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42 Cards in this Set
- Front
- Back
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DSM-V |
coordinated system of mental disorder diagnoses. "Method to the madness" |
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Value of the DSM V System |
1. Shared vocabulary (eff. way of communication of symptoms and beh. set) 2. Improves case conceptualization and treatment planning (need to work w/__ people, need to label __ ppl) 3. Client education (Parents who know nothing vs counselors who have an understanding) 4. Faciliates psychiatric and epidemiological research 5. Provides prognostic information (course of disorder) Common Theme--> comm and underst shortcut |
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Hierarchy Principle |
The principle that... psychiatric disorders exist on a hierarchy of severity and diagnosticians should select the highest ranking disorder in the hierarchy that best accounts for a client's multiple symptoms and impairments Diagnosis= tattoo (even if wrong) |
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Principle 2 (Use of Polythetic Criteria Sets) |
The principle that... Rather than requiring that all clients exhibit the exact same symptoms to justify a diagnosis, this principle allows a diagnosis to be made if only a subset from a larger symptom list is expressed by a client |
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Principle 3 (Careful use of Clinical Judgement) |
*Not a phase or experimentation; clients are not checklists The explicit diagnostic criteria in the DSM-V were designed to facilitate reliable diagnoses among clinicians; the criteria sets are not absolute scientific truth but rather are our own best approximation for describing important clinical conditions. A diagnosis can be made even if a client does not meet all of the diagnosis criteria for the disorder; such a diagnosis is informed by clinical judgement & enhances the treatment planning process. |
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Add. Roles of Clinical Judgement |
*Do the symptoms or behaviors experienced by an individual substantially deviate from the normal range of human experiences or the norms of a social cultural group? *Do the symptoms or behaviors cause clinically significant distress or impairment in important areas of functioning? (HOW SEVERE IS IT?) |
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Principle 4 (Primacy of Direct Biological Causes) |
The Principle that... Most of diagnostic criteria sets in the DSM-V Require the clinician to rule out both substance use & general medical conditions as explanations for a client's symptoms before assigning a primary diagnosis of mental disorder. |
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Are the symptom being caused by... substance use, intoxication, or withdrawal? |
*Which came first-psych symptoms or substance use? *Do the psych symptoms persist for more than a month after substance use is stopped? Is the drug(s) being used by a client likely to cause the psych symptoms reported? |
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Are the symptoms being caused by.... general medical conditons? |
*What came first, psych symptoms or general medical condition? *Do the psych symptoms persist beyond the resolution or control of the general medical condition? *Are the psych symptoms being experienced atypical? |
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Ethical Issues in Diagnosis |
*Proper diagnosis of mental disorders-1)upcoding, 2) based on agency's treatment plan *Client's right to know diagnosis and it's implications *Conscientious objector clause--> (E5.d) refraining from diagnosis; counselors may refrain from making a diagnosis if they believe it would cause harm to the client and others |
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Common Diagnostic Errors |
1) Labeling Effects 2)Primacy Effect 3)Confimatory Bias 4)Diagnostic Overshadowing 5)Base Rate Problem 6)Context Effect |
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1) Labeling Effect |
Prior diagnoses bias the way the next clinician conceptualizes the client's presentation |
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2)Primacy Effect |
Diagnostic impressions are formed and cemented early in the interview and are unlikely to be changed by information later presented in interview |
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3) Confirmatory Bias |
Clinician inadvertently seeks evidence to confirm a premature diagnoses |
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4)Diagnostic Overshadowing |
Fixating on a single diagnosis and failing to consider additional diagnoses |
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5)Base Rate Problem |
Failure to consider prevalence of various psychiatric disorders in assigning diagnoses |
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6) Context Effect |
Environment inappropriately influences the diagnoses that are given (LOC, hospital, jail) |
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Outline of Diagnostic Interviewing |
1) Chief Complaint- Use open eneded ?'s to help explore the complaint 2)Additions questions on client's perspective 3)Evaluation of premorbid functioning 4) Differential Diagnostic Process 5)Collect psychiatric history 6)Rule out alternative options/explanations for reported psychiatric symptomd 7)Complete MSE 8) Evaluate for suicidal risk/ homicidal 9)Assess psychosocial functioning impairment 10) Develop diagnostic impressions and an initial treatment plan |
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Symptom Oriented Interviews |
Assumptions: Goals: |
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1) Chief Complaint |
client's description of presenting problem; record in exact words |
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2) additional quest's on client's perspective |
*Why now? *Source of referral *Goals and expectations for seeking help- how do you think i can help you? *What does the client perceive to be the problem and the solution? |
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3)Evaluation of pre-morbid functioning |
When did you first notice these problems? When was the last time you felt normal? ~chronicity! how long has that persisted? |
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4)differential diagnostic process |
*Use symptom checking to evaluate if client meets diagnostic criteria for suspected mental disorders? *Review of systems to assess for additional mental disorders *Pinpoint a diagnosis |
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5)Collect psychiatric history |
*Prior experience with MH problems *Prior treatment exp.- meds/counseling *faimly history of mental distress/genetics, hereditary |
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6) Rule out alternative options/explanations for reported psych symptoms |
*Due to general medical conditions/ substance use/withdrawl? *Malingering--> Faking for ext. reward ($) *Factitious disorder--> for a psych reason, want to be taken care of |
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7)COmplete MSE |
Mental Status Exam |
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10)Develop diagnostic impressions & an initial treatment plan |
Start small Do not have perfect background Live with ambiguity Low and Move Publicity test--> Be able to back it up |
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Depressive Disorders |
1)Major Depressive Disorder
2)Persistent Depressive Disorder (Dysthymic Disorder) 3)Disruptive Mood Dysregulation Disorder 4)Premenstrual Dysphoric Disorder |
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Bipolar Disorders |
1)Bipolar 1 2)Bipolar II 3)Cyclothymic Disorder |
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Building Blocks to Current Mood Episode |
1)Hypomanic Episode 2)Manic Episode 3)Major Depressive Episode |
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Major Depressive Episode |
*Essential Features: *sad mood *anhedonia *Add'l symptoms: Sleep dist, changes in weight/app, psychomot. retard/agitation, low energy, low self-esteem or excessive guilt, cognitive impairments, suicidal ideation *Duration: 2 weeks/more |
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Manic Episode |
*Essential Features: *distinct period of abnormally & persistently elevated, expansive, or irritable mood along with increased goal-directed activity or energy that lasts for more than a week unless hospitalization occurs (high but no drugs) *Add'l symptoms: Racing thoughts/flight of ideas; hyperactivity; decreased need for sleep; inflated self-esteem or grandiosity; distractibility; pressured speech; hedonistic pleasure seeking w/o regard for neg. consequences |
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Hypomanic Episode |
*Essential Feature: *Distinct period of abnormally & persistently elevated, expansive or irritable mood along with increased goal directed activity or energy that lasts at least four days. *presentation represents clear change from ind.'s regular functioning and is observable by others. *Shorter, less severe, does not exp. clinically significant impairments |
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Major Depressive Disorder |
*Essential Features: *A major depressive episode *No history of manic or hypomanic episodes *symptoms are not just a component of psychiatric disorders (schizoaffective disorder) *Expected course: 3-12 m if untreated, >50% have repeated episodes, 5-10% later develop manic episodes *Know- single episode, recurrent *Co-morbidity: 50% have another disorder; SU, Anxiety, Personality, ED |
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*Persistent Depressive Disorder |
*New- Subsumes both chronic major depression disorder and Dysthymic disorder (long term exp of depression) *Essential Features: Less severe depressive symptoms that persist for a min. of two years *exclusion: no mania/hypomanic episodes; nor psychotic disorder *Comorbidity: SU, Anxiety, and Personality Disorder *Prognosis: Chronic course with continued impairment 1% prevalence *Add'l specifiers: -Early/Late onset -Characteristics of last 2y: with pure dysthymic syndrome, persisten MDE, interm> MDE with current epi, intermit MDE w/o CE |
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Premenstual Dysphoric Disorder |
*New to DSM-V; different from PMS *Essen F: *Persistent & sign. depressive and anxiety symptoms that occur prior to the onset of menses, improve shortly after menses, & symptoms are neither minimal or absent during the week after menses *Different Diag: Rule out primary depressive/ bipolar disorder *provisional: Should be added to diagnosis if symptoms have not been confirmed through daily ratings of two cycles 1-2% prevalence |
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Pediatric Bipolar Disorder-Emergence |
*Affective instability & aggression ere considered associated features of disruptive behaviors disorders (ADHD ODD, etc) *Severe emotional and behavioral instability represented the unique developmental manifestation of bipolar disorder in youth, has been asserting recently. |
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Pediatric Bipolar Disorder-Developmental Differences |
*Symptom Presentation: *Negative affect characterized by irritability, aggression, impulsivity, temper tantrum, & hyperactivity *Cycling Patterns: In place of clear cut mood episodes, there are extreme mood swings that change on a daily, even hourly, basis. *NIMH suggests Bipolar D/O Nos for this population |
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Pediatric Bipolar Disorder-Problems |
*Impulsivity (trademark of PBD) is not unique to PBD and lacks specificity *PBD has very high comorbidity w/ ADHD, ODD, CD. *Youths diagnosed with PBD do not carry this diagnosis into adulthood; are diagnosed with CMDD, SUD, and Pers. Dis. |
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Disruptive Mood Dysregulation Disorder |
*New-Reduce inapp. diagnosis of BPD in children & provide diagnostic home for children *EF: Recurrent temper outbursts that are severe, developmentally inappropriate, and out of proportion to any antecedent event *Chronically irritable mood b/w temper outbursts *Symptoms occur for more than 1 yr & manifested in more than 1 setting *Age of onset before age 10 and condit must be diagnosed b/w ages of 6-18 *Different Diag: Be sure symptoms are not MDE, BD, anything else *cannot be made simultaneously w/ ODD IED or BD *overrules diagnosis of ODD 2-5% prevalence *C: likely to evolve into depressive & anxiety disorder in adulthood, not bipolar disorder |
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Bipolar I Disorder |
*Esse F: *At least I manic episode *Not req to have any history of MDE *Assoc F: Mood lability, lack of insight, poor judgement, occup impairm, cogn. deficits *Diag Hierar: Rule out not explained by psychotic *Diff Diag: Subst-Rel D/o's, person. dis, MDD with irritable mood, Adult ADHD, Impulse control disorders *Comorbidity:anxiety disorders, ADHD, impulse control disor, SU disorders *typical age of onset: early adulthood (late onset suggests symptoms likely medical conditions |
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Mood changes |
Switch: Change to a mood episode of the opposite polarity or 2 months w/o symptoms Rapid Cycling: 4 different episodes in a year (about 10% prev rate) |
