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13 Cards in this Set
- Front
- Back
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Nervous System- Diagnosis in Psychiatry by Eitel
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Nervous System- Diagnosis in Psychiatry by Eitel
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What is Psychiatric Illness?
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Disorder involving the impairment of an individual's normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma.
Also called emotional illness, mental illness, mental disorder. |
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Etiology: Brain Disease or “Psychological” ?
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Most major mental illnesses are brain diseases with pathology based in abnormal brain function
e.g., dementia, schizophrenia, mental retardation Some neurologic diseases are associated with mental disorders e.g., Parkinson’s disease, Huntington’s disease, MS Some mental illnesses have a predominant psychological component e.g., personality disorders, eating disorders |
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Psychiatric Symptoms vs Disorder
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Psychiatric Symptoms:
Can occur in medical conditions Can be caused by medications Can be a transient reaction to stress or loss Can occur across psychiatric disorders Psychiatric Disorder: A group of symptoms that tend to cluster together Has a characteristic prevalence, onset, and course |
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Primary vs Secondary Disorders
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Primary psychiatric disorders:
No underlying medical disorder to account for the diagnosis Not caused by medication Not caused by substance abuse or withdrawal Secondary psychiatric disorders: Due to a medical condition Due to a medication(s) Due to substance abuse or withdrawal |
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Domains of Psychiatric Illness include:
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Sensorium: level of consciousness, ability to attend to stimuli
Perception: 5 senses Cognition: thinking, memory Emotion: feeling Behavior: action The Environment: external reality, other people, society |
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Classification of Psychiatric Disorders
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Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR):
Published by the American Psychiatric Association (2000) Most recent update of criteria: DSM-IV (1994) Current DSM bases diagnostic codes on ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): Published by the US government in 1979 Official coding system in the US for all diseases (Ch.5 Mental Dis) Revises codes annually but has not kept up with diagnostic changes in the DSM |
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DSM-IV-TR. what does it have? what doesn't it have? what does it use as a diagnosis system?
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Contains a listing of psychiatric disorders, diagnostic codes, and criteria for each disorder
Also contains text with information about the disorder (e.g., associated features, prevalence, course, familial patterns, age-,culture- and gender-specific features, differential diagnosis) Does NOT contain information about presumed etiology or treatment Uses a multi-axial diagnosis system |
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Mutiaxial means biopsychosocial. ok. what are the 5 axises?
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Psych:
Axis I: major mental illness, clinical disorders (psychiatric) Axis II: personality disorders; mental retardation, prominent defense mechanisms Bio: Axis III: general medical disorders (diabetes, hypothyroid, etc) Social: Axis IV: psychosocial stressors Axis V: Global Assessment of Functioning (1-100 scale) |
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Psychiatric Evaluation
-how are almost all psych diagnoses made? OBJ! |
Almost all psychiatric diagnoses are made clinically
i.e. from taking a history, making observations during the interview, etc. Laboratory tests, imaging studies, EEG and other tests used mainly to rule out non-psychiatric causes of psychiatric symptoms |
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Elements of the Psychiatric Evaluation
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History
History of present illness Past psychiatric history Medical history Review of systems Psychosocial history, developmental history Family history Examination General physical examination Neurological examination (motor / sensory function) Mental status examination (higher cortical function) Radiological and laboratory examinations |
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Radiological and Laboratory Evaluation in Psychiatry
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CT, MRI, PET, SPECT, fMRI
Toxicology (blood, urine) Chemistry, serology, endocrinology CSF studies EEG, polysomnogram Psychological, neuropsychological assessment |
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Summary
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Psychiatric symptoms can be seen in many conditions
The etiology of most primary psychiatric disorders is not known Diagnosis is based primarily on history and mental status exam Physical exam, neurologic exam, lab, and other studies are performed to rule out possible non-psychiatric causes of psychiatric symptoms The DSM-IV-TR increases reliability of diagnosis |
