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Substance/Medication-Induced Depressive Disorder

Diagnostic Criteria

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

“

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. .

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Epidemiology and Demographics

Prevalence

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

Risk Factors

• Antisocial behavior
• Alcohol or drug use disorders
• History of drug induced depression
• Higher family history of substance use disorders
• History of stressful life events
• Major depressive disorder
• Psychosocial stressors
• Specific type of medication

Differential Diagnosis

• Depressive disorder due to another medical condition
• Primary depressive disorder
• Substance intoxication and withdrawal

Depressive Disorder Due to Another Medical Condition

Diagnostic Criteria

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

“

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.

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Risk Factors

• CVA

• Left frontal strokes

Differential Diagnosis

• Adjustment disorders
• Depressive disorders not due to another medical condition
• Medication-induced depressive disorder

• Alpha-interferon
• steroids

Specific Phobia

Diagnostic Criteria

DSM-V Diagnostic Criteria for Specific Phobia

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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).

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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.

Risk Factors

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

Differential Diagnosis

• Agoraphobia
• Eating disorders
• Obsessive-compulsive disorder
• Panic disorder
• Schizophrenia spectrum and other psychotic disorders
• Separation anxiety disorder
• Social anxiety disorder
• Trauma- and stressor-related disorders

Substance/Medication-Induced Anxiety Disorder

Diagnostic Criteria

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

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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 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 .

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Epidemiology and Demographics

Prevalence

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

Differential Diagnosis

• Anxiety disorder (i.e., not induced by a substance/medication)
• Anxiety disorder due to another medical condition
• Delirium
• Substance intoxication and substance withdrawal

Anxiety Disorder Due to Another Medical Condition

Diagnostic Criteria

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

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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.

Epidemiology and Demographics

Prevalence

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

Differential Diagnosis

• Associated feature of another mental disorder

• Anorexia nervosa

• Schizophrenia .

• Adjustment disorders

• Anxiety disorder (not due to a known medical condition).

• Delirium
• Illness anxiety disorder

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

• Substance/medication-induced anxiety disorder

• Corticosteroids
• Estrogens
• Metoclopramide

Excoriation (Skin-Picking) Disorder

Diagnostic Criteria

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

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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 E.The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in non suicidal self-injury).

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Epidemiology and Demographics

Prevalence

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

Risk Factors

• Genetic predisposition
• obsessive-compulsive disorder(OCD)

Differential Diagnosis

• Neurodevelopmental disorders

• Prader-Willi syndrome
• Tourette's disorder

• Other obsessive-compulsive and related disorders

• Body dysmorphic disorder

• Other disorders
• Other medical conditions

• Acne

• Scabies

• Psychotic disorder

• Delusion
• Tactile hallucination

• Somatic symptom and related disorders

• Factitious disorder

• Substance/medication-induced disorders

• Cocaine

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder

Diagnostic Criteria

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

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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 .

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