Mental Disorders Guide - Letra D

Delirium

Delirium is characterized by a disturbance of attention, orientation, and awareness that develops within a short period of time, typically presenting as significant confusion or global neurocognitive impairment, com transient symptoms that may fluctuate depending on the underlying causal condition or etiology. Delirium often includes disturbance of behaviour and emotion, and may include impairment in multiple cognitive domains. A disturbance of the sleep-wake cycle, including reduced arousal of acute onset or total sleep loss com reversal of the sleep-wake cycle, may also be present. Delirium may be caused by the direct physiological effects of a medical condition not classified under Transtornos mentais, comportamentais ou do neurodesenvolvimento, by the direct physiological effects of a substance or medication, including abstinência, or by multiple or unknown etiological factors.

Delirium due to disease classified elsewhere

All definitional requirements for Delirium are met. There is evidence from history, physical examination, or laboratory findings that Delirium is caused by the direct physiological consequences of a transtorno or disease classified elsewhere.

Delirium due to multiple etiological factors

All definitional requirements for Delirium are met. There is evidence from history, physical examination, or laboratory findings that the Delirium is attributable to multiple etiological factors, which may include transtornos or diseases not classified under mental and behavioural transtornos, substance intoxicação or abstinência, or a medication.

Delirium due to psychoactive substances including medications

All definitional requirements for Delirium are met. There is evidence from history, physical examination, or laboratory findings that the Delirium is caused by the direct physiological effects of a substance or medication (including abstinência). If the specific substance inducing the Delirium has been identified, it should be classified using the appropriate subcategory (e.g., alcohol-induced Delirium).

Delirium induced by multiple specified psychoactive substances including medications

Delirium induced by multiple specified psychoactive substances is characterised by an acute state of disturbed attention and awareness com specific features of Delirium that develops during or soon after substance intoxicação or abstinência or during the uso of multiple specified substances. The amount and duration of uso of the multiple specified substances must be capable of producing Delirium. The symptoms are not better explained by a primary mental transtorno, by uso of or abstinência from a substance other than those specified, or by another health condition that is not classified under Mental, behavioural and Transtornos do neurodesenvolvimento. Note that this diagnosis applies only to those situations in which Delirium is present but it cannot be determined which of multiple psychoactive substances is the cause of the Delirium. In cases of multiple psychoactive substance uso in which more than one specific substance can be identified as a cause of the Delirium, the corresponding specific substance-induced Delirium diagnoses should be given instead.

Delirium induced by other specified psychoactive substance including medications

Delirium induced by outro especificado psychoactive substance is characterised by an acute state of disturbed attention and awareness com specific features of Delirium that develops during or soon after substance intoxicação or abstinência or during the uso of a specified psychoactive substance. The amount and duration of uso of the specified substance must be capable of producing Delirium. The symptoms are not better explained by a primary mental transtorno, by uso of or abstinência from a different substance, or by another health condition that is not classified under Mental, behavioural and Transtornos do neurodesenvolvimento.

Delirium induced by unknown or unspecified psychoactive substance

Delirium induced by unknown or não especificado psychoactive substance is characterised by an acute state of disturbed attention and awareness com specific features of Delirium that develops during or soon after substance intoxicação or abstinência or during the uso of an unknown or não especificado substance. The symptoms are not better explained by a primary mental transtorno, by uso of or abstinência from another substance, or by another health condition that is not classified under Mental, behavioural and Transtornos do neurodesenvolvimento.

Dementia due to Alzheimer disease with early onset

Demência due to Alzheimer disease in which symptoms emerge before the age of 65 years. It is relatively rare, representing less than 5% of all cases, and may be genetically determined (autosomal dominant Alzheimer disease). Clinical presentation may be similar to cases com later onset, but progression of cognitive deficits may be more rapid.

Dementia due to Alzheimer disease with late onset

Demência due to Alzheimer disease that develops at the age of 65 years or above. This is the most common padrão, representing more than 95% of all cases.

Dementia due to cerebrovascular disease

Demência due to brain parenchyma injury resulting from cerebrovascular disease (ischemic or haemorrhagic). The onset of the cognitive deficits is temporally related to one or more vascular events. Cognitive decline is typically most prominent in speed of information processing, complex attention, and frontal-executive functioning. There is evidence of the presence of cerebrovascular disease considered to be sufficient to account for the neurocognitive deficits from history, physical examination and neuroimaging.

Dementia due to diseases classified elsewhere

Dementia due to Down syndrome

Demência due to Down syndrome is a neurodegenerative transtorno related to the impact of abnormal increased production and accumulation of amyloid precursor protein (APP) leading to formation of beta-amyloid plaques and tau tangles. APP gene expression is increased due to its location on chromosome 21, which is abnormally triplicated in Down syndrome. Cognitive deficits and neuropathological features are similar to those observed in Alzheimer disease. Onset is typically after the fourth decade of life com a gradual decline in functioning, and may impact 50% or more of individuals com Down syndrome.

Dementia due to exposure to heavy metals and other toxins

Demência due to exposure to heavy metals and other toxins caused by toxic exposure to specific heavy metals such as aluminium from dialysis water, lead, mercury or manganese. The characteristic cognitive impairments in Demência due to exposure to heavy metals and other toxins depend on the specific heavy metal or toxin that the individual has been exposed to but can affect any cognitive domain. Onset of symptoms is related to exposure and progression can be rapid especially com acute exposure. In many cases, symptoms are reversible when exposure is identified and ceases. Investigations such as brain imaging or neurophysiological testing may be abnormal. Lead poisoning is associated com abnormalities on brain imaging including widespread calcification and increased signal on MRI T2-weighted images of periventricular white matter, basal ganglia hypothalamus and pons. Demência due to aluminium toxicity may demonstrate characteristic paroxysmal high-voltage delta EEG changes. Examination may make evident other features such as peripheral neuropathy in the case of lead, arsenic, or mercury.

Dementia due to human immunodeficiency virus

Demência due to human immunodeficiency virus develops during the course of confirmed HIV disease, in the absence of a concurrent illness or condition other than HIV infection that could explain the clinical features. Although a variety of patterns of cognitive deficit are possible depending on where the HIV pathogenic processes have occurred, typically deficits follow a subcortical padrão com impairments in executive function, processing speed, attention, and learning new information. The course of Demência due to human immunodeficiency virus varies including resolution of symptoms, gradual decline in functioning, improvement, or fluctuation in symptoms. Rapid decline in cognitive functioning is rare com the advent of antiretroviral medications.

Dementia due to Huntington disease

Demência due to Huntington disease occurs as part of a widespread degeneration of the brain due to a trinucleotide repeat expansion in the HTT gene, which is transmitted through autosomal dominance. Onset of symptoms is insidious typically in the third and fourth decade of life com gradual and slow progression. Initial symptoms typically include impairments in executive functions com relative sparing of memory, prior to the onset of motor deficits (bradykinesia and chorea) characteristic of Huntington disease.

Dementia due to injury to the head

Demência due to injury to the head is caused by damage inflicted on the tissues of the brain as the direct or indirect result of an external force. Trauma to the brain is known to have resulted in loss of consciousness, amnesia, disorientation and confusion, or neurological signs. The symptoms characteristic of Demência due to injury to the head must arise immediately following the trauma or after the individual gains consciousness and must persist beyond the acute post-injury period. Cognitive deficits vary depending on the specific brain areas affected and the severity of the injury but can include impairments in attention, memory, executive functioning, personality, processing speed, social cognition, and language abilities.

Dementia due to Lewy body disease

Demência preceding or occurring within one year after the onset of motor parkinsonian signs in the setting of Lewy body disease. Characterized by presence of Lewy bodies, which are intraneuronal inclusions containing α-synuclein and ubiquitin in the brain stem, limbic area, forebrain, and neocortex. Onset is insidious com attentional and executive functioning deficits often present. These cognitive deficits are often accompanied by visual hallucinations and symptoms of REM sleep behaviour transtorno. Hallucinations in other sensory modalities, depressive symptoms, and delusions may also be present. The symptom presentation usually varies significantly over the course of days necessitating longitudinal assessment and differentiation from Delirium. Spontaneous onset of Parkinsonism within approximately 1 year of the onset of cognitive symptoms is common.

Dementia due to multiple sclerosis

Demência due to multiple sclerosis is a neurodegenerative disease due to the cerebral effects of multiple sclerosis, a demyelinating disease. Onset of symptoms is insidious and not secondary to the functional impairment attributable to the primary disease (i.e., multiple sclerosis). Cognitive impairments vary according to the location of demyelination but typically include deficits in processing speed, memory, attention, and aspects of executive functioning.

Dementia due to normal pressure hydrocephalus

Demência due to normal pressure hydrocephalus results from excess accumulation of cerebrospinal fluid in the brain as a result of idiopathic, non-obstructive causes but can also be secondary to haemorrhage, infection or inflammation. Progression is gradual but intervention (e.g., shunt) may result in improvement of symptoms, especially if administered earlier in the course of the condition. Typically, cognitive impairments include reduced processing speed and deficits in executive functioning and attention. These symptoms are also typically accompanied by gait abnormalities and urinary incontinence. Brain imaging to reveal ventricular volume and characterize brain displacement is often necessary to confirm the diagnosis.

Dementia due to Parkinson disease

Demência due to Parkinson disease develops among individuals com idiopathic Parkinson disease and is characterized by impairment in attention, memory, executive and visuo-spatial functions. Mental and behavioral symptoms such as changes in affect, apathy and hallucinations may also be present. Onset is insidious and the course is one of gradual worsening of symptoms.

Dementia due to pellagra

Demência due to pellagra is caused by persistent lack of vitamin B3 (niacin) or tryptophan either in the diet or due to poor absorption in the gastrointestinal tract due to disease (e.g., Crohn disease) or due to the effects of some medications (e.g., isoniazid). Core signs of pellagra include dermatological changes (sensitivity to sunlight, lesions, alopecia, and oedema) and diarrhoea. com prolonged nutritional deficiency cognitive symptoms that include aggressivity, motor disturbances (ataxia and restlessness), confusion, and weakness are observed. Treatment com nutritional supplementation (e.g., niacin) typically results in reversal of symptoms.

Dementia due to prion disease

Demência due to prion disease is a primary neurodegenerative disease caused by a group of spongiform encephalopathies resulting from abnormal prion protein accumulation in the brain. These can be sporadic, genetic (caused by mutations in the prion-protein gene), or transmissible (acquired from an infected individual). Onset is insidious and there is a rapid progression of symptoms and impairment characterised by cognitive deficits, ataxia, and motor symptoms (myoclonus, chorea, or dystonia). Diagnosis is typically made on the basis of brain imaging studies, presence of characteristic proteins in spinal fluid, EEG, or genetic testing.

Dementia due to psychoactive substances including medications

Demência due to psychoactive substances including medications includes forms of Demência that are judged to be a direct consequence of substance uso and that persist beyond the usual duration of action or abstinência syndrome associated com the substance. The amount and duration of substance uso must be sufficient to produce the cognitive impairment. The cognitive impairment is not better accounted for by a transtorno that is not induced by substances such as a Demência due to another medical condition.

Dementia due to use of alcohol

Demência due to uso of alcohol is characterised by the development of persistent cognitive impairments (e.g., memory problems, language impairment, and an inability to perform complex motor tasks) that meet the definitional requirements of Demência that are judged to be a direct consequence of alcohol uso and that persist beyond the usual duration of alcohol intoxicação or acute abstinência. The intensity and duration of alcohol uso must have been sufficient to produce the cognitive impairment. The cognitive impairment is not better accounted for by a transtorno or disease that is not induced by alcohol such as a Demência due to another transtorno or disease classified elsewhere.

Dementia due to use of sedatives, hypnotics or anxiolytics

Demência due to uso of sedatives, hypnotics or anxiolytics is characterised by the development of persistent cognitive impairments (e.g., memory problems, language impairment, and an inability to perform complex motor tasks) that meet the definitional requirements of Demência that are judged to be a direct consequence of sedative, hypnotic, or anxiolytic uso and that persist beyond the usual duration of action or abstinência syndrome associated com the substance. The amount and duration of sedative, hypnotic, or anxiolytic uso must be sufficient to produce the cognitive impairment. The cognitive impairment is not better accounted for by a transtorno that is not induced by sedatives, hypnotics, or anxiolytics such as a Demência due to another medical condition.

Dementia due to use of volatile inhalants

Demência due to uso of volatile inhalants is characterised by the development of persistent cognitive impairments (e.g., memory problems, language impairment, and an inability to perform complex motor tasks) that meet the definitional requirements of Demência that are judged to be a direct consequence of inhalant uso or exposure and that persist beyond the usual duration of action or abstinência syndrome associated com the substance. The amount and duration of inhalant uso or exposure must be sufficient to be capable of producing the cognitive impairment. The cognitive impairment is not better accounted for by a transtorno that is not induced by volatile inhalants such as a Demência due to another medical condition.

Dementia due to Alzheimer disease

Demência due to Alzheimer disease is the most common form of Demência. Onset is insidious com memory impairment typically reported as the initial presenting complaint. The characteristic course is a slow but steady decline from a previous level of cognitive functioning com impairment in additional cognitive domains (such as executive functions, attention, language, social cognition and judgment, psychomotor speed, visuoperceptual or visuospatial abilities) emerging com disease progression. Demência due to Alzheimer disease may be accompanied by mental and behavioural symptoms such as depressed mood and apathy in the initial stages of the disease and may be accompanied by psychotic symptoms, irritability, aggression, confusion, abnormalities of gait and mobility, and seizures at later stages. Positive genetic testing, family history and gradual cognitive decline are suggestive of Demência due to Alzheimer disease.

Depersonalization-derealization disorder

Depersonalization-derealization transtorno is characterised by persistent or recurrent experiences of depersonalization, derealization, or both. Depersonalization is characterised by experiencing the self as strange or unreal, or feeling detached from, or as though one were an outside observer of, one’s thoughts, feelings, sensations, body, or actions. Derealization is characterised by experiencing other persons, objects, or the world as strange or unreal (e.g., dreamlike, distant, foggy, lifeless, colourless, or visually distorted) or feeling detached from one’s surroundings. During experiences of depersonalization or derealization, reality testing remains intact. The experiences of depersonalization or derealization do not occur exclusively during another dissociative transtorno and are not better explained by another mental, behavioural or neurodevelopmental transtorno. The experiences of depersonalization or derealization are not due to the direct effects of a substance or medication on the central nervous system, including abstinência effects, and are not due to a disease of the nervous system or to head trauma. The symptoms result in significant distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.

Depressive mood symptoms in primary psychotic disorders

Depressive mood symptoms in primary psychotic transtornos refer to depressed mood as reported by the individual (feeling down, sad) or manifested as a sign (e.g. tearful, defeated appearance). If only non-mood symptoms of a depressive episódio are present (e.g., anhedonia, psychomotor slowing), this descriptor should not be used. This descriptor may be used whether or not depressive symptoms meet the diagnostic requirements of a separately diagnosed Depressive transtorno. The rating should be made based on the severity of depressive mood symptoms during the past week.

Detachment in personality disorder or personality difficulty

The core feature of the Detachment trait domain is the tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment). Common manifestations of Detachment, not all of which may be present in a given individual at a given time, include: social detachment (avoidance of social interactions, lack of friendships, and avoidance of intimacy); and emotional detachment (reserve, aloofness, and limited emotional expression and experience).

Developmental language disorder

Developmental language transtorno is characterised by persistent deficits in the acquisition, understanding, production or uso of language (spoken or signed), that arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. The individual’s ability to understand, produce or uso language is markedly below what would be expected given the individual’s age. The language deficits are not explained by another neurodevelopmental transtorno or a sensory impairment or neurological condition, including the effects of brain injury or infection.

Developmental language disorder with impairment of mainly expressive language

Developmental language transtorno com impairment of mainly expressive language is characterised by persistent difficulties in the acquisition, production, and uso of language that arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. The ability to produce and uso spoken or signed language (i.e., expressive language) is markedly below the expected level given the individual’s age and level of intellectual functioning, but the ability to understand spoken or signed language (i.e., receptive language) is relatively intact.

Developmental language disorder with impairment of mainly pragmatic language

Developmental language transtorno com impairment of mainly pragmatic language is characterised by persistent and marked difficulties com the understanding and uso of language in social contexts, for example making inferences, understanding verbal humour, and resolving ambiguous meaning. These difficulties arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. Pragmatic language abilities are markedly below the expected level given the individual’s age and level of intellectual functioning, but the other components of receptive and expressive language are relatively intact. This qualifier should not be used if the pragmatic language impairment is better explained by Transtorno do espectro autista or by impairments in other components of receptive or expressive language.

Developmental language disorder with impairment of receptive and expressive language

Developmental language transtorno com impairment of receptive and expressive language is characterised by persistent difficulties in the acquisition, understanding, production, and uso of language that arise during the developmental period, typically during early childhood, and cause significant limitations in the individual’s ability to communicate. The ability to understand spoken or signed language (i.e., receptive language) is markedly below the expected level given the individual’s age and level of intellectual functioning, and is accompanied by persistent impairment in the ability to produce and uso spoken or signed language (i.e., expressive language).

Developmental language disorder, with other specified language impairment

Developmental language transtorno com outro especificado language impairment is characterised by persistent difficulties in the acquisition, understanding, production or uso of language (spoken or signed), that arise during the developmental period and cause significant limitations in the individual’s ability to communicate. The padrão of specific deficits in language abilities is not adequately captured by any of the other developmental language transtorno categories.

Developmental speech fluency disorder

Developmental speech fluency transtorno is characterised by frequent or pervasive disruption of the normal rhythmic flow and rate of speech characterised by repetitions and prolongations in sounds, syllables, words, and phrases, as well as blocking and word avoidance or substitutions. The speech dysfluency is persistent over time. The onset of speech dysfluency occurs during the developmental period and speech fluency is markedly below what would be expected for age. Speech dysfluency results in significant impairment in social communication, personal, family, social, educational, occupational or other important areas of functioning. The speech dysfluency is not better accounted for by a transtorno of Intellectual Development, a Disease of the Nervous System, a sensory impairment, or a structural abnormality, or other speech or voice transtorno.

Developmental speech sound disorder

Developmental speech sound transtorno is characterised by difficulties in the acquisition, production and perception of speech that result in errors of pronunciation, either in number or types of speech errors made or the overall quality of speech production, that are outside the limits of normal variation expected for age and level of intellectual functioning and result in reduced intelligibility and significantly affect communication. The errors in pronunciation arise during the early developmental period and cannot be explained by social, cultural, and other environmental variations (e.g., regional dialects). The speech errors are not fully explained by a hearing impairment or a structural or neurological abnormality.

Disinhibited social engagement disorder

Disinhibited social engagement transtorno is characterised by grossly abnormal social behaviour, occurring in the context of a history of grossly inadequate child care (e.g., grave neglect, institutional deprivation). The child approaches adults indiscriminately, lacks reticence to approach, will go away com unfamiliar adults, and exhibits overly familiar behaviour towards strangers. Disinhibited social engagement transtorno can only be diagnosed in children, and features of the transtorno develop within the first 5 years of life. However, the transtorno cannot be diagnosed before the age of 1 year (or a developmental age of less than 9 months), when the capacity for selective attachments may not be fully developed, or in the context of Transtorno do espectro autista.

Disinhibition in dementia

In addition to the cognitive disturbances characteristic of Demência, the atual clinical picture includes clinically significant lack of restraint manifested in disregard for social conventions, impulsivity, and poor risk assessment.

Disinhibition in personality disorder or personality difficulty

The core feature of the Disinhibition trait domain is the tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), sem consideration of potential negative consequences. Common manifestations of Disinhibition, not all of which may be present in a given individual at a given time, include: impulsivity; distractibility; irresponsibility; recklessness; and lack of planning.

Dissociality in personality disorder or personality difficulty

The core feature of the Dissociality trait domain is disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality, not all of which may be present in a given individual at a given time, include: self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviours, concern com one's own needs, desires and comfort and not those of others); and lack of empathy (i.e., indifference to whether one’s actions inconvenience or hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others' suffering, and ruthlessness in obtaining one’s goals).

Dissociative drug dependence including ketamine or PCP

Dissociative drug dependência including ketamine or PCP is a transtorno of regulation of dissociative drug uso arising from repeated or continuous uso of dissociative drugs. The characteristic feature is a strong internal drive to uso dissociative drugs, which is manifested by impaired ability to control uso, increasing priority given to uso over other activities and persistence of uso despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to uso dissociative drugs. The features of dependência are usually evident over a period of at least 12 months but the diagnosis may be made if dissociative drugs uso is continuous (daily or almost daily) for at least 3 months.

Dissociative drug dependence including Ketamine or PCP, current use

Dissociative drug dependência including Ketamine and PCP, atual uso refers to uso of dissociative drugs within the past month.

Dissociative drug dependence including ketamine or PCP, early full remission

After a diagnosis of Dissociative drug dependência including ketamine and PCP, and often following a treatment episódio or other intervention (including self-help intervention), the individual has been abstinent from dissociative drugs during a period lasting between 1 and 12 months.

Dissociative drug dependence including Ketamine or PCP, sustained full remission

After a diagnosis of Dissociative drug dependência including Ketamine and PCP, and often following a treatment episódio or other intervention (including self-intervention), the person has been abstinent from dissociative drugs for 12 months or longer.

Dissociative drug dependence including Ketamine or PCP, sustained partial remission

After a diagnosis of Dissociative drug dependência including Ketamine and PCP, and often following a treatment episódio or other intervention (including self-help intervention), there is a significant reduction in dissociative drug consumption for more than 12 months, such that even though intermittent or continuing dissociative drug uso has occurred during this period, the definitional requirements for dependência have not been met.

Dissociative drug intoxication including Ketamine or PCP

Dissociative drug intoxicação including Ketamine and PCP is a clinically significant transient condition that develops during or shortly after the consumption of a dissociative drug that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of a dissociative drug and their intensity is closely related to the amount of the dissociative drug consumed. They are time-limited and abate as the dissociative drug is cleared from the body. Presenting features may include aggression, impulsiveness, unpredictability, anxiety, psychomotor agitation, impaired judgment, numbness or diminished responsiveness to pain, slurred speech, and dystonia. Physical signs include nystagmus (repetitive, uncontrolled eye movements), tachycardia, elevated blood pressure, numbness, ataxia, dysarthria, and muscle rigidity. In rare instances, uso of dissociative drugs including Ketamine and PCP can result in seizures.

Dissociative drug-induced anxiety disorder including Ketamine or PCP

Dissociative drug-induced anxiety transtorno including Ketamine or PCP is characterised by anxiety symptoms (e.g., apprehension or worry, fear, physiological symptoms of excessive autonomic arousal, avoidance behaviour) that develop during or soon after intoxicação com dissociative drugs. The intensity or duration of the symptoms is substantially in excess of anxiety symptoms that are characteristic of Dissociative drug intoxicação. The amount and duration of Dissociative drug uso must be capable of producing anxiety symptoms. The symptoms are not better explained by a primary mental transtorno (e.g., an Anxiety and Fear-Related transtorno, a Depressive transtorno com prominent anxiety symptoms), as might be the case if the anxiety symptoms preceded the onset of the dissociative drug uso, if the symptoms persist for a substantial period of time after cessation of the dissociative drug uso, or if there is other evidence of a pre-existing primary mental transtorno com anxiety symptoms (e.g., a history of prior episodes not associated com dissociative drug uso).

Dissociative drug-induced delirium including ketamine or PCP

Dissociative drug-induced Delirium including Ketamine or PCP is characterised by an acute state of disturbed attention and awareness com specific features of Delirium that develops during or soon after substance intoxicação or during the uso of dissociative drugs. The amount and duration of dissociative drug uso must be capable of producing Delirium. The symptoms are not better explained by a primary mental transtorno, by uso of or abstinência from a different substance, or by another health condition that is not classified under Mental, behavioural and Transtornos do neurodesenvolvimento.

Dissociative drug-induced mood disorder including Ketamine or PCP

Dissociative drug-induced mood transtorno including Ketamine or PCP is characterised by mood symptoms (e.g., depressed or elevated mood, decreased engagement in pleasurable activities, increased or decreased energy levels) that develop during or soon after intoxicação com dissociative drugs. The intensity or duration of the symptoms is substantially in excess of mood disturbances that are characteristic of Dissociative drug intoxicação. The amount and duration of Dissociative drug uso must be capable of producing mood symptoms. The symptoms are not better explained by a primary mental transtorno (e.g., a Depressive transtorno, a Bipolar transtorno, Transtorno esquizoafetivo), as might be the case if the mood symptoms preceded the onset of the dissociative drug uso, if the symptoms persist for a substantial period of time after cessation of the dissociative drug uso, or if there is other evidence of a pre-existing primary mental transtorno com mood symptoms (e.g., a history of prior episodes not associated com dissociative drug uso).

Dissociative drug-induced psychotic disorder including Ketamine or PCP

Dissociative drug-induced psychotic transtorno including Ketamine or PCP is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxicação com dissociative drugs. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of Dissociative drug intoxicação. The amount and duration of Dissociative drug uso must be capable of producing psychotic symptoms. The symptoms are not better explained by a primary mental transtorno (e.g., Esquizofrenia, a Mood transtorno com psychotic symptoms), as might be the case if the psychotic symptoms preceded the onset of the dissociative drug uso, if the symptoms persist for a substantial period of time after cessation of the dissociative drug uso, or if there is other evidence of a pre-existing primary mental transtorno com psychotic symptoms (e.g., a history of prior episodes not associated com dissociative drug uso).

Dissociative neurological symptom disorder

Dissociative neurological symptom transtorno is characterised by the presentation of motor, sensory, or cognitive symptoms that imply an involuntary discontinuity in the normal integration of motor, sensory, or cognitive functions and are not consistent com a recognised disease of the nervous system, other mental or behavioural transtorno, or other medical condition. The symptoms do not occur exclusively during another dissociative transtorno and are not due to the effects of a substance or medication on the central nervous system, including abstinência effects, or a Sleep-Wake transtorno.

Dissociative neurological symptom disorder, with auditory disturbance

Dissociative neurological symptom transtorno, com auditory disturbance is characterised by auditory symptoms such as loss of hearing or auditory hallucinations that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with chorea

Dissociative neurological symptom transtorno, com chorea is characterised by irregular, non-repetitive, brief, jerky, flowing movements that move randomly from one part of the body to another that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with cognitive symptoms

Dissociative neurological symptom transtorno, com cognitive symptoms is characterised by impaired cognitive performance in memory, language or other cognitive domains that is internally inconsistent and not consistent com a recognised disease of the nervous system, a neurodevelopmental or neurocognitive transtorno, other mental, behavioural or neurodevelopmental transtorno, or another medical condition and does not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with dystonia

Dissociative neurological symptom transtorno, com dystonia is characterised by sustained muscle contractions that frequently cause twisting and repetitive movements or abnormal postures that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with facial spasm

Dissociative neurological symptom transtorno, com facial spasm is characterised by involuntary muscle contractions or twitching of the face that is not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and does not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with gait disturbance

Dissociative neurological symptom transtorno, com gait disturbance is characterised by symptoms involving the individual’s ability or manner of walking, including ataxia and the inability to stand unaided, that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with movement disturbance

Dissociative neurological symptom transtorno, com movement disturbance is characterised by symptoms such as chorea, myoclonus, tremor, dystonia, facial spasm, parkinsonism, or dyskinesia that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with myoclonus

Dissociative neurological symptom transtorno, com myoclonus is characterised by sudden rapid jerks that may be focal, multifocal or generalised that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with non-epileptic seizures

Dissociative neurological symptom transtorno, com non-epileptic seizures is characterised by a symptomatic presentation of seizures or convulsions that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with other sensory disturbance

Dissociative neurological symptom transtorno, com other sensory disturbance is characterised by sensory symptoms not identified in other specific categories in this grouping such as numbness, tightness, tingling, burning, pain, or other symptoms related to touch, smell, taste, balance, proprioception, kinesthesia, or thermoception. The symptoms are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with paresis or weakness

Dissociative neurological symptom transtorno, com paresis or weakness is characterised by a difficulty or inability to intentionally move parts of the body or to coordinate movements that is not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and does not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with Parkinsonism

Dissociative neurological symptom transtorno, com Parkinsonism is characterised by a symptomatic presentation of a Parkinson-like syndrome in the absence of confirmed Parkinson disease that does not occur exclusively during another mental, behavioural or neurodevelopmental transtorno, other medical condition, or another dissociative transtorno. Dissociative neurological symptom transtorno, com Parkinsonism can be distinguished from Parkinson disease by features such as abrupt onset, early disability, bilateral shaking and slowness, nondecremental slowness when performing repetitive movements, voluntary resistance against passive movement sem cogwheel rigidity, distractability, ‘give-way’ weakness, stuttering speech, bizarre gait, and a variety of behavioural symptoms.

Dissociative neurological symptom disorder, with speech disturbance

Dissociative neurological symptom transtorno, com speech disturbance is characterised by symptoms such as difficulty com speaking (dysphonia), loss of the ability to speak (aphonia) or difficult or unclear articulation of speech (dysarthria) that are not consistent com a recognised disease of the nervous system, a neurodevelopmental or neurocognitive transtorno, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with tremor

Dissociative neurological symptom transtorno, com tremor is characterised by involuntary oscillation of a body part that is not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and does not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with vertigo or dizziness

Dissociative neurological symptom transtorno, com vertigo or dizziness is characterised by a sensation of spinning while stationary (vertigo) or dizziness that is not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and does not occur exclusively during another dissociative transtorno.

Dissociative neurological symptom disorder, with visual disturbance

Dissociative neurological symptom transtorno, com visual disturbance is characterised by visual symptoms such as blindness, tunnel vision, diplopia, visual distortions or hallucinations that are not consistent com a recognised disease of the nervous system, other mental, behavioural or neurodevelopmental transtorno, or other medical condition and do not occur exclusively during another dissociative transtorno.

Dysthymic disorder

Distimia is characterised by a persistent depressive mood (i.e., lasting 2 years or more), for most of the day, for more days than not. In children and adolescents depressed mood can manifest as pervasive irritability. The depressed mood is accompanied by additional symptoms such as markedly diminished interest or pleasure in activities, reduced concentration and attention or indecisiveness, low self-worth or excessive or inappropriate guilt, hopelessness about the future, disturbed sleep or increased sleep, diminished or increased appetite, or low energy or fatigue. During the first 2 years of the transtorno, there has never been a 2-week period during which the number and duration of symptoms were sufficient to meet the diagnostic requirements for a Depressive episódio. There is no history of Manic, Mixed, or Hypomanic Episodes.

Diurnal enuresis

Diurnal enuresis refers to repeated voiding of urine into clothes that occurs only during waking hours in an individual who has reached a developmental age when urinary continence is ordinarily expected (5 years). The urinary incontinence may have been present from birth (i.e., an atypical extension of normal infantile incontinence), or may have arisen following a period of acquired bladder control. In most cases, the behaviour is involuntary but in some cases it appears intentional.