DSM___Multiaxial_Diagnosis_1
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Transcript DSM___Multiaxial_Diagnosis_1
Abnormality: Past & Present
Dr Paul F Hard
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Why a Psychiatric Diagnosis?
Define clinical entities so that clinicians
have the same understanding of the
disorder, which generally has similar:
Symptoms
Natural history: onset, prognosis, complications
Etiology: origins
Pathogenesis: course of development
• Determine treatment
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How was the DSM developed?
DSM-I (1952)
– Created around the same time as ICD-6
– Purpose: “create a classification that was a
consensus of contemporary thinking”
– Diagnoses were created by committees and
revised by 10% of the members of the American
Psychological Association
– Included approximately 60 disorders
– Definitions were vague, wordy descriptions
– Based on psychoanalytic theory
How was the DSM developed?
DSM-II (1968)
– Created around the same time as ICD-8
– Purpose: “created to promote international
consensus in the realm of mental health”
– Similar to DSM-I in terms of its development
and the presentation of disorders
– 180 disorders were included
– Homosexuality was included as a
psychological diagnosis
How was the DSM developed?
DSM-III (1980) & DSM-III-R (1987):
– First attempt to use research in the
development of diagnostic categories, but still
mostly based on clinical judgment
– Definitions were changed to be more specific
– Both inclusion and exclusion criteria
– Homosexuality no longer considered a mental
disorder
How was the DSM developed?
DSM-IV (1994) & DSM-IV-TR (2000):
– Attempted to systematize the way diagnostic
criteria are developed
– 175 psychologists did literature reviews of the
research on each diagnosis
– Field trials were conducted that tested the
reliability of the diagnoses
– There is still the criticism that the diagnoses
are based on the clinical judgment of a few
psychologists in the individual field
– Added Culture Bound Syndromes to address
Why a Multi-axial Diagnosis?
Originally proposed in 1947 and incorporated into DSM in 1980
Clarify the complexities and relationships
of bio-psychosocial difficulties
Facilitate treatment planning
Distinguish between long term chronic and
stable Axis II disorders and more treatable
Axis I disorders
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Why a Multi-axial Diagnosis?
Shorthand communication between
clinicians
Attempts to assess the multiple factors
contributing to the source and treatment of
the disorder
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What Are the Five Axes?
Axis I: Clinical syndromes (mental
disorders); developmental disorders; other
conditions that may be a focus of clinical
attention
Axis II: Personality disorders and traits;
mental retardation
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What Are the Five Axes?
Axis III: General medical conditions or
symptoms that pertain to current problems
Axis IV: Psychosocial and environmental
problems
Axis V: Global Assessment of
Functioning (GAF)
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Example of Multi-axial Diagnosis
Axis I: Major Depressive Disorder,
Recurrent, Severe without
Psychotic Symptoms
Axis II: None
Axis III: Multiple Sclerosis, progressive
relapsing, remitting
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Example of Multiaxial Diagnosis
Axis IV: Occupational, acute – loss of
employment due to Axis III
Diagnosis
Primary support group, acute –
marital separation
• Axis V: GAF present: 45
Highest in last 12 months: 75
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Axis I
Disorders usually first diagnosed in
infancy, childhood, or adolescence
Delirium, dementia, amnestic and other
cognitive disorders
Mental disorders due to a general medical
condition
Substance related disorders
Schizophrenia and other psychotic
disorders
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Axis I
Mood disorders
Anxiety disorders
Somatoform disorders
Factitious disorders
Dissociative disorders
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Axis I
Sexual and gender identity disorders
Eating disorders
Sleep disorders
Impulse control disorders
Adjustment disorders
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Axis II
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
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Axis II
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
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Axis II
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Personality Disorder, Not Otherwise Specified
(NOS)
Mental Retardation
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Axis III
Infectious and parasitic diseases
Neoplasm
Endocrine, nutritional, metabolic diseases
Immunity disorders
Diseases of the blood and blood forming organs
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Axis III
Diseases of the nervous system and sense
organs
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
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Axis III
Diseases of the genitourinary system
Complications of pregnancy, childbirth and postpartum
Diseases of the skin and subcutaneous tissue
Diseases of the muscular-skeletal system and
connective tissue
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Axis III
Congenital anomalies
Certain conditions originating in the
perinatal period
Symptoms, signs and ill-defined
conditions, injury and poisoning
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Axis IV
Psychosocial and environmental problems
Problems with primary support group
Problems related to the social environment
Educational problems
Occupational problems
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Axis IV
Housing problems
Economic problems
Problems with access to health care services
Legal problems
Other psychosocial or environmental stress
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Axis V
Global Assessment of Functioning (GAF)
Why use the Axis V rating?
• Indicates client’s current OVERALL level of
social, psychological and occupational
functioning
• Does not include physical functioning and
limitations reported in Axis III
• Ascertains level of functioning in the present
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Axis V
Global Assessment of Functioning (GAF)
•
Along with Axis I, helps clinicians decide
on any immediate actions
•
Usually includes highest level of
functioning in the last 12 months to help
with prognosis issues
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The Subsections of Each DSM
Grouping of Disorders
Listing of all disorders in the group
Organization listing of the disorder section
Coding guidelines
Episode or disorder
Specifiers for coding
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Organization of One Disorder
Features
Associated features and disorders
Associated laboratory findings
Culture, age and gender features
Course of the disorder
Prevalence of the disorder
Differential diagnosis guidelines
Criteria for episode or disorder
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Mood Disorders
Prevalence:
– During a six month period, 6% of the
population have a diagnosis of a mood
disorder.
– Major depressive disorder and dysthymia
affect 3% of the population.
– The actual percentages vary depending on
each survey. These seem to be accepted
numbers at present, although may believe that
numbers are higher due to undiagnosed cases.
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Mood Disorders
– There is also agreement that depression is
twice as high in women, greater in young
adults and that the overall rate of depression is
increasing.
– There is a high probability of relapse in the
future.
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Where to Get More Information
See the bibliography at the end of Module Two.
Websites:
www.samhsa.gov
www.nattc.org
www.kenminkoff.com
www.nami.org
http://faculty.washington.edu/linehan
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