The Mental Health Diagnostic Desk Reference

Visual Guides and More for Learning to Use the Diagnostic and Statistical Manual (DSM-IV-TR), Second

Carlton Munson

• Éditeur: Routledge
• Année: 2013
• ISBN:
  9781317825647
• Édition: 1
• Sujet: Psychology
• Sous-sujet: History & Theory in Psychology

Make the DSM-IV-TR user-friendly with this powerful learning tool! This expanded and updated edition of Dr. Munson's highly acclaimed book is the indispensable companion volume and guide to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR), published by the American Psychiatric Association. The only study guide currently available for the DSM-IV-TR, The Mental Health Diagnostic Desk Reference, Second Edition, provides clear, cogent expositions of every disorder in the manual. All the information in this edition has been updated to reflect the new thinking and the current criteria. Easy to use in a consistent, all-inclusive format, The Mental Health Diagnostic Desk Reference, Second Edition, offers a detailed explanation of every part of the DSM-IV-TR, from its multi-axial classification system to the criteria for diagnosing individual disorders. It offers guidelines of diagnosis, examples of treatment planning, and 81 helpful illustrations, including color-coded supplemental visuals highlighting the diagnostic criteria for disorders most frequently encountered in clinical practice. It even features a thorough review of the 26 syndromes considered for inclusion in the DSM-IV-TR that did not reach the research criteria for a full-scale disorder. In addition, The Mental Health Diagnostic Desk Reference, Second Edition, is the only guide to applying the new culture-bound syndromes. It even includes a detailed case example of preparing a cultural formulation. References are provided at the end of each chapter, and a master reference list is printed at the end of the book, which enhances ease of use. Summaries for each class of disorders include:

• a listing of codes and disorders
• a fundamental features section describing core aspects of disorders
• brief tips to highlight significant information and helpful diagnostic techniques
• differential diagnosis strategies and tips
• standardized measures and scales recommended for their effectiveness, ease of use, brevity of administration, and cost
• recommended reading

Written by nationally respected clinician, supervisor, and educator Dr. Carlton Munson, The Mental Health Diagnostic Desk Reference, Second Edition, will help end clinical gridlock and enable you to improve services to your clients within the context of managed care.

Chapter 1

Introduction

ABOUT THIS BOOK

This book is about how to use the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), published by the American Psychiatric Association in 2000. The manual has expanded and become more complex since the first edition was published in 1952. The current edition has 943 pages containing 340 disorders. About a dozen study guides review the manual and assist practitioners in becoming effective users of the DSM-IV. Most of these guides assume a certain level of preexisting knowledge of the DSM system and its terminology. This book is the first study guide and reference manual that is compatible with the latest edition of the DSM manual, which is the DSM-IV-TR. This study guide is intended to be different from the previous guides in that it employs a conceptual framework of mastering the organization of the manual through a narrative and visual approach. This book includes eighty-one illustrations that aid in conceptualizing how to perform diagnosis.

I have been doing diagnosis for thirty years, and in 1987, I was required to teach a course in the DSM system at Fordham University in New York City, where I was a faculty member. There I was confronted for the first time with the task of effectively conveying to others how to use the DSM. Since teaching that first class, I have taught over 3,500 students and practicing professionals how to use the DSM. Although I have been teaching this system for twelve years, I still learn something new each time I prepare for a seminar. The complexity of teaching the system led me to develop many visuals to convey the information. Students and practitioners responded favorably to this visual approach and frequently asked for copies of the transparencies. Consequently, I decided to make the visuals into a book. When I sat at the computer for the first time and tried to create narratives to accompany the visuals, I discovered that writing about the visuals was not nearly as easy as talking about them. I did develop a renewed respect for the DSM manual as I was going through it page by page in preparing this book. Although I have been through the manual hundreds of times, and have employed it thousands of times to make diagnoses, I learn something new each time I use the manual.

For those who feel discouraged by the wealth of detail in the DSM-IV-TR and who believe they will never master the system, some solace may be found in the fact that probably not one person in the world has mastered the entire DSM-IV-TR, or knows completely how to use this book as a clinical tool. The DSM-IV-TR was never designed to be mastered in toto, and I believe that is why many professionals have difficulty learning to use it. In school we are not taught to use books as reference tools, but to read them cover to cover and somehow comprehend them as whole documents. The DSM system is not designed that way and cannot be mastered completely. Remember, DSM-IV-TR was designed by a committee. When you assume the reference book stance in relation to the DSM-IV-TR, you are in a position to master it by learning to conceptualize the discrete classes of disorders rather than trying to learn a method that works for the entire manual. The manual was not put together that way. The DSM-IV-TR was compiled by a committee of over 1,600 people! If you do not believe this, look at Appendix J of the manual, which lists all the contributors to the DSM-IV project. I am sure these people did not sit in a room together and work on the manual, but over forty task groups and forty organizations contributed to its production. If you keep in mind the number of persons and groups that contributed to this work, understanding why it is difficult for one person to master this large volume becomes a little easier. For these and other reasons, you cannot expect the DSM-IV-TR to be highly conceptualized from one perspective. It does not represent any theoretical orientation. The numbering system is not completely consistent because it had to be compatible with the International Classification of Diseases System. The organization of the different sections is inconsistent because of the varied nature of the disorders. For example, mood disorders do not lend themselves to the same framework as anxiety disorders, and anxiety disorders do not lend themselves to the same organization as psychotic disorders. For the same reason, the specifiers and subtypes vary greatly from class to class and disorder to disorder. The manual employs a unique grammatical construction and use of words, as well as a unique use of capitalization. You should note that all disorders use capitalization for all words that are key in the diagnosis and the subtypes and specifiers.

This study guide, or any other, for that matter, is not a substitute for using the DSM-IV-TR for doing diagnosis. Whenever making a diagnosis, the diagnostician should always consult the DSM-IV-TR manual. The only goal and function of this guide is to enhance your ability to use and understand the DSM-IV-TR.

Following this introduction, Chapter 2 provides a brief review of the history of classification of mental disorders. Classification of mental illness has a long history, and any person performing diagnosis should have a basic knowledge of this history. Laypeople reading this chapter can be reassured that many mental conditions described in this book have a long history of research and confirmation of effective treatments. Chapter 3 gives an overview of the organization of the manual and explains each section and its relevance to diagnosis. Some basic concepts used in the DSM-IV-TR are explained in this chapter. Chapter 4 describes the multiaxial system of the DSM-IV-TR, including a detailed explanation of the five axes and how to use and understand them. This chapter also has a discussion on treatment planning using the DSM-IV-TR criteria as the basis for intervention. Chapter 5 begins the coverage of the specific classes of disorders in the DSM-IV-TR. Chapters 5 through 20 explain the disorders in the same order as they are presented in the DSM-IV-TR. Chapter 21 describes the conditions in the DSM-IV-TR that can be listed as part of the multiaxial diagnosis, but are not considered full-fledged mental disorders. This section of the DSM-IV-TR is titled “Other Conditions That May Be a Focus of Clinical Attention.” Chapter 22 reviews the twenty-six disorders or items that were considered for inclusion in the DSM-IV-TR as full-scale disorders, but that did not quite meet the research criteria for a mental disorder. These twenty-six items were in a group of over 100 disorders considered for possible inclusion in the manual. Based on research findings, the Task Force that prepared the DSM-IV-TR manual decided that the disorders in this section had been sufficiently researched to warrant partial inclusion. Further research that will stem from these disorders being listed in Appendix B of the DSM-IV-TR will determine whether they qualify for full recognition as mental disorders in future editions of the DSM diagnostic system. How to use and correctly diagnose these potential disorders is explained in Chapter 22. The final chapter explains how to use Appendix I of the DSM-IV-TR, which is a new section that takes into account cultural factors that may influence the behaviors and symptoms of a person who seeks a mental health evaluation.

ORGANIZATION OF THE CHAPTERS RELATED TO SPECIFIC DISORDERS

The organization of this book is based on common topical headings used in the chapters that cover specific disorders. Some deviations from the format occur because of the nature of variation in presentation of disorders in the DSM-IV-TR. The headings provided in most chapters are as follows.

Disorders

Each chapter begins with a listing of the disorders in the corresponding section of the DSM-IV-TR. No commentary is included as part of the list. The list is presented as a quick reference for the class of disorders covered in the chapter.

Fundamental Features

This section includes short paragraphs, often with each main point indicated by a bullet. Key words are highlighted in italic or bold type throughout. This section describes the most basic and fundamental information needed to understand the disorders in the corresponding section of the DSM-IV-TR. It also includes a brief conceptualization of the disorders in that section of the manual. Each set of disorders is supplemented with visual representations of the disorders explained in the text. These visuals are central to this book, and the text material is organized around them. The visuals can be studied as overviews of each disorder or class of disorders. The specifics of the organization of the disorder or class of disorders illustrated in the visuals are explained in the chapter’s text. “Tip boxes” are presented throughout the chapters to highlight significant diagnosis-related information and techniques that are not in the DSM-IV-TR or that may be difficult to locate in the manual.

Differential Diagnosis

Where appropriate, a section on differential diagnosis lists the other disorders of which the diagnostician should be aware when considering a particular disorder or set of disorders.

Recommended Standardized Measures

For those disorders for which scales and standardized measures are available, I have listed several scales useful in providing objective information regarding that particular disorder. I am familiar with the scales I have recommended and have selected them based on effectiveness, ease of use, brevity of administration, and cost. Additional scales that can be helpful in diagnosis are contained in The Handbook of Psychiatric Measures, published by the American Psychiatric Association (APA, 2000). This book has an accompanying CD-ROM that contains various scales, but some of the scales are not usable because scoring instructions, interpretative data, and normative information are not included.

Recommended Reading

Most sections have a recommended reading list. Readings have been selected based on relevance to diagnosis and assessment. I have tried to keep each list brief and to select readings that are highly relevant to the disorder rather than providing an exhaustive reading list.

References

The references cited in each chapter are included at the end of the chapter. A master list of all references used in the book can be found at the end of the book, along with multimedia resources available for use in learning the DSM system. The placement of the references both at the end of each chapter and at the end of the book deviates from traditional citation methods, but this was done to facilitate use of the book as a reference guide. The reader does not have to go to the back of the book to find references used in a particular section of the book.

OTHER KEY FEATURES OF THE BOOK

Visuals

The visuals are consistent for the different classes of disorders. They include a brief mention of the disorders’ essential features, those disorders included in the class, and those disorders which are in Appendix B and can, therefore, be used for research purposes. The visuals are my representation of how the disorders and the criteria for diagnosis are explained in the DSM-IV-TR text. They include a listing of subtypes and specifiers when they are used for specific disorders. In some visuals I have included supplemental information that can be helpful in understanding the disorders. The graphic presentation of the visuals does vary because of the nature and uniqueness of each class of disorders. The primary intent of each visual is to capture, on one page, an overall image of the organization and conceptualization of all the disorders in a specific class. Other visuals have been included that expand on the information about the disorders. For example, in Chapter 17, “Sleep Disorders,” the visuals are related to stages of sleep and age-related patterns of sleep. The text provides explanation of the disorders in each visual. The visuals are designed to be studied and can be used while reviewing the DSM-IV-TR manual. It is recommended that the visuals be used in connection with the DSM-IV-TR because the material in the visuals is summary information, and in-depth understanding can only occur through study of the DSM-IV-TR manual. Where relevant, the page numbers of the DSM-IV-TR that correspond to the visual are included in the visual.

Lay Reader Accessibility

My hope is that this book can aid laypersons who have an interest in understanding mental disorders through reading the DSM-IV-TR manual. People read this manual for numerous reasons. Some may want to learn more about disorders that affect them or family members. Having a diagnosis comes as a relief to some people after years of living with unexplained symptoms. Such relief arises from finally knowing the name for what you have experienced for years, and also from the knowledge that you are not the only person suffering from a particular set of symptoms. Family members can become supporters of an affected relative by reading this guide and developing further understanding of specific disorders; they can come to see that disorders are not always caused by human failures.

This is illustrated by the family of an eight-year-old child I evaluated who had a classic case of Obsessive-Compulsive Disorder (OCD). She had a collection of seventy dolls, stored neatly in boxes, dressed and named uniquely, and carefully cataloged in writing. The catalogs were updated weekly. The child took ninety minutes each morning to groom herself for school. She selected clothes cautiously and combed her hair with five different combs. The parents were supportive and cooperated with treatment, but the grandparents chastised the parents that the child’s lack of discipline was the cause of the problem. The grandparents were interviewed and given the content of this book on OCD, as well as other resource material. They changed their view after the meeting and after reading the material. They became supporters of the parents and aided them in the treatment, which was an enormous removal of stress for already stressed parents.

Psychoeducation is a powerful factor in recovery and treatment of many disorders. This book can aid people in seeking understanding. It is not designed, however, to enable self-diagnosis or diagnosis of a friend or relative. The intent is that this book will be read by a layperson who has received mental health intervention and who is attempting to gain more insight into mental disorders.

Abbreviations Used

A number of key abbreviations are used in the text and in the visuals. Visual 1.1 lists these abbreviations.

VISUAL 1.1. Abbreviations Used in This Book

A FINAL INTRODUCTORY WORD

To experience a mental disorder personally, or through a family member or friend, can be a very difficult and f...

Table des matières

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Visuals
• Preface to the First Edition
• Preface to the Second Edition
• Acknowledgments
• Disclaimer
• Chapter 1. Introduction
• Chapter 2. The Historic Heritage of Classification
• Chapter 3. Organization of the DSM-IV-TR
• Chapter 4. The Multiaxial System
• Chapter 5. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence (ICA Disorders)
• Chapter 6. Delirium, Dementia, and Amnestic and Other Cognitive Disorders
• Chapter 7. Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
• Chapter 8. Substance-Related Disorders
• Chapter 9. Schizophrenia and Other Psychotic Disorders
• Chapter 10. Mood Disorders
• Chapter 11. Anxiety Disorders
• Chapter 12. Somatoform Disorders
• Chapter 13. Factitious Disorders
• Chapter 14. Dissociative Disorders
• Chapter 15. Sexual and Gender Identity Disorders
• Chapter 16. Eating Disorders
• Chapter 17. Sleep Disorders
• Chapter 18. Impulse-Control Disorders Not Elsewhere Classified
• Chapter 19. Adjustment Disorders
• Chapter 20. Personality Disorders
• Chapter 21. Other Conditions That May Be a Focus of Clinical Attention
• Chapter 22. Appendix B of the DSM-IV-TR: Criteria Sets and Axes Provided for Further Study
• Chapter 23. Appendix I of the DSM-IV-TR: Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes
• Bibliography
• Index