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Table 1.1DSM-V PagesDSM-V Diagnostic CriteriaCodingFeeding and Eating Disorders1. Pica329-332A. Persistent eating of nonnutritive, nonfood substances over a period of at least one month.B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. C. The eating behavior is not part of a culturally supported or socially normative practice.D. If the eating behavior occurs in the context of another mental health disorder or medical condition, it is sufficiently severe to warrant additional clinical attention.(American Psychiatric Association, 2013, p.329).Children: 307.52 (F98.3)Adults: 307.52 (F50.8)Specify if:In remission: After full criteria for pica were previously met, the criteria have not been met for a sustained period of time.(American Psychiatric Association, 2013, p.139).2. Rumination Disorder332-333A. Repeated regurgitation of food over a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition.C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.D. If the symptoms occur in the context of another mental disorder or another neurodevelopmental disorder they are sufficiently severe to warrant additional clinical attention. (American Psychiatric Association, 2013, p.332).307.53 (F98.21)Specify if:In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time.(American Psychiatric Association, 2013, p.332).3. Avoidant/Restrictive Food Intake Disorder334-338A. An eating or feeding disturbance as manifested by the persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: 1. Significant weight loss (or failure toe achieve expected weight gain or faltering growth in children) 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning.B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced. D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention. (American Psychiatric Association, 2013, p.334).307.59 (F50.8)Specify if:In remission: After full criteria for avoidant/restrictive food intake disorder were previously met, the criteria have not been met for a sustained period of time.(American Psychiatric Association, 2013, p.334).4. Anorexia Nervosa338-345A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.(American Psychiatric Association, 2013, p.338-339).307.1Specify whether:(F50.01) Restricting Type:(F50.2) Binge-eating/purging type:Specify when:In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A has not been met for a sustained period, but either Criterion B or C is still being met.In remission: After full criteria for anorexia nervosa were previously met, the criteria have not been met for a sustained period of time.Specify current severity:Mild: BMI ≥ 17kg/m2Moderate: BMI 16-16.99kg/m2Severe: BMI 15-15.99kg/m2Extreme: BMI < 15kg/m2(American Psychiatric Association, 2013, p.339).5. Bulimia Nervosa345-350A. Recurrent episodes of binge eating. An episode of binge eating is characterized by the following: 1. Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode.B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.D. Self-evaluation is unduly influenced by body shape and weight.E. The disturbance does not occur exclusively during episodes of anorexia nervosa. (American Psychiatric Association, 2013, p.345).307.51 (F50.2)Specify when:In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.In remission: After full criteria for bulimia nervosa were previously met, the criteria have not been met for a sustained period of timeSpecify current severity:Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week.Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week.Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week.Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.(American Psychiatric Association, 2013, p.345).6. Binge-Eating Disorder350-353A. Recurrent episodes of binge eating. An episode of binge eating is characterized by the following: 1. Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode.B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward.C. Marked distress regarding binge eating is present.D. The binge eating occurs, on average, at least once a week for 3 months.E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior in bulimia nervosa and does not occur exclusively during the course of bulimia or anorexia nervosa.(American Psychiatric Association, 2013, p.350).307.51 (F50.8)Specify when:In partial remission: After full criteria for binge-eating disorder were previously met, binge-eating occurs at an average frequency of less than one episode per week for a sustained period of time.In remission: After full criteria for binge-eating disorder were previously met, the criteria have not been met for a sustained period of timeSpecify current severity:Mild: 1-3 binge-eating episodes per week.Moderate: 4-7 binge-eating episodes per week.Severe: 8-13 binge-eating episodes per week.Extreme: 14 or more binge-eating episodes per week.(American Psychiatric Association, 2013, p.350).7. Other Specified Feeding or Eating Disorder353-354This category applies to presentations in which symptoms characteristic of a feeding or eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. The other specified feeding or eating disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific feeding and eating disorder. (American Psychiatric Association, 2013, p.353).307.59 (F50.8)Code by recording “other specified feeding and eating disorder” followed by the specific reason. Examples: 1. Atypical anorexia nervosa: All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight loss is within or above the normal range. 2. Bulimia nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.(American Psychiatric Association, 2013, p.353-354).8. Unspecified Feeding or Eating Disorder354This category applies to presentations in which symptoms characteristic of a feeding or eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.The unspecified feeding or eating disorder category is used in situations in which the clinician chooses not to communicate the specific reason that the presentation does not meet the criteria for any specific feeding and eating disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room setting).(American Psychiatric Association, 2013, p.354).307.50 (F50.9)(American Psychiatric Association, 2013, p.354).Other Mental Disorders9. Other Specified Mental Disorder Due to Another Medical Condition707This category applies to presentations in which symptoms characteristic of a mental disorder due to another medical condition that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific mental disorder attributable to another medical condition.The other specified mental disorder due to another medical condition category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific mental disorder attributable to another medical condition.(American Psychiatric Association, 2013, p.707).294.8 (F06.8)Record the name of the disorder with the specific etiological medical condition inserted in place of “another medical condition,” followed by the specific symptomatic manifestation that does not meet the criteria for any specific mental disorder due to another medical condition. The diagnostic code for the specific medical condition must be listed immediately before the code for the other specified mental disorder due to another medical condition. i.e. dissociative symptoms due to complex partial seizures would be 345.40 (G40.209), complex seizures 294.8 (F06.8) other specified mental health disorder due to complex partial seizures, dissociative symptoms. (American Psychiatric Association, 2013, p.707).10. Unspecified Mental Health Disorder Due to Another Medical Condition708This category applies to presentations in which symptoms characteristic of a mental disorder due to another medical condition that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific mental disorder attributable to another medical condition.The unspecified mental disorder due to another medical condition category is used in situations in which the clinician chooses to not communicate the specific reason that the presentation does not meet the criteria for any specific mental disorder attributable to another medical condition, and includes presentation for which there is insufficient information to make a more specific diagnosis (e.g. emergency room setting). (American Psychiatric Association, 2013, p.708).294.9 (F09)Record the name of the disorder, with the specific etiological medical condition in place of “another medical condition.”The diagnostic code for the specific medical condition must be listed immediately before the code for the unspecified mental disorder due to another medical condition.i.e. dissociative symptoms due to complex partial seizures would be 345.40 (G40.209), complex partial seizures 294.8 (F06.9) unspecified mental disorder due to complex partial seizures. (American Psychiatric Association, 2013, p.708).11. Other Specified Mental Health Disorder708This category applies to presentations in which symptoms characteristic of a mental disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific mental disorder.The other specified mental health disorder is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific mental health disorder.(American Psychiatric Association, 2013, p.708).300.9 (F99)Record “other specified mental health disorder” followed by the specific reason.(American Psychiatric Association, 2013, p.708).12. Unspecified Mental Health Disorder708This category applies to presentations in which symptoms characteristic of a mental disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any specific mental disorder.The other specified mental health disorder is used in situations in which the clinician chooses not to communicate the specific reason that the presentation does not meet the criteria for any specific mental health disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g. emergency room).(American Psychiatric Association, 2013, p.708).300.9 (F99)(American Psychiatric Association, 2013, p.708).Medication-Induced Movement Disorders and Other Adverse Effects of Medication13. Neuroleptic-Induced Parkinsonism/Other Medication-Induced Parkinsonism709Parkinsonian tremor, muscular rigidity, akinesia (i.e. loss of movement or difficulty initiating movement), or bradykinesia (i.e. slowing movement) developing within a few weeks of starting or raising the dosage of a medication (e.g. neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms. (American Psychiatric Association, 2013, p.709).Neuroleptic-Induced Parkinsonism: 332.1 (G21.11)Other Medication-Induced Parkinsonism:322.1 (G21.19)(American Psychiatric Association, 2013, p.709).14. Neuroleptic Malignant Syndrome 709-711-Patients have generally been exposed to a dopamine antagonist within 72 hours prior to symptom development-Hyperthermia (>100.4°F on at least two occasions, measured orally), associated with profuse diaphoresis. Extreme elevations in temperature, reflecting a breakdown in central thermoregulation, are more likely to support the diagnosis.-Generalized rigidity (may be associated with neurological symptoms)-Creatine kinase elevation of at least 4x the upper limit of normal-Changes in mental status-Dazed or unresponsive/catatonic stupor-Tachycardia, diaphoresis, blood pressure elevation/fluctuation, urinary incontinence, pallor.-Tachypnea and respiratory distress. -It is essential to diagnose using a workup, including a laboratory investigation, to exclude other infectious, toxic, metabolic, and neuropsychiatric etiologies or complications.(American Psychiatric Association, 2013, p.710).333.92 (G21.0)(American Psychiatric Association, 2013, p.709).15. Medication-Induced Acute Dystonia711Abnormal and prolonged contraction of the muscles of the eyes (oculogyric crisis), head, neck (torticollis or retrocollis), limbs, or trunk developing within a few days of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.(American Psychiatric Association, 2013, p.711).333.72 (G24.02)(American Psychiatric Association, 2013, p.711).16. Medication-Induced Acute Akathisia711Subjective complaints of restlessness, often accompanied by observed excessive movements, developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.(American Psychiatric Association, 2013, p.711).333.00 (G25.71)(American Psychiatric Association, 2013, p.711).17. Tardive Dyskinesia/Neuroleptic Withdrawal-Emergent Dyskinesia712Involuntary athetoid or choreiform movements (lasting at least a few weeks) generally of the tongue, lower face and jaw, and extremities (but sometimes involving pharyngeal, diaphragmatic, or trunk muscles) developing in association with the use of a neuroleptic medication for at least a few months.Symptoms may develop after a shorter period of medication use in older persons. In some patients, movements of this type may appear after discontinuation, or after change or reduction in dosage, of neuroleptic medications, in which case the condition is called neuroleptic withdrawal-emergent dyskinesia. Because withdrawal-emergent dyskinesia is usually time limited, lasting less than 4-8 weeks, dyskinesia that persists beyond this window is considered to be tardive dyskinesia. (American Psychiatric Association, 2013, p.712).333.85 (G24.01)(American Psychiatric Association, 2013, p.712).18. Tardive Dystonia/ Tardive Akathisia712Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinuation or dosage reduction.(American Psychiatric Association, 2013, p.712).Tardive Dystonia: 333.72 (G24.09)Tardive Akathisia: 333.99 (G25.71)(American Psychiatric Association, 2013, p.712).19. Medication-Induced Postural Tremor712Fine tremor (usually in the range of 8-12Hz) occurring during attempts to maintain a posture and developing in association with the use of medication (e.g. lithium, antidepressants, valproate). This tremor is very similar to the tremor seen with anxiety, caffeine, and other stimulants. (American Psychiatric Association, 2013, p.712).333.1 (G25.1)(American Psychiatric Association, 2013, p.712).20. Other Medication-Induced Movement Disorder712This category is for medication-induced movement disorders not captured by any of the specific disorders listed above. Examples include 1) presentations resembling neuroleptic malignant syndrome that are associated with medications other than neuroleptics and 2) other medication-induced tardive conditions.(American Psychiatric Association, 2013, p.712).333.99 (G25.79)(American Psychiatric Association, 2013, p.712).21. Antidepressant Discontinuation Syndrome712-714-Abrupt cessation of an antidepressant medication that was taken continuously for at least 1 month. -Symptoms begin within 2-4 days and typically include specific sensory, somatic, and cognitive-emotional manifestations (flash of lights, nausea, “electric shock,” and hypersensitivity to noise and lights.-Symptoms are alleviated by restarting the same medication or a different medication with similar mechanisms of action.-Symptoms not present before the antidepressant drug was reduced and are not better explained by another mental disorder.(American Psychiatric Association, 2013, p.713).Initial Encounter: 995.29 (T43.205A)Subsequent Encounter:995.29 (T43.205D)Sequelae:995.29 (T43.205S)(American Psychiatric Association, 2013, p.712).22. Other Adverse Effect of Medication 714This category is available for optional use by clinicians to code side effects for medication (other than movement symptoms) when these adverse effects become a main focus of clinical attention, i.e. sever hypotension, cardiac arrhythmias, and priapism. (American Psychiatric Association, 2013, p.714).Initial Encounter: 995.20 (T50.905A)Subsequent Encounter:995.20 (T50.905D)Sequelae:995.20 (T50.905S)(American Psychiatric Association, 2013, p.714).Table 1.2MedicationsInterventionsTools and AssessmentsFeeding and Eating Disorders1. Pica -Nutritional supplements(Pica, n.d.)CHILDREN: Rates are highest among children. May outgrow pica behaviors.PREGNANT WOMEN: Sometimes display symptoms of Pica-Behavioral management: replacement behaviors, reinforcement, response interruption, redirection, and restrictive procedures.-Environmental Structuring: Decrease the availability of nonfood and dangerous items. Monitor the physical environment to remove all nonedible items that are commonly ingested.(Kress & Paylo, 2015, p.372-373)-Test iron and zinc levels-Blood tests for anemia-Check lead levels in children-Health care provider may choose to test client for infections depending on what they have been ingesting.-Eating Disorders Screening Tool(Pica, n.d.)(Screening Tool, n.d.)(Kress & Paylo, 2015, p.371)2. Rumination Disorder-Proton pump inhibitors: Protect the lining of the esophagus(Rumination Syndrome, n.d.)INFANTS & CHILDREN: Rates are highest.ADOLESCENTS/ADULTS: Possible, but may manifest differently.-Diaphragmatic Breathing and Distraction: Breathing/behavioral intervention used to increase relaxation and distract from desire to regurgitate.-Self-Monitoring/Monitoring: Charting regurgitating behaviors, symptoms, triggers, etc.-Aversive Techniques and Positive Reinforcement: Aversive techniques involve linking unwanted or unpleasant stimuli with regurgitation to prevent it from recurring. Positive reinforcement involves a tangible reward, such as social praise, with a desired activity to promote diminished symptoms.-Satiation: Allowing the person to continue to consume food, to eat starchy foods, or to eat more slowly in an attempt to replicate the desired physical sensations. Gum chewing, chewing a plastic ring, and oral stimulation have been helpful as well.-Family counseling: Use techniques that promote family relationships with guardians as well as parenting skills and strengthening family bonds. Promoting caregivers’ empathy and understanding of child’s emotions.(Kress & Paylo, 2015, p.374-375)-Medical tests to rule out other causes of regurgitation -Eating Disorders Screening Tool(Screening Tool, n.d.)(Kress & Paylo, 2015, p.373)3. Avoidant/Restrictive Food Intake Disorder (ARFID)-N/A-Contingency Management: Evaluating antecedents in order to target problem behaviors. Create a plan that reinforced optimal eating behaviors and prolonging time in front of food. Remove any form of escape from eating. -Shaping: Track successful attempts that come close to the desired behavior of eating and reinforce them by slowly introducing new eating habits.-Parent Training and Family Counseling: Provide parents with literature and information about AFRID. Help parents model behaviors, coach through healthy interactions with their children regarding food, and how to use positive/negative reinforcement related to food intake. (Kress & Paylo, 2015, p.376-377)-Medical tests to rule out other reasons for behaviors. -Eating Disorders Screening Tool(Screening Tool, n.d.)(Kress & Paylo, 2015, p.377)4. Anorexia Nervosa-Antidepressant Medications (SSRIs and TCAs)-Antipsychotic Medications (olanzapine is most promising)(Kress & Paylo, 2015, p.357-358)ADOLESCENCE: Typical onset age.-Family Based Treatments (FBT): FBT is an outpatient model that is intended to create adolescents who live with family. It views the parents as responsible for taking control of their child’s eating and activity behaviors until the child is able to do so for him or herself. This is considered the gold standard of treatments for anorexia nervosa. -Cognitive Behavioral Therapy (CBT): Focuses on cognitive, affective, and behavioral dynamics of the disorder. -Enhanced CBT for Eating Disorders (CBT-E): This CBT adaptation was designed to treat all eating disorders by pulling on a transdiagnostic framework to address core pathology across all eating disorders. It was designed for use with adults, but adaptations have been used with adolescents.-Pyschopharmacotherapy: Use of medications with treatment (combined with behavioral methods). (Kress & Paylo, 2015, p.354-358)-Medical examination to test for all health issues related to disorder.-Becks Depression Inventory-Eating Disorders Screening Tool-Suicide Assessment(Screening Tool, n.d.)(Kress & Paylo, 2015, p.357)5. Bulimia Nervosa-Antidepressant medications (tricyclics and SSRIs) (SSRI fluoxetine is the only FDA-approved medication for the treatment of bulimia nervosa).-Anticonvulsants, particularly topiramate, has been effective in short-term treatment in reducing the frequency of binges.(Kress & Paylo, 2015, p.365)- CBT: CBT and CBT-E have the strongest empirical evidence of bulimia nervosa treatment. They are used to pull on a transdiagnostic framework to address core pathology across all eating disorders.-Interpersonal Psychotherapy: ITP is used to help the client address current interpersonal issues that are perpetuating eating disorder symptoms.-Dialectical Behavioral Therapy: Often addresses the treatment of a client with both an ED and borderline personality disorder. Clients learn to replace maladaptive behaviors with skillful/adaptive ones. Mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance are increased. -Family Based Treatment Model: FBT is considered to be the current gold standard for bulimia nervosa treatment. Created for adolescents, but can be adopted to use with younger children. -Psychopharmacotherapy: Use of medications with treatment (combined with behavioral methods).(Kress & Paylo, 2015, p.360-365)-Medical examination to test for all health issues related to disorder.-Becks Depression Inventory-Eating Disorders Screening Tool-Suicide Assessment(Screening Tool, n.d.)(Kress & Paylo, 2015, p.359-360)6. Binge Eating Disorder-Antiepileptics, particularly topiramate and zonisamide, has been effective in short-term treatment in reducing the frequency of binges.-SSRIs can be useful in decreasing binges (recommended to be used in conjunction with other more effective meds)(Kress & Paylo, 2015, p.369)Cognitive Behavioral Therapy: Self Help (CBT-SH): This is a 6-step self-help plan that uses CBT techniques to address BED. It can be used with counselors, or simply as self-help for clients, who have BED.-Interpersonal Psychotherapy: ITP is used to help the client address current interpersonal issues that are perpetuating eating disorder symptoms.-Dialectical Behavior Therapy: This is often used for clients with bulimia nervosa, but is adapted to treat BED in a 20-session format. -Psychopharmacotherapy: Use of medications with treatment (combined with behavioral methods).(Kress & Paylo, 2015, p.367-369)-Medical examination to test for all health issues related to disorder.-Becks Depression Inventory-Eating Disorders Screening Tool-Suicide Assessment(Screening Tool, n.d.)(Kress & Paylo, 2015, p.366-367)7. Other Specified Feeding or Eating DisorderIt is most effective to follow the recommended treatments for the eating disorder that the OSFED is most similar to.(NEDC, 2017)It is most effective to follow the recommended treatments for the eating disorder that the OSFED is most similar to.(NEDC, 2017)-Eating Disorders Screening Tool(Screening Tool, n.d.)8. Unspecified Feeding or Eating DisorderIt is most effective to follow the recommended treatments for the eating disorder that the USFED is most similar to.(NEDC, 2017)It is most effective to follow the recommended treatments for the eating disorder that the USFED is most similar to.(NEDC, 2017)-Eating Disorders Screening Tool (Screening Tool, n.d.)Other Mental Disorders9. Other Specified Mental Disorder Due to Another Medical ConditionN/A: Depends on client’s presenting symptoms/concerns.I could not find information on the treatment of other specified mental disorder due to another medical condition. I think this is because the diagnosis varies so greatly.N/A: Depends on client’s presenting symptoms/concerns.10. Unspecified Mental Health Disorder Due to Another Medical ConditionN/A: Depends on client’s presenting symptoms/concerns.I could not find information on the treatment of unspecified mental disorder due to another medical condition. I think this is because the diagnosis varies so greatly.N/A: Depends on client’s presenting symptoms/concerns.11. Other/Unspecified Mental Health DisorderN/A: Depends on client’s presenting symptoms/concerns.I could not find information on the treatment of unspecified mental disorder due to another medical condition. I think this is because the diagnosis varies so greatly.N/A: Depends on client’s presenting symptoms/concerns.Medication-Induced Movement Disorders and Other Adverse Effects of Medication12. Neuroleptic-Induced Parkinsonism /Other Medication-Induced Parkinsonism-60% of people will recover within two months, and often within hours or days, of stopping the offending drug-Anticholinergic drugs (do not use with elderly)-Amantadine is used to treat Parkinson’s and can also be used to treat drug-induced parkinsonism when the client cannot stop taking the offending drug.(PDS, 2008)The most effective treatment is to stop the drug causing the parkinsonism. Sometime other drugs are considered if the dosage of the offending drug cannot be stopped or reduced. This may be due to a client’s presenting concerns needing the offending drug.(PDS, 2008)Consult physician to determine whether this is a side effect of a medication or a disease. Other tests can be done by a medical physician.13. Neuroleptic Malignant Syndrome -Stop the offending drug-Dantrolene and bromocriptine (limited supporting evidence)-Amantadine-Lorazepam(Neuroleptic Malignant Parkinsonism, 2016)The most effective treatment is to stop the neuroleptic drug(s) that are causing the NMS.NMS treatment is supportive and directed toward controlling symptoms.(Neuroleptic Malignant Parkinsonism, 2016)-Consult physician for tests and watch (monitor) client in ICU. -Test can be used to locate abnormalities, but not to diagnose.(Neuroleptic Malignant Parkinsonism, 2016)14. Medication-Induced Acute Dystonia-"Atypical" neuroleptics (such as clozapine, olanzapine, and quetiapine) may be a suitable substitute.(Drug-Induced Dystonia, n.d.)-Stop the offending medication.-Consider switching to a different drug (i.e. a class of newer, "atypical" neuroleptics (such as clozapine, olanzapine, and quetiapine) may be a suitable substitute.(Drug-Induced Dystonia, n.d.)-Consult physician for tests to rule out other issues. (Drug-Induced Dystonia, n.d.)15. Medication-Induced Acute Akathisia-Beta blockers (i.e. propranolol) are considered first-line in treatment-Low dose mirtazapine-Anticholinergics-Anticonvulsants-A-adrenergic agonists-D2 agonists(Forsen, 2015)-Discontinue or decrease the offending medication.-Add other medication to alleviate symptoms. (Forsen, 2015)-Consult physician for tests to rule out other issues. -Evaluation by a clinician familiar with medication-induced acute akathisia is recommended. -Barnes Akathisia Rating Scale-Suicide Assessment(Forsen, 2015)16. Tardive Dyskinesia/Neuroleptic Withdrawal-Emergent Dyskinesia-Eliminate offending drug.-There’s no FDA approved medicine to treat tardive dyskinesia, but a few drugs might ease the movements (amantadine, clonazepam, tetrabenzine)(Goldberg, 2015)-Discontinue or decrease dose of offending drug.-Switch to a drug that is less likely to cause TD(Goldberg, 2015)-Consult physician for tests to rule out other issues. -Abnormal Involuntary Movement Scale(Goldberg, 2015)17. Tardive Dystonia/ Tardive Akathisia-Clonazepam (Treating and Managing Tardive Symptoms, n.d.)-Stop offending medication.-Switch to a different drug. -Surgeries such as deep brain stimulation or ECT-Herbal therapy (ginkgo biloba) can help treat people who are also hospitalized with schizophrenia (not studied in other populations)(Treating and Managing Tardive Symptoms, n.d.)-Consult physician for tests to rule out other issues. 18. Medication-Induced Postural Tremor-Propranolol may be added to control tremors(NY Times, 2013)-Tremor will usually go away when medication is stopped.-Consider trying different dosage or different medication.(NY Times, 2013)-Consult physician for tests to rule out other issues. (NY Times, 2013)19. Other Medication-Induced Movement DisorderN/A: Depends on client’s presenting symptoms/concerns.I could not find information on the treatment of other medication-induced movement disorder. I think this is because the diagnosis varies so greatly.-Consult physician for tests to rule out other issues. 20. Antidepressant Discontinuation Syndrome-Continue medication.-Replace with other antidepressant.(AAFP, 2006)-Return to medication causing the ADS.-When stopping an antidepressant, slowly stop the medication by tapering.-The physician can provide reassurance to the patient that the condition is reversible, is not serious or life threatening, and will run its course within one to two weeks.?-Consider replacing with another drug.(AAFP, 2006)-Consult physician for tests to rule out other issues. 21. Other Adverse Effect of Medication N/A: Depends on client’s presenting symptoms/concerns.I could not find information on the treatment of other adverse effect of medication. I think this is because the diagnosis varies so greatly.-Consult physician for tests to rule out other issues. Table 1.3HandoutsCultural IssuesOther Issues1. PicaIt is important to teach someone with pica, or the parent/guardian of a child with pica, about pica itself as well as nutrition.(Kress & Paylo, 2015, p.371)-Eating dirt, clay, and non-food items is acceptable in some cultures. -Some have theorized that eating nonfood substances is due to nutritional deficiencies. (Kress & Paylo, 2015, p.371)-Can cause serious medical issues so regular communication with medical professionals and primary physicians will be important.-Pica is not yet considered to be well understood. Most research has been conducted in residential settings. -Often comorbid with other disorders.(Kress & Paylo, 2015, p.371)2. Rumination Disorder be correlated with poor child-parent relations.(Kress & Paylo, 2015, p.373)-Often misdiagnosed-Counselors should collaborate with medical professionals.-Counselor’s often working with infants’/children’s caregivers.(Kress & Paylo, 2015, p.373)3. Avoidant/Restrictive Food Intake Disorder (AFRID) with children who experience ARFID tend to report higher levels of stress.-Always assess how ARFID tendencies could be connected to client’s culture. (Kress & Paylo, 2015, p.376)-Symptoms of ARFID often go to PCP initially. -Consider working with an OT-Consider including parents in counseling.(Kress & Paylo, 2015, p.376)4. Anorexia Nervosa common in industrialized countries. -Counselors should be sensitive to the experience diverse populations may have in disclosing and managing anorexia. -Different cultures present weight concerns (and desired weights) differently. (Kress & Paylo, 2015, p.353)-Potentially life threatening-Must pay attention to broad medical, nutritional, and psychological aspects (thorough medical evaluation is key). -Must be aware of common co-occurring disorders (i.e. depression, anxiety, OCD).-Must be certain you, as a counselor, are qualified to help this client.-Consider client when prescribing medications, as side effects can be detrimental to condition.(Kress & Paylo, 2015, p.353, 357-358)5. Bulimia Nervosa women to 1-man ratio(Kress & Paylo, 2015, p.359)-A common misconception is that people must engage in purging behaviors to be diagnosed with BN.-Diagnosis sometimes missed in men.-Coordinate clients’ care with a physician. -Prone to impulsive behaviors.-Consider client when prescribing medications, as side effects can be detrimental to condition.(Kress & Paylo, 2015, p.359, 365)6. Binge Eating Disorder women to 1man ratio-Most common in industrialized countries.(Kress & Paylo, 2015, p.367)-Shame and guilt may cause those with BED to be reluctant in disclosing behaviors.-Consider side effects when prescribing medications, as side effects can be detrimental to condition (i.e. suicidal thoughts and birth defects in pregnant women… monitor for suicidality).(Kress & Paylo, 2015, p.367, 369)7. Other Specified Feeding or Eating Disorder is most effective to consider the impact culture has on the eating disorder that the OSFED is most similar to.(NEDC, 2017)It is most effective to consider the eating disorder that the OSFED is most similar to.(NEDC, 2017)8. Unspecified Feeding or Eating Disorder is most effective to consider the impact culture has on the eating disorder that the USFED is most similar to.(NEDC, 2017)It is most effective to consider the eating disorder that the USFED is most similar to.(NEDC, 2017)Other Mental Disorders9. Other Specified Mental Disorder Due to Another Medical ConditionI could not find any handouts on other specified mental disorder due to another medical condition.I could not find information about cultural impact on other specified mental disorder due to another medical condition. I think this is because the diagnosis varies so greatly.N/A10. Unspecified Mental Health Disorder Due to Another Medical ConditionI could not find any handouts on unspecified mental disorder due to another medical condition.I could not find information about cultural impact on unspecified mental disorder due to another medical condition. I think this is because the diagnosis varies so greatly.N/A11. Other/Unspecified Mental Health DisorderI could not find any handouts on other or unspecified mental health disorder.I could not find information about cultural impact on other/unspecified mental health disorder due because the diagnosis varies so greatly.N/AMedication-Induced Movement Disorders and Other Adverse Effects of Medication12. Neuroleptic-Induced Parkinsonism/Other Medication-Induced Parkinsonism could not find information about cultural impact on neuroleptic-induced parkinsonism/other medication-induced parkinsonism. -Always consider side effects of stopping (or lowering) offending medication AND the side effects when adding another medication (if offending med cannot be stopped at this time).-Never stop or reduce medication, despite side-effects, without physician’s approval.(PDS, 2008)13. Neuroleptic Malignant Syndrome could not find information about cultural impact on Neuroleptic Malignant Syndrome.-This can be life threatening.-ICU monitoring is recommended.-Never stop or reduce medication, despite side-effects, without physician’s approval.(Neuroleptic Malignant Syndrome, 2016)14. Medication-Induced Acute Dystonia could not find information about cultural impact on medication-induced dystonia.-Work with physician15. Medication-Induced Acute Akathisia could not find information about cultural impact on medication-induced akathisia.-Akathisia has been linked with an increased likelihood of suicidal ideation and behavior.-Never stop or reduce medication, despite side-effects, without physician’s approval.(Forsen, 2015)16. Tardive Dyskinesia/ Neuroleptic Withdrawal-Emergent Dyskinesia could not find information about cultural impact on tardive dyskinesia.(Goldberg, 2015)-Work with physician-Never stop or reduce medication, despite side-effects, without physician’s approval.17. Tardive Dystonia/ Tardive Akathisia could not find information about cultural impact on tardive dystonia/akathisia.(Treating and Managing Tardive Symptoms, n.d.)-Rule out other causes with physician-Never stop or reduce medication, despite side-effects, without physician’s approval.(Treating and Managing Tardive Symptoms, n.d.)18. Medication-Induced Postural Tremor could not find information about cultural impact on medication-induced induced postural tremor.-Rule out other causes with physician-Never stop or reduce medication, despite side-effects, without physician’s approval.(NY Times, 2013)19. Other Medication-Induced Movement DisorderI could not find any handouts on other medication-induced movement disorder.I could not find information about cultural impact on medication-induced induced movement disorder.N/A20. Antidepressant Discontinuation Syndrome, depending on cultural background, some clients may be more likely to stop an antidepressant without consulting their physician first. This should be evaluated.-Women may discontinue antidepressant use after discovering that they are pregnant.?(AAFP , 2006)- Patients may be tempted to discontinue their antidepressant medication after they begin to feel better(AAFP, 2006)21. Other Adverse Effect of Medication I could not find any handouts on other adverse effect of medication.I could not find information about cultural impact on other adverse effects of medication.N/AReferencesACA. (n.d.). Suicide Assessment. Retrieved from . (n.d.). Retrieved July 06, 2017, from Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.) Choose MyPlate. (n.d.). Retrieved July 06, 2017, from Induced Dystonia. (n.d.). Retrieved July 06, 2017, from , F., M.D. (2015, January 04). Akathisia: Is restlessness a primary condition or an adverse drug effect? Retrieved July 05, 2017, from , J., M.D. (2015). What Is Tardive Dyskinesia? Retrieved from of Handouts. (n.d.). Retrieved July 06, 2017, from , V. E., & Paylo, M. J. (2015).?Treating those with mental disorders: a comprehensive approach to case conceptualization and treatment. Boston: Pearson.NEDC. (n.d.). OSFED Fact Sheet. Retrieved from Malignant Syndrome. (2016, December 22). Retrieved July 05, 2017, from Times. (2013) Drug Induced Tremor. Retrieved July 06, 2017, from . (2008). Drug-induced Parkinsonism. Retrieved from . (n.d.). Retrieved July 03, 2017, from Syndrome. (n.d.). Retrieved July 05, 2017, from Tool. (n.d.). Retrieved July 04, 2017, from AND MANAGING TARDIVE SYNDROMES. (n.d.). Retrieved from , C. H., Bobo, W., Warner, C. M., Reid, S., & Rachal, J. (2006, August 01). Antidepressant Discontinuation Syndrome. Retrieved July 07, 2017, from is OSFED? (2017, February 22). Retrieved July 05, 2017, from ................
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