Monday, September 3, 2012

License Exam: Assessment and Diagnosis - Treatment Planning (11%)

Assessment and Diagnosis, Treatment Planning (11%)


In the DSM-IV-TR system, an individual is diagnosed on five different domains, or "axes."  The multi-axial system in DSM-IV-TR was developed in part in order to capture more of the complexity surrounding psychiatric conditions.
Axis I: Clinical Disorders: Major psychiatric disorders are diagnosed on Axis I. For example, major depressive disorder and posttraumatic stress disorder disorders of learning, and developmental disabilities.   Axis I tends to be reserved for major disorders that are thought to be somewhat episodic
Axis II: Personality Disorders or Mental Retardation: these are thought to be longer-standing conditions of thinking and behavior that are typically present before age 18.  For example, personality disorders and Mental retardation (or MR).  These are chronic conditions separated from Axis I conditions in order to allow them to be highlighted
Axis III: Medical or Physical Conditions: Axis III is reserved for medical or physical conditions that may affect or be affected by mental health issues.  For example, if someone has cancer, and their illness and treatment are affecting their mental health, that would be important information to be conveyed in the diagnosis.
Axis IV: Contributing Environmental or Psychosocial Factors: Often, a psychiatric diagnosis happens in the context of major environmental or social stressors. For example, job loss, divorce, financial problems, or homelessness.
Axis V: Global Assessment of Functioning: The GAF is a number between 0 and 100 which is meant to indicate level of functioning, or a person's ability to engage in adaptive daily living.  Lower scores indicate lower functioning. 

Click here for the Expanded text on Multiaxial Diagnosis

 Axis I is reserved for clinical disorders and developmental and learning disorders. Disorders that may be present on Axis I include:

Axis II is for personality disorders or mental retardation. Disorders that may appear on Axis II include:
Axis III is for medical and/or physical conditions or disorders. For example:
Axis IV indicates factors contributing to, or affecting, the current psychiatric disorder and treatment outcomes. These include:
  • Lack of an adequate support system
  • Social issues
  • Educational problems
  • Problems with work
  • Financial difficulties
  • Legal problems
  • Other psychosocial and environmental problems
Axis V is for the GAF or global assessment functioning. This is a 100-point scale that the mental health professional uses to describe the patient’s overall level of performance in usual daily activities and social, occupational, academic and interpersonal functioning.
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.  

DSM Decision Trees for Differential Diagnosis

The purpose of these decision trees is to aid the clinician in understanding the organization and hierarchical structure of the DSM-IV Classification. Each decision tree starts with a set of clinical features. When one of these features is a prominent part of the presenting clinical picture, the clinician can follow the series of questions to rule in or rule out various disorders.
I. Differential Diagnosis of Mental Disorders Due to a General Medical Condition
II. Differential Diagnosis of Substance-Induced Disorders
III. Differential Diagnosis of Psychotic Disorders
IV. Differential Diagnosis of Mood Disorders
V. Differential Diagnosis of Anxiety Disorders
VI. Differential Diagnosis of Somatoform Disorders
Click here for expanded text on Differential Diagnosis

Mental/Behavioral Health DISORDERS

Mood and Anxiety Disorders

Personality Disorders

The DSM-IV-TR states that Borderline Personality Disorder (BPD) is an Axis II disorder characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and emotions/affects. The diagnostic criteria for BPD is that it is manifested by 5 or more symptoms, such as inappropriate, intense anger, fear of abandonment, impulsive self-damaging behaviors, suicidal threats and gestures, and chronic feelings of emptiness. People with BPD may have a tendency to themselves and others as all good or all bad, with no grey areas; this is termed “splitting.”


No comments:

Post a Comment