DSM - Disorders Study Guide

Intellectual Disability (ID)

(an individual must meet the following three criteria) Fundamental deficit in the individuals' ability to think such as a combination of problems with abstract thinking, judgment, planning, problem solving, reasoning, and general learning (whether from academic study or from experience). This is confirmed by clinical assessment and individualized, standardized intelligence testing. Deficits in the individual's ability to adapt to the demands of normal life. Deficits in adaptive functioning in one or more areas that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Need help to cope across multiple environments such as school, at work, at home with their family. Adaptive functioning includes: conceptual - language, math, reading, writing, reasoning, and memory to solve problems. social - deploying such abilities as empathy, communication, awareness of the experiences of other people, social judgment, and self-regulation. Gullibility is often a feature, involving naïveté in social situations and a tendency for being easily led by others. practical - includes regulating behavior organizing tasks, managing finances, and managing personal care and recreation. Onset of intellectual and adaptive deficits during the developmental period (Duration). ID begins during the developmental years (childhood and adolescence). However in most instances the onset is at the very beginning of this period usually infancy, often even before birth. — must be fulfilled by history or current presentation. The age and characteristic features at onset depend on the etiology and severity of brain dysfunction. The essential features of ID disorder are deficits in general mental abilities (Criterion A) and impairment in everyday adaptive functioning, in comparison to an individual's age-, gender, and socioculturally matched peers (Criterion B). Onset is during the developmental period (Criterion C). *The diagnosis of intellectual disability is based on both clinical assessment and standardized testing of intellectual and adaptive functions. All criteria must be fulfilled by history or current presentation. When ID is associated with a genetic syndrome, there may be a characteristic physical appearance (i.e. Down syndrome)

Depressive Major Disorder Essential Features

- The criterion symptoms for major depressive disorder must be present nearly every day to be considered present, with the exception of weight change and suicidal ideation. - A major depressive episode must meet five major requirements. There must be (1) a quality of depressed mood (or loss of interest or pleasure) that (2) has existed for a minimum period of time, (3) is accompanied by a required number of symptoms, (4) has resulted in distress or disability (the episode must be serious enough to cause material distress or to impair the individual's work or school performance, social life (withdrawal or discord), or some other area of functioning, including sex), and (5) violates none of the listed exclusions (should not be diagnosed in the face of clinically important substance use or general medical disorder that could cause the symptoms). - These people are miserable. Most feel sad, down, depressed, or some equivalent; however, some few will instead insist that they've only lost interest in nearly all their once-loved activities.All will admit to varying numbers of other symptoms fatigue, inability to concentrate, feelings of worthlessness or guilty (look for guilt feelings that are way outside the boundaries of what's reasonable), and wishes for death or thoughts of suicide - In addition, these symptoms listed above, three symptom areas may show either an increase or decrease from normal: sleep, appetite/weight, and psychomotor activity. - Also, children or adolescents may only feel or seem irritable, not depressed. - Co-occurring disorders are common with any of the depressive disorder and should also be assessed, as should suicidal ideation, past suicide attempts, and the presence of any hypomanic or psychotic symptoms. Duration: the individual must have felt bad most of the day, almost every day, for at least two weeks. This requirement is included to ensure that major depressive episodes are differentiated from the transient "down" spells that most of us sometimes feel. Quality of mood: Depression is usually experienced as a mood lower than normal; individuals may describe feeling "unhappy" "downhearted" "bummed," "blue," or any other terms expressing sadness. (must be carefully assessed as clients may not express sadness but lack of interest; keep a lookout for cultural interpretations of depression)

Major Depressive Disorder Treatment

- Treatment recommendations for major depressive disorder will generally be determined based on the number and severity of symptoms, the age and functional ability of the person, and the presence of any co-occurring disorders. - When psychosis or suicidal thoughts or actions are present the combination of medication and psychotherapy is almost always recommended. In severe cases, hospitalization may be necessary to ensure the client's safety. - Psychosocial treatments: behavioral activation therapy, ACT, MBCT (Mindfulness Behavioral Cognitive Therapy), cognitive-behavioral analysis of psychotherapy (CBASP), and Interpersonal therapy (IP) - Emotion-focused therapies that are process-experiential are also supported. Reminiscence/Life Review Therapy can be effective when working with an older population. - Outpatient treatment for depression will typically occur one to two times a week and will maintain a fairly rapid pace. - Medication is often used if depression is severe, recurrent, or chronic. - Exercise therapy is beneficial for some. - Major depressive disorder has a high relapse rate, so a relapse prevention component is an important part of any treatment for this disorder. - For children, CBT and IP are recommended. CBT and IP is also effective with adolescents - Medication should not be the first treatment term-88choice for children and adolescents. However, if needed for severe cases, SSRI- Fluoxetine (Prozac) for the treatment of childhood depression. Combine with IP and CBT

obsessive-compulsive disorder (OCD)

1. Characterized by the presence of obsessions and/or compulsions. 2. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. 3. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 4. The distinction between the presence of subclinical symptoms and a clinical disorder requires assessment of a number of factors, including the individual's level of distress and impairment in functioning. · the mean age at onset of OCD is 19.5 years, and 25% of cases start by age 14 years · Onset after age 35 years is unusual but does occur. · Males have an earlier age at onset than females: nearly 25% of males have onset before age 10 years.

DMDD (disruptive mood dysregulation disorder) Essential Features

1. For at least a year, several times a week, on slight provocation (e.g., insufficient cheese in a sandwich, a favorite shirt in the wash) a child has severe tantrums - screaming or actually attacking someone (or something) - that is inappropriate for the individual's age and stage of development. 2. Between outbursts, the child seems mostly angry, grumpy, or sad (the child's mood is persistently negative - depressed, angry, or irritable) 3. The attacks and intervening moods occur across multiple settings (home. School, with friends). These individuals have no manic episodes. Duration and demographics: 1+ years, and never absent longer than 3 months, starting before age 10; the diagnosis can only be made from age 6 through 17 Distress or disability: symptoms are severe in at least one setting - home, school, with other kids - and present in other settings.

Essential Features of Obsessive-Compulsive Personality Disorder (OCPD) 301.4 (F60.5)

1. People with OCPD are perfectionistic and preoccupied with orderliness 2. Need to exert interpersonal and mental control They can become so absorbed with details, organization, and rules of an activity that they lose sight of its purpose. 3. They tend to be rigid and stubborn, perhaps so perfectionistic that it interferes with the completion of tasks. 4. They can be overly conscientious, inflexible, or scrupulous about ethics, morals, and values 5. They may be workaholics; others won't work unless others agree to do things there way 6. Some may save worthless items; others are stingy with themselves and with other people. Depressed mood is common. The common disorders that should be looked for include OCD and major depressive disorder. Duration (begins in teens or early 20s and endures) Differential diagnosis: physical and substance use disorders, OCD, hoarding disorder, other PDs

Essential Features of Avoidant Personality Disorder 301.82 (F60.6)

1. Socially inhibited 2. Overly sensitive to criticism 3. Feel inadequate 4. They feel inferior, unappealing, or clumsy 5. They reluctant to form new relationships 6. They only become involved with others if they know in advance that they will be accepted 7. Their worry about being rejected or criticized (or embarrassed) on the job or in social situations will lead them to avoid new pursuits. 8. Individuals with APD spend most of their time alone but are unhappy about their situations.

dissociative identity disorder (DID)

1. The defining feature of dissociative identity disorder is the presence of two or more distinct personality states or an experience of possession 2. When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and sense of agency (Criterion A), and 2) recurrent dissociative amnesias (Criterion B). 3. Individuals with dissociative identity disorder may report the feeling that they have suddenly become depersonalized observers of their "own" speech and actions, which they may feel powerless to stop. Such individuals may also report perceptions of voices. 4. Strong emotions, impulses, and even speech or other actions may suddenly emerge, without a sense of personal ownership or control 5. Non-epileptic seizures and other conversion symptoms are prominent in some presentations of dissociative identity disorder, 6. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. 7. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Essential Features of Dissociative Amnesia

1. The inability to recall important autobiographical information that should be (a) successfully stored in memory and (b) ordinarily would be readily remembered (criterion A) --- far beyond forgetfulness, there is a loss of recall for important personal (usually distressing or traumatic) information. 2. It differs from the permanent amnesias due to neurobiological damage or toxicity that prevent memory storage or retrieval in that it is always potentially reversible because the memory has been successfully stored. 3. Individuals with dissociative amnesia are frequently unaware (or only partially aware) of their memory problems. Many, especially those with localized amnesia, minimize the importance of their memory loss and may become uncomfortable when prompted to address it. In systematic amnesia, the individual loses memory for a specific category of information (e.g., all memories relating to one's family, a particular person, or childhood sexual abuse). In continuous amnesia, an individual forgets each new event as it occurs. 4. The symptoms of dissociative amnesia must cause clinically significant impairment and cannot be related to the use of alcohol, medication, or another substance, or medical condition. 5. Dissociative amnesia tends to occur suddenly following a traumatic or stressful life event. *There are two main requirements for dissociative amnesia (DA): (1) the patient has forgotten something important, and (2) other disorders have been ruled out. 6. The memory loss is episodic and only affects the person's recall of certain events (generally traumatic events). 7. Most cases of dissociative amnesia with or without dissociative fugue will remit spontaneously. The central feature is the inability to remember significant events (the loss of autobiographical information is a defining feature of dissociative amnesia). Duration ranges widely, from minutes to perhaps years, after which the amnesia usually ends abruptly with complete recovery of memory. In some individuals, it may occur again, perhaps more than once.

Essential Features of Dependent Personality Disorder 301.6 (F60.7)

1. The need for supportive relationships draws these people into clinging and submissive behavior 2. Fears separation 3. Fear of disapproval makes it hard to disagree with others 4. To gain support, they will even take extraordinary steps, such as assuming unpleasant tasks. 5. Low self-confidence prevents them from starting or carrying out projects independently 6. They want others to take responsibility for their own major life areas 7. If they do make even everyday decisions, they require lots of advice and reassurance 8. They desperately seek a replacement for a lost close personal relationship 9. Exaggerated, unrealistic FEARS OF ABANDONMENT and the notion that they cannot care for themselves will cause these people to feel helpless or uncomfortable when alone Duration(begins in teens or early 20s and endures) *An individual must meet five criteria to receive this diagnosis *dependent behavior is found in several mental disorders like physical and substance use disorders, mood and anxiety disorders, or other PD's (i.e. Histrionic PD - "attention-seeking")

Obsessive-Compulsive and Related Disorder Due to Another Medical Condition

294.8 (F06.8) Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorder predominate in the clinical picture. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. The disturbance is not better explained by another mental disorder. The disturbance does not occur exclusively during the course of a delirium. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if any of the OCD predominates in the clinical presentation. Coding note: Include the name of the other medical condition in the name of the mental disorder (e.g., 294.8 [F06.8] obsessive-compulsive and related disorder due to cerebral infarction). The other medical condition should be coded and listed separately immediately before the obsessive-compulsive and related disorder due to the medical condition (e.g., 438.89 [I69.398] cerebral infarction; 294.8 [F06.8] obsessive-compulsive and related disorder due to cerebral infarction

Other Specified Obsessive-Compulsive and Related Disorder

300.3 ( F42.8 ) 1. This category applies to presentations in which symptoms characteristic of an obsessive-compulsive and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related disorders diagnostic class. 2. The other specified obsessive-compulsive and related disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific obsessive-compulsive and related disorder. 3. This is done by recording "other specified obsessive-compulsive and related disorder" followed by the specific reason (e.g., "body-focused repetitive behavior disorder"). 4. Example: Body dysmorphic-like disorder without repetitive behaviors: Presentations that meet body dysmorphic disorder except that the individual has not performed repetitive behaviors or mental acts in response to the appearance concerns.

Unspecified Obsessive-Compulsive and Related Disorder

300.3 (F42.9) 1. This category applies to presentations in which symptoms characteristic of an obsessive-compulsive and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the obsessive-compulsive and related disorders diagnostic class. 2. The unspecified obsessive-compulsive and related disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific obsessive-compulsive and related disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

Hoarding Disorder

300.3/F42.3 Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities). The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder). · The mean age at disorder onset is 16-17 years, the median age at onset is 15 years, and the most common age at onset is 12-13 years · Two-thirds of individuals have disorder onset before age 18 · Subclinical body dysmorphic disorder symptoms begin, on average, at age 12 or 13 years

Body Dysmorphic Disorder (BDD)

300.7 (F45.22) 1. Characterized by preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others 2. And by repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (e.g., comparing one's appearance with that of other people) in response to the appearance concerns. 3. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. 5. The preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3-8 hours per day), and usually difficult to resist or control · The mean age at disorder onset is 16-17 years, the median age at onset is 15 years, and the most common age at onset is 12-13 years · Two-thirds of individuals have disorder onset before age 18 · Subclinical body dysmorphic disorder symptoms begin, on average, at age 12 or 13 years

Trichotillomania (Hair-Pulling Disorder)

312.39 (F63.3) Recurrent pulling out of one's hair, resulting in hair loss. Repeated attempts to decrease or stop hair pulling. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition). The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder). · Onset of hair pulling in trichotillomania most commonly coincides with, or follows the onset of, puberty. · Sites of hair pulling may vary over time. · The usual course of trichotillomania is chronic, with some waxing and waning if the disorder is untreated.

Excoriation (Skin-Picking) Disorder

698.4 (F42.4 ) Recurrent skin picking resulting in skin lesions. Repeated attempts to decrease or stop skin picking. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury). · Although individuals with excoriation disorder may present at various ages, the skin picking most often has onset during adolescence, commonly coinciding with or following the onset of puberty. · The disorder frequently begins with a dermatological condition, such as acne

ID Diagnostic Markers

A comprehensive evaluation includes an assessment of intellectual capacity and adaptive functioning. Identification of genetic and non genetic etiologies Evaluation for medical conditions (e.g., cerebral palsy, seizure disorder) Evaluation for co-occurring mental, emotional, and behavioral disorders. the diagnosis of intellectual disability should be made whenever all three criteria have been met. A diagnosis of ID should not be assumed because of a particular genetic or medical condition. A genetic syndrome linked to intellectual disability should be noted as a concurrent diagnosis with the intellectual disability.

Histrionic Personality Disorder

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Is uncomfortable in situations in which he or she is not the center of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. 3. Displays rapidly shifting and shallow expression of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. 7. Is suggestible (i.e., easily influenced by others or circumstances). 8. Considers relationships to be more intimate than they actually are.

Narcissistic Personality Disorder (NPD)

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). 4. Requires excessive admiration. 5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). 6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends). 7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others. 8. Is often envious of others or believes that others are envious of him or her. 9. Shows arrogant, haughty behaviors or attitudes.

Substance/Medication-Induced Depressive Disorder Diagnostic Criteria

A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2) 1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Criterion A. The disturbance is not better explained by a depressive disorder that is not substance/medication-induced. Such evidence of an independent depressive disorder could include the following : 1. The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder (e.g., a history of recurrent non-substance/medication-related episodes). The disturbance does not occur exclusively during the course of a delirium. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

Depressive Disorder Due to Another Medical Condition Diagnostic Criteria

A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominate in the clinical picture. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition). The disturbance does not occur exclusively during the course of a delirium. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: With depressive features: full criteria are not met for a major depressive episode. With major depressive-like episode: full criteria met (except Criterion C) for a major depressive episode. With mixed features: symptoms of mania or hypomania are also present but do not predominate in the clinical picture.

antisocial personality disorder (APD)

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others. 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Hypomanic Episode Criteria

A. Abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased energy/activity, lasting at least 4 consecutive days and present most of the day, everyday. B. 3 or more (4 or more if mood is only irritable) of the following symptoms: - inflated self-esteem or grandiosity - decreased need for sleep (e.g. feels rested after only 3 hours of sleep) - more talkative than usual or pressure to keep talking - flight of ideas (or subjective feeling that thoughts are racing) - distractibility (reported or observed) - increase in goal-directed activity or psychomotor agitation (i.e. purposeless non-goal-directed activity) - excessive involvement in activities that have a high potential for painful consequences (e.g. buying sprees, sexual indiscretions, foolish business investments) C. No marked impairment, no need for hospitalization, and no psychotic symptoms D. Not due to a substance or other medical condition

Manic Episode Criteria

A. Abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased energy/activity, occurring 1+ weeks (or any duration if requires hospitalization) B. 3 or more (4 or more if mood is only irritable) of the following symptoms: - inflated self-esteem or grandiosity - decreased need for sleep (e.g. feels rested after only 3 hours of sleep) - more talkative than usual or pressure to keep talking - flight of ideas (or subjective feeling that thoughts are racing) - distractibility (reported or observed) - increase in goal-directed activity or psychomotor agitation (i.e. purposeless non-goal-directed activity) - excessive involvement in activities that have a high potential for painful consequences (e.g. buying sprees, sexual indiscretions, foolish business investments) C. Causes marked impairment, necessitates hospitalization, or has psychotic features D. Not due to a substance or other medical condition

Dissociative Amnesia Diagnostic Criteria Dissociative Amnesia 300.12 (F44.0) without dissociative fugue Dissociative Amnesia 300.13 (F44.1) with dissociative fugue

A. An inability to recall important autobiographical information. Usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists of: Localized (or circumscribed) - has no recollection for none of the events that occurred within a particular time frame, often during a calamity such as a wartime battle or a natural disaster (most common) Selective - specific events or event; certain portions of a time period, such as the birth of a child, have been forgotten. (less common) Generalized - all of the experiences during the individual's entire lifetime have been forgotten (identity and life history) B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The disturbance is not attributable to the physiological effects of a substance (e.g. alcohol or other drug abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition). D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder Specify if: 300.13 (F44.1) with dissociative fugue: (suddenly journeys from home) Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.

Tourette's Disorder 307.23 (F95.2)

A. Both multiple motors and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. 1+ vocal tics & 2+ motor tics (a tic is a sudden rapid, recurrent, nonrhythmic more movement or vocalization) B. Duration and demographics (1+years) the tics may wax and wane in the frequency but have persisted for more than 1 year since the first tic onset. Motor and vocal tics need not occur in the same time frame. C. Onset is before age of 18 years, though typically by age 4-6 (first tics are often eye blinks) D. The disturbance is not attributable to the physiological effects of a substance (e.g cocaine) or another medical condition (is Huntington's disease, OCD, other physical or tic disorders)

Persistent Depressive Disorder (Dysthymia) Code 300.4 (F34.1) Diagnostic Criteria

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. (Note: In children and adolescents, mood can be irritable and duration must be at least 1 year). B. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: criteria for the major depressive episode include FOUR symptoms that are not listed in the above criteria, they cannot receive this diagnosis even if those symptoms have persisted longer than two years. If they have been previously diagnosed with a major depressive episode, then REDIAGNOSED them with MAJOR DEPRESSIVE DISORDER. Otherwise, a diagnosis of other specified or unspecified depressive disorder is warranted. *Specifiers may be added ---- pg169

Childhood-Onset Fluency Disorder (Stuttering) 315.35 (F80.81)

A. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual's age and language skills persisted over time, and are characterized by frequent and marked occurrences of one (or more) sound and syllable repetitions, sound prolongation of consonants as well as vowels. They have problems speaking smoothly, most notably with sounds that are drawn out or repeated; there may be pauses in the middle of words. B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination. They experience marked tension while speaking, and will repeat entire words or substitute easier words for those that are difficult to produce (the result: anxiety about the act of speaking). C. The onset of symptoms is in the early developmental period. (Beginning in early childhood) D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with a neurological insult (e.g. stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder.

Major Depressive Disorder: Diagnostic Criteria

A. Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (eg., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful) (Note: in children and adolescents, can be irritable mood) 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation) 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: in children, consider failure to make expected weight gain) 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others.) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or to another medical condition. (Note: Criteria A-C represent a major depressive episode) D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or a hypomanic episode (Note: this exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition. **Coding and recording procedures: the diagnostic code for major depressive disorder is based on whether this is a single or recurrent episode, current severity, presence of psychotic features are only indicated if full criteria are currently met for a major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a major depressive episode (DSM pg 162; pg 188)

Stereotypic Movement Disorder 307.3

A. Repetitive, seeming driven, and apparently purposeless motor behavior (e.g.hand shaking or waving, body rocking, head banging, self-biting, hitting own body) B. The repetitive motor behavior interferes with social, academic, or other activities and may result in self-injury. C. Onset is in the early developmental period (begins in early childhood, such behavior is common in infants D. it's when the behavior persists in early childhood) The repetitive behavior is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder (i.e. OCD, trichotillomania, ASD, excoriation disorder, ID, substance use disorders, and physical disorders)

Major Depressive Episode Criteria

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. - Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). - Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). - Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) - Insomnia or hypersomnia nearly every day. - Psychomotor agitation or retardation nearly every day - Fatigue or loss of energy nearly every day. - Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). - Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). - Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Social (Pragmatic) Communication Disorder 315.39 (F80.82)

A. Has difficulty with each of these features: using language for social reasons, adapting impairment of the ability to change communication to fit the context (e.g. classroom talk vs playground talk), following the conventions (rules) of conversation (i.e.taking turns in conversation), and understanding implied communications (e.g. making inferences). Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context. B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individual or in combination (interference in work/educational, social, or personal impairment) C. The onset of the symptoms is in the early developmental period (usually identified but age 4-5, but deficits may not fully manifest until social communication exceeds limited capacities) D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of the word structure and word grammar, and not better explained by ASD, ID, social anxiety disorder, ADHD)

Psychotic Disorder Due to Another Medical Condition Diagnostic Criteria

A. Prominent hallucinations or delusions. B. There is evidence from history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. C. The disturbance is not better explained by another mental disorder. D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify whether: Code based on predominant symptom: 293.81 (F06.2) with delusions: if delusions are the predominant symptom. 293.82 (F06.0) with hallucinations: if hallucinations are the predominant symptom. Coding note: include the name of the other medical condition in the name of the mental disorder (e.g., 293.81 [F06.02] psychotic disorder due to malignant lung neoplasm, with delusions) Specify severity: severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe) Note: diagnosis of this disorder can be made without using the severity specifier. *in addition to the symptom domain areas identified in the diagnostic criteria, the assessment of cognition, depression, and mania symptom domains is vital for making critically important distinctions between the various schizophrenia spectrum and other psychotic disorders.

Disruptive Mood Dysregulation Disorder (DMDD) Code: 296.99 (F34.8) Diagnostic Criteria

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The outbursts occur, on average, three or more times a week. D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A-D has been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. F. Criteria A and D are present in at least two of three settings (i.e, at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age of onset of Criteria A-E is before 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode, have been met. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, PTSD, separation anxiety disorder, persistent depressive disorder, ADHD, conduct disorders, bipolar disorders) K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition. Hallmark Persistent irritability accompanied by anger and temper outbursts that occur over a 12-month. This diagnosis can only be diagnosed in children between the ages of 6 and 18.

Provisional Tic Disorder

A. Single or multiple motor and/or vocal tics. B. The tics have been present for less than 1 year since the first tic onset. (They usually are simple motor tics that begins at ages 3-10 and wax and wane over a period of weeks to months; vocal tics are less common than motor tics) C. Onset is before age 18 years. D. The disturbance is not attributable to the physiological effects of a substance (e.g. cocaine) or another medical condition (e.g. Huntington's disease, post-viral encephalitis). E. An individual who has been diagnosed with persistent motor or vocal tic disorder can never receive the diagnosis of provisional tic disorder.

Persistent (Chronic) Motor or Vocal Tic Disorder 307.22 (F95.1)

A. Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal. B. Persist for more than 1 year since the first tic onset. Persistent motor tics also wax and wane over a range of severity. Usually, persistent motor tics disappear eventually after many years but reoccur in individuals who are tired or stressed. C. Onset is before age 18 years. D. The disturbance is not attributable to the physiological effects of a substance (e.g. cocaine) or another medical condition (e.g. Huntington's disease, post-viral encephalitis). E. Criteria have never been met for Tourette's Disorder (individuals with TD cannot receive this diagnosis) *specifiers only required for this order - specify with motor tics or vocal tics only

Assessment: Bipolar and Related Disorders

Adults: - Use the Bipolarity Index to distinguish BP-I from MDD - Beck Depression Inventory (BDI) - Schedule of Affective Disorders and Schizophrenia (SADS) - Mood Disorder Questionaire (MDQ) - Hypomania Checklist-32 - If anxious distress is present, assess for suicidal ideation - Medical examination to assess for physical symptoms - Broad-based inventory of mental disorders (such as Minnesota Multiphasic Personality Inventory) to identity comorbid disorders - Self-assessments of alcohol and substance use (such as RAP, CAGE, MAST, AUDIT, and SASSI) Children: - Interview parent and child together and separately - Establish a baseline of the child's behavioral history for comparison - Distinguish between decreased need for sleep and ability to sleep - Define the time period in which the euphoria or heightened irritability take place - Compare level of elevated mood from other times when the child experienced excitement - Notice if manic symptoms occur during a mood change - Ask: Is the grandiosity or irritable behavior a change from the norm? - Assessment tools for kids: 1) Washington University K-SADS (includes mania-rating scale) 2) Young Mania Rating Scale (YMRS) 3) Child Behavioral Checklist (CBCL)

ID Severity level: Moderate

All through development, the individual's skills are significantly lower than most people. Progress in reading, writing, mathematics, and understanding of time and money occurs slowly across the school years and in comparison to their peers, it is limited. Though they can learn these skills, language use is slow to develop and relatively simple. As they get older, ongoing assistance is needed to complete conceptual tasks of day-to-day life (conceptual). They need help in learning to provide their own self-care and engage in household tasks (practical). Relationships with others are possible, but they may not perceive or interpret social cues accurately. Also, social judgment and decision-making abilities are limited, and caretakers must assist the person with life decisions (social).

F32.9 [311] Unspecified Depressive Disorder Diagnostic Criteria

As for unspecified bipolar and related disorder, when you don't care to indicate the reason for a more secure diagnosis, you can use the unspecified depressive disorder category. The advantage: mood disorders "of uncertain etiology" have been used so often in the past as to undermine their value. The unspecified depressive disorder diagnosis is given if the clinician chooses not to specify the reason the criteria are not met or there is insufficient information to make the diagnosis, as might occur in an emergency room setting.

Specific Learning Disorder Treatment

Assessment assessment should include the language and cultural context in which the person is living. All children should be assessed for visual and hearing problems as well as for perceptual and cognitive processing, and emotional functioning. Treatment Team Includes the school; family and occupational, physical, or language therapists. Interventions - most interventions will occur at school. An individualized education plan (IEP) must be designed by the school for all children with learning disabilities. - Evidence-based treatments include direct instruction and sometimes over mastery in the specific area of deficit. - Help them with their interpersonal skills. - Nonverbal approaches to therapy (play therapy or activity therapy) may work best for children with significant language deficits. - Social skills training program: teach children how to socially approach other people, attend to and listen, and communicate in a manner appropriate to the setting. Social skills training is frequently conducted in a small-group setting to encourage practice, provide feedback, and fostered improved social skills. Proactive interventions include remediation of learning and skill deficits, psychotherapy, and social skills training.

Autism Spectrum Disorder (ASD) Treatment Interventions

Assessment - three part process that includes an initial screening of all toddlers at 18- and 24-months of age. *Children whose screenings indicate symptoms of ASD should receive a thorough diagnostic test. Those who are subsequently diagnosed with ASD are then referred for a more extensive multidisciplinary (medical, psychological, and genetic) assessment. Screening - screening instruments and more in-depth behavioral assessments The Social Communication Questionnaire (SCQ) The Modified Checklist for Autism in Toddlers - is a screening tool for low-risk toddlers between 16 and 30 months old (if scored positive - then parents follow up with a healthcare provider) The Screening Tool for Autism in Two-Year-Olds - helps differentiate between children with autism and those with other developmental disorders Communication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist - early screening for infants between 9 and 24 months of age. Screening tools for older children (with mild ASD) Autism Spectrum Screening Questionnaire (ASSQ) Childhood Asperger Syndrome Test (CAST) Australian Scale for Asperger's Syndrome (ASAS) Diagnostic Testing - if a child has been screened and fermented to have symptoms of ASDs, a more extensive assessment is needed. the Childhood Autism Rating Scale (CARS) - it assesses children's performance in 15 different domains. The Autism Diagnostic Observation Schedule (ADOS) - a structured interactive tool used with the child and parent and it is helpful when the diagnosis is unclear or the child's history is not available to support a diagnosis. Medical Referral- referred for a more extensive medical and genetic assessment. Treatment Inventions Referrals and advocacy is needed to help parents obtain knowledge about their legal rights and provisions under applicable federal and state laws (parents need support throughout this complicated process) *The combination of early intervention and intensive, behaviorally based treatment is KEY to developing positive outcomes in ASDs. Structural behavioral and educational interventions - based on the child's interests, teach tasks as a series of simple steps, engage the child's attention, and provide positive reinforcement for behavior. Programs should include parent training and support Inventions should focus on improving language and communication skills, social skills, and skills of daily living. Individual goals and objectives should be set Training should emphasize generalizability to other areas. Early Interventions - communication may be the most important area that must be addressed early on in the treatment of most children with ASD. Parent involvement in interventions -can learn and deliver early intervention techniques to address core symptoms of ASD. Involvement decreases parental anxiety and increases parental feelings of empowerment. Children with severe ASDs are usually involved in Special education Speech and language therapy Physical therapy *may also be under the care of physicians, neurologists, or other medical specialists. Consultation with other service providers, as well as case management falls on the Therapists Role. School-Age Children Interventions - Individualized education plan (IEP) - addresses the child's academic concerns but also the social and emotional challenges they will encounter. Children with MILD ASD - Individualized behavior therapy Group therapy - can practice their skills with peers Psychoeducation Social skills training - to improve eye contact, initiate greetings, and answer social questions Adolescent Therapy - Social skills training - incorporates script fading. Social stories, and role-playing new situations (can help adolescents develop conversation skills, understand appropriate social behavior, and reduce anxiety associated with social situations. Parents' involvement- may need to teach their child's teachers about their child's particular needs or intervene if their child is being bullied. Sexual education should also be included Adult Therapy - Vocational rehabilitation (I.e. the Got Transition program) Behavior therapy is recommended for adults with mild ASDs to help them communicate in novel situations that may be challenging (I.e. death of parents) Medication - Sometimes helpful to reduce symptoms, particularly if repetitive behaviors, tics, anxiety, inattention, or other co-occurring conditions Interfere with the child's ability to learn. Usually prescribed Risperdal and Abilify. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends the use of pharmacotherapy for children with ASDs to treat a specific symptom or co-morbid condition. Family Therapy - Parents need education. Advocacy training, and support Training to provide early interventions Recommend parents in joining support groups Refer to network resources (I.e. the Autism Society of America) *Therapists work with parents to serve as advocates, coordinate services and reduce family stress. *Treatment for children and their families requires a life-span developmental approach.

Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment Interventions

Assessment- A clinical diagnosis of ADHD in childhood requires careful review of medical history, school history and performance, child behavioral rating scales, results of any tests performed (e.g. IQ, achievement tests), and interviews with the child, parents, and teachers (if the child has more than one teacher,the teachers who spend the most time with the client should be interviewed). To determine the client's behavior in more than one setting, therapists should ask about Classroom behavior Relationships with other students Behaviors in a multitude of social situations (I.e. group situations, waiting in line, etc) Ask the teachers about how they manage the child's behavior and if any evaluations have been made. *No single objective test is currently available that can definitively diagnose ADHD Diagnosis must be inferred from behavior, tests of reaction time, psychological assessments, observer reports, along with any neurological findings in conjunction with developmental reports. Behavioral checklists for children Achenbach Child Behavior checklist: parent, teacher, and youth self-report forms Behavior Assessment System for children (2nd Ed) Diagnosis of ADHD requires a multidisciplinary team that includes a medical practitioner, a mental health therapist, teachers or employers, parent or partners, and accurate reporting of historical, developmental, and current levels of functioning Adolescents and Adults - Reports for adolescent behavior - best source teachers and parents Assessments for adults: Conners' Adult ADHD Rating Scales (CAARS) Six-item Adult ADHD Self-Report Scale *because a diagnosis of ADHD in adulthood requires the presence of substantial symptoms before the age of 12, information obtained in the clinical interview must be corroborated with other sources (e.g., report cards, interviews with friends and family, I.Q. Or achievement test results). The symptoms must reflect problems in two or more settings (e.g., at work, in relationships, at home) Intervention Strategies - Behavioral interventions and social-skills training designed to improve attention, enhance motivation and delay gratification. These behavioral interventions must be employed in all areas of the child's life (home, school, relationships with friends) and require learning, practice, encouragement, monitoring, and reinforcement not only on the part of the therapist but also on the part of the teachers and parents. For children who have prescribed medication, therapists may be enlisted to monitor symptoms and behavioral improvement. The abbreviated Conners' Teaching Rating Scale Can be used to document how a child's behavior has improved. Evidence-based parent and teacher- administered behavior therapy is the first line of treatment for children 5 years of age and under. For children over the age of 5, parent management training l, behavior-targeted classroom interventions, in combination with medication management are recommended. Parent Management Training - can help reduce parent-child conflict Implement successful strategies parents can use at home Ultimately, reduce the possibility of ADHD escalating along the developmental pathway to conduct disorder (in adolescence) or antisocial personality disorder (in adulthood) Adolescents do not respond well to parent training. So alternatives include: Individual therapy Choice therapy Problem-solving Parent-child interaction training Medication Management *medication management of ADHD in childhood has mainly focused on elementary school-aged children. behavior-Management Training and medication for the treatment of children between the ages of 6-11 and meet the DSM-5 criteria for ADHD For adolescents between the ages of 12 and 18, both medication and behavioral therapy are to be recommended, with the agreement of the adolescent. Coordination of treatment between parents, schools, and providers is essential for effective management of ADHD. *Stimulant medication is the most researched and the most effective medication for ADHD in children. Adults Treatments for adults with ADHD should be individualized to suit the ski cents specific symptoms of inattention (lack of concentration, irritability, restlessness, problems getting organized) and impulsivity (e.g. poor money management, frequent job changes, relationship problems, inappropriate sexual relationships), or substance abuse. Cognitive behavior therapy combined with medication Management (same medication used for children) Cognitive-behavioral therapy designed to help problem solve, reduce distractibility, and improve coping skills through relaxation techniques Other types of treatment include biofeedback, relaxation training, and environmental manipulation. Treatment generally begins with psychoeducation about the disorder, medication for symptoms of ADHD and any other co-occurring disorders Skill training with CBT to address specific problematic behavior Individual therapy may address relationship issues, low self-esteem, fear of failure, perfectionistic beliefs, and problems related to impulse control. Assessment and treatment of depression and anxiety must also be part of the treatment plan. Adjunctive group therapy: time management, task completion, and social skills Recommend resources such as contacting adults with ADHD advocacy groups

Oppositional Defiant Disorder (ODD) Treatment

Assessment: - Helpful to access with one of the following questionnaires/check lists: Child Behavior Checklist; Eyberg Child Behavior Inventory; New York Teacher Rating Scale for Disruptive and Antisocial Behavior; Home and School Situation Questionnaires. Interventions: - Parent Management Training (PMT): CBT approach that teaches parents how to maintain discipline, monitor children's behaviors, and provide positive reinforcement - CBT-based skills training for kids - Group-based treatments or school programs to help with bullying, good for children but not suggested for adolescents with ODD - Structured interventions such as role playing, games, and computer programs to teach problem-solving, interpersonal skills, and empathy - Problem-solving skills training: most positively researched and suggested intervention - No approved medication for ODD

Kleptomania Treatment

Assessment: - do medical evaluation to rule out epilepsy, traumatic brain injury, or other head trauma - Use the Yale-Brown Obsessive-Compulsive Scale to determine the severity Treatment: - generally not much research on treatment - CBT with motivational interviewing

Conduct Disorder (CD) Treatment

Assessment: - Helpful to access with one of the following questionnaires/check lists: Child Behavior Checklist; Eyberg Child Behavior Inventory; New York Teacher Rating Scale for Disruptive and Antisocial Behavior; Home and School Situation Questionnaires - Obtaining accurate family history (can involve talking to multiple sources) to look for substance abuse, domestic violence, and criminal activity - Important to conduct risk assessment Treatment: - Teaching empathy - Parent Management Training (PMT) - Functional Family Therapy (FFT) - Multidimensional Family Therapy (MDFT) - Multisystemic Treatment (MST) -CBT emphasizing problem-solving skills

Pyromania Treatment

Assessment: - gather history of fire-setting behavior (ask questions like you would a suicide assessment) - look for other impulse-control disorders Treatment: - fire-safety education - CBT

Tourette's and other tic disorders Treatment interventions

Assessment: The Yale Global Tic Severity Scale and the Movement assessment battery for children (2nd ed) are often used in the diagnosis of tic disorders. Involves the combination of medication and behavioral or cognitive therapy. Behavioral interventions range from self-monitoring and relaxation techniques to habit reversal training to increase awareness of the premonitory urges and replace the tic with different behavior. *Tics that involve extreme distress or self-injury may require medication (Clonidine and Guanfacine sometimes prescribed; medication cautiously used with this population) medication cannot cure Tourette's disorder (TD); it can only decrease the frequency of the tics or help to suppress them.

Borderline Personality Disorder (BPD) con't

Associated Features Supporting Diagnosis · Individuals with borderline personality disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last). · Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, hypnagogic phenomena) during times of stress.

Intermittent Explosive Disorder (IED) Treatment

CBT interventions for anger and aggression such as: - relaxation training - self-inoculation training - cognitive restructuring - cognitive and behavioral combination treatment Referral to Psychiatrist to assess prescribing fluoxetine, mood stabilizers, beta-blockers, anticonvulsants, SSRIs, and/or antipsychotic risperidone

Persistent Depressive Disorder (Dysthymia - PDD) Treatment

Cognitive behavior therapy with interventions that focus on reducing rumination and improving social relationships with others, interpersonal therapy, and combination treatment with medication and psychotherapy are the first line of treatment for PDD. Cognitive Behavioral Analysis System of Psychotherapy (effective for chronic depression) - uses three techniques: situational analysis, interpersonal discrimination exercises, and behavioral skills training/rehearsal to modify the person's thought and feeling patterns and improve their ability to relate interpersonally. Mindfulness-Based Cognitive Therapy - MBCT helps people become aware of their thoughts, feelings, and bodily sensations and learn to accept them, without judgment. People who consciously practice focused thinking have found it provides an acceptable alternative to rumination and negative thinking. (ACT, DBT, MBCT - EFFECTIVE also for the major depressive disorder) Interpersonal Therapy - effective and utilize for older adults Behavioral Therapy - Behavioral activation therapy for depression, problem-solving therapy, behavioral couple therapy Medication - The combination of psychotherapy with medication management increases the likelihood that clients will stay on their medication, allows for psychoeducation on medication use, and also allows the therapist to teach social skills, mindfulness, and other targeted interventions based on the specific needs of the client.

ID Severity level: Profound

Conceptual skills generally involve the physical world rather than symbolic processes. The individual may use objects in goal-directed fashion for self-care, work, and recreation. However, co-occurring motor and sensory impairments may prevent functional use of objects (conceptual). The individual has very limited understanding of symbolic communication in speech or gesture. With limited speech, he or she may understand some simple instructions and gestures. The individual expresses his or her own desires and emotions largely through nonverbal, nonsymbolic communication, so much of what these individuals communicate may be through gestures (social). The individual is dependent on others for all aspects of daily physical care, health, and safety, though they may help with simple chores (practical) *Profound ID usually results from a serious neurological disorder, which often carries with it sensory or motor disabilities.

antisocial personality disorder (APD) con't

Culture-Related Diagnostic Issues 1. Antisocial personality disorder appears to be associated with low socioeconomic status and urban settings. 2. Concerns have been raised that the diagnosis may at times be misapplied to individuals in settings in which seemingly antisocial behavior may be part of a protective survival strategy. 3. In assessing antisocial traits, it is helpful for the clinician to consider the social and economic context in which the behaviors occur.

Disinhibited Social Engagement Disorder (DSED)

Definition: A trauma-related disorder characterized by a pattern of overly familiar and culturally inappropriate behavior with relative strangers, due to social neglect. DSM Category: Trauma and Stress-Related Disorders Duration: No duration specified for diagnosis. If disturbances have been present for more than 12 months it is considered persistent. Age: Developmental age of at least 9 months through adolescence. Has not been seen in adults. Number of Symptoms: At least 2 of the following. 1) reduced or absent reticence in approaching and interacting with unfamiliar adults; 2) overly familiar verbal or physical behavior (inconsistent with culture); 3) diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings; 4) willingness to go off with an unfamiliar adult with minimal or no hesitation

Bipolar I Disorder (296.xx) (F31.xx)

Defining criteria: At least one-lifetime full manic episode that is not better explained by a psychotic disorder. (NOTE: though only one manic episode is required for diagnosis, 90% of individuals who have one episode go onto have recurrent mood episodes, so the likelihood of only one is small) DSM Category: Bipolar and Related Disorders Age of onset/developmental considerations when diagnosing: - Mean age of onset of the first manic, hypomanic, or major depressive episode is 18 years old. - Diagnosing children is challenging because it is more difficult to determine with precision what is "normal" behavior. Therefore, each child should be judged according to their OWN baseline. Duration: - Symptoms of mania must persist for at least a week to meet diagnostic criteria for a manic episode. - If there have been no significant signs or symptoms in the last two months, coded as "in full remission" - If criteria for full manic episode are not currently met, but some symptoms are present or have been present within the past two months, coded as "in partial remission" Additional diagnostic criteria: Hypomanic episodes and major depressive episodes can occur in Bipolar I, however they are not necessary for the diagnosis. Thus, the only impairment diagnostic criteria is one manic episode. Specifications: Specify severity of the current manic episode: 1. With psychotic features - delusions or hallucinations are present at any time in the episode (if psychotic features are present in the episode, you code that instead of specifying the severity. So, the severity level only applies to episodes that are not psychotic in nature) 2. Mild - minimum criteria met for manic episode 3. Moderate - very significant increase in activity/impairment 4. Severe - almost continual supervision is required to prevent physical harm to self or others Specify course if full criteria for mood episode is not met: 1. In partial remission - symptoms of the immediately previous manic, hypomanic, or major depressive episode are present but full criteria are not met, or there is a period lasting less than 6 months without any significant symptoms 2. In full remission - during the past 2 months, no significant signs or symptoms of the disturbance

Substance/Medication-Induced Bipolar and Related Disorder 292.xx (Fxx.xx)

Defining criteria: A prominent and persistent mood disturbance that includes symptoms of mania or hypomania (with or without depressed mood) or markedly diminished interest in all or almost all activities that is evidenced to be caused by substance intoxication or exposure to a medication. Other criteria: 1) not better explained by bipolar or related disorder that is not substance/mediation induced; 2) disturbance does not occur exclusively within the course of a delirium; 3) symptoms cause clinically significant distress Age of onset: n/a Duration: n/a Specifications: Specify the substance class (see DSM p. 142-143 for coding table) Specify the onset: "With onset during intoxication" - if the criteria are met for intoxication with the substance and the symptoms develop during intoxication "With onset during withdrawal" - if criteria are met for withdrawal. from substance and the symptoms develop during, or shortly after, withdrawal

Bipolar and Related Disorder Due to Another Medical Condition 293.83 (F06.3x)

Defining criteria: A prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy, in which their is evidence that the disturbance is the direct pathophysiological consequence of another medical condition. Other criteria: 1) not better explained by another mental disorder; 2) disturbance does not occur exclusively within the course of a delirium; 3) symptoms cause clinically significant distress Development/course: typically develops within the first week to month of the medical condition onset Duration: n/a Specifications: "With manic features" (F06.33) - Full criteria are not met fora manic or hypomanic episode "With manic- or hypomanic-like episode" (F06.33) - Full criteria are met except for Criteria D for a manic disorder and Criteria F for a hypomanic episode "With mixed features" (F06.34) - symptoms of depression are also present but do not predominate the clinical picture

Bipolar II Disorder (296.89) (F31.81)

Defining criteria: Criteria are met for at least one hypomanic episode and at least one major depressive episode, and criteria for a manic episode has never been met. Additional criteria: - not attributable to a psychotic or other disorder - symptoms of depression or unpredictability caused by frequent alternation between depression and hypomania causes clinically significant distress DSM Category: Bipolar and related disorders Age of onset/developmental considerations when diagnosing: - Average age of onset mid-20s, notable later than Bipolar I - Illness typically begins with a depressive episode Duration: - At least 4 consecutive days of continuous hypomanic symptoms to meet criteria for hypomanic episode - At least 2 weeks of depressive symptoms to meet criteria for major depressive episode Specifications: Specify current or most recent episode as: 1. Hypomanic 2. Depressed Specify course if full criteria for mood episode is not met: 1. In partial remission - symptoms of the immediately previous manic, hypomanic, or major depressive episode are present but full criteria are not met, or there is a period lasting less than 6 months without any significant symptoms 2. In full remission - during the past 2 months, no significant signs or symptoms of the disturbance Specify severity if full criteria for major depressive episode are currently met: Mild - few if any symptoms in excess of those required for diagnosis/intensity is distressing but manageable/only minor impairment Moderate - the number/intensity/impairment of symptoms is between mild and severe Severe - number of symptoms is substantially more than required for diagnosis/intensity is seriously distressing or unmanageable/symptoms markedly interfere with functioning

Cyclothymic Disorder 301.13(F34.0)

Defining criteria: Numerous periods of hypomanic and depressive symptoms that do not meet the respective diagnostic criteria for hypomanic or major depressive episodes. Other criteria: 1) symptoms are not attributable to drug/medication; 2) symptoms are not better explained by psychotic disorder; 3) symptoms cause clinically significant distress Age of onset: Typically develops in adolescence or early adult life and can be considered a predisposition to other bipolar or mood disorders Duration: Adults - at least 2 years of symptoms in which the individual has not been without symptoms for more than 2 months at a time; Adolescents/children - at least 1 year of symptoms in which the individual has not been without symptoms for more than 2 months at a time Specifications: "With anxious distress" - the presence of at least 2 of the following symptoms during the majority of days of the current or most recent episode of mania, hypomania, or depression: - Feeling keyed up or tense - Feeling unusually restless - Difficulty concentrating because of worry - Fear that something awful is going to happen - Feeling that the individual might lose control of themself **Specify the severity of anxious distress: mild (two symptoms), moderate (three symptoms), moderate-severe (four or five symptoms), severe (four or five symptoms w/ motor agitation)**

Social Anxiety Disorder (Social Phobia)

Definition: Marked fear of interacting with others or being in social situations that might lead to a negative evaluation. DSM Category: Anxiety Disorders Age: any age, but age of onset is typically between 8 and 15 years old Duration: At least 6 months Symptoms: 1) fear that they will act in a way or show anxiety symptoms that will lead to a negative evaluation by others; 2) social situations almost always provoke fear/anxiety; 3) social situations are avoided or endured with intense fear/anxiety; 4) Fear/anxiety is disproportionate to the actual threat posed by the social situation; 5) causes significant distress/impairment; 6) is not attributable to substance intoxication, another disorder, or physical condition. Specifications: If the fear is restricted to speaking or performing, specify as: "Performance only"

Oppositional Defiant Disorder (ODD)

Definition: A disorder characterized by age-inappropriate and persistent displays of angry, defiant, and irritable behaviors towards at least one individual that is not a sibling, which. causes significant distress or impairment and are not associated with a psychotic or manic episode or substance abuse. DSM Category: Disruptive, Impulse-Control, and Conduct Disorders Duration: At least 6 months. Age: If 5 and under, symptomatic behavior should occur on most days for 6 months or more. If 5 or older, symptomatic behavior should occur at least once per week for 6 months or more. Symptoms usually appear. between preschool age and early adolescence. Number of Symptoms: At least 4 of the following. 1) often loses temper; 2) is often touchy or easily annoyed; 3) is often angry and resentful; 4) often argues with authority figures (or if a child, with any adult); 5) often defies or refuses to comply with requests from authority figures or with rules; 6) often deliberately annoys others; 7) often blames others for their mistakes or misbehavior; 8) has been. spiteful or vindictive at least twice in past 6 months. Specifications: MILD if symptoms are confined to one setting (e.g. only at home); MODERATE if some symptoms are present in two or more settings; SEVERE if symptoms are present in three or more settings.

Conduct Disorder (CD)

Definition: A disorder characterized by patterns of aggressive and destructive behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. DSM Category: Disruptive, Impulse-Control, and Conduct Disorders Duration: At least 12 months of 3 or more symptoms, and 6 months of one symptom. Age: There are three age specifications: Childhood-onset type: Show at least one symptom before age 10. Adolescent-onset type: Shows no symptoms until age 10. Unspecified onset: Do not know if it started before or after age 10. Number of Symptoms: At least 3 of the following. 1) Bullies, threatens, or intimidates others; 2) Initiates physical fights; 3) Has used a weapon that can cause physical harm; 4) Has been physically cruel to people; 5) Has been cruel to animals; 6) Has stolen while confronting a victim (e.g. mugging, armed robbery); 7) Has forced someone into sexual activity; 8) Has destroyed others' property with fire; 9) Has destroyed others' property by other means; 10) Has broken into a car, house, or building; 11) Lies to obtain goods, favor, or not avoid obligations; 12) Has stolen items without confronting a victim (e.g. shoplifting); 13) Stays out at night despite house rules when under 13 years old; 14) Has run away from home overnight at least twice when living with parents, or once without returning for a lengthy period; 15) Leaves or ditches school without explanation, beginning before 13 years. Specifications: "With Limited Prosocial Emotions" - to qualify for this specifier, must meet diagnostic criteria and have least 2 of the following characteristics over at least 12 months in varying settings/relationships: 1) Lack of remorse or guilt; 2) Callous, lack of empathy; 3) Unconcerned about performance in school, at work, or other activities; 4) Does not show or express emotions unless they are shallow or superficial, or used to gain. MILD - Only the minimum symptomatic behaviors required for diagnosis are present, and minor harm is done to others. MODERATE - The number of symptoms and effects they have on others are in between Mild and Severe. SEVERE - Excess of symptomatic behaviors past diagnostic criteria, and/or considerable harm done to others.

Depersonalization/Derealization Disorder

Definition: A dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization, derealization, or both. Depersonalization: Experiences of unreality, detachment, or being an observer with respect to one's feelings, sensations, body, or actions (e.g. perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing) Derealization: Experiences of unreality or detachment with respect to surroundings (e.g. individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted) DSM Category: Dissociative Disorders Age of onset: No specified age, BUT typical age of onset is between early childhood and 20 years old. Mean age of onset is 16 years. Duration: No specified duration Diagnositic Criteria: 1. The presence of persistent or reoccurent experiences of depersonalization, realization, or both. 2. During depersonalization/derealization experiences, reality testing remains intact 3. Must cause distress 4. Not better explained by other mental disorder or medical condition

Separation Anxiety Disorder (SAD)

Definition: A form of anxiety disorder in which the individual displays age-inappropriate, excessive, and disabling anxiety about being apart from his or her parents or away from home. DSM Category: Anxiety Disorders Age: any age Duration: 4 weeks or more in children/adolescents; 6 months or more in adults Number of Symptoms: 3 or more of the following. 1) recurrent. excessive distress when anticipating or experiencing separation from home or from caregivers; 2) worry about losing parents/caregivers or possible harm to them; 3) worry about an event that would cause separation from caregiver/parent (i.e. getting kidnapped); 4) reluctance or refusal to leave home because of fear of separation; 5) fear of being home without caregiver/parent; 6) refusal/reluctance to sleep away from caregiver/parent; 7) nightmares that involve separation; 8) complaints of physical symptoms when separated from caregiver/parent (i.e. headache).

Gender Dysphoria in Adolescents and Adults

Definition: A strong and persistent cross-gender identification that involves clinically significant distress or social impairment. DSM Category: Gender Dysphoria Duration: At least 6 months. Age: Adolescents through adulthood Number of Symptoms: At least 2 of the following. 1) incongruence between one's experienced/expressed gender and primary/secondary sex characteristics; 2) strong desire to be rid of primary/secondary sex characteristics because of incongruence with experienced/expressed gender; 3) desire for sex characteristics of other gender; 4) desire to be of the other gender; 5) desire to be treated as the other gender; 6) strong conviction that one has the typical feelings/reactions of the other gender.

Gender Dysphoria in Children

Definition: A strong and persistent cross-gender identification that involves clinically significant distress or social impairment. DSM Category: Gender Dysphoria Duration: At least 6 months. Age: Typically develops between 2-4 years, but can develop later (i.e. when entering elementary school). Number of Symptoms: At least six of the following. 1) A strong desire to be of the other gender or a strong insistence that one is another gender; 2) Preference for cross-dressing; 3) Preference for cross-gender roles in make-believe play; 4) Preference for toys, games, or activities typical of other gender; 5) Preference for playmates of other gender; 6) Strong rejection of typical toys, games, and activities of their assigned gender; 7) A strong dislike of their sexual anatomy; 8) A strong desire for sex characteristics that match their experienced gender.

Unspecified Communication Disorder 307.9 (F80.9)

Diagnose unspecified communication disorder when a problem with communication doesn't fulfill criteria for one of the previously mentioned conditions, yet causes problems for the individual

Posttraumatic Stress Disorder (PTSD)

Definition: A trauma-related disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience. DSM Category: Trauma and Stress-Related Disorders Duration: More than 1 month. Age: All ages but different diagnostic criteria apply for children under age 6 (see below). Number of Symptoms when over 6 years: At least 5 total. At least one of the following: 1) recurrent, involuntary, and intrusive distressing memories of the event(s); 2) recurrent distressing dreams related to event(s) 3) disassociative reactions (e.g. flashbacks) in which they feel or act as if event(s) was reoccurring; 4) intense or prolonged distress at exposure to cues that symbolize or resemble an aspect of the event(s); 5) marked physiological reactions to cues that symbolize or resemble an aspect of the event(s). At least 2 of the following: 1) inability to remember an important aspect of the event(s); 2) persistent and exaggerated negative beliefs about oneself, others, or the world; 3) distorted cognitions about the cause or consequences of the event(s) that lead to blaming oneself or others; 4) Persistent negative emotional state; 5) markedly diminished interest in significant activities; 6) feelings of detachment or estrangement from others; 7) persistent inability to experience positive emotions. At least 2 of the following: 1) irritable behavior/angry outbursts; 2) reckless or self-destructive behavior; 3) hypervigilance; 4) exaggerated startle response; 5) problems with concentration; 6) sleep disturbance. Number of Symptoms when under 6 years: At least 4 total. At least one of the following: 1) recurrent, involuntary, and intrusive distressing memories of the event(s) (Note: they may appear in play and seem non-distressing); 2) recurrent distressing dreams related to event(s) (Note: it may not be possible to ascertain that dreams are related to the event); 3) disassociative reactions (e.g. flashbacks) in which they feel or act as if event(s) was reoccurring; 4) intense or prolonged distress at exposure to cues that symbolize or resemble an aspect of the event(s); 5) marked physiological reactions to cues that symbolize or resemble an aspect of the event(s). At least one of the following: 1) avoidance of or efforts to avoid activities, places, or physical reminders of the event(s); 2) avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the event(s); 3) substantially increased frequency of negative emotional states; 4) markedly diminished interest in significant activities, including constriction of play; 5) socially withdrawn behavior; 6) persistent reduction in expression of positive emotions. At least 2 of the following: 1) irritable behavior/angry outbursts; 2) reckless or self-destructive behavior; 3) hypervigilance; 4) exaggerated startle response; 5) problems with concentration; 6) sleep disturbance.

Reactive Attachment Disorder (RAD)

Definition: A trauma-related disorder characterized by inhibited, avoidant social behaviors, and reluctance to seek or respond to attention or nurturing (in children who do NOT meet criteria for Autism Spectrum Disorder). The child must have experienced social neglect by their caretakers(s) to qualify for this diagnosis. DSM Category: Trauma and Stress-Related Disorders Duration: No duration specified for diagnosis. If disturbances have been present for more than 12 months it is considered persistent. Age: A developmental age of at least 9 months but younger than 5 years. Number of Symptoms: At least 4 total. BOTH of the following: 1) rarely or minimally seeks comfort when distressed; 2) rarely or minimally responds to comfort when distressed At least 2 of the following: 1) minimal social and emotional responsiveness to others; 2) Limited positive affect; 3) episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers

Intermittent Explosive Disorder (IED)

Definition: A type of impulse-control disorder characterized by repeated episodes of impulsive, uncontrollable aggression in which people strike out at others or destroy property in response to stimuli that would not typically result in an outburst. Note: confirm that the behavior cannot be explained. by another disorder before diagnosis. DSM Category: Disruptive, Impulse-Control, and Conduct Disorders Duration: If symptomatic behavior does not involve outbursts that harm others or destroy property, they must occur twice weekly for 3 months. If symptomatic behavior involves outbursts that cause harm/destruction, they must occur three times in 12 months. Age: At least 6 years old. Number of Symptoms: One or both of the following. 1) verbal or physical aggression toward property, animals, or other individuals, occurring twice weekly for a period of 3 months, in which no damage or physical harm occurred; 2) three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12 month period.

Generalized Anxiety Disorder (GAD)

Definition: An anxiety disorder characterized by chronic excessive worry that is difficult to control. DSM Category: Anxiety Disorders Age: Very broad age of onset for this disorder. Median age of onset = 30 years. Duration: Symptoms occur in more than one setting more days than not for 6 months or more. Number of symptoms: At least 3 of the following in adults (at least 1 for kids). 1) Restlessness or feeling keyed up or on edge; 2) Being easily fatigued; 3) Difficulty concentrating or mind going blank; 4) Irritability; 5) Muscle tension; 6) Sleep disturbance.

Anxiety Disorder Due to Another Medical Condition

Definition: An anxiety disorder characterized by symptoms of anxiety/panic due to another medical condition (the specific condition should be noted in diagnosis.) DSM Category: Anxiety Disorders Age: not specified Duration: not specified Symptoms: 1) Panic attacks or anxiety; 2) Evidence that the panic or anxiety developed as a direct pathophysiological consequence of another medical condition; 3) Not better explained by another mental disorder; 4) The disturbance does not occur exclusively during the course of a delirium.

Substance/Medication-Induced Anxiety Disorder

Definition: An anxiety disorder characterized by symptoms of anxiety/panic produced by a substance or medication. DSM Category: Anxiety Disorders Age: not specified Duration: not specified Symptoms: 1) Panic attacks or anxiety; 2) Evidence that the panic or anxiety developed during or soon after substance intoxication, withdrawal, or exposure to a medication that is proven to be capable of producing anxiety symptoms; 3) Not better explained by anxiety disorder; 4) The disturbance does not occur exclusively during the course of a delirium. Specifications: 1) Specify the substance/medication, and whether or not this is occurring alongside mild, moderate, or severe substance use disorder f this substance. 2) Specify if the diagnostic criteria are met "With onset during intoxication"; "With onset during withdrawal"; or "With onset after medication use"

Panic Disorder

Definition: An anxiety disorder marked by recurrent, unexpected panic attacks. DSM Category: Anxiety Disorders Age: Can occur at any age. Median age of onset is 20-24 years old. Duration: At least one of the panic attacks has been followed by ONE MONTH or more of at least one of these symptoms: 1) persistent concern or worry about additional panic attacks; 2) a significant maladaptive change in behavior related to the attacks. A panic attack is defined as "an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which 4 or more of a following occur: 1) palpitations, pounding heart, or accelerated heart rate; 2) sweating; 3) trembling or shaking; 4) sensations of shortness of breath; 5) feelings of choking; 6) chest pain or discomfort; 7) nausea or abdominal distress; 8) feeling dizzy, unsteady, light-headed, or faint; 9) chills or heat sensations; 10) numbness or tingling sensations; 11) feelings of unreality and/or feeling detached from one-self; 12) Fear of losing control or "going crazy"; 13) fear of dying.

Selective Mutism (SM)

Definition: Anxiety disorder characterized by a consistent lack of speech in one or more settings in which speaking is socially expected, despite speaking in other settings. DSM Category: Anxiety Disorders Age: Typically develops before age 5 Duration: At least 1 month Symptoms: The disturbance must interfere with educational/occupational achievement, and it must not be attributable to a lack of knowledge of comfort with the spoken language required in the setting or to a communication disorder or another disorder.

Specific Phobia

Definition: Marked fear or anxiety about a specific object or situation. DSM Category: Anxiety Disorders Age: any age, but typically develops before age 10 Duration: At least 6 months Symptoms: 1) the phobic object or situation almost always provokes immediate fear/anxiety; 2) The phobic object or situation is actively avoided or endured with intense fear/anxiety; 3) The fear/anxiety is disproportionate with the actual danger posed by object/situation; 4) The fear/anxiety/avoidance causes significant distress/impairment; 5) is not better explained by another disorder/condition. Specifications: Use specifying code for the following categories of the phobic stimulus - 1) Animal; 2) Natural environment; 3) Blood-injection-injury; 4) Situational (e.g. airplanes, elevators); 5) Other. Note: (When more than one apply, code all of them)

Agoraphobia

Definition: Marked fear or anxiety about two or more of the following five situations : 1) using public transportation; 2) being in open spaces; 3) being in enclosed places; 4) standing in line or being in a crowd; 5) being outside of the home alone. DSM Category: Anxiety Disorders Age: Typically develops in adulthood, though it can develop in childhood. Initial onset is usually before 35 years. Duration: At least 6 months Other Symptoms: 1) the individuals fear or avoids the definitive situations because they think escape might be hard or help might not be available if they develop panic-like symptoms; 2) the situations almost always provoke fear/anxiety; 3) the situations are actively avoided, require presence of a companion, or are endured with intense fear/anxiety; 4) the fear/anxiety is disproportionate to the actual danger posed by the situation; 5) involves clinical distress and is not attributable to physical condition or another disorder.

Pyromania

Definition: Multiple episodes of deliberate and purposeful fire setting without any reason (e.g. monetary gain, covering up a crime, revenge), characterized by tension or arousal before the act, pleasure/gratification after the act, and an overall fascination with fire. DSM Category: Disruptive, Impulse-Control, and Conduct Disorders Duration: Unspecified. Age: Unspecified. Number of Symptoms: No symptoms outside of characteristics noted in definition.

Unspecified Gender Dysphoria

Definition: Presentations in which symptoms characteristic of gender dysphoria cause clinically significant distress or impairment but do not meet the full criteria for gender dysphoria because the client does not wish to disclose enough information to confirm a diagnosis. DSM Category: Gender Dysphoria Duration; Age; Number of Symptoms: not applicable

Other Specified Gender Dysphoria

Definition: Presentations in which symptoms characteristic of gender dysphoria cause clinically significant distress or impairment but do not meet the full criteria for gender dysphoria. (e.g. duration was under 6 months). DSM Category: Gender Dysphoria Duration; Age; Number of Symptoms: not applicable

Kleptomania

Definition: Reoccurant failure to resist impulses to steal objects without an economic need or another purpose (e.g. revenge), involving a sense of tension before theft and pleasure/gratification afterwards. DSM Category: Disruptive, Impulse-Control, and Conduct Disorders Duration: Unspecified. Age: Unspecified. Number of Symptoms: No symptoms outside of characteristics noted in definition.

antisocial personality disorder (APD) con't

Development and Course 1. Antisocial personality disorder has a chronic course but may become less evident or remit as the individual grows older, particularly by the fourth decade of life. 2. Although this remission tends to be particularly evident with respect to engaging in criminal behavior, there is likely to be a decrease in the full spectrum of antisocial behaviors and substance use. 3. By definition, antisocial personality cannot be diagnosed before age 18 years.

dissociative identity disorder (DID)

Development and Course 1. Associated with overwhelming experiences, traumatic events, and/or abuse occurring in childhood 2. The full disorder may first manifest at almost any age (from earliest childhood to late life). 3. Dissociation in children may generate problems with memory, concentration, attachment, and traumatic play. Nevertheless, children usually do not present with identity changes; instead they present primarily with overlap and interference among mental states (Criterion A phenomena), with symptoms related to discontinuities of experience. 4. Older individuals may present to treatment with what appear to be late-life mood disorders, obsessive-compulsive disorder, paranoia, psychotic mood disorders, or even cognitive disorders due to dissociative amnesia.

Narcissistic Personality Disorder (NPD) con't

Development and Course Narcissistic traits may be particularly common in adolescents and do not necessarily indicate that the individual will go on to have narcissistic personality disorder. Individuals with narcissistic personality disorder may have special difficulties adjusting to the onset of physical and occupational limitations that are inherent in the aging process. Gender-Related Diagnostic Issues Of those diagnosed with narcissistic personality disorder, 50%-75% are male.

Borderline Personality Disorder (BPD) con't

Development and Course There is considerable variability in the course of borderline personality disorder. The most common pattern is one of chronic instability in early adulthood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources

Borderline Personality Disorder (BPD)

Diagnostic Criteria A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Developmental Coordination Disorder 315.4 (F82)

Diagnostic Criteria - Motor skills are so much poorer than you'd expect, given a child's age. Difficulties are manifested as clumsiness (dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (jumping, throwing or catching a ball, and handwriting). Delayed developmental disabilities. These motor skills deficits interfere in the individuals daily and living activities (school, sports, other age appropriate activities) Onset of symptoms is in the early developmental period. The motor skills are not better explained by differential diagnosis (physical conditions such as cerebral palsy, intellectual disability, ASD, ADHD)

Speech Sound Disorder 3125.39 (F80.0)

Diagnostic Criteria- A. Persistent problems producing the sounds of speech, compromising communication that interferes with speech intelligence, or prevents verbal communication of messages. (I.e. substituting one sound for another or omitting certain sounds completely) B. Work/educational or social impairment. The disturbance causes limitations in effective communication that interferes with social participation, academic achievement, or occupational performance, individually or in any combination. C. The onset of symptoms is in the early developmental period (begins in early childhood) D. The difficulties are not attributable to congenital or acquired conditions (cleft palate or neurological disorders, sensory impairment such as hearing impairment; selective mutism)

Language Disorder 315.32 (F80.2)

Diagnostic Criteria- A. The use of spoken and written language persistently lags behind age expectations. Persistent difficulties in the acquisition and use of language across modalities (i.e. spoken, written, sign language, or other). B. Compared to age-mates, individuals will have small vocabularies, impaired use of words to form sentences, and reduced ability to employ sentences to express ideas. Language abilities are substantially and quantifiably below those expected for age. Functional limitations in work/educational, social, or personal impairment) C. Onset of symptoms is in the early developmental period (begins in early childhood, tends to chronicity) D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, and other mental disorders - ASD, ID, learning disorder).

Specific Learning Disorder

Diagnostic Criteria- Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptom as that persisted for at least SIX months, despite the provision of interventions that target those difficulties - (1) inaccurate or slow reading, requires inordinate effort, or the patient has marked difficulty grasping the meaning. (2) The patient has trouble with writing content (there are grammatical errors, ideas expressed in an unclear manner, or poorly organized, or spelling is unusually "creative" - missing letters may add vowels or consonants. (3)difficulties with math facts, calculation, or mathematical reasoning. The affected academic skills are substantially and quantifiably below those expected for the individuals chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living The learning difficulties begin in early school years, though full manifestation may come only when demands exceed an individual's abilities. The learning difficulties are not better accounted for by intellectual disabilities por any other mental or physical disorders *The four diagnostic criteria are to be met based on a clinical examination on the individual's history, school reports, and psychological assessment. School records of impairment can be used instead of testing for someone 17+ years of age.

Histrionic Personality Disorder con't

Diagnostic Features The essential feature of histrionic personality disorder is pervasive and excessive emotionality and attention-seeking behavior. This pattern begins by early adulthood and is present in a variety of contexts. The appearance and behavior of individuals with this disorder are often inappropriately sexually provocative or seductive (Criterion 2). Emotional expression may be shallow and rapidly shifting (Criterion 3). Individuals with this disorder consistently use physical appearance to draw attention to themselves (Criterion 4). These individuals have a style of speech that is excessively impressionistic and lacking in detail (Criterion 5). Individuals with this disorder are characterized by self-dramatization, theatricality, and an exaggerated expression of emotion (Criterion 6).

Premenstrual Dysphoric Disorder Essential Features

For a few days before menstruating, the client experiences pronounced mood shifts, depression, anxiety, anger, or other expressions of dysphoria (These are the essential features of premenstrual dysphoric disorder). They will also admit to typical symptoms of depression, including trouble concentrating, loss of interest, fatigue, feeling out of control, and changes in appetite or sleep. They may have physical symptoms such as the sensitivity of breasts, muscle pain, weight gain, and a sensation of abdominal distention. Shortly after menstruation begins, she snaps back to normal. The intensity and/or expressivity of the accompanying symptoms may be closely related to social and cultural background characteristics of the affected female, family perspectives, and more specific factors such as religious beliefs, social tolerance, and female gender role issues. Symptoms typically peak around the time of the onset of menses. It is not uncommon for symptoms to linger into the first few days of menses, they MUST have a symptom-free period in the follicular phase after the menstrual period begins. Symptoms are of comparable severity (but not duration) to those of another mental disorder, such as major depressive episode or GAD. Symptoms of PMDD are sometimes as severe as a major depressive episode and can cause great havoc in relationships and occupational functioning, even though it recedes after a week. In order to confirm a provisional diagnosis, daily prospective symptom ratings are required for at least two cycles. Duration: for several days around menstrual periods, for most cycles during the past year

ID Severity level: Mild

For school age children and adults - there are difficulties learning academic skills involving reading, writing, arithmetic, time, or money, with support needed in one or more areas to meet age-related expectations (conceptual). As they mature, deficiencies in judgement and solving problems cause them to require extra help managing everyday situations - and personal relationships may suffer. There may be difficulties regulating emotion and behavior in age-appropriate manner and these behaviors are noticed by peers in social situations (social). May need help in tasks like paying their bills, grocery shopping, and finding appropriate accommodations (practical)

Premenstrual Dysphoric Disorder Code: 625.4 (N94.3) Diagnostic Criteria

In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses. One (or more) of the following symptoms must be present: Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection). Marked irritability or anger or increased interpersonal conflicts. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. Marked anxiety, tension, and/or feelings of being keyed up or on edge. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above. Decreased interest in usual activities (e.g., work, school, friends, hobbies). Subjective difficulty in concentration. Lethargy, easy fatigability, or marked lack of energy Marked change in appetite; overeating; or specific food cravings. Hypersomnia or insomnia A sense of being overwhelmed or out of control. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain. Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreases productivity and efficiency at work, school, or home). The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders). Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles (Note: the diagnosis may be made provisionally prior to this confirmation.) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).

ID Severity level: Severe

Little understanding of written language or of concepts involving numbers, quantity, time, and money (conceptual). They may learn simple commands and instructions, communication skills are limited to single words, some phrases. Speech and communication are focused on the here and now with everyday events. They can maintain personal relationships with relatives (social), but also require help from them assistance for all activities of daily living. So they require supervision at all times as they cannot make responsible decisions regarding well-being of self and others (practical)

Treatment: Bipolar and Related Disorders

Objectives: - Stabilize mood (alleviate depression, mania, and hypomania) - Improve coping mechanisms - Re-engage with family and other relationships, career, and overall adjustment - Establish a consistent and healthy lifestyle - Identify and intervene with early warning signs of relapse Location of treatment: - Usually outpatient setting, but inpatient setting if symptoms are severe, if risk of suicide is high, or loss of reality - Partial hospitalization if necessary until stable on medication Interventions: - Begin treatment being more directive, but get less directive and more exploratory with time - Medication management is first-line treatment for Bipolar I - Supportive and interpersonal therapy - Social Rhythm Therapy - STEP-BD models of treatment - Mindfulness-based CBT to reduce rumination - Family-focused therapy for adults, adolescents, and children - Psychoeducation for client and family about disorder - Reduce drug and alcohol misuse - Relapse prevention - Group therapy (or support groups) useful after symptoms have abated - Social skills training Timing: - Duration is typically at least 3-6 months - Pace is typically 1-2 sessions a week - Maintenance and follow-up phases are common Medication: - Bipolar I almost always requires medication, so referral and collaboration with psychiatrist will be needed with this diagnosis - Mood stabilizers, antidepressants, and antipsychotics are often needed in combination with psychotherapy, especially for manic symptoms, severe depression, anxious agitation, or psychosis Prognosis: - Good for recovery from first episode, repeated manic episodes indicate worse prognosis - Relapses are common

Developmental Coordination Disorder Treatment Interventions

Physical and occupational therapy (Occupational and physical therapists can also educate parents on the coordination difficulties the child is having and help them to understand and help teach the child compensation strategies. Cognitive behavioral interventions teach the child problem-solving skills Help with self-esteem, avoidance, and social isolation. *With help, children may be able to acquire certain skills with practice but lifelong problems with coordination may remain.

Intellectual disability (Intellectual Developmental Disorder) Treatments

Successful interventions include 1. Early interventions (I.e include special education, home health care, language stimulation, and social skills training) to reduce stereotypies and reduce dysfunction 2. A family-centered approach 3. Integration of therapy into the person's environment 4. Inclusion or mainstreaming into the academic and social environment * Specific treatment recommendations will vary based on the severity of the disorder and cognitive age. Parent training and individual therapy (individuals with mild to moderate deficits) Vocational training during adolescence and young adulthood can help prepare many people with ID for employment. Work to help them recreational interests and improve social skills while residing in institutional settings (individuals with severe or profound levels of ID) Behavior modification is the treatment of choice especially when self-injurious behaviors ) SIBs are present.

Treatments for Dissociative Disorders

The choice of treatment modality will depend on the disorder, the severity of symptoms, therapist expertise, and preferences of the client. Interventions supportive therapy Cognitive therapy DBT EMDR Hypnosis (Reasonable approach) Trauma-related psychotherapy that takes a staged approach - 1) providing safety and stabilization while focusing on symptom reduction (2) involves trauma processing, re-experiencing, a reaction, and desensitization to traumatic events Any underlying depression, anxiety, and cognitive distortions should be treated. Yoga, mindfulness meditation may assist to improve general well -being Must review and ensure the treatment does not make the client worse.

Substance/Medication-Induced Depressive Disorder Essential Features

The diagnostic features of substance/medication-induced depressive disorder include the symptoms of a depressive disorder, such as major depressive disorder; however, the depressive symptoms are associated with the ingestion, injection, or inhalation of a substance (e.g., drug of abuse, toxin, psychotropic medication, other medication), and the depressive symptoms persist beyond the expected length of physiological effects, intoxication, or withdrawal period. As evidenced by clinical history, physical examination, or laboratory findings, the relevant depressive disorder should have developed during or within one month after the use of a substance that is capable of producing depressive disorder. The diagnosis is better explained by an independent depressive disorder. Evidence of an independent depressive disorder includes the depressive disorder preceded the onset of ingestion or withdrawal from the substance; the depressive disorder persists beyond a substantial period of time after the cessation of the substance abuse, or other evidence suggests the existence of an independent non-substance/medication-induced depressive disorder The diagnosis should not be made when symptoms occur exclusively during the course of a delirium. The depressive disorder associated with substance abuse, intoxication, or withdrawal must cause significant distress or impairment in social, occupational, or other important areas of functioning to qualify for this diagnosis. The use of some substance appears to have caused the client to experience marked, persistent depressed mood or loss of interest in usual activities. Chronic use of alcohol, illicit substances, and some prescription drugs can cause the development of depression while the drug is being used, or during the period of withdrawal. Many medications are known to have psychiatric side effects that result in depression, thoughts of death, and even suicide. Oxycodone, benzodiazepines, leukotriene inhibitors for asthma (e.g., Singular); the beta-blocker propranolol, which is used to treat high blood pressure; the anti-malarial medication mefloquine (Lariam), and Chantix, which is used to help people stop smoking all have psychiatric side effects listed on the packet inserts that accompany the medications. Some medications cause a dose-response increase in depression. Note: A substance/medication-induced depressive disorder is distinguished from a primary depressive disorder by considering the onset, course, and other factors associated with substance abuse.

Autism Spectrum Disorder 299.00 (F84.0)

The essential Diagnostic features Persistent impairment in reciprocal social communication and social interaction includes, failure of normal back-and-forth conversation; failures to initiate or respond to social interactions ; to reduced sharing interests, emotions, or affect. Deficits in nonverbal communicative behaviors used in social interactions includes abnormalities in eye contact and body language or deficits in understanding and use of gestures ; to total lack of facial expressions and nonverbal communication. Additionally deficits in developing, maintaining, and understanding relationships includes difficulties in adjusting behavior to suit various social contexts; to absence of interest in peers (these deficits fall on a spectrum therefore, each individual may vary on the range of impairment in this criterion which is identified in the specifier the level of severity) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at LEAST TWO of the following, CURRENTLY or by HISTORY Stereotyped or repetitive motor movements, use of objects or speech (e.g. simple motor stereotypes, hand flapping, lining up toys or flipping objects, head banging, sucking on toys, repetition of vocalizations made by another person (echolalia), idiosyncratic phrases) They tend to resist change, preferring to adhere rigidly to routine. Insistence on sameness Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. their restricted interests leads them to be preoccupied with parts of objects, a child preoccupied with vacuum cleaners) Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (they may appear indifferent to pain or extremes of temperature; they may be preoccupied with smelling or touching things; adverse response sounds or textures C. Symptoms must be present in the early developmental period (from early childhood, though symptoms may appear only later, in response to the demands of socialization). D. Distress or disability - symptoms cause clinically significant impairment in social, occupational, or personal, or other important areas of functioning. E. These disturbances are not better explained by intellectual disability or global developmental delay. For comorbid diagnosis of ID & ASD, social communication should be below that expected for general developmental level. *Specify severity (separate ratings are required for social communication and restricted, repetitive behavior). (I.e. level 1 (mild - requiring support) , level 2 (moderate - requiring substantial support ), level 3 (severe- requiring very substantial support) ).

attention-deficit/hyperactivity disorder (ADHD)

The essential diagnostic features: A persistent pattern of inattention and/or hyperactivity - impulsivity that interferes with functioning or development. (1) Inattention six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and negatively impacts social ands academic/occupational activities: manifests behaviorally as wandering off task, lacking persistence, having difficulty sustaining focus, and being disorganized and is not due to defiance or lack of comprehension. (2) Hyperactivity refers to excessive motor activity when it is not appropriate, or excessive fidgeting, tapping, or talkativeness. Impulsivity refers to hasty actions that occur in the moment without forethought and that have high potential for harm to the individual (darting into the street without looking). Hyperactivity and Impulsivity six (or more) of the following symptoms have persisted for at least SIX months Several inattentive or hyperactive - impulsive symptoms were present prior to age 12 years. Duration and demographics (6+ months; onset before age 12) Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (at home, school, or work; with friends or relatives; or other activities) There is clear evidence that the symptoms interfere with, or reduce the quality of, socia, academic, or occupational functioning. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and not better explained by another mental disorder (e.g. anxiety disorder, mood disorder, etc). Specify whether both criterion's A1 and A2 are met (combined presentation) if only criterion A1 is only met (predominantly inattentive presentation) or if only criterion A2 is only met (predominantly hyperactive/impulsive presentation). Specify whether in partial remission - full criteria was previously met but not fewer than the full criteria have been met for the past six months but the present symptoms still cause impairment in social, academic, or occupational functioning. Lastly, specify the current severity - mild, moderate, or severe.

Persistent Depressive Disorder (Dysthymia - PDD) Essential Features

The essential feature is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years or at least 1 year for children and adolescents (these individuals are indeed chronically depressed). Individuals with persistent depressive disorder describe their mood as sad or "down in the dumps." During periods of depressed mood, at least TWO symptoms of the SIX symptoms from Criterion B are present. Because these symptoms have become a part of the individual's day-to-experience, particularly in the case of early-onset (e.g., "I've always been this way"), they may not be reported unless the individual is directly prompted. During the 2-year period (1 year for children or adolescents), any symptom-free intervals last no longer than 2 months (Criterion C). For years at a time, they have many of the same symptoms found in major depressive episodes, including low mood, fatigue, hopelessness, trouble concentrating, and problems with appetite, and sleep. --- Absent - INAPPROPRIATE GUILT FEELINGS AND THOUGHTS OF DEATH or SUICIDAL IDEAS. They tend to suffer quietly, and their disability can be subtle: they tend to put much of their energy into work, with less leftover for social aspects of their life. Some individuals aren't aware that they are depressed, though others can see it. The onset of persistent depressive disorder should be specified as either early (before the age of 21), or late (21 or older). Because the symptoms are pervasive and enduring, they develop into a lifelong way of perceiving and reacting to life events. When treatment is sought, which is uncommon, it is usually for related symptoms (significant weight gain, failure to achieve expected career goals).

Depressive Disorder Due to Another Medical Condition Essential Features

The essential feature is a prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominate in the clinical picture. Related to the direct physiological effects of another medical condition The clinician must first establish the presence of a general medical condition. Clients who have a prior history of an MDE should not be diagnosed with depressive disorder due to another medical condition, because it is likely that the current depression was not caused solely by the medical condition.

Obsessive- Compulsive PD 301.4 (F60.5) Diagnostic Criteria

The essential feature of OCPD is a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. This pattern begins by early adulthood and is present in a variety of contexts. 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. They may become so involved in making every detail of a project absolutely perfect that the project is never finished (shows perfectionism that interferes with task completion) 3. Display excessive devotion to work and productivity to the exclusion of leisure activities and friendships 4. Excessively conscientious, scrupulous, and inflexible about matters of morality, ethics, or values. They may force themselves or others to follow rigid moral principles and very strict standards of performance. (not accounted for by cultural or religious identification) 5. Unable to discard worn-out or worthless objects, even when they have no sentimental value 6. Reluctant to delegate tasks or to work with others. They stubbornly and unreasonably insist that everything is done their way and that people conform to their way of doing things. 7. May be miserly and stingy and maintain a standard of living far below what they can afford, believing that spending must be tightly controlled to provide for future catastrophes 8. Shows rigidity and stubbornness (are so concerned about having things done the one "correct" way that they have trouble going along with anyone else's ideas)

Avoidant PD 301.82 (F60.6) Diagnostic Criteria

The essential feature of avoidant PD is a pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation that begins in early adulthood and is present in a variety of contexts. 1. Avoid work activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection 2. Avoid making new friends unless they are certain they will be liked and accepted without criticism 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. 4. Preoccupied with being criticized or rejected in social situations. 5. Inhibited in new interpersonal situations because of feelings of inadequacy (Despite their longing to be active participants in social life, they fear to place their welfare in the hands of others) 6. View self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. (i.e. they are prone to exaggerate the potential dangers of ordinary situations, and a restricted lifestyle may result from their need for certainty and security)

Dependent PD 301.6 (F60.7) Diagnostic Criteria

The essential feature of dependent PD is a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. This pattern begins by early adulthood and is present in a variety of contexts. The dependent and submissive behaviors are designed to elicit caregiving and arise from a self-perception of being unable to function adequately without the help of others. 1. Great difficulty making everyday decisions (i.e. what color shirt to wear to work) without an excessive amount of advice and reassurance from others 2. Tend to be passive and to allow other people (often another person) to take initiative and assume responsibility for most major areas of their lives. (This need for others to assume responsibility goes beyond age-appropriate and situation-appropriate requests for assistance from others) 3. Have difficulty expressing disagreement with other individuals, especially those on whom they are dependent. 4. Have difficulty initiating projects or doing things independently 5. Goes to excessive lengths to obtain nurturance and support from others, even to the point of volunteering for unpleasant tasks if such behavior will bring the care they need. 6. Feel uncomfortable or helpless when alone, because of their exaggerated fears of being unable to care for themselves (they will tag along with important others just to avoid being alone, even if they are not interested or involved in what is happening.) 7. Urgently seeks another relationship as a source of care and support when a close relationship ends (their belief that they are unable to function in the absence of a close relationship motivates these individuals to become quickly and indiscriminately attached to another individual.) 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself (the fears must be excessive and unrealistic; they see themselves as so totally dependent on the advice and help of an important another person that they worry about being abandoned by that person when there are no grounds to justify such fears.)

Psychotic Disorder Due to Another Medical Condition Essential Features

The essential features of this disorder are prominent delusions or hallucinations that are judged to be attributable to the physiological effects of another medical condition and are not better explained by another mental disorder (e.g., the symptoms are not a physiologically mediated response to a severe medical condition, in which case a diagnosis of brief psychotic disorder, with a marked stressor, would be appropriate). A physical condition causes hallucinations or delusions. A variety of medical and neurological conditions can produce psychotic symptoms that may not meet the criteria for any of the conditions above. Timing of onset: Mental or behavioral symptoms that begin shortly after the start of the physical illness offer a pretty obvious etiological clue. Remission follows treatment for the physical issue. Proportionality of symptoms: as the physical disorder worsens, so do the behavioral or emotional symptoms Above all, there must be a known physiological connection between the physical condition and the symptom in question. That is, the physical disorder must be known to be capable of producing the symptom (for example, through the production of chemicals, by imprinting on brain structures). It cannot simply be that the prospect of having a serious illness evokes psychosis, depression, anxiety, and so forth. When symptoms of a psychotic disorder are present along with a medical condition known to cause delusions or hallucinations, the diagnosis of psychotic disorder due to another medical condition should be considered. However, this diagnosis should not be given if the condition occurs solely in the presence of delirium. In that case, the diagnosis of major or mild neurocognitive disorder would be more appropriate. Medical conditions known to trigger hallucinations and delusions include endocrine and metabolic conditions, deafness, migraine, CNS infections, fluid or electrolyte imbalance, hepatic or renal disease, autoimmune disorders, and other neurological conditions such as Huntington's disease, cerebrovascular disease, and multiple sclerosis. Epilepsy is the most frequently cited cause of psychotic disorder due to another medical condition. Age-related processes (i.e., atherosclerosis) and people in older age groups have a higher prevalence rate for this disorder. Younger age groups are more likely to have preexisting conditions such as epilepsy, head trauma, autoimmune or neoplastic diseases. The course of a psychotic disorder due to another medical condition may be a single episode that remits, or it may be part of a recurring state that is exacerbated by changes in the underlying medical condition. Pre Existing symptoms of head trauma or cerebrovascular disease generally result in a worse outcome. Consider the presence of features that are atypical for a psychotic disorder (e.g., atypical age at onset or presence of visual or olfactory hallucinations). Psychotic disorder due to another medical condition is generally not diagnosed if the individual maintains reality testing for the hallucinations and appreciates that they result from the medical condition. Olfactory hallucinations are suggestive of temporal lobe epilepsy. Additional factors may include concomitant treatments for the underlying medical condition that confer risk for psychosis independently, such as steroid treatment for autoimmune disorders. The temporal association of the onset or exacerbation of the medical condition offers the greatest diagnostic certainty that the delusions or hallucinations are attributable to a medical condition.

DMDD (disruptive mood dysregulation disorder) Treatment

The first line of treatment for children with mood disorders should always be psychotherapy and parent psychoeducation. If symptoms are severe enough to warrant the risk of side effects inherent in the use of psychotropic medications. Treatment that has been proven to be effective for IED, ODD, and other impulse control disorders should be effective for treating the same symptoms diagnosed in DMDD.

Premenstrual Dysphoric Disorder Treatment

The first-line of treatment for PMDD is generally selective serotonin reuptake inhibitors administered during the period between ovulation and onset of menses. The treatment for PMDD focuses on symptom reduction, with many different types of treatments being helpful. Hormones that suppress ovulation may work for some women, although rebound symptoms are possible Vitamins (especially the B vitamins, magnesium, and calcium) may help others. Antidepressants and anxiolytics can help to reduce symptoms of moodiness and irritability. Therapy that targets cognitive distortions and negative thinking can help to decrease hopelessness and helplessness associated with PMDD. Women may also be advised to reduce their caffeine intake, modify their diets, or take diuretics and pain-relievers. Many also choose to educate friends, family members, and partners in advance of anticipated changes in mood.

Intermittent Explosive Disorder 312.34 (F63.81)

The individual has frequent, repeated, spontaneous outbursts of aggression (verbal or physical without damage) or less frequent physical eruptions with harm to people, property, or animals. These outbursts are unplanned, have no goal, and are excessive for the provocation. A) Recurrent behavioral outbursts representing a failure to control aggressive impulsive manifested as : Verbal aggression (e.g. temper tantrums, verbal arguments, or fights) or physical aggression toward property, animals, or other individuals, DURATION (aggression without harm 2 times a week for 3 months, or aggression with harm 3 times in past year) B) The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors. C) The recurrent aggressive outbursts are not premeditated (they are impulsive and/or anger based) and are not committed to achieve some tangible objective (e.g. power, intimidation, money) D) Cause either marked distress in the individual or impairment in work/educational, social, or personal impairment or associated with financial or legal consequences. E) The individual is 6+ years old (or equivalent developmental level). F) The recurrent aggressive outbursts are not better explained by another mental disorder (substance use and physical disorders, cognitive disorders, mood disorders, personality disorders, ordinary anger; adjustment disorder for children under age 18; disruptive mood dysregulation disorder)

Oppositional Defiant Disorder 313.81 (F91.3)

These individuals are often angry and irritable, tending towards touchiness and a hair-trigger temper. They will disobey authority figures or argue with them, they may refuse to cooperate or follow rules - if only annoy. They sometimes accuse others of their own misdeeds; some appear malicious. Diagnostic Criteria: A) A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least SIX months by at least FOUR symptoms from any of the following categories described above. AND exhibited during interaction with at least one individual who is not a sibling. DURATION AND DEMOGRAPHICS (6+ months - more or less daily for age 5 and under; weekly for older children) B) The disturbance in behavior is associated with distress in the individual or the others in his or her immediate social context (e.g. family, peer group, work colleagues), or it impacts negatively educational/work, social, or personal impairment. C) The behaviors do not occur exclusively during the course of a psychotic, substance abuse, depressive, or bipolar disorder, disruptive mood dysregulation disorder, ordinary childhood growth development. specify severity = mild (symptoms occur in only 1 location - home, school, with friends), moderate (some symptoms in 2+ locations), Severe (Symptoms in 3+ locations

Unspecified Catatonia Diagnostic Criteria Coding note: 781.99 (R29.818) other symptoms involving nervous and musculoskeletal symptoms 293.89 (F06.1) unspecified catatonia

This category applies to presentations in which symptoms characteristic of catatonia cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but either the nature of the underlying mental disorder or other medical condition is unclear, full criteria for catatonia are not met, or there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings). This diagnosis is given when the individual has symptoms of catatonia but there isn't enough information to substantiate a more definitive diagnosis.

Global Developmental Delay 315.8 (F88)

This category is reserved for individuals under the age of five who cannot be evaluated by standardized testing because they are young. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning. This category requires reassessment after a period of time.

Unspecified intellectual disorder 319 (F79)

This category is used for in ideals over the age of 5 or older who have additional disabilities (blindness, severe mental disorder, presence, etc) too severe which make it difficult to allow a full evaluation of intellectual disabilities. * This category should only be used in exceptional circumstances and requires reassessment after a period of time.

F32.8 [311] Other Specified Depressive Disorder Diagnostic Criteria

Use other specified depressive disorder in the same way as described above for other specified bipolar and related disorders. DSM-5 provides the following examples of other specified depressive disorder: Recurrent brief depression. Every month for 12+ months, lasting from 2 to 13 days at a time, these patients have low mood plus at least four other symptoms of depression that aren't associated with menstruation. The patients have never fulfilled the criteria for another mood disorder, and they've not been psychotic. Short-duration depressive episode. These patients would meet criteria for major depressive episode except for duration—their episodes last 4-13 days. Here's the full run-down: depressed mood; at least four other major depressive symptoms; clinically significant distress or impairment; have never met criteria for other mood disorders; not currently psychotic, and don't meet criteria for other conditions. A depressive episode with insufficient symptoms. These patients would meet criteria (duration, distress) for major depression, except that they have too few symptoms. They don't have another psychotic or mood disorder. The other specified depressive disorder designation might be used in brief depressive episodes of 4 to 13 days that do not meet the duration criterion, in depressive episodes with insufficient symptoms (i.e., depressed affect with only one other symptom), or in other cases in which the clinician chooses to communicate Those symptoms of any of the depressive disorders were present, but the DSM-5 criteria were not met.

Other Specified Neurodevelopmental Disorder 315.8 (F88)/ Unspecified Neurodevelopmental Disorder 315.9 (F89)

Use these categories for those individuals who have disorders that appear to begin before adulthood and are not better defined elsewhere. For those in the first group, specify a reason (Neurodevelopmental disorder associated with prenatal alcohol exposure), in contrast the other category is used especially when you lack adequate information.

Other specified or unspecified Attention-Deficit/Hyperactivity Disorder

Used when the client meets some prominent criteria of ADHD such as clinically significant status or impairment in social, occupational or other important areas of functioning predominant but do not meet the full criteria (e.g. symptoms first identified at age of 13). If you want to specify the reason why you gave this diagnosis then choose (other specified 314.01 - (F90.8) ) if you don't have a specific reason then choose (unspecified 314.01 - F90.9) then explain why there is insufficient information to make a specific diagnosis.

Childhood Onset Fluency Disorder (Stuttering) treatment

Working with a speech pathologist to reduce the severity of the disorder (form words properly, reduce tensions while speaking and speak slowly) and eliminate any secondary or reactive behaviors, such as tics, tremors, fist-clenching, or eye blinks, that often are the result of attempts to avoid stuttering. Regulated breathing, in which the child learns to take a deep breath before beginning to speak CBT - reduce the anxiety that often accompanies social or other events in which the person might be expected to interact with others.

Bipolar I and II Disorder: Specifiers

With anxious distress - the presence of at least 2 of the following symptoms during the majority of days of the current or most recent episode of mania, hypomania, or depression: - Feeling keyed up or tense - Feeling unusually restless - Difficulty concentrating because of worry - Fear that something awful is going to happen - Feeling that the individual might lose control of themself **Specify the severity: mild (two symptoms), moderate (three symptoms), moderate- severe (four or five symptoms), severe (four or five symptoms w/ motor agitation)** With mixed features - this specifier applies to the current or most recent manic, hypomanic, or depressive episode when the manic/hypomanic episode includes three or more symptoms of a depressive episode in addition to full criteria for manic/hypomanic episode, or vice versa. **NOTE: if the episode meets the full diagnostic criteria for both manic and depressive episode simultaneously, the diagnosis is "manic episode, with mixed features"** With rapid cycling - presence of at least 4 mood episodes in the previous 12 months that meet criteria for manic, hypomanic, or major depressive episode. **NOTE: episodes are demarcated by either partial or full remissions of at least 2 months OR a switch to an episode of the opposite polarity.** With melancholic features - One or more of the following are present during the most severe period of current episode: - Loss of pleasure in all or almost all activities - Lack of reactivity to usually pleasurable stimuli Three or more of the following: - A distinct quality of depressed mood characterized by profound despair or "empty-mood" - Depression that is regularly worse in the morning - Early-morning awakening (at least two hours before normal) - Marked psychomotor agitation or retardation - Significant anorexia or weight loss - Excessive or inappropriate guilt With atypical features - Mood reactivity (i.e. mood brightens in response to actual positive stimuli) Two or more of the following: - Significant weight gain or increase in appetite - Hypersomnia - Leaden paralysis - A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) Criteria are not met for "with melancholic features" or "with catatonia features" With catatonia - catatonia symptoms present in most of the manic, hypomanic or depressive episode. Catatonia = A behavioral syndrome marked by an inability to move normally. With peripartum onset - if the onset of mood symptoms in most recent or current episode began during pregnancy or in the 4 weeks following delivery With seasonal pattern - if at least one type of mood episode occurs in a regular seasonal pattern for at least two consecutive years

What is Intellectual development disorder?

is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. *ID disorder is divided in levels of severity. These levels of severity are defined on the basis of adaptive functioning, and not IQ scores, because it is the adaptive functioning that determines the level of support required. The level of severity is identified in the specifier (i.e. intellectual disability disorder specifier: mild)

Other Specified Tic Disorder 307.20 (F95.8) / Unspecified Tic Disorder 307.20 (F95.9)

use unspecified tic disorder to code tics that don't fulfill criteria for one of the preceding tic disorders. Or you can specify the reason by using other Specified tic disorder (e.g. tics appeared begun after age 18)