Recap:

To make a given diagnosis, the clinician must observe a particular criteria the
symptoms and signs that the DSM indicates must be met (of course, if he or she
is using the DSM)

DSM Diagnostic and Statistical Manual of Mental Disorders, currently in its
fifth edition but its still too new to be studied so were using the DSM and its
recent modifications published in 2000
The standard for classifying mental disorders that are used by mental
health professionals in the U.S. likewise in the Philippines
Intended to be applicable in a wide variety of contexts used by clinicians
and researchers of many different orientations

DSM IV/ -IV TR treatment planning
3 early sections
Use of the Manila guidelines for coding, terminology,
organizational plan, explanations of discussions
DSM IV classification non-annotated outline of axis I and II;
codes into 16 diagnostic classes and a miscellaneous category
Other Conditions That May Be A Focus of Attention
Multi-Axial System
Additional key diagnostic issues should be properly understood before
proceeding with the diagnosing
1. Coexistence of more than one disorder in the same patient complexities
of patients physical, emotional and interpersonal lives lead to more than
one diagnoses
2. Lack of discrete division between disorders fine line between mental
disorder and normalcy
3. Hierarchical precedence of some diagnoses over others blocking other
diagnoses when due to general medical disorders or are substance-
induced increases clinical accuracy; encourages clinician or treatment
team to attend to disorders before devoting time and resources on others
4. Limitations in transcultural application of DSM-IV disorders and
techniques cultures may vary and may be different from the evaluating
clinician; must understand what is both normal and psychopathological
to a patient
Specific culture, age, and gender features and Appendix I outlines
for cultural formation

Multi-axial evaluation
Assessment that focuses on several domains that may help a clinician
plan treatment and predict outcomes.
Provides a convenient format for organizing and communicating clinical
information.
Multi-axial approach to diagnosing because rarely do other factors in a persons
life not impact their mental health. It assesses five dimensions.

Axis I-III - assess an individuals present clinical status or condition
More than one diagnosis is permissible even encouraged since one
person may be diagnosed as having multiple psychiatric syndromes,
personality disorders, or potentially relevant medical problems

Axis I - The particular clinical syndromes or other conditions that may be a
focus of clinical attention; This is what is thought of as the diagnosis
Substance-Related Disorders
Mood Disorders
Anxiety Disorders
Schizophrenia and Other Psychotic Disorders
Eating Disorders

Axis II - Personality disorders Personality disorders which are clinical
syndromes having more long lasting symptoms and encompass the individuals
way of interacting with the world. They include Paranoid, Antisocial and
Borderline Personality Disorders.; Developmental disorders including autism,
mental retardation and disorders which are typically first evident in childhood.
Paranoid Personality Disorder
Borderline Personality Disorder
Obsessive-Compulsive Personality Disorder
Mental Retardation

Axis III - General medical conditions - which play a role in the development,
continuance, or exacerbation of Axis I and II Disorders
Infections & Parasitic Diseases
Immunity Disorders
Diseases of the Respiratory System
Injury and Poisoning

Axis I and II: to present individual disorders, you will need DSM-IV TR criteria
for each - diagnoses are regarded as fitting into several broad etiological (major
causal) groupings
Substance-use disorders - habitual drug or alcohol abuse
Disorders secondary to gross destruction or malfunctioning of brain
tissue - cognitive conditions based on permanent or irreversible organic
brain pathology such as Alzheimers dementia
Disorders of psychological or sociocultural origin with no brain
pathology as the primary causal factor - major mood disorders and
schizophrenia - several mental disorders with no specific organic brain
pathology but increasingly likely there seems to have at least a minimal
cause in certain types of aberrant brain functioning
Disorders arising from childhood or adolescence - cognitive impairment,
large variety of behavioral problems that constitute deviations from the
expected or normal path of development
Terms
Acute - disorders of relatively short duration, under 6 months (transitory
adjustment disorders; behavioral symptoms of high intensity in some
contexts)
Chronic - long-standing and often permanent disorders (alzheimers
dementia and forms of schizophrenia; low-intensity disorders in some
contexts, long term difficulties are usually this sort)
Mild moderate and severe - reflect different points of dimension of
severity or seriousness
Episodic and recurrent - unstable disorder patterns that tend to come
and go (mood and schizophrenic conditions)

Axis IV-V
First introduced in DSM-III
Knowing what frustrations and demands a person is facing - to
understand the context in which the problem behavior has developed
Unnecessarily compromises a patients right to privacy
Considered optional for diagnosis, rarely used in the clinical settings

Axis IV - severity of Psychosocial and environmental problems used to report
problems that may affect the diagnosis, treatment, and prognosis of mental
disorders.
These problems can develop as a consequence of a diagnosis
May be problems that should be considered in treatment plan
Psychosocial and Environmental Problems
Problems with primary support group
Death of a family member
Disruption of family by divorce, estrangement
Parental overprotection
Birth of a sibling
Educational problems
Illiteracy
Academic problems
Economic problems
Extreme Poverty
Professional/Job problems
Unemployment
Stressful work schedule

Axis V - Global assessment of functioning
Used to report clinicians judgment of an individuals level of functioning
Useful in planning treatment, measuring its impact, and predicting
outcome
On the final axis, the clinician rates the persons level of functioning both at
the present time and the highest level within the past year. This helps the
clinician understand how the above four axes are affecting the person and
what type of changes could be expected.
GAF scale - The GARF Scale can be used to indicate an overall judgment of the
functioning of a family or other ongoing relationship on a hypothetical
continuum ranging from competent, optimal relational functioning to a
disrupted, dysfunctional relationship
Rating the patients level of functioning according to the GAF Scale is relatively
easy if adequate information is available. Simply locate a description that
accurately portrays the individual by referring to page 32 of DSM-IV. Each
description has an associated range of numbers or codes (e.g., the person
with serious impairment is rated from 41 to 50). The clinician selects a
number in range which best represents the patients level of functioning.
For example, year-old male presents for evaluation in a catatonic state. He is
mute and will not follow any commands. According to the GAF Scale, a person
who has gross impairment in communication falls into a rating range between
11 and 20. The clinician would rate the patients current level of functioning
within the appropriate range. An individual who is unable to maintain minimal
personal hygiene is rated between 1 and 10. (See Table 8.1 for an abbreviated
GAF Scale).

DSM 5
APA began revising the Diagnostic and Statistical Manual in 2007 -
substantial input from numerous mental health professionals
Many aspects of the current were continued in the new DSM generation
because of their clarity and acceptance - some categories will be modified
and new diagnostic criteria will be added
Allen J. Frances (2012) has written an article DSM 5 is a Guide, not a Bible
about his dejection of the DSM
Deeply flawed clearly unsafe and scientifically unsound
Advices to clinician, press and the general public be skeptical and
dont follow the DSM 5 to the point of overdiagnosis and harmul over
medication
Background: premature and unrealized goal, wanted to produce a
paradigm shift in psychiatry; vigorously opposed by many clinicians
Listed the ten most potentially harmful changes
Diagnostic hyperinflation
Diverts attention from the really ill people to with the everyday
problems; will be mislabeled will be harmed not helped
10 MOST POTENTIALLY HARMFUL CHANGES
1. Disruptive Mood Dysregulation Disorder
2. Normal grief will become a major depressive disorder
3. Minor neurocognitive disorder
4. Adult Attention Deficit Disorder
5. Binge eating disorder
6. Changes in definition of Autism
7. First time substance abusers are considered hard core addictines
8. Behavioral addictions
9. Generalized Anxiety Disorder
10. Misdiagnosis of PTSD
Controversies
The need for classification of personality disorders, currently on Axis
II
Requirement of direct involvement in an experienced trauma for the
PTSD diagnosis to bed applied
As a result of the Twin Towers terrorist attack, many were
traumatized through media coverage of events - indirect exposure
Labeling people who might experiencing normal grief as a major
depressive disorder
Medicalization of normal emotion
Pharmaceuticals to bank own the bereaveds emotions
Expansion of clinical diagnosis to inappropriate areas