Transcript DSM IV Diagnosis of EB

Clinical Impression
Bipolar I Disorder
• Also known as Bipolar Affective Disorder
• A psychiatric diagnosis that describes a category of
mood disorders defined by the presence of one or
more episodes of abnormally elevated mood clinically
referred to as mania or hypomania
• Bipolar disorder is a condition in which people
experience abnormally elevated (manic or hypomanic)
and abnormally depressed states for a period of time in
a way that interferes with functioning.
http://en.wikipedia.org/wiki/Bipolar_disorder
Bipolar I Disorder
DSM IV-TR Diagnostic Criteria for Bipolar I Disorder, Most
Recent Episode Manic
A. Currently or mostly in a manic episode.
B. There has previously been at least one major depressive
episode, manic episode, or mixed episode.
C. The mood episodes in Criteria A and are not better accounted
for by schizoaffective disorder and are not superimposed on
schizophrenia, schizophreniform disorder, delusional disorder, or
psychotic disorder not otherwise specified.
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DSM IV-TR Criteria for Manic Episode
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 (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 (attention too easily drawn to unimportant or irrelevant
external stimuli, impulsive)
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 (unrestrained buying sprees, sexual indescretions, etc)
C. The symptoms do not meet criteria for a mixed episode.
D. The mood disturbance is sufficiently severe to cause marked impairment…
E. The symptoms are not due to direct physiological effects of a substance…
Previous Manic Episode
1993
• Impulsive: grabbed the car’s steering wheel while mother
was driving.
• Very talkative in class because or numerous running ideas in
her mind
April 2002 • Spend recklessly, buying a lot of things from the mall maxing
out her 2 credit cards
2008
• October: Observed to be very talkative while on the way to
the cemetery, spent 14,000 for shopping
• December: episodes of hyperactivity, spent most of the time
at the gym to lose weight
Bipolar I Disorder
DSM IV-TR Diagnostic Criteria for Secerity/ Psychotic/ Remission Specifiers for
Current or Most Recent Manic Episode
Severe With Psychotic Features
Presence of Delusions or Hallucinations
Specify:
Mood Congruent Psychotic Features
Delusions or hallucinations whose
content is consistent with the typical
depressive themes of personal
inadequacy, guilt, disease, death,
nihilism, or deserved punishment.
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Mood-Incongruent Psychotic Features
Delusions or hallucinations whose
content does not involve typical
depressive themes of personal
inadequacy, guilt, disease, death,
nihilism, or deserved punishment.
Included are such symptoms as
persecutory delusions (not directly
related to depressive themes), thought
insertion, thought broadcasting, and
delusions of control.
Psychotic Features
April
2002
PERSECUTORY
• Thought that her coworkers at the library were
talking about her of the
thesis that she 
was doing.
DELUSIONS
MOOD - INCONGRUENT PSYCHOSIS
October
31, 2008
• Got out and ran away from
the car because she
thought there was a coup
d’etat going on.
Clinical Impression: DSM IV
• Bipolar I Disorder with Recent
Axis I Manic Episode and Mood
Incongruent Psychotic Symptoms
Axis II
•No Personality Traits/ Disorders
•No Mental Retardation
Axis III
•No Physical Disorders
•No Medical Conditions
Clinical Impression: DSM IV
Axis IV
• Pyschosocial and Environmental Factors
contributing to her disorder
• Previous history of ADHD
• Pressures from growing up years to
excel academically
• Moving to the Philippines
91-100 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 qualities. No symptoms.
81-90 Absent or minimal symptoms, 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.
71-80 If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than
slight impairment in social, occupational, or school functioning.
61-70 Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning
pretty well, has some meaningful interpersonal relationships.
51-60 Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.
41-50 Serious symptoms OR any serious impairment in social, occupational, or school functioning.
31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or
school, family relations, judgment, thinking, or mood.
21-30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or
judgment OR inability to function in all areas.
11-20 Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross
impairment in communication.
1-10 Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene
OR serious suicidal act with clear expectation of death.
0 Not enough information available to provide GAF.
Clinical Impression: DSM IV
Axis V
• Global Assessment of Functioning Score of 31-40
• Some impairment in reality testing or
communication OR major impairment in
several areas, such as work or school, family
relations, judgment, thinking, or mood.
Review DSM IV
DSM IV Diagnosis of EB
Axis I
Axis II
Axis III
Axis IV
Axis V
Bipolar I Disorder with Recent Manic Episode and Mood
Incongruent Psychotic Symptoms
• No Personality Traits/ Disorders
• No Mental Retardation
•No Physical Disorders
•No Medical Conditions
• Pyschosocial and Environmental Factors contributing to her
disorder
• Previous history of ADHD
• Pressures from growing up years to excel academically
• Moving to the Philippines
• Global Assessment of Functioning Score of 31-40
• Some impairment in reality testing or communication OR
major impairment in several areas, such as work or
school, family relations, judgment, thinking, or mood.
Clinical Impression: ICD 10
• Mood (Affective) Disorder
F30-39
F31.2.21
Bipolar
Affective
Disorder,
• Bipolar
Affective
Disorder, Current
Episode
Manic
with
Psychotic
Symptoms
F31.2
Current Episode Manic with Mood
Incongruent
Psychotic
• With mood
incongruentSymptoms
psychotic
.21
symptoms
http://priory.com/psych/ICD.htm