DSM: Development of diagnosis
hypothesis (diagnostic formulation); Gather information and make assessment
(723.1)
Diagnostic Formulation
... [Show More] considerations:
1. onset of issue
2. chronic/episodic
3. Family history
4. Use Multiple Sources (client, collateral)
5. context of information (e.g., currently in crisis?)
6. Use clinician observation and client reports
(723.1)
Assessment
Rule out:
1) Malingering and Factitious Disorder,
2) a substance etiology,
3) an etiological medical condition,
4) determining the specific primary disorder(s),
5) differentiating Adjustment Disorder from the residual Other Specified and Unspecified conditions, and
6) establishing the boundary with no mental disorder.
(723.1)
Parsimony
Use the fewest dx's to explain the most/all symptoms
(723.1)
Diagnostic Challenges
1. inadequate data
2. multiple diagnoses
3. atypical presentations
4. limited intake time
(723.1)
MSE (Mental Status Exam) Considerations
1. Appearance (hygiene, facial hair, body art/piercings, clothing)
2. Attitude (rapport, degree of engagement)
3. Behavior (calm, energetic, tired? )
4. Movement (pscyhomotor retardation/agitation)
5. Gait/posture/tics
6. Eye contact and Facial Expressions
7. Speech (volume, rate, style, accent, clarity)
8. Mood: Client's report of emotional state
9. Affect: Clinician's observation of outward emotional presentation
10. Thought Process: Quality, content and Rate (obsessions?)
11. Perceptions: client experience of world
12: Oriented x 3 (person, place, date)
13. SI/HI (current, recent, hx)
14. Insight: level of awareness
15. Judgment: impulse control
16. Memory: Immediate/ST(recent)/LT(remote)
(723.1)
[II.A]
Schizophrenia
1. increase in prodromal sx: isolation, depression, reduced self care, and changes in perception
2. onset: Late teens/early adult
3. compounded or triggered by AOD/SA
4. Positive Sx:
*hallucinations
*delusions (beliefs in the face of contradictory reality)
*Disorganized: Speech/Behavior/Thinking
5. Negative Sx:
*Lack of motivation/interest
*limited emotional expression
6. Duration: sx for >6 months
*Brief Psychotic Disorder: 1 day to 1 month
*Schizophreniform Disorder: 1 to 6 months
(723.2)
Other Psychotic Disorders
1. Schizoaffective: Schizophrenia with a concurrent mood disorder
2. Delusional disorder: (bizarre beliefs)
(723.2)
Anti-psychotic medications:
Neuroleptics. First generation (typical) anti-psychotics (1940s)
1. Thorazine
2. Stelazine
Second Generation: (atypical) (1980s)
1. Clozapine
2. Risperidone
All work on neurotransmitters (dopamine, sometimes serotonin)
(723.2)
Social Work Interventions for Schizophrenia
1. SST-Social Skills Training
2. CBT- Cognitive Behavioral Therapy
3. ACT-Assertive Community Treatment
(723.2)
Differential Diagnosis
(723.3)
Major Depressive Disorder
1. Depressed mood
2. Decreased motivation
3. Decreased interest in previously pleasurable activities
4. Anhedonia
5. Inappropriate guilt/self-deprecation
6. Insomnia/hypersomnia
7. increased fatigue
8. Cognitive issues
9. Suicidal ideation
(723.3)
Etiology of Depression
*no 'brain test'
*Neurotransmitters: imbalances in serotonin, dopamine and norepinepherine are correlated with depression
*Hypothalamic-pituitary-adrenal axis is hyperactive (impacts stress)
*fMRI : abnormalities in reward seeking, emotion processing in adults with depression
Risk Factors for depression:
1. First degree family member w/ dx/hx
2. Environment factors: abuse, adverse experiences
3. Temperament: negative affect
Prevalence of depression
According to the National Institute of Mental Health, the twelve-month prevalence rate is 7%, with 30% of those cases, or 2% of the U.S. adult population, considered to be severe.
The percentage sounds low, but if the adult population is around 237.6 million, that means around 4 million people in the U.S. have reported having depression in the past year.
The percentages by age group are as follows: 18-25 years: 9%, 26-49 years: 7.5%, 50+ years: 4.5%. The breakdown by gender is as follows: Women 8%, Men 4.5%.
(723.3) [Show Less]