Diagnosing Mental Disorder

Diagnosing Mental Disrders with DSM-IV

DSM-IV

1

Why Diagnose? • • • • •

Communiction Etiology (Reasons) Treatment Help in scientific research Insurance claim

DSM-IV

2

Progress of Clinical Treatment • Assessment • Diagnosis • Treatment

DSM-IV

3

Diagnosis - Etiology • Normally, diagnostic category contains certain etiologies • Reasons for mental problem may be similar for every disorder in that particular category • Diagnosis may explain some of known reasons

DSM-IV

4

Diagnosis - Communication • Normally, client has several symptoms • Difficult to communicate among mental health professionals if they have to list all the symptoms • Easier to state syndrom, ie a set of symptoms

DSM-IV

5

Diagnosis – Help for Science • Diagnosis group people who have similar symptoms • This enables systematic research • From syndrome can study etiology and treatment

DSM-IV

6

Diagnosis - Treatment • Diagnosis enables the clinical professional to focus on treatment • Example, paranoid symtom cannot be treated just by talking • Needs anti-psyhotic treatment in this type of case

DSM-IV

7

Diagnosis – Payment to Third Party • People who experience mental disorder need treatment • Treatment is expensive • Patients need to be diagnosed so that third party pay cost of treatment

DSM-IV

8

Classification System • ICD – International Classification of Disesaes • DSM – The Diagnostic and Statistical Manual for Mental Disorders • History – not relevant

DSM-IV

9

Issue of Classification • Chronic vs acute problem – Chronic problem continues for a long duration – Acute problem is response to change of significant life change

• Continuous vs episodic – Continuous problem retains intensity – Episodic symptoms up and down

DSM-IV

10

DSM-IV • Definition of mental disorder – Psychological syndrome related with distress or disability as an individual

DSM-IV

11

DSM - IV • Five dimensions in classification • Axis I – clinical symptom • Axix II – personality disorder & mental retardation • Axis III – general medical condition • Axis IV – psychosocial & environment problems • Axis V – current functional level DSM-IV

12

Axis I • • • • • • •

Disorder associated with dependency Alcohol Amphatamine Canabis Cocaine Halisynogen Nicotine DSM-IV

13

Axis I, ctd… • Disorder diagnosed during infancy, early childhood or adolescence – Attention deficit / hyperactivity disorder – Pervasive developmental disorder – Separation anxiety disorder – Behaviouyarl disorder – Learning disorder – Tic disorder DSM-IV

14

Axis I, ctd… • Schizophrenia – Paranoid – Untidy / disorganised teratur – Catatonic

DSM-IV

15

Axis I, ctd… • Mood disorder – Major depression disorder – Dysthemic disorder – Double depression – Mania – Bi-polar disorder

DSM-IV

16

Axis I, ctd… • Somatoform disorder – Somata disorder – Conversion disorder – Pain disorder – Hipochondriasis – Body dysmorphic disorder

DSM-IV

17

Axis I, ctd… • Anxiety disorder – Phobia – Panic disorder • Agoraphobia

– Genealized anxiety disorder – Obssesive-compulsive disorder – Post-trauma stress disorder – Acute stress disorder DSM-IV

18

Axis I, ctd… • Dissociative disorder – Dissociative amnesia – Dissociative fugue – Dissociative identity disorder – Depersonalisation disorder

DSM-IV

19

Axis I, ctd… • Sexual and gender identity disorder – Paraphilia – Sexual malfunction – Gender identity disorder

• Eating disorder – Anorexia nervosa – Bulimia nervosa

DSM-IV

20

Axis I, ctd… • Impulsive-control disorder – Explosive behavioral disorder – Cleptomania (eg. shop lifting) – Pyromania (Likes to burn) – Gambling

DSM-IV

21

Axis I, ctd… • Sleeping disorder – Dissomnia – Parasomnia

• Adjustment disorder • Delirium, Dementia, Amnesic, & other cognitive disorders

DSM-IV

22

Axis II • Personality disorder (Funny) – Paranoid – Schizoid – Schizotypal – (All associated with schizophrenia)

DSM-IV

23

Axis II • Personality disorder (Dramatic-Erratic) – Borderline – Histrionic – Narssistic – Antisocial

DSM-IV

24

Axis II • Personality disorder (Anxiety-Fear) – Avoidance – Dependent – Obssessive-compulsive personality disorder

• Mental retardation

DSM-IV

25

Axis III • General medical condition – problem relevant with psychological problem • Caused by certain disorder – eg. Dental problem because of drug abuse • It contributes toward disorder – Cancer causes depression

DSM-IV

26

Axis IV • Psychosocial and Environmental Problem – Education – Social – Support group – Work – Housing – Economy – Legal DSM-IV

27

Axis V • Global assessment on functionality • Evaluate one’s current functional level & highest level for the previous year. This method assists the clinical professional understand how the four axis affect the individual concerned & what are the expected outcomes • Give number between 0 and 100 • 0 means no information • 1 – low; 100 - high DSM-IV

28

Critiques on DSM • Evaluated based on reliability and validity • Good for certain fields, but problematic in other areas

DSM-IV

29

Reliability among Raters for DSM • • • • • • • •

Bipolar Major Depression Schiizophrenia Alcohol Abuse Aneroxia Nervosa Bulimia Nervosa Panic Disorder Social Phobia

- .84 - .64 - .65 - .75 - .75 - .85 - .58 - .47 DSM-IV

30

Whole Life Mental Sickness • • • • • • • •

Major depression episod Panic disorder Agoraphobia Social phobia Simple Phobia General Anxiety Disorder Alcohol Dependency Antisocial DSM-IV

17.1 (F) 3.5 (F) 5.3 (F) 13.3 (F) 11.3 (F) 5.1 (F) 14.1 (M) 3.5 (M) 31