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DSM > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What is in DSM?

What does it contain?

A
  • Criteria, descriptions, symptoms, and other signs for diagnosing mental disorders.
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2
Q

What is in DSM?

What is the purpose?

A
  • Ensure that a diagnosis is both accurate and reliable
  • as best we can, given our current knowledge
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3
Q

What is in DSM

  • What is not offered?
A
  • reccomendatin on the preferred course of treatment
  • atheoretical
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4
Q

History of DSM

How has the DSM evolved over the years?

A
  • 1952: DSM I – 106 disorders
  • 1968: DSM II – 182 disorders
  • 1980: DSM III – 265 disorders
  • 1987: DSM III-R Revised – 292 disorders
  • 1994: DSM IV- 297 disorders
  • 2000: DSM IV-TR – 365 disorders
  • May, 2013 – DSM 5- 367
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5
Q

Why is DSM being revised?

To reflect what?

A
  • new information in neurobiology, genetics, and behavioral sciences
  • clearer understanding of how the brain works
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6
Q

Why is DSM being revised?

What will it help?

A
  • researchers study how disorders relate to each other
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7
Q

Why is DSM being revised?

To guide what?

A
  • clinicians in making more accurate and consistent diagnoses
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8
Q

Why is DSM being revised?

Being more responsive to…?

A
  • research findings
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9
Q

Four Principles Guided This Revision

A
  • Clinical utility
  • Research based…”validators”- what validates your claim that this is a criterion for disorder.
  • Continuity with prior editions
  • No “a priori” restraints on the change
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10
Q

What is good mental health?

A
  • ability to recover quickly from stressors of life
  • ability to judge reality accurately
  • ability to see long range effects of choices
  • ability to love an sustain personal relationships
  • ability to work cheerfully and productively
  • ability to gratify hunger, thirst, sex urges in. Such a way as to not hurt others or oneself
  • ability to exercise one’s conscience effectively
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11
Q

DSM-5 Diagnostic Classification

A
  • Symptoms that satisfy DSM-5 diagnostic criteria for diagnosis(eThe first diagnosis written down is the primary diagnosis
  • Technically, a diagnosis requires completion of all five Axes. (DSM-IV policy)
  • Symptoms that satisfy DSM-IV diagnostic criteria listed for primary and secondary or dual diagnoses
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12
Q

DSM 5 Diagnostic Classification

Axis I

A
  • records every mental disorder except for mental retardation and personality disorder
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13
Q

DSM 5 Diagnostic Classification

Axis II

A
  • records mental retardation and personality disorders
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14
Q

DSM-5 Diagnostic Classification

Axis III

A
  • Records ICD-9 CM
  • (International Classification of Diseases 9, Clinically Modified)
  • general medical conditions – according to patient
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15
Q

DSM-5 Diagnostic Classification

Axis IV

A
  • records psychosocial and environmental problems
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16
Q

DSM-5 Diagnostic Classification

Axis V

A
  • records current and past year Global Assessment of Functioning (GAF) – [GAF Scale is located on page 34 of the DSM IV TR]
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17
Q

DSM 5 Diagnostic Classification:

The History

A
  • Are these data that supports the diagnosis reliable?
  • Are there other data that have been over-looked?
  • Are there enough data to make a diagnosis?
  • Are there other plausible diagnoses that may be over-looked?
  • Has the diagnosis been unduly influenced by data (age, sex, appearance, etc.)?
  • Try to disprove your diagnosis:
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18
Q

DSM-5 Diagnostic Classification: The History

Try to disprove your diagnosis:

A
  • “Young adult client, dysphoric, tired, socially withdrawn, has little drive to work… recently lost his job due to poor work performance…”
    • Hypothesis 1: Adjustment Disorder (job loss)
    • Hypothesis 2: Prodromal stage of schizophrenia (socially withdrawn, job problems, young adult)
    • Hypothesis 3: Severe anemia (tired, no drive)

Rule these out. If you do not have enough information, must find more.

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19
Q

DSM-IV TR

DSM

A
  • Diagnostic and Statistical Manual of Mental Disorders
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20
Q

DSM-IV TR

Manual of Mental Disorders

A
  • implies there is a differentiation between an organic disorder and a mental disorder
  • – no such thing exists – a mental disorder has an organic component and vice versa
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21
Q

DSM-IV TR

Mental disorder

A
  • a clinically significant behavioral or psychological syndrome or pattern that occurs and is associated with present distress
    • (a painful symptom) or a disability (an impairment of one or more important areas of functioning- psychological, social or occupational).
  • There is no mental disorder that is not also physiological.
  • It is not a mental disorder if it is not clinically significant
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22
Q

DSM-IV TR

DSM IV myths:

A
  • It dehumanizes people – it looks at five areas of functioning in a person –
  • a broad range of disorders described, not people [“alcoholism” not “alcoholic”]
  • Does not help with treatment - it gives guidance – points out what needs to be remedied
  • Too complicated to be useful – No it’s not.
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23
Q

DSM IV TR

Limitations

A
  • you either have the disorder or you don’t
  • There are real world​ challenges with categorical symptoms
  • DSM IV is a categorical system
  • Categorical systems have construct validity problems because they don’t/can’t capture the clinical complexity of a patient’s experience
24
Q

Limitations to DSM IV

DSM IV is a categorical system

A
  • Categorical systems do not always fit with the range of symptoms of a specific client
    • Client with schizophrenia can have several other symptoms not included in the criteria set
    • Depression, anxiety, insomnia, suicidal ideation
    • There was no way to directly assess the level or severity of these other symptoms (dimensions)
    • So, Dimensional Assessments were added in DSM 5
25
Q

What does DSM 5 do for categorized diagnoses?

A
  • Doesn’t replace it, but adds a dimensional option
26
Q

Creating DSM 5

The workgroups were tasked to

A
  • Clarify boundaries between specific mental illness and normal functioning in specific cases
  • Clarify the boundaries between mental disorders
  • Consider “cross-cutting” symptoms (Dimensions)
  • Symptoms that are common across different diagnoses
  • Anxiety/depression, etc.
  • Provide research justification for all recommendations (validators)
27
Q

DSM 5

Process Timeline

A
  • 1999-2007: white paper monographs published
  • 2007: 13 workgroups appointed to study 20 categories of disorders
  • April 2010 – December 2011
  • first drafts submitted for public review and revised
  • Field trials occurred and were followed by revisions
  • These revisions were put on the Internet for feedback
  • December 2012
  • Final draft presented to APA and approved
  • May 22, 2013
  • DSM 5 launched
28
Q

The 3 Sections of the DSM 5

Section 1

A
  • Introduction on use (Please read intro)
29
Q

The 3 Sections of the DSM 5

Section 2

A
  • the 20 Chapters of categorical disorders
30
Q

The 3 Sections of the DSM 5

Section 3

A
  • conditions that require further research, assessment instruments (greater emphasis on measurement on DSM-5) (proposal personality disorders, these have been left unchanged form DSM-IV
31
Q

DSM 5 Chapter Sequence

A
  • DSM 5 chapters are broad categories
  • Each category describes related disorders in developmental lifespan sequence (childhood, adolescence, adulthood and later life)
  • The rationale is to advance the understanding of the relationship between diagnoses.
32
Q

Overarching Perspective

A
  • Most of DSM 5 will be familiar
  • Important organizational and criteria set differences exist
  • Comorbidity within and across diagnoses addressed
  • Criteria sets parallel the ICD 11 (proposed)
33
Q

Purpose of Diagnosis

A
  • Facilitate treatment
  • Uniform clinical language
  • Features of a diagnosis
34
Q

Purpose of Diagnosis

Features of a diagnosis

A

Must show some impairment of function

Must be a clear deviation from usual roles, i.e. most people do not have it.

Must cause distress to the person with it

All 3 items must be clinically significant: speaks to the level of disruption it creates in a person’s life, the level of distress it causes to the person.

35
Q

Making a diagnosis

A
  • Avoid the rush to certainty: postpone judgment and think of any information you could have missed
  • It’s a process not an event
  • It’s an art as well as a science
  • It’s a “search for the locus of pain”
36
Q

Diagnostic Criteria Sets

Signs

A
  • are an objective finding observed by the therapist
37
Q

Diagnostic Criteria Sets

Symptoms

A
  • are subjective experiences described by the client
38
Q

Diagnostic Criteria Sets

Syndromes

A
  • a group of signs and symptoms that occur together and present the picture of a recognizable condition.
  • (Diagnoses in the DSM are syndromes- a combination of signs and symptoms).
39
Q

Medical History Form

Remerber*** DO NOT DO WHAT?

A
  • For liablility reasons, do not miss anything so you can make recommendations and referrals.
  • DO NOT FORGET THAT PATIENTS’ CASE HISTORY IS A LEGAL DOCUMENT
40
Q

The Counselor Should Be Able To

A
  • Document a DSM-5 Diagnosis
  • Demonstrate that the condition is treatable; no one will pay for something that is not treatable
  • Outline a treatment plan
  • Provide a rationale for the intervention
  • Describe the progress toward goals
  • Provide a timeline (in reality, managed care defines the timeline)
  • Outline discharge criteria
41
Q

Attitude

A
  • systematic way of feeling, thinking, and reacting
42
Q

Etiology

A
  • cause or origin of disorder (Many disorders have multiple etiologies meaning many causes; although 2 clients may have the same disorder, they may have different causes)
43
Q

Pathogenesis

A
  • course of development of the disorder (how it develops)
44
Q

Incidence

A
  • the number of new cases that occur in a given period
45
Q

Prevalence

A
  • the number of existing cases in any time period
  • (ex: The incidence of flu in December was 46% of the total flu cases for the season.)
46
Q

Point Prevalence

A
  • how prevalent it is on a given day or a particular point in time (how epidemiology data is collected)
47
Q

Psychopathology

A
  • impairment of psychological, social or occupational functioning that is clinically significant and causes distress to the individual.
48
Q

Diagnosis: Two major approaches

psychosocial

A
  • Suggests diagnosis is based on some inferred cause, some underlying event that explains why.
  • Disturbance, in that approach, paranoid part of personality cause that response.
  • DSM I & II based on – psychodynamic theory influences
49
Q

Diagnosis: Two major approaches

descriptive

A
  • Objective signs, symptoms and natural history
  • comes from British approach
  • basis for DSM III & IV
50
Q

Diagnosis

Psychopathology is defined by 3 distinct features:

A
  • Clinically significant impairment
    • Psychological, social, or occupational functioning
  • Clinically significant deviance from the norm
  • Clinically significant distress
51
Q

Diagnosis with the DSM-IV: ● For a person to meet criteria for a disorder we look for 3 things

signs

A
  • objective findings observed by clinician (client was crying)
52
Q

Diagnosis with the DSM-IV: ● For a person to meet criteria for a disorder we look for 3 things

symptoms

A
  • subjective experiences of client
    • (“I have no energy.”)
  • Counselor cannot see them unless the client tells them
53
Q

Diagnosis with the DSM-IV: ● For a person to meet criteria for a disorder we look for 3 things

syndromes

A
  • clusters of signs and symptoms that occur together as a recognizable condition that support a Dx
54
Q

Diagnosis with the DSM-IV

“Issues”

A
  • problems of living
  • non-reimbursable and not for diagnosing with the DSM IV
  • (use of this term exemplifies counselor’s lack of skill level!) …
  • also don’t use the term “concerns” either.
55
Q

Diagnosis with the DSM-IV

Diagnostic Codes

A
  • First 3 numbers are the number of the disorder, then other numbers indicate items such as severity
56
Q

Diagnosis with the DSM-IV

Severity

A
  • mild, moderate, or severe – some have subtypes to them (delusional disorder – 7 subtypes)

DSM (7 decks)

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