DEPRESSIVE BIPOLAR RELATED DISORDERS Disorder Codes Major Depressive
DEPRESSIVE, BIPOLAR, & RELATED DISORDERS
Disorder Codes • Major Depressive Disorder Mild MDD Single 296. 21(F 32. 0) Recurrent 296. 31 (F 33. 0) Moderate Single 296. 22(F 32. 1) Recurrent 296. 32(F 33. 1) Severe Single 296. 23(F 32. 2) Recurrent 296. 33(F 33. 2) With Psychotic Features Single 296. 24(F 32. 3) Recurrent 296. 34(F 33. 3) In Partial Remission Single 296. 25(F 32. 4) Recurrent 296. 35(F 33. 41) In Full Remission Single 296. 26 (F 32. 5) Recurrent 296. 36(F 33. 42) Unspecified Single 296. 20(F 32. 9) Recurrent 296. 30(F 33. 9) Treatment Assessments Cognitive Behavioral Therapy (CBT) Mindfulness-based Cognitive Therapy (MBCT) Behavioral Activation Therapy (BAT) Interpersonal Psychotherapy (IPT) Emerging Adjunct Therapies Mindfulness-Based Interventions Electroconvulsive Therapy (ECT) Bright Light Therapy Neurofeedback Transcranial Magnetic Stimulation (TMS) Vagus Nerve Stimulation Psych pharmacotherapy Divided into 7 Categories*** Cross-Cutting Symptom Measure Clinician-Rated Dimensions of Psychosis Symptom Severity WHODAS 2. 0 Cultural Formulation Interview (CFI)
Disorder Treatment MDD Continued Antidepressant Medication Divided into 7 Categories: • Tricyclic antidepressants (TCA’s; e. g. , Elavil, Norpramin) • Monoamine oxidase inhibitors (MAOIs; e. g. , Marplan, Nardil) • Norepinephrine and dopamine reuptake inhibitors (NDRI’se. g. , Wellbutrin) • Selective Serotonin reuptake (SSRI’s; e. g. , Prozac, Paxil, Zoloft, Luvox, Lexapro) • Serotonin Norepinephrine reuptake inhibitors (SNRI’s e. g. Cymbalta, Effexor) • Serotonin antagonist and reuptake inhibitors (SARI’s; e. g. , Serzone) • Alpha-2 adrenergic antagonists (e. g. , Remeron) Assessments
Disorder Codes Treatment Assessments Persistent Depressive Disorder (PDD) 300. 4(F 34. 1) Specify if: • With anxious distress • Mixed features • Melancholic features • Atypical Features • Mood-congruent psychotic features • Mood-incongruent psychotic features • Per partum onset • Partial remission • Full remission • Early onset • Late onset • Mild • Moderate • Severe Medication & Maintenance Therapy • Cognitive Behavioral Therapy • Behavioral Activation Therapy • Interpersonal Psychotherapy • Psych pharmacotherapy • Cross-Cutting Symptom Measure • Clinician-rated dimensions of Psychosis symptom severity • WHODAS 2. 0 • Cultural Formulation Interview
Disorder Codes Treatment Assessments Premenstrual Dysphoric Disorder PMDD 625. 4 (N 94. 3) A Biopsychosocial etiology • Cognitive Behavioral Interventions combined with Psychopharmacology PSST Screening Tool (Arch Women's Mental Health 2003, 6: 203 -209). Disruptive Mood Dysregulation Disorder DMDD 296. 99(F 34. 8) • Parent Management Training (PMT) • Problem Solving Skills Training (PSST) • Cognitive Behavioral Training (CBT) The Children’s Interview for Psychiatric Syndromes (Ch. IPS) Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)
Disorder Codes BIPOLAR & Related Disorders BIPOLAR I Disorder MILD Current or Most recent 296. 41(F 31. 11)Manic 296. 51(F 31. 31) Depressed MODERATE Current or Most Recent 296. 42 (F 31. 12) Manic 296. 52 (F 31. 32) Depressed SEVERE Current or Most Recent 296. 43 (F 31. 13) Manic 296. 53 (F 31. 4) Depressed With Psychotic Features 296. 44 (F 31. 2) Manic 296. 54(F 31. 5) Depressed 296. 45 (F 31. 73) Manic 296. 45(F 31. 73) Hypomanic 296. 55(F 31. 75) Depressed 296. 46 (F 31. 74) Manic 296. 46(F 31. 74) Hypomanic 296. 56 (F 31. 76) Depressed In Partial Remission In Full Remission Treatment Assessments • Cognitive Behavioral Therapy (CBT) • Family-Focused Therapy (FFT) • Interpersonal and Social Rhythm Therapy • Psych pharmacotherapy • Emerging Adjunct Therapies • Transcranial Magnetic Stimulation (TMS) • Electroconvulsive Therapy (ECT) • Diet & Exercise • Cranial Electrotherapy Stimulation (CES) • Beck Depression Inventory II • Suicide Assessment • SASSI • The Child Bipolar Questionnaire
Disorder Codes Treatment Assessments BIPOLARII 296. 89 (F 31. 81) Specify current or most recent episode: Hypomanic Depressed Specify if: With anxious distress With mixed features Rapid cycling Mood-congruent psychotic features Mood-incongruent Psychotic features Catatonia Per partum onset Seasonal Pattern Specify Course: Partial or Full Remission Specify Severity: Mild Moderate Severe • Cognitive Behavioral Therapy • Psychoeducation • Psychotherapy • Psych pharmacotherapy • Antipsychotic • Antidepressant • Selective Serotonin Reuptake Inhibitor (SSRI) • Mood Disorder Questionnaire (MDQ) • Bipolar Spectrum Diagnostic Scale (BSDS) • WHODAS 2. 0 • Severity Measure for Depression (PHQ-9) • PROMIS Emotional Distress- Depression • Cross-Cutting Symptom Measure
Disorder Codes Treatments Assessments Cyclothymic Disorder 301. 13 • Psychotherapy • Cognitive Behavioral Therapy • Family Therapy Cyclothymic Disorder test Cross-Cutting Symptom Measure Substance/Medication. Induced Bipolar & Related Disorder Alcohol: 291. 89 Mild F 10. 14 Moderate/Severe F 10. 24 Without Use F 10. 94 Phencyclidine: 292. 84 Mild F 16. 14 Moderate/Severe F 16. 24 Without Use F 16. 94 Other hallucinogen: 292. 84 Mild F 16. 14 Moderate/Severe F 16. 24 Without Use F 16. 94 Sedative, hypnotic, or anxiolytic: 292. 84 Mild F 13. 14 Moderate/Severe F 13. 24 • Psychotherapy • Cognitive Behavioral Therapy Cross-Cutting Symptom Measure
Disorder Bipolar & Related Disorder Due to Another Medical Condition Other Specified Bipolar & Related Disorder Unspecified Bipolar & Related Disorder Coding Treatment Assessments 293. 83 (F 06. 33) • Cognitive Behavioral Therapy • Psychoeducation • Psychotherapy • Psych pharmacotherapy Bipolar Diagnostic Spectrum Scale Severity Measure for Depression Beck Depression Inventory Specify if: (F 06. 33) With Manic Features (F 06. 33) With Manic- or hypomanic-like episode (F 06. 34) With mixed features 296. 89 (F 31. 89) 296. 80 (F 31. 9)
BIPOLAR & RELATED DISORDERS DIAGNOSTIC CRITERIA Major Depressive Disorder MDD Persistent Depressive Disorder PDD Premenstrual Dysphoric Disorder PMDD A persistently depressed mood with lack of interest in activities and impairment to daily living. Causes are biological, psychological and interpersonal relationships. Neural circuitry is impaired within the brain which alters sleep patterns, appetite, focus, energy levels, self esteem and behaviors. Depression is also linked to suicidal ideation. Depressed mood observed for over a period of at least two years. A sense of hopelessness is found within the client, with lack of appetite, or binge eating. Energy levels are low and it is difficult to concentrate/focus. Difficulty with sleeping insomnia or hypersomnia. No presence of manic of hypomanic episodes and the criteria for Cyclothymic Disorder has never been met. The symptoms of this disorder are not associated with physiological effects from drugs. Five symptoms must be present within the week prior to the onset of menses. Mood Swings, anger, irritability, increased interpersonal conflicts, feeling uptight and overwhelmed. Physical symptoms bloating, breast tenderness and joint and muscle discomfort. A significant interference with regular functioning.
Disruptive Mood Dysregulation Disorder DMDD Bipolar I Disorder Bipolar II Disorder DMDD is a newer diagnosis, a childhood condition where the child has difficulty self-regulating anger, with frequent outbursts more than 3 times per week. Displays daily anger. The developmental level does not coincide with the chronological age. Mania is the prime symptom. Alternates between mania and depression. Lack of joy in daily functioning. Weight loss or gain. Too little sleep or too much sleep. Psychomotor agitation observed daily by others. Concentration levels are scarce. Recurrent SI ( Suicidal Ideation). Manic episode is when the individual is in a euphoric mood but displays an irritable mood and alternates between the two. Increased self-esteem, delusional sense of expertise, racing thoughts, distractabilty, high risk pleasurable activities. Hypomanic is less intense from the manic episode and a mixed episode combines the two major depressive and manic episode need only last for 1 week. The difference between Bipolar I (BPI)and Bipolar II (BPII) is full mania for 7 days versus hypomania for four days. Once a person has an episode of full mania they will receive BPI diagnosis. No manic episode, one major depressive episode and at least one hypomanic episode.
Cyclothymic Disorder Substance/Medication Induced Bipolar & Related Disorder Due to Another Medical Condition Mood cycling over a two year period and have not met diagnostic criteria for BPI, BPII and Depressive Disorder. Substance induced mood disorders occur from the drugs taken that can alter the hypothalamic-pituitary-adrenal axis. Drugs such as: Interferon-alpha, Corticosteroids, Digitalis/digoxin, antiepileptic drugs, antidepressants and weak and conflicting drug associations. Episodes of distress and impairment in regard to social, work related and in everyday functioning that necessitates hospitalization due to the risk of causing harm to self or others with psychotic features.
Other Specified Bipolar & Related Disorder Unspecified Bipolar Related Disorder This category is used when the symptoms can not be extended for clinical diagnosis to a subject/client but they have had symptomatic features of this BPI/BPII.
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