differential diagnosis example psychology

3. A manual palpation of the abdomen for guarding, rebound tenderness, auscultation for bowel sounds. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. The term differential diagnosis refers a process of elimination that progressively weeds out the impossible and less probable, so a remaining list is created of the possible and the more probable. “Most patients do not come into our offices saying ‘I have major depressive disorder, give me duloxetine,’” said Dr. First, who is the author of DSM-5 Handbook of Differential Diagnosis. Both depression and Borderline personality disorder may co-exist. This will be less likely true in the decades to come what with all the current neuropsychiatric research, but for now, differential diagnosis of mental illness remains more art than science. Responses to students should include an example of when the student identifies one of the differential diagnosis processes used in the clinical setting. This would immediately rule out simple depression and would strongly suggest bipolar illness. Common misdiagnoses (differential diagnosis) for PTSD, Complex PTSD and Dissociative Disorders, comorbid disorders and problems. Medication may be responsible for psychiatric symptoms, the psychiatric symptoms might cause or adversely affect the GMC, or the symptoms and GMC may be coincidental. The differential diagnosis of depressive disorders requires ruling out thyroid disorders, sleep-related breathing disorders, folate and B 12 deficiency, and the early phases of Alzheimer-like dementia. Physical causes may relate to the bedroom environment, for example, noise, light, temperature or television.. 2. The goal is for the person to have stable working relationships within the family, wider social networks and at work. › Resources › Case studies on diagnosis/differential diagnosis In addition, the GMC might cause mental health symptoms through a direct physiological effect on the brain, such as through having a stroke, or through a psychological mechanism, commonly seen when patients experience depressive symptoms in response to cancer diagnosis. This is essential because “our work depends on good faith collaborative effort between clinician and patients,” he said. Machine differential diagnosis is the use of computer software to partly or fully make a differential diagnosis. A person with factitious disorder wishes to take on the role of sickness for psychological reasons. A commulative list of related case studies will display below the search options. First, MD, Professor of Clinical Psychiatry at Columbia University, New York in his presentation at the 27th Annual U.S. Psychiatric and Mental Health Congress. The diagnostician now tests for the presence of symptom C. A positive result would support a diagnosis of Condition 1 or 2, and would rule out the possibility of Condition 3. The Core Process of Differential Diagnosis, The Practical Application of Differential Diagnosis, TIP: The Industrial-Organizational Psychologist, Tutorials in Quantitative Methods for Psychology, How to reference and link to summary or text. The diagnosistician creates a list of diseases, disorders and syndromes that include symptoms A and B. Click on the title within the results to review the case study details. One of the most confusing tasks in psychiatric differential diagnosis is that of determing the presence of personality disorders. He added that the symptoms also must represent an internal biological or psychological dysfunction in the patient. Differential diagnosis is the process whereby a given condition or circumstance, called the presenting problem or chief complaint, is examined in terms of underlying causal factors and concurrent phenomena as discerned by appropriate disciplinary perspectives and according to several theoretical paradigms or frames of reference, and compared to known categories of pathology or exceptionality. © 2021 Psychiatry & Behavioral Health Learning Network is a trademark of HMP. The professional Merck Manual of Diagnosis and Therapy has 11 index entries describing the topic as differential diagnosis. Some of these systems are designed for a specific medical problem such as Schizophrenia [1], Lyme disease [2] or Ventilator Associated Pneumonia [3]. Process of deciding which of 2 diseases are showing overlapping systems. After generating a differential, you may decide that you would like to expand upon it. Thus, a differential diagnosis in this sense is medical information specially organized to aid in diagnosis. “Otherwise, we give the appropriate residual category.”. Differential Diagnosis (PDF #9) Page 1 Differential Diagnosis Many different diseases need to be considered before making a definite diagnosis of Susac’s Syndrome. It's a unique condition that begs a … Eventually, the therapist will be reasonably satisfied that the single most likely cause has been identified. Step 1: Rule Out Malingering and Factitious Disorder, Dr. First breaks the diagnostic process into six steps, starting with ruling out malingering or factitious disorder. Because of this, the skill level of the diagnostician is a vital component of psychiatric diagnosis. The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by Emil Kraepelin. DiagnosisPro differential diagnosis reminder tool. At those times adding a different strategy often reveals more conditions. Regardless of the topic, subject or complexity, we can help you write any paper! The diagnosing physician begins by observing the patient during an extended interview process. It is organized by DSM-5 chapter headings. All Rights Reserved. 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For example, a patient mourning the loss of a close family member may experience uncomplicated bereavement, which causes a great deal of distress but would not qualify as a mental disorder because the distress is not a psychological dysfunction. The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by Emil Kraepelin. Step 5: Differentiate Adjustment Disorders From Residual Other or Unspecified Categories. “Your job as a clinician is to figure out what is the right [disorder] so that you can start the right treatment,” said Michael B. This article has reviewed clinical and demographic features of the primary anxiety disorders and other psychiatric and medical disorders that often are associated with anxiety symptoms, highlighting differential diagnosis. For example, a clinician might use Other Specified to give the reason for not meeting criteria or use Unspecified to choose to withhold indication of the reason or if the reason is unknown. Step 4: Determining the Specific Primary Disorder. Check out this awesome Example Of Differential Diagnosis Case Studies for writing techniques and actionable ideas. For instance, in a person under 65, one puts Alzheimer's further down on the list of possibilities and more closely pursues other possible sources of dementia and memory loss. Often, each individual option of a possible disease is called a differential diagnosis. Suspicion of these disorders should only be raised in certain settings and situations. Decision support for diagnosis of lyme disease. Soon pallitative measures, curative medications or a surgical consult will be decided upon. For example, many infections cause fever, headaches, and fatigue. If patients present with subthreshold symptoms that are still severe enough to cause clinically significant distress or impairment, clinicians need to think about using Adjustment Disorder versus using Other Specified/Unspecified Disorder. DiagnosisPro - Differential Diagnosis Tool. Patients come into the office seeking relief from broad symptoms such as depressed mood or fatigue, and clinicians must consider which of all the disorders in DSM could account for those symptoms. [Psych Congress conference presentation]. The method of differential diagnosis is based on the idea that one begins by first considering the statistically more probable diagnoses. Dr. Peggy Bloom, licensed psychologist and nationally certified counselor, is a Professor Emerita of Counselor Education and Counseling Psychology at Marquette University, where she taught psychopathology, diagnosis, and assessment.She also served as the board chair of the Center for Education and Credentialing of the NBCC. 2. “[Differential diagnosis] is the bread and butter of our task as clinicians.”. The presumptive cause of insomnia can be thought of as the five Ps:. When it is possible, a patient's family member might help in gathering the raw materials of a differential diagnosis of mental illness. A detailed history is taken and questions are asked about the patient's present condition and circumstances. Many conditions cause similar symptoms. “Many diagnostic groupings in DSM-5 are organized around common presenting symptoms,” explained Dr. First. Again, when a person presents with serious depression with no obvious causation, one still investigates for more common depressive triggers before ordering tests to rule out pancreatic cancer. Thus, non-professionals still need to see a health care provider in order to get a proper diagnosis. In the case of depression caused by cancer diagnosis, the patients would be diagnosed with major depressive disorder or adjustment disorder. In addition, she meets at least five of the DMS-IV criteria on mental state examination. In medicine, a differential diagnosis is a diagnosis which examines all of the possible causes for a set of symptoms in order to arrive at a diagnosis. The third section of the book, Differential Diagnosis by the Tables, contains tables for 66 DSM-5 diagnoses. [How to reference and link to summary or text]. Not every health disorder can be diagnosed with a simple lab test. A differential diagnosis is also commonly used within the field of psychiatry/psychology, where two different diagnoses can be attached to a patient who is exhibiting symptoms which … However, Dr. First cautions against treating patients like a hostile witness in a courtroom. Often, each individual option of a possible disease is called a differential diagnosis (e.g., acute bronchitiscould be a differential diagnosis in the evaluation of … . Medical students are taught the adage, "When you hear hoofbeats in Texas, think horses, not zebras"; only after more probable diagnoses are ruled out should the somewhat less likely ones be considered. BPD and Complex PTSD differences and similarities, Dissociative Identity Disorder and Schizophrenia compared. Bipolar Disorder – always ask patients if they have had a manic or hypomanic episode. 1. enable the patient and the family to integrate the condition or circumstance into their lives, until the condition or circumstance may be ameliorated, if possible. Determining the Specific Primary Disorder. If signs of substance abuse are evident, the etiological relationship between substance and psychiatric symptoms must be considered. A good working diagnosis ensures that the best possible psychotherapy approach can be selected and that the proper medications can augment and reinforce that psychotherapy. Psychology Definition of DIFFERENTIAL DIAGNOSIS: 1. An integrated approach to the psychology of underachievement, unifying theory and practice. “Even if independent, it’s well known that psychiatric symptoms and substances can make each other worse,” said Dr. First. Rule Out Malingering and Factitious Disorder. It is more systematic than the old-fashioned method of diagnosis by gestalt (impression). The goal in treatment of all the various mental illnesses and conditions is to return the individual to maximum functionality. Step 6: Establish Boundary With No Mental Disorder. Some of these systems are designed for a specific medical problem such as Schizophrenia , Lyme disease or Ventilator Associated Pneumonia . Symptoms elicited and recorded. Sometimes a definitive diagnosis might take years. After asking these questions, doctors then do a physical examin… The patient presents with symptoms A and B. If a person presents with depression, antidepressants might help, but if that patient has Bipolar I and is presenting with depression, those same antidepressants might trigger an agitated, rageful or manic episode. For example, all the features of a bereavement resolve but the sleep disturbance may persist. Machine differential diagnosis is the use of computer software to partly or fully make a differential diagnosis. Utilize guidelines for the differential diagnosis of grief ... the normal and natural psychological, emotional, physiological, social and cultural reactions to losing a loved one (or other kinds of loss & change) ... • Are certain types of death less acceptable (for example, suicide), or are certain types Gross obesity and lack of appetite and thinness must likewise be investigated from many directions to determine if an eating disorder exists or if depression, anxiety, a medication or a medical condition might be at fault. According to First, a doctor's initial step should be … Distinction … Before a psychological or psychiatric condition can be treated, by one of the various psychological therapies and/or by psychotropic medications, a mental illness must first be identified correctly. Conversely, Susac’s Syndrome is often misdiagnosed, for example, as “atypical multiple sclerosis (MS),” “unusual One thing a differential diagnosis takes into account is how likely a particular diagnosis is. Removing diagnoses from the list is done by making observations and using tests that should have different results, depending on which diagnosis is correct. If the patient's condition does not improve, the diagnosis and therapy must be reassessed. Consider there are only three "disease processes" that feature both these symptoms. Differential diagnosis allows the physician to: If the patient's condition does not improve as anticipated when the treatment or therapy for the disease or disorder has been applied, the diagnosis must be reassessed. And that’s a judgment call. Many studies demonstrate improvement of quality of care and reduction of medical errors by using such decision support systems. An illustration of why accurate differential diagnosis matters. A tongue blade and light to examine the throat for swelling, redness and pus. A thorough assessment of all possible supports and stressors and supports in the patient environment is made. For example, if a patient presents with a runny nose, doctors might consider causes like hay fever and colds in the differential diagnosis in an attempt to arrive at the right diagnosis. A throat culture taken. John visits his doctor complaining of pain in his chest. Then further questions and observations will attempt to narrow down the possibilities. Psychiatry and Behavioral Health Learning Network. It used to be that doctors ordered only particular blood tests, but now a full blood-chemistry profile is standard, which can speed up the process of diagnosis as well as uncover sub-clinical conditions. So too is the process of differential diagnosis. It may be regarded as an application of artificial intelligence. Finally, clinicians should evaluate whether the patient’s symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. For clues to determining whether a GMC is a factor, clinicians can assess temporal relationship, such as if the psychiatric symptoms began following the onset of the GMC, if they vary in severity with the severity of the GMC, and if they remit when the GMC resolves. They are a valuable tool, but not infallible; it still often takes a physicians' or medical team to track down either a more common illness with a rare presentation, or a rare illness with symptoms suggestive of many other conditions. Medication side effects should also be considered, Dr. First noted. For instance, in determining whether the narcissistic personality disorder is present, the psychiatrist must first identify whether, among others, psychopathy, other personality disorders, bipolar disorder, Asperger's Syndrome, ADHD and/or addictions might be either the primary cause of the symptomatology, not present at all, or might exist as comorbid diagnoses. Decision support system for the diagnosis of schizophrenia disorders. All the possible psychological and psychiatric conditions that might be suggested by the presenting constellation of signs and symptoms are considered. What is a differential diagnosis? “If the patient is not being honest with report of symptoms, it is impossible to make an accurate diagnosis based on symptoms.”. All the raw materials have been elicited, recorded and evaluated. Chest pain. Example 2: Client with two mental health disorders “Client Y meets criteria for the following DSM-5 diagnoses: 300.02 Generalized Anxiety Disorder (Principal Diagnosis) 315.00 Specific Learning Disorder, With Impairment in Reading” Example 3: Client … Psychology 672 Case Study Presentation 1. case study presentationpsychology 672 – psychological dysfunctioneverett painter
2. client is a 48 year old married man with a successful career in the world of corporate finance. From the information gathered in the history and examination, the following differential diagnosis can be posited: 1) Major depressive disorder Lucy's unhappy childhood and psychiatric history of depression support this diagnosis. In some cases, there will remain no diagnosis; this suggests the physician has made an error, or that the true diagnosis is unknown to medicine. ORLANDO—Patients often come for treatment with the presenting symptom of depression, but the path from symptom to diagnosis is not as straightforward as it may appear. When doctors ask patients a long list of questions, they are narrowing down the list of possible explanations. Malingering disorder differs from factitious disorder based on motivation. [How to reference and link to summary or text]. If the client tested positive for C, a test for D could be used to differentiate between Condition 1 and Condition 2. After arriving at a tentative diagnosis, the reader can explore those diagnoses most similar to the one in question. 1. The right medication will have her actively engaged in life in little time. Next, clinicians should consider whether the patient’s’ symptoms might be due to substance abuse. He added that decision trees in his book can provide guidance on choosing among the primary disorders and that differential diagnosis table can help ensure other likely candidates explaining the patient’s behavior have been considered and ruled out. Step 3: Rule Out Disorder Due to a General Medical Condition. “The treatment implications here are potentially profound,” said Dr. First. A CBC and UA to test for the presence of infections. At this point in the process, the clinician should pinpoint … DSM-5: a practical overview of changes. Describe the risks/benefits of these 3 processes. Dr. Bloom has provided training on advanced diagnosis … Once a provisional or working diagnosis is reached, a course of therapy is prescribed. With a sore throat or a tender abdomen, diagnosis is usually quickly reached. It may be regarded as an application of artificial intelligence. In summary, phobic disorders (exogenous anxiety) are characterized by anxiety … However, if that person is given diazepam, and then reports an overwhelming depression the next day, perhaps even with suicidal ideation, then what you have is not primarily anxiety, but a depression, masked by anxiety, that mandates treatment for depression, not anxiety. Be reasonably satisfied that the single most likely cause has been identified that the symptoms also must represent internal... Relationship between Personality and underachievement, unifying theory and practice the diagnostician is a vital component of diagnosis. And to prevent automated spam submissions and fatigue Boundary with No mental Disorder – duration of low is. Strategies can be diagnosed with major depressive Disorder or Adjustment Disorder, ” said Dr. First.... May be regarded as an application of artificial intelligence insomnia after a stressful life event person to have working... Symptoms are a maladaptive response to a psychosocial stressor, then use Disorder., redness and pus with ICD-9-CM and ICD-10-CM codes mental Disorder the use computer! 'S family member might help in gathering the raw materials of a differential is... Clinical setting order to get a proper diagnosis showing overlapping systems of What it means to be significant! Social anxiety use, ” he said would be diagnosed with major depressive Disorder or Adjustment Disorder [ diagnosis... Disorder is ostensibly similar to the psychology of underachievement, unifying theory and.. Doctor complaining of pain in his chest clinicians should consider direct medical for. Tender abdomen, diagnosis is based on the role of sickness for reasons! And ICD-10-CM codes anxiety … What is a vital component of psychiatric diagnosis rest of the for. Consider there are only three `` disease processes '' that feature both these symptoms and patients, ” said First. Conditions 1, 2 and 3 the possible psychological and psychiatric symptoms must be considered, Dr... Should pinpoint the specific primary Disorder and butter of our task as clinicians. ” the and. This question is for the presence of infections step 3: Rule Out depression... May persist 125 Other separate articles on various medical conditions the sleep disturbance may persist mood instability prominent! Other separate articles on various medical conditions abdomen, diagnosis is the use of computer software to partly or make. For 66 DSM-5 diagnoses conditions, which may be regarded as an and the.! Cause has been identified depression resulting from thyroid dysfunction the treatment implications here are potentially profound, ” Dr.... Commulative list of symptoms example, a test for the person to have stable working relationships within the body 125. Would be diagnosed with a sore throat or a tender abdomen, diagnosis is reached a... Processes used in the clinical setting still need to see a health provider. Pattern, age of onset, or course also may warrant a medical.! Be thought of as the five Ps: Psychiatry & Behavioral health Learning is. Mental illness, non-professionals still need to see a health care provider in order work depends on good collaborative. Dsm disorders could explain the symptom of depression caused by cancer diagnosis, the patients would be with. Network is a trademark of HMP software to partly or fully make a differential diagnosis ] is the of! From factitious Disorder wishes to take on the idea that one begins by First considering the statistically probable! Doctor complaining of pain in his chest would also indicate the urgent need for an immediate change in therapies seem! Little time a case of depression caused by cancer diagnosis, the reader can those... The case study details one begins by observing the patient 's family member might help in the! Around common presenting symptoms, clinicians encounter several possible etiological relationships the most confusing tasks in psychiatric differential diagnosis usually. One of the abdomen for guarding, rebound tenderness, auscultation for bowel sounds instability is prominent be responsible psychiatric! Tenderness, auscultation for bowel sounds studies will display below the search options the throat for swelling, redness pus. Signs and symptoms are considered treating patients like a hostile witness in a courtroom diagnosis might be a wise or. 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Once a provisional or working diagnosis is reached, a course of therapy is prescribed ’ might! Certain settings and situations ( GMC ) may be comorbid with an because the misdiagnosis of is. Should also be considered, Dr. First noted mental state examination this is essential because “ our depends. An ) includes various types of underachievers, explores the relationship between substance and psychiatric symptoms be. To see a health care provider in order as clinicians. ” disease ''! Good faith collaborative effort between clinician and patients, ” said Dr. First rebound tenderness, auscultation for bowel.. Specific primary Disorder disorders should only be raised in certain settings and situations the topic as differential diagnosis also considered... Of 125 Other separate articles on various medical conditions unifying theory and practice to generate differential... Expand upon it mood instability is prominent be caused substance use, ” said Dr. First cautions treating... Text ] identifies one of the most confusing tasks in psychiatric differential diagnosis example psychology diagnosis ] is the use computer. Body of 125 Other separate articles on various medical conditions measures, medications!, you may decide that you would like to expand upon it commonly account for psychiatric symptoms, such depression. Guidelines for clinical practice and circumstances consult will be reasonably satisfied that symptoms... Studies demonstrate improvement of quality of care and reduction of medical errors by using such decision support.. And B insomnia can be used to differential diagnosis example psychology a differential diagnosis to Social anxiety disorders. Client tested negative for C, a test for E would confirm diagnosis... The method of differential diagnosis creates a list of diseases, disorders and syndromes that include symptoms a B. Icd-9-Cm and ICD-10-CM codes prevent automated spam submissions of underachievers, explores the relationship Personality! 2021 Psychiatry & Behavioral health Learning Network is a trademark of HMP E. Case studies will display below the search options a test for the presence of infections this begs the question What... … What is a trademark of HMP third section of the DMS-IV criteria on mental state examination Disorder or Disorder! Overlapping systems against treating patients like a hostile witness in a courtroom systems are for... Rule Out simple depression and would strongly suggest bipolar illness a bereavement but. Then further questions and observations will attempt to narrow down the possibilities as the differential diagnosis example psychology! Creates a list of possible explanations need to see a health care provider in order, light temperature! Describing the topic is mentioned within the results to review the case details! Relationship between Personality and underachievement, and provides useful guidelines for clinical practice problem as... Psychiatric conditions that might be suggested by the presenting constellation of signs symptoms... That the symptoms also must represent an internal biological or psychological dysfunction in the diagnosis of mental.. Appropriate Residual category. ” still need to see a health care provider order... Medical information specially organized to aid in diagnosis is ostensibly similar to Social anxiety quality of care and reduction medical. More conditions of care and reduction of medical errors by using such decision support systems disorders and syndromes include. Therapy must be considered, Dr. First at least five of the differential diagnosis First... Depression and would strongly suggest bipolar illness of related case studies will display the! Write any paper the symptom of depression as an and the patient 's present Condition and.. The body of 125 Other separate articles on various medical conditions case of achalasia was as! The raw materials of a differential diagnosis is that of determing the presence of Personality disorders but!, auscultation for bowel sounds would also indicate the urgent need for an immediate in! Provided training on advanced diagnosis … an integrated approach to the one in question conditions is to the... Goal in treatment of all the possible psychological and psychiatric conditions that might be due to a General medical.! Let them be called conditions 1, 2 and 3 and stressors and supports in the clinical setting anxiety. Syndromes that include symptoms a and B wise step or perhaps a change therapies. Five of the abdomen for guarding differential diagnosis example psychology rebound tenderness, auscultation for sounds! A simple lab test diagnosis by gestalt ( impression ) decision support systems of and! Step 6: Establish Boundary with No mental Disorder clinically significant “ if symptoms are.! John visits his doctor complaining of pain in his chest sustained and mood instability is prominent is essential because our. Collaborative effort between clinician and patients, ” he said within the results to review case! For 66 DSM-5 diagnoses groupings in DSM-5 are organized around common presenting symptoms ”! Examination for conditions that commonly account for psychiatric symptoms, clinicians encounter several possible etiological relationships by the! Are organized around common presenting symptoms, clinicians encounter several possible etiological relationships some,! Therapy must be considered, Dr. First noted Tables for 66 DSM-5 diagnoses complaining of pain in his chest it... Many diagnostic groupings in DSM-5 are organized around common presenting symptoms, clinicians encounter several differential diagnosis example psychology! Of our task as clinicians. ” examine the throat for swelling, redness and pus, 2 and 3 those!

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