Summary for the final exam for Clinical Interviewing and Diagnostic Skills (CIDS). Includes Chapter 1 of the handbook of differential diagnoses, all mandatory articles for Personal Recovery, Case Conceptualization, the DSM and HiTOP, and all lectures.
CHAPTER 1 OF THE HANDBOOK OF DIFFERENTIAL DIAGNOSES
THE SIX STEPS OF DIFFERENTIAL DIAGNOSIS
Step 1: Rule out malingering and factitious disorder
- Malingering Disorder: When the motivation is the achievement of a clearly
recognisable goal
- Factitious Disorder: When the deceptive behaviour is present even in the absence of
obvious external rewards
- When the clinician’s index of suspicion should be raised:
1. There are clear external incentives to the patient’s being diagnosed with a
psychiatric condition
2. The patient presents with a cluster of symptoms that conforms more to a lay
perception of mental illness rather than to a recognised clinical entity
3. The nature of the symptoms shifts radically from one encounter to another
4. The patient has a presentation that mimics that of a role model (such as another
patient on the unit or a mentally ill close family member)
5. The patient is characteristically manipulative or suggestible
Step 2: Rule out substance etiology → Substance-Induced Disorder: Depressive, anxiety,
psychotic or manic symptoms that occur as a physiological consequence of the use of
substances of abuse or medication
- Determine whether the person has been using a substance
- Determine whether there is an etiological relationship between it and the psychiatric
symptomatology
↓
Three possible relationships between the substance use and the psychopathology
1. The psychiatric symptoms result from effects of the substance on the CNS
1. Determine whether there is a close temporal relationship between the
substance use and the psychiatric symptoms
- Psychiatric symptoms should be attributed to substance use if
they improve within one month after cessation of acute
intoxication, withdrawal or medication use
2. Consider the likelihood that the particular pattern of substance use can
result in the observed psychiatric symptoms
3. Consider whether there are better alternative explanations (E.g.: strong
family history, medical condition, similar episodes unrelated to
substance use)
2. The substance use is a result of having a primary psychiatric disorder – A form
of self-medication
3. The psychiatric symptoms and the substance use are independent
Step 3: Rule out a disorder due to a general medical condition
- Difficult because:
1. Symptoms of some psychiatric disorders and of many general medical
conditions are identical
, 2. Sometimes the first presenting symptoms of a general medical condition are
psychiatric
3. The relationship between the general medical condition and the psychiatric
symptoms may be complicated – Can influence each other
4. Patients are often seen in settings primarily geared for the identification and
treatment of mental disorders in which there may be a lower expectation for,
and familiarity with, the diagnosis of medical conditions
- Mental Disorder Due To Another Medical Condition: Diagnostic category that refers
to mental health disorders that are directly caused by or significantly influenced by a
medical condition
- Five possible relationships:
1. The general medical condition causes the psychiatric symptoms through a
direct physiological effect on the brain
2. The general medical condition causes the psychiatric symptoms through a
psychological mechanism (E.g.: depressive symptoms in response to being
diagnosed with cancer)
3. Medication taken for the general medical condition causes the psychiatric
symptoms → Medication-Induced Mental Disorder: Depressive, anxiety,
psychotic, or manic symptoms that occur as a physiological consequence of the
use of medications
4. The psychiatric symptoms cause or adversely affect the general medical
condition → Psychological Factors Affecting Other Medical Condition: The
influence of psychological factors such as stress, emotions, thoughts and
behaviour on a person’s physical health and the course or outcome of various
medical conditions
5. The psychiatric symptoms and the general medical condition are coincidental
- Two clues suggesting that psychopathology is caused by the direct physiological effect
of a general medical condition:
1. The psychiatric symptoms begin following the onset of the general medical
condition, vary in severity with the severity of the general medical condition,
and disappear when the general medical condition resolves
2. The psychiatric presentation is atypical in symptom pattern, age at onset or
course (E.g.: when severe memory or weight loss accompanies a relatively
mild depression)
Step 4: Determine the specific primary disorders
Step 5: Differentiate Adjustment Disorder from the residual other specified or unspecified
disorders
- If the clinical judgment is made that the symptoms have developed as a maladaptive
response to a psychosocial stressor → Adjustment Disorder
- If it is judged that a stressor is not responsible for the development of the clinically
significant symptoms:
- Other Specified Disorder → If the clinician wants to indicate the specific
reason, then the name of the disorder (i.e. ‘Other Specified Disorder’) is
followed by the reason why the presentation does not conform to any of the
specific disorder definitions
, - Unspecified Disorder → If the clinician chooses not to indicate the specific
reason why the presentation does not conform to any of the specific disorder
definitions
Step 6: Establish the boundary with no mental disorder
- ‘Clinically significant impairment’ → Often a nonissue; the fact that the individual has
sought help automatically makes it clinically significant
- Other Conditions That May Be a Focus of Clinical Attention: ‘Normal’ but impairing
symptomatic presentations that may be worthy of clinical attention, but do not qualify
as a mental disorder
DIFFERENTIAL DIAGNOSIS AND COMORBIDITY
ix different ways in which two comorbid conditions may be related to one another:
1. Condition A may cause or influence condition B
2. Condition B may cause or influence condition A
3. An underlying condition C may cause or influence both conditions A and B
4. Conditions A and B may be part of a more complex unified syndrome that
has been artificially split in the diagnostic system
5. The relationship between conditions A and B may be artifactually enhanced
by definitional overlap (E.g.: depression and anxiety disorders share many
symptoms, so it can create the appearance of a close relationship between
the conditions, but they are in fact distinct disorders)
6. The comorbidity is the result of a chance co-occurrence that may be particularly likely
for those conditions that have high base rates
Diagnosing someone with more than one DSM-5 diagnosis does not mean that there is more
than one underlying pathophysiological process → DSM-5 diagnoses should be considered
descriptive building blocks that are useful for communicating diagnostic information
CHAPTER 9 (SLADE) – THE PERSONAL RECOVERY FRAMEWORK
Personal recovery: An approach to psychopathology that emphasises the individual’s journey
toward rebuilding a meaningful and satisfying life despite experiencing mental health
challenges or psychiatric conditions – Unlike traditional medical models that focus primarily
on symptom reduction and management, personal recovery places emphasis on
empowerment, self-determination, and holistic well-being
Four key domains of recovery:
1. Hope: A primarily future-oriented expectation of attaining personally valued goals,
relationships or spirituality which lead to meaning and are subjectively considered
possible → What will happen to me? → Mental illness and its devaluing consequences
can take away hope for a good future
2. Identity: Those persistent characteristics which make us unique and by which we are
connected to the rest of the world → Who am I? → Mental illness undermines
personal and social identity
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