DSM-IV Set 1
Criteria for all Episodes/Disorders
*Not* due to the direct physiological effects of a substance (e.g., a drug of abuse, medicaiton) or to a general medical condition
Psychotic Module Screeners, always determine 2 things...
1st, if subject endorses the question (i.e. hallucinations? delusions? intrusive thoughts? ), determine if just before experiencing SX if the subject was on drugs/medications/drinking more than usual/ill and IF SO, if there has ever been a time when subject experienced Psychotic SX w/o substance; 2nd, content and time period when SX was present
Major Depressive Episode
2 weeks of 5/9 SIG E CAPS
Hypomanic Episode Criterion E. (same Criterion for all Episodes...)
? marked impairment in social / occupational functioning/ hospitalization ?
Manic Episode Criteria (A)
A distinct period of abnormally and persistently elevated, expansive, or irritable mood *lasting at least one week* (shorter if hospitalization is necessary)
Hypomanic Episode Criteria A
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood
Alcohol/Substance Dependence Criteria A
A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by 3 (or more) of the 6 criteria at any time during the same twelve month period
Alcohol/ Substance Abuse Criteria A
A maladaptive pattern of substance use *leading to clinically significant impairment or distress*, as manifested by 1 (or more) of the 4 criteria within a twelve month period
Hypomanic Episode Criterion B- 3?
At least 3 B SXS are coded "3" (4 if mood only irritable)
Current Manic Episode - 3?
At least 3 of of 7 B SXS are coded (3) (4 is mood only irritable)
Panic Attack....
At least 4 of 13 SXS Criteria
Current Major Depressive Episode - 3?
At least 5 criteria A(1-9) are coded (3) and at least one of these is Criteria (1) or (2)
Bipolar Type II
At least one hypomanic and one major depressive episode 3/7 criteria of DIG FAST if mood is elevated 4/7 criteria of DIG FAST if mood is irritable At least 4 days Noticeable change from baseline. No significant functional impairment while hypomanic, no psychosis
Bipolar Disorder Type I (with or without psychotic features)
At least one manic or mixed episode 3/7 criteria of DIG FAST if mood is elevated, good 4/7 criteria of DIG FAST if mood is irritable At least one week or requiring hospitalization.
Obsessive Compulsive Disorder Criteria B
At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
Depressive Disorder NOS
Clinically significant depressive symptoms that do not meet criteria for a specific Depressive Disorder or Adjustment Disorder. Subtypes: Minor depressive disorder and Recurrent brief depressive disorder.
Hypomanic Episode - 3?
Criteria A B C D E and F are coded (3)
Dysthymic Disorder Criterion A.
Depressed mood (or can be irritable mood in children and adolescents) for most of the day, for more days than not, as indicated either by subjective account or observation made by others, for at least two years (one year for children and adolescents).
DIG FAST
Distractibility, Insomnia, Grandiosity, FOI, Activities, Speech pressured, Thoughtlessness/risktaking
Generalized Anxiety Disorder Criterion F(2)
Does occur exclusively during the course of a Mood Disorder, Psychotic Disorder, or a Pervasive Developmental Disorder
Dysthymic Disorder Criterion C.
During the two year period of the disturbance, the person has never been without the symptoms in A and B for more than two months at a time. NOTE: This criterion is *not* met if subject experiences normal mood for at least two months at a time
Bipolar NOS
Episodes do not meet time length criteria (of 4 days/1 week) Recurrent hypomanic episodes Unable to tell if from a general medical condition, substance-induced
Generalized Anxiety Disorder Criterion A
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance)
BIPOLAR I DISORDER CRITERIA
History of one or more Manic or Mixed Episodes, i.e. a discrete period in which criteria are met for both Manic and MD episodes are met for *at least one week period*; not a result of GMC/substance-use; at least one Manic or Mixed Episode is not better explained by a more psychotic disorder
Additional qualifiers for depression
In remission if no symptoms for two months, In recovery if no symptoms for greater than than two months, Relapse is symptoms in the period of remission, Recurrence is symptoms in the period of recovery.
Adjustment Disorder
Major mood, anxiety, conduct/behavioral symptoms in response to an identifiable stressor. Either in excess of what is expected or causing significant functional impairment. Happens within three months of the stressor. Can be chronic if the stressor is persistent and chronic. Does not meet criteria for MDD. Is not an exaccerabation of another Axis I or II disorder.
If subject does not meet for any Seasonal Pattern screeners, go to .....
Mood Chronoloy D.10
MAPSS TOA MEDS
Mood, Anxiety, Psychosis, Substance, Suicide, Trauma, ODD/Conduct, ADHD, Medical/Somatic, Eating, Developmental, School/Social/Family
Dysthymic Disorder Criterion D.
No major depressive episode during the first two years of the disturbance i.e., not better accounted for by chronic Major Depressive Disorder or Major Depressive Disorder in partial remission
Cyclothymic Disorder
Recurrent depressive and hypomanic symptoms. Do not meet criteria for mania. Do not meet criteria for a major depressive episode
Generalized Anxiety Disorder Criterion C.
The anxiety and worry are associated with at least three of the six symptoms with at least some of the symtoms present for more days than not *for the past six months*
Hypomanic Episode Criterion D.
The disturbance in mood and the change in functioning are observable by others
Hypomanic Episode Criterion C.
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic (when person is not usually depressed)
Obsessive Compulsive Disorder Criterion C
The obsessions or compulsions caused marked distress are time-consuming (take more than an hour a day), or significantly interfere with the person's normal routine, occupational functioning, or usual social activities or relationships.
Generalized Anxiety Disorder Criterion B
The person finds it difficult to control the worry
Criteria for all Episodes/Disorders
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning/ marked impairment in occupational, relational, and social activity/ harm to self or others
If met for Current or Past Major Depressive Episode, Dysthymic Disorder may also be met if...
Two years prior to Current MDE, subject was bothered by depressed mood most of the day, more days than not; Before and After onset of Past MDE, subject was bothered by depressed mood most of the day more days than not
Alcohol/ Substance Dependence Criteria A(5)
a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
Panic Disorder Criteria A(2)c
a significant change in behavior related to the attacks
Alcohol/ Substance Dependence Criteria A(1)
a: a need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b: markedly diminished effect with continued use of the same amount of alcohol
Alcohol/Substance Dependence Criteria A(3)
alcohol is often taken in larger amounts or over a longer period than was intended
Alcohol/Substance Dependence Criteria A(7)
alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
MAJOR DEPRESSIVE DISORDER CRITERIA
at least one MDE and has never had any manic, mixed, or unequivocal hypomanic episodes
Panic Disorder Criteria A(2)b
at least one of the attacks has been followed by a month (or more) of worry about the implications of the attack or its consequences
Generalized Anxiety Disorder (C) SX 2
being easily fatigued
Alcohol/ Substance Abuse Criteria A(4)
continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
Manic Episode SX B(2)
decreased need for sleep (e.g., feels rested after only three hours of sleep)
Hypomanic Episode SX B(2)
decreased need for sleep (e.g., feels rested after only three hours of sleep_
1st MDE Criteria - must have (1) or (2)
depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)>
Generalized Anxiety Disorder (C) SX 3
difficulty concentrating or mind going blank
MDE Criteria (8)
diminished ability to think or concentrate or indecisiveness, nearly every day
Hypomanic Episode SX B(5)
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Manic Episode SX B(5)
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Manic Episode SX B(7)
excessive involvement in pleasurable activities that have a high potential for painful consequences (.e.g, engaging in unrestrained buying sprees, sexual, indiscretions, or foolish business investments)
Hypomanic Episode SX B(7)
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
MDE Criteria (6)
fatigue or loss of energy nearly every day
Dysthymic DIsorder SX B(6)
feelings of hopelessness
MDE Criteria (7)
feelings of worthlessness or excessive or inappropriate guilt (maybe delusional) nearly every day (not merely self-reproach or guilt about being sick.
Hypomanic Episode SX B(4)
flight of ideas or subjective experience that thoughts are racing
Manic Episode SX B(4)
flight of ideas or subjective experience that thoughts are racing
IF BIPOLAR I DISORDER CRITERIA MET determine....
if RAPID CYCLING
Screen for Dysthymic Disorder Criteria only..
if there has *never* been a Manic or Hypomanic episode
Alcohol/ Substance Dependence Criteria A(6)
important social, occupational, or recreational activities given up or reduced because of alcohol use
Manic Episode SX B(6)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
Hypomanic Episode SX B(6)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Hypomanic Episode SX B(1)
inflated self-esteem or grandiosity
Manic Episode SX B(1)
inflated self-esteem or grandiosity
MDE Criteria (4)
insomnia or hyperinsomnia nearly every day
Dysthymic Disorder SX B(2)
insomnia or hypersomnia
Generalized Anxiety Disorder (C) SX 4
irritability
Dysthymic Disorder SX B(3)
low energy or fatigue
Dysthymic Disorder SX B(4)
low self-esteem
2nd MDE Criteria - must have (1) or (2)
markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective acct. or observation)
Qualify for depression
mild, moderate, severe, with/without psychosis, seasonal, post-partum, catatonic, atypical. Melancholic.
BIPOLAR II DISORDER CRITERIA
mix of Hypomanic and MD episodes....
Hypomanic Episode SX B(3)
more talkative than usual or pressure to keep talking
Manic Episode SX B(3)
more talkative than usual or pressure to keep talking
Generalized Anxiety Disorder (C) SX 5
muscle tension
Panic Disorder Criteria A(2)a
persistent concern about having additional attacks
Dysthymic Disorder SX B(1)
poor appetite or overeating
Dysthymic Disorder SX B(5)
poor concentration or difficulty making decisions
MDE Criteria (5)
psychomotor agitation or retardation nearly every day (observable by others not merely subjective feelings of restlessness or being slowed down)
Alcohol/ Substance Abuse Criteria A(2)
recurrent alcohol use in situations in which it is physically hazardous (e.g., driving a car or operating a machine)
Alcohol Abuse Criteria A(1)
recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use etc.,)
Alcohol/ Substance Abuse Criteria A(3)
recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct)
Obsessive Compulsive Disorder Criteria A(obsessions)(1)
recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate, and cause marked anxiety or distress
MDE Criteria (9)
recurrent thoughts of death (not just fear or dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Panic Disorder Criteria A(1)
recurrent unexpected panic attacks
Obsessive Compulsive Disorder Criteria A(compulsions)1
repetitive behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
Generalized Anxiety Disorder (C) SX 1
restlessness or feeling keyed up or on edge
MDE Criteria (3)
significant weight loss when not dieting, or weight gain or decrease or increase in appetite nearly every day.
Generalized Anxiety Disorder (C) SX 6
sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
SIG E CAPS
sleep, interest/pleasure reduction, guilt/worthless, energy, concentration, appetited/weight changes, psychomotor disturbance, suicidal thoughts
Obsessive Compulsive Disorder Criteria A(compulsions)2
the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
Obsessive Compulsive Disorder Criteria A(obsessions)(3)
the person attempts to ignore or suppress such thoughts or to neutralize them with some other thought or action
Obsessive Compulsive Disorder Criteria A(obsessions)(4)
the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Obsessive Compulsive Disorder Criteria A(obsessions)(2)
the thoughts, impulses, or images are not simply excessive worries about real-life problems
Alcohol/ Substance Dependence Criteria A(4)
there is a persistent desire or unsuccessful efforts to cut down or control substance use
Major Depressive Disorder may be co-diagnosed/ superimposed onto Dysthymic Disorder if....
there was a Past MDE followed by a full remission (no significant symptoms for two months) before developing SXS of Dysthymia; if after the first 2 years of Dysthymic Disorder, there can be superimposed episodes of MDD and both diagnoses can be given
Alcohol/ Substance Dependence Criteria A(2)
withdrawal symptoms