ࡱ> ?A>'` Bbjbj 4$B $]!2  $"h$!666!!rrr6  r6 rr |  01{1@ -!0]!{%V{%$ {% X0 "rB^!!h ]!6666  Roadmap for Diagnosis EPC 659B Level I. Gather a complete database from counselee and other informants, including: History of current illness Previous mental health Personal and social background (See Table 8.1, p. 89) Family history (p. 96-97) Medical history (See Table 9.1, p. 102-105) (See Table 9.2, p.113) Mental status examination Level II. Identify syndromes; i.e., a collection of symptoms (See DSM-IV-TR, p. 13 26) Level III. Construct a differential diagnosis; i.e., a listing of all possible diagnoses (#1 below). Level IV. Using a decision tree, select most likely provisional diagnosis. Level V. Identify other diagnoses that might be comorbid with principal diagnosis (See Table 3.1, Hierarchy of Conservative (Safe) Diagnoses, p. 17) Arrange multiple diagnoses according to urgency of need for treatment. Level VI. Write a formulation; i.e., a brief summary of findings and conclusions, as a check on your evaluation. Level VII. Reevaluate the diagnoses as new data become available. Diagnostic Principles Create a Differential Diagnosis A. Arrange your wide-ranging differential diagnoses according to a safety hierarchy (See Table 3.1, p. 17) Hierarchy of Conservative (Safe) Diagnoses Most desirable (most dangerous, most treatable, best outcome) Any disorder due to substance use or a medical illness Recurrent depression Mania or hypomania Middle ground Alcohol dependence Panic disorder Phobic disorders Obsessive-compulsive disorder Anorexia nervosa Adjust disorder Substance (other that alcohol) dependence Borderline personality disorder Least desirable (hard to treat poor outcome) Schizophrenia Antisocial personality disorder AIDS-related dementia Alzheimers dementia Family history can guide diagnosis, but because you often cant trust reports, clinicians should attempt to rediagnose each family member (p. 29) Physical disorders & their treatment can produce or worsen mental symptoms (p.102-105) Consider somatoform disorder; i.e., multiple, unexplained symptoms (including pain and mood symptoms), whenever symptoms dont jibe or treatments dont work (p.110) Substance use can cause a variety of mental disorders (p.17) Always consider mood disorders, because of their ubiquity, potential for harm, and ready response to treatment. When Information Sources Conflict History beats current appearance (p.24) Recent history beats ancient history (p.26) Collateral information sometimes beats the clients own (p.26) Signs beat symptoms (p.27) Be wary when evaluating crisis-generated data (p.28) Objective findings beat subjective judgment (p.28) Use Occams razor: Choose the simplest explanation (p.30) Horses are more common than zebras; prefer the more frequently encountered diagnosis (p.31) Watch for contradictory information (p.36) Resolve Uncertainty The best predictor of future behavior is past behavior (p.47) More symptoms of a disorder increase its likelihood as your diagnosis (p.47) Typical feature of a disorder increase its likelihood as your diagnosis; in the presence of nontypical features, look for alternatives (p.47) Previous typical response to treatment for a disorder increases its likelihood as your diagnosis (p.48) Use the word undiagnosed whenever you cannot be sure of your diagnosis (p.48) Consider the possibility that this client should be given no mental diagnosis at all (p.51) Multiple Diagnoses When symptoms cannot be adequately explained by a single disorder, consider multiple diagnoses (p.61) Avoid personality disorder diagnoses when your client is acutely ill with an Axis I disorder (p.62) Arrange multiple diagnoses to list first the one that is most urgent, treatable, or specific. Whenever possible, also list diagnoses chronologically (p.64) Morrison, J. (2007). Diagnosis made easier: Principles and techniques for mental health clinicians. New York: The Guilford Press.  + * A \ f  & R ] i q   I S  i j FGBhm&hQ[ hP5\ hAh8Ah8Ah[R hP>*h> hHhh67h& hP6]hhShPB yB \  i  I   7  & F h0`0 $|^`|a$ |^`| & F pTT^T 8^8`$a$B7 8  I ` u "Bo~[ & F^ ^` ^`[W'(P| >xS.@AT & F h0`0 & FTUB & F21h:pS/ =!"#$8% @@@ NormalCJ_HaJmH sH tH >@> Heading 1$$@&a$>*DA@D Default Paragraph FontViV  Table Normal :V 44 la (k@(No List 2>@2 Title$a$5\LC@L Body Text Indent^`2B@2 Body TextCJB$  yB\iI78I`u"Bo~[W  ' ( P | > x   S . @ A T U D0000 0 0 0 0 0 00000000000 0000000000000000000000000 0 0 0 0 00 00 0 0 0 0 0  0  0  0  0 0 00 0 0 0 0 0 00 00 0 0 00z0z0B 7 [TB B;8[ )#<8[ W=8[ T #11D+99D9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsplace VD(hD3A[[gg78ijFG& (   S T ADD=`f.9FesINT9[m>i|NT8|tbh pp^p`OJQJo(h @ @ ^@ `OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h PP^P`OJQJo(h   ^ `OJQJo(oh ^`OJQJo(^`o(.^`o(.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.h ^`OJQJo(h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h^`.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.i|sI=`9[.9F8|          \                                           Am&J,678A9CQ[PSHh> &[Rm@]B`@UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"hEFEFEFF F  $24d;;2QHX)?9C2Roadmap for DiagnosisRie Rogers MitchellOwner$      Oh+'0 $0 P \ h tRoadmap for DiagnosisRie Rogers Mitchell Normal.dotOwner2Microsoft Office Word@@l1@l1@l1F ՜.+,0 hp|   ;' Roadmap for Diagnosis Title  !"#$%&'()*+,-/012345789:;<=@Root Entry FӋ1BData 1Table%WordDocument4$SummaryInformation(.DocumentSummaryInformation86CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q