10.5 Tables of Mental Disorders secondary to General Medical Conditions

Table 10.5-3 DSM-IV-TR Criteria for Mood Disorder Due to a General Medical Condition
  1. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
    1. Depressed mood or markedly diminished pleasure in all, or almost all, activities
    2. Elevated, expansive, or irritable mood.
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., adjustment disorder with depressed mood in response to the stress of having a general medical condition).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify:
   With depressive features: if the predominant mood is depressed, but the full criteria are not met for a major depressive disorder
   With major depressive-like episode: if all criteria for major depressive episode are met, except, clearly, for the criterion that the symptoms are not due to the physiological effects of a substance or a general medical condition
   With manic features: if the predominant mood is elevated, euphoric, or irritable
   With mixed features: if the symptoms of mania and depression are present, but neither predominates
(From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC; American Psychiatric Association; 2000, with permission
Table 10.5-4 DSM-IV-TR Criteria for Psychotic Disorder Due to a General Medical Condition
  1. Prominent hallucinations or delusions.
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder.
  4. The disturbance does not occur exclusively during the course of a delirium.
Specify:
   With delusions: if delusions are the predominant symptom
   With hallucinations: if hallucinations are the predominant symptom

 

Table 10.5-5 Psychotic Symptoms Associated with Abnormality of Specific Brain Regions
Symptoms Site Laterality
First-rank symptoms
   Thoughts spoken aloud
   Voices commenting
   Third-person voices arguing
   Made actions
   Made feelings
   Thought withdrawal
   Thought diffusion
   Delusional perception
Temporal lobe Dominant hemisphere
Complex delusions Subcortical or limbic  
Anton syndrome Occipital lobe, optic tract Bilateral
Anosognosia Parietal lobe Nondominant hemisphere
Misidentification syndromes Parietal, temporal, frontal lobes Nondominant hemisphere, bilateral
   Capgras syndrome
   Reduplicative paramnesia
   Fregoli syndrome
   Intermetamorphosis syndrome
(Courtesy of Eric D. Caine, M.D., and Jeffrey M. Lyness, M.D.)

 

Table 10.5-6 DSM-IV-TR Criteria for Anxiety Disorder Due to a General Medical Condition
  1. Prominent anxiety, panic attacks, or obsessions or compulsions predominate in the clinical picture.
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., adjustment disorder with anxiety in which the stressor is a serious general medical condition).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The disturbance causes clinical significant distress or impairment in social, occupational, or other important areas of functioning.
Specify:
   With generalized anxiety: if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation
   With panic attacks: if panic attacks predominate in the clinical presentation
   With obsessive–compulsive symptoms: if obsessions or compulsions predominate in the clinical presentation

 

Table 10.5-7 DSM-IV-TR Criteria for Sleep Disorder Due to a General Medical Condition
  1. A prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention.
  2. There is evidence from the history, physical examination, or laboratory findings that the sleep disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., an adjustment disorder in which the stressor is a serious medical illness).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The disturbance does not meet the criteria for breathing-related sleep disorder or narcolepsy.
  6. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify type:
Insomnia type: if the predominant sleep disturbance is insomnia
   Hypersomnia type: if the predominant sleep disturbance is hypersomnia
   Parasomnia type: if the predominant sleep disturbance is a parasomnia
   Mixed type: if more than one sleep disturbance is present and none predominate of comparable sexual dysfunction that was not substance-induced

 

Table 10.5-8 Medical Conditions Commonly Associated with a Secondary Sleep Disorder
Condition Sleep Symptoms
Parkinsonism Frequent awakenings, disturbance of circadian rhythms
Dementia Sundowning, frequent awakenings
Epilepsy Difficulty initiating sleep, frequent awakenings, parasomnias
Cerebrovascular disease Difficulty initiating sleep, frequent awakenings
Huntington’s disease Frequent awakening
Kleine-Levin syndrome Hypersomnia
Uremia Restless legs, nocturnal myoclonus
(Courtesy of Eric D. Caine, M.D., and Jeffrey M. Lyness, M.D.)
Table 10.5-9 DSM-IV-TR Criteria for Sexual Dysfunction Due to a General Medical Condition
  1. Clinically significant sexual dysfunction that results in marked distress or interpersonal difficulty predominates in the clinical picture.
  2. There is evidence from the history, physical examination, or laboratory findings that the sexual dysfunction is fully explained by the direct physiological effects of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., major depressive disorder).
Select code and term based on the predominant sexual dysfunction:
   Female hypoactive sexual desire disorder due to… [insert general medical condition here]: if deficient or absent sexual desire is the predominant feature.
   Male hypoactive sexual desire disorder due to… [insert general medical condition here]: if deficient or absent sexual desire is the predominant feature.
   Male erectile disorder due to… [insert general medical condition here]: if male erectile dysfunction is the predominant feature.
   Female dyspareunia due to… [insert general medical condition here]: if pain associated with intercourse is the predominant feature.
   Male dyspareunia due to… [insert general medical condition here]: if pain associated with intercourse is the predominant feature.
   Other female sexual dysfunction due to… [insert general medical condition here]: if some other feature is predominant (e.g., orgasmic disorder) or if no feature predominates.
   Other male sexual dysfunction due to… [insert general medical condition here]: if some other feature is predominant (e.g., orgasmic disorder) or if no feature predominates.
(From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC; American Psychiatric Association; 2000, with permission.)

 

Table 10.5-10 Causes of Secondary Sexual Dysfunctions
Medications
   Cardiac drugs, antihypertensives (e.g., reserpine, β-adrenergic receptor antagonists, clonidine, α-methyldopa, diuretics)
   H2-receptor blockers
   Carbonic anhydrase inhibitors
   Anticholinergics
   Anticonvulsants (e.g., carbamazepine, phenytoin, primidone)
   Antipsychotics
   Antidepressants (e.g., tricyclic drugs, MAO inhibitors, trazodone, SSRIs)
   Sedative-hypnotics
Substances of abuse
   Alcohol
   Opioids
   Stimulants
   Cannabis
   Sedative-hypnotics
Local disease processes that affect primary or secondary sexual organs
   Congenital anomalies or malformations
   Trauma
   Tumor
   Infection
   Postsurgical or postirradiation local neurological and vascular pathology
Systemic disease processes
   Neurological
      Central nervous system (e.g., strokes, multiple sclerosis)
      Peripheral nervous system (e.g., peripheral neuropathy)
   Vascular
      Atherosclerosis, vasculitis (as examples)
   Endocrine
      Diabetes mellitus, alterations in function of thyroid, adrenal cortex, gonadotropins, gonadal hormones (as examples)
MAO, monoamine oxidase; SSRI, selective serotonin reuptake inhibitor.
(Courtesy of Eric D. Caine, M.D., and Jeffrey M. Lyness, M.D.)

 

Table 10.5-11 DSM-IV-TR Diagnostic Criteria for Catatonic Disorder Due to a General Medical Condition
  1. The presence of catatonia as manifested by motoric immobility, excessive motor activity (that is apparently purposeless and not influenced by external stimuli), extreme negativism or mutism, peculiarities of voluntary movement, or echolalia or echopraxia.
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., a manic episode).
  4. The disturbance does not occur exclusively during the course of a delirium.
Coding note: Include the name of the general medical condition on Axis I, e.g., Catatonic disorder due to hepatic encephalopathy; also code the general medical condition on Axis III.
(From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000, with permission.

 

Table 10.5-12 DSM-IV-TR Diagnostic Criteria for Mental Disorder Not Otherwise Specified Due to a General Medical Condition
This residual category should be used for situations in which it has been established that the disturbance is caused by the direct physiological effects of a general medical condition, but the criteria are not met for a specific mental disorder due to a general medical condition (e.g., dissociative symptoms due to complex partial seizures).
Coding note: Include the name of the general medical condition on Axis I, e.g., Mental disorder not otherwise specified due to HIV disease; also code the general medical condition on Axis III.
(From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000, with permission.)
Table 10.5-13 DSM-IV-TR Diagnostic Criteria for Personality Change Due to General Medical Condition
  1. A persistent personality disturbance that represents a change from the individual’s previous characteristic personality pattern. (In children, the disturbance involves a marked deviation from normal development or a significant change in the child’s usual behavior patterns lasting at least 1 year.)
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (including other mental disorders due to a general medical condition).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify type:
   Labile type: if the predominant feature is affective lability
   Disinhibited type: if the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc.
   Aggressive type: if the predominant feature is aggressive behavior
   Apathetic type: if the predominant feature is marked apathy and indifference
   Paranoid type: if the predominant feature is suspiciousness or paranoid ideation
   Other type: if the presentation is not characterized by any of the above subtypes
   Combined type: if more than one feature predominates in the clinical picture
   Unspecified type
Coding note: Include the name of the general medical condition on Axis I, e.g., Personality change due to temporal lobe epilepsy; also code the general medical condition on Axis III.
(From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000, with permission.)

 

Table 10.5-14 International Classification of Epileptic Seizures
  1. Partial seizures (seizures beginning locally)
    1. Partial seizures with elementary symptoms (generally without impairment of consciousness)
      1. With motor symptoms
      2. With sensory symptoms
      3. With autonomic symptoms
      4. Compound forms
    2. Partial seizures with complex symptoms (generally with impairment of consciousness; temporal lobe or psychomotor seizures)
      1. With impairment of consciousness only
      2. With cognitive symptoms
      3. With affective symptoms
      4. With psychosensory symptoms
      5. With psychosensory symptoms (automatisms)
      6. Compound forms
    3. Partial seizures secondarily generalized
  2. Generalized seizures (bilaterally symmetrical and without local onset)
    1. Absences (petit mal)
    2. Myoclonus
    3. Infantile spasms
    4. Clonic seizures
    5. Tonic seizures
    6. Tonic-clonic seizures (grand mal)
    7. Atonic seizures
    8. Akinetic seizures
  3. Unilateral seizures
  4. Unclassified seizures (because of incomplete data)
(Adapted from Gastaut H. Clinical and electroencephalographical classification of epileptic seizures. Epilepsia. 1970;11:102, with permission.)

 

Table 10.5-15 Differentiating Features of Pseudoseizures and Epileptic Seizures
Feature Epileptic Seizures Pseudoseizure
Clinical features
   Nocturnal seizure Common Uncommon
   Stereotyped aura Usually None
   Cyanotic skin changes during seizures Common None
   Self-injury Common Rare
   Incontinence Common Rare
   Postictal confusion Present None
   Body movements Tonic or clonic or both Nonstereotyped and asynchronous
   Affected by suggestion No Yes
EEG features
   Spike and waveforms Present Absent
   Postictal slowing Present Absent
   Interictal abnormalities Variable Variable
EEG, electroencephalogram.
(From Stevenson JM, King JH. Neuropsychiatric aspects of epilepsy and epileptic seizures. In: Hales RE, Yodofsky SC, eds. American Psychiatric Press Textbook of Neuropsychiatry. Washington, DC: American Psychiatric Press; 1987:220, with permission.)
Table 10.5-16 Commonly Used Anticonvulsant Drugs
Drug Use Maintenance Dosage (mg/day)
Carbamazepine (Tegretol, Carbatrol) Generalized tonic-clonic, partial 600–1,200
Clonazepam (Klonopin) Absence, atypical myoclonic 2–12
Ethosuximide (Zarontin) Absence 1,000–2,000
Gabapentin (Neurontin) Complex partial seizures (augmentation) 900–3,600
Lamotrigine (Lamictal) Complex partial seizures, generalized (augmentation) 300–500
Oxcarbazepine (Trileptal) Partial 600–2,400
Phenobarbital Generalized tonic-clonic 100–200
Phenytoin (Dilantin) Generalized tonic-clonic, partial, status epilepticus 300–500
Primidone (Mysoline) Partial 750–1,000
Tiagabine (Gabitril) Generalized 32–56
Topiramate (Topamax) Complex partial seizures (augmentation) 200–400
Valproate Absence, myoclonic generalized tonic-clonic akinetic, partial seizures 750–1,000
Zonisamide (Zonegran) Generalized 400–600
Table 10.5-17 DSM-IV-TR Research Criteria for Postconcussional Disorder
  1. A history of head trauma that has caused significant cerebral concussion.
    Note: The manifestations of concussion include loss of consciousness, posttraumatic amnesia, and, less commonly, posttraumatic onset of seizures. The specific method of defining this criterion needs to be established by further research.
  2. Evidence from neuropsychological testing or quantified cognitive assessment of difficulty in attention (concentrating, shifting focus of attention, performing simultaneous cognitive tasks) or memory (learning or recalling information).
  3. Three (or more) of the following occur shortly after the trauma and last at least 3 months:
    1. becoming fatigued easily
    2. disordered sleep
    3. headache
    4. vertigo or dizziness
    5. irritability or aggression on little or no provocation
    6. anxiety, depression, or affective lability
    7. changes in personality (e.g., social or sexual inappropriateness)
    8. apathy or lack of spontaneity
  4. The symptoms in Criteria B and C have their onset following head trauma or else represent a substantial worsening of preexisting symptoms.
  5. The disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning. In school-age children, the impairment may be manifested by a significant worsening in school or academic performance dating from the trauma.
  6. The symptoms do not meet criteria for dementia due to head trauma and are not better accounted for by another mental disorder (e.g., amnestic disorder due to head trauma, personality change due to head trauma).
Table 10.5-18 ICD-10 Diagnostic Criteria for Personality and Behavioral Disorders Due to Brain Disease, Damage, and Dysfunction
G1. There must be objective evidence (from physical and neurological examination and laboratory tests) and/or history of cerebral disease, damage, or dysfunction.
G2. There is no clouding of consciousness or significant memory deficit.
G3. There is insufficient evidence for an alternative causation of the personality or behavior disorder that would justify its placement in disorders of adult personality and behavior category.
Organic personality disorder

  1. The general criteria for personality and behavioral disorders due to brain disease, damage, and dysfunction must be met.
  2. At least three of the following features must be present over a period of 6 months or more:
    1. consistently reduced ability to persevere with goal-directed activities, especially those involving relatively long periods and postponed gratification;
    2. one or more of the following emotional changes:
      1. emotional lability (uncontrolled, unstable, and fluctuating expression of emotions):
      2. euphoria and shallow, inappropriate jocularity, unwarranted by the circumstances;
      3. irritability and/or outbursts of anger and aggression;
      4. apathy;
    3. disinhibited expression of needs or impulses without consideration of consequences or of social conventions (the individual may engage in dissocial acts such as stealing, inappropriate sexual advances, or voracious eating, or exhibit extreme disregard for personal hygiene);
    4. cognitive disturbances, typically in the form of:
      1. excessive suspiciousness and paranoid ideas;
      2. excessive preoccupation with a single theme such as religion, or rigid categorization of other people’s behavior in terms of “right” and “wrong”;
    5. marked alteration of the rate and flow of language production, with features such as circumstantiality, overinclusiveness, viscosity, and hypergraphia;
    6. altered sexual behavior (hyposexuality or change in sexual preference).
Specification of features for possible subtypes
Option 1. A marked predominance of the symptoms in criteria (1) and (2) (d) is thought to define a pseudoretarded or apathetic type; a predominance of (1), (2) (c), and (3) is considered a pseudopsychopathic type; and a combination of (4), (5), and (6) is regarded as characteristic of the limbic epilepsy personality syndrome. None of these entities has yet been sufficiently validated to warrant a separate description.
Option 2. If desired, the following types may be specified: labile type, disinhibited type, aggressive type, apathetic type, paranoid type, mixed type, and other.
Postencephalitic syndrome

  1. The general criteria for personality and behavioral disorders due to brain disease, damage, and dysfunction must be met.
  2. At least one of the following residual neurological dysfunctions must be present:
    1. paralysis;
    2. deafness;
    3. aphasia;
    4. constructional apraxia;
    5. acalculia.
  3. The syndrome is reversible, and its duration rarely exceeds 24 months.
Comments
Criterion C constitutes the main difference between this disorder and organic personality disorder.
Residual symptoms and behavioral change following either viral or bacterial encephalitis are nonspecific and do not provide a sufficient basis for a clinical diagnosis. They may include: general malaise, apathy, or irritability; some lowering of cognitive functioning (learning difficulties); disturbances in the sleep–wake pattern; or altered sexual behavior.
Postconcussional syndrome
Note: The nosological status of this syndrome is uncertain, and criterion G1 of the introduction to this rubric is not always ascertainable. However, for those undertaking research into this condition, the following criteria are recommended:

  1. The general criteria of personality and behavioral disorders due to brain disease, damage, and dysfunction must be met.
  2. There must be a history of head trauma with loss of consciousness, preceding the onset of symptoms by a period of up to 4 weeks. (Objective EEG, brain imaging, or oculonystagmographic evidence for brain damage may be lacking.)
  3. At least three of the following features must be present:
    1. complaints of unpleasant sensations and pains, such as headache, dizziness (usually lacking the features of true vertigo), general malaise, and excessive fatigue, or noise intolerance;
    2. emotional changes, such as irritability, emotional lability (both easily provoked or exacerbated by emotional excitement or stress), or some degree of depression and/or anxiety:
    3. subjective complaints of difficulty in concentration and in performing mental tasks, and of memory problems (without clear objective evidence, e.g., psychological tests, of marked impairment):
    4. insomnia;
    5. reduced tolerance to alcohol;
    6. preoccupation with the above symptoms and fear of permanent brain damage, to the extent of hypochondriacal, overvalued ideas and adoption of a sick role.
Other organic personality and behavioral disorders due to brain disease, damage, and dysfunction
Brain disease, damage, or dysfunction may produce a variety of cognitive, emotional, personality, and behavioral disorders, some of which may not be classifiable under organic personality disorder, postencephalitic syndrome, postconcussional syndrome. However, since the nosological status of the tentative syndromes in this area is uncertain, they should be coded as “other.” A fifth character may be added, if necessary, to identify presumptive individual entities.
Unspecified organic personality and behavioral disorder due to brain disease, damage, and dysfunction
ICD, International Classification of Diseases.
(From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research, Copyright, World Health Organization, Geneva, 1993, with permission.)
Table 10.5-19 ICD-10 Diagnostic Criteria for Other Mental Disorders Due to Brain Damage and Dysfunction and Due to Physical Disease
G1. There is objective evidence (from physical and neurological examination and laboratory tests) and/or history of cerebral disease, damage, or dysfuction, or of systemic physical disorder known to cause cerebral dysfunction, including hormonal disturbances (other than alcohol- or other psychoactive substance-related) and nonpsychoactive drug effects.
G2. There is a presumed relationship between the development (or marked exacerbation) of the underlying disease, damage, or dysfunction, and the mental disorder, the symptoms of which may have immedite onset or may be delayed.
G3. There is recovery from or significant improvement in the mental disorder following removal or improvement of the underlying presumed cause.
G4. There is insufficient evidence for an alternative causation of the mental disorder, e.g., a strong family history of a clinically similar or related disorder.
If criteria G1, G2, and G4 are met, a provisional diagnosis is justified; if, in addition, there is evidence of G3, the diagnosis can be regarded as certain.
Organic hallucinosis

  1. The general criteria for other mental disorders due to brain damage and dysfunction and to physical disease must be met.
  2. The clinical picture is dominated by persistent or recurrent hallucinations (usually visual or auditory).
  3. Hallucinations occur in clear consciousness.
Comments
Delusional elaboration of the hallucinations, as well as full or partial insight, may or may not be present: these features are not essential for the diagnosis.
Organic catatonic disorder

  1. The general criteria for other mental disorders due to brain damage and dysfunction and to physical diseases must be met.
  2. One of the following must be present:
    1. stupor, i.e., profound diminution or absence of voluntary movements and speech, and of normal responsiveness to light, noise, and touch, but with normal muscle tone, static posture, and breathing maintained (and often limited coordinated eye movements);
    2. negativism (positive resistance to passive movement of limbs or body or rigid posturing).
  3. There is catatonic excitement (gross hypermotility of a chaotic quality, with or without a tendency to assaultiveness).
  4. There is rapid and unpredictable alternation of stupor and excitement.
Comments
Confidence in the diagnosis is increased if additional catatonic phenomena are present, e.g., stereotypies, waxy flexibility, and impulsive acts. Care should be taken to exclude delirium; however, it is not known whether an organic catatonic state always occurs in clear consciousness, or whether it represents an atypical manifestation of a delirium in which criteria A, B, and D are only marginally met, whereas criterion C is prominent.
Organic delusional (schizophrenialike) disorder

  1. The general criteria for other mental disorders due to brain damage and dysfunction and to physical disease must be met.
  2. The clinical picture is dominated by delusions (of persecution, bodily change, disease, death, jealousy), which may exhibit a varying degree of systematization.
  3. Consciousness is clear and memory is intact.
Comments
Further features that complete the clinical picture but that are not invariably present include: hallucinations (in any modality); schizophrenic-type thought disorder, isolated catatonic phenomena such as stereotypies, negativism, or impulsive acts. The clinical picture may meet the symptomatic criteria for schizophrenia, persistent delusional disorder, or acute and transient psychotic disorders. However, if the state also meets the general criteria for a presumptive organic etiology laid down in the introduction to other mental disorders due to brain damage and dysfunction and to physical disease, it should be classified here. Marginal or nonspecific findings such as enlarged cerebral ventricles or “soft” neurological signs do not qualify as evidence for criterion G1 of other mental disorders due to brain damage and dysfunction and to physical disease.
Organic mood (affective) disorder

  1. The general criteria for other medical disorders due to brain damage and dysfunction and to physical disease must be met.
  2. The condition must meet the criteria for one of the affective disorders.
The diagnosis of the affective disorder may be specified by using a fifth character:
Organic manic disorder
Organic bipolar disorder
Organic depressive disorder
Organic mixed affective disorder
Organic anxiety disorder

  1. The general criteria for other medical disorders due to brain damage and dysfunction and to physical disease must be met.
  2. The condition must meet the criteria for either panic disorder or generalized anxiety disorder.
Organic dissociative disorder

  1. The general criteria for other mental disorders due to brain damage and dysfunction and to physical disease must be met.
  2. The condition must meet the criteria for one of the dissociative (conversion) disorders categories.
Organic emotionally labile (asthenic) disorder

  1. The general criteria for other mental disorders due to brain damage and dysfunction and to physical disease must be met.
  2. The clinical picture is dominated by emotional lability (uncontrolled, unstable, and fluctuating expression of emotions).
  3. There is a variety of unpleasant physical sensations such as dizziness or pains and aches.
Comments
Fatigability and listlessness (asthenia) are often present but are not essential for the diagnosis.
Mild cognitive disorder
Note: The status of this construct is being examined. Specific research criteria must be viewed as tentative. One of the principal reasons for its inclusion is to obtain further evidence allowing its differentiation from disorders such as dementia organic amnestic syndrome, delirium, and several disorders in personality and behavioral disorders due to brain disease, damage, and dysfunction.

  1. The general criteria for other mental disorders due to brain damage and dysfunction and to physical disease must be met.
  2. There is a disorder in cognitive function for most of the time over a period of at least 2 weeks as reported by the individual or a reliable informant. The disorder is exemplified by difficulties in any of the following areas:
    1. memory (particularly recall) or new learning;
    2. attention or concentration;
    3. thinking (e.g., slowing in problem solving or abstraction);
    4. language (e.g., comprehension, word finding);
    5. visual-spatial functioning.
  3. There is an abnormality or decline in performance in quantified cognitive assessments (e.g., neuropsychological tests or mental status examination).
  4. None of the difficulties listed in criterion B(1)–(5) is such that a diagnosis made of dementia, organic amnesic syndrome, delirium, postencephalitic syndrome, postconcussional syndrome, or other persisting cognitive impairment due to psychoactive substance use.
Comments
If criterion G1 for other mental disorders due to brain damage and dysfunction and to physical disease is fulfilled by the presence of central nervous system dysfunction, it is usually presumed that this is the cause of the mild cognitive disorder. If criterion G1 is fulfilled by the presence of a systemic physical disorder, it is often unjustified to assume that there is a direct causative relationship. Nevertheless, it may be useful in such instances to record the presence of the systemic physical disorder as “associated,” without implying a necessary causation. An additional fifth character may be used for this:
Not associated with a systemic physical disorder
Associated with a systemic physical disorder
The systemic physical disorder should be recorded separately by its appropriate ICD-10 code.
Other specified mental disorders due to brain damage and dysfunction and to physical disease
Examples of this category are transient or mild abnormal mood states occurring during treatment with steroids or antidepressants which do not meet the criteria for organic mood disorder.
Unspecified mental disorder due to brain damage and dysfunction and to physical disease
ICD, International Classification of Diseases.
(From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993, with permission.)

 

Table 10.5-2 Causes of Secondary Mood Disorders
Drug Intoxication
   Alcohol or sedative-hypnotics
   Antipsychotics
   Antidepressants
   Metoclopramide, H2-receptor blockers
   Antihypertensives (especially centrally acting agents, e.g., methyldopa, clonidine, reserpine)
   Sex steroids (e.g., oral contraceptives, anabolic steroids)
   Glucocorticoids
   Levodopa
   Bromocriptine
Drug Withdrawal
   Nicotine, caffeine, alcohol or sedative-hypnotics, cocaine, amphetamines
Tumor
   Primary cerebral
   Systemic neoplasm
Trauma
   Cerebral contusion
   Subdural hematoma
Infection
   Cerebral (e.g., meningitis, encephalitis, HIV, syphilis)
   Systemic (e.g., sepsis, urinary tract infection, pneumonia)
Cardiac and Vascular
   Cerebrovascular (e.g., infarcts, hemorrhage, vasculitis)
   Cardiovascular (e.g., low-output states, congestive heart failure, shock)
Physiological or Metabolic
   Hypoxemia, electrolyte disturbances, renal or hepatic failure, hypo- or hyperglycemia, postictal states
Endocrine
   Thyroid or glucocorticoid disturbances
Nutritional
   Vitamin B12, folate deficiency
Demyelinating
   Multiple sclerosis
Neurodegenerative
   Parkinson’s disease, Huntington’s disease

 

Table 10.5-1 Mental Disorders Due to a General Medical Condition
DSM-IV-TR Category Mental Disorders Due to a General Medical Condition Section
Delirium, dementia, amnestic and other cognitive disorders Delirium due to a general medical condition 10.2
  Dementia due to other general medical conditions 10.3
  Amnestic disorder due to a general medical condition 10.4
Schizophrenia and other psychotic disorders Psychotic disorder due to a general medical condition 14.1
Mood disorders Mood disorder due to a general medical condition 15.3
Anxiety disorders Anxiety disorder due to a general medical condition 16.7
Sexual disorders Sexual dysfunction due to a general medical condition 21.2
Sleep disorders Sleep disorder due to a general medical condition 24.2
Mental disorders due to a general medical condition not elsewhere classified Catatonic disorder due to a general medical condition 10.5
  Personality change due to a general medical condition 10.5
  Mental disorder not otherwise specified due to a general medical condition
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About kraeplinpsychiatry

I am a practising psychiatrist. I have strong liking for both biological and psychodynamics aspects of psychiatry. This blog is made to collect my thoughts , sort of self diary where i can use input of others to come to better conclusions. Thanks.
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