Diagnostic Boundaries of Bipolar Disorders. Terence A. Ketter, M.D.
|
|
- Annice Preston
- 8 years ago
- Views:
Transcription
1 Diagnostic Boundaries of Bipolar Disorders Terence A. Ketter, M.D.
2 Disclosure Information Research Support / Consultant / Speaker Abbott Laboratories, Inc. AstraZeneca Pharmaceuticals LP Bristol Myers Squibb Company Cephalon Inc. Corcept Therapeutics Elan Pharmaceuticals, Inc. Eli Lilly and Company Forest Laboratories, Inc. GlaxoSmithKline Janssen Pharmaceutica Products, LP Jazz Pharmaceuticals, Inc. Merck & Co., Inc. Novartis Pharmaceuticals Corporation Pfizer Inc. Shire Pharmaceuticals Group plc. Solvay Pharmaceuticals, Inc. UCB Pharmaceuticals Wyeth Pharmaceuticals
3 Overview Complex, variable phenomenology Different subtypes, mood states, courses Age dependent presentations Crucial differential diagnosis Major depressive disorder Confounding comorbidities Disruptive behavioral disorders (ADHD, ODD, CD) Substance abuse, anxiety, cluster B disorders Measures to enhance diagnostic accuracy Collateral information Screening instruments Mood Disorders Questionnaire Bipolar Spectrum Diagnostic Scale Bipolarity Index
4 Manic Depressive Psychosis A Unitary Entity (Kraepelin, 1899) Later dichotomized into unipolar versus bipolar (Angst 1966; Perris 1966; Winokur & Clayton 1969) Bipolar Unipolar
5 DSM IV Classification of Bipolar Disorders Bipolar I Bipolar II Cyclothymia Secondary Bipolar (due to other illnesses or drugs) Bipolar NOS Current episode features Severity Catatonic Melancholic Atypical Post partum onset Course specifiers Full interepisode recovery Seasonal pattern Rapid Cycling DSM IV TR: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision
6 Akiskal Bipolar Spectrum BP I BP II 4 d BP II½ Cyclothymic Depression BP III Pharmacologic Hypomania Antidepressants Akiskal HS, Pinto O. Psychiatr Clin North Am 1999;22:
7 Other Proposed Akiskal Bipolar Spectrum Subtypes BP IV Hyperthymia + Depression Depressive Mixed State Recurrent Unipolar Hyperthymic Temperament Akiskal, et al. J Affect Disord 2000;59(Suppl 1):S5 S30.
8 Bipolar Spectrum Concept Recurrent brief hypomania (<4 days) Sporadic brief hypomania Medication or substance induced hypomania Cyclothymia Recurrent depression (+ family history of mania)? Seasonal affective disorder? Atypical depression Angst J. J Affect Disord. 1998;50:143 51; Dunner DL, et al. Arch Gen Psychiatry. 1976;33:117 20; Klerman GL. ComprPsychiatry. 1981;22:11 20
9 High Bipolarity Risk in Prepubertal and Severe Adolescent / Young Adult Major Depression Prepubertal Major Depression (Age at intake 10.3 yrs) 49% Bipolar at 10 year follow up Adolescents / Young Adults Hospitalized for Major Depression (Age at intake 23.0 yrs) 41% Bipolar at 15 year follow up 51.4% (37/72) Not BP 33.3% (24/72) BPI 59.4% (44/74) Not BP 14.8% (11/74) BPI 25.6% (19/74) BPII 15.3% (11/72) BPII Geller B, et al. Am J Psychiatry 2001;158: Goldberg JF, et al. Am J Psychiatry 2001;158:
10 Most Bipolar Disorder Patients Have Lifetime Comorbid Axis I Diagnoses Percent of Patients All BP BP I BP II 0 None 1 or more 2 or more 3 or more Number of Lifetime Comorbid Axis I Diagnoses McElroy SL, et al. Am J Psychiatr. 2001;158:420 6.
11 Comorbidities More Common with Mania/Hypomania than Depression National Comorbidity Survey Replication (N = 9,282 adults) Substance Use Disorders Alcohol Abuse* Alcohol Dependence* Drug Abuse Disruptive Behavioral Disorders Attention Deficit/Hyperactivity Disorder* Oppositional Defiant Disorder Conduct Disorder Anxiety Disorders Panic Disorder Social Anxiety Disorder Intermittent Explosive Disorder *correlation with Mania/Hypomania at least 0.1 > than with Depression Kessler et al. Arch Gen Psychiatry 2005;62:
12 Lifetime Prevalence of Substance Use Disorders in Mental Illnesses % 70 Odds Ratio (bars) % 47% 36% 33% 31% 27% Percent (diamonds) Bipolar I Bipolar II Schizophrenia Panic OCD Dysthymia Major Depression 0 Regier DA, et al. JAMA 1990;264:
13 Clues That Unipolar Unipolar Depression May Be Bipolar Depression Early age of onset Postpartum mood disorders Seasonal mood changes Hypersomnia and/or psychomotor slowing Severe anhedonia Depression with catatonia and/or psychotic features Bipolar family history Pharmacological induced mania or hypomania History of recurrent but brief depressive episodes Marchand WR. Hosp Physician. 2003;39: Geller B, Luby J. J Am Acad Child Adolesc Psychiatry. 1997;36: Akiskal HS, et al. J Affect Disord. 1983;5:
14 Symptom Differences in Bipolar Depression (BP) versus Unipolar Depression (UP) Total sleep time Fragmented REM sleep Shut down depressions Postpartum episodes Weight loss BP > UP BP > UP BP > UP BP > UP UP > BP Bowden CL. Psychiatr Serv. 2001;52:51 5.
15 Unipolar versus Bipolar Depression Symptoms Unipolar depression Somatic anxiety Appetite disturbances Physical complaints Irritability Bipolar depression Psychic anxiety Fatigue Fewer physical complaints Psychomotor retardation Hypersomnia Anger attacks Bowden CL. J Affect Disord. 2005;84: Mitchell PB, et al. J Clin Psychiatry. 2001;62: Perlis RH, et al. J Clin Psychiatry. 2005;66:
16 Clinical Differences Between Bipolar & Unipolar Depression Bipolar depression associated with Bipolar family history Earlier onset age Greater number of prior depressive episodes More anxiety Atypical features Loss of response to antidepressants Cycle acceleration with antidepressants Perlis RH, et al. Am J Psychiatry 2006;163:225 31; Ghaemi SN, et al. Am J Psychiatry 2004;161:163 5.
17 3 44 Year Prospective Prediction of Bipolar Outcome in 41 of 205 Depressives Variable % Sensitivity % Specificity Pharmacologic hypomania Bipolar family history Loaded pedigree Hypersomnic retarded Psychotic depression Postpartum onset Onset <26 years Akiskal HS, et al. J Affect Disord. 1983;5(2):
18 Characteristics Differentiating Bipolar Versus Unipolar Depression History of mania or hypomania Temperament Sex ratio Age at onset Onset of episode Number of episodes Postpartum episodes Psychotic episodes Psychomotor activity Sleep Family history of BPD Family history of UPD Bipolar Yes Cyclothymic Equal Teens, 20s, and 30s Often abrupt Numerous More common More common Retardation > agitation Less common Less common Agitation > retardation Hypersomnia > insomnia Insomnia > hypersomnia High High Unipolar No Dysthymic Women > men 30s, 40s, 50s More insidious Fewer Low High Adapted from Akiskal HS. J Affect Disord 2005;84:
19 History of Bipolar I Disorder in Outpatients* with History of Major Depressive Episode 70 Percentage with History of Mania on Psychiatric Diagnostic Interview Risk Factor History of psychosis 1 relative with mania Depression onset < 25 yrs Overall 26.9% (200/744) 14.7% (32/217) Odds Ratio % (62/322) 48.8% (84/172) 66.7% (22/33) 0 *Mean age 37.5; p < None One Two Three Number of Risk Factors Othmer E, et al. The Psychiatric Diagnostic Interview (PDI). West Psychol Serv, Los Angeles. 1981; Othmer E, et al. J Clin Psychiatry 2007;68:47 51.
20 Summary of Clinical Features of Risk of Bipolar Diathesis in Depression Onset Early 1 3, postpartum 1 Depressive episodes Hypersomnic retarded, catatonic, psychotic 1 Acute, severe, psychotic 2,4 Comorbidity Substance abuse, minor antisocial acts 2 Course Long, tempestuous course; brief well intervals 2 Educational, marital, occupational disruption 2 Temperament Mood lability, energy activity, daydreaming (BPII) 2 Family history Bipolar / consecutive generation mood disorder 1 Treatment response Pharmacologic hypomania 1 1 Akiskal HS, et al. J Affect Disord 1983;5:115 28; 2 Akiskal HS, et al. Arch Gen Psychiatry 1995;52:114 23; 3 Geller B, et al. Am J Psychiatry 2001;158:125 7; 4 Goldberg JF, et al. Am J Psychiatry 2001;158:
21 Steps to Avoid Misdiagnosis of Patients Presenting With Depressive Symptoms Involve family / significant others in evaluation Ask about Personal history of mania or hypomania Family history of bipolar disorder Administer bipolar disorder screening instrument Hirschfeld RM, et al. J Clin Psychiatry. 2004;65(suppl 15):5 9.
22 Mood Disorder Questionnaire: Overview 7/13 DSM mood elevation criteria Mood symptoms concurrent At least moderate consequences Family history of bipolar Diagnosed as bipolar Hirschfeld RM, et al. Am J Psychiatry 2000;157:
23 Bipolarity Index: Five Bipolarity Domains (DSM IV TR and beyond) I. Episode Characteristics (DSM IV TR) Mania; hypomania; cyclothymia II. III. IV. Onset Age (non DSM) Especially yrs Course (non DSM) Recurrence and remission; comorbidity Treatment Effects (non DSM) Mood stabilizers effective Antidepressants ineffective, adverse effects V. Family History (non DSM) Bipolar; recurrent unipolar Sachs GS. Acta Psychiatr Scand Suppl 2004;422:7 17.
24 Categorical Dimensional Mood Disorders Schema Bipolarity Index 100 Bipolar Domain Equivalents 5 Bipolar I Disorder (BP I) 80 4 Bipolar II Disorder (BP II) Bipolar Disorder NOS (BP NOS) Major Depressive Disorder (MDD II) (Highly recurrent, antidepressant resistant subgroup) Major Depressive Disorder (MDD I) (Minimally recurrent, antidepressant responsive subgroup) I = Exclusive Phenotype; II = Inclusive Phenotype 2 1 0
25 Conclusions Complex, variable phenomenology Different subtypes, mood states, courses Age dependent presentations Crucial differential diagnosis Major depressive disorder Confounding comorbidities Disruptive behavioral disorders (ADHD, ODD, CD) Substance abuse, anxiety, cluster B disorders Measures to enhance diagnostic accuracy Collateral information Screening instruments Mood Disorders Questionnaire Bipolar Spectrum Diagnostic Scale Bipolarity Index
26 Neuroimaging Study of Reward Circuitry People with mania, manic depression or bipolar disorder Earn $25 per hour Participants must: be in good physical health have no neurological disorders other than Bipolar Disorder be years of age be a US citizen or non citizen with a Green Card Participants will, if eligible: be interviewed about mood changes do various computer activities participate in a safe, non invasive fmri brain scan For more information call (650) or Stanford.RewardsStudy@gmail.com For further information regarding questions, concerns, or complaints about research, research related injury, and questions about the rights of research participants, please call (650) or call toll free , or write the Administrative Panel on Human Subjects in Medical Research, Administrative Panels Office, Stanford University, Stanford, CA
27 Coming Soon: New Collaborative Bipolar Disorder Studies Pritzker/Prechter Clinical Genetics Study Clinical evaluation Neuropsychological evaluation Neuroendocrine evaluation Neuroimaging evaluation Genetic analyses Lithium Treatment Moderate dose Use Study (LiTMUS) 6 month randomized trial Lithium+Treatment as Usual versus Treatment as Usual
3/17/2014. Pediatric Bipolar Disorder
Pediatric Bipolar Disorder 1 Highlighted Topics 1. Review the current DSM-5 definition and criteria for bipolar disorder 2. Highlight major historical developments in the scientific understanding of bipolar
More informationHow to Recognize Depression and Its Related Mood and Emotional Disorders
How to Recognize Depression and Its Related Mood and Emotional Disorders Dr. David H. Brendel Depression s Devastating Toll on the Individual Reduces or eliminates pleasure and jo Compromises and destroys
More informationFeeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999
Feeling Moody? Is it just a bad mood or is it a disorder? Major Depressive Disorder Prevalence: 7%; 18-29 years old; Female>Male DDx: Manic episodes with irritable mood or mixed episodes, mood disorder
More informationImproving the Recognition and Treatment of Bipolar Depression
Handout for the Neuroscience Education Institute (NEI) online activity: Improving the Recognition and Treatment of Bipolar Depression Learning Objectives Apply evidence-based tools that aid in differentiating
More informationThis continuing education activity is co-sponsored by Indiana University School of Medicine and by CME Outfitters, LLC.
This continuing education activity is co-sponsored by Indiana University School of Medicine and by CME Outfitters, LLC. Indiana University School of Medicine and CME Outfitters, LLC, gratefully acknowledge
More informationPreferred Practice Guidelines Bipolar Disorder in Children and Adolescents
These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,
More informationDSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D.
DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. GOALS Learn DSM 5 criteria for DMDD Understand the theoretical background of DMDD Discuss background, pathophysiology and treatment
More informationBipolar disorders: Changes from DSM IV TR to DSM 5
Bipolar disorders: Changes from DSM IV TR to DSM 5 M. Amin Esmaeili, MD, MPH Iranian Research Center for HIV/AIDS (IRCHA) Iranian National Center for Addiction Studies (INCAS) Mood disorders committee
More informationCHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014. 2014 MVP Health Care, Inc.
CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014 2014 MVP Health Care, Inc. CHAPTER 5 CHAPTER SPECIFIC CATEGORY CODE BLOCKS F01-F09 Mental disorders due to known physiological
More informationSuicide in Bipolar Disorder. Julie Anderson, MD Oregon State Hospital Psychiatrist OHSU Assistant Professor September 25, 2012
Suicide in Bipolar Disorder Julie Anderson, MD Oregon State Hospital Psychiatrist OHSU Assistant Professor September 25, 2012 Disclosure Statement I have no significant financial relationships to disclose...
More informationBipolar and related disorders and depressive disorders in DSM-5
Should be cited as: Psychiatr. Pol. 2014; 48(2): 245 260 PL ISSN 0033-2674 www.psychiatriapolska.pl Bipolar and related disorders and depressive disorders in DSM-5 Dorota Łojko, Aleksandra Suwalska, Janusz
More informationUpdate on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice
Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological
More informationDepression Treatment Guide
Depression Treatment Guide DSM V Criteria for Major Depressive Disorders A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous
More informationSleep Medicine and Psychiatry. Roobal Sekhon, D.O.
Sleep Medicine and Psychiatry Roobal Sekhon, D.O. Common Diagnoses Mood Disorders: Depression Bipolar Disorder Anxiety Disorders PTSD and other traumatic disorders Schizophrenia Depression and Sleep: Overview
More informationBipolar Disorders. Poll Question
Bipolar Disorders American Counseling Association DSM-V Webinar Series July 10, 2013 Dr. Todd F. Lewis, Ph.D., LPC, NCC The University of North Carolina at Greensboro Poll Question Who are you? Clinical
More informationSchizoaffective disorder
Schizoaffective disorder Dr.Varunee Mekareeya,M.D.,FRCPsychT Schizoaffective disorder is a psychiatric disorder that affects about 0.5 to 0.8 percent of the population. It is characterized by disordered
More informationIrritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children
Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders National Institute
More informationMajor Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions
Major Depressive Disorder Major Depressive Disorder (MDD) Guideline Diagnostic omenclature for Clinical Depressive Conditions Conditions Diagnostic Criteria Duration Major Depression 5 of the following
More informationDSM-5 to ICD-9 Crosswalk for Psychiatric Disorders
DSM-5 to ICD-9 Crosswalk for Psychiatric s The crosswalk found on the pages below contains codes or descriptions that have changed in the DSM-5 from the DSM-IV TR. DSM-5 to ICD-9 crosswalk is available
More informationMental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca
Mental health issues in the elderly January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Cognitive Disorders Outline Dementia (294.xx) Dementia of the Alzheimer's Type (early and late
More informationBipolar Disorder: Advances in Psychotherapy
Bipolar Disorder: Advances in Psychotherapy Questions from chapter 1 1) Which is characterized by one or more major depressive episodes with at least one hypomanic episode in which the patient s functioning
More informationDSM-5 and mood disorders: The Good, the Bad and the Ugly
DSM-5 and mood disorders: The Good, the Bad and the Ugly Serge Beaulieu MD, Ph.D., FRCPC Chef médical Programme des troubles de l'humeur, d'anxiété et d'impulsivité et Programme des troubles bipolaires,
More informationScreening for Bipolar Disorder
REPORTS Screening for Bipolar Disorder Robert M. A. Hirschfeld, MD Abstract Bipolar disorder is a recurrent and sometimes chronic illness involving episodes of depression and mania or hypomania. The most
More informationPsychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome
Dr. May Lam Assistant Professor, Department of Psychiatry, The University of Hong Kong Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome a mental state in
More informationBipolar Disorder. When people with bipolar disorder feel very happy and "up," they are also much more active than usual. This is called mania.
Bipolar Disorder Introduction Bipolar disorder is a serious mental disorder. People who have bipolar disorder feel very happy and energized some days, and very sad and depressed on other days. Abnormal
More informationCLINICIAN INTERVIEW COMPLEXITIES OF BIPOLAR DISORDER. Interview with Charles B. Nemeroff, MD, PhD
COMPLEXITIES OF BIPOLAR DISORDER Interview with Charles B. Nemeroff, MD, PhD Dr Nemeroff is the Reunette W. Harris Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at Emory
More informationThe Essential of Bipolarity Assessment
The Essential of Bipolarity Assessment Elie-G. HANTOUCHE The Bipolar Spectrum from Somatic Illness To Manic-Depressive Illness Rome, January 20, 2012 Why simple things become complex and how complex things
More informationB i p o l a r D i s o r d e r
B i p o l a r D i s o r d e r Professor Ian Jones Director National Centre for Mental Health www.ncmh.info @ncmh_wales /WalesMentalHealth 029 2074 4392 info@ncmh.info Robert Schumann 1810-1856 Schumann's
More informationDepression Assessment & Treatment
Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting
More information1 Classification of Depression: Research and Diagnostic Criteria: DSM-IV and ICD-10
1 1 Classification of Depression: Research and Diagnostic Criteria: DSM-IV and ICD-10 Alan M. Gruenberg, Reed D. Goldstein and Harold Alan Pincus Abstract This chapter shall address the classification
More informationPresently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1
What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated
More informationDepression Remission at Six Months Specifications 2014 (Follow-up Visits for 07/01/2012 to 06/30/2013 Index Contact Dates)
Description Methodology Rationale Measurement Period A measure of the percentage of adults patients who have reached remission at six months (+/- 30 days) after being identified as having an initial PHQ-9
More informationDEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource
E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population
More informationAnew understanding of the symptoms
An Overview of Primary Care Assessment and Management of Bipolar Disorder Frederick T. Lewis, DO Ethan Kass, DO, MBA Robert M. Klein, DO Because patients with major psychiatric illnesses increasingly are
More informationMajor Depression: Screening and Diagnosis in Primary Care
BARRY J. WU, MD, FACP Yale University Major Depression: Screening and Diagnosis in Primary Care Dr Wu is clinical professor of medicine at Yale School of Medicine. He is also associate program director
More informationRecognizing and Treating Depression in Children and Adolescents.
Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital
More informationDepression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City
Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,
More informationDepression, Mental Health and Native American Youth
Depression, Mental Health and Native American Youth Aisha Mays, MD UCSF Department of Family And Community Medicine Native American Health Center Oakland, CA July 8, 2015 Presenter Disclosures No relationships
More informationProvider Notice 1.13. May 30, 2008. Pre-Authorization 1915(b) Service
Provider Notice 1.13 May 30, 2008»» Pre-Authorization 1915(b) Service 1915(b) Attendant Care Services (CPT T1019HE) and 1915(b) Case Conference services (CPT 99366, 99367, 99368) are pre-authorized services
More informationPart 1: Depression Screening in Primary Care
Part 1: Depression Screening in Primary Care Toni Johnson, MD Kristen Palcisco, BA, MSN, APRN MetroHealth System Objectives Part 1: Improve ability to screen and diagnose Depression in Primary Care Increase
More informationDisruptive Mood Dysregulation Disorder
The Center for Counseling Practice, Policy, and Research counseling.org/practice_briefs 703-823-9800 x324 Disruptive Mood Dysregulation Disorder Brandy L. Gilea Ph.D. and Rachel M. O Neill Ph.D., Walden
More informationCrosswalk to DSM-IV-TR
Crosswalk to DSM-IV-TR Note: This Crosswalk includes only those codes most frequently found on existing CDERs. It does not include all of the codes listed in the DSM-IV-TR nor does it include all codes
More informationDSM-5: What Counselors Need to Know. Gary G. Gintner, Ph.D., LPC Louisiana State University Baton Rouge, LA gintner@lsu.edu
DSM-5: What Counselors Need to Know Gary G. Gintner, Ph.D., LPC Louisiana State University Baton Rouge, LA gintner@lsu.edu Disclosures Dr. Gintner has never received any funding or consulting fees from
More informationEXHIBIT D, COVERED BEHAVIORAL HEALTH DIAGNOSES
EXHIBIT D, COVERED BEHAVIORAL HEALTH DIAGNOSES Part I- Mental Health Covered Diagnoses 295-298.9 295 Schizophrenic s (the following fifth-digit sub-classification is for use with category 295) 0 unspecified
More informationTransitioning to ICD-10 Behavioral Health
Transitioning to ICD-10 Behavioral Health Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii LLC 1 Course Objectives Review of new requirements to ICD-10-CM Identify the areas of
More informationWashington State Regional Support Network (RSN)
Access to Care Standards 11/25/03 Eligibility Requirements for Authorization of Services for Medicaid Adults & Medicaid Older Adults Please note: The following standards reflect the most restrictive authorization
More informationBehavioral Health Best Practice Documentation
Behavioral Health Best Practice Documentation Click on the desired Diagnoses link or press Enter to view all information. Diagnoses: DSM-5 and ICD-10 Codes Major Depressive Disorder Bipolar Disorder Eating
More informationWelcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders
Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders After this presentation, you will be able to: Understand the term Serious
More informationIL DHS/DMH DSM 5 Diagnoses Effective 10-1-2015 Target Population: Serious Mental Illness (SMI) for DHS/DMH funded MH services
IL DHS/DMH DSM 5 Diagnoses Effective 10-1-2015 Target Population: Serious Mental Illness (SMI) for DHS/DMH funded MH services ICD-10 DSM-V Description F22 Delusional Disorder F23 Brief Psychotic Disorder
More informationProvider Attestation (Expedited Requests Only) Clinical justification for expedited review:
Inpatient Treatment Request Fax completed form to: 866 949 4846 Fill out completely to avoid delays Date: / / Request Type (Check one): Standard Expedited (additional information required below) Provider
More informationDSM-5: A Comprehensive Overview
1) The original DSM was published in a) 1942 b) 1952 c) 1962 d) 1972 DSM-5: A Comprehensive Overview 2) The DSM provides all the following EXCEPT a) Guidelines for the treatment of identified disorders
More informationPost Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD
Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Definition and Criteria PTSD is unlike any other anxiety disorder. It requires that
More informationMOLINA HEALTHCARE OF CALIFORNIA
MOLINA HEALTHCARE OF CALIFORNIA MAJOR DEPRESSION IN ADULTS IN PRIMARY CARE HEALTH CARE GUIDELINE (ICSI) Health Care Guideline Twelfth Edition May 2009. The guideline was reviewed and adopted by the Molina
More informationThe Clinical Presentation of Mood Disorders. Bob Boland MD
The Clinical Presentation of Mood Disorders. Bob Boland MD 1 The Clinical Presentation of Mood Disorders 2 Concentrating On Depression Major Depression Mania Bipolar Disorder (Manic-Depression) For the
More informationTowards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families
Towards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families Presented By Dr. Pamela Gillen University of Colorado Anschutz Medical Campus and Dan
More informationDepressive Disorder in DSM-5
Depressive Disorder in DSM-5 Gary G. Gintner, Ph.D., LPC Louisiana State University Baton Rouge, LA gintner@lsu.edu Who are you? Poll Question Clinical counselor in Private Practice Clinical Counselor
More informationDepression Screening in Primary Care
Depression Screening in Primary Care Toni Johnson, MD Kristen Palcisco, BA, MSN, APRN MetroHealth System Our Vision Make Greater Cleveland a healthier place to live and a better place to do business. 2
More informationDiagnosis Codes Requiring PASRR Level II_011.22.11.xls
291.0 DELIRIUM TREMENS ALCOHOL WITHDRAWAL DELIRIUM Mental Illness 291.1 ALCOHOL AMNESTIC DISORDEALCOHOL INDUCED PERSISTING AMNESTIC DISORDER Mental Illness 291.2 ALCOHOLIC DEMENTIA NEC ALCOHOL INDUCED
More informationWidow with clear history of recurrent depressions and hypomanias. Previously well-maintained on lithium.
W. Vaughn McCall, MD, MS Chart Review: ECT PATIENT INFO 73 Age: Female Sex: Widow with clear history of recurrent depressions and hypomanias. Previously well-maintained on lithium. Background: History
More informationChildren s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT
Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Please fax with CCHP prior authorization form to 608-252-0853
More informationOverview of DSM-5. With a Focus on Adult Disorders. Gordon Clark, MD
Overview of DSM-5 With a Focus on Adult Disorders Gordon Clark, MD Sources include: 1. DSM-5: An Update D Kupfer & D Regier, ACP Annual Meeting, 2/21-22/13, Kauai 2. Master Course, DSM-5: What You Need
More informationOverall, the prognosis
Bipolar Disorder for Family Physicians Part 1: Diagnosis By Kevin Kjernisted, MD, FRCPC Clinical Associate Professor, Department of Psychiatry, University of British Columbia Vancouver, British Columbia
More informationENTITLEMENT ELIGIBILITY GUIDELINE
ENTITLEMENT ELIGIBILITY GUIDELINE BIPOLAR DISORDERS MPC 00608 ICD-9 296.0, 296.1, 296.4, 296.5, 296.6, 296.7, 296.8, 301.13 ICD-10 F30, F31, F34.0 DEFINITION BIPOLAR DISORDERS Bipolar Disorders include:
More information308: Adult Psychopathology: Bipolar Disorder. A Training Outline. Developed by: Denise Anderson, Ph.D.
308: Adult Psychopathology: Bipolar Disorder A Training Outline Developed by: Denise Anderson, Ph.D. For the Pennsylvania Child Welfare Training Program University of Pittsburgh School of Social Work Pittsburgh,
More informationBipolar Disorder. in Children and Teens. Does your child go through intense mood changes? Does your child have
Bipolar Disorder in Children and Teens Does your child go through intense mood changes? Does your child have extreme behavior changes too? Does your child get too excited or silly sometimes? Do you notice
More informationMood Disorders. What Are Mood Disorders? Unipolar vs. Bipolar
Mood Disorders What Are Mood Disorders? In mood disorders, disturbances of mood are intense and persistent enough to be clearly maladaptive Key moods involved are mania and depression Encompasses both
More informationElizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller
Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You
More informationNaomi M. Simon, MD, MSc
Generalized Anxiety Disorder and Psychiatric Comorbidities Such as Depression, Bipolar Disorder, and Substance Abuse Naomi M. Simon, MD, MSc Generalized anxiety disorder (GAD) has a high rate of comorbidity
More informationBipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic
More informationThe Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Cardwell C Nuckols, PhD cnuckols@elitecorp1.com Cardwell C. Nuckols, PhD www.cnuckols.com SECTION I-BASICS DSM-5 Includes
More informationCriteria to Identify Abnormal Behavior
Criteria to Identify Abnormal Behavior Unusualness Social deviance Emotional distress Maladaptive behavior Dangerousness Faulty perceptions or interpretations of reality Hallucinations Delusions Copyright
More informationAssessment and Diagnosis of DSM-5 Substance-Related Disorders
Assessment and Diagnosis of DSM-5 Substance-Related Disorders Jason H. King, PhD (listed on p. 914 of DSM-5 as a Collaborative Investigator) j.king@lecutah.com or 801-404-8733 www.lecutah.com D I S C L
More informationMayor s Round Table on Mental Health and Addictions
Mayor s Round Table on Mental Health and Addictions Addressing serious mental health and addictions and the health of our City October 2, 2013 Media Resource Part 1 Seriously Addicted & Mentally Ill (SAMI)
More informationHow to Read the DSM-IV A Tutorial for Beginners
How to Read the DSM-IV A Tutorial for Beginners By Dr. Robert Tippie, Ph.D. MARET Systems International Previously we explained the validity of pastors using the DSM-IV. In this article we will discuss
More informationADHD. & Coexisting Disorders in Children
ADHD & Coexisting Disorders in Children ADHD AND CHILDREN Attention-deficit/hyperactivity disorder (ADHD) is a recognized medical condition that often requires medical intervention. Establishing a diagnosis
More informationBilly. Austin 8/27/2013. ADHD & Bipolar Disorder: Differentiating the Behavioral Presentation in Children
ADHD & Bipolar Disorder: Differentiating the Behavioral Presentation in Children Judy Goodwin, MSN, CNS Meadows Psychiatric Associates Billy Austin 1 Introduction Distinguishing between ADHD and Bipolar
More informationADHD PRACTISE PARAMETER. IRSHAAD SHAFFEEULLAH, M.D. A diplomate American Board of CHILD AND ADOLESCENT PSYCHIATRY
ADHD PRACTISE PARAMETER IRSHAAD SHAFFEEULLAH, M.D. A diplomate American Board of CHILD AND ADOLESCENT PSYCHIATRY Similar type of idea Similar document Similar document AACAP document Neurobiological condition
More informationDepression Signs & Symptoms
Depression Signs & Symptoms Contents What Is Depression? What Are The Signs And Symptoms Of Depression? How Do The Signs And Symptoms Of Depression Differ In Different Groups? What Are The Different Types
More informationPHENOTYPE PROCESSING METHODS.
PHENOTYPE PROCESSING METHODS. We first applied exclusionary criteria, recoding diagnosed individuals as phenotype unknown in the presence of: all dementias, amnestic and cognitive disorders; unknown/unspecified
More informationDual Diagnosis Nursing Care: Treating the Patient with Co-Occurring Addiction & Mental Health Disorders. Deborah Koivula R.N.
Dual Diagnosis Nursing Care: Treating the Patient with Co-Occurring Addiction & Mental Health Disorders. Deborah Koivula R.N. Webinar Overview & Objectives I. Review current trends in co-occurring disorders
More informationAlgorithm for Initiating Antidepressant Therapy in Depression
Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression
More informationDSM IV TR Diagnostic Codes. (In Numeric Order) DSM IV Codes: Through revisions on 10.01.1996 and 10.01.2005. Code Description Code Description
290.0 Dementia of the Alzheimer's type, with late onset, uncomplicated NO DSM IV TR 290 code / See codes [294.10 294.1x] 290.10A Dementia due to Creutzfeldt Jakob disease NO DSM IV TR 290.10 code / See
More informationTELEMEDICINE SERVICES Brant Haldimand Norfolk INITIAL MENTAL HEALTH ASSESSMENT NAME: I.D. # D.O.B. REASON FOR REFERRAL:
TELEMEDICINE SERVICES Brant Haldimand Norfolk TMS INITIAL MENTAL HEALTH ASSESSMENT NAME: I.D. # D.O.B. (OPTINAL) ADDRESS: CITY: P.C. HOME PHONE: ALTERNATE PHONE: G.P: MARITAL STATUS: AGE: ASSSESSMENT DATE:
More informationNew Treatments. For Bipolar Disorder. Po W. Wang, MD Clinical Associate Professor Bipolar Disorders Clinic Stanford University School of Medicine
New Treatments For Bipolar Disorder Po W. Wang, MD Clinical Associate Professor Bipolar Disorders Clinic Stanford University School of Medicine Abbott Laboratories AstraZeneca Bristol-Myers Squibb Corcept
More informationMULTIPLE SCLEROSIS AND DEPRESSION. Michael Racke, MD The Ohio State University Meera Narasimhan, MD University of South Carolina
MULTIPLE SCLEROSIS AND DEPRESSION Michael Racke, MD The Ohio State University Meera Narasimhan, MD University of South Carolina MICHAEL RACKE, MD Disclosures!! Research/Grants: National Institute of Neurologic
More informationICD- 9 Source Description ICD- 10 Source Description
291.0 Alcohol withdrawal delirium F10.121 Alcohol abuse with intoxication delirium 291.0 Alcohol withdrawal delirium F10.221 Alcohol dependence with intoxication delirium 291.0 Alcohol withdrawal delirium
More informationPlanning Services for Persons with Developmental Disabilities and Mental Health Diagnoses
Planning Services for Persons with Developmental Disabilities and Mental Health Diagnoses Persons with Intellectual Disabilities (ID) have mental disorders three to four times more frequently than do persons
More informationTreating Children with Anxiety and Bipolar Disorder. Ellen Leibenluft, M.D.
Treating Children with Anxiety and Bipolar Disorder Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders Emotion and Development Branch National Institute of Mental Health National Institutes
More informationIntroduction to bipolar disorder
Introduction to bipolar disorder Bipolar I is when the individual experiences manic episodes when high as well as episodes of depression Bipolar II is when the individual experiences hypomanic episodes
More informationSLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS
E-Resource December, 2013 SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep
More informationPAPEL DE LA PSICOTERAPIA EN EL TRATAMIENTO DEL TRASTORNO BIPOLAR
PAPEL DE LA PSICOTERAPIA EN EL TRATAMIENTO DEL TRASTORNO BIPOLAR Dr. Francesc Colom PsyD, MSc, PhD Bipolar Disorders Program IDIBAPS- CIBERSAM -Hospital Clínic Barcelona, University of Barcelona Centro
More informationAddiction Billing. Kimber Debelak, CMC, CMOM, CMIS Director, Recovery Pathways
Addiction Billing Kimber Debelak, CMC, CMOM, CMIS Director, Recovery Pathways Objectives Provide overview of addiction billing contrasting E&M vs. behavioral health codes Present system changes in ICD-9
More informationDepre r s e sio i n o i n i a dults Yousuf Al Farsi
Depression in adults Yousuf Al Farsi Objectives 1. Aetiology 2. Classification 3. Major depression 4. Screening 5. Differential diagnosis 6. Treatment approach 7. When to refer 8. Complication 9. Prognosis
More informationRecognizing and Treating Bipolar Disorder
Clinical Review Article Recognizing and Treating Bipolar Disorder William R. Marchand, MD All physicians need to be familiar with the diagnosis and treatment of mood disorders. Fifty percent of all depressive
More informationTEEN MARIJUANA USE WORSENS DEPRESSION
TEEN MARIJUANA USE WORSENS DEPRESSION An Analysis of Recent Data Shows Self-Medicating Could Actually Make Things Worse Millions of American teens* report experiencing weeks of hopelessness and loss of
More informationSee also www.thiswayup.org.au/clinic for an online treatment course.
Depression What is depression? Depression is one of the common human emotional states. It is common to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments.
More informationICD-9/DSM IV TO ICD-10 CROSSWALK TABLE
ICD-9/DSM IV TO ICD-10 CROSSWALK TABLE DIAGNOSIS MEETS OUTPATIENT "MEDICAL NECESSITY" CRITERIA ICD-9 DSM IV Description ICD-10 ICD-10 Description PSYCHOTIC DISORDERS 295.30 Schizophrenia, Paranoid Type
More informationThis program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.
This program is approved for 1.0 contact hour of continuing education (which includes 0.25 hours of pharmacology) by the American Academy of Nurse Practitioners. Program ID 1012385. This program was planned
More informationBipolar Disorder Practice Guidelines for Adults
Bipolar Disorder Practice Guidelines for Adults Introduction PerformCare s condensed guidelines for the treatment of Bipolar Disorder are derived from the American Psychiatric Association (APA) Guidelines
More informationFACT SHEET 4. Bipolar Disorder. What Is Bipolar Disorder?
FACT SHEET 4 What Is? Bipolar disorder, also known as manic depression, affects about 1 percent of the general population. Bipolar disorder is a psychiatric disorder that causes extreme mood swings that
More information