introduction to dsm-iv tr_mccc

8/7/2019 Introduction to DSM-IV TR_MCCC

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Diagnostic & Statistical Manual

of Mental Disorders,

4th Edition, Text Revision


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History of the DSM

DSM-I 1952

DSM-II 1968

DSM-III 1980 DSM-III-R 1988

DSM-IV 1993 DSM-IV-TR 2000 (Over 200 disorders)


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What is considered

abnormal/illness/disorder?

The most widely accepted definition

used in DSM-IV-TR describesbehavioral, emotional or cognitivedysfunctions that areunexpected in their

cultural contextand associated with

personal distressorsubstantialimpairment in functioning.


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What can you find in DSM-IV?

Names of various mental disorders

Symptoms & features of various mentaldisorders

Diagnostic criteria of mental disorders

Differential diagnosis

X causes

X treatment


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Common DSM-IV Disorders

Mood Disorders

Anxiety Disorder

Disorders usually first diagnosed in

Childhood & Adolescence

Dementia, Delirium & other cognitivedisorders

Schizophrenia & psychotic disorders

Substance-related disorders

Mental Disorders due to general medical

conditions


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Less common DSM-IV disorders

Eating Disorders

Sexual Disorders

Sleep Disorders

Personality Disorders

Somatoform Disorders etc.


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Major Depressive Disorder

Depressed mood Loss of interest, pleasure or

motivation

LOW/LOA

Insomnia or hypersomnia Poor concentration or memory or

indecisiveness

Easily tired or fatigue

Psychomotor agitation or retardation Feeling useless, worthless or guilty

Hopelessness, suicidal thought orattempt


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Major Depressive Disorder

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2 weeks

Everyday, throughout the day Not due to drugs

Not due to medical conditions

Not part of bereavement

Not part of bipolar disorder

Not part of psychotic disorder

Significant impairment infunction


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How should counselors

recognize the symptoms?

Sad & crying Depressive Disorders

Abnormal Happy Bipolar Disorders

Fear & Worry Anxiety Disorders Weird/Odd Schizophrenia

Psychological rating scales e.g. DASS,BDI, BAI etc.


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When should counselors refer

patients to see a psychiatrist?

Psychotic disorders Bipolar disorders Suicidal

Violent Suspected medical causes e.g. thyroid Multiple medical problems e.g. elderly Alcohol/heroin/substance dependence Significant impairment in functions e.g. not

eating, not sleeping, cant work Multiple problems & not improving MC & medical report


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TREATMENT

Antidepressant

AntipsychoticMood stabilizer

Biological(

shng w)


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What would a psychiatrist do?

A detail interview about your symptoms &background

Collateral history from friends/family

Mental state examination

Physical examination

Blood, urine, imaging investigations

Psychological tests

Diagnosis & psycho-education Individualized treatment plan medications

or/and counseling/psychotherapy & wardadmission if severe


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Diagnosis in DSM-IV

Multi-axial Dx:

Axis I: Clinical Disorders

Axis II: Personality Disorders/Mental Retardation Axis III: General Medical Condition

Axis IV: Psychosocial & Environmental Problems

Axis V: Global Assessment Functioning

Provides a format for organizing and communicatingcomplex clinical information.


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Mental Health Diagnosis

Example I:

Axis I: Major Depression Axis II: Anxious & obsessive personality

Axis III: Breast cancer

Axis IV: Financial problem

Axis V: Function - cant manage household

- interfere with cancer treatment


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Example II:

Axis I: Mood Disorder due to Medical Condition Axis II: None

Axis III: Hypothyroidism

Axis IV: Poor family support accuse of malingering

Axis V: Function cant drive & get out of house


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Example III:

Axis I: Major Depressive Disorder Axis II: Low self-esteem

Axis III: Diabetes Mellitus

Axis IV: Poor social support

Axis V: Function neglected self-care


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CAUSES & TREAMENT Genetics

Hormonal Brain injury

Drug abuse

Physical illness

Biological(shngw)

Personality -

anxious/pessimistic/perfectionist Family/marital problem

History of child abuse

Keep things to himself/herself

Pathological grief

Psychological(xnl)

Unemployment

Financial difficulty

Stressful work environment

Political instability

Natural disaster

Social

( shhu)


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What can a counselor do to support a

psychiatrist in managing patients/ clients?

Make a good referral to psychiatrists

Advice on referral system

Therapeutic listening

Manage various Axis-IV problems

Skills training relaxation, problem solving,communication

Specific therapy e.g. CBT, family therapy Dont simply say that medicine is no good !!!

Encourage to seek 2ndopinion if patient doesntclick well with psychiatrist


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What if my so and so refuseto see a psychiatrist?

See a counselor or clinical psychologist

See a GP for physical symptoms of depression

See a private psychiatrist more convenient time

Get a second opinion from another psychiatrist Introduce websites/brochures/talks on depression

Many great people suffered from depression too..

Online therapy e.g. MoodGym

Seek advice from a psychological minded Sangha member

Get help from someone whom patient respects & listens to

You see a psychiatrist & ask him/her to accompany you

Make a police report if violent to self or others


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Importance of DSM-IV

Reduce mis-diagnosis

Professional standard

Speaking common language Psycho-education

Facilitate referral

Research purpose


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Limitations of DSM-IV

Not self-rating

No causes

No treatment Interviewing skills required

Mental state examination skills

required Pathologizing a normal experience?

Stigma? Over-medications


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introduction to dsm-iv tr_mccc

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