DC-LD: Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities Mental Retardation

152 Pages·2001·0.51 MB·English

by  Royal College of Psychiatrists

DC–LD
(cid:1)
[[[[[DDDDDiiiiiaaaaagggggnnnnnooooossssstttttiiiiiccccc cccccrrrrriiiiittttteeeeerrrrriiiiiaaaaa fffffooooorrrrr pppppsssssyyyyyccccchhhhhiiiiiaaaaatttttrrrrriiiiiccccc
dddddiiiiisssssooooorrrrrdddddeeeeerrrrrsssss fffffooooorrrrr uuuuussssseeeee wwwwwiiiiittttthhhhh aaaaaddddduuuuullllltttttsssss wwwwwiiiiittttthhhhh
RRRRRoooooyyyyyaaaaalllll CCCCCooooolllllllllleeeeegggggeeeee ooooofffff PPPPPsssssyyyyyccccchhhhhiiiiiaaaaatttttrrrrriiiiissssstttttsssss
OOOOOccccccccccaaaaasssssiiiiiooooonnnnnaaaaalllll PPPPPaaaaapppppeeeeerrrrr OOOOOPPPPP 4444488888
(cid:1)(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:6)
1
This page intentionally left blank
2
DC–LD
(cid:1)
[Diagnostic criteria for psychiatric
disorders for use with adults with learning
disabilities/mental retardation]
Royal College of Psychiatrists
Occasional Paper OP48
Gaskell
London
i
DC–LD
© The Royal College of Psychiatrists 2001
Gaskell is an imprint of the Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG
All rights reserved. No part of this book may be reprinted
or reproduced or utilised in any form or by any electronic,
mechanical or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
BBBBBrrrrriiiiitttttiiiiissssshhhhh LLLLLiiiiibbbbbrrrrraaaaarrrrryyyyy CCCCCaaaaatttttaaaaallllloooooggggguuuuuiiiiinnnnnggggg-----iiiiinnnnn-----PPPPPuuuuubbbbbllllliiiiicccccaaaaatttttiiiiiooooonnnnn DDDDDaaaaatttttaaaaa
A catalogue record for this book is available from
the British Library.
ISBN 1-901242-61-7
Distributed in North America
by American Psychiatric Press, Inc.
Occasional Papers have not been formally approved by Council of
the Royal College of Psychiatrists, and do not constitute College
policy. The views presented in this book do not necessarily reflect
those of the Royal College of Psychiatrists, and the publishers are
not responsible for any error of omission or fact.
Gaskell is a registered trademark of the Royal College of
Psychiatrists.
The Royal College of Psychiatrists is a registered charity
(no. 228636).
ii
CONTENTS
PREFACE x
CAUTIONARY NOTE xii
DC–LD DEVELOPMENT WORKING GROUP MEMBERS xiii
DC–LD CONSULTATIVE GROUP MEMBERS xiv
INTRODUCTION 1
The relationship of DC–LD to ICD–10 and DSM–IV 1
The process of development of DC–LD 2
CODING AND RECORDING 4
DIAGNOSIS OF PSYCHIATRIC DISORDERS IN ADULTS
WITH LEARNING DISABILITIES 6
The stages of psychiatric diagnosis 6
Additional considerations regarding psychiatric
diagnosis in adults with learning disabilities the
that have led to development of DC–LD 7
SPECIAL ISSUES IN DEVELOPING DC–LD 10
ICD–10 ‘organic’ disorders 10
Behavioural phenotypes 11
A hierarchical approach to diagnosis 13
AXIS I: SEVERITY OF LEARNING DISABILITIES 18
Severity of learning disabilities: Introduction 18
AXIS II: CAUSES OF LEARNING DISABILITIES 19
Causes of learning disabilities: Introduction 19
II 1.1 Unknown 19
Chapter I: Certain infectious and parasitic diseases 19
Chapter IV: Endocrine, nutritional and metabolic
diseases 19
Chapter V: Mental and behavioural disorders 20
Chapter VI: Diseases of the nervous system 20
Chapter XVI: Certain conditions originating in the
perinatal period 20
Chapter XVII: Congenital malformations,
deformities, and chromosomal abnormalities 21
Chapter XIX: Injury, poisoning and certain other
consequences of external causes 23
iii
DC–LD
AXIS III: PSYCHIATRIC DISORDERS 24
DC–LD LEVEL A: DEVELOPMENTAL DISORDERS 24
Pervasive developmental disorders: Introduction 24
IIIA1.1 Autism (childhood onset) [equivalent to
F84.0]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999999999.....0000000000]]]]] 24
IIIA1.2 Autism (age of onset unknown)
[equivalent to F84.0]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999999999.....0000000000]]]]] 24
Other ICD–10 pervasive developmental disorders 25
Specific developmental disorders: Introduction 25
DC–LD LEVEL B: PSYCHIATRIC ILLNESS 26
Dementia: Introduction 26
IIIB1.1 Unspecified dementia [equivalent to F03];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999944444.....88888]]]]] 29
IIIB1.2 Dementia in Alzheimer’s disease,
unspecified [equivalent to F00.9xx]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt
tttttooooo 222229999900000.....00000,,,,, 222229999900000.....11111xxxxx,,,,, 222229999900000.....22222xxxxx,,,,, 222229999900000.....33333]]]]] 30
IIIB1.3 Vascular dementia, unspecified [equivalent
to F01.9xx]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999900000.....44444xxxxx]]]]] 31
IIIB1.4 Dementia in Huntington’s disease
[equivalent to F02.2xx]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999944444.....11111]]]]] 31
Other ICD–10 dementias 31
Delirium: Introduction 32
IIIB2.1 Delirium [equivalent to F05.x];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999933333.....00000,,,,, 777778888800000.....0000099999]]]]] 33
Non-affective psychotic disorders: Introduction 35
IIIB3.1x Schizophrenic/delusional episode;
schizophrenic/delusional disorders [equivalent
to F20. xx, F22.x, F23.xx]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
222229999955555.....xxxxxxxxxx,,,,, 222229999955555.....4444400000,,,,, 222229999977777.....11111,,,,, 222229999988888.....88888]]]]] 38
IIIB3.2xx Schizoaffective episode; schizoaffective
disorders [equivalent to F25.xx];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999955555.....7777700000]]]]] 40
IIIB3.3 Other non-affective psychotic disorders
[equivalent to F28]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999988888.....99999]]]]] 41
Other ICD–10 non-affective psychotic disorders 41
Affective disorders: Introduction 43
IIIB4.1xx Depressive episode; bipolar affective
disorder; recurrent depressive disorder
[equivalent to F32.xx, F31.3, F31.4, F31.5,
F33.xx]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999966666.....22222xxxxx,,,,, 222229999966666.....55555xxxxx,,,,, 222229999966666.....8888899999
(((((dddddeeeeeppppprrrrreeeeesssssssssseeeeeddddd))))),,,,, 222229999966666.....33333xxxxx]]]]] 44
IIIB4.2xx Manic episode; bipolar affective disorder
[equivalent to F30.x, F31.0, F31.1, F31.2];
iv
Contents
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999966666.....00000xxxxx,,,,, 222229999966666.....4444400000,,,,, 222229999966666.....44444xxxxx,,,,, 222229999966666.....8888899999
(((((hhhhhyyyyypppppooooommmmmaaaaannnnniiiiiccccc)))))]]]]] 47
IIIB4.3xx Mixed affective episode; bipolar affective
disorder [equivalent to F38.00, F31.6];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999966666.....00000xxxxx (((((mmmmmiiiiixxxxxeeeeeddddd))))),,,,, 222229999966666.....66666xxxxx]]]]] 48
IIIB4.4 Other specified mood (affective) disorders
[equivalent to F38.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 222229999966666.....9999900000]]]]] 49
Other ICD–10 affective disorders 49
Neurotic and stress-related disorders: Introduction 50
IIIB5.1x Agoraphobia [equivalent to F40.00,
F40.01]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....2222211111,,,,, 333330000000000.....2222222222]]]]] 53
IIIB5.2 Social phobia [equivalent to F40.1];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....2222233333]]]]] 54
IIIB5.3 Specific phobias [equivalent to F40.2];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....2222299999]]]]] 55
IIIB5.4 Panic disorder [equivalent to F41.0];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....11111]]]]] 55
IIIB5.5 Generalised anxiety disorder [equivalent
to F41.1]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....0000022222]]]]] 56
IIIB5.6 Other specified anxiety disorders
[F41.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....0000000000]]]]] 57
IIIB5.7 Other phobic anxiety disorders
[F40.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....0000000000]]]]] 57
IIIB5.8 Obsessive–compulsive disorder
[equivalent to F42.x]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000000000.....33333]]]]] 57
IIIB5.9 Acute stress reaction [equivalent to
F43.0x]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000088888.....33333]]]]] 58
IIIB5.10 Adjustment disorders [equivalent to
F43.2x]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000099999.....00000,,,,, 333330000099999.....22222xxxxx,,,,, 333330000099999.....33333,,,,,
333330000099999.....44444,,,,, 333330000099999.....99999]]]]] 59
IIIB5.11 Other reactions to severe stress
[F43.8]; [[[[[–––––]]]]] 60
Other ICD–10 neurotic and stress-related disorders 60
Eating disorders: Introduction 61
IIIB6.1 Anorexia nervosa [equivalent to F50.0,
F50.1]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000077777.....11111,,,,, 333330000077777.....5555500000]]]]] 64
IIIB6.2 Bulimia nervosa [equivalent to F50.2,
F50.3]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000077777.....5555511111,,,,, 333330000077777.....5555500000]]]]] 64
IIIB6.3 Binge eating disorder [equivalent to F50.8];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000077777.....5555500000]]]]] 65
IIIB6.4x Psychogenic over-eating episode;
psychogenic over-eating disorder [equivalent
to F50.4]; [[[[[–––––]]]]] 66
IIIB6.5x Psychogenic vomiting episode; psycho-
genic vomiting disorder [equivalent to F50.5]; [[[[[–––––]]]]] 66
v
DC–LD
IIIB6.6x Psychogenic loss of appetite episode;
psychogenic loss of appetite disorder
[equivalent to F50.8]; [[[[[–––––]]]]] 67
IIIB6.7 Food faddiness/food refusal disorder
[equivalent to F50.8, F98.2]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
333330000077777.....5555599999,,,,, 333330000077777.....5555500000]]]]] 68
IIIB6.8 Food rumination/regurgitation disorder
[equivalent to F50.8, F98.2]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
333330000077777.....5555533333,,,,, 333330000077777.....5555500000]]]]] 68
IIIB6.9 Pica [equivalent to F50.8, F98.3, F7x.12];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000077777.....5555522222]]]]] 68
IIIB6.10 Excessive chewing/spitting out food
disorder [equivalent to F50.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
333330000077777.....5555500000]]]]] 69
Hyperkinetic disorders: Introduction 69
IIIB7.1 Attention-deficit hyperactivity disorder of
adults (childhood onset) [equivalent to F90.0,
F7x.13]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111144444.....0000011111]]]]] 70
IIIB7.2 Attention-deficit hyperactivity disorder of
adults (age of onset unknown) [equivalent to
F90.0, F7x.13]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111144444.....0000011111]]]]] 71
Tic and movement disorders: Introduction 72
DC–LD LEVEL C: PERSONALITY DISORDERS 72
Personality disorders: Introduction 72
IIIC1.1 Personality disorder, unspecified
[equivalent to F60.9]; [[[[[–––––]]]]] 75
IIIC1.2 Paranoid personality disorder [equivalent
to F60.0]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....00000]]]]] 76
IIIC1.3 Dissocial personality disorder [equivalent
to F60.2]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....77777]]]]] 76
IIIC1.4 Emotionally unstable personality
disorder – impulsive type [equivalent to F60.30];
[[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....99999]]]]] 77
IIIC1.5 Emotionally unstable personality
disorders – borderline type [equivalent to
F60.31]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....8888833333]]]]] 77
IIIC1.6 Histrionic personality disorder [equivalent
to F60.4]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....5555500000]]]]] 78
IIIC1.7 Anankastic personality disorder [equivalent
to F60.5]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....44444]]]]] 78
IIIC1.8 Other specific personality disorder
[equivalent to F60.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333330000011111.....8888811111,,,,,
333330000011111.....99999]]]]] 78
Other ICD–10 personality disorders 79
vi
Contents
DC–LD LEVEL D: PROBLEM BEHAVIOURS 79
Problem behaviours: Introduction 79
IIID1.1 General diagnostic criteria for problem
behaviours [equivalent to F7x.1, F69]; [[[[[–––––]]]]] 83
IIID1.2 Verbally aggressive behaviour [equivalent
to F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 84
IIID1.3 Physically aggressive behaviour [equivalent
to F7x.15, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 84
IIID1.4 Destructive behaviour [equivalent to
F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 84
IIID1.5 Self-injurious behaviour [equivalent to
F7x.11, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 85
IIID1.6 Sexually inappropriate behaviour
[equivalent to F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
333331111122222.....99999]]]]] 85
IIID1.7 Oppositional behaviour [equivalent to
F7x.1, F91.3, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111133333.....8888811111,,,,,
333331111122222.....99999]]]]] 85
IIID1.8 Demanding behaviour [equivalent to
F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 86
IIID1.9 Wandering behaviour [equivalent to F7x.14,
F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 86
IIID1.10(x–x) Mixed problem behaviours
[equivalent to F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
333331111122222.....99999]]]]] 86
IIID1.11 Other problem behaviours [equivalent
to F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo 333331111122222.....99999]]]]] 86
IIID1.12 Mixed other problem behaviours
[equivalent to F7x.1, F68.8]; [[[[[eeeeeqqqqquuuuuiiiiivvvvvaaaaallllleeeeennnnnttttt tttttooooo
333331111122222.....99999]]]]] 87
Supplementary categories – problem behaviours
that are directly caused by other disorders:
Introduction 87
IIID2.1(x–x) Problem behaviour/s due to
pervasive developmental disorder (type/s)
[–]; [[[[[–––––]]]]] 87
IIID2.2(x–x) Problem behaviour/s due to
psychiatric illness (type/s) [–]; [[[[[–––––]]]]] 88
IIID2.3(x–x) Problem behaviour/s due to
personality disorder (type/s) [–]; [[[[[–––––]]]]] 89
IIID2.4(x–x) Problem behaviour/s due to
physical illness/disorder (type/s) [–]; [[[[[–––––]]]]] 89
DC–LD LEVEL E: OTHER DISORDERS 90
Other disorders: Introduction 90
vii
DC–LD
ACKNOWLEDGEMENTS 94
REFERENCES 95
APPENDIX 1: LEARNING DISABILITIES SYNDROMES
AND BEHAVIOURAL PHENOTYPES 96
Aicardi syndrome 96
Angelman syndrome 96
Cornelia de Lange syndrome 97
Cri du Chat syndrome 97
Down’s syndrome 97
Foetal alcohol syndrome 98
Fragile X syndrome 98
Klinefelter syndrome 99
Lesch-Nyhan syndrome 99
Noonan syndrome 99
Phenylketonuria 100
Prader-Willi syndrome 100
Rett syndrome 101
Rubenstein-Taybi syndrome 101
Smith-Magenis syndrome 101
Sotos syndrome 102
Tuberous sclerosis 102
Turner syndrome 103
Velocardiofacial syndrome 103
Williams syndrome 103
APPENDIX 2: ICD–10 CHAPTERS OTHER THAN V –
OTHER ASSOCIATED MEDICAL CONDITIONS 105
Chapter I: Certain infectious and parasitic diseases 105
Chapter II: Neoplasms 105
Chapter III: Diseases of the blood and blood-forming
organs and certain diseases involving the immune
mechanism 105
Chapter IV: Endocrine, nutritional and metabolic
diseases 105
Chapter VI: Diseases of the nervous system 106
Chapter VII: Diseases of the eye and adnexa 108
Chapter VIII: Diseases of the ear and mastoid process 108
Chapter IX: Diseases of the circulatory system 108
Chapter X: Diseases of the respiratory system 109
Chapter XI: Diseases of the digestive system 109
Chapter XII: Diseases of the skin and subcutaneous
tissue 109
Chapter XIII: Diseases of the musculoskeletal
system and connective tissue 110
Chapter XIV: Diseases of the genitourinary system 110
viii