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PHSI 208 (10)
Chapter 3

Chapter 3.doc

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PHSI 208
Neil Hibbert

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th  Diagnostic and statistical manual of mental disorders (DSM) now in its 4 edition, commonly referred to as DSM –IV or DSM –IV-TR. The DSM is published by the American psychiatric association A BRIEF HISTORY OF CLASSIFICATION  Bloodletting was part of treatment of all physical problems Development of the WHO and DSM systems  In 1939 the world health organization (WHO) added mental disorders to the international list of causes of death  In 1948 the list was expanded to become the international statistical classification of diseases, injuries and causes of death (ICD) a comprehensive listing of all diseases including a classification of ab beh. Metal disorders section was not widely accepted  American psychiatric association published its own diagnostic and statistical manual (DSM) in 1952  In 1969 the WHO published a new classification system that was more widely accepted. A 2 version of the American psychiatric associations DSM, DSM-II was similar to the WHO system  The WHO classifications were simply a listing of diagnostic categories; the actual beh or symptoms that were the bases for the diagnoses were not specified  In 1980 the American psychiatric association published an extensively revised diagnostic manual; a somewhat revised version DSM-III – R appeared in 1987  DSM –IV is used throughout the U.S and Canada is becoming widely accepted around much of he world THE DIAGNOSITIC SYSTEM OF THE AMERICAN PSYCHITIARTC ASSOCIATION (DSM-IV AND DSM-IV-TR)  The term mental disorder is problematic and that no definition adequately specifies precise boundaries for the concept. DSM-IV-TR provides the following definition:  A clinically significant beh or psychological syndrome or pattern that occurs in an indiv 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 Five dimensions of classification  Most sweeping change in the use of multiaxal classification whereby each indiv is rated on 5 separate dimensions or axes  The five axes are:  1) axis I- all diagnosis categories except personality disorder and mental retardation  2) axis II- personality disorders and mental retardation  3) axis III- general medical conditions  4) axis IV- psychological and environmental problems  5) axis V – current level of functioning  most ppl consult a mental health professional for an Axis I condition  although the remaining three axes not needed to make the actual diagnosis their inclusion in the DSM indicates that factors other than a persons symptoms should be considered in an assessment so that the persons overall life situation can be better be understood  axis III conditions may be quite common. A recent study in Toronto found that more tan half of the inpatients had an identifiable medical condition and that having an infectious disease was associated with disruptive beh  these include occupational problems, economic problems, interpersonal difficulties with family members and a verity of problems in other life areas that may influence psychological functioning  life areas considered are social relationships, occupational functioning are supposed to give info about the need for treatment Diagnostic Categories  the DSM indicates that the disorder may be due to a medical condition or substances abuse  DSM-III there has been a dramatic expansion of the # of diagnostic categories Issues and possible categories in need of further study BOX  Caffeine withdrawal- caffeine withdrawal results in significant distress or impairment in occupational or social functioning. Symptoms include headache, fatigue, anxiety, depression, nauseas and impaired thinking  Premenstrual Dysphoric disorder- this proposed syndrome occurs a week or so before menstruation for most months in a given year and is marked by depression, anxiety, anger, mood swings, and decreased interest in activities usually engaged in with pleasure. The symptoms are severe enough to interfere with social or occupational functioning. This category is to be distinguished from premenstrual syndrome which is experienced by many more women and is not nea
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