* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download DSM___Multiaxial_Diagnosis_1
Comorbidity wikipedia , lookup
Impulsivity wikipedia , lookup
Bipolar II disorder wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Panic disorder wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Bipolar disorder wikipedia , lookup
Hypothalamic–pituitary–adrenal axis wikipedia , lookup
Gender dysphoria in children wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Eating disorders and memory wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Autism spectrum wikipedia , lookup
Conversion disorder wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Eating disorder wikipedia , lookup
Munchausen by Internet wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Personality disorder wikipedia , lookup
Depression in childhood and adolescence wikipedia , lookup
Asperger syndrome wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Spectrum disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Diagnosis of Asperger syndrome wikipedia , lookup
History of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Abnormality: Past & Present Dr Paul F Hard 1 5/24/2017 Why a Psychiatric Diagnosis? Define clinical entities so that clinicians have the same understanding of the disorder, which generally has similar: Symptoms Natural history: onset, prognosis, complications Etiology: origins Pathogenesis: course of development • Determine treatment 2 5/24/2017 How was the DSM developed? DSM-I (1952) – Created around the same time as ICD-6 – Purpose: “create a classification that was a consensus of contemporary thinking” – Diagnoses were created by committees and revised by 10% of the members of the American Psychological Association – Included approximately 60 disorders – Definitions were vague, wordy descriptions – Based on psychoanalytic theory How was the DSM developed? DSM-II (1968) – Created around the same time as ICD-8 – Purpose: “created to promote international consensus in the realm of mental health” – Similar to DSM-I in terms of its development and the presentation of disorders – 180 disorders were included – Homosexuality was included as a psychological diagnosis How was the DSM developed? DSM-III (1980) & DSM-III-R (1987): – First attempt to use research in the development of diagnostic categories, but still mostly based on clinical judgment – Definitions were changed to be more specific – Both inclusion and exclusion criteria – Homosexuality no longer considered a mental disorder How was the DSM developed? DSM-IV (1994) & DSM-IV-TR (2000): – Attempted to systematize the way diagnostic criteria are developed – 175 psychologists did literature reviews of the research on each diagnosis – Field trials were conducted that tested the reliability of the diagnoses – There is still the criticism that the diagnoses are based on the clinical judgment of a few psychologists in the individual field – Added Culture Bound Syndromes to address Why a Multi-axial Diagnosis? Originally proposed in 1947 and incorporated into DSM in 1980 Clarify the complexities and relationships of bio-psychosocial difficulties Facilitate treatment planning Distinguish between long term chronic and stable Axis II disorders and more treatable Axis I disorders 7 5/24/2017 Why a Multi-axial Diagnosis? Shorthand communication between clinicians Attempts to assess the multiple factors contributing to the source and treatment of the disorder 8 5/24/2017 What Are the Five Axes? Axis I: Clinical syndromes (mental disorders); developmental disorders; other conditions that may be a focus of clinical attention Axis II: Personality disorders and traits; mental retardation 9 5/24/2017 What Are the Five Axes? Axis III: General medical conditions or symptoms that pertain to current problems Axis IV: Psychosocial and environmental problems Axis V: Global Assessment of Functioning (GAF) 10 5/24/2017 Example of Multi-axial Diagnosis Axis I: Major Depressive Disorder, Recurrent, Severe without Psychotic Symptoms Axis II: None Axis III: Multiple Sclerosis, progressive relapsing, remitting 11 5/24/2017 Example of Multiaxial Diagnosis Axis IV: Occupational, acute – loss of employment due to Axis III Diagnosis Primary support group, acute – marital separation • Axis V: GAF present: 45 Highest in last 12 months: 75 12 5/24/2017 Axis I Disorders usually first diagnosed in infancy, childhood, or adolescence Delirium, dementia, amnestic and other cognitive disorders Mental disorders due to a general medical condition Substance related disorders Schizophrenia and other psychotic disorders 13 5/24/2017 Axis I Mood disorders Anxiety disorders Somatoform disorders Factitious disorders Dissociative disorders 14 5/24/2017 Axis I Sexual and gender identity disorders Eating disorders Sleep disorders Impulse control disorders Adjustment disorders 15 5/24/2017 Axis II Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder 16 5/24/2017 Axis II Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder 17 5/24/2017 Axis II Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Personality Disorder, Not Otherwise Specified (NOS) Mental Retardation 18 5/24/2017 Axis III Infectious and parasitic diseases Neoplasm Endocrine, nutritional, metabolic diseases Immunity disorders Diseases of the blood and blood forming organs 19 5/24/2017 Axis III Diseases of the nervous system and sense organs Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system 20 5/24/2017 Axis III Diseases of the genitourinary system Complications of pregnancy, childbirth and postpartum Diseases of the skin and subcutaneous tissue Diseases of the muscular-skeletal system and connective tissue 21 5/24/2017 Axis III Congenital anomalies Certain conditions originating in the perinatal period Symptoms, signs and ill-defined conditions, injury and poisoning 22 5/24/2017 Axis IV Psychosocial and environmental problems Problems with primary support group Problems related to the social environment Educational problems Occupational problems 23 5/24/2017 Axis IV Housing problems Economic problems Problems with access to health care services Legal problems Other psychosocial or environmental stress 24 5/24/2017 Axis V Global Assessment of Functioning (GAF) Why use the Axis V rating? • Indicates client’s current OVERALL level of social, psychological and occupational functioning • Does not include physical functioning and limitations reported in Axis III • Ascertains level of functioning in the present 25 5/24/2017 Axis V Global Assessment of Functioning (GAF) • Along with Axis I, helps clinicians decide on any immediate actions • Usually includes highest level of functioning in the last 12 months to help with prognosis issues 26 5/24/2017 The Subsections of Each DSM Grouping of Disorders Listing of all disorders in the group Organization listing of the disorder section Coding guidelines Episode or disorder Specifiers for coding 27 5/24/2017 Organization of One Disorder Features Associated features and disorders Associated laboratory findings Culture, age and gender features Course of the disorder Prevalence of the disorder Differential diagnosis guidelines Criteria for episode or disorder 28 5/24/2017 Mood Disorders Prevalence: – During a six month period, 6% of the population have a diagnosis of a mood disorder. – Major depressive disorder and dysthymia affect 3% of the population. – The actual percentages vary depending on each survey. These seem to be accepted numbers at present, although may believe that numbers are higher due to undiagnosed cases. 29 5/24/2017 Mood Disorders – There is also agreement that depression is twice as high in women, greater in young adults and that the overall rate of depression is increasing. – There is a high probability of relapse in the future. 30 5/24/2017 Where to Get More Information See the bibliography at the end of Module Two. Websites: www.samhsa.gov www.nattc.org www.kenminkoff.com www.nami.org http://faculty.washington.edu/linehan 31 5/24/2017