LinkExchange Member Free Home Pages at GeoCities DIAGNOSIS The Diagnostic and Statistical Manual, IV is the American Psychiatric Association's manual of diagnosis and classification. The diagnosis of mental illness is called the five-axis diagnosis. Certain things belong on each of these five axes. This means that a professional needs to have information about the patient's current level of functioning, physical health, education and employment history, and family background. The arrangement of information on the axes is as follows: Axis I: Clinical syndromes and/or other areas of concern (i.e. marriage counseling or occupational problems). Axis II: Personality disorders and mental retardation. Axis III: Medical conditions which may impact emotions. Axis IV: Psychosocial stressors (death, divorce, loss of job, etc.) Axis V: Global assessment of functioning. To make a diagnosis, psychiatrists and psychologists use several techniques. The components of this evaluation are the interview, testing, and observation. In the interview, the patient will be asked about legal, educational, occupational, medical, and family history. In addition, he/she will be asked about the reason for the evaluation. Various types of tests can be used in psychological evaluation. Usually three tests are given: an IQ test, a projective test, and a self-report inventory. The most common IQ tests are the Stanford-Binet and the Wechsler. Projective tests include the Rorschach inkblot test and the TAT. The most common self-report inventory is the Minnesota Multiphasic Personality Inventory (MMPI), which is a very comprehensive set of true-or-false questions in which the person evaluates his experiences. The MMPI enables an evaluator to examine tendencies toward certain disorders as well as tendencies toward dishonesty in reporting on the part of the patient. During the evaluation, the evaluator may make notes about appearance, clarity and consistency of communication, and mood. The notes from this observation can be compared with the rest of the data from the evaluation to make a diagnosis. Problems with diagnosis include inconsistency of data collected, bias of the evaluator, insufficient information, comfort with diagnosing specific disorders, and poor performance due to circumstances. CATEGORIES OF BIPOLAR AFFECTIVE DISORDER Bipolar I: Mania and depression. Bipolar II: Hypomania and depression. Bipolar III: Cyclothymic disorders. Bipolar IV: Hypomania or mania precipitated by antidepressant drugs. Bipolar V: Depressed patients with bipolar relatives. Bipolar VI: Mania without depression. List of Symptoms This is extracted from Manic-Depressive Illness, by Frederick K. Goodwin & Kay Redfield Jamison, Page 92, Table 5-3 DSM-III-R "Criteria for Manic Episode." Note: A "Manic Syndrome" is defined as including criteria A, B, And C below A "Hypomanic Syndrome" is defined as including criteria A and B but not C (DSM-III-R has added criterion C to the definition of "Manic Syndrome," thereby differentiating it from "Hypomanic Syndrome." In DSM-III, criteria for Hypomania were listed under Cyclothemia. A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood. (DSM-III called for one or more distinct periods; mood must be prominent part of the illness and might alternate with depressive mood.) B. During the period of mood disturbance, at least 3 of the following symptoms have persisted (4 if only irritable) and have been present to a significant degree 1.inflated self-esteem or grandiosity (DSM-III note that grandiosity may be delusional) 2.decrease need for sleep, e.g. fells rested after 3 hours 3.unusually talkative or pressure to continue talking 4.flight of ideas or subjective experience that thoughts are racing 5.distractibility, i.e. attention too easily drawn to unimportant or irrelevant external stimuli 6.increase in goal-directed activity (social, work, school, sex) or psychomotor agitation 7.excessive involvement in pleasurable activities which have a high potential for painful consequences, e.g. buying sprees, sexual indiscretions, or foolish investments C. Mood disturbance sufficiently severe to cause marked impairment in occupational functioning in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or to others. (DSM-II-R has added this criterion) D. At no time during the disturbance have there been delusions or hallucinations for s long as 2 weeks in the absence of prominent mood symptoms (i.e., before development or after remission) (DSM-III also excluded bizarre behavior) E. Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder(Paranoid Disorder in DSM-III), or Psychotic Disorder NOS (DSM-III-R had added Psychotic Disorder NOS) F. It cannot be established that an organic factor initiated and maintained the disturbance. Note: Somatic antidepressant treatment (e.g. drugs, ECT) that apparently precipitates a mod disturbance should not be considered an etiologic organic factor (DSN-III-R has added this note) Manic Episode Codes: 5th-digit code numbers and criteria for severity of current date of Bipolar Disorder, Manic or Mixed Mild: meets minimum symptoms criteria (or almost meets symptom criteria if a previous episode) Moderate: extreme increase in activity or impairment of judgment Severe, without Psychotic Features: almost continual supervision required in order to prevent harm to self or others (DSM-III-R has added these 3 specifications) With Psychotic Features: delusions, hallucinations, or catatonic symptoms. If possible specify if mood-congruent or mood-incongruent Mood incongruent psychotic features: delusions or hallucinations whose content is entirely consistent with the typical manic themes of inflated worth, power, knowledge, identity, etc. (DSM-III also included flight of ideas and unawareness that speech is not understandable) Mood-incongruent psychotic features: Either A or B: A. delusions or hallucinations whose content does not involve the typical manic themes mentioned above. Also included are persecutory delusions, though insertions, and delusions of being controlled B. catatonic symptoms, e.g., stupor, mutism, negativism, and posturing In Partial Remission: full criteria were previously, but not currently, met, some sing or symptoms have persisted In Full Remission: full criteria were previously met, but there are no sign or symptoms for a least 6 months DSM-III-R has divided and clarified the DSM-III "In Remission" category riteria for Manic Episode (DSM-IV, p.332) A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). B. 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: 1.inflated self-esteem or grandiosity 2.decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3.more talkative than usual or pressure to keep talking 4.flight of ideas or subjective experience that thoughts are racing 5.distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 6.increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7.excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.) C. The symptoms do not meet criteria for a Mixed Episode. D. 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. E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) 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. If five or more of the following symptoms have been present in either you or someone you know for more than two weeks, please talk to your doctor about the possibility of depression being present. Keep in mind that these symptoms could indicate a medical condition other than depression. Feelings of sadness and/or irritability Loss of interest or pleasure in activities normally enjoyed Changes in weight or appetite Changes in sleeping pattern Feelings of guilt, hopelessness, or worthlessness Inability to concentrate, remember things, or make decisions Constant fatigue or loss of energy Observable restlessness or decreased activity Recurrent thoughts of suicide or death robbie@siscom.net HOME PAGE THE AUTHOR (ME) IS A MEMBER OF This page hosted by Get your own Free Home Page
The Diagnostic and Statistical Manual, IV is the American Psychiatric Association's manual of diagnosis and classification. The diagnosis of mental illness is called the five-axis diagnosis. Certain things belong on each of these five axes. This means that a professional needs to have information about the patient's current level of functioning, physical health, education and employment history, and family background. The arrangement of information on the axes is as follows: Axis I: Clinical syndromes and/or other areas of concern (i.e. marriage counseling or occupational problems). Axis II: Personality disorders and mental retardation. Axis III: Medical conditions which may impact emotions. Axis IV: Psychosocial stressors (death, divorce, loss of job, etc.) Axis V: Global assessment of functioning. To make a diagnosis, psychiatrists and psychologists use several techniques. The components of this evaluation are the interview, testing, and observation. In the interview, the patient will be asked about legal, educational, occupational, medical, and family history. In addition, he/she will be asked about the reason for the evaluation. Various types of tests can be used in psychological evaluation. Usually three tests are given: an IQ test, a projective test, and a self-report inventory. The most common IQ tests are the Stanford-Binet and the Wechsler. Projective tests include the Rorschach inkblot test and the TAT. The most common self-report inventory is the Minnesota Multiphasic Personality Inventory (MMPI), which is a very comprehensive set of true-or-false questions in which the person evaluates his experiences. The MMPI enables an evaluator to examine tendencies toward certain disorders as well as tendencies toward dishonesty in reporting on the part of the patient. During the evaluation, the evaluator may make notes about appearance, clarity and consistency of communication, and mood. The notes from this observation can be compared with the rest of the data from the evaluation to make a diagnosis. Problems with diagnosis include inconsistency of data collected, bias of the evaluator, insufficient information, comfort with diagnosing specific disorders, and poor performance due to circumstances.
The diagnosis of mental illness is called the five-axis diagnosis. Certain things belong on each of these five axes. This means that a professional needs to have information about the patient's current level of functioning, physical health, education and employment history, and family background. The arrangement of information on the axes is as follows: Axis I: Clinical syndromes and/or other areas of concern (i.e. marriage counseling or occupational problems). Axis II: Personality disorders and mental retardation. Axis III: Medical conditions which may impact emotions. Axis IV: Psychosocial stressors (death, divorce, loss of job, etc.) Axis V: Global assessment of functioning.
To make a diagnosis, psychiatrists and psychologists use several techniques. The components of this evaluation are the interview, testing, and observation. In the interview, the patient will be asked about legal, educational, occupational, medical, and family history. In addition, he/she will be asked about the reason for the evaluation.
Various types of tests can be used in psychological evaluation. Usually three tests are given: an IQ test, a projective test, and a self-report inventory. The most common IQ tests are the Stanford-Binet and the Wechsler. Projective tests include the Rorschach inkblot test and the TAT. The most common self-report inventory is the Minnesota Multiphasic Personality Inventory (MMPI), which is a very comprehensive set of true-or-false questions in which the person evaluates his experiences. The MMPI enables an evaluator to examine tendencies toward certain disorders as well as tendencies toward dishonesty in reporting on the part of the patient.
During the evaluation, the evaluator may make notes about appearance, clarity and consistency of communication, and mood. The notes from this observation can be compared with the rest of the data from the evaluation to make a diagnosis.
Problems with diagnosis include inconsistency of data collected, bias of the evaluator, insufficient information, comfort with diagnosing specific disorders, and poor performance due to circumstances.
CATEGORIES OF BIPOLAR AFFECTIVE DISORDER Bipolar I: Mania and depression. Bipolar II: Hypomania and depression. Bipolar III: Cyclothymic disorders. Bipolar IV: Hypomania or mania precipitated by antidepressant drugs. Bipolar V: Depressed patients with bipolar relatives. Bipolar VI: Mania without depression. List of Symptoms This is extracted from Manic-Depressive Illness, by Frederick K. Goodwin & Kay Redfield Jamison, Page 92, Table 5-3 DSM-III-R "Criteria for Manic Episode." Note: A "Manic Syndrome" is defined as including criteria A, B, And C below A "Hypomanic Syndrome" is defined as including criteria A and B but not C (DSM-III-R has added criterion C to the definition of "Manic Syndrome," thereby differentiating it from "Hypomanic Syndrome." In DSM-III, criteria for Hypomania were listed under Cyclothemia. A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood. (DSM-III called for one or more distinct periods; mood must be prominent part of the illness and might alternate with depressive mood.) B. During the period of mood disturbance, at least 3 of the following symptoms have persisted (4 if only irritable) and have been present to a significant degree 1.inflated self-esteem or grandiosity (DSM-III note that grandiosity may be delusional) 2.decrease need for sleep, e.g. fells rested after 3 hours 3.unusually talkative or pressure to continue talking 4.flight of ideas or subjective experience that thoughts are racing 5.distractibility, i.e. attention too easily drawn to unimportant or irrelevant external stimuli 6.increase in goal-directed activity (social, work, school, sex) or psychomotor agitation 7.excessive involvement in pleasurable activities which have a high potential for painful consequences, e.g. buying sprees, sexual indiscretions, or foolish investments C. Mood disturbance sufficiently severe to cause marked impairment in occupational functioning in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or to others. (DSM-II-R has added this criterion) D. At no time during the disturbance have there been delusions or hallucinations for s long as 2 weeks in the absence of prominent mood symptoms (i.e., before development or after remission) (DSM-III also excluded bizarre behavior) E. Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder(Paranoid Disorder in DSM-III), or Psychotic Disorder NOS (DSM-III-R had added Psychotic Disorder NOS) F. It cannot be established that an organic factor initiated and maintained the disturbance. Note: Somatic antidepressant treatment (e.g. drugs, ECT) that apparently precipitates a mod disturbance should not be considered an etiologic organic factor (DSN-III-R has added this note) Manic Episode Codes: 5th-digit code numbers and criteria for severity of current date of Bipolar Disorder, Manic or Mixed Mild: meets minimum symptoms criteria (or almost meets symptom criteria if a previous episode) Moderate: extreme increase in activity or impairment of judgment Severe, without Psychotic Features: almost continual supervision required in order to prevent harm to self or others (DSM-III-R has added these 3 specifications) With Psychotic Features: delusions, hallucinations, or catatonic symptoms. If possible specify if mood-congruent or mood-incongruent Mood incongruent psychotic features: delusions or hallucinations whose content is entirely consistent with the typical manic themes of inflated worth, power, knowledge, identity, etc. (DSM-III also included flight of ideas and unawareness that speech is not understandable) Mood-incongruent psychotic features: Either A or B: A. delusions or hallucinations whose content does not involve the typical manic themes mentioned above. Also included are persecutory delusions, though insertions, and delusions of being controlled B. catatonic symptoms, e.g., stupor, mutism, negativism, and posturing In Partial Remission: full criteria were previously, but not currently, met, some sing or symptoms have persisted In Full Remission: full criteria were previously met, but there are no sign or symptoms for a least 6 months
Bipolar I: Mania and depression. Bipolar II: Hypomania and depression. Bipolar III: Cyclothymic disorders. Bipolar IV: Hypomania or mania precipitated by antidepressant drugs. Bipolar V: Depressed patients with bipolar relatives. Bipolar VI: Mania without depression. List of Symptoms This is extracted from Manic-Depressive Illness, by Frederick K. Goodwin & Kay Redfield Jamison, Page 92, Table 5-3 DSM-III-R "Criteria for Manic Episode." Note: A "Manic Syndrome" is defined as including criteria A, B, And C below A "Hypomanic Syndrome" is defined as including criteria A and B but not C (DSM-III-R has added criterion C to the definition of "Manic Syndrome," thereby differentiating it from "Hypomanic Syndrome." In DSM-III, criteria for Hypomania were listed under Cyclothemia. A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood. (DSM-III called for one or more distinct periods; mood must be prominent part of the illness and might alternate with depressive mood.) B. During the period of mood disturbance, at least 3 of the following symptoms have persisted (4 if only irritable) and have been present to a significant degree 1.inflated self-esteem or grandiosity (DSM-III note that grandiosity may be delusional) 2.decrease need for sleep, e.g. fells rested after 3 hours 3.unusually talkative or pressure to continue talking 4.flight of ideas or subjective experience that thoughts are racing 5.distractibility, i.e. attention too easily drawn to unimportant or irrelevant external stimuli 6.increase in goal-directed activity (social, work, school, sex) or psychomotor agitation 7.excessive involvement in pleasurable activities which have a high potential for painful consequences, e.g. buying sprees, sexual indiscretions, or foolish investments C. Mood disturbance sufficiently severe to cause marked impairment in occupational functioning in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or to others. (DSM-II-R has added this criterion) D. At no time during the disturbance have there been delusions or hallucinations for s long as 2 weeks in the absence of prominent mood symptoms (i.e., before development or after remission) (DSM-III also excluded bizarre behavior) E. Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder(Paranoid Disorder in DSM-III), or Psychotic Disorder NOS (DSM-III-R had added Psychotic Disorder NOS) F. It cannot be established that an organic factor initiated and maintained the disturbance. Note: Somatic antidepressant treatment (e.g. drugs, ECT) that apparently precipitates a mod disturbance should not be considered an etiologic organic factor (DSN-III-R has added this note) Manic Episode Codes: 5th-digit code numbers and criteria for severity of current date of Bipolar Disorder, Manic or Mixed Mild: meets minimum symptoms criteria (or almost meets symptom criteria if a previous episode) Moderate: extreme increase in activity or impairment of judgment Severe, without Psychotic Features: almost continual supervision required in order to prevent harm to self or others (DSM-III-R has added these 3 specifications) With Psychotic Features: delusions, hallucinations, or catatonic symptoms. If possible specify if mood-congruent or mood-incongruent Mood incongruent psychotic features: delusions or hallucinations whose content is entirely consistent with the typical manic themes of inflated worth, power, knowledge, identity, etc. (DSM-III also included flight of ideas and unawareness that speech is not understandable) Mood-incongruent psychotic features: Either A or B: A. delusions or hallucinations whose content does not involve the typical manic themes mentioned above. Also included are persecutory delusions, though insertions, and delusions of being controlled B. catatonic symptoms, e.g., stupor, mutism, negativism, and posturing In Partial Remission: full criteria were previously, but not currently, met, some sing or symptoms have persisted In Full Remission: full criteria were previously met, but there are no sign or symptoms for a least 6 months
This is extracted from Manic-Depressive Illness, by Frederick K. Goodwin & Kay Redfield Jamison, Page 92, Table 5-3 DSM-III-R "Criteria for Manic Episode." Note: A "Manic Syndrome" is defined as including criteria A, B, And C below A "Hypomanic Syndrome" is defined as including criteria A and B but not C (DSM-III-R has added criterion C to the definition of "Manic Syndrome," thereby differentiating it from "Hypomanic Syndrome." In DSM-III, criteria for Hypomania were listed under Cyclothemia.
Manic Episode Codes: 5th-digit code numbers and criteria for severity of current date of Bipolar Disorder, Manic or Mixed
A. delusions or hallucinations whose content does not involve the typical manic themes mentioned above. Also included are persecutory delusions, though insertions, and delusions of being controlled B. catatonic symptoms, e.g., stupor, mutism, negativism, and posturing In Partial Remission: full criteria were previously, but not currently, met, some sing or symptoms have persisted In Full Remission: full criteria were previously met, but there are no sign or symptoms for a least 6 months
DSM-III-R has divided and clarified the DSM-III "In Remission" category riteria for Manic Episode (DSM-IV, p.332)
If five or more of the following symptoms have been present in either you or someone you know for more than two weeks, please talk to your doctor about the possibility of depression being present. Keep in mind that these symptoms could indicate a medical condition other than depression.
Feelings of sadness and/or irritability Loss of interest or pleasure in activities normally enjoyed Changes in weight or appetite Changes in sleeping pattern Feelings of guilt, hopelessness, or worthlessness Inability to concentrate, remember things, or make decisions Constant fatigue or loss of energy Observable restlessness or decreased activity Recurrent thoughts of suicide or death
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