Mental disorder history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diagnosis
Many mental health professionals, particularly psychiatrists, seek to diagnose individuals by ascertaining their particular mental disorder. Some professionals, for example some clinical psychologists, may avoid diagnosis in favor of other assessment methods such as formulation of a client's difficulties and circumstances.[1] The majority of mental health problems are actually assessed and treated by family physicians during consultations, who may refer on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview (which may be referred to as a mental status examination), where judgements are made of the interviewee's appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of relatives or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in relatively rare specialist cases neuroimaging tests may be requested, but these methods are more commonly found in research studies than routine clinical practice.[2][3] Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.[4] It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.[5]
Comorbidity is very usual with mental disorders, i.e. same person can suffer one or more disorder. The work for fifth version of Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
[6] has raised some questions about dimensional diagnostic criteria compared to categorical diagnostic criteria. Journal of Abnormal Psychology (Vol 114, Issue 4) [7] devoted a whole issue to discuss about categorical and dimensional diagnostic criteria. In short it the argument is that diagnosis of mental disorder can be based on several overlapping dimensions and not categorical and/or two-dimensional classes. One possibility in diagnosis is to have several (>2) dimensions overlapping and that it is harder to describe. In the following picture idea is that multiple dimension lines are crossed with one diagnostic line and the combination of crossing points is basis for a diagnosis.
In practical clinical settings it might be problematic to find several disorders in different dimensions and also differentiate the position of specific disorder in its dimensional axis like the picture indicates.
References
- ↑ Kinderman, P. and Lobban, F. (2000) Evolving formulations: Sharing complex information with clients. Behavioural and Cognitive Psychotherapy, 28(3), 307-310.
- ↑ HealthWise (2004) Mental Health Assessment. Yahoo! Health
- ↑ Davies, T. (1997) ABC of mental health: Mental health assessment British Medical Journal 314:1536
- ↑ Kashner TM, Rush AJ, Surís A, Biggs MM, Gajewski VL, Hooker DJ, Shoaf T, Altshuler KZ. (2003) Impact of structured clinical interviews on physicians' practices in community mental health settings. Psychiatr Serv. 2003 May;54(5):712-8. PMID 12719503
- ↑ Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M. (2000) Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. Apr;157(4):581-7 PMID 10739417
- ↑ DSM-V Prelude Project website
- ↑ Journal of Abnormal Psychology - Vol 114, Issue 4