Medical Criteria – M

Medical Criteria – M

MULTIPLE MYELOMA:

• International Myeloma Working Group Criteria (“SLiM CRAB”):
  • Sixty (60) percent or greater abnormal plasma cells on bone marrow examination
  • Light chain ratio (free, involved/uninvolved) of 100 or more in the blood (involved must be at least 100 mg/L)
  • MRI with more than one bone lesion (5 mm or greater)
  • CRAB – presence of end-organ damage related to plasma cell dyscrasia, such as:
    1. Increased serum Ca2+
    2. Renal failure
    3. Anaemia
    4. Lytic bone lesions

MIGRAINE HEADACHES:

• Definition of Common Migraine

• • ≥5 attacks fulfilling each of the following criteria
    1. 4-72 h duration
    2. 2 of the following: unilateral, pulsating, moderate-severe (interferes with daily activity), aggravated by routine physical activity
    3. 1 of the following: nausea/vomiting, photophobia/phonophobia/osmophobia

REVISED MCDONALD CRITERIA (2017):

• Dissemination in time: ≥2 attacks, simultaneous presence of gadolinium enhancing and non-enhancing MRI lesions at any time, or a new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, presence of CSF oligoclonal bands
• Dissemination in space: ≥1 T2 lesions on MRI in at least 2 of the 4 CNS regions (periventricular, juxtacortical, infratentorial, or spinal cord) or developing a second attack that implicates a different CNS region

MODIFIED DANDY’S CRITERIA:

• Symptoms of raised ICP
• No localizing signs except sixth nerve palsy
• Patient awake and alert
• Normal neuroimaging without evidence of thrombosis
• LP opening pressure >25 cm H2O, normal CSF
• No better explanation for raised ICP

MIREL’S CRITERIA FOR IMPENDING FRACTURE RISK AND PROPHYLACTIC INTERNAL FIXATION:

• Table:

MÉNIÈRE’S DISEASE DIAGNOSTIC CRITERIA:

(Must have all three)

• Two spontaneous episodes of rotational vertigo ≥20 min
• Audiometric confirmation of SNHL (often low frequency)
• Tinnitus and/or aural fullness

MOOD DISORDERS:

• DSM-5 Criteria for mood episodes

• • Types of mood disorders include:

• • 1. Depressive (major depressive disorder, persistent depressive disorder)
    2. Bipolar (bipolar I/II disorder, cyclothymia)
    3. Induced by or due to (“secondary to”) a general medical condition, substance, medication, other
    4. psychiatric condition

MAJOR DEPRESSIVE EPISODE DSM-5 DIAGNOSTIC CRITERIA: 

1. ≥5 of the following symptoms has been present during the same 2 wks. 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 (anhedonia)

Note: Do not include symptoms that are clearly attributable to another medical condition

1. • Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
   • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
   • Signifi­cant and unintentional weight loss/weight gain, or decrease/increase in appetite nearly every day
   • Insomnia or hypersomnia nearly every day
   • Psychomotor agitation or retardation nearly every day
   • Fatigue or loss of energy nearly every day
   • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
   • Diminished ability to think or concentrate, or indecisiveness, nearly every day
   • 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
2. The symptoms cause clinically signifi­cant distress or impairment in social, occupational, or other important areas of functioning
3. The episode is not attributable to the direct physiological effects of a substance or a GMC

MANIC EPISODE DSM-5 CRITERIA:

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting ≥1 wks. and present most of the day, nearly every day (or any duration if hospitalization is necessary)
• During the period of mood disturbance and increased energy or activity, ≥3 of the following symptoms has persisted (4 if the mood is only irritable) have been present to a signifi­cant degree and represent a noticeable change from usual behaviour
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (i.e., feels rested after only 3 hrs of sleep)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (i.e., engaging in unrestrained shopping sprees, sexual indiscretions, or foolish business investments)
• The mood disturbance is sufficiently severe to cause marked impairment in social/occupational functioning or to necessitate hospitalization to prevent harm to self or
  others, or there are psychotic features.
• The episode is not attributable to the physiological effects of a substance or another medical condition

Note: A full manic episode that emerges during antidepressant treatment but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode, and therefore, a bipolar I diagnosis

Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder

• Hypomanic Episode
  • Criterion A and B of a manic episode is met, but duration is ≥4 d
  • Episode associated with an uncharacteristic change in functioning that is observable by others but not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
  • Absence of psychotic features (if these are present the episode is, by defi­nition, manic)
• Mixed Features
  • An episode specifi­er in bipolar or depression that indicates the presence of both depressive and manic symptoms concurrently, classi­fied by the disorder and primary mood episode component (i.e., bipolar disorder, current episode manic, with mixed features)
  • Clinical importance due to increased suicide risk and appropriate treatment
  • If found in patient diagnosed with major depression, high index of suspicion for bipolar disorder
  • While meeting the full criteria for a major depressive episode, the patient has on most days ≥3 of criteria B for a manic episode
  • While meeting the full criteria for a manic/hypomanic episode, the patient has on most days ≥3 of criteria A for a depressive episode (the following criterion A cannot count: psychomotor agitation, insomnia, difficulties concentrating, or weight changes)

MANIA CRITERIA (≥3):

• GST PAID
  • Grandiosity
  • Sleep (decreased need)
  • Talkative
  • Pleasurable activities, Painful consequences
  • Activity
  • Ideas (flight of)
  • Distractible

MAJOR DEPRESSIVE DISORDER:

• DSM-5 diagnostic criteria for major depressive disorder (MDD)

1. • Presence of a MDE
   • The MDE is not better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS
   • There has never been a manic episode or a hypomanic episode

Note: This exclusion does not apply if all of the manic-like, or hypomanic-like episodes are substance or treatment-induced or are due to the direct physiological effects of another medical condition

• Speci­fiers: With anxious distress, mixed features, melancholic features, atypical features, mood-congruent psychotic features, mood-incongruent psychotic features, catatonia, peripartum onset, seasonal pattern
• Single vs. recurrent is an episode descriptor that carries prognostic signi­ficance. Recurrent is classi­fied as the patient having two or more distinct MDE episodes; to be considered separate the patient must have gone 2 consecutive months without meeting criteria.

MAJOR NEUROCOGNITIVE DISORDER (DEMENTIA):

• DSM-5 Diagnostic Criteria for Major Neurocognitive Disorder
  • Evidence of signi­ficant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on both:
    1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a signi­ficant decline in cognitive function; and
    2. Substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantifi­ed clinical assessment
  • Cognitive defi­cits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications)

* Note: If defi­cits do not interfere (as in B) and cognitive impairments are mild-moderate (as in A.2), this is considered “mild neurocognitive disorder”;

• • Cognitive defi­cits do not occur exclusively in the context of a delirium
  • Cognitive defi­cits are not better explained by another mental disorder (i.e., major depressive disorder, schizophrenia)
  • In the case of neurodegenerative dementias such as Alzheimer’s disease, disturbances should be of insidious onset and progressive
• Specify whether due to: Alzheimer’s disease, Frontotemporal lobar degeneration, Lewy body disease, Vascular disease, Traumatic brain injury, Normal pressure hydrocephalus, Substance/medication use, HIV infection, Prion disease, Parkinson’s disease, Huntington’s disease, Another medical condition, Multiple etiologies, Unspecified.

Also read:

1. Criteria in GPNotebook
2. Criteria in NICE
3. Criteria in Statpearls