decision tree
TRANSCRIPT
Decision Trees for Decision Trees for Differential Diagnosis.Differential Diagnosis.
Decision Trees for Decision Trees for Differential Diagnosis.Differential Diagnosis.
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Pick a differential diagnosisPick 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
Is there a disturbance of consciousness and a change in cognition
Symptoms that are due to the direct physiological effects of a general Symptoms that are due to the direct physiological effects of a general medical conditionmedical condition
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
Start Over
Delirium Due to Multiple Etiologies
Start Over
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
Start Over
Evidence that cerebrovascular disease is etiologically related to the
disturbance
Yes No
Start Over
Vascular Dementia
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
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Dementia of the Alzheimer’s Type
Dementia Not Otherwise Specified
Start Over
Amnestic Disorder due to a General Medical
Condition
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Prominent delusions or hallucinations
predominate
Yes No
Start Over
Psychotic Disorder Due to a General Medical Condition
Prominent and persistent mood disturbance
predominates
Yes No
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Mood Disorder Due to a General Medical
Condition
Prominent anxiety, panic attacks, obsessions, or
compulsions predominate
Yes No
Start Over
Anxiety Disorder due to a General Medical
Condition
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
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Personality Change Due to a General Medical
Condition
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
Start Over
Mental Disorder Not Otherwise Specified
Due to a General Medical Condition
Start Over
No Mental Disorder (Symptoms that are not
clinically significant)
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
Start Over
Start Over
Substance Induced
Intoxication Delirium
Start Over
Delirium Due to Multiple Etiologies
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
Start Over
Substance-Induced Persisting Dementia
Start Over
Dementia Due to Multiple Etiologies
Substance-Induced Persisting Amnestic
Disorder
Start Over
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
Start Over
Substance-Induced Mood Disorder – Specify if onset during
intoxication or withdrawal
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
Start Over
Substance-Induced Anxiety Disorder – Specify if onset during intoxication
or withdrawal
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
Start Over
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
Start Over
Substance-Induced Sleep Disorder – Specify if onset
during intoxication or withdrawal
Development of a reversible syndrome due to recent use of a substance
Yes No
Start Over
Substance IntoxicationSubstance Intoxication
Development of a syndrome Development of a syndrome due to reduction or cessation of due to reduction or cessation of
use of substanceuse of substance
Yes No
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Substance WithdrawalSubstance Withdrawal
Clinically significant symptoms Clinically significant symptoms due to a substance that do not due to a substance that do not
meet criteria for one of the meet criteria for one of the Substance-Induced DisordersSubstance-Induced Disorders
Yes No
Start Over
Substance-Related Disorder Substance-Related Disorder Not Otherwise SpecifiedNot Otherwise Specified
Start Over
No Substance-Induced No Substance-Induced Disorder (substance-induced Disorder (substance-induced
symptoms that are not clinically symptoms that are not clinically significant)significant)
Delusions, hallucinations, disorganized Delusions, hallucinations, disorganized speech, or grossly disorganized behaviorspeech, or grossly disorganized behavior
Due to the direct Due to the direct physiological effects of a physiological effects of a general medical conditiongeneral medical condition
Yes No
Start Over
Psychotic Disorder Due Psychotic Disorder Due to a General Medical to a General Medical
ConditionCondition
Due to the direct physiological Due to the direct physiological effects of a substance (e.g., a effects of a substance (e.g., a
drug of abuse, a medication, or drug of abuse, a medication, or a toxin)a toxin)
Yes No
Start Over
Substance-Induced Psychotic Substance-Induced Psychotic DisorderDisorder
Symptoms of active phase of Symptoms of active phase of Schizophrenia, lasting at least Schizophrenia, lasting at least
1 month1 month
Yes No
Major Depressive or Manic Major Depressive or Manic Episode concurrent with active-Episode concurrent with active-
phase symptomsphase symptoms
Yes No
Total duration of mood Total duration of mood episodes has been brief episodes has been brief
relative to duration of active relative to duration of active and residual periodsand residual periods
Yes No
Duration at least 6 monthsDuration at least 6 months
Yes No
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SchizophreniaSchizophrenia
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Schizophreniform DisorderSchizophreniform Disorder
At least 2 weeks of delusions At least 2 weeks of delusions or hallucinations in the absence or hallucinations in the absence of prominent mood symptomsof prominent mood symptoms
Yes No
Start Over
Schizoaffective DisorderSchizoaffective Disorder
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Mood Disorder with Psychotic Mood Disorder with Psychotic Features (see Features (see Mood Disorders tree)
Nonbizarre delusions lasting at Nonbizarre delusions lasting at least 1 monthleast 1 month
Yes No
Total duration of mood episodes Total duration of mood episodes has been brief relative to duration has been brief relative to duration
of delusional periodsof delusional periods
Yes No
Apart from delusions, Apart from delusions, functioning not markedly functioning not markedly
impairedimpaired
Yes No
Delusions occur only Delusions occur only during mood episodesduring mood episodes
Yes No
Start Over
Delusional DisorderDelusional Disorder
Start Over
Psychotic Disorder Not Psychotic Disorder Not Otherwise SpecifiedOtherwise Specified
Start Over
Mood Disorder with Mood Disorder with Psychotic Features (see Psychotic Features (see
Mood Disorders tree)
Duration more than 1 day but Duration more than 1 day but less than 1 monthless than 1 month
Yes No
Start Over
Brief Psychotic DisorderBrief Psychotic Disorder
Start Over
Psychotic Disorder Not Psychotic Disorder Not Otherwise SpecifiedOtherwise Specified
Depressed, elevated, expansive, or irritable moodDepressed, elevated, expansive, or irritable mood
Due to the direct Due to the direct physiological effects of a physiological effects of a general medical conditiongeneral medical condition
Yes No
Start Over
No Mood Disorder (mood No Mood Disorder (mood symptoms that are not clinically symptoms that are not clinically significant)significant)
Start Over
Mood Disorder Due to a Mood Disorder Due to a General Medical ConditionGeneral Medical Condition
Due to the direct physiological Due to the direct physiological effects of a substance (i.e., a effects of a substance (i.e., a drug of abuse, a medication, drug of abuse, a medication,
or a toxin)or a toxin)
Yes No
Start Over
Substance-Induced Substance-Induced Mood DisorderMood Disorder
Next
Determine type of present and Determine type of present and past mood episodespast mood episodes
Elevated, expansive, or irritable Elevated, expansive, or irritable mood, at least 1-week duration; mood, at least 1-week duration;
marked impairment or marked impairment or hospitalizationhospitalization
Yes No
Start Over
Manic EpisodeManic Episode
Mixed Diagnosis
Elevate, expansive, or irritable Elevate, expansive, or irritable mood, at least 4-day duration; mood, at least 4-day duration; changes observable by others changes observable by others but less severe than a Manic but less severe than a Manic
EpisodeEpisode
Yes No
Start Over
Hypomanic EpisodeHypomanic Episode
Mixed Diagnosis
Start Over
Major Depressive EpisodeMajor Depressive Episode
Mixed Diagnosis
At least 2 weeks of depressed At least 2 weeks of depressed mood or loss of interest plus mood or loss of interest plus
associated symptoms, and not associated symptoms, and not better accounted for by better accounted for by
Bereavement Bereavement
Yes No
Criteria met for Manic Criteria met for Manic Episode and Major Episode and Major
Depressive Episode nearly Depressive Episode nearly every day for at least 1 weekevery day for at least 1 week
Yes No
Start Over
Mixed Diagnosis
Mixed EpisodeMixed Episode
Has ever had a Manic Episode Has ever had a Manic Episode or a Mixed Episodeor a Mixed Episode
Yes No
Psychotic symptoms occur at Psychotic symptoms occur at times other than during Manic times other than during Manic
or Mixed Episodesor Mixed Episodes
Yes No
Start Over
Bipolar I DisorderBipolar I Disorder
Occurred exclusively during Occurred exclusively during Schizoaffective Disorder (review Schizoaffective Disorder (review
Psychotic Disorders tree)
Yes No
Start Over
Schizoaffective Disorder, Schizoaffective Disorder, Bipolar TypeBipolar Type
Start Over
Bipolar Disorder Not Otherwise Bipolar Disorder Not Otherwise Specified (superimposed on a Specified (superimposed on a
Psychotic Disorder)Psychotic Disorder)
Has ever had a Hypomanic Has ever had a Hypomanic Episode and at least one Major Episode and at least one Major
Depressive EpisodeDepressive Episode
Yes No
Start Over
Bipolar II DisorderBipolar II Disorder
2+ years of hypomanic 2+ years of hypomanic symptoms and periods of symptoms and periods of
depressed mooddepressed mood
Yes No
Start Over
Cyclothymic DisorderCyclothymic Disorder
Clinically significant Clinically significant manic/hypomanic symptoms manic/hypomanic symptoms that do not meet criteria for a that do not meet criteria for a
specific Bipolar Disorderspecific Bipolar Disorder
Yes No
Start Over
Bipolar Disorder NOSBipolar Disorder NOS
Has ever had a Major Has ever had a Major Depressive EpisodeDepressive Episode
Yes No
Psychotic symptoms occur at Psychotic symptoms occur at times other than during Major times other than during Major
Depressive EpisodesDepressive Episodes
Yes No
Start Over
Major Depressive DisorderMajor Depressive Disorder
Occurred exclusively during Occurred exclusively during Schizoaffective Disorder Schizoaffective Disorder
(review (review Psychotic Disorders tree)
Yes No
Start Over
Schizoaffective Disorder, Schizoaffective Disorder, Depressive TypeDepressive Type
Start Over
Depressive Disorder NOS Depressive Disorder NOS (superimposed on Psychotic (superimposed on Psychotic
Disorder)Disorder)
Depressed mood, more days Depressed mood, more days than not, for at least 2 years than not, for at least 2 years with associated symptomswith associated symptoms
Yes No
Start Over
Dysthymic DisorderDysthymic Disorder
Depressed mood not meeting Depressed mood not meeting criteria for one of the previous criteria for one of the previous Mood Disorders that develops Mood Disorders that develops
in response to a stressorin response to a stressor
Yes No
Start Over
Adjustment Disorder Adjustment Disorder with Depressed Moodwith Depressed Mood
Clinically significant depressive Clinically significant depressive symptoms that do not meet symptoms that do not meet criteria for a specific Mood criteria for a specific Mood
DisorderDisorder
Yes No
Start Over
Depressive Disorder NOSDepressive Disorder NOS
Start Over
No Mood Disorder (mood No Mood Disorder (mood symptoms that are not clinically symptoms that are not clinically
significant)significant)
Symptoms of anxiety, fear, avoidance, or Symptoms of anxiety, fear, avoidance, or increased arousalincreased arousal
Due to the direct physiological Due to the direct physiological effects of a general medical effects of a general medical
conditioncondition
Yes No
Start Over
Anxiety disorder due to a Anxiety disorder due to a general medical conditiongeneral medical condition
Due to the direct physiological Due to the direct physiological effects of a substance (e.g., a drug effects of a substance (e.g., a drug
of abuse, a medication, a toxin)of abuse, a medication, a toxin)
Yes No
Start Over
Substance-Induced Substance-Induced Anxiety DisorderAnxiety Disorder
Recurrent unexpected Panic Recurrent unexpected Panic Attacks plus a month of worry, Attacks plus a month of worry,
concern about attacks, or concern about attacks, or change in behavior change in behavior
Yes No
Agoraphobia, i.e., anxiety about Agoraphobia, i.e., anxiety about being in places from which escape being in places from which escape might be difficult or embarrassing might be difficult or embarrassing
in the event of having a Panic in the event of having a Panic AttackAttack
Yes No
Start Over
Panic Disorder with AgoraphobiaPanic Disorder with Agoraphobia
Start Over
Panic Disorder Without Panic Disorder Without Agoraphobia Agoraphobia
Agoraphobia, i.e., anxiety about Agoraphobia, i.e., anxiety about being in places from which being in places from which escape might be difficult or escape might be difficult or
embarrassing in the event of embarrassing in the event of having panic-like symptomshaving panic-like symptoms
Yes No
Start Over
Agoraphobia without Agoraphobia without History of Panic DisorderHistory of Panic Disorder
Anxiety concerning separation Anxiety concerning separation from attachment figures with from attachment figures with
onset in childhoodonset in childhood
Yes No
Start Over
Separation Anxiety DisorderSeparation Anxiety Disorder
Fear of humiliation or Fear of humiliation or embarrassment in social or embarrassment in social or
performance performance
Yes No
Start Over
Social Phobia (Social Anxiety Social Phobia (Social Anxiety Disorder)Disorder)
Fear cued by object or situationFear cued by object or situation
Yes No
Start Over
Specific PhobiaSpecific Phobia
Obsessions or compulsionsObsessions or compulsions
Yes No
Start Over
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
6-month period of excessive 6-month period of excessive anxiety and worry plus anxiety anxiety and worry plus anxiety
symptomssymptoms
Yes No
Occurs exclusively during a Occurs exclusively during a Mood or Psychotic DisorderMood or Psychotic Disorder
See mood disorders tree No
Start Over
Generalized Anxiety DisorderGeneralized Anxiety Disorder
Anxiety in response to a severe Anxiety in response to a severe traumatic eventtraumatic event
Yes No
Reexperiencing of event, Reexperiencing of event, increased arousal, and increased arousal, and
avoidance of stimuli associated avoidance of stimuli associated with traumatic event with traumatic event
Yes No
Duration of more than 1 monthDuration of more than 1 month
Yes No
No Anxiety Disorder No Anxiety Disorder (symptoms of fear, anxiety, (symptoms of fear, anxiety, or avoidance that are not or avoidance that are not
clinically significant)clinically significant)
Start Over
Start Over
Posttraumatic Stress Posttraumatic Stress DisorderDisorder
Start Over
Acute Stress DisorderAcute Stress Disorder
Anxiety that does not meet Anxiety that does not meet criteria for one of the above criteria for one of the above
Anxiety Disorders and Anxiety Disorders and develops in response to a develops in response to a
stressorstressor
Yes No
Start Over
Adjustment Disorder Adjustment Disorder with Anxietywith Anxiety
Clinically significant symptoms Clinically significant symptoms that do not meet criteria for a that do not meet criteria for a
specific Anxiety Disorderspecific Anxiety Disorder
Yes No
Start Over
Anxiety Disorder NOSAnxiety Disorder NOS
Physical Complaints or irrational anxiety about illness or appearancePhysical Complaints or irrational anxiety about illness or appearance
Physical complaints are fully Physical complaints are fully explained by a general medical explained by a general medical condition and complaints are condition and complaints are
not in excess of expectednot in excess of expected
Yes No
Start Over
No Anxiety Disorder No Anxiety Disorder (symptoms of fear, anxiety, or (symptoms of fear, anxiety, or
avoidance that are not clinically avoidance that are not clinically significant)significant)
Specific General Medical Specific General Medical Condition (no somatoform Condition (no somatoform
disorder)disorder)
Next
Psychological factors adversely Psychological factors adversely affect general medical affect general medical
conditioncondition
Next
Psychological Factor Psychological Factor Affecting Medical ConditionAffecting Medical Condition
Start Over
Physical symptoms are Physical symptoms are intentionally producedintentionally produced
Yes No
External incentives are absentExternal incentives are absent
Yes No
Start Over
Factitious DisorderFactitious Disorder
Start Over
MalingeringMalingering
History of multiple physical History of multiple physical complaints with at least 4 pain complaints with at least 4 pain symptoms, 2 gastrointestinal symptoms, 2 gastrointestinal
symptoms, 1 sexual symptom, symptoms, 1 sexual symptom, and 1 pseudoneurological and 1 pseudoneurological
symptomsymptom
Yes No
Start Over
Somatization DisorderSomatization Disorder
Symptom or deficit affecting Symptom or deficit affecting voluntary motor or sensory voluntary motor or sensory
functionfunction
Yes No
Start Over
Conversion DisorderConversion Disorder
Symptom or deficit affecting Symptom or deficit affecting sexual functioningsexual functioning
Yes No
Start Over
Sexual DysfunctionSexual Dysfunction
Pain is focus of clinical Pain is focus of clinical attention, and psychological attention, and psychological factors have important rolefactors have important role
Yes No
Start Over
Pain DisorderPain Disorder
Other physical complaints Other physical complaints lasting at least 6 monthslasting at least 6 months
Yes No
Start Over
Undifferentiated Somatoform Undifferentiated Somatoform DisorderDisorder
Preoccupation with idea of Preoccupation with idea of having a serious diseasehaving a serious disease
Yes No
Belief is of delusional intensityBelief is of delusional intensity
Yes No
Start Over
HypochondriasisHypochondriasis
Start Over
See See Psychotic Disorders tree
Preoccupation with imagined Preoccupation with imagined defect in appearancedefect in appearance
Yes No
Start Over
Body Dysmorphic Disorder (if Body Dysmorphic Disorder (if delusional, also see delusional, also see
Psychotic Disorders tree)
Clinically significant Clinically significant somatoform symptoms that do somatoform symptoms that do not meet criteria for a specific not meet criteria for a specific
Somatoform DisorderSomatoform Disorder
Yes No
Start Over
Somatoform Disorder NOSSomatoform Disorder NOS
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No Somatoform Disorder No Somatoform Disorder (somatoform symptoms that (somatoform symptoms that are not clinically significant)are not clinically significant)