Chapter 1: Differential diagnosis step by step

Question 1

de 6 stappen

Answer 1

1. rule out malingering and factitious disorder
2. rule out substance etiology (including drugs of abuse and medication)
3. rule out a disorder due to a general medical condition
4. determine the specific primary disorders
5. differentiate adjustment disorder from the residual other specified or unspecified disorders
6. establish the boundary with no mental disorder

Question 2

verschil malingering en factitious

Answer 2

malingering = the motivation is the achievement of a clearly recognizable goal
factitious
factitious = the deceptive behaviour is present even in the absence of obvious external rewards

Question 3

when should suspicion be raised for malingering/factitious:

Answer 3

1. when there are clearly recognizable external incentives to a diagnosis
2. when the presentation aligns more with lay perception than clinical
3. when the nature of the symptoms radically switches
4. when the patients presentation mimics that of a role model
5. when the patient is manipulative or suggestive

Question 4

most frequent diagnostic oversight=

Answer 4

neglecting medication-induced psychopathology

Question 5

2 clues for general medical condition

Answer 5

1. temporal relationship: the symptoms correlate with the onset, severity, and resolution of a medical condition
2. atypical presentation: bv pattern, age of onset, course, etc.

Question 6

differentiate adjustment disorder from residual other specified, or unspecified disorders:

Answer 6

• diagnosis is justified if there is significant impairment
• if it is a maladaptive reaction to a stressor: adjustment disorder. (dus niet super veel distress)
• otherwise: other specified/unspecified category

Question 7

establish the boundary with no mental disorder:

Answer 7

het gaat hier echt om clinical judgement. dus als iemand hulp zoekt is het automatisch al significant, ook als er bijvoorbeeld een opname nodig is

Question 8

wat is het meest voorkomende antwoord bij stap 1

Answer 8

there is no information suggesting malingering or factitious disorder