Diagnostic and Statistical Manual

DSM -- IV

March 24, 2012

Prepared for

The BiPolar Bears of Phoenix and Mesa

C R E D I T S

Definitions from WWW.medical-dictionary.com

Definitions from Webster’s Dictionary

Global Assessment of Functioning (GAF) from en.wikipedia.org

T A B L E O F C O N T E N T S

1.0 D E F I N I T I O N S

1.1 NOTES 3

1.2 RECOGNIZED MENTAL DISORDERS 3

1.3 MODE / MOOD 3

2.0 E P I S O D E S

2.1 MAJOR DEPRESSIVE EPISODE 4

2.2 MANIC EPISODE 4

2.3 HYPOMANIC EPISODE 5

2.4 MIXED EPISODE 6

3.0 D E P R E S S I V E D I S O R D E R S

3.1 MAJOR DEPRESSIVE DISORDER 8

3.2 DYSTHYMIC DISORDER 8

3.3 DEPRESSIVE DISORDER NOT OTHERWISE SPECIFIED 9

4.0 B I P O L A R D I S O R D E R S

5.0 B I P O L A R I D I S O R D E R S

5.1 BIPOLAR I DISORDER (MOST RECENT DISORDER MAJOR DEPRESSED) 13

5.2 BIPOLAR I DISORDER (MOST RECENT EPISODE HYPOMANIC) 13

5.3 BIPOLAR I DISORDER (MOST RECENT EPISODE MANIC) 14

5.4 BIPOLAR I DISORDER (MOST RECENT EPISODE MIXED) 15

5.5 BIPOLAR I DISORDER (MOST RECENT EPISODE UNSPECIFIED) 16

6.0 B I P O L A R II D I S O R D E R

7.0 O T H E R M O O D D I S O R D E R S

7.1 CYCLOTHYMIC DISORDER 19

7.2 BORDERLINE PERSONALITY DISORDER 20

8.0 A N X I E T Y D I S O R D E R S

8.1 PANIC DISORDER WITHOUT AGORAPHOBIA 22

8.2 POSTTRAUMATIC STRESS DISORDER (PTSD) 23

9.0 P S Y C H O T I C D I S O R D E R S

9.1 SCHIZOAFFECTIVE DISORDER 25

10.0 R E L A T E D P H Y S I C A L D I S O R D E R S

10.1 MOOD DISORDER DUE TO A GENERAL MEDICAL CONDITION 26

10.2 SLEEP APNEA 27

10.3 NARCOLEPSY 28

11.0 D I A G N O S TR I C A X I S

12.0 M E N T A L H E A L T H I N A R I Z O N A

12.1 REGIONAL BEHAVIORAL HEALTH AUTHORITIES

12.2 ENROLLMENT BY RHBA

13.0 G L O S S A R Y

14.0 I N D E X

1.0 D E F I N I T I O N S

1.1 NOTES:

· This document is intended for those people who are interested in mood disorders and other related illnesses. It is not intended to cover all mental illnesses.

· This document is not intended for children or adolescent clients.

• This document only contains a synopsis of the information in the DSM-IV for use by an untrained client. Consult the volume directly, or ask your Health Professional for additional information and diagnosis.

• [ ] shows DSM Diagnoses and Codes

1.2 RECOGNIZED MENTAL DISORDERS

• [123] Cognitive Disorders (Delirium, Dementia, Amnestic)

• [165] General Medical Conditions causing mental illness

• [175] Substance-Related Disorders

• [273] Psychotic Disorders (Schizophrenia, Delusional Disorder)

• [317] Mood Disorders (Bi-Polar)

• [393] Anxiety Disorders (Panic Disorder, Obsessive-Compulsive Disorder)

• [445] Somatoform Disorders (Suggest a general medical condition)

• [471] Factitious Disorders (Psychological symptoms that are not real or genuine)

• [477] Dissociative Disorders (Sudden temporary alterations of consciousness)

• [493] Sexual and Gender Identity Disorders (male/female identity)

• [539] Eating Disorders (Bulimia)

• [551] Sleeping Disorders (Sleep Apnea, Narcolepsy)

• [312] Impulse-Control Disorders (n.e.c) (Kleptomania, Pathological Spending)

• [623] Adjustment Disorders (Maladaptive reactions to stressors)

• [629] Personality Disorders (A Major Deviation from normal patterns of behavior)

• [675] Other conditions that may be a focus of clinical attention

1.3 MODE / MOOD

• Temper of mind, a temporary state of the mind in regard to passion or feeling, humor as, a melancholy mood; a suppliant mood

• Manner; style; mode; logical form; musical style; manner of action or being.

• Manner of conceiving and expressing action or being as positive, possible hypothetical, etc., without regard to other accidents, such as time, person, number, etc.; as the indicative mood; the infinitive mood; the subjective mood.

2.0 E P I S O D E S

2.1 MAJOR DEPRESSIVE EPISODE

A Major Depressive Episode is a feeling of intense sadness; it may follow a recent loss or other sad event but is out of proportion to that event, and persists beyond an appropriate length of time. It is manifested by a combination of symptoms that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities.

CRITERIA FOR MAJOR DEPRESSIVE EPISODE:

• 5 (or more) of the following symptoms nearly every day over a 2-week period:

- Depressed mood most of the day

- Diminished interest or pleasure in almost all activities

- Significant weight loss or gain (Å 5%) or appetite (Å)

- Insomnia or hypersomnia

- Psychomotor agitation or retardation

- Fatigue

- Feelings of worthlessness or guilt

- Diminished ability to think or concentrate, or indecisiveness

- Recurrent thoughts of death, recurrent suicidal ideation, suicide attempt, or specific plan

NOTES:

The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

DO NOT CONFUSE WITH:

· A mixed episode

· Physiological effects of a substance (i.e. A drug of abuse, a medication, or other treatment)

· A General Medical Condition (i.e. Hyperthyroidism)

· The symptoms are not better accounted for by: bereavement, functionall impairment, morbid preoccupation with worthlessness, suicidal ideation psychotic, or retardation

2.2 MANIC EPISODE

Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behavior and elevation of mood. There may abnormalities involving the brain hormones such as norepinephrine, serotonin, acetylcholine, dopamine, or gamma-aminobutyric acid neurotransmitter systems. Manic episodes typically begin suddenly, with rapid escalation of symptoms over a few days.

CRITERIA FOR MANIC EPISODE:

· A distinctive period of abnormality and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

· During the period of mood disturbance, 3 (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

- Inflated self-esteem or grandiosity

- Decreased need for sleep (e.g., a person feels rested after only 3 hours of sleep)

- More talkative than usual or pressure to keep talking

- Flight of ideas or subjective experience that thoughts are racing

- Distractibility (i.e. Attention too easily drawn to unimportant or irrelevant external stimuli)

- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments

NOTES:

• The mood disturbance is sufficiently severe to cause marked impairment in

occupational functioning or in usual social activities or relationships with others,

or to necessitate hospitalization to prevent harm to self or others, or there are

psychotic features.

DO NOT CONFUSE WITH:

• A Mixed Episode.

• Physiological effects of a substance (i.e. A drug of abuse, a medication, or other treatment)

• A General Medical Condition (e.g. Hyperthyroidism)

• Manic-like episodes that are clearly caused by somatic antidepressant treatment

(e.g. Medication, electroconvulsive therapy, light therapy) should not count

toward a diagnosis of Bipolar I Disorder.

2.3 HYPOMANIC EPISODE

An abnormality of mood resembling mania, but of lesser intensity.

CRITERIA FOR A HYPOMANIC EPISODE [296.40]:

• A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout 4 days, that is clearly different from the usual nondepressed mood.

• The episode is not severe enough to cause marked impairment in social or occupational functioning, or to require hospitalization, and there are no psychotic features

• During a period of mood disturbance, 3 (or more) of the following symptoms have persisted, and to a significant degree:

- Inflated self-esteem or grandiosity

- Decreased need for sleep

- More talkative than usual or pressure to keep talking

- Flight of ideas or subjective experience that thoughts are racing

- Distractibility (i.e. attention too easily drawn to unimportant or irrelevant external stimuli)

- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. The person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

· The episode is associated with an unequivocal change in functioning that is not

characteristic of the person when not symptomatic.

• The disturbance in mood and the change in functioning are observable by others

NOTES:

Hypomanic-like episodes that are clearly caused by somatic antidepressant

treatment (e.g. medication, electroconvulsive therapy, light therapy) should not

count toward a diagnosis of Bipolar II Disorder.

DO NOT CONFUSE WITH:

• Physiological effects of a substance (e.g. A drug of abuse, a medication, or other treatment)

• A general medical condition (e.g. Hyperthyroidism)

• Manic Episodes

• Attention-Deficit/Hyperactivity Disorder

• Euthymia (A “high” following remission of a Major Depressive Episode)

2.4 MIXED EPISODE

A Mixed Episode is characterized by a period of time (lasting at least 1 week) in which the criteria are met both a Manic Episode and for a Major Depressive Episode nearly every day. The individual experiences rapidly alternating moods (sadness, irritability, euphoria). Associated features of a Mixed Episode are similar to those for Manic Episodes and Major Depressive Episodes. Individuals may be disorganized in their thinking or behavior.

CRITERIA FOR A MIXED EPISODE:

· The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

· The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or when there are psychotic features

NOTES:

Mixed-like episodes that are clearly caused by somatic antidepressant treatment

(e.g. Medication, electroconvulsive therapy, light therapy) should not count

toward a diagnosis of Bipolar I Disorder.

DO NOT CONFUSE WITH:

• Physiological effects of a substance (e.g. A drug of abuse, a medication, or other treatment)

• A General Medical Condition (e.g. Hyperthyroidism)

• Major Depressive Episodes with prominent irritable mood

• Manic Episodes with prominent irritable mood

• Attention-Deficit/Hyperactivity Disorder

3.0 D E P R E S S I V E D I S O R D E R S

3.1 MAJOR DEPRESSIVE DISORDER

The essential feature of a Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes.

CRITERIA FOR MAJOR DEPRESSIVE DISORDER [296]:

• Presence of 2 or more Major Depressive Episodes

ADDITIONAL SPECIFIERS:

• Severity / Psychotic / Remission Specifiers

• Chronic

• With Catatonic Features

• With Melancholic Features

• With Atypical Features

• With Postpartum Onset

• With or Without Interepisode Recovery

• With Seasonal Pattern

• With Manic [or Mixed] Features (only if caused by medications)

NOTES:

• To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

• If Manic or Hypomanic Episodes occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxic exposure, the diagnosis is not changed.

• Lifetime prevalence is in a wide range of 10% - 25% in women, 5% - 12% in men

• Up to 15% die from suicide

DO NOT CONFUSE WITH:

• Schizoaffective Disorder

• There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode:

· Unless all episodes are substance

· Unless treatment is induced or due to direct effects of a General Medical Condition

3.2 DYSTHYMIC DISORDER

A chronically depressed mood that occurs for most of the day more days than not (as indicated by observation by others) for at least 2 years. Individuals with Dysthymic Disorder describe their mood as sad or “down in the dumps”. These symptoms have become so much of an individual’s day-to-day experience (“That’s how I am”), these incidents are often not reported, unless directly asked by the interviewer.

CRITERIA FOR DYSTHYMIC DISORDER [300.4]:

• During periods of depressed mood, 2 (or more) of the following additional symptoms are present:

- Poor appetite or overeating

- Insomnia or hypersomnia

- Low energy of fatigue

- Low self esteem

- Poor concentration, Low interest

- Difficulty or incapable of making decisions

- Feeling of hopelessness, Self-criticism

- Feel uninterested in events

• No Major Depressive Disorders during the first 2 years

• During the first 2 years, the person has not been without symptom

for more than 2 months at a time.

• The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or when there are psychotic features

ADDITIONAL SPECIFIERS:

• Early Onset (< 21 years)

• Late Onset (after 21 years)

• With Atypical Features

NOTES:

• Lifetime prevalence of this disorder is approximately 6%

• By definition, suicide is not included under this diagnosis

DO NOT CONFUSE WITH

• Physiological effects of a substance (e.g. A drug of abuse, a medication, or other treatment)

• A General Medical Condition (e.g. hyperthyroidism)

• Chronic Major Depression Disorder

• Major Depression Disorder, in Partial Remission

• Manic Episode, Mixed Episode, Hypomanic Episode

• Not exclusively during a Psychotic Episode

3.3 DEPRESSIVE DISORDER NOT OTHERWISE SPECIFIED

EXAMPLES OF DEPRESSIVE DISORDER N.O.S. INCLUDE [311]:

• Premenstrual Dysphoric Disorder: In most menstrual cycles during the past year, symptoms, which must be severe enough to markedly interfere with work, school, or usual activities are absent for at least one week

• Minor Depressive Disorder: Episodes of at least 2 weeks of depressive symptoms but with fewer than the 5 items required for Major Depressive Disorder

• Recurrent Brief Depressive Disorder: Depressive episodes lasting from 2 days up to 2 weeks, occurring at least once a month for 12 months (not associated with the menstrual cycle)

• Postpsychotic Depressive Disorder of Schizophrenia: A Major Depressive Episode that occurs during the residual phase of Schizophrenia

• A Major Depressive Episode Superimposed on a Delusional Disorder, Psychotic Disorder Not Otherwise Specified, or an active phase of Schizophrenia

• Situations in which the clinician has concluded that a depressive disorder is present but is unable to determine which is primary, due to a General Medical Condition, or substance induced

DO NOT CONFUSE WITH:

• Major Depressive Disorder

• Dysthymic Disorder

• Adjustment Disorder with Depressed Mood

• Adjustment Disorder with Mixed Anxiety and Depressed Mood

5.0 B I P O L A R I D I S O R D E R S

Bipolar I Disorder is used to describe the occurrence of one or more Manic or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Recurrence is indicated by either a shift in polarity of the episode, or an interval between episodes of at least 2 months without manic symptoms. Bipolar I Disorder is reoccurring, rather than Bipolar II, where it is a single cycle occurrence .

CRITERIA FOR BIPOLAR I DISORDER [296.0x]

• Presence of one or more Manic or Mixed Episodes and one or more Major Depressive Episodes

NOTES:

• Recurrence is indicated by either a shift in the polarity of the episode or an interval between episodes without manic symptoms

• A shift in polarities defining a clinical course in which

· A Major Depressive Episode evolves into a Manic Episode

· A Mixed Episode or Manic Episode which evolves into

a Major Depressive Episode

• In contrast, a Hypomanic Episode which evolves into a Mixed Episode (or visa versa), is considered to be only a single episode

• For recurrent Bipolar I disorders, the name of the most recent episode can be specified

· A majority of individuals return to a fully functional level or occupation between episodes

· 20% to 30% continue to show mood lability and interpersonal or occupational difficulties

· Completed suicide occurs in 10% - 15% of individuals

· The lifetime prevalence of Bipolar I Disorder varies from 0.4% to 1.6%.

• More than 90% of individuals who have a Single Manic Episode go on to have future episodes.

ADDITIONAL SPECIFIERS FOR BIPOLAR I DISORDER:

• Used to describe Mixed or major Depressive Mixed or Major Depressive Episode, the most recent Manic, Mixed, or Major Depressive Episode

· Mild, Moderate, or Severe, Without Psychotic Features (in Partial or Full Remission)

· Severe with Psychotic Features, In Partial, in Full Remission

· With Catatonic Features

· With Postpartum Onset

• Specify to indicate the pattern of episodes:

· Longitudinal Course Specifiers (With or Without Full Interepisode Recovery)

· With Seasonal Pattern (Applies only to major depressive episodes)

· With Rapid Cycling

• The following specifiers can be specified of the most recent Bipolar I Episode:

· Most Recent Episode Hypomanic

· Most Recent Episode Manic

· Most Recent Episode Mixed

· Most Recent Episode Depressed

· Most Recent Episode Unspecified

DO NOT CONFUSE WITH:

• Physiological effects of a substance (e.g. A drug of abuse, a medication, or other treatment)

• Mood Disorder due to General Medical Condition

• Major Depressive Disorder

• Dysthymic Disorder

• Bipolar II Disorder

• Cyclothymic Disorder

• Psychotic Disorder

· Schizophreniform Disorder

· Schizoaffective Disorder

· Schizophrenia (may be added)

· Delusional Disorder (may be added)

· Psychotic Disorder (n.o.s.)

· Bipolar Disorder Not Otherwise Specified (may be added)

· Very rapid alternation (over days) between manic and depressive

symptoms that do not meet other criteria may be included elsewhere

5.1 BIPOLAR I DISORDER (MOST RECENT DISORDER MAJOR DEPRESSED)

CRITERIA FOR BIPOLAR I DISORDER (MOST RECENT EPISODE MAJOR DEPRESSED) [296.50]:

· The individual is currently (or most recently) in a Major Depressive Episode

• There has previously been at least one Manic Episode or Mixed Episode

• The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

ADDITIONAL SPECIFIERS FOR BIPOLAR I DISORDER (MOST RECENT EPISODE DEPRESSIVE):

• Applies only to the most recent Major Depressive Episode and only if it is the most recent type of episode:

- Chronic

- With Melancholic Features

- With Atypical Features

• Specify (for the current or most recent episode)

- Severity / Psychotic / Remission Specifiers

- Chronic

- With Catatonic Features

- With Melancholic Features

- With Atypical Features

- With Postpartum Onset

• The following specifiers can be used to indicate the pattern of episodes

- Longitudinal Course Specifiers (With or Without Full Interepisode Recovery)

- With Seasonal Pattern (Only applies to major depressive episodes)

- With Rapid Cycling

DO NOT CONFUSE WITH:

• Schizoaffective Disorder

• Not superimposed on

- Schizophrenia

- Schizophreniform Disorder

- Delusional Disorder

- Psychotic Disorder, n.o.s.

5.2 BIPOLAR I DISORDER (MOST RECENT EPISODE HYPOMANIC)

The occurrence of one (or more) Hypomanic Episodes.

CRITERIA FOR BIPOLAR I DISORDER (MOST RECENT EPISODE HYPOMANIC) [296.4x]:

• Currently (or most recently) in a Hypomanic Episode

• There has previously been at least one Manic or Mixed Episode

• The mood disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning.

ADDITIONAL SPECIFIERS FOR BIPOLAR I DISORDER, MOST RECENT EPISODE HYPOMANIC:

• Specify (for current or most recent episode)

- Severity/Psychotic/Remission Specifiers

- With Catatonic Features

- With Postpartum Onset

• Specify to indicate the pattern of episodes

- Longitudinal Course Specifiers (With or Without Full Interepisode Recovery)

- With Seasonal Pattern (Only applies to Major Depressive Episodes)

- With Rapid Cycling

DO NOT CONFUSE WITH:

• Schizoaffective Disorder

• Not superimposed on

- Schizophrenia

- Schizophreniform Disorder

- Delusional Disorder

- Psychotic Disorder, n.o.s.

5.3 BIPOLAR I DISORDER (MOST RECENT EPISODE MANIC)

The occurrence of one Manic or Mixed Episode. Often individuals have had one or more Major Depressive Episodes

CRITERIA FOR BIPOLAR I DISORDER (MOST RECENT EPISODE MANIC) [296.0x]:

• Currently (or most recently) in a Manic Episode

• There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode

NOTES:

• More than 90% of individuals who have a Single Manic Episode go on to have future episodes.

ADDITIONAL SPECIFIERS FOR BIPOLAR I DISORDER, MOST RECENT EPISODE MANIC

• Specify (for current or most recent episode)

- Severity/Psychotic/Remission Specifiers

- With Catatonic Features

- With Postpartum Onset

• Specify to indicate the pattern of episodes

- Mixed

- Longitudinal Course Specifiers (With or Without Full Interepisode Recovery)

- With Seasonal Pattern (Only applies to Major Depressive Episodes)

- With Rapid Cycling

DO NOT CONFUSE WITH:

• Schizoaffective Disorder

• Not superimposed on

- Schizophrenia

- Schizophreniform Disorder

- Delusional Disorder

- Psychotic Disorder, n.o.s.

5.4 BIPOLAR I DISORDER (MOST RECENT EPISODE MIXED)

CRITERIA FOR BIPOLAR I DISORDER (MOST RECENT EPISODE MIXED) [296.6x]:

• Currently (or most recently) in a Mixed Episode

• There has previously been at least one Major Depressive Episode, Manic Episode or Mixed Episode

ADDITIONAL SPECIFIERS FOR BIPOLAR I DISORDER, MOST RECENT EPISODE MIXED:

• Specify (for current or most recent episode)

- Severity / Psychotic / Remission Specifiers

- With Catatonic Features

- With Postpartum Onset

• Specify to indicate the pattern of episodes

- Longitudinal Course Specifiers (With or Without Full Interepisode Recovery)

- With Seasonal Pattern (Applies to Major Depressive Episodes only)

- With Rapid Cycling

DO NOT CONFUSE WITH:

• Schizoaffective Disorder

• Not superimposed on

- Schizophrenia

- Schizophreniform Disorder

- Delusional Disorder

- Psychotic Disorder, n.o.

5.5 BIPOLAR I DISORDER (MOST RECENT EPISODE UNSPECIFIED)

CRITERIA FOR BIPOLAR I DISORDER (MOST RECENT EPISODE UNSPECIFIED [296.7]):

• Criteria, except for duration, are not currently (or most recently) met for a Manic, a Hypomanic, a Mixed, or a Major Depressive Episode

• There has previously been at least one Manic Episode or Mixed Episode

• The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

ADDITIONAL SPECIFIERS FOR BIPOLAR I DISORDER, MOST RECENT EPISODE UNSPECIFIED:

• Specify to indicate the pattern of episodes

- Longitudinal Course Specifiers (With or Without Full Interepisode Recovery)

- With Seasonal Pattern (Only applies to Major Depressive Episodes)

- With Rapid Cycling

DO NOT CONFUSE WITH:

• Schizoaffective Disorder

• Not superimposed on

- Schizophrenia

- Schizophreniform Disorder

- Delusional Disorder

- Psychotic Disorder, n.o.s.

• Mood Disorder due to General Medical Condition (e.g. hyperthyroidism)

• Physiological effects of a substance (e.g. A drug of abuse medication, or other treatment)

6.0 B I P O L A R II D I S O R D E R

Bipolar II Disorder used to describe a clinical course characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode. It is not as pronounced as Bipolar I Disorder.

CRITERIA FOR BIPOLAR II DISORDER [296.89]:

• Presence of one or more Major Depressive Episodes

• Presence of one or more Hypomanic Episodes

• The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

NOTES:

· Hypomanic Episodes, themselves, do not define a “course of impairment”

• The impairment may result from

- A Major Depressive Episode

- A chronic pattern of unpredictable mood episodes and fluctuation causing unpredictable interpersonal or occupational functioning

• A majority of individuals return to a fully functional level or occupation between episodes.

• Others may be troubled by the individuals’ erratic behavior

Individuals with Bipolar Disorder may not view the Hypomanic episodes as pathological

• Often individuals, particularly when in the midst of a Major Depressive Episode, do not recall periods of hypomania without reminders from close friends or relatives

• Information from other informants is often critical in establishing the diagnosis of Bipolar II disease.

• Lifetime prevalence of Bipolar II Disorder is approximately 0.5%

• Completed suicide (usually during Major Depressive Episodes) is a significant risk, occurring in 10-15% of persons with Bipolar II Disorder

• School truancy, school failure, occupational failure, or divorce may be associated with Bipolar II Disorder

• Associated mental disorders include Substance Abuse or Dependance, Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit/Hyperactivity Disorder, Panic Disorder, Social Phobia, and Borderline Personality Disorder

ADDITIONAL SPECIFIERS FOR BIPOLAR II DISORDER:

• Used to describe the current (or the most recent)

- Hypomanic

- Depressed

• Used to describe the current Major Depressive Episode

- Severity / Psychotic / Remission Specifiers

- Chronic

- With Catatonic Features

- With Melancholic Features

- With Atypical Features

- With Postpartum Onset

• Specify to indicate the pattern of episodes

- Longitudinal Course Specifiers (With or without Full Interepisode Recovery)

- With Seasonal Pattern (Only applies to Major Depressive episodes)

- With Rapid Cycling

DO NOT CONFUSE WITH:

· •Mood Disorder due to General Medical Condition (e.g. hyperthyroidism)

· Direct physiological effects of a substance (e.g. A drug of abuse, a medication, or other treatment)

· Major Depressive Disorder

· Euthymia

· Cyclothymic Disorder

· Psychotic Disorder

· Schizophreniform Disorder

· Schizoaffective Disorder

· Schizophrenia (may be added)

· Delusional Disorder (may be added)

· Psychotic Disorder (n.o.s.) (may be added)

· Dysthymic Disorder

· Bipolar I Disorder (n.o.s.)

7.0 O T H E R M O O D D I S O R D E R S

7.1 CYCLOTHYMIC DISORDER

A Cyclothymic disorder is characterized by chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. The hypomanic or depressive symptoms are of insufficient number, severity, pervasiveness, or duration to meet the full criteria for a Manic or Major Depressive Episode. Symptom free periods last no more than 2 months over the first 2 years. The impairment may develop as a result of prolonged periods of cyclical, often unpredictable mood changes (e.g. The person may be regarded as temperamental, moody, inconsistent, or unreliable)

CRITERIA FOR CYCLOTHYMIC DISORDER [301.13]:

• For at least 2 years, the presence of numerous periods of hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.

• During the 2 year period, the person has not been free of Major Depressive, Manic, or Mixed Episodes for more than 2 months at a time.

• After the first 2 years of Cyclothymic Disorder, there may be superimposed Manic and Mixed Episodes, or Major Depressive Episodes.

• The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

NOTES:

· Some people may function particularly well during some of the periods of hypomania.

· Substance-Related Disorders and Sleep Disorders may be present

· A lifetime prevalence ranges from 3% - 5%

· There is a 15% to 50% risk that a person will subsequently develop Bipolar I or Bipolar II disorder

· The impairment may develop symptoms, often unpredictable

· The impairment does not occur exclusively during Delirium

ADDITIONAL SPECIFIERS FOR CYCLOTHYMIC DISORDER:

• With Depressive Features

• With Major Depressive-Like Episodes

• With Manic Features

• With Mixed Features

DO NOT CONFUSE WITH:

• Over the first 2 year period, there are no:

- Major Depressive Episode

- Manic Episode

- Mixed Episode

• Schizoaffective Disorder

• Bipolar I, with Rapid Cycling

• Bipolar II, with Rapid Cycling

• Borderline Personality Disorder

· Major Depressive Disorder

· Adjustment Disorder with Depressed Mood

· Dementia due to a General Medical Condition

· Dementia of the Alzheimer’s type

· Dementia of the Vascular type

· Not superimposed on

· Schizophrenia

· Schizophreniform Disorder

· Delusional Disorder

· Psychotic Disorder, n.o.s

7.1 BORDERLINE PERSONALITY DISORDER

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins in early adulthood and is present in a variety of contexts. These people make frantic efforts to avoid real or imagined abandonment. This leads to profound changes in self-image, affect, cognition, and behavior. They may believe that this “abandonment” implies that they are “bad”. These individuals are prone to sudden and dramatic shifts in their view of others. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. They may display extreme sarcasm, enduring bitterness, or verbal outbursts. They may include impulse actions of societal disfunction.

CRITERIA FOR BORDERLINE PERSONALITY DISORDER [301.83]:

Five (or more) of the following:

• Frantic efforts to avoid real or imagined abandonment.

• A pattern of unstable and intense interpersonal relationships, characterized by alternating between extremes of idealization and devaluation.

• Identify disturbance: markedly and persistently unstable self-image or sense of self.

• Impulsivity in at least 2 areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

• Affective instability due to a marked reactivity in mood (e.g. Intense Episodic Dysphoria, Irritability, or Anxiety) usually lasting a few hours and only rarely more than a few days.

• Chronic feelings of emptiness

• Inappropriate, intense anger or difficulty controlling anger (e.g. Frequent displays of temper, constant anger, recurrent physical fights)

• Transient, stress-related paranoid ideation or severe Dissociative symptoms

NOTES:

• Individuals may have a pattern of undermining themselves at the moment a goal is about to be reached (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 was clear that the relationship could last).

• Individuals with this disorder may feel more secure with transitional objects (i.e. A pet or inanimate possession) than in interpersonal relationships.

• Recurrent job losses, interrupted education, and broken marriages are common.

• Common co-concurrent disorders include Mood Disorders, Substance-Related Disorders, Eating Disorders (notably Bulimia), PTSD, ADD, and other Personality Disorders.

• The lifetime prevalence of Borderline Personality is about 2%

• Individuals are 75% female.

• Completed suicide occurs in 8% - 10% of individuals

DO NOT CONFUSE WITH:

• Mood disorders (but both may be diagnosed)

• Histrionic Personality Disorder (attention seeking)

• Schizotypal Personality Disorder

• Paranoid Personality Disorder

• Narcissistic Personality Disorder

• Antisocial Personality Disorder

• Dependent Personality Disorder

• Personality Change Due to General Medical Condition

• Symptoms that may develop in association with chronic substance abuse

• Identity Problem (usually in adolescence and not a mental disorder)

8.0 A N X I E T Y D I S O R D E R S

8.1 PANIC DISORDER WITHOUT AGORAPHOBIA

A Panic Attack is discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering, and fear of “going crazy” or losing control are present. A Panic Disorder is characterized by recurrent unexpected Panic Attacks about which there is persistent concern for at least 1 month.

CRITERIA FOR A PANIC ATTACK:

· A discrete period of intense fear or discomfort, in which 4 (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

o palpitations, pounding heart, or accelerated heart rate

o sweating

o trembling or shaking

o sensations of shortness of breath or smothering

o feeling of choking

o chest pain or discomfort

o nausea or abdominal distress

o feeling dizzy, unsteady, lightheaded, of faint

derealization (feeling of unreality) or depersonalization

being detached from oneself)

o fear of losing control or going crazy

o fear of dying

o paresthesias (numbness or tingling sensations)

o chills or hot flashes

CRITERIA FOR PANIC DISORDER WITHOUT AGORAPHOBIA [300.01]:

• Both of the following

· Recurrent unexpected Panic Attacks

· At least one of the attacks has been followed by 1 month (or more) for the following:

o Persistent concern about having additional attacks

o Worry about the implications of the attack or its consequences (e.g. losing control)

o A significant change in behavior related to the attacks

o Absence of Agoraphobia (fear about places or situations from which escape may be difficult)

NOTES:

o Panic Disorder is frequently associated with Agoraphobia [300.21]

o The lifetime prevalence of Panic Disorder is between 1.5% and 3.5%

o Generalized anxiety may also be reported by individuals already diagnosed with Panic Disorder

o Anxiety usually peaks in late adolescence and the mid-30s.

ADDITIONAL SPECIFIERS FOR PANIC DISORDER:

· With or without Agoraphobia

DO NOT CONFUSE WITH:

· Direct physiological effects of a substance

· A General Medical Condition

· Another mental disorder, such as

· Social Phobia

· Special Phobia

· Obsessive-Compulsive Disorder

· PTSD

· Separation Anxiety Disorder

8.2 POSTTRAUMATIC STRESS DISORDER (PTSD)

The development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct, personal experience of an event(s) that involve actual or threatened death, or serious injury, or a threat to the physical integrity of self or others

CRITERIA FOR POSTTRAUMATIC STRESS DISORDER (PTSD) [309.81]:

• The person has been exposed to a traumatic event in which both of the following are present:

o the person has experienced, witnessed, or was confronted with an event(s) that involve actual or threatened death, or serious injury, or a threat to the physical integrity of self or others

o the person’s response involved intense fear, helplessness, or horror

· The traumatic event is persistently reexperienced in 1 (or more) of the following ways:

o recurrent and intrusive distressing recollections of the event

o recurrent dreams of the event

o acting or feeling as if the traumatic events are recurring

intense psychological distress at exposure to internal or external clues that represent the event

· Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, as indicated by 3 of the following:

o efforts to avoid thoughts, feelings, or conversations associated with the trauma

o efforts to avoid activities, places, or people that arouse recollections

o inability to recall an important aspect of the trauma

o markedly diminished interest in activities

o feelings of detachment

o restricted range of affect (unable to have loving feelings)

o sense of foreshortened future

· New persistent symptoms of increased arousal by 2 of the following:

o difficulty in falling or staying asleep

o irritability or outbursts of anger

o difficulty concentrating

o hypervigilance

o exaggerated startle response

· Duration of the disturbance is more than 1 month

· The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

NOTES:

Typical events causing PTSD include:

o military combat

o violent personal assault

o being kidnaped / taken hostage

o terrorist attack / torture

o incarceration

o natural or manmade disasters

o severe automobile accidents

o diagnosis of a life-threatening illness

o violent witnessed events

ADDITIONAL SPECIFIERS FOR PTSD:

o Acute (duration of symptoms less than 3 months)

o Chronic (duration of symptoms than 3 months)

o With delayed onset (onset greater than 6 months after event)

DO NOT CONFUSE WITH:

Adjustment Disorder

Avoidance before the stressor occurs

Another mental disorder

Acute Stress Disorder

Obsessive-Compulsive Disorder

Malingering

9.0 P S Y C H O T I C D I S O R D E R S

Disorders in which there is gross impairment in reality testing. The individual incorrectly evaluates his or her perception and thoughts and makes incorrect inferences about reality even in the face of contrary evidence. Delusions or hallucinations are present.

9.1 SCHIZOAFFECTIVE DISORDER

An affective disorder is characterized within a single uninterrupted period (at least 1 month, but may be years or even decades) of illness (active or residual symptoms of psychotic illness). There may have been delusions or hallucinations. There is also a Major Depressive, Manic or Mixed Episode.

CRITERIA FOR SCHIZOAFFECTIVE DISORDER [295.70]:

• An uninterrupted period of illness during which, at some time, there is either a Manic Episode, or a Mixed Episode.

· A depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful).

· Two (or more) of the following, each present for a significant period of time during a 1-month period (or less if successfully treated):

· delusions

· hallucinations

· disorganized speech (e.g. frequent derailment or incoherence)

· grossly disorganized or catatonic behavior

· negative symptoms (i.e. affective flattening, alogia or abolition)

during the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

• Symptoms that meet criteria for a mood episode are present for a substantial portion of the of the total duration of the active and residual periods of the illness.

NOTES:

· There may be poor occupational functioning, a restricted range of social contact, difficulties with self-care, and increased risk of suicide.

· Residual and negative symptoms are usually less severe and less chronic than those seen in Schizophrenia (perception, inferential thinking, communication, behavior, affect, fluency, speech productivity, etc.)

o There is increased risk for later development of mood disorders

o The determination may be difficult and may require longitudinal observation and multiple sources of information

o There may be associated alcohol and other substance-related disorders

ADDITIONAL SPECIFIERS FOR SCHIZOAFFECTIVE DISORDER:

• Specify type:

- Bipolar Type (The disturbance includes a Manic or Mixed Episode)

- Depressive Type (The disturbance only includes Major Depressive Episodes)

- Psychotic Disorder due to a General Medical Condition

DO NOT CONFUSE WITH:

• Psychotic Disorder due to a General Medical Condition (may be added)

• Delirium, Dementia

• Substance-Induced Psychotic Disorder

• Substance-Induced Delirium

• Schizophrenia

• Mood Disorders With Psychotic Features

• Delusional Disorder

• Psychotic Disorder n.o.s.

10.0 R E L A T E D P H Y S I C A L D I S O R D E R S

General medical conditions which are frequently seen in combination with mood disorders.

10.1 MOOD DISORDER DUE TO A GENERAL MEDICAL CONDITION

A prominent and persistent disturbance in mood that is judged to be the direct physiological effects of a general medical condition. The mood disorder may resemble that of a Major Depressive, Manic, Mixed, or Hypomanic Episode, but the full criteria for one of these episodes need not be met.

CRITERIA FOR A MOOD DISORDER DUE TO A GENERAL MEDICAL CONDITION: [293.83]:

• A prominent or persistent disturbance in mood predominates in the clinical picture

• Characterized by one (or both of the following):

- depressed Mood or Markedly diminished interest or pleasure in all, or almost all, activities

- elevated, expansive, or irritated mood

• There is evidence from a history, physical examination, or laboratory finding that the disturbance is the direct physiological consequence of a General Medical Condition.

• The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

NOTES:

• 25% - 40% of individuals with certain neurological conditions (e.g. Parkinson’s Disease, Alzheimer’s Disease) will develop a marked depressive disturbance.

ADDITIONAL SPECIFIERS FOR A GENERAL MEDICAL DISORDER

· With Depressive Features

· With Major Depressive-Like Episode

· With Manic Features

· With Mixed Features

DO NOT CONFUSE WITH::

• Adjustment Disorder with Depressed Mood

• Does not occur exclusively during delirium

• Dementia due to a General Medical Condition

• Dementia of the Alzheimer’s Type

• Dementia of the Vascular Type

• Substance-induced Disorder

• Substance-induced Delirium

• Major Depressive Disorder

• Bipolar I Disorder

• Bipolar II Disorder

10.2 SLEEP APNEA

Sleep Apnea is a disorder in which a sleeping person repeatedly stops breathing (apnea) long enough to decrease the amount of oxygen in the blood and the brain and to increase the amount of carbon dioxide. Naps tend to be unrefreshing. There can be considerable variation in the intensity of sleepiness. The disorder may be the result of being overweight. Loud snoring is common, but is unrecognized by the individual. Individuals may also complain of nocturnal chest discomfort, choking, suffocation, or intense anxiety. Restless sleeping is typical.

CRITERIA FOR SLEEP APNEA [780.59]:

• Sleep disruption, leading to excessive sleeplessness or insomnia, that is judged to be due to a sleep-related breathing condition

• Snoring with episodes of gasping, choking

• Pauses in breathing and episodes of sudden awakening

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

NOTES:

• Must be described by someone who observes the person sleeping

• Best diagnosed in a sleep study laboratory

• Sleep Apnea occurs most often in overweight individuals between 40 and 80

• Prevalence of lifetime disorder is 1% or 10% of the adult population

• The occurrence is considerably higher in males that females (8:1)

• Noctunia (awakening in the middle of the night) is common and gets progressively worse

· Dry Mouth (awakening with a need to take a drink of water) is common

• May cause daytime fatigue

• The sleepiness is most evident in relaxing situations (e.g. reading, watching TV, boring meetings)

Mood disorders, Anxiety, and Dementia are common are common

Narcolepsy is also frequently related

Usually the course is progressive and can ultimately lead to premature death due to cardiovascular disease or arrhythmia

• The disorder may be associated with general medical or neurological conditions

ADDITIONAL SPECIFIERS FOR SLEEP APNEA:

· Obstructive Sleep Apnea (blockage in the upper airway)

· Central Sleep Apnea Syndrome (brain dysfunction controlling breathing)

· Central Alveolar Hypoventilation Syndrome (low arterial blood without blood hypopneas)

· Daytime fatigue

DO NOT CONFUSE WITH::

• Another General Medical Condition (other than a Breathing-Related Disorder)

• Direct physiological effects of a substance (e.g. A drug of abuse, a medication,or other treatment)

• Primary Insomnia

• Primary Hypersomnia

• Hypopneas (abnormal slow or shallow respiration)

• Circadian Rhythm Sleep Disorder

• Hypersomnia related to a Major Depressive Episode

• Asymptomatic Adults who Snore

• Nocturnal panic attacks

10.3 NARCOLEPSY

An uncommon sleep disorder, narcolepsy is marked by recurring irresistible attacks of refreshing sleep and intense intrusions of dream-like imagery (hallucinations) caused by REM into the transition period between sleep and awake during normal working hours. Cataplexy, Sleep Paralysis, and Hallucinations may be present. It may occur several times a day. The person may feel refreshed, but goes to sleep again minutes later.

CRITERIA FOR NARCOLEPSY [347]:

• Must occur daily over a period of 3 months

• Irresistible sleepiness that can occur at any time

• One or both of the following are present:

- Cataplexy (brief episodes of sudden bilateral loss of muscle tone, often in association with intense emotion)

- Recurring intrusions of REM sleep into the transition period between sleep and wakefulness (as manifested by hallucinations)

NOTES:

· Sleep may occur in inappropriate situations (i.e. while driving an automobile. attending a meeting, or carrying on a conversation)

· Individuals may be able to drive, talk, or work during some episodes

• Individuals may hesitate to participate in social activities fearing an attack

• Lifetime prevalence is 0.02% to 0.16%

• It may be difficult to diagnose, except in a sleep laboratory

• Falling asleep can be resisted only temporarily, but may be easily aroused

• Vivid dreaming (hallucinations) are frequently reported especially just before sleeping or waking up

· Narcolepsy and sleep apnea are frequently related

• Concurrent mental disorders are found in 40% of the cases

• Onset after age 40 is unusual

• Disturbed nocturnal sleeplessness occurs when individuals are 40 to 50

• Episodes may improve over time

ADDITIONAL SPECIFIERS FOR NARCOLEPSY:

• Cataplexy (momentary paralysis) (present in about 70% in individuals)

• Sleep paralysis (a person can not move after awaking)

• Hallucinations (vivid, intense dreams)

DO NOT CONFUSE WITH::

· Normal, periodic sleep patterns

· Ability to sleep during the day

· Sleep Apnea (but may be added later)

· Hypersomnia related to another mental illness

· Sleep deprivation

· Primary Hypersomnia

• Substance-Induced Sleep Disorder, Hypersomnia type

11.0 D I A G N O S I S A X I S

The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis I: Clinical disorders, including major mental disorders, learning disorders, substance abuse disorders, developmental disorders

Examples: Depression, BiPolar disorder, Anxiety disorders, schizophrenia, ADHD, Autism, anorexia nervosa

Axis II: Personality disorders and intellectual disabilities

Examples: Paranoid personality disorder, schizoid personality disorder, borderline personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive disorder, and intellection disabilities

Axis III: Acute medical conditions and physical disorders

Examples: brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders

Axis IV: Psychosocial and environmental factors contributing to the disorder

Examples: Coping skills, asbestos dangers, legal issues

Axis V: Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used to subjectively rate the social, occupational and psychological functioning of adults, e.g. how well a person is meeting various problems in daily life. The following ranges are typical:

91-100 No symptoms. Superior functioning in a wide range of activities, life’s problems never seem to get out–of-hand; is sought out by others because of his or her many positive qualities.

81-90 Absent or minimal symptoms (e.g. mild anxiety before a public speech), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (such as a typical family squabble).

71-80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g. difficulty concentrating after a family argument); no more than slight impairment in social, occupational or school function (e.g. temporarily falling behind in homework)

61-70 Some mild symptoms (e.g. depressed mood or mild insomnia) or some difficulty in social, occupational or school functioning (i.e. occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

51-60 Moderate symptoms (e.g. flat affect or occasional panic attacks) OR moderate difficulty in social, occupational or school functioning (i.e. few friends, conflicts with peers or co-workers).

41-50 Serious symptoms (e.g. suicidal ideation, severe obsessional rituals, frequent shoplifting OR any serious impairment in social, occupational or school functioning (e.g. no friends, unable to keep a job).

31-40 Some impairments in reality testing or communications (e.g. speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking or mood (e.g. depressed person avoids friends neglects family and is unable to work); or is boisterous.

21-30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g. sometimes incoherent, acts grossly inappropriately, suicidal preoccupation OR inability to function in almost all areas (e.g. stays in bed all day, no job, home or friends).

11-20 Some danger of hurting self or others (e.g. suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g. smears feces) OR gross impairment in communications (e.g. largely incoherent or mute).

1-10 Persistent danger of severely hurting self or others (e.g. recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

12.0 M E N T A L H E A L TH I N A R I Z O N A

12.1 REGIONAL BEHAVIOIRAL HEALTH AUTHORITIES

Mental Health is Arizona is managed by the Arizona Department of Health Services / Division of Behavioral Health. Services are generally delivered through Regional Behavioral Health Authorities, (RBHAs) which are managed by private companies and put out to bid periodically. Indian nations may use traditional REBA services, or manage their own Tribal RBHAs.

The following REBAs are currently in operation:

RBHA Name	Operator	Counties
Central AZ	Magellan	Maricopa & Apache.Jct..
NARBHA	NARBHA	Apache Coconino Mohave Navajo Yavapai
CBHS-4	Cenpatico	Gila Pinal
CBHS-5	CPSA	Pima
CBHS-3	Cenpatico	Cochise Graham Greenlee Santa Cruz
CBHS-2	Cenpatico	LaPaz Yuma
Tribal	Various	Various

Providers contract with RBHA to manage clinics (PNOs), provide Crisis services (Crisis Response Network), or provide other services.

Magellan Provider Network Organizations (PNOs) include:

· Southwest Network (adults, children and adolescents)

· Choices (adults)

· People of Color (adults, children and adolescents)

· Partners in Recovery (adults)

· Quality of Care Network (children and adolescents)

12.2 Enrollment by RBHA

As of December, 2011.

RHBA	GSA	Total Child	General Mental H	Substance Abuse	SMI Non T XIX	SMI T XIX	Total
Magellan	6	22,858	17,441	4,001	4,546	10,027	58,873
NARBHA	1	5,258	6,377	2,190	1,553	3,506	18,884
Yuma/LaPaz	2	1,252	1,453	350	110	347	3,512
SE AZ	3	1,465	1,516	486	259	473	4,199
Gila /Pinal	4	2,468	2,574	694	242	553	6,531
Pima	5	10,396	10,067	2,976	3,067	7,347	33,853
Tribal Nation		971	434	607	11	94	2,117
Arizona		44,660	39,862	11,304	9,788	22,342	127,956

13.0 G L O S S A R Y

ADD Attention Deficit Disorder: The inability of individuals (especially children) to maintain attention or problems with impulsivity and hyperactivity (ALSO abreviated ADHD)

Affect The general attitude behind an idea, such as feelings, pleasure, reactions (typically emotion)

Agoraphobia The fear/anxiety of being in a “trapped” situation, frequently in a public place. Many people do not leave home unless absolutely necessary

Anorexia Nervosa An eating disorder where the individual sees herself as being too fat

Apnea A condition where a sleeping person repeatedly stops breathing long enough to affect the amount of oxygen in the blood

Arrhythmia A variation in the normal rhythm of the heartbeat

Atypical Features Symptoms which fall short of the definition of a disorder

AXIS (SEE DIAGNOSIS AXIS)

Brief Depression Disorder Depressive episodes lasting from 2 days up to 2 weeks, occurring at least once a month for 12 (not associated with the menstrual cycle), which do not meet the criteria for a Major Depressive Disorder

Bulimia Nervosa Eating disorder which is characterized by binging and purging

Chronic The duration of an illness or therapy, typically 3 months

Circadian Rhythm Denoting a 24-hour period

Delirium An organic mental syndrome which is characterized by global impairment of cognitive functions, such as memory, perceptions, behavior

Delusional Disorder Unfounded, unrealistic, or belief that is without supporting evidence

Dementia Global impairment of cognitive functions, such as impairment of memory, reasoning, and behavior

Depression A state of lowered mood, often involving disturbances of sleep, energy, appetite or concentration

Diagnosis Axis An organization of psychalogical diagnosis

Dissociative Symptoms The feeling of being “disconnected” from reality

Dopamine A neurotransmitter which is needed for communications within in the brain. Typically, too much causes dysfunction in psychotic behavior

Dry Mouth A condition which usually occurs during the night when an individual must often get up to drink water

Eating Disorders Situations where the individual takes action to avoid digesting food to avoid gaining weight

Electroconvulsive A therapy using electric shock to treat mental

Therapy illnesespecially severe depression

Euphoria Abnormal sense of well-being

Euthymia A “high” following remission of a Major Depressive Episode

General Medical A prominent and persistent disturbance in mood thais

Condition judged to be the direct physical effects of a General Medical Condition. The General Medical Conditions must be unrelated to behavioral factors or processes.

Global Assessment of A subjective rating system for adult social,

Functioning (GAF) occupational and psychological behavior

GSA Geographical Service Area

Hallucinations Recurring, intense, dream-like imagery

Histrionic Disorder Attention Seeking Activities

Hyperthyroidism Excessive thyroid gland activity, typically marked by increased metabolic rate

Hypervigilance Excessive attention and focus on all internal and external stimuli

Hypopneas Abnormal slow of shallow breathing

Intercurrent Depressive Depression occurring during and

Symptoms modifying the course of another disease

Lability Emotional instability

Lifetime Prevalence The probability of the occurrence the disorder anytime during the lifetime of a normal individual

Light Therapy Bright light used to treat Seasonal Affective Disorder

Longitudinal Course These identifiers (typically With and Without Full

Specifiers Interepisode recovery) are used to characterize the extent of Bipolar Disorder

Minor Depressive Episodes of at least 2 weeks of depressive symptoms,

Disorder butfewer than the 5 items required for Major Depressive Disorder

n.o.s. Not Otherwise Specified

NARBHA Northern Arizona Regional Behavioral Authority

Narcolepsy Sleep Disorder characterized by sudden attacks of sleep, excessive daytime sleepiness, and sleep hallucinations during the day

Non-Title XIX From Title XIX of the Social Security Act which defines a person asnot eligible to ebroll in Medic-Aid (AHCCCS)

Paranoid Ideation Unfounded suspiciousness (of less than delusional proportions) that one is being harassed, persecuted, or unfairly treated.

PNO Provider Network Organization – A company which primarily operates BehavioraL Health Cliiics

Postpsychotic Episode A Major Depressive Episode that occurs during the residual phase of Schizophrenia

Premenstrual Dysphoric In most menstrual cycles during the past year,

Disorder year, symptoms must be severe enough to interfere with , school, or usual activities. Symptoms must be absent for at least one week per month

Psychological The science dealing with the mind and mental processes, especially as it applies to human behavior

Melancholy A depressed and unhappy emotional state with abnormal inhibition of mental and bodily activity

Psychomotor Agitation Generalized physical and emotional overactivity in response to internal/external stimuli, as in hypomania

PTSD Post-Traumatic Stress Disorder

Anxiety disorder attributable to an unusual experience that would be stressful to almost anyone

Rapid Cycling Occurrence of 4 or more episodes of affective illness per year; frequent mood fluctuations without discrete intermorbid periods; 24-48-hour cycles of affective disorders

Reality Testing A sometimes unsuccessful attempt to differentiate what is real from what is a delusion in one’s environment

REBA Regional Behavioral Health Authority

REM Rapid Eye Movement. A critical time during sleep when dreaming occurs. REM is important to minimize depression and narcolepsy

Schizophreniform Schizophrenia-like illness with acute onset, atypical form

Disorder and rapid recovery. These individuals often return to full functionality within 6 months of the episode

Schizotypal Disorder Non-psychotic personality disorder with cognitive disturbances similar to those of Schizophrenia

Seasonal Affective A Major Depressive Disorder characterized by an annual

Disorder (SAD) pattern of symptoms (Depression in Fall and Winter; Hypomania in Spring and Summer). It may be diagnosed as a variant of Bipolar Disorder, or may occur in Unipolar patients

Serotonin A hormone and neurotransmitter when found in smaller than normal amounts in the brain may cause depression in vulnerable subjects

Severe Mental Illness A condition of persons whoi are eighteen years of age or older and who, as a result of a mental disorder, exhibit emotional or behavioral functioning which is so impaired as to interfere substantially with their capacity to remain in the communiuty without supportive treatment or servicesa of a long-term or indefininate durationb. In these persons mental disability is severe and persistent, resulting in a long-term limitation of their functional capacities of daily living such as interpersional relationships, homemaking, self-care, employment and recreation.

Severity/Psychotic/ An indicator of a recent Major Depressive Episode

Remission Specifiers 1 - Mild Major Depressive Disorder

2 - Moderate Major Depressive Disorder

3 - Severe Without Psychotic Features

4 - Severe With Psychotic Features

5 - In Partial Remission

6 - In Full Remission

It is used as the 5th digit in the DSM code

Societal Dysfunction A marked and persistent fear of social or performance situations in which embarrassment may occur

Somatic Disorders The presence of physical symptoms that suggest a General Medical Condition, but are not fully explained upon further examination

T/RBHA Trribal or Regional Behavioral Health

Traumatic Effect An aversive state often accompanying the experience of catastrophic stressors. Often a precursor to PTSD