Diagnosis and Treatment of Individuals with Mental Illness

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Diagnosis and Treatment of Individuals with
Mental Illness
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Lecture Outline

• Diagnosing mental illness
• Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV)
• Multi-axial assessment
• Treatment options for individuals with mental
  illness

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Diagnosing mental illness

• DSM is the standard classification of mental
  disorder used by mental health professionals
• Intended to be applicable in a wide array of
  contexts and by various clinicians
• Necessary tool for collecting and communicating
  accurate public health statistics
• Three major components
• Diagnostic classification, criteria sets,
  descriptive text

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Diagnostic classification16 categories

• Disorders usually first diagnosed in infancy,
  childhood or adolescence
• Delirium, dementia and other cognitive disorders
• Mental disorders due to a general medical
  condition
• Substance related
• Schizophrenia and other psychotic disorders
• Mood disorders
• Anxiety disorders
• Somatoform disorders

• Factitious disorders
• Dissociative disorders
• Sexual and gender disorders
• Eating disorders
• Sleep disorders
• Impulse Control disorders
• Adjustment disorders
• Personality disorders
• Other conditions that may be a focus of clinical
  attention

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Diagnostic criteria

• Indicates what symptoms must be present
  (inclusion criteria)
• For how long
• Symptoms that must not be present (exclusion
  criteria)
• Increases diagnostic reliability
• Meant to be used as guidelines clinical
  judgment is important

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Descriptive text

• Accompanies each disorder
• Systematically describes each disorder under the
  following headings
• Diagnostic features
• Subtypes
• Recording procedures
• Associated features and disorders
• Specific culture, age and gender features
• Prevalence
• Course
• Familial pattern
• Differential diagnosis

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Multi-axial Assessment

• Assessment on several axes refers to a
  different domain of information that assist in
  treatment and outcomes
• Leads to a comprehensive evaluation that includes
  mental and physical conditions as well as
  psychosocial and environmental problems
• Format for organizing and communicating
  information

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Multi-axial Assessment

• Five axes
• Axis I
• Clinical disorders and other conditions that may
  be a focus of clinical attention
• Axis II
• Personality disorders
• Mental retardation
• Axis III
• General medical conditions
• Axis IV
• Psychosocial and environmental problems
• Axis V
• Global assessment of functioning

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Treatment options

• Traditional approaches to treatment
• Moral treatment
• 1800 1850
• Human, restorative treatment
• Mental hygiene
• 1890 1920
• Prevention, scientific orientation
• Community mental health
• 1955 1970
• De-institutionalization, social integration
• Community support
• 1970 present
• Mental illness as a social welfare problem

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Treatment options

• Current approaches to treatment
• Psychotherapy, psychotropic medications,
  alternative therapies
• Overall current treatments focus on the
  following
• Share a positive view of the patient
• Learning/skill training
• Outcome orientation
• Mobilize nonprofessional resources

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Stigma associated with mental illness

• Often do not seek treatment
• People are less willing to pay for mental health
  services in comparison to physical ailments
• Less likely to get treatment if incarcerated
• Less likely to be employed or promoted
• Housing discrimination
• Portrayed as violent in the media