For example, one-time use of cocaine would not likely initiate and maintain a manic episode lasting 6 weeks. If you suspect an organic precipitant, try to determine if there has been at least one clean episode, i. See Appendix D on page for a list of common organic causes of mania. When rating number of episodes, if the subject has had any manias count the number of manic episodes, or, if the subject has had no manias count the number of hypomanic episodes i.
Dysthymia cannot be diagnosed in the presence of bipolar disorder, however information about chronic mild depressive symptoms is important in charting the course of illness. Therefore, it is site optional to score this section for subjects who already meet criteria for a bipolar disorder.
Dysthymic disorder describes a depressed mood and associated symptoms that occur for most of the day, more days than no t, for at least 2 years. It is a depressed mood that continues over an extended period of time, accompanied by depressive symptoms, but not as severe as a major depressive episode. Chronic periods of low mood that are contiguous with any two-week period meeting criteria for major depression should be scored as major depression.
If either Q2 or Q3 are coded yes, identify another episode that is clean.
If a clean episode can be identified, re-code ages given in Q1a and Q1b. If a clean episode cannot be identified, it is site optional to complete the section anyway obtaining information on the period even though it might be ruled out.
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Cyclothymic disorder is a relatively persistent often life-long pattern of mood disturbance characterized by frequent shifts between normal, high, and low moods, with accompanying symptoms. In this case, the interviewer must look for periods of depressive symptoms and establish chronicity.
Two additional questions are included to address ICD criteria. Skip outs: There are four separate skip-outs for this section. First, on page 68, if the subject has never had a full drink of alcohol. Second, on page 69, if the subject never drank regularly and never got drunk.
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Third, on page 70, if the subject never had more than 3 drinks in a hour period. Always record the name of the drink if it is not a well-known brand. Ask the subject about each category of alcohol, starting with the previous day, and go through all the categories before starting on the next day of the week. The number of drinks is coded in Col. I, the consumption time minutes in Col. How many beers or lite beers did you have on Friday? We finished it off with dinner, so I guess that was about 45 minutes. Proceed in this fashion to ask the subject day-by-day and drink type-by-drink type habits to get a pattern of use for the previous week.
Skip-outs: There are 4 separate skip-outs for this section. First, on the top of page 77 and after Q1 , if the subject has never tried any form on tobacco. Second, on the bottom of page 77 and after Q2b , if the subject never smoked a total of cigarettes this is also a site-optional skip out even if the subject smoked enough to score Q2b positive — please consult your PI for determination of how much of the section will be completed by your site. Third, on page 79 after Q8 and fourth, at the top of page 83 , if this subject codes positive in less than 3 boxes on the tally sheet.
The Marijuana section has been separated from the general drug section because the use of marijuana is very common, but not necessarily indicative of other drug use. Entrance into this section requires use of the drug more than 21 times in a year. Subjects who currently use marijuana and have not reached this threshold will be excluded from this section. The interviewer hands the subject a card that lists many prescription and nonprescription drugs.
The subject is asked whether he has used any of these when the drugs were not prescribed or to feel good, high, more active, or more alert. If the subject has never taken drugs except when prescribed, or over- the-counter medications as indicated, skip to the next section. The subject may have experimented with drugs briefly, and the number of times and age when he began to use each drug will be assessed. If the subject has tried several drugs, such as cocaine, stimulants, or hallucinogens, but no drug has been used 11 or more times, skip to the next section.
If several drugs have been used 11 or more times, choose the two most frequently used and ask about those in the diagnostic drug section beginning with Q The diagnostic drug section focuses on use of cocaine, stimulants, sedatives, and opiates. Drugs used 11 or more times and not included in these categories will be coded in the miscellaneous column. If more than one drug could be included in the miscellaneous column, ask about the one most frequently used.
Psychotic behavior presents as a symptom of many psychiatric disorders. It is for this reason that the Psychosis section focuses on psychotic behavior independent of any diagnostic category. Here the emphasis is on identifying and describing specific psychotic experiences for subsequent analysis using a variety of diagnostic schemes. The interviewer is required to codify whether specific psychotic symptoms have ever been present.
Often, the presence or absence of psychosis will be eluded to in previous sections of the DIGS e. When this occurs, the interviewer should use all previously ascertained information to code as positive those symptoms already confirmed to exist. The goal of this section is to establish whether or no t: 1 the subject has ever experienced any psychotic symptoms, 2 the subject has ever had a psychotic syndrome, and 3 the subject is currently experiencing any psychotic symptoms or a current psychotic syndrome.
A subject who does not give a history of, or describes psychotic symptoms during the initial screening questions will not be administered this portion of the instrument. Note for Q1.
For any positive responses endorsed on the screening questions 1a—e , determine whether the symptom meets psychotic threshold requirements by using the 5-standard probes listed on the top of page 94, as needed. Establish duration and frequency for every positive response and obtain examples and note them in the space provided or the margins if necessary. The attainment of examples for each endorsed symptom will allow for future informed discussion if and when any discrepancies in threshold, duration etc.
If psychotic symptoms are endorsed or suspected based on responses to screening questions, try to determine if the subject is currently symptomatic day of interview. Thus, some subjects may not be actively psychotic at the time of the interview and yet still be in a psychotic syndrome. Thus, a subject who experienced two weeks of grandiose delusions and auditory hallucinations preceded and followed by several months of prodromal symptoms and 2 years of residual symptoms would be described for the entire period of the disorder starting with the first prodromal symptoms, including the active psychotic symptoms and continuing to the current residual symptoms.
In summary, if the subject has shown significant signs of psychosis more or less continuously since onset e. False beliefs or judgments that are out of proportion to actual experience and reality. Delusions are based on incorrect inference about external reality and are firmly sustained in spite of what almost everyone else believes and in spite of what constitutes incontrovertible and obvious proof to the contrary.
Furthermore, the distinction between a delusion and a strongly held idea is sometimes difficult to make and depends on the degree of conviction with which the belief is held despite clear contradictory evidence. In addition, some religious or culturally supported beliefs may be hard to distinguish from non-bizarre delusions e.
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For this reason, interviewers are asked to record multiple detailed examples of every psychotic symptom. Delusions are to be distinguished from illusions and hallucinations, which are perceptual experiences. Is there an organization behind this, like the Mafia? Why are they singling you out? Are they trying to harm you in any other way? Examples of Fragmentary themes : A subject thinks his room is bugged, believes people doubt his sexual potency, and suspects he may be the son of Paul McCartney. CASH ; a women patient felt that the nurses approaching her had homosexual intentions, that the patients were really nurses and doctors in disguise planted there to assist her, and the people could read her mind by looking at her hands RDC.
These may be auditory, visual, olfactory, tactile or gustatory in nature. Hallucinations differ from illusions in that there is not objective external stimulus for the perception. NOTE: Clearly inappropriate sexual behavior in subjects with schizophrenia- like disorders often manifests itself in behavior such as public masturbation. Characteristic symptoms Criterion A : for each subpart, refer back to the corresponding question s listed in order to determine coding.