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    PSY4032 Differential Diagnosis V2

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    Junjie Goh
    The document discusses the process of differential diagnosis, which involves determining the most accurate diagnosis when a client presents with overlapping symptoms of multiple potential disorders. It describes a 6-step process: 1) exclude malingering or factitious disorder, 2) exclude substance use, 3) exclude general medical conditions, 4) determine the primary disorder using DSM-5 criteria and decision trees, 5) consider disorders if full criteria aren't met, and 6) rule out mental disorders if symptoms are insufficient or reasonable given life circumstances.

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    PSY4032 Differential Diagnosis V2

    Uploaded by

    Junjie Goh
    34 views19 pages
    The document discusses the process of differential diagnosis, which involves determining the most accurate diagnosis when a client presents with overlapping symptoms of multiple potential disorders. It describes a 6-step process: 1) exclude malingering or factitious disorder, 2) exclude substance use, 3) exclude general medical conditions, 4) determine the primary disorder using DSM-5 criteria and decision trees, 5) consider disorders if full criteria aren't met, and 6) rule out mental disorders if symptoms are insufficient or reasonable given life circumstances.

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    The document discusses the process of differential diagnosis, which involves determining the most accurate diagnosis when a client presents with overlapping symptoms of multiple potential disorders. It describes a 6-step process: 1) exclude malingering or factitious disorder, 2) exclude substance use, 3) exclude general medical conditions, 4) determine the primary disorder using DSM-5 criteria and decision trees, 5) consider disorders if full criteria aren't met, and 6) rule out mental disorders if symptoms are insufficient or reasonable given life circumstances.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views19 pages

    PSY4032 Differential Diagnosis V2

    Uploaded by

    Junjie Goh
    The document discusses the process of differential diagnosis, which involves determining the most accurate diagnosis when a client presents with overlapping symptoms of multiple potential disorders. It describes a 6-step process: 1) exclude malingering or factitious disorder, 2) exclude substance use, 3) exclude general medical conditions, 4) determine the primary disorder using DSM-5 criteria and decision trees, 5) consider disorders if full criteria aren't met, and 6) rule out mental disorders if symptoms are insufficient or reasonable given life circumstances.

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    © All Rights Reserved
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    Download as pdf or txt
    of 19

    Differential Diagnosis

    P S Y C H O P A T H O L O G Y A N D C L I N I C A L S C I E N C E
    The Diagnostic Process
    Consequences?
    DIAGNOSIS
    More than 1
    diagnosis?

    What if it’s incorrect?

    What if we miss
    SYMPTOMS a diagnosis?
    Provisional Diagnosis

    Provisioan l diagnossis
    309.81 §Post-traumatic Stress Disorder (Provisional)
    Differential Diagnosis

    “the process of determining which of two or more


    diseases or disorders with overlapping symptoms
    a particular client has” and “the distinction
    between two or more similar conditions by
    identifying critical symptoms present in one but
    not the other”.
    (APA Dictionary of Psychology, 2022)
    The Process
    § List our hypotheses
    § Explanations of client symptoms
    § Use of DSM-5 criteria
    § Series of steps to eliminate explanations
    § Directs our ongoing assessment
    § Questioning narrows down focus
    § Determine
    § Diagnosis
    § Prognosis
    § Treatment
    The Toolset

    § Handbook of Differential Diagnoses


    § Dr. Michael First
    § Based on DSM-5
    § Diagnostic criteria
    § Symptoms
    § Requirements for diagnosis
    Step 1: Exclude Malingering/Factitious Disorder

    § Malingering
    § Purposeful deception of clinician
    § Symptoms are feigned
    § Partial malingering: Exaggerated
    § Secondary gain motive
    § Factitious disorder
    § Recognised disorder
    § Sick role/attention motive
    Step 2: Exclude Substance Use

    § Drug-induced psychiatric symptoms


    § Legal drugs
    § e.g., corticosteroids
    § Illicit drugs
    § Comorbidity of substance disorders
    § DSM exclusion clause
    Step 3: Exclude General Medical Condition

    § Illness mirrors psychiatric symptoms


    § Hypothyroidism (depressive)
    § Hyperthyroidism (anxiety)
    § Pre-screening by GP
    § DSM exclusion clause
    Step 4: Determine Primary Disorder

    § Current DSM criteria


    § 29 decision-trees/flowcharts
    § Based on presenting symptoms
    § Series of decision points
    § Several trees may be applicable
    § May lead to same diagnosis
    § >1 diagnosis may be appropriate
    Decision Tree: Panic Attack
    Panic Attack

    Due to the Y Panic attacks predominate Y SUBSTANCE/MEDICATION


    physiological effects of a in the clinical picture and INDUCED ANXIETY
    substance (including are sufficiently severe to DISORDER
    medication) warrant clinical attention
    N N SUBSTANCE INTOXICATION,
    SUBSTANCE WITHDRAWAL
    OTHER ADVERSE EFFECT OF
    MEDICATION
    Decision Trees: Panic Attack

    ANXIETY DISORDER DUE TO


    Y
    Due to the ANOTHER MEDICAL
    physiological effects of a CONDITION, WITH PANIC
    general medical condition ATTTACKS

    Recurrent unexpected
    panic attacks Y
    accompanied by at least 1 PANIC DISORDER (3.5.5)
    month of concern or
    maladaptive changes in
    behaviour
    N
    Decision Trees: Panic Attack

    Y
    Trigger for panic attack is SOCIAL ANXIETY DISORDER
    fear of embarrassment in (3.5.4) WITH PANIC
    social situations ATTACKS
    N

    Trigger for panic attack is


    fear of specific object Y
    (e.g., spiders) or situation SPECIFIC PHOBIA (3.5.3)
    WITH PANIC ATTACKS
    (e.g., heights, seeing
    blood)
    N
    Decision Trees: Panic Attack

    Trigger for panic attack is Y SEPARATION ANXIETY


    fear of separation from DISORDER (3.5.1) WITH
    major attachment figures PANIC ATTACKS

    N
    Decision Trees: Panic Attack

    Trigger for panic attack is


    exposure to a situation
    resembling a prior
    traumatic experience
    occurring in the context of Y Y POSTTRAUMATIC STRESS
    intrusion symptoms, Duration of more
    than 1 month DISORDER (3.7.1) WITH
    avoidance of stimuli PANIC ATTACKS
    associated with the N
    traumatic stressor,
    negative alterations in
    cognitions and mood, and ACUTE STRESS DISORDER
    alterations in arousal and (3.7.1) WITH PANIC
    ATTACKS
    activity

    N
    Decision Trees: Panic Attack

    Y
    Trigger for panic attack is ILLNESS ANXIETY DISORDER
    the threat of having a (3.9.2) WITH PANIC
    serious illness ATTACKS
    N

    Trigger for panic attack is


    exposure to a focus of an Y OBSESSIVE-COMPULSIVE
    obsessional concern (e.g., DISORDER (3.6.1) WITH
    to dirt to an individual PANIC ATTACKS
    with contamination
    obsession)
    N
    Decision Trees: Panic Attack

    Trigger for panic attack is Y GENERALISED ANXIETY


    excessive anxiety and DISORDER (3.5.4) WITH
    worry about a number of PANIC ATTACKS
    events or activities such as
    work or school
    performance
    N

    Failure to meet threshold


    Step 5: Failure to Meet Threshold

    § Adjustment Disorder
    § Exaggerated, persistent response
    § Other specified categories
    § Failed to meet full criteria
    § Other Unspecified categories
    § Symptoms align with disorder
    § Symptoms not met
    § No reason given
    Step 6: No Mental Disorder

    § Insufficient level distress/dysfunction


    § A reasonable response
    § Life event, e.g., bereavement

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