Sandbox/JRH

1.- Substance/Medication-Induced Psychotic Disorder

Synonyms and keywords: Medication induced psychotic disorder; substance induced psychotic disorder; substance-medication induced psychotic disorder;

Differential Diagnosis

• Alcohol withdrawal
• Brief psychotic disorder
• Cannabis intoxication
• Delusional disorder
• Flashback hallucinations
• Intoxication with stimulants
• Phencyclidine
• Schizophrenia
• Schizoaffective disorder
• Schizophrenia spectrum
• Delusional disorder
• Opioid meperidine

Epidemiology and Demographics

Prevalence

The prevalence of substance/medication-induced psychotic disorder is unknown of the overall population.

Risk Factors

• Cocaine usage
• Heavy and constant ingestion of alcohol
• History of psychopathic disorder

Natural History, Complications and Prognosis

Poor prognosis factors include:

• Depersonalization
• Flashbacks
• Hallucinations
• Marked anxiety
• Persecutory delusions

Diagnostic Criteria

• A. Presence of one or both of the following symptoms:

1. Delusions

2. Hallucinations

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 a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic 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 of an independent non-substance/medication-induced psychotic 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.

2.- Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

Synonyms and keywords: Catatonia

Epidemiology and Demographics

Prevalence

The prevalence of catatonia associated with another mental disorder is unknown of the overall population.

Risk Factors

• Bipolar disorders
• Depressive disorders
• Schizophrenia

Natural History, Complications and Prognosis

Poor prognostic factors include:

• Bipolar disorder
• Depressive disorder
• Mental disorder
• Metabolic conditions
• Infectious conditions
• Psychotic disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Catatonic Disorder Due to Another IVIedical Condition

“

A. The clinical picture is dominated by three (or more) of the following symptoms: Stupor (i.e., no psychomotor activity; not actively relating to environment). Catalepsy (i.e., passive induction of a posture held against gravity). Waxy flexibility (i.e., slight, even resistance to positioning by examiner). Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]). Negativism (i.e., opposition or no response to instructions or external stimuli). Posturing (i.e., spontaneous and active maintenance of a posture against gravity). Mannerism (i.e., odd, circumstantial caricature of normal actions). Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). Agitation, not influenced by external stimuli. Grimacing. Echolalia (i.e., mimicking another’s speech). Echopraxia (i.e., mimicking another’s movements).

”

3. Catatonic Disorder Due to Another Medical Condition

Differential Diagnosis

• Brief psychotic disorder
• Cerebrovascular disease
• Diabetic ketoacidosis
• Encephalitis
• Neoplasms
• Head trauma
• Hepatic encephalopathy
• Hypercalcemia
• Homocystinuria
• Schizoaffective disorder
• Schizophrenia
• Schizophreniform disorder
• Substance/medication-induced psychotic disorder

Epidemiology and Demographics

Prevalence

The prevalence of catatonia associated with another medical disorder is unknown of the overall population.

Natural History, Complications and Prognosis

Poor prognostic factors are:

• Neuroleptic malignant syndrome
• Neuroleptic medication intake

Diagnostic Criteria

DSM-V Diagnostic Criteria for Paranoid Personality Disorder

“

A. The clinical picture is dominated by three (or more) of the following symptoms: Stupor (i.e., no psychomotor activity; not actively relating to environment). Catalepsy (i.e., passive induction of a posture held against gravity). Waxy flexibility (i.e., slight, even resistance to positioning by examiner). Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]). Negativism (i.e., opposition or no response to instructions or external stimuli). Posturing (i.e., spontaneous and active maintenance of a posture against gravity). Mannerism (i.e., odd, circumstantial caricature of normal actions). Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). Agitation, not influenced by external stimuli. Grimacing. Echolalia (i.e., mimicking another’s speech). Echopraxia (i.e., mimicking another’s movements). 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.,amanicepisode). 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.

”

4.- Sleep-Related Hypoventilation

Synonyms and keywords: Obesity hypoventilation disorder

Differential Diagnosis

• Lung diseases
• Skeletal malformations
• Neuromuscular disorders
• Sleep-related hypoxemia
• Obstructive sleep apnea hypopnea
• Central sleep apnea

Epidemiology and Demographics

Prevalence

The prevalence of sleep-related hypoventilation is unknown of the overall population.

Risk Factors

• Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
• Hypothiroidism
• Neuromuscular or chest wall disorder
• Pulmonary disorder

Natural History, Complications and Prognosis

Prognosis

Poor prognostic criteria include:

• Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
• Hypothiroidism
• Neuromuscular or chest wall disorder

• Amyotrophic lateral sclerosis
• Spinal cord injury
• Diaphragmatic paralysis
• Myasthenia gravis
• Lambert-Eaton syndrome
• Toxic or metabolic myopathies
• Postpolio syndrome
• Char-cot-Marie-Tooth syndrome

• Pulmonary disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Paranoid Personality Disorder

“

A. Polysomnograpy demonstrates episodes of decreased respiration associated with elevated CO2 levels. (Note: In the absence of objective measurement of CO2, persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.) B. The disturbance is not better explained by another current sleep disorder. Specify whether: Idiopathic hiypoventilation: This subtype is not attributable to any readily identified condition. Congenital central alveolar hypoventilation: This subtype is a rare congenital disorder in which the individual typically presents in the perinatal period with shallow breathing, or cyanosis and apnea during sleep. Comorbid sleep-related hypoventilation: This subtype occurs as a consequence of a medical condition, such as a pulmonary disorder (e.g., interstitial lung disease, chronic obstructive pulmonary disease) or a neuromuscular or chest wall disorder (e.g., muscular dystrophies, postpolio syndrome, cervical spinal cord injury, kyphoscoliosis), or medications (e.g., benzodiazepines, opiates). It also occurs with obesity (obesity hypoventilation disorder), where it reflects a combination of increased work of breathing due to reduced chest wall compliance and ventilation-perfusion mismatch and variably reduced ventilatory drive. Such individuals usually are characterized by body mass index of greater than 30 and hypercapnia during wakefulness (with a PCO2 of greater than 45), without other evidence of hypoventilation. Specify current severity: Severity is graded according to the degree of hypoxemia and hypercarbia present during sleep and evidence of end organ impairment due to these abnormalities (e.g., right sided heart failure). The presence of blood gas abnormalities during wakefulness is an indicator of greater severity.

”

5.- Circadian Rhythm Sleep-Wake Disorders

Synonyms and keywords:

6.- Non-Rapid Eye Movement Sleep Arousal Disorders

Synonyms and keywords: NREM sleep arousal disorder; sleep terror

Differential Diagnosis

• Alcohol-induced blackouts
• Breathing-related sleep disorders
• Dissociative amnesia, with dissociative fugue
• Sleep-related seizures
• Malingering or other voluntary behavior occurring during wakefulness
• Medication-induced complex behaviors
• REM sleep behavior disorder
• Night eating syndrome
• Nightmare disorder
• Panic disorder
• Parasomnia overlap syndrome

Epidemiology and Demographics

Prevalence

The lifetime prevalence of non-rapid eye movement sleep arousal disorders is 10,000 to 30,000 per 100,000 (10% to 30%) among children. The lifetime prevalence of NREM sleep arousal disorder is 29,200 (29.2%) among adults.

Risk Factors

• Sedative use,
• Sleep deprivation,
• Sleep-wake schedule disruptions
• Fatigue, and physical or emotional stress

Prognosis

Poor prognostic factors include:

• Emotional stress
• Males during adulthood
• Fatigue
• Females during childhood
• Physical stress
• Sleep-wake schedule disruptions

Diagnostic Criteria

DSM-V Diagnostic Criteria for Paranoid Personality Disorder

“

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following: Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually be ginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes. AND B. No or little (e.g., only a single visual scene) dream imagery is recalled. AND C. Amnesia for the episodes is present. AND D. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). AND F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors. Specify whether: Sleepwalking type Specify if: With sleep-related eating With sleep-related sexual behavior (sexsomnia) Sleep terror type

”

7.- Other hallucinogen Use Disorder

Synonyms and keywords:

Differential Diagnosis

• Alcohol withdrawal
• Bipolar disorders
• Central nervous system tumors
• Depressive disorder
• Hypoglycemia
• Panic disorder
• Schizophrenia
• Sedative withdrawal
• Seizure disorder
• Stroke
• Ophthalmological disorder
• Other substance use disorders

Risk Factors

• Alcohol intake
• Tobacco usage
• Cannabis usage
• Major depressive disorder

Epidemiology and Demographics

Prevalence

The 12-month prevalence is 500 per 100,000 (0.5%) among 12- to 17-year-olds and 100 per 100,000 (0.1%) among adults age 18 and older in the United States.

Risk Factors

• Younger age than 30-year-old
• Female gender

Diagnostic Criteria

A. A problematic pattern of hallucinogen (other than phencyclidine) use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. The hallucinogen 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 hallucinogen use.
3. A great deal of time is spent in activities necessary to obtain the hallucinogen, use the hallucinogen, or recover from its effects.
4. Craving, or a strong desire or urge to use the hallucinogen.
5. Recurrent hallucinogen use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to hallucinogen use; hallucinogen-related absences, suspensions, or expulsions from school; neglect of children or household).
6. Continued hallucinogen use despite having persistent or recurrent social or inter personal problems caused or exacerbated by the effects of the hallucinogen (e.g., arguments with a spouse about consequences of intoxication; physical fights).
7. Important social, occupational, or recreational activities are given up or reduced be cause of hallucinogen use.
8. Recurrent hallucinogen use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by the hallucinogen).
9. hallucinogen use is continued despite knowledge of having a persistent or recur rent physical or psychological problem that is likely to have been caused or exacerbated by the hallucinogen.
10. Tolerance, as defined by either of the following:

1. A need for markedly increased amounts of the hallucinogen to achieve intoxication or desired effect.
2. A markedly diminished effect with continued use of the same amount of the hallucinogen.

Note: Withdrawal symptoms and signs are not established for hallucinogens, and so this criterion does not apply.

Specify the particular hallucinogen.

Specify if:

In early remission: After full criteria for other hallucinogen use disorder were previously met, none of the criteria for other hallucinogen 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 hallucinogen,” may be met).

In sustained remission: After full criteria for other hallucinogen use disorder were previously met, none of the criteria for other hallucinogen 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 hallucinogen,” may be met).

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

Specify current severity:

Mild: Presence of 2-3 symptoms.

Moderate: Presence of 4-5 symptoms.

Severe: Presence of 6 or more symptoms.

8.- Hallucinogen Persisting Perception Disorder

Synonyms and keywords:

Differential Diagnosis

• Brain tumors
• Head trauma
• Infections
• Neurodegenerative disorders
• Schizophrenia
• Stroke

Epidemiology and Demographics

Prevalence

The prevalence of is 4,200 per 100,000 (4.2%) of the overall population.

Risk Factors

• Genetic factors are suggested as a possible factor that leads to susceptibility for this condition.

Natural History, Complications and Prognosis

Prognosis

Poor prognostic factors include:

• Alcohol use disorder
• Major depressive disorder
• Panic disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Paranoid Personality Disorder

“

A. Following cessation of use of a hallucinogen, there experiencing of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia and micropsia). AND B. The symptoms in Criterion A cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND C. The symptoms are not attributable to another medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better explained by an other mental disorder (e.g., delirium, major neurocognitive disorder, schizophrenia) or hypnopompic hallucinations.

”

9.- Other hallucinogen-Induced Disorders

Synonyms and keywords:

10.- Unspecified Phencyclidine-Related Disorder

Synonyms and keywords:

Stimulant Use Disorder

Synonyms and keywords:

Differential Diagnosis

• Depressive and bipolar disorder
• Generalized anxiety disorder
• Schizophrenia
• Stimulant intoxication
• Stimulant withdrawal
• Panic disorder
• Phencyclidine intoxication

Epidemiology and Demographics

Prevalence

The prevalence of stimulant use disorder is 2,000 per 100,000 (0.2%) of the overall population.

Risk Factors

• Adult antisocial personality disorder
• Antisocial personality disorder
• Bipolar disorder
• Childhood conduct disorder
• Exposure to community violence during childhood
• Schizophrenia
• Substance use disorder
• Impulsivity
• Prenatal cocaine exposure,
• Postnatal cocaine use by parents
• Unstable home environment, having a psychiatric condition

Natural History, Complications and Prognosis

Prognosis

Poor prognostic factors include:

• Antisocial personality
• Impulsivity
• Substance use disorders
• Living in an unstable home environment

Diagnostic Criteria

DSM-V Diagnostic Criteria for Paranoid Personality Disorder

“

A. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: The stimulant is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use. A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects. Craving, or a strong desire or urge to use the stimulant. Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home. Continued stimulant use despite having persistent or recurrent social or intepersonal problems caused or exacerbated by the effects of the stimulant. Important social, occupational, or recreational activities are given up or reduced because of stimulant use. Recurrent stimulant use in situations in which it is physically hazardous. Stimulant use 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 stimulant. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the stimulant.Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy. 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal). b. The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit hyperactivity disorder or narcolepsy. Specify if: In early remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant 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 stimulant,” may be met). In sustained remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant 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 stimulant,” may be met). Specify if: In a controlled environment: This additional specifier is used if the individual is in an environment where access to stimulants is restricted. Specify current severity: Mild: Presence of 2-3 symptoms. Amphetamine-type substance Cocaine Other or unspecified stimulant Moderate: Presence of 4-5 symptoms. Amphetamine-type substance Cocaine Other or unspecified stimulant Severe: Presence of 6 or more symptoms. Amphetamine-type substance Cocaine Other or unspecified stimulant

”

Stimulant Intoxication

Synonyms and keywords:

Differential Diagnosis

• Anxiety disorder
• Bipolar disorder
• Depressive disorder
• Psychotic disorder
• Stimulant intoxication delirium
• Schizophrenia
• Stimulant-induced depressive disorder
• Generalized anxiety disorder
• Panic disorder

Epidemiology and Demographics

Prevalence

The prevalence of stimulant intoxication is unknown of the overall population.

Risk Factors

• High chronicity of use
• Low tolerance
• High rate of absortion

Natural History, Complications and Prognosis

Prognosis

Poor prognostic factors include:

• Convulsions
• Cardiac arrhythmia
• Hyperpyrexia
• Impaired social or occupational functioning

Diagnostic Criteria

DSM-V Diagnostic for Stimulant Intoxication

“

A. Recent use of an amphetamine-type substance, cocaine, or other stimulant. AND B. Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting: changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant. AND C. Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use: Tachycardia or bradycardia. Pupillary dilation. Elevated or lowered blood pressure. Perspiration or chills. Nausea or vomiting. Evidence of weight loss. Psychomotor agitation or retardation. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. Confusion, seizures, dyskinesias, dystonias, or coma. AND D. 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. Specify the specific intoxicant (i.e., amphetamine-type substance, cocaine, or other stimulant). Specify if: With perceptual disturbances: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.

”

Stimulant Withdrawal

Synonyms and keywords:

Differential Diagnosis

• Anxiety disorder
• Bipolar disorder
• Depressive disorder
• Psychotic disorder
• Sexual dysfunction
• Sleep disorder
• Stimulant-induced intoxication delirium

Epidemiology and Demographics

Prevalence

The prevalence of stimulant withdrawal is unknown of the overall population.

Risk Factors

Repetitive high-dose use

Natural History, Complications and Prognosis

Poor prognostic factors include:

• Anhedonia
• Drug craving
• Impairment in a functional area (social, work, school)

Diagnostic Criteria

• A. Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use.

AND

• B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:

1. Fatigue.
2. Vivid, unpleasant dreams.
3. Insomnia or hypersomnia.
4. Increased appetite.
5. Psychomotor retardation or agitation.

AND

• C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

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

Specify the specific substance that causes the withdrawal syndrome (i.e., amphetamine-type substance, cocaine, or other stimulant).

Other (or Unknown) Substance Use Disorder

Synonyms and keywords:

Other (or Unknown) Substance Intoxication

Synonyms and keywords:

Other (or Unknown) Substance Withdrawal

Synonyms and keywords:

Other (or Unknown) Substance-Induced Disorders

Synonyms and keywords:

Personality Change Due to Another Medical Condition

Synonyms and keywords:

Exhibitionistic Disorder

Synonyms and keywords:

Frotteuristic Disorder

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Other Specified Mental Disorder Due to Another Medical Condition

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