Medical Criteria – S

Medical Criteria – S

STOPP/START CRITERIA:

• Another screening tool for potentially inappropriate prescribing in the elderly
• STOPP: Screening Tool of Older Person’s Prescriptions
• Systems-based list of medications contraindicated in adults ≥65 in the context of their diagnoses
• START: Screening Tool to Alert doctors to Right Treatment
• Systems-based list of medications indicated in adults ≥65 in the context of their diagnoses

SEPSIS AND SEPTIC SHOCK:

• qSOFA score used initially to screen patients for suspected sepsis using three criteria:

1. • respiratory rate >22/min
   • systolic BP <100 mmHg
   • altered mentation (GCS <15)

SCHIZOPHRENIA:

• DSM-5 DIAGNOSTIC CRITERIA FOR SCHIZOPHRENIA

• • Two (or more) of the following, each present for a signifi­cant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1),
    (2), or (3)

1. 1. 1. 1. Delusions
         2. Hallucinations
         3. Disorganized speech (i.e., frequent derailment or incoherence)
         4. Grossly disorganized or catatonic behaviour
         5. Negative symptoms (i.e., diminished emotional expression or avolition)

• • Decreased level of function: for a signi­ficant portion of time since onset, one or more major areas affected (i.e., work, interpersonal relations, self-care) is markedly
    decreased (or if childhood/adolescent onset, failure to achieve expected level)

• • At least 6 months of continuous signs of the disturbance. Must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-
    phase symptoms) and may include periods of prodromal or residual symptoms, during which, disturbance may manifest by only negative symptoms or by two or more
    Criterion A symptoms present in an attenuated form (i.e., odd beliefs, unusual perceptual experiences)

• • Rule out schizoaffective disorder and depressive or bipolar disorder with psychotic features because either 1) no major depressive or manic episodes have occurred
    concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total
    duration of the active and residual periods of the illness
  • Rule out other causes: GMC, substances (i.e. drug of abuse, medication)
  • If history of autism spectrum disorder or communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or
    hallucinations are also present for at least 1 month (or less if successfully treated)

• Specifi­ers: type of episode (i.e., ­first episode, multiple episodes, continuous), with catatonia, current severity based on quantitative assessment of primary symptoms of psychosis (in acute episode, in partial remission, in full remission.

SCHIZOPHRENIFORM DISORDER:

• Diagnosis Criteria
  • Criteria A, D, and E of schizophrenia are met; an episode of the disorder lasts for at least 1 month but less than 6 months.

SCHIZOAFFECTIVE DISORDER

• Dsm-5 Diagnostic Criteria for Schizoaffective Disorder

• • Concurrent psychosis (criterion A of schizophrenia) and major mood episode – uninterrupted period of illness
  • Delusions or hallucinations for 2 or more wks. in the absence of a major mood episode during the lifetime duration of the illness
  • Major mood episode symptoms are present for the majority of the total duration of the active and Residual periods of the illness
  • The disturbance is not attributable to the effects of a substance or another medical condition

• Specifi­ers: Bipolar type, depressive type, with catatonia, type of episode, severity

SUBSTANCE-RELATED AND ADDICTIVE DISORDERS:

• Substance use disorders are measured on a continuum from mild to severe based on the number of criteria met within 12 months
  • Mild: 2-3
  • Moderate: 4-5
  • Severe: 6 or more
• Each speci­fic substance is addressed as a separate use disorder and diagnosed utilizing the same overarching criteria (i.e., a single patient may have moderate alcohol use disorder, and a mild stimulant use disorder)
• Testing for illicit drugs is most commonly done on urine or blood samples
  • Serum toxicology screen is needed to assess alcohol level
  • Toxicology may be helpful in differentiating withdrawal from other mental disorders
• Criteria for substance use disorders (PEC WITH MCAT)
  • Use despite physical or psychological problem (i.e., alcoholic liver disease or cocaine related nasal problems)
  • Failures to fulfil external roles at work/school/home
  • Craving or a strong desire to use substance
  • Withdrawal
  • Continued use despite interpersonal problems
  • Tolerance, needing to use more substance to get same eect
  • Use in physically hazardous situations
  • More substance used or for longer period than intended
  • Unsuccessful attempts to cut down
  • Activities given up due to substance
  • Excessive time spent on using or ­finding substance

SOMATIC SYMPTOM DISORDER:

• DSM-5 Diagnostic Criteria for Somatic Symptom Disorder

• • One or more somatic symptoms that are distressing or result in signi­cant disruption of daily life
  • Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
    • Disproportionate and persistent thoughts about the seriousness of one’s symptoms
    • Persistently high level of anxiety about health or symptoms
    • Excessive time and energy devoted to these symptoms or health concerns
  • Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically >6 months)
    • Somatic symptom disorder with predominant pain (previously pain disorder) for those whose somatic symptom is primarily pain
    • Patients have physical symptoms and believe these symptoms represent the manifestation of a serious illness
    • Persistent belief despite negative medical investigations and may develop different symptoms over time
    • Lifetime prevalence may be around 5-7% in the general adult population
    • Females tend to report more somatic symptoms than males do, cultural factors may influence sex ratio
    • Complications: anxiety and depression commonly comorbid (up to 80%), unnecessary medications, or surgery
    • Often a misdiagnosis for an insidious illness, so rule out all organic illnesses (i.e., multiple sclerosis)

SLEEP DISORDERS:

• Criteria
  • Must cause signi­ficant distress or impairment in normal functioning
  • Not due to a GMC or medications/drugs (unless speci­fied)

SEPSIS:

• Signs and Symptoms criteria
  • New guidelines recommend the use of quick SOFA (qSOFA) criteria and SOFA score to replace SIRS criteria
  • In patients with suspected infection, bedside application of qSOFA criteria identifies individuals with high likelihood of poor outcomes, including prolonged ICU stay and/or death
  • A positive qSOFA (≥2 criteria) should prompt application of the SOFA score, and further evaluation of possible infection and organ dysfunction
  • In the context of suspected infection, a SOFA score ≥2 reflects an overall mortality risk of 10%
  • The absence of ≥2 criteria on either qSOFA or SOFA score should not delay or defer investigation or treatment of infection or any other aspect of care deemed necessary by the practitioners

SEROPOSITIVE RHEUMATIC DISEASE:

• Diagnostic criteria are selected for sensitivity, as opposed to specificity, thus may misdiagnose some cases
• Classification criteria are developed for specificity so well-defined cases can be studied in clinical trials
• Modern classification criteria are more sensitive and specific for diagnostic use in studies of earlier disease

SYSTEMIC LUPUS ERYTHEMATOSUS:

• Diagnostic Criteria of SLE*

*Note: “4, 7, 11” rule → 4 (or more) out of 11 criteria (4 lab, 7 clinical) must be present, serially or simultaneously, for diagnosis

• American College of Rheumatology, 1997 update

DIAGNOSTIC CRITERIA OF SYSTEMIC LUPUS ERYTHEMATOSUS:

• MD SOAP BRAIN

SCLERODERMA:

• Criteria for Scleroderma*
  • The American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR)

* Score of ≥9 is sufficient to classify a patient as having definite scleroderma (sensitivity 0.95, specificity 0.93) Arthritis & Rheum 2013;65(11):2737-2747

SJÖGREN’S SYNDROME:

• Criteria for Primary Sjögren’s Syndrome (no condition in exclusion criteria, score ≥6)

• • The American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR)

• Arthritis Rheumatol. 2017; 69:35-45

Also read:

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