Chapter 1 - Differential Diagnosis Flashcards
What are the six steps to the DSM’s differential diagnosis? (no details!)
- Ruling out malingering and factitious disorder
- Ruling out substance etiology
- Ruling out an etiological medical condition
- Determining the specific independent mental disorders (independent of above)
- Differentiating adjustment disorders from the risidual other specified and unspecified conditions
- Establishing the boundary with no mental disorder
What is step 1 of the differential diagnosis and what does it mean?
To rule out malingering and factitious disorder, to ensure that the client is not intentionally producing or falsy exaggerating about the nature of their symptoms
What is the difference between malingering and factitious disorder (basic)?
Malingering = deception with an external goal in mind (e.g., insurance compensation, etc.)
Factitious = deception present without the presence of external rewards
When should a clinician’s suspicion be raised (in the context of step 1 of differential diagnosis)?
5 total
- Clear external incentives for the diagnosis
- Patient presents with a cluster of symptoms that conforms more to a layperson’s perception than a clinical entity
- Nature of symptoms shift radically from appointment to appointment
- Presentation mimics that of a role model (e.g., mentally ill family member)
- Patient is seemingly manipulative or susceptible
What is step 2 of the differential diagnosis and what does it mean?
Ruling out substance etiology, to ensure that symptoms are not caused by the use of a substance
although; substance use and an independent disorder can be present
What are the steps within determining substance etiology?
- Determine if a substance is being used (surprising, I know)
- Determine if there is an etiological relationship between substance use and psychiatric symptomatology
- If due to substance use, determine which DSM classification is appropriate
What three further considerations should be made when there is substance use present, and you are in the process of deciding if there is an eitiological relationship? (3, basic)
- Is it a direct result from the effects of the substance on the CNS
- Is the substance use a consequence of having a psychiatric disorder
- Are they independent
What are the three steps in determining a causal relationship between substance use and psychiatric symptomatology?
- Temporal relationship (e.g., where the symptoms present in a time without medication use- non perfect method)
- Do the nature, amount and duration of substance use coinside with the development of symptoms
- Consider factors in the presentation different from substance use as a cause (e.g., family history)
What is the third step in differential diagnosis, and what does it mean?
Ruling out a disorder due to another medical condition, to ensure symptoms are not caused by a medical ailment
What are four reasons that make the excluding of nonpsychiatric medical conditions, difficult to determine?
- psychiatric conditions and nonpsychiatric conditions may have the same or similar symptoms (e.g., weight-loss)
- Sometimes psychiatric symptoms will precede in a medical condition
- The relationship between medical conditions and psychiatric conditions can be difficult (e.g., depression as a reaction to cancer)
- Psychiatric patients tend to be in settings more biased towards the identification of psychiatric disorders- and the knowledge about medical disorders may be a lot lower
What are the five variations of the type of etiological relationship between a medical condition and a psychiatric condition?
- medical causes psychiatric symptoms through a direct effect on the brain
- medical causes the symptoms through a psychological mechanism (e.g., depression bc of cancer diagnoses)
- meds for the medical causes the symptoms
- psych symptoms cause of affect the medical
- psych symptoms and medical are coincidental (not related)
What is multifactorial etiology (in the context of step 3)
When multiple presentations of the relationship between medical and psych symptoms are true
What is step five in the differential diagnosis, what does it mean?
Differentiate adjustment disorders from the risidual other specified or unspecified mental disorders, which are the categories for when the symptoms are present and impairing, but do not reach the threshold for a specific mental disorder
Which two clues suggesting the involvement of medical in psych symptoms?
- Temporal, a) psych symptoms begin after the onset of medical, b) vary in severity with the severity of medical and c) remit when medical leaves. (when all can be demonstrated, you can be decently convinced)
- is psych symptom atypical in symptom pattern, age, or course; (severe memory loss/weight-loss with depression calls for attention)
