Diagnosis Notes

Focus on the informational part of diagnosing and diagnostic case formulation.
Diagnosis is a tool, not an identity; it aids in selecting a framework and intervention.
Diagnosis should be used thoughtfully.

DSM stands for the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association (APA).
It's the primary tool for classifying and diagnosing mental health conditions in the U.S. and standardized writing.
Currently in DSM-5 TR (text revision of DSM-5), which updates language, clarifies, and expands sections.
The DSM provides criteria lists, descriptions, guidance on severity, and cultural/developmental considerations for each diagnosis.

Standardization: Ensures uniform language across different settings and interdisciplinary teams.
Practical uses: Required by insurance companies for reimbursement; used by researchers, schools, courts, and disability services for decisions and accommodations.

Essential process for determining which diagnosis best fits a person's presentation.
Involves examining overlapping symptoms and possibilities based on observation, patient information, and data.
Example: Symptoms like feeling down, disconnected, and fatigued could indicate depression, bipolar II, or PTSD.
Components:
- Assessment: Data gathering via interviews, observation, and history.
- Rule-outs: Determining what doesn't fit.
- Clinical judgment: Integrating training, intuition, and gathered data.

Misdiagnosis is common, leading to ineffective or harmful treatments.
Differential diagnosis acknowledges the complexity of human experience, understanding that individuals with the same diagnosis can have different stories and needs.
Promotes critical thinking by connecting dots, asking questions, and challenging assumptions.
Ethical consideration: Ensures treating the person, not just the label.

Understanding diagnosis enhances trauma-informed and culturally sensitive practice.
Improves collaboration with other clinicians in various settings (schools, hospitals, etc.).
Reduces stigma by promoting understanding over judgment.
Encourages a reflective, person-centered approach, even without direct assessment.

Diagnosis is a tool to guide care, not a permanent label.
The DSM is a helpful guide but has limitations.
Differential diagnosis involves clinical reasoning and understanding someone's story.
Diagnostic literacy is beneficial across various roles (clinical, advocacy, education, etc.).

Jordan is a 23-year-old biracial, nonbinary individual presenting with low mood, isolation, academic issues, mild paranoia, prior self-injury, cannabis use, family invalidation, and systemic stress.
Appearance: Disheveled, minimal eye contact.
Speech: Limited, soft, slow.
Mood/Affect: Numb, flat.
Thought Process: Tangential, slow.
Cognition: Oriented times three, poor concentration, partial insight, cannabis as coping mechanism.
Symptomology:
- Emotional/Psychological: Numbness, disconnection, feeling overwhelmed, passive thoughts of escape, heightened anxiety, mild paranoia under stress.
- Behavioral: Withdrawal, decline in academic performance, disrupted sleep patterns.

Five or more symptoms during the same two-week period, including:
- Depressed mood.
- Loss of interest or pleasure.
- Symptoms cause distress or impairment of functioning.
- Not due to substances or medical conditions.
Specifier: Anxious distress.

Symptoms are reactive and not pervasive or generalized over the last six months.
Generalized Anxiety Disorder:
- Excessive anxiety for more than 6 months
- $\text{Difficulty controlling the worry}$
- At least three of the following symptoms are present:
  - Restlessness
  - Feeling keyed up
  - Fatigue
  - Difficulty concentrating
  - Irritability
  - Muscle Tension
  - Sleep disturbance

Preoccupied with being criticized or rejected (distrust of others, social withdrawal, fear of judgement).
Not Present: Long standing pattern of persuasice interpersonal avoidance. Behavior seems situational and reactive.
Cannabis Use Disorder
Cannabis is often token in large amounts over a larger period of time.
Persistent desire or unsuccessful effort to cut down.
Craving or a strong desire to use or continued use despite social interperonsal problems or negative effect, using hazardous situations, tolerance, or withdrawal issues.
Fits: uses marijuana three to five times a week acknowledges it, sometimes increases paranoia. No mention of attempts to cut down or any withdrawal symptoms at all.
Likely qualifes for a provison diagnosis, but not the primary diagnosis.
Conclusion - Mild