Diangosis+of+Mental+Illness,+Classification+of+DSM+IV-TR,+and+Mental+Status+Evaluation

=**Diangosis of Mental Illness, Classification of DSM IV-TR, and Mental Status Evaluation**=


 * 1. Define the fundamentals of classification of mental illness with the DSM IV-TR.**

Classification system based on description not cause using a categorical approach dividing mental disorders into types based on criteria set with defining features. No description of treatment. Associated features of the disorder are described including, age, cultural, gender-related features, prevalence, incidence, course, complications, predisposing factors, familial pattern and differential diagnosis.


 * 2. Explain the usefulness of the multiaxial system of diagnosis of mental illness.**

The multiaxial system allows one to narrow down a broad differential in mental illness when there are few specific confirmitive tests. The different axies acount for factors that differentiate diseases that may seem identical on any one axis.


 * 3. List and describe each component of the multiaxial system of diagnosis of mental illness.**

Axis I: Clinical disorders and other conditions that may be a focus of clinical attention (MDD, developmental and learning disorders etc.) Axis II: Personality disorder and mental retardation Axis III: Any physical disorder or general medical condition that is present in addition to the mental disorder Axis IV: Psychosocial and environmental factors that significantly contribute to the development or exacerbation of the current disorders Axis V: Global assessment of function (GAF) scale - 100 point scale in which the clinician judges the patient’s overall level of functioning


 * 4. Describe the relevance of DSM IV-TR to the practice of primary care.**

Primary care physician must be able to recognize mental illness in order to advise the patient to seek treatment (screening). Also used in determining mental status of and competencey of patient to make healthcare decisions (elderly).


 * 5. Differentiate between classification with the DSM IV-TR and the ICD (International Classification of Disease) systems.**

The ICD is developed by World Health Organization and covers diagnosis of all diseases and is required by Medicare for biling. The ICD is less restrictive than DSM using only 3 axes: Clinical diagnosis, Disablements and Contextual factors. These two systems share codes, but the DSM is used exclusivly in psychology to give a more specific diagnosis.


 * 6. Define and demonstrate aspects of psychiatic differential diagnosis.**

A group of possible diagnoses which have similar features, overlapping pathology and presentation. An all inclusive list from which a final diagnosis is made. Examine all 5 axises for the patient and identify the diagnosis. Usualy based on a psychiatric evaluation including:
 * Chief Complaint
 * History of Present Illness
 * Past History
 * Psychiatric
 * Medical
 * Family History
 * Social History
 * Mental Status Examination


 * 7. Characterize the components of the mental status exam.**

> -Hallucinations (false sensory perception not associated with real external stimuli. Visual, auditory, olfactory, gustatory, tactile) > -Illusion (misperception or misinterpreta-tion of real external sensory stimuli. Disturbed perceptions of self or environment) > -Alertness and level of consciousness on a continuum of alert to coma. > -Remote memory (distant past) > -recent past memory (past few months) > -recent memory (past few days) > -immediate retention and recall (seconds to minutes) > -Attention (ability to focus perception on an outside or inside stimulus) > -Concentration (sustained attention to an internal thought process. Capacity to read or write) > -Visuospatial ability (ability to reproduce a figure) > -Abstract thinking (the ability to deal with concepts, appreciate nuances of meaning) > -Judgment - ability to assess a situation correctly and to act appropriately within that situation > -Insight - ability of the person to understand the true cause or meaning of a situation
 * Appearance: Grooming, clothing, hygene
 * Speech: speed, volume, vocabulary
 * Mood and affect: eye contact, facial expression
 * Thought: Thinking which may reflect impaired reality testing and evidence of perceptual disturbances. Ideas, beliefs, preoccupations, obsessions.
 * Perceptual disturbances:
 * Sensorium and recognition:
 * Impulse control: shopping spree, promiscuity, anger
 * Judgment and insight:
 * Reliability: ability to maintain employment, relationships etc.


 * 8. Explain the rationale for the mental status examination.**

A formal evaluation of the examiner’s observations and impressions of the patient at the time of the interview. It is a description of the patient’s appearance, speech, actions and thoughts during the interview. The examination of the patient is used to assess mental functioning and its relationship to underlying pathology. Can be used to determine competency, risk to self, possible medical pathology.


 * 9. Demonstrate the procedure of the mental status examination.**


 * Direct Observation: appearance, behavior, speech, mood affect, thought content and process, alertness and level of consciousness
 * Direct Questioning: perceptual disturbances, orientation
 * Memory: immediate retention and recall - digit span, recent memory - word recall, day’s events, recent past memory - current events of last few months, remote memory - verifiable information about personal and general past events
 * Concentration:serial subtractions, reverse spelling, changing sets, i.e., go-no go test
 * Reading and Writing: write a sentence, read sentence and follow instructions
 * Visuospatial Ability: copy figure, i.e., clock, geometric figure
 * Abstract Thinking: explain similarities, i.e., rose-daisy, table-chair, interpret proverbs
 * Fund of Knowledge and Intelligence: computations, vocabulary, facts.