Decision Trees for Decision Trees for Differential Diagnosis. Differential Diagnosis.

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Differential Diagnosis of Mental Disorders Due to a General Medical Condition Differential Diagnosis of Substance-Induced Disorders

Differential Diagnosis of Psychotic Disorders

Differential Diagnosis of Mood Disorders

Differential Diagnosis of Anxiety Disorders

Differential Diagnosis of Somatoform Disorders

Symptoms that are due to the direct physiological effects of a general medical condition

Is there a disturbance of consciousness and a change in cognition

Yes

No

Evidence that the disturbance has more than one etiology (e.g., substance and general medical condition)

Yes

No

Memory impairment? Yes No

Delirium Due to a General Medical Condition
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Delirium Due to Multiple Etiologies
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At least one additional cognitive deficit

Yes

No

Evidence that the disturbance has more than one etiology (e.g., cerebrovascular disease and Alzheimer’s disease)

Yes

No

Dementia Due to Multiple Etiologies
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Evidence that cerebrovascular disease is etiologically related to the disturbance

Yes

No

Vascular Dementia
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Disturbance due to central nervous system condition or systemic condition known to cause dementia

Yes

No

Dementia Due to a General Medical Condition Start Over

Gradual onset and continuing cognitive decline

Yes

No

Dementia of the Alzheimer’s Type

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Dementia Not Otherwise Specified
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Amnestic Disorder due to a General Medical Condition
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Prominent delusions or hallucinations predominate

Yes

No

Psychotic Disorder Due to a General Medical Condition Start Over

Prominent and persistent mood disturbance predominates

Yes

No

Mood Disorder Due to a General Medical Condition Start Over

Prominent anxiety, panic attacks, obsessions, or compulsions predominate

Yes

No

Anxiety Disorder due to a General Medical Condition Start Over

Clinically significant sexual dysfunction exclusively due to a general medical condition

Yes

No

Sexual Dysfunction Due to a General Medical Condition

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Disturbance in sleep sufficiently severe to warrant independent clinical attention

Yes

No

Sleep Disorder Due to a General Medical Condition
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Catatonia?

Yes

No

Catatonic Disorder Due to a General Medical Condition
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Change in previous personal pattern

Yes

No

Personality Change Due to a General Medical Condition

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Clinically significant symptoms etiologically related to a general medical condition that do not meet criteria for a specific Mental Disorder Due to a General Medical Condition

Yes

No

Mental Disorder Not Otherwise Specified Due to a General Medical Condition
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No Mental Disorder (Symptoms that are not clinically significant)
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Symptoms must be due to the direct physiological effects of a substance

A disturbance of consciousness and a change in cognition that are in excess of that usually seen in intoxication or withdrawal and that warrant independent clinical attention

Yes

No

Evidence that the disturbance has more than one etiology (e.g., substance and general medical condition)

Yes

No

Persistent memory impairment

Yes

No

Onset of delirium during withdrawal from a substance

Yes

No

Substance-Induced Withdrawal Delirium

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Substance Induced Intoxication Delirium

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Delirium Due to Multiple Etiologies
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At least one additional cognitive deficit

Yes

No

Evidence that the disturbance has more than one etiology (e.g., substance and general medical condition)

Yes

No

Substance-Induced Persisting Dementia

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Dementia Due to Multiple Etiologies
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Substance-Induced Persisting Amnestic Disorder

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Delusions or hallucinations predominate, are in excess of that usually seen in intoxication or withdrawal, and warrant independent clinical attention

Yes

No

Substance-Induced Psychotic Disorder – Specify if onset during intoxication or withdrawal Start Over

A mood disturbance predominates, is in excess of that usually seen in intoxication or withdrawal, and warrants independent clinical attention.

Yes

No

Substance-Induced Mood Disorder – Specify if onset during intoxication or withdrawal

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Anxiety, panic attacks, or obsessions or compulsions predominate; are in excess of that usually seen in intoxication or withdrawal; and warrant independent clinical attention

Yes

No

Substance-Induced Anxiety Disorder – Specify if onset during intoxication or withdrawal

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Clinically significant sexual dysfunction exclusively due to a substance, is in excess of that usually seen in intoxication, and warrants independent clinical attention

Yes

No

Substance-Induced Sexual Dysfunction

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Disturbance is sleep that is sufficiently severe to warrant independent clinical attention and is in excess of that usually seen in intoxication or withdrawal

Yes

No

Substance-Induced Sleep Disorder – Specify if onset during intoxication or withdrawal Start Over

Development of a reversible syndrome due to recent use of a substance

Yes

No

Substance Intoxication

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Development of a syndrome due to reduction or cessation of use of substance

Yes

No

Substance Withdrawal

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Clinically significant symptoms due to a substance that do not meet criteria for one of the Substance-Induced Disorders

Yes

No

Substance-Related Disorder Not Otherwise Specified

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No Substance-Induced Disorder (substance-induced symptoms that are not clinically significant)

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Delusions, hallucinations, disorganized speech, or grossly disorganized behavior

Due to the direct physiological effects of a general medical condition

Yes

No

Psychotic Disorder Due to a General Medical Condition

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Due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or a toxin)

Yes

No

Substance-Induced Psychotic Disorder

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Symptoms of active phase of Schizophrenia, lasting at least 1 month

Yes

No

Major Depressive or Manic Episode concurrent with activephase symptoms

Yes

No

Total duration of mood episodes has been brief relative to duration of active and residual periods

Yes

No

Duration at least 6 months

Yes

No

Schizophrenia

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Schizophreniform Disorder

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At least 2 weeks of delusions or hallucinations in the absence of prominent mood symptoms

Yes

No

Schizoaffective Disorder

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Mood Disorder with Psychotic Features (see Mood Disorders tree)

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Nonbizarre delusions lasting at least 1 month

Yes

No

Total duration of mood episodes has been brief relative to duration of delusional periods

Yes

No

Apart from delusions, functioning not markedly impaired

Yes

No

Delusions occur only during mood episodes

Yes

No

Delusional Disorder

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Psychotic Disorder Not Otherwise Specified

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Mood Disorder with Psychotic Features (see Mood Disorders tree)

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Duration more than 1 day but less than 1 month

Yes

No

Brief Psychotic Disorder

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Psychotic Disorder Not Otherwise Specified

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Depressed, elevated, expansive, or irritable mood

Due to the direct physiological effects of a general medical condition

Yes

No

No Mood Disorder (mood symptoms that are not clinically significant)

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Mood Disorder Due to a General Medical Condition

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Due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or a toxin)

Yes

No

Substance-Induced Mood Disorder

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Determine type of present and past mood episodes

Next

Elevated, expansive, or irritable mood, at least 1-week duration; marked impairment or hospitalization

Yes

No

Manic Episode

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Mixed Diagnosis

Elevate, expansive, or irritable mood, at least 4-day duration; changes observable by others but less severe than a Manic Episode

Yes

No

Hypomanic Episode

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Mixed Diagnosis

Major Depressive Episode

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Mixed Diagnosis

At least 2 weeks of depressed mood or loss of interest plus associated symptoms, and not better accounted for by Bereavement

Yes

No

Criteria met for Manic Episode and Major Depressive Episode nearly every day for at least 1 week

Yes

No

Mixed Episode

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Mixed Diagnosis

Has ever had a Manic Episode or a Mixed Episode

Yes

No

Psychotic symptoms occur at times other than during Manic or Mixed Episodes

Yes

No

Bipolar I Disorder

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Occurred exclusively during Schizoaffective Disorder (review Psychotic Disorders tree)

Yes

No

Schizoaffective Disorder, Bipolar Type

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Bipolar Disorder Not Otherwise Specified (superimposed on a Psychotic Disorder)

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Has ever had a Hypomanic Episode and at least one Major Depressive Episode

Yes

No

Bipolar II Disorder

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2+ years of hypomanic symptoms and periods of depressed mood

Yes

No

Cyclothymic Disorder

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Clinically significant manic/hypomanic symptoms that do not meet criteria for a specific Bipolar Disorder

Yes

No

Bipolar Disorder NOS

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Has ever had a Major Depressive Episode

Yes

No

Psychotic symptoms occur at times other than during Major Depressive Episodes

Yes

No

Major Depressive Disorder

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Occurred exclusively during Schizoaffective Disorder (review Psychotic Disorders tree)

Yes

No

Schizoaffective Disorder, Depressive Type

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Depressive Disorder NOS (superimposed on Psychotic Disorder)

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Depressed mood, more days than not, for at least 2 years with associated symptoms

Yes

No

Dysthymic Disorder

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Depressed mood not meeting criteria for one of the previous Mood Disorders that develops in response to a stressor

Yes

No

Adjustment Disorder with Depressed Mood

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Clinically significant depressive symptoms that do not meet criteria for a specific Mood Disorder

Yes

No

Depressive Disorder NOS

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No Mood Disorder (mood symptoms that are not clinically significant)

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Symptoms of anxiety, fear, avoidance, or increased arousal

Due to the direct physiological effects of a general medical condition

Yes

No

Anxiety disorder due to a general medical condition

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Due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, a toxin)

Yes

No

Substance-Induced Anxiety Disorder

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Recurrent unexpected Panic Attacks plus a month of worry, concern about attacks, or change in behavior

Yes

No

Agoraphobia, i.e., anxiety about being in places from which escape might be difficult or embarrassing in the event of having a Panic Attack

Yes

No

Panic Disorder with Agoraphobia

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Panic Disorder Without Agoraphobia

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Agoraphobia, i.e., anxiety about being in places from which escape might be difficult or embarrassing in the event of having panic-like symptoms

Yes

No

Agoraphobia without History of Panic Disorder

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Anxiety concerning separation from attachment figures with onset in childhood

Yes

No

Separation Anxiety Disorder

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Fear of humiliation or embarrassment in social or performance

Yes

No

Social Phobia (Social Anxiety Disorder)

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Fear cued by object or situation

Yes

No

Specific Phobia

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Obsessions or compulsions

Yes

No

Obsessive-Compulsive Disorder

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6-month period of excessive anxiety and worry plus anxiety symptoms

Yes

No

Occurs exclusively during a Mood or Psychotic Disorder
See mood disorders tree

No

Generalized Anxiety Disorder

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Anxiety in response to a severe traumatic event

Yes

No

Reexperiencing of event, increased arousal, and avoidance of stimuli associated with traumatic event

Yes

No

Duration of more than 1 month

Yes

No

No Anxiety Disorder (symptoms of fear, anxiety, or avoidance that are not clinically significant)

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Posttraumatic Stress Disorder

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Acute Stress Disorder

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Anxiety that does not meet criteria for one of the above Anxiety Disorders and develops in response to a stressor

Yes

No

Adjustment Disorder with Anxiety

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Clinically significant symptoms that do not meet criteria for a specific Anxiety Disorder

Yes

No

Anxiety Disorder NOS

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Physical Complaints or irrational anxiety about illness or appearance

Physical complaints are fully explained by a general medical condition and complaints are not in excess of expected

Yes

No

No Anxiety Disorder (symptoms of fear, anxiety, or avoidance that are not clinically significant)

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Specific General Medical Condition (no somatoform disorder)

Next

Psychological factors adversely affect general medical condition

Next

Psychological Factor Affecting Medical Condition

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Physical symptoms are intentionally produced

Yes

No

External incentives are absent

Yes

No

Factitious Disorder

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Malingering

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History of multiple physical complaints with at least 4 pain symptoms, 2 gastrointestinal symptoms, 1 sexual symptom, and 1 pseudoneurological symptom

Yes

No

Somatization Disorder

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Symptom or deficit affecting voluntary motor or sensory function

Yes

No

Conversion Disorder

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Symptom or deficit affecting sexual functioning

Yes

No

Sexual Dysfunction

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Pain is focus of clinical attention, and psychological factors have important role

Yes

No

Pain Disorder

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Other physical complaints lasting at least 6 months

Yes

No

Undifferentiated Somatoform Disorder

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Preoccupation with idea of having a serious disease

Yes

No

Belief is of delusional intensity

Yes

No

Hypochondriasis

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See Psychotic Disorders tree

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Preoccupation with imagined defect in appearance

Yes

No

Body Dysmorphic Disorder (if delusional, also see Psychotic Disorders tree)

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Clinically significant somatoform symptoms that do not meet criteria for a specific Somatoform Disorder

Yes

No

Somatoform Disorder NOS

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No Somatoform Disorder (somatoform symptoms that are not clinically significant)

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