Making a Mental Health Diagnosis

 

Making a Diagnosis

Symptoms alone do not define illness and do not require treatment. Rather diagnostic criteria are required to help make a diagnosis and let others know what is going on. If there is no functional impairment, there is no illness.

 

Mental illness is difficult to define. What is considered abnormal varies with time and across cultures, being shaped by social conventions. The DSM-IV-TR is a categorical approach to mental health conditions, leading to increased research studies but also generating much controversy surrounding.

DSM is a categorical judgement placing a patient in a box at this specific time. However, patients are dynamic; labels need not be permanent.

 

Formulation

Formulation is a diagram outlining the current issues, and interrelations between an individual's biological, psychological, and social factors. For each category, there are predisposing, precipitating, perpetuating, and protecting factors.

 

Syndrome

A syndrome is a central feature with typical associated symptoms. Fear is the central feature of anxiety, while sadness is the central feature of depression. Mental health diagnoses are therefore patterns..

There should be no difficulty with multiplicity of diagnoses (co-morbidities).

Important question: are things that look the same, the same?

 

Duration

Minimum duration is important - feeling down for one day is very common and should not be too concerning.

 

Disability and Distress

Disability and distress are also very very important.

 

DSM Axes

 

What is occurring is sometimes unclear: use a working diagnosis, but make a differential. You may occasionally need to defer and observe over time.

 

DSM-V is in process as our thoughts evolve.

 

The DSM-IV is supposed to be a-theoretical. A criteria: what people need to have

Diagnostic criteria help with treatment and management, follow-up and evaluation of treatments, easier communication among health care providers, counseling of risk.