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Substance/Medication-Induced Depressive Disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Substance/Medication-Induced Depressive Disorder [1]

“
  • A.A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings of both

(1)and(2):

  • 1.The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
  • 2.The involved substance/medication is capable of producing the symptoms in Criterion A.
  • C.The disturbance is not better explained by a depressive disorder that is not substance/medication-induced. Such evidence of an independent depressive disorder could include the following:

The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder (e.g., a history of recurrent non-substance/medication-related episodes).

AND

  • D.The disturbance does not occur exclusively during the course of a delirium.

AND

  • E.The disturbance causes clinically significant distress or impairment in social, occupational,or other important areas of functioning.

Note:This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention. .

”

References

  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.



Epidemiology and Demographics

Prevalence

The prevalence of substance/medication-induced depressive disorder is 260 per 100,000 (0.26%) of the overall population.[1]


Risk Factors


Differential Diagnosis



Depressive Disorder Due to Another Medical Condition

Diagnostic Criteria

DSM-V Diagnostic Criteria for Depressive Disorder Due to Another Medical Condition [1]

“
  • A.A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

AND

  • C.The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).

AND

  • D.The disturbance does not occur exclusively during the course of a delirium.

AND

  • E.The disturbance causes clinically significant distress or impairment in social, occupational,or other important areas of functioning.
 ”

References

  1. ↑ 1.0 1.1 1.2 1.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Risk Factors

  • Left frontal strokes


Differential Diagnosis

  • Alpha-interferon
  • steroids



Specific Phobia

Diagnostic Criteria

DSM-V Diagnostic Criteria for Specific Phobia[1]

“
  • A.Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

Note:In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging .

AND

  • B.The phobic object or situation almost always provokes immediate fear or anxiety.

AND

  • C.The phobic object or situation is actively avoided or endured with intense fear or anxiety.

AND

  • D.The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the socio cultural context.

AND

  • E.The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

AND

  • F.The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

  • G.The disturbance is not better explained by the symptoms of another mental disorder,including fear, anxiety, and avoidance of situations associated with panic-like symptoms

or other incapacitating symptoms (as in agoraphobia): objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

”


References

  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemilogy and Demographics

Prevalence

The 12 month prevalence of specific phobia is 7,000-9,000 per 100,000 (7%-9%) of the overall population.[1]

Risk Factors

  • Behavioral inhibition
  • Genetic predisposition
  • Negative affectivity (neuroticism)
  • Parental over protectiveness
  • Parental loss and separation
  • Physical and sexual abuse[1]

Differential Diagnosis


Substance/Medication-Induced Anxiety Disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Substance/Medication-Induced Anxiety Disorder [1]

“
  • A.Panic attacks or anxiety is predominant in the clinical picture.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings of both (1)and (2):
  • 1.The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
  • 2.The involved substance/medication is capable of producing the symptoms in Criterion A.

AND

  • C.The disturbance is not better explained by an anxiety disorder that is not substance/medication-induced. Such evidence of an independent anxiety disorder could include

the following:

  • The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication: or there is other evidence suggesting the existence of an independent non-substance/medication-induced anxiety disorder

(e.g., a history of recurrent non-substance/medication-related episodes).

AND

  • D.The disturbance does not occur exclusively during the course of a delirium.

AND

  • E.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note:This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and they are sufficiently severe to warrant clinical attention .


”

References

  1. ↑ 1.0 1.1 1.2 1.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemiology and Demographics

Prevalence

The prevalence of substance/medication-induced anxiety disorder is not clear in the overall population.[1]


Differential Diagnosis


Anxiety Disorder Due to Another Medical Condition

Diagnostic Criteria

DSM-V Diagnostic Criteria for Anxiety Disorder Due to Another Medical Condition [1]

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  • A.Panic attacks or anxiety is predominant in the clinical picture.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

AND

  • C.The disturbance is not better explained by another mental disorder.

AND

  • D.The disturbance does not occur exclusively during the course of a delirium.

AND

  • E.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemiology and Demographics

Prevalence

The prevalence of anxiety disorder due to another medical condition is unclear in the overall population.[1]


Differential Diagnosis

  • Associated feature of another mental disorder
  • Mixed presentation of symptoms (e.g., mood and anxiety)
  • Other specified or unspecified anxiety disorder


Excoriation (Skin-Picking) Disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Excoriation (Skin-Picking) Disorder [1]

“
  • A.Recurrent skin picking resulting in skin lesions.

AND

  • B.Repeated attempts to decrease or stop skin picking.

AND

  • C.The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

  • D.The skin picking is not attributable to the physiological effects of a substance (e.g.,cocaine) or another medical condition (e.g., scabies).

AND


”


References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemiology and Demographics

Prevalence

The prevalence of excoriation (Skin-Picking) disorder is 1,400 per 100,000 (1.4%) of the overall population.[1]


Risk Factors


Differential Diagnosis

  • Neurodevelopmental disorders
  • Other obsessive-compulsive and related disorders
  • Other disorders
  • Other medical conditions
  • Psychotic disorder
  • Somatic symptom and related disorders
  • Substance/medication-induced disorders

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Substance/Medication-Induced Obsessive-Compulsive and Related Disorder [1]

“
  • A.Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors,or other symptoms characteristic of the obsessive-compulsive and related disorders predominate in the clinical picture.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings of both (1)and (2):
  • 1.The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
  • 2.The involved substance/medication is capable of producing the symptoms in Criterion A.

AND

  • C.The disturbance is not better explained by an obsessive-compulsive and related disorder that is not substance/medication-induced. Such evidence of an independent obsessive-compulsive and related disorder could include the following:
  • The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute

withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced obsessive-compulsive and related disorder (e.g., a history of recurrent non-substance/medication related episodes).

AND

  • D.The disturbance does not occur exclusively during the course of a delirium.

AND

  • E.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


Note:This diagnosis should be made in addition to a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and are sufficiently severe to warrant clinical attention .


”

References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemiology and Demographics

Prevalence

The prevalence of substance induced obsessive-compulsive and related disorder is very rare.[1]


Differential Diagnosis


Obsessive-Compulsive and Related Disorder Due to Another Medical Condition

Diagnostic Criteria

DSM-V Diagnostic Criteria for Obsessive-Compulsive and Related Disorder Due to Another Medical Condition [1]

“

A.Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic 0f obsessive-compulsive and related disorder predominate in the clinical picture. 

B.There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C.The disturbance is not better explained by another mental disorder.

D.The disturbance does not occur exclusively during the course of a delirium.

E.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning


”


References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.

Differential Diagnosis

  • Associated feature of another mental disorder
  • Substance/medication-induced obsessive-compulsive and related disorders


Major or Mild Neurocognitive Disorder Due to Another Medical Condition

Diagnostic Criteria

DSM-V Diagnostic Criteria for Major or Mild Neurocognitive Disorder Due to Another Medical Condition [1]

“
  • A.The criteria are met for major or mild neurocognitive disorder.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is the pathophysiological consequence of another medical

condition.

AND


”

References

  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Differential Diagnosis

  • Other major or mild neurocognitive disorder[1]

Major or Mild Neurocognitive Disorder Due to Multiple Etiologies

Diagnostic Criteria

DSM-V Diagnostic Criteria for Major or Mild Neurocognitive Disorder Due to Multiple Etiologies [1]

“
  • A.The criteria are met for major or mild neurocognitive disorder.

AND

  • B.There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is the pathophysiological consequence of more than one etiological process, excluding substances (e.g., neurocognitive disorder due to Alzheimer’s disease with subsequent development of vascular neurocognitive disorder).

Note:Please refer to the diagnostic criteria for the various neurocognitive disorders due to specific medical conditions for guidance on establishing the particular etiologies .

AND

  • C.The cognitive deficits are not better explained by another mental disorder and do not occur exclusively during the course of a delirium.


 ”

References

  1. ↑ 1.0 1.1 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Other (or Unknown) Substance Intoxication


Diagnostic Criteria

DSM-V Diagnostic Criteria for Other (or Unknown) Substance Intoxication[1]

“
  • A.The development of a reversible substance-specific syndrome attributable to recent ingestion of (or exposure to) a substance that is not listed elsewhere or is unknown.

AND

  • B.Clinically significant problematic behavioral or psychological changes that are attributable to the effect of the substance on the central nervous system (e.g., impaired motor

coordination, psychomotor agitation or retardation, euphoria, anxiety, belligerence, mood lability, cognitive impairment, impaired judgment, social withdrawal) and develop during, or shortly after, use of the substance.

AND

  • C.The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.


 ”

References

  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemiology and Demographics

Prevalence

The prevalence of Other (or Unknown) Substance Intoxication is unknown.[1]


Differential Diagnosis

  • Different types of other (or unknown) substance-related disorders
  • Other toxic, metabolic, traumatic, neoplastic, vascular, or infectious disorders that impair brain function and cognition
  • Substance intoxication or other substance/medication-induced disorders
  • Use of Other or unknown substance, without meeting criteria for other (or unknown)substance intoxication[1]

Other (or Unknown) Substance Use Disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Other (or Unknown) Substance Use Disorder [1]

“
  • 1.The substance is often taken in larger amounts or over a longer period than was intended.
  • 2.There is a persistent desire or unsuccessful efforts to cut down or control use of the substance.
  • 3.A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  • 4.Craving, or a strong desire or urge to use the substance.
  • 5.Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
  • 6.Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  • 7.Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
  • 8.Recurrent use of the substance in situations in which it is physically hazardous.
  • 9.Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated

by the substance.

  • 10.Tolerance, as defined by either of the following:
  • a.A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
  • b.A markedly diminished effect with continued use of the same amount of the substance.
  • 11.Withdrawal, as manifested by either of the following:
  • a.The characteristic withdrawal syndrome for other (or unknown) substance (refer to Criteria A and B of the criteria sets for other [or unknown] substance withdrawal).
  • b.The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Specify if:

  • In early remission: After full criteria for other (or unknown) substance use disorder were previously met, none of the criteria for other (or unknown) substance use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the substance,” may be met).
  • In sustained remission: After full criteria for other (or unknown) substance use disorder were previously met, none of the criteria for other (or unknown) substance use disorder

have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the substance,”may be met).

Specify if:

  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to the substance is restricted.


 ”

References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Risk Factors

Differential Diagnosis

  • Other (or unknown) substance/medication-induced disorder
  • Other medical conditions
  • Substance use disorders
  • Use of Other or unknown substances without meeting criteria for other (or unknown) substance use disorder[1]


Other (or Unknown) Substance Withdrawal

Diagnostic Criteria

DSM-V Diagnostic Criteria for Other (or Unknown) Substance Withdrawal [1]

“
  • A.Cessation of (or reduction in) use of a substance that has been heavy and prolonged.

AND

  • B.The development of a substance-specific syndrome shortly after the cessation of (or reduction in) substance use.

AND

  • C.The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

  • D.The symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including withdrawal from another substance.

AND


”

References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Epidemiology and Demographics

Prevalence

The prevalence of Other (or Unknown) Substance Withdrawal is unknown.[1]

Differential Diagnosis

  • Dose reduction after extended dosing, but not meeting the criteria for other (or unknown)substance withdrawal
  • Different types of other (or unknown) substance-related disorders
  • Other toxic, metabolic, traumatic, neoplastic, vascular, or infectious disorders that impair brain function and cognition
  • Substance withdrawal or other substance/medication-induced disorders[1]


Personality Change Due to Another Medical Condition

Diagnostic Criteria

DSM-V Diagnostic Criteria for Personality Change Due to Another Medical Condition[1]

“
  • A.A persistent personality disturbance that represents a change from the individual’s previous characteristic personality pattern.


Note: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.


AND

  • B.There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

AND

  • C.The disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition).

AND

  • D.The disturbance does not occur exclusively during the course of a delirium.

AND

E.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify whether:

  • 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

”


References

  1. ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


Differential Diagnosis

  • Another mental disorder due to another medical condition
  • Chronic medical conditions associated with pain and disability
  • Delirium or major neurocognitive disorder
  • Other mental disorders
  • Other personality disorders
  • Substance use disorders[1]
  1. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
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