Mental Health

Have Mental Health Questions? Ask a Psychiatrist Online

Ask an Expert,
Get an Answer ASAP!

Mental Health

What is diagnostic code 300.40 please? i supplemented this

Customer Question
post with further info, please...
what is diagnostic code 300.40 please? i supplemented this post with further info, please advise you did get that further info please.
Submitted: 7 years ago.Category: Mental Health
Show More
Show Less
Ask Your Own Mental Health Question
Answered in 11 minutes by:
12/8/2010
Mental Health Professional: Dr. Mark, Psychotherapist replied 7 years ago
Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
Experience: Dr. Mark is a PhD in psychology in private practice
Verified

Hi! I believe I can be of help with this issue.

300.40 is the diagnostic code (both in ICD-9, which is what insurance companies have us report the diagnoses in, and DSM-IV which is the psychiatric diagnostic coding system) for dysthymic disorder. What is that?

Well, without getting too technical, dysthymic disorder is one of the depressive disorders.

In order to truly understand the diagnosis, though, I will have to explain that a clear difference between Dysthymia and Major Depressive Disorder (MDD) doesn't exist. Functionally, I can tell you that the difference is a matter of how long the problem has manifested. If it's lasted without abating longer than a few months, it's going to be Dysthymic Disorder. Otherwise it will be MDD. Here's how the Diagnostic and Statistical Manual classifies them so you can see for yourself and get a better idea. Let's look at it and then I'll continue. Here's the entry for MDD:

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Major Depressive Disorder


Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Recurrent

A. Presence of two or more Major Depressive Episodes.

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.

Now, let’s look at the criteria for Dysthymic disorder:

According to the DSM-IV, dysthymia is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:

  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem
  • poor concentration or difficulty making decisions
  • feelings of hopelessness

In addition, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. Further, the symptoms cannot be due to the direct physiological effects of a the use or abuse of a substance such as alcohol, drugs or medication or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

So you see she's been diagnosed with dysthymic disorder probably because the depressive symptoms have been going on for a long while and there wasn't a specific event that triggered them. Your description of her, though, doesn't seem to match the diagnosis very well. So, she may not have told her doctors and psychologists much of what you told me here.

I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, ***** *****

Ask Your Own Mental Health Question
Customer reply replied 7 years ago
it sounds like you did get my description of her that includes the sexual acting out when she drinks while on wellbutrin...is there an express contraindication for -OH and an ssri like wellbutrin? what to make of the sexual acting out?
Mental Health Professional: Dr. Mark, Psychotherapist replied 7 years ago
I got it. And I don't blame the Wellbutrin for her acting out sexually while drinking. This is her own permission giving mechanism more than anything else most often.

What do I make from the acting out? There's no definitive statement that can be made. I can, however, share with you my first thoughts:

I would, if she were in my session room, first explore the following if I had this information about her. I would want to know about sexual abuse or molestation when she was young. The behavior, in my experience, is most consistent with that type of childhood situation and is often part of a personality disorder problem or PTSD reaction. After that, I would be looking for dysfunction in the home when she grew up, but this isn't quite the behavior that fits that but sometimes it is seen like this.

So you see my first thought is not just a behavioral issue. Caveat: the drinking is most likely a numbing agent for her. Emotional numbing. Whatever the pain is. Again, you see I'm still thinking in terms of something in her early life that didn't go right. But, my point here is that no treatment is worth much in therapy without her first getting treated for the alcoholism. Yeah, I know, you didn't say that. But in my practice, it's a waste of the client's money and my time unless the person actually admits to herself she's got a problem. And then goes to AA where they know how to give the support she'll need to win over the bottle. Then I would accept her as a client/patient.

So, that's as honest and open as I can be about this that you've presented. I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, ***** *****

Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
Experience: Dr. Mark is a PhD in psychology in private practice
Verified
Dr. Mark and 87 other Mental Health Specialists are ready to help you
Ask your own question now
Customer reply replied 6 years ago

Hello Dr. Mark,

Following up on the above, now-former gf.

We had a rocky winter, spring and summer. In August, her parents - bitterly divorced since she was 10 and rarely speak - met at mom's behest to discuss my 48 yo gf's behavior. Mom was concerned. Dad is a lawyer. The meeting got back to me, and I learned they had contemplated not only formal intervention but involuntary inpatient tx. [Understand this is a highly functioning doctor.....] The symptoms concerning them were irritability, paranoia, lability, drinking and others.

When I learned of it I reported it to her. As an atty myself, I felt it was inappropriate, nws my 18 month concerns about the same symptoms. When the family learned I had disclosed this, they scattered and I became odd man out. She was of course terrified.

So with that background, i have new questions. What do borderline PD and narcissistic PD look like? Ive read the DSM. But in the trenches? She's NEVER been married, has that pervasive history of unstable relationships, great feelings of abandonment and emptiness, and random outburts of scary anger that go on for awhile. She's really a difficult person, her family and office staff describe to me years of just being difficult. And her education and family of origin: parents divorced at 10, lived thereafter with very bitter mom, Wellesley undergrad, long series of rel's w/older, married men began in med school, fellowship and practice in MFM, which is all women all the time and her staff is all women. But she is very highly hetero-sexed. Help me understand this woman....

Mental Health Professional: Dr. Mark, Psychotherapist replied 6 years ago

Hi! It's nice to hear from you. I guess that's a tough thing to say given that it's because she's not doing well and you've had a hard time, but it's nice to know what's going on.

Let's first discuss narcissism vs. Borderline Personality Disorder (BPD). You've seen the DSM criteria so we'll dispense with the broad technical aspects. I already had BPD in my thoughts before you mentioned it. So you know right away my diagnostic bias here. Why BPD?

Narcissists can be controlling, manipulative, have unstable relationships, and be hypersexual like those with BPD. But the defining aspect of narcissism is this: she's the sun and everyone else is a moon that revolves around her. Of course the people around her should want to make her happy and make sure she's satisfied: after all, if she's feeling good, then they already are mostly all the way to feeling good as well. the controlling aspect is paramount: narcissists don't let people go that easily from their orbit. And they're rarely emotionally labile in uncontrolled ways. And NPD forms during the first few years in life.

She seems to have had the BPD childhood of instability and parents who were unstable themselves during the mid childhood. So, you've more likely experienced what BPD is like. Loved ones rarely stay. The turnover rate is very, very high. Because there's always drama, always blaming, always emotional intensity.

Randi Krieger and Paul Mason wrote a book you will find in the library though it's very popular and may be checked out. So you may want to buy it online. It is called Stop Walking on Eggshells. Her is the Amazon page for it:

http://www.amazon.com/Stop-Walking-Eggshells-Borderline-Personality/dp/1572246901/ref=sr_1_1?s=books&ie=UTF8&qid=1284441698&sr=1-1

She also has a wonderful online group called the Oz Online Community for Family Members. If you look through the discussions in her groups you'll more than likely recognize what you've experienced. The book, though, may do that enough now that you're out of it. She's a very nice person, too. Here's the web page:

http://www.bpdcentral.com/support/email.shtml



It was very kind of you to step in and help her like that. BPD more than likely prevented her from being able to deal with that niceness in a normal healthy way. But it was an honorable thing to do. BPD often lands sufferers in the hospital but involuntary hospitalization would have precipitated a crisis and long instability almost certainly.

Okay, I wish you the very best!

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. Feel free to continue the discussion as my goal is to get you the best answer possible. You can continue the discussion even after pressing ACCEPT. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, ***** *****

Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
Experience: Dr. Mark is a PhD in psychology in private practice
Verified
Dr. Mark and 87 other Mental Health Specialists are ready to help you
Ask your own question now
Ask Dr. Mark Your Own Question
Dr. Mark
Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
5,334 Satisfied Customers
Experience: Dr. Mark is a PhD in psychology in private practice

Dr. Mark is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much

Corrie MollPretoria, South Africa

I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well!

ClaudiaAlbuquerque, NM

Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.

KevinBeaverton, OR

Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
I feel better already! Thank you.

ElanorTracy, CA

Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem.

JulieLockesburg, AR

You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions.

John and StefanieTucson, AZ

I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!!

Janet VPhoenix, AZ

< Previous | Next >

Meet the Experts:

Dr. Keane

Dr. Keane

Therapist

1,379 satisfied customers

Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.

TherapistMarryAnn

TherapistMarryAnn

Therapist

4,021 satisfied customers

Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.

Dr. Olsen

Dr. Olsen

Psychologist

2,336 satisfied customers

PsyD Psychologist

Norman M.

Norman M.

Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA

2,246 satisfied customers

ADHP(NC), DEHP(NC), ECP, UKCP Registered.

Dr. Michael

Dr. Michael

Psychologist

2,177 satisfied customers

Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.

Steven Olsen

Steven Olsen

Therapist

1,728 satisfied customers

More than twenty years of expertise in counseling, psychological diagnosis and education

Anna

Anna

Mental Health Professional

1,656 satisfied customers

Licensed Clinical Social Worker with 29 years in addictions and mental health.

< Previous | Next >

Related Mental Health Questions
I'm depressed just finished my divorce yesterday feel so sad
Hello, I'm depressed just finished my divorce yesterday feel so sad how to get over it faster no energy my eyes tell on me. My X is who wanted it he has abusive and acts like the victim and blames me … read more
Linda D.
Linda D.
Master\u0027s Degree
794 satisfied customers
Just having really bad insomnia feel like I'm never getting
Just having really bad insomnia feel like I'm never getting sleep no energy, hallucinations and delusions since I was a teenager, and recently been biting my tongue non stop … read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
204 satisfied customers
I have schizoaffective disorder. Sometimes, I hear mumbling
I have schizoaffective disorder. Sometimes, I hear mumbling audible voices in the air conditioning and heating systems. These voices shut off when the systems shut off. I don't always hear these voice… read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
204 satisfied customers
I have a question about schizophrenia: I have been told it
Hi I have a question about schizophrenia: I have been told it burns itself out in your fifties, is that True?… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
Im struggling alot about handling. Strws. Sad and i dont
Ever since i was little i always struggled with waking up sad and then bursting into tears for no reason… read more
Linda D.
Linda D.
Master\u0027s Degree
794 satisfied customers
I suffer from social anxiety, insomnia, panic attacks, and
Hi, My name is***** suffer from social anxiety, insomnia, panic attacks, and ocd. I had a doctor for a while, when i had health insurance. I lost my insurance, and she changed practices and can't see … read more
JohnMichaels,MS,LPC
JohnMichaels,MS,LPC
Counselor
Master\u0027s Degree
170 satisfied customers
I feel this feeling of guilt and sadness and I'm not sure
I feel this feeling of guilt and sadness and I'm not sure why Would you happen to have an explanation for that … read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
Im stopping 25mg zyprexa used for insomnia and dr prescribed
Im stopping 25mg zyprexa used for insomnia and dr prescribed me restoril and cogentin as a replacement will i have any withdrawls … read more
Dr. Scott
Dr. Scott
Doctor
1,030 satisfied customers
I feel sad so much I need help dealing with how I feel
I feel sad so much I need help dealing with how I feel because it's affecting with my relationship with my boyfriend and my happiness in general… read more
JohnMichaels,MS,LPC
JohnMichaels,MS,LPC
Counselor
Master\u0027s Degree
170 satisfied customers
I have anxiety issues as well as insomnia and I no longer
I have anxiety issues as well as insomnia and I no longer have a PCP and am looking for a good dr … read more
Dr. Mo
Dr. Mo
Board Certified Physician
MD
1,781 satisfied customers
Second opinion] OKMH98-130 I've been very sad and in a bad
second opinion] OKMH98-130 I've been very sad and in a bad state of mind ever since my mother figure passed away last year. I suffer from insomnia ever since. Loss of interest in daily activities. I p… read more
Juliet Cooper
Juliet Cooper
Doctorate of Psychology
29 satisfied customers
After 1 year schizophrenia phase, my ego got disintegrated
HI. After 1 year long schizophrenia phase, my ego got disintegrated and now pieces of my personality is being slowly organized. I can feel that diffenence (like the feelings of sense of self, and ego … read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,678 satisfied customers
OKMH98-130 I've been very sad and in a bad state of mind
OKMH98-130 I've been very sad and in a bad state of mind ever since my mother figure passed away last year. I suffer from insomnia ever since. I've been sad often. I noticed my mood is better when I'm… read more
Linda D.
Linda D.
Master\u0027s Degree
794 satisfied customers
I think I have Borderline Personality Disorder, but this is
I think I have Borderline Personality Disorder, but this is just self-diagnosis. How will I know if I really do have it and what are the ways to cope up?… read more
Linda D.
Linda D.
Master\u0027s Degree
794 satisfied customers
I take Risperdal Consta for schizoaffective disorder and
I take Risperdal Consta for schizoaffective disorder and have been taking it every two weeks since 2008. Now, I hear it causes breast cancer. It's a great drug for me. Keeps me very stable. Along with… read more
Dr. Z
Dr. Z
Psychologist
Doctoral Degree
9,633 satisfied customers
I have been in a major depression disorder since 2008 when I
I have been in a major depression disorder since 2008 when I was laid off from my job. I go therapy and take cymbalta 60 x 2, 300 of lamictal and 25 of seraquel. An yet out seems like it doesn't impro… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
I have been diagnosed with Major Depressive disorder by my
I have been diagnosed with Major Depressive disorder by my psychiatrist with Kaiser. I am in my fourth episode in 30 years now brought on by my son leaving for college, divorcing my wife of 27 years a… read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
204 satisfied customers
I have borderline personality disorder and anxiety attacks
I live with borderline personality disorder and since I lost my job I started to have quite bad anxiety attacks and I wake up at night from nightmares and shake and cry. The level of anxiety is so hig… read more
Therapist Leslie
Therapist Leslie
Masters, Professional Psychology
5 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x