DSM-IV Most widely used diagnostic classification system(DSM) was first published in 1952. DSM-IV adopts a descriptive approach. It defines mental D/Os in terms of the behavioral signs and Sx, characterizing the various disorders on the basis of their shared characteristics. Atheoretical approach to etiology Multiaxial System Axis I: Clinical D/Os Axis II: Personality D/Os & Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Conditions Axis V: Global Assessment of Functioning Important to consider cultural, gender, and age related variations

Multiaxial Example Axis I Major Depression, Recurrent Axis II Paranoid Personality D/O Axis III Hearing Loss Axis IV Unemployment; Inadequate Finances Axis V GAF=30 (current) 65 (highest level in past year)

Mental Disorder …a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or disability…or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable response to a particular event… Whatever its original cause, it must currently be considered a manifestation of behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g.... political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above.

“Fiona” Courtesy of Sally Jensen (2004)

DSM-IV Warnings Not limited to listed disorders DSM-IV isn’t for amateurs Not uniformly applicable to all cultures Not meant to have the force of the law

Sources of Information History Test Results Behavioral Observations

DSM diagnoses are a communication tool… A man and his wife were having problems at home and were giving each other the silent treatment. This had gone on for several weeks when the man realized he would need his wife to wake him up at 5:00 A.M. for an early flight to Sydney. Not wanting to be the first one to break the silence, he finally wrote on a piece of paper, "Please wake me at 5:00 A.M." The next morning the man woke up only to discover it was 9:00 A.M., and he had missed his business flight. Furious, he was about to go and see why his wife hadn't woken him, when he noticed a piece of paper beside his bed. It said...in big bold, black print... "IT'S 5:00 A.M., WAKE UP!!!"

Common Interview Techniques Establish rapport early Determine patients chief complaint and use it to develop a provisional diagnosis Rule out possibilities with focused Q’s Follow up vague/obscure replies Let the patient talk freely enough to observe how tightly the thoughts are connected Use mixture of open and closed-ended questions Don’t be afraid to explore difficult/embarrassing areas Give the patient a chance to ask Q’s & conclude initial interview with a sense of confidence and optimism.