Overview plus moods and substance

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Information about Overview plus moods and substance

Published on August 9, 2007

Author: Amateur

Source: authorstream.com

DSM-IV TR INTRODUCTION:  DSM-IV TR INTRODUCTION Dr. Haydn Bush DSM IV MULTIAXIAL ASSESSMENT:  DSM IV MULTIAXIAL ASSESSMENT AXIS I CLINICAL DISORDERSOTHER DISORDERS THAT MAY BE A FOCUS OF CLINICAL ATTENTION:  AXIS I CLINICAL DISORDERS OTHER DISORDERS THAT MAY BE A FOCUS OF CLINICAL ATTENTION Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence (excluding Mental Retardation, which is diagnosed on Axis II) Delirium, Dementia, and Amnestic and other Cognitive Disorders Substance-Related Disorders Schizophrenia and Other Psychotic Disorders Mood Disorders Anxiety Disorders AXIS I CONTINUED:  AXIS I CONTINUED Somatoform Disorders Factitious Disorders Dissociative Disorders Sexual and Gender Identity Disorders Eating Disorders Sleep Disorders Impulse Control Disorders Adjustment Disorders Other Conditions that may be a focus of Clinical Attention AXIS IIPERSONALITY DISORDERS:  AXIS II PERSONALITY DISORDERS Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder AXIS II CONTINUED:  AXIS II CONTINUED Avoidant Personality Disorder Dependent personality Disorder Obsessive-Compulsive Personality Disorder Personality Disorder Not Otherwise Specified Mental Retardation AXIS IIIGENERAL MEDICAL CONDITIONS (ICD 10):  AXIS III GENERAL MEDICAL CONDITIONS (ICD 10) Infectious and Parasitic Disease Neoplasms Diseases of the Blood and Blood-forming Organs Diseases of the Nervous System and Sense Organs Diseases of the Circulatory System Diseases of the Respiratory System Diseases of the Digestive System AXIS III CONTINUED:  AXIS III CONTINUED Diseases of the Genitourinary System Complications of Pregnancy, Childbirth, and the Puerperium Diseases of the Skin and Subcutaneous Tissue Diseases of the Musculoskeletal System and connective Tissue Congenital Anomalies Certain Conditions Originating in the Perinatal Period Symptoms, Signs, and Ill defined Conditions Injury and Poisoning AXIS IVPSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS:  AXIS IV PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS Problems with primary support group Problems related to the social environment Educational problems Occupational problems Housing problems Economic problems Problems with access to health care services Problems related to interaction with the legal system/crime Other psychosocial and environmental problems AXIS VGLOBAL ASSESSMENT OF FUNCTIONING:  AXIS V GLOBAL ASSESSMENT OF FUNCTIONING 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. No symptoms. Absent or minimal symptoms (e.g., mild anxiety before an exam), 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 (e.g., an occasional argument with family members). If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). AXIS V CONTINUED:  AXIS V CONTINUED Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. Moderate symptoms (e.g., flat effect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g.’ few friends, conflicts with peers or co-workers). 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). AXIS V CONTINUED:  AXIS V CONTINUED Some impairment in reality testing or communication (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 man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). 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). AXIS V CONTINUED:  AXIS V CONTINUED Some dangers 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 communication (e.g., largely incoherent or mute). 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. Inadequate information. DSM IV TEXT DESCRIPTIONS OF DISORDERS:  DSM IV TEXT DESCRIPTIONS OF DISORDERS FRAMEWORK Diagnostic Features Associated Features and Disorders Prevalence Course Familial Pattern Differential Diagnosis SUMMARY OF CODING DIGIT APPLICATIONS:  SUMMARY OF CODING DIGIT APPLICATIONS First three digits designates major clinical disorders e.g., 296= Mood Disorder Fourth Digit is a specifier Fifth Digit indicates features /severity/remission status TEST: What is 296.34 MI or MC DIAGNOSTIC EXCLUSION CRITERIA I:  DIAGNOSTIC EXCLUSION CRITERIA I A 45 year old lawyer appealed his conviction (by the provincial Law Society) of negligence due to alcohol abuse to the supreme court of New Brunswick. His defense was that he suffered from major depression and dysthymia. I was subpoenaed by the law society to refute the diagnosis of depression and dysthymia using explicit information from the defendant (clinical interviews) and DSM IV. How? DIAGNOSTIC EXCLUSION CRITERIA II:  DIAGNOSTIC EXCLUSION CRITERIA II The case rested on two specific items in DSM IV i)The mood disorder (by detailed history) was judged to be etiologically related to substance abuse (intoxication and withdrawal –page 380) ii) The dysthymia symptoms were due to the direct physiological effects of a substance (381 note G). PERSONALITY DISORDERS:  PERSONALITY DISORDERS Cluster A Paranoid Personality Disorder 301.10 Schizoid Personality Disorder 301.20 Schizotypal Personality Disorder 301.22 PERSONALITY DISORDERS CONTINUED:  PERSONALITY DISORDERS CONTINUED Cluster B Antisocial Personality Disorder 301.7 Borderline Personality Disorder 301.83 Narcissistic Personality Disorder 301.81 Histrionic Personality Disorder 301.50 PERSONALITY DISORDERS CONTINUED:  PERSONALITY DISORDERS CONTINUED Cluster C Avoidant Personality Disorder 301.82 Dependant Personality Disorder 301.6 Obsessive Compulsive Personality Disorder 301.4 Personality Disorder Not Otherwise Specified 301.9 MAJOR DEPRESSIVE EPISODEOTHER INCLUSION & EXCLUSION CRITERIA:  MAJOR DEPRESSIVE EPISODE OTHER INCLUSION andamp; EXCLUSION CRITERIA The symptoms do meet criteria for a Mixed Episode (see p. 365). The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). MAJOR DEPRESSIVE EPISODE CONTINUED:  MAJOR DEPRESSIVE EPISODE CONTINUED The symptoms are not better accounted for by the Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic, or psychomotor retardation. RECORDING PROCEDURES:  RECORDING PROCEDURES The diagnostic codes for Major Depressive Disorder are selected as follows: The first three digits are 296. The fourth digit is either 2 (if there is only a single Major Depressive Episode) or 3 (if there are recurrent Major Depressive Episodes). RECORDING PROCEDURES CONTINUED:  RECORDING PROCEDURES CONTINUED If the criteria are currently met for a Major Depressive Episode, the fifth digit indicates the current severity as follows: 1 for Mild severity, 2 for Moderate severity, 3 for Severe Without Psychotic Features, 4 for Severe With Psychotic Features. If the criteria are not currently met for a Major Depressive Episode, the fifth digit indicates the current clinical status of the Major Depressive Disorder as follows: 5 for In Partial Remission, 6 for In Full Remission. If the severity of the current episode or the current remission status of the disorder is unspecified, then the fifth digit is 0. Other specifiers for Major Depressive Disorder cannot be coded. SUBSTANCE RELATED DISORDERS:OVERVIEW OF DSM IV TR:  SUBSTANCE RELATED DISORDERS: OVERVIEW OF DSM IV TR AGENDA:  AGENDA DSM IV organization Definitions Substance induced versus independent diagnoses Coding information Classification of common terms (slang) Summary SUBSTANCE RELATED DISORDERS:  SUBSTANCE RELATED DISORDERS Substance Abuse (SA) Substance Dependence (SD) Substance intoxication (SI) Substance withdrawal (SW) Substance induced conditions (SIC) Substance Use Disorders Substance Induced Disorders SUBSTANCE: ANY MEDICATION, DRUG OF ABUSE OR TOXIN1:  SUBSTANCE: ANY MEDICATION, DRUG OF ABUSE OR TOXIN1 Alcohol Amphetamines Caffeine Cannabis Cocaine Hallucinogens Inhalants Nicotine Opioids Phencyclidine Sedatives/hypnotics Polysubstance Other 1. Alphabetically arranged; 11 Classes SUBSTANCE ABUSE:  SUBSTANCE ABUSE Maladaptive pattern of substance use, leading to distress or impairment, ≥1 over 12 months: Failure to fulfill role obligations Use in physically hazardous situations Legal problems Use despite social/interpersonal problems Never met criteria for substance dependence SUBSTANCE DEPENDENCE:  SUBSTANCE DEPENDENCE Maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by ≥ 3, of the following at any time in a 12 month period: With or Without physiological dependence Six course specifies: Four remission related (require none criteria for SD or SA present for 1 ) (i) Early (a) full, or (b) partial remission (i) Sustained (a) full, or (b) partial remission, Two others (i) On agonist therapy (ii) In a controlled environment SUBSTANCE DEPENDENCE:  SUBSTANCE DEPENDENCE Tolerance Withdrawal Taken in larger amounts or over longer time Desire or unsuccessful efforts to cut down Time spent obtaining/using/recovering Give up/reduce activities Use despite knowledge of physical/psychological problems SUBSTANCE INDUCED DISORDERS:  SUBSTANCE INDUCED DISORDERS Only a limited number of conditions Psychotic Mood Anxiety Sleep Sexual Dementia Amnesia Refer to table DIAGNOSES ASSOCIATED WITH CLASS OF SUBSTANCE :  DIAGNOSES ASSOCIATED WITH CLASS OF SUBSTANCE SUBSTANCE INDUCED CONDITIONS vs. INDEPENDENT CONDITIONS:  SUBSTANCE INDUCED CONDITIONS vs. INDEPENDENT CONDITIONS Presentation linked to substance use (with onset during intoxication/withdrawal) Symptoms do not precede use Symptoms do not persist after use (*4 weeks) Symptoms not in excess of expected with amount and duration of substance No history of non substance related episodes CODING INFORMATION:  CODING INFORMATION Specify substance in class after appropriate code (e.g. 304.00 Heroin Dependence not 304 Opioid Dependence) If criteria met for multiple substances, make multiple diagnoses (Polysubstance Dependence only diagnosed with no one substance predominates or independent criteria met) RECORDING FOR OTHER SUBSTANCE-INDUCED MENTAL DISORDER:  RECORDING FOR OTHER SUBSTANCE-INDUCED MENTAL DISORDER When more than one substance judged to play significant role in development of symptoms, each should be listed separately If substance judged to be etiological factor, but specific substance or class of substances is unknown, the class 'Unknown Substance' should be used HOW COMMON TERMS ARE CLASSIFIED:  HOW COMMON TERMS ARE CLASSIFIED 'DT’s' - Alcohol withdrawal delirium 'Alcohol Hallucinosis' - Alcohol withdrawal with perceptual disturbances 'Acid burns' - Hallucinogen Persisting Perception Disorder (Flashbacks)

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