Thursday, November 1, 2012

Fobia Social and DSM and ICD classification systems diseases

diagnostic codes is essential for the collection of medical information.
The diagnosis coding facilitates data collection and retrieval and compilation of statistical information. Also often requires codes to facilitate communication of diagnostic data to third parties, including government agencies, private insurers and the Organization Salud.Los subtypes (some of which is encoded by the fifth character) and specifications are intended to increase the specificity. Within a diagnostic subgroups defined subtypes phenomenological mutually exclusive and are indicated in the criteria set by the words "specify the type." For example, delusional disorder includes different types according to the content of the delusions. Specifically, there are seven types: Erotomanic, grandiose, jealous, persecutory, somatic, mixed and unspecified. By contrast, the specifications are not intended to be mutually exclusive and are indicated in the set of criteria for the words "specify whether" (eg., In social phobia, the instructions say "Specify if: Generalized"). Specifications to define more homogeneous subgroups of individuals affected by a disorder, and that share certain characteristics (eg., major depressive disorder with melancholic). Although sometimes assigns fourth or fifth character to encode a subtype or a specification (eg., F00.01 Dementia Alzheimer type, with early onset, with hallucinations [290.12]) or severity (F32.0 Major depressive disorder , Single Episode, mild [296.21]), most of the subtypes and specifications listed in DSM-IV have not been coded according to the CIE-9-MC and are indicated only by including the specification subtype or after the name of the disorder (eg., social phobia, generalized). The ICD-10 system to encode a large part of subtypes and specifications. Specifications of gravity and cursor. Habitual manta, DSM-IV diagnosis applied to the subject's current manifestations and does not usually used to denote the previous diagnoses that individual has recovered. Once diagnosed, the following specifications are applicable indicator of severity and course: mild, moderate, severe, in partial remission, in full remission and history anterior. Las specifications mild, moderate and severe only be used when the condition meets in At present all the criteria. In deciding whether the presentation of the disorder has been described as mild, moderate or severe, the clinician should consider the number and intensity of the signs and symptoms of the disorder in question, and any irregularity in social or occupational functioning. In most disorders must use the following guidelines: Leveson few or no symptoms which exceed those required to make the diagnosis. Symptoms but do not lead to a slight impairment in social or symptoms or deterioration laboral. Moderato Existent works] located between "mild" and "severe." GraveSe detect several symptoms that exceed those required to make the diagnosis, or different symptoms are particularly severe symptoms or result in a significant impairment in social or laboral.En parcialCon remission before it met all the criteria for the disorder, but now only remain some of the symptoms or remission signos.En there totalYa any symptoms or signs of the disorder, but it is still relevant from a clinical point of view consider the disorder, for example, an individual with previous episodes of bipolar disorder has remained symptom free for the past three years, under treatment with lithium . After a period of time in complete remission, the clinician may consider that the subject is recovered and therefore encode no disorder as a current diagnosis. The differentiation in remission requires consideration of various factors, including the characteristic course of the disorder, the lapse of time since the last period pathological, the total duration of the disorder and the need for evaluation or treatment persistent profiláctico.Historia anteriorEn certain it may be useful to reconstruct the history of the criteria fulfilled by the disorder, even when the individual is currently recovered. These previous diagnosis of a mental disorder should be indicated using the specification above story (eg., Separation anxiety disorder, previous history, applicable to an individual with a history of separation anxiety disorder, which currently suffers no disorder now meets some or panic criteria). Several disorders have specific criteria to define them as mild, moderate and severe mental retardation, conduct disorder, manic episode and major depressive episode. Others have specific criteria to define partial remission and complete remission: manic, major depressive episode sustancias. Recidiva. En dependence clinical practice, it is common for the subjects, after a period of time that no longer met all the criteria of the disorder (eg., remissions or recoveries in whole or part), develop certain symptoms suggesting recurrence of the original condition, but nevertheless do not meet the requirements specified in the diagnostic criteria table. The best way to indicate the presence of these symptoms is a matter of clinical judgment. You have the following options: • If symptoms are thought to constitute a new episode of a recurrent disorder, the disorder can be diagnosed as current (or provisional) even before they have met all the criteria (eg., After meeting the criteria a major depressive episode during only 10 days instead of 14 days usually required). • Assuming that the symptoms are clinically significant but it is unclear which represent a recurrence of the original condition, you can use the unspecified category. • If opinion that the symptoms are not clinically significant, do not add any actual or provisional diagnosis, but may be logged "back story." Main diagnosis / reason for hospitalization consulta.Cuando in establishing a diagnosis over an individual, the principal diagnosis corresponds to that disorder, after studying the case, is considered primarily responsible for the income. In ambulatory care, when a subject is applied to more than one diagnosis, the reason for the visit is the disorder that warrants first ambulatory medical care received during the visit. In most cases the principal diagnosis or the reason for the visit are also the main subject of attention or tratamiento.Con is often difficult (and rather arbitrary) to determine which is the principal diagnosis or the reason for the consultation, especially in situations 'dual diagnosis' (a substance-related diagnosis, as dependence on amphetamines, accompanied by another diagnosis unrelated substances, such as schizophrenia). For example, it may not be clear what diagnosis should be considered "major" in the case of a person hospitalized for schizophrenia and amphetamine intoxication, since each of these disorders could have also contributed to the need for income and multiple diagnoses tratamiento.Los may be formulated as non-axial or multiaxial. When the principal diagnosis corresponds to an Axis I disorder, this is indicated by placing first. The other disorders are sorted according to the objective and therapeutic care. When a person has both Axis I diagnoses and axis II, it is assumed that the principal diagnosis or the reason for the visit will lie on Axis I unless the Axis II diagnosis is followed by the words "(principal diagnosis) "or" (during the consultation). "Diagnosis provisional.Cuando a clear presumption that all criteria for a disorder ultimately be fulfilled, but not enough information available to make a firm diagnosis in this case can provisional specification used. The clinician may indicate diagnostic uncertainty scoring "(provisional)" after diagnosis. For example, the subject seems to suffer a major depressive disorder, but it is possible to obtain an adequate history that establishes that all criteria are met. The term is also used in temporary situations in which the differential diagnosis depends solely on the duration of the disease. For example, a diagnosis of schizophreniform disorder requires less than 6 months and can be made only if assigned provisionally to have occurred before the unspecified category remisión.Utilización: Given the diversity of clinical presentations, it is impossible for the diagnostic nomenclature cover every possible situation. For this reason, each diagnostic class has at least one category and some unspecified classes include several categories including unspecified. There are four situations that may be appropriate to formulate a diagnosis not specified: • The presentation of the box coincides with the general guidelines specific mental disorder in the corresponding diagnostic class, but the symptoms do not meet the criteria for any of the specific disorders. This happens when the symptoms are below the diagnostic threshold of one's own specific disorders or when an atypical or mixed. • The presentation of the box is a symptom pattern that has not been included in the DSM-IV classification, but leads to clinically significant impairment or distress. Research criteria for any of these symptom patterns are included in Appendix B ("Criteria Sets and Axes Provided for Further Study forth"), in which case it is stated on page Appendix B includes criteria suggested research. • The etiology is uncertain (eg., if the condition is due to a medical condition, is induced by a substance, or is primary). • No opportunity for a full data collection (eg., in situations emergency) or the information is inconsistent or contradictory, but there is sufficient information for inclusion within a particular diagnostic class (eg., the clinician determines that the subject has psychotic symptoms, but not enough information to diagnose a specific psychotic disorder ).
Criteria often used: Criteria used to exclude other diagnoses and diagnoses suggest diferencialesLa most sets of criteria presented in this manual include exclusion criteria necessary to establish boundaries between different disorders and to clarify differential diagnoses. The various terms used to describe the exclusion criteria along the DSM-IV reflect the different types of possible relationships between disorders: • "It has never fulfilled criteria for ... "Used this exclusion criterion to define a hierarchy between different disorders throughout life. For example, a diagnosis of major depressive disorder and can not be made once had a manic episode, so it should be replaced with a diagnosis of bipolar disorder I. • "Does not meet criteria for ... "Used this exclusion criterion to establish a hierarchy between disorders (or subtypes) defined transversely. For example, specifying "with melancholic 'overrides' with atypical symptoms" to describe the current major depressive episode. • "Do not occur exclusively during the course of ... "This exclusion criterion prevents a disorder is diagnosed when symptomatic presentation occurs only during the course of another disorder. For example, not separately diagnosed dementia if only appears during a delirium; not separately conversion disorder if only appears for a somatization disorder; not separately diagnosed bulimia nervosa if only appears during episodes of anorexia nervosa . Typically, this exclusion is used in situations where the symptoms of a disorder are associated characteristics or a subset of the main symptoms of the disorder. The clinician should consider partial remission periods as part of the "course of another disorder." It should be noted that the diagnosis can be attributed excluded those occasions occur independently (eg., When the disorder is in remission exclusive). • "It is due to the direct physiological effects of a substance (eg ., a psychoactive substance, a medication) or a general medical condition "that is used to indicate exclusion criteria to be considered and ruled out general medical etiology or substance induced before diagnosing the disorder (eg., one can only be diagnosed MDD after discarding etiologies based substance abuse or a medical condition). • "Not better accounted for by ... "Used this exclusion criterion to indicate that the conditions mentioned in the criteria should be considered in the differential diagnosis of psychopathology in question and that in borderline cases will require clinical judgment to determine which disorder leads to diagnosis suitable. In these cases, you should consult the section "Differential Diagnosis" of entries for implicados.Existe disorders generally agreed that the DSM-IV should allow multiple diagnoses attributing those who meet clinical criteria for a DSM over -IV. There are three situations in which the aforementioned exclusion criteria help establish a diagnostic hierarchy (and thus avoid multiple diagnoses) or differential diagnostic considerations underline (and thus rule out multiple diagnoses): • When a mental disorder due to a general medical condition or a substance is responsible for the symptoms, diagnosis, priority is given to the corresponding primary disorder with similar symptoms (eg., mood disorder induced by cocaine is priority MDD). In such cases, the set of criteria for the primary disorder is an exclusion criterion includes the phrase "not due to the direct physiological effects of ... '. • When a more generalized disorder (e.g.. Schizophrenia) includes among its symptoms defining (or associated symptoms) which are symptoms of a disorder defining less widespread (eg., Dysthymic disorder), the set of less widespread disorder criteria appears one of the three following exclusion criteria, indicating that the disorder is diagnosed only more widespread, "has never fulfilled criteria for ... "," Does not meet criteria for ... "," does not occur exclusively during the course of ... ". • When there are limits particularly difficult differential diagnosis, included the phrase" not better accounted for by ... "To indicate that clinical judgment is required to determine which is most appropriate diagnosis. For example, panic disorder with agoraphobia include the criterion "not better accounted for by the presence of social phobia", and social phobia include the criterion "not better accounted for by the presence of panic disorder with agoraphobia 'recognizing the fact that in this case there is a boundary between the two conditions particularly difficult. In some cases both diagnoses are apropiados.Criterios for sustancias.Con use disorders is often difficult to determine whether the symptoms observed are induced by a substance, that is, whether it is the direct physiological consequence of intoxication or withdrawal substances, the use of a medication or toxin exposure. In an attempt to provide some help in making this determination, each of the substance use disorders were added the two criteria are reproduced below. It is understood that these criteria provide general guidelines, but also allow clinical judgment involved in determining whether symptoms are present or not better explained by the direct physiological effects of the substance. For further discussion of this topic, see "substance-induced mental disorders included in other sections of the manual" B. Based on the history, physical examination, or laboratory findings, evidence of (1) or (2): (1) symptoms appear within a substance intoxication or withdrawal, or for 1 month after (2) medication use is etiologically related to the trastorno.C. The disturbance is not better accounted for by the presence of a disorder that is not substance induced. Evidence that the symptoms are better explained by a disorder is not substance induced might include the following: the symptoms precede the onset of substance use (or medication use), the symptoms persist for a substantial period of time (p . example., about 1 month) after the cessation of acute withdrawal or severe intoxication, or are excessive in relation to what would be expected given the type, duration or volume of the substance used, or there is other evidence suggesting the existence of an independent non-induced disorder substances (eg., a history of recurrent non-substance). Criteria for a mental disorder due to a disease médicaEl aforementioned criterion is then necessary to establish the etiologic requirement each of the mental disorders due to a general medical condition (eg., mood disorder due to hypothyroidism). For a more extensive discussion of this topic, see "Mental Disorders Due to a General Medical Condition" The history, physical examination, or laboratory findings show that the disorder is the direct physiological consequence of a disease clinically significant médica.Criterios: The definition mental disorder consisting in the introduction of the DSM-IV requires that clinically significant impairment or distress. To underscore the importance of considering this fact, the criteria tables of most disorders include a clinical significance criterion (usually said "... cause clinically significant distress or impairment in social or occupational functioning, or other important areas of activity of the subject "). This approach helps to set the threshold for diagnosing a disorder in cases where symptomatic presentation (particularly in its milder forms) is not inherently pathological and can occur in individuals who would be inappropriate diagnosis of "mental disorder". To assess whether this criterion is met, especially in terms of activity, is inherently difficult clinical judgment. Often must rely on information about the subject's activity and family gathered from third parties (other than those from individual). Types of information that appear in the text of DSM-Ivel DSM-IV text describes each disorder under the following headings: "Diagnostic Features", "Subtypes and / or specifications", "typing procedure", "Associated Features and Disorders", "culture-bound symptoms, age and sex", "prevalence", "Course , "" familiar pattern "and" differential diagnosis. " If no information on one of these sections is not included in the text. In some cases, when several specific disorders a group of disorders share common characteristics, this information is included in the general information section clarifies diagnósticas.Esta grupo.Características diagnostic criteria and usually provides examples ilustrativos.Subtipos and / or make specification section provides brief definitions and analyzes concerning the subtypes and / or specifications of tipificación.Esta aplicables.Procedimiento section provides guidelines to register the name of the disorder and to select and record the ICD-10 diagnosis codes and ICD-9-CM adequate. It also includes instructions for applying any subtypes and / or specifications section asociados.Esta apropiados.Síntomas and disorders usually subdivided into three parts: • Descriptive characteristics and mental disorders asociadosEsta section includes certain clinical characteristics that are often associated with the disorder, but they are not considered essential to make the diagnosis. In some cases these features were proposed to be included as potential diagnostic criteria, but were not sufficiently sensitive or specific to be part of the final set of criteria. In this section also include other mental disorders associated with the disorder that is being analyzed. It is specified (when known) if these disorders precede, coincide or are consequences of the condition in question (eg. An alcohol-induced persisting dementia is a result of chronic alcohol dependence). When available, also included in this section information on predisposing factors and complications. • laboratorioEsta Findings section provides information about three types of laboratory findings that may be associated with the disorder: 1) those associated laboratory findings that are considered "diagnostic", for example, polysomnographic findings in some sleep disorders, 2) those associated laboratory findings that are not considered diagnostic of the disorder, but have been considered abnormal in groups disorder affected individuals compared with control subjects, eg ventricular volume computed tomography as a validator of the construct of schizophrenia, and 3) those laboratory findings that are associated with the complications of a disorder, such as electrolyte imbalances in individuals with anorexia nervosa. • examination findings asociadasEsta physical and medical conditions section includes information about symptoms collected in history, or findings observed during physical examination, which may have diagnostic significance but are not essential for diagnosis, such as dental erosion in bulimia nervosa. Also included are those disorders that are encoded outside the ICD chapter devoted to "mental and behavioral disorders", but which are associated with the disorder under study. As in the mental disorders, specified, if you know the type of association (eg., Precedes, coincides with, is a consequence of), for example, cirrhosis is a consequence of alcohol dependence. Symptoms depend on the culture, age and the clinical sexo.Esta section provides guidelines on different variations in the presentation of the disorder that can be attributed to the cultural, developmental stage (eg., infancy, childhood, adolescence, maturity, old age) or sex of the subject. This section also includes information on prevalence rates differentials related to sex, age and culture (eg., Sex ratio). Prevalencia.Esta section provides current data on prevalence and throughout life, incidence and risk throughout life. This data is provided in relation to different situations (eg., Community, primary care, outpatient mental health clinics and psychiatric inpatient facilities) when you have such información.Curso.Esta section describes the typical patterns of presentation and course of the condition over time. Contains information on the age of onset and the start mode (eg., Sudden or insidious) typical of the disorder; continuous versus episodic course: recurrent versus single episode, duration, characterizing the typical length of the disease and its episodes; and progression, which describes the general trend of the disorder over time (eg., stable, worsening, improvement). familiar.Esta Pattern section describes data on the frequency of the disorder among first-degree biological relatives compared with frequency in the general population. It also indicates other conditions that tend to occur more often in family members of those suffering from the disorder diferencial.Esta cuestión.Diagnóstico section discusses how to differentiate this disorder from others who have some presentation characteristics of DSM organization similares.Plan -IV: Diagnostic Classes principalesLos DSM-IV are grouped into 16 major diagnostic classes (eg., substance-related disorders, mood disorders, anxiety disorders) and an additional section called "Other problems that can be clinical care. "The first section is devoted to" Disorders in Infancy, Childhood, or Adolescence ". This division of the classification according to the age of onset of a disorder is raised only for convenience and is not absolute. Although the disorders included in this section often become apparent for the first time during childhood and adolescence, some individuals diagnosed with disorders that appear in the above section (eg., Attention deficit disorder with hyperactivity) can not be focus of clinical attention until adulthood. Furthermore, it is not unusual childhood or adolescence are the age of onset of various disorders included in other sections (eg., Major depressive disorder, schizophrenia, generalized anxiety disorder). Therefore, clinicians working primarily with children and adolescents should be familiar with the entire manual, and those who work primarily with adults should be familiar with this apartado.Las three sections - "Delirium, dementia and amnestic disorders and other trastornoscognoscitivos ',' Disorders mental due to a general medical condition "and" Substance-Related Disorders "- were grouped together in the DSM-III-R unit under the heading of 'organic mental syndromes and disorders." The term "organic mental disorder" is no longer used in the DSM-IV, since it implies incorrectly that other mental disorders that appear in the manual have no biological basis. As in the DSM-III-R, these sections are in the manual before the other disorders because of its priority in the differential diagnosis (eg., The causes of a depressed mood related substances should be ruled out before to make a diagnosis of major depressive disorder). To facilitate the differential diagnosis in these sections are complete lists of mental disorders due to medical conditions and substance-related disorders, while text and criteria for these disorders have been located in the diagnostic sections for disorders with which phenomenology share. For example, the text and criteria for the disorder of mood and substance-induced mood disorder due to general medical condition are included in "mood disorders." The organizing principle of all remaining sections (except adjustment disorder) disorders is grouped according to their shared phenomenological features to facilitate the differential diagnosis. The section "Adjustment Disorders" is organized differently as these disorders have been grouped according to their common etiology (eg., Maladaptive response to stress). Therefore, adjustment disorders include a wide variety of heterogeneous clinical presentations (eg., Adjustment disorder with depressed mood, adjustment disorder with anxiety, adjustment disorder with disturbance of conduct). Finally, the DSM-IV includes a section "Other issues that may be of clinical care." Included in this digital version of the DSM-IV, in addition, the following appendices: Criteria Sets and Axes Provided for studies posteriores.Este appendix contains a number of proposals suggested for possible inclusion in the DSM-IV. Was provided a series of short texts and research criteria related to the following disorders: postconcussional disorder, mild neurocognitive disorder, caffeine withdrawal, pospsicótico depressive disorder in schizophrenia, deteriorating simple, premenstrual dysphoric disorder, minor depressive disorder, depressive disorder recurrent brief, mixed anxiety depressive disorder, factitious disorder by proxy, dissociative trance disorder, binge eating disorder, depressive personality disorder, disorder passive-aggressive personality, neuroleptic-induced parkinsonism, neuroleptic malignant syndrome, acute dystonia induced neuroleptics, neuroleptic-induced acute akathisia, neuroleptic-induced tardive dyskinesia and medication-induced postural tremor. Furthermore, some descriptions are included schizophrenia dimensional alternatives and alternative Criterion B dysthymic disorder. Finally, this is indicated proposed three axes: defense mechanisms Scale, Global Assessment Scale relational activity (GARF) Scale and evaluation of social and labor (SOFAS). Técnicos.Este Glossary appendix contains a glossary definitions of selected terms to help users of the manual in implementing criterios.Indice tables of DSM-IV.Este modifications appendix lists the major changes, from the DSM-III-R, have been included in the terms and categories of DSM-IV.Indice alphabetical diagnoses and DSM-IV codes (ICD-10). This appendix lists the DSM-IV (with ICD-10) in alphabetical order. It has been included to facilitate the selection of diagnostic codes and numerical diagnósticos.Indice DSM-IV codes (ICD-10). This appendix lists the DSM-IV (with ICD-10) in numerical order according to code. It has been included to facilitate the registration of terms diagnósticos.Guía for cultural formulation and glossary cultura.Este bound syndromes appendix is ​​divided into two sections. The first provides an outline for cultural formulation to assist the clinician to systematically assess and report regarding the impact of cultural context on a particular individual. The second section is a glossary of bound syndromes alphabetical subject cultura.Indice
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