Decision

Decision Trees
Trees for
for
Differential
Differential Diagnosis.
Diagnosis.
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 Pick a differential diagnosis

Differential Diagnosis of Differential Diagnosis of

Mental Disorders Due to a Substance-Induced
General Medical Condition Disorders

Differential Diagnosis of Differential Diagnosis of

Psychotic Disorders Mood Disorders

Differential Diagnosis of Differential Diagnosis of

Anxiety Disorders Somatoform Disorders
Symptoms that are due to the direct physiological effects of a general
medical condition

Is there a disturbance of
consciousness and a
change in cognition

Yes No
Evidence that the disturbance
has more than one etiology
(e.g., substance and general
medical condition)

Yes No
Memory impairment?

Yes No
Delirium Due to
a General
Medical
Condition
Start Over
Delirium Due
to Multiple
Etiologies

Start Over
At least one additional
cognitive deficit

Yes No
 Evidence that the disturbance
has more than one etiology (e.g.,
cerebrovascular disease and
Alzheimer’s disease)

Yes No
Dementia Due to
Multiple
Etiologies

Start Over
 Evidence that
cerebrovascular disease is
etiologically related to the
disturbance

Yes No
Vascular Dementia

Start Over
Disturbance due to central nervous
system condition or systemic
condition known to cause dementia

Yes No
Dementia Due to a
General Medical
Condition

Start Over
 Gradual onset and
continuing cognitive decline

Yes No
Dementia of the
Alzheimer’s Type

Start Over
 Dementia Not
Otherwise Specified

Start Over
Amnestic Disorder due
to a General Medical
Condition

Start Over
Prominent delusions
or hallucinations
predominate

Yes No
Psychotic Disorder
Due to a General
Medical Condition

Start Over
Prominent and persistent
mood disturbance
predominates

Yes No
Mood Disorder Due to
a General Medical
Condition

Start Over
Prominent anxiety, panic
attacks, obsessions, or
compulsions predominate

Yes No
Anxiety Disorder due
to a General Medical
Condition

Start Over
 Clinically significant sexual
dysfunction exclusively due to a
general medical condition

Yes No
Sexual Dysfunction
Due to a General
Medical Condition

Start Over
Disturbance in sleep
sufficiently severe to
warrant independent
clinical attention

Yes No
Sleep Disorder Due to
a General Medical
Condition

Start Over
 Catatonia?

Yes No
Catatonic Disorder
Due to a General
Medical Condition

Start Over
Change in previous
personal pattern

Yes No
Personality Change Due
to a General Medical
Condition

Start Over
 Clinically significant symptoms
etiologically related to a general
medical condition that do not meet
criteria for a specific Mental Disorder
Due to a General Medical Condition

Yes No
Mental Disorder Not
Otherwise Specified
Due to a General
Medical Condition

Start Over
 No Mental Disorder
(Symptoms that are not
clinically significant)

Start Over
Symptoms must be due to the direct
physiological effects of a substance

A disturbance of consciousness and a

change in cognition that are in excess of that
usually seen in intoxication or withdrawal and
that warrant independent clinical attention

Yes No
Evidence that the disturbance
has more than one etiology
(e.g., substance and general
medical condition)

Yes No
 Persistent memory
impairment

Yes No
Onset of delirium
during withdrawal
from a substance

Yes No
Substance-Induced
Withdrawal
Delirium

Start Over
 Substance
Induced
Intoxication
Delirium

Start Over
 Delirium Due to
Multiple Etiologies

Start Over
 At least one
additional cognitive
deficit

Yes No
Evidence that the disturbance
has more than one etiology
(e.g., substance and general
medical condition)

Yes No
Substance-Induced
Persisting Dementia

Start Over
Dementia Due to
Multiple Etiologies

Start Over
Substance-Induced
Persisting Amnestic
Disorder

Start Over
Delusions or hallucinations predominate, are
in excess of that usually seen in intoxication
or withdrawal, and warrant independent
clinical attention

Yes No
 Substance-Induced
Psychotic Disorder –
Specify if onset during
intoxication or withdrawal

Start Over
 A mood disturbance predominates, is
in excess of that usually seen in
intoxication or withdrawal, and warrants
independent clinical attention.

Yes No
 Substance-Induced Mood
Disorder – Specify if onset during
intoxication or withdrawal

Start Over
 Anxiety, panic attacks, or obsessions
or compulsions predominate; are in
excess of that usually seen in
intoxication or withdrawal; and warrant
independent clinical attention

Yes No
Substance-Induced Anxiety Disorder
– Specify if onset during intoxication
or withdrawal

Start Over
 Clinically significant sexual dysfunction
exclusively due to a substance, is in excess
of that usually seen in intoxication, and
warrants independent clinical attention

Yes No
Substance-Induced Sexual
Dysfunction

Start Over
 Disturbance is sleep that is sufficiently
severe to warrant independent clinical
attention and is in excess of that usually
seen in intoxication or withdrawal

Yes No
Substance-Induced Sleep
Disorder – Specify if onset
during intoxication or
withdrawal

Start Over
Development of a reversible syndrome
due to recent use of a substance

Yes No
Substance Intoxication

Start Over
 Development of a syndrome
due to reduction or cessation of
use of substance

Yes No
Substance Withdrawal

Start Over
Clinically significant symptoms
due to a substance that do not
meet criteria for one of the
Substance-Induced Disorders

Yes No
Substance-Related Disorder
Not Otherwise Specified

Start Over
 No Substance-Induced
Disorder (substance-induced
symptoms that are not clinically
significant)

Start Over
Delusions, hallucinations, disorganized
speech, or grossly disorganized behavior

Due to the direct

physiological effects of a
general medical condition

Yes No
Psychotic Disorder Due
to a General Medical
Condition

Start Over
Due to the direct physiological
effects of a substance (e.g., a
drug of abuse, a medication, or
a toxin)

Yes No
Substance-Induced Psychotic
Disorder

Start Over
Symptoms of active phase of
Schizophrenia, lasting at least
1 month

Yes No
 Major Depressive or Manic
Episode concurrent with active-
phase symptoms

Yes No
 Total duration of mood
episodes has been brief
relative to duration of active
and residual periods

Yes No
Duration at least 6 months

Yes No
Schizophrenia

Start Over
Schizophreniform Disorder

Start Over
 At least 2 weeks of delusions
or hallucinations in the absence
of prominent mood symptoms

Yes No
Schizoaffective Disorder

Start Over
 Mood Disorder with Psychotic
Features (see Mood Disorders tree)

Start Over
Nonbizarre delusions lasting at
least 1 month

Yes No
 Total duration of mood episodes
has been brief relative to duration
of delusional periods

Yes No
 Apart from delusions,
functioning not markedly
impaired

Yes No
 Delusions occur only
during mood episodes

Yes No
Delusional Disorder

Start Over
Psychotic Disorder Not
Otherwise Specified

Start Over
 Mood Disorder with
Psychotic Features (see
Mood Disorders tree)

Start Over
Duration more than 1 day but
less than 1 month

Yes No
Brief Psychotic Disorder

Start Over
Psychotic Disorder Not
Otherwise Specified

Start Over
Depressed, elevated, expansive, or irritable mood

Due to the direct

physiological effects of a
general medical condition

Yes No
No Mood Disorder (mood
symptoms that are not clinically
significant)

Start Over
 Mood Disorder Due to a
General Medical Condition

Start Over
Due to the direct physiological
effects of a substance (i.e., a
drug of abuse, a medication,
or a toxin)

Yes No
Substance-Induced
Mood Disorder

Start Over
Determine type of present and
past mood episodes

Next
Elevated, expansive, or irritable
mood, at least 1-week duration;
marked impairment or
hospitalization

Yes No
Manic Episode

Start Over

Mixed Diagnosis
Elevate, expansive, or irritable
mood, at least 4-day duration;
changes observable by others
but less severe than a Manic
Episode

Yes No
Hypomanic Episode

Start Over

Mixed Diagnosis
Major Depressive Episode

Start Over

Mixed Diagnosis
At least 2 weeks of depressed
mood or loss of interest plus
associated symptoms, and not
better accounted for by
Bereavement

Yes No
 Criteria met for Manic
Episode and Major
Depressive Episode nearly
every day for at least 1 week

Yes No
Mixed Episode

Start Over

Mixed Diagnosis
Has ever had a Manic Episode
or a Mixed Episode

Yes No
Psychotic symptoms occur at
times other than during Manic
or Mixed Episodes

Yes No
Bipolar I Disorder

Start Over
 Occurred exclusively during
Schizoaffective Disorder (review
Psychotic Disorders tree)

Yes No
Schizoaffective Disorder,
Bipolar Type

Start Over
Bipolar Disorder Not Otherwise
Specified (superimposed on a
Psychotic Disorder)

Start Over
 Has ever had a Hypomanic
Episode and at least one Major
Depressive Episode

Yes No
Bipolar II Disorder

Start Over
 2+ years of hypomanic
symptoms and periods of
depressed mood

Yes No
Cyclothymic Disorder

Start Over
 Clinically significant
manic/hypomanic symptoms
that do not meet criteria for a
specific Bipolar Disorder

Yes No
Bipolar Disorder NOS

Start Over
Has ever had a Major
Depressive Episode

Yes No
Psychotic symptoms occur at
times other than during Major
Depressive Episodes

Yes No
Major Depressive Disorder

Start Over
Occurred exclusively during
Schizoaffective Disorder
(review
Psychotic Disorders tree)

Yes No
Schizoaffective Disorder,
Depressive Type

Start Over
 Depressive Disorder NOS
(superimposed on Psychotic
Disorder)

Start Over
Depressed mood, more days
than not, for at least 2 years
with associated symptoms

Yes No
Dysthymic Disorder

Start Over
Depressed mood not meeting
criteria for one of the previous
Mood Disorders that develops
in response to a stressor

Yes No
Adjustment Disorder
with Depressed Mood

Start Over
Clinically significant depressive
symptoms that do not meet
criteria for a specific Mood
Disorder

Yes No
Depressive Disorder NOS

Start Over
 No Mood Disorder (mood
symptoms that are not clinically
significant)

Start Over
Symptoms of anxiety, fear, avoidance, or
increased arousal

Due to the direct physiological

effects of a general medical
condition

Yes No
Anxiety disorder due to a
general medical condition

Start Over
 Due to the direct physiological
effects of a substance (e.g., a drug
of abuse, a medication, a toxin)

Yes No
Substance-Induced
Anxiety Disorder

Start Over
 Recurrent unexpected Panic
Attacks plus a month of worry,
concern about attacks, or
change in behavior

Yes No
 Agoraphobia, i.e., anxiety about
being in places from which escape
might be difficult or embarrassing
in the event of having a Panic
Attack

Yes No
Panic Disorder with Agoraphobia

Start Over
Panic Disorder Without
Agoraphobia

Start Over
Agoraphobia, i.e., anxiety about
being in places from which
escape might be difficult or
embarrassing in the event of
having panic-like symptoms

Yes No
 Agoraphobia without
History of Panic Disorder

Start Over
Anxiety concerning separation
from attachment figures with
onset in childhood

Yes No
Separation Anxiety Disorder

Start Over
 Fear of humiliation or
embarrassment in social or
performance

Yes No
Social Phobia (Social Anxiety
Disorder)

Start Over
Fear cued by object or situation

Yes No
Specific Phobia

Start Over
Obsessions or compulsions

Yes No
Obsessive-Compulsive
Disorder

Start Over
 6-month period of excessive
anxiety and worry plus anxiety
symptoms

Yes No
Occurs exclusively during a
Mood or Psychotic Disorder

See mood
disorders tree
No
Generalized Anxiety Disorder

Start Over
Anxiety in response to a severe
traumatic event

Yes No
 Reexperiencing of event,
increased arousal, and
avoidance of stimuli associated
with traumatic event

Yes No
Duration of more than 1 month

Yes No
 No Anxiety Disorder
(symptoms of fear, anxiety,
or avoidance that are not
clinically significant)

Start Over
Posttraumatic Stress
Disorder

Start Over
Acute Stress Disorder

Start Over
Anxiety that does not meet
criteria for one of the above
Anxiety Disorders and
develops in response to a
stressor

Yes No
Adjustment Disorder
with Anxiety

Start Over
Clinically significant symptoms
that do not meet criteria for a
specific Anxiety Disorder

Yes No
Anxiety Disorder NOS

Start Over
Physical Complaints or irrational anxiety about illness or appearance

Physical complaints are fully

explained by a general medical
condition and complaints are
not in excess of expected

Yes No
 No Anxiety Disorder
(symptoms of fear, anxiety, or
avoidance that are not clinically
significant)

Start Over
Specific General Medical
Condition (no somatoform
disorder)

Next
Psychological factors adversely
affect general medical
condition

Next
 Psychological Factor
Affecting Medical Condition

Start Over
Physical symptoms are
intentionally produced

Yes No
External incentives are absent

Yes No
Factitious Disorder

Start Over
Malingering

Start Over
 History of multiple physical
complaints with at least 4 pain
symptoms, 2 gastrointestinal
symptoms, 1 sexual symptom,
and 1 pseudoneurological
symptom

Yes No
Somatization Disorder

Start Over
Symptom or deficit affecting
voluntary motor or sensory
function

Yes No
Conversion Disorder

Start Over
Symptom or deficit affecting
sexual functioning

Yes No
Sexual Dysfunction

Start Over
 Pain is focus of clinical
attention, and psychological
factors have important role

Yes No
Pain Disorder

Start Over
Other physical complaints
lasting at least 6 months

Yes No
Undifferentiated Somatoform
Disorder

Start Over
Preoccupation with idea of
having a serious disease

Yes No
Belief is of delusional intensity

Yes No
Hypochondriasis

Start Over
See Psychotic Disorders tree

Start Over
Preoccupation with imagined
defect in appearance

Yes No
Body Dysmorphic Disorder (if
delusional, also see
Psychotic Disorders tree)

Start Over
 Clinically significant
somatoform symptoms that do
not meet criteria for a specific
Somatoform Disorder

Yes No
Somatoform Disorder NOS

Start Over
 No Somatoform Disorder
(somatoform symptoms that
are not clinically significant)

Start Over