Diagnosis and differential diagnosis

Rumke Differential Table Updated

The main diagnostic challenges are to identify pathological grief, and to identify other mental disorders provoked by bereavement ( Table ). Table 2 Complications of bereavement Pathological grief has different meanings. It can be defined as follows (25) chronic grief the failure to resolve all adverse bereavement-related symptoms within 6 months inhibited grief the absence of expected grief symptoms delayed grief the avoidance of painful symptoms within the first 2 weeks of a loss. An...

Developing an idiosyncratic model of the patients problem

Assessment ends with the development of an idiosyncratic version of the cognitive model. In particular, therapists aim to show patients how the specific triggers for their anxiety produce negative automatic thoughts relating to feared outcomes and how these are maintained by safety behaviours and other maintenance processes. The model is usually drawn on a whiteboard, so that patient and therapist can look at it and discuss it together. Figure 1 shows an example for a panic disorder patient....

Language and speech disorder

'Speech disorder' refers to defects in the ability to generate and pronounce verbal statements, whereas 'language disorder' designates deficits in the use of language.(.51> In view of frequent difficulties in making this distinction, the two terms are often used interchangeably. In medical nomenclature the prefix 'a' denotes the complete loss of an ability, and the prefix 'dys' denotes a less pronounced impairment. However, this principle is not always followed strictly. Thus the terms...

Cluster A personality disorders Paranoid personality disorder JLC

Personailty Disorder Table

This disorder is characterized by pervasive suspiciousness, mistrust, and hypersensitivity to criticism and hostility. Paranoid individuals live an isolated emotional life because they fear the malevolent intent of others. As a rule, paranoid people are ready to counter-attack, provoking repeated confrontations. In this way, they induce hostility and resentment in others. The term paranoia may lead to some confusion if it is not properly delimited. Paranoid had been used as an adjective to...

Indications and contraindications for psychoanalysis and derived psychotherapies

The indications for these three modalities of treatment remain controversial. With the recognition of the limitations of psychoanalysis in many cases with severe, chronic, life-threatening, self-destructive behaviour, such as chronic suicidal behaviour, severe eating disorders, dependence upon drugs or alcohol, and severely antisocial behaviour, psychoanalytic psychotherapy has proven to be a highly effective treatment for many but by no means all patients with these conditions. The...

The EPOR modela human sexual response cycle model

The most successful model was that formulated by Masters and Johnson. 20 In the laboratory, they observed the changes that took place in the male and female body and especially the genitals during sexual arousal to orgasm either by masturbation or by natural or artificial coitus with a plastic penis that allowed internal filming of the female genitalia. After studying approximately 7500 female and 2500 male arousals to orgasm in some 382 female and 312 male volunteers over 11 years they...

Overcoming barriers to communication

Patient Physician Empathy

Of the many potential barriers to effective patient-physician communication Table , the most important is the health professional him- or herselfA6 7 and 8 gt Although practising primary care is stressful because of the rapid pace and an obligation to accommodate patients' demands at inopportune moments, health professionals must meet these challenges by being empathic, assertive, and respectful. This is more easily said than done. Table 1 Challenging situations in the consultation Being...

Definitions of perceptual disturbances

Cutting defines hallucinations as 'perception without an object within a realistic philosophical framework or as the appearance of an individual thing in the world without any corresponding material event within a Kantian framework '. There is a problem with this definition. Although some hallucinating patients mistake a hallucinatory perception for a realistic one, others can differentiate them there is an 'as if' quality even when patients assert that they perceive real objects or events....

Etic and emic approaches to understanding illness

Apart from changing its site, the study of primary care psychiatry in non-European countries will raise an important methodological issue that of cultural equivalents of the disease concepts and thus the validity of measuring instruments. The traditional approach to the cross-cultural approach will be the 'etic', which involves the application of an internationally agreed classificatory system using appropriately translated standardized instruments. Data obtained in this way are comparable...

Diagnosis and classification

Bulimia Diagrams

Bulimia nervosa is one of the two main eating disorders recognized in DSM-IV and ICD-10. The other is anorexia nervosa (see C.h.a.PteI 4, .0, .). Three features must be present to make a diagnosis of bulimia nervosa. 1. Recurrent episodes of 'binge eating' (defined below). 2. The regular use of extreme methods of weight control (e.g. highly restrictive dieting, self-induced vomiting, the misuse of laxatives and diuretics, or overexercising). 3. A characteristic set of attitudes to shape and...

Schneiderian firstrank symptoms

Schneiderian First Rank

Kurt Schneider(4) identified a set of phenomena that he considered were strongly indicative of schizophrenia in the absence of overt brain disease. These symptoms, listed in Table , have become known as first-rank symptoms. Schneider did not consider that the diagnosis could be made simply on the presence of one such symptom on the contrary, he warned(4), 'a psychotic phenomenon is not like a defective stone in an otherwise perfect mosaic'. Schneider did not define the phenomena precisely, and...

Neuroendocrine challenge tests

Secretion of hormones in the anterior pituitary is under the control, both direct and indirect, of central neuronal cell bodies that may project relatively widely within the brain. The secretion of a given hormone in response to specific precursors or agonists for individual neurotransmitter receptors has been proposed as a way of testing the security of such connections. Hormone secretion provides a bioassay of the system of interest. There is a measure of consensus about the findings in major...

Mixed disorders of scholastic skills

In ICD-10, this is specified as an ill-defined and inadequately conceptualized, but necessary residual, category of disorders in which both arithmetical and reading or spelling skills can be significantly impaired, and in which the disorder cannot be explained in terms of general mental retardation or inadequate schooling. This category covers disorders that meet the criteria of 'Specific disorder of arithmetical skills' (F81.2) and either 'Specific reading disorder' (F81.0) or 'Specific...

Passiveaggressive negativistic personality disorder DLT Definition

Passive-aggressive disorder was not included in DSM-IV because of the many unsolved problems related to its concept in previous classifications. Instead, it is placed in Appendix B of DSM-IV where it is alternatively called negativistic personality disorder. Research criteria are proposed which are expected to be empirically evaluated and to determine the validity and reliability of this diagnosis ( Table 15). A. A pcrvxivc Eua-rrr rwpirrnix ir--Q* and -c rcum-cc i OTur-di far to - pfrfofmmcc....

F231 Acute polymorphic disorder with symptoms of schizophrenia bouffe dlirante or cycloid psychosis with symptoms of

This diagnostic category combines the symptoms of acute polymorphic psychotic disorder with some typical symptoms of schizophrenia F20 present for most of the time. However, the schizophrenic symptoms are not precisely listed. F23.1 can be a provisional diagnosis, which is changed to schizophrenia if the criteria of F20 persist more than a month. Acute polymorphic disorder with symptoms of schizophrenia satisfies the general criteria for acute and transient psychotic disorders acute onset of...

Schizotypal personality disorder JLC

Schizotypia is a controversial term in psychiatry. The term was used by Kretschmer(l0) to denominate the phenotypic characters that antedated the development of schizophrenia. Nevertheless, the term schizotypal personality disorder was not included in psychiatric classifications until the publication of DSM-IIIR in 1987. (U.) Before that date, schizotypal individuals were allocated either with schizoids or with schizophrenics, and were usually labelled as latent schizophrenics or pseudoneurotic...

Infanticide and maternal filicide

Infanticide has a legal definition in England and Wales that is narrower than the generally accepted meaning of the term (see Chapter 5.4). It is the killing of a baby aged under 12 months by its mother, the balance of whose mind is disturbed at the time by the effects of childbirth (Section l(i), Infanticide Act 1938). In recent years there have been fewer than five infanticides per year. Infant killing today has little to do with outdated notions of 'milk fever' upon which infanticide...

Specific spelling disorder

In ICD-10, the main characteristic of this disorder is a specific and significant impairment in the development of spelling skills in the absence of a history of specific reading disorder, which is not solely accounted for by low mental age, visual acuity problems, or inadequate schooling. The children have difficulties in spelling orally and writing words correctly. For this diagnosis, the following criteria are required (ICD-10). The spelling performance of the child should be significantly...

The stigma of personality disorder

The diagnosis of personality disorder generally implies the idea of untreatability and frequently leads to a lack of proper medical care. This attitude is the expression of a negative, moralizing, and, according to Tyrer et al.,(7) delusional attitude of the doctor towards the patient. The preparation of the Green Book on The Health of the Nation in the United Kingdom raised a problem of great interest with respect to personality disorders. (8) On the one hand, they have a prevalence between 7...

The cognitive model of depression and case conceptualization Enduring cognitive vulnerability to depression

Cognitive therapy of depression is defined as 'an active, directive, time-limited, structured approach based on an underlying theoretical rationale that an individual's affect and behaviour are largely determined by the way in which he structures the world'.(1) The cognitive model of depression proposes that enduring cognitive structures and processes shape how everyday experience is interpreted, and are in turn reinforced by these interpretations. This model (illustrated in Fig 1) forms the...

Cognitive therapy to challenge delusions and dysfunctional assumptions

The application of cognitive therapy in the challenging of delusions and dysfunctional beliefs draws upon the approach described by Chadwick et al. (16> and builds upon the pioneering work of Chadwick and Lowe.(H) Those research groups that have been developing CBT approaches agree that engaging patients is perhaps the greatest challenge facing a therapist. It is noticeable that many individuals either never attend or do so for a few sessions and then stop. Once individuals get past the...

Clinical features of bereavement and normal grief

Although the terms bereavement, grief, and mourning are often used interchangeably, the Committee on Health Consequences of the Stress of Bereavement suggests the following definitions. Bereavement is the loss of a loved person through death (coded in ICD-10 as Z63.4 and in DSM-IV as V62.82). Mourning is the voluntary social expression of that loss. Grief is the involuntary emotional and related behavioural reaction to that loss. Women are not only more at risk of bereavement than men, but they...

F233 Other acute predominantly delusional psychotic disorders

The main clinical features of this category are delusions and hallucinations. The foreground delusions are mostly persecutory (delusions that the person or close relatives are being malevolently treated or are under external influence, with thought disturbances) auditory hallucinations are present in the background. Despite their stability, these psychotic features do not meet the criteria for schizophrenia (F20). As for F23.0, the duration of this acute predominantly delusional psychotic...