Learning Objectives: Psychiatry and Psychiatric Diagnosis: How and Why. 1. Understand what constitutes a Mental Disorder.

Clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability (impaired functioning), or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. It must be a manifestation of a behavioral, psychological, or biological dysfunction, no matter the cause. 2. Understand how Mental Disorders are currently diagnosed. DSM-IV guidelines 3. Understand the purpose, creation, organization and use of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Helpful guide to clinical practice; tool to increase diagnostic reliability and validity of mental disorders for treatment and research; improve communication among clinicians and researchers; educational tool for teaching psychopathology. American Psychiatric Associaton task force and 13 work groups, with literature reviews, data analysis, field trials, input from 1000 people and 60 groups; continual updating 4. Understand strengths and limitations of the DSM-IV. Strengths: Disorders, not people, are classified. Empirical foundation Avoids norms/normal Culturally Aware Not a legal document Clinically significant impairment or distress is a core criteria Weaknesses: Categorical diagnosis, not dimensional Inappropriate segregation of mental and physical disorders (they are very integrated in real life, and psych illnesses are 25 to 75 % genetic) Etiology is not included in diagnostic criteriadiagnoses are ONLY DESCRIPTIVE. People with same diagnosis may look very different Addiction is not in DSM, but it is a real problem 5. Recognize that the next edition of the DSM (DSM-V) with updated diagnostic criteria is expected in 2013 6. Be able to use the DSM to correctly diagnosis Mental Disorders Categories of Mental Disorders:

Disorders usually first diagnosed in childhood Cognitive disorders Mental disorders due to a general medical condition not elsewhere classified 4. Substance- related disorders 5. Schizophrenia and other psychotic disorders 6. Mood disorders 7. Anxiety disorders 8. Somatoform disorders 9. Factitious disorders 10. Dissociative disorders 11. Sexual and general identity disorders 12. Eating disorders 13. Sleep disorders 14. Impulse-control disorders not elsewhere classified 15. Adjustment disorders 16. Personality disorders 17. Other conditions that may be a focus of clinical attention (impt conditions not considered mental disorders) 7. Understand and be able to correctly use the Multiaxial System of Diagnosis. 5 Axes: 1. Axis IClinical Disorders (diagnoses in the above list of categories) 2. Axis IIPersonality Disorders/Mental Retardation (this category is here to make sure you dont overlook a personality disorder or mental retardation. Check for it again to see if axis 2 applies) 3. Axis IIIGeneral Medical Conditions (medical diseases that are physiologically causing the mental disorder observed) 4. Axis IVPsychosocial and Environmental Problems 5. Axis VGlobal Axis of Functioning (GAF): 1-100 scale quantifying level of functioning 8. Avoid common confusions and pitfalls in using the DSM-IV. See below about substance abuse. Know that the following are not diagnoses: Major Depressive Episode; Manic Episode; Hypomanic Episode; Panic Attack; Agoraphobia. Know that drugs/meds can cause an Axis I disorder, and this would go into the category of Substance-Induced Disorders (i.e. amphetamine-induced anxiety disorder as a diagnosis) Know that general medical conditions can physiologically cause an Axis I disorder. You would diagnose Axis I: Depression due to Pancreatic Cancer and also Axis III: Pancreatic Cancer. 9. Be able to differentiate the concept of physical (also called biological)
1. 2. 3.

dependence from the DSM-IV diagnosis of Substance Dependence. Physical Dependence requires the presence of tolerance or withdrawal symptoms. Substance Dependence in DSM IV can use those as criteria, but they are not required for a diagnosis. 10. Be prepared to use the SPP cases - a major resource in learning psychiatric (& neurological) diagnosis and treatment.