical injury; or three behavior outburst involving damage or physical injury within a 12 month period. Chronological age is at least six years. Not premeditated, not for a goal

Narcolepsy

Recurrent periods of an irresistible need to sleep, lapsing into sleep, or napping occurring within a given day, at least three times per week, for at least a three-month duration. Involves at least one: cataplexy (either brief episodes of sudden bilateral loss of muscle tone, typically precipitated by laughter are joking, or grimaces our job opening with tongue thrusting, without obvious emotional triggers),hypocretin deficiency, or REM indicators. Severity a specified is mild moderate or severe. Individuals commonly experience recurrent intrusion of REM sleep into the transition between sleep and wakefulness. Manifested as hypnagogic hallucinations at the onset of sleep, as hypnopompic hallucinations on awakening, or sleep paralysis at the beginning or end of sleep episodes.

Excoriation (Skin-Picking) Disorder

Recurrent picking at one and resulting in skin lesions, with repeated attempts to decrease or stop picking.

Trichotillomania

Recurrent pulling out of one's own hairs, resulting in noticeable hair loss with repeated attempts to decrease or stop hair pulling.

Problems related to other psychosocial, personal, and environmental circumstances

Religious or spiritual problem; problems related to unwanted pregnancy, problems related to multiparity (giving birth to multiples), discord with social services provider (probation officer, case manager, social service worker), victim of terrorism or torture, exposure to disaster or war, or other problem related to psychosocial circumstances, and unspecified problem related to unspecified psychosocial circumstances

Sleepwalking disorder (NREM Sleep Arousal Dis)

Repeated episodes of arriving from bed and walking about. The person has a blank, staring face, is unresponsive, can be awakened with great difficulty. Occurs early part of the night

Nightmare Disorder

Repeated occurrences of detailed, frightening dreams about threats to survival. Dreams generally occur during the second half of the night commonly during REM sleep. On awakening the person rapidly becomes alert and oriented. Specifiers: with associated non-sleep disorder, with associated other medical condition, and with associated other sleep disorder. Also specify severity based on the frequency with which the nightmare occurs mild moderate or severe.

Major depressive episode

Requires at least 5 sxs during a 2 week period represented change from previous functioning. At least one symptom must be either depressed mood or loss of interest or pleasure (anhedonia). Other sxs: unintentional weight loss or gain or change in appetite; disturbed sleep; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or guilt; poor concentration or indecisiveness; and recurrent thoughts of death or suicidal ideation, intent or plan.

Restless Leg Syndrome

Sensorimotor, neurological sleep disorder that involves an urge to move the legs, typically in response to unpleasant sensations in the legs. That urge begins or worsens during periods of rest/inactivity, is relieved by movement, and is worse in the evening/night or only occurs at these times. Must be present at least three times a week and have persisted for at least 3 months.

Acute stress disorder

Similar exposure to trauma as with PTSD and evidences nine or more symptoms from any five categories of intrusion, negative mood, dissociation, avoidance, and arousal. Symptoms typically begin immediately after the trauma and must persist for at least three days but no longer than one month.

Spouse or partner abuse, psychological

Spouse or partner abuse, psychological, confirmed; spouse or partner abuse, psychological, suspected; and other circumstances related to spouse or partner abuse, psychological

Spouse or partner neglect

Spouse or partner neglect, confirmed; spouse or partner neglect, suspected; and other circumstances related to spouse or partner neglect

Spouse or partner violence, physical

Spouse or partner violence,physical, confirmed; spouse or partner violence,physical, suspected; and other circumstances related to spouse or partner violence,physical

Spouse or partner violence, sexual

Spouse or partner violence,sexual, confirmed; spouse or partner violence, sexual, suspected; and other circumstances related to spouse or partner violence,sexual

Due to vascular disease

Stepwise pattern of deterioration and a patchy distribution of deficits; evidence of cerebrovascular disease; decline is prominent in complex attention and frontal - executive functions

Substance/medication induced bipolar and related disorder

Substances that can induce a bipolar related disorder include stimulants, phencyclidine (PCP), and steroids

Substance/medication induced depressive disorder

Substances that can induce a depressive disorder include alcohol, hallucinogens (including PCP), inhalants, opioids, sedatives, hypnotics and anxiolytics, and stimulants (including cocaine)

Substance/medication induced psychotic disorder

Substances that can induce a psychotic disorder include alcohol, cannabis, hallucinogens (including PCP), inhalants, sedatives, hypnotics, anxiolytics and stimulants including (cocaine)

Substance/Medication-Induced Anxiety Disorder

Substances that can induce an anxiety disorder: alcohol, caffeine, cannabis, hallucinogens (including PCP), inhalants, opioids, sedatives, hypnotics and anxiolytics, and stimulants (including cocaine)

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder

Substances that can induce an obsessive-compulsive and related disorder include amphetamines (or other stimulants) and cocaine.

Substance/medication induced sleep disorder

Substances that can induce include alcohol, caffeine, cannabis, opioids, sedatives, hypnotics or anxiolytics, and stimulants (including cocaine) and tobacco.

Substance/Medication-Induced Sexual Dysfunction

Substances that can induce include alcohol, opioids, sedatives, hypnotics or anxiolytics, and stimulants (including cocaine)

Schizophreniform Disorder

Symptoms are identical to schizophrenia and distinguished only by duration. Diagnosis is made when the duration of the illness is at least one month but less than six. If person has not recovered after onset "provisional" is added to the dx and will be changed to schizophrenia after 6 months. Specifiers include with good prognostic features & without good prognostic features. catatonia is also used if present

Other specific/unspecified depressive disorder

Symptoms are present but do not meet full criteria

Problems related to access to medical and other healthcare

Unavailability or inaccessibility of healthcare facilities, and unavailability or inaccessibility of other helping agencies

Other specified/unspecified anxiety disorder

Symptoms of anxiety that do not fit in any category

Mental disorder

Syndrome characterized by clinically significant disturbance in an individual cognition, emotion regulation, or behavior that reflect the dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Excludes expectable or culturally approved responses to a stressor or loss. Socially deviant behavior is not a mental disorder on its own unless the deviants results from a dysfunction in the person.

CD associated features

Tendency to misperceive others intentions as hostile or threatening and thereby feeling justified in responding aggressively. Poor frustration tolerance, irritability, temper outburst, and recklessness are frequently seen. Often associated with precocious sexual behavior, drinking, smoking, use of illegal substances, and risk taking. Suicide attempts and completions are higher than average. ADHD and ODD commonly co-occur. Other concomitant dx include: specific learning disorder, anxiety disorders, depressive and bipolar disorders, and substance related disorders.

Premenstrual dysphoric disorder

That in the majority of menstrual cycles there are at least five symptoms present in the week before the onset of menses, symptoms start to improve within a few days after the onset of menses, and are minimal or absent in the week postmenses. At least one must be present: marked affective lability, marked irritability or increased interpersonal conflict, marked depressed mode or marked anxiety. Additionally, at least one let's be present. Decreased interest in usual activities, difficulty concentrating, lethargy or fatigue, change in appetite, sleep difficulties, feeling overwhelmed, and physical sxs. Symptoms must be present for most menstrual cycles in the preceding year.

Other unspecified/unspecified personality disorder

The apply to presentations and which symptoms of a personality predominate, but the full criteria are not met for any personality disorder

Other adverse effects of medication

This diagnosis is assigned in the presence of adverse side effects of medication other than movement symptoms

Anxiety disorders

Typically include both fear (response to a real or perceived emotional threat) or anxiety (response to a future threat). Fear is often associated with increased autonomic arousal, escape behaviors, and panic attacks. Many develop in childhood and tend to persist, more frequent in females. The disorders in this section are arranged developmentally and sequenced based on typical age of onset.

Problems related to crime or interaction with the legal system

Victim of crime, conviction in civil or criminal proceedings without imprisonment, imprisonment or other incarceration, problems related to release from prison, and problems related to other legal circumstances

Stimulant use disorder

When use of a stimulant meets criteria for substance use disorder

Opioid use disorder

When use of an opioid me to criteria for substance use disorder

Substance-Induced Disorders - Substance Intoxication

The development of a reversible, substance specific syndrome due to the recent ingestion of a substance. Typically involves disturbances in perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior due to the substance's effects on the CNS. Can occur for all substances except tobacco.

Substance-Induced Disorders - Substance Withdrawal

The development of substance-specific behavioral change, with physical and cognitive elements, due to either stopping or reducing the use of a substance. Causes distress and/or impairment in functioning. Can occur with all substances except hallucinogens and inhalants.

MDE vs grief

The distinction between the two is that in grief, feeling of emptiness and loss dominate, with MDE there is a persistent depressive mood and inability to experience pleasure. The dysphoria in grief tends to occur in waves, associated with thoughts of the loss rather than being persistent. Themes in MDE include feelings of self loathing, worthlessness, and wanting to end ones life due to inadequacy. These themes are not commonly seen in grief and loss. The presence of an MDE in addition to grief can be considered & be diagnosed with appropriate.

Münchausen syndrome (not a separate disorder)

The most severe Intermatic presentation of fictitious disorder. Predominantly physical symptoms, can include extensive travel and seeking of multiple invasive procedures and operations. Impersonation of fabrication often accompany.

Dissociative identity disorder

The presence of two or more distinct identities or personalities. Involves discontinuity in sense of self, frequently with accompanying alterations in affect, bx, consciousness, memory, perception, cognition, and/or sensory motor functioning. Also an inability to recall every day events, important personal information, and/or traumatic events that are too extensive to be explained by forgetfulness

Other conditions that may be a focus of clinical attention

These are what used to be V codes

Medication-induced movement disorders and other adverse effects of medication

These conditions are not considered mental disorders

Tardive Dystonia/Akathisia

These symptoms are part of a tardive syndrome and involve additional movement problems such as restlessness and muscle spasm

Obsessive-Compulsive and Related Disorders

This section begins with OCD - characterized by obsessions and/or compulsions, then related disorders of body dysmorphic disorder and hoarding disorder - characterized by cognitive symptoms(perceived defects in appearance, perceived need to save possessions), trichotillomania and excoriation -characterized by recurrent body focused repetitive behaviors.

Bipolar and related disorders

Three types of mood episodes: manic, depressive, hypomanic. episodes should be specified as mild moderate or severe. Full criteria not met it should be specified as in partial remission or in full remission. Other specifiers include: with anxious distress, with mixed features, with rapid cycling, with mood congruent or mood incongruent psychotic features, with catatonia, with peripartum onset, and with seasonal pattern.

With anxious distress specifier

To a more symptoms present most days during the mood episode: feeling keyed up our tents, feeling unusually restless, difficulty concentrating because of worry, fear that something awful may happen, or feeling like one may lose self-control.

Schizophrenia onset & course

Typically occurs between late teens and early 30s with onset prior to adolescence rarely occurring. Median age is early to mid 20s for men and late 20s for women. It may be abrupt or gradual and in most cases involve a prodromal phase which is characterized by deterioration in overall functioning in the beginning. The course is variable but full remission is rather uncommon, some individuals have a course characterized by exacerbations and remissions while other show progressive deterioration

Sleep-Wake Disorders

Typically complain of dissatisfaction with the quality, timing, and amount of sleep, resulting in daytime distress and impairment. Include difficulties getting enough sleep, problems with excessive sleepiness in spite of sleeping adequate hours, sleep intrusion, breathing related sleep disorders, and parasomnias.

Schizoaffective Disorder

Uninterrupted period of illness during which there has been a major mood episode concurrent with the sxs of schizophrenia and delusions or hallucinations for at least 2 weeks w/out prominent mood sxs. Mood symptoms are present for the majority of the course of the disorder but the schizophrenia symptoms are prominent. With Catatonia is used if sxs are present

Schizoaffective Dis Bipolar type

Used if a manic episode is part of the presentation, whether or not a major depressive episode occurs

Schizoaffective Dis Depressive type

Used only if major depressive episodes are part of the presentation

Disorganized Thinking

Usually inferred from speech - person switches from topic to topic (derailment or loose associations) or provides answers that diverge from questions asked (tangentiality)

Hallucinations (perception)

Vivid & clear perceptions that occur w/out external stimuli. May occur in any sensory modality. Auditory hallucinations are the most common and tend to be experienced as voices that are distinct from one's own thoughts

Other specified/unspecified related disorder

When the full criteria is not met but symptoms are present

With peripartum onset

When the onset of the current or most recent mood episode is during pregnancy or within four weeks of delivery

With seasonal pattern

When there is a regular temporal relationship between the onset of a mood episode and a particular time of the year and full remissions also occur at a characteristic time of the year

Suicide & MDD

Women make more attempts but men follow through more. Older people commit suicide more often. Whites and Native Americans have the highest rates. Most who commit suicide have a mental disorder, most often mood, schizophrenia, personality, or substance use. Hopelessness is a stronger predictor than the presence and severity of depression. Single best predictor of completed suicide is history of serious suicide attempts. Most frequently cited risk factors include being male, single/living alone, family history of suicide, and chronic pain or illness.

Hallucinogen Persisting Perception Disorder

involves reexperiencing perceptual symptoms that were experienced while intoxicated. May persist for weeks, months, or years