Digitized version of the decision tree in the new DSM-IV TR

1. Decision Trees for Differential Diagnosis. By clicking below I agree to not use this as an official diagnostic tool. I Agree

2. Pick a differential diagnosis 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

3. Is there a disturbance of consciousness and a change in cognition Symptoms that are due to the direct physiological effects of a general medical condition Yes No

4. Evidence that the disturbance has more than one etiology (e.g., substance and general medical condition) Yes No

5. Memory impairment? Yes No

6. Delirium Due to a General Medical Condition Start Over

7. Delirium Due to Multiple Etiologies Start Over

8. At least one additional cognitive deficit Yes No

9. Evidence that the disturbance has more than one etiology (e.g., cerebrovascular disease and Alzheimer’s disease) Yes No

10. Dementia Due to Multiple Etiologies Start Over

11. Evidence that cerebrovascular disease is etiologically related to the disturbance Yes No

12. Vascular Dementia Start Over

13. Disturbance due to central nervous system condition or systemic condition known to cause dementia Yes No

14. Dementia Due to a General Medical Condition Start Over

15. Gradual onset and continuing cognitive decline Yes No

16. Dementia of the Alzheimer’s Type Start Over

17. Dementia Not Otherwise Specified Start Over

18. Amnestic Disorder due to a General Medical Condition Start Over

19. Prominent delusions or hallucinations predominate Yes No

20. Psychotic Disorder Due to a General Medical Condition Start Over

21. Prominent and persistent mood disturbance predominates Yes No

22. Mood Disorder Due to a General Medical Condition Start Over

23. Prominent anxiety, panic attacks, obsessions, or compulsions predominate Yes No

24. Anxiety Disorder due to a General Medical Condition Start Over

25. Clinically significant sexual dysfunction exclusively due to a general medical condition Yes No

26. Sexual Dysfunction Due to a General Medical Condition Start Over

27. Disturbance in sleep sufficiently severe to warrant independent clinical attention Yes No

28. Sleep Disorder Due to a General Medical Condition Start Over

29. Catatonia? Yes No

30. Catatonic Disorder Due to a General Medical Condition Start Over

31. Change in previous personal pattern Yes No

32. Personality Change Due to a General Medical Condition Start Over

33. 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

34. Mental Disorder Not Otherwise Specified Due to a General Medical Condition Start Over

35. No Mental Disorder (Symptoms that are not clinically significant) Start Over

36. 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

37. Evidence that the disturbance has more than one etiology (e.g., substance and general medical condition) Yes No

38. Persistent memory impairment Yes No

39. Onset of delirium during withdrawal from a substance Yes No

40. Substance-Induced Withdrawal Delirium Start Over

41. Substance Induced Intoxication Delirium Start Over

42. Delirium Due to Multiple Etiologies Start Over

43. At least one additional cognitive deficit Yes No

44. Evidence that the disturbance has more than one etiology (e.g., substance and general medical condition) Yes No

45. Substance-Induced Persisting Dementia Start Over

46. Dementia Due to Multiple Etiologies Start Over

47. Substance-Induced Persisting Amnestic Disorder Start Over

48. Delusions or hallucinations predominate, are in excess of that usually seen in intoxication or withdrawal, and warrant independent clinical attention Yes No

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

50. A mood disturbance predominates, is in excess of that usually seen in intoxication or withdrawal, and warrants independent clinical attention. Yes No

51. Substance-Induced Mood Disorder – Specify if onset during intoxication or withdrawal Start Over

52. 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

53. Substance-Induced Anxiety Disorder – Specify if onset during intoxication or withdrawal Start Over

54. 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

55. Substance-Induced Sexual Dysfunction Start Over

56. 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

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

58. Development of a reversible syndrome due to recent use of a substance Yes No

59. Substance Intoxication Start Over

60. Development of a syndrome due to reduction or cessation of use of substance Yes No

61. Substance Withdrawal Start Over

62. Clinically significant symptoms due to a substance that do not meet criteria for one of the Substance-Induced Disorders Yes No

63. Substance-Related Disorder Not Otherwise Specified Start Over

64. No Substance-Induced Disorder (substance-induced symptoms that are not clinically significant) Start Over

65. Delusions, hallucinations, disorganized speech, or grossly disorganized behavior Due to the direct physiological effects of a general medical condition Yes No

66. Psychotic Disorder Due to a General Medical Condition Start Over

67. Due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or a toxin) Yes No

68. Substance-Induced Psychotic Disorder Start Over

69. Symptoms of active phase of Schizophrenia, lasting at least 1 month Yes No

70. Major Depressive or Manic Episode concurrent with active-phase symptoms Yes No

71. Total duration of mood episodes has been brief relative to duration of active and residual periods Yes No

72. Duration at least 6 months Yes No

73. Schizophrenia Start Over

74. Schizophreniform Disorder Start Over

75. At least 2 weeks of delusions or hallucinations in the absence of prominent mood symptoms Yes No

76. Schizoaffective Disorder Start Over

77. Mood Disorder with Psychotic Features (see Mood Disorders tree ) Start Over

78. Nonbizarre delusions lasting at least 1 month Yes No

79. Total duration of mood episodes has been brief relative to duration of delusional periods Yes No

80. Apart from delusions, functioning not markedly impaired Yes No

81. Delusions occur only during mood episodes Yes No

82. Delusional Disorder Start Over

83. Psychotic Disorder Not Otherwise Specified Start Over

84. Mood Disorder with Psychotic Features (see Mood Disorders tree ) Start Over

85. Duration more than 1 day but less than 1 month Yes No

86. Brief Psychotic Disorder Start Over

87. Psychotic Disorder Not Otherwise Specified Start Over

88. Depressed, elevated, expansive, or irritable mood Due to the direct physiological effects of a general medical condition Yes No

89. No Mood Disorder (mood symptoms that are not clinically significant) Start Over

90. Mood Disorder Due to a General Medical Condition Start Over

91. Due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or a toxin) Yes No

92. Substance-Induced Mood Disorder Start Over

93. Determine type of present and past mood episodes Next

94. Elevated, expansive, or irritable mood, at least 1-week duration; marked impairment or hospitalization Yes No

95. Manic Episode Start Over Mixed Diagnosis

96. Elevate, expansive, or irritable mood, at least 4-day duration; changes observable by others but less severe than a Manic Episode Yes No

97. Hypomanic Episode Start Over Mixed Diagnosis

98. Major Depressive Episode Start Over Mixed Diagnosis

99. At least 2 weeks of depressed mood or loss of interest plus associated symptoms, and not better accounted for by Bereavement Yes No

100. Criteria met for Manic Episode and Major Depressive Episode nearly every day for at least 1 week Yes No

101. Mixed Episode Start Over Mixed Diagnosis

102. Has ever had a Manic Episode or a Mixed Episode Yes No

103. Psychotic symptoms occur at times other than during Manic or Mixed Episodes Yes No

104. Bipolar I Disorder Start Over

105. Occurred exclusively during Schizoaffective Disorder (review Psychotic Disorders tree ) Yes No

106. Schizoaffective Disorder, Bipolar Type Start Over

107. Bipolar Disorder Not Otherwise Specified (superimposed on a Psychotic Disorder) Start Over

108. Has ever had a Hypomanic Episode and at least one Major Depressive Episode Yes No

109. Bipolar II Disorder Start Over

110. 2+ years of hypomanic symptoms and periods of depressed mood Yes No

111. Cyclothymic Disorder Start Over

112. Clinically significant manic/hypomanic symptoms that do not meet criteria for a specific Bipolar Disorder Yes No

113. Bipolar Disorder NOS Start Over

114. Has ever had a Major Depressive Episode Yes No

115. Psychotic symptoms occur at times other than during Major Depressive Episodes Yes No

116. Major Depressive Disorder Start Over

117. Occurred exclusively during Schizoaffective Disorder (review Psychotic Disorders tree ) Yes No

118. Schizoaffective Disorder, Depressive Type Start Over

119. Depressive Disorder NOS (superimposed on Psychotic Disorder) Start Over

120. Depressed mood, more days than not, for at least 2 years with associated symptoms Yes No

121. Dysthymic Disorder Start Over

122. Depressed mood not meeting criteria for one of the previous Mood Disorders that develops in response to a stressor Yes No

123. Adjustment Disorder with Depressed Mood Start Over

124. Clinically significant depressive symptoms that do not meet criteria for a specific Mood Disorder Yes No

125. Depressive Disorder NOS Start Over

126. No Mood Disorder (mood symptoms that are not clinically significant) Start Over

127. Symptoms of anxiety, fear, avoidance, or increased arousal Due to the direct physiological effects of a general medical condition Yes No

128. Anxiety disorder due to a general medical condition Start Over

129. Due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, a toxin) Yes No

130. Substance-Induced Anxiety Disorder Start Over

131. Recurrent unexpected Panic Attacks plus a month of worry, concern about attacks, or change in behavior Yes No

132. 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

133. Panic Disorder with Agoraphobia Start Over

134. Panic Disorder Without Agoraphobia Start Over

135. 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

136. Agoraphobia without History of Panic Disorder Start Over

137. Anxiety concerning separation from attachment figures with onset in childhood Yes No

138. Separation Anxiety Disorder Start Over

139. Fear of humiliation or embarrassment in social or performance Yes No

140. Social Phobia (Social Anxiety Disorder) Start Over

141. Fear cued by object or situation Yes No

142. Specific Phobia Start Over

143. Obsessions or compulsions Yes No

144. Obsessive-Compulsive Disorder Start Over

145. 6-month period of excessive anxiety and worry plus anxiety symptoms Yes No

146. Occurs exclusively during a Mood or Psychotic Disorder See mood disorders tree No

147. Generalized Anxiety Disorder Start Over

148. Anxiety in response to a severe traumatic event Yes No

149. Reexperiencing of event, increased arousal, and avoidance of stimuli associated with traumatic event Yes No

150. Duration of more than 1 month Yes No

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

152. Posttraumatic Stress Disorder Start Over

153. Acute Stress Disorder Start Over

154. Anxiety that does not meet criteria for one of the above Anxiety Disorders and develops in response to a stressor Yes No

155. Adjustment Disorder with Anxiety Start Over

156. Clinically significant symptoms that do not meet criteria for a specific Anxiety Disorder Yes No

157. Anxiety Disorder NOS Start Over

158. 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

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

160. Specific General Medical Condition (no somatoform disorder) Next

161. Psychological factors adversely affect general medical condition Next

162. Psychological Factor Affecting Medical Condition Start Over

163. Physical symptoms are intentionally produced Yes No

164. External incentives are absent Yes No

165. Factitious Disorder Start Over

166. Malingering Start Over

167. History of multiple physical complaints with at least 4 pain symptoms, 2 gastrointestinal symptoms, 1 sexual symptom, and 1 pseudoneurological symptom Yes No

168. Somatization Disorder Start Over

169. Symptom or deficit affecting voluntary motor or sensory function Yes No

170. Conversion Disorder Start Over

171. Symptom or deficit affecting sexual functioning Yes No

172. Sexual Dysfunction Start Over

173. Pain is focus of clinical attention, and psychological factors have important role Yes No

174. Pain Disorder Start Over

175. Other physical complaints lasting at least 6 months Yes No

176. Undifferentiated Somatoform Disorder Start Over

177. Preoccupation with idea of having a serious disease Yes No

178. Belief is of delusional intensity Yes No

179. Hypochondriasis Start Over

180. See Psychotic Disorders tree Start Over

181. Preoccupation with imagined defect in appearance Yes No

182. Body Dysmorphic Disorder (if delusional, also see Psychotic Disorders tree ) Start Over

183. Clinically significant somatoform symptoms that do not meet criteria for a specific Somatoform Disorder Yes No

184. Somatoform Disorder NOS Start Over

185. No Somatoform Disorder (somatoform symptoms that are not clinically significant) Start Over