Diagnostic and Statistical Manual
DSM -- IV
March 24, 2012
Prepared
for
The
BiPolar Bears of Phoenix and Mesa
2012 W. Philip Sawyer
All
Rights Reserved
C
R E D I T S
DSM-IV 1994 American
Psychological Society
Definitions from WWW.medical-dictionary.com
Definitions from Websters Dictionary
Definitions from Dorlins Pocket Medical Dictionary 1995 E.B. Saunders Co.
Definitions from Lexicon of Psychiatry, Neurology and the
Neurosciences 1995 Williams
and Williams
Explanations from The Merick
Manual, Home Edition
1997 Merick & Co.
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 ( 5%) or appetite ()
- 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
individuals day-to-day experience (Thats 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
4.0 B
I P O L A R D I S O R D E R S
A type of
depressive disease, formerly called Manic-Depressive illness. Not nearly as prevalent as other forms
of depressive disorders, Bipolar Disorder involves cycles of depression and
elation or mania. Sometimes mood
switches are rapid and dramatic, but most often they are gradual. Mania often affects thinking, judgement
and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or
financial decisions may be made when an individual is in a manic phase. Bipolar disorder is often a chronic
recurring condition.
This section
includes Bipolar I Disorder, Bipolar II Disorder, Cyclothymia, and Bipolar Disorder
Not Otherwise Specified. Bipolar I
Disorder represents people with continuing alternating cycles of polarity,
while Bipolar II is used to describe individuals who are having lower levels of
mania. The remaining criteria are
used to specify the current (or most recent) episode in individuals who have
had recurrent mood swings.
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 Alzheimers 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 persons 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. Parkinsons
Disease, Alzheimers 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 Alzheimers 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, lifes 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
DSM-IV Diagnostic
and Statistical Manual of Mental Disorders The standard reference for mental disorders with checklists for each
diagnosis. 1994 American
Psychiatric Association
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 ones 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