Category Archives: Mental Health Diagnosis

Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes




Trauma and Stressor-Related Disorders: New category

The trauma and stressor related disorders category is a new chapter in the DSM-V. This category now includes post traumatic stress disorder, acute stress disorder, reactive attachment disorder (RAD), adjustment disorders and the new diagnostic category, disinhibited social engagement disorder (DSED). In the previous DSM-IV-TR, acute stress disorder and posttraumatic stress disorder were included in the anxiety disorders category. These disorders are now included in the same diagnostic category in the DSM-V because of their common roots in external events.

Trauma and Stressor-Related Disorders: Overview

Besides being placed in the new category, a significant change includes the necessity for the stressor criterion for posttraumatic stress disorder and acute stress disorder to be met. The stressor or traumatic event can be either directly or indirectly experienced or witnessed by an individual receiving a diagnosis of either post traumatic stress disorder or acute stress disorder. The traumatic event can be experienced by a family member or friend, having a significant effect on the individual receiving the diagnosis.

The term trauma usually refers to a significant response to a very distressing experience such as a terrible accident, sexual assault, abuse, combat or exposure to natural or human disasters. Stressful events can be either emotionally or physically harmful or both and can involve either a single experience or repetitive events over a period of time. Traumatic events can affect different people in very different ways, but have the overall experience of threatening their physical, emotional or spiritual welfare. The trauma is always experienced as overwhelming the individual’s ability to cope.

Some of the more common traumatic events have included sexual and physical assault, robbery, combat, terrorist attacks being kidnapped and taken hostage, being tortured, disasters, child abuse, automobile accidents and life-threatening illnesses. Traumatic events may also include witnessing a person’s death or serious injury through violence, war, accidents or natural disasters.




Prevalence:

The prevalence rate of traumatic related disorders is very high among the general population in the United States. The lifetime prevalence rate among men is 3.6% with a rate of 9.7% among women. The rate among children does not seem to be currently available although it is recognized that children who have experienced traumatic events are also at very high risk of developing posttraumatic stress disorder. The prevalence rates of acute stress disorder are between 6% and 94% depending upon the type of stressor involved. It is estimated that approximately 1% of children under the age of five have some degree of reactive attachment disorder. Children who are placed in foster care or are orphaned are at a much higher risk of developing reactive attachment disorder. Adjustment disorders are estimated to be between 2% and 8% in community-based samples of children, adolescents and among the elderly.

Diagnosis:

The onset of traumatic stress related disorders also increases the risk of associated mental health disorders such as anxiety, depression, sleeping and eating disorders, problems with substance use and suicidal ideation. It is also common for individuals diagnosed with a traumatic or stress related disorder to also have symptoms of somatic symptom disorder and/or attention deficit hyperactivity disorder and impulse control disorders. Many children who survived traumatic events are also misdiagnosed as having attention deficit hyperactivity disorder. Children diagnosed with reactive attachment disorder are also frequently mistaken for children with attention deficit hyperactivity disorder or oppositional defiant disorder and frequently have behavioral problems during childhood and throughout their adolescent years.

Important information:

It is important for mental health counselors and clinicians to understand that with the new category of traumatic stress related disorders that the most fundamental feature is trauma rather than anxiety serving as the precipitant to the development of the disorder.
Specific information and treatment information related to each of the individual diagnosis within the category of trauma and stress related disorders follows on subsequent pages.

Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes

313.89 (F94.1) Reactive Attachment Disorder
Specify if: Persistent
Specify current severity: Severe

313.89 (F94.2) Disinhibited Social Engagement Disorder

Specify if: Persistent
Specify current severity: Severe

309.81 (F43.10) Posttraumatic Stress Disorder (includes Posttraumatic Stress Disorder for Children 6 Years and Younger)

Specify whether: With dissociative symptoms
Specify if: With delayed expression

308.3 (F43.0) Acute Stress Disorder

___.__ (___.__) Adjustment Disorders

Specify whether:
309.0 (F43.21) With depressed mood
309.24 (F43.22) With anxiety
309.28 (F43.23) With mixed anxiety and depressed mood
309.3 (F43.24) With disturbance of conduct
309.4 (F43.25) With mixed disturbance of emotions and conduct
309.9 (F43.20) Unspecified
309.89 (F43.8) Other Specified Trauma-and Stressor-Related Disorder
309.9 (F43.9) Unspecified Trauma-and Stressor-Related Disorder

Diagnostic Information and Criterion for Trauma and Stressor-Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:





Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes: Overview

Psychiatric diagnosis that fall within the category of schizophrenia spectrum and other psychotic disorders are characterized by abnormalities in one or more of the following five categories: hallucinations, delusions, disorganized thinking, disorganized or abnormal motor behavior (including catatonia) negative symptoms. This section includes information related to each of the specific schizophrenia spectrum and other psychotic disorders included in the DSM-5. These include delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, psychotic disorder due to another medical condition and catatonia.

Psychotic disorders involve a variety of both positive and negative as well as some related cognitive symptoms. Positive symptoms involve thoughts and behaviors that you would not usually expect while negative symptoms involve the absence of expected experiences. Some of the basic positive symptoms include hallucinations and delusions, as well as thinking or movement disorders in which the individual seems to lose touch with reality. Hallucinations are sensory experiences such as visual and auditory hallucinations, olfactory hallucinations, gustatory hallucinations (tasting), or tactile or somatic hallucinations in which a person feels things that are not really there or do not seem to have an actual physical stimulus. Delusions are rigid beliefs that do not seem to have any basis in reality and from which an individual cannot be persuaded otherwise. Auditory hallucinations seem to be the most common and tactile hallucinations are frequently associated with withdrawal or intoxication from substances. Olfactory and gustatory hallucinations often indicate a possible underlying medical problem. Disorganized thoughts often referred to as thought disorder involves disruptions in thinking in such a way that communication becomes difficult. Disorganized or abnormal motor behavior frequently referred to as movement disorder, includes agitation, recurrent motions or an inability to respond or move in relation to specific stimuli such as with catatonia.

Negative symptoms within the schizophrenia spectrum category include a lack of motivation, pleasure or engagement in what are believed to be normal activities of daily living or the normal experiencing of emotion. Problems with cognitive symptoms are usually related to having a difficulty with executive functioning, memory or attention.

Schizophrenia Spectrum and Other Psychotic Disorders: Prevalence

According to the APA (2013) psychotic disorders are fairly uncommon, citing prevalence rates of disorders within the schizophrenia spectrum category to range from 0.2% to 0.7%. These do not account for any cross-cultural considerations that are not identified in the DSM-5 but seem to be commonly found in specific cultures throughout the world.




Individuals who experience psychotic disorders have various characteristics and experiences. For about 50% of the individuals diagnosed within this category, they experience a lifelong struggle of trying to maintain their symptoms and a modest level of functioning in their lives. A small minority of individuals who have a later age of onset and frequently a higher level of functioning, seem to be able to manage their symptoms more adequately over their lifetime.

The presence of positive symptoms of psychosis does not always indicate the presence of a psychotic disorder. Medical conditions and substance use and abuse can also lead to the onset and often the exacerbation of psychotic symptoms. In many or most cases, it is probably better for a mental health clinician to refer clients with psychotic symptoms for a thorough medical examination.

Cause and Treatment:

At the present time, researchers have not determined the cause of schizophrenia and other psychotic disorders. Medical conditions and substance use as well as other mental health conditions can lead or contribute to the severity of schizophrenia spectrum and other psychotic disorders. Studies have found a strong genetic connection among individuals with schizophrenia spectrum disorders and have identified various physiological conditions associated with psychosis. Individuals with first-degree relatives who have a condition within the schizophrenia spectrum may be as much as 10 times higher risk of developing the symptoms of psychotic disorders. Neuroscientific researchers have found that individuals with schizophrenic spectrum disorders have different brain structures and physiological components from those who do not.

The main focus of the treatment of schizophrenia and related disorders includes medications for the relief of symptoms and the management of relapse. Psychological interventions are used to promote coping, and for preventing relapse, providing assistance through supportive measures to attain the highest level of functioning in an individual’s activities of daily life.

The same treatment principles seem to apply to all disorders within the schizophrenic spectrum. In the acute phase, clinicians will try to manage the most acute symptoms through medication management and supportive services. Following the medication management of the acute symptoms, clinicians may then focus more on psychosocial treatments to reduce stress and assist the client and their families through psychoeducation and supportive services to maintain a relatively higher managed level of psychosis that allows them to function at the highest level possible in their lives. Finally, as they continue with their medications, clinicians can then attend to preventing relapse through psychological treatments which include skills training, psychoeducation, cognitive behavioral therapy, family interventions, supported employment and other psychological support services within the treatment community. Strong therapeutic relationships have been identified to be very important in assisting and promoting more positive attitudes and compliance with medications.

Please see below the specific schizophrenia spectrum and other psychotic disorders diagnostic codes as well as important diagnostic and treatment information.

Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:

301.22 (F21) Schizotypal (Personality) Disorder

297.1 (F22) Delusional Disorder

Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecutory type, Somatic type, Mixed type, Unspecified type

298.8 (F23) Brief Psychotic Disorder

Specify if: With marked stressor(s), Without marked stressor(s), With postpartum onset

295.40 (F20.81) Schizophreniform Disorder

Specify if: With good prognostic features, Without good prognostic features

295.90 (F20.9) Schizophrenia

___.__ (__.__} Schizoaffective Disorder
Specify whether:

295.70 (F25.0) Bipolar Type

295.70 (F25.1) Depressive Type

___.__ (__.__) Substance/Medication-Induced Psychotic Disorder

Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

___.__ (__.__) Psychotic Disorder Due to Another Medical Condition
Specify whether:

293.81 (F06.2) With Delusions

293.82 (F06.0) With Hallucinations

293.89 (F0 61) Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

293.89 (F06.1) Catatonia Disorder Due to Another Medical Condition

293.89 (F06.1) Unspecified Catatonia
Note: Code first 781.99 (R29.818) other symptoms involving nervous and musculoskeletal systems.

298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Diagnostic Information and Criterion for Schizophrenia Spectrum and Other Psychotic Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist


Obsessive-Compulsive and Related Disorders: DSM-5 Diagnostic Codes




Obsessive-Compulsive and Related Disorders: Introduction

Conditions which fall within the category of Obsessive-Compulsive and Related Disorders all share some key features of obsessions and compulsions. Obsessions are recurrent, persistent and intrusive anxiety provoking thoughts or images resulting in subsequent repetitive behaviors referred to as compulsions. Obsessions may include thoughts, feelings, ideas and sensations that compel a person to do specific behaviors or compulsions. Some of the more common obsessions include excessive counting, ruminating about physical flaws, hoarding and picking at one’s skin. Some of the resulting rituals which are common among individuals diagnosed with obsessive-compulsive disorder frequently include recurrent handwashing, frequently checking doors and locks and avoidance of specific situations. For an individual to be considered for a diagnosis of obsessive-compulsive disorder it must be disruptive to their daily existence and functioning. Disorders listed in this category all share the common feature of excessive preoccupation along with the subsequent engagement in repetitive behaviors.

Changes from the DSM-4 TR to the DSM-5:

There were significant changes from previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Obsessive-compulsive disorder was previously classified in the DSM-4 TR as an anxiety disorder. The new DSM-5 has created a standalone chapter separate from the other anxiety disorders. This also follows revisions within the ICD 10 CM which also classifies OCD separately from anxiety disorders. However, there should never be any confusion as to the close relationship between obsessive-compulsive disorders and anxiety disorders. When the separation of obsessive-compulsive disorder from anxiety disorders was anticipated prior to the publication of the new DSM-5, psychiatrists supported the move significantly more often than other mental health clinicians, with only 40% to 45% of other mental health professionals supporting the move to the new category. Many psychologists, counselors and other mental health professionals did not support the change because of the fact that most treatment protocols for obsessive-compulsive disorder are also similar for anxiety and other related disorders. As is the case with most anxiety related disorders and depression, comorbidity is frequently the rule rather than the exception.




Some of the new disorders that fall within this category include excoriation (skin picking) disorder, substance/medication -induced obsessive compulsive and related disorder, hoarding disorder and obsessive-compulsive and related disorder due to another medical condition. Also, the diagnosis of trichotillomania (hair pulling disorder) was moved from the DSM-4 TR classification of impulse control disorders to this new classification of Obsessive-Compulsive and Related Disorders in the DSM-5.

Diagnosis:

An important aspect of diagnosis is to differentiate obsessive-compulsive disorder from other mental health disorders by the key features of obsessive preoccupation and repetitive behaviors. Once this has been accomplished, diagnosis can proceed.

Diagnosis of obsessive-compulsive disorder can be challenging in that there is a high level of comorbidity with other diagnosis. It is very common for a person with this diagnosis to also exhibit

symptoms of anxiety disorders and depression; eating disorder; somatoform disorder; hypochondriasis; impulse-control disorder, especially kleptomania; and attention deficit hyperactivity disorder (ADHD). Also, there is a significant amount of literature considering the comorbidity between obsessive-compulsive disorder and Tourette’s syndrome.

Prevalence:

It has been estimated that as many as one in 100 or 2 to 3 million adults currently have obsessive-compulsive disorder. Among children it is estimated that nearly one in 200 or 500,000 children and adolescents may receive this diagnosis. These estimates do not include other related disorders. Hoarding is believed to affect about 4% of the general population. Trichotillomania may affect as many as 2.5 million Americans, and as many as 3.8% of college students are believed to exhibit symptoms of excoriation.

Treatment for Obsessive-Compulsive and Related Disorders:

The most commonly reported treatments include a combination of medication and psychological treatments. Some studies have found cognitive behavioral therapy to be more effective than treatment with drugs or often has been found to be an appropriate replacement after the initial symptoms have been reduced. The International Obsessive-Compulsive Disorder Foundation has recommended exposure and response prevention (ERP), which is a type of cognitive behavioral therapy and has concluded that this type of therapy may reduce the symptoms by as much as 60% to 80% for active participants in therapy.

General information on obsessive-compulsive disorder can be found on subsequent pages along with information specific to each diagnosis within the new DSM-5 category of Obsessive-Compulsive and Related Disorders.

Obsessive-Compulsive and Related Disorders DSM-5 Diagnostic Codes:

300.3 (F42) Obsessive-Compulsive Disorder
Specify if: Tic-related

300.7 (F45.22) Body Dysmorphic Disorder
Specify if: With muscle dysmorphia

300.3 (F42) Hoarding Disorder
Specify if: With excessive acquisition

312.39 (F63.2) Trichotillomania (hair pulling disorder)

698.4 (L96.1) Excoriation (skin picking) Disorder

294.8 (F06.8) Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
Specify if: With obsessive-compulsive disorder-like symptoms, With appearance preoccupations, With hoarding symptoms, With hair pulling symptoms, With skin picking symptoms.

300.3 (F42) Other Specified Obsessive-Compulsive and Related Disorder

300.3 (F42) Unspecified Obsessive-Compulsive and Related Disorder

Diagnostic Information and Criterion for Obsessive-Compulsive and Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Schizoid Personality Disorder Symptoms and DSM-V Diagnosis




F60.1 (301.20) Schizoid Personality Disorder: Overview

Individuals with schizoid personality disorder are indifferent to social experiences and interpersonal relationships. There is usually a lifelong history of very restricted emotional expression and feeling, unsociability, reclusiveness and emotional coldness.

Persons with schizoid personality disorder have little interest in relationships, even family relationships. They usually prefer isolated experiences which rarely involve other people. They typically have few to no friends, take no pleasure in activities with others and most often have no interest in intimate relationships and sex with others. Emotional reactions to others are usually cold, elusive and they have difficulty experiencing emotions in general. Usually they are uninterested in and not responsive to the assessments of others or even to encouragement or criticism.




The symptoms of schizoid personality disorder cannot occur only during a psychotic episode such as with schizophrenia and cannot be attributed to antisocial personality disorder. The symptoms must significantly impair the individuals functioning to warrant a diagnosis of this personality disorder.

Although this disorder may affect as many as 3.1% of the population in the United States, these individuals will usually not seek treatment. The impairment in social and occupational functioning is very significant.

Treatment of Schizoid Personality Disorder

Treatment for this disorder may be conducted using cognitive behavioral therapy along with a psychodynamic theoretical perspective when conceptualized within the perspective of attachment theory. Several psychological theorists and clinicians have concluded that the role of the counselor may be crucial in that this individual seems to need a model for interpersonal relationships. Also, it is important to recognize that people with this disorder may experience brief psychotic episodes when experiencing significant levels of stress.

Additional Considerations: Schizoid Personality Disorder:

Schizoid personality disorder seems to occur more often among men than women. It is important for the therapist to consider the cultural context when working with and diagnosing individuals with schizoid personality disorder as some cultures seem to emphasize defensive behaviors and detachment more than others. Also, additional consideration needs to be given to individuals who have changed cultures such as immigrants who experience issues related to acculturation.

Differential Diagnosis of Schizoid Personality Disorder
:
When considering whether an individual has schizoid personality disorder, the clinician needs to be careful that the symptoms are not related to substance use, another medical condition such as those that affect the central nervous system and medication use. It is also important to understand that this diagnosis should not be given if the symptoms only occur within the context of psychosis.

F60.1 (301.20) Schizoid Personality Disorder Diagnostic Criteria:

A. A pervasive pattern of detachment from social relationships and a very restricted range of expression of emotions in interpersonal experiences, usually beginning in early adulthood and manifested in a variety of contexts, as well as indicated by four or more of the following symptoms:

1. Neither enjoys nor desires close interpersonal relationships, including being part of a family experience.
2. Almost always chooses solitary activities.
3. Has little to no interest in having sexual relationships with others.
4. Takes pleasure in a very limited number of activities.
5. Has no close friends or confidants besides first-degree relatives.
6. Is indifferent to the praise or criticism of others.
7. Seems cold emotionally, detached or has a very flattened affect.

B. The symptoms do not occur exclusively during the course of schizophrenia, bipolar disorder or a depressive disorder with psychotic features, another psychotic disorder, an autism spectrum disorder and is not attributable to the physiological effects of another medical condition

Note: If the above symptoms and criteria are met prior to the onset of schizophrenia, add “premorbid” such as “schizoid personality disorder (premorbid).”

Adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) American Psychiatric Association by Paul Susic Ph.D. Licensed Psychologist


Personality Disorders Symptoms and DSM-V Diagnosis




Personality Disorders Symptoms and Diagnosis: An overview

Personality disorders symptoms are not always easy to distinguish from relatively normal behaviors, although the consequences can be tremendously different. Personality disorders are groups of traits and characteristics that have become very rigid and dysfunctional, severely limiting functioning and most often resulting in severe distress and impairment. These thinking and behavioral patterns have usually been identified in these individual for a long time and in most cases since late adolescence or early adulthood.

The characteristics associated with personality disorders should probably be considered dimensional rather than categorical in that they are also seen in normal individuals to a significantly lesser degree. The DSM-V however has continued the traditional structure of categories that has been used over the last 30 years.

Common Characteristics of the Personality Disorders:

In order to receive a diagnosis of a personality disorder there needs to be an enduring pattern of negative behaviors, thoughts, feelings and sensations that are substantially different from the individual’s culture. This pattern includes an individual’s affect, cognition, control of impulses, and interpersonal relationships. This pattern of behaving and thinking has to apply in a broad-based manner over the individual’s personal and social life.




Personality disorders usually begin in adolescence (sometimes childhood) or early adulthood and manifest themselves in many social and personal contexts and cause a high level of distress and disability in an individual’s working and educational experience, as well as social and personal functioning. These characteristics cannot be associated with substance abuse, other mental disorders, physical illness, other personality disorders or personality changes associated with other medical conditions. The hallmark of personality disorders is their level of early onset (most commonly late teens), intensity of characteristics and pervasive nature in that it affects multiple aspects of an individual’s life including work, personal and social life.

A couple of the problems associated with the recognition and diagnosis of personality disorders is that they are frequently overlooked and at other times may be over-diagnosed. Two of the more notorious over diagnosed personality disorders are probably the narcissistic and borderline personality disorders. In DSM-V Made Easy, James Morrissey identified several things for a clinician keep in mind when making a diagnosis of personality disorder.

1. Verify the duration of the symptoms. Make sure that your patient’s symptoms have been present at least since early adulthood (before age 15 for antisocial personality disorder).
2. Verify that the symptoms affect several areas of the patient’s life.
3. Make sure that the patient fully qualifies for the particular diagnosis in question.
4. If the patient is under age 18, make sure that the symptoms have been present for at least the past 12 months.
5. Rule out other mental pathology that may be more accurate and have greater potential for doing harm.
6. Search for other personality disorders. Evaluate the entire history to learn whether any additional personality disorders are present.
7. Record all personality and non-personality mental diagnosis.

The following are the most commonly diagnosed personality disorders:


Cluster A Personality Disorders:

The Cluster A personality disorders usually involve behaviors described as suspicious, cold, withdrawn and/or irrational.

F60.0 (301.0) Paranoid Personality Disorder
F60.1 (301.20) Schizoid Personality Disorder
F21 (301.22) Schizotypal Personality Disorder

Cluster B Personality Disorders:

People who experience Cluster B Personality Disorders usually tend to be dramatic, very emotional and attention seeking with shallow, fluctuating moods. They often have intense interpersonal problems.

F60.2 (301.7) Antisocial Personality Disorder
F60,3 (301.83) Borderline Personality Disorder
F60.4 (301.50) Histrionic Personality Disorder
F60.81 (301.81) Narcissistic Personality Disorder

Cluster C Personality Disorders:

The Cluster C Personality Disorders usually feature characteristics of being typically tense, anxious and being over controlled.

F60.6 (301.82) Avoidant Personality Disorder
F60.7 (301.6) Dependent Personality Disorder
F60.5 (301.4) Obsessive-Compulsive Personality Disorder

Other Personality Conditions:

F07.0 (301.1) Personality Change Due to Another Medical Condition
F60.89 (301.89) Other Specified Personality Disorder
F60.9 (301.9) Unspecified Personality Disorder

By Paul Susic Ph.D. Licensed Psychologist



Paranoid Personality Disorder Symptoms and DSM-V Criteria




301.0 (F 60.0) Paranoid Personality Disorder: Overview

The key features of paranoid personality disorder involve suspicion of others and mistrust in their motivations. This disorder begins in early adulthood and persists for life and may affect multiple areas of functioning in their daily experience. The signs of mistrust must be manifested in at least four areas of their life including an inability to trust or rely upon friends and difficulty confiding in others because of fear that what is shared will be used against them, constant suspicion that others are trying to harm, trick or exploit them. They may have a pervasive pattern of not forgiving others and may misperceive insults and threats in normal conversation. They often believe that others are trying to assault their character. They obviously then feel a need to respond to the attack and frequently have a chronic suspicion that their spouse or partner is unfaithful to them.





Additional Aspects of Paranoid Personality Disorder:

This personality disorder occurs more often in men than women and is estimated to affect about 4.4% of the population in the United States. The sentiment and perspective of individuals with this disorder should not be confused with the feelings of oppression or disenfranchisement experienced by some minority, immigrant and refugee groups in the United States of America. Individuals who experience or have a family history of psychotic disorders such as schizophrenia or have other unique experiences such as being incarcerated are more often diagnosed with paranoid personality disorder.

Diagnosing Paranoid Personality Disorder:

As mentioned above, it is very important not to confuse the symptoms of psychotic disorders such as schizophrenia with paranoid personality disorder. This diagnosis would be given if the symptoms of paranoid personality disorder also persist before and after the psychotic symptoms of schizophrenia. It is important to understand that there is a significant overlap or comorbidity among personality disorders. Psychologists, psychiatrists and other mental health clinicians need to screen for whether another personality disorder may be even more appropriate such as schizotypal personality disorder.

301.0 (F 60.0) Paranoid Personality Disorder Diagnostic Criteria

A. Suspiciousness and pervasive mistrust of others in their motivations that are interpreted as malevolent, which began in early adulthood and is manifested in a variety of contexts as indicated by four (or more) of the following:

1. Suspects without a sufficient basis that others are harming, exploiting or deceiving them.
2. Has a preoccupation without justification about the trustworthiness or loyalty of friends, family or associates.
3. A reluctance to confide in others because of an unwarranted fear that the information will be used negatively against them.
4. Reads threatening meanings and demeaning motivations behind benign remarks or events.
5. Unforgiving of other’s insults, slights and perceived injuries and persistently bearing grudges
6. Perceives attacks on their character and reputation that is not apparent to others and reacts quickly and angrily in counterattack.
7. Has recurrent suspicions although unjustified about the fidelity of their spouse or sexual partner.

B. The symptoms do not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or other psychotic disorders that are not attributable to the physiological effects of another medical condition.

Note: If the criteria are met before the onset of schizophrenia, add “premorbid,” such as “paranoid personality disorder (premorbid).”

Adapted from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) American Psychiatric Association By Paul Susic Ph.D. Licensed Psychologist


Prozac Medication: The Benefits, Side Effects and Dosages




Prozac Medication: An Overview

Prozac is a medication used to treat depression, obsessive-compulsive disorder, bulimia, and frequently severe symptoms of premenstrual syndrome. Prozac is within the drug classification referred to as selective serotonin reuptake inhibitors (SSRI’s), which is believed to help maintain a elevated level of the neurotransmitter serotonin in the brain.

Serotonin is a neurotransmitter in the brain which is believed to affect moods. This neurotransmitter is usually quickly reabsorbed after its initial release from neurons in the brain. It is believed that excess serotonin between the neurons is blocked by medications such as Prozac from being taken back up into the releasing neurons resulting in increased levels of serotonin in the brain.

Prozac is most often prescribed to treat depression of the moderate to severe variety which interferes with daily functioning and most often is referred to as major depression. The symptoms of major depression include low mood and low energy, changes in sleeping habits and appetite, decreased sex drive, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts. However, Prozac can be taken for a variety of other mental health disorders including obsessive-compulsive disorder, premenstrual dysphoric disorder as well as others. It is most often prescribed for adolescents, adults and the elderly but may occasionally be prescribed for children.

Prozac Medication for Obsessive- Compulsive Disorders:

In addition to being used for the treatment of depression, Prozac is also used to treat obsessive-compulsive disorder. Obsessions are thoughts that won’t go away, and compulsions are repetitive behaviors and actions which are done to relieve anxiety often associated with the obsessions. Prozac is used at times to also treat bulimia which is a binge eating disorder which involves deliberate vomiting and has also been used to treat other eating disorders including obesity.

Premenstrual Dysphoric Disorder:

Under the brand name Serafem which includes the active ingredients in Prozac, this depression medication is sometimes prescribed for premenstrual dysphoric disorder (PMDD), which is often referred to as premenstrual syndrome (PMS) including mood changes such as anxiety, depression, persistent anger, irritability, and mood swings. There are various physical problems associated with PMDD, including bloating, breast tenderness, headache and joint muscle pain. Symptoms usually tend to begin about 1 to 2 weeks before a woman’s premenstrual period. They are frequently severe enough to interfere with a woman’s daily activities, functioning and relationships.

Prozac Medication: Precautions

You should always be open and honest with your doctor when your taking Prozac. Always give a complete medical history, including liver problems, kidney disease, seizures, heart problems, allergies and history of diabetes. This depression medication has been known to make individuals dizzy or drowsy, making it necessary to be cautious when engaging in activities that require alertness such as driving or using heavy machinery. Alcohol should be limited when on this medication. Caution is also advised if you have diabetes, alcohol dependence or liver disease. Also, caution should be taken when this medication is being used by the elderly as they are more sensitive to the effects of the drug. This drug should only be used if necessary if an individual is pregnant as the medication passes into the breast milk. Because of the possible risk to the infant, breast-feeding while on this medication is not recommended. Consultation with your physician about the benefits and risks of Prozac used during pregnancy and breast-feeding is imperative. Obviously, you should never share your Prozac with others.




Important Facts About This Depression Medication

It has been noted that there can be some very serious and at times even fatal reactions to occur when Prozac is taken at the same time as some other antidepressants such as the MAO inhibitors. Also, you need to be careful when taking high doses of Prozac over a prolonged period of time. If you are taking any other medications for depression or any other prescription or nonprescription drugs you need to notify your physician before beginning on Prozac.

Prozac Side Effects:

Although the Prozac side effects seem to be less than some of the earlier generation antidepressant medications such as desipramine, amitriptyline and nortriptyline, there are still side effects that you need to be aware of. Some of the more common side effects of Prozac are sweating, dry mouth, drowsiness, headache, insomnia and nausea. Some of the side effects that are less likely but at times even more severe are loss of appetite and unusual weight loss, uncontrollable movements such as tremors, decreased interest in sex, flu-like symptoms, and either unusual or severe mood changes. Even less likely but even more potentially serious Prozac side effects include trouble swallowing, vision changes, white spots and swelling on the mouth and tongue, painful and/or prolonged erection and changes in sexual ability. The most severe side effects associated with Prozac are irregular and fast heartbeat, and fainting. Allergic reactions to Prozac are relatively rare but may include itching, rash, swelling, trouble breathing and dizziness. If you notice any reactions after beginning treatment with Prozac, you need to notify your pharmacist or physician immediately. A more complete listing of Prozac side effects follows.

The Most Common Prozac Side Effects:

Abnormal vision, abnormal ejaculation, abnormal dreams, increased anxiety, reduced sex drive, dry mouth, dizziness, flushing, flulike symptoms, headache, gas, impotence, itching, insomnia, loss of appetite, nervousness, nausea, sinusitis, rash, sleepiness, sweating, sore throat, upset stomach, tremors, yawning, vomiting, weakness

Less Common Prozac Side Effects:

Agitation, abnormal taste, weight gain, sleep disorders, bleeding problems, confusion, chills, weight gain, ringing in the ears, palpitations, loss of memory, increased appetite, high blood pressure, frequent urination, ear pain, emotional instability

There have been other very rare side effects reported while taking Prozac. If you develop any unexplained or new symptoms after initiating treatment with this depression medication you need to contact your physician immediately.

Drug Interactions:

In addition to the Prozac side effects mentioned above, there are also concerns for negative food and drug interactions when taking this antidepressant medication. As mentioned previously, Prozac should never be taken at the same time as you are taking MAO inhibitors. This can cause a very serious medication interaction. Also, when Prozac is taken with other medications the effect may be increased, decreased or altered in other ways. You should always check with your doctor when Prozac is taken with the following medications:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Tryptophan
Vinblastine (Velban)
Warfarin (Coumadin)

Special Warnings if You are Pregnant or Breast-feeding:

Prozac has not been adequately studied for its effects on pregnancy. If you are pregnant or plan to become pregnant in the near future, you need to talk with your physician as soon as possible to determine whether you should continue taking this depression medication. Prozac is known to appear in breast milk, so breast-feeding is obviously discouraged when taking this drug.

Prozac Dosage:

It is most common for your Prozac dosage to be taken once or twice a day and should be taken exactly as prescribed by your physician. It needs to be taken regularly to be effective. If it is possible, you should take your Prozac dosage at the same time every day.

Some patients have found that it can take as much as four weeks to feel any significant effects and get some relief from their depression. Doctors will also commonly maintain the treatment regimen for about nine months after the first initial three-month treatment trial. Some individuals who experience obsessive-compulsive disorder may not feel the full effects for as much as five weeks.

The Recommended Prozac Dosage:

The most common starting dosage of Prozac is 20 mg daily taken in the morning. Your physician may increase your dose after several weeks if there has been no improvement in symptoms. Elderly people with kidney and liver disease, and any other individual taking other medications may have their dosage adjusted by their doctor.

When taking a dosage of Prozac over 20 mg, the doctor may ask you to take it once a day in the morning or may ask that you to take two smaller doses in the morning and also at noontime.

The usual Prozac dosage for depression ranges between 20 mg and 60 mg. For obsessive-compulsive disorder, the usual dosage of Prozac ranges from 20 mg to 60 mg per day, although at times a maximum of 80 mg may be prescribed. The usual dosage of Prozac for bulimia nervosa is 60 mg taken in the morning. As with other disorders, the doctor may start at a lower dosage and increase to this level over a period of time. The most common Prozac dosage for premenstrual dysphoric disorder is 20 mg per day.

For some individuals who have been treated successfully with the daily form of Prozac, their doctor may switch them to a long acting form sometimes referred to as Prozac weekly. Your physician may ask you to skip your daily doses for seven days and then take your first weekly capsule.

If you miss your dose of Prozac you should take it as soon as you remember. If a significant time has passed however, you should skip that dosage and resume your normal dosage schedule.

Over dosage of Prozac:

Prozac like all medications, needs to be taken as recommended. Dosages more than the recommended amount can be dangerous and even fatal. Also, combining Prozac with certain other medications or drugs may cause symptoms of over dosage. If you suspect an overdose, you need to contact your doctor or go to an emergency room immediately.

The most common symptoms of Prozac over dosage include rapid heartbeat, nausea, seizures, vomiting and sleepiness. Some of the less common symptoms of Prozac over dosage include stupor, sweating, rigid muscles, low blood pressure, mania, coma, delirium, fainting, high fever and irregular heartbeat.

By Paul Susic Ph.D. Licensed Psychologist


Help Wanted: Psychologists in Metropolitan St. Louis Missouri





Part-time and Full-time Psychologists Wanted in the St. Louis Metropolitan Area:

An excellent opportunity and exceptional pay for doctoral level psychologists in St. Louis city, St. Louis county, St. Charles County and the surrounding metropolitan area is now available. Senior Care Psychological Consulting is looking for psychologists to provide services in office, long-term care facilities and homes. Hours are very flexible including part-time and full-time opportunities to provide counseling, assessment and/or psychological testing services to geriatric patients and individuals with long-term chronic medical and mental health concerns. Experienced individuals are preferred but we will train individuals with the right personality and aptitude.

Compensation:

Senior Care Psychological Consulting provides excellent compensation, paid twice monthly without your having to wait on billing cycles or having to assume the risk of nonpayment. The average hourly rates are between $70-$114 per hour. This is a wonderful opportunity for a doctoral level psychologist who is interested in learning or continuing their experience in working with geriatrics and individuals with long-term medical and mental health disability. If you’re interested you may contact Paul Susic Ph.D. Licensed Psychologist at (636) 300-9922 or you may email me at seniorcarepsych@yahoo.com for more information or to express your interest. Senior Care Psychological Consulting is an equal opportunity employer.

Paul Susic Ph.D. Licensed Psychologist
Clinical Director
Senior Care Psychological Consulting





Senior Care Psychological Consulting:

Senior Care Psychological Consulting in St. Charles, Missouri





The Only Strictly Doctoral Psychology Practice in St. Louis, Missouri

Senior Care Psychological Consulting is the premier provider of doctoral level geropsychology services for the metropolitan St. Louis, Missouri area. Senior Care Psychological Consulting is a specialty geriatric psychology practice providing psychological assessment, mental health counseling services, psychological testing, neuropsychological evaluation and disability evaluation to the elderly and chronic mentally ill in an office-based practice in St. Charles, Missouri. We also provide in- home services as well as providing services in nursing homes and other long term care facilities throughout the metropolitan St. Louis, Missouri area.




Paul Susic Ph.D. Licensed Psychologist and Senior Care Psychological Consulting

Senior Care Psychological was founded by Paul Susic Ph.D Licensed Psychologist who has been providing mental health services to the senior community for well over two decades. Paul developed one of the first exclusively geriatric psychiatric Partial Hospital programs in the St. Louis area, which he managed for approximately five years as the Program Manager at the former Incarnate Word Hospital. He also created and developed a whole continuum of outpatient mental health services which he also managed at Incarnate Word Hospital. He later was promoted to Director of the Department of Psychiatry of Incarnate Word Hospital, which he left in December, 1999 to begin a full-time geropsychology practice.

Paul Susic and Senior Care Psychological Counseling have continued their commitment to providing high-quality psychological assessment and mental health counseling services to the senior community. Senior Care specializes in providing psychological counseling and assessment services, psychological testing and neuropsychological evaluation in- home, in nursing homes and long-term care facilities throughout the metropolitan St. Louis area and also in an office based practice in St. Charles, Missouri. All services are provided under the direction of Dr.Susic who is the Clinical Director. Mental health assessments, testing as well as assessments for cognitive (memory) functioning and need for long-term placement are also available at senior care.

Please feel free to call and ask for Paul Susic Ph.D. Licensed Psychologist, and he will be pleased to assist you in any way possible. He may be reached at his office at (636) 300-9922 for local calls, or or he may also be reached by e-mail at seniorcarepsych@yahoo.com

Senior Care Psychological Consulting 500 Huber Park Ct. Suite 205, Weldon Spring, MO 63304

Information and webpage by Paul Susic Ph.D. Licensed Psychologist




Senior Care Psychological Consulting:

Bipolar I Disorder: Most Recent Episode Manic Diagnosis




Bipolar I Disorder: Most Recent Episode Manic Diagnosis: Most Essential Features

In order to have a bipolar I disorder diagnosis, it is absolutely essential to have at least one episode of mania. This manic episode will need to last at least a week, almost every day with symptoms present most of the time. During this period of mania, you will experience a high level of energy along with an elevated, irritable or expansive mood. Many individuals also experience an increased level of goal-directed behaviors. These behaviors need to be much more pronounced than normal, usual behaviors. If the mood is only irritable you may experience the following symptoms: the need for sleep; pressured speech or abnormally talkative; flight of ideas and racing thoughts; inflated sense of self-esteem or grandiosity; difficulty concentrating and easily distracted; major increase in psychomotor agitation or goal-directed activity associated with work, social, sexually related and possibly a significant increase in behaviors that could be riskier and result in severe negative consequences.

Additionally, individuals experiencing bipolar I disorder frequently also have histories of major depressive and hypomanic episodes, but it is not essential. Although many people believe that bipolar I disorder involves rapid mood swings, frequently that does not occur. Changes from mania to depression or hypomania could go on for weeks, months or longer. They may resolve to be followed by additional episodes at a later point in time.


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Bipolar I Disorder: Most Recent Episode Manic-Special Considerations:

Bipolar I most recent episode manic have some special concerns in that it can be an extremely dangerous mood at times. Some research has found that as many as 25% to 50% of individuals who have a diagnosis of bipolar I disorder eventually attempt suicide.

Individuals experiencing a manic episode often become involved in very risky behavior. Some of these experiences can even be life-threatening. Clinicians working with patients having bipolar I mood episodes need to be very aware of the risks involved in that they need to make it a part of their work with clients to make risk assessments and have crisis planning.

The healthcare costs associated with bipolar I disorder are very high. Some research has found that bipolar I disorder results in three times higher cost than among other individuals because of the increased level of hospitalization, visits to doctors and the expense of medications.

Bipolar I Disorder: Most Recent Episode Manic-Psychological Treatment and Medications

Bipolar I disorder requires lifelong management of symptoms. Fortunately, there are effective treatments that can help you or your loved ones to have a relatively normal life. Medications are available to stabilize mood and psychosocial treatments are available. Research has found that some of the more effective treatments include the combination of medications along with psychological interventions. Some of the more effective psychological interventions for the treatment of bipolar I disorder include cognitive behavioral therapy, psychoeducation, family-focused therapy, and interpersonal social rhythm therapy.

The specific criteria for bipolar I disorder most recent episode manic follow:

Basic Bipolar I Disorder Diagnosis Criteria

A. Criteria have been met for at least one manic episode.
B. The occurrence of the manic and major depressive episode or episodes is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other schizophrenia spectrum and other psychotic disorders.

Manic Episode;

A. A distinct period of abnormal and persistent, elevated, expansive or irritable mood, and abnormal and persistent increased goal directed activity or energy. This must last for at least a week and be present most of the day, nearly every day.

B. During this period of mood disturbance with increased energy or activity, three (or more) of the following symptoms (except for if the mood is only irritable) and are to a significant degree and must be a noticeable change from your usual behavior.

1. Inflated self-esteem or sense of grandiosity.
2. A decreased need for sleep such as feeling rested after only three hours of sleep.
3. More talkative than usual or a sense of pressure when talking.
4. Racing thoughts and flight of ideas.
5. Easily distracted.
6. Increase in goal-directed activity socially, at work or school, or sexually, or psychomotor agitation.
7. Excessive involvement in negative or high-risk situations such as engaging in unrestrained buying sprees, uninhibited sexual indiscretions, or foolish business investments.

C. The disturbance must be severe enough to cause significant impairment in social or occupational functioning, or to result in hospitalization to prevent harm to yourself or others, or if there are psychotic features present.

D. The episode cannot be attributed to the physiological effects of a substance such as a specific drug of abuse, a medication or other treatment or another medical condition.
Note: A full manic episode that emerged during antidepressant treatment or electroconvulsive therapy. Manic symptoms significantly at a level beyond the actual physiological effect of that treatment may be sufficient evidence for a manic episode and therefore of a bipolar one diagnosis.

Note: Criteria A-D above constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Coding for Specific Bipolar I Diagnoses:

The diagnostic code for bipolar I diagnosis are 296. _ _ (F31. _ _). The specific diagnosis and the related coding is based upon the current or most recent episode only. Mental health clinicians also need to consider and specify the severity, whether psychotic features are present, whether the client is in partial or full remission.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic And Statistical Manual of Mental Disorders Fifth Edition DSM-5



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