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{"sheet":"Sheet1","index":0,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"DT-Anxiety","index":1,"n_rows":23,"n_cols":3,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct physiological effects of a general medical condition?","A3","D:Delirium or Dementia or Anxiety Disorder due to a General Medical Condition, A3"]
["Due to the direct physiological effects of a substance?","A5","A4"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A5","D:Substance-Induced Anxiety Disorder, A5"]
["Discrete periods of intense fear or discomfort building within 10 minutes?","A6","D:See Panic Attacks Tree, A6"]
["Recurrent unexpected clinically significant panic attacks?","A8","A7"]
["Accompanied by agoraphobia","D:Panic Disorder without Agoraphobia, A8","D:Panic Disorder with Agoraphobia, A8"]
["Anxiety about being in places from which escape might be difficult or embarrassing in the event of having panic-like symptoms?","A9","D:Agoraphobia without History of Panic Disorder, A9"]
["Anxiety or worry concerning separation from attachment figures with onset in childhood?","A10","D:Separation Anxiety Disorder, A10"]
["Anxiety or worry about being humiliated or embarrassed in social or performance situations?","A11","D:Social Phobia, A11"]
["Anxiety about exposure to a feared to a feared object (e.g., spiders) or situation (e.g., heights)?","A12","D:Specific Phobia, A12"]
["Anxiety or worry about having a serious general medical condition despite reassurance to the contrary?","A14","A13"]
["Belief about serious physical illness is of delusional intensity?","D:Hypochondriasis, A14","D:See Delusions Tree, A14"]
["Anxiety or worry about an imagined defect in appearance?","A15","D:Body Dysmorphic Disorder,A15"]
["Anxiety associated with recurrent reminations or worries?","A19","A16"]
["Intrusive and ego-dysonic?","A17","D:Obsessive-Compulsive Disorder, A17"]
["Occurs exclusively during a Mood Disorder or Psychotic Disorder?","A18","D:Associated feature of Mood or Psychotic Disorder (no separate Anxiety Disorder diagnosis necessary), A18"]
["Chronic worry and anxiety lasting at least 6 months?","A19","D:Generalized Anxiety Disorder, A19"]
["Anxiety in response to a severe traumatic event?","A22","A20"]
["Reexperiencing of event, increased arousal, and avoidance of stimuli associated with the traumatic event?","A22","A21"]
["Duration of more than 1 month?","Acute Stress Disorder, A22","D:Posttraumatic Stress Disorder, A22"]
["Clinically significant anxiety not covered above?",":END","A23"]
["Occuring in response to a psychosocial stressor?","D:Anxiety Disorder NOS, :END","D:Adjustment Disorder with Anxiety, :END"]

{"sheet":"DT-AgressiveBehavior","index":2,"n_rows":18,"n_cols":3,"rows_kept":18,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct effects of a general medical condition","A6","A3"]
["Associated with a disturbance in consciousness and other cognitive deficits and characterized by a fluctuating course","A4","D:Delirium Due to a General Medical Condition, A4"]
["Associated with multiple cognitive deficits (including memory impairment)","A5","D:Dementia due to a General Medical Condition with Behavioral Disturbance, A5"]
["Occurring in a pattern representing a change from previous personality patter","D:Mental Disorder NOS Due to a General Medical Condition, A6","D:Personality Change due to a General Medical Condition, A6"]
["Due to the direct effects of a substance","A8","A7"]
["In excess of that usually encountered with intoxication or withdrawal","D:Substance Intoxication, D:Substance Withdrawal, A8","D:Other Substance-Induced Disorders (e.g. Substance-Induced Delirium or Psychotic Disorder), A8"]
["In the context of a delusion or hallucination","A9","D:Psychotic Disorder(e.g. Schizophrenia or Mood Disorder with Psychotic Features), A9"]
["Occurring in the context of elevated mood","A10","D:Manic or Mixed Episode in Bipolar Disorder, D:Schizoaffective Disorder, A10"]
["Occurring in the context of depressed mood (e.g., murder of loved one preceding a suicide)","A11","D:Major Depressive Episode in Major Depressive Disorder or Schizoaffective Disorder, A11"]
["Occurring as part of a pattern of antisocial behavior","A13","A12"]
["Over age 18","D:Conduct Disorder, A13","D:Antisocial Personality Disorder, A13"]
["Occuring as part of a pattern of intense anger with onset in early adulthood","A14","D:Borderline Personality Disorder, A14"]
["Episodes of aggressive behavior out of proportion to the situation","A15","D:Intermittent Explosive Disorder, A15"]
["Associated with a psychosocial stressor","A17","A16"]
["In response to an extreme stressor and accompanied by recurrent reexperiencing of the traumatic event","D:Adjustment Disorder NOS, A17","D:Acute Stress Disorder, D:Posttraumatic Stress Disorder, A17"]
["Clinically significant impairment in impulse control not covered above","A18","D:Impulse-Control Disorder NOS, A18"]
["Occuring for gain",":END","D:Criminal Behavior, :END"]

{"sheet":"DT-AppetiteOrUnusualEating","index":3,"n_rows":22,"n_cols":3,"rows_kept":22,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Weight Loss (or failure to make expected weight gains) or decrease in appetite","A10","A3"]
["Accounted for by a general medical condition","A4","D:General Medical Condition, A4"]
["Accounted for by substance use (e.g., Cocaine Dependence, medication side effects)","A5","D:Substance-related Disorder, D:Adverse Effect of Medication NOS, A5"]
["Not eating in response to delusion or hallucination","A6","D:Psychotic Disorder (e.g. Schizophrenia), A6"]
["Accompanied by depressive symptoms","A7","D:Major Depressive Episode in Major Depressive Disorder, D:Bipolar Disorder, D:Schizoaffective Disorder, D:Dysthymic Disorder, D:Bereavement, A7"]
["Accompanied by manic symptoms","A8","D:Manic Episode in Bipolar Disorder, D:Schizoaffective Disorder, A8"]
["Related to fear of getting fat","A9","D:Anorexia Nervosa, A9"]
["Onset during infancy or early childhood","A10","D:Rumination Disorder, D:Feeding Disorder of Infancy or Early Childhood, A10"]
["Weight gain (not due to bing eating)","A14","A11"]
["Accounted for by a general medical condition","A12","D:General Medical Condition, A2"]
["Accounted for by substance use (e.g., Cannabis Dependence, lithium)","A13","D:Substance-related Disorder, D:Adverse Effect of Medication NOS, A13"]
["Accompanied by depressive symptoms","A14","D:Major Depressive Episode in Major Depressive Disorder, D:Bipolar Disorder, D:Schizoaffective Disorder, D:Dysthymic Disorder, D:Bereavement, A14"]
["Binge eating","A19","A15"]
["Accompanied by abnormally low weight","A16","D:Anorexia Nervosa, A16"]
["Recurrent and frequent","A18","A17"]
["Accompanied by inappropriate compensatory mechanisms","D:Eating Disorder NOS (Binge-Eating Disorder), A18","D:Bulimia Nervosa, A18"]
["As part of a pattern of impusivity with onset by early adulthood","A19","D:Borderline Personality Disorder, A19"]
["Regurgitation and rechewing of food in an infant","A20","D:Rumination Disorder, A20"]
["Eating of nonnutritive substances","A21","D:PICA, A21"]
["Clinically significant changes in weight or eating behavior not covered above","D:Normal variations in eating or weight (e.g. fad dieting), :END","A22"]
["Occurring as a maladaptive response to a stressor","D:Eating Disorder NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-AvoidanceBehavior","index":4,"n_rows":16,"n_cols":3,"rows_kept":16,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Avoidance of a characteristic cluster of situations (e.g., being outside the home alone, crowds, bridges, traveling)","A4","A3"]
["Related to recurrent unexpected panic attacks","D:Agoraphobia without History of Panic Disorder, A4","D:Panic Disorder with Agoraphobia, A4"]
["Avoidance of social situations because of fear of embarrassment","A6","A5"]
["Related to embarrassment about having a mental disorder (e.g., Anorexia Nervosa) or a general medical condition (e.g., Parkinson's)","D:Social Phobia (also consider Avoidant Personality Disorder), A6","D:Anxiety Disorder NOS, A6"]
["Avoidance cued by specific objects (e.g., spiders) or situations (e.g., heights, seeing blood)","A7","D:Specific Phobia, A7"]
["Avoidance of stimuli assocations with an extreme stressor","A9","A8"]
["Duration more than 1 month","D:Acute Stress Disorder, A9","D:Posttraumatic Stress Disorder, A9"]
["Avoidance of stimuli associated with an obsession (e.g., contamination, knives)","A10","D:Obsessive-Compulsive Disorder, A10"]
["Avoidance of situations related to delusional fears (e.g., not leaving home because of the conviction that one is a victim of a plot)","A11","D:Psychotic Disorders (including Schizophrenia or Delusional Disorder or Mood Disorder with Psychotic Features), A12"]
["Avoidance of situations related to lack of energy of anhedonia","A12","D:Major Depressive Disorder, D:Schizophrenia, A12"]
["Avoidance of situations in which one is away from major attachement figures","A13","D:Separation Anxiety Disorder, A13"]
["Avoidance of all genital contact with a partner","A14","D:Sexual Aversion Disorder, A14"]
["Pattern of avoidance related to fears of negative evalutaion with an onset by early adulthood","A15","D:Avoidant Personality Disorder, A15"]
["Clinically significant avoidance not covered above","D:Normal Avoidance Behavior, :END","A16"]
["Occurring in response to a stressor","D:Anxiety Disorder NOS, :END","D:Adjustment Disorder, :END "]

{"sheet":"DT-Catatonia","index":5,"n_rows":12,"n_cols":3,"rows_kept":12,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Neurological or other general medical condition judged to be etiological","A4","A3"]
["Associated with a disturbance in consciousness, other cognitive deficits, and characterized by a fluctuating course","D:Catatonic Disorder Due to a General Medical Condition, A4","D:Delirium Due to a General Medical Condition, A4"]
["Judged to be due to the use of a neuroleptic medication","A8","A5"]
["Muscular rigidity and elevated temperature","A6","D:Neuroleptic Malignant Syndrome, A6"]
["Abnormal posturing or muscle spasm","A7","D:Neuroleptic-Induced Dystonia, A7"]
["Muscular rigidity, usually with tremor and/or akinesia","A8","D:Neuroleptic-Induced Parkinsonism, A8"]
["Due to Substance Intoxication (e.g., PCP) or Withdrawal","A9","D:Substance Intoxication, D:Substance Withdrawal, A9"]
["Associated with Bipolar Disorder","A10","D:Bipolar Disorder with Catatonic Features, A10"]
["Associated with Major Depressive Disorder","A11","D:Major Depressive Disorder with Catatonic Features, A11"]
["Associated with a Psychotic Disorder",":END","A12"]
["Occurs as part of Schizophrenia","D:Schizoaffective Disorder, D:Schizophreniform Disorder, D:Brief Psychotic Disorder, :END","D:Schizophrenia Catatonic Type, :END"]

{"sheet":"DT-ChildOrAdolescent","index":6,"n_rows":17,"n_cols":3,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Associated with substance use","A5","A3"]
["Due to its direct physiological effects on the central nervous system","A4","D:Substance Intoxication, D:Substance Withdrawal, A4"]
["Related to pattern of use (e.g., illegal behavior to fund habit)","A5","D:Substance Dependence/Abuse, A5"]
["Due to the direct physiological effect of a general medical condition","A6","D:Delirium, D:Personality Change Due to a General Medical Condition, A6"]
["Associated with low IQ and impariment in adaptive functioning","A7","D:Mental Retardation, A7"]
["Part of a pattern of antisocial behavior","A8","D:Conduct Disorder, A8"]
["Part of a pattern of negativistic, hostile, and defiant behavior","A10","A9"]
["Behavior occurs more frequently than typical for child of that age and causes clinically significant impairment","A10","D:Oppositional Defiant Disorder, A10"]
["Part of a pattern of inattention and/or hyperactivity","A12","A11"]
["Occurs in at least two different situations and causes clinically significant impairment or distress, and onset is before age 7","A12","D:Attention-Deficit/Hyperactivity Disorder, A12"]
["Associated with episodes of elevated, irritable, or depressed mood","A13","D:Manic Episode, D:Hypomanic Episode, D:Major Depressive Episode, D:Dysthymic Disorder, D:Cyclothymic Disorder, A13"]
["Associated with psychotic symptoms in the absence of mood disturbance","A14","D:Schizophrenia, D:Schizophreniform, D:Schizoaffective, D:Delusional Disorder, D:Brief Psychotic Disorder, A14"]
["A consequence of stereotyped movements","A16","A15"]
["Part of a pattern of gross impairment in social relatedness and language","D:Stereotypic Movement Disorder, A16","D:Pervasive Developmental Disorder, A16"]
["Maladative response to a psychosocial stressor","A17","D:Adjustment Disorder, A17"]
["Illegal behavior for gain or revenge",":END","D:Childhood Antisocial Behavior (V Code), :END"]

{"sheet":"DT-Delusion","index":7,"n_rows":17,"n_cols":3,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct physiological effects of a general medical condition","A4","A3"]
["Associated with a disturbance in consciousness and other cognitive deficits and characterized by a fluctuating course","D:Psychotic Disorder Due to a General Medical Condition (includes delusions occuring as part of Dementia Due to a General Medical Condition, A4","D:Delirium Due to a General Medical Condition, A4"]
["Due to the direct physiological effects of a substance (e.g., drugs of abuse, medications)","A6","A5"]
["In excess of that usually encountered with intoxication or withdrawal","D:Substance Intoxication, D:Substance Withdrawal, A6","D:Substance-induced Psychotic Disorder or Substance-Induced Delirium, A6"]
["Delusions occur exclusively during Major Depressive, Mixed, or Manic episodes of Mood Disorder","A7","D:Mood Disorder with Psychotic Features, A7"]
["Delusions last for 1 month or more","A17","A8"]
["Accompanied by hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms","A9","A10"]
["Content of delusions is bizarre","A14","A10"]
["Psychotic symptoms concurrent with mood episodes","A12","A11"]
["Total duration of mood episodes brief relative to active and residual phases","A13","A12"]
["Duration at least 6 months","D:Schizoaffective Disorder, :END","D:Schizophrenia, :END"]
["Delusions or hallucinations for at least 2 weeks in the absence of mood symptoms","D:Schizophreniform Disorder, :END","D:Schizoaffective Disorder, :END"]
["Total duration of mood episodes has been brief relative to durations of delusional periods","A16","A15"]
["Apart from delusions, functioning not markedly impaired","D:Psychotic Disorder NOS, :END","D:Delusional Disorder, :END"]
["Delusions occur only during mood episodes","D:Psychotic Disorder NOS, :END","D:Mood Disorder with Psychotic Features, :END"]
["Duration more than 1 day but less than 1 month","D:Psychotic Disorder NOS, :END","D:Brief Psychotic Disorder, :END"]

{"sheet":"DT-DepressedMood","index":8,"n_rows":21,"n_cols":3,"rows_kept":21,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Due to the direct physiological effecs of a general medical condition?","A3","D:Mood Disorder Due to a General Medical Condition, A3"]
["Due to the direct physiological effects of a substance (i.e., a drub of abuse, a medication, or a toxin)?","A5","A4"]
["In excess of that usually seen with intoxication or withdrawal?","D:Substance Intoxication, D:Substance Withdrawal, A5","D:Substance-Induced Mood Disorder, A5"]
["At least 2 weeks of depressed mood or loss of interest plus associated symptoms, and not better accounted for by Bereavement?","A9","A6"]
["Criteria also met for a Manic Episode nearly every day for at least 1 week?","A7","A8"]
["Major Depressive Episode?","A9","A9"]
["Mixed Episode?","A9","A9"]
["Clinically significant manic/hypomaniac symptoms?","A14","A10"]
["Has ever had a Manic Episode or a Mixed Episode?","A12","A11"]
["Psychotic symptoms occur at times other than during Manic or Mixed Episodes","D:Bipolar I Disorder, A12","D:Schizoaffective Disorder, D:Bipolar Type, D:Bipolar Disorder NOS, A12"]
["Has ever had a Hypomanic Episode and has ever had at least one Major Depressive Episode?","A13","D:Bipolar II Disorder, A13"]
["2+ Years of hypomanic symptoms and periods of depressed mood?","D:Bipolar Disorder NOS, A14","D:Cyclothymic Disorder, A14"]
["One or more Major Depressive Episodes without any Manic, Mixed, or Hypomanic Episodes?","A16","A15"]
["Psychotic symptoms occur at times other than during Major Depressive Episodes?","D:Major Depressive Disorder, A16","D:Schizoaffective Disorder Depressive Type, D:Depressive Disorder NOS, A16"]
["Depressed mood, more days than not, for at least 2 years with associated symptoms?","A17","D:Dysthymic Disorder, A17"]
["Depressed or dysphoric mood as an associated feature of another mental disorder (e.g., \"demoralization\" about having Obsessive-Compulsive Disorder)","A19","A18"]
["Mood disturbance clinically significant",":END","D:Depressive Disorder NOS, A19"]
["Clinically significant depressed mood not covered above",":END","A20"]
["Occurring after the deat of a loved one","A21","D:Bereavement, A21"]
["Occurring in response to another psychosocial stressor","D:Depressive Disorder NOS, :END","D:Adjustment Disorder with Depressed Mood, :END"]

{"sheet":"DT-DisorganizedOrUnusualSpeech","index":9,"n_rows":15,"n_cols":3,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Due to the direct effects of a general medical condition?","A5","A3"]
["Associated with disturbance in consciousness and other cognitive deficits and characterized by a fluctuating course?","A4","D:Delirium Due to a General Medical Condition, A5"]
["Associated with memory impairment?","D:Aphasia, A5","D:Delirium Due to a General Medical Condition, A5"]
["Due to the direct effects of a substance (including medication)?","A7","A6"]
["In excess of that usually expected with intoxication or withdrawal?","D:Substance Intoxication, D:Substance Withdrawal, A7","D:Substance-Induced Disorder(e.g. Substance-Induced Delirium), A7"]
["Rapid pressured speech with subjective sense of racing thoughts, associated with euphoric or irritable mood?","A8","D:Manic Episode in Bipolar Disorder, D:Manic Episode in Schizoaffective Disorder, A8"]
["Disorganized speech in association with delusions, hallucinations, grossly disorganized behavior, or negative symptoms?","A12","A9"]
["Duration at least 6 months?","A10","D:Schizophrenia, A12"]
["Duration between 1 month and 6 months?","A11","D:Schizophreniform Disorder, A12"]
["Duration at least 1 day and less than 1 month?","A12","D:Brief Psychotic Disorder, A12"]
["Difficulty in production of language?","A13","D:Expressive or Mixed Receptive-Expressive Language Disorder, A13"]
["Stereotypical, socially stilted speech?","A14","D:Pervasive Developmental Disorder, A14"]
["Repetitive, rythmic vocal outbursts?","A15","D:Tic Disorder, A15"]
["Clinically significant speech disturbance not covered above?",":END","D:Communication Disorder NOS, :END"]

{"sheet":"DT-Distraction","index":10,"n_rows":14,"n_cols":3,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Due to the direct effects of a general medical condition?","A4","A3"]
["Associated with other cognitive deficits and characterized by a fluctuating course?","D:Cognitive Disorder NOS, A4","D:Delirium Due to a General Medical Condition, A4"]
["Due to the direct effects of a substance?","A6","A5"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, D:Substance Withdrawal, A6","D:Substance-Induced Delirium, D:Substance-Induced Psychotic Disorder, A6"]
["Accompanied by other symptoms of mania?","A7","D:Manic or Mixed Episode in Bipolar Disorder, D:Manic or Mixed Episode in Schizoaffective Disorder, A7"]
["Accompanied by other symptoms of depression?","A8","D:Major Depressive Episode in Major Depressive Disorder, D:Major Depressive Episode in Bipolar Disorder, D:Major Depressive Episode in Schizoaffective Disorder, D:Dysthymic Disorder, A8"]
["Associated with delusions or hallucinations?","A9","D:Psychotic Disorder (e.g. Schizophrenia or Delusional Disorder), A9"]
["Associated with an extreme stressor?","A11","A10"]
["Lasts at least 1 month?","D:Acute Stress Disorder, A11","D:Posttraumatic Stress Disorder, A11"]
["Accompanied by at least 6 months of excessive anxiety and worry?","A12","D:Generalized Anxiety Disorder, A12"]
["Accompanied by other symptoms of inattention and/or hyperactivity/impulsivity?","A13","D:Attention-Deficit/Hyperactivity Disorder, A13"]
["Clinically significant distractibility not covered above?",":END","A14"]
["Occurring in response to a psychosocial stressor?","D:Attention-Deficit/Hyperactivity Disorder NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-ElevatedOrIrritableMood","index":11,"n_rows":18,"n_cols":3,"rows_kept":18,"cut":false,"hidden":false,"merged":[]}
["Questions","No","Yes"]
["Due to the direct physiological effects of a general medical condition?","A4","A3"]
["Associated with a disturbance in consciousness and other cognitive deficits and characterized by a fluctuating course?","D:Mood Disorder due to a General Medical Condition, A4","D:Delirium Due to a General Medical Condition, A4"]
["Due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or a toxin)?","A6","A5"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, D:Substance Withdrawal, A6","D:Substance-Induced Mood Disorder, A6"]
["Elevated, expansive, or irritable mood; 1-week duration; marked impairment or hospitalization?","A8","A7"]
["Manic Episode?","A12","A12"]
["Elevated, expansive, or irritable mood; 4-day duration, changes observable by others but less severe than a Manic Episode?","A10","A9"]
["Hypomanic Episode?","A12","A12"]
["Criteria met for Manic Episode and Major Depressive Episode nearly every day for at least 1 week?","A12","A11"]
["Mixed Episode?","A12","A12"]
["Present or past Manic Episode or Mixed Episode?","A14","A13"]
["Psychotic symptoms occur at times other than during Manic or Mixed Episodes?","D:Bipolar I Disorder, A14","D:Schizoaffective Disorder Bipolar Type, D:Bipolar Disorder NOS, A14"]
["Has ever had a Hypomanic Episode and has ever had at least one Major Depressive Episode?","A15","D:Bipolar II Disorder, A15"]
["2+ years of hypomanic symptoms and periods of depressed mood?","A16","D:Cyclothymic Disorder, A16"]
["Part of a long-term pattern of irritability with onset by early adulthood?","A17","D:Borderline or Antisocial Personality Disorder, A17"]
["Clinically significant manic/hypomanic symptoms not covered above?",":END","A18"]
["Occuring in response to a stressor?","D:Bipolar Disorder NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-Suicide","index":12,"n_rows":14,"n_cols":3,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Associated with Major Depressive Episode?","A3","D:Major Depressive Episode in Major Depressive Disorder, Bipolar Disorder, Schizoaffective Disorder, A3"]
["Associated with Manic or Mixed Episode?","A4","D:Manic or Mixed Episode in Bipolar Disorder, Schizoaffective Disorder, A4"]
["In response to delusions or hallucinations?","A5","D:Schizophrenia and Other Psychotic Disorders, A5"]
["Associated with a mood disturbance due to the direct physiological effects of a general medical condition?","A6","D:Mood Disorder Due to a General Medical Condition, A6"]
["Associated with the disinhibition, dysphoria, or confusion related to Substance Intoxication or Withdrawal or medication use?","A7","D:Substance Intoxication, Substance Withdrawal, Substance-Induced Mood Disorder, Substance-Induced Delirium, A7"]
["Associated with confusion/lack of judgment due to the direct effects of a general medical condition?","A8","D:Delirium Due to a General Medical Condition, Dementia Due to a General Medical Condition (e.g. Alzheimer's Disease) With Behavioral Disturbance, A8"]
["Motivation is to terminate intractable psychiatric symptom (e.g., insomnia, panic attacks)?","A9","D:Pain Disorder, Sleep Disorder, Panic Disorder, A9"]
["Related to irritability, aggressiveness, impulsivity, and legal problems?","A10","D:Conduct Disorder, Antisocial Personality Disorder, A10"]
["Related to a chronic pattern of fears of abandonment, intense anger, and poor impulse control?","A11","D:Borderline Personality Disorder, A11"]
["Motivation is for gain or to achieve the sick role?","A12","D:Factitious Disorder, Malingering, A12"]
["Demoralization associated with mental disorder or general medical condition?","A13","D:Adjustment Disorder, A13"]
["In response to psychosocial stressor and behavior not accounted for by another specific mental disorder?","A14","D:Adjustment Disorder, A14"]
["Motivation is to terminate intractable physical symptoms or their consequences (e.g., terminal cancer)?",":END",":END"]

{"sheet":"DT-SelfMutilation","index":13,"n_rows":12,"n_cols":3,"rows_kept":12,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Part of a failed suicide attempt?","A3","D:See Suicidal Ideation or Attempt Tree, A3"]
["Motivation is to reduce dysphoria, to vent angry feelings, or to reduce feelings of numbness or \"being dead\" in association with a pattern of impulsivity and identity disturbance?","A4","D:Borderline Personality Disorder, A4"]
["In response to a delusion or hallucination?","A5","D:Schizophrenia and Other Psychotic Disorders, A5"]
["Due to the direct effect of a general medical condition (e.g., as a result of cognitive impairment or disinhibition)?","A6","D:Delirium Due to a General Medical Condition, Dementia Due to a General Medical Condition (e.g. Alzheimer's Disease) With Behavioral Disturbance, Amnestic Disorder due to a General Medical Condition, Personality Change due to a General medical Condition, Lesch-Nyhan Syndrome, A6"]
["Due to the direct effect of a substance?","A7","D:Substance Intoxication, Substance Withdrawal, A7"]
["The result of a compulsion (e.g., hand washing)?","A8","D:Obsessive-Compulsive Disorder, A8"]
["Associated with hair pulling?","A9","D:Trichotillomania, A9"]
["Motivation is for sexual pleasure?","A10","D:Sexual Masochism, A10"]
["Repetitive, seemingly driven and nonfunctional (e.g., head banging)?","A11","D:Stereotyped Movement Disorder, Pervasive Development Disorder, Mental Retardation, A11"]
["Motivation is for gain or to achieve the sick role?","A12","D:Factitious Disorder, Malingering, A12"]
["Occurs in response to psychosocial stressor and not better accounted for by a specific mental disorder?",":END","D:Adjustment Disorder, :END"]

{"sheet":"DT-PsychomotorRetardation","index":14,"n_rows":11,"n_cols":3,"rows_kept":11,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct physiological effects of a general medical condition?","A6","A3"]
["Associated with a disturbance in consciousness and characterized by a fluctuating course?","A4","D:Delirium Due to a General Medical Condition, A4"]
["Associated with memory impairment and other severe cognitive deficits?","A5","D:Dementia Due to a General Medical Condition (e.g. Alzheimer's Disease), A5"]
["Catatonic mutism or other catatonic symptoms?","D:Symptom of a general medical condition (e.g. hypothyroidism), A6","D:Catatonic Disorder Due to a General Medical Condition, A6"]
["Due to the direct effects of a substance (including medication?","A9","A7"]
["Related to neuroleptics?","A8","D:Neuroleptic-Induced Parkinsonism, Neuroleptic malignant Syndrome, A8"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A9","D:Substance-Induced Disorder (e.g. Substance-Induced Delirium), A9"]
["Associated with at least 2 weeks of depressed mood and other symptoms?","A10","D:Major Depressive Episode in Major Depressive Disorder, Bipolar I or Bipolar II Disorder, Schizoaffective Disorder, A10"]
["Associated with delusions of hallucinations?",":END","A11"]
["At least two characteristic symptoms of catatonia?","D:Psychotic Disorder (e.g. other subtypes of Schizophrenia besides Catatonic), :END","D:Catatonic Schizophrenia, :END"]

{"sheet":"DT-PoorSchoolPerformance","index":15,"n_rows":13,"n_cols":3,"rows_kept":13,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Associated with an IQ of below 70 and concurrent impairment in adaptive functioning?","A3","D:Mental Retardation, A3"]
["Associated with gross impairment in social relatedness, language, and stereotyped or restricted interests and activities?","A4","D:Pervasive Developmental Disorder, A4"]
["Associated with a significantly below-average performance on an academic achievement test?","A5","D:Reading Disorder, Mathematics Disorder, Disorder of Written Expression, A5"]
["Associated with delay in language development?","A6","D:Expressive or Mixed Receptive-Expressive Language Disorder, A6"]
["Failure to speak in school (despite speaking at home)?","A7","D:Selective Mutism, A7"]
["Associated with clinically significant inatention and/or hyperactivity-impulsivity?","A8","D:Attention-Deficit/Hyperactivity Disorder, A8"]
["Associated with a pattern of antisocial behavior?","A9","D:Conduct Disorder, A9"]
["Associated with a pattern of negativistic, hostile, and defiant behavior?","A10","D:Oppositional Defiant Disorder, A10"]
["Related to excessive substance use?","A11","D:Substance Dependence, Substance Abuse, A11"]
["Refusal to attend school related to fears of separation?","A12","D:Separation Anxiety Disorder, A12"]
["Anxiety, mood, psychotic, or other symptoms that interfere with school performance?","A13","D:?????? A13"]
["Maladaptive response to a psychosocial stressor?","D:Not related to a mental disorder, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-PhysicalComplaints","index":16,"n_rows":15,"n_cols":3,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Physical complaints are fully accounted for by a diagnosed general medical condition?","A4","A3"]
["Psychological factors adversely affect general medical condition?","A4","D:Psychological Factors Affecting Medical Condition, A4"]
["Physical symptoms are intentionally produced?","A6","A5"]
["External incentives are absent?","D:Malingering, A6","D:Factitious Disorder, A6"]
["Associated with other symptoms (e.g. depressed mood) of a specific diagnosable mental disorder?","A7","D:Other Mental Disorder (e.g. Major Depressive Disorder), A7"]
["History of many physical complaints with at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom?","A8","D:Somatization Disorder ,A8"]
["Symptom or deficit affecting voluntary motor or sensory function?","A9","D:Conversion Disorder, A9"]
["Pain is focus of clinical attention and psychological factors have important role in the etiology or maintenance of the pain?","A10","D:Pain Disorder, A10"]
["Other physical complaints lasting at least 6 months?","A11","D:Undifferentiated Somatoform Disorder"]
["Preoccupation with idea of having a serious disease?","A13","A12"]
["Belief is of delusional intensity?","D:Hypochondriasis, A13","D:See Delusions Tree, A13"]
["Preoccupation with imagined defect in appearance?","A14","D:Body Dysmorphic Disorder (if Delusional also see Delusions Tree), A14"]
["Clinically unexplained physical complaints not covered above?",":END","A15"]
["Occurring in response to a psychosocial stressor?","D:Somatoform Disorder NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-PanicAttacks","index":17,"n_rows":12,"n_cols":3,"rows_kept":12,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct effects of a general medical condition?","A3","D:Anxiety Disorder due to a General Medical Condition With Panic Attacks, A3"]
["Due to the direct effects of a substance (including medications)?","A5","A4"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A5","D:Substance-Induced Anxiety Disorder With Panic Attacks, A5"]
["Recurrent unexpected panic attacks that are clinically significant?","A7","A6"]
["Presence of agoraphobia?","D:Panic Disorder Without Agoraphobia, A7","D:Panic Disorder With Agoraphobia, A7"]
["Trigger for panic attack is fear of embarrassment in social situations?","A8","D:Social Phobia, A8"]
["Trigger for panic attack is an object (e.g. spiders) or situation (e.g. heights, seeing blood)?","A9","D:Specific Phobia, A9"]
["Trigger for panic attack is exposure to situation resembling prior traumatic experience?","A10","D:Posttraumatic Stress Disorder, A10"]
["Trigger for panic attack is exposure to a focus of an obsessional concern (e.g. to dirt in an individual with a contamination obsession)?","A11","D:Obsessive-Compulsive Disorder, A11"]
["Clinically significant discrete periods of anxiety not covered above?",":END","A12"]
["Occurring in response to a stressor?","D:Anxiety Disorder NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-Pain","index":18,"n_rows":10,"n_cols":3,"rows_kept":10,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Pain is associated with a general medical condition and psychological factors do not play an important role?","A3","D:General Medical Condition (or site of pain) is coded on Axis III, A3"]
["Pain is an associated feature of another mental disorder and pain is not a focus of clinical attention?","A4","D:Other Mental Disorder is Diagnosed (e.g. Major Depressive Disorder),A4"]
["There is also a history of pain in at least three other sites plus other unexplained physical complaints (e.g. gastrointestinal)?","A5","D:Somatization Disorder, A5"]
["Pain is limited to sexual intercourse?","A6","D:Dyspareunia, A6"]
["Pain is associated with a general medical condition and psychological factors play an important role?","A7","D:Pain Disorder Associated With Psychological Factors, A7"]
["Pain is associated with both psychological factors and a general medical condition?","A8","D:Pain Disorder Associated With Psychological Factors and a General Medical Condition, A8"]
["Pain is intentionally produced or feigned?","A10","A9"]
["Motivation is for obvious external gain?","D:Factitious Disorder, A10","D:Malingering, A10"]
["Pain occurs in response to a stressor?",":END","D:Adjustment Disorder, :END"]

{"sheet":"DT-MemoryImpairment","index":19,"n_rows":17,"n_cols":3,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct effects of a general medical condition?","A5","A3"]
["Accompanied by a disturbance of consciousness?","A4","D:Delirium Due to a General Medical Condition, A4"]
["Accompanied by aphasia, apraxia, agnosia, or disturbances in executive functioning?","D:Amnestic Disorder due to a General Medical Condition","D:Dementia Due to a General Medical Condition (e.g. Alzheimer's Disease), A5"]
["Due to the persisting effects of substance use?","A7","A6"]
["Accompanied by aphasia, apraxia, agnosia, or disturbances in executive functioning?","D:Substance-Induced Persisting Amnestic Disorder, A7","D:Substance-Induced Persisting Dementia, A7"]
["Due to the acute effects of substance use (e.g. blackouts)?","A9","A8"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A9","D:Substance-Induced Delirium, A9"]
["Due to a medication side effect (e.g. lithium)?","A10","D:Adverse Effect of Medication NOS, A10"]
["Memory loss for aspects of an extremely traumatic event?","A14","A11"]
["Accompanied by reexperiencing of trauma, avoidance of stimuli associated with trauma, and increased arousal?","A13","A12"]
["Lasts for at least 1 month?","D:Acute Stress Disorder, A13","D:Posttraumatic Stress Disorder, A13"]
["Associated with loss of personal identity and sudden unexpected travel?","D:Dissociative Amnesia, A14","D:Dissociative Fugue, A14"]
["Associated with the experience of more than one identity state?","A15","D:Dissociative Identity Disorder, A15"]
["Memory loss or impairment is feigned?","A16","D:Malingering, Factitious Disorder, A16"]
["Occurs as an associated feature of Major Depressive Episode?","A17","D:Major Depressive Episode in Major Depressive Disorder, Bipolar Disorder, Schizoaffective Disorder, A17"]
["Consequent to aging process but within normal limits given person's age?",":END","D:Aging-Associated Cognitive Decline, :END"]

{"sheet":"DT-Insomnia","index":20,"n_rows":13,"n_cols":3,"rows_kept":13,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct effects of a general medical condition?","A4","A3"]
["Occurs exclusively during Delirium?","D:Sleep Disorder Related to a General Medical Condition Insomnia Type, A4","D:Delirium Due to a General Medical Condition, A4"]
["Due to the direct effects of a substance (including medication)?","A6","A5"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A6","D:Substance-Induced Sleep Disorder Insomnia Type, A6"]
["Related to another mental disorder (e.g. Schizophrenia, Mood Disorder, Generalized Anxiety Disorder, PTSD)?","A8","A7"]
["Warrants independent clinical attention?","D:Mental Disorder only (no separate diagnosis of Insomnia necessary), A8","D:Insomnia Related to Another Disorder, A8"]
["Related to breathing problems during sleep?","A9","D:Breathing-Related Sleep Disorder, A9"]
["Related to nightmares, sleep terrors, or sleepwalking?","A10","D:Parasomnia (no separate diagnosis of Insomnia necessary), A10"]
["Related to mismatch between individual's schedule and natural sleep-wake cycle?","A11","D:Circadian Rhythm Sleep Disorder, A11"]
["Duration at least 1 month?","A12","D:Primary Insomnia, A12"]
["Causes clinically significant distress or impairment?",":END","A13"]
["Occurring in response to a stressor?","D:Dyssomnia NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-Impulsivity","index":21,"n_rows":23,"n_cols":3,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct effects of a general medical condition?","A6","A3"]
["Associated with multiple cognitive deficits (including memory impairment)?","A4","D:Dementia due to a General Medical Condition with Behavioral Disturbance, A6"]
["Associated with a disturbance in consciousness and other cognitive deficits and characterized by a fluctuating course?","A5","D:Delirium Due to a General Medical Condition, A6"]
["Occurring in a pattern representing a change from previous personality pattern?","D:Mental Disorder NOS due to a General Medical Condition, A6","D:Personality Change due to a General Medical Condition, A6"]
["Due to the direct effects of a substance?","A8","A7"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A8","D:Other Substance-Induced Disorders (e.g. Substance-Induced Delirium), A8"]
["Occurring in response to a delusion?","A9","D:Psychotic Disorder (e.g. Mood Disorders with Psychotic Features), A9"]
["Occurring in the context of elevated mood?","A10","D:Manic or Mixed Episode in Bipolar Disorder or Schizoaffective Disorder, A10"]
["Occurring in the context of depressed mood (e.g. suicidal behavior)?","A11","D:Major Depressive Episode in Major Depressive Disorder, Major Depressive Episode in Bipolar Disorder, Major Depressive Episode in Schizoaffective Disorder, A11"]
["Part of a pattern of antisocial behavior?","A12","D:Conduct Disorder, Antisocial Personality Disorder, A12"]
["Associated with symptoms of inattention?","A13","D:Attention-Deficit/Hyperactivity Disorder, A13"]
["Part of a pattern of impulsivity with onset in early adulthood?","A14","D:Borderline Personality Disorder, A14"]
["Impaired ability to control use of substances?","A15","D:Substance Dependence, A15"]
["Episodes of failure to resist acting on sexual impulses?","A16","D:Paraphilias, Sexual Disorder NOS, A16"]
["Failure to resist impulses to binge eat?","A17","D:Anorexia Nervosa, Bulimia Nervosa, A17"]
["Failure to resist impulses to gamble?","A18","D:Pathological Gambling, A18"]
["Episodes of failure to resist an impulse to start fires?","A19","D:Pyromania, A19"]
["Episodes of failure to resist an impulse to steal objects not needed for personal use?","A20","D:Kleptomania, A20"]
["Episodes of failure to resist the impulse to pull out one's hair?","A21","D:Trichotillomania, A21"]
["Episodes of failure to resist aggressive impulses?","A22","D:Intermittent Explosive Disorder, A22"]
["Clinically significant impulsivity not covered above?",":END","A23"]
["Occurring in response to a psychosocial stressor?","D:Impulse-Control Disorder NOS, :END","D:Adjustment Disorder, :END"]

{"sheet":"DT-Hypersomnia","index":22,"n_rows":15,"n_cols":3,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct effects of a general medical condition?","A6","A3"]
["Occurs exclusively during Delirium?","A4","D:Delirium Due to a General Medical Condition, A4"]
["Accompanied by sleep attacks and by cataplexy, sleep paralysis, or sleep-related hallucinations?","A5","D:Narcolepsy, A5"]
["Daytime fatigue related to breathing problems during sleep?","D:Sleep Disorder Related to a General Medical Condition (Hypersomnia Type), A6","D:Breathing-Related Sleep Disorder, A6"]
["Due to the direct effects of a substance (including medication)?","A8","A7"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A8","D:Substance-Induced Sleep Disorder (Hypersomnia Type), A8"]
["Related to another mental disorder (e.g. Schizophrenia, Mood Disorder)?","A10","A9"]
["Warrants independent clinical attention?","D:Mental Disorder only (no separate diagnosis of Hypersomnia necessary), :END","D:Hypersomnia Related to Another Mental Disorder, A10"]
["Daytime fatigue related to nightmares, sleep terrors, or sleepwalking?","A11","D:Parasomnia (no separate Hypersomnia diagnosis necessary), :END"]
["Daytime fatigue related to a mismatch between individual's schedule and natural sleep-wake pattern?","A12","D:Circadian Rhythm Sleep Disorder, A12"]
["Due to an inadequate amount of sleep not related to above causes?","A14","A13"]
["Related to insomnia?","D:Voluntary Sleep Deprivation (No Mental Disorder), A14","D:Primary Insomnia, A14"]
["Duration of at least 1 month?","A15","D:Primary Hypersomnia, A15"]
["Causes clinically significant distress or impairment?",":END","D:Dyssomnia NOS, :END"]

{"sheet":"DT-Hallucinations","index":23,"n_rows":17,"n_cols":3,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
["Question","No","Yes"]
["Due to the direct physiological effects of a general medical condition?","A4","A3"]
["Associated with a disturbance in consciousness and other cognitive deficits and characterized by a fluctuating course?","D:Psychotic Disorder due to a General Medical Condition With Hallucinations (includes hallucinations that are part of Dementia due to a General Medical Condition), A4","D:Delirium Due to a General Medical Condition, A4"]
["Due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication, or a toxin)?","A6","A5"]
["In excess of that usually encountered with intoxication or withdrawal?","D:Substance Intoxication, Substance Withdrawal, A6","D:Substance-Induced Psychotic Disorder or Substance-Induced Delirium, A6"]
["Hallucinatory exeriences with intact insight, not accompanied by other psychotic symptoms, usually occurring in several sensory modalities, and having a fantastic or childish content?","A7","D:\"Pseudohallucinations\" in Conversion Disorder, A7"]
["Hallucinatory experiences are culturally sanctioned?","A8","D:No mental disorder, A8"]
["Hallucinations occur exclusively during episodes of Mood Disorder?","A11","A9"]
["During a Major Depressive Episode?","A10","D:Major Depressive Episode With Psychotic Features, A10"]
["During a Manic or Mixed Episode?","A11","D:Manic or Mixed Episode with Psychotic Features, A11"]
["Hallucinations last for 1 month or more?","A17","A12"]
["Accompanied by delusions, disorganized speech, disorganized or catatonic behavior, or negative symptoms?","D:Psychotic Disorder NOS, A17","A13"]
["Psychotic symptoms concurrent with mood episodes?","A15","A14"]
["Total duration of mood episodes brief relative to active and residual phases?","A16","A15"]
["Duration at least 6 months?","D:Schizophreniform Disorder, :END","D:Schizophrenia, :END"]
["Delusions or hallucinations for at least 2 weeks in the absence of mood symptoms?","D:Mood Disorder With Psychotic Features, :END","D:Schizoaffective Disorder, :END"]
["Duration more than 1 day but less than 1 month?","D:Psychotic Disorder NOS, :END","D:Brief Psychotic Disorder, :END"]

{"sheet":"Diagnoses","index":24,"n_rows":204,"n_cols":2,"rows_kept":204,"cut":false,"hidden":false,"merged":[]}
["Normal variations in eating or weight (e.g. fad dieting)"]
["Pseudohallucinations in Conversion Disorder","http://psychiatryonline.com/content.aspx?aID=9452"]
["Acute Stress Disorder","http://psychiatryonline.com/content.aspx?aID=3434"]
["Adjustment Disorder"]
["Adjustment Disorder NOS"]
["Adjustment Disorder with Anxiety"]
["Adjustment Disorder with Depressed Mood"]
["Adverse Effect of Medication NOS"]
["Aging-Associated Cognitive Decline"]
["Agoraphobia without History of Panic Disorder","http://psychiatryonline.com/content.aspx?aID=3149"]
["Amnestic Disorder due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=8750"]
["Anorexia Nervosa","http://psychiatryonline.com/content.aspx?aID=3617"]
["Antisocial Personality Disorder","http://psychiatryonline.com/content.aspx?aID=3928"]
["Delirium or Dementia or Anxiety Disorder due to a General Medical Condition"]
["Anxiety Disorder due to a General Medical Condition With Panic Attacks","http://psychiatryonline.com/content.aspx?aID=8750"]
["Anxiety Disorder NOS"]
["Aphasia"]
["Associated feature of Mood or Psychotic Disorder (no separate Anxiety Disorder diagnosis necessary)"]
["Attention-Deficit/Hyperactivity Disorder","http://psychiatryonline.com/content.aspx?aID=7721"]
["Attention-Deficit/Hyperactivity Disorder NOS"]
["Avoidant Personality Disorder","http://psychiatryonline.com/content.aspx?aID=4089"]
["Bereavement"]
["Bipolar Disorder"]
["Bipolar Disorder NOS"]
["Bipolar Disorder with Catatonic Features"]
["Bipolar I Disorder","http://psychiatryonline.com/content.aspx?aID=2444"]
["Bipolar I or Bipolar II Disorder","http://psychiatryonline.com/content.aspx?aID=2444"]
["Bipolar II Disorder","http://psychiatryonline.com/content.aspx?aID=2585"]
["Bipolar Type"]
["Body Dysmorphic Disorder","http://psychiatryonline.com/content.aspx?aID=9613"]
["Body Dysmorphic Disorder (if Delusional also see Delusions Tree)","http://psychiatryonline.com/content.aspx?aID=9613"]
["Borderline or Antisocial Personality Disorder","http://psychiatryonline.com/content.aspx?aID=3974"]
["Borderline Personality Disorder","http://psychiatryonline.com/content.aspx?aID=3974"]
["Breathing-Related Sleep Disorder","http://psychiatryonline.com/content.aspx?aID=10608"]
["Brief Psychotic Disorder","http://psychiatryonline.com/content.aspx?aID=9215"]
["Bulimia Nervosa","http://psychiatryonline.com/content.aspx?aID=3679"]
["Catatonic Disorder Due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=8852"]
["Catatonic Schizophrenia","http://psychiatryonline.com/content.aspx?aID=9053"]
["Childhood Antisocial Behavior (V Code)"]
["Circadian Rhythm Sleep Disorder","http://psychiatryonline.com/content.aspx?aID=10664"]
["Cognitive Disorder NOS"]
["Communication Disorder NOS"]
["Conduct Disorder","http://psychiatryonline.com/content.aspx?aID=7808"]
["Conversion Disorder","http://psychiatryonline.com/content.aspx?aID=9452"]
["Criminal Behavior"]
["Cyclothymic Disorder","http://psychiatryonline.com/content.aspx?aID=2669"]
["Delirium"]
["Delirium Due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=8378"]
["Delusional Disorder"]
["Dementia"]
["Dementia Due to a General Medical Condition (e.g. Alzheimer's Disease)","http://psychiatryonline.com/content.aspx?aID=8653"]
["Dementia Due to a General Medical Condition (e.g. Alzheimer's Disease) With Behavioral Disturbance","http://psychiatryonline.com/content.aspx?aID=8653"]
["Dementia due to a General Medical Condition with Behavioral Disturbance","http://psychiatryonline.com/content.aspx?aID=8653"]
["Depressive Disorder NOS"]
["Disorder due to a general Medical Condition"]
["Disorder of Written Expression","http://psychiatryonline.com/content.aspx?aID=7363"]
["Dissociative Amnesia","http://psychiatryonline.com/content.aspx?aID=9708"]
["Dissociative Fugue","http://psychiatryonline.com/content.aspx?aID=9744"]
["Dissociative Identity Disorder","http://psychiatryonline.com/content.aspx?aID=9776"]
["Dyspareunia","http://psychiatryonline.com/content.aspx?aID=10108"]
["Dyssomnia NOS"]
["Dysthymic Disorder","http://psychiatryonline.com/content.aspx?aID=2375"]
["Eating Disorder NOS"]
["Eating Disorder NOS (Binge-Eating Disorder)"]
["Expressive or Mixed Receptive-Expressive Language Disorder","http://psychiatryonline.com/content.aspx?aID=7416"]
["Factitious Disorder"]
["Feeding Disorder of Infancy or Early Childhood","http://psychiatryonline.com/content.aspx?aID=7980"]
["General Medical Condition"]
["General Medical Condition (or site of pain) is coded on Axis III"]
["Generalized Anxiety Disorder","http://psychiatryonline.com/content.aspx?aID=3476"]
["Hypersomnia Related to Another Mental Disorder"]
["Hypochondriasis","http://psychiatryonline.com/content.aspx?aID=9570"]
["Hypomanic Episode","http://psychiatryonline.com/content.aspx?aID=2228"]
["Impulse-Control Disorder NOS"]
["Insomnia Related to Another Disorder","http://psychiatryonline.com/content.aspx?aID=10882"]
["Intermittent Explosive Disorder","http://psychiatryonline.com/content.aspx?aID=11056"]
["Kleptomania","http://psychiatryonline.com/content.aspx?aID=11096"]
["Lesch-Nyhan Syndrome"]
["Major Depressive Disorder","http://psychiatryonline.com/content.aspx?aID=2270"]
["Major Depressive Disorder with Catatonic Features"]
["Major Depressive Episode","http://psychiatryonline.com/content.aspx?aID=2089"]
["Major Depressive Episode in Bipolar Disorder"]
["Major Depressive Episode in Major Depressive Disorder","http://psychiatryonline.com/content.aspx?aID=2270"]
["Major Depressive Episode in Major Depressive Disorder or Schizoaffective Disorder"]
["Major Depressive Episode in Schizoaffective Disorder"]
["Major Depressive Episode With Psychotic Features","http://psychiatryonline.com/content.aspx?aID=14913"]
["Malingering","http://psychiatryonline.com/content.aspx?aID=11409"]
["Manic Episode","http://psychiatryonline.com/content.aspx?aID=2149"]
["Manic Episode in Bipolar Disorder"]
["Manic Episode in Schizoaffective Disorder","http://psychiatryonline.com/content.aspx?aID=9117"]
["Manic or Mixed Episode in Bipolar Disorder"]
["Manic or Mixed Episode in Bipolar Disorder or Schizoaffective Disorder"]
["Manic or Mixed Episode in Schizoaffective Disorder"]
["Manic or Mixed Episode with Psychotic Features"]
["Mathematics Disorder","http://psychiatryonline.com/content.aspx?aID=7341"]
["Mental Disorder NOS Due to a General Medical Condition"]
["Mental Disorder NOS due to a General Medical Condition"]
["Mental Disorder only (no separate diagnosis of Hypersomnia necessary)"]
["Mental Disorder only (no separate diagnosis of Insomnia necessary)"]
["Mental Retardation","http://psychiatryonline.com/content.aspx?aID=16914"]
["Mood Disorder due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=2715"]
["Mood Disorder Due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=2715"]
["Mood Disorder with Psychotic Features"]
["Mood Disorder With Psychotic Features"]
["Narcolepsy","http://psychiatryonline.com/content.aspx?aID=10557"]
["Neuroleptic Malignant Syndrome","http://psychiatryonline.com/content.aspx?aID=5565"]
["Neuroleptic malignant Syndrome","http://psychiatryonline.com/content.aspx?aID=5565"]
["Neuroleptic-Induced Dystonia"]
["Neuroleptic-Induced Parkinsonism","http://psychiatryonline.com/content.aspx?aID=5556"]
["No mental disorder"]
["Normal Avoidance Behavior"]
["Not related to a mental disorder"]
["Obsessive-Compulsive Disorder","http://psychiatryonline.com/content.aspx?aID=3291"]
["Oppositional Defiant Disorder","http://psychiatryonline.com/content.aspx?aID=7888"]
["Other Mental Disorder (e.g. Major Depressive Disorder)"]
["Other Mental Disorder is Diagnosed (e.g. Major Depressive Disorder)"]
["Other Substance-Induced Disorders (e.g. Substance-Induced Delirium or Psychotic Disorder)"]
["Other Substance-Induced Disorders (e.g. Substance-Induced Delirium)"]
["Pain Disorder","http://psychiatryonline.com/content.aspx?aID=9510"]
["Pain Disorder Associated With Psychological Factors","http://psychiatryonline.com/content.aspx?aID=9510"]
["Pain Disorder Associated With Psychological Factors and a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=9510"]
["Panic Disorder","http://psychiatryonline.com/content.aspx?aID=3088"]
["Panic Disorder with Agoraphobia","http://psychiatryonline.com/content.aspx?aID=15264"]
["Panic Disorder With Agoraphobia","http://psychiatryonline.com/content.aspx?aID=15264"]
["Panic Disorder without Agoraphobia","http://psychiatryonline.com/content.aspx?aID=15264"]
["Panic Disorder Without Agoraphobia","http://psychiatryonline.com/content.aspx?aID=15264"]
["Paraphilias"]
["Parasomnia (no separate diagnosis of Insomnia necessary)"]
["Parasomnia (no separate Hypersomnia diagnosis necessary)"]
["Pathological Gambling","http://psychiatryonline.com/content.aspx?aID=11154"]
["Personality Change due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=8873"]
["Personality Change Due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=8873"]
["Personality Change due to a General medical Condition","http://psychiatryonline.com/content.aspx?aID=8873"]
["Pervasive Development Disorder"]
["Pervasive Developmental Disorder"]
["PICA","http://psychiatryonline.com/content.aspx?aID=7932"]
["Posttraumatic Stress Disorder","http://psychiatryonline.com/content.aspx?aID=3357"]
["Primary Hypersomnia","http://psychiatryonline.com/content.aspx?aID=10502"]
["Primary Insomnia","http://psychiatryonline.com/content.aspx?aID=10451"]
["Psychological Factors Affecting Medical Condition"]
["Psychotic Disorder (e.g. Mood Disorders with Psychotic Features)"]
["Psychotic Disorder (e.g. other subtypes of Schizophrenia besides Catatonic)"]
["Psychotic Disorder (e.g. Schizophrenia)"]
["Psychotic Disorder Due to a General Medical Condition (includes delusions occuring as part of Dementia Due to a General Medical Condition","http://psychiatryonline.com/content.aspx?aID=9282"]
["Psychotic Disorder due to a General Medical Condition With Hallucinations (includes hallucinations that are part of Dementia due to a General Medical Condition)","http://psychiatryonline.com/content.aspx?aID=9282"]
["Psychotic Disorder NOS"]
["Psychotic Disorder(e.g. Schizophrenia or Mood Disorder with Psychotic Features)"]
["Psychotic Disorders (including Schizophrenia or Delusional Disorder or Mood Disorder with Psychotic Features)"]
["Psychotic Disorder (e.g. Schizophrenia or Delusional Disorder)"]
["Pyromania","http://psychiatryonline.com/content.aspx?aID=11126"]
["Reading Disorder","http://psychiatryonline.com/content.aspx?aID=7313"]
["Rumination Disorder","http://psychiatryonline.com/content.aspx?aID=7958"]
["Schizoaffective","http://psychiatryonline.com/content.aspx?aID=9117"]
["Schizoaffective Disorder","http://psychiatryonline.com/content.aspx?aID=9117"]
["Schizoaffective Disorder Bipolar Type","http://psychiatryonline.com/content.aspx?aID=9117"]
["Schizoaffective Disorder Depressive Type","http://psychiatryonline.com/content.aspx?aID=9117"]
["Schizophrenia","http://psychiatryonline.com/content.aspx?aID=8939"]
["Schizophrenia and Other Psychotic Disorders","http://psychiatryonline.com/content.aspx?aID=265156"]
["Schizophrenia Catatonic Type","http://psychiatryonline.com/content.aspx?aID=9053"]
["Schizophreniform Disorder","http://psychiatryonline.com/content.aspx?aID=9078"]
["See Delusions Tree"]
["See Panic Attacks Tree"]
["See Suicidal Ideation or Attempt Tree"]
["Selective Mutism","http://psychiatryonline.com/content.aspx?aID=8213"]
["Separation Anxiety Disorder","http://psychiatryonline.com/content.aspx?aID=8166"]
["Sexual Aversion Disorder","http://psychiatryonline.com/content.aspx?aID=9929"]
["Sexual Disorder NOS"]
["Sexual Masochism","http://psychiatryonline.com/content.aspx?aID=10323"]
["Schizophreniform","http://psychiatryonline.com/content.aspx?aID=9078"]
["Sleep Disorder"]
["Sleep Disorder Related to a General Medical Condition (Hypersomnia Type)","http://psychiatryonline.com/content.aspx?aID=15645"]
["Sleep Disorder Related to a General Medical Condition Insomnia Type","http://psychiatryonline.com/content.aspx?aID=15645"]
["Social Phobia","http://psychiatryonline.com/content.aspx?aID=3236"]
["Social Phobia (also consider Avoidant Personality Disorder)","http://psychiatryonline.com/content.aspx?aID=3236"]
["Somatization Disorder","http://psychiatryonline.com/content.aspx?aID=9381"]
["Somatoform Disorder NOS"]
["Specific Phobia","http://psychiatryonline.com/content.aspx?aID=3175"]
["Stereotyped Movement Disorder","http://psychiatryonline.com/content.aspx?aID=8285"]
["Stereotypic Movement Disorder","http://psychiatryonline.com/content.aspx?aID=8285"]
["Substance Abuse","http://psychiatryonline.com/content.aspx?aID=812"]
["Substance Dependence","http://psychiatryonline.com/content.aspx?aID=629"]
["Substance Dependence/Abuse","http://psychiatryonline.com/content.aspx?aID=629"]
["Substance Intoxication","http://psychiatryonline.com/content.aspx?aID=828"]
["Substance Withdrawal","http://psychiatryonline.com/content.aspx?aID=841"]
["Substance-Induced Anxiety Disorder","http://psychiatryonline.com/content.aspx?aID=3556"]
["Substance-Induced Anxiety Disorder With Panic Attacks","http://psychiatryonline.com/content.aspx?aID=3556"]
["Substance-Induced Delirium","http://psychiatryonline.com/content.aspx?aID=8400"]
["Substance-Induced Disorder (e.g. Substance-Induced Delirium)"]
["Substance-Induced Disorder(e.g. Substance-Induced Delirium)"]
["Substance-Induced Mood Disorder","http://psychiatryonline.com/content.aspx?aID=2759"]
["Substance-Induced Persisting Amnestic Disorder","http://psychiatryonline.com/content.aspx?aID=8780"]
["Substance-Induced Persisting Dementia","http://psychiatryonline.com/content.aspx?aID=8674"]
["Substance-Induced Psychotic Disorder","http://psychiatryonline.com/content.aspx?aID=9320"]
["Substance-induced Psychotic Disorder or Substance-Induced Delirium","http://psychiatryonline.com/content.aspx?aID=9320"]
["Substance-Induced Psychotic Disorder or Substance-Induced Delirium","http://psychiatryonline.com/content.aspx?aID=9320"]
["Substance-Induced Sleep Disorder (Hypersomnia Type)","http://psychiatryonline.com/content.aspx?aID=10984"]
["Substance-Induced Sleep Disorder Insomnia Type","http://psychiatryonline.com/content.aspx?aID=10984"]
["Substance-related Disorder"]
["Symptom of a general medical condition (e.g. hypothyroidism)"]
["Tic Disorder"]
["Trichotillomania","http://psychiatryonline.com/content.aspx?aID=11196"]
["Voluntary Sleep Deprivation (No Mental Disorder)"]
["Voluntary Sleep Deprivation (No Mental Disorder)"]
["Anxiety"]

{"sheet":"DSM-IV Data","index":25,"n_rows":201,"n_cols":11,"rows_kept":201,"cut":false,"hidden":false,"merged":[]}
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[null,null,null,"DSM-IV-TR"]
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[null,null,null,"Sleep Disorders"]
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[null,"Sections of This Chapter:",null,null,null,"  Email a Link     Bookmark This     PDA Download     Print Section     Print Chapter "]
[null,"Introduction"]
[null,null,null,null,null,null,"Previous Section   |   Next Section"]
[null,"Primary Sleep Disorders"]
[]
[null,"Dyssomnias",null,null,null,null,null,null,"DOI: 10.1176/appi.books.9780890423349.10714"]
[]
[null,"307.42 Primary Insomnia",null,null,null,null,null,null,"327.xx Circadian Rhythm Sleep Disorder (formerly Sleep-Wake Schedule Disorder) "]
[null,null,null,null,null,null,null,null,"Diagnostic criteria for 327.xx Circadian Rhythm Sleep Disorder"]
[null,"307.44 Primary Hypersomnia"]
[null,null,null,null,null,null,null,null,"A. A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person's environment and his or her circadian sleep-wake pattern."]
[null,"347.00 Narcolepsy",null,null,null,null,null,null,"B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."]
[null,null,null,null,null,null,null,null,"C. The disturbance does not occur exclusively during the course of another Sleep Disorder or other mental disorder."]
[null,"780.57 Breathing-Related Sleep Disorder",null,null,null,null,null,null,"D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition."]
[]
[null,"327.xx Circadian Rhythm Sleep Disorder (formerly Sleep-Wake Schedule Disorder)",null,null,null,null,null,null,"Specify type:"]
[null,null,null,null,null,null,null,null,null,".31 Delayed Sleep Phase Type: a persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time"]
[null,"307.47 Dyssomnia Not Otherwise Specified",null,null,null,null,null,null,null,".35 Jet Lag Type: sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone"]
[null,null,null,null,null,null,null,null,null,".36 Shift Work Type: insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work"]
[null,"Parasomnias",null,null,null,null,null,null,null,".30 Unspecified Type"]
[]
[null,"307.47 Nightmare Disorder (formerly Dream Anxiety Disorder)",null,null,null,null,null,null,"Diagnostic Features"]
[null,null,null,null,null,null,null,null,"The essential feature of Circadian Rhythm Sleep Disorder is a persistent or recurrent pattern of sleep disruption that results from altered function of the circadian timing system or from a mismatch between the individual's endogenous circadian sleep-wake system and exogenous demands regarding the timing and duration of sleep (Criterion A). In contrast to other primary Sleep Disorders, Circadian Rhythm Sleep Disorder does not result from dysfunction of the mechanisms generating sleep and wakefulness per se. As a result of the circadian mismatch, individuals with this disorder may complain of insomnia at certain times during the 24-hour day and excessive sleepiness at other times, with resulting impairment in social, occupational, or other important areas of functioning or marked subjective distress (Criterion B). The sleep problems are not better accounted for by other Sleep Disorders or other mental disorders (Criterion C) and are not due to the direct physiological effects of a substance or a general medical condition (Criterion D)."]
[null,"307.46 Sleep Terror Disorder",null,null,null,null,null,null,"The diagnosis of Circadian Rhythm Sleep Disorder should be reserved for those presentations in which the individual has significant social or occupational impairment or marked distress related to the sleep disturbance. Individuals vary widely in their ability to adapt to circadian changes and requirements. Many, if not most, individuals with circadian-related symptoms of sleep disturbance do not seek treatment and do not have symptoms of sufficient severity to warrant a diagnosis. Those who present for evaluation because of this disorder are most often troubled by the severity or persistence of their symptoms. For example, it is not unusual for shift workers to present for evaluation after falling asleep while on the job or while driving."]
[null,null,null,null,null,null,null,null,"The diagnosis of Circadian Rhythm Sleep Disorder rests primarily on the clinical history, including the pattern of work, sleep, naps, and \"free time.\" The history should also examine past attempts at coping with symptoms, such as attempts at advancing the sleep-wake schedule in Delayed Sleep Phase Type. Prospective sleep-wake diaries or sleep charts are often a useful adjunct to diagnosis."]
[null,"307.46 Sleepwalking Disorder",null,null,null,null,null,null,"Subtypes"]
[null,null,null,null,null,null,null,null,null,null,".31 Delayed Sleep Phase Type. This type of Circadian Rhythm Sleep Disorder is characterized by a delay of circadian rhythms, including the sleep-wake cycle, relative to the demands of society. Measurement of endogenous circadian rhythms (e.g., core body temperature, plasma melatonin levels) during the individual's usual (i.e., delayed) sleep-wake schedule reflects this delay. Individuals with this subtype are hypothesized to have an abnormally diminished ability to phase-advance sleep-wake hours (i.e., to move sleep and wakefulness to earlier clock times) or an alteration in the usual alignment of sleep with other circadian rhythms. As a result, these individuals are \"locked in\" to habitually late sleep hours and have great difficulty shifting these sleep hours forward to an earlier time. The circadian phase of sleep is stable: individuals will fall asleep and awaken at consistent, albeit delayed, times when left to their own schedule (e.g., on weekends or vacations). Affected individuals complain of difficulty falling asleep at socially acceptable hours, but once sleep is initiated, it is normal. There is concomitant difficulty awakening at socially acceptable hours (e.g., multiple alarm clocks are often unable to arouse the individual). Many individuals with this disorder will be chronically sleep deprived as a result of the need to awaken for social and occupational obligations in the morning. Sleepiness during the desired wake period may result."]
[null,"307.47 Parasomnia Not Otherwise Specified",null,null,null,null,null,null,null,null,".35 Jet Lag Type. In this type of Circadian Rhythm Sleep Disorder, the endogenous circadian sleep-wake cycle is normal and the disturbance arises from conflict between the pattern of sleep and wakefulness generated by the circadian system and the pattern of sleep and wakefulness required by a new time zone. Individuals with this type complain of a mismatch between desired and required hours of sleep and wakefulness. The severity of symptoms is proportional to the number of time zones traveled, with maximal difficulties often noted after traveling through eight or more time zones in less than 24 hours. Eastward travel (advancing sleep-wake hours) is typically more difficult for most individuals to tolerate than westward travel (delaying sleep-wake hours)."]
[null,null,null,null,null,null,null,null,null,null,".36 Shift Work Type. In this type of Circadian Rhythm Sleep Disorder, the endogenous circadian sleep-wake cycle is normal and the disturbance arises from conflict between the pattern of sleep and wakefulness generated by the circadian system and the desired pattern of sleep and wakefulness required by shift work. Night-shift schedules (with shifting back to a day schedule on days off) and rotating-shift schedules are the most disruptive because they force sleep and wakefulness into aberrant circadian positions and prevent any consistent adjustment. Workers on these shifts typically have a shorter sleep duration and more frequent disturbances in sleep continuity than morning and afternoon workers. Conversely, these individuals may feel sleepy or fall asleep during the desired wake period, that is, in the middle of the night work shift. Work schedules that involve slowly rotating shifts or rotations to progressively earlier shifts (i.e., nights–afternoons–days) are also associated with higher degrees of sleep disturbance and other complaints than other types of rotating-shift schedules. The circadian mismatch of the Shift Work Type is further exacerbated by insufficient sleep time, social and family demands, alcohol use, and environmental disturbances (e.g., telephone, traffic noise) during intended sleep times."]
[null,"Sleep Disorders Related to Another Mental Disorder",null,null,null,null,null,null,null,null,".30 Unspecified Type. This type of Circadian Rhythm Sleep Disorder should be indicated if another pattern of circadian sleep disturbance (e.g., advanced sleep phase, non-24-hour sleep-wake pattern, or irregular sleep-wake pattern) is present. An \"advanced sleep phase pattern\" is the analog of Delayed Sleep Phase Type, but in the opposite direction: individuals complain of an inability to stay awake in the evening and spontaneous awakening in the early morning hours. \"Non-24-hour sleep-wake pattern\" denotes a free-running cycle: the sleep-wake schedule follows the endogenous circadian rhythm period of slightly over 24 hours despite the presence of 24-hour time cues in the environment. In contrast to the stable sleep-wake pattern of the Delayed or advanced sleep phase types, these individuals' sleep-wake schedules become progressively delayed relative to the 24-hour clock, resulting in a changing sleep-wake pattern and changing sleep-wake complaints over successive days (e.g., several days of sleep-onset insomnia followed by days of daytime sleepiness followed by days of difficulty staying awake in the evening). \"Irregular sleep-wake pattern\" indicates the absence of an identifiable pattern of sleep and wakefulness."]
[null,null,null,null,null,null,null,null,"Associated Features and Disorders"]
[null,"327.02 Insomnia Related to Another Mental Disorder; 327.15 Hypersomnia Related to Another Mental Disorder",null,null,null,null,null,null,"Associated descriptive features and mental disorders."]
[]
[null,"Other Sleep Disorders",null,null,null,null,null,null,"In Delayed Sleep Phase Type, individuals frequently go to bed later and wake up later on weekends or during vacations, with a reduction in sleep-onset difficulties and difficulty awakening. They will typically give many examples of school, work, and social difficulties arising from their difficulty awakening at socially desired times. If awakened earlier than the time dictated by the circadian timekeeping system, the individual may demonstrate \"sleep drunkenness\" (i.e., extreme difficulty awakening, confusion, and inappropriate behavior). Performance often also follows a delayed phase, with peak efficiency occurring in late-evening hours."]
[null,null,null,null,null,null,null,null,"Jet Lag Type may be more common in individuals who are \"morning larks.\" It is often accompanied by other symptoms such as impaired concentration and memory, impaired coordination, weakness, lightheadedness, headache, fatigue, malaise, decreased appetite, and indigestion. These symptoms may relate not only to circadian mismatch but also to other travel conditions such as sleep deprivation, alcohol and caffeine use, and decreased ambient air pressure in airplanes. Performance is often impaired, following the pattern that would be predicted by the underlying endogenous circadian rhythms. Shift Work Type may also be more common in individuals who are \"morning types.\" Concentration and attention, performance, and alertness are often impaired during desired waking hours, following the pattern that would be predicted by the underlying endogenous circadian rhythms. Reduced quality of life and dysfunction in occupational, family, and social roles are often observed in shift workers, particularly those who have sleep difficulties. Shift work is a risk factor for sleepiness-related work and motor vehicle accidents."]
[null,"327.xx Sleep Disorder Due to a General Medical Condition",null,null,null,null,null,null,"The non-24-hour sleep-wake pattern has been described primarily in blind individuals, particularly those with no light perception (e.g., from retrolental fibroplasia or surgical enucleation) as opposed to those with some degree of conscious light perception. Napping and regularly recurring insomnia occur when the individual's endogenous circadian rhythms (which are slightly longer than 24 hours) are out of phase with the light-dark cycle and socially appropriate sleep-wake hours."]
[null,null,null,null,null,null,null,null,"Individuals with any Circadian Rhythm Sleep Disorder may use increased amounts of alcohol, sedative-hypnotic, or stimulants in an attempt to control their inappropriately phased sleep-wake tendencies. The use of these substances may in turn exacerbate the Circadian Rhythm Sleep Disorder. Delayed Sleep Phase Type has been associated with schizoid, schizotypal, and avoidant personality features, particularly in adolescents, as well as with depressive symptoms and Depressive Disorders. \"Non-24-hour sleep-wake pattern\" and \"irregular sleep-wake pattern\" have also been associated with these same features. Jet Lag and Shift Work Types may precipitate or exacerbate a Manic or Major Depressive Episode or an episode of a Psychotic Disorder. Shift work is also associated with depressive symptoms."]
[null,"Substance-Induced Sleep Disorder",null,null,null,null,null,null,"Associated laboratory findings."]
[]
[null,"SEE ALSO on PsychiatryOnline:",null,null,null,null,null,null,"Sleep studies yield different results depending on what time they are performed. For individuals with Delayed Sleep Phase Type, studies conducted at the preferred sleep times will be essentially normal for age. However, when studied at socially normal sleep times, these individuals have prolonged sleep latency, reduced sleep efficiency (due mainly to sleep-onset difficulties), short sleep duration, and, in some individuals, moderately short REM sleep latency. Laboratory procedures designed to measure the phase of the endogenous circadian pacemaker (e.g., core body temperature, plasma melatonin levels) reveal the expected phase delay in the timing of acrophase (peak time) and nadir when individuals are studied during their usual sleep-wake times. In addition, awakening time may be delayed relative to other circadian rhythms."]
[null,"- circadian rhythm sleep disorder, unspecified type",null,null,null,null,null,null,"When studied during their habitual workweek sleep hours, individuals with Shift Work Type usually have normal or short sleep latency, reduced sleep duration, and more frequent sleep continuity disturbances compared with age-matched individuals with \"normal\" nocturnal sleep patterns. There may be a specific reduction in stage 2, stages 3 and 4, and REM sleep in many cases. Polysomnographic patterns in shift workers have been shown to remain stable over intervals of 2 years, suggesting neither adaptation nor worsening. Measures of physiological sleepiness, such as the Multiple Sleep Latency Test (MSLT), show a high degree of sleepiness during desired wake times (e.g., during the night shift). After a period of adjustment to a normal diurnal schedule, these individuals have normal nocturnal sleep and normal levels of daytime sleepiness. When studied on their usual shift-work schedules in their usual environment, shift workers demonstrate changes in the overt timing of their circadian rhythms relative to normal diurnal patterns. However, these changes seldom if ever result in a complete nocturnal orientation. Interventions such as bright light can shift endogenous circadian rhythms into phase with the night shift, but this does not necessarily improve subjective complaints or performance. Night shift work may be associated with increases in triglyceride or cholesterol levels."]
[null,"- delayed sleep phase syndrome",null,null,null,null,null,null,"Laboratory studies of simulated jet lag demonstrate prolonged sleep latency, impaired sleep efficiency, reductions in REM sleep, and minor reductions in slow-wave sleep. These features recover toward baseline values over 1–2 weeks and are more severe with simulated eastward travel (i.e., advanced sleep hours) than with simulated westward travel (i.e., delayed sleep hours). Other laboratory measures, including circadian rhythms of melatonin, core body temperature, alertness, and performance, also take several days or weeks to adjust following simulated jet lag. Non-24-hour sleep-wake pattern in blind individuals is often characterized by \"free-running\" circadian rhythms of core body temperature, melatonin secretion, and sleep propensity. In other words, these rhythms have a period of slightly longer than 24 hours, similar to those of sighted individuals deprived of all time cues in experimental settings. Individuals with \"advanced sleep phase pattern,\" as expected, show earlier timing of endogenous circadian rhythms, as well as a shortening of the endogenous circadian rhythm period."]
[null,"- jet lag syndrome",null,null,null,null,null,null,"Associated physical examination findings and general medical conditions."]
[null,"- shift-work sleep disorder"]
[null,"- sleep disorders",null,null,null,null,null,null,"No specific physical findings are described for Circadian Rhythm Sleep Disorder. Shift workers may appear haggard or sleepy and may have an excess of gastrointestinal disturbances, including gastritis and peptic ulcer disease. The roles of caffeine and alcohol consumption and altered eating patterns have not been fully evaluated in these cases. Shift work has been associated with risk factors for cardiovascular disease, such as hypertension, \"nondipping\" 24-hour blood pressure patterns, increased atherogenic lipids, and abnormal electrocardiographic measures (prolonged QTc interval). It may also be associated with a slightly increased risk for actual cardiovascular disease, although not all studies have found this. Non-24-hour sleep-wake pattern often occurs in blind individuals, particularly those with no light perception. Circadian Rhythm Sleep Disorder may exacerbate preexisting general medical conditions."]
[null,"- sleep disorders, circadian rhythm",null,null,null,null,null,null,"Specific Age Features"]
[null,"Related DSM-IV-TR Categories:",null,null,null,null,null,null,"The onset of Delayed Sleep Phase Type most often occurs between late childhood and early adulthood. Shift work and jet lag symptoms are often reported to be more severe, or more easily induced in laboratory settings, in late-middle-aged and elderly individuals compared with young adults. Older adults also have more severe polysomnographic sleep disturbances following simulated jet lag in the laboratory, but their circadian rhythms appear to adjust at the same rate as younger adults. \"Advanced sleep phase pattern\" also increases with age. These findings may result from age-related deterioration in nocturnal sleep and shortening of the endogenous circadian period."]
[null,null,null,null,null,null,null,null,"Prevalence"]
[null,"DSM-IV-TR:",null,null,null,null,null,null,"The prevalence for any of the types of Circadian Rhythm Sleep Disorder has not been well established. Prevalence figures for the Delayed Sleep Phase Type from population surveys have varied widely, ranging from 0.1% to 4% in adults and up to 7% in adolescents. Up to 60% of night shift workers may have Shift Work Type."]
[null,null,null,null,null,null,null,null,"Course"]
[null,"Sleep Disorders >  Diagnostic Features ",null,null,null,null,null,null,"Delayed Sleep Phase Type typically begins during adolescence and may follow a psychosocial stressor. Without intervention, Delayed Sleep Phase Type typically lasts for years or decades but may \"correct\" itself given the tendency for endogenous circadian rhythm phase to advance with age. Treatment can often normalize sleep hours at least temporarily, but there is a persistent vulnerability for delayed sleep hours and other symptoms."]
[null,null,null,null,null,null,null,null,"Shift Work Type typically persists for as long as the individual works that particular schedule. Reversal of symptoms generally occurs within 2 weeks of a return to a normal diurnal sleep-wake schedule."]
[null,"Sleep Disorders >  Subtypes ",null,null,null,null,null,null,"Experimental and field data concerning jet lag indicate that it takes approximately 1 day per time zone traveled for the circadian system to resynchronize itself to the new local time. Different circadian rhythms (such as core body temperature, hormonal level, alertness, and sleep patterns) may readjust at different rates."]
[null,null,null,null,null,null,null,null,"Familial Pattern"]
[null,"More...",null,null,null,null,null,null,"A family history may be present in up to 40% of individuals with Delayed Sleep Phase Type. A familial form of Advanced Sleep Phase Type, segregating as an autosomal dominant trait with high penetrance, has been identified."]
[null,null,null,null,null,null,null,null,"Differential Diagnosis"]
[null,"Sleep Disorders > Specific Age Features",null,null,null,null,null,null,"Circadian Rhythm Sleep Disorder must be distinguished from normal patterns of sleep and normal adjustments following a change in schedule. The key to such distinctions lies in the persistence of the disturbance and the presence and degree of social or occupational impairment. For instance, many adolescents and young adults maintain delayed sleep-wake schedules, but without distress or interference with school or work routines. Likewise, many individuals characterize themselves as either \"night owls\" or \"morning larks,\" because of their preference for either late or early sleep schedules. These tendencies in themselves do not warrant a diagnosis of Delayed Sleep Phase Type or \"advanced sleep phase pattern.\" A diagnosis would be made only in individuals who persistently experience clinically significant distress or impairment and who have difficulty changing their sleep-wake pattern. Similarly, almost anyone who travels across time zones will experience transient sleep disruption. The diagnosis of the Jet Lag Type should be reserved for individuals with associated severe sleep disturbances and work disruption."]
[null,null,null,null,null,null,null,null,"Delayed Sleep Phase Type must be differentiated from volitional patterns of delayed sleep hours. Some individuals who voluntarily delay sleep onset to participate in social or work activities may complain of difficulty awakening. When permitted to do so, these individuals fall asleep readily at earlier times and, after a period of recovery sleep, have no significant difficulty awakening in the morning. In such cases, the primary problem is sleep deprivation rather than a Circadian Rhythm Sleep Disorder. Other individuals (particularly children and adolescents) may volitionally shift sleep hours to avoid school or family demands. The pattern of difficulty awakening vanishes when desired activities are scheduled in the morning hours. In a similar way, younger children involved in limit-setting battles with parents may present as having Delayed Sleep Phase Type."]
[null,"Sleep Disorders > Prevalence",null,null,null,null,null,null,"Jet Lag and Shift Work Types must be distinguished mainly from other primary Sleep Disorders, such as Primary Insomnia and Primary Hypersomnia. The history of jet lag or shift work, with undisturbed sleep on other schedules, usually provides sufficient evidence to exclude these other disorders. In some cases, other primary Sleep Disorders, such as Breathing-Related Sleep Disorder or periodic limb movements disorder, may complicate Shift Work or Jet Lag Types. This possibility should be suspected when reversion to a normal diurnal schedule does not provide relief from sleep-related symptoms. Other types of Circadian Rhythm Sleep Disorder, such as \"non-24-hour sleep-wake pattern\" and \"irregular sleep-wake pattern,\" are distinguished from the Delayed Sleep Phase Type by the stable pattern of delayed sleep-wake hours characteristic of the latter."]
[null,null,null,null,null,null,null,null,"Patterns of delayed or advanced sleep that occur exclusively during another mental disorder are not diagnosed separately. For instance, an individual with Major Depressive Disorder may have delayed sleep hours similar to those in Delayed Sleep Phase Type, but if this sleep pattern occurs only during the Major Depressive Episode, an additional diagnosis of Circadian Rhythm Sleep Disorder would not be warranted. Likewise, an individual experiencing an acute exacerbation of Schizophrenia may have a very irregular sleep-wake pattern, but if this sleep pattern is only associated with the exacerbation, no additional diagnosis of Circadian Rhythm Sleep Disorder would be made."]
[null,"Sleep Disorders > Course",null,null,null,null,null,null,"Substances (including medications) can cause delayed sleep onset or awakening in the morning. For instance, consumption of caffeine or nicotine in the evening may delay sleep onset, and the use of hypnotic medications in the middle of the night may delay the time of awakening. A diagnosis of Substance-Induced Sleep Disorder may be considered if the sleep disturbance is judged to be a direct physiological consequence of regular substance use and warrants independent clinical attention (see Substance-Induced Sleep Disorder). General medical conditions rarely cause fixed delays or advances of the sleep-wake schedule and typically pose no difficulty in differential diagnosis."]
[null,null,null,null,null,null,null,null,"Relationship to the International Classification of Sleep Disorders"]
[null,"Sleep Disorders > Familial Pattern",null,null,null,null,null,null,"The International Classification of Sleep Disorders (ICSD) includes categories for Delayed Sleep Phase Syndrome, Shift Work Sleep Disorder and Time Zone Change (Jet Lag) Syndrome, and specific categories for three other Circadian Rhythm Sleep Disorders (Irregular Sleep-Wake Pattern, Advanced Sleep Phase Syndrome, and Non-24-Hour Sleep-Wake Syndrome)."]
[null,null,null,null,null,null,"Previous Section   |   Next Section"]
[null,"Sleep Disorders > Differential Diagnosis"]
[]
[null,"Sleep Disorders > Relationship to the International Classification of Sleep Disorders",null,null,null,"  Email a Link     Bookmark This     PDA Download     Print Section     Print Chapter "]
[]
[null,"Sleep Disorders > Diagnostic criteria for 327.xx Circadian Rhythm Sleep Disorder"]
[]
[null,"Sleep Disorders > Associated descriptive features and mental disorders."]
[]
[null,"Sleep Disorders > Associated laboratory findings."]
[]
[null,"Sleep Disorders > Associated physical examination findings and general medical conditions."]
[]
[]
[null,"DSM-IV-TR Cases:"]
[]
[null,"Mental Disorders in Adults > DSM-IV-TR Casebook Diagnosis of \"The Director\""]
[]
[null,"Mental Disorders in Adults > Follow-Up"]
[]
[null,"More..."]
[]
[null,"Mental Disorders in Adults > DSM-IV-TR Casebook Diagnosis of \"Evening Shift\""]
[]
[null,"Related Textbook Chapters:"]
[]
[]
[null,"Textbook of Psychiatry:"]
[]
[null,"Chapter 22. Sleep Disorders >  Circadian Rhythm Sleep Disorders "]
[]
[null,"Chapter 22. Sleep Disorders >  Assessment and Diagnosis "]
[]
[null,"More..."]
[]
[null,"Chapter 22. Sleep Disorders > Nonentrained Type"]
[]
[null,"Chapter 22. Sleep Disorders > Delayed Sleep Phase Disorder"]
[]
[null,"Chapter 22. Sleep Disorders > Definition and Description"]
[]
[null,"Chapter 22. Sleep Disorders > Epidemiology and Consequences"]
[]
[null,"Chapter 22. Sleep Disorders > Pathophysiology"]
[]
[null,"Chapter 22. Sleep Disorders > Treatment"]
[]
[null,"Chapter 22. Sleep Disorders > Shift Work Type (Shift Work Disorder)"]
[]
[null,"Chapter 22. Sleep Disorders > Definition and Description"]
[]
[null,"Chapter 22. Sleep Disorders > Epidemiology"]
[]
[null,"Chapter 22. Sleep Disorders > Pathophysiology"]
[]
[null,"Chapter 22. Sleep Disorders > Treatment"]
[]
[null,"Chapter 22. Sleep Disorders > Jet Lag Disorder"]
[]
[null,"Chapter 22. Sleep Disorders > Definition and Description"]
[]
[null,"Chapter 22. Sleep Disorders > Pathophysiology"]
[]
[null,"Chapter 22. Sleep Disorders > Treatment"]
[]
[]
[null,"Gabbard's Treatments of Psychiatric Disorders:"]
[]
[null,"Chapter 56. Sleep Disorders > Circadian Rhythm Sleep Disorder"]
[]
[null,"Chapter 56. Sleep Disorders > Delayed Sleep-Phase Type"]
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[null,"More..."]
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[null,"Chapter 56. Sleep Disorders > Jet Lag Type"]
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[null,"Chapter 56. Sleep Disorders > Shift Work Type"]
[]
[]
[null,"Textbook of Psychopharmacology:"]
[]
[null,"Chapter 60. Treatment of Insomnia > Step 4—Circadian Rhythm Disorders"]
[]
[null,"Chapter 60. Treatment of Insomnia > Shift Work– and Jet Lag–Related Insomnia"]
[]
[]
[null,"Dulcan's Textbook of Child and Adolescent Psychiatry:"]
[]
[null,"Chapter 29. Sleep Disorders > Circadian Rhythm Sleep Disorder"]
[]
[null,"Chapter 29. Sleep Disorders > TABLE 29–5. DSM-IV-TR diagnostic criteria for circadian rhythm sleep disorder"]
[]
[null,"More..."]
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[null,"Chapter 29. Sleep Disorders > Prevalence"]
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[null,"Chapter 29. Sleep Disorders > Clinical Characteristics"]
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[null,"Chapter 29. Sleep Disorders > Treatment"]
[]
[]
[null,"Textbook of Traumatic Brain Injury:"]
[]
[null,"Chapter 20. Sleep Disturbance and Fatigue > Sleep-Wake Cycle Disturbances"]
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[null,"Related Journal Articles:"]
[]
[]
[null,"American Journal of Psychiatry:"]
[]
[null,"2006 Jan;163(1):156-8 >  Prevalence of the night eating syndrome in a psychiatric population. "]
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[null,"2001 May;158(5):704-11 >  Sundowning and circadian rhythms in Alzheimer's disease. "]
[]
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[null,null,null,"DSM-IV-TR"]
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[]
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[null,"Copyright Â© American Psychiatric Association. All Rights Reserved."]
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[null,"Silverchair"]