Methods of diagnosis Flashcards
Psychiatric assessment
-history
-MSE
-risk assessment
-physical examination
-formulation
-diagnosis
-management plan
History
- Presenting Complaint
- History of PC
- Past psych hx
- Past medical hx
- psychosis due to medication?
- anxiety: palpitation, sweating → hyperthyroidism
- Medication hx
- Drugs and alcohol
- Family hx
- Personal hx
- Social hx
Mental State Examination
- Appearance
- hygiene
- eye contact
- Behaviour
- agitated
- aggressive
- Speech
- tone
- volume
- speed
- Mood
- subjective mood swings
- Affect
- objective observation of mood
- Thought
- thought disorder?
- delusions?
- Perception
- hallucinations
- Cognition
- oriented
- Insight
- reality?
- important for treatment - know something wrong with them then more engage with treatment
Risk Assessment
- risk to self
- risk to others
- self-neglect
- determines urgency of treatment
Physical examination/investigations
- exclude organic causes!
- imaging to rule out dementia
- vascular? non-vascular?
Diagnosis
- best treatment for patient
- label allows research and validates person thinkings
- assistance from government and resources - social housing, adhd - uni deadlines etc
- hope for treatment helping them improve - anxiety
Why is diagnosis important?
- Clarification of treatment options
- Understanding the problem/difficulty
- Enable health promotion and disease prevention
- Enables further research
- Entitles access to health and social care services
Potential social benefits
- Education and Health Care Plan (EHCP)
- Social care package
- Access to community activities
- DLA/PIP
- Freedom pass
- Free prescription
- Housing aid
- Help with CV/job-seeking
The concept of ‘Labelling’
- Positives ‘finally know what’s wrong with me’
- social benefits?- freedom pass etc
- Stigma associated with psychiatric diagnosis
- e.g. schizophrenia
- e.g. CAMHS
- Generalisation of certain psychiatric diagnosis e.g. OCD, ‘depressed’
- Diagnoses can change so might not seem consistent
Formulation
- A summary and interpretation of the presenting problem (based on assessment) (3+2P’s)
- prior to conclusion of diagnosis
-biological, psychological, social
-Predisposing; what factor lead to that mental health issue
-Precipitating; current trigger/risks for problem
-Perpetuating; what factor makes problem continue
-Protective
-Presenting
THE DIAGNOSIS
> ‘The identification of a disease or other problem by means of its symptoms and signs, and investigation results’
- Diagnostic criteria: an algorithm or a classification/ list of features required to demonstrate a specific diagnosis
- Historical classification?
- ICD? (International classification of diseases)
- DSM? (Diagnostic and statistic manual of mental health disorders)
Categories of diagnosis
-
The Neuroses:
- Depression, Anxiety, Mania, Obsessions and compulsions
- usually the patient retains insight and orientation; they experience deep distress and may commit suicide
-
The Psychoses:
- Schizophrenia, puerperal psychosis
- the patient is disorientated, deluded, and lacking in insight
-
The Dementias:
- Progressive deterioration with loss of recent memory and deterioration of a normal personality
- They may be primary or more commonly secondary to another condition
- e.g. alcohol, stroke
emil kraepelin (1865-1926)
-two major groups of mental illnesses
1. dementia praecox (SZ)
-thought chemical imbalance as cause for SZ
2. Manic-depressive psychosis (BPD)
-irregular metabolism as cause
-became basis for diagnostics
The current psychiatry diagnostic hierarchy
-organic disorders e.g. dementia
-psychotic e.g. SZ
-mood e.g. bipolar affective disorder
-anxiety
-personality
Current diagnostic systems:ICD 10/11 and DSM IV/V
-
All coding systems currently contain following categories:
- Organic disorder
- Psychoses
- Affective disorders
- Anxiety and related conditions
- Personality disorder
- Developmental disorder
- autism
- adhd
- Disorders with their onset in childhood or adolescence
- Substance misuse
