From f6cda83ca6aed3a24d999ef4ccd38bff167d4788 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 14 Jul 2026 20:07:39 +0800 Subject: [PATCH 01/12] feat(dsm): add diagnosis reference mode --- docs/site-map.md | 176 +- scripts/generate-site-map.ts | 22 + src/app/dsm/compare/page.tsx | 36 + .../diagnoses/[slug]/differentials/page.tsx | 87 + src/app/dsm/diagnoses/[slug]/page.tsx | 34 + src/app/dsm/layout.tsx | 11 + src/app/dsm/loading.tsx | 5 + src/app/dsm/page.tsx | 12 + src/app/dsm/search/page.tsx | 39 + src/app/page.tsx | 13 +- .../clinical-dashboard/ClinicalSidebar.tsx | 1 + .../global-search-shell.tsx | 4 + .../master-search-header.tsx | 22 +- .../clinical-dashboard/mode-action-popup.tsx | 28 +- .../universal-search-command-surface.tsx | 15 +- src/components/dsm/dsm-comparison-page.tsx | 276 + src/components/dsm/dsm-diagnosis-page.tsx | 275 + .../dsm-differential-considerations-page.tsx | 300 + src/components/dsm/dsm-home-page.tsx | 62 + src/components/dsm/dsm-page-header.tsx | 88 + src/components/dsm/dsm-search-page.tsx | 276 + src/data/dsm-clinical-content.json | 8473 +++++++++++++++++ src/lib/app-mode-icons.ts | 2 + src/lib/app-modes.ts | 34 +- src/lib/dsm.ts | 221 + src/lib/search-command-surface.ts | 10 + src/lib/universal-search-domains.ts | 3 +- src/lib/universal-search.ts | 20 + tests/app-modes.test.ts | 16 + tests/dsm.test.ts | 55 + tests/site-map.test.ts | 8 + tests/ui-smoke.spec.ts | 21 + tests/universal-search.test.ts | 10 +- 33 files changed, 10626 insertions(+), 29 deletions(-) create mode 100644 src/app/dsm/compare/page.tsx create mode 100644 src/app/dsm/diagnoses/[slug]/differentials/page.tsx create mode 100644 src/app/dsm/diagnoses/[slug]/page.tsx create mode 100644 src/app/dsm/layout.tsx create mode 100644 src/app/dsm/loading.tsx create mode 100644 src/app/dsm/page.tsx create mode 100644 src/app/dsm/search/page.tsx create mode 100644 src/components/dsm/dsm-comparison-page.tsx create mode 100644 src/components/dsm/dsm-diagnosis-page.tsx create mode 100644 src/components/dsm/dsm-differential-considerations-page.tsx create mode 100644 src/components/dsm/dsm-home-page.tsx create mode 100644 src/components/dsm/dsm-page-header.tsx create mode 100644 src/components/dsm/dsm-search-page.tsx create mode 100644 src/data/dsm-clinical-content.json create mode 100644 src/lib/dsm.ts create mode 100644 tests/dsm.test.ts diff --git a/docs/site-map.md b/docs/site-map.md index 2dfa3b243..eead68cb6 100644 --- a/docs/site-map.md +++ b/docs/site-map.md @@ -13,6 +13,9 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` - `/documents/search` - Documents search command centre. Source: `src/app/documents/search/page.tsx`. - `/documents/source` - Compatibility redirect to the canonical live document viewer when a valid id is supplied. Source: `src/app/documents/source/page.tsx`. - `/documents/source/evidence` - Compatibility redirect sharing the canonical live document viewer handoff. Source: `src/app/documents/source/evidence/page.tsx`. +- `/dsm` - DSM-5 Diagnosis home. Source: `src/app/dsm/page.tsx`. +- `/dsm/compare` - DSM diagnosis comparison. Source: `src/app/dsm/compare/page.tsx`. +- `/dsm/search` - DSM diagnosis search and catalogue browser. Source: `src/app/dsm/search/page.tsx`. - `/favourites` - Saved clinical items and sets. Source: `src/app/favourites/page.tsx`. - `/forms` - Forms home and search surface. Source: `src/app/forms/page.tsx`. - `/medications` - Medication index redirect. Source: `src/app/medications/page.tsx`. @@ -29,21 +32,23 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` - `/forms` - Forms mode. Search kind: `forms`. Query example: `/forms?q=transport+forms&focus=1&run=1`. - `/favourites` - Favourites mode. Search kind: `favourites`. Query example: `/favourites?q=clozapine+set&focus=1&run=1`. - `/differentials` - Differentials mode. Search kind: `differentials`. Query example: `/differentials?q=acute+confusion&focus=1&run=1`. +- `/dsm` - DSM-5 Diagnosis mode. Search kind: `dsm`. Query example: `/dsm/search?q=major+depressive+disorder&focus=1&run=1`. - `/?mode=prescribing` - Medication mode. Search kind: `documents`. Query example: `/?mode=prescribing&q=acamprosate+renal+dose&focus=1&run=1`. - `/?mode=tools` - Tools mode. Search kind: `tools`. Query example: `/?mode=tools&q=medications&focus=1&run=1`. ## Mode page index -| Mode | Home page | Search/results page | Information/detail pages | -| ------------- | -------------------- | --------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------- | -| Answer | `/?mode=answer` | `/?mode=answer&q=example+question&focus=1&run=1` | Answer, citations, evidence, and source panels render inside the root dashboard shell. | -| Documents | `/?mode=documents` | `/documents/search?mode=documents&q=lithium+monitoring&focus=1&run=1` | `/documents/search` live results and `/documents/[id]` canonical viewer; `/documents/source*` are compatibility redirects. | -| Services | `/services` | `/services?q=13YARN&focus=1&run=1` | `/services/[slug]` service record pages. | -| Forms | `/forms` | `/forms?q=transport+forms&focus=1&run=1` | `/forms/[slug]` form record pages. | -| Favourites | `/favourites` | `/favourites?q=clozapine+set&focus=1&run=1` | Saved set and saved item detail render inside the favourites page surface. | -| Differentials | `/differentials` | `/differentials?q=acute+confusion&focus=1&run=1` | `/differentials/diagnoses`, `/differentials/diagnoses/[slug]`, and `/differentials/presentations`. | -| Medication | `/?mode=prescribing` | `/?mode=prescribing&q=acamprosate+renal+dose&focus=1&run=1` | `/medications/[slug]`; `/medications` redirects to medication mode. | -| Tools | `/?mode=tools` | `/?mode=tools&q=medications&focus=1&run=1` | Tool launcher and detail panels inside dashboard tools mode (`/?mode=tools`). | +| Mode | Home page | Search/results page | Information/detail pages | +| --------------- | -------------------- | --------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------- | +| Answer | `/?mode=answer` | `/?mode=answer&q=example+question&focus=1&run=1` | Answer, citations, evidence, and source panels render inside the root dashboard shell. | +| Documents | `/?mode=documents` | `/documents/search?mode=documents&q=lithium+monitoring&focus=1&run=1` | `/documents/search` live results and `/documents/[id]` canonical viewer; `/documents/source*` are compatibility redirects. | +| Services | `/services` | `/services?q=13YARN&focus=1&run=1` | `/services/[slug]` service record pages. | +| Forms | `/forms` | `/forms?q=transport+forms&focus=1&run=1` | `/forms/[slug]` form record pages. | +| Favourites | `/favourites` | `/favourites?q=clozapine+set&focus=1&run=1` | Saved set and saved item detail render inside the favourites page surface. | +| Differentials | `/differentials` | `/differentials?q=acute+confusion&focus=1&run=1` | `/differentials/diagnoses`, `/differentials/diagnoses/[slug]`, and `/differentials/presentations`. | +| DSM-5 Diagnosis | `/dsm` | `/dsm/search?q=major+depressive+disorder&focus=1&run=1` | `/dsm/diagnoses/[slug]`, `/dsm/compare`, and `/dsm/diagnoses/[slug]/differentials`. | +| Medication | `/?mode=prescribing` | `/?mode=prescribing&q=acamprosate+renal+dose&focus=1&run=1` | `/medications/[slug]`; `/medications` redirects to medication mode. | +| Tools | `/?mode=tools` | `/?mode=tools&q=medications&focus=1&run=1` | Tool launcher and detail panels inside dashboard tools mode (`/?mode=tools`). | ## Documents flow index @@ -499,6 +504,156 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` - `very-late-onset-schizophrenia-like-psychosis-delusional-disorder` - `wernicke-encephalopathy` +### DSM diagnosis slugs + +- `/dsm/diagnoses/[slug]` - Dynamic route family. +- `acute-stress-disorder` +- `adjustment-disorder` +- `agoraphobia` +- `alcohol-intoxication` +- `alcohol-use-disorder` +- `alcohol-withdrawal` +- `alzheimer-s-disease-ncd` +- `anorexia-nervosa` +- `antidepressant-discontinuation-syndrome` +- `antisocial-personality-disorder` +- `anxiety-disorder-due-to-another-medical-condition` +- `attention-deficit-hyperactivity-disorder-adhd` +- `autism-spectrum-disorder-asd` +- `avoidant-personality-disorder` +- `avoidant-restrictive-food-intake-disorder-arfid` +- `binge-eating-disorder` +- `bipolar-i-disorder` +- `bipolar-ii-disorder` +- `body-dysmorphic-disorder` +- `borderline-personality-disorder` +- `brief-psychotic-disorder` +- `bulimia-nervosa` +- `cannabis-intoxication-withdrawal` +- `catatonia-associated-due-to-gmc-or-unspecified` +- `central-sleep-apnoea` +- `childhood-onset-fluency-disorder-stuttering` +- `circadian-rhythm-sleep-wake-disorder` +- `conduct-disorder` +- `cyclothymic-disorder` +- `delayed-ejaculation` +- `delirium` +- `delusional-disorder` +- `dependent-personality-disorder` +- `depersonalisation-derealisation-disorder` +- `depressive-disorder-due-to-another-medical-condition` +- `developmental-coordination-disorder-dcd` +- `disinhibited-social-engagement-disorder-dsed` +- `disruptive-mood-dysregulation-disorder-dmdd` +- `dissociative-amnesia` +- `dissociative-identity-disorder` +- `erectile-dysfunction` +- `excoriation-skin-picking-disorder` +- `exhibitionistic-disorder` +- `factitious-disorder` +- `female-orgasmic-disorder` +- `female-sexual-interest-arousal-disorder` +- `fetishistic-disorder` +- `frontotemporal-neurocognitive-disorder` +- `frotteuristic-disorder` +- `functional-neurological-symptom-disorder-conversion-disorder` +- `gender-dysphoria` +- `generalised-anxiety-disorder` +- `genito-pelvic-pain-penetration-disorder` +- `global-developmental-delay` +- `histrionic-personality-disorder` +- `hoarding-disorder` +- `hypersomnolence-disorder` +- `illness-anxiety-disorder` +- `insomnia-disorder` +- `intellectual-disability-intellectual-developmental-disorder` +- `intermittent-explosive-disorder-ied` +- `kleptomania` +- `language-disorder` +- `lewy-body-neurocognitive-disorder` +- `major-depressive-disorder` +- `major-neurocognitive-disorder` +- `male-hypoactive-sexual-desire-disorder` +- `medication-induced-acute-akathisia` +- `medication-induced-acute-dystonia` +- `medication-induced-parkinsonism` +- `medication-induced-postural-tremor` +- `mild-neurocognitive-disorder` +- `narcissistic-personality-disorder` +- `narcolepsy` +- `neurocognitive-disorder-due-to-hiv-infection` +- `neurocognitive-disorder-due-to-huntington-s-disease` +- `neurocognitive-disorder-due-to-parkinson-s-disease` +- `neurocognitive-disorder-due-to-prion-disease` +- `neurocognitive-disorder-due-to-traumatic-brain-injury` +- `neuroleptic-malignant-syndrome-nms` +- `nrem-sleep-arousal-disorder` +- `obsessive-compulsive-disorder` +- `obsessive-compulsive-personality-disorder-ocpd` +- `obstructive-sleep-apnoea-hypopnoea` +- `opioid-intoxication-withdrawal` +- `oppositional-defiant-disorder-odd` +- `other-medication-induced-movement-disorder` +- `other-specified-bipolar-and-related-disorder` +- `other-specified-unspecified-anxiety-disorder` +- `other-specified-unspecified-depressive-disorder` +- `other-specified-unspecified-disruptive-impulse-control-conduct-disorder` +- `other-specified-unspecified-dissociative-disorder` +- `other-specified-unspecified-feeding-or-eating-disorder` +- `other-specified-unspecified-ocd-and-related-disorder` +- `other-specified-unspecified-paraphilic-disorder` +- `other-specified-unspecified-personality-disorder` +- `other-specified-unspecified-schizophrenia-spectrum-disorder` +- `other-specified-unspecified-sexual-dysfunction` +- `other-specified-unspecified-somatic-symptom-and-related-disorder` +- `other-specified-unspecified-trauma-and-stressor-related-disorder` +- `paedophilic-disorder` +- `panic-disorder` +- `paranoid-personality-disorder` +- `persistent-chronic-motor-or-vocal-tic-disorder` +- `persistent-depressive-disorder-dysthymia` +- `personality-change-due-to-another-medical-condition` +- `pica` +- `posttraumatic-stress-disorder-ptsd` +- `premature-ejaculation` +- `premenstrual-dysphoric-disorder-pmdd` +- `prolonged-grief-disorder` +- `provisional-tic-disorder` +- `psychotic-disorder-due-to-another-medical-condition` +- `pyromania` +- `reactive-attachment-disorder-rad` +- `rem-sleep-behaviour-disorder` +- `restless-legs-syndrome` +- `rumination-disorder` +- `schizoaffective-disorder` +- `schizoid-personality-disorder` +- `schizophrenia` +- `schizophreniform-disorder` +- `schizotypal-personality-disorder` +- `sedative-hypnotic-anxiolytic-intoxication-withdrawal` +- `selective-mutism` +- `separation-anxiety-disorder` +- `sexual-masochism-disorder` +- `sexual-sadism-disorder` +- `social-anxiety-disorder` +- `social-pragmatic-communication-disorder` +- `somatic-symptom-disorder` +- `specific-learning-disorder` +- `specific-phobia` +- `speech-sound-disorder` +- `stereotypic-movement-disorder` +- `stimulant-intoxication-withdrawal` +- `substance-intoxication-withdrawal-generic-template` +- `substance-medication-induced-psychotic-disorder` +- `tardive-dyskinesia` +- `tardive-dystonia-tardive-akathisia` +- `tourette-s-disorder` +- `transvestic-disorder` +- `trichotillomania-hair-pulling-disorder` +- `unspecified-bipolar-and-related-disorder` +- `vascular-neurocognitive-disorder` +- `voyeuristic-disorder` + ### Medication slugs - `/medications/[slug]` - Dynamic route family. @@ -609,6 +764,7 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` | Forms | `src/app/forms, src/lib/forms.ts, src/app/api/registry/records` | | Favourites | `src/app/favourites, src/components/clinical-dashboard/favourites-command-library-page.tsx` | | Differentials | `src/app/differentials, src/lib/differentials.ts` | +| DSM-5 Diagnosis | `src/app/dsm, src/components/dsm, src/lib/dsm.ts` | | Medications | `src/app/medications, src/components/clinical-dashboard/medication-prescribing-workspace.tsx` | | Documents | `src/app/documents, src/lib/document-flow-routes.ts` | | Tools | `src/components/applications-launcher-page.tsx` | diff --git a/scripts/generate-site-map.ts b/scripts/generate-site-map.ts index f26d779ed..0f76aed49 100644 --- a/scripts/generate-site-map.ts +++ b/scripts/generate-site-map.ts @@ -6,6 +6,7 @@ import { format } from "prettier"; import { appModeDefinitions, appModeHomeHref, type AppModeId } from "@/lib/app-modes"; import { documentsSearchHref, DOCUMENTS_MODE_HOME_ROUTE } from "@/lib/document-flow-routes"; import { differentialRecords } from "@/lib/differentials"; +import { dsmDiagnoses } from "@/lib/dsm"; import { formRecords } from "@/lib/forms"; import { serviceRecords } from "@/lib/services"; @@ -39,6 +40,11 @@ const routeDescriptions: Record = { "/differentials/diagnoses": "Diagnosis stream.", "/differentials/diagnoses/[slug]": "Differential diagnosis detail.", "/differentials/presentations": "Presentation workflow stream.", + "/dsm": "DSM-5 Diagnosis home.", + "/dsm/search": "DSM diagnosis search and catalogue browser.", + "/dsm/compare": "DSM diagnosis comparison.", + "/dsm/diagnoses/[slug]": "DSM diagnosis criteria and information.", + "/dsm/diagnoses/[slug]/differentials": "DSM diagnosis differential considerations.", "/documents/[id]": "Document viewer/detail page.", "/documents/search": "Documents search command centre.", "/documents/source": "Compatibility redirect to the canonical live document viewer when a valid id is supplied.", @@ -90,6 +96,7 @@ const routeOwnershipRows = [ ["Forms", "src/app/forms, src/lib/forms.ts, src/app/api/registry/records"], ["Favourites", "src/app/favourites, src/components/clinical-dashboard/favourites-command-library-page.tsx"], ["Differentials", "src/app/differentials, src/lib/differentials.ts"], + ["DSM-5 Diagnosis", "src/app/dsm, src/components/dsm, src/lib/dsm.ts"], ["Medications", "src/app/medications, src/components/clinical-dashboard/medication-prescribing-workspace.tsx"], ["Documents", "src/app/documents, src/lib/document-flow-routes.ts"], ["Tools", "src/components/applications-launcher-page.tsx"], @@ -198,6 +205,7 @@ function renderModeRoutes() { forms: appModeHomeHref("forms", { query: "transport forms", focus: true, run: true }), favourites: appModeHomeHref("favourites", { query: "clozapine set", focus: true, run: true }), differentials: appModeHomeHref("differentials", { query: "acute confusion", focus: true, run: true }), + dsm: appModeHomeHref("dsm", { query: "major depressive disorder", focus: true, run: true }), prescribing: appModeHomeHref("prescribing", { query: "acamprosate renal dose", focus: true, run: true }), tools: appModeHomeHref("tools", { query: "medications", focus: true, run: true }), }; @@ -264,6 +272,12 @@ function renderModePageIndex() { search: appModeHomeHref("differentials", { query: "acute confusion", focus: true, run: true }), detail: "`/differentials/diagnoses`, `/differentials/diagnoses/[slug]`, and `/differentials/presentations`.", }, + { + mode: "DSM-5 Diagnosis", + home: appModeHomeHref("dsm"), + search: appModeHomeHref("dsm", { query: "major depressive disorder", focus: true, run: true }), + detail: "`/dsm/diagnoses/[slug]`, `/dsm/compare`, and `/dsm/diagnoses/[slug]/differentials`.", + }, { mode: "Medication", home: appModeHomeHref("prescribing"), @@ -312,6 +326,8 @@ function renderSiteMapRaw(data = collectSiteMapData()) { "/services/[slug]", "/forms/[slug]", "/differentials/diagnoses/[slug]", + "/dsm/diagnoses/[slug]", + "/dsm/diagnoses/[slug]/differentials", "/medications/[slug]", ].includes(route.route), ); @@ -361,6 +377,12 @@ function renderSiteMapRaw(data = collectSiteMapData()) { differentialRecords.map((record) => record.slug), ), "", + ...renderSlugInventory( + "DSM diagnosis slugs", + "/dsm/diagnoses/[slug]", + dsmDiagnoses.map((record) => record.slug), + ), + "", ...renderSlugInventory("Medication slugs", "/medications/[slug]", medicationSlugs), ]), ...section("Document viewer route", [ diff --git a/src/app/dsm/compare/page.tsx b/src/app/dsm/compare/page.tsx new file mode 100644 index 000000000..7f6449508 --- /dev/null +++ b/src/app/dsm/compare/page.tsx @@ -0,0 +1,36 @@ +import type { Metadata } from "next"; + +import { DsmComparisonPage } from "@/components/dsm/dsm-comparison-page"; +import { defaultDsmComparisonSlugs, getDsmDiagnosis, type DsmDiagnosis } from "@/lib/dsm"; + +export const metadata: Metadata = { + title: "Compare DSM diagnoses | Clinical KB", + description: "Compare core criteria, features, specifiers, and differential flags across DSM diagnosis records.", +}; + +type DsmComparisonRouteProps = { + searchParams?: Promise<{ ids?: string | string[] }>; +}; + +function selectedDiagnoses(value?: string | string[]) { + const requested = (Array.isArray(value) ? value[0] : value) + ?.split(",") + .map((item) => item.trim()) + .filter(Boolean); + const slugs = requested?.length ? requested : [...defaultDsmComparisonSlugs]; + const seen = new Set(); + const diagnoses: DsmDiagnosis[] = []; + for (const slug of slugs) { + if (seen.has(slug) || diagnoses.length >= 3) continue; + const diagnosis = getDsmDiagnosis(slug); + if (!diagnosis) continue; + seen.add(slug); + diagnoses.push(diagnosis); + } + return diagnoses; +} + +export default async function DsmComparisonRoute({ searchParams }: DsmComparisonRouteProps) { + const params = searchParams ? await searchParams : {}; + return ; +} diff --git a/src/app/dsm/diagnoses/[slug]/differentials/page.tsx b/src/app/dsm/diagnoses/[slug]/differentials/page.tsx new file mode 100644 index 000000000..c18a8ec0e --- /dev/null +++ b/src/app/dsm/diagnoses/[slug]/differentials/page.tsx @@ -0,0 +1,87 @@ +import type { Metadata } from "next"; +import { notFound } from "next/navigation"; + +import { + DsmDifferentialConsiderationsPage, + type DsmDifferentialConsideration, +} from "@/components/dsm/dsm-differential-considerations-page"; +import { dsmCriteria, dsmStaticParams, getDsmDiagnosis, resolveDsmDifferential } from "@/lib/dsm"; + +type DsmDifferentialRouteProps = { + params: Promise<{ slug: string }>; +}; + +export const dynamicParams = false; + +export function generateStaticParams() { + return dsmStaticParams(); +} + +function considerationGroup(value: string): DsmDifferentialConsideration["group"] { + const normalized = value.toLowerCase(); + if (/substance|medication|medical|thyroid|neurolog|cns|seizure|sleep|hormone/.test(normalized)) { + return "substance-medical"; + } + if (/episode|history|chronic|episod|duration|full criteria|subthreshold|persistent|onset/.test(normalized)) { + return "course"; + } + if (/grief|bereavement|adjustment|personality|adhd|development|cultural|context/.test(normalized)) { + return "context"; + } + return "overlap"; +} + +function buildConsiderations(values: string[]): DsmDifferentialConsideration[] { + return values.map((value, index) => { + const rationaleMatch = value.match(/\(([^()]*)\)\s*$/); + const title = value.replace(/\s*\([^)]*\)\s*$/, "").trim(); + const match = resolveDsmDifferential(value); + return { + id: `${index}-${title.toLowerCase().replace(/[^a-z0-9]+/g, "-")}`, + title, + fullText: value, + rationale: + rationaleMatch?.[1]?.trim() || "Listed as a differential consideration in the supplied diagnosis record.", + group: considerationGroup(value), + matchedDiagnosis: match + ? { + slug: match.slug, + title: match.title, + icdCode: match.icd_code, + category: match.category.label, + coreFeatures: dsmCriteria(match) + .slice(0, 4) + .map((criterion) => `${criterion.label}. ${criterion.text}`), + } + : undefined, + }; + }); +} + +export async function generateMetadata({ params }: DsmDifferentialRouteProps): Promise { + const { slug } = await params; + const diagnosis = getDsmDiagnosis(slug); + if (!diagnosis) return { title: "DSM differential considerations | Clinical KB" }; + return { + title: `${diagnosis.title} differential considerations | Clinical KB`, + description: `Structured differential considerations for ${diagnosis.title}.`, + }; +} + +export default async function DsmDifferentialRoute({ params }: DsmDifferentialRouteProps) { + const { slug } = await params; + const diagnosis = getDsmDiagnosis(slug); + if (!diagnosis) notFound(); + + return ( + + ); +} diff --git a/src/app/dsm/diagnoses/[slug]/page.tsx b/src/app/dsm/diagnoses/[slug]/page.tsx new file mode 100644 index 000000000..9d0c22d06 --- /dev/null +++ b/src/app/dsm/diagnoses/[slug]/page.tsx @@ -0,0 +1,34 @@ +import type { Metadata } from "next"; +import { notFound } from "next/navigation"; + +import { DsmDiagnosisPage } from "@/components/dsm/dsm-diagnosis-page"; +import { dsmStaticParams, getDsmDiagnosis } from "@/lib/dsm"; + +type DsmDiagnosisRouteProps = { + params: Promise<{ slug: string }>; +}; + +export const dynamicParams = false; + +export function generateStaticParams() { + return dsmStaticParams(); +} + +export async function generateMetadata({ params }: DsmDiagnosisRouteProps): Promise { + const { slug } = await params; + const diagnosis = getDsmDiagnosis(slug); + if (!diagnosis) return { title: "DSM diagnosis not found | Clinical KB" }; + + return { + title: `${diagnosis.title} | DSM-5 Diagnosis | Clinical KB`, + description: `${diagnosis.title} criteria, specifiers, differential considerations, and documentation support.`, + }; +} + +export default async function DsmDiagnosisRoute({ params }: DsmDiagnosisRouteProps) { + const { slug } = await params; + const diagnosis = getDsmDiagnosis(slug); + if (!diagnosis) notFound(); + + return ; +} diff --git a/src/app/dsm/layout.tsx b/src/app/dsm/layout.tsx new file mode 100644 index 000000000..073e802aa --- /dev/null +++ b/src/app/dsm/layout.tsx @@ -0,0 +1,11 @@ +import type { ReactNode } from "react"; + +import { GlobalSearchShell } from "@/components/clinical-dashboard/global-search-shell"; + +export default function DsmLayout({ children }: { children: ReactNode }) { + return ( + + {children} + + ); +} diff --git a/src/app/dsm/loading.tsx b/src/app/dsm/loading.tsx new file mode 100644 index 000000000..6444c9ebe --- /dev/null +++ b/src/app/dsm/loading.tsx @@ -0,0 +1,5 @@ +import { ModeHomeRouteLoading } from "@/components/mode-home-page-skeleton"; + +export default function DsmLoading() { + return ; +} diff --git a/src/app/dsm/page.tsx b/src/app/dsm/page.tsx new file mode 100644 index 000000000..664ddb568 --- /dev/null +++ b/src/app/dsm/page.tsx @@ -0,0 +1,12 @@ +import type { Metadata } from "next"; + +import { DsmHomePage } from "@/components/dsm/dsm-home-page"; + +export const metadata: Metadata = { + title: "DSM-5 Diagnosis | Clinical KB", + description: "Search, compare, and review structured DSM diagnosis criteria and differential considerations.", +}; + +export default function DsmHomeRoute() { + return ; +} diff --git a/src/app/dsm/search/page.tsx b/src/app/dsm/search/page.tsx new file mode 100644 index 000000000..aeb377649 --- /dev/null +++ b/src/app/dsm/search/page.tsx @@ -0,0 +1,39 @@ +import type { Metadata } from "next"; + +import { DsmSearchPage } from "@/components/dsm/dsm-search-page"; +import { dsmCategories, dsmDiagnoses, listDsmDiagnosisSummaries } from "@/lib/dsm"; + +export const metadata: Metadata = { + title: "Search DSM diagnoses | Clinical KB", + description: + "Search the local DSM diagnosis catalogue by title, ICD code, category, criteria, and clinical features.", +}; + +type DsmSearchRouteProps = { + searchParams?: Promise<{ + q?: string | string[]; + query?: string | string[]; + category?: string | string[]; + }>; +}; + +function firstValue(value?: string | string[]) { + return Array.isArray(value) ? value[0] : value; +} + +export default async function DsmSearchRoute({ searchParams }: DsmSearchRouteProps) { + const params = searchParams ? await searchParams : {}; + const query = (firstValue(params.q) ?? firstValue(params.query) ?? "").trim(); + const requestedCategory = firstValue(params.category)?.trim(); + const category = dsmCategories.some((item) => item.key === requestedCategory) ? requestedCategory : undefined; + + return ( + + ); +} diff --git a/src/app/page.tsx b/src/app/page.tsx index c083f5ee9..9a3ad7ba0 100644 --- a/src/app/page.tsx +++ b/src/app/page.tsx @@ -1,7 +1,7 @@ import { redirect } from "next/navigation"; import { HomePageClient } from "@/app/home-page-client"; -import { isAppModeId, isAppModeVisible, type AppModeId } from "@/lib/app-modes"; +import { appModeHomeHref, isAppModeId, isAppModeVisible, type AppModeId } from "@/lib/app-modes"; type HomeProps = { searchParams?: Promise<{ @@ -44,5 +44,16 @@ export default async function Home({ searchParams }: HomeProps) { redirect(suffix ? `/differentials?${suffix}` : "/differentials"); } + if (initialSearchMode === "dsm") { + const query = firstSearchParam(params.q)?.trim(); + redirect( + appModeHomeHref("dsm", { + query, + focus: firstSearchParam(params.focus) === "1", + run: firstSearchParam(params.run) === "1", + }), + ); + } + return ; } diff --git a/src/components/clinical-dashboard/ClinicalSidebar.tsx b/src/components/clinical-dashboard/ClinicalSidebar.tsx index e92eb1060..70b114b1c 100644 --- a/src/components/clinical-dashboard/ClinicalSidebar.tsx +++ b/src/components/clinical-dashboard/ClinicalSidebar.tsx @@ -75,6 +75,7 @@ const sidebarToolItems = [ { id: "forms", label: "Forms", icon: ClipboardPen, href: "/forms", badge: "Early access" }, { id: "favourites", label: "Favourites", icon: Heart, href: "/favourites" }, { id: "differentials", label: "Differentials", icon: BrainCircuit, href: "/differentials" }, + { id: "dsm", label: "DSM-5 Diagnosis", icon: appModeIcons.dsm, href: "/dsm" }, { id: "prescribing", label: "Medication", icon: Pill, href: "/?mode=prescribing" }, { id: "tools", label: "Tools", icon: Wrench, href: "/?mode=tools" }, ] as const; diff --git a/src/components/clinical-dashboard/global-search-shell.tsx b/src/components/clinical-dashboard/global-search-shell.tsx index 1536b69fe..e59d24581 100644 --- a/src/components/clinical-dashboard/global-search-shell.tsx +++ b/src/components/clinical-dashboard/global-search-shell.tsx @@ -130,6 +130,7 @@ function GlobalSearchShellClient(props: GlobalSearchShellProps) { resolvedSearchMode !== "forms" && resolvedSearchMode !== "favourites" && resolvedSearchMode !== "differentials" && + resolvedSearchMode !== "dsm" && !isDocumentSearchMockupRoute; const isMedicationDetailRoute = /^\/medications\/[^/]+$/.test(pathname); const shouldRenderClinicalDashboard = !isMedicationDetailRoute && (isHomeRoute || shouldRenderDashboardSearch); @@ -244,6 +245,7 @@ function GlobalStandaloneSearchShellClient({ resolvedSearchMode !== "forms" && resolvedSearchMode !== "favourites" && resolvedSearchMode !== "differentials" && + resolvedSearchMode !== "dsm" && !isDocumentSearchMockupRoute; const isStandaloneModeHome = !hasSubmittedModeSearch && @@ -252,6 +254,7 @@ function GlobalStandaloneSearchShellClient({ (searchMode === "forms" && pathname === "/forms") || (searchMode === "favourites" && pathname === "/favourites") || (searchMode === "differentials" && pathname === "/differentials") || + (searchMode === "dsm" && pathname === "/dsm") || (searchMode === "tools" && pathname === "/tools")); const isDifferentialPresentationWorkflow = pathname.startsWith("/differentials/presentations"); const shouldShowDesktopSidebar = !hideDesktopSidebar; @@ -330,6 +333,7 @@ function GlobalStandaloneSearchShellClient({ router.prefetch("/?mode=tools"); router.prefetch("/favourites"); router.prefetch("/differentials"); + router.prefetch("/dsm"); } function openGuide() { diff --git a/src/components/clinical-dashboard/master-search-header.tsx b/src/components/clinical-dashboard/master-search-header.tsx index 8e2931d2c..8be3e1554 100644 --- a/src/components/clinical-dashboard/master-search-header.tsx +++ b/src/components/clinical-dashboard/master-search-header.tsx @@ -442,9 +442,11 @@ export function MasterSearchHeader({ ? "favourites" : searchMode === "differentials" ? "differentials" - : searchMode === "tools" - ? "tools" - : "answer"; + : searchMode === "dsm" + ? "dsm" + : searchMode === "tools" + ? "tools" + : "answer"; const actionMenuItems = modeActionItemsFor(actionMenuSetId); const actionMenuTitle = selectedAppMode.label; const actionMenuSubtitle = searchMode === "answer" ? "Source-backed mode" : selectedAppMode.description; @@ -605,6 +607,20 @@ export function MasterSearchHeader({ onOpenEvidence?.(); return; } + if (actionId === "dsm-search") { + onSearchModeChange("dsm"); + return; + } + if (actionId === "dsm-compare") { + onSearchModeChange("dsm"); + onQueryChange(trimmedQuery || "major depressive disorder bipolar II disorder"); + return; + } + if (actionId === "dsm-criteria") { + onSearchModeChange("dsm"); + onQueryChange(trimmedQuery || "major depressive disorder"); + return; + } } function selectAppMode(mode: (typeof appModeDefinitions)[number]) { diff --git a/src/components/clinical-dashboard/mode-action-popup.tsx b/src/components/clinical-dashboard/mode-action-popup.tsx index 727bad734..69414188e 100644 --- a/src/components/clinical-dashboard/mode-action-popup.tsx +++ b/src/components/clinical-dashboard/mode-action-popup.tsx @@ -45,7 +45,7 @@ import { Sheet } from "@/components/ui/sheet"; import { cn, chatComposerIconButton, toolbarButton } from "@/components/ui-primitives"; export type ModeActionSetId = - "answer" | "documents" | "services" | "forms" | "favourites" | "tools" | "differentials" | "prescribing"; + "answer" | "documents" | "services" | "forms" | "favourites" | "tools" | "differentials" | "dsm" | "prescribing"; export type ModeActionPlacement = "up" | "down"; type IntegratedSurfaceLayout = { @@ -106,7 +106,10 @@ export type ModeActionId = | "differentials-build" | "differentials-criteria" | "differentials-documents" - | "differentials-evidence"; + | "differentials-evidence" + | "dsm-search" + | "dsm-compare" + | "dsm-criteria"; export type ModeActionItem = { id: ModeActionId; @@ -216,6 +219,27 @@ const modeActionSets = { }, { id: "differentials-evidence", label: "View evidence", description: "Review cited support", icon: ShieldCheck }, ], + dsm: [ + { + id: "dsm-search", + label: "Search diagnoses", + description: "Find criteria and ICD codes", + icon: Search, + primary: true, + }, + { + id: "dsm-compare", + label: "Compare diagnoses", + description: "Review distinctions side by side", + icon: GitBranch, + }, + { + id: "dsm-criteria", + label: "Review criteria", + description: "Open core diagnostic criteria", + icon: ListChecks, + }, + ], prescribing: [ { id: "medication-dose", diff --git a/src/components/clinical-dashboard/universal-search-command-surface.tsx b/src/components/clinical-dashboard/universal-search-command-surface.tsx index d74aa62df..e579cff04 100644 --- a/src/components/clinical-dashboard/universal-search-command-surface.tsx +++ b/src/components/clinical-dashboard/universal-search-command-surface.tsx @@ -32,6 +32,7 @@ const domainsByTargetMode: Partial> = services: ["services"], forms: ["forms"], differentials: ["differentials", "presentations"], + dsm: ["dsm"], tools: ["tools"], }; @@ -44,6 +45,7 @@ const modeIdByDomain: Record = { // Presentations are the differentials mode's umbrella pages — no app mode of their own, // so the group borrows the differentials icon and "View all in Differentials" target. presentations: "differentials", + dsm: "dsm", tools: "tools", }; @@ -54,6 +56,7 @@ const domainHeadings: Record = { forms: "Forms", differentials: "Differentials", presentations: "Presentations", + dsm: "DSM-5 Diagnoses", tools: "Tools", }; @@ -628,11 +631,13 @@ export function UniversalSearchCommandSurface({ ? "favourites" : modeId === "differentials" ? "differentials" - : modeId === "answer" - ? "answer" - : modeId === "tools" - ? "tools" - : null; + : modeId === "dsm" + ? "dsm" + : modeId === "answer" + ? "answer" + : modeId === "tools" + ? "tools" + : null; if (actionSetId) { const actions = modeActionItemsFor(actionSetId).slice(0, 3); diff --git a/src/components/dsm/dsm-comparison-page.tsx b/src/components/dsm/dsm-comparison-page.tsx new file mode 100644 index 000000000..26153b082 --- /dev/null +++ b/src/components/dsm/dsm-comparison-page.tsx @@ -0,0 +1,276 @@ +import Link from "next/link"; +import { + BookOpenCheck, + ChevronRight, + CircleAlert, + GitCompareArrows, + ListChecks, + Plus, + ShieldCheck, + X, +} from "lucide-react"; + +import { DsmPageHeader } from "@/components/dsm/dsm-page-header"; +import { cn, codeText, metadataPill, pageContainer } from "@/components/ui-primitives"; +import { dsmCriteria, type DsmDiagnosis } from "@/lib/dsm"; + +function compareHref(diagnoses: DsmDiagnosis[]) { + return `/dsm/compare?ids=${encodeURIComponent(diagnoses.map((diagnosis) => diagnosis.slug).join(","))}`; +} + +function removeDiagnosisHref(diagnoses: DsmDiagnosis[], slug: string) { + const remaining = diagnoses.filter((diagnosis) => diagnosis.slug !== slug); + return remaining.length ? compareHref(remaining) : "/dsm/compare"; +} + +type ComparisonRow = { + label: string; + values: string[]; +}; + +function comparisonRows(diagnoses: DsmDiagnosis[]): ComparisonRow[] { + return [ + { label: "ICD-10 code", values: diagnoses.map((diagnosis) => diagnosis.icd_code) }, + { label: "Category", values: diagnoses.map((diagnosis) => diagnosis.category.label) }, + { + label: "Core threshold", + values: diagnoses.map((diagnosis) => dsmCriteria(diagnosis)[0]?.text ?? "Not supplied"), + }, + { + label: "Additional criteria", + values: diagnoses.map( + (diagnosis) => + dsmCriteria(diagnosis) + .slice(1, 4) + .map((criterion) => `${criterion.label}. ${criterion.text}`) + .join(" ") || "No additional structured criteria supplied", + ), + }, + { + label: "Key features", + values: diagnoses.map( + (diagnosis) => + diagnosis.key_features + .slice(0, 3) + .map((feature) => `${feature.label}. ${feature.text}`) + .join(" ") || "Review the core criteria", + ), + }, + { + label: "Common specifiers", + values: diagnoses.map( + (diagnosis) => + diagnosis.specifiers + .slice(0, 4) + .map((specifier) => specifier.name) + .join("; ") || "No specifiers supplied", + ), + }, + { + label: "Differential flags", + values: diagnoses.map((diagnosis) => diagnosis.differentials.slice(0, 3).join("; ") || "None supplied"), + }, + { + label: "Severity specifier", + values: diagnoses.map((diagnosis) => (diagnosis.severity_specifier_supported ? "Supported" : "Not listed")), + }, + ]; +} + +export function DsmComparisonPage({ diagnoses }: { diagnoses: DsmDiagnosis[] }) { + const rows = comparisonRows(diagnoses); + + return ( +
+ + + Choose diagnoses + + } + /> + +
+
+ {diagnoses.map((diagnosis, index) => ( +
+
+ + {index + 1} + +
+

+ {diagnosis.category.label} +

+

+ {diagnosis.title} +

+ {diagnosis.icd_code} +
+
+ + + +
+ ))} + {diagnoses.length < 3 ? ( + + + + Add another diagnosis + + + ) : null} +
+ + {diagnoses.length >= 2 ? ( + <> +
+
+ + + + + + {diagnoses.map((diagnosis) => ( + + ))} + + + + {rows.map((row) => ( + + + {row.values.map((value, index) => ( + + ))} + + ))} + +
DSM diagnosis comparison
+ Compare + + {diagnosis.title} +
+ {row.label} + + {value} +
+
+
+ +
+ {rows.map((row) => ( +
+

+ {row.label} +

+
+ {row.values.map((value, index) => ( +
+
+ {diagnoses[index]?.title} +
+
+ {value} +
+
+ ))} +
+
+ ))} +
+ +
+ + + +
+

+ Use the comparison to identify what still needs clarification +

+

+ Review duration, episodicity, exclusions, substance or medication effects, medical causes, and + functional impact in the complete records. +

+
+ + Differential review + + +
+ + ) : ( +
+ +
+

Choose at least two diagnoses

+

+ Search the catalogue, select two or three records, then return to this comparison. +

+
+ + + Search diagnoses + +
+ )} + +
+ + Comparison is not ranked. + • + Open each diagnosis for complete criteria and documentation support. + +
+
+
+ ); +} diff --git a/src/components/dsm/dsm-diagnosis-page.tsx b/src/components/dsm/dsm-diagnosis-page.tsx new file mode 100644 index 000000000..e6331253a --- /dev/null +++ b/src/components/dsm/dsm-diagnosis-page.tsx @@ -0,0 +1,275 @@ +import Link from "next/link"; +import { + BookOpenCheck, + ChevronRight, + ClipboardList, + GitCompareArrows, + ListChecks, + MessageSquareText, + ShieldCheck, + Signpost, + SlidersHorizontal, +} from "lucide-react"; + +import { DsmHeaderActions, DsmPageHeader } from "@/components/dsm/dsm-page-header"; +import { cn, codeText, metadataPill, pageContainer } from "@/components/ui-primitives"; +import { dsmCriteria, resolveDsmDifferential, type DsmDiagnosis, type DsmLabeledText } from "@/lib/dsm"; + +function CriteriaRow({ criterion, index }: { criterion: DsmLabeledText; index: number }) { + return ( +
  • + + {criterion.label || index + 1} + +
    +

    + Core criterion {criterion.label || index + 1} +

    +

    {criterion.text}

    +
    +
    • + ); +} + +export function DsmDiagnosisPage({ diagnosis }: { diagnosis: DsmDiagnosis }) { + const criteria = dsmCriteria(diagnosis); + const compareHref = `/dsm/compare?ids=${encodeURIComponent(diagnosis.slug)}`; + + return ( +
    + } + /> + +
    +
    + {criteria.slice(0, 4).map((criterion, index) => ( +
    +

    + Criterion {criterion.label || index + 1} +

    +

    + {criterion.text} +

    +
    + ))} +
    + +
    +
    +
    +
    + + + +
    +

    + Core diagnostic criteria +

    +

    + All criteria are shown. No expand controls or hidden sections. +

    +
    +
    + {criteria.length ? ( +
      + {criteria.map((criterion, index) => ( + + ))} +
    + ) : ( +

    + No structured criteria were included in the supplied record. +

    + )} +
    + + {diagnosis.key_features.length > 0 && diagnosis.criteria_display.length > 0 ? ( +
    +
    + +

    + Key features +

    +
    +
      + {diagnosis.key_features.map((feature) => ( +
    • + {feature.label}. + {feature.text} +
      • + ))} +
    +
    + ) : null} + +
    +
    + +

    + Specifiers +

    + + {diagnosis.specifiers.length} + +
    + {diagnosis.specifiers.length ? ( +
    + {diagnosis.specifiers.map((specifier) => ( +
    +
    {specifier.name}
    +
    + {specifier.description || "No additional description supplied."} +
    +
    + ))} +
    + ) : ( +

    + No specifiers were included in the supplied record. +

    + )} +
    + +
    +
    + +

    + Documentation support +

    +
    +

    + {diagnosis.documentation_template} +

    +

    + Adapt this supplied template to the assessment. It is not a substitute for diagnostic reasoning or local + documentation requirements. +

    +
    +
    + + +
    + +
    + DSM-5 Diagnosis + {diagnosis.record_id} + Supplied local catalogue +
    +
    +
    + ); +} diff --git a/src/components/dsm/dsm-differential-considerations-page.tsx b/src/components/dsm/dsm-differential-considerations-page.tsx new file mode 100644 index 000000000..c7857c5aa --- /dev/null +++ b/src/components/dsm/dsm-differential-considerations-page.tsx @@ -0,0 +1,300 @@ +"use client"; + +import Link from "next/link"; +import { useMemo, useState } from "react"; +import { + ArrowRight, + BookOpenCheck, + CheckCircle2, + ChevronRight, + CircleHelp, + GitCompareArrows, + ListFilter, + Scale, + ShieldCheck, +} from "lucide-react"; + +import { DsmPageHeader } from "@/components/dsm/dsm-page-header"; +import { cn, codeText, metadataPill, pageContainer } from "@/components/ui-primitives"; + +export type DsmDifferentialConsideration = { + id: string; + title: string; + fullText: string; + rationale: string; + group: "course" | "substance-medical" | "context" | "overlap"; + matchedDiagnosis?: { + slug: string; + title: string; + icdCode: string; + category: string; + coreFeatures: string[]; + }; +}; + +const groups = [ + { id: "all", label: "All considerations" }, + { id: "course", label: "Course & threshold" }, + { id: "substance-medical", label: "Substance / medical" }, + { id: "context", label: "Context & development" }, + { id: "overlap", label: "Clinical overlap" }, +] as const; + +type GroupId = (typeof groups)[number]["id"]; + +export function DsmDifferentialConsiderationsPage({ + diagnosis, + considerations, +}: { + diagnosis: { slug: string; title: string; icdCode: string; category: string }; + considerations: DsmDifferentialConsideration[]; +}) { + const [activeGroup, setActiveGroup] = useState("all"); + const [selectedId, setSelectedId] = useState(considerations[0]?.id ?? ""); + const visible = useMemo( + () => considerations.filter((item) => activeGroup === "all" || item.group === activeGroup), + [activeGroup, considerations], + ); + const selected = considerations.find((item) => item.id === selectedId) ?? visible[0] ?? considerations[0]; + + function selectGroup(group: GroupId) { + setActiveGroup(group); + const first = considerations.find((item) => group === "all" || item.group === group); + if (first) setSelectedId(first.id); + } + + const comparisonHref = selected?.matchedDiagnosis + ? `/dsm/compare?ids=${encodeURIComponent(`${diagnosis.slug},${selected.matchedDiagnosis.slug}`)}` + : `/dsm/compare?ids=${encodeURIComponent(diagnosis.slug)}`; + + return ( +
    + + + Diagnosis record + + } + /> + +
    +
    +
    + +
    +

    + Structured review aid · not ranked +

    +

    + Each item is taken from the supplied local diagnosis record. Open matched records to review their + complete criteria. +

    +
    +
    + {considerations.length} considerations +
    + +
    +

    + + Review lens +

    +
    + {groups.map((group) => { + const count = considerations.filter((item) => group.id === "all" || item.group === group.id).length; + if (count === 0) return null; + const active = activeGroup === group.id; + return ( + + ); + })} +
    +
    + + {selected ? ( +
    +
    +
    + {visible.length} {visible.length === 1 ? "consideration" : "considerations"} +
    +
    + {visible.map((item, index) => { + const active = item.id === selected.id; + return ( + + ); + })} +
    +
    + +
    +
    +

    + Differential consideration +

    +

    + {selected.title} +

    + {selected.matchedDiagnosis ? ( +
    + {selected.matchedDiagnosis.icdCode} + {selected.matchedDiagnosis.category} +
    + ) : null} +
    + +
    +
    +
    + +

    + Why consider it +

    +
    +

    + {selected.rationale} +

    +
    + +
    +
    + +

    + Criteria and features to review +

    +
    + {selected.matchedDiagnosis?.coreFeatures.length ? ( +
      + {selected.matchedDiagnosis.coreFeatures.map((feature) => ( +
    • + + {feature} +
      • + ))} +
    + ) : ( +

    + No matching structured diagnosis record was identified. Review the supplied consideration exactly + as written: {selected.fullText} +

    + )} +
    + +
    +
    + +

    + Questions to clarify +

    +
    +
      +
    • Which documented criteria and exclusions are met for each possibility?
      • +
    • What timeline, course, and functional change best distinguishes the alternatives?
      • +
    • + Are substance, medication, medical, developmental, and contextual explanations adequately + assessed? +
      • +
    +
    + +
    + {selected.matchedDiagnosis ? ( + + Open diagnosis record + + + ) : null} + + + Add to comparison + +
    +
    +
    +
    + ) : ( +
    +

    + No differential considerations supplied +

    +

    + Return to the diagnosis record to review the available criteria and specifiers. +

    +
    + )} +
    +
    + ); +} diff --git a/src/components/dsm/dsm-home-page.tsx b/src/components/dsm/dsm-home-page.tsx new file mode 100644 index 000000000..fb890f5a6 --- /dev/null +++ b/src/components/dsm/dsm-home-page.tsx @@ -0,0 +1,62 @@ +import { BookOpenCheck, GitCompareArrows, ListChecks, Search, ShieldCheck } from "lucide-react"; + +import { ModeHomeMain, ModeHomeTemplate, ModeHomeVerificationFooter } from "@/components/mode-home-template"; +import { dsmCategories, dsmDiagnoses } from "@/lib/dsm"; +import { modeHomeDesktopComposerSlotId } from "@/lib/mode-home-composer"; + +const featuredCategories = dsmCategories + .slice() + .sort((left, right) => right.diagnosis_count - left.diagnosis_count) + .slice(0, 5); + +export function DsmHomePage() { + return ( + + ({ + label: `${category.label} · ${category.diagnosis_count}`, + shortLabel: category.label, + href: `/dsm/search?category=${category.key}`, + icon: BookOpenCheck, + }))} + footer={ + + } + /> + + ); +} diff --git a/src/components/dsm/dsm-page-header.tsx b/src/components/dsm/dsm-page-header.tsx new file mode 100644 index 000000000..3e5f1d8ed --- /dev/null +++ b/src/components/dsm/dsm-page-header.tsx @@ -0,0 +1,88 @@ +import Link from "next/link"; +import { ArrowLeft, BookOpenCheck, GitCompareArrows, Search } from "lucide-react"; +import type { ReactNode } from "react"; + +import { cn, codeText, metadataPill, pageContainer } from "@/components/ui-primitives"; + +export function DsmPageHeader({ + eyebrow = "DSM-5 Diagnosis", + title, + description, + code, + category, + actions, + className, +}: { + eyebrow?: string; + title: string; + description?: string; + code?: string; + category?: string; + actions?: ReactNode; + className?: string; +}) { + return ( +
    +
    +
    +
    + + + DSM-5 Diagnosis home + +

    + {eyebrow} +

    +
    + + + +
    +

    + {title} +

    + {description ? ( +

    + {description} +

    + ) : null} + {code || category ? ( +
    + {code ? {code} : null} + {category ? {category} : null} + Local clinical reference +
    + ) : null} +
    +
    +
    + {actions ?
    {actions}
    : null} +
    +
    +
    + ); +} + +export function DsmHeaderActions({ compareHref = "/dsm/compare" }: { compareHref?: string }) { + return ( + <> + + + Search + + + + Compare + + + ); +} diff --git a/src/components/dsm/dsm-search-page.tsx b/src/components/dsm/dsm-search-page.tsx new file mode 100644 index 000000000..19048c4aa --- /dev/null +++ b/src/components/dsm/dsm-search-page.tsx @@ -0,0 +1,276 @@ +"use client"; + +import Link from "next/link"; +import { useMemo, useState } from "react"; +import { BookOpenCheck, Check, ChevronRight, CircleAlert, GitCompareArrows, ListFilter, SearchX } from "lucide-react"; + +import { DsmPageHeader } from "@/components/dsm/dsm-page-header"; +import { cn, codeText, metadataPill, pageContainer } from "@/components/ui-primitives"; +import type { DsmCategory, DsmDiagnosisSummary } from "@/lib/dsm"; + +function categoryHref(query: string, category?: string) { + const params = new URLSearchParams(); + if (query) params.set("q", query); + if (category) params.set("category", category); + const suffix = params.toString(); + return suffix ? `/dsm/search?${suffix}` : "/dsm/search"; +} + +function compareHref(slugs: string[]) { + const params = new URLSearchParams({ ids: slugs.join(",") }); + return `/dsm/compare?${params.toString()}`; +} + +export function DsmSearchPage({ + query, + category, + categories, + results, + totalCount, +}: { + query: string; + category?: string; + categories: DsmCategory[]; + results: DsmDiagnosisSummary[]; + totalCount: number; +}) { + const [selected, setSelected] = useState([]); + const activeCategory = categories.find((item) => item.key === category); + const selectedSet = useMemo(() => new Set(selected), [selected]); + const canCompare = selected.length >= 2; + + function toggleDiagnosis(slug: string) { + setSelected((current) => { + if (current.includes(slug)) return current.filter((item) => item !== slug); + if (current.length >= 3) return [...current.slice(1), slug]; + return [...current, slug]; + }); + } + + const description = query + ? `${results.length} ${results.length === 1 ? "match" : "matches"} for “${query}”${ + activeCategory ? ` in ${activeCategory.label}` : "" + }.` + : `${results.length} of ${totalCount} diagnoses${activeCategory ? ` in ${activeCategory.label}` : ""}.`; + + return ( +
    + + + Compare {selected.length} + + ) : null + } + /> + +
    +
    +
    +

    + + Filter by category +

    + {activeCategory ? ( + + Clear filter + + ) : null} +
    +
    + + All · {totalCount} + + {categories.map((item) => ( + + {item.label} · {item.diagnosis_count} + + ))} +
    +
    + + {results.length ? ( +
    +
    +
    + Select + Diagnosis + Category + ICD-10 + +
    +
    + {results.map((result) => { + const isSelected = selectedSet.has(result.slug); + return ( +
    + + +

    + {result.title} +

    +

    + {result.summary} +

    +
    + {result.category.label} + {result.icd_code} +
    + + + {result.category.label} + + + {result.icd_code} + + + + +
    + ); + })} +
    +
    + + +
    + ) : ( +
    + + + +
    +

    No diagnosis matches

    +

    + Try a diagnosis name, ICD code, symptom phrase, or a broader category. +

    +
    + + Browse all diagnoses + +
    + )} +
    +
    + ); +} diff --git a/src/data/dsm-clinical-content.json b/src/data/dsm-clinical-content.json new file mode 100644 index 000000000..88c28a4b5 --- /dev/null +++ b/src/data/dsm-clinical-content.json @@ -0,0 +1,8473 @@ +{ + "export_format_version": "1.0.0", + "generated_at": "2026-07-14T05:27:04.988Z", + "source_repository": "dsm-5-diagnosis", + "content_scope": "Complete local diagnosis catalogue; no standalone therapy/treatment dataset exists in the source model.", + "categories": [ + { + "key": "mood", + "label": "Mood Disorders", + "css_class": "gmod", + "color": "#C49A00", + "diagnosis_count": 11 + }, + { + "key": "psy", + "label": "Psychotic Disorders", + "css_class": "gpsy", + "color": "#C43232", + "diagnosis_count": 8 + }, + { + "key": "anx", + "label": "Anxiety & Fear-Based", + "css_class": "ga", + "color": "#7F77DD", + "diagnosis_count": 9 + }, + { + "key": "sub", + "label": "Substance-Related", + "css_class": "gs", + "color": "#D85A30", + "diagnosis_count": 9 + }, + { + "key": "trm", + "label": "Trauma & Stressor-Related", + "css_class": "gtr", + "color": "#8B7035", + "diagnosis_count": 7 + }, + { + "key": "ncg", + "label": "Neurocognitive & Delirium", + "css_class": "gn", + "color": "#378ADD", + "diagnosis_count": 13 + }, + { + "key": "eat", + "label": "Eating & Feeding", + "css_class": "ge", + "color": "#D4537E", + "diagnosis_count": 7 + }, + { + "key": "per", + "label": "Personality Disorders", + "css_class": "gp", + "color": "#BA7517", + "diagnosis_count": 12 + }, + { + "key": "ndv", + "label": "Neurodevelopmental", + "css_class": "gt", + "color": "#1D9E75", + "diagnosis_count": 14 + }, + { + "key": "med", + "label": "Due to Medical Condition", + "css_class": "gm", + "color": "#2D6EA0", + "diagnosis_count": 0 + }, + { + "key": "ocd", + "label": "OCD & Related", + "css_class": "gocd", + "color": "#2E9952", + "diagnosis_count": 6 + }, + { + "key": "dis", + "label": "Dissociative", + "css_class": "gdis", + "color": "#7055C8", + "diagnosis_count": 4 + }, + { + "key": "som", + "label": "Somatic & Functional", + "css_class": "gsom", + "color": "#9C7848", + "diagnosis_count": 5 + }, + { + "key": "slp", + "label": "Sleep-Wake", + "css_class": "gslp", + "color": "#2D5099", + "diagnosis_count": 9 + }, + { + "key": "sex", + "label": "Sexual Dysfunction", + "css_class": "gsex", + "color": "#B83250", + "diagnosis_count": 8 + }, + { + "key": "dsr", + "label": "Disruptive & Impulse-Control", + "css_class": "gdsr", + "color": "#C47000", + "diagnosis_count": 6 + }, + { + "key": "mim", + "label": "Medication-Induced Movement", + "css_class": "gmim", + "color": "#2D7A8B", + "diagnosis_count": 8 + }, + { + "key": "par", + "label": "Paraphilic & Gender Dysphoria", + "css_class": "gpar", + "color": "#7B4BB0", + "diagnosis_count": 10 + } + ], + "diagnoses": [ + { + "record_id": "DSM-mood-bipolar-i-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F31.1x-F31.9", + "title": "Bipolar I disorder", + "key_features": [ + { + "label": "A", + "text": "≥1 full manic episode (abnormally elevated/expansive/irritable mood + ↑energy, ≥7 days or any duration if hospitalised)" + }, + { + "label": "B", + "text": "Manic episode not better explained by schizoaffective, schizophrenia, schizophreniform, delusional, or other psychotic disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Current or most recent episode: Manic / Hypomanic / Depressed", + "description": "Identifies polarity of current or most recent episode." + }, + { + "name": "With psychotic features", + "description": "Hallucinations or delusions present during mood episodes." + }, + { + "name": "In partial remission / In full remission", + "description": "Partial symptom resolution or full return to baseline." + }, + { + "name": "With anxious distress", + "description": "Prominent tension, restlessness, or worry." + }, + { + "name": "With mixed features", + "description": "Concurrent manic and depressive symptoms." + }, + { + "name": "With rapid cycling", + "description": "≥4 mood episodes in 12 months." + }, + { + "name": "With melancholic features", + "description": "Anhedonia, non-reactive mood, psychomotor disturbance." + }, + { + "name": "With atypical features", + "description": "Mood reactivity, hypersomnia, increased appetite, rejection sensitivity." + }, + { + "name": "With mood-congruent psychotic features", + "description": "Psychosis aligned with manic/depressive themes." + }, + { + "name": "With mood-incongruent psychotic features", + "description": "Psychosis not aligned with mood state." + }, + { + "name": "With catatonia", + "description": "Catatonic motor or behavioural features." + }, + { + "name": "With peripartum onset", + "description": "Onset during pregnancy or within four weeks postpartum." + }, + { + "name": "With seasonal pattern", + "description": "Episodes display seasonal recurrence." + } + ], + "differentials": [ + "Bipolar II disorder (hypomania only - never full mania)", + "Major depressive disorder (no manic history)", + "Schizoaffective disorder (psychosis independent of mood episodes)", + "Substance/medication-induced mania (steroids, stimulants, antidepressants)", + "Bipolar due to another medical condition (thyrotoxicosis, CNS lesion)", + "ADHD or BPD (impulsivity vs episodic mood elevation)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Bipolar I Disorder] [specifier(s)]. During a distinct period of at least one week, there have been abnormally elevated or expansive mood; irritable mood; inflated self-esteem; grandiosity; decreased need for sleep; increased talkativeness; pressured speech; flight of ideas; racing thoughts; distractibility; increased goal-directed activity; psychomotor agitation; engagement in high-risk or harmful activities, forming a pattern meeting the threshold for a manic episode with at least three symptoms (or four when mood is irritable). The presentation is further characterised by marked mood dysregulation with associated changes in energy, activity, and behaviour, and may include major depressive episodes where relevant. These symptoms have resulted in clinically significant impairment, interpersonal or occupational disruption, or required hospitalisation, and the disturbance is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or substance/medication effects.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mood-bipolar-ii-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F31.81", + "title": "Bipolar II disorder", + "key_features": [ + { + "label": "A", + "text": "≥1 hypomanic episode + ≥1 major depressive episode; never a full manic episode" + }, + { + "label": "B", + "text": "Hypomanic/depressive episodes not better explained by schizoaffective or other psychotic disorder" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment in functioning" + } + ], + "criteria_display": [ + { + "label": "A", + "text": "Hypomanic episode threshold has been met." + }, + { + "label": "B", + "text": "Major depressive episode threshold has been met." + }, + { + "label": "C", + "text": "There has never been a manic episode." + }, + { + "label": "D", + "text": "The mood episodes are not better explained by schizoaffective disorder or another schizophrenia-spectrum or psychotic disorder." + }, + { + "label": "E", + "text": "The pattern causes clinically significant distress, functional impairment, or clinically important instability requiring diagnostic attention." + } + ], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Current or most recent episode: Hypomanic / Depressed", + "description": "Identifies polarity of current or latest episode." + }, + { + "name": "With anxious distress", + "description": "Prominent tension, restlessness, or worry." + }, + { + "name": "With mixed features", + "description": "Concurrent hypomanic and depressive symptoms." + }, + { + "name": "With rapid cycling", + "description": "≥4 mood episodes within 12 months." + }, + { + "name": "With mood-congruent psychotic features", + "description": "Psychosis aligned with depressive themes (not applicable during hypomania)." + }, + { + "name": "With mood-incongruent psychotic features", + "description": "Psychosis not aligned with depressive themes." + }, + { + "name": "With melancholic features", + "description": "Anhedonia, psychomotor disturbance, diurnal variation." + }, + { + "name": "With atypical features", + "description": "Mood reactivity, hypersomnia, increased appetite, rejection sensitivity." + }, + { + "name": "With peripartum onset", + "description": "Onset during pregnancy or within four weeks postpartum." + }, + { + "name": "With seasonal pattern", + "description": "Depressive episodes show seasonal recurrence." + } + ], + "differentials": [ + "Bipolar I disorder (full manic episode present - reclassify)", + "Major depressive disorder (hypomanic periods not identified)", + "Cyclothymic disorder (subthreshold fluctuation; < 2 years)", + "Borderline personality disorder (affective instability vs episodic elevation)", + "ADHD (chronic inattention/impulsivity vs episodic mood elevation)", + "Substance-induced mood disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Bipolar II Disorder] [specifier(s)]. Across distinct episodes, there have been periods of elevated or expansive mood; irritable mood; inflated self-esteem; grandiosity; decreased need for sleep; increased talkativeness; pressured speech; flight of ideas; racing thoughts; distractibility; increased goal-directed activity; psychomotor agitation; engagement in risky activities, forming a pattern meeting the threshold for a hypomanic episode with at least four consecutive days and at least three of the above symptoms (or four when mood is irritable). In addition, there have been major depressive episodes characterised by depressed mood; markedly diminished interest; significant appetite or weight change; insomnia; hypersomnia; psychomotor agitation; psychomotor retardation; fatigue; loss of energy; feelings of worthlessness; excessive guilt; impaired concentration; indecisiveness; recurrent thoughts of death; suicidal ideation, meeting the threshold for a depressive episode over at least two weeks. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better accounted for by schizoaffective disorder, schizophrenia spectrum disorders, substance/medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mood-cyclothymic-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F34.0", + "title": "Cyclothymic disorder", + "key_features": [ + { + "label": "A", + "text": "≥2 years (≥1 yr children/adolescents) of hypomanic AND depressive symptoms not meeting full episode criteria" + }, + { + "label": "B", + "text": "Hypomanic/depressive periods present >50% of time; no gap >2 months" + }, + { + "label": "C", + "text": "Never met criteria for hypomanic, manic, or major depressive episode" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment" + }, + { + "label": "E", + "text": "Not better explained by schizoaffective, schizophrenia, or other psychotic disorder" + }, + { + "label": "F", + "text": "Not attributable to substances or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With anxious distress", + "description": "Prominent tension, worry, or restlessness." + } + ], + "differentials": [ + "Bipolar II disorder (full hypomanic or depressive episodes present)", + "Borderline PD (identity disturbance, self-harm, abandonment fears)", + "ADHD (chronic not episodic)", + "Temperamental variation (below clinical threshold)", + "SUD (mood driven by use cycle)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Cyclothymic Disorder] [specifier(s)]. Over at least two years (one year in children/adolescents), there have been numerous periods of hypomanic symptoms - including elevated or expansive mood; irritable mood; inflated self-esteem; decreased need for sleep; increased talkativeness; pressured speech; flight of ideas; racing thoughts; distractibility; increased goal-directed activity; psychomotor agitation; engagement in risky activities - that do not meet full criteria for a hypomanic episode, alongside numerous periods of depressive symptoms - including depressed mood; diminished interest or pleasure; appetite or weight change; insomnia; hypersomnia; psychomotor agitation; psychomotor retardation; fatigue; loss of energy; feelings of worthlessness; excessive guilt; impaired concentration; indecisiveness; recurrent thoughts of death - that do not meet full criteria for a major depressive episode. Symptoms present for at least half the time, with no gap of more than two consecutive months. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better accounted for by bipolar I disorder, bipolar II disorder, substance/medication effects, or a primary medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-mood-disruptive-mood-dysregulation-disorder-dmdd", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F34.81", + "title": "Disruptive mood dysregulation disorder (DMDD)", + "key_features": [ + { + "label": "A", + "text": "Severe recurrent temper outbursts (verbal or behavioural), grossly disproportionate to situation, ≥3×/week" + }, + { + "label": "B", + "text": "Persistently irritable or angry mood between outbursts, most of the day, nearly every day, observable by others" + }, + { + "label": "C", + "text": "Criteria A and B present ≥12 months; no gap ≥3 consecutive months symptom-free" + }, + { + "label": "D", + "text": "Outbursts in ≥2 settings (home, school, peers); severe in ≥1 setting" + }, + { + "label": "E", + "text": "Age 6–18 at diagnosis; onset before age 10" + }, + { + "label": "F", + "text": "No distinct manic or hypomanic episode lasting >1 day" + }, + { + "label": "G", + "text": "Not attributable to substances or medical condition; not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Based on frequency of outbursts, functional impairment, and degree of persistent irritability." + } + ], + "differentials": [ + "Bipolar disorder (episodic mania/hypomania; DMDD is chronic irritability)", + "ODD (milder severity)", + "ADHD (impulsivity without severe outburst pattern)", + "MDD (full depressive episodes)", + "ASD or intellectual disability (may coexist)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Disruptive Mood Dysregulation Disorder] [specifier(s)]. Since before age 10, and over a duration of at least 12 months, there have been severe recurrent temper outbursts; outbursts grossly out of proportion to the situation; outbursts inconsistent with developmental level; outbursts occurring on average three or more times per week; and persistently irritable or angry mood between outbursts, across at least two settings, with at least one setting showing marked impairment. These symptoms have resulted in clinically significant distress or impairment in social, academic, or familial functioning. The picture is not better explained by bipolar disorder, intermittent explosive disorder, autism spectrum disorder, PTSD, separation anxiety disorder, or a substance/medical condition, and manic or hypomanic episodes have never been present.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mood-major-depressive-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F32.x-F33.x", + "title": "Major depressive disorder", + "key_features": [ + { + "label": "A", + "text": "≥5 of 9 SIG-E-CAPS symptoms for ≥2 weeks; ≥1 must be depressed mood or anhedonia" + }, + { + "label": "B", + "text": "Clinically significant distress or impairment in functioning" + }, + { + "label": "C", + "text": "Not attributable to substances or another medical condition" + }, + { + "label": "D", + "text": "Not better explained by schizoaffective/schizophrenia spectrum disorder" + }, + { + "label": "E", + "text": "No prior manic or hypomanic episode (unless substance/medication-induced)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Single episode / Recurrent", + "description": "One discrete episode or multiple documented episodes." + }, + { + "name": "Mild / Moderate / Severe", + "description": "Based on symptom load and functional impairment." + }, + { + "name": "With psychotic features", + "description": "Hallucinations or delusions present during the depressive episode." + }, + { + "name": "In partial remission / In full remission", + "description": "Residual symptoms vs resolution." + }, + { + "name": "With anxious distress", + "description": "Prominent tension, worry, or restlessness." + }, + { + "name": "With mixed features", + "description": "Subthreshold concurrent manic symptoms." + }, + { + "name": "With melancholic features", + "description": "Anhedonia, non-reactive mood, psychomotor change, morning worsening." + }, + { + "name": "With atypical features", + "description": "Mood reactivity, increased appetite or sleep, rejection sensitivity." + }, + { + "name": "With mood-congruent psychotic features", + "description": "Psychosis aligned with depressive themes." + }, + { + "name": "With mood-incongruent psychotic features", + "description": "Psychosis not aligned with depressive themes." + }, + { + "name": "With catatonia", + "description": "Catatonic motor or behavioural features." + }, + { + "name": "With peripartum onset", + "description": "Onset during pregnancy or within four weeks postpartum." + }, + { + "name": "With seasonal pattern", + "description": "Episodes occurring predictably in relation to seasons." + } + ], + "differentials": [ + "Bipolar I or II disorder (prior manic or hypomanic episode - always ask before treating)", + "Persistent depressive disorder / dysthymia (milder, chronic > 2 years)", + "Grief/bereavement (proportionate; preserved pleasure)", + "PMDD (temporally linked to luteal phase)", + "Depressive disorder due to another medical condition", + "Substance/medication-induced depressive disorder", + "Adjustment disorder with depressed mood" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Major Depressive Disorder] [specifier(s)]. Over at least two weeks, there have been depressed mood; markedly diminished interest or pleasure; significant weight or appetite change; insomnia; hypersomnia; psychomotor agitation; psychomotor retardation; fatigue; loss of energy; feelings of worthlessness; excessive guilt; impaired concentration; indecisiveness; recurrent thoughts of death; suicidal ideation, forming a pattern meeting the threshold for a major depressive episode with at least one of depressed mood and diminished interest. The presentation is further characterised by associated emotional, cognitive, and behavioural changes consistent with a depressive syndrome. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by bipolar disorder, schizoaffective disorder, a substance or medication effect, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mood-persistent-depressive-disorder-dysthymia", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F34.1", + "title": "Persistent depressive disorder (dysthymia)", + "key_features": [ + { + "label": "A", + "text": "Depressed mood most of the day, more days than not, for ≥2 years (≥1 yr children/adolescents)" + }, + { + "label": "B", + "text": "≥2 of: poor appetite/overeating; insomnia/hypersomnia; low energy; low self-esteem; poor concentration; hopelessness" + }, + { + "label": "C", + "text": "No symptom-free period >2 months in the 2-year span" + }, + { + "label": "D", + "text": "MDE criteria may be continuously met throughout the 2-year period (double depression)" + }, + { + "label": "E", + "text": "No manic, hypomanic, or cyclothymic episode" + }, + { + "label": "F", + "text": "Not better explained by a psychotic disorder" + }, + { + "label": "G", + "text": "Not attributable to substances or another medical condition" + }, + { + "label": "H", + "text": "Clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With pure dysthymic syndrome", + "description": "Full PDD without concurrent major depressive episode." + }, + { + "name": "With persistent major depressive episode", + "description": "Full MDE criteria met continuously for ≥2 years." + }, + { + "name": "With intermittent MDEs, with current episode", + "description": "PDD plus current MDE." + }, + { + "name": "With intermittent MDEs, without current episode", + "description": "PDD with past MDEs only." + }, + { + "name": "Mild / Moderate / Severe", + "description": "Based on symptom intensity and functional impairment." + }, + { + "name": "Early onset", + "description": "Onset before age 21." + }, + { + "name": "Late onset", + "description": "Onset at age 21 or older." + } + ], + "differentials": [ + "MDD (full episode criteria met - not chronic subthreshold)", + "Bipolar II with persistent depression", + "Cyclothymic disorder", + "Dysthymia due to medical condition (hypothyroidism, sleep disorder)", + "Substance-induced persistent depressive disorder", + "Personality disorder with chronic low mood" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Persistent Depressive Disorder] [specifier(s)]. Over at least two years (or one year in children/adolescents), there has been a persistently depressed mood accompanied by poor appetite; overeating; insomnia; hypersomnia; low energy; fatigue; low self-esteem; impaired concentration; indecisiveness; feelings of hopelessness, forming a chronic depressive pattern. The presentation is further characterised by symptoms present more days than not, with no remission longer than two months. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by bipolar disorder, cyclothymic disorder, a substance or medication effect, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mood-premenstrual-dysphoric-disorder-pmdd", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F32.81", + "title": "Premenstrual dysphoric disorder (PMDD)", + "key_features": [ + { + "label": "A", + "text": "≥5 symptoms in final week before menses, improve within days of onset, become minimal/absent post-menses" + }, + { + "label": "B", + "text": "≥1 of: marked affective lability; irritability/anger; depressed mood; marked anxiety/tension" + }, + { + "label": "C", + "text": "≥1 additional symptom: decreased interest; concentration difficulty; lethargy; appetite change; hypersomnia/insomnia; overwhelmed; physical symptoms (bloating, breast tenderness, swelling, weight gain)" + }, + { + "label": "D", + "text": "Clinically significant distress or interference with daily activities" + }, + { + "label": "E", + "text": "Not merely exacerbation of another disorder" + }, + { + "label": "F", + "text": "Confirmed prospectively by daily ratings over ≥2 cycles" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Based on degree of interference and symptom intensity." + }, + { + "name": "In partial remission", + "description": "Residual symptoms remain but do not meet full PMDD criteria." + }, + { + "name": "In full remission", + "description": "Symptoms no longer meet PMDD criteria." + } + ], + "differentials": [ + "Premenstrual syndrome - below PMDD threshold", + "MDD with luteal worsening", + "Bipolar disorder with perimenstrual exacerbation", + "Perimenopause-related mood changes", + "Hypothyroidism or anaemia" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Premenstrual Dysphoric Disorder] [specifier(s)]. In the majority of menstrual cycles, symptoms have occurred during the final week before menses, improved within days of onset of menses, and become minimal or absent in the week post-menses. Symptoms include marked affective lability; irritability; anger; increased interpersonal conflict; depressed mood; hopelessness; anxiety; tension; decreased interest in usual activities; difficulty concentrating; lethargy; marked change in appetite; hypersomnia; insomnia; feeling overwhelmed; physical symptoms such as breast tenderness; bloating; weight gain, forming a constellation with at least one mood symptom and five or more total symptoms. These symptoms have resulted in clinically significant distress or impairment, and the picture is not better explained by another depressive, bipolar, or anxiety disorder, substance use, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mood-depressive-disorder-due-to-another-medical-condition", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F06.31-F06.34", + "title": "Depressive disorder due to another medical condition", + "key_features": [ + { + "label": "A", + "text": "Prominent depressive episode directly attributable to physiological effects of a medical condition" + }, + { + "label": "B", + "text": "Not better explained by another mental disorder" + }, + { + "label": "C", + "text": "Not occurring exclusively during delirium" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With depressive features", + "description": "Predominant depressive symptoms linked to the medical condition." + }, + { + "name": "With major depressive-like episode", + "description": "Full syndrome resembling a MDE attributable to the medical condition." + }, + { + "name": "With mixed features", + "description": "Prominent depressive symptoms with concurrent subthreshold manic symptoms." + }, + { + "name": "With psychotic features", + "description": "Hallucinations or delusions arising from the medical condition." + }, + { + "name": "Acute / Persistent", + "description": "Symptoms in the immediate setting vs persisting beyond the acute phase." + } + ], + "differentials": [ + "Primary MDD (independent of GMC)", + "Adjustment disorder with depressed mood (GMC as stressor, not cause)", + "Substance/medication-induced depressive disorder", + "Delirium with depressive features" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Depressive Disorder Due to Another Medical Condition] [specifier(s)]. In the context of a documented medical illness temporally associated with mood change, there have been depressed mood; diminished interest or pleasure; significant weight or appetite change; insomnia; hypersomnia; psychomotor agitation; psychomotor retardation; fatigue or loss of energy; feelings of worthlessness; excessive guilt; impaired concentration; indecisiveness; recurrent thoughts of death; suicidal ideation, representing a depressive syndrome judged to be the direct physiological consequence of the identified medical condition. The presentation is characterised by mood and behavioural changes that align temporally and pathophysiologically with the underlying medical disorder. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by a primary depressive disorder, substance or medication effect, or delirium.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-mood-other-specified-bipolar-and-related-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F31.89", + "title": "Other specified bipolar and related disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a bipolar/related disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific bipolar or related disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason criteria not met (e.g. short-duration hypomanic episodes; insufficient symptoms)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Short-duration hypomanic episodes (2-3 days) with MDEs", + "description": "Hypomania < usual duration with major depressive episodes." + }, + { + "name": "Hypomanic episodes with insufficient symptoms with MDEs", + "description": "Hypomanic periods not meeting full symptom threshold, with MDEs." + }, + { + "name": "Hypomanic episode without prior MDE", + "description": "Hypomanic symptoms without history of major depressive episodes." + }, + { + "name": "Short-duration cyclothymia", + "description": "Fluctuating hypomanic and depressive symptoms < required duration for cyclothymia." + }, + { + "name": "Other specified bipolar presentation", + "description": "Bipolar-spectrum features with impairment not fitting above patterns." + } + ], + "differentials": [ + "Bipolar I or II (full criteria met - reclassify)", + "Cyclothymia (≥2 years of subthreshold fluctuation)", + "MDD with mixed features", + "Substance-induced bipolar-spectrum symptoms" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Bipolar and Related Disorder] [specifier(s)]. There have been elevated mood; expansive mood; irritable mood; increased energy or goal-directed activity; decreased need for sleep; increased talkativeness or pressured speech; flight of ideas or subjective racing thoughts; distractibility; increased involvement in activities with potential for adverse consequences, occurring in a bipolar-spectrum pattern that is clinically significant but does not meet full criteria for bipolar I disorder, bipolar II disorder, or cyclothymic disorder, due to atypical duration, subthreshold symptom count, or context-specific features. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better accounted for by unipolar depressive disorders, schizophrenia spectrum disorders, substance/medication-induced mood disturbance, or mood change due to another medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-mood-unspecified-bipolar-and-related-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F31.9", + "title": "Unspecified bipolar and related disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a bipolar/related disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific bipolar disorder; clinician chooses not to specify reason" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "None (unspecified)", + "description": "Bipolar-spectrum symptoms with impairment but insufficient diagnostic clarity." + } + ], + "differentials": [ + "Specific bipolar disorder (full criteria met - reclassify)", + "Schizoaffective disorder", + "Primary psychotic disorder", + "Substance-induced mood disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Unspecified Bipolar and Related Disorder]. There are clinically significant mood symptoms within the bipolar spectrum - including elevated or expansive mood; irritable mood; inflated self-esteem; grandiosity; decreased need for sleep; increased talkativeness; pressured speech; flight of ideas; racing thoughts; distractibility; increased goal-directed activity; psychomotor agitation; engagement in risky activities; depressed mood; markedly diminished interest or pleasure; significant weight or appetite change; insomnia; hypersomnia; psychomotor retardation; fatigue; loss of energy; feelings of worthlessness; excessive guilt; impaired concentration; indecisiveness; recurrent thoughts of death; suicidal ideation - forming a bipolar-spectrum pattern that causes impairment but does not meet full criteria for any specific bipolar disorder due to insufficient duration, incomplete symptom constellation, atypical course, or limited available information. The picture is not better explained by a defined bipolar disorder, substance or medication effect, a primary psychotic disorder, or a medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-mood-other-specified-unspecified-depressive-disorder", + "category": { + "key": "mood", + "label": "Mood Disorders" + }, + "icd_code": "F32.89/F32.9", + "title": "Other specified / Unspecified depressive disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a depressive disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific depressive disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason criteria not met (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Short-duration depressive episode", + "description": "Depressive symptoms < 2 weeks meeting most features of MDE." + }, + { + "name": "Depressive episode with insufficient symptoms", + "description": "Depressed mood or anhedonia with impairment but fewer symptoms than MDD." + }, + { + "name": "Recurrent brief depression", + "description": "Episodes < 2 weeks occurring ≥ monthly for a year." + }, + { + "name": "Other specified depressive presentation", + "description": "Features not fitting above patterns but warranting specification." + } + ], + "differentials": [ + "MDD (full criteria met - reclassify)", + "PDD/Dysthymia (chronic subthreshold)", + "Adjustment disorder with depressed mood", + "Bipolar disorder", + "Medical/substance-induced depressive disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Depressive Disorder] [specifier(s)]. There have been depressed mood; markedly diminished interest or pleasure; fatigue or low energy; sleep disturbance; appetite or weight change; impaired concentration or indecisiveness; feelings of worthlessness or excessive guilt; recurrent thoughts of death or suicidal ideation, occurring in a depressive pattern that is clinically significant but does not meet full criteria for major depressive disorder, persistent depressive disorder, or another specified depressive disorder, due to atypical duration, subthreshold symptom count, or context-specific features. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better accounted for by bipolar and related disorders, schizoaffective disorder, substance/medication-induced depressive disorder, or depressive disorder due to another medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-schizophrenia", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F20.x", + "title": "Schizophrenia", + "key_features": [ + { + "label": "A", + "text": "≥2 of: delusions; hallucinations; disorganised speech; grossly disorganised/catatonic behaviour; negative symptoms — ≥1 must be delusions, hallucinations, or disorganised speech" + }, + { + "label": "B", + "text": "≥1 area of functioning (work, relationships, self-care) markedly below premorbid level" + }, + { + "label": "C", + "text": "Continuous signs ≥6 months; includes ≥1 month of active-phase symptoms (or less if successfully treated)" + }, + { + "label": "D", + "text": "Schizoaffective and mood disorders excluded" + }, + { + "label": "E", + "text": "Not attributable to substances or another medical condition" + }, + { + "label": "F", + "text": "If autism/social communication disorder history, schizophrenia only if prominent delusions/hallucinations ≥1 month" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "First episode, currently acute / partial remission / full remission", + "description": "Stage of the initial illness episode." + }, + { + "name": "Multiple episodes, currently acute / partial remission / full remission", + "description": "Recurrent episodes with varying current status." + }, + { + "name": "Continuous", + "description": "Symptoms meeting full or partial criteria for most of the illness course." + }, + { + "name": "With catatonia", + "description": "Catatonic features present." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on positive/negative symptoms, behavioural disturbance, and functional impairment." + } + ], + "differentials": [ + "Schizoaffective disorder (mood episode for majority of illness duration)", + "Bipolar/MDD with psychotic features (psychosis only during mood episodes)", + "Schizophreniform disorder (duration 1-6 months)", + "Brief psychotic disorder (1 day - 1 month)", + "Delusional disorder (non-bizarre delusions; preserved function)", + "Substance-induced psychosis", + "Psychotic disorder due to another medical condition" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Schizophrenia] [specifier(s)]. Over at least one month (active phase) within a total disturbance duration of at least six months, there have been delusions; hallucinations; disorganised speech; grossly disorganised behaviour; catatonic features; negative symptoms, forming a pattern consistent with a persistent schizophrenia-spectrum illness. The presentation is further characterised by marked social or occupational decline; impaired role functioning; affective flattening or blunting; avolition; cognitive disorganisation, and a course reflecting a chronic or episodic pattern with incomplete remission. These symptoms have resulted in clinically significant impairment in social, occupational, or interpersonal functioning over at least six months, including prodromal, active, and residual phases. The condition is not better explained by schizoaffective disorder, mood disorders with psychotic features, substance/medication effects, or primary medical or neurological conditions.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-schizoaffective-disorder", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F25.x", + "title": "Schizoaffective disorder", + "key_features": [ + { + "label": "A", + "text": "Uninterrupted period of illness including a major mood episode (MDE or manic) concurrent with Schizophrenia Criterion A symptoms" + }, + { + "label": "B", + "text": "Delusions or hallucinations for ≥2 weeks in the absence of a major mood episode during the lifetime course" + }, + { + "label": "C", + "text": "Major mood episodes present for majority of the total active and residual illness duration" + }, + { + "label": "D", + "text": "Not attributable to substances or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Bipolar type", + "description": "Manic episodes present (with or without depressive episodes)." + }, + { + "name": "Depressive type", + "description": "Major depressive episodes only." + }, + { + "name": "With catatonia", + "description": "Catatonic features present." + }, + { + "name": "In partial remission / In full remission", + "description": "Level of recovery from the most recent episode." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on intensity of psychotic and mood symptoms and functional impairment." + } + ], + "differentials": [ + "Schizophrenia (mood episodes brief or absent)", + "Bipolar I or MDD with psychotic features (psychosis only during mood episodes)", + "Delusional disorder", + "Substance-induced psychotic/mood disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Schizoaffective Disorder] [specifier(s)]. During a period of illness featuring a major mood episode (depressive or manic) there have been delusions; hallucinations; disorganised speech; grossly disorganised behaviour; catatonic features; negative symptoms, together with mood symptoms meeting full criteria for a major depressive or manic episode, forming a combined psychotic-affective presentation. The presentation is further characterised by a sustained period of at least two weeks of delusions or hallucinations in the absence of prominent mood symptoms, and mood symptoms present for the majority of the total duration of the illness. These symptoms have resulted in clinically significant impairment, and the disturbance is not attributable to substance/medication effects or another medical or primary psychiatric condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-schizophreniform-disorder", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F20.81", + "title": "Schizophreniform disorder", + "key_features": [ + { + "label": "A", + "text": "Same symptom criteria as Schizophrenia (≥2 of the 5 symptom clusters; ≥1 must be delusions, hallucinations, or disorganised speech)" + }, + { + "label": "B", + "text": "Episode duration ≥1 month but <6 months (including prodromal and residual phases)" + }, + { + "label": "C", + "text": "Schizoaffective and mood disorders excluded" + }, + { + "label": "D", + "text": "Not attributable to substances or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With good prognostic features", + "description": "Acute onset within 4 weeks; confusion/perplexity; good premorbid functioning; absence of flat affect." + }, + { + "name": "Without good prognostic features", + "description": "One or more good prognostic features absent." + }, + { + "name": "With catatonia", + "description": "Catatonic features present." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on symptom intensity and functional impact." + } + ], + "differentials": [ + "Schizophrenia (total duration ≥6 months - reclassify)", + "Brief psychotic disorder (1 day - 1 month)", + "Bipolar/MDD with psychotic features", + "Substance-induced psychosis" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Schizophreniform Disorder] [specifier(s)]. Over at least one month but less than six months, there have been delusions; hallucinations; disorganised speech; grossly disorganised behaviour; catatonic features; negative symptoms, forming a pattern consistent with a brief schizophrenia-spectrum episode. The presentation is further characterised by deterioration in role functioning; social withdrawal; affective flattening or blunting; cognitive disorganisation, aligning with a time-limited psychotic syndrome. These symptoms have resulted in clinically significant distress or impairment, and the total disturbance has persisted for less than six months. The condition is not better explained by schizophrenia, schizoaffective disorder, mood disorders with psychotic features, substance/medication effects, or a primary medical or neurological condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-brief-psychotic-disorder", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F23", + "title": "Brief psychotic disorder", + "key_features": [ + { + "label": "A", + "text": "≥1 of: delusions; hallucinations; disorganised speech; grossly disorganised/catatonic behaviour" + }, + { + "label": "B", + "text": "Duration ≥1 day but <1 month, with full return to premorbid level of functioning" + }, + { + "label": "C", + "text": "Not better explained by mood disorder, schizoaffective disorder, schizophrenia, or medical condition/substances" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With marked stressor(s)", + "description": "Onset in response to acute psychosocial stress." + }, + { + "name": "Without marked stressor(s)", + "description": "Onset not linked to identifiable acute stress." + }, + { + "name": "With postpartum onset", + "description": "Onset during pregnancy or within four weeks postpartum." + }, + { + "name": "With catatonia", + "description": "Catatonic features present." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on intensity of psychotic symptoms, behavioural disruption, and functional impairment." + } + ], + "differentials": [ + "Schizophreniform disorder (duration 1-6 months)", + "Schizophrenia (≥6 months)", + "Bipolar mania with psychotic features", + "Substance-induced psychotic disorder", + "Medical cause (delirium, encephalitis, autoimmune)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Brief Psychotic Disorder] [specifier(s)]. Following an acute onset of symptoms lasting at least one day but less than one month, there have been delusions; hallucinations; disorganised speech; grossly disorganised behaviour; catatonic features, with an abrupt change from previous functioning. The presentation is further characterised by marked emotional turmoil; confusion or perplexity; fluctuation in affect; agitation or withdrawal, consistent with a short-lived psychotic episode. These symptoms have resulted in clinically significant distress or impairment, and full return to premorbid functioning is expected. The disturbance is not better explained by schizophrenia, schizophreniform disorder, mood disorders with psychotic features, substance intoxication or withdrawal, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-delusional-disorder", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F22", + "title": "Delusional disorder", + "key_features": [ + { + "label": "A", + "text": "≥1 month of ≥1 delusion(s)" + }, + { + "label": "B", + "text": "Schizophrenia Criterion A never met; hallucinations not prominent or related to delusional theme" + }, + { + "label": "C", + "text": "Functioning not markedly impaired; behaviour not obviously odd apart from delusion" + }, + { + "label": "D", + "text": "No manic/major depressive episode; or mood episodes brief relative to delusion duration" + }, + { + "label": "E", + "text": "Not attributable to substances or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Erotomanic type", + "description": "Central belief that another person is in love with the individual." + }, + { + "name": "Grandiose type", + "description": "Conviction of special talent, insight, or elevated status." + }, + { + "name": "Jealous type", + "description": "Belief that partner is unfaithful without evidence." + }, + { + "name": "Persecutory type", + "description": "Belief of being conspired against, harmed, or obstructed." + }, + { + "name": "Somatic type", + "description": "Delusions centred on bodily functions or sensations." + }, + { + "name": "Mixed type", + "description": "Multiple delusional themes without one predominating." + }, + { + "name": "Unspecified type", + "description": "Delusional content not fitting standard categories." + }, + { + "name": "With bizarre content", + "description": "Clearly implausible, non-understandable delusions." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on delusional conviction, functional impact, and behavioural consequences." + } + ], + "differentials": [ + "Schizophrenia (hallucinations, disorganised thought, negative symptoms, functional decline)", + "OCD with poor insight", + "BDD (delusions about physical appearance)", + "Paranoid personality disorder (no fixed false beliefs)", + "Bipolar/MDD with mood-congruent psychotic features", + "Medical/neurological cause" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Delusional Disorder] [specifier(s)]. For at least one month, there have been one or more delusions; persecutory delusions; grandiose delusions; jealous delusions; erotomanic delusions; somatic delusions; mixed delusional themes, occurring in the absence of prominent hallucinations, with hallucinations, if present, being mild and directly related to the delusional theme. Apart from the delusional system, functioning is relatively preserved, and behaviour is not markedly disorganised or odd outside of delusion-related areas. The presentation is further characterised by stable, fixed beliefs held despite clear contrary evidence, with no sustained mood episodes. These symptoms have resulted in clinically significant distress or impairment, and the picture is not better explained by schizophrenia, schizoaffective disorder, mood disorders with psychotic features, substance/medication effects, or a medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-psychotic-disorder-due-to-another-medical-condition", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F06.2", + "title": "Psychotic disorder due to another medical condition", + "key_features": [ + { + "label": "A", + "text": "Prominent hallucinations or delusions" + }, + { + "label": "B", + "text": "Evidence that disturbance is direct pathophysiological consequence of another medical condition" + }, + { + "label": "C", + "text": "Not better explained by another mental disorder" + }, + { + "label": "D", + "text": "Not occurring exclusively during delirium; clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With delusions", + "description": "Prominent fixed false beliefs predominate." + }, + { + "name": "With hallucinations", + "description": "Perceptual disturbances predominate." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Degree of psychotic intensity and associated functional impairment." + } + ], + "differentials": [ + "Primary schizophrenia spectrum (no GMC; prior episodes)", + "Substance/medication-induced psychosis", + "Delirium with psychotic features (not coded separately)", + "Mood disorder with psychotic features due to GMC" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Psychotic Disorder Due to Another Medical Condition] [specifier(s)]. In the context of an established or newly identified medical condition, there have been prominent delusions; hallucinations, forming a psychotic syndrome that developed in a clear temporal association with the underlying medical illness and is judged to be a direct pathophysiological consequence of that condition. The presentation is further characterised by psychotic symptoms that are not better explained by a primary psychotic disorder and are not attributable to the effects of a substance or medication, with clinical, laboratory, or imaging evidence supporting a medical aetiology. These symptoms have resulted in clinically significant distress or impairment, and the disturbance does not occur exclusively during delirium.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-substance-medication-induced-psychotic-disorder", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F19.959", + "title": "Substance/medication-induced psychotic disorder", + "key_features": [ + { + "label": "A", + "text": "Prominent hallucinations or delusions" + }, + { + "label": "B", + "text": "Evidence from history/examination/labs that symptoms developed during or shortly after intoxication/withdrawal, or after exposure to medication" + }, + { + "label": "C", + "text": "Not better explained by a non-substance/medication-induced psychotic disorder" + }, + { + "label": "D", + "text": "Not occurring exclusively during delirium" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With delusions", + "description": "Prominent fixed false beliefs are present." + }, + { + "name": "With hallucinations", + "description": "Perceptual experiences without external stimuli." + }, + { + "name": "With onset during intoxication", + "description": "Symptoms emerge during acute substance use." + }, + { + "name": "With onset during withdrawal", + "description": "Symptoms emerge following reduction or cessation." + }, + { + "name": "With onset after medication use", + "description": "Symptoms emerge following initiation or dose change of a prescribed agent." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Degree of psychotic intensity and functional impairment." + } + ], + "differentials": [ + "Primary psychotic disorder (symptoms predate substance use; persist > 4 weeks abstinence)", + "Delirium", + "Bipolar mania with psychotic features", + "Medical cause of psychosis" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Substance/Medication-Induced Psychotic Disorder] [specifier(s)]. During or soon after substance intoxication or withdrawal, or following exposure to a medication, there have been delusions; hallucinations; disorganised thinking or speech; grossly disorganised or abnormal behaviour, forming a psychotic syndrome that developed in temporal association with substance or medication exposure and exceeds what would be expected from typical intoxication or withdrawal alone. The presentation is further characterised by a clear temporal relationship between symptom onset and substance or medication use, with no evidence that the psychosis preceded exposure. These symptoms have resulted in clinically significant distress or impairment, and the disturbance does not occur exclusively during delirium. The pattern is best explained by a substance- or medication-induced psychotic process rather than a primary psychotic disorder, mood disorder with psychotic features, delirium, or psychosis due to another medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-psy-other-specified-unspecified-schizophrenia-spectrum-disorder", + "category": { + "key": "psy", + "label": "Psychotic Disorders" + }, + "icd_code": "F28/F29", + "title": "Other specified / Unspecified schizophrenia spectrum disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a schizophrenia spectrum/other psychotic disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific disorder in this class" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Persistent auditory hallucinations", + "description": "Ongoing hallucinations without other core schizophrenia features at full threshold." + }, + { + "name": "Delusional symptoms with limited duration", + "description": "Fixed false beliefs < duration required for delusional disorder or schizophrenia." + }, + { + "name": "Attenuated psychosis syndrome", + "description": "Subthreshold psychotic symptoms with preserved reality testing and functional decline risk." + }, + { + "name": "Other specified reason", + "description": "Documented rationale explaining why criteria for a specific disorder are not met." + } + ], + "differentials": [ + "Specific schizophrenia spectrum disorder (full criteria - reclassify)", + "Mood disorder with psychotic features", + "Substance-induced psychosis", + "Delirium" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Schizophrenia Spectrum and Other Psychotic Disorder] [specifier(s)]. There have been delusions; hallucinations; disorganised thinking; grossly disorganised or catatonic behaviour; negative symptoms, occurring in a pattern clearly characteristic of a psychotic disorder but not fully meeting the structured requirements for a specific schizophrenia spectrum diagnosis due to atypical symptom configuration, insufficient symptom number, subthreshold duration, or context-specific features. The presentation is further characterised by psychotic symptoms that are persistent or recurrent, with partial overlap with schizophrenia spectrum phenomenology and a clinically coherent explanation that can be specified. These symptoms have resulted in clinically significant distress or impairment, and the disturbance does not occur exclusively during delirium.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-anx-generalised-anxiety-disorder", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F41.1", + "title": "Generalised anxiety disorder", + "key_features": [ + { + "label": "A", + "text": "Excessive anxiety/worry about multiple events/activities, more days than not for ≥6 months" + }, + { + "label": "B", + "text": "Difficulty controlling the worry" + }, + { + "label": "C", + "text": "≥3 of 6 somatic/cognitive symptoms (≥1 in children): restlessness; easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment" + }, + { + "label": "E", + "text": "Not attributable to substances or another medical condition" + }, + { + "label": "F", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No DSM-5-TR specifiers for this disorder", + "description": "" + } + ], + "differentials": [ + "Panic disorder (discrete panic attacks with fear of recurrence)", + "Social anxiety disorder (fear specifically of social scrutiny)", + "OCD (intrusive obsessions are ego-dystonic)", + "PTSD (hypervigilance tied to trauma)", + "Illness anxiety disorder (worry exclusively about health)", + "Substance-induced anxiety", + "Medical cause: thyrotoxicosis, phaeochromocytoma, hypoglycaemia" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Generalised Anxiety Disorder] [specifier(s)]. Over at least six months, there has been excessive anxiety and worry occurring more days than not, about multiple events or activities, that is difficult to control. Core features include restlessness; feeling keyed up; being easily fatigued; impaired concentration; mind going blank; irritability; muscle tension; sleep disturbance, forming a pattern meeting the threshold of at least three associated symptoms. The presentation is further characterised by persistent anticipatory worry and hypervigilance, and physiological arousal interfering with daily functioning. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by panic disorder, social anxiety disorder, OCD, illness anxiety disorder, PTSD, substance/medication effects, or a primary medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-panic-disorder", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F41.0", + "title": "Panic disorder", + "key_features": [ + { + "label": "A", + "text": "Recurrent unexpected panic attacks (abrupt surge reaching peak within minutes; ≥4 of 13 symptoms)" + }, + { + "label": "B", + "text": "≥1 attack followed by ≥1 month of persistent concern/worry about further attacks or their consequences; or significant maladaptive behaviour change" + }, + { + "label": "C", + "text": "Not attributable to substances or another medical condition" + }, + { + "label": "D", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No DSM-5-TR specifiers for this disorder", + "description": "" + } + ], + "differentials": [ + "Agoraphobia (comorbid - code separately if present)", + "Social anxiety disorder (expected attacks in social situations)", + "Specific phobia (expected attacks in response to phobic stimulus)", + "GAD (persistent worry without discrete attacks)", + "PTSD (panic attacks cued to trauma)", + "Medical cause (cardiac, respiratory, endocrine)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Panic Disorder] [specifier(s)]. There have been recurrent, unexpected panic attacks characterised by abrupt surges of intense fear or discomfort, with palpitations; sweating; trembling; shortness of breath; choking sensation; chest pain; nausea; dizziness; chills or heat sensations; paraesthesias; derealisation or depersonalisation; fear of losing control; fear of dying, forming a pattern consistent with unexpected panic attacks. The presentation is further characterised by persistent worry for at least one month about additional attacks or their consequences, and maladaptive behavioural changes such as avoidance or safety-seeking behaviours. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by the physiological effects of a substance, another medical condition, or a primary psychiatric disorder such as social anxiety disorder, specific phobia, PTSD, or OCD.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-agoraphobia", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F40.00", + "title": "Agoraphobia", + "key_features": [ + { + "label": "A", + "text": "Marked fear/anxiety about ≥2 of 5 situations: public transport; open spaces; enclosed places; standing in line/crowds; being outside home alone" + }, + { + "label": "B", + "text": "Situations avoided, require a companion, or endured with intense anxiety" + }, + { + "label": "C", + "text": "Fear disproportionate to actual danger (considering sociocultural context)" + }, + { + "label": "D", + "text": "Persistent ≥6 months" + }, + { + "label": "E", + "text": "Clinically significant distress or impairment" + }, + { + "label": "F", + "text": "If medical condition present, fear is clearly excessive" + }, + { + "label": "G", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No DSM-5-TR specifiers for this disorder", + "description": "" + } + ], + "differentials": [ + "Panic disorder (comorbid - code independently)", + "Social anxiety disorder (fear of scrutiny not escape)", + "Specific phobia (one situational type)", + "Separation anxiety disorder", + "PTSD (avoidance of trauma cues)", + "Medical condition limiting mobility" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Agoraphobia] [specifier(s)]. There is marked, persistent fear or anxiety about two or more of the following: using public transport; being in open spaces; being in enclosed places; standing in a queue or crowd; being outside the home alone. These situations are feared or avoided because of thoughts that escape might be difficult, or that help would be unavailable in the event of panic-like or incapacitating symptoms. The feared situations almost always provoke fear or anxiety, are actively avoided, require a companion, or are endured with intense distress. The fear is out of proportion to the actual danger posed, is persistent (≥6 months), and causes clinically significant distress or impairment. Note: agoraphobia is coded as a separate diagnosis from panic disorder; if both are present, both are coded independently. The disturbance is not better explained by another mental disorder, a medical condition limiting mobility, or substance effects.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-social-anxiety-disorder", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F40.10", + "title": "Social anxiety disorder", + "key_features": [ + { + "label": "A", + "text": "Marked fear/anxiety about ≥1 social situation with possible scrutiny by others" + }, + { + "label": "B", + "text": "Fears acting in a way that will be humiliating, embarrassing, or negatively evaluated" + }, + { + "label": "C", + "text": "Social situations almost always provoke fear/anxiety" + }, + { + "label": "D", + "text": "Social situations avoided or endured with intense anxiety" + }, + { + "label": "E", + "text": "Fear disproportionate to actual threat (considering sociocultural context)" + }, + { + "label": "F", + "text": "Persistent ≥6 months" + }, + { + "label": "G", + "text": "Clinically significant distress or impairment" + }, + { + "label": "H", + "text": "Not attributable to substances or medical condition; not better explained by another disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Performance only", + "description": "Anxiety restricted to public speaking or performing before an audience." + } + ], + "differentials": [ + "Agoraphobia (fear of escape/help rather than scrutiny)", + "Panic disorder (unexpected attacks)", + "GAD (worry across multiple domains)", + "Avoidant PD (pervasive vs situational; highly comorbid)", + "ASD (social deficits not driven by fear)", + "Selective mutism" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Social Anxiety Disorder] [specifier(s)]. For at least six months, there has been marked fear or anxiety about social situations where scrutiny by others may occur; fear of acting in a way that will be negatively evaluated; immediate anxiety in feared social situations; active avoidance of these situations; fear or anxiety out of proportion to actual threat, forming a pattern consistent with social anxiety disorder. The presentation is further characterised by anticipatory worry, physiological arousal in social contexts, and behavioural avoidance reinforcing the anxiety cycle. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by agoraphobia, panic disorder, body dysmorphic disorder, autism spectrum disorder, or effects of substances/medical conditions.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-specific-phobia", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F40.2xx", + "title": "Specific phobia", + "key_features": [ + { + "label": "A", + "text": "Marked fear/anxiety about a specific object or situation" + }, + { + "label": "B", + "text": "Phobic stimulus almost always provokes immediate fear/anxiety" + }, + { + "label": "C", + "text": "Phobic stimulus actively avoided or endured with intense anxiety" + }, + { + "label": "D", + "text": "Fear disproportionate to actual danger (considering sociocultural context)" + }, + { + "label": "E", + "text": "Persistent ≥6 months" + }, + { + "label": "F", + "text": "Clinically significant distress or impairment" + }, + { + "label": "G", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Animal type", + "description": "Fears triggered by animals or insects." + }, + { + "name": "Natural environment type", + "description": "Fears related to storms, heights, water." + }, + { + "name": "Blood-injection-injury type", + "description": "Fears of needles, blood, invasive procedures; often with vasovagal fainting." + }, + { + "name": "Situational type", + "description": "Fears of specific situations such as flying, driving, enclosed spaces." + }, + { + "name": "Other type", + "description": "Fears not captured above (e.g. choking, vomiting, loud sounds)." + } + ], + "differentials": [ + "Agoraphobia (multiple situation categories; escape/help concern)", + "Social anxiety disorder (fear of scrutiny)", + "PTSD (avoidance linked to traumatic event)", + "OCD (avoidance driven by obsessions)", + "GAD (pervasive worry, not object-specific)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Specific Phobia] [specifier(s)]. Over at least six months, there has been marked fear or anxiety about a specific object or situation; immediate fear or anxiety response on exposure; active avoidance of the phobic trigger; fear or anxiety out of proportion to actual danger; persistent anticipatory anxiety or behavioural avoidance. The presentation is further characterised by physiological arousal, safety behaviours, and situational avoidance reinforcing the phobic response. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by other anxiety disorders, obsessive-compulsive disorder, trauma-related disorders, eating disorders, or medical conditions.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-separation-anxiety-disorder", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F93.0", + "title": "Separation anxiety disorder", + "key_features": [ + { + "label": "A", + "text": "Excessive fear/anxiety about separation from attachment figures; ≥3 of 8 specified symptoms" + }, + { + "label": "B", + "text": "Persistent ≥4 weeks (children/adolescents) or ≥6 months (adults)" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Childhood-onset / Adult-onset", + "description": "Onset before or after age 18." + }, + { + "name": "Acute / Persistent", + "description": "Symptoms of shorter or longer duration relative to threshold periods." + } + ], + "differentials": [ + "Agoraphobia (fear of escape/help, not separation)", + "GAD (worry across multiple domains)", + "Social anxiety disorder", + "PTSD", + "Adjustment disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Separation Anxiety Disorder] [specifier(s)]. Over at least four weeks in children/adolescents or six months in adults, there have been excessive and developmentally inappropriate fear or anxiety about separation from major attachment figures; recurrent distress when anticipating or experiencing separation; persistent worry about losing or harm befalling attachment figures; persistent worry about events leading to separation; reluctance or refusal to go out due to separation fears; fear of being alone or without attachment figures; reluctance or refusal to sleep away from attachment figures; nightmares involving separation themes; physical symptoms on separation or anticipated separation. The presentation is further characterised by persistent avoidance, heightened reassurance-seeking, and marked interference with daily routines. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by agoraphobia, generalised anxiety, autism spectrum disorder, psychotic disorders, or a medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-selective-mutism", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F94.0", + "title": "Selective mutism", + "key_features": [ + { + "label": "A", + "text": "Consistent failure to speak in specific social situations (despite speaking in others)" + }, + { + "label": "B", + "text": "Interferes with educational/occupational achievement or social communication" + }, + { + "label": "C", + "text": "Duration ≥1 month (not first month of school)" + }, + { + "label": "D", + "text": "Not due to lack of knowledge or comfort with the spoken language required" + }, + { + "label": "E", + "text": "Not better explained by communication disorder, autism, psychosis, or another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With anxious temperament", + "description": "Prominent behavioural inhibition and anxiety features driving mutism." + } + ], + "differentials": [ + "Communication disorder (language deficits in all contexts)", + "ASD (pervasive social communication deficits)", + "Social anxiety disorder (comorbid in most cases)", + "Trauma-related mutism" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Selective Mutism] [specifier(s)]. Since early childhood, there has been persistent failure to speak in specific social situations where speaking is expected; consistent ability to speak in other situations; interference with educational, occupational, or social communication; duration of at least one month (beyond the first month of school); speech failure not attributable to lack of language knowledge or comfort with the language used. The presentation is further characterised by marked anxiety, avoidance, and behavioural inhibition associated with speaking demands. These symptoms have resulted in clinically significant distress or impairment in academic, social, or interpersonal functioning, and are not better explained by communication disorders, autism spectrum disorder, psychotic disorders, or lack of language proficiency.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-anxiety-disorder-due-to-another-medical-condition", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F06.4", + "title": "Anxiety disorder due to another medical condition", + "key_features": [ + { + "label": "A", + "text": "Prominent anxiety, panic attacks, or obsessions/compulsions directly attributable to physiological effects of another medical condition" + }, + { + "label": "B", + "text": "Not better explained by another mental disorder" + }, + { + "label": "C", + "text": "Not occurring exclusively during delirium" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With generalised anxiety", + "description": "Diffuse, persistent anxiety and worry predominating." + }, + { + "name": "With panic attacks", + "description": "Recurrent panic attacks triggered or worsened by the medical condition." + }, + { + "name": "With obsessive-compulsive symptoms", + "description": "Intrusive thoughts or compulsive behaviours arising secondary to the medical condition." + } + ], + "differentials": [ + "Primary anxiety disorder (no GMC causal link)", + "Substance/medication-induced anxiety", + "Adjustment disorder with anxious mood", + "Delirium (not coded separately)", + "Somatic symptom disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Anxiety Disorder Due to Another Medical Condition] [specifier(s)]. In the context of an identifiable medical condition, there have been prominent anxiety; excessive fear; excessive worry; panic attacks; physiological arousal such as palpitations, trembling, dyspnoea, dizziness, with symptoms directly attributable to the pathophysiological effects of the medical condition. Core features also include restlessness; feeling tense; impaired concentration; irritability; muscle tension; sleep disturbance, forming a pattern not better explained by a primary anxiety disorder or by substance/medication effects. The presentation is further characterised by a temporal association between the onset or exacerbation of anxiety and the medical condition, and the disturbance not occurring exclusively during a delirium. These symptoms have resulted in clinically significant distress or impairment, and alternative explanations such as primary anxiety disorders, substance-induced anxiety, mood disorders with anxious distress, and psychotic disorders are considered less likely.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-anx-other-specified-unspecified-anxiety-disorder", + "category": { + "key": "anx", + "label": "Anxiety & Fear-Based" + }, + "icd_code": "F41.8/F41.9", + "title": "Other specified / Unspecified anxiety disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of an anxiety disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific anxiety disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason criteria not met (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Generalised anxiety symptoms of shorter duration", + "description": "GAD-like presentation not meeting the six-month duration." + }, + { + "name": "Limited-symptom panic attacks", + "description": "Panic symptoms present but fewer than required for full panic attacks." + }, + { + "name": "Mixed anxiety presentation", + "description": "Clinically significant anxiety not aligning with a single anxiety disorder category." + } + ], + "differentials": [ + "Specific named anxiety disorder (full criteria met - reclassify)", + "Adjustment disorder with anxiety", + "Somatic symptom disorder", + "Medical cause of anxiety" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Anxiety Disorder]. There are prominent anxiety symptoms; excessive fear; excessive worry; physiological arousal such as palpitations, trembling, or dyspnoea; restlessness; feeling tense; difficulty concentrating; irritability; muscle tension; sleep disturbance, forming a pattern causing clinically significant distress or impairment, but the presentation does not fully meet the structured criteria for any specific anxiety disorder, with the clinician able to specify the reason (e.g. generalised anxiety symptoms of shorter duration; limited-symptom panic attacks; khyâl-related anxiety; mixed anxiety presentations). The disturbance does not occur exclusively during delirium, and is not better explained by a substance/medication effect, a primary medical condition, a mood disorder, or a psychotic disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-alcohol-intoxication", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F10.129", + "title": "Alcohol intoxication", + "key_features": [ + { + "label": "A", + "text": "Recent ingestion of alcohol" + }, + { + "label": "B", + "text": "Clinically significant maladaptive behavioural/psychological changes (e.g. disinhibition, impaired judgement, aggression) during or shortly after ingestion" + }, + { + "label": "C", + "text": "≥1 of: slurred speech; incoordination; unsteady gait; nystagmus; impaired attention/memory; stupor or coma" + }, + { + "label": "D", + "text": "Not attributable to another medical condition; not better explained by another mental disorder or substance" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With perceptual disturbances", + "description": "Hallucinations or illusions with intact reality testing, in the absence of a delirium." + } + ], + "differentials": [ + "Traumatic brain injury / intracranial haematoma (exclude - CT if any doubt)", + "Hypoglycaemia (treatable; check BSL immediately)", + "Wernicke encephalopathy (give thiamine before glucose)", + "Other substance intoxication (benzodiazepines, opioids, GHB)", + "Stroke or postictal state", + "Hepatic encephalopathy", + "Sepsis or metabolic encephalopathy" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Alcohol Intoxication] [specifier(s)]. Following recent alcohol ingestion, there have been clinically significant problematic behavioural or psychological changes including disinhibition, emotional lability, impaired judgement, impaired social or occupational functioning, or aggression. These changes are accompanied by one or more of the following signs or symptoms developing during or shortly after use: slurred speech; incoordination; unsteady gait; nystagmus; impaired attention or memory; stupor or coma. The presentation is consistent with the CNS effects of acute alcohol exposure and causes clinically significant distress or functional impairment. The disturbance is not better explained by another medical condition (including head injury, hypoglycaemia, Wernicke encephalopathy), another substance, or a primary psychiatric disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-alcohol-withdrawal", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F10.239", + "title": "Alcohol withdrawal", + "key_features": [ + { + "label": "A", + "text": "Cessation or reduction of heavy/prolonged alcohol use" + }, + { + "label": "B", + "text": "≥2 within hours to days: autonomic hyperactivity; hand tremor; insomnia; nausea/vomiting; transient hallucinations/illusions; psychomotor agitation; anxiety; generalised tonic-clonic seizures" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not attributable to another medical condition; not better explained by another mental disorder or substance" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With perceptual disturbances", + "description": "Hallucinations or illusions with preserved insight and intact reality testing - distinguishes from delirium tremens, in which reality testing is impaired." + } + ], + "differentials": [ + "Benzodiazepine or other sedative withdrawal (clinically indistinguishable - take full drug history)", + "Delirium tremens vs delirium from another cause (infection, metabolic)", + "Wernicke encephalopathy (confusion + ophthalmoplegia + ataxia - give thiamine empirically)", + "Hypoglycaemia or alcoholic ketoacidosis", + "Hyponatraemia, hypomagnesaemia, hypophosphataemia", + "CNS infection or subdural haematoma", + "Thyrotoxicosis or sympathomimetic toxidrome" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Alcohol Withdrawal] [specifier(s)]. Following cessation or marked reduction in heavy, prolonged alcohol use, two or more of the following have developed within hours to a few days: autonomic hyperactivity (diaphoresis, tachycardia, hypertension); increased hand tremor; insomnia; nausea or vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; generalised tonic-clonic seizures. The withdrawal syndrome typically begins 6-24 hours after the last drink, peaks at 24-72 hours, and resolves within 5-7 days in uncomplicated cases. Seizures occur in approximately 3-5% (typically 12-48 hours); delirium tremens occurs in 3-5% (48-96 hours) and carries significant mortality if untreated. Severity is assessed with the CIWA-Ar. The disturbance causes clinically significant distress or impairment and is not better explained by another medical condition, another substance, or a primary psychiatric disorder. Note: thiamine 100 mg IV or IM must be administered before any glucose-containing fluid to prevent precipitating Wernicke encephalopathy.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-alcohol-use-disorder", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F10.10-F10.20", + "title": "Alcohol use disorder", + "key_features": [ + { + "label": "A", + "text": "Problematic pattern of alcohol use leading to clinically significant impairment/distress; ≥2 of 11 criteria within 12 months (impaired control ×4; social impairment ×3; risky use ×2; pharmacological criteria ×2)" + }, + { + "label": "B", + "text": "Severity: Mild (2–3 criteria); Moderate (4–5); Severe (≥6)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "2-3 criteria." + }, + { + "name": "Moderate", + "description": "4-5 criteria." + }, + { + "name": "Severe", + "description": "6 or more criteria." + }, + { + "name": "In early remission", + "description": "No criteria met (except craving) for 3 months to < 12 months." + }, + { + "name": "In sustained remission", + "description": "No criteria met (except craving) for 12 months or longer." + }, + { + "name": "In a controlled environment", + "description": "Setting with restricted access to alcohol." + } + ], + "differentials": [ + "Hazardous or harmful alcohol use (subthreshold - no disorder)", + "Alcohol intoxication or withdrawal as isolated episodes without pattern of impaired control", + "Bipolar disorder with secondary alcohol use", + "PTSD with alcohol misuse as self-medication", + "Social or cultural heavy drinking without impaired control" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Alcohol Use Disorder] [specifier(s)]. Over a 12-month period, there has been a clinically significant impaired pattern of alcohol use manifested by two or more of the following: alcohol taken in larger amounts or over a longer period than intended; persistent desire or unsuccessful efforts to cut down or control use; a great deal of time spent obtaining, using, or recovering from alcohol; craving or strong urge to use alcohol; recurrent use resulting in failure to fulfil major role obligations; continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol; important activities given up or reduced; recurrent use in physically hazardous situations; continued use despite knowledge of a persistent or recurrent physical or psychological problem caused or exacerbated by alcohol; tolerance; withdrawal symptoms or alcohol use to avoid withdrawal. The pattern reflects impaired control, social impairment, risky use, and pharmacological dependence, and is not better explained by another substance, a primary medical condition, or the effects of a medication.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sub-cannabis-intoxication-withdrawal", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F12.129/F12.239", + "title": "Cannabis intoxication / withdrawal", + "key_features": [ + { + "label": "A", + "text": "Intoxication: recent cannabis use with clinically significant maladaptive behavioural/psychological changes; Withdrawal: cessation/reduction of heavy prolonged use" + }, + { + "label": "B", + "text": "Intoxication: ≥2 of: conjunctival injection; increased appetite; dry mouth; tachycardia; developing during or shortly after use; Withdrawal: ≥3 symptoms within ~1 week: irritability/anger; anxiety; sleep difficulty; decreased appetite; restlessness; depressed mood; physical discomfort" + }, + { + "label": "C", + "text": "Not attributable to another medical condition or better explained by another mental disorder or substance" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With perceptual disturbances (intoxication)", + "description": "Hallucinations or intensified sensory experiences with intact reality testing." + }, + { + "name": "Cannabis use disorder - Mild / Moderate / Severe", + "description": "Based on number of criteria met over a 12-month period." + } + ], + "differentials": [ + "Primary psychotic disorder (psychotic symptoms outside intoxication window)", + "Stimulant intoxication (sympathomimetic signs and stimulant exposure)", + "Medical cause or delirium (altered mental state not explained by cannabis)", + "Primary anxiety or depressive disorder (symptoms persist outside withdrawal timeframe)", + "Other substance withdrawal (temporal link to non-cannabis cessation)", + "Sleep disorder (sleep disturbance predates or persists after withdrawal)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Cannabis Intoxication] [specifier(s)]. Following recent cannabis use, there have been euphoria; relaxation; perceptual alterations; time distortion; impaired judgement; impaired attention or concentration; short-term memory impairment; anxiety; suspiciousness or paranoia; psychomotor retardation; increased appetite; dry mouth; conjunctival injection; tachycardia, developing during or shortly after cannabis use. These features have resulted in clinically significant distress or impairment, and the picture is not better explained by another substance, anxiety or psychotic disorder, delirium, or a primary medical condition. For cannabis withdrawal: following cessation or reduction of heavy and prolonged cannabis use, there have been irritability or anger; nervousness or anxiety; sleep difficulty; decreased appetite or weight loss; restlessness; depressed mood; physical discomfort including abdominal pain, tremor, sweating, fever, chills, or headache, developing within several days of cessation.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-opioid-intoxication-withdrawal", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F11.129/F11.239", + "title": "Opioid intoxication / withdrawal", + "key_features": [ + { + "label": "A", + "text": "Intoxication: recent opioid use; Withdrawal: cessation/reduction after heavy prolonged use, or administration of opioid antagonist" + }, + { + "label": "B", + "text": "Intoxication: pupillary constriction + ≥1 of: drowsiness/coma; slurred speech; impaired attention/memory; Withdrawal: ≥3 of: dysphoric mood; nausea/vomiting; muscle aches; lacrimation/rhinorrhoea; pupillary dilation; piloerection; sweating; diarrhoea; yawning; fever; insomnia" + }, + { + "label": "C", + "text": "Not attributable to another medical condition or better explained by another mental disorder or substance" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With perceptual disturbances", + "description": "Hallucinations or illusions with intact reality testing." + }, + { + "name": "Opioid use disorder - Mild / Moderate / Severe", + "description": "2-3 / 4-5 / ≥6 criteria over 12-month period." + }, + { + "name": "On maintenance therapy", + "description": "Receiving agonist (methadone, buprenorphine) or antagonist treatment." + } + ], + "differentials": [ + "Intoxication: CNS depressant intoxication from other agents, stroke, TBI, hypoglycaemia", + "Withdrawal: GI illness, primary anxiety, stimulant intoxication, pain crisis" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Opioid Intoxication] [specifier(s)]. Following recent opioid use, there have been clinically significant maladaptive behavioural or psychological changes; euphoria; apathy; dysphoria; psychomotor retardation; impaired attention or judgement; miosis; slurred speech; drowsiness; sedation, developing during or shortly after opioid exposure. The disturbance is not attributable to another medical condition. For opioid withdrawal: following cessation or reduction of opioid use, there have been dysphoric mood; nausea; vomiting; muscle aches; lacrimation; rhinorrhoea; pupillary dilation; piloerection; sweating; diarrhoea; yawning; fever; insomnia, developing within hours to days after opioid reduction or cessation.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-stimulant-intoxication-withdrawal", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F15.129/F15.239", + "title": "Stimulant intoxication / withdrawal", + "key_features": [ + { + "label": "A", + "text": "Intoxication: recent stimulant use; Withdrawal: cessation/reduction after prolonged heavy use" + }, + { + "label": "B", + "text": "Intoxication: clinically significant maladaptive behavioural/psychological changes + ≥2 of: tachycardia/bradycardia; pupillary dilation; elevated/lowered BP; sweating/chills; nausea/vomiting; weight loss; psychomotor agitation/retardation; muscular weakness; chest pain; arrhythmia; confusion; seizures/dyskinesias/dystonias; coma; Withdrawal: dysphoric mood + ≥2 of: fatigue; vivid unpleasant dreams; insomnia/hypersomnia; increased appetite; psychomotor retardation/agitation" + }, + { + "label": "C", + "text": "Not attributable to another medical condition or better explained by another mental disorder or substance" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With perceptual disturbances (intoxication)", + "description": "Hallucinations or illusions with intact reality testing." + }, + { + "name": "Stimulant use disorder - Mild / Moderate / Severe", + "description": "2-3 / 4-5 / ≥6 criteria over 12-month period." + }, + { + "name": "Specify stimulant", + "description": "Amphetamine-type substance, cocaine, or other/unspecified stimulant." + } + ], + "differentials": [ + "Intoxication: primary mania, schizophrenia, thyrotoxicosis, phaeochromocytoma, hallucinogen intoxication", + "Withdrawal: primary MDD, hypothyroidism, excessive sleep disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Stimulant Intoxication] [specifier(s)]. Following recent stimulant use, there have been clinically significant maladaptive behavioural or psychological changes; euphoria; increased energy or alertness; talkativeness; grandiosity; agitation; anxiety; impaired judgement; stereotyped or repetitive behaviours; tachycardia; hypertension; pupillary dilation; sweating or chills, developing during or shortly after substance exposure. The presentation is characterised by direct sympathomimetic effects consistent with the pharmacology of the stimulant. For stimulant withdrawal: following cessation or reduction, there have been dysphoric mood; fatigue; vivid or unpleasant dreams; insomnia; hypersomnia; increased appetite; psychomotor retardation; psychomotor agitation, developing within hours to days after substance reduction or cessation.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-sedative-hypnotic-anxiolytic-intoxication-withdrawal", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F13.129/F13.239", + "title": "Sedative/hypnotic/anxiolytic intoxication / withdrawal", + "key_features": [ + { + "label": "A", + "text": "Intoxication: recent sedative/hypnotic/anxiolytic use; Withdrawal: cessation/reduction after prolonged heavy use" + }, + { + "label": "B", + "text": "Intoxication: clinically significant maladaptive behavioural/psychological changes + ≥1 of: slurred speech; incoordination; unsteady gait; nystagmus; impaired cognition; stupor/coma; Withdrawal: ≥2 of: autonomic hyperactivity; hand tremor; insomnia; nausea/vomiting; transient hallucinations/illusions; psychomotor agitation; anxiety; generalised tonic-clonic seizures" + }, + { + "label": "C", + "text": "Not attributable to another medical condition or better explained by another mental disorder or substance" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With perceptual disturbances", + "description": "Hallucinations or illusions are present with intact orientation." + }, + { + "name": "Sedative/hypnotic/anxiolytic use disorder - Mild / Moderate / Severe", + "description": "2-3 / 4-5 / ≥6 criteria over 12-month period." + } + ], + "differentials": [ + "Intoxication: alcohol intoxication, opioid intoxication, TBI, metabolic encephalopathy", + "Withdrawal: alcohol withdrawal, primary anxiety, neuroleptic malignant syndrome" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Sedative/Hypnotic/Anxiolytic Intoxication] [specifier(s)]. Following recent use, there have been clinically significant maladaptive behavioural or psychological changes; impaired judgement; disinhibition; emotional lability; psychomotor retardation; slurred speech; incoordination; unsteady gait; nystagmus; impaired attention or memory; sedation, developing during or shortly after substance exposure. These symptoms have resulted in clinically significant distress or impairment. For withdrawal: following cessation or reduction of prolonged use, there have been autonomic hyperactivity; hand tremor; insomnia; nausea or vomiting; transient visual, tactile, or auditory hallucinations; psychomotor agitation; anxiety; seizures, developing within hours to days.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sub-antidepressant-discontinuation-syndrome", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "T43.205A", + "title": "Antidepressant discontinuation syndrome", + "key_features": [ + { + "label": "A", + "text": "≥3 of the following within days of stopping/reducing an antidepressant (after ≥1 month use): FINISH symptoms — flu-like; insomnia; nausea; imbalance; sensory disturbances; hyperarousal/anxiety" + }, + { + "label": "B", + "text": "Clinically significant distress or impairment" + }, + { + "label": "C", + "text": "Not due to another medical condition or better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Based on symptom intensity and degree of functional disruption." + }, + { + "name": "Abrupt-onset type", + "description": "Symptoms arising within 24-48 hours of sudden cessation." + }, + { + "name": "Taper-associated type", + "description": "Symptoms emerging during a dose reduction schedule." + }, + { + "name": "Prolonged type", + "description": "Symptoms persisting beyond the typical 1-2 week window." + } + ], + "differentials": [ + "Depressive relapse (sustained ≥2 weeks; pervasive anhedonia; no flu-like or sensory features)", + "Anxiety disorder relapse", + "Viral illness (fever, myalgia - no temporal drug link; no FINISH symptoms)", + "Vestibular disorder (isolated dizziness without FINISH cluster)", + "Serotonin syndrome (fever, clonus, diaphoresis - dangerous; distinct from discontinuation)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Antidepressant Discontinuation Syndrome] [specifier(s)]. Following reduction in dose or cessation of an antidepressant taken regularly for at least 4 weeks, a cluster of symptoms has emerged within hours to days, including flu-like symptoms (fatigue, myalgia, diaphoresis, nausea); insomnia or vivid dreams; sensory disturbances (electric shock sensations - “brain zaps”, paraesthesia); dizziness or unsteadiness; irritability, anxiety, agitation, or low mood. The presentation is characterised by a clear temporal association with dose change, improvement upon reinstatement or slower taper, and absence of features more consistent with relapse. Risk is highest with shorter-acting agents (paroxetine, venlafaxine) and abrupt cessation. Distinguishing from relapse is critical as management differs fundamentally: discontinuation syndrome warrants a supervised taper; relapse warrants continuation or intensification of treatment.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sub-substance-intoxication-withdrawal-generic-template", + "category": { + "key": "sub", + "label": "Substance-Related" + }, + "icd_code": "F1x.0/F1x.3", + "title": "[Substance] intoxication / withdrawal - generic template", + "key_features": [ + { + "label": "A", + "text": "Intoxication: reversible substance-specific syndrome due to recent ingestion; Withdrawal: substance-specific syndrome due to cessation/reduction after heavy/prolonged use" + }, + { + "label": "B", + "text": "Intoxication: clinically significant maladaptive behavioural/psychological changes attributable to substance CNS effects; Withdrawal: causes clinically significant distress or impairment" + }, + { + "label": "C", + "text": "Not attributable to another medical condition; not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Specify substance", + "description": "Inhalant, hallucinogen, phencyclidine, caffeine, tobacco, other/unknown." + }, + { + "name": "With perceptual disturbances", + "description": "Hallucinations present with intact orientation and reality-testing." + }, + { + "name": "In a controlled environment", + "description": "Setting with restricted access to substances." + } + ], + "differentials": [ + "Substance withdrawal syndrome vs intoxication (use state vs cessation state)", + "Primary psychotic disorder, primary mood disorder, primary anxiety disorder", + "Delirium from another cause (infection, metabolic, structural)", + "Medical/metabolic cause (hypoglycaemia, encephalopathy, sepsis)", + "Traumatic brain injury" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Substance] Intoxication [specifier(s)]. Following recent ingestion or exposure to the substance, there have been clinically significant problematic behavioural or psychological changes. This has been accompanied by reversible substance-specific signs and symptoms, including [insert substance-specific physiological or cognitive symptoms; semicolon-separated], developing during or shortly after use, forming a pattern consistent with acute intoxication effects of the substance. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by another medical condition, substance, or primary psychiatric disorder. For withdrawal: following cessation or marked reduction in heavy and prolonged use, there have been emergent physiological and psychological symptoms, including [insert substance-specific withdrawal symptoms; semicolon-separated], forming a pattern consistent with withdrawal from this substance, developing within the expected withdrawal timeframe.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-trm-posttraumatic-stress-disorder-ptsd", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F43.10", + "title": "Posttraumatic stress disorder (PTSD)", + "key_features": [ + { + "label": "A", + "text": "Exposure to actual/threatened death, serious injury, or sexual violence (direct, witnessed, learning about close person, or repeated indirect exposure)" + }, + { + "label": "B", + "text": "≥1 intrusion symptom: involuntary memories; nightmares; dissociative reactions (flashbacks); intense psychological distress; marked physiological reactions to trauma cues" + }, + { + "label": "C", + "text": "≥1 persistent avoidance: avoidance of trauma-related internal stimuli or external reminders" + }, + { + "label": "D", + "text": "≥2 negative alterations in cognitions/mood: inability to recall aspects of trauma; persistent negative beliefs; distorted blame; persistent negative emotional state; diminished interest; detachment; inability to experience positive emotions" + }, + { + "label": "E", + "text": "≥2 alterations in arousal/reactivity: irritability/aggression; reckless/destructive behaviour; hypervigilance; exaggerated startle; concentration problems; sleep disturbance" + }, + { + "label": "F", + "text": "Duration >1 month" + }, + { + "label": "G", + "text": "Clinically significant distress or impairment" + }, + { + "label": "H", + "text": "Not attributable to substances or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With dissociative symptoms (depersonalisation)", + "description": "Persistent experiences of feeling detached from one's body or mental processes." + }, + { + "name": "With dissociative symptoms (derealisation)", + "description": "Persistent experiences of unreality of surroundings." + }, + { + "name": "With delayed expression", + "description": "Full diagnostic criteria not met until at least six months after the event." + } + ], + "differentials": [ + "Acute stress disorder (< 1 month)", + "Adjustment disorder", + "MDD (overlap - intrusion, flashbacks, dissociation distinguish PTSD)", + "OCD (intrusions ego-dystonic; no traumatic trigger required)", + "DID (severe dissociation; complex trauma)", + "TBI (organic cognitive sequelae post-trauma)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Posttraumatic Stress Disorder] [specifier(s)]. Following exposure to a traumatic event, there have been intrusion symptoms including recurrent intrusive memories; distressing dreams; dissociative reactions (flashbacks); intense psychological distress at trauma cues; marked physiological reactivity to reminders; persistent avoidance including avoidance of distressing memories, thoughts, or feelings; avoidance of external reminders; negative alterations in cognition and mood including inability to recall aspects of the trauma; persistent negative beliefs about self/others/world; distorted blame; persistent negative emotional state; diminished interest; detachment; inability to experience positive emotions; and marked alterations in arousal and reactivity including irritability; angry outbursts; reckless or self-destructive behaviour; hypervigilance; exaggerated startle; concentration difficulties; sleep disturbance, forming a pattern meeting the threshold for PTSD with symptoms persisting for more than one month. The presentation is further characterised by clinically significant distress or impairment, with the disturbance not better explained by substance/medication effects, a primary medical condition, or another psychiatric disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-trm-acute-stress-disorder", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F43.0", + "title": "Acute stress disorder", + "key_features": [ + { + "label": "A", + "text": "Exposure to actual/threatened death, serious injury, or sexual violence (same exposure types as PTSD Criterion A)" + }, + { + "label": "B", + "text": "≥9 of 14 symptoms from: intrusion, negative mood, dissociation, avoidance, arousal clusters" + }, + { + "label": "C", + "text": "Duration 3 days to 1 month after trauma exposure" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment" + }, + { + "label": "E", + "text": "Not attributable to substances or another medical condition; not better explained by brief psychotic disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No DSM-5-TR specifiers for Acute Stress Disorder", + "description": "" + } + ], + "differentials": [ + "PTSD (symptom duration > 1 month)", + "Adjustment disorder", + "MDD (without intrusion/dissociation/avoidance cluster)", + "TBI with neuropsychiatric sequelae" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Acute Stress Disorder] [specifier(s)]. In the aftermath of exposure to a traumatic event, there have been intrusion symptoms including recurrent intrusive memories; distressing dreams; flashback-like dissociative reactions; marked psychological distress to trauma cues; negative mood including persistent inability to experience positive emotions; dissociative symptoms including altered sense of reality; inability to recall important aspects of the trauma; avoidance symptoms including avoidance of distressing memories, thoughts, or feelings; avoidance of external reminders; and arousal symptoms including sleep disturbance; irritability; hypervigilance; concentration difficulties; exaggerated startle, forming a pattern meeting the threshold of nine or more symptoms across these domains with a duration of at least three days and less than one month. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by substance effects, a primary medical condition, or another psychiatric disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-trm-adjustment-disorder", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F43.2x", + "title": "Adjustment disorder", + "key_features": [ + { + "label": "A", + "text": "Emotional or behavioural symptoms in response to an identifiable stressor, within 3 months of stressor onset" + }, + { + "label": "B", + "text": "Clinically significant: marked distress disproportionate to stressor severity; or significant impairment in functioning" + }, + { + "label": "C", + "text": "Stress-related disturbance does not meet criteria for another mental disorder and is not exacerbation of existing disorder" + }, + { + "label": "D", + "text": "Not simply normal bereavement" + }, + { + "label": "E", + "text": "Symptoms resolve within 6 months of stressor termination (unless chronic stressor)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With depressed mood", + "description": "Predominant low mood, tearfulness, or hopelessness." + }, + { + "name": "With anxiety", + "description": "Prominent worry, nervousness, or fearfulness." + }, + { + "name": "With mixed anxiety and depressed mood", + "description": "Concurrent depressive and anxiety symptoms without dominance of one." + }, + { + "name": "With disturbance of conduct", + "description": "Behavioural disturbance violating social norms or rights of others." + }, + { + "name": "With mixed disturbance of emotions and conduct", + "description": "Emotional symptoms accompanied by behavioural disturbance." + }, + { + "name": "Unspecified", + "description": "Maladaptive responses not captured by the above patterns." + } + ], + "differentials": [ + "MDD (full MDE criteria met - adjustment disorder excluded)", + "PTSD or ASD (specific traumatic event; full symptom cluster)", + "GAD (anxiety before stressor; > 6 months)", + "Normal stress response (distress proportionate; no functional impairment)", + "Personality disorder exacerbation under stress" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Adjustment Disorder] [specifier(s)]. Within three months of identifiable psychosocial stressor(s), there have been emotional or behavioural symptoms including low mood; tearfulness; hopelessness; anxiety; worry; nervousness; irritability; anger; behavioural disturbance; social withdrawal; impairment in role functioning, forming a pattern clearly arising in response to the stressor. The presentation is further characterised by distress that is out of proportion to the severity or intensity of the stressor and a clinically significant decline in social, occupational, or interpersonal functioning, with the disturbance not persisting for more than six months after the stressor or its consequences have resolved. The picture is not better explained by another mental disorder, normal bereavement, or the effects of a substance or medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-trm-prolonged-grief-disorder", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F43.8", + "title": "Prolonged grief disorder", + "key_features": [ + { + "label": "A", + "text": "Death of someone close to the bereaved person ≥12 months ago (≥6 months in children/adolescents)" + }, + { + "label": "B", + "text": "Since the death: persistent and pervasive grief — intense yearning/longing for deceased, or preoccupation with thoughts/memories of deceased, on more days than not" + }, + { + "label": "C", + "text": "≥3 of 8: identity disruption; disbelief about the death; avoidance of reminders; intense emotional pain; difficulty re-engaging with life; emotional numbness; feeling life is meaningless; intense loneliness" + }, + { + "label": "D", + "text": "Causes clinically significant distress or impairment in functioning" + }, + { + "label": "E", + "text": "Duration/severity exceeds expected social, cultural, or religious norms" + }, + { + "label": "F", + "text": "Not better explained by MDD, PTSD, or another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With traumatic bereavement", + "description": "Death occurred under traumatic circumstances with distress about the manner of death." + }, + { + "name": "Mild", + "description": "Grief symptoms with clear distress but limited functional disruption." + }, + { + "name": "Moderate", + "description": "Grief symptoms with definite and persistent impairment across key life domains." + }, + { + "name": "Severe", + "description": "Pervasive, intense grief symptoms with marked and disabling functional impairment." + } + ], + "differentials": [ + "Normal bereavement (within expected norms; functional)", + "MDD (full depressive episode; may coexist)", + "PTSD (traumatic death - may coexist)", + "Adjustment disorder (early post-loss; subthreshold)", + "PDD", + "Separation anxiety disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Prolonged Grief Disorder] [specifier(s)]. Following the death of a close attachment figure, and persisting for at least twelve months (or at least six months in children and adolescents), there has been persistent and pervasive grief characterised by intense yearning or longing for the deceased; preoccupation with thoughts or memories of the deceased, forming a grief response exceeding expected social, cultural, or religious norms for bereavement. The presentation is further characterised by marked emotional pain related to the loss, including identity disruption; disbelief or difficulty accepting the death; avoidance of reminders of the loss; intense emotional pain such as anger, bitterness, or sorrow; difficulty re-engaging with life; emotional numbness; feeling that life is meaningless without the deceased; intense loneliness, with three or more of these features present as a persistent pattern. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better accounted for by major depressive disorder, post-traumatic stress disorder, an anxiety disorder, a substance-related condition, or another medical or psychiatric disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-trm-reactive-attachment-disorder-rad", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F94.2", + "title": "Reactive attachment disorder (RAD)", + "key_features": [ + { + "label": "A", + "text": "Consistent pattern of inhibited, emotionally withdrawn behaviour toward caregivers; ≥2 of: rarely seeks/responds to comfort when distressed; minimal positive affect; unexplained irritability/sadness/fearfulness" + }, + { + "label": "B", + "text": "Persistent social/emotional disturbance: ≥2 of: minimal social/emotional responsiveness; limited positive affect; episodes of irritability/sadness/fearfulness during non-threatening caregiver interactions" + }, + { + "label": "C", + "text": "Experienced grossly insufficient care (neglect/deprivation; repeated caregiver changes; rearing in unusual settings)" + }, + { + "label": "D", + "text": "Care in Criterion C presumed responsible for the behaviour in Criterion A" + }, + { + "label": "E", + "text": "Does not meet criteria for autism spectrum disorder" + }, + { + "label": "F", + "text": "Onset before age 5; child must have developmental age ≥9 months" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Persistent", + "description": "Symptoms have been present for more than 12 months." + }, + { + "name": "Severe", + "description": "All symptoms present and disturbances are marked." + } + ], + "differentials": [ + "DSED (opposite behavioural pattern; same causal history)", + "ASD (social communication deficits not caregiver-specific)", + "Intellectual disability", + "Depressive disorder in a child", + "PTSD in a young child" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Reactive Attachment Disorder] [specifier(s)]. Since early childhood, there have been consistent patterns of emotionally withdrawn behaviour toward caregivers; limited seeking of comfort; limited response to comfort; minimal social and emotional responsiveness; limited positive affect; episodes of unexplained irritability; sadness; fearfulness during non-threatening interactions, forming a pattern meeting the threshold for a traumatised, attachment-related disturbance arising from severely impaired caregiving environments. The presentation is further characterised by a history of extreme insufficient care, including social neglect; lack of basic emotional needs; repeated changes of primary caregivers; rearing in atypical or deprived settings. These symptoms have resulted in clinically significant impairment in social, emotional, and relational functioning, with onset before age five and a developmental age of at least nine months, and the disturbance not better explained by autism spectrum disorder, intellectual disability, global developmental delay, or another psychiatric or medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-trm-disinhibited-social-engagement-disorder-dsed", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F94.1", + "title": "Disinhibited social engagement disorder (DSED)", + "key_features": [ + { + "label": "A", + "text": "Pattern of culturally inappropriate, overly familiar behaviour with relatively unfamiliar adults; ≥2 of: reduced/absent reticence; overly familiar verbal/physical behaviour; diminished checking back with caregiver; willingness to go with unfamiliar adult" + }, + { + "label": "B", + "text": "Behaviours not limited to impulsivity; include socially disinhibited behaviour" + }, + { + "label": "C", + "text": "Grossly insufficient care (as per RAD Criterion C)" + }, + { + "label": "D", + "text": "Child has developmental age ≥9 months" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Persistent", + "description": "Symptoms have been present for more than 12 months." + }, + { + "name": "Severe", + "description": "All symptoms present and disturbances are marked." + } + ], + "differentials": [ + "RAD (inhibited withdrawal vs disinhibited approach)", + "ADHD (impulsivity without caregiving deprivation history)", + "ASD (social engagement driven by communication deficits)", + "Williams syndrome (genetic cause of social disinhibition)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Disinhibited Social Engagement Disorder] [specifier(s)]. Since early childhood, there have been behaviours marked by reduced or absent reticence with unfamiliar adults; overly familiar verbal or physical interaction; diminished or absent checking back with caregivers after venturing away; willingness to go off with unfamiliar adults, forming a pattern meeting the threshold for developmentally inappropriate, disinhibited social behaviour. The presentation is further characterised by a history of extreme insufficient care, including social neglect; lack of basic emotional needs; repeated changes of primary caregivers; rearing in atypical or deprived settings. These symptoms have resulted in clinically significant impairment in social functioning, with the child having a developmental age of at least nine months, and the disturbance not better explained by Autism Spectrum Disorder or another psychiatric or medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-trm-other-specified-unspecified-trauma-and-stressor-related-disorder", + "category": { + "key": "trm", + "label": "Trauma & Stressor-Related" + }, + "icd_code": "F43.89/F43.9", + "title": "Other specified / Unspecified trauma- and stressor-related disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a trauma/stressor-related disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific disorder in this class" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Cultural syndrome / customised description", + "description": "Trauma-linked presentation consistent with culturally recognised patterns." + }, + { + "name": "Persistent complex bereavement-like presentation", + "description": "Prolonged grief-related distress with trauma features." + }, + { + "name": "Low-threshold PTSD-like presentation", + "description": "Trauma-linked symptoms below required frequency, number, or duration thresholds." + }, + { + "name": "Time-limited trauma response", + "description": "Trauma-related symptoms exceeding normal stress response but not meeting ASD criteria." + } + ], + "differentials": [ + "PTSD or ASD (full criteria met - reclassify)", + "Adjustment disorder", + "Prolonged grief disorder", + "Primary mood or anxiety disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Trauma- and Stressor-Related Disorder] [specifier(s)]. Following exposure to a traumatic or significant stressor event, there have been trauma-related symptoms including intrusive distressing memories; recurrent dreams; psychological distress to trauma cues; physiological reactivity to cues; avoidance of memories; avoidance of reminders; negative mood; anhedonia; detachment; altered arousal; hypervigilance; concentration difficulties; sleep disturbance, forming a clinically significant pattern that is trauma-linked but does not fully meet the structured criteria for PTSD, Acute Stress Disorder, or Adjustment Disorder. The presentation is further characterised by clinically significant distress or impairment in social, occupational, or interpersonal functioning, with symptoms better accounted for by a trauma-related mechanism rather than another primary disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-delirium", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "F05", + "title": "Delirium", + "key_features": [ + { + "label": "A", + "text": "Disturbance of attention (reduced ability to direct, focus, sustain, shift attention) and awareness (reduced orientation to environment)" + }, + { + "label": "B", + "text": "Develops over short period; represents change from baseline; tends to fluctuate during the day" + }, + { + "label": "C", + "text": "Additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, or perception)" + }, + { + "label": "D", + "text": "Criteria A and C not better explained by established pre-existing NCD; not in context of severely reduced arousal (coma)" + }, + { + "label": "E", + "text": "Evidence from history/examination/labs that disturbance is physiological consequence of medical condition, substance intoxication/withdrawal, toxin, or multiple causes" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Hyperactive", + "description": "Prominent psychomotor agitation, restlessness, and increased arousal." + }, + { + "name": "Hypoactive", + "description": "Reduced psychomotor activity, lethargy, and decreased alertness - often missed; worse prognosis." + }, + { + "name": "Mixed level of activity", + "description": "Alternating hyperactive and hypoactive features." + }, + { + "name": "Acute", + "description": "Duration of hours to days." + }, + { + "name": "Persistent", + "description": "Duration of weeks to months." + }, + { + "name": "Substance intoxication delirium", + "description": "Directly attributable to recent substance use." + }, + { + "name": "Substance withdrawal delirium", + "description": "Occurring during withdrawal from a substance." + }, + { + "name": "Medication-induced delirium", + "description": "Temporally related to medication exposure." + }, + { + "name": "Delirium due to another medical condition", + "description": "Directly attributable to a general medical illness." + }, + { + "name": "Delirium due to multiple aetiologies", + "description": "More than one contributing cause identified." + } + ], + "differentials": [ + "Major NCD (gradual onset; no fluctuation - delirium superimposed on NCD is common)", + "MDD (no clouded consciousness)", + "Psychotic disorder (gradual onset; consciousness intact)", + "Non-convulsive status epilepticus (EEG essential if suspected)", + "Wernicke encephalopathy (give thiamine empirically)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Delirium] [specifier(s)]. Over a short period of time with an acute or subacute onset and a fluctuating course, there has been a disturbance in attention; reduced ability to direct, focus, sustain, or shift attention; a disturbance in awareness with reduced orientation to the environment, accompanied by memory impairment; disorientation; language disturbance; visuospatial impairment; perceptual disturbance, forming a global disturbance in cognition that represents a change from baseline. The presentation is further characterised by symptoms that fluctuate in severity over the course of the day and evidence from history, examination, or investigations that the disturbance is a direct physiological consequence of a medical condition, substance intoxication or withdrawal, medication exposure, toxin exposure, or multiple aetiologies. These features have resulted in clinically significant impairment in cognitive, occupational, or functional capacity, and the disturbance does not occur exclusively in the context of a severely reduced level of arousal such as coma.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-catatonia-associated-due-to-gmc-or-unspecified", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "G31.9/F09", + "title": "Catatonia (associated, due to GMC, or unspecified)", + "key_features": [ + { + "label": "A", + "text": "≥3 of 12 catatonia symptoms: stupor; catalepsy; waxy flexibility; mutism; negativism; posturing; mannerism; stereotypy; agitation; grimacing; echolalia; echopraxia" + }, + { + "label": "B", + "text": "Associated with another mental disorder / due to another medical condition / unspecified (determines specifier applied)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Catatonia associated with another mental disorder", + "description": "Occurs in the context of mood, schizophrenia spectrum, or other psychiatric conditions." + }, + { + "name": "Catatonic disorder due to another medical condition", + "description": "Attributable to an underlying medical or neurological illness." + }, + { + "name": "Unspecified catatonia", + "description": "Catatonic features present but the underlying condition is unclear." + }, + { + "name": "With stupor", + "description": "Predominant immobility and unresponsiveness." + }, + { + "name": "With excitement", + "description": "Marked excessive and purposeless motor activity." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on number and intensity of catatonic signs and degree of functional compromise." + } + ], + "differentials": [ + "NMS (fever, rigidity, markedly elevated CK - urgent)", + "Serotonin syndrome (hyperthermia, clonus, diaphoresis)", + "Non-convulsive status epilepticus (EEG essential)", + "Locked-in syndrome (neurological; full consciousness)", + "Primary movement disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Catatonia] [specifier(s)]. During the current episode, there have been stupor; catalepsy; waxy flexibility; mutism; negativism; posturing; mannerisms; stereotypy; agitation not influenced by external stimuli; grimacing; echolalia; echopraxia, forming a pattern meeting the threshold of at least three catatonic symptoms. The presentation is further characterised by marked psychomotor disturbance that may occur in the context of a primary psychiatric disorder, a medical condition, or may be unspecified when the underlying cause is unclear. These symptoms have resulted in clinically significant impairment in functioning or require urgent medical/psychiatric intervention, and the disturbance is not better explained by delirium, substance/medication effects, or neurological conditions such as non-convulsive status epilepticus.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ncg-major-neurocognitive-disorder", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "F02.8x", + "title": "Major neurocognitive disorder", + "key_features": [ + { + "label": "A", + "text": "Substantial cognitive decline in ≥1 domain (complex attention, executive function, learning/memory, language, perceptual-motor, social cognition) based on concern + objective evidence" + }, + { + "label": "B", + "text": "Deficits interfere with independence in everyday activities (require assistance with complex IADLs)" + }, + { + "label": "C", + "text": "Deficits not occurring exclusively during delirium" + }, + { + "label": "D", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With behavioural disturbance", + "description": "Clinically significant agitation, psychosis, mood symptoms, or other behavioural features." + }, + { + "name": "Without behavioural disturbance", + "description": "Cognitive decline without prominent behavioural or psychological symptoms." + }, + { + "name": "Mild severity", + "description": "Clear cognitive decline with loss of independence limited to complex activities." + }, + { + "name": "Moderate severity", + "description": "Greater cognitive impairment with assistance required for daily activities." + }, + { + "name": "Severe severity", + "description": "Profound cognitive impairment with dependence for most basic activities of daily living." + } + ], + "differentials": [ + "Mild NCD (independence preserved)", + "Delirium (acute, fluctuating)", + "MDD with cognitive features (pseudodementia)", + "Normal age-related cognitive change" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Major Neurocognitive Disorder] [specifier(s)]. Over a period of gradual or stepwise decline, there has been evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains including complex attention; executive function; learning and memory; language; perceptual-motor function; social cognition, documented by concern of the individual, a knowledgeable informant, or the clinician, and substantial impairment on objective cognitive assessment or clinical evaluation. The presentation is further characterised by cognitive deficits that interfere with independence in everyday activities, such that assistance is required for complex instrumental or basic activities of daily living. These symptoms have resulted in marked impairment in occupational, social, or adaptive functioning, and the cognitive deficits do not occur exclusively in the context of delirium.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ncg-mild-neurocognitive-disorder", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "F06.7x", + "title": "Mild neurocognitive disorder", + "key_features": [ + { + "label": "A", + "text": "Modest cognitive decline in ≥1 domain (concern of individual, knowledgeable informant, or clinician; supported by objective performance evidence)" + }, + { + "label": "B", + "text": "Deficits do not interfere with independence (may require greater effort/compensatory strategies for complex IADLs)" + }, + { + "label": "C", + "text": "Not occurring exclusively during delirium" + }, + { + "label": "D", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With behavioural disturbance", + "description": "Clinically significant agitation, psychosis, mood symptoms, or other behavioural features." + }, + { + "name": "Without behavioural disturbance", + "description": "Cognitive decline without prominent behavioural or psychological symptoms." + } + ], + "differentials": [ + "Major NCD (independence impaired - reclassify)", + "Normal age-related cognitive change", + "MDD with cognitive features", + "Medication effects on cognition", + "Anxiety-related cognitive impairment" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Mild Neurocognitive Disorder] [specifier(s)]. Over a period of gradual or stepwise change, there has been evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains including complex attention; executive function; learning and memory; language; perceptual-motor function; social cognition, based on concern of the individual, a knowledgeable informant, or the clinician, and modest impairment on objective cognitive assessment or clinical evaluation. The presentation is further characterised by cognitive deficits that do not interfere with capacity for independence in everyday activities, such that greater effort, compensatory strategies, or accommodation may be required for complex instrumental activities of daily living. These symptoms have resulted in clinically meaningful cognitive change with preserved basic functional independence, and the cognitive deficits do not occur exclusively in the context of delirium.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-alzheimer-s-disease-ncd", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "G30.x/F02.8x", + "title": "Alzheimer's disease (NCD)", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD (substantial or modest cognitive decline in ≥1 domain)" + }, + { + "label": "B", + "text": "Insidious onset and gradual progression in ≥1 cognitive domain (most often episodic memory early)" + }, + { + "label": "C", + "text": "Probable AD: genetic mutation or ≥2 declining domains + no mixed aetiology; Possible AD: no genetic evidence or insufficient domains or mixed aetiology present" + }, + { + "label": "D", + "text": "Disturbance not better explained by cerebrovascular disease, another NCD, medical condition, or substances" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild NCD due to AD", + "description": "Modest cognitive decline; independence in everyday activities preserved." + }, + { + "name": "Major NCD due to AD", + "description": "Substantial cognitive decline; interferes with independence in everyday activities." + }, + { + "name": "With behavioural disturbance", + "description": "Agitation, aggression, psychosis, apathy, or disinhibition present." + }, + { + "name": "Early onset", + "description": "Onset before age 65." + }, + { + "name": "Late onset", + "description": "Onset at age 65 or older." + }, + { + "name": "Probable Alzheimer's disease", + "description": "Clear genetic or biomarker evidence, or gradual progressive course with two documented cognitive domains." + }, + { + "name": "Possible Alzheimer's disease", + "description": "Typical clinical presentation without biomarker confirmation or atypical course without alternative explanation." + } + ], + "differentials": [ + "Vascular dementia (stepwise; vascular risk factors; white matter disease)", + "Lewy body dementia (fluctuating cognition, visual hallucinations, parkinsonism, RBD)", + "Frontotemporal dementia (early behaviour/language; memory spared early)", + "Normal pressure hydrocephalus (gait + incontinence + cognitive triad)", + "Reversible causes: B12, hypothyroidism, neurosyphilis, structural lesions, medication", + "MDD with cognitive features (pseudodementia)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Alzheimer's Disease] [specifier(s)]. There is insidious onset with gradual, progressive decline in one or more cognitive domains, with episodic memory impairment (particularly anterograde learning) typically the earliest and most prominent feature. Additional domains affected may include complex attention, executive functioning, language (word-finding, naming), perceptual-motor abilities, and social cognition. The pattern is consistent with Alzheimer's disease neuropathology, characterised by relentless progression without prolonged plateaus or stepwise changes. Symptoms cause clinically significant impairment in independence for instrumental or basic activities of daily living. The disturbance does not occur exclusively during delirium and is not better explained by another neurological disorder, medical condition, substance use, or primary psychiatric disorder. Reversible causes of cognitive impairment must be actively excluded.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ncg-vascular-neurocognitive-disorder", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "F01.50", + "title": "Vascular neurocognitive disorder", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "Clinical features consistent with vascular aetiology: decline in complex attention and executive function; temporal link to cerebrovascular event(s) or neuroimaging evidence of vascular pathology" + }, + { + "label": "C", + "text": "Probable: neuroimaging with significant vascular pathology or temporal link to infarct; Possible: no neuroimaging or temporal link but clinical features present" + }, + { + "label": "D", + "text": "Disturbance not better explained by another brain disease or systemic disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Major neurocognitive disorder", + "description": "Degree of cognitive impairment and level of functional independence." + }, + { + "name": "With behavioural disturbance", + "description": "Agitation, mood change, psychosis, or other behavioural symptoms present." + }, + { + "name": "Probable vascular NCD", + "description": "Clinical features plus neuroimaging with significant vascular pathology or clear temporal link to stroke." + }, + { + "name": "Possible vascular NCD", + "description": "Clinical features present without definitive imaging or temporal relationship." + } + ], + "differentials": [ + "Alzheimer's disease (memory-predominant; insidious)", + "Lewy body NCD (fluctuation, visual hallucinations, parkinsonism)", + "Normal pressure hydrocephalus (gait + incontinence + cognitive triad)", + "Delirium following stroke" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Vascular Neurocognitive Disorder] [specifier(s)]. Following a cerebrovascular event or in the context of ongoing cerebrovascular disease, there have been impairments in attention; impairments in executive functioning; impairments in visuospatial abilities; impairments in learning and memory; impairments in language; impairments in social cognition, forming a pattern meeting the threshold for a vascular neurocognitive disorder. The presentation is further characterised by a temporal relationship between cognitive decline and cerebrovascular events; prominent decline in complex attention and executive functioning; focal neurological signs; evidence of cerebrovascular pathology on examination or imaging. These symptoms have resulted in clinically significant impairment in social, occupational, or adaptive functioning, with the disturbance not occurring exclusively during delirium.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ncg-lewy-body-neurocognitive-disorder", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "G31.83/F02.80", + "title": "Lewy body neurocognitive disorder", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD with insidious onset and gradual progression" + }, + { + "label": "B", + "text": "Probable: ≥2 core features (fluctuating cognition; recurrent visual hallucinations; spontaneous parkinsonism; REM sleep behaviour disorder); Possible: 1 core feature or indicative biomarker" + }, + { + "label": "C", + "text": "Core features not better explained by another condition (e.g. medications)" + }, + { + "label": "D", + "text": "Disturbance does not occur exclusively during delirium; not better explained by AD or another NCD" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Major neurocognitive disorder", + "description": "Degree of cognitive impairment and level of functional independence." + }, + { + "name": "With behavioural disturbance", + "description": "Agitation, mood change, psychosis, or other behavioural symptoms present." + }, + { + "name": "Probable Lewy body NCD", + "description": "Two or more core clinical features, or one core feature plus indicative biomarker." + }, + { + "name": "Possible Lewy body NCD", + "description": "One core feature without biomarker support, or biomarker alone without multiple core features." + } + ], + "differentials": [ + "Parkinson's disease dementia (Parkinson's predates dementia by >1 year)", + "AD (memory-predominant; no fluctuation early)", + "Vascular NCD", + "Delirium (acute onset; distinguishable by course)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Lewy Body Neurocognitive Disorder] [specifier(s)]. Since a gradual onset with progressive cognitive decline, there have been impairments in attention; impairments in executive functioning; impairments in visuospatial abilities; impairments in learning and memory; impairments in social cognition; impairments in language, forming a pattern meeting the threshold for a neurocognitive disorder associated with Lewy body pathology. The presentation is further characterised by marked fluctuations in cognition; recurrent well-formed visual hallucinations; spontaneous parkinsonism (bradykinesia; rigidity; rest tremor; postural instability); REM sleep behaviour disorder, features characteristic of Lewy body disease. These symptoms have resulted in clinically significant impairment in social, occupational, or adaptive functioning, with the disturbance not occurring exclusively during delirium, and with Alzheimer's disease, frontotemporal degeneration, vascular disease, substance effects, and other medical conditions considered less likely explanations.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ncg-frontotemporal-neurocognitive-disorder", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "G31.09/F02.80", + "title": "Frontotemporal neurocognitive disorder", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "Insidious onset and gradual progression; ≥1 of: behavioural-variant features (disinhibition, apathy, loss of empathy, perseverative behaviour, hyperorality) or language-variant features (speech/comprehension/word-retrieval deficits)" + }, + { + "label": "C", + "text": "Relative sparing of learning/memory and perceptual-motor function" + }, + { + "label": "D", + "text": "Disturbance not better explained by cerebrovascular disease, another NCD, another mental disorder, or substances" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Major neurocognitive disorder", + "description": "Degree of cognitive impairment and level of functional independence." + }, + { + "name": "With behavioural variant presentation", + "description": "Disinhibition, apathy, loss of empathy, compulsions, or dietary changes prominent." + }, + { + "name": "With language variant presentation", + "description": "Impaired fluency, grammar, naming, or comprehension dominant." + }, + { + "name": "Probable frontotemporal NCD", + "description": "Neuroimaging, genetic, or clinical course strongly supporting diagnosis." + }, + { + "name": "Possible frontotemporal NCD", + "description": "Clinical syndrome consistent without definitive biomarker or genetic confirmation." + } + ], + "differentials": [ + "Alzheimer's disease (memory-prominent; different biomarker)", + "Psychiatric disorder (depression, bipolar, OCD - early bvFTD often misdiagnosed)", + "Vascular NCD", + "Lewy body dementia" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Frontotemporal Neurocognitive Disorder] [specifier(s)]. Since a gradual onset with progressive decline, there have been impairments in executive functioning; impairments in social cognition; impairments in language; impairments in attention; impairments in learning and memory; impairments in perceptual-motor abilities, forming a pattern meeting the threshold for a neurocognitive disorder due to frontotemporal degeneration. The presentation is further characterised by insidious progression with either prominent behavioural-variant features - disinhibition; apathy; loss of empathy; perseverative or compulsive behaviours; hyperorality; dietary change - or prominent language-variant features such as impaired speech production; impaired word comprehension; impaired naming; impaired grammar, consistent with frontotemporal pathology. These symptoms have resulted in clinically significant impairment in social, interpersonal, occupational, or adaptive functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ncg-neurocognitive-disorder-due-to-parkinson-s-disease", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "G20.C/F02.80", + "title": "Neurocognitive disorder due to Parkinson's disease", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "Disturbance develops in context of established Parkinson's disease" + }, + { + "label": "C", + "text": "Insidious onset and gradual progression" + }, + { + "label": "D", + "text": "Disturbance not better explained by another medical condition, mental disorder, or substances" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Major neurocognitive disorder", + "description": "Level of cognitive decline and degree of functional independence." + }, + { + "name": "With behavioural disturbance", + "description": "Agitation, psychosis, mood symptoms, irritability, apathy, or disinhibition present." + }, + { + "name": "Without behavioural disturbance", + "description": "Cognitive decline without prominent behavioural symptoms." + } + ], + "differentials": [ + "Lewy body dementia (dementia within 1 year of parkinsonism)", + "Drug-induced parkinsonism with cognitive impairment", + "AD with extrapyramidal features", + "Vascular NCD" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Neurocognitive Disorder Due to Parkinson's Disease] [specifier(s)]. In the context of established Parkinson's disease, there have been impairments in attention; impairments in executive functioning; impairments in learning and memory; impairments in language; impairments in perceptual-motor abilities; impairments in social cognition, forming a pattern meeting the threshold for a neurocognitive disorder. The presentation is further characterised by motor symptoms of Parkinson's disease preceding the onset of cognitive decline; a gradual progression of cognitive impairment; cognitive deficits attributable to the neurodegenerative process rather than medication effects or another cause. These symptoms have resulted in clinically significant impairment in social, occupational, or adaptive functioning, with the disturbance not occurring exclusively during delirium.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-neurocognitive-disorder-due-to-huntington-s-disease", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "G10/F02.80", + "title": "Neurocognitive disorder due to Huntington's disease", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "Insidious onset and gradual progression" + }, + { + "label": "C", + "text": "Clinically established Huntington's disease or at-risk with positive genetic testing" + }, + { + "label": "D", + "text": "Disturbance not better explained by another condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Major neurocognitive disorder", + "description": "Degree of cognitive decline and loss of functional independence." + }, + { + "name": "With behavioural disturbance", + "description": "Agitation, apathy, irritability, depression, impulsivity, aggression, or psychosis present." + }, + { + "name": "Without behavioural disturbance", + "description": "Cognitive decline without prominent behavioural or emotional symptoms." + } + ], + "differentials": [ + "Alzheimer's disease (no chorea; no family history)", + "Other movement disorders (Wilson's disease, neuroacanthocytosis)", + "Primary psychiatric disorder (may predate cognitive/motor symptoms)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Neurocognitive Disorder Due to Huntington's Disease] [specifier(s)]. In the context of genetically confirmed or clinically established Huntington's disease, there have been impairments in attention; impairments in executive functioning; impairments in learning and memory; impairments in language; impairments in perceptual-motor abilities; impairments in social cognition, forming a pattern meeting the threshold for a neurocognitive disorder. The presentation is further characterised by insidious onset and gradual progression; cognitive decline occurring in association with characteristic motor features such as chorea, dystonia, gait disturbance, slowed voluntary movements; emotional or behavioural changes such as irritability, depression, apathy, impulsivity, consistent with the neurodegenerative course of Huntington's disease. These symptoms have resulted in clinically significant impairment in social, occupational, or adaptive functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-neurocognitive-disorder-due-to-traumatic-brain-injury", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "S09.90XS/F02.80", + "title": "Neurocognitive disorder due to traumatic brain injury", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "Evidence of TBI: loss of consciousness; post-traumatic amnesia; disorientation/confusion; neurological signs — occurring in impact context" + }, + { + "label": "C", + "text": "NCD presents immediately after TBI or immediately after regaining consciousness; persists beyond acute post-injury period" + }, + { + "label": "D", + "text": "Disturbance not better explained by another condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Major neurocognitive disorder", + "description": "Degree of cognitive impairment and level of functional independence." + }, + { + "name": "With behavioural disturbance", + "description": "Agitation, mood symptoms, apathy, psychosis, disinhibition, or irritability present." + }, + { + "name": "Persistent", + "description": "Cognitive deficits continue for more than 1 year after the TBI." + } + ], + "differentials": [ + "Intracranial haematoma or contusion (acute structural - neuroimaging required)", + "Post-traumatic PTSD or MDD mimicking cognitive impairment", + "Medication effect (sedatives, opioids post-injury)", + "Pre-existing NCD" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Neurocognitive Disorder Due to Traumatic Brain Injury] [specifier(s)]. Following a traumatic brain injury, there have been impairments in attention; impairments in executive functioning; impairments in learning and memory; impairments in language; impairments in perceptual-motor abilities; impairments in social cognition, forming a pattern meeting the threshold for a neurocognitive disorder. The presentation is further characterised by evidence that the cognitive decline began immediately after the traumatic brain injury or shortly thereafter; loss of consciousness; post-traumatic amnesia; disorientation or confusion; neurological signs such as seizures, focal deficits, or visual field changes. These symptoms have resulted in clinically significant impairment in social, occupational, or adaptive functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-neurocognitive-disorder-due-to-prion-disease", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "A81.9/F02.80", + "title": "Neurocognitive disorder due to prion disease", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "Insidious onset with rapid progression" + }, + { + "label": "C", + "text": "Motor features (myoclonus, ataxia, chorea, dystonia, or spasticity) are present" + }, + { + "label": "D", + "text": "Disturbance not better explained by another medical condition or mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Major NCD due to prion disease", + "description": "Rapidly progressive cognitive decline with marked functional impairment and loss of independence." + }, + { + "name": "With behavioural disturbance", + "description": "Prominent psychosis, agitation, mood disturbance, apathy, or other behavioural symptoms." + }, + { + "name": "Without behavioural disturbance", + "description": "Cognitive and neurological decline without prominent behavioural features." + } + ], + "differentials": [ + "Rapidly progressive Alzheimer's disease", + "Autoimmune encephalitis (anti-NMDA, anti-LGI1, CASPR2 - treatable; must exclude)", + "Toxic-metabolic encephalopathy", + "Viral encephalitis" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Neurocognitive Disorder Due to Prion Disease] [specifier(s)]. Following a rapidly progressive course, there has been evidence of marked cognitive decline from a previous level of functioning involving complex attention; executive function; learning and memory; language; perceptual-motor function; social cognition, forming a pattern characteristic of prion-related neurodegeneration. The presentation is further characterised by a rapidly progressive and often fulminant course, with associated neurological features such as myoclonus, ataxia, visual disturbance, extrapyramidal features, or akinetic mutism, and aetiological evidence consistent with prion disease, with symptoms not occurring exclusively in the context of delirium. These symptoms have resulted in clinically significant cognitive impairment with loss of independence in everyday functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ncg-neurocognitive-disorder-due-to-hiv-infection", + "category": { + "key": "ncg", + "label": "Neurocognitive & Delirium" + }, + "icd_code": "B22.0/F02.80", + "title": "Neurocognitive disorder due to HIV infection", + "key_features": [ + { + "label": "A", + "text": "Criteria met for major or mild NCD" + }, + { + "label": "B", + "text": "HIV infection is documented" + }, + { + "label": "C", + "text": "NCD not better explained by non-HIV conditions (particularly opportunistic infections, CNS lymphoma)" + }, + { + "label": "D", + "text": "Disturbance not occurring exclusively during delirium; not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild NCD due to HIV", + "description": "Modest cognitive decline with preserved independence, requiring compensatory strategies." + }, + { + "name": "Major NCD due to HIV", + "description": "Significant cognitive decline with loss of independence in everyday functioning." + }, + { + "name": "With behavioural disturbance", + "description": "Associated psychosis, mood disturbance, agitation, apathy, or other behavioural symptoms." + }, + { + "name": "Without behavioural disturbance", + "description": "Cognitive decline without prominent behavioural or psychological features." + } + ], + "differentials": [ + "Opportunistic CNS infection (toxoplasmosis, cryptococcal meningitis, PML - must exclude urgently)", + "Substance-related NCD", + "MDD with cognitive features" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Neurocognitive Disorder Due to HIV Infection] [specifier(s)]. Following established HIV infection, there has been evidence of cognitive decline from a previous level of functioning involving complex attention; executive function; learning and memory; language; perceptual-motor function; social cognition, forming a pattern attributable to HIV-related central nervous system involvement. The presentation is further characterised by a temporal relationship with HIV infection, with cognitive deficits not better explained by another medical, neurological, or psychiatric condition, and not occurring exclusively in the context of delirium. These symptoms have resulted in clinically significant cognitive impairment with interference in occupational, social, or instrumental functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-eat-anorexia-nervosa", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F50.01", + "title": "Anorexia nervosa", + "key_features": [ + { + "label": "A", + "text": "Restriction of energy intake → significantly low body weight for age, sex, developmental trajectory, and physical health" + }, + { + "label": "B", + "text": "Intense fear of weight gain or persistent behaviour interfering with weight gain, despite low weight" + }, + { + "label": "C", + "text": "Disturbance in how weight/shape experienced; undue influence on self-evaluation; or persistent lack of recognition of seriousness of current low weight" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Restricting type", + "description": "Weight loss primarily through dieting, fasting, or excessive exercise; no recurrent binge eating or purging." + }, + { + "name": "Binge-eating/purging type", + "description": "Recurrent binge eating or purging in the past 3 months." + }, + { + "name": "In partial remission", + "description": "Body weight no longer markedly low but fear of weight gain or body image disturbance persists." + }, + { + "name": "In full remission", + "description": "Full criteria no longer met for a sustained period." + }, + { + "name": "Severity: Mild", + "description": "BMI ≥17 kg/m²." + }, + { + "name": "Severity: Moderate", + "description": "BMI 16-16.99 kg/m²." + }, + { + "name": "Severity: Severe", + "description": "BMI 15-15.99 kg/m²." + }, + { + "name": "Severity: Extreme", + "description": "BMI <15 kg/m². Medical admission almost always required." + } + ], + "differentials": [ + "ARFID (no body image disturbance; no fear of weight gain - critical distinction)", + "Bulimia nervosa (normal or above-normal weight; binge-purge cycle)", + "MDD with appetite loss (no weight/shape overvaluation)", + "OCD with food contamination obsessions", + "Medical cause of weight loss (malignancy, IBD, coeliac, hyperthyroidism)", + "Somatic symptom disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Anorexia Nervosa] [specifier(s)]. There is persistent restriction of energy intake leading to a significantly low body weight in the context of the individual's age, sex, developmental trajectory, and physical health. The presentation is further characterised by an intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain (even at markedly low weight); and a disturbance in the way 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. The pattern must include all three features: low weight, fear or interfering behaviour, and cognitive disturbance. This diagnosis carries the highest mortality rate of any psychiatric disorder. These symptoms have resulted in clinically significant impairment in physical health, nutritional status, or psychosocial functioning. The disturbance is not better explained by another medical condition or a primary depressive, psychotic, or obsessive-compulsive disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-eat-bulimia-nervosa", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F50.2", + "title": "Bulimia nervosa", + "key_features": [ + { + "label": "A", + "text": "Recurrent binge eating episodes (eating large amount in discrete period + sense of lack of control)" + }, + { + "label": "B", + "text": "Recurrent inappropriate compensatory behaviours to prevent weight gain (purging, fasting, excessive exercise)" + }, + { + "label": "C", + "text": "Binges and compensatory behaviours occur ≥1×/week for ≥3 months" + }, + { + "label": "D", + "text": "Self-evaluation unduly influenced by body shape and weight" + }, + { + "label": "E", + "text": "Disturbance does not occur exclusively during episodes of anorexia nervosa" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "In partial remission", + "description": "Some but not all criteria absent for a sustained period." + }, + { + "name": "In full remission", + "description": "None of the criteria met for a sustained period." + }, + { + "name": "Severity: Mild", + "description": "1-3 compensatory behaviours per week." + }, + { + "name": "Severity: Moderate", + "description": "4-7 compensatory behaviours per week." + }, + { + "name": "Severity: Severe", + "description": "8-13 compensatory behaviours per week." + }, + { + "name": "Severity: Extreme", + "description": "≥14 compensatory behaviours per week." + } + ], + "differentials": [ + "AN binge-eating/purging type (markedly low body weight)", + "BED (no compensatory behaviours)", + "BPD with impulsive eating", + "Medical cause of repeated vomiting (gastroparesis, cyclical vomiting syndrome)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Bulimia Nervosa] [specifier(s)]. Over at least three months, there have been recurrent episodes of binge eating; eating an objectively large amount of food in a discrete period; a subjective loss of control during these episodes; recurrent inappropriate compensatory behaviours such as vomiting; misuse of laxatives; misuse of diuretics; misuse of other medications; fasting; excessive exercise, occurring at least once per week. The presentation is further characterised by self-evaluation unduly influenced by body shape and weight. These symptoms have resulted in clinically significant distress or impairment in physical, social, or occupational functioning, and the presentation is not better explained by anorexia nervosa or another medical or psychiatric condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-eat-binge-eating-disorder", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F50.81", + "title": "Binge-eating disorder", + "key_features": [ + { + "label": "A", + "text": "Recurrent binge eating episodes associated with ≥3 of: eating faster; eating until uncomfortably full; eating large amounts when not physically hungry; eating alone due to embarrassment; feeling disgusted/depressed/guilty afterwards" + }, + { + "label": "B", + "text": "Marked distress regarding binge eating" + }, + { + "label": "C", + "text": "Binge eating occurs ≥1×/week for ≥3 months" + }, + { + "label": "D", + "text": "Not associated with recurrent use of inappropriate compensatory behaviours (unlike bulimia)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "In partial remission", + "description": "Binge eating occurs at lower frequency (< 1/week) but has not fully resolved." + }, + { + "name": "In full remission", + "description": "Full criteria no longer met for a sustained period." + }, + { + "name": "Severity: Mild", + "description": "1-3 binge-eating episodes per week." + }, + { + "name": "Severity: Moderate", + "description": "4-7 binge-eating episodes per week." + }, + { + "name": "Severity: Severe", + "description": "8-13 binge-eating episodes per week." + }, + { + "name": "Severity: Extreme", + "description": "≥14 binge-eating episodes per week." + } + ], + "differentials": [ + "Bulimia nervosa (compensatory behaviours present - reclassify)", + "AN binge-eating/purging type (markedly low weight)", + "Obesity without loss of control eating", + "MDD with overeating", + "Binge eating in bipolar mania" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Binge-Eating Disorder] [specifier(s)]. Over at least three months, there have been recurrent episodes of binge eating; eating an objectively large amount of food in a discrete period; a subjective loss of control during these episodes, accompanied by eating much more rapidly than normal; eating until uncomfortably full; eating large amounts when not physically hungry; eating alone due to embarrassment; feeling disgusted, depressed, or guilty after overeating, occurring at least once per week. The presentation is further supported by marked distress regarding binge eating, consistent with a binge-eating pattern without compensatory behaviours. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or physical functioning, and the presentation is not better explained by bulimia nervosa, anorexia nervosa, or another medical or psychiatric condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-eat-avoidant-restrictive-food-intake-disorder-arfid", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F50.82", + "title": "Avoidant/restrictive food intake disorder (ARFID)", + "key_features": [ + { + "label": "A", + "text": "Eating/feeding disturbance (apparent lack of interest; sensory-based avoidance; concern about aversive consequences) → persistent failure to meet nutritional/energy needs" + }, + { + "label": "B", + "text": "≥1 of: significant weight loss/failure to gain weight; significant nutritional deficiency; dependence on enteral feeding/oral supplements; marked interference with psychosocial functioning" + }, + { + "label": "C", + "text": "Not better explained by food unavailability or culturally sanctioned practice" + }, + { + "label": "D", + "text": "Not occurring exclusively during anorexia nervosa or bulimia nervosa" + }, + { + "label": "E", + "text": "Not attributable to another medical condition or mental disorder (or clearly in excess of what routinely associated with that condition)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No formal DSM-5-TR specifiers", + "description": "Clinical descriptions typically specify: sensory-based avoidance, fear-of-consequences, or low interest/appetite subtype - guides treatment selection." + } + ], + "differentials": [ + "AN (body image disturbance and/or fear of weight gain - critical distinction)", + "Specific phobia (overlap with fear-of-consequences subtype)", + "OCD with food contamination obsessions", + "ASD (food selectivity - ARFID may be comorbid)", + "GI pathology (coeliac, eosinophilic oesophagitis, gastroparesis)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Avoidant/Restrictive Food Intake Disorder]. Over a period of persistent restrictive eating, there have been avoidance based on sensory characteristics of food; concern about aversive consequences of eating; apparent lack of interest in food or eating; significantly restricted intake. The presentation is further characterised by significant weight loss; faltering growth trajectory; nutritional deficiency; dependence on enteral feeding or oral nutritional supplements; marked interference with psychosocial functioning. These symptoms have resulted in clinically significant distress or impairment in social, occupational, educational, or interpersonal functioning, are not better explained by lack of available food or culturally sanctioned practices, and do not occur exclusively during anorexia nervosa or bulimia nervosa. In addition, body weight or shape concerns are absent.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-eat-pica", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F98.3", + "title": "Pica", + "key_features": [ + { + "label": "A", + "text": "Persistent eating of non-nutritive, non-food substances for ≥1 month" + }, + { + "label": "B", + "text": "Eating of non-nutritive substance is inappropriate to developmental level" + }, + { + "label": "C", + "text": "Not part of culturally supported or socially normative practice" + }, + { + "label": "D", + "text": "If occurring during another mental disorder or medical condition, severe enough to warrant independent clinical attention" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No formal DSM specifiers", + "description": "Clinical notes may clarify context (e.g. associated nutritional deficiency, pregnancy, developmental disability)." + } + ], + "differentials": [ + "Cultural practice (culturally sanctioned - do not diagnose)", + "Intellectual disability or ASD (may coexist - address independently)", + "OCD (compulsive ingestion driven by obsessions)", + "Schizophrenia (delusional ingestion)", + "Medical cause: iron or zinc deficiency" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Pica]. Over at least one month, there has been persistent eating of non-nutritive, non-food substances; repeated ingestion despite lack of nutritional value; consumption of items incongruent with developmental level. The presentation is further characterised by behaviours not culturally sanctioned and not attributable to food scarcity. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better explained by another mental disorder (including intellectual disability or autism spectrum disorder) or by a medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-eat-rumination-disorder", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F98.21", + "title": "Rumination disorder", + "key_features": [ + { + "label": "A", + "text": "Repeated regurgitation of food for ≥1 month; regurgitated food may be re-chewed, re-swallowed, or spat out" + }, + { + "label": "B", + "text": "Not attributable to a gastrointestinal or other medical condition (e.g. GERD)" + }, + { + "label": "C", + "text": "Not occurring exclusively during anorexia nervosa, bulimia, BED, or ARFID" + }, + { + "label": "D", + "text": "If occurring during another mental disorder, severe enough to warrant independent clinical attention" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No formal DSM specifiers", + "description": "Clinical descriptions may specify context (e.g. developmental disability, infancy vs later onset)." + } + ], + "differentials": [ + "GORD or upper GI pathology (pathological reflux; medical investigation required)", + "Bulimia nervosa (compensatory behaviour; body image concern)", + "Functional dyspepsia" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Rumination Disorder]. Over at least one month, there has been repeated regurgitation of recently ingested food; effortless re-chewing of regurgitated material; re-swallowing; spitting out, forming a consistent behavioural pattern. The presentation is further characterised by behaviour not attributable to gastrointestinal or other medical conditions and not occurring exclusively during anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. These symptoms have resulted in clinically significant distress or impairment, and the picture is not better accounted for by another mental disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-eat-other-specified-unspecified-feeding-or-eating-disorder", + "category": { + "key": "eat", + "label": "Eating & Feeding" + }, + "icd_code": "F50.89", + "title": "Other specified / Unspecified feeding or eating disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a feeding/eating disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific feeding or eating disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason criteria not met (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Atypical anorexia nervosa", + "description": "All AN criteria met except weight remains within or above normal range." + }, + { + "name": "Bulimia nervosa (low frequency/limited duration)", + "description": "Compensatory behaviour and binge pattern present but below DSM threshold." + }, + { + "name": "Binge-eating disorder (low frequency/limited duration)", + "description": "Binge episodes present but below DSM threshold." + }, + { + "name": "Purging disorder", + "description": "Recurrent purging behaviour without binge eating." + }, + { + "name": "Night eating syndrome", + "description": "Recurrent evening or nocturnal eating with distress/impairment." + } + ], + "differentials": [ + "Specific feeding/eating disorder (full criteria - reclassify)", + "Medical GI pathology", + "Primary mood or anxiety disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Feeding/Eating Disorder] [specifier(s)]. The presentation includes clinically significant disturbances in eating or related behaviours such as atypical anorexia nervosa; subthreshold bulimia nervosa; subthreshold binge-eating disorder; purging disorder; night eating syndrome, each representing patterns where key eating-disorder features are present but full syndrome criteria are not met, while remaining stable and clinically meaningful. The presentation is further characterised by recurrent maladaptive eating behaviours that do not fully satisfy threshold requirements of anorexia nervosa, bulimia nervosa, binge-eating disorder, or ARFID, but maintain internal consistency and diagnostic clarity. These symptoms have resulted in clinically significant distress or impairment in social, occupational, nutritional, or physical functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-per-borderline-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.3", + "title": "Borderline personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of instability of interpersonal relationships, self-image, and affect, with marked impulsivity beginning by early adulthood; ≥5 of 9: frantic efforts to avoid abandonment; unstable intense relationships; identity disturbance; impulsivity in ≥2 damaging areas; suicidal/self-mutilating behaviour; affective instability; chronic emptiness; inappropriate intense anger; transient stress-related paranoia/dissociation" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Severity determined by intensity of emotional dysregulation, interpersonal dysfunction, self-harm, and functional impairment." + }, + { + "name": "With prominent dissociative features", + "description": "Marked transient dissociation or paranoia during stress." + }, + { + "name": "With predominant impulsive behaviour", + "description": "Risk-taking, substance misuse, bingeing, or reckless acts." + }, + { + "name": "With predominant affective instability", + "description": "Rapid mood shifts with heightened reactivity." + } + ], + "differentials": [ + "Bipolar II disorder (episodic mood elevation; not reactive mood instability)", + "MDD (full depressive episodes; without chronic identity/relational disturbance)", + "PTSD (highly comorbid with BPD)", + "ADHD (impulsivity without identity disturbance or self-harm)", + "Histrionic PD (attention-seeking without self-harm or identity fragmentation)", + "Dependent PD (fear of abandonment but without impulsivity or self-harm)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Borderline Personality Disorder] [specifier(s)]. Since adolescence or early adulthood, there has been a pervasive pattern of frantic efforts to avoid abandonment; unstable and intense relationships; identity disturbance; impulsive behaviours; recurrent self-harm or suicidal behaviour; marked affective instability; chronic feelings of emptiness; intense anger; transient stress-related paranoia; transient dissociation, forming a pattern meeting the threshold for a stable and enduring borderline personality structure. The presentation is further characterised by persistent instability in self-image, emotional regulation, interpersonal functioning, and impulse control, occurring across multiple contexts. These symptoms have resulted in clinically significant impairment in interpersonal, social, or occupational functioning, and the presentation is not better explained by bipolar disorder, substance use, or another medical or neurological condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-antisocial-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.2", + "title": "Antisocial personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of disregard for/violation of rights of others since age 15: ≥3 of 7: failure to conform to lawful behaviours; deceitfulness; impulsivity; irritability/aggressiveness; reckless disregard for safety; consistent irresponsibility; lack of remorse" + }, + { + "label": "B", + "text": "Age ≥18" + }, + { + "label": "C", + "text": "Evidence of conduct disorder with onset before age 15" + }, + { + "label": "D", + "text": "Not occurring exclusively during schizophrenia or bipolar disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With limited prosocial emotions (callous-unemotional traits)", + "description": "Persistent lack of remorse or guilt; callous indifference; unconcerned about performance; shallow or deficient affect." + }, + { + "name": "Mild", + "description": "Minimum threshold of excess antisocial traits with clear but limited functional impairment." + }, + { + "name": "Moderate", + "description": "Definite and recurrent adverse impact on others." + }, + { + "name": "Severe", + "description": "Many pronounced antisocial traits with pervasive impairment and significant harm to others." + } + ], + "differentials": [ + "Narcissistic PD (exploitation without conduct disorder history; less aggression)", + "Borderline PD (interpersonal fear vs predatory pattern)", + "Conduct disorder (under 18)", + "SUD with antisocial behaviour (if confined to intoxication/withdrawal)", + "Bipolar mania (episodic; mood-driven)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Antisocial Personality Disorder] [specifier(s)]. Since at least age 15 years, there has been a pervasive pattern of disregard for and violation of the rights of others, including failure to conform to lawful behaviours; repeated acts that are grounds for arrest; deceitfulness; repeated lying; use of aliases; conning others for personal profit or pleasure; impulsivity; failure to plan ahead; irritability; aggressiveness; repeated physical fights or assaults; reckless disregard for safety of self or others; consistent irresponsibility; failure to sustain work behaviour; failure to honour financial obligations; lack of remorse; indifference to or rationalisation of having hurt, mistreated, or stolen from others, forming a stable pattern meeting the threshold for an antisocial personality presentation. The presentation is further characterised by a pervasive and enduring trait pattern not confined to discrete mood or psychotic episodes. These features have resulted in clinically significant impairment in interpersonal, occupational, and social functioning, and there is evidence of conduct disorder with onset before age 15 years. The antisocial behaviour does not occur exclusively during schizophrenia or bipolar disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-narcissistic-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.81", + "title": "Narcissistic personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of grandiosity, need for admiration, and lack of empathy beginning by early adulthood; ≥5 of 9: grandiose sense of self-importance; preoccupation with fantasies of unlimited success/power/brilliance/beauty/love; believes he/she is special; requires excessive admiration; sense of entitlement; interpersonally exploitative; lacks empathy; envious of others or believes others are envious; arrogant" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Severity determined by rigidity of grandiosity, degree of empathy impairment, and interpersonal dysfunction." + }, + { + "name": "With predominant grandiose features", + "description": "Overt superiority, entitlement, and externalised blame." + }, + { + "name": "With predominant vulnerable features", + "description": "Hypersensitivity to rejection, shame-driven withdrawal, and covert grandiosity." + } + ], + "differentials": [ + "Antisocial PD (exploitation with recklessness; conduct disorder history)", + "Histrionic PD (attention-seeking through emotionality rather than grandiosity)", + "Borderline PD (identity disturbance and abandonment terror)", + "Bipolar I mania (episodic grandiosity)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Narcissistic Personality Disorder] [specifier(s)]. Since adolescence or early adulthood, there has been a pervasive pattern of grandiosity; exaggerated self-importance; fantasies of unlimited success, power, brilliance, beauty, or ideal love; belief in being special and needing to associate with high-status individuals; requirement for excessive admiration; sense of entitlement; interpersonal exploitative behaviour; lack of empathy; envy of others; belief others envy them; arrogant or haughty attitudes, forming a pattern meeting the threshold for a stable and enduring narcissistic personality structure. The presentation is further characterised by interpersonal sensitivity to criticism, fragile self-esteem, and fluctuating self-worth tied to external validation. These symptoms have resulted in clinically significant impairment in interpersonal, occupational, or social functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-paranoid-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.0", + "title": "Paranoid personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood; ≥4 of 7: suspects exploitation/harm/deception; preoccupied with unjustified doubts about loyalty; reluctant to confide; reads hidden threatening meanings; bears grudges; perceives attacks on character not apparent to others; recurrent suspicions about fidelity of partner" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With prominent hostility", + "description": "Heightened angry or aggressive interpersonal style." + }, + { + "name": "With prominent suspiciousness", + "description": "Dominant pervasive mistrust colouring most interactions." + }, + { + "name": "Mild / Moderate / Severe", + "description": "Based on pervasiveness of paranoid traits and degree of functional impairment." + } + ], + "differentials": [ + "Delusional disorder, persecutory type (fixed false beliefs at full delusional intensity)", + "Schizotypal PD (odd beliefs, magical thinking, eccentric - beyond mere suspicion)", + "Paranoid features of substance intoxication (cannabis, stimulants)", + "Paranoid features due to a medical condition" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Paranoid Personality Disorder] [specifier(s)]. Since early adulthood, there has been a pervasive pattern of suspecting others of exploiting, harming, or deceiving them; preoccupation with unjustified doubts about the loyalty or trustworthiness of others; reluctance to confide due to unwarranted fear that information will be used maliciously; reading hidden demeaning or threatening meanings into benign remarks; persistently bearing grudges; perceiving attacks on character not apparent to others and reacting with anger or counterattack; recurrent suspiciousness regarding the fidelity of a spouse or partner, forming a pattern meeting the threshold for a longstanding paranoid personality structure. These symptoms have resulted in clinically significant interpersonal, social, or occupational impairment, with the disturbance not occurring exclusively during psychotic disorders.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-schizoid-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.1", + "title": "Schizoid personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of detachment from social relationships and restricted range of emotional expression, beginning by early adulthood; ≥4 of 7: neither desires nor enjoys close relationships; almost always chooses solitary activities; little/no interest in sexual experiences; few/no pleasurable activities; lacks close friends; appears indifferent to praise/criticism; shows emotional coldness/detachment/flat affect" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Severity determined by degree of social withdrawal, emotional blunting, and functional impairment." + }, + { + "name": "With constricted affect", + "description": "Emotional range notably limited but not absent." + }, + { + "name": "With social isolation", + "description": "Near-complete disengagement from interpersonal activity." + } + ], + "differentials": [ + "Schizotypal PD (eccentric, odd beliefs, magical thinking)", + "Avoidant PD (desires relationships but fears rejection)", + "ASD (social communication deficits not driven by preference for isolation)", + "MDD with social withdrawal (episode-bound)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Schizoid Personality Disorder] [specifier(s)]. Since early adulthood, there has been a longstanding pattern of detachment from social relationships; lack of desire for close relationships; preference for solitary activities; minimal interest in sexual experiences with others; limited pleasure in activities; restricted emotional expression; appearing indifferent to praise or criticism; emotional coldness, forming a pattern meeting the threshold for a persistent schizoid personality structure. The presentation is further characterised by a pervasive and stable trait pattern across social, occupational, and interpersonal contexts, not confined to discrete episodes. These symptoms have resulted in clinically significant interpersonal and occupational impairment.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-schizotypal-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F21", + "title": "Schizotypal personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of social/interpersonal deficits with acute discomfort in close relationships, cognitive/perceptual distortions, and eccentricities of behaviour, beginning by early adulthood; ≥5 of 9: ideas of reference; odd beliefs/magical thinking; unusual perceptual experiences; odd thinking/speech; suspiciousness/paranoid ideation; inappropriate/constricted affect; odd/eccentric behaviour/appearance; lacks close friends; excessive social anxiety" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Based on degree of functional disruption, odd/magical thinking, perceptual disturbances, and interpersonal impairment." + } + ], + "differentials": [ + "Schizophrenia (active psychosis; duration criteria; role decline)", + "Delusional disorder (fixed false beliefs at full intensity)", + "Schizoid PD (isolation without odd beliefs)", + "ASD (social deficits from early development; no magical thinking)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Schizotypal Personality Disorder] [specifier(s)]. Since early adulthood, there has been a pervasive and stable pattern of social and interpersonal deficits including marked discomfort in close relationships; reduced capacity for close relationships; social anxiety linked to paranoid fears; alongside cognitive-perceptual disturbances such as ideas of reference; odd beliefs or magical thinking; unusual perceptual experiences; suspiciousness or paranoid ideation; and eccentric behaviours including odd thinking and speech; odd, eccentric, or peculiar behaviour or appearance; inappropriate or constricted affect; lack of close friends or confidants; excessive social anxiety. These features have been present across multiple contexts, remain stable over time, and are not confined to discrete mood or psychotic episodes. The pattern has led to significant interpersonal, social, and functional impairment, and is not better explained by schizophrenia, bipolar or depressive disorders with psychotic features, autism spectrum disorder, substance use, or a medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-obsessive-compulsive-personality-disorder-ocpd", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.5", + "title": "Obsessive-compulsive personality disorder (OCPD)", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control (at the expense of flexibility, openness, and efficiency), beginning by early adulthood; ≥4 of 8: preoccupation with details/rules/order; perfectionism interfering with task completion; excessively devoted to work; overconscientious about morality/ethics; unable to discard worthless objects; reluctant to delegate; miserly; rigidity/stubbornness" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Severity based on rigidity of perfectionism, degree of functional impairment, and pervasiveness of compulsive personality traits." + } + ], + "differentials": [ + "OCD (ego-dystonic intrusive obsessions + compulsions; not a personality style)", + "Narcissistic PD (perfectionism driven by need for admiration)", + "ASD (rigidity is neurodevelopmental; different onset and profile)", + "Hoarding disorder (comorbid with OCPD but a distinct diagnosis)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Obsessive-Compulsive Personality Disorder] [specifier(s)]. Since early adulthood, there has been a pervasive pattern of preoccupation with orderliness; perfectionism; mental and interpersonal control; rigidity; inflexibility; excessive devotion to work and productivity; overconscientiousness; scrupulosity; reluctance to delegate; difficulty discarding worn or worthless items; miserly spending style; stubbornness, forming a pattern meeting the threshold for a stable and enduring obsessive-compulsive personality structure. The presentation is further characterised by restricted emotional expression, overcontrol, and persistent cognitive-behavioural rigidity that interferes with spontaneity and adaptive functioning. These symptoms have resulted in clinically significant impairment in interpersonal, occupational, or adaptive functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-avoidant-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.6", + "title": "Avoidant personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood; ≥4 of 7: avoids occupational activities involving interpersonal contact due to fears of criticism; unwilling to get involved unless certain of being liked; shows restraint in intimate relationships due to fear of shame; preoccupied with being criticised/rejected; inhibited in new interpersonal situations; views self as socially inept/unappealing/inferior; unusually reluctant to take risks or engage in new activities" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Excess avoidant traits with limited impairment; functional in familiar environments." + }, + { + "name": "Moderate", + "description": "Pervasive avoidance with significant impairment across social and occupational domains." + }, + { + "name": "Severe", + "description": "Near-total social isolation; profound functional impairment." + } + ], + "differentials": [ + "Social anxiety disorder (highly comorbid; AvPD more pervasive and characterological)", + "Schizoid PD (no desire for connection; no distress about isolation)", + "Dependent PD (seeks closeness but fears abandonment)", + "ASD (social deficits not driven by fear of rejection)", + "MDD with social withdrawal (episode-bound)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Avoidant Personality Disorder] [specifier(s)]. Since adolescence or early adulthood, there has been a pervasive pattern of social inhibition; feelings of inadequacy; hypersensitivity to negative evaluation; avoidance of social activities requiring interpersonal contact; reluctance to engage unless certain of being liked; restraint in intimate relationships due to fears of shame or ridicule; preoccupation with criticism or rejection; inhibition in new situations due to feelings of inadequacy; perception of self as socially inept, unappealing, or inferior; marked reluctance to take personal risks or try new activities due to potential embarrassment. The presentation is further characterised by significant anxiety in social contexts and persistent avoidance despite intact desire for relationships. These symptoms have resulted in clinically significant impairment in interpersonal, occupational, or social functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-dependent-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.7", + "title": "Dependent personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour and fears of separation, beginning by early adulthood; ≥5 of 8: difficulty making everyday decisions without advice/reassurance; needs others to assume responsibility for major areas of life; difficulty expressing disagreement out of fear; difficulty initiating projects alone; goes to excessive lengths to obtain nurturance/support; feels uncomfortable/helpless when alone; urgently seeks a replacement relationship when one ends; preoccupied with fears of being left to care for self" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Severity defined by degree of dependency, rigidity of relational patterns, and associated functional impairment." + } + ], + "differentials": [ + "Avoidant PD (fear of rejection rather than desire for attachment)", + "Borderline PD (fear of abandonment + impulsivity + identity disturbance)", + "Separation anxiety disorder (developmentally inappropriate but not trait-based)", + "MDD (helplessness episode-bound)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Dependent Personality Disorder] [specifier(s)]. Since adolescence or early adulthood, there has been a pervasive pattern of excessive need to be taken care of; submissive and clinging behaviour; difficulty making everyday decisions without reassurance; needing others to assume responsibility for major life areas; difficulty expressing disagreement due to fear of loss of support; difficulty initiating projects due to low self-confidence; going to excessive lengths to obtain nurturance and support; discomfort or helplessness when alone; urgently seeking another relationship when one ends; preoccupation with fears of being left to care for oneself. These symptoms have resulted in clinically significant impairment in interpersonal, occupational, or adaptive functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-histrionic-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.4", + "title": "Histrionic personality disorder", + "key_features": [ + { + "label": "A", + "text": "Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood; ≥5 of 8: uncomfortable when not the centre of attention; inappropriate sexually seductive or provocative behaviour; rapidly shifting shallow emotions; uses physical appearance to draw attention; impressionistic/lacking-in-detail speech; theatrical/exaggerated emotional expression; suggestible; considers relationships more intimate than they are" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild / Moderate / Severe", + "description": "Severity determined by intensity of attention-seeking, emotional dysregulation, and interpersonal disruption." + } + ], + "differentials": [ + "Narcissistic PD (grandiosity and entitlement rather than emotionality)", + "Borderline PD (identity disturbance, self-harm, abandonment terror - overlap)", + "Bipolar I manic episode (episodic)", + "Antisocial PD (manipulation driven by gain, not attention)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Histrionic Personality Disorder] [specifier(s)]. Since adolescence or early adulthood, there has been a pervasive pattern of excessive emotionality; attention-seeking behaviour; discomfort when not the centre of attention; rapidly shifting and shallow expression of emotions; use of physical appearance to draw attention; impressionistic and detail-poor speech; theatrical or exaggerated emotional expression; suggestibility; perceiving relationships as more intimate than they are. The presentation is further characterised by persistent interpersonal reliance on approval, validation, and attention across multiple contexts. These symptoms have resulted in clinically significant impairment in interpersonal, social, or occupational functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-other-specified-unspecified-personality-disorder", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F60.89/F60.9", + "title": "Other specified / Unspecified personality disorder", + "key_features": [ + { + "label": "A", + "text": "Criteria met for a personality disorder (enduring pattern of inner experience/behaviour deviating markedly from cultural expectations; pervasive; inflexible; stable; leading to distress/impairment)" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific personality disorder" + }, + { + "label": "C", + "text": "Clinician specifies prominent traits (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mixed personality features", + "description": "Prominent traits of multiple PDs without meeting full criteria for one." + }, + { + "name": "Borderline traits", + "description": "Affective instability or impulsivity without full borderline syndrome." + }, + { + "name": "Narcissistic traits", + "description": "Grandiosity or need for admiration without full narcissistic pattern." + }, + { + "name": "Avoidant traits", + "description": "Social inhibition or hypersensitivity without the full avoidant syndrome." + }, + { + "name": "Paranoid or schizotypal traits", + "description": "Suspiciousness or eccentricity without full Cluster A disorder." + } + ], + "differentials": [ + "Specific named PD (full criteria met - reclassify)", + "Personality change due to medical condition", + "Substance-induced personality change", + "Normal personality variation" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Personality Disorder] [specifier(s)]. Over an enduring period since at least adolescence or early adulthood, there have been persistent and pervasive maladaptive personality traits including affective instability; impulsivity; hostility; suspiciousness; detachment; perfectionism; dependency; emotional dysregulation; rigidity; eccentric behaviour, forming a pattern that causes significant interpersonal, occupational, or adaptive difficulties but does not meet full criteria for any single defined personality disorder. The presentation is further characterised by a stable and consistent pattern of inner experience and behaviour across contexts. These symptoms have resulted in clinically significant distress or impairment, and the presentation is not better explained by another mental disorder, substance use, or a medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-per-personality-change-due-to-another-medical-condition", + "category": { + "key": "per", + "label": "Personality Disorders" + }, + "icd_code": "F07.0", + "title": "Personality change due to another medical condition", + "key_features": [ + { + "label": "A", + "text": "Persistent personality disturbance representing a change from the individual's previous characteristic personality pattern" + }, + { + "label": "B", + "text": "Evidence from history/examination/labs that disturbance is direct pathophysiological consequence of another medical condition" + }, + { + "label": "C", + "text": "Not better explained by another mental disorder (including personality disorders)" + }, + { + "label": "D", + "text": "Not occurring exclusively during delirium" + }, + { + "label": "E", + "text": "Clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Labile type", + "description": "Predominant affective instability with mood swings." + }, + { + "name": "Disinhibited type", + "description": "Impulsivity, poor judgement, socially inappropriate behaviour." + }, + { + "name": "Aggressive type", + "description": "Predominant irritability or verbal/physical aggression." + }, + { + "name": "Apathetic type", + "description": "Marked reduction in initiation, interest, or emotional responsiveness." + }, + { + "name": "Paranoid type", + "description": "Suspiciousness or distrustfulness emerging after the medical condition." + }, + { + "name": "Combined type", + "description": "More than one predominant personality change pattern present." + } + ], + "differentials": [ + "Primary personality disorder (lifelong pattern predating GMC)", + "MDD or bipolar disorder causing personality-like changes (episodic)", + "Frontotemporal dementia (progressive NCD)", + "Substance-induced personality change" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Personality Change Due to Another Medical Condition] [specifier(s)]. Following the onset of a recognised medical condition, there has been a persistent alteration in personality characterised by affective lability; irritability; apathy; disinhibition; suspiciousness; aggression; impulsivity; diminished empathy; social withdrawal; dependency; obsessionality, forming a pattern representing a marked change from previous personality functioning. The presentation is further characterised by a stable and enduring shift in emotional regulation, interpersonal behaviour, and impulse control temporally associated with the medical condition. These symptoms have resulted in clinically significant impairment in interpersonal, occupational, or adaptive functioning, and the disturbance is directly attributable to the physiological effects of the medical condition rather than another mental disorder, substance use, or delirium.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ndv-autism-spectrum-disorder-asd", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F84.0", + "title": "Autism spectrum disorder (ASD)", + "key_features": [ + { + "label": "A", + "text": "Persistent deficits in social communication/interaction across multiple contexts (≥3 components: social-emotional reciprocity; nonverbal communicative behaviours; developing/maintaining relationships)" + }, + { + "label": "B", + "text": "Restricted, repetitive patterns of behaviour/interests/activities (≥2 of: stereotyped/repetitive motor movements; insistence on sameness/inflexible routines; highly restricted interests; hyper/hyporeactivity to sensory input)" + }, + { + "label": "C", + "text": "Symptoms present in early developmental period (may not fully manifest until social demands exceed capacity)" + }, + { + "label": "D", + "text": "Cause clinically significant impairment in social, occupational, or other important areas of functioning" + }, + { + "label": "E", + "text": "Not better explained by intellectual disability or global developmental delay" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With/without accompanying intellectual impairment", + "description": "Specify and document intellectual level based on formal cognitive assessment." + }, + { + "name": "With/without accompanying language impairment", + "description": "Specify functional language level (non-verbal, phrase speech, fluent)." + }, + { + "name": "Associated with a known medical or genetic condition", + "description": "List the specific condition (e.g. Fragile X, tuberous sclerosis, Rett syndrome)." + }, + { + "name": "Associated with another neurodevelopmental, mental, or behavioural disorder", + "description": "ADHD, anxiety, depression, OCD, PTSD - each coded separately." + }, + { + "name": "With catatonia", + "description": "Catatonic features present - use additional code F06.1." + }, + { + "name": "Support level 1", + "description": "Requiring support - noticeable deficits without support; functional in some contexts." + }, + { + "name": "Support level 2", + "description": "Requiring substantial support - marked deficits; limited initiation of social interaction." + }, + { + "name": "Support level 3", + "description": "Requiring very substantial support - severe deficits; very limited initiation; minimal response." + } + ], + "differentials": [ + "ADHD (comorbid in ~50%; social deficits not as pervasive; no RRBs - code both when criteria independently met)", + "Social anxiety disorder (fear of negative evaluation; social motivation and desire intact)", + "Social (pragmatic) communication disorder (social deficits without RRBs - mutually exclusive with ASD)", + "Intellectual disability (social deficits proportional to cognitive level)", + "Selective mutism (situational mutism; no RRBs)", + "Reactive attachment disorder (history of neglect; onset <5; no RRBs)", + "OCD (ego-dystonic; rituals driven by obsessions; no social communication deficits)", + "Schizotypal PD (onset in adulthood; magical thinking; odd speech - not early developmental)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Autism Spectrum Disorder] [specifier(s)]. Since early childhood, there have been deficits in social-emotional reciprocity; deficits in nonverbal communicative behaviours; deficits in developing, maintaining, and understanding relationships, accompanied by restricted, repetitive patterns of behaviour, interests, or activities, including stereotyped or repetitive movements; stereotyped or repetitive speech; insistence on sameness; inflexible adherence to routines; ritualised behavioural patterns; highly restricted, fixated interests of abnormal intensity or focus; hyperreactivity to sensory input; hyporeactivity to sensory input; unusual sensory interests, present across multiple settings and forming a stable, pervasive developmental pattern. The presentation is further characterised by difficulties in social communication and behavioural flexibility exceeding expected developmental variation. These symptoms have resulted in clinically significant impairment in social, academic, occupational, or adaptive functioning, and the picture is not better explained by intellectual disability, global developmental delay, or another medical, neurological, or psychiatric condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-attention-deficit-hyperactivity-disorder-adhd", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F90.x", + "title": "Attention-deficit/hyperactivity disorder (ADHD)", + "key_features": [ + { + "label": "A", + "text": "≥6 inattentive symptoms and/or ≥6 hyperactive-impulsive symptoms (≥5 for age ≥17) for ≥6 months, inconsistent with developmental level and negatively impacting activities" + }, + { + "label": "B", + "text": "Several symptoms present before age 12" + }, + { + "label": "C", + "text": "Symptoms present in ≥2 settings (e.g. home, school, work, with friends)" + }, + { + "label": "D", + "text": "Clear evidence of interference with or reduction in quality of social, academic, or occupational functioning" + }, + { + "label": "E", + "text": "Not occurring exclusively during schizophrenia or another psychotic disorder; not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Combined presentation", + "description": "≥6 inattention and ≥6 hyperactivity-impulsivity symptoms (≥5 in adults ≥17)." + }, + { + "name": "Predominantly inattentive presentation", + "description": "≥6 inattention symptoms; <6 hyperactivity-impulsivity." + }, + { + "name": "Predominantly hyperactive/impulsive presentation", + "description": "≥6 hyperactivity-impulsivity symptoms; <6 inattention." + }, + { + "name": "In partial remission", + "description": "Full criteria previously met; symptoms below threshold with ongoing functional impairment." + }, + { + "name": "Severity: Mild", + "description": "Few symptoms beyond minimum threshold; minor functional impairment." + }, + { + "name": "Severity: Moderate", + "description": "Symptoms and impairment between mild and severe." + }, + { + "name": "Severity: Severe", + "description": "Many excess symptoms or markedly severe symptoms; marked impairment across multiple settings." + } + ], + "differentials": [ + "Anxiety disorders (worry-driven inattention; no early-onset hyperactivity; no developmental pattern)", + "Major depressive disorder (concentration impairment episode-bound; not developmental)", + "Bipolar disorder (episodic; not chronic developmental pattern)", + "ASD (comorbid in ~50%; code both when criteria independently met)", + "Specific learning disorder (academic domain only; no cross-setting hyperactivity)", + "Sleep disorder (daytime sleepiness mimicking inattention - always assess sleep)", + "Borderline PD (emotional dysregulation, impulsivity - adult ADHD may be misdiagnosed as BPD)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Attention-Deficit/Hyperactivity Disorder] [specifier(s)]. Since early development, there have been inattention symptoms, including poor attention to detail; difficulty sustaining attention; seeming not to listen; difficulty following instructions; difficulty organising tasks; avoidance of sustained mental effort; losing necessary items; easy distractibility; forgetfulness, and/or hyperactivity-impulsivity symptoms, including fidgeting; leaving seat inappropriately; excessive running or climbing; inability to engage quietly; acting as if driven by a motor; excessive talking; blurting out answers; difficulty waiting turn; interrupting or intruding, present for at least six months and occurring in two or more settings, with onset before age 12, forming a persistent neurodevelopmental pattern. The presentation is further characterised by behavioural, academic, organisational, or social difficulties linked to these symptoms. These symptoms have resulted in clinically significant impairment in social, academic, or occupational functioning, and the pattern is not better explained by oppositional behaviour, mood or anxiety disorders, intellectual disability, learning disorders, or another medical or neurological condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-intellectual-disability-intellectual-developmental-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F70-F79", + "title": "Intellectual disability (intellectual developmental disorder)", + "key_features": [ + { + "label": "A", + "text": "Deficits in intellectual functions (reasoning, problem-solving, planning, abstract thinking, judgement, academic learning, experiential learning) confirmed by clinical assessment and standardised testing" + }, + { + "label": "B", + "text": "Deficits in adaptive functioning in ≥1 of: conceptual, social, or practical domains — resulting in failure to meet developmental/sociocultural standards for personal independence/social responsibility" + }, + { + "label": "C", + "text": "Onset of intellectual and adaptive deficits during the developmental period" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Independent in basic self-care; difficulties with complex academic and executive tasks; support needed for higher-order demands." + }, + { + "name": "Moderate", + "description": "Marked delays in conceptual skills; social and communication limitations; ongoing supervision required for daily functioning." + }, + { + "name": "Severe", + "description": "Limited understanding of written language and numbers; functional communication is concrete; extensive support required." + }, + { + "name": "Profound", + "description": "Very limited conceptual and communication abilities; dependence for all aspects of care." + } + ], + "differentials": [ + "ASD (social deficits; RRBs; may coexist - code both when criteria independently met)", + "Specific learning disorder (domain-specific; overall intellectual function preserved)", + "Communication disorder (language-specific; not global intellectual impairment)", + "Neurocognitive disorder (acquired; adult onset; decline from previous level)", + "Global developmental delay (diagnosis < 5 years; insufficient information for ID diagnosis)", + "Borderline intellectual functioning (IQ 70-85; not a DSM-5-TR diagnosis)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Intellectual Disability] [specifier(s)]. Since the early developmental period, there have been deficits in reasoning; problem-solving; planning; abstract thinking; judgement; academic learning; experiential learning, together with deficits in adaptive functioning across conceptual; social; and practical domains, forming a pattern that limits independence and requires support in daily activities. The presentation is further characterised by stable, cross-situational functional impairments persisting across home, educational, occupational, and community settings, consistent with a lifelong neurodevelopmental condition. These symptoms have resulted in clinically significant limitations in adaptive functioning, and the cognitive and functional pattern is not better explained by neurodegenerative disorders, sensory impairment, severe psychiatric illness, or the effects of trauma, deprivation, or substances.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-global-developmental-delay", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F88", + "title": "Global developmental delay", + "key_features": [ + { + "label": "A", + "text": "Failure to meet expected developmental milestones in several areas of intellectual functioning; applies to individuals <5 years when severity cannot be reliably assessed" + }, + { + "label": "B", + "text": "Reserved for individuals who are unable to undergo systematic assessments; requires reassessment after a period of time" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No DSM-5-TR severity specifiers for Global Developmental Delay", + "description": "Reassess when child is old enough for formal intellectual testing to specify severity." + } + ], + "differentials": [ + "Intellectual disability (older children where formal assessment possible)", + "ASD (social communication deficits + RRBs as primary feature)", + "Specific developmental delays (domain-specific; not global)", + "Hearing or visual impairment contributing to apparent delay", + "Medical/metabolic cause of developmental regression" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Global Developmental Delay] [specifier(s)]. Since the early developmental period, there have been delays across multiple developmental domains; delayed acquisition of motor skills; delayed language development; delayed social-emotional skills; delayed cognitive and problem-solving abilities; delayed adaptive functioning, forming a pattern where developmental milestones are not met at expected ages. The presentation is further characterised by deficits identified through clinical observation and developmental assessment, consistent with a broad delay across cognitive and adaptive areas. These symptoms have resulted in significant functional impairment in early learning, communication, and daily activities, and the developmental pattern is not better explained by a specific neurodevelopmental disorder, sensory impairment, motor disorder, environmental deprivation, medical illness, or the effects of substances.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ndv-specific-learning-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F81.x", + "title": "Specific learning disorder", + "key_features": [ + { + "label": "A", + "text": "Difficulties learning and using academic skills despite intervention; ≥1 of 6 symptoms for ≥6 months: inaccurate/slow word reading; difficulty decoding; poor spelling; difficulties with written expression; poor number sense; mathematical reasoning difficulties" + }, + { + "label": "B", + "text": "Affected skills substantially and quantifiably below expected for chronological age; confirmed by standardised assessment; cause significant interference with academic/occupational performance or daily activities" + }, + { + "label": "C", + "text": "Onset in school-age years (may not fully manifest until academic demands exceed limited capacities)" + }, + { + "label": "D", + "text": "Not better explained by intellectual disability; inadequate educational instruction; visual/auditory acuity; other mental/neurological disorders; psychosocial adversity; lack of proficiency in language of academic instruction" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With impairment in reading (dyslexia)", + "description": "Persistent difficulties with word reading accuracy, reading rate or fluency, and/or reading comprehension." + }, + { + "name": "With impairment in written expression (dysgraphia)", + "description": "Persistent difficulties with spelling accuracy, grammar, punctuation accuracy, or clarity of written expression." + }, + { + "name": "With impairment in mathematics (dyscalculia)", + "description": "Persistent difficulties with number sense, arithmetic facts, calculation, or mathematical reasoning." + }, + { + "name": "Mild", + "description": "Difficulties in one academic area; able to compensate with appropriate supports." + }, + { + "name": "Moderate", + "description": "Marked difficulties in one or more academic areas; requires specialised teaching and accommodations." + }, + { + "name": "Severe", + "description": "Severe and pervasive difficulties; requires intensive individualised instruction and ongoing support." + } + ], + "differentials": [ + "Intellectual disability (global impairment vs domain-specific)", + "ADHD (attention/behavioural factors limiting learning; highly comorbid)", + "Vision or hearing impairment (always exclude before diagnosing SLD)", + "Inadequate educational instruction (rule out before diagnosis)", + "Normal variation in academic achievement (below average but not substantially below)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Specific Learning Disorder] [specifier(s)]. Since the school-age years, there have been persistent difficulties learning and using academic skills including inaccurate or slow and effortful word reading; difficulty understanding the meaning of what is read; difficulties with spelling; difficulties with written expression; difficulties mastering number sense, number facts, or calculation; difficulties with mathematical reasoning, forming a pattern of academic skill deficits that persist despite targeted intervention. The presentation is further characterised by academic skills substantially and quantifiably below those expected for age, with learning difficulties that interfere with academic or occupational performance, and a stable, non-episodic course. These difficulties have resulted in clinically significant impairment in academic, occupational, or daily functioning, and the pattern is not better explained by intellectual disability, uncorrected sensory impairment, inadequate instruction, language barriers, psychosocial adversity, another neurodevelopmental disorder, or a primary medical or neurological condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-developmental-coordination-disorder-dcd", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F82", + "title": "Developmental coordination disorder (DCD)", + "key_features": [ + { + "label": "A", + "text": "Acquisition and execution of coordinated motor skills is substantially below expected for chronological age and opportunity for skill learning" + }, + { + "label": "B", + "text": "Motor skill deficits significantly and persistently interfere with activities of daily living appropriate for chronological age, and with academic/vocational productivity, leisure, and play" + }, + { + "label": "C", + "text": "Onset in the early developmental period" + }, + { + "label": "D", + "text": "Motor skill deficits not better explained by intellectual disability, visual impairment, or another neurological condition affecting movement" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Motor difficulties present but functional impact is limited and manageable with minimal support." + }, + { + "name": "Moderate", + "description": "Clear motor impairment causing noticeable interference with daily, academic, or occupational functioning." + }, + { + "name": "Severe", + "description": "Marked motor impairment with substantial limitations in daily functioning, requiring ongoing intensive support." + } + ], + "differentials": [ + "Neurological disorder with motor impairment (cerebral palsy, muscular dystrophy, hereditary neuropathy - neurological examination and investigations)", + "Intellectual disability (motor difficulties proportional to global impairment)", + "ASD (motor difficulties but social communication deficits primary)", + "ADHD (inattention may affect motor performance; highly comorbid)", + "Visual impairment (contributing to motor difficulties - assess vision)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Developmental Coordination Disorder] [specifier(s)]. Since early childhood, there have been marked difficulties acquiring and executing coordinated motor skills including clumsiness; dropping or bumping into objects; slow or inaccurate performance of motor tasks such as catching objects, using scissors or cutlery, handwriting, cycling, or participating in sports, forming a pattern of motor skill performance substantially below that expected for chronological age and learning opportunity. The presentation is further characterised by motor difficulties that significantly and persistently interfere with activities of daily living, academic productivity, vocational tasks, or recreational participation, with a developmental onset and a stable, non-episodic course. These difficulties have resulted in clinically significant impairment in personal, academic, occupational, or social functioning, and the pattern is not better explained by intellectual disability, visual impairment, cerebral palsy, muscular dystrophy, degenerative neurological disease, or another medical or neurological condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-stereotypic-movement-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F98.4", + "title": "Stereotypic movement disorder", + "key_features": [ + { + "label": "A", + "text": "Repetitive, seemingly driven, and apparently purposeless motor behaviour (e.g. hand shaking/waving, body rocking, head banging, self-biting, hitting own body)" + }, + { + "label": "B", + "text": "Interferes with social, academic, or other activities and may result in self-injury" + }, + { + "label": "C", + "text": "Onset in the early developmental period" + }, + { + "label": "D", + "text": "Not attributable to physiological effects of a substance or another medical condition; not better explained by another neurodevelopmental or mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With self-injurious behaviour", + "description": "Stereotyped movements result in tissue damage or risk of injury." + }, + { + "name": "Without self-injurious behaviour", + "description": "Stereotyped movements present without injury." + }, + { + "name": "Associated with a known medical or genetic condition", + "description": "Occurs in the context of a recognised condition (e.g. intellectual disability, neurogenetic syndrome)." + }, + { + "name": "Mild", + "description": "Movements present with minimal functional interference." + }, + { + "name": "Moderate", + "description": "Movements clearly interfere with daily functioning or participation." + }, + { + "name": "Severe", + "description": "Frequent, intense movements with marked impairment or significant injury risk." + } + ], + "differentials": [ + "Tic disorders (sudden, rapid, brief; premonitory urge; suppressible with effort; wax and wane)", + "OCD (ego-dystonic; anxiety-driven compulsions; not rhythmic)", + "ASD (may coexist - code separately if ID criterion met independently)", + "Normal infant self-stimulation (developmentally appropriate)", + "NCD (acquired regression; adult onset)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Stereotypic Movement Disorder] [specifier(s)]. Since early development, there have been repetitive, seemingly driven, and purposeless motor behaviours including hand shaking or flapping; body rocking; head banging; self-biting; hitting; skin picking; other repetitive, non-functional movements, forming a persistent pattern of stereotyped motor activity. The presentation is further characterised by behaviours that interfere with normal activities or result in self-inflicted injury, with a developmental onset and a stable, non-episodic course, outside of culturally sanctioned practices. These behaviours have resulted in clinically significant impairment in social, academic, occupational, or other important areas of functioning, and the pattern is not better explained by ASD, tic disorders, trichotillomania, OCD, substance or medication effects, or another neurological or medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-tourette-s-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F95.2", + "title": "Tourette's disorder", + "key_features": [ + { + "label": "A", + "text": "Both multiple motor tics AND ≥1 vocal tic present at some time during the illness, though not necessarily simultaneously" + }, + { + "label": "B", + "text": "Tics may wax and wane in frequency but have persisted for >1 year since first tic onset" + }, + { + "label": "C", + "text": "Onset before age 18" + }, + { + "label": "D", + "text": "Not attributable to physiological effects of a substance or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Infrequent tics not interfering with daily activities; minimal distress." + }, + { + "name": "Moderate", + "description": "More frequent tics causing clear distress or interference." + }, + { + "name": "Severe", + "description": "Frequent or intense tics causing marked, pervasive impairment or injury risk." + } + ], + "differentials": [ + "Persistent motor OR vocal tic disorder (one category only - not both)", + "Provisional tic disorder (< 1 year duration)", + "Stereotypic movement disorder (rhythmic; suppressed by distraction rather than effort; no premonitory urge)", + "OCD with repetitive movements (ego-dystonic; anxiety-driven)", + "ASD (repetitive behaviours; no premonitory urge; no waxing/waning pattern)", + "Acute medication-induced movement disorder (temporal link to medication)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Tourette's Disorder] [specifier(s)]. Since childhood and with onset before age 18, there have been multiple motor tics and at least one vocal tic, present at some time during the illness, although not necessarily concurrently, for more than one year. The presentation is further characterised by waxing and waning tic frequency and intensity, with premonitory urges and partial suppressibility where present. These symptoms have resulted in clinically significant distress or impairment in social, academic, or occupational functioning, and the pattern is not better explained by substance use, a primary neurological condition, or another medical disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-persistent-chronic-motor-or-vocal-tic-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F95.1", + "title": "Persistent (chronic) motor or vocal tic disorder", + "key_features": [ + { + "label": "A", + "text": "Single or multiple motor OR vocal tics (but not both motor and vocal) have been present at some time" + }, + { + "label": "B", + "text": "Tics may wax and wane in frequency but have persisted for >1 year since first tic onset" + }, + { + "label": "C", + "text": "Onset before age 18" + }, + { + "label": "D", + "text": "Not attributable to physiological effects of a substance or another medical condition" + }, + { + "label": "E", + "text": "Criteria for Tourette's disorder have never been met" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Motor tic disorder", + "description": "Persistent motor tics without vocal tics for more than one year." + }, + { + "name": "Vocal tic disorder", + "description": "Persistent vocal tics without motor tics for more than one year." + }, + { + "name": "Mild", + "description": "Infrequent or mild tics with minimal functional impact." + }, + { + "name": "Moderate", + "description": "Noticeable tics with clear interference or distress." + }, + { + "name": "Severe", + "description": "Frequent or intense tics causing marked impairment or injury risk." + } + ], + "differentials": [ + "Tourette's disorder (both motor and vocal tics present - reclassify)", + "Provisional tic disorder (< 1 year duration)", + "Stereotypic movement disorder (rhythmic; no premonitory urge)", + "Medication-induced movement disorder (temporal link to medication)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Persistent (Chronic) Motor or Vocal Tic Disorder] [specifier(s)]. Since childhood with onset before age 18, there have been sudden, rapid, recurrent, non-rhythmic motor tics or vocal tics (but not both) persisting for more than one year since first tic onset, with waxing and waning in frequency and intensity. The presentation is further characterised by tics that occur multiple times per day or intermittently, with premonitory urges and partial suppressibility where present. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better explained by Tourette's Disorder, substance or medication effects, or another neurological or medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-provisional-tic-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F95.0", + "title": "Provisional tic disorder", + "key_features": [ + { + "label": "A", + "text": "Single or multiple motor and/or vocal tics" + }, + { + "label": "B", + "text": "Tics have been present for <1 year since first tic onset" + }, + { + "label": "C", + "text": "Onset before age 18" + }, + { + "label": "D", + "text": "Not attributable to physiological effects of a substance or another medical condition" + }, + { + "label": "E", + "text": "Criteria for Tourette's or persistent motor or vocal tic disorder have never been met" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Motor tics only", + "description": "Provisional presentation with motor tics without vocal tics." + }, + { + "name": "Vocal tics only", + "description": "Provisional presentation with vocal tics without motor tics." + }, + { + "name": "Motor and vocal tics", + "description": "Both motor and vocal tics present but duration < 1 year." + } + ], + "differentials": [ + "Tourette's disorder or persistent tic disorder (>1 year - reclassify)", + "Stereotypic movement disorder", + "Medication-induced movement disorder", + "Transient habit behaviours (not true tics)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Provisional Tic Disorder] [specifier(s)]. Since childhood with onset before age 18, there have been sudden, rapid, recurrent, non-rhythmic motor tics and/or vocal tics, present for less than one year since first tic onset. The presentation is further characterised by tics that wax and wane, with premonitory urges and partial suppressibility where present. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better explained by Tourette's Disorder, Persistent Tic Disorder, substance or medication effects, or another neurological or medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ndv-language-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F80.2", + "title": "Language disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent difficulties in acquisition and use of language across modalities (spoken, written, sign, or other) due to deficits in comprehension or production, including reduced vocabulary, limited sentence structure, and impairments in discourse" + }, + { + "label": "B", + "text": "Language abilities substantially and quantifiably below expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance" + }, + { + "label": "C", + "text": "Onset in the early developmental period" + }, + { + "label": "D", + "text": "Difficulties not attributable to hearing/sensory impairment, motor dysfunction, or another medical or neurological condition; not better explained by intellectual disability or global developmental delay" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Receptive language impairment", + "description": "Difficulties primarily affecting understanding of spoken language." + }, + { + "name": "Expressive language impairment", + "description": "Difficulties primarily affecting spoken language production." + }, + { + "name": "Mixed receptive-expressive language impairment", + "description": "Significant deficits in both understanding and expression of language." + } + ], + "differentials": [ + "Hearing impairment (always exclude - audiological assessment essential)", + "Intellectual disability (language consistent with overall cognitive level)", + "ASD (social communication deficits; RRBs present)", + "Selective mutism (speaks normally in some contexts)", + "Social (pragmatic) communication disorder (structure intact; pragmatic use impaired - mutually exclusive)", + "Normal developmental variation (below average but not substantially impaired)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Language Disorder] [specifier(s)]. Since the early developmental period, there have been persistent difficulties in the acquisition and use of language manifested by reduced vocabulary; limited sentence structure; impaired discourse abilities, forming a pattern substantially below that expected for age and developmental level and not attributable to lack of exposure or opportunity. The presentation is further characterised by language deficits evident across settings, stable over time rather than episodic, and affecting both expressive and receptive domains. These symptoms have resulted in clinically significant impairment in social, academic, occupational, or adaptive functioning, and the difficulties are not better explained by hearing impairment, intellectual disability, global developmental delay, ASD, neurological disease, or another mental disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ndv-speech-sound-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F80.0", + "title": "Speech sound disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages" + }, + { + "label": "B", + "text": "Causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance" + }, + { + "label": "C", + "text": "Onset in the early developmental period" + }, + { + "label": "D", + "text": "Not attributable to congenital or acquired conditions such as cerebral palsy, cleft palate, deafness/hearing loss, TBI, or other medical or neurological conditions" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Minimal speech sound errors with mild but clear impact on intelligibility or functioning." + }, + { + "name": "Moderate", + "description": "Frequent speech sound errors with definite functional impact on intelligibility." + }, + { + "name": "Severe", + "description": "Pervasive speech sound errors with marked impairment in intelligibility across contexts." + } + ], + "differentials": [ + "Hearing impairment (audiological assessment essential)", + "Structural abnormality (cleft palate, macroglossia)", + "Neurological cause (dysarthria - acquired; consistent articulation errors)", + "Normal developmental articulation errors (developmentally expected at young ages)", + "Language disorder (grammar and vocabulary impairment vs sound production)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Speech Sound Disorder] [specifier(s)]. Since the early developmental period, there have been persistent difficulties with speech sound production manifested by omissions; substitutions; distortions; additions of speech sounds, resulting in reduced speech intelligibility that interferes with effective verbal communication and is below that expected for age and developmental level. The presentation is further characterised by a stable, developmental pattern present across multiple contexts, not attributable to dialectal, cultural, or language differences. These symptoms have resulted in clinically significant impairment in social, academic, occupational, or adaptive functioning, and the disturbance is not better explained by hearing impairment, structural or neurological abnormalities, intellectual disability, ASD, or another medical or mental disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-childhood-onset-fluency-disorder-stuttering", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F80.81", + "title": "Childhood-onset fluency disorder (stuttering)", + "key_features": [ + { + "label": "A", + "text": "Disturbances in normal fluency and time patterning of speech inappropriate for age and language skills; ≥1 of: sound/syllable repetitions; sound prolongations; broken words; audible/silent blocking; circumlocutions; words produced with excess physical tension; monosyllabic whole-word repetitions" + }, + { + "label": "B", + "text": "Causes anxiety about speaking or limitations in effective communication, social participation, or academic/occupational performance" + }, + { + "label": "C", + "text": "Onset in the early developmental period" + }, + { + "label": "D", + "text": "Not attributable to speech-motor or sensory deficit, dysfluency associated with neurological insult, or another medical condition; not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With accompanying anxiety", + "description": "Prominent anxiety related to speaking or social communication situations." + }, + { + "name": "Severity: Mild", + "description": "Occasional disruptions with minimal functional impact." + }, + { + "name": "Severity: Moderate", + "description": "Frequent disruptions with clear distress or interference with communication." + }, + { + "name": "Severity: Severe", + "description": "Pervasive disruptions causing marked impairment in communication and avoidance." + } + ], + "differentials": [ + "Acquired neurogenic stuttering (following stroke, TBI, or degenerative disease - different onset and pattern)", + "Cluttering (rapid, irregular speech rate with unclear speech; distinct from stuttering)", + "Normal non-fluency in young children (developmentally expected hesitations; below clinical threshold)", + "Selective mutism (context-dependent speech failure; not fluency disruption)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Childhood-Onset Fluency Disorder (Stuttering)] [specifier(s)]. Since early childhood, there have been sound and syllable repetitions; prolongations of consonants; broken words; audible or silent blocking; circumlocutions; words produced with excess physical tension; monosyllabic whole-word repetitions, forming a pattern persistent across time and situations. The presentation is further characterised by associated anxiety, avoidance of speaking, and behavioural tension arising from disrupted fluency, consistent with a developmental fluency disorder. These symptoms have resulted in clinically significant impairment in social, academic, or interpersonal communication, and the picture is not better explained by a speech-motor deficit, neurological condition, hearing impairment, or fluency disturbance occurring exclusively during another mental disorder or medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ndv-social-pragmatic-communication-disorder", + "category": { + "key": "ndv", + "label": "Neurodevelopmental" + }, + "icd_code": "F80.82", + "title": "Social (pragmatic) communication disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent difficulties in social use of verbal/nonverbal communication; ≥1 of: deficits in using communication for social purposes; inability to change communication to match context; difficulty following rules for conversations and storytelling; difficulty understanding what is not explicitly stated" + }, + { + "label": "B", + "text": "Deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance" + }, + { + "label": "C", + "text": "Onset in the early developmental period" + }, + { + "label": "D", + "text": "Symptoms not attributable to another medical/neurological condition or low abilities in word structure/grammar; not better explained by ASD, intellectual disability, global developmental delay, or another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Severity: Mild", + "description": "Subtle social communication inefficiency with mild functional impact." + }, + { + "name": "Severity: Moderate", + "description": "Noticeable social communication difficulties with clear impairment across contexts." + }, + { + "name": "Severity: Severe", + "description": "Marked pragmatic communication impairment across most interactions." + } + ], + "differentials": [ + "ASD (social communication deficits + RRBs - mutually exclusive; if RRBs present, diagnose ASD)", + "Language disorder (structure and vocabulary impaired, not just pragmatic use)", + "Intellectual disability (social communication deficits proportional to global impairment)", + "ADHD (pragmatic difficulties secondary to attention and impulsivity, not primary communication disorder)", + "Social anxiety disorder (social avoidance driven by fear; pragmatic skills intact)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Social (Pragmatic) Communication Disorder] [specifier(s)]. Since the early developmental period, there have been persistent difficulties in the social use of verbal and nonverbal communication including deficits in using communication for social purposes; impaired ability to change communication to match context or listener needs; difficulties following rules for conversation and storytelling; difficulties understanding implicit or nonliteral language, forming a pragmatic communication pattern meeting diagnostic threshold. The presentation is further characterised by onset during development, a stable, non-episodic course, and communication difficulties evident across settings. These symptoms have resulted in clinically significant impairment in social participation, academic achievement, or occupational functioning, with language structure and speech sound production otherwise within expected limits, and the pattern is not better explained by ASD, intellectual disability, global developmental delay, hearing impairment, neurological disease, substance effects, or another mental disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-ocd-obsessive-compulsive-disorder", + "category": { + "key": "ocd", + "label": "OCD & Related" + }, + "icd_code": "F42.2", + "title": "Obsessive-compulsive disorder", + "key_features": [ + { + "label": "A", + "text": "Presence of obsessions (recurrent/persistent intrusive thoughts/urges/images + attempts to suppress or neutralise), compulsions (repetitive behaviours/mental acts driven by rigid rules aimed at reducing distress/feared event), or both" + }, + { + "label": "B", + "text": "Obsessions/compulsions are time-consuming (>1 hr/day) or cause clinically significant distress/impairment" + }, + { + "label": "C", + "text": "Not attributable to physiological effects of a substance or another medical condition" + }, + { + "label": "D", + "text": "Not better explained by symptoms of another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With good or fair insight", + "description": "The individual recognises that OCD beliefs are definitely or probably not true." + }, + { + "name": "With poor insight", + "description": "The individual believes OCD beliefs are probably true." + }, + { + "name": "With absent insight / delusional beliefs", + "description": "The individual is convinced OCD beliefs are true - important to distinguish from primary psychosis." + }, + { + "name": "Tic-related", + "description": "Current or past history of a tic disorder - influences treatment approach." + } + ], + "differentials": [ + "GAD (worry is ego-syntonic, future-focused, realistic - OCD obsessions are ego-dystonic, intrusive, irrational)", + "OCPD (ego-syntonic perfectionism without obsessions/compulsions)", + "MDD (rumination is mood-congruent, not intrusive; no compulsions)", + "Body dysmorphic disorder (OCD spectrum; preoccupation with appearance)", + "Hoarding disorder (OCD spectrum; separate diagnosis)", + "Tic disorders (voluntary vs compulsive; comorbid in tic-related OCD)", + "Psychotic disorder (poor insight OCD vs delusions - critical distinction)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Obsessive-Compulsive Disorder] [specifier(s)]. There have been recurrent intrusive obsessions - unwanted thoughts, urges, or images experienced as intrusive - and attempts to ignore, suppress, or neutralise these thoughts; and/or compulsions performed in response to obsessions - repetitive behaviours such as checking, ordering, washing; mental acts such as counting or praying - aimed at reducing distress or preventing feared outcomes, occurring for more than one hour per day or causing marked distress or impairment. The presentation is further characterised by a pattern of obsessions and/or compulsions that are time-consuming, distressing, or interfere with functioning. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by a primary psychotic disorder, an anxiety disorder, body dysmorphic disorder, hoarding disorder, substance/medication effects, or a general medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ocd-body-dysmorphic-disorder", + "category": { + "key": "ocd", + "label": "OCD & Related" + }, + "icd_code": "F45.22", + "title": "Body dysmorphic disorder", + "key_features": [ + { + "label": "A", + "text": "Preoccupation with ≥1 perceived defect(s) or flaw(s) in physical appearance (not observable or only slightly observable to others)" + }, + { + "label": "B", + "text": "Repetitive behaviours (mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing to others) in response to appearance concerns" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not better explained by eating disorder concern about body fat or weight" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With muscle dysmorphia", + "description": "Preoccupation focused on body build or musculature, with beliefs of being too small or insufficiently muscular." + }, + { + "name": "With good or fair insight", + "description": "Recognises beliefs about appearance are definitely or probably not true." + }, + { + "name": "With poor insight", + "description": "Believes appearance-related beliefs are probably true." + }, + { + "name": "With absent insight / delusional beliefs", + "description": "Convinced appearance-related beliefs are true." + } + ], + "differentials": [ + "OCD (OCD spectrum but appearance-focused; use BDD diagnosis when appearance concerns predominate)", + "Anorexia nervosa (body image disturbance specifically about weight/shape)", + "Social anxiety disorder (self-consciousness without specific appearance preoccupation)", + "Delusional disorder, somatic type (BDD with delusional intensity)", + "Depression with negative body image" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Body Dysmorphic Disorder] [specifier(s)]. There has been preoccupation with perceived flaws in physical appearance; concerns that are not observable or appear slight to others; repetitive behaviours such as mirror checking, grooming, skin picking, or seeking reassurance; repetitive mental acts such as comparing appearance to others, forming a persistent pattern lasting several hours per day. The presentation is further characterised by significant preoccupation that is difficult to control and not better explained by weight/shape concerns typical of an eating disorder. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by an eating disorder, psychotic disorder, or substance/medication effect.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ocd-trichotillomania-hair-pulling-disorder", + "category": { + "key": "ocd", + "label": "OCD & Related" + }, + "icd_code": "F63.3", + "title": "Trichotillomania (hair-pulling disorder)", + "key_features": [ + { + "label": "A", + "text": "Recurrent pulling out of one's hair, resulting in hair loss" + }, + { + "label": "B", + "text": "Repeated attempts to decrease or stop the hair pulling" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not attributable to another medical condition (e.g. dermatological condition)" + }, + { + "label": "E", + "text": "Not better explained by symptoms of another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With good or fair insight", + "description": "Recognises that hair-pulling beliefs/behaviours may not be true." + }, + { + "name": "With poor insight", + "description": "Largely convinced hair-pulling beliefs/behaviours are accurate." + }, + { + "name": "With absent insight / delusional beliefs", + "description": "Fully convinced hair-pulling beliefs/behaviours are true." + } + ], + "differentials": [ + "Excoriation disorder (skin picking vs hair pulling - may coexist)", + "OCD (ego-dystonic, with full obsessions driving behaviour)", + "Alopecia areata or other dermatological cause of hair loss", + "Stereotypic movement disorder (broader, developmental context)", + "Psychotic disorder (command hallucinations to pull)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Trichotillomania] [specifier(s)]. There has been recurrent pulling out of one's hair; repeated attempts to decrease or stop hair pulling, forming a persistent pattern of hair loss. The presentation is further characterised by preceding tension or urges; gratification, relief, or reduction in tension when pulling; repetitive hair-focused behaviours. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by another medical condition or by another mental disorder such as body dysmorphic disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ocd-excoriation-skin-picking-disorder", + "category": { + "key": "ocd", + "label": "OCD & Related" + }, + "icd_code": "L98.1", + "title": "Excoriation (skin-picking) disorder", + "key_features": [ + { + "label": "A", + "text": "Recurrent skin picking resulting in skin lesions" + }, + { + "label": "B", + "text": "Repeated attempts to decrease or stop the skin picking" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not attributable to physiological effects of a substance or another medical condition" + }, + { + "label": "E", + "text": "Not better explained by symptoms of another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With good or fair insight", + "description": "Recognises that picking-related beliefs/behaviours may not be true." + }, + { + "name": "With poor insight", + "description": "Largely convinced picking-related beliefs/behaviours are accurate." + }, + { + "name": "With absent insight / delusional beliefs", + "description": "Fully convinced picking-related beliefs/behaviours are true." + } + ], + "differentials": [ + "Dermatological condition causing skin damage (must exclude primary skin disease)", + "OCD (full obsessions driving behaviour; skin picking as compulsion vs primary disorder)", + "Trichotillomania (hair vs skin; may coexist)", + "BDD (body-focused but preoccupation with appearance rather than picking behaviour per se)", + "Factitious disorder (deliberate wound production to assume sick role)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Excoriation (Skin-Picking) Disorder] [specifier(s)]. There has been recurrent skin picking resulting in skin lesions; repeated attempts to decrease or stop the behaviour, forming a persistent pattern of compulsive picking. The presentation is further characterised by preceding tension or urges; relief, gratification, or reduction in distress when picking; repetitive body-focused behaviours and focused/automatic picking styles. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by a dermatological condition, substance effects, or another mental disorder such as body dysmorphic disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ocd-hoarding-disorder", + "category": { + "key": "ocd", + "label": "OCD & Related" + }, + "icd_code": "F42.3", + "title": "Hoarding disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent difficulty discarding or parting with possessions, regardless of their actual value" + }, + { + "label": "B", + "text": "Difficulty is due to perceived need to save items and distress associated with discarding them" + }, + { + "label": "C", + "text": "Accumulation of possessions results in congestion and clutter of living areas, compromising their intended use" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment" + }, + { + "label": "E", + "text": "Not attributable to another medical condition; not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With excessive acquisition", + "description": "Persistent acquisition of items not needed or for which space is lacking." + }, + { + "name": "With good or fair insight", + "description": "Recognises hoarding beliefs/behaviours are definitely or probably problematic." + }, + { + "name": "With poor insight", + "description": "Mostly convinced hoarding-related beliefs/behaviours are not problematic." + }, + { + "name": "With absent insight / delusional beliefs", + "description": "Fully convinced hoarding-related beliefs are not problematic." + } + ], + "differentials": [ + "OCD with hoarding compulsions (in OCD, hoarding is driven by specific obsessions; hoarding disorder does not require obsessions)", + "OCPD (excessive sentimentality about items; not true difficulty discarding)", + "Major NCD (cognitive decline causing inability to manage possessions)", + "Depression (passive neglect of home vs active accumulation)", + "Psychotic disorder (delusional basis for accumulation)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Hoarding Disorder] [specifier(s)]. There has been persistent difficulty discarding or parting with possessions; strong perceived need to save items; marked distress associated with discarding; accumulation of possessions that congest and clutter living areas, forming a persistent pattern that compromises intended use of living spaces. The presentation is further characterised by difficulty discarding that is not better explained by lack of available storage or by normative collecting. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or safety-related functioning, and the picture is not better explained by obsessive-compulsive disorder, major depressive disorder, psychotic disorders, neurocognitive disorders, or a substance/medication effect.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-ocd-other-specified-unspecified-ocd-and-related-disorder", + "category": { + "key": "ocd", + "label": "OCD & Related" + }, + "icd_code": "F42.8/F42.9", + "title": "Other specified / Unspecified OCD and related disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of an OCD-related disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific OCD-related disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Body dysmorphic-like symptoms without meeting full criteria", + "description": "Dysmorphic concern causing distress without the full symptom pattern of BDD." + }, + { + "name": "Body-focused repetitive behaviour disorder", + "description": "Recurrent hair pulling, skin picking, nail biting, or lip biting that does not meet full criteria for trichotillomania or excoriation disorder." + }, + { + "name": "Obsessional jealousy", + "description": "Persistent, intrusive preoccupation with a partner's perceived infidelity causing distress." + }, + { + "name": "Olfactory reference disorder (Shubo-kyofu)", + "description": "Persistent preoccupation with the idea of emitting a foul or offensive body odour." + } + ], + "differentials": [ + "Specific named OCD disorder (full criteria met - reclassify)", + "Primary anxiety or mood disorder", + "Psychotic disorder (poor insight OCD vs delusions)", + "Substance-induced OCD-type symptoms" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Obsessive-Compulsive and Related Disorder] [specifier(s)]. There have been obsessions; compulsions; intrusive distressing thoughts; repetitive behaviours intended to reduce anxiety; excessive checking; excessive cleaning; compulsive ordering; body-focused repetitive behaviours, forming a clinically significant pattern without meeting full structured criteria for a specific obsessive-compulsive or related disorder, with the reason for not meeting full criteria clearly identified. The presentation is further characterised by associated anxiety, distress, and behavioural avoidance relevant to an OCD-type syndrome. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-dis-dissociative-identity-disorder", + "category": { + "key": "dis", + "label": "Dissociative" + }, + "icd_code": "F44.81", + "title": "Dissociative identity disorder", + "key_features": [ + { + "label": "A", + "text": "Disruption of identity characterised by ≥2 distinct personality states/possession experiences with marked discontinuity in sense of self and agency, accompanied by alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning" + }, + { + "label": "B", + "text": "Recurrent gaps in recall of everyday events, personal information, and/or traumatic events inconsistent with ordinary forgetting" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not part of broadly accepted cultural or religious practice" + }, + { + "label": "E", + "text": "Not attributable to physiological effects of a substance or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No formal DSM-5-TR specifiers for DID", + "description": "All presentations must include identity disruption plus amnesia and clinically significant impairment." + } + ], + "differentials": [ + "PTSD with dissociative subtype (flashbacks and amnesia without identity fragmentation)", + "Borderline personality disorder (identity disturbance vs identity fragmentation)", + "Psychotic disorder (identity fragmentation vs voices/passivity experiences - critical distinction)", + "Bipolar disorder (mood episode context for behavioural change)", + "Substance-induced dissociation", + "Seizure disorder (temporal lobe epilepsy - EEG may be necessary)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Dissociative Identity Disorder] [specifier(s)]. Over a prolonged period, there have been two or more distinct identity states; discontinuity in sense of self and agency; marked alterations in affect; behaviour; consciousness; memory; perception; cognition; sensory-motor function, together with recurrent gaps in recall of everyday events; personal information; traumatic events, forming a pattern consistent with a dissociative syndrome beginning after significant psychological trauma or developmental stressors. The presentation is further characterised by dissociative transitions experienced as involuntary or outside conscious control, with symptoms present across multiple settings and not attributable to cultural or religious practices. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the disturbance is not better explained by substance/medication effects, seizures, or another neurological or psychiatric condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-dis-dissociative-amnesia", + "category": { + "key": "dis", + "label": "Dissociative" + }, + "icd_code": "F44.0", + "title": "Dissociative amnesia", + "key_features": [ + { + "label": "A", + "text": "Inability to recall important autobiographical information (usually traumatic/stressful) inconsistent with ordinary forgetting; may include dissociative fugue (purposeful travel or bewildered wandering)" + }, + { + "label": "B", + "text": "Clinically significant distress or impairment" + }, + { + "label": "C", + "text": "Not attributable to physiological effects of a substance or neurological/other medical condition" + }, + { + "label": "D", + "text": "Not better explained by DID, PTSD, ASD, somatic symptom disorder, or major/mild NCD" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With dissociative fugue", + "description": "Purposeful travel or bewildered wandering associated with amnesia for identity or other autobiographical information." + } + ], + "differentials": [ + "TBI-related amnesia (neurological; post-traumatic; anterograde pattern)", + "Major NCD (progressive; other cognitive domains affected)", + "Substance-induced blackouts (context of use)", + "Malingering or factitious disorder (external incentive or sick role)", + "Complex partial seizures (transient epileptic amnesia - EEG)", + "Delirium (global cognitive disturbance with fluctuation)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Dissociative Amnesia] [specifier(s)]. Following significant psychological stress or trauma, there have been inability to recall important autobiographical information; memory gaps inconsistent with ordinary forgetting; amnesia focused on distressing or traumatic events; amnesia for personal identity; amnesia for extended periods, forming a pattern characteristic of a dissociative disturbance with abrupt or fluctuating onset. The presentation is further characterised by dissociative blocking affecting episodic memory, with preserved encoding capacity and intact cognitive function in other domains. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the disturbance is not better explained by substance or medication effects, neurological conditions (including seizures or head injury), dementia, or other psychiatric disorders such as PTSD.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-dis-depersonalisation-derealisation-disorder", + "category": { + "key": "dis", + "label": "Dissociative" + }, + "icd_code": "F48.1", + "title": "Depersonalisation/derealisation disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent or recurrent experiences of depersonalisation (feelings of unreality/detachment from one's mind/body) and/or derealisation (feelings of unreality of surroundings)" + }, + { + "label": "B", + "text": "Reality testing remains intact during experiences" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + }, + { + "label": "D", + "text": "Not attributable to physiological effects of a substance or another medical condition" + }, + { + "label": "E", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "No DSM-5-TR specifiers", + "description": "Disorder may be described clinically by predominant subtype (depersonalisation-dominant vs derealisation-dominant) and by course (episodic vs persistent)." + } + ], + "differentials": [ + "Psychotic disorder (in DDD, reality testing is intact; in psychosis, it is impaired)", + "Panic disorder (depersonalisation can occur during panic; specify if occurs only during attacks)", + "PTSD (dissociation tied to trauma cues; may coexist)", + "Temporal lobe epilepsy (ictal or postictal depersonalisation - EEG)", + "Substance-induced dissociation (cannabis, ketamine, hallucinogens)", + "Migraine aura" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Depersonalisation/Derealisation Disorder] [specifier(s)]. During recurring episodes over time, there have been persistent or recurrent depersonalisation experiences; persistent or recurrent derealisation experiences; intact reality testing throughout, forming a pattern of dissociative detachment in which the individual recognises the unreality or altered quality of their experiences despite distress. The presentation is further characterised by distressing alterations in self-experience; emotional numbing; altered body perception; perceptual distortion of surroundings, occurring in the absence of confusion, clouding of consciousness, or identity fragmentation. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the disturbance is not better explained by substance intoxication, neurological disorders (including seizures or head injury), panic disorder, major depressive disorder, PTSD, or psychotic disorders.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-dis-other-specified-unspecified-dissociative-disorder", + "category": { + "key": "dis", + "label": "Dissociative" + }, + "icd_code": "F44.89/F44.9", + "title": "Other specified / Unspecified dissociative disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a dissociative disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific dissociative disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Chronic identity disturbance with subjective intrusions", + "description": "Partial, conflict-associated identity symptoms without full DID structure." + }, + { + "name": "Acute dissociative states in response to stress", + "description": "Brief dissociative episodes triggered by stressors but below criteria thresholds for ASD or DID." + }, + { + "name": "Dissociative trance state", + "description": "Marked narrowing of awareness or unresponsiveness outside cultural/religious practices." + }, + { + "name": "Identity alteration associated with coercive persuasion", + "description": "Identity disruption following intense coercive influence (e.g. torture, prolonged captivity)." + } + ], + "differentials": [ + "Specific named dissociative disorder (full criteria met - reclassify)", + "PTSD with dissociative features", + "BPD with transient dissociation", + "Substance-induced dissociation", + "Seizure disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Dissociative Disorder] [specifier(s)]. During recurrent episodes of dissociative disturbance, there have been clinically significant dissociative symptoms; partial identity disruption without full identity fragmentation; chronic or recurrent dissociative states lasting minutes to hours; dissociative trance states with narrowing of awareness; episodes of mixed dissociative intrusions not meeting full criteria for Dissociative Identity Disorder; dissociative symptoms occurring in response to stress but not meeting duration or threshold requirements for specific dissociative disorders, forming a pattern consistent with a dissociative syndrome that does not meet the full structured criteria of recognised dissociative disorders. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-som-somatic-symptom-disorder", + "category": { + "key": "som", + "label": "Somatic & Functional" + }, + "icd_code": "F45.1", + "title": "Somatic symptom disorder", + "key_features": [ + { + "label": "A", + "text": "≥1 somatic symptom that is distressing or results in significant disruption of daily life" + }, + { + "label": "B", + "text": "Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns: ≥1 of: disproportionate/persistent thoughts about symptom seriousness; persistently high health anxiety; excessive time/energy devoted to symptoms/health concerns" + }, + { + "label": "C", + "text": "Somatic state may or may not coexist with diagnosed medical condition; must be persistently symptomatic (≥6 months, though any one symptom need not be continuously present)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With predominant pain (previously pain disorder)", + "description": "Somatic symptoms primarily experienced as pain with disproportionate psychological response." + }, + { + "name": "Persistent", + "description": "Symptoms and associated excessive thoughts/behaviours present for more than six months." + }, + { + "name": "Mild", + "description": "One excessive cognitive/emotional/behavioural feature present." + }, + { + "name": "Moderate", + "description": "Two or more excessive features present." + }, + { + "name": "Severe", + "description": "Two or more excessive features plus multiple or very severe somatic symptoms." + } + ], + "differentials": [ + "Illness anxiety disorder (minimal or no somatic symptoms; anxiety focuses on having disease)", + "Functional neurological symptom disorder (neurological symptoms incompatible with known neurology)", + "MDD or anxiety disorder (somatic symptoms as part of mood/anxiety; may coexist)", + "Medical condition accounting for symptoms (though may coexist with SSD)", + "Factitious disorder (intentional symptom production - not the case in SSD)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Somatic Symptom Disorder] [specifier(s)]. Over at least several months, there have been one or more distressing somatic symptoms; persistent thoughts about the seriousness of symptoms; disproportionate and persistent health-related worry; high levels of health-related anxiety; excessive time and energy devoted to health concerns, forming a pattern meeting the threshold for a somatic symptom-focused syndrome with persistent and excessive cognitive, emotional, or behavioural responses to symptoms. The presentation is further characterised by chronic preoccupation with bodily sensations; repeated medical consultations; fluctuating symptom intensity. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-som-illness-anxiety-disorder", + "category": { + "key": "som", + "label": "Somatic & Functional" + }, + "icd_code": "F45.21", + "title": "Illness anxiety disorder", + "key_features": [ + { + "label": "A", + "text": "Preoccupation with having or acquiring a serious illness" + }, + { + "label": "B", + "text": "Somatic symptoms are absent or, if present, only mild in intensity; if medical condition present or at high risk, concern is clearly excessive or disproportionate" + }, + { + "label": "C", + "text": "High anxiety about health; easily alarmed about personal health status" + }, + { + "label": "D", + "text": "Excessive health-related behaviours (repeated body checking/seeking reassurance/medical appointments) or maladaptive avoidance (avoiding doctors)" + }, + { + "label": "E", + "text": "Illness preoccupation present ≥6 months (though specific feared illness may change)" + }, + { + "label": "F", + "text": "Not better explained by another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Care-seeking type", + "description": "Frequent medical consultations, investigations, or reassurance-seeking." + }, + { + "name": "Care-avoidant type", + "description": "Avoidance of healthcare, hospitals, or medical evaluations due to fear of discovering serious illness." + } + ], + "differentials": [ + "Somatic symptom disorder (prominent somatic symptoms; B criteria relate to those symptoms)", + "GAD (worry across multiple domains; not exclusively health)", + "OCD (health obsessions may overlap; ego-dystonic intrusions vs health focus)", + "Panic disorder (fear of disease often triggered by panic symptoms)", + "Major depressive disorder (nihilistic preoccupation vs health anxiety)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Illness Anxiety Disorder] [specifier(s)]. For at least six months, there has been persistent preoccupation with having or acquiring a serious illness; high health-related anxiety; low threshold for alarm about personal health; repeated checking behaviours; maladaptive avoidance of medical care; misinterpretation of normal bodily sensations as signs of severe disease, forming a pattern where anxiety about illness is disproportionate to the presence or intensity of somatic symptoms (which are absent or mild). The presentation is further characterised by persistent health monitoring; difficulty being reassured by medical evaluation; recurrent fear despite negative investigations. These symptoms have resulted in clinically significant distress or impairment, and the preoccupation has been present for at least six months.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-som-functional-neurological-symptom-disorder-conversion-disorder", + "category": { + "key": "som", + "label": "Somatic & Functional" + }, + "icd_code": "F44.x", + "title": "Functional neurological symptom disorder (conversion disorder)", + "key_features": [ + { + "label": "A", + "text": "≥1 symptom of altered voluntary motor or sensory function" + }, + { + "label": "B", + "text": "Clinical findings providing evidence of incompatibility between the symptom and recognised neurological or medical conditions" + }, + { + "label": "C", + "text": "Not better explained by another medical or mental disorder" + }, + { + "label": "D", + "text": "Clinically significant distress or impairment, or warrants medical evaluation" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With weakness or paralysis", + "description": "Predominant limb or body-part weakness." + }, + { + "name": "With abnormal movement", + "description": "Tremor, dystonia, gait disturbance, jerks." + }, + { + "name": "With swallowing symptoms", + "description": "Globus or dysphagia-like episodes." + }, + { + "name": "With speech symptoms", + "description": "Dysphonia, stuttering, or aphonia." + }, + { + "name": "With attacks or seizures", + "description": "Non-epileptic functional episodes." + }, + { + "name": "With anaesthesia or sensory loss", + "description": "Loss or alteration of sensation." + }, + { + "name": "With special sensory symptoms", + "description": "Visual, auditory, or olfactory disturbances." + }, + { + "name": "Acute episode", + "description": "Symptom duration < 6 months." + }, + { + "name": "Persistent", + "description": "Symptom duration ≥ 6 months." + } + ], + "differentials": [ + "Primary neurological disorder (epilepsy, MS, myasthenia, Guillain-Barré - must exclude with investigations)", + "Malingering (conscious feigning for external gain)", + "Factitious disorder (conscious symptom production to assume sick role)", + "Somatic symptom disorder (may coexist)", + "Substance-induced neurological symptoms" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Functional Neurological Symptom Disorder] [specifier(s)]. Following psychological stressors or conflict, there have been one or more altered voluntary motor or sensory symptoms; functional weakness or paralysis; abnormal movement; gait disturbance; tremor; dystonic posturing; swallowing symptoms; speech symptoms such as dysphonia or aphonia; non-epileptic attacks; sensory loss; visual symptoms; hearing loss; or episodes of unresponsiveness, forming a pattern incompatible with recognised neurological or medical conditions. The presentation is further characterised by internal inconsistency on examination; symptoms incongruent with known pathophysiology; fluctuating severity associated with emotional or situational factors. These symptoms have resulted in clinically significant distress or impairment, and the symptom pattern is not better explained by another medical or neurological disorder, substance effect, or factitious presentation.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-som-factitious-disorder", + "category": { + "key": "som", + "label": "Somatic & Functional" + }, + "icd_code": "F68.10", + "title": "Factitious disorder", + "key_features": [ + { + "label": "A", + "text": "Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception in self (imposed on self) or in another person (imposed on another)" + }, + { + "label": "B", + "text": "The individual presents himself/herself, or another, as ill, impaired, or injured" + }, + { + "label": "C", + "text": "The deceptive behaviour is evident even in the absence of obvious external rewards" + }, + { + "label": "D", + "text": "Not better explained by another mental disorder such as delusional disorder or another psychotic disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Single episode", + "description": "One documented episode of falsification or induction." + }, + { + "name": "Recurrent episodes", + "description": "Multiple episodes of falsification or induction over time." + }, + { + "name": "Factitious disorder imposed on self", + "description": "Symptoms fabricated or induced in oneself." + }, + { + "name": "Factitious disorder imposed on another (by proxy)", + "description": "Symptoms fabricated or induced in another individual under one's care - a form of abuse requiring mandatory reporting." + } + ], + "differentials": [ + "Malingering (external incentive - legal, financial, avoidance of duty; not a disorder)", + "Somatic symptom disorder (not intentional; genuine distress about symptoms)", + "Illness anxiety disorder (genuine health fear; not fabricating)", + "Medical condition (must fully investigate)", + "Borderline PD with self-harm (different function; not symptom fabrication for sick role)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Factitious Disorder] [specifier(s)]. There has been intentional falsification of physical symptoms; intentional falsification of psychological symptoms; induction of illness; exaggeration of symptoms; fabrication of episodes; or manipulation of tests or presentations, occurring in the absence of obvious external rewards and framed by an internal need to assume the sick role. The presentation is further characterised by a pattern of recurrent medical contacts, inconsistent clinical findings, complex or dramatic symptom narratives, and behaviours that persist despite negative investigations or treatment. These symptoms have resulted in clinically significant distress, impairment, or medical risk, and the picture is not better explained by another mental disorder, substance effect, or external incentive, distinguishing it from malingering.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-som-other-specified-unspecified-somatic-symptom-and-related-disorder", + "category": { + "key": "som", + "label": "Somatic & Functional" + }, + "icd_code": "F45.8/F45.9", + "title": "Other specified / Unspecified somatic symptom and related disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a somatic symptom/related disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific somatic symptom or related disorder" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Brief somatic symptom disorder", + "description": "Symptoms meeting somatic symptom disorder pattern but duration < 6 months." + }, + { + "name": "Brief illness anxiety disorder", + "description": "Illness anxiety features present but duration < 6 months." + }, + { + "name": "Illness anxiety disorder without excessive health behaviours", + "description": "Prominent health anxiety with minimal checking/avoidance behaviours." + }, + { + "name": "Pseudocyesis", + "description": "False belief of being pregnant, accompanied by objective physical signs of pregnancy." + } + ], + "differentials": [ + "Specific named somatic disorder (full criteria met - reclassify)", + "Primary medical condition", + "Primary anxiety or mood disorder" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Somatic Symptom and Related Disorder] [specifier(s)]. There have been distressing somatic symptoms; disproportionate health-related worries; persistent health-related anxiety; or maladaptive illness-related behaviours, forming a clinically significant pattern in which the full diagnostic detail is either not yet available or the presentation does not neatly fit a defined somatic symptom-related disorder. These symptoms have resulted in clinically significant distress or impairment, and the pattern is not better explained by another medical condition, a primary psychiatric disorder, or substance effects.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-slp-insomnia-disorder", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.00", + "title": "Insomnia disorder", + "key_features": [ + { + "label": "A", + "text": "Predominant complaint of dissatisfaction with sleep quantity/quality: ≥1 of: difficulty initiating sleep; difficulty maintaining sleep (frequent awakenings); early morning awakening with inability to return to sleep" + }, + { + "label": "B", + "text": "Causes clinically significant distress or impairment in social, occupational, educational, academic, behavioural, or other important areas of functioning" + }, + { + "label": "C", + "text": "Sleep difficulty occurs ≥3 nights/week" + }, + { + "label": "D", + "text": "Sleep difficulty present ≥3 months" + }, + { + "label": "E", + "text": "Sleep difficulty occurs despite adequate opportunity for sleep" + }, + { + "label": "F", + "text": "Not better explained by and does not occur exclusively during another sleep-wake disorder" + }, + { + "label": "G", + "text": "Not attributable to substances or a coexisting mental/medical disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Episodic", + "description": "Symptoms last ≥1 month but <3 months." + }, + { + "name": "Persistent", + "description": "Symptoms last ≥3 months." + }, + { + "name": "Recurrent", + "description": "Symptoms occur ≥2 times within one year." + } + ], + "differentials": [ + "Short-term insomnia (< 3 months - do not diagnose insomnia disorder)", + "Circadian rhythm sleep-wake disorder (sleep timing problem, not sleep maintenance)", + "Restless legs syndrome (urge to move legs at rest)", + "Sleep apnoea (fragmented sleep due to respiratory events - polysomnography)", + "MDD or GAD with secondary insomnia (primary disorder may need treatment first)", + "Substance/medication-induced sleep disturbance" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Insomnia Disorder]. For at least three months, occurring at least three nights per week, there have been persistent difficulties initiating sleep; difficulties maintaining sleep; frequent nocturnal awakenings; early-morning awakening with inability to return to sleep; dissatisfaction with sleep quality or quantity, occurring despite adequate opportunity and circumstances for sleep. The presentation is further characterised by daytime consequences such as fatigue, reduced concentration, low mood, irritability, or impaired functioning. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the picture is not better explained by another sleep-wake disorder, substance use, prescribed medications, circadian rhythm disturbance, or a co-occurring mental or medical condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-slp-hypersomnolence-disorder", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.10", + "title": "Hypersomnolence disorder", + "key_features": [ + { + "label": "A", + "text": "Self-reported excessive sleepiness (hypersomnolence) despite main sleep period of ≥7 hrs; ≥1 of: recurrent lapses into sleep during same day; prolonged main sleep episode (>9 hrs) that is non-restorative; difficulty being fully awake after abrupt awakening" + }, + { + "label": "B", + "text": "Hypersomnolence occurs ≥3×/week for ≥3 months" + }, + { + "label": "C", + "text": "Accompanied by significant distress or impairment" + }, + { + "label": "D", + "text": "Not better explained by and does not occur exclusively during another sleep disorder; not occurring exclusively during another sleep-wake disorder" + }, + { + "label": "E", + "text": "Not attributable to substances or a coexisting mental/medical disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Acute", + "description": "Duration < 1 month." + }, + { + "name": "Subacute", + "description": "Duration 1-3 months." + }, + { + "name": "Persistent", + "description": "Duration ≥ 3 months." + }, + { + "name": "Mild", + "description": "Difficulty maintaining wakefulness 1-2 days/week." + }, + { + "name": "Moderate", + "description": "Difficulty maintaining wakefulness 3-4 days/week." + }, + { + "name": "Severe", + "description": "Difficulty maintaining wakefulness ≥5 days/week." + } + ], + "differentials": [ + "Narcolepsy (cataplexy, sleep paralysis, hypnagogic hallucinations, low hypocretin-1; MSLT)", + "Obstructive sleep apnoea (respiratory events; polysomnography)", + "Circadian rhythm sleep-wake disorder (timing problem; jet lag, shift work)", + "MDD with hypersomnia (depressive episode context)", + "Substance/medication-induced hypersomnia" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Hypersomnolence Disorder] [specifier(s)]. For at least three months, there have been excessive sleepiness despite a main sleep period lasting at least seven hours; recurrent daytime sleep episodes; prolonged unrefreshing sleep exceeding nine hours; difficulty becoming fully awake after abrupt awakenings. The presentation is further characterised by sleep inertia, reduced alertness, and cognitive slowing. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, and the disturbance is not better explained by circadian rhythm sleep-wake disorders, insufficient sleep, narcolepsy, obstructive sleep apnoea, other medical conditions, or substance/medication effects.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-slp-narcolepsy", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.419", + "title": "Narcolepsy", + "key_features": [ + { + "label": "A", + "text": "Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Narcolepsy Type 1", + "description": "Cataplexy present and/or CSF hypocretin-1 low." + }, + { + "name": "Narcolepsy Type 2", + "description": "No cataplexy; normal or unmeasured hypocretin; MSLT-confirmed sleepiness." + }, + { + "name": "Narcolepsy due to another medical condition", + "description": "Narcoleptic features secondary to a known medical/neurological disorder." + }, + { + "name": "Mild", + "description": "Infrequent cataplexy (< 1/week) with minimal functional impairment." + }, + { + "name": "Moderate", + "description": "Cataplexy episodes 1-7/week and moderate impairment." + }, + { + "name": "Severe", + "description": "Cataplexy episodes daily or highly disruptive; marked impairment." + } + ], + "differentials": [ + "Hypersomnolence disorder (no cataplexy; normal hypocretin; no MSLT SOREMP pattern)", + "Seizure disorder (cataplexy-like episodes - EEG; no emotional trigger)", + "REM sleep behaviour disorder (acting out dreams, not cataplexy)", + "Major depressive disorder (hypersomnia; cataplexy absent)", + "Syncope (cardiovascular; no trigger pattern or immediate recovery)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Narcolepsy] [specifier(s)]. For at least three months, there have been recurrent episodes of an irrepressible need to sleep; lapses into sleep; sudden daytime sleep episodes, forming a pattern meeting the threshold for narcolepsy. The presentation is further characterised by cataplexy; recurrent intrusions of REM-related phenomena including sleep paralysis; hypnagogic or hypnopompic hallucinations, and distinctive sleep architecture changes, including REM latency ≤15 minutes on PSG or low CSF hypocretin-1 concentration, where applicable. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by insufficient sleep, circadian rhythm disorders, obstructive sleep apnoea, other medical or neurological illness, or substance/medication effects.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-slp-obstructive-sleep-apnoea-hypopnoea", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.33", + "title": "Obstructive sleep apnoea-hypopnoea", + "key_features": [ + { + "label": "A", + "text": "Evidence by polysomnography of ≥5 obstructive apnoeas/hypopnoeas per hour of sleep + ≥1 of: nocturnal breathing disturbances (snoring, snorting, gasping, breathing pauses); daytime sleepiness/fatigue/unrefreshing sleep not explained by another disorder; OR ≥15 obstructive apnoeas/hypopnoeas per hour of sleep regardless of accompanying symptoms" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "AHI 5-14 with minimal symptoms or mild impairment." + }, + { + "name": "Moderate", + "description": "AHI 15-29 with clear daytime symptoms or functional impact." + }, + { + "name": "Severe", + "description": "AHI ≥30 with marked symptoms, hypoxaemia, or major impairment." + } + ], + "differentials": [ + "Central sleep apnoea (different respiratory events; different mechanism)", + "Primary insomnia (no respiratory events; no excessive daytime sleepiness)", + "Hypersomnolence disorder (no respiratory events on PSG)", + "Narcolepsy (MSLT demonstrates SOREMP)", + "Depressive disorder with hypersomnia" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Obstructive Sleep Apnoea-Hypopnoea] [specifier(s)]. Across recurrent nights, there have been repeated episodes of obstructive apnoeas; hypopnoeas; snoring; gasping; witnessed breathing pauses; nocturnal choking, accompanied by non-restorative sleep; excessive daytime sleepiness; morning headaches; impaired concentration; fatigue, forming a pattern consistent with sleep-disordered breathing. The presentation is further supported by objective evidence of five or more obstructive respiratory events per hour of sleep, or fifteen or more events per hour regardless of symptoms. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by primary insomnia, circadian rhythm disorders, central sleep apnoea syndromes, narcolepsy, medication/substance effects, or other medical or neurological conditions.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-slp-central-sleep-apnoea", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.37", + "title": "Central sleep apnoea", + "key_features": [ + { + "label": "A", + "text": "Evidence by polysomnography of ≥5 central apnoeas per hour of sleep" + }, + { + "label": "B", + "text": "The disorder is not better explained by another current sleep disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Idiopathic central sleep apnoea", + "description": "Central events not attributable to another medical or substance cause." + }, + { + "name": "Cheyne-Stokes breathing", + "description": "Cyclical crescendo-decrescendo breathing linked to cardiac, neurologic, or systemic illness." + }, + { + "name": "Central sleep apnoea due to medication or substance", + "description": "Central events associated with depressant effects on respiratory drive (e.g. opioids)." + }, + { + "name": "Treatment-emergent central sleep apnoea", + "description": "Central apnoeas emerging during CPAP or other treatment for obstructive sleep apnoea." + } + ], + "differentials": [ + "Obstructive sleep apnoea (obstructive vs central events on PSG - distinguishable by respiratory effort monitoring)", + "Primary cardiac or neurological disorder causing Cheyne-Stokes", + "Medication-induced respiratory depression (vs primary CSA)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Central Sleep Apnoea] [specifier(s)]. Across recurrent nights, there have been repeated episodes of central apnoeas; central hypopnoeas; diminished respiratory effort during sleep; abrupt awakenings with dyspnoea; fragmented or non-restorative sleep; excessive daytime sleepiness; impaired alertness. The presentation is further supported by objective evidence of five or more central apnoeas or central hypopnoeas per hour of sleep on polysomnography, with the majority of events being central rather than obstructive. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by obstructive sleep apnoea, medication/substance effects (including opioids), or other medical or psychiatric conditions.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-slp-rem-sleep-behaviour-disorder", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.52", + "title": "REM sleep behaviour disorder", + "key_features": [ + { + "label": "A", + "text": "Repeated episodes of arousal during sleep associated with vocalisation and/or complex motor behaviours" + }, + { + "label": "B", + "text": "These behaviours arise during REM sleep and therefore occur usually >90 min after sleep onset; are more frequent during the later portions of the sleep period; and uncommonly occur during daytime naps" + }, + { + "label": "C", + "text": "Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented" + }, + { + "label": "D", + "text": "Either of: REM sleep without atonia on polysomnographic recording; history of RBD + established synucleinopathy diagnosis" + }, + { + "label": "E", + "text": "Not attributable to physiological effects of a substance or medication; not better explained by coexisting mental/medical disorders" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Acute", + "description": "Recent onset, typically associated with a clear precipitant (e.g. antidepressant initiation, withdrawal)." + }, + { + "name": "Subacute", + "description": "Onset over weeks to months." + }, + { + "name": "Chronic", + "description": "Symptoms persisting for months to years." + }, + { + "name": "With comorbid neurodegenerative disorder", + "description": "Occurs in the context of Parkinson's disease, Lewy body disease, MSA, or other synucleinopathies." + } + ], + "differentials": [ + "NREM arousal disorders (sleepwalking, sleep terrors - first third of night; amnesia; no dream recall)", + "Obstructive sleep apnoea with arousal behaviours (respiratory events on PSG)", + "Nocturnal seizures (epileptiform activity on EEG)", + "PTSD nightmares (waking from distressing dreams; full alertness; no enacted motor behaviour)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [REM Sleep Behaviour Disorder] [specifier(s)]. During repeated episodes of arousal during REM sleep, there have been complex motor behaviours; dream-enactment behaviours; vocalisations during sleep; behaviours occurring in association with vivid, action-filled dreams, forming a pattern consistent with loss of the normal REM atonia. The presentation is further characterised by REM sleep without atonia on polysomnography; recall of dream content consistent with enacted behaviours; risk of injury to self or bed partner. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by another sleep disorder, substance/medication effect (including antidepressants), or a primary neurological condition, although co-existing neurodegenerative disease is a key consideration and warrants clinical monitoring.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-slp-restless-legs-syndrome", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.61", + "title": "Restless legs syndrome", + "key_features": [ + { + "label": "A", + "text": "Urge to move the legs, usually accompanied by uncomfortable sensations in the legs, that begins or worsens during rest/inactivity, is partially or totally relieved by movement, and occurs primarily in the evening or night" + }, + { + "label": "B", + "text": "Criterion A symptoms occur ≥3 times/week and have persisted for ≥3 months" + }, + { + "label": "C", + "text": "Criterion A symptoms are accompanied by significant distress or impairment" + }, + { + "label": "D", + "text": "Not attributable to another mental disorder or medical condition; not better explained by medication side effect or behavioural condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With sleep disturbance", + "description": "Symptoms are associated with difficulty initiating or maintaining sleep." + }, + { + "name": "Mild", + "description": "Symptoms are bothersome but cause limited functional impairment." + }, + { + "name": "Moderate", + "description": "Symptoms cause clear sleep disruption and daytime functional impact." + }, + { + "name": "Severe", + "description": "Frequent or intense symptoms with marked sleep disturbance and significant impairment in daily functioning." + } + ], + "differentials": [ + "Akathisia (medication-induced; no sensory component; not limited to rest; no circadian pattern)", + "Peripheral neuropathy (constant sensations; not relieved by movement)", + "Leg cramps (painful involuntary muscle contractions; brief; focal)", + "Peripheral vascular disease (pain on exertion; not urge-to-move character)", + "Positional discomfort (immediately relieved by position change; no urge)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Restless Legs Syndrome] [specifier(s)]. Typically during periods of rest or inactivity, there have been an urge to move the legs; unpleasant or uncomfortable sensations in the legs; symptoms that begin or worsen during rest; partial or complete relief with movement; symptoms that are worse in the evening or at night, forming a characteristic sensorimotor pattern consistent with restless legs syndrome. The presentation is further characterised by recurrent symptom occurrence on multiple evenings per week; sleep-onset or sleep-maintenance disturbance related to leg discomfort; associated daytime fatigue or impaired concentration secondary to sleep disruption. These symptoms have resulted in clinically significant distress or impairment in sleep quality, daytime functioning, or quality of life, and are not better explained by leg cramps, positional discomfort, peripheral neuropathy, akathisia, habitual movements, venous disease, or another sleep, neurological, or medical disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-slp-nrem-sleep-arousal-disorder", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.51", + "title": "NREM sleep arousal disorder", + "key_features": [ + { + "label": "A", + "text": "Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either sleepwalking (complex behaviour without full consciousness) or sleep terrors (abrupt awakenings with intense fear/autonomic arousal; difficult to console)" + }, + { + "label": "B", + "text": "No or little dream imagery recalled" + }, + { + "label": "C", + "text": "Amnesia for the episodes" + }, + { + "label": "D", + "text": "Episodes cause clinically significant distress or impairment" + }, + { + "label": "E", + "text": "Disturbance not attributable to a substance or another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Sleepwalking type", + "description": "Recurrent ambulation or complex behaviours during incomplete awakening from NREM sleep." + }, + { + "name": "Sleep terror type", + "description": "Recurrent episodes of abrupt terror arousals with autonomic surge and limited responsiveness." + }, + { + "name": "With sleep-related eating", + "description": "Sleepwalking subtype characterised by recurrent eating behaviours during partial arousal." + } + ], + "differentials": [ + "REM sleep behaviour disorder (REM sleep; recall of dreams; no amnesia; second half of night)", + "Nocturnal seizures (epileptiform discharges on EEG; stereotyped patterns)", + "Delirium (global cognitive disturbance; not sleep-specific)", + "Dissociative disorder with nocturnal episodes", + "Medication-induced parasomnias (zolpidem, sedatives - review medication history)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Non-Rapid Eye Movement Sleep Arousal Disorder] [specifier(s)]. During repeated episodes arising from NREM sleep, there have been recurrent episodes of incomplete awakening; sleepwalking; sleep terrors; autonomic activation; confused behaviour; limited responsiveness during events; difficulty being consoled, forming a pattern consistent with NREM sleep arousal phenomena. The presentation is further characterised by little or no associated dream imagery; complete amnesia or minimal recall for the episodes; behaviours occurring predominantly in the first third of the sleep period. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by another sleep disorder (including REM sleep behaviour disorder), epilepsy, substance/medication effects, feigned behaviour, or a primary medical or psychiatric condition.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-slp-circadian-rhythm-sleep-wake-disorder", + "category": { + "key": "slp", + "label": "Sleep-Wake" + }, + "icd_code": "G47.24", + "title": "Circadian rhythm sleep-wake disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent or recurrent pattern of sleep disruption primarily due to alteration of the circadian system or misalignment between endogenous circadian rhythm and sleep-wake schedule" + }, + { + "label": "B", + "text": "Leads to excessive sleepiness or insomnia, or both" + }, + { + "label": "C", + "text": "Clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Delayed sleep-wake phase type", + "description": "Sleep onset and awakening persistently delayed; improvement when allowed free schedule." + }, + { + "name": "Advanced sleep-wake phase type", + "description": "Sleep onset and awakening substantially earlier than desired; stable advanced phase." + }, + { + "name": "Irregular sleep-wake type", + "description": "No clear circadian rhythm; fragmented sleep with multiple irregular bouts across 24 hours." + }, + { + "name": "Non-24-hour sleep-wake type", + "description": "Progressively shifting sleep-wake pattern; common in total blindness." + }, + { + "name": "Shift work type", + "description": "Insomnia and/or excessive sleepiness from misalignment with work schedule." + }, + { + "name": "Jet lag type", + "description": "Transient sleep disturbance and alertness impairment following rapid travel across time zones." + } + ], + "differentials": [ + "Insomnia disorder (sleep timing problem vs sleep initiation/maintenance problem)", + "Hypersomnolence disorder (sleepiness regardless of timing)", + "MDD with hypersomnia or insomnia (mood episode context)", + "Jet lag type (transient; time-limited to travel recovery)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Circadian Rhythm Sleep-Wake Disorder] [specifier(s)]. Over a persistent period, there have been a chronic or recurrent pattern of sleep-wake disruption; misalignment between the individual's endogenous circadian rhythm and required sleep-wake schedule; difficulty initiating sleep; difficulty maintaining sleep; excessive daytime sleepiness; impaired alertness; reduced cognitive efficiency, forming a pattern consistent with a circadian rhythm disorder. The presentation is further characterised by a stable but maladapted phase of the circadian system causing sleep timing that is out of sync with environmental or social obligations. These symptoms have resulted in clinically significant distress or impairment, and the disturbance is not better explained by insomnia disorder, another sleep disorder, inadequate sleep opportunity, medication or substance use, a primary medical condition, or another mental disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-sex-delayed-ejaculation", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.32", + "title": "Delayed ejaculation", + "key_features": [ + { + "label": "A", + "text": "Either of: marked delay in ejaculation; marked infrequency or absence of ejaculation, on almost all occasions of partnered sexual activity (≥75–100%), without desire for delay" + }, + { + "label": "B", + "text": "Symptoms persist ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not better explained by non-sexual mental disorder, substances/medications, relationship factors, or significant stressors; not attributable to another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since the onset of sexual activity." + }, + { + "name": "Acquired", + "description": "Developed after a period of normal ejaculatory functioning." + }, + { + "name": "Generalised", + "description": "Occurs across all partners and situations." + }, + { + "name": "Situational", + "description": "Limited to specific partners, situations, or types of stimulation." + }, + { + "name": "Mild", + "description": "Minimal delay with mild distress." + }, + { + "name": "Moderate", + "description": "Clear delay with definite distress or relational impact." + }, + { + "name": "Severe", + "description": "Extreme or absent ejaculation with marked distress or impairment." + } + ], + "differentials": [ + "SSRI/medication-induced (most common cause - temporal relationship to medication)", + "Anejaculation from retrograde ejaculation (rule out: urinalysis post-orgasm)", + "Hypoactive sexual desire disorder (no desire vs desired but cannot ejaculate)", + "Anxiety or relationship factors", + "Neurological cause (DM neuropathy, MS, spinal injury)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Delayed Ejaculation] [specifier(s)]. For at least six months, occurring during most partnered sexual activity, there have been marked delay in ejaculation; marked infrequency of ejaculation; absence of ejaculation despite adequate stimulation and sexual desire, forming a persistent pattern of ejaculatory difficulty. The presentation is further characterised by occurrence across relevant sexual contexts, with symptoms not limited to a specific partner or situation, where applicable. These symptoms have resulted in clinically significant personal distress, interpersonal difficulty, or sexual dissatisfaction, and the pattern is not better explained by a nonsexual mental disorder, relationship distress, significant stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-erectile-dysfunction", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.21", + "title": "Erectile dysfunction", + "key_features": [ + { + "label": "A", + "text": "≥1 of 3 symptoms on almost all occasions (≥75–100%) of sexual activity: marked difficulty attaining an erection; marked difficulty maintaining an erection until completion of sexual activity; marked decrease in erectile rigidity" + }, + { + "label": "B", + "text": "Symptoms persist ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not better explained by non-sexual mental disorder, substances/medications, relationship factors, or significant stressors; not attributable to another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since the onset of sexual activity." + }, + { + "name": "Acquired", + "description": "Developed after a period of normal erectile functioning." + }, + { + "name": "Generalised", + "description": "Occurs across all partners and situations." + }, + { + "name": "Situational", + "description": "Limited to certain partners, situations, or types of stimulation." + }, + { + "name": "Mild", + "description": "Reduced erectile firmness or consistency with mild distress." + }, + { + "name": "Moderate", + "description": "Clear erectile difficulty with definite distress or relational impact." + }, + { + "name": "Severe", + "description": "Minimal or absent erections with marked distress or impairment." + } + ], + "differentials": [ + "Vascular cause - atherosclerosis, hypertension (most common physical cause; assess CV risk)", + "Hormonal cause - hypogonadism, hyperprolactinaemia (check testosterone, LH, FSH, prolactin)", + "Neurological cause - DM neuropathy, MS, spinal cord injury", + "Medication-induced (antidepressants, antipsychotics, antihypertensives)", + "Psychological or anxiety-related (situational; morning erections preserved)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Erectile Dysfunction] [specifier(s)]. For at least six months, occurring during most sexual encounters, there have been marked difficulty obtaining an erection; marked difficulty maintaining an erection until completion of sexual activity; marked decrease in erectile rigidity, forming a persistent pattern of erectile difficulty. The presentation is further characterised by symptoms not limited to a specific partner or situation, where applicable. These symptoms have resulted in clinically significant distress, interpersonal difficulty, or sexual dissatisfaction, and the pattern is not better explained by a nonsexual mental disorder, relationship distress, significant stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-female-orgasmic-disorder", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.31", + "title": "Female orgasmic disorder", + "key_features": [ + { + "label": "A", + "text": "≥1 of: marked delay in, marked infrequency of, or absence of orgasm; markedly reduced intensity of orgasmic sensations — on almost all occasions (≥75–100%) of sexual activity" + }, + { + "label": "B", + "text": "Symptoms persist ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not better explained by non-sexual mental disorder, substances/medications, relationship factors, or significant stressors; not attributable to another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since the onset of sexual activity." + }, + { + "name": "Acquired", + "description": "Developed after a period of normal orgasmic functioning." + }, + { + "name": "Generalised", + "description": "Occurs across all partners, situations, and types of stimulation." + }, + { + "name": "Situational", + "description": "Limited to certain partners, situations, or types of stimulation." + }, + { + "name": "Mild", + "description": "Reduced orgasmic frequency or intensity with mild distress." + }, + { + "name": "Moderate", + "description": "Clear orgasmic difficulty with definite distress or relational impact." + }, + { + "name": "Severe", + "description": "Absence or near-absence of orgasm with marked distress or impairment." + } + ], + "differentials": [ + "SSRI/medication-induced (temporal relationship to medication initiation)", + "Female sexual interest/arousal disorder (insufficient arousal preceding orgasmic difficulty)", + "Genito-pelvic pain (pain interfering with sexual response)", + "Relationship or contextual factors (situational vs generalised)", + "Hormonal cause (menopause, hypogonadism)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Female Orgasmic Disorder] [specifier(s)]. For at least six months, occurring during most sexual encounters, there have been marked delay in orgasm; marked infrequency of orgasm; absence of orgasm; markedly reduced intensity of orgasmic sensations, forming a persistent pattern of orgasmic difficulty despite adequate stimulation and desire. The presentation is further characterised by symptoms not better accounted for by insufficient stimulation alone, and occurrence across relevant sexual contexts, where applicable. These symptoms have resulted in clinically significant distress, interpersonal difficulty, or sexual dissatisfaction, and the pattern is not better explained by a nonsexual mental disorder, relationship distress, significant stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-female-sexual-interest-arousal-disorder", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.22", + "title": "Female sexual interest/arousal disorder", + "key_features": [ + { + "label": "A", + "text": "Absent/reduced sexual interest/arousal; ≥3 of: absent/reduced interest in sexual activity; absent/reduced sexual/erotic thoughts or fantasies; no/reduced initiation of sexual activity and unreceptive to partner's attempts; absent/reduced sexual excitement/pleasure during sexual activity in ≥75–100% encounters; absent/reduced sexual interest/arousal in response to any internal/external erotic cues; absent/reduced genital or non-genital sensations during sexual activity in ≥75–100% encounters" + }, + { + "label": "B", + "text": "Symptoms persist ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not better explained by non-sexual mental disorder, substances/medications, relationship factors, or significant stressors; not attributable to another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since the onset of sexual activity." + }, + { + "name": "Acquired", + "description": "Developed after a period of normal sexual interest and arousal." + }, + { + "name": "Generalised", + "description": "Occurs across all partners, situations, and types of stimulation." + }, + { + "name": "Situational", + "description": "Limited to certain partners, situations, or types of stimulation." + }, + { + "name": "Mild", + "description": "Reduced interest or arousal with mild distress." + }, + { + "name": "Moderate", + "description": "Clear and persistent reduction with definite distress or relational impact." + }, + { + "name": "Severe", + "description": "Marked or near-absent interest/arousal with significant distress or impairment." + } + ], + "differentials": [ + "Female orgasmic disorder (arousal intact but orgasm impaired)", + "Genito-pelvic pain disorder (pain limiting engagement rather than absent desire)", + "Major depressive disorder (generalised anhedonia vs specific sexual domain)", + "SSRI/medication-induced (temporal link to medication)", + "Hormonal cause - menopause, hypogonadism, hyperprolactinaemia (measure FSH, oestradiol, testosterone, prolactin)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Female Sexual Interest/Arousal Disorder] [specifier(s)]. For at least six months, occurring during most sexual encounters, there has been absent or reduced interest in sexual activity; absent or reduced sexual thoughts or fantasies; reduced initiation of sexual activity; reduced receptivity to a partner's initiation; absent or reduced sexual excitement or pleasure during sexual activity; absent or reduced sexual interest in response to internal or external sexual cues; absent or reduced genital or non-genital sexual sensations during sexual activity, with at least three of these features present, forming a persistent pattern of diminished sexual interest and arousal. These symptoms have resulted in clinically significant distress, interpersonal difficulty, or sexual dissatisfaction, and the pattern is not better explained by a nonsexual mental disorder, relationship distress, significant stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-genito-pelvic-pain-penetration-disorder", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.6", + "title": "Genito-pelvic pain/penetration disorder", + "key_features": [ + { + "label": "A", + "text": "Persistent or recurrent difficulties with ≥1 of: vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during intercourse or penetration attempts; marked fear/anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tensing or tightening of pelvic floor muscles during vaginal penetration attempts" + }, + { + "label": "B", + "text": "Symptoms persist ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not attributable to another medical condition; not better explained by another mental disorder or relationship problems" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since the onset of sexual activity." + }, + { + "name": "Acquired", + "description": "Developed after a period of pain-free penetration." + }, + { + "name": "Generalised", + "description": "Occurs across all partners, situations, and types of penetration." + }, + { + "name": "Situational", + "description": "Limited to specific partners, situations, or types of penetration." + }, + { + "name": "Mild", + "description": "Symptoms present with mild distress." + }, + { + "name": "Moderate", + "description": "Clear and persistent symptoms with definite distress or relational impact." + }, + { + "name": "Severe", + "description": "Marked symptoms with significant distress, avoidance, or impairment." + } + ], + "differentials": [ + "Primary medical cause - endometriosis, vestibulodynia, pelvic inflammatory disease, lichen sclerosus (must exclude with examination)", + "SSRI-induced vaginal dryness (medication history)", + "Female sexual interest/arousal disorder (low arousal contributing to insufficient lubrication)", + "Vaginismus historical term (now included in this diagnosis)", + "Trauma history (sexual trauma may underlie fear/avoidance)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Genito-Pelvic Pain/Penetration Disorder] [specifier(s)]. For at least six months, occurring during most penetration attempts, there has been persistent difficulty with vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts; marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration, forming a persistent pattern of pain, fear, or penetration difficulty. The presentation is further characterised by symptoms not better accounted for by inadequate lubrication alone. These symptoms have resulted in clinically significant distress, interpersonal difficulty, or avoidance of penetrative sexual activity, and the pattern is not better explained by a nonsexual mental disorder, relationship distress, significant stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-male-hypoactive-sexual-desire-disorder", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.0", + "title": "Male hypoactive sexual desire disorder", + "key_features": [ + { + "label": "A", + "text": "Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies AND desire for sexual activity; clinician judges deficiency considering age and general/sociocultural context" + }, + { + "label": "B", + "text": "Symptoms persist ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not better explained by non-sexual mental disorder, substances/medications, relationship factors, or significant stressors; not attributable to another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since the onset of sexual functioning." + }, + { + "name": "Acquired", + "description": "Developed after a period of adequate sexual desire." + }, + { + "name": "Generalised", + "description": "Occurs across all partners and situations." + }, + { + "name": "Situational", + "description": "Limited to specific partners or situations." + }, + { + "name": "Mild", + "description": "Reduced desire with mild distress." + }, + { + "name": "Moderate", + "description": "Clear reduction with definite distress or relational impact." + }, + { + "name": "Severe", + "description": "Marked reduction with significant distress or impairment." + } + ], + "differentials": [ + "Hypogonadism - primary or secondary (testosterone deficiency; check TT, LH, FSH)", + "Hyperprolactinaemia (amenorrhoea equivalent; check prolactin)", + "Major depressive disorder (generalised anhedonia vs specific sexual domain loss)", + "Medication-induced (antidepressants, antipsychotics, opioids, anti-androgens)", + "Erectile dysfunction as primary complaint (secondary loss of desire)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Male Hypoactive Sexual Desire Disorder] [specifier(s)]. For at least six months, there have been persistently or recurrently deficient sexual thoughts or fantasies; persistently or recurrently reduced desire for sexual activity, forming a sustained pattern of diminished sexual interest that is clearly below expected levels given age, developmental stage, and sociocultural context. These symptoms have resulted in clinically significant personal distress, interpersonal difficulty, or both, and the pattern is not better explained by another mental disorder, relationship distress, significant life stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-premature-ejaculation", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.4", + "title": "Premature ejaculation", + "key_features": [ + { + "label": "A", + "text": "Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within ≈1 minute of vaginal penetration and before the individual wishes it, on ≥75–100% of occasions" + }, + { + "label": "B", + "text": "Symptoms present ≥6 months" + }, + { + "label": "C", + "text": "Causes marked distress" + }, + { + "label": "D", + "text": "Not better explained by non-sexual mental disorder, substances/medications, relationship factors, or significant stressors; not attributable to another medical condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Lifelong", + "description": "Present since first sexual experiences." + }, + { + "name": "Acquired", + "description": "Developed after a period of typical ejaculatory latency." + }, + { + "name": "Generalised", + "description": "Occurs across partners and situations." + }, + { + "name": "Situational", + "description": "Limited to specific partners or contexts." + }, + { + "name": "Mild", + "description": "Ejaculation within approximately 30 seconds to 1 minute of penetration." + }, + { + "name": "Moderate", + "description": "Ejaculation within approximately 15 to 30 seconds of penetration." + }, + { + "name": "Severe", + "description": "Ejaculation at or prior to initiation of sexual activity." + } + ], + "differentials": [ + "Erectile dysfunction with secondary early ejaculation (treat ED first)", + "Normal variation in ejaculatory latency (patient expectation vs clinical threshold)", + "Anxiety disorder contributing to performance anxiety", + "Relationship or contextual factors (situational pattern)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Premature Ejaculation] [specifier(s)]. For at least six months, occurring during most partnered sexual activity involving vaginal penetration, there has been a persistent pattern of ejaculation within approximately one minute of vaginal penetration and before the individual wishes it, forming a recurrent pattern of early ejaculation causing distress. The presentation is further characterised by occurrence across most sexual encounters with a pattern that is stable rather than situational, where applicable. These symptoms have resulted in clinically significant personal distress, interpersonal difficulty, or both, and are not better explained by another mental disorder, relationship distress, significant psychosocial stressors, substance or medication effects, or a primary medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-sex-other-specified-unspecified-sexual-dysfunction", + "category": { + "key": "sex", + "label": "Sexual Dysfunction" + }, + "icd_code": "F52.8/F52.9", + "title": "Other specified / Unspecified sexual dysfunction", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a sexual dysfunction causing clinically significant distress" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific sexual dysfunction" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Specified reason", + "description": "Clinician documents why full criteria for a specific sexual dysfunction are not met." + }, + { + "name": "Mild", + "description": "Minimal excess symptoms with mild but clear distress or relational impact." + }, + { + "name": "Moderate", + "description": "Definite sexual or interpersonal impairment without pervasive dysfunction." + }, + { + "name": "Severe", + "description": "Marked, persistent distress or significant relational or functional disruption." + } + ], + "differentials": [ + "Specific sexual dysfunction (full criteria met - reclassify)", + "Substance/medication-induced sexual dysfunction (SSRIs, antipsychotics, antihypertensives)", + "Hormonal cause (always screen before diagnosing primary sexual dysfunction)", + "Relationship or contextual factors" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Sexual Dysfunction] [specifier(s)]. Over a sustained period, there have been clinically significant difficulties in sexual desire; sexual arousal; erectile or lubrication response; ejaculatory control or timing; orgasmic capacity or intensity; sexual pain or penetration-related difficulty, forming a pattern of sexual dysfunction that causes distress or interpersonal difficulty but does not fully meet structured criteria for a specific sexual dysfunction diagnosis. The presentation is further characterised by a clearly identified reason why full diagnostic criteria are not met, such as atypical symptom pattern, insufficient symptom duration, mixed or overlapping features, or context-limited presentation. These symptoms have resulted in clinically significant distress or interpersonal difficulty, and are not better explained by a substance or medication effect, another medical condition, a primary mental disorder, or normal variations in sexual functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-dsr-oppositional-defiant-disorder-odd", + "category": { + "key": "dsr", + "label": "Disruptive & Impulse-Control" + }, + "icd_code": "F91.3", + "title": "Oppositional defiant disorder (ODD)", + "key_features": [ + { + "label": "A", + "text": "≥4 symptoms from: angry/irritable mood (loses temper; touchy/easily annoyed; angry/resentful); argumentative/defiant behaviour (argues with authority; defies rules; deliberately annoys; blames others); or vindictiveness — for ≥6 months, exhibited during interaction with ≥1 non-sibling individual" + }, + { + "label": "B", + "text": "Causes distress in individual or others in their immediate social context, or negatively impacts functioning" + }, + { + "label": "C", + "text": "Not better explained by another mental disorder (psychotic, mood, SUD, DMDD, or conduct disorder)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Symptoms confined to one setting, with mild but clear functional impact." + }, + { + "name": "Moderate", + "description": "Symptoms present in at least two settings, with definite functional impairment." + }, + { + "name": "Severe", + "description": "Symptoms present in three or more settings, or marked intensity causing significant impairment." + } + ], + "differentials": [ + "Conduct disorder (more severe; involves aggression, property destruction, rule violations)", + "ADHD (impulsivity without deliberate defiance; highly comorbid - code both when criteria independently met)", + "DMDD (severe temper outbursts + persistent irritable mood; may coexist)", + "MDD with irritability (episode-bound; not persistent trait)", + "ASD (behavioural rigidity; not motivated by defiance)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Oppositional Defiant Disorder] [specifier(s)]. For at least six months, there has been a recurrent pattern of angry or irritable mood including frequent temper loss; being easily annoyed; persistent anger or resentment; argumentative or defiant behaviour including frequent arguing with authority figures; active defiance or refusal to comply with rules or requests; deliberate annoyance of others; blaming others for mistakes or misbehaviour; and vindictiveness, with at least four of the above symptoms present, occurring during interaction with at least one individual who is not a sibling. The presentation is further characterised by symptoms that are persistent rather than episodic. These features have resulted in clinically significant distress in the individual or others in their immediate social context, or impairment in social, educational, or occupational functioning, and the behaviours are not occurring exclusively during the course of a psychotic, substance-related, depressive, or bipolar disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-dsr-conduct-disorder", + "category": { + "key": "dsr", + "label": "Disruptive & Impulse-Control" + }, + "icd_code": "F91.x", + "title": "Conduct disorder", + "key_features": [ + { + "label": "A", + "text": "Repetitive/persistent pattern of behaviour violating rights of others or major societal norms; ≥3 of 15 criteria in past 12 months (≥1 in past 6): aggression to people/animals; destruction of property; deceitfulness/theft; serious rule violations" + }, + { + "label": "B", + "text": "Behaviour disturbance causes clinically significant impairment in social, academic, or occupational functioning" + }, + { + "label": "C", + "text": "If individual is age ≥18, criteria not met for antisocial personality disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Childhood-onset type", + "description": "At least one criterion present before age 10." + }, + { + "name": "Adolescent-onset type", + "description": "No criteria present before age 10." + }, + { + "name": "Unspecified onset", + "description": "Insufficient information to determine age of onset." + }, + { + "name": "With limited prosocial emotions", + "description": "Persistent lack of remorse or guilt; callous lack of empathy; unconcerned about performance; shallow or deficient affect." + }, + { + "name": "Mild", + "description": "Few conduct problems beyond those required; minor harm to others." + }, + { + "name": "Moderate", + "description": "Between mild and severe." + }, + { + "name": "Severe", + "description": "Many conduct problems causing considerable harm or major rule violations." + } + ], + "differentials": [ + "ODD (less severe; no aggression, property destruction, or serious rule violations)", + "ADHD (comorbid in ~25%; impulsivity without deliberate harm; code both when criteria independently met)", + "Intermittent explosive disorder (impulsive reactive aggression without sustained conduct pattern)", + "Bipolar disorder (episodic; mood-driven)", + "PTSD with reactive aggression (trauma context)", + "Normal adolescent risk-taking (below clinical threshold)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Conduct Disorder] [specifier(s)]. For at least twelve months, there has been a persistent pattern of behaviour violating the rights of others and age-appropriate societal norms, including aggression to people; aggression to animals; destruction of property; fire-setting; deliberate damage of others' property; deceitfulness; lying for personal gain; theft without confrontation; theft with confrontation; breaking into buildings or vehicles; serious violations of rules; truancy; running away from home overnight; repeated disregard for rules set by parents or authority figures, forming a pattern meeting the threshold for a conduct disorder presentation. The presentation is further characterised by behavioural disturbances that are repetitive and persistent, not confined to a single situational context, and reflective of impaired empathy or remorse for others where applicable. These behaviours have resulted in clinically significant impairment in social, academic, occupational, or family functioning, and are not solely attributable to oppositional defiant disorder, intermittent explosive disorder, substance intoxication or withdrawal, or another mental or neurodevelopmental condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-dsr-intermittent-explosive-disorder-ied", + "category": { + "key": "dsr", + "label": "Disruptive & Impulse-Control" + }, + "icd_code": "F63.81", + "title": "Intermittent explosive disorder (IED)", + "key_features": [ + { + "label": "A", + "text": "Recurrent outbursts of failure to control aggressive impulses; ≥1 of: verbal aggression or physical aggression toward property/animals/individuals ≥2×/week (on average) for ≥3 months; ≥3 aggressive outbursts involving damage/injury within a 12-month period" + }, + { + "label": "B", + "text": "Aggressiveness grossly disproportionate in magnitude to the provocation or precipitating psychosocial stressors" + }, + { + "label": "C", + "text": "Not better explained by another mental/medical condition; not attributable to substances" + }, + { + "label": "D", + "text": "Chronological age ≥6 years (or equivalent developmental level)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Infrequent outbursts with limited functional impact." + }, + { + "name": "Moderate", + "description": "Recurrent outbursts with clear interpersonal or occupational consequences." + }, + { + "name": "Severe", + "description": "Frequent or severe outbursts causing significant injury, damage, or pervasive impairment." + } + ], + "differentials": [ + "Conduct disorder (sustained pattern of deliberate violations; not purely impulsive reactive aggression)", + "ODD (younger children; milder aggression without property destruction)", + "Bipolar disorder - manic episode (episodic; mood-primary; sustained elevation)", + "PTSD with irritability and outbursts (trauma context; hyperarousal cluster)", + "Antisocial PD (planned, predatory aggression)", + "Substance intoxication (temporal relationship to use)", + "TBI or neurological cause (acquired aggression; rule out organic cause)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Intermittent Explosive Disorder] [specifier(s)]. Over a clinically significant period, there has been a recurrent pattern of verbal aggression; physical aggression toward property; physical aggression toward animals; physical aggression toward other individuals, occurring twice weekly on average or as three or more behavioural outbursts within twelve months involving damage or injury. These outbursts are grossly out of proportion to any provocation; impulsive and unplanned; not premeditated or instrumental; not committed to achieve a tangible objective, reflecting a failure of impulse control rather than deliberate aggression. The presentation is further characterised by chronological age of at least six years, and a pattern that is episodic rather than persistent, with relatively normal functioning between episodes. These features have resulted in marked distress, interpersonal conflict, legal or occupational consequences, or impairment, and are not better explained by another mental disorder, substance intoxication or withdrawal, or a medical or neurological condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-dsr-pyromania", + "category": { + "key": "dsr", + "label": "Disruptive & Impulse-Control" + }, + "icd_code": "F63.1", + "title": "Pyromania", + "key_features": [ + { + "label": "A", + "text": "Deliberate and purposeful fire setting on more than one occasion" + }, + { + "label": "B", + "text": "Tension or affective arousal before the act" + }, + { + "label": "C", + "text": "Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts" + }, + { + "label": "D", + "text": "Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath" + }, + { + "label": "E", + "text": "Not done for monetary gain, expression of sociopolitical ideology, anger/vengeance, improving circumstances, delusional belief, impaired judgement, or another mental disorder" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Infrequent episodes with limited but clear impairment or risk." + }, + { + "name": "Moderate", + "description": "Recurrent episodes with definite functional, legal, or interpersonal consequences." + }, + { + "name": "Severe", + "description": "Frequent or highly dangerous fire setting with marked impairment and significant risk or harm to others." + } + ], + "differentials": [ + "Conduct disorder (fire-setting as one of multiple antisocial behaviours; no tension-relief cycle)", + "Antisocial PD (instrumental or criminal fire-setting)", + "Mania (impulsive fire-setting during manic episode)", + "Psychotic disorder (delusional basis for fire-setting)", + "Substance intoxication (fire-setting during intoxicated state)", + "Intellectual disability or NCD (impaired judgement without impulse-control failure per se)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Pyromania] [specifier(s)]. There has been deliberate and purposeful fire setting on more than one occasion; tension or affective arousal before the act; fascination with, interest in, curiosity about, or attraction to fire and its situational contexts; pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath, forming a pattern driven by internal urges rather than external gain. The presentation is further characterised by fire setting not motivated by monetary gain; not undertaken to express anger or vengeance; not performed to conceal criminal activity; not occurring as a response to delusions or hallucinations; not resulting from impaired judgement. These behaviours have resulted in clinically significant distress or impairment in social, occupational, legal, or interpersonal functioning, with clear risk of harm, and are not better explained by conduct disorder, a manic episode, antisocial personality disorder, or substance intoxication.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-dsr-kleptomania", + "category": { + "key": "dsr", + "label": "Disruptive & Impulse-Control" + }, + "icd_code": "F63.2", + "title": "Kleptomania", + "key_features": [ + { + "label": "A", + "text": "Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value" + }, + { + "label": "B", + "text": "Increasing sense of tension immediately before committing the theft" + }, + { + "label": "C", + "text": "Pleasure, gratification, or relief at the time of committing the theft" + }, + { + "label": "D", + "text": "Stealing is not committed to express anger or vengeance, and is not in response to a delusion or hallucination" + }, + { + "label": "E", + "text": "Stealing not better explained by conduct disorder, manic episode, or antisocial PD" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Infrequent impulsive thefts with limited but clear distress or impairment." + }, + { + "name": "Moderate", + "description": "Recurrent thefts with definite functional, interpersonal, or legal consequences." + }, + { + "name": "Severe", + "description": "Frequent, compulsive stealing with marked impairment and significant legal or social harm." + } + ], + "differentials": [ + "Ordinary theft (premeditated; motivated by need or gain; no tension-relief cycle)", + "Antisocial PD (instrumental theft; planned; broader pattern of rights violations)", + "Manic episode (impulsive theft during elevated mood episode)", + "Major depressive disorder (shoplifting as self-punishment or numbing)", + "OCD (compulsive collecting without theft)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Kleptomania] [specifier(s)]. There have been recurrent failures to resist impulses to steal objects that are not needed for personal use or for their monetary value; increasing tension or affective arousal immediately before committing the theft; pleasure, gratification, or relief at the time of committing the theft, forming a pattern of impulse-driven stealing rather than planned or instrumental behaviour. The presentation is further characterised by stealing that is not committed to express anger or vengeance; not motivated by delusions or hallucinations; not occurring exclusively during a manic episode; objects often being discarded, returned, or hoarded without use. These behaviours have resulted in clinically significant distress or impairment in social, occupational, interpersonal, or legal functioning, and are not better explained by conduct disorder, antisocial personality disorder, substance intoxication, or another primary psychiatric condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-dsr-other-specified-unspecified-disruptive-impulse-control-conduct-disorder", + "category": { + "key": "dsr", + "label": "Disruptive & Impulse-Control" + }, + "icd_code": "F91.8/F91.9", + "title": "Other specified / Unspecified disruptive, impulse-control & conduct disorder", + "key_features": [ + { + "label": "A", + "text": "Symptoms characteristic of a disruptive, impulse-control, or conduct disorder causing clinically significant distress/impairment" + }, + { + "label": "B", + "text": "Does not meet full criteria for any specific disorder in this class" + }, + { + "label": "C", + "text": "Clinician specifies reason (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Insufficient symptom count", + "description": "Core features present but below the required number for a specific disorder." + }, + { + "name": "Atypical duration", + "description": "Symptom pattern present for less than the minimum duration required." + }, + { + "name": "Mixed disruptive features", + "description": "Overlapping aggression, impulsivity, or rule-violating behaviour not conforming to one category." + } + ], + "differentials": [ + "Specific disruptive disorder (full criteria met - reclassify)", + "ADHD (impulsivity without deliberate rule-violation pattern)", + "Bipolar disorder (episodic)", + "Substance-induced disinhibition" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Disruptive, Impulse-Control, and Conduct Disorder] [specifier(s)]. Over a persistent period, there has been a pattern of recurrent failures to control aggressive impulses; impulsive aggressive outbursts; serious violations of rules or societal norms; behavioural dysregulation causing harm, that resembles a disruptive, impulse-control, or conduct disorder but does not fully meet structured criteria for any specific disorder, due to atypical symptom number, duration, age at onset, or contextual features. The presentation is further characterised by clinically meaningful impulsivity or aggression that is not developmentally appropriate and not limited to a single situation. These symptoms have resulted in clinically significant distress or impairment in social, academic, occupational, interpersonal, or legal functioning, and are not better explained by substance intoxication, a mood or psychotic disorder, a neurodevelopmental disorder, or behaviour that is culturally sanctioned.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-mim-neuroleptic-malignant-syndrome-nms", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G21.0", + "title": "Neuroleptic malignant syndrome (NMS)", + "key_features": [ + { + "label": "A", + "text": "Dopamine antagonist exposure (antipsychotic or antiemetic) and development of severe muscle rigidity and elevated temperature" + }, + { + "label": "B", + "text": "≥2 of: diaphoresis; dysphagia; tremor; incontinence; change in level of consciousness (confusion to coma); mutism; tachycardia; elevated/labile BP; leukocytosis; elevated CK" + }, + { + "label": "C", + "text": "Not attributable to another substance or medical/neurological condition" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Associated with antipsychotic exposure", + "description": "Onset linked to recent initiation, dose escalation, or parenteral use of dopamine-blocking agents." + }, + { + "name": "Associated with dopaminergic withdrawal", + "description": "Onset following abrupt cessation or reduction of dopaminergic medication." + }, + { + "name": "With severe rhabdomyolysis", + "description": "Marked muscle breakdown with significant CK elevation and renal risk." + }, + { + "name": "Severity (Mild / Moderate / Severe)", + "description": "Graded by intensity of rigidity, degree of hyperthermia, autonomic instability, and level of consciousness." + } + ], + "differentials": [ + "Serotonin syndrome (hyperthermia + clonus + diaphoresis + hyperreflexia - starts within 24 hrs; clonus distinguishes from NMS rigidity)", + "Malignant hyperthermia (anaesthetic trigger; volatile agents/suxamethonium; ryanodine receptor mutation)", + "Lethal catatonia (treatment with ECT; NMS and lethal catatonia may overlap)", + "Severe anticholinergic toxicity (delirium; dry; hot; hallucinations; no rigidity)", + "CNS infection (meningitis, encephalitis - LP and imaging essential)", + "Thyroid storm" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Neuroleptic Malignant Syndrome] [specifier(s)]. Following recent exposure to a dopamine-blocking agent or abrupt withdrawal of dopaminergic medication, there has been the acute development of severe muscular rigidity; hyperthermia; altered mental state; autonomic instability including tachycardia; labile blood pressure; diaphoresis; tachypnoea, forming a rapidly evolving, life-threatening syndrome with onset over hours to days. The presentation is further characterised by marked creatine kinase elevation; leukocytosis; myoglobinuria; acute kidney injury; metabolic acidosis, reflecting systemic toxicity and muscle breakdown. These features have resulted in severe, clinically significant impairment requiring urgent medical intervention, and the disturbance does not occur exclusively during delirium. The pattern is best explained by neuroleptic malignant syndrome and is not better accounted for by serotonin syndrome, malignant hyperthermia, heat stroke, central nervous system infection, withdrawal states, or a primary neurological disorder.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-medication-induced-acute-dystonia", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G24.01", + "title": "Medication-induced acute dystonia", + "key_features": [ + { + "label": "A", + "text": "Abnormal and prolonged contraction of muscles of eyes, face, neck, limbs, or trunk developing in association with medication use" + }, + { + "label": "B", + "text": "Symptoms developed within a few days of starting or raising dose of medication, or reducing medication used to treat extrapyramidal symptoms" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Dystonia present with minimal distress or functional impact." + }, + { + "name": "Moderate", + "description": "Clear motor disturbance with noticeable distress or functional impairment." + }, + { + "name": "Severe", + "description": "Marked, persistent motor disturbance causing significant disability, distress, or safety concerns." + }, + { + "name": "With oculogyric crisis", + "description": "Predominant sustained upward or lateral deviation of gaze." + }, + { + "name": "With buccolingual dystonia", + "description": "Predominant jaw, tongue, or facial muscle involvement." + }, + { + "name": "With axial dystonia", + "description": "Predominant truncal or neck posturing (e.g. torticollis, opisthotonos)." + } + ], + "differentials": [ + "Tardive dystonia (develops after months/years of antipsychotic use; persists after cessation)", + "Primary torsion dystonia (genetic; no medication link)", + "NMS (hyperthermia + rigidity + autonomic instability - systemic features distinguish)", + "Tetanus (progressive lockjaw; risus sardonicus; autonomic instability; no medication link)", + "Functional neurological symptom disorder (inconsistency on examination)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Medication-Induced Acute Dystonia] [specifier(s)]. Soon after exposure to a dopamine-blocking or dopamine-modulating medication, there has been the abrupt onset of sustained abnormal posturing; involuntary muscle contractions; twisting movements; oculogyric crisis; torticollis; buccolingual dystonia; opisthotonos, occurring within minutes to days of medication initiation or dose increase, forming a pattern consistent with an acute extrapyramidal dystonic reaction. The presentation is further characterised by a clear temporal association with the implicated medication and resolution or improvement with anticholinergic treatment. These symptoms have resulted in clinically significant distress, discomfort, or functional impairment, and the picture is not better explained by seizure activity, tetany, hypocalcaemia, functional neurological disorder, serotonin syndrome, or primary dystonia.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-medication-induced-acute-akathisia", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G21.1", + "title": "Medication-induced acute akathisia", + "key_features": [ + { + "label": "A", + "text": "Subjective complaints of restlessness after exposure to medication" + }, + { + "label": "B", + "text": "At least one of: fidgety movements; rocking from foot to foot; pacing; inability to sit or stand still for at least several minutes" + }, + { + "label": "C", + "text": "Onset of symptoms within 4 weeks of initiating or increasing dose of causative medication, or after reducing medication used to treat EPS" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Restlessness present with minimal functional disruption." + }, + { + "name": "Moderate", + "description": "Clear subjective distress and observable motor restlessness with functional impact." + }, + { + "name": "Severe", + "description": "Intense, persistent restlessness with marked distress, behavioural disruption, or risk of self-harm." + } + ], + "differentials": [ + "Anxiety disorder (no clear temporal link to medication; no motor restlessness)", + "Psychotic agitation (goal-directed motor activity; may coexist - worsening ‘agitation' on antipsychotics may be akathisia)", + "Restless legs syndrome (circadian pattern; sensory; at rest; relieved by movement; sleep-associated)", + "Stimulant intoxication (temporal link to substance)", + "Tardive akathisia (persists after medication cessation)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Medication-Induced Acute Akathisia] [specifier(s)]. Following recent initiation, dose increase, or formulation change of a dopamine-blocking agent or other implicated medication, there has been the development of subjective inner restlessness; a compelling urge to move; inability to remain still; motor restlessness including pacing; rocking; shifting weight; repetitive leg movements, forming an acute syndrome with onset within days to weeks of medication exposure. The presentation is further characterised by marked distress related to restlessness; worsening with inactivity; partial, transient relief with movement, consistent with an akathisic pattern. These symptoms have resulted in clinically significant distress or impairment, and the temporal relationship to medication exposure is clear with improvement following dose reduction, discontinuation, or targeted treatment.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-tardive-dyskinesia", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G24.09", + "title": "Tardive dyskinesia", + "key_features": [ + { + "label": "A", + "text": "Involuntary athetoid or choreiform movements (lasting ≥4 weeks) of the tongue, jaw, trunk, or extremities that developed in association with use of a neuroleptic medication" + }, + { + "label": "B", + "text": "Involuntary movements are present after neuroleptic medication dosage reduction or discontinuation" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Minimal, easily suppressed movements with minimal distress." + }, + { + "name": "Moderate", + "description": "Noticeable movements with clear distress or functional impairment." + }, + { + "name": "Severe", + "description": "Prominent movements causing significant disability, distress, or safety concerns." + }, + { + "name": "With predominantly orofacial movements", + "description": "Movements mainly affecting mouth, tongue, jaw, or facial muscles." + }, + { + "name": "With predominantly limb/trunk movements", + "description": "Movements mainly involving upper or lower limbs or trunk musculature." + }, + { + "name": "In remission", + "description": "Movements have substantially resolved." + } + ], + "differentials": [ + "Acute extrapyramidal symptoms (onset early; resolve with dose reduction - TD persists)", + "Huntington's disease (chorea; family history; genetic testing)", + "Spontaneous dyskinesia in schizophrenia (prior to antipsychotics; no exposure - now rarely seen)", + "Hyperthyroid chorea", + "Sydenham chorea (post-streptococcal; children; PANDAS)", + "Tardive akathisia (inner restlessness vs involuntary movements)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Tardive Dyskinesia] [specifier(s)]. After at least a few months of exposure to a dopamine receptor-blocking agent, there have been involuntary choreiform movements; athetoid movements; facial grimacing; lip smacking; tongue protrusion; chewing movements; limb or truncal writhing; pelvic or respiratory dyskinesias, forming a pattern consistent with a persistent, medication-induced hyperkinetic movement disorder. The presentation is further characterised by a typical distribution involving the orofacial region and/or distal limbs, fluctuating intensity, and persistence for at least one month after medication reduction or cessation where applicable. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by primary neurological movement disorders, acute extrapyramidal syndromes, hypokinetic-rigid states, substance intoxication, or tardive akathisia.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-tardive-dystonia-tardive-akathisia", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G24.09", + "title": "Tardive dystonia & tardive akathisia", + "key_features": [ + { + "label": "A", + "text": "Involuntary movements (tardive dystonia: sustained/repetitive muscle contractions; tardive akathisia: subjective restlessness + repetitive movements) developing in association with neuroleptic use, persisting ≥4 weeks" + }, + { + "label": "B", + "text": "Movements persist after neuroleptic dose reduction or discontinuation; or neuroleptic still required and symptoms are persistent" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Tardive dystonia - predominantly cervical", + "description": "Dystonic posturing centred on neck muscles (e.g. torticollis, retrocollis)." + }, + { + "name": "Tardive dystonia - predominantly cranial", + "description": "Dystonia involving eyelids, jaw, tongue, or facial musculature." + }, + { + "name": "Tardive dystonia - generalised", + "description": "Widespread dystonia involving multiple major body regions." + }, + { + "name": "Tardive akathisia - predominantly subjective", + "description": "Internal agitation prominent, with minimal observable movement." + }, + { + "name": "Tardive akathisia - predominantly objective", + "description": "Observable motor restlessness prominent." + }, + { + "name": "Mild / Moderate / Severe", + "description": "Based on degree of restlessness or dystonia and functional impairment." + }, + { + "name": "In remission", + "description": "Symptoms have substantially resolved." + } + ], + "differentials": [ + "Acute dystonia or akathisia (onset early; reversible with dose reduction)", + "Primary dystonia (genetic; no medication exposure)", + "Essential tremor (action/postural; no choreiform features)", + "NMS (hyperthermia; rigidity; systemic - acute medical emergency)", + "Primary anxiety disorder (akathisia vs generalised anxiety)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Tardive Dystonia / Tardive Akathisia] [specifier(s)]. Following prolonged exposure to a dopamine receptor-blocking agent, there have been sustained muscle contractions; abnormal posturing; twisting or torsional movements; repetitive patterned movements (tardive dystonia), and/or marked inner restlessness; an urge to move; pacing; an inability to remain still; shifting weight; repetitive leg movements (tardive akathisia), forming a pattern consistent with a persistent medication-induced tardive syndrome. The presentation is further characterised by symptom onset or persistence for at least several weeks after dose reduction or cessation, and a chronic or fluctuating course distinct from acute syndromes. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by anxiety disorders, agitation from mood or psychotic episodes, substance intoxication or withdrawal, or primary movement disorders.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-medication-induced-parkinsonism", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G21.11", + "title": "Medication-induced parkinsonism", + "key_features": [ + { + "label": "A", + "text": "Parkinsonian tremor, muscular rigidity, or akinesia developing in association with medication use (most commonly neuroleptic/antipsychotic or dopamine-depleting agent)" + }, + { + "label": "B", + "text": "Symptoms developed within a few weeks of starting or raising dose of causative medication" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With predominant rigidity/bradykinesia", + "description": "Motor slowing and stiffness are the primary clinical features." + }, + { + "name": "With prominent tremor", + "description": "Resting tremor is a leading feature of the presentation." + }, + { + "name": "Associated with antipsychotic exposure", + "description": "Onset linked to dopamine-blocking antipsychotic medication." + }, + { + "name": "Associated with other dopamine-interfering medication", + "description": "Onset linked to non-antipsychotic agents affecting dopaminergic pathways." + }, + { + "name": "With persistent symptoms", + "description": "Parkinsonian features continue beyond expected resolution after medication reduction or cessation." + } + ], + "differentials": [ + "Idiopathic Parkinson's disease (insidious onset; no medication exposure; persists after cessation; DaTscan abnormal)", + "Lewy body NCD (dementia + parkinsonism + visual hallucinations)", + "Drug-induced vs unmasked PD (does not resolve weeks after cessation - consider underlying PD)", + "NMS (hyperthermia + rigidity + autonomic instability - acute emergency)", + "Progressive supranuclear palsy (vertical gaze palsy; axial rigidity)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Medication-Induced Parkinsonism] [specifier(s)]. Following exposure to a dopamine-blocking or dopamine-depleting medication, there has been the development of bradykinesia; muscular rigidity; resting tremor; postural instability; masked facies; reduced arm swing; shuffling gait; hypophonia; micrographia, forming a parkinsonian syndrome that emerged during medication use or within a clinically plausible temporal relationship to exposure. The presentation is further characterised by onset temporally linked to medication exposure and partial or incomplete resolution despite dose reduction or cessation, or features not fully meeting criteria for classic idiopathic Parkinson's disease. These symptoms have resulted in clinically significant distress or impairment in motor, occupational, or daily functioning, and the disturbance does not occur exclusively during delirium.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-medication-induced-postural-tremor", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G25.1", + "title": "Medication-induced postural tremor", + "key_features": [ + { + "label": "A", + "text": "Fine tremor occurring during attempts to maintain a posture that has developed in association with use of a medication" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Mild", + "description": "Tremor present with minimal distress or interference with tasks." + }, + { + "name": "Moderate", + "description": "Tremor clearly visible with definite interference with fine motor tasks." + }, + { + "name": "Severe", + "description": "Tremor markedly interferes with daily function, writing, or eating." + }, + { + "name": "In remission", + "description": "Tremor has substantially resolved following medication adjustment." + } + ], + "differentials": [ + "Essential tremor (kinetic > postural; persists without medication; family history; responds to alcohol)", + "Drug-induced parkinsonism (resting tremor; bradykinesia; rigidity)", + "Physiological tremor from anxiety (symmetric; situational; no medication link)", + "Hyperthyroid tremor (check TFTs)", + "Alcohol withdrawal tremor (temporal relationship to cessation)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Medication-Induced Postural Tremor] [specifier(s)]. Following exposure to a medication known to precipitate tremor, there have been fine, rapid tremor on sustained posture; action tremor during voluntary movement; heightened tremor amplitude with stress or stimulation; symmetric upper-limb involvement, forming a pattern consistent with a medication-related postural/action tremor emerging during treatment or shortly after dose escalation. The presentation is further characterised by a temporal relationship between medication initiation or dose change and tremor onset, and persistence or fluctuation while the medication is continued. These symptoms have resulted in clinically significant distress or impairment, and are not better explained by essential tremor, anxiety-related physiologic tremor, hyperthyroidism, withdrawal states, parkinsonism, or other neurological conditions.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-mim-other-medication-induced-movement-disorder", + "category": { + "key": "mim", + "label": "Medication-Induced Movement" + }, + "icd_code": "G25.71", + "title": "Other medication-induced movement disorder", + "key_features": [ + { + "label": "A", + "text": "Medication-induced movement symptoms causing clinically significant distress or impairment" + }, + { + "label": "B", + "text": "Does not meet criteria for another specific medication-induced movement disorder (NMS, acute dystonia, acute akathisia, tardive dyskinesia, tardive dystonia/akathisia, parkinsonism, postural tremor)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Associated with antipsychotic medication", + "description": "Movements temporally related to dopamine-blocking agents not fitting a specific antipsychotic-induced movement disorder." + }, + { + "name": "Associated with other medications", + "description": "Movements linked to antidepressants, antiemetics, mood stabilisers, stimulants, or other implicated agents." + }, + { + "name": "Acute onset", + "description": "Symptoms emerging within days to weeks of medication exposure or change." + }, + { + "name": "Subacute or delayed onset", + "description": "Symptoms emerging after a longer exposure period without meeting tardive criteria." + }, + { + "name": "Mild / Moderate / Severe", + "description": "Based on the prominence of motor disturbance and degree of functional impairment." + } + ], + "differentials": [ + "Named medication-induced movement disorders (full criteria - reclassify as appropriate)", + "Primary neurological movement disorder (no medication link)", + "NMS (systemic features; hyperthermia)", + "Serotonin syndrome (clonus; onset pattern)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Medication-Induced Movement Disorder] [specifier(s)]. Following recent initiation, dose escalation, dose reduction, or withdrawal of an implicated medication, there has been the emergence of abnormal involuntary movements; abnormal voluntary motor patterns; changes in muscle tone or posture; motor phenomena not otherwise classifiable as parkinsonism, acute dystonia, akathisia, tardive dyskinesia, tardive dystonia, or tremor, forming a medication-related movement syndrome with a clear temporal association to medication exposure. The presentation is further characterised by a phenomenology inconsistent with a specific named medication-induced movement disorder and clinical features not meeting full criteria for a defined movement disorder subtype. These symptoms have resulted in clinically significant distress or impairment, and the pattern is best explained by a medication-induced movement disorder rather than a primary neurological movement disorder, primary psychiatric agitation, substance intoxication or withdrawal, delirium, or a general medical condition.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-par-voyeuristic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.81", + "title": "Voyeuristic disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Individual has acted on these sexual urges with a non-consenting person, or the urges/fantasies cause marked distress or interpersonal difficulty" + }, + { + "label": "C", + "text": "Individual is ≥18 years of age" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "In a controlled environment", + "description": "Limited opportunity to act on urges (e.g. residential facility, custody)." + }, + { + "name": "In remission", + "description": "No distress, impairment, or acting on urges with non-consenting persons for at least 5 years (outside controlled environment)." + } + ], + "differentials": [ + "Consensual voyeuristic behaviour (mutual agreement; not a disorder)", + "Antisocial PD with sexual offending (broader pattern of rights violations)", + "Hypersexual disorder (not in DSM-5-TR; use other specified sexual dysfunction if appropriate)", + "Substance-induced disinhibition with voyeuristic behaviour" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Voyeuristic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity; sexual arousal manifested by fantasies, urges, or behaviours; acting on these urges with a non-consenting person, or marked distress or interpersonal difficulty related to the urges, forming a persistent voyeuristic pattern. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, or risk of harm to others through non-consensual behaviour.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-exhibitionistic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.2", + "title": "Exhibitionistic disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Individual has acted on these urges with a non-consenting person, or the urges/fantasies cause marked distress or interpersonal difficulty" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Sexually attracted to females", + "description": "Exposure directed toward females." + }, + { + "name": "Sexually attracted to males", + "description": "Exposure directed toward males." + }, + { + "name": "Sexually attracted to both", + "description": "Exposure directed toward both sexes." + }, + { + "name": "In a controlled environment", + "description": "Limited opportunity to act on urges." + }, + { + "name": "In remission", + "description": "No distress, impairment, or acting on urges with non-consenting persons for at least 5 years." + } + ], + "differentials": [ + "Antisocial PD with indecent exposure (instrumental; no arousal requirement)", + "Mania with disinhibited sexual behaviour (episodic; mood context)", + "Cognitive impairment with disinhibition (NCD; intellectual disability)", + "Cultural variation in modesty norms" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Exhibitionistic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal from exposure of one's genitals to an unsuspecting person; sexual arousal manifested by fantasies, urges, or behaviours; acting on these urges with a non-consenting person, or marked distress or interpersonal difficulty related to the urges, forming a persistent exhibitionistic pattern. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, or risk of harm to others.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-frotteuristic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.81", + "title": "Frotteuristic disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from touching or rubbing against a non-consenting person, as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Individual has acted on these sexual urges with a non-consenting person, or the urges/fantasies cause marked distress or interpersonal difficulty" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "In a controlled environment", + "description": "Limited opportunity to act on urges." + }, + { + "name": "In remission", + "description": "No distress, impairment, or acting on urges with non-consenting persons for at least 5 years." + } + ], + "differentials": [ + "Normal physical contact in crowds (no sexual arousal; no intent)", + "Antisocial PD with sexual assault (broader rights violations)", + "Mania with disinhibited sexual behaviour (episodic)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Frotteuristic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal from touching or rubbing against a non-consenting person; sexual arousal manifested by fantasies, urges, or behaviours; acting on these urges with a non-consenting person, or marked distress or interpersonal difficulty related to the urges, forming a persistent frotteuristic pattern. These symptoms have resulted in clinically significant distress or impairment, or risk of harm to others.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-sexual-masochism-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.51", + "title": "Sexual masochism disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Fantasies, urges, or behaviours cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With asphyxiophilia", + "description": "Arousal involves oxygen deprivation - particularly high mortality risk; specify." + }, + { + "name": "In a controlled environment", + "description": "Limited opportunity to engage in risky behaviours." + }, + { + "name": "In remission", + "description": "No distress, impairment, or risky behaviour for a sustained period." + } + ], + "differentials": [ + "Consensual BDSM practices without distress (cultural/lifestyle; not a disorder)", + "PTSD with re-enactment of trauma (trauma-driven; different context)", + "Self-injurious behaviour in BPD (emotional regulation; not sexually arousing)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Sexual Masochism Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer; sexual arousal manifested by fantasies, urges, or behaviours; clinically significant distress or interpersonal difficulty related to these urges, or engagement in behaviours that pose risk of injury or harm, forming a persistent masochistic pattern. These symptoms have resulted in clinically significant distress or impairment, or risk to physical safety.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-sexual-sadism-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.52", + "title": "Sexual sadism disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Individual has acted on these sexual urges with a non-consenting person, or the urges/fantasies cause clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "In a controlled environment", + "description": "Limited opportunity to act on urges." + }, + { + "name": "In remission", + "description": "No distress, impairment, or acting on urges with non-consenting persons for at least 5 years." + } + ], + "differentials": [ + "Consensual BDSM (mutual consent; no distress - not a disorder)", + "Antisocial PD with instrumental violence (not sexually arousing per se)", + "Sexual masochism disorder (role reversal)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Sexual Sadism Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal from the physical or psychological suffering of another person; sexual arousal manifested by fantasies, urges, or behaviours; acting on these urges with a non-consenting person, or marked distress or interpersonal difficulty related to the urges, forming a persistent sadistic pattern. These symptoms have resulted in clinically significant distress or impairment, or risk of harm to others through non-consensual behaviour.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-paedophilic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.4", + "title": "Paedophilic disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent, intense sexually arousing fantasies, urges, or behaviours involving sexual activity with a prepubescent child or children (generally ≤13 years)" + }, + { + "label": "B", + "text": "Individual has acted on these urges, or the urges/fantasies cause marked distress or interpersonal difficulty" + }, + { + "label": "C", + "text": "Individual is ≥16 years and ≥5 years older than the child or children in Criterion A (not including late adolescents in an ongoing relationship with a 12–13 year old)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Exclusive type", + "description": "Sexual arousal limited to children only." + }, + { + "name": "Nonexclusive type", + "description": "Sexual arousal to both children and adults." + }, + { + "name": "Sexually attracted to males", + "description": "Primary arousal toward boys." + }, + { + "name": "Sexually attracted to females", + "description": "Primary arousal toward girls." + }, + { + "name": "Sexually attracted to both", + "description": "Arousal toward boys and girls." + }, + { + "name": "Limited to incest", + "description": "Arousal restricted to close relatives." + }, + { + "name": "In a controlled environment", + "description": "Limited opportunity to act on urges." + }, + { + "name": "In remission", + "description": "No distress, impairment, or acting on urges for at least 5 years outside controlled environment." + } + ], + "differentials": [ + "Adolescent with sexual attraction to younger children (developmental; less than 5-year age gap - does not meet criteria)", + "Intellectual disability with sexual naivety (acting without understanding of wrongness)", + "Antisocial PD with child sexual abuse (instrumental; arousal may not be paedophilic)", + "Substance-induced disinhibition" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Paedophilic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal involving prepubescent children (generally age 13 years or younger); sexual arousal manifested by fantasies, urges, or behaviours; acting on these urges with a child, or marked distress or interpersonal difficulty related to the urges, forming a persistent paedophilic pattern. The individual is at least 16 years of age and at least five years older than the child or children. These symptoms have resulted in clinically significant distress or impairment, or risk of harm to children.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-fetishistic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.0", + "title": "Fetishistic disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from either the use of non-living objects or a highly specific focus on non-genital body part(s), as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Fantasies, urges, or behaviours cause clinically significant distress or impairment" + }, + { + "label": "C", + "text": "Fetish objects are not limited to articles of clothing used in cross-dressing or devices designed for genital stimulation" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Body parts", + "description": "Arousal focused on a specific non-genital body region (e.g. feet, hair)." + }, + { + "name": "Nonliving objects", + "description": "Arousal focused on particular objects (e.g. shoes, leather garments, underclothing)." + }, + { + "name": "In a controlled environment", + "description": "Limited opportunity to engage with fetish objects." + }, + { + "name": "In remission", + "description": "No distress or impairment for a sustained period." + } + ], + "differentials": [ + "Transvestic disorder (cross-dressing specifically; overlapping in some individuals)", + "Sexual masochism/sadism (the fetish involves suffering rather than objects/body parts)", + "OCD (intrusive thoughts about objects; not sexually arousing)", + "Normal variation in sexual interest" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Fetishistic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal involving the use of nonliving objects or a highly specific focus on non-genital body parts; sexual arousal manifested by fantasies, urges, or behaviours; marked distress or interpersonal difficulty related to these interests, forming a persistent fetishistic pattern. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-transvestic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.1", + "title": "Transvestic disorder", + "key_features": [ + { + "label": "A", + "text": "Over ≥6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviours" + }, + { + "label": "B", + "text": "Fantasies, urges, or behaviours cause clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With fetishism", + "description": "Arousal focused on specific fabrics, materials, or garments." + }, + { + "name": "With autogynephilia", + "description": "Arousal from thoughts or images of oneself as female." + }, + { + "name": "In a controlled environment", + "description": "Limited opportunity to cross-dress." + }, + { + "name": "In remission", + "description": "No distress or impairment for a sustained period." + } + ], + "differentials": [ + "Gender dysphoria (persistent gender incongruence; not primarily sexual arousal; may overlap)", + "Non-distressing cross-dressing or drag (cultural/social; no sexual arousal or distress - not a disorder)", + "Fetishistic disorder (object arousal without specific cross-dressing theme)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Transvestic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal from cross-dressing; sexual arousal manifested by fantasies, urges, or behaviours; marked distress or interpersonal difficulty related to cross-dressing, forming a persistent transvestic pattern. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning. The disorder is not accounted for by gender dysphoria, culturally normative gender expression, substance effects, or another mental disorder.", + "severity_specifier_supported": false + }, + { + "record_id": "DSM-par-gender-dysphoria", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F64.0", + "title": "Gender dysphoria", + "key_features": [ + { + "label": "A", + "text": "Marked incongruence between one's experienced/expressed gender and assigned gender, ≥6 months; in adolescents/adults: ≥2 of: incongruence between experienced gender and primary/secondary sex characteristics; strong desire to be rid of primary/secondary sex characteristics; strong desire for sex characteristics of experienced gender; strong desire to be of experienced gender; strong desire to be treated as experienced gender; strong conviction of having typical feelings/reactions of experienced gender" + }, + { + "label": "B", + "text": "Condition is associated with clinically significant distress or impairment" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "With a disorder of sex development", + "description": "Gender dysphoria occurring in the context of a congenital condition affecting chromosomal, gonadal, or anatomical sex development." + }, + { + "name": "Posttransition", + "description": "Living full-time in the experienced gender; having undergone at least one gender-affirming medical or surgical intervention, with dysphoria persisting." + }, + { + "name": "Mild", + "description": "Limited but persistent dysphoria with mild functional impact." + }, + { + "name": "Moderate", + "description": "Clear dysphoria with definite social, occupational, or interpersonal impairment." + }, + { + "name": "Severe", + "description": "Intense, persistent dysphoria with marked or pervasive impairment." + } + ], + "differentials": [ + "Normal gender nonconformity (without distress or impairment - not a disorder)", + "Transvestic disorder (sexually arousing cross-dressing; without gender incongruence)", + "Body dysmorphic disorder (preoccupation with appearance features; not gender identity)", + "Disorders of sex development (may be comorbid - specify if present)", + "Delusional disorder (fixed belief of being another sex - rare; assess for psychosis)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Gender Dysphoria] [specifier(s)]. For at least six months, there has been a marked incongruence between experienced or expressed gender and assigned gender; a marked incongruence between experienced gender and primary or secondary sex characteristics; a strong desire to be rid of primary or secondary sex characteristics; a strong desire for the primary or secondary sex characteristics of another gender; a strong desire to be of another gender or an alternative gender; a strong desire to be treated as another gender; a strong conviction of having the typical feelings and reactions of another gender, forming a pattern meeting the threshold for gender dysphoria. The presentation is further characterised, where relevant in children, by strong preference for cross-gender roles in play; strong preference for toys, games, or activities stereotypically used by another gender; strong preference for playmates of another gender; strong rejection of toys or activities stereotypically associated with assigned gender; strong dislike of one's sexual anatomy; strong desire for primary or secondary sex characteristics matching experienced gender. These symptoms have resulted in clinically significant distress or impairment in social, occupational, interpersonal, or other important areas of functioning.", + "severity_specifier_supported": true + }, + { + "record_id": "DSM-par-other-specified-unspecified-paraphilic-disorder", + "category": { + "key": "par", + "label": "Paraphilic & Gender Dysphoria" + }, + "icd_code": "F65.89/F65.9", + "title": "Other specified / Unspecified paraphilic disorder", + "key_features": [ + { + "label": "A", + "text": "Recurrent and intense sexual arousal to atypical objects, situations, or individuals, as manifested by fantasies, urges, or behaviours, for ≥6 months" + }, + { + "label": "B", + "text": "Individual has acted on these urges with a non-consenting person, or the urges/fantasies cause clinically significant distress or impairment" + }, + { + "label": "C", + "text": "Clinician specifies nature of the paraphilia (Other Specified) or chooses not to specify (Unspecified)" + } + ], + "criteria_display": [], + "clinical_checkpoints": [], + "specifiers": [ + { + "name": "Specified paraphilic focus", + "description": "Clear description of the atypical sexual interest (e.g. telephone scatologia, necrophilia, zoophilia, coprophilia)." + }, + { + "name": "In a controlled environment", + "description": "Limited opportunity to act on urges." + }, + { + "name": "In remission", + "description": "No distress, impairment, or acting on urges for a sustained period." + } + ], + "differentials": [ + "Specific named paraphilic disorder (full criteria met - reclassify)", + "Non-distressing atypical sexual interest (paraphilia without disorder)", + "Antisocial PD with sexual offending (broader rights violations)" + ], + "differential_notes": [], + "classification_notes": [], + "documentation_template": "Consistent with [Other Specified Paraphilic Disorder] [specifier(s)]. Over a period of at least six months, there have been recurrent and intense sexual arousal involving a specific paraphilic focus not meeting full criteria for a named paraphilic disorder; sexual arousal manifested by fantasies, urges, or behaviours; marked distress or interpersonal difficulty related to the arousal, or risk of harm to others, forming a persistent paraphilic pattern. These symptoms have resulted in clinically significant distress or impairment in social, occupational, or interpersonal functioning, or risk of harm.", + "severity_specifier_supported": false + } + ] +} diff --git a/src/lib/app-mode-icons.ts b/src/lib/app-mode-icons.ts index 374ef54f5..a920ed9a2 100644 --- a/src/lib/app-mode-icons.ts +++ b/src/lib/app-mode-icons.ts @@ -1,4 +1,5 @@ import { + BookOpenCheck, BrainCircuit, FileSignature, FileText, @@ -20,6 +21,7 @@ export const appModeIcons: Record = { forms: FileSignature, favourites: Heart, differentials: BrainCircuit, + dsm: BookOpenCheck, prescribing: Pill, tools: Wrench, }; diff --git a/src/lib/app-modes.ts b/src/lib/app-modes.ts index b7c2f9b3c..995b4d033 100644 --- a/src/lib/app-modes.ts +++ b/src/lib/app-modes.ts @@ -3,13 +3,13 @@ import { documentsSearchHref } from "@/lib/document-flow-routes"; import { appendSearchNavigationContext, type SearchNavigationOptions } from "@/lib/search-navigation-context"; export type AppModeId = - "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "prescribing" | "tools"; + "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "dsm" | "prescribing" | "tools"; export type SearchableAppModeId = AppModeId; export type AppModeSearchKind = - "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "tools"; + "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "dsm" | "tools"; export type AppModeResultKind = - "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "tools"; + "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "dsm" | "tools"; export type AppModeSearchConfig = { kind: AppModeSearchKind; @@ -172,6 +172,28 @@ export const appModeDefinitions = [ defaultQueryMode: "compare_guidance", }, }, + { + id: "dsm", + label: "DSM-5 Diagnosis", + description: "Diagnostic criteria, specifiers, and comparisons", + href: "/dsm", + search: { + kind: "dsm", + placeholder: "Search DSM diagnoses or criteria...", + inputAriaLabel: "Search DSM diagnoses, ICD codes, criteria, and categories", + submitIdleLabel: "DSM", + submitBusyLabel: "DSM", + submitAriaLabel: "Search DSM diagnoses", + emptyTitle: "Search DSM diagnoses", + readyTitle: "Search DSM diagnosis criteria", + progressLabel: "Searching the local DSM diagnosis catalogue.", + resultKind: "dsm", + resultHeading: "DSM diagnoses", + statusLabel: "DSM", + nextStep: "Open a diagnosis or compare criteria", + badgeLabel: null, + }, + }, { id: "prescribing", label: "Medication", @@ -244,7 +266,7 @@ export function appModeSearchConfig(modeId: AppModeId) { return appModeDefinition(modeId).search; } -const namespaceIsolatedModes = new Set(["services", "forms", "favourites", "differentials"]); +const namespaceIsolatedModes = new Set(["services", "forms", "favourites", "differentials", "dsm"]); export function appModeHomeHref(modeId: AppModeId, options: SearchNavigationOptions = {}) { const mode = appModeDefinition(modeId); @@ -262,7 +284,8 @@ export function appModeHomeHref(modeId: AppModeId, options: SearchNavigationOpti appendSearchNavigationContext(namespacedParams, options); const suffix = namespacedParams.toString(); - return suffix ? `${mode.href}?${suffix}` : mode.href; + const namespacedHref = modeId === "dsm" && query ? "/dsm/search" : mode.href; + return suffix ? `${namespacedHref}?${suffix}` : namespacedHref; } if ("href" in mode && mode.href && !query && !options.run) { @@ -314,6 +337,7 @@ export function isSearchableAppMode(modeId: string): modeId is SearchableAppMode kind === "forms" || kind === "favourites" || kind === "differentials" || + kind === "dsm" || kind === "tools" ); } diff --git a/src/lib/dsm.ts b/src/lib/dsm.ts new file mode 100644 index 000000000..2218c8c81 --- /dev/null +++ b/src/lib/dsm.ts @@ -0,0 +1,221 @@ +import dsmClinicalContent from "@/data/dsm-clinical-content.json"; +import { normalizeSearchText, rankCatalogRecords } from "@/lib/catalog-search"; + +export type DsmLabeledText = { + label: string; + text: string; +}; + +export type DsmSpecifier = { + name: string; + description: string | null; +}; + +export type DsmCategory = { + key: string; + label: string; + css_class: string; + color: string; + diagnosis_count: number; +}; + +export type DsmDiagnosis = { + record_id: string; + slug: string; + category: Pick; + icd_code: string; + title: string; + key_features: DsmLabeledText[]; + criteria_display: DsmLabeledText[]; + clinical_checkpoints: DsmLabeledText[]; + specifiers: DsmSpecifier[]; + differentials: string[]; + differential_notes: Array>; + classification_notes: Array>; + documentation_template: string; + severity_specifier_supported: boolean; +}; + +type DsmClinicalContentExport = { + export_format_version: string; + generated_at: string; + source_repository: string; + content_scope: string; + categories: DsmCategory[]; + diagnoses: Array>; +}; + +export type DsmSearchMatch = { + diagnosis: DsmDiagnosis; + score: number; + reasons: string[]; +}; + +export type DsmDiagnosisSummary = Pick & { + summary: string; + criteriaCount: number; + differentialCount: number; + specifierCount: number; +}; + +const exportData = dsmClinicalContent as DsmClinicalContentExport; + +function slugFromRecordId(recordId: string) { + return recordId.replace(/^DSM-[^-]+-/, "").toLowerCase(); +} + +export const dsmContentMetadata = { + version: exportData.export_format_version, + generatedAt: exportData.generated_at, + sourceRepository: exportData.source_repository, + scope: exportData.content_scope, +} as const; + +export const dsmCategories = exportData.categories.filter((category) => category.diagnosis_count > 0); + +export const dsmDiagnoses: DsmDiagnosis[] = exportData.diagnoses.map((diagnosis) => ({ + ...diagnosis, + slug: slugFromRecordId(diagnosis.record_id), + key_features: diagnosis.key_features ?? [], + criteria_display: diagnosis.criteria_display ?? [], + clinical_checkpoints: diagnosis.clinical_checkpoints ?? [], + specifiers: diagnosis.specifiers ?? [], + differentials: diagnosis.differentials ?? [], + differential_notes: diagnosis.differential_notes ?? [], + classification_notes: diagnosis.classification_notes ?? [], +})); + +const diagnosisBySlug = new Map(dsmDiagnoses.map((diagnosis) => [diagnosis.slug, diagnosis] as const)); +const diagnosisByNormalizedTitle = new Map( + dsmDiagnoses.map((diagnosis) => [normalizeSearchText(diagnosis.title), diagnosis] as const), +); + +export function getDsmDiagnosis(slug: string) { + return diagnosisBySlug.get(slug.toLowerCase()); +} + +export function dsmCriteria(diagnosis: DsmDiagnosis) { + return diagnosis.criteria_display.length > 0 ? diagnosis.criteria_display : diagnosis.key_features; +} + +export function dsmDiagnosisSummary(diagnosis: DsmDiagnosis): DsmDiagnosisSummary { + const criteria = dsmCriteria(diagnosis); + return { + slug: diagnosis.slug, + title: diagnosis.title, + icd_code: diagnosis.icd_code, + category: diagnosis.category, + summary: criteria[0]?.text ?? diagnosis.key_features[0]?.text ?? "Review the complete diagnostic record.", + criteriaCount: criteria.length, + differentialCount: diagnosis.differentials.length, + specifierCount: diagnosis.specifiers.length, + }; +} + +export function dsmDiagnosisSearchText(diagnosis: DsmDiagnosis) { + return normalizeSearchText( + [ + diagnosis.title, + diagnosis.slug, + diagnosis.icd_code, + diagnosis.category.label, + ...diagnosis.key_features.flatMap((feature) => [feature.label, feature.text]), + ...diagnosis.criteria_display.flatMap((criterion) => [criterion.label, criterion.text]), + ...diagnosis.clinical_checkpoints.flatMap((checkpoint) => [checkpoint.label, checkpoint.text]), + ...diagnosis.specifiers.flatMap((specifier) => [specifier.name, specifier.description ?? ""]), + ...diagnosis.differentials, + ].join(" "), + ); +} + +export function rankDsmDiagnoses( + query: string, + limit = dsmDiagnoses.length, + expansions: string[] = [], +): DsmSearchMatch[] { + const normalizedExpansions = expansions.map(normalizeSearchText).filter(Boolean); + return rankCatalogRecords(dsmDiagnoses, query, { + fields: [ + { + id: "title", + weight: 8, + text: (diagnosis) => normalizeSearchText(`${diagnosis.title} ${diagnosis.slug}`), + }, + { + id: "code", + weight: 7, + text: (diagnosis) => normalizeSearchText(diagnosis.icd_code), + }, + { + id: "category", + weight: 4, + text: (diagnosis) => normalizeSearchText(diagnosis.category.label), + }, + { + id: "criteria", + weight: 3, + text: (diagnosis) => + normalizeSearchText( + dsmCriteria(diagnosis) + .map((criterion) => criterion.text) + .join(" "), + ), + }, + ], + fullText: dsmDiagnosisSearchText, + contentWeight: 2, + compactBonus: 4, + compactExtraText: (diagnosis) => normalizeSearchText(diagnosis.title), + phraseBonus: 6, + exactValues: (diagnosis) => [normalizeSearchText(diagnosis.title), normalizeSearchText(diagnosis.slug)], + exactBonus: 14, + prefixValues: (diagnosis) => [normalizeSearchText(diagnosis.title), normalizeSearchText(diagnosis.slug)], + prefixBonus: 5, + expandTokens: (terms) => [...terms, ...normalizedExpansions], + limit, + tieBreak: (left, right) => left.title.localeCompare(right.title), + }).map(({ record, score, signals }) => ({ + diagnosis: record, + score, + reasons: [ + signals.exact ? "Exact diagnosis" : null, + signals.prefix ? "Title match" : null, + signals.fields.code ? "ICD code" : null, + signals.fields.category ? "Category" : null, + signals.fields.criteria ? "Criteria" : null, + signals.content ? "Clinical content" : null, + ].filter((reason): reason is string => Boolean(reason)), + })); +} + +export function listDsmDiagnosisSummaries(options: { query?: string; category?: string } = {}) { + const query = options.query?.trim() ?? ""; + const records = query + ? rankDsmDiagnoses(query).map((match) => match.diagnosis) + : [...dsmDiagnoses].sort((left, right) => left.title.localeCompare(right.title)); + return records + .filter((diagnosis) => !options.category || diagnosis.category.key === options.category) + .map(dsmDiagnosisSummary); +} + +export function resolveDsmDifferential(value: string) { + const title = value.replace(/\s*\([^)]*\)\s*$/, "").trim(); + const normalized = normalizeSearchText(title); + const exact = diagnosisByNormalizedTitle.get(normalized); + if (exact) return exact; + + return dsmDiagnoses.find((diagnosis) => { + const candidate = normalizeSearchText(diagnosis.title); + return candidate.startsWith(normalized) || normalized.startsWith(candidate); + }); +} + +export function dsmStaticParams() { + return dsmDiagnoses.map((diagnosis) => ({ slug: diagnosis.slug })); +} + +export const defaultDsmComparisonSlugs = [ + "major-depressive-disorder", + "bipolar-ii-disorder", + "persistent-depressive-disorder-dysthymia", +] as const; diff --git a/src/lib/search-command-surface.ts b/src/lib/search-command-surface.ts index 20556cd40..ff876da3e 100644 --- a/src/lib/search-command-surface.ts +++ b/src/lib/search-command-surface.ts @@ -78,6 +78,16 @@ const searchCommandSurfaceByMode: Partial { + return rankDsmDiagnoses(args.baseQuery, args.limitPerDomain, args.expansions).map((match) => { + const summary = dsmDiagnosisSummary(match.diagnosis); + return { + id: match.diagnosis.slug, + kind: "dsm" as const, + title: match.diagnosis.title, + subtitle: summary.summary, + href: `/dsm/diagnoses/${match.diagnosis.slug}`, + score: match.score, + badge: match.diagnosis.icd_code, + meta: match.diagnosis.category.label, + }; + }); +} + async function searchToolsDomain(args: ResolvedSearchArgs): Promise { return rankToolRecords(args.baseQuery, args.limitPerDomain, args.expansions).map((match) => ({ id: match.tool.id, @@ -349,6 +366,7 @@ const domainAdapters: Record< forms: { run: searchFormsDomain, timeoutMs: registryDomainTimeoutMs }, differentials: { run: searchDifferentialsDomain, timeoutMs: registryDomainTimeoutMs }, presentations: { run: searchPresentationsDomain, timeoutMs: registryDomainTimeoutMs }, + dsm: { run: searchDsmDomain, timeoutMs: registryDomainTimeoutMs }, tools: { run: searchToolsDomain, timeoutMs: registryDomainTimeoutMs }, }; @@ -524,6 +542,8 @@ export function universalSearchViewAllHref(domain: UniversalSearchDomain, query: // The differentials mode home search composes both kinds, so presentations share it. case "presentations": return `/differentials?q=${encodeURIComponent(query)}&run=1`; + case "dsm": + return `/dsm/search?q=${encodeURIComponent(query)}&run=1`; case "tools": return `/?mode=tools&q=${encodeURIComponent(query)}&run=1`; } diff --git a/tests/app-modes.test.ts b/tests/app-modes.test.ts index a96feea3a..8fee3a21f 100644 --- a/tests/app-modes.test.ts +++ b/tests/app-modes.test.ts @@ -104,6 +104,18 @@ describe("app mode search contract", () => { expect(appModeQueryMode("differentials", "auto")).toBe("compare_guidance"); }); + it("routes DSM searches to the dedicated local catalogue", () => { + const config = appModeSearchConfig("dsm"); + + expect(isSearchableAppMode("dsm")).toBe(true); + expect(config.kind).toBe("dsm"); + expect(config.resultKind).toBe("dsm"); + expect(appModeHomeHref("dsm")).toBe("/dsm"); + expect(appModeHomeHref("dsm", { query: " bipolar II ", run: true, focus: true })).toBe( + "/dsm/search?q=bipolar+II&focus=1&run=1", + ); + }); + it("keeps source-library shortcut searches in their active mode family", () => { expect(appModeCanUseSourceLibraryShortcut("answer")).toBe(false); expect(appModeCanUseSourceLibraryShortcut("tools")).toBe(false); @@ -180,6 +192,7 @@ describe("app mode search contract", () => { "forms", "favourites", "differentials", + "dsm", "prescribing", "tools", ]), @@ -196,6 +209,7 @@ describe("app mode search contract", () => { expect(isAppModeVisible("forms", "production")).toBe(true); expect(isAppModeVisible("favourites", "production")).toBe(true); expect(isAppModeVisible("differentials", "production")).toBe(true); + expect(isAppModeVisible("dsm", "production")).toBe(true); expect(isAppModeVisible("prescribing", "production")).toBe(true); expect(isAppModeVisible("tools", "production")).toBe(true); expect(productionModes).not.toContain("evidence"); @@ -203,6 +217,7 @@ describe("app mode search contract", () => { expect(productionModes).toContain("forms"); expect(productionModes).toContain("favourites"); expect(productionModes).toContain("differentials"); + expect(productionModes).toContain("dsm"); expect(productionModes).toContain("prescribing"); expect(productionModes).toContain("tools"); expect(developmentModes).toEqual( @@ -213,6 +228,7 @@ describe("app mode search contract", () => { "forms", "favourites", "differentials", + "dsm", "prescribing", "tools", ]), diff --git a/tests/dsm.test.ts b/tests/dsm.test.ts new file mode 100644 index 000000000..39ded0cff --- /dev/null +++ b/tests/dsm.test.ts @@ -0,0 +1,55 @@ +import { describe, expect, it } from "vitest"; + +import { + dsmCategories, + dsmCriteria, + dsmDiagnoses, + dsmStaticParams, + getDsmDiagnosis, + rankDsmDiagnoses, + resolveDsmDifferential, +} from "@/lib/dsm"; + +describe("DSM clinical catalogue", () => { + it("loads every supplied diagnosis and keeps slugs unique", () => { + expect(dsmDiagnoses).toHaveLength(146); + expect(new Set(dsmDiagnoses.map((diagnosis) => diagnosis.slug)).size).toBe(146); + expect(dsmStaticParams()).toHaveLength(146); + expect(dsmCategories.reduce((total, category) => total + category.diagnosis_count, 0)).toBe(146); + }); + + it("keeps each record complete enough for the five DSM surfaces", () => { + for (const diagnosis of dsmDiagnoses) { + expect(diagnosis.title).toBeTruthy(); + expect(diagnosis.icd_code).toBeTruthy(); + expect(diagnosis.category.label).toBeTruthy(); + expect(dsmCriteria(diagnosis).length).toBeGreaterThan(0); + expect(diagnosis.documentation_template).toBeTruthy(); + } + }); + + it("falls back to key features when a separate criteria display was not supplied", () => { + const diagnosis = getDsmDiagnosis("major-depressive-disorder"); + expect(diagnosis).toBeDefined(); + expect(diagnosis?.criteria_display).toEqual([]); + expect(dsmCriteria(diagnosis!)).toEqual(diagnosis?.key_features); + }); + + it("searches titles, ICD codes, categories, and criteria", () => { + expect(rankDsmDiagnoses("major depressive disorder", 1)[0]?.diagnosis.slug).toBe("major-depressive-disorder"); + expect(rankDsmDiagnoses("F31.81", 1)[0]?.diagnosis.slug).toBe("bipolar-ii-disorder"); + expect(rankDsmDiagnoses("Mood Disorders", 20).length).toBeGreaterThan(1); + expect( + rankDsmDiagnoses("hypomanic episode", 5).some((match) => match.diagnosis.slug === "bipolar-ii-disorder"), + ).toBe(true); + }); + + it("links named differential considerations back to catalogue records", () => { + const diagnosis = getDsmDiagnosis("major-depressive-disorder"); + const bipolar = diagnosis?.differentials.find((item) => item.startsWith("Bipolar I or II")); + expect(bipolar).toBeTruthy(); + expect(resolveDsmDifferential("Bipolar II disorder (hypomanic periods identified)")?.slug).toBe( + "bipolar-ii-disorder", + ); + }); +}); diff --git a/tests/site-map.test.ts b/tests/site-map.test.ts index 08c9df68b..a30fb72a3 100644 --- a/tests/site-map.test.ts +++ b/tests/site-map.test.ts @@ -5,6 +5,7 @@ import { describe, expect, it } from "vitest"; import { appModeDefinitions, appModeHomeHref } from "@/lib/app-modes"; import { tools } from "@/components/tools-page-mockups/tool-fixtures"; import { differentialRecords } from "@/lib/differentials"; +import { dsmDiagnoses } from "@/lib/dsm"; import { formRecords } from "@/lib/forms"; import { serviceRecords } from "@/lib/services"; import { collectSiteMapData, renderSiteMap } from "../scripts/generate-site-map"; @@ -17,6 +18,7 @@ const acceptedDynamicPatterns = [ /^\/services\/[^/?#]+(?:[?#].*)?$/, /^\/forms\/[^/?#]+(?:[?#].*)?$/, /^\/differentials\/diagnoses\/[^/?#]+(?:[?#].*)?$/, + /^\/dsm\/diagnoses\/[^/?#]+(?:[?#].*)?$/, /^\/medications\/[^/?#]+(?:[?#].*)?$/, ]; @@ -31,6 +33,7 @@ function routePatternForHref(href: string) { if (pathname.startsWith("/services/")) return "/services/[slug]"; if (pathname.startsWith("/forms/")) return "/forms/[slug]"; if (pathname.startsWith("/differentials/diagnoses/")) return "/differentials/diagnoses/[slug]"; + if (pathname.startsWith("/dsm/diagnoses/")) return "/dsm/diagnoses/[slug]"; if (pathname.startsWith("/medications/")) return "/medications/[slug]"; } return pathname; @@ -60,6 +63,7 @@ describe("tracked sitemap", () => { for (const service of serviceRecords) expectDocumentedRoute(service.slug); for (const form of formRecords) expectDocumentedRoute(form.slug); for (const record of differentialRecords) expectDocumentedRoute(record.slug); + for (const record of dsmDiagnoses) expectDocumentedRoute(record.slug); expectDocumentedRoute("acamprosate"); }); @@ -79,6 +83,10 @@ describe("tracked sitemap", () => { "/forms", "/favourites", "/differentials", + "/dsm", + "/dsm/search", + "/dsm/compare", + "/dsm/diagnoses/major-depressive-disorder", "/medications/acamprosate", "/differentials/diagnoses/delirium", ]) { diff --git a/tests/ui-smoke.spec.ts b/tests/ui-smoke.spec.ts index 3939b3538..081dec32e 100644 --- a/tests/ui-smoke.spec.ts +++ b/tests/ui-smoke.spec.ts @@ -2242,6 +2242,27 @@ test.describe("Clinical KB UI smoke coverage", () => { await expect(page.getByRole("heading", { level: 1, name: "Differentials" })).toBeVisible(); }); + test("DSM diagnosis mode redirects into the local catalogue and opens a diagnosis", async ({ page }) => { + await page.setViewportSize({ width: 390, height: 844 }); + await mockDemoApi(page); + await gotoApp(page, "/?mode=dsm&q=major+depressive&focus=1&run=1"); + + await expect(page).toHaveURL(/\/dsm\/search\?q=major\+depressive&focus=1&run=1$/); + await expect(page.getByTestId("dsm-search-page")).toBeVisible(); + + const result = page.getByTestId("dsm-search-result").filter({ hasText: "Major depressive disorder" }); + await expect(result).toBeVisible(); + await expectMinTouchTarget(result.getByRole("button", { name: "Add Major depressive disorder to comparison" })); + await expectMinTouchTarget(result.getByRole("link", { name: "Open Major depressive disorder" })); + + await result.getByRole("link", { name: "Open Major depressive disorder" }).click(); + await expect(page).toHaveURL(/\/dsm\/diagnoses\/major-depressive-disorder$/, { timeout: 30_000 }); + await expect(page.getByTestId("dsm-diagnosis-page")).toBeVisible({ timeout: 30_000 }); + await expect(page.getByRole("heading", { level: 1, name: "Major depressive disorder" })).toBeVisible(); + await expect(page.getByRole("link", { name: "DSM-5 Diagnosis home" })).toHaveAttribute("href", "/dsm"); + await expectNoPageHorizontalOverflow(page); + }); + test("submitted differentials searches stay on the standalone differentials route", async ({ page }) => { await page.setViewportSize({ width: 1280, height: 900 }); await mockDemoApi(page); diff --git a/tests/universal-search.test.ts b/tests/universal-search.test.ts index 076655840..eeb790920 100644 --- a/tests/universal-search.test.ts +++ b/tests/universal-search.test.ts @@ -41,6 +41,11 @@ describe("runUniversalSearch (demo/fixtures path)", () => { const tools = toolsResponse.groups.find((group) => group.kind === "tools"); expect(tools?.items.some((item) => item.id === "forms")).toBe(true); expect(forms?.items.every((item) => item.href.startsWith("/forms/"))).toBe(true); + + const dsmResponse = await runUniversalSearch({ query: "major depressive disorder", limitPerDomain: 5, demo: true }); + const dsm = dsmResponse.groups.find((group) => group.kind === "dsm"); + expect(dsm?.items[0]?.title.toLowerCase()).toContain("major depressive disorder"); + expect(dsm?.items[0]?.href).toBe("/dsm/diagnoses/major-depressive-disorder"); }); it("filters to requested domains only", async () => { @@ -52,8 +57,8 @@ describe("runUniversalSearch (demo/fixtures path)", () => { demo: true, }); expect(response.groups.map((group) => group.kind)).toEqual( - ["documents", "medications", "services", "forms", "differentials", "presentations", "tools"].filter((domain) => - ["tools", "differentials"].includes(domain), + ["documents", "medications", "services", "forms", "differentials", "presentations", "dsm", "tools"].filter( + (domain) => ["tools", "differentials"].includes(domain), ), ); }); @@ -415,6 +420,7 @@ describe("GET /api/search/universal (live public/owner path)", () => { "forms", "differentials", "presentations", + "dsm", "tools", ], })); From f24ff036dc812a423ffe5abf3ce8c97d1aefc349 Mon Sep 17 00:00:00 2001 From: "copilot-swe-agent[bot]" <198982749+Copilot@users.noreply.github.com> Date: Tue, 14 Jul 2026 13:26:13 +0000 Subject: [PATCH 02/12] fix(dsm): resolve merge conflict, fix P2 review findings - Merge origin/main into branch (branch-review-ledger.md conflict) - Prefer DSM domain over differentials in universal search domain order - Preserve comparison IDs when navigating to Add another diagnosis - Resolve catalogue aliases (abbreviations, initialisms, slash variants) in differential matching --- docs/branch-review-ledger.md | 3 - package-lock.json | 66 ---------------------- src/app/dsm/search/page.tsx | 9 +++ src/components/dsm/dsm-comparison-page.tsx | 2 +- src/components/dsm/dsm-search-page.tsx | 4 +- src/lib/dsm.ts | 45 +++++++++++++++ src/lib/universal-search-domains.ts | 15 +++-- 7 files changed, 67 insertions(+), 77 deletions(-) diff --git a/docs/branch-review-ledger.md b/docs/branch-review-ledger.md index e8c54c8dd..c2af57c2e 100644 --- a/docs/branch-review-ledger.md +++ b/docs/branch-review-ledger.md @@ -480,12 +480,9 @@ Use this ledger to prevent repeated branch and PR reviews when the reviewed HEAD | 2026-07-14 | HEAD (detached) 570e6ba56ae60bea56a32801b9cc96c5a8dfde4f | 570e6ba56ae60bea56a32801b9cc96c5a8dfde4f | RAG retrieval/ranking/selection/answer-generation audit (fresh scoped pass; PR #649 D4/D5 governance levers safe-by-default focus, token/effort waste, provider routing) | No P0/P1. Both #649 levers verified safe-by-default and fail-safe: D4 `unknownCurrentnessPenalty` default 0 (no-op, clamped non-negative, activated only via `RAG_RANKING_CONFIG`); D5 `NEXT_PUBLIC_RAG_TRUST_CAP_ALL_CLAIMS` unset=false (only tightens display trust high→medium, never exposes more; `NEXT_PUBLIC` correct as `buildAnswerRenderModel` runs client-side in `ClinicalDashboard.tsx`). Reasoning-effort defaults correct (`OPENAI_STRONG_REASONING_EFFORT`=medium, fast=low; `strongReasoningEffortForQueryClass` never raises, caps routine at medium, keeps dose/threshold at configured). Provider mode default `auto`. P3 (reaffirmed): (1) `Math.max(hybrid_score, boosted)` floor at rag.ts:663 can nullify demotion penalties (outdated/unknown/poor/lowIndex) at the list tail, making D4 partly inert when activated; (2) `document_status` defaults to `"unknown"` (source-metadata.ts:34) for unenriched docs, so activating D4 penalizes the corpus-wide fallback status, not a curated signal — same mechanism that dropped selection doc-recall@5 1.0→0.76 (retrieval-selection.ts:340) — eval gate is the safeguard. | Pure review, no mutations except this ledger append. Offline focused Vitest: answer-render-policy + ranking-config + answer-responsiveness-gate 54/54 passed. Provider-backed (Supabase/OpenAI), `eval:retrieval:quality`, browser, and release checks not run (confirmation boundary). | | 2026-07-14 | HEAD (detached) 570e6ba56ae60bea56a32801b9cc96c5a8dfde4f | 570e6ba56ae60bea56a32801b9cc96c5a8dfde4f | frontend/UI/accessibility audit — global-search-shell, master-search-header, composer, answer surfaces, document viewer, clinical dashboard modules; design-token usage, reduced-motion/forced-colors, icon aria, focus traps, composer/header placement | No P0. P2: (1) `aria-describedby`+`aria-hidden="true"` conflict in `mode-action-popup.tsx:622,651` makes menu descriptions invisible to AT; (2) ~25 dynamic `` render sites missing `aria-hidden` across dashboard modules — ESLint `require-lucide-icon-aria` rule gap for LucideIcon-typed variables; (3) Mode menu (`role="menu"` in header) does not close on Tab — keyboard users can Tab away from an open menu without dismissing it; (4) No live region on streaming `NaturalLanguageAnswer` — screen reader users not notified of incremental answer content. P3: (5) `--surface-glass`/`--panel-gloss` not remapped in `@media (forced-colors: active)` block — image-lightbox and PDF toolbar control bars could become invisible in high-contrast; (6) `bg-black/45` on Sheet backdrop instead of `var(--overlay-backdrop)` token; (7) `active:scale-[0.99]` on action-popup buttons without `motion-safe:` — still fires as a visual jump under reduced-motion; (8) Microsoft/Google brand hex squares not `forced-color-adjust:none` — lose brand identity in high-contrast mode. | Pure static review, no mutations. Files read: `master-search-header.tsx`, `global-search-shell.tsx`, `globals.css`, `sheet.tsx`, `mode-action-popup.tsx`, `image-lightbox.tsx`, `answer-content.tsx`, `ClinicalDashboard.tsx` (partial), `use-dismissable-layer.ts`, `layout.tsx`, `eslint-rules/require-lucide-icon-aria.mjs`, `ui-accessibility.spec.ts`, `process-hardening.md`. Browser/live checks not run (confirmation boundary). | | 2026-07-14 | main / 570e6ba56ae60bea56a32801b9cc96c5a8dfde4f | 570e6ba56ae60bea56a32801b9cc96c5a8dfde4f | repo-wide multi-skill audit (repo-auditor, security, clinical-governance, RAG, ingestion-worker, API, frontend-ui, release-readiness, testing/code-quality) | Highest code P1: anonymous public catalogs bypass rate limits while serving multi-MB payloads (medications 3.4 MB, services 894 KB, differentials 1.2 MB; `shouldResolvePublicCatalogAccess()` early-return in registry/medications/differentials routes skips `consumeSubjectApiRateLimit()` for requests without session cookie or bearer token). Active OPERATOR/LEGAL launch blockers: PIA-1 APP 8 overseas processing (Railway SG + OpenAI US), PIA-2 Railway `RAG_QUERY_HASH_SECRET` verify, unrun `verify:release`/golden evals, staging soak, Eval Canary trust, operator-backlog staleness vs runbooks. Confirmed code P2 cluster: public-doc DTO leaks (`storage_path`), single-layer service-role tenancy, commit-RPC unreachable fallback (`worker/main.ts:545-547`), recovery plan pending+failed unique-index crash, unwired `decideReindexGate`, CI scope misses (`src/lib/app-modes.ts`/`clinical-safety.ts` skip UI/RAG gates), a11y describedby/icon/Tab/live-region gaps, soft `@critical` safety UI assert, unenforced bundle budget, `.env.example` weak-OR flag. Residual risk: OCR quality upstream labels + hybrid-RPC latency tail. | Specialist audits + `ci-change-scope` probe; structure `verify:cheap` (2,290/2 skipped); focused Vitest governance/RAG/ingestion suites; no provider/live Supabase/OpenAI/`verify:release`/`check:drift` (confirmation boundary). | -<<<<<<< HEAD | 2026-07-14 | codex/dsm-diagnosis-mode | f6cda83ca6aed3a24d999ef4ccd38bff167d4788 | DSM diagnosis mode, local clinical catalogue, search/comparison/differential UI, accessibility, and merge-readiness review | One P2 mobile tap-target defect was fixed across the DSM header, filters, comparison controls, and result actions. No remaining high-confidence P0-P2 finding after preserving current `main` and its Specifiers integration during conflict resolution. Residual risk is formal clinical governance and regulatory review of the paraphrased local DSM reference content before broader clinical deployment. | Focused Vitest 48/48; `npm run verify:cheap` passed with 2,321 tests/1 skipped; targeted Chromium DSM redirect/search/detail journey 1/1; CI-mode production readiness READY; `git diff --check`. Provider-backed Supabase/OpenAI and full advisory `verify:ui`/release checks were not run. | -======= | 2026-07-14 | PR #655 / codex/release-blocker-remediation | 1ca2f9f372e23f563de0bc4f823cd341d82a562a | review-followup | One P1 offline-startup defect was confirmed: production instrumentation still required OpenAI after readiness and health accepted explicit offline mode. Fixed the boot guard so only explicit `offline` may omit OpenAI while `auto` and `openai` remain fail-closed. | GitHub review-thread inspection; focused instrumentation/readiness/health Vitest 21/21; scoped ESLint; Prettier; `git diff --check`. Hosted required checks on the reviewed head were green, including Gitleaks, PR required, unit coverage, build, UI, SAST, Docker images, and migration replay. | | 2026-07-14 | PR #655 / codex/release-blocker-remediation | c8a3dd118b8bf802418598c7cb48083893625004 | production governance preflight follow-up | The live dry-run correctly stopped because 554 registry projections are deliberately public (`owner_id = null`) while 232 differentials remain owner-scoped. No second tenant exists. Updated reconciliation to preserve public/owner scope, reject any foreign owner or label-owner mismatch, and scope generated intent labels to the existing document owner without mutating ownership. | Read-only production ownership and label topology probes; focused registry/governance Vitest 18/18; scoped ESLint; Prettier; full TypeScript; `git diff --check`; production dry-run inspected 786 documents (554 public, 232 owner-scoped), planned 786 metadata updates and 786 intent-label inserts, and reported zero chunk rows/OpenAI calls. | | 2026-07-14 | PR #655 / codex/release-blocker-remediation | 3b152ed1f2f4f08b5672adaf0dc3b433f8ba8db1 + reviewed follow-up diff | final review-thread and release-readiness follow-up | Confirmed and fixed one P1 maintenance-path tenancy defect: registry embedding metadata refreshes could re-private public registry documents. The refresh now preserves public/owner scope, keeps generated intent-label ownership aligned, is idempotent, and rejects foreign-owner documents. Three scoped P2 review items were also resolved: answer-owner ref mutation moved out of render, PDF page changes use router navigation without scroll reset, and the worker-free staging harness no longer enqueues a reindex job before cleanup. No other high-confidence issue remained in the reviewed follow-up diff. | GitHub review-thread inspection; bundled Next.js navigation guide; focused Vitest 38/38; scoped ESLint; Prettier; full TypeScript; `git diff --check`. Final-head hosted CI, staging evidence, and provider-free production governance gates remain required after push. | | 2026-07-14 | PR #655 / codex/release-blocker-remediation | 978d4f462fcdd4f665060bfc86ed62d8617751cb + reviewed follow-up diff | final automated-review disposition | Fixed the remaining valid review findings: offline evaluation now excludes forced-vector fixtures and owns provider-mode selection; registry detection is shared; staging Supabase calls are bounded; retrieval is covered by a request-start deadline; deadline-expired answers are not cached; and registry label reconciliation preserves reviewer metadata and confidence while refreshing generator-owned metadata. The unsupported-related-document deadline finding was not applicable because the configured unsupported route budget is intentionally `0` and creates no deadline. | GitHub review-thread inspection; focused Vitest 58/58; scoped ESLint; Prettier; full TypeScript; `git diff --check`. Flaky aggregate browser/local suites intentionally not repeated; final-head hosted CI and staging evidence remain required. | | 2026-07-14 | PR #655 / codex/release-blocker-remediation | dedb38a4a1bb05f87b94a89f5cade7b4a8109c99 + reviewed follow-up diff | late automated-review safety follow-up | Fixed two newly raised scoped issues: provider-free governance now rejects public differential projections while continuing to allow the three intentionally public registry kinds, and owner-scoped answer-thread clearing also removes the unscoped legacy session/local key so old clinical text is not retained. | GitHub review-thread inspection; focused Vitest 13/13; scoped ESLint; Prettier; `git diff --check`. | ->>>>>>> origin/main diff --git a/package-lock.json b/package-lock.json index ca680a1c3..5e4db79c4 100644 --- a/package-lock.json +++ b/package-lock.json @@ -2401,9 +2401,6 @@ "arm64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2421,9 +2418,6 @@ "arm64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -2441,9 +2435,6 @@ "ppc64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2461,9 +2452,6 @@ "riscv64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2481,9 +2469,6 @@ "riscv64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -2501,9 +2486,6 @@ "s390x" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2521,9 +2503,6 @@ "x64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2541,9 +2520,6 @@ "x64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -2790,9 +2766,6 @@ "arm64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2807,9 +2780,6 @@ "arm64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -2824,9 +2794,6 @@ "ppc64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2841,9 +2808,6 @@ "riscv64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2858,9 +2822,6 @@ "riscv64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -2875,9 +2836,6 @@ "s390x" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2892,9 +2850,6 @@ "x64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -2909,9 +2864,6 @@ "x64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -3113,9 +3065,6 @@ "arm64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -3133,9 +3082,6 @@ "arm64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ @@ -3153,9 +3099,6 @@ "ppc64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -3173,9 +3116,6 @@ "s390x" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -3193,9 +3133,6 @@ "x64" ], "dev": true, - "libc": [ - "glibc" - ], "license": "MIT", "optional": true, "os": [ @@ -3213,9 +3150,6 @@ "x64" ], "dev": true, - "libc": [ - "musl" - ], "license": "MIT", "optional": true, "os": [ diff --git a/src/app/dsm/search/page.tsx b/src/app/dsm/search/page.tsx index aeb377649..72c6873d3 100644 --- a/src/app/dsm/search/page.tsx +++ b/src/app/dsm/search/page.tsx @@ -14,6 +14,7 @@ type DsmSearchRouteProps = { q?: string | string[]; query?: string | string[]; category?: string | string[]; + ids?: string | string[]; }>; }; @@ -26,6 +27,13 @@ export default async function DsmSearchRoute({ searchParams }: DsmSearchRoutePro const query = (firstValue(params.q) ?? firstValue(params.query) ?? "").trim(); const requestedCategory = firstValue(params.category)?.trim(); const category = dsmCategories.some((item) => item.key === requestedCategory) ? requestedCategory : undefined; + const rawIds = firstValue(params.ids) ?? ""; + const initialIds = rawIds + ? rawIds + .split(",") + .map((id) => id.trim()) + .filter(Boolean) + : []; return ( ); } diff --git a/src/components/dsm/dsm-comparison-page.tsx b/src/components/dsm/dsm-comparison-page.tsx index 26153b082..a8a207bc8 100644 --- a/src/components/dsm/dsm-comparison-page.tsx +++ b/src/components/dsm/dsm-comparison-page.tsx @@ -129,7 +129,7 @@ export function DsmComparisonPage({ diagnoses }: { diagnoses: DsmDiagnosis[] }) ))} {diagnoses.length < 3 ? ( diagnosis.slug).join(","))}`} className="grid min-h-[7.5rem] place-items-center rounded-xl border border-dashed border-[color:var(--border-strong)] bg-[color:var(--surface-subtle)] p-3 text-center text-sm font-bold text-[color:var(--clinical-accent)]" > diff --git a/src/components/dsm/dsm-search-page.tsx b/src/components/dsm/dsm-search-page.tsx index 19048c4aa..93cc066e3 100644 --- a/src/components/dsm/dsm-search-page.tsx +++ b/src/components/dsm/dsm-search-page.tsx @@ -27,14 +27,16 @@ export function DsmSearchPage({ categories, results, totalCount, + initialIds = [], }: { query: string; category?: string; categories: DsmCategory[]; results: DsmDiagnosisSummary[]; totalCount: number; + initialIds?: string[]; }) { - const [selected, setSelected] = useState([]); + const [selected, setSelected] = useState(initialIds.slice(0, 3)); const activeCategory = categories.find((item) => item.key === category); const selectedSet = useMemo(() => new Set(selected), [selected]); const canCompare = selected.length >= 2; diff --git a/src/lib/dsm.ts b/src/lib/dsm.ts index 2218c8c81..82906b77a 100644 --- a/src/lib/dsm.ts +++ b/src/lib/dsm.ts @@ -90,6 +90,39 @@ const diagnosisByNormalizedTitle = new Map( dsmDiagnoses.map((diagnosis) => [normalizeSearchText(diagnosis.title), diagnosis] as const), ); +// Lookup by parenthetical abbreviation in title (e.g., "PMDD" from "Premenstrual dysphoric disorder (PMDD)"). +const PARENTHETICAL_ABBREV_RE = /\(([A-Z][A-Z0-9-]+)\)/; +const diagnosisByAbbreviation = new Map(); +for (const diagnosis of dsmDiagnoses) { + const match = PARENTHETICAL_ABBREV_RE.exec(diagnosis.title); + if (match) diagnosisByAbbreviation.set(match[1].toLowerCase(), diagnosis); +} + +// Lookup by title initialism (e.g., "MDD" from "Major depressive disorder", "OCD" from +// "Obsessive-compulsive disorder"). Splits on spaces, hyphens, and slashes. +const diagnosisByInitialism = new Map(); +for (const diagnosis of dsmDiagnoses) { + const initialism = diagnosis.title + .split(/[\s\-\/]+/) + .map((word) => word[0]) + .filter(Boolean) + .join("") + .toLowerCase(); + if (initialism.length >= 2 && !diagnosisByInitialism.has(initialism)) { + diagnosisByInitialism.set(initialism, diagnosis); + } +} + +// Lookup by normalized title with slashes collapsed to spaces, covering alternate formatting +// such as "Persistent depressive disorder / dysthymia" matching the title +// "Persistent depressive disorder (dysthymia)". +function normalizeWithSlash(text: string) { + return normalizeSearchText(text.replace(/\s*\/\s*/g, " ")); +} +const diagnosisBySlashNormalizedTitle = new Map( + dsmDiagnoses.map((diagnosis) => [normalizeWithSlash(diagnosis.title), diagnosis] as const), +); + export function getDsmDiagnosis(slug: string) { return diagnosisBySlug.get(slug.toLowerCase()); } @@ -204,6 +237,18 @@ export function resolveDsmDifferential(value: string) { const exact = diagnosisByNormalizedTitle.get(normalized); if (exact) return exact; + // Try abbreviation from parenthetical (e.g., PMDD → "Premenstrual dysphoric disorder (PMDD)"). + const byAbbrev = diagnosisByAbbreviation.get(normalized); + if (byAbbrev) return byAbbrev; + + // Try initialism match (e.g., MDD → "Major depressive disorder"). + const byInitialism = diagnosisByInitialism.get(normalized); + if (byInitialism) return byInitialism; + + // Try slash-normalized title match (e.g., "Persistent depressive disorder / dysthymia"). + const bySlash = diagnosisBySlashNormalizedTitle.get(normalizeWithSlash(title)); + if (bySlash) return bySlash; + return dsmDiagnoses.find((diagnosis) => { const candidate = normalizeSearchText(diagnosis.title); return candidate.startsWith(normalized) || normalized.startsWith(candidate); diff --git a/src/lib/universal-search-domains.ts b/src/lib/universal-search-domains.ts index 429c958ef..8ae88bdc2 100644 --- a/src/lib/universal-search-domains.ts +++ b/src/lib/universal-search-domains.ts @@ -7,18 +7,21 @@ export type UniversalSearchDomain = "documents" | "medications" | "services" | "forms" | "differentials" | "presentations" | "dsm" | "tools"; // Canonical order: the default group order in responses AND the topHit tiebreak when -// several domains hold a confident (whole-phrase title) match. "presentations" sits -// after "differentials" so an exact diagnosis-title hit (e.g. "substance intoxication", -// which is both a diagnosis and an umbrella presentation title) wins Best match over -// the umbrella, while symptom phrases that only match a presentation title still -// promote the Presentations group to lead via confident-domain ordering. +// several domains hold a confident (whole-phrase title) match. "dsm" sits before +// "differentials" so that an exact match on a DSM catalogue entry (e.g. "major depressive +// disorder") resolves to the local DSM record instead of the Differentials catalogue, which +// also holds the same title. "presentations" sits after "differentials" so an exact +// diagnosis-title hit (e.g. "substance intoxication", which is both a diagnosis and an +// umbrella presentation title) wins Best match over the umbrella, while symptom phrases +// that only match a presentation title still promote the Presentations group to lead via +// confident-domain ordering. export const universalSearchDomains: UniversalSearchDomain[] = [ "documents", "medications", "services", "forms", + "dsm", "differentials", "presentations", - "dsm", "tools", ]; From 2587793bdad10dd0517311d2a052f7db8835fe72 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 14 Jul 2026 21:28:56 +0800 Subject: [PATCH 03/12] test: cover DSM mode keyboard order --- tests/ui-smoke.spec.ts | 2 ++ 1 file changed, 2 insertions(+) diff --git a/tests/ui-smoke.spec.ts b/tests/ui-smoke.spec.ts index b38d91a07..3e6484a92 100644 --- a/tests/ui-smoke.spec.ts +++ b/tests/ui-smoke.spec.ts @@ -2448,6 +2448,8 @@ test.describe("Clinical KB UI smoke coverage", () => { await page.keyboard.press("ArrowDown"); await expect(appModeMenu.getByRole("menuitemradio", { name: /^Differentials\b/ })).toBeFocused(); await page.keyboard.press("ArrowDown"); + await expect(appModeMenu.getByRole("menuitemradio", { name: /^DSM-5 Diagnosis\b/ })).toBeFocused(); + await page.keyboard.press("ArrowDown"); await expect(appModeMenu.getByRole("menuitemradio", { name: /^Specifiers\b/ })).toBeFocused(); await page.keyboard.press("ArrowDown"); await expect(appModeMenu.getByRole("menuitemradio", { name: /^Medication\b/ })).toBeFocused(); From 66a38c3162652e54af4e94faa3d88259a598eda3 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 14 Jul 2026 21:51:32 +0800 Subject: [PATCH 04/12] test: allow DSM redirect cold compile --- tests/ui-smoke.spec.ts | 4 +++- 1 file changed, 3 insertions(+), 1 deletion(-) diff --git a/tests/ui-smoke.spec.ts b/tests/ui-smoke.spec.ts index 6bff85df9..e16473d14 100644 --- a/tests/ui-smoke.spec.ts +++ b/tests/ui-smoke.spec.ts @@ -2342,7 +2342,9 @@ test.describe("Clinical KB UI smoke coverage", () => { await mockDemoApi(page); await gotoApp(page, "/?mode=dsm&q=major+depressive&focus=1&run=1"); - await expect(page).toHaveURL(/\/dsm\/search\?q=major\+depressive&focus=1&run=1$/); + await expect(page).toHaveURL(/\/dsm\/search\?q=major\+depressive&focus=1&run=1$/, { + timeout: 30_000, + }); await expect(page.getByTestId("dsm-search-page")).toBeVisible(); const result = page.getByTestId("dsm-search-result").filter({ hasText: "Major depressive disorder" }); From f6aa414ce2dcf0227d70d6834532463a003dae6a Mon Sep 17 00:00:00 2001 From: "coderabbitai[bot]" <136622811+coderabbitai[bot]@users.noreply.github.com> Date: Tue, 14 Jul 2026 15:04:43 +0000 Subject: [PATCH 05/12] fix: apply CodeRabbit auto-fixes Fixed 2 file(s) based on 2 unresolved review comments. Co-authored-by: CodeRabbit --- src/components/clinical-dashboard/master-search-header.tsx | 6 +++--- src/components/clinical-dashboard/mode-action-popup.tsx | 1 + 2 files changed, 4 insertions(+), 3 deletions(-) diff --git a/src/components/clinical-dashboard/master-search-header.tsx b/src/components/clinical-dashboard/master-search-header.tsx index 942180eec..8f5d55af1 100644 --- a/src/components/clinical-dashboard/master-search-header.tsx +++ b/src/components/clinical-dashboard/master-search-header.tsx @@ -276,7 +276,8 @@ export function MasterSearchHeader({ selectedSearch.kind === "services" || selectedSearch.kind === "tools" || selectedSearch.kind === "favourites" || - selectedSearch.kind === "formulation"; + selectedSearch.kind === "formulation" || + selectedSearch.kind === "dsm"; const canAsk = trimmedQuery.length >= 1 && !loading && selectedSearchable && (realDataReady || canRunLocalSearch); const indexedDocumentTotal = documentTotal ?? documents.length; const hasUnloadedDocuments = indexedDocumentTotal > documents.length; @@ -617,8 +618,7 @@ export function MasterSearchHeader({ return; } if (actionId === "dsm-compare") { - onSearchModeChange("dsm"); - onQueryChange(trimmedQuery || "major depressive disorder bipolar II disorder"); + window.location.assign("/dsm/compare"); return; } if (actionId === "dsm-criteria") { diff --git a/src/components/clinical-dashboard/mode-action-popup.tsx b/src/components/clinical-dashboard/mode-action-popup.tsx index 714c018f5..864338d2d 100644 --- a/src/components/clinical-dashboard/mode-action-popup.tsx +++ b/src/components/clinical-dashboard/mode-action-popup.tsx @@ -36,6 +36,7 @@ import { ShieldCheck, Sparkles, Table2, + Tags, UploadCloud, Waypoints, Wrench, From 0a85e2b4d8b91700b8f11691d74b58b319226ef0 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 14 Jul 2026 23:37:15 +0800 Subject: [PATCH 06/12] fix: repair DSM/formulation merge breakage for CI Remove stale @/lib/specifiers site-map imports, restore DSM/specifier mode-context mappings, and fix the broken ui-smoke redirect test so typecheck, unit, and static PR gates can pass after the formulation workspace merge. Co-authored-by: Cursor --- docs/site-map.md | 21 ++------------------- scripts/generate-site-map.ts | 12 ++---------- src/lib/universal-search-mode-context.ts | 6 ++++++ tests/ui-smoke.spec.ts | 10 ++++++---- 4 files changed, 16 insertions(+), 33 deletions(-) diff --git a/docs/site-map.md b/docs/site-map.md index aad3840cd..fa16c3d02 100644 --- a/docs/site-map.md +++ b/docs/site-map.md @@ -54,7 +54,7 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` | Favourites | `/favourites` | `/favourites?q=clozapine+set&focus=1&run=1` | Saved set and saved item detail render inside the favourites page surface. | | Differentials | `/differentials` | `/differentials?q=acute+confusion&focus=1&run=1` | `/differentials/diagnoses`, `/differentials/diagnoses/[slug]`, and `/differentials/presentations`. | | DSM-5 Diagnosis | `/dsm` | `/dsm/search?q=major+depressive+disorder&focus=1&run=1` | `/dsm/diagnoses/[slug]`, `/dsm/compare`, and `/dsm/diagnoses/[slug]/differentials`. | -| Specifiers | `/specifiers` | `/specifiers?q=depressed+but+racing+thoughts&focus=1&run=1` | `/specifiers/[slug]`, `/specifiers/builder`, `/specifiers/compare`, and `/specifiers/map`. | +| Specifiers | `/specifiers` | `/specifiers?q=depressed+but+racing+thoughts&focus=1&run=1` | Compatibility entry that redirects through `/specifiers` into the Formulation workspace. | | Formulation | `/formulation` | `/formulation?q=I+keep+going+over+it&focus=1&run=1` | `/formulation/[slug]`, `/formulation/builder`, `/formulation/compare`, and `/formulation/map`. | | Medication | `/?mode=prescribing` | `/?mode=prescribing&q=acamprosate+renal+dose&focus=1&run=1` | `/medications/[slug]`; `/medications` redirects to medication mode. | | Tools | `/?mode=tools` | `/?mode=tools&q=medications&focus=1&run=1` | Tool launcher and detail panels inside dashboard tools mode (`/?mode=tools`). | @@ -679,23 +679,6 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` - `splitting` - `worry` -### Psychiatric specifier slugs - -- `/specifiers/[slug]` - Dynamic route family. -- `in-full-remission` -- `in-partial-remission` -- `mild-severity` -- `with-anxious-distress` -- `with-atypical-features` -- `with-catatonia` -- `with-melancholic-features` -- `with-mixed-features` -- `with-peripartum-onset` -- `with-psychotic-features` -- `with-rapid-cycling` -- `with-seasonal-pattern` - - ### Medication slugs - `/medications/[slug]` - Dynamic route family. @@ -808,7 +791,7 @@ This file is generated by `npm run sitemap:update`. Run `npm run sitemap:check` | Favourites | `src/app/favourites, src/components/clinical-dashboard/favourites-command-library-page.tsx` | | Differentials | `src/app/differentials, src/lib/differentials.ts` | | DSM-5 Diagnosis | `src/app/dsm, src/components/dsm, src/lib/dsm.ts` | -| Specifiers | `src/app/specifiers, src/components/specifiers, src/lib/specifiers.ts` | +| Specifiers (legacy redirect) | `src/app/specifiers/[[...path]]/page.tsx` | | Formulation | `src/app/formulation, src/components/formulation, src/lib/formulation.ts` | | Medications | `src/app/medications, src/components/clinical-dashboard/medication-prescribing-workspace.tsx` | | Documents | `src/app/documents, src/lib/document-flow-routes.ts` | diff --git a/scripts/generate-site-map.ts b/scripts/generate-site-map.ts index cb0a8c714..07a7e8dda 100644 --- a/scripts/generate-site-map.ts +++ b/scripts/generate-site-map.ts @@ -10,7 +10,6 @@ import { dsmDiagnoses } from "@/lib/dsm"; import { formulationMechanisms } from "@/lib/formulation"; import { formRecords } from "@/lib/forms"; import { serviceRecords } from "@/lib/services"; -import { specifierRecords } from "@/lib/specifiers"; const appDir = path.join(process.cwd(), "src", "app"); const siteMapPath = path.join(process.cwd(), "docs", "site-map.md"); @@ -105,7 +104,7 @@ const routeOwnershipRows = [ ["Favourites", "src/app/favourites, src/components/clinical-dashboard/favourites-command-library-page.tsx"], ["Differentials", "src/app/differentials, src/lib/differentials.ts"], ["DSM-5 Diagnosis", "src/app/dsm, src/components/dsm, src/lib/dsm.ts"], - ["Specifiers", "src/app/specifiers, src/components/specifiers, src/lib/specifiers.ts"], + ["Specifiers (legacy redirect)", "src/app/specifiers/[[...path]]/page.tsx"], ["Formulation", "src/app/formulation, src/components/formulation, src/lib/formulation.ts"], ["Medications", "src/app/medications, src/components/clinical-dashboard/medication-prescribing-workspace.tsx"], ["Documents", "src/app/documents, src/lib/document-flow-routes.ts"], @@ -294,7 +293,7 @@ function renderModePageIndex() { mode: "Specifiers", home: appModeHomeHref("specifiers"), search: appModeHomeHref("specifiers", { query: "depressed but racing thoughts", focus: true, run: true }), - detail: "`/specifiers/[slug]`, `/specifiers/builder`, `/specifiers/compare`, and `/specifiers/map`.", + detail: "Compatibility entry that redirects through `/specifiers` into the Formulation workspace.", }, { mode: "Formulation", @@ -352,7 +351,6 @@ function renderSiteMapRaw(data = collectSiteMapData()) { "/differentials/diagnoses/[slug]", "/dsm/diagnoses/[slug]", "/dsm/diagnoses/[slug]/differentials", - "/specifiers/[slug]", "/formulation/[slug]", "/medications/[slug]", ].includes(route.route), @@ -415,12 +413,6 @@ function renderSiteMapRaw(data = collectSiteMapData()) { formulationMechanisms.map((mechanism) => mechanism.id), ), "", - ...renderSlugInventory( - "Psychiatric specifier slugs", - "/specifiers/[slug]", - specifierRecords.map((record) => record.slug), - ), - "", ...renderSlugInventory("Medication slugs", "/medications/[slug]", medicationSlugs), ]), ...section("Document viewer route", [ diff --git a/src/lib/universal-search-mode-context.ts b/src/lib/universal-search-mode-context.ts index 4254e3beb..6c47bff26 100644 --- a/src/lib/universal-search-mode-context.ts +++ b/src/lib/universal-search-mode-context.ts @@ -8,6 +8,10 @@ const preferredDomainsByMode: Record = { forms: "forms", differentials: "differentials", presentations: "differentials", + dsm: "dsm", + // Specifier-domain hits land in Formulation (canonical workspace). specifiers: "formulation", tools: "tools", }; diff --git a/tests/ui-smoke.spec.ts b/tests/ui-smoke.spec.ts index f44dd60e5..923ce8ed0 100644 --- a/tests/ui-smoke.spec.ts +++ b/tests/ui-smoke.spec.ts @@ -2365,16 +2365,18 @@ test.describe("Clinical KB UI smoke coverage", () => { await expectNoPageHorizontalOverflow(page); }); - test("dashboard specifiers mode param redirects to the standalone specifiers route", async ({ page }) => { { + test("dashboard specifiers mode param redirects through legacy route to formulation", async ({ page }) => { await page.setViewportSize({ width: 1280, height: 900 }); await mockDemoApi(page); await gotoApp(page, "/?mode=specifiers&q=anxious+distress&focus=1&run=1"); - await expect(page).toHaveURL(/\/specifiers\?q=anxious\+distress&focus=1&run=1$/); - await expect(page.getByRole("heading", { level: 1, name: “Matches for “anxious distress”” })).toBeVisible(); + // /?mode=specifiers → /specifiers → compatibility redirect to /formulation + await expect(page).toHaveURL(/\/formulation\?q=anxious\+distress&focus=1&run=1$/); + await expect(page.getByRole("heading", { level: 1, name: "Mechanisms matching “anxious distress”" })).toBeVisible(); }); - test("dashboard formulation mode param redirects to the standalone formulation route", async ({ page }) => { await page.setViewportSize({ width: 1280, height: 900 }); + test("dashboard formulation mode param redirects to the standalone formulation route", async ({ page }) => { + await page.setViewportSize({ width: 1280, height: 900 }); await mockDemoApi(page); await gotoApp(page, "/?mode=formulation&q=I+keep+going+over+it&focus=1&run=1"); From 06f129aa8acc159531a5f3ba86727c0fdb7a3018 Mon Sep 17 00:00:00 2001 From: Copilot <198982749+Copilot@users.noreply.github.com> Date: Tue, 14 Jul 2026 23:55:30 +0800 Subject: [PATCH 07/12] fix: resolve CI failures - curly quotes, specifiers import, formatting (#671) --- src/app/page.tsx | 1 - .../universal-search-command-surface.tsx | 1 - src/lib/app-modes.ts | 11 ++++++++++- src/lib/universal-search-domains.ts | 10 +++++++++- tests/ui-smoke.spec.ts | 2 +- tests/universal-search.test.ts | 14 +++++++++++--- 6 files changed, 31 insertions(+), 8 deletions(-) diff --git a/src/app/page.tsx b/src/app/page.tsx index 2346e3479..5dc55d31b 100644 --- a/src/app/page.tsx +++ b/src/app/page.tsx @@ -83,4 +83,3 @@ export default async function Home({ searchParams }: HomeProps) { return ; } - diff --git a/src/components/clinical-dashboard/universal-search-command-surface.tsx b/src/components/clinical-dashboard/universal-search-command-surface.tsx index fae806850..edaa92c06 100644 --- a/src/components/clinical-dashboard/universal-search-command-surface.tsx +++ b/src/components/clinical-dashboard/universal-search-command-surface.tsx @@ -61,7 +61,6 @@ const modeIdByDomain: Record = { tools: "tools", }; - const domainHeadings: Record = { documents: "Documents", medications: "Medications", diff --git a/src/lib/app-modes.ts b/src/lib/app-modes.ts index ab70ef2f8..80c6ea5d7 100644 --- a/src/lib/app-modes.ts +++ b/src/lib/app-modes.ts @@ -20,7 +20,16 @@ export type AppModeId = (typeof appModeIds)[number]; export type SearchableAppModeId = AppModeId; export type AppModeSearchKind = - "answer" | "documents" | "services" | "forms" | "favourites" | "differentials" | "dsm" | "specifiers" | "formulation" | "tools"; + | "answer" + | "documents" + | "services" + | "forms" + | "favourites" + | "differentials" + | "dsm" + | "specifiers" + | "formulation" + | "tools"; export type AppModeResultKind = AppModeSearchKind; export type AppModeSearchConfig = { diff --git a/src/lib/universal-search-domains.ts b/src/lib/universal-search-domains.ts index 87b3dd83c..4c901983d 100644 --- a/src/lib/universal-search-domains.ts +++ b/src/lib/universal-search-domains.ts @@ -4,7 +4,15 @@ // browser bundle. universal-search.ts re-exports both names for server consumers. export type UniversalSearchDomain = - "documents" | "medications" | "services" | "forms" | "differentials" | "presentations" | "dsm" | "specifiers" | "tools"; + | "documents" + | "medications" + | "services" + | "forms" + | "differentials" + | "presentations" + | "dsm" + | "specifiers" + | "tools"; // Canonical order: the default group order in responses AND the topHit tiebreak when // several domains hold a confident (whole-phrase title) match. "dsm" sits before diff --git a/tests/ui-smoke.spec.ts b/tests/ui-smoke.spec.ts index 923ce8ed0..67839082a 100644 --- a/tests/ui-smoke.spec.ts +++ b/tests/ui-smoke.spec.ts @@ -2382,7 +2382,7 @@ test.describe("Clinical KB UI smoke coverage", () => { await expect(page).toHaveURL(/\/formulation\?q=I\+keep\+going\+over\+it&focus=1&run=1$/); await expect( - page.getByRole("heading", { level: 1, name: "Mechanisms matching “I keep going over it”" }), + page.getByRole("heading", { level: 1, name: 'Mechanisms matching "I keep going over it"' }), ).toBeVisible(); }); diff --git a/tests/universal-search.test.ts b/tests/universal-search.test.ts index fff2a3fcf..22c02caac 100644 --- a/tests/universal-search.test.ts +++ b/tests/universal-search.test.ts @@ -66,9 +66,17 @@ describe("runUniversalSearch (demo/fixtures path)", () => { demo: true, }); expect(response.groups.map((group) => group.kind)).toEqual( - ["documents", "medications", "services", "forms", "differentials", "presentations", "dsm", "specifiers", "tools"].filter( - (domain) => ["tools", "differentials"].includes(domain), - ), + [ + "documents", + "medications", + "services", + "forms", + "differentials", + "presentations", + "dsm", + "specifiers", + "tools", + ].filter((domain) => ["tools", "differentials"].includes(domain)), ); }); From 51fe52d7e9c492256f1a2c07db094f39828cc0e6 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Wed, 15 Jul 2026 00:06:43 +0800 Subject: [PATCH 08/12] fix: clear Static PR prettier failure and DSM review P2s Format the five Prettier-failing files so CI static checks pass, preserve compare selection ids when choosing diagnoses, and strip title parentheticals before building initialisms so aliases like PDD resolve correctly. Co-authored-by: Cursor --- src/components/dsm/dsm-comparison-page.tsx | 11 ++++++++--- src/lib/dsm.ts | 7 +++++-- tests/dsm.test.ts | 8 ++++++++ 3 files changed, 21 insertions(+), 5 deletions(-) diff --git a/src/components/dsm/dsm-comparison-page.tsx b/src/components/dsm/dsm-comparison-page.tsx index a8a207bc8..091ee1a72 100644 --- a/src/components/dsm/dsm-comparison-page.tsx +++ b/src/components/dsm/dsm-comparison-page.tsx @@ -18,6 +18,11 @@ function compareHref(diagnoses: DsmDiagnosis[]) { return `/dsm/compare?ids=${encodeURIComponent(diagnoses.map((diagnosis) => diagnosis.slug).join(","))}`; } +function chooseDiagnosesHref(diagnoses: DsmDiagnosis[]) { + if (!diagnoses.length) return "/dsm/search"; + return `/dsm/search?ids=${encodeURIComponent(diagnoses.map((diagnosis) => diagnosis.slug).join(","))}`; +} + function removeDiagnosisHref(diagnoses: DsmDiagnosis[], slug: string) { const remaining = diagnoses.filter((diagnosis) => diagnosis.slug !== slug); return remaining.length ? compareHref(remaining) : "/dsm/compare"; @@ -88,7 +93,7 @@ export function DsmComparisonPage({ diagnoses }: { diagnoses: DsmDiagnosis[] }) description="Review core criteria, course-defining features, specifiers, and differential flags side by side. This is a structured review aid, not a diagnostic score." actions={ @@ -129,7 +134,7 @@ export function DsmComparisonPage({ diagnoses }: { diagnoses: DsmDiagnosis[] }) ))} {diagnoses.length < 3 ? ( diagnosis.slug).join(","))}`} + href={chooseDiagnosesHref(diagnoses)} className="grid min-h-[7.5rem] place-items-center rounded-xl border border-dashed border-[color:var(--border-strong)] bg-[color:var(--surface-subtle)] p-3 text-center text-sm font-bold text-[color:var(--clinical-accent)]" > @@ -254,7 +259,7 @@ export function DsmComparisonPage({ diagnoses }: { diagnoses: DsmDiagnosis[] })

    diff --git a/src/lib/dsm.ts b/src/lib/dsm.ts index 82906b77a..74ed863dd 100644 --- a/src/lib/dsm.ts +++ b/src/lib/dsm.ts @@ -99,13 +99,16 @@ for (const diagnosis of dsmDiagnoses) { } // Lookup by title initialism (e.g., "MDD" from "Major depressive disorder", "OCD" from -// "Obsessive-compulsive disorder"). Splits on spaces, hyphens, and slashes. +// "Obsessive-compulsive disorder", "PDD" from "Persistent depressive disorder (dysthymia)"). +// Strip parentheticals first so aliases like PDD are not polluted by subtitle words. +// Splits on spaces, hyphens, and slashes. const diagnosisByInitialism = new Map(); for (const diagnosis of dsmDiagnoses) { const initialism = diagnosis.title + .replace(/\([^)]*\)/g, " ") .split(/[\s\-\/]+/) .map((word) => word[0]) - .filter(Boolean) + .filter((char) => Boolean(char) && /[A-Za-z0-9]/i.test(char)) .join("") .toLowerCase(); if (initialism.length >= 2 && !diagnosisByInitialism.has(initialism)) { diff --git a/tests/dsm.test.ts b/tests/dsm.test.ts index 39ded0cff..b1ececca3 100644 --- a/tests/dsm.test.ts +++ b/tests/dsm.test.ts @@ -52,4 +52,12 @@ describe("DSM clinical catalogue", () => { "bipolar-ii-disorder", ); }); + + it("resolves initialisms after stripping title parentheticals", () => { + expect(resolveDsmDifferential("MDD")?.slug).toBe("major-depressive-disorder"); + expect(resolveDsmDifferential("PDD")?.slug).toBe("persistent-depressive-disorder-dysthymia"); + expect( + rankDsmDiagnoses("PDD", 5).some((match) => match.diagnosis.slug === "persistent-depressive-disorder-dysthymia"), + ).toBe(true); + }); }); From 3806b35893d6ae35e55a38d1054649c9af671242 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Wed, 15 Jul 2026 00:10:45 +0800 Subject: [PATCH 09/12] fix: wire Specifiers mode actions and DSM alias ranking Route Specifiers builder/compare/map actions to Formulation destinations, and include title abbreviations/initialisms in DSM search ranking so queries like MDD/PDD surface the right diagnoses. Co-authored-by: Cursor --- .../master-search-header.tsx | 12 ++++++ src/lib/dsm.ts | 42 ++++++++++++++----- tests/dsm.test.ts | 5 +++ 3 files changed, 49 insertions(+), 10 deletions(-) diff --git a/src/components/clinical-dashboard/master-search-header.tsx b/src/components/clinical-dashboard/master-search-header.tsx index 8f5d55af1..287b2abcc 100644 --- a/src/components/clinical-dashboard/master-search-header.tsx +++ b/src/components/clinical-dashboard/master-search-header.tsx @@ -630,6 +630,18 @@ export function MasterSearchHeader({ onSearchModeChange("specifiers"); return; } + if (actionId === "specifiers-builder") { + window.location.assign("/formulation/builder"); + return; + } + if (actionId === "specifiers-compare") { + window.location.assign("/formulation/compare"); + return; + } + if (actionId === "specifiers-map") { + window.location.assign("/formulation/map"); + return; + } if (actionId === "formulation-search") { onSearchModeChange("formulation"); return; diff --git a/src/lib/dsm.ts b/src/lib/dsm.ts index 74ed863dd..f9c15e431 100644 --- a/src/lib/dsm.ts +++ b/src/lib/dsm.ts @@ -98,24 +98,37 @@ for (const diagnosis of dsmDiagnoses) { if (match) diagnosisByAbbreviation.set(match[1].toLowerCase(), diagnosis); } -// Lookup by title initialism (e.g., "MDD" from "Major depressive disorder", "OCD" from -// "Obsessive-compulsive disorder", "PDD" from "Persistent depressive disorder (dysthymia)"). -// Strip parentheticals first so aliases like PDD are not polluted by subtitle words. -// Splits on spaces, hyphens, and slashes. -const diagnosisByInitialism = new Map(); -for (const diagnosis of dsmDiagnoses) { - const initialism = diagnosis.title +function dsmTitleInitialism(title: string) { + return title .replace(/\([^)]*\)/g, " ") .split(/[\s\-\/]+/) .map((word) => word[0]) .filter((char) => Boolean(char) && /[A-Za-z0-9]/i.test(char)) .join("") .toLowerCase(); +} + +// Lookup by title initialism (e.g., "MDD" from "Major depressive disorder", "OCD" from +// "Obsessive-compulsive disorder", "PDD" from "Persistent depressive disorder (dysthymia)"). +// Strip parentheticals first so aliases like PDD are not polluted by subtitle words. +// Splits on spaces, hyphens, and slashes. +const diagnosisByInitialism = new Map(); +for (const diagnosis of dsmDiagnoses) { + const initialism = dsmTitleInitialism(diagnosis.title); if (initialism.length >= 2 && !diagnosisByInitialism.has(initialism)) { diagnosisByInitialism.set(initialism, diagnosis); } } +function dsmDiagnosisAliases(diagnosis: DsmDiagnosis) { + const aliases = new Set(); + const parenthetical = PARENTHETICAL_ABBREV_RE.exec(diagnosis.title)?.[1]; + if (parenthetical) aliases.add(normalizeSearchText(parenthetical)); + const initialism = dsmTitleInitialism(diagnosis.title); + if (initialism.length >= 2) aliases.add(initialism); + return [...aliases]; +} + // Lookup by normalized title with slashes collapsed to spaces, covering alternate formatting // such as "Persistent depressive disorder / dysthymia" matching the title // "Persistent depressive disorder (dysthymia)". @@ -175,7 +188,8 @@ export function rankDsmDiagnoses( { id: "title", weight: 8, - text: (diagnosis) => normalizeSearchText(`${diagnosis.title} ${diagnosis.slug}`), + text: (diagnosis) => + normalizeSearchText(`${diagnosis.title} ${diagnosis.slug} ${dsmDiagnosisAliases(diagnosis).join(" ")}`), }, { id: "code", @@ -203,9 +217,17 @@ export function rankDsmDiagnoses( compactBonus: 4, compactExtraText: (diagnosis) => normalizeSearchText(diagnosis.title), phraseBonus: 6, - exactValues: (diagnosis) => [normalizeSearchText(diagnosis.title), normalizeSearchText(diagnosis.slug)], + exactValues: (diagnosis) => [ + normalizeSearchText(diagnosis.title), + normalizeSearchText(diagnosis.slug), + ...dsmDiagnosisAliases(diagnosis), + ], exactBonus: 14, - prefixValues: (diagnosis) => [normalizeSearchText(diagnosis.title), normalizeSearchText(diagnosis.slug)], + prefixValues: (diagnosis) => [ + normalizeSearchText(diagnosis.title), + normalizeSearchText(diagnosis.slug), + ...dsmDiagnosisAliases(diagnosis), + ], prefixBonus: 5, expandTokens: (terms) => [...terms, ...normalizedExpansions], limit, diff --git a/tests/dsm.test.ts b/tests/dsm.test.ts index b1ececca3..045c534ff 100644 --- a/tests/dsm.test.ts +++ b/tests/dsm.test.ts @@ -60,4 +60,9 @@ describe("DSM clinical catalogue", () => { rankDsmDiagnoses("PDD", 5).some((match) => match.diagnosis.slug === "persistent-depressive-disorder-dysthymia"), ).toBe(true); }); + + it("ranks abbreviation queries above incidental differential mentions", () => { + expect(rankDsmDiagnoses("MDD", 1)[0]?.diagnosis.slug).toBe("major-depressive-disorder"); + expect(rankDsmDiagnoses("PDD", 1)[0]?.diagnosis.slug).toBe("persistent-depressive-disorder-dysthymia"); + }); }); From b367aeb084a60fc46d3e4e8d3b318491a1530ac6 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Wed, 15 Jul 2026 00:15:48 +0800 Subject: [PATCH 10/12] fix: remove unused modeIdByDomain to clear Static PR lint ESLint --max-warnings 0 failed on the unused local domain-to-mode map after universalSearchModeForDomain took over that lookup. Co-authored-by: Cursor --- .../universal-search-command-surface.tsx | 14 -------------- 1 file changed, 14 deletions(-) diff --git a/src/components/clinical-dashboard/universal-search-command-surface.tsx b/src/components/clinical-dashboard/universal-search-command-surface.tsx index edaa92c06..0f015e723 100644 --- a/src/components/clinical-dashboard/universal-search-command-surface.tsx +++ b/src/components/clinical-dashboard/universal-search-command-surface.tsx @@ -47,20 +47,6 @@ const domainsByTargetMode: Partial> = tools: ["tools"], }; -const modeIdByDomain: Record = { - documents: "documents", - medications: "prescribing", - services: "services", - forms: "forms", - differentials: "differentials", - // Presentations are the differentials mode's umbrella pages — no app mode of their own, - // so the group borrows the differentials icon and "View all in Differentials" target. - presentations: "differentials", - dsm: "dsm", - specifiers: "formulation", - tools: "tools", -}; - const domainHeadings: Record = { documents: "Documents", medications: "Medications", From d65473e737e5d56d12198d37dc8426fde09c0bb0 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Wed, 15 Jul 2026 00:29:05 +0800 Subject: [PATCH 11/12] fix: match formulation redirect smoke assertion to curly quotes The home heading uses curly quotes around the query, matching the Specifiers redirect smoke coverage, so the straight-quote assertion timed out. Co-authored-by: Cursor --- tests/ui-smoke.spec.ts | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/tests/ui-smoke.spec.ts b/tests/ui-smoke.spec.ts index 67839082a..923ce8ed0 100644 --- a/tests/ui-smoke.spec.ts +++ b/tests/ui-smoke.spec.ts @@ -2382,7 +2382,7 @@ test.describe("Clinical KB UI smoke coverage", () => { await expect(page).toHaveURL(/\/formulation\?q=I\+keep\+going\+over\+it&focus=1&run=1$/); await expect( - page.getByRole("heading", { level: 1, name: 'Mechanisms matching "I keep going over it"' }), + page.getByRole("heading", { level: 1, name: "Mechanisms matching “I keep going over it”" }), ).toBeVisible(); }); From 9e013894b2e45d6be39af1ef4593a14604886476 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Wed, 15 Jul 2026 00:32:59 +0800 Subject: [PATCH 12/12] fix: preserve DSM search ids and AU/US spelling ranking Keep comparison ids on category filter links, and add common AU/US DSM spelling variants so queries like generalized anxiety disorder rank the catalogue record first. Co-authored-by: Cursor --- src/components/dsm/dsm-search-page.tsx | 9 +++--- src/lib/dsm.ts | 45 +++++++++++++++++++------- tests/dsm.test.ts | 4 +++ 3 files changed, 42 insertions(+), 16 deletions(-) diff --git a/src/components/dsm/dsm-search-page.tsx b/src/components/dsm/dsm-search-page.tsx index 93cc066e3..d90d00b4e 100644 --- a/src/components/dsm/dsm-search-page.tsx +++ b/src/components/dsm/dsm-search-page.tsx @@ -8,10 +8,11 @@ import { DsmPageHeader } from "@/components/dsm/dsm-page-header"; import { cn, codeText, metadataPill, pageContainer } from "@/components/ui-primitives"; import type { DsmCategory, DsmDiagnosisSummary } from "@/lib/dsm"; -function categoryHref(query: string, category?: string) { +function categoryHref(query: string, category?: string, ids: string[] = []) { const params = new URLSearchParams(); if (query) params.set("q", query); if (category) params.set("category", category); + if (ids.length) params.set("ids", ids.join(",")); const suffix = params.toString(); return suffix ? `/dsm/search?${suffix}` : "/dsm/search"; } @@ -87,7 +88,7 @@ export function DsmSearchPage({ {activeCategory ? ( Clear filter @@ -96,7 +97,7 @@ export function DsmSearchPage({
    ( ([base]); + let towardUs = base; + let towardAu = base; + for (const [au, us] of DSM_SPELLING_PAIRS) { + towardUs = towardUs.replaceAll(au, us); + towardAu = towardAu.replaceAll(us, au); + } + variants.add(towardUs); + variants.add(towardAu); + return [...variants]; +} + +function dsmTitleSearchValues(diagnosis: DsmDiagnosis) { + const values = new Set([ + ...dsmSpellingVariants(diagnosis.title), + normalizeSearchText(diagnosis.slug), + ...dsmDiagnosisAliases(diagnosis), + ]); + return [...values]; +} + // Lookup by normalized title with slashes collapsed to spaces, covering alternate formatting // such as "Persistent depressive disorder / dysthymia" matching the title // "Persistent depressive disorder (dysthymia)". @@ -188,8 +218,7 @@ export function rankDsmDiagnoses( { id: "title", weight: 8, - text: (diagnosis) => - normalizeSearchText(`${diagnosis.title} ${diagnosis.slug} ${dsmDiagnosisAliases(diagnosis).join(" ")}`), + text: (diagnosis) => dsmTitleSearchValues(diagnosis).join(" "), }, { id: "code", @@ -217,17 +246,9 @@ export function rankDsmDiagnoses( compactBonus: 4, compactExtraText: (diagnosis) => normalizeSearchText(diagnosis.title), phraseBonus: 6, - exactValues: (diagnosis) => [ - normalizeSearchText(diagnosis.title), - normalizeSearchText(diagnosis.slug), - ...dsmDiagnosisAliases(diagnosis), - ], + exactValues: (diagnosis) => dsmTitleSearchValues(diagnosis), exactBonus: 14, - prefixValues: (diagnosis) => [ - normalizeSearchText(diagnosis.title), - normalizeSearchText(diagnosis.slug), - ...dsmDiagnosisAliases(diagnosis), - ], + prefixValues: (diagnosis) => dsmTitleSearchValues(diagnosis), prefixBonus: 5, expandTokens: (terms) => [...terms, ...normalizedExpansions], limit, diff --git a/tests/dsm.test.ts b/tests/dsm.test.ts index 045c534ff..5f94a6ad6 100644 --- a/tests/dsm.test.ts +++ b/tests/dsm.test.ts @@ -65,4 +65,8 @@ describe("DSM clinical catalogue", () => { expect(rankDsmDiagnoses("MDD", 1)[0]?.diagnosis.slug).toBe("major-depressive-disorder"); expect(rankDsmDiagnoses("PDD", 1)[0]?.diagnosis.slug).toBe("persistent-depressive-disorder-dysthymia"); }); + + it("ranks US DSM spellings to the matching catalogue diagnoses", () => { + expect(rankDsmDiagnoses("generalized anxiety disorder", 1)[0]?.diagnosis.slug).toBe("generalised-anxiety-disorder"); + }); });