Assessment and Diagnosis, Treatment Planning (11%)
MULTIAXIAL DIAGNOSISIn 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.
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Axis I is reserved for clinical disorders and developmental and learning disorders. Disorders that may be present on Axis I include:
- Panic Disorder
- Generalized Anxiety Disorder
- Social Phobia
- Obsessive-Compulsive Disorder
- Posttraumatic Stress Disorder
- Specific Phobia
Axis II is for personality disorders or mental retardation. Disorders that may appear on Axis II include:
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Dependent Personality Disorder
- Obsessive-Compulsive Personality Disorder
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.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
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Mental/Behavioral Health DISORDERS
Mood and Anxiety Disordershttp://ptsd.about.com/od/ptsdbasics/a/PTSDoverview.htm