chapter 1? Flashcards
definition of mental disorder
term “mental” remains even with caution: “there is as much physical in mental disorders as a mental in physical disorders”
- mental disorder is an inadequate and unfortunate defintion
- mental disorder is a syndrome charcterized by clinically significant distrubances (in certain areas) that reflecs dysfunction
- mental disorder does NOT classify people; but other the disorders
Limitations of categories
- all individuals with same disorder are not similar
- categories are useful in transmitting information
- a category is not completely isolated from other categories
- important to gather more information than just criteria review
- use clinical judgement often
- criteria and categories are meant to be guidelines
Rule out (do not use it)
this is actually means assessing for this disorder (“I think this is what it is”)
V codes (a way to describe what the problem is if there isn’t a diagnosis yet)
other conditions that may be focus of clinical attention (this are often not billable)
Directions for Diagnosis
level 1: history of current problems, previous MH history, social/work/family history, MSE
level 2: syndromes are collections of symptoms
level 3: differential diagnosis (what might one have any medical issues, substance, somatic, depression/bipolar
level 4: come to provisonisal diagnosis okay
level 5: comorbid (simmultaneous, but idenpent, arrange by uregncy
level 6: summarize your findings
level 7: reevlaute as needed
Symptoms (what the client tells you)
- a subjective report from client
- feelings noted
- trouble sleeping
- hallunctions
- fears
- anxiety, worry, nervousness
Signs (what the clinicians notice)
- indications that can be observed/SIGNS TRUMP SYMPTOMS CLINICALLY
- high heart rate
- tearfulness
- rapid speech
- posture
- train of thought
Hierarchy of Diagnosis
First: the most desirable, emergent, most treatable, best outcome (substance use, medical illness, mania)
Second: stuff were not sure about (provisional diagnosis(OCD, borderline)
Third: least desirable, hard to treat, poor outcome
Principle to resolve conflict
- history beats current appearance
- recent history trumps ancient history
- group perspective history better than clients
- signs beat symptoms
- increase crisis/stress = increased skewed perception
- objective better than subjective
- family history good to get
- principe of parsimony (occumans razor) think common (horses) before uncommon disorders (zebras)/ simplest answer is often the best one
Red flag info
- client with poor memory (vague details with some things and not with others)
- extreme language (absolutes, totals, exaggerations)
- criminal behavior and clients that have been hospitalized
- repeated suicide attempts
- absence/presence of usual/unusual symptoms
- appropriate treatment not working
- incongruent affect (emotions)
- many medical/mental services encountered
Imporving your diganosising ability
- the best predictor of future behavior is past behavior
- more symptoms for disorder; but remember, some symptoms carry more weight
- consider typical features first
- previous responses to treatment matching typical disorder treatment
- use “unspecified” as last resort
- think clincially (not personally) about what os normal
