module f anxiety disorders

7/28/2019 Module F Anxiety Disorders

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SCID-I (for DSM-IV-TR) Panic (JAN 2010) Anxiety Disorders F. 3

?=inadequate information 1=absent or false 2=subthreshold 3=threshold or true

did you have tingling or numbness inparts of your body?

(12) paresthesias (numbness ortingling sensations)

? 1 2 3 F15

did you have flushes (hot flashes) orchills?

(13) chills or hot flushes ? 1 2 3 F16

AT LEAST FOUR ITEMS CODED 3

AND REACHED PEAK WITHIN 10MINUTES (item F3)

1 3 F17

Just before you began having panicattacks, were you taking any drugs,caffeine, diet pills, or other medicines?

(How much coffee, tea, or caffeinatedsoda do you drink a day?)

Just before the attacks, were youphysically ill?

IF YES: What did the doctorsay?

C. Not due to the direct physiologicaleffects of a substance (e.g., a drug ofabuse, medication) or to a generalmedical condition.

Etiological general medical conditionsinclude: hyperthyroidism,hyperparathyroidism, pheochromocy-toma, vestibular dysfunctions, seizuredisorders, and cardiac conditions (e.g.,arrhythmias, supraventriculartachycardia).

Etiological substances include:intoxication with central nervousstimulants (e.g., cocaine, amphetamines,

caffeine) or cannabis or withdrawal fromcentral nervous system depressants(e.g., alcohol, barbiturates) or fromcocaine.

? 1 3 F18

D. The panic attacks are not betteraccounted for by another mentaldisorder, such as Social Phobia (e.g.,occurring on exposure to feared socialsituations), Specific Phobia, Obsessive-Compulsive Disorder (e.g., on exposureto dirt in someone with an obsessionabout contamination), Posttraumatic

Stress Disorder, or Separation AnxietyDisorder.

A, B, C, AND D CODED 3.

? 1 3

? 1 3

F19

F19a

GO TO *AWOPD* F. 7

DUE TOSUBSTANCEUSE OR GMC

GO TO*AWOPD*F. 7

IF THERE IS ANY INDICATION THATPANIC ATTACKS MAY BESECONDARY (I.E., A DIRECTPHYSIOLOGICAL CONSEQUENCE OF

A GMC OR SUBSTANCE, GO TO*GMC / SUBSTANCE,* F. 36, AND

RETURN HERE TO MAKE A RATINGOF 1 OR 3.

PRIMARYANXIETYDISORDER

CONTINUE

GO TO*AWOPD*F. 7

GO TO*AWOPD*F. 7

PANICDISORDER


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(3) the anxiety or phobic avoidance isnot better accounted for by anothermental disorder, such as SocialPhobia (e.g., avoidance limited tosocial situations because of fear ofembarrassment), Specific Phobia(e.g., avoidance limited to a singlesituation like elevators), Obsessive-Compulsive Disorder (e.g., avoidanceof dirt in someone with an obsessionabout contamination), PosttraumaticStress Disorder (e.g., avoidance ofstimuli associated with a severestressor), or Separation AnxietyDisorder (e.g., avoidance of leavinghome or relatives)

NOTE: CONSIDER SPECIFICPHOBIA IF FEAR IS LIMITED TO

ONE OR ONLY A FEW SPECIFICSITUATIONS OR SOCIAL PHOBIAIF FEAR IS LIMITED TO SOCIALSITUATIONS

? 1 3 F22

B(1), B(2), B(3) ALL CODED 3. 1 3 F23

PANICDISORDERWITHOUT

AGORA-PHOBIA

GO TO*CHRON-OLOGY*F. 6

PANICDISORDERWITHOUT

AGORA-PHOBIA

PANICDISORDERWITH

AGORA-PHOBIA


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*PANIC DISORDER CHRONOLOGY*

IF UNCLEAR: During the past monthhow many panic attacks have you had?

Has met symptomatic criteria forPanic Disorder during the pastmonth, i.e., recurrent unexpectedpanic attacks or agoraphobicavoidance

? 1 3 F24

F25

F26

F27

*AGE AT ONSET*

IF UNKNOWN: How old were youwhen you first started having panic

attacks?

Age at onset of Panic Disorder(CODE 99 IF UNKNOWN).

____ ____F28

IF CURRENT CRITERIA NOT FULLY MET (OR NOT AT ALL):4 - In Partial Remission: The full criteria for the disorder were previously met but currently

only some of the symptoms or signs of the disorder remain.5 - In Full Remission: There are no longer any symptoms or signs of the disorder, but it

Is still clinically relevant to note the disorder--for example, in an individual with previousepisodes of Panic Disorder who has been symptom free on antidepressants for the past3 years.

6 - Prior History: There is a history of the criteria having been met for the disorder but theindividual is considered to have recovered from it.

When did you last have (ANY SXSOF PANIC DISORDER)?

Number of months prior to ____ ____ ____interview when last had asymptom of Panic Disorder

INDICATE CURRENT SEVERITY:1 - Mild: Few, if any, symptoms in excess of those required to make the diagnosis are

present, and symptoms result in no more than minor impairment in social oroccupational functioning.

2 - Moderate: Symptoms or functional impairment between mild and severe arepresent.

3 - Severe: Many symptoms in excess of those required to make the diagnosis, orseveral symptoms that are particularly severe, are present, or the symptoms resultin marked impairment in social or occupational functioning.

CONTINUE WITH *AGE AT ONSET*, BELOW.

GO TO *SOCIALPHOBIA* F. 11


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SCID-I (for DSM-IV-TR) AWOPD (JAN 2010) Anxiety Disorders F. 8


Do you avoid these situations?

IF NO: When you are in one ofthese situations, do you feel veryuncomfortable or like you might havea panic attack?

(Can you go into one of these situationsonly if you are with someone youknow?)

(2) agoraphobic situations areavoided (e.g., travel is restricted), orelse endured with marked distress orwith anxiety about having panic-likesymptoms, or require the presenceof a companion

? 1 2 3 F37

(3) the anxiety or phobic avoidance isnot better accounted for by anothermental disorder, such as SocialPhobia (e.g., avoidance limited tosocial situations because of fear ofembarrassment), Specific Phobia(e.g., avoidance limited to singlesituations like elevators), Obsessive-Compulsive Disorder (e.g., avoidance

of dirt in someone with an obsessionabout contamination), PosttraumaticStress Disorder (e.g., avoidance ofstimuli associated with a severestressor), Separation AnxietyDisorder (e.g., avoidance of leavinghome or relatives)

NOTE: CONSIDER SPECIFICPHOBIA IF FEAR IS LIMITED TOONE OR ONLY A FEW SPECIFICSITUATIONS, OR SOCIAL PHOBIA

IF FEAR IS LIMITED TO SOCIALSITUATIONS.

? 1 3 F38

A(1), A(2), A(3) ALL CODED 3. 1 3 F39

GO TO*SOCIALPHOBIA*F. 11




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Just before you began having thesefears, were you taking any drugs,caffeine, diet pills, or other medicines?

(How much coffee, tea, or caffeinatedsoda do you drink a day?)

Just before the fears began, were youphysically ill?


C. Not due to the direct physiologicaleffects of a substance (e.g., a drug ofabuse, medication) or to a generalmedical condition.

? 1 3 F40

Etiological general medical condi-tions include hyper- and hypo-thyroidism, hypoglycemia, hyper-parathyroidism, pheochromocytoma,congestive heart failure, arrhythmias,pulmonary embolism, chronicobstructive pulmonary disease,pneumania, hyperventilation, B-12deficiency, porphyria, CNSneoplasms, vestibular dysfunction,encephalitis.

Etiological substances includeintoxication with central nervousstimulants (e.g., cocaine,amphetamines, caffeine) or cannabis,hallucinogens, PCP, or alcohol, orwithdrawal from central nervoussystem depressants (e.g., alcohol,sedatives, hypnotics) or fromcocaine.

D. If an associated generalmedical condition is present, thefear described in criterion A is clearlyin excess of that usually associatedwith the condition.

1 3 F41


GO TO

*SOCIALPHOBIA* F. 11


CONTINUE


AWOPD

IF THERE IS ANY INDICATIONTHAT THE ANXIETY MAY BE

SECONDARY (I.E., A DIRECTPHYSIOLOGICAL CONSE-QUENCE OF A GMC OR SUB-STANCE, GO TO *GMC/SUBSTANCE,* F. 36, ANDRETURN HERE TO MAKE ARATING OF 1 OR 3.


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*AGORAPHOBIA WITHOUT PANIC CHRONOLOGY*

IF UNCLEAR: During the past month,have you avoided (PHOBICSITUATIONS)?

Has met criteria for Agoraphobiawithout History of Panic Disorderduring past month

? 1 3 F42

F43

F44

F45

*AGE AT ONSET*

IF UNKNOWN: How old were youwhen you first started having (SXSOF AGORAPHOBIA)?

Age at onset of Agoraphobia WithoutPanic Disorder (CODE 99 IFUNKNOWN)

____ ____ F46

INDICATE CURRENT SEVERITY:1 - Mild: Few, if any, symptoms in excess of those required to make the diagnosis

are present, and symptoms result in no more than minor impairments in social oroccupational functioning.



CONTINUE WITH *AGE AT ONSET* BELOW.

IF CURRENT CRITERIA NOT FULLY MET (OR NOT AT ALL):4 - In Partial Remission: The full criteria for the disorder were previously met, but currently only

some of the symptoms or signs of the disorder remain.5 - In Full Remission: There are no longer any symptoms or signs of the disorder, but it is still

clinically relevant to note the disorder--for example, in an individual with previous episodes ofAWOPD who has been symptom free on an antianxiety agent for the past 3 years.

6 - Prior History: There is a history of the criteria having been met for the disorder, but theindividual is considered to have recovered from it.

When did you last have (ANY SXOF AGORAPHOBIA)?

Number of months prior ____ ____ ____to interview when last hada symptom of AgoraphobiaWithout Panic Disorder


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SCID-I (for DSM-IV-TR) Social Phobia (JAN 2010) Anxiety Disorders F. 13


Just before you began having thesefears, were you taking any drugs,caffeine, diet pills, or other medicines?

(How much coffee, tea, or caffeinatedsoda did you drink a day?)

Just before the fears began, were youphysically ill?


G. The fear or avoidance is not dueto the direct physiological effects of asubstance (e.g., a drug of abuse, amedication) or a general medicalcondition.

Etiological general medical condi-tions include: hyper- and hypo-thyroidism, hypoglycemia, hyper-

parathyroidism, pheochromocytoma,congestive heart failure, arrhythmias,pulmonary embolism, chronicobstructive pulmonary disease,pneumonia, hyperventilation, B-12deficiency, porphyria, CNSneoplasms, vestibular dysfunction,encephalitis.

Etiological substances include:intoxication with central nervousstimulants (e.g., cocaine, ampheta-

mines, caffeine) or cannabis, hallu-cinogens, PCP, or alcohol, orwithdrawal from central nervoussystem depressants (e.g., alcohol,sedatives, hypnotics) or fromcocaine.

? 1 3 F58

and is not better accounted for byanother mental disorder (e.g., PanicDisorder Without Agoraphobia,Separation Anxiety Disorder, BodyDysmorphic Disorder, a Pervasive

Developmental Disorder, or SchizoidPersonality Disorder).

? 1 2 3 F59


GO TO

*SPECIFICPHOBIA* F. 16


CONTINUE

GO TO*SPECIFICPHOBIA*

F. 16

IF THERE IS ANY INDICATIONTHAT THE ANXIETY MAY BESECONDARY (I.E., A DIRECTPHYSIOLOGICAL CONSE-QUENCE OF THE GMC ORSUBSTANCE, GO TO *GMC/SUBSTANCE,* F. 36, ANDRETURN HERE TO MAKE ARATING OF 1 OR 3.


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SCID-I (for DSM-IV-TR) Specific Phobia (JAN 2010) Anxiety Disorders F. 18


IF NOT ALREADY CLEAR:RETURN TO THIS ITEM AFTERCOMPLETING SECTION ON PTSD

AND OBSESSIVE-COMPULSIVEDISORDER.

G. The anxiety, panic attacks, orphobic avoidance associated with thespecific object or situation are notbetter accounted for by anothermental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirtin someone with an obsession aboutcontamination), Posttraumatic StressDisorder (e.g. avoidance of stimuliassociated with a severe stressor),Separation Anxiety Disorder( e. g., avoidance of school), SocialPhobia (e.g., avoidance of socialsituations because of fear ofembarrassment), Panic DisorderWith Agoraphobia, or AgoraphobiaWithout History of Panic Disorder.

? 1 3 F73

SPECIFIC PHOBIA CRITERIA A, B,C, D, E, F, AND G ARE CODED 3.

1 3 F74

INDICATE TYPE:(Check all that apply)

___ An imal type (includes insects)

___ Natural Environment Type (includesstorms, heights, water)

___ Blood-Injection-Injury Type (includes

seeing blood or injury, receiving aninjection or other invasive procedure)

___ Situational Type (includes publictransportation, tunnels, bridges, elevators,flying, driving, or enclosed places)

___ Other Type (e.g., fear of situations thatmight lead to choking, vomiting, orcontracting an illness; in children,avoidance of loud sounds or costumedcharacters) Specify:_________________

F75

F76

F77

F78

F79

GO TO*OBSESSIVECOMPULSIVEDISORDER*F. 20

GO TO *OBSESSIVECOMPULSIVEDISORDER* F. 20

SPECIFICPHOBIA


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SCID-I (for DSM-IV-TR) Specific Phobia (JAN 2010) Anxiety Disorders F. 19


*SPECIFIC PHOBIA CHRONOLOGY*

IF UNCLEAR: During the past month,have you been bothered by (SPECIFICPHOBIA)?

Has met criteria for Specific Phobiaduring past month

? 1 3 F80

F81

F82

F83

*AGE AT ONSET*

IF UNKNOWN: How old were youwhen you first started having (SXSOF SPECIFIC PHOBIA)?

Age at onset of Specific Phobia(CODE 99 IF UNKNOWN).

____ ____ F84

INDICATE CURRENT SEVERITY:1 - Mild: Few, if any, symptoms in excess of those required to make the diagnosis

are present, and symptoms result in no more than minor impairments in social oroccupational functioning.



CONTINUE WITH *AGE AT ONSET,* BELOW.

IF CURRENT CRITERIA NOT FULLY MET (OR NOT AT ALL):4 - In Partial Remission: The full criteria for the disorder were previously met, but currently only

some of the symptoms or signs of the disorder remain.5 - In Full Remission: There are no longer any symptoms or signs of the disorder, but it is still

clinically relevant to note the disorder--for example, in an individual with previous episodes ofSpecific Phobia who has been symptom free on an antianxiety agent for the past 3 years.

6 - Prior History: There is a history of the criteria having been met for the disorder, but theindividual is considered to have recovered from it.

When did you last have(ANY SX OF SPECIFIC PHOBIA)?

Number of months prior to ____ ____ ____interview when last had asymptom of Specific Phobia

GO TO *OBSESSIVECOMPULSIVE

DISORDER* F. 20


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SCID-I (for DSM-IV-TR) Obsessive-Compulsive (JAN 2010) Anxiety Disorders F. 22


*CHECK FOR OBSESSIONS / COMPULSIONS*

IF: EITHER OBSESSIONS, COMPULSIONS, OR BOTH, CONTINUE BELOW.

IF: NEITHER OBSESSIONS NOR COMPULSIONS, CHECK HERE ___ AND GO TO*POSTTRAUMATIC STRESS DISORDER,* F 25. F91

Have you (thought about [OBSESSIVETHOUGHTS]/done [COMPULSIVE

ACTS]) more than you should have (orthan made sense)?

IF NO: How about when you firststarted having this problem?

B. At some point during the courseof the disorder, the person hasrecognized that the obsessions orcompulsions are excessive orunreasonable. Note: this does notapply to children.

Check here ___ ifWith Poor Insight:i.e., for most of the time during thecurrent episode, the person does notrecognize that the obsessions andcompulsions are excessive or

unreasonable.

? 1 2 3 F92

F93

What effect did this (OBSESSION ORCOMPULSION) have on your life? (Did[OBSESSION OR COMPULSION]bother you a lot?)

(How much time do you spend[OBSESSION OR COMPULSION])?

C. The obsessions or compulsionscause marked distress, are time-consuming (take more than an hour aday), or significantly interfere with thepersons normal routine, occupationalfunctioning, or usual social activitiesor relationships.

? 1 2 3 F94

IF NOT ALREADY CLEAR: RETURNTO THIS ITEM AFTER COMPLETING

INTERVIEW

D. If another Axis I disorder ispresent, the content of the

obsessions or compulsions is notrestricted to it (e.g., preoccupationwith food in the presence of an EatingDisorder; hair pulling in the presenceof Trichotillomania; concern withappearance in the presence of BodyDysmorphic Disorder; preoccupationwith drugs in the presence of aSubstance Use Disorder;preoccupation with having aserious illness in the presence ofHypochondriasis; preoccupation

with sexual urges or fantasies inthe presence of a Paraphilia, orguilty ruminations in the presenceof Major Depressive Disorder).

? 1 3 F95

GO TO*PTSD*F. 25

GO TO*PTSD*F. 25

GO TO*PTSD*F. 25


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SCID-I (for DSM-IV-TR) Generalized Anxiety Disorder (JAN 2010) Anxiety Disorders F. 31


*GENERALIZED ANXIETY DISORDER*(CURRENT ONLY)

GENERALIZED ANXIETYDISORDER CRITERIA F134a

IF: IN RESIDUAL PHASE OF SCHIZOPHRENIA,

CHECK HERE ___ AND GO TO *ANXIETY DISORDER NOS,* F. 40

IF SCREENING QUESTION #10 ANSWERED NO, SKIP TO*ANXIETY DISORDER NOS,* F. 40

IF QUESTION #10 ANSWERED YES:Youve said that in the last 6 monthsyouve been particularly nervous or anxious . . .

IF SCREENER NOT USED: In the last 6 months,have you been particularly nervous or anxious?

F134b

Do you also worry a lot about badthings that might happen?

IF YES: What do you worryabout? (How much do you worryabout [EVENTS OR

ACTIVITIES]?)

During the last 6 months, wouldyou say that you have beenworrying more days than not?

A. Excessive anxiety and worry(apprehensive expectation), occurringmore days than not for at least 6

months, about a number of events oractivities (such as work or schoolperformance).

? 1 2 3 F135

When youre worrying this way, do youfind that its hard to stop yourself?

B. The person finds it difficult tocontrol the worry.

? 1 2 3 F136

When did this anxiety start?COMPARE ANSWER WITH ONSETOF MOOD OR PSYCHOTICDISORDER.

F(2). Does not occur exclusivelyduring the course of a MoodDisorder, Psychotic Disorder, or aPervasive Developmental Disorder.

? 1 3 F137

IF NO: GO TO*ANXIETY DISORDERNOS* F. 40

GO TO*ANXIETYDISORDER

NOS* F. 40

GO TO*ANXIETYDISORDERNOS* F. 40

GO TO*ANXIETYDISORDER

NOS* F. 40

SCREEN Q# 10

YES NO


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SCID-I (for DSM-IV-TR) Generalized Anxiety Disorder (JAN 2010) Anxiety Disorders F. 35


*CHRONOLOGY OF GENERALIZED ANXIETY DISORDER*

INDICATE CURRENT SEVERITY:1 - Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present,

and symptoms result in no more than minor impairments in social or occupational functioning.2 - Moderate: Symptoms or functional impairment between mild and severe are present.3 - Severe: Many symptoms in excess of those required to make the diagnosis, or several

symptoms that are particularly severe are present, or the symptoms result in markedimpairment in social or occupational functioning.

F148a

*AGE AT ONSET*

IF UNKNOWN: How old were youwhen you first started having (SXS OFGAD)?

Age at onset of Generalized AnxietyDisorder (CODE 99 IF UNKNOWN)

____ ____ F149

GO TO NEXTMODULE


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SCID-I (for DSM-IV-TR) Substance-induced (JAN 2010) Anxiety Disorders F. 38


SUBSTANCE-INDUCED ANXIETYDISORDER

SUBSTANCE-INDUCED ANXIETYDISORDER CRITERIA

IF SYMPTOMS NOT TEMPORALLY ASSOCIATED WITHSUBSTANCE USE, CHECK HERE ___ AND RETURN TODISORDER BEING EVALUATED.

F152d

CODE BASED ON INFORMATIONALREADY OBTAINED

A. Prominent anxiety, panic attacks,obsessions or compulsionspredominate in the clinical picture.

? 1 2 3 F153

IF NOT KNOWN: When did the(ANXIETY SYMPTOMS) begin? Wereyou already using (SUBSTANCE) orhad you just stopped or cut down youruse?

B. There is evidence from thehistory, physical examination, orlaboratory findings that either: (1) thesymptoms in A developed during, orwithin a month of, substance

intoxication or withdrawal, or (2)medication use is etiologically relatedto the disturbance.

? 1 2 3 F154

ASK ANY OF THE FOLLOWINGQUESTIONS AS NEEDED TO RULEOUT A NON-SUBSTANCE-INDUCEDETIOLOGY:

C. The disturbance is NOT betteraccounted for by an Anxiety Disorderthat is not substance-induced.

Guidelines for Primary Anxiety:Evidence that the symptoms arebetter accounted for by a primary

(i.e., non-substance-induced) AnxietyDisorder may include any (or all) ofthe following:

? 1 3 F155

IF UNKNOWN: Which came first, the(SUBSTANCE USE) or the (ANXIETYSYMPTOMS)?

IF UNKNOWN: Have you had a periodof time when you stopped using(SUBSTANCE)?

IF YES: After you stopped using(SUBSTANCE) did the (ANXIETYSYMPTOMS) get better or didthey continue?

(1) the anxiety symptomsprecede the onset of theSubstance Abuse orDependence (or medicationuse)

(2) the anxiety symptomspersist for a substantial period

of time (e.g., about a month)after the cessation ofacute withdrawal or severeintoxication

NOTSUBSTANCEINDUCED

RETURN TODISORDERBEINGEVALUATED

NOTSUBSTANCEINDUCED

RETURN TODISORDERBEINGEVALUATED

EPISODE BEING EVALUATED:Panic F. 3

AWOPD F. 9Social Phobia F. 13OCD F. 23GAD F. 34

Anxiety Nos F. 40Mixed Anxiety Dep J. 5


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module f anxiety disorders

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