1 / 14

DSM-IV Structure

DSM-IV Structure. EDUC 345/645. Multiaxial Assessment. Facilitates comprehensive diagnostic picture. Mental disorders General medical conditions Psychosocial problems Environmental problems Level of Functioning Most of which would be missed with a “single” diagnosis.

shateque
Download Presentation

DSM-IV Structure

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. DSM-IV Structure EDUC 345/645

  2. Multiaxial Assessment • Facilitates comprehensive diagnostic picture. • Mental disorders • General medical conditions • Psychosocial problems • Environmental problems • Level of Functioning • Most of which would be missed with a “single” diagnosis. • Also provides for the use of a biopsychosocial model for conceptualizing mental disorders.

  3. Multiaxial System • Axis I: Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention • Axis II: Personality Disorders and Mental Retardation • Axis III: General Medical Conditions • Axis IV: Psychosocial and Environmental Problems • Axis V: Global Assessment of Functioning

  4. Axis IClinical DisordersOther Conditions That May Be a Focus of Clinical Attention • All of the various disorders except Personality Disorders and Mental Retardation • If more than one Axis I diagnosis, all should be reported • Best to also label the “principal diagnosis” or “reason for visit” • If more info is needed to make an Axis I diagnosis, code: Deferred (799.9) • If no Axis I diagnosis is warranted, code: None (V71.09)

  5. Axis IIPersonality DisordersMental Retardation • Axis II notes “prominent maladaptive personality features and defense mechanisms”. • Having a separate axis for these concerns “ensures that consideration will be given to the possible presence of Personality Disorders and Mental Retardation” that would otherwise be overlooked in a single-axis diagnostic schema. • Note: Borderline Intellectual Functioning is also coded on Axis II • Even if Axis I diagnoses are “more florid” Axis II diagnoses are equally important. • If more info is needed to make an Axis I diagnosis, code: Deferred (799.9) • If no Axis I diagnosis is warranted, code: None (V71.09)

  6. Severity • For Axis I and Axis II, can code severity either in some diagnostic categories (e.g., mental retardation) or using specifiers: • Mild: meets criteria for the diagnosis; however, few additional symptoms • Moderate: “between Mild and Severe” • Severe: either has many more symptoms than required for a diagnosis, some of the symptoms are particularly severe (e.g., suicide attempt), or daily functioning (school, work, family) is severely affected. • Can also note the following for Axis I or Axis II: • In Partial Remission: patient no longer meets full diagnostic criteria; some symptoms may still remain. • In Full Remission: patient has been free of symptoms for an extended period of time. • Prior History: patient no longer meets criteria for this diagnosis; however, it is clinically prudent to include this diagnosis.

  7. Rule - Outs • Suppose you assess a patient and believe a diagnosis is warranted; however, you do not have enough assessment data to confirm the diagnosis. • However, to not diagnose this “hunch” would not communicate the clinical picture of the patient effectively. • You may consider using a “rule-out” diagnosis: R/O in place of the actual diagnosis.

  8. Axis IIIGeneral Medical Conditions • These should be “potentially relevant to the understanding or management of the individual’s mental disorder.” • Primary purpose of Axis III: • “to encourage thoroughness in evaluation” • “to enhance communication among health care providers” • Differential diagnostic issue: • If a general medical condition is a direct physiologic cause of a mental disorder, it is coded on Axis I and Axis III. • Axis I: Mood Disorder Due to Hypothyroidism • Axis III: Hypothyroidism

  9. Axis IIIGeneral Medical Conditions • Medical conditions can influence choice in pharmacotherapy. • If multiple diagnoses are present on Axis III, code them all. • If no diagnosis is present, code “None”. • Notes: • Numerical codes for Axis III come from the ICD-9 (or ICD-10) • No numerical code for “None”.

  10. Axis IVPsychosocial and Environmental Problems • Biopsychosocial model: • Axis III + Axis I + Axis II + Axis IV • These are typically a negative life event, an environmental difficulty or deficiency, familial or interpersonal stress, poor social support or personal resources.

  11. Axis IVPsychosocial and Environmental Problems • Examples: • Problems with the primary support group • Death of a family member • Problems related to the social environment • Difficulty with acculturation • Educational problems • Discord with teachers • Occupational problems • Unemployment

  12. Axis IVPsychosocial and Environmental Problems • Examples: • Housing problems • Homelessness • Economic problems • Insufficient welfare support • Problems with access to health care services • Inadequate health insurance • Problems related to interaction with the legal system • Incarceration • Other psychosocial and environmental problems • War, natural disasters

  13. Axis VGlobal Assessment of Functioning • Clinical judgment involved in Axis V • “How is the patient doing, overall.” • 100-point scale, divided into 10 ranges • GAF – adult scale • CGAS (Children’s Global Assessment Scale) – GAF adapted for children • Can also report the time period that the rating encompasses: • Current, highest over past year, at admission, at discharge

  14. Multiaxial Evaluation Report Form • Used to report all five DSM axes in a systematic, organized way. • Ideally, when you are diagnosing a patient you should include a 5-axis diagnosis. • Example form is located here (reproduced from the DSM-IV-TR).

More Related