DSM-IV - Panic Attack
Labels:
Anxiety Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Note: A panic attack is not a codable disorder. Code the specific diagnosis in which the panic attack occurs (e.g., panic disorder with agoraphobia).
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
- palpitations, pounding heart, or accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feeling of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded, or faint
- derealization (feelings of unreality) or depersonalization (being detached from oneself)
- fear of losing control or going crazy
- fear of dying
- paresthesias (numbness or tingling sensations)
- chills or hot flushes
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DSM-IV - Longitudinal Course Specifiers
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if (can be applied to recurrent major depressive disorder or bipolar I or II disorder):
With full interepisode recovery: if full remission is attained between the two most recent mood episodes
Without full interepisode recovery: if full remission is not attained between the two most recent mood episodes
With full interepisode recovery: if full remission is attained between the two most recent mood episodes
Without full interepisode recovery: if full remission is not attained between the two most recent mood episodes
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DSM-IV - Seasonal Pattern Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
With seasonal pattern (can be applied to the pattern of major depressive episodes in bipolar I disorder, bipolar II disorder, or major depressive disorder, recurrent)
With seasonal pattern (can be applied to the pattern of major depressive episodes in bipolar I disorder, bipolar II disorder, or major depressive disorder, recurrent)
- There has been a regular temporal relationship between the onset of major depressive episodes in bipolar I or bipolar II disorder or major depressive disorder, recurrent, and a particular time of the year (e.g., regular appearance of the major depressive episode in the fall or winter).
Note: Do not include cases in which there is an obvious effect of seasonal-related psychosocial stressors (e.g., regularly being unemployed every winter). - Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of the year (e.g., depression disappears in the spring).
- In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined in Criteria A and B, and no nonseasonal major depressive episodes have occurred during that same period.
- Seasonal major depressive episodes (as described above) substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individual's lifetime.
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DSM-IV - Rapid-Cycling Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
With rapid cycling (can be applied to bipolar I disorder or bipolar II disorder)
At least four episodes of a mood disturbance in the previous 12 months that meet criteria for a major depressive, manic, mixed, or hypomanic episode.
Note: Episodes are demarcated either by partial or full remission for at least 2 months or a switch to an episode of opposite polarity (e.g., major depressive episode to manic episode).
With rapid cycling (can be applied to bipolar I disorder or bipolar II disorder)
At least four episodes of a mood disturbance in the previous 12 months that meet criteria for a major depressive, manic, mixed, or hypomanic episode.
Note: Episodes are demarcated either by partial or full remission for at least 2 months or a switch to an episode of opposite polarity (e.g., major depressive episode to manic episode).
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DSM-IV - Chronic Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
Chronic (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or II disorder only if it is the most recent type of mood episode)
Full criteria for a major depressive episode have been met continuously for at least the past 2 years.
Chronic (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or II disorder only if it is the most recent type of mood episode)
Full criteria for a major depressive episode have been met continuously for at least the past 2 years.
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DSM-IV - Postpartum Onset Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
With postpartum onset (can be applied to the current or most recent major depressive, manic, or mixed episode in major depressive disorder, bipolar I disorder, or bipolar II disorder; or to brief psychotic disorder)
Onset of episode within 4 weeks postpartum
With postpartum onset (can be applied to the current or most recent major depressive, manic, or mixed episode in major depressive disorder, bipolar I disorder, or bipolar II disorder; or to brief psychotic disorder)
Onset of episode within 4 weeks postpartum
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DSM-IV - Catatonic Features Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
With catatonic features (can be applied to the current or most recent major depressive episode, manic episode, or mixed episode in major depressive disorder, bipolar I disorder, or bipolar II disorder)
The clinical picture is dominated by at least two of the following:
With catatonic features (can be applied to the current or most recent major depressive episode, manic episode, or mixed episode in major depressive disorder, bipolar I disorder, or bipolar II disorder)
The clinical picture is dominated by at least two of the following:
- motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
- excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
- extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
- peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
- echolalia or echopraxia
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DSM-IV - Atypical Features Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
With atypical features (can be applied when these features predominate during the most recent 2 weeks of a current major depressive episode in major depressive disorder or in bipolar I or bipolar II disorder when a current major depressive episode is the most recent type of mood episode, or when these features predominate during the most recent 2 years of dysthymic disorder; if the major depressive episode is not current, it applies if the feature predominates during any 2-week period)
With atypical features (can be applied when these features predominate during the most recent 2 weeks of a current major depressive episode in major depressive disorder or in bipolar I or bipolar II disorder when a current major depressive episode is the most recent type of mood episode, or when these features predominate during the most recent 2 years of dysthymic disorder; if the major depressive episode is not current, it applies if the feature predominates during any 2-week period)
- Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
- Two (or more) of the following features:
- significant weight gain or increase in appetite
- hypersomnia
- leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
- long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
- Criteria are not met for with melancholic features or with catatonic features during the same episode.
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DSM-IV - Melancholic Features Specifier
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
Specify if:
With melancholic features (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or bipolar II disorder only if it is the most recent type of mood episode)
With melancholic features (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or bipolar II disorder only if it is the most recent type of mood episode)
- Either of the following, occurring during the most severe period of the current episode:
- loss of pleasure in all, or almost all, activities
- lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
- Three (or more) of the following:
- distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
- depression regularly worse in the morning
- early morning awakening (at least 2 hours before usual time of awakening)
- marked psychomotor retardation or agitation
- significant anorexia or weight loss
- excessive or inappropriate guilt
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DSM-IV - Mixed Episode
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
- 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 usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
- The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: 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.
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DSM-IV - Hypomanic Episode
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
- A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
- During the period of mood disturbance, three (or more) of the following symptoms have persisted (four 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., 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., 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 uncharacteristic of the person when not symptomatic.
- The disturbance in mood and the change in functioning are observable by others.
- The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
- The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: 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.
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DSM-IV - Manic Episode
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
- A distinct period of abnormally 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, three (or more) of the following symptoms have persisted (four 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., 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)
- The symptoms do not meet criteria for a mixed episode.
- 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.
- The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: 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.
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DSM-IV - Major Depressive Episode
Labels:
Mood Disorders
[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...
- Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.- 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). Note: In children and adolescents, can be irritable mood
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
- significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
- The symptoms do not meet criteria for a mixed episode.
- 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).
- The symptoms are not better accounted for by 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 symptoms, or psychomotor retardation.
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