Assessment & Classification Flashcards
Operationalised approach to diagnosis
- In DSM-III operationalised diagnosis was first introduced.
- Operational criteria include the use of precise clinical description of disorders, together with predefined exclusion and inclusion criteria and details of the number and duration of symptoms required for diagnosis.
- It enables algorithm-based clinical diagnosis using intensity, duration of the symptoms and impairment tests. - This more or less equates to using a checklist for diagnosis, but some rules are necessary while some are optional for a diagnosis.
Atheoretical Approach to diagnosis
- Diseases are described according to the observed phenomenology
- Classification is NOT based on the understanding of what might be causing the disturbances.
- So various aetiological schools such as behaviourism or psychoanalysis, etc. are not employed in describing a disorder.
- No theory forms the basis of the classifications
- Only neutral observations are taken into account.
Descriptive approach to diagnosis
- Classifying illnesses on the basis of what constitutes the illness rather than what causes it
- Lack of pathogenetic knowledge of most psychiatric disorders makes this approach more rational.
- This forms the basis of any atheoretical classification.
Define Atypical Anorexia Nervosa
- One or more of these essential features may be absent, or all are present but to a lesser degree.
- Atypical anorexia nervosa is described as “ a disorder that fulfills some of the features of anorexia nervosa but in which the overall clinical picture does not justify that diagnosis.
- For instance, one of the key symptoms, such as amenorrhoea or marked dread of being fat, may be absent in the presence of marked weight loss and weight-reducing behaviour.
- This diagnosis should not be made in the presence of known physical disorders associated with weight loss.” (ICD-10)
Several features are noted in patients with atypical anorexia when compared to those with typical anorexia.
- Older age at onset and presentation
- Recurring bouts of depression
- Numerous somatic complaints
- Unmet dependency needs
- Little evidence of distortion in body image is seen.
Characterisation of Somatization disorder
(a) at least 2 years of multiple and variable physical symptoms for which no adequate physical explanation has been found
(b) persistent refusal to accept the advice and reassurance of several doctors regarding the absence of a physical illness
(c) notable impairment of social and family functioning due to the symptoms and the illness behaviour.
- The term Briquet Syndrome or St. Louis Hysteria is sometimes applied to denote somatisation disorder.
ADHD age of onset for diagnosis according to DSM
Several inattentive or hyperactive-impulsive symptoms were present prior to age 12
Multi-axial approach
- Recently there has been an upsurge of interest in the multi-axial system for achieving a complete diagnosis. - This method helps in a more ‘holistic assessment’ of an individual patient.
- The multi-axial version of ICD-10 uses three axes.
1. Axis 1 - the mental disorder (also personality disorder and mental handicap)
2. Axis 2 - the degree of disability
3. Axis 3 - current psychosocial problems. - The multi-axial system of DSM uses 5 axes.
1. Axis I - Clinical Disorders
2. Axis II - Personality Disorders/ Mental Retardation
3. Axis III - General Medical Conditions
4. Axis IV - Psychosocial and Environmental Problems
5. Axis V - Global Assessment of Functioning.
Note that child and adolescent mental disorders have a different axial system in DSM-IV.
Dissociation disorder Features
- Mental effects of a conflict
2. E.g. Amnesia, Loss of identity, alter personality
Conversion disorder Features
- Physical effects of a conflict
- Paralysis, blindness, ataxia, anaesthesia,
aphonia, seizures
Somatoform/somatisation disorder Features
- Production of a symptom (positive)
- Pain, vomiting, etc.
- GIT and Musculoskeletal
- Polysymptomatic
Hypochondriasis Features
- Preoccupied with diagnosis
- Concern: ‘One dreadful disease.’
- Gastrointestinal features most common
Malingering Features
- Clearly intentional
- Often monetary benefits
- Military, compensation claims, etc.
Factitious disorder features
- ‘Truly puzzling’ with ‘no cause.’
- Only gain is sick role
- Seen in paramedical professionals
- Munchaussen is severe form – wide doctor
shopping is seen
Fregoli delusion
Belief that strangers are actually person’s well known to the patient, in disguise
(Fregoli - friend)
Capgras syndrome
The belief that strangers in disguise have replaced persons known to the patient.
(Capgras - snake in the grass - they’re not who they say they are)
Othello Syndrome
- Characterised by a delusion of infidelity.
Patients possess the fixed belief that their spouse or syndrome) partner has been unfaithful. - Often patients try to collect evidence and/or attempt to restrict their partner’s activities.
- Contributes to both wife battering and homicide.
Ekbom syndrome
1) delusional parasitosis, the belief that the skin is infested with parasites, sometimes associated with cocaine use
2) restless legs syndrome, the condition of annoying sensations in the extremities that disturbs sleep onset.
European physicians prefer the first definition, Americans the second.
(Ekbom - infestation)
De Clerambault syndrome
Erotomania, or more specifically a female patient’s belief that a wealthier older man, whom she does not know, loves her.
Cotard syndrome
Patient’s belief that he does not exist, that part of him is not there (e.g., his organs), or that he is dead.
