Miscellaneous

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Miscellaneous psychiatric disorders

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Miscellaneous

  1. 1. Other Conditions That May Be The Focus of Clinical Attention
  2. 2. Mental disorder affecting medical condition Axis I disorder such as major depressive disorder delaying recovery from myocardial infarction. Psychological symptoms affecting medical conditions Depressive symptoms delaying recovery from surgery; anxiety exacerbating asthma. Personality traits or coping style affecting medical condition Pathological denial of the need for surgery in a patient with cancer; hostile, pressured behavior contributing to cardiovascular disease. Maladaptive health behaviors affecting medical condition lack of exercise, unsafe sex, overeating, etc. Stress-related physiological response affecting medical condition Ulcer, hypertension, arrhythmia, or tension headaches Other unspecified psychological factors affecting med. Condition Interpersonal, cultural, or religious factors Psychological Factors Affecting Medical Condition
  3. 3. Medication-Induced Movement Disorders <ul><li>Neuroleptic-Induced Parkinsonism </li></ul><ul><li>Parkinsonian tremor, muscular rigidity, or akinesia developing within a few weeks of starting or raising the sdose of a neuroleptic medication, or after reducing a medication to treat EPS. </li></ul><ul><li>Neuroleptic-Induced Acute Dystonia </li></ul><ul><ul><li>Characterized by abnormal positioning of the head and neck in relation to the body. </li></ul></ul><ul><ul><li>Spasms of the jaw muscles </li></ul></ul><ul><ul><li>impaired swallowing, speaking, or breathing </li></ul></ul><ul><ul><li>slurred speech due to enlarged tongue </li></ul></ul><ul><ul><li>tongue protrusion or tongue dysfunction </li></ul></ul><ul><ul><li>eyes deviated up, down, or sideward </li></ul></ul><ul><ul><li>abnormal positioning of the distal limbs or trunk </li></ul></ul>
  4. 4. <ul><li>Neuroleptic Malignant Syndrome </li></ul><ul><li>Development of severe muscle rigidity and elevated temperature </li></ul><ul><li>with two or more of the following: </li></ul><ul><ul><li>diaphoresis (artificially induced sweating) </li></ul></ul><ul><ul><li>dysphagia (difficulty swallowing) </li></ul></ul><ul><ul><li>tremor </li></ul></ul><ul><ul><li>incontinence </li></ul></ul><ul><ul><li>changes in consciousness ranging from confusion to coma </li></ul></ul><ul><ul><li>mutism </li></ul></ul><ul><ul><li>tachycardia (rapid heartbeat) </li></ul></ul><ul><ul><li>elevated or labile blood pressure </li></ul></ul><ul><ul><li>leukocytosis (indication of infection from blood work) </li></ul></ul><ul><ul><li>lab evidence of muscle injury (elevated CPK) </li></ul></ul><ul><ul><li>CPK = creatine phosphokinase </li></ul></ul>Medication-Induced Movement Disorders
  5. 5. Medication-Induced Movement Disorders <ul><li>Neuroleptic-Induced Acute Akathisia </li></ul><ul><ul><li>fidgety movements or swinging of the legs </li></ul></ul><ul><ul><li>rocking from foot to foot while standing </li></ul></ul><ul><ul><li>pacing to relieve restlessness </li></ul></ul><ul><ul><li>inability to sit or stand for at least several minutes </li></ul></ul><ul><li>Neuroleptic-Induced Tardive Dyskinesia </li></ul><ul><li>Involuntary movements of the tongue, jaw, trunk, or extremities. </li></ul><ul><ul><li>choreiform movements (rapid, jerky, nonrepetitive) </li></ul></ul><ul><ul><li>athetoid movements (slow, sinuous, continual) </li></ul></ul><ul><ul><li>rhythmic movements (stereotypies) </li></ul></ul>
  6. 6. V - Codes (Relational Problems) May be comorbid condition with another classified disorder. Insurance carriers will not pay for most of these. Relational Problem Related to a Mental Disorder - impaired interaction with family members Parent-Child Relational Problem - impaired communication, overprotection, inadequate discipline Partner Relational Problem - poor interaction between spouses or partners Sibling Relational Problem - causes significant impairment in individual/family functioning Relational Problem NOS - not classified above, (e.g., difficulties with co-workers)
  7. 7. V - Codes (Abuse or Neglect) Physical Abuse of Child Sexual Abuse of Child Neglect of Child Physical Abuse of Adult Sexual Abuse of Adult
  8. 8. V - Codes (Additional Conditions) Noncompliance With treatment Malingering Adult Antisocial Behavior Child or Adolescent Antisocial Behavior Borderline Intellectual Functioning (coded on Axis II) Age-Related Cognitive Decline Bereavement
  9. 9. V - Codes (Additional Conditions) Academic Problem Occupational Problem Identity Problem (not a V-code) 313.82 Religious or Spiritual Problem Acculturation Problem Phase of Life Problem V71.09 No Diagnosis or Condition on Axis I or II 799.9 Diagnosis Deferred on Axis I or II
  10. 10. The End

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