Psychiatristic Diagnosis & Nosology

Question 1

Defining Psychological disorder, characteristics must include

Answer 1

Distress, Disability, or Risk of further suffering or harm

Question 2

DSM

Answer 2

Diagnostic and Statistical Manual of the American Psychiatric Association

Question 3

DSM-I (1952)

Answer 3

• All “disorders of psychogenic origin or without clearly defined physical cause” were considered “reactions”–
• Treated through therapy because medication and electro-convulsive therapy were not well-developed
• All diagnoses not known to be biologically based had anxiety at their core

Question 4

DSM-II (1968)

Answer 4

• Provided brief descriptions of characteristic signs and symptoms of the disorders but no criteria as such
• Under 100 pages

Question 5

DSM-III (1980) & DSM-III-R (1987)

Answer 5

• 1980 (Revised was 1987)
• A similar approach to the DSM-II was followed here; but now diagnostic criteria for the various disorders were provided
• Better inter-rater reliability and evidence of predictive reliability
  Specified a group of disorders as “usually first evident in infancy, childhood, or adolescence.”
• Moving to an era of evidence-based care

Question 6

Criticism of DSM-III

Answer 6

• Limited evidence of childhood diagnoses
• Atheoretical approach (previously steeped in psychodynamic tradition)
• Elimination of the term neurosis

Question 7

Benefits of DSM-III

Answer 7

• Increased diagnostic reliability
• Contributed to the flourishing of evidence-based research and treatment
• Put diagnostic criteria to the “test”
  ^–Accurate criteria have remained–Inaccurate criteria have been removed.

Question 8

DSM-IV (1994)

Answer 8

• Further clarified diagnoses/refined diagnostic criteria
• TR (2000) was a Text Revision with increased background information regarding risk factors, epidemiology, and course & development of disorders
• Multiaxial system
  –Clinical significance/severity criteria were added
  –new diagnoses were added
  –Asperger’s, ADD became ADHD

Question 9

Sexual orientation in DSM I

Answer 9

• Homosexuality is listed as a “Sexual Deviation Disorder”
• Included along with transvestism, pedophilia, fetishism, and sexual sadism (e.g., rape, assault, mutilation)

Question 10

Sexual orientation in DSM III

Answer 10

Ego-Dystonic Homosexuality- People who were comfortable with their own homosexuality were ego-systonic. This diagnosis was reserved for people who struggled with their identity

Question 11

DSM V

Answer 11

• 2013
• Goal: To move away from categorical diagnoses and toward dimensional diagnoses
• Recognizes the cross-over between diagnoses (the “porous boundaries”)
• Evident in symptom cross-over, shared genetic & environmental risk factors, high frequency of NOS (not otherwise specified) diagnoses, and lack of treatment specificity (example. Prozac)
• NOS = unspecified
• Organized developmentally
• Grouped by “internalized” and “externalized”

Question 12

Multiaxial System

Answer 12

• I = Clinical mental disorders
• II = Personality disorder & mental retardation
• III = Major medical diagnoses
• IV = Psychosocial and environmental stressors
• V = Global assessment of functioning (a numeric scale (0 through 100) used to rate social, occupational and psychological functioning)

Question 13

What year did the DSM finally remove all mention of homosexuality as a psychiatric disorder?

Answer 13

1987

Question 14

History of Present Illness

Answer 14

• Patient’s description of current difficulties
• Parent’s (collateral) description of current difficulties
• Recent stressors
• Review neuro vegetative status
• Sleep history should include evening routine, sleep pathology, co-sleeping
• Energy level
• Attention/ concentration
• Appetite (weight loss/gain)

Question 15

Major diagnostic categories to consider

Answer 15

• psychosis
• anxiety disorder
• mood disorder
• ADHD
  -Tics & Tourettes
• Externalizing disorders
• Pervasive developmental disorder
  -Eating disorder
  -Substance abuse disorders
  -Self-injurious behavior
  -Trauma