1 de março de 2018

Notes on “Diagnostic and Statistical Manual”.

Filed under: Organizações, Saúde e bem-estar — Tags:, , — Yurinho @ 22:57

“Diagnostic and Statistical Manual: Mental Disorders” was written by American Psychiatric Association. Below are some paraphrased statements made in that book.

  1. There was a time when every health institution had it’s own manual, which made the dialog between professionals harder, both in terms of nomenclature and in terms of statistics.
  2. The first attempt at writing a standard manual (a disease catalog, with their names and symptoms, in order to make diagnosing easier) was the Standard Classified Nomenclature of Diseases, published in 1932.
  3. The nomenclature and statistics for mental disorders, however, was easier to do, because it was more homogenous, which enabled them to get their own manual with their own update pace.
  4. When the second world war exploded, that manual was next to useless, as only 10% of the disorders that soldiers developed in war had an official name and diagnosis.
  5. “Psychopathic personality” was a blanket term for all minor personality traits that only became relevant in a war setting.
  6. The american navy and, afterwards, all american armed forces ended up helping to revise the system.
  7. After so many revisions for different purposes, three manuals were in use: Standard, the armed forces nomenclature and the Veteran’s Administration nomenclature.
  8. A new revision was needed and there was pressure for the publishing of a definitive version backed by American Psychiatric Association.
  9. Only then the DSM-I was born.
  10. The collection of statistics on mental disorders produces interesting data for the federal government.
  11. Those statistics couldn’t be collected without colletive effort between the American Psychiatric Association and the National Comittee on Mental Hygiene.
  12. So, unless it’s redundant, each mental disorder may come with a modifier, attributed by the doctor, in it’s diagnostic, so that another doctor who receives the patient can have access to more specific data on that patient.
  13. The modifiers are “with psychotic reaction”, “with neurotic reaction” and “with behavioral reaction”.
  14. The DSM also lists disorders with biologic origin, such as a mental disorder that began after brain damage.
  15. If a brain problem starts because of an infection, the doctor is supposed to specify which infection caused it, to write a more complete diagnostic.
  16. Specification is also needed if the problem began after substance use (specify the substance).
  17. Specification is also needed if the problem began after a personal experience (such as a traumatic event).
  18. Specification is also needed if the problem began after an unknown trigger (in that case, the doctor must say that he doesn’t know the cause).
  19. DSM-I used the term “Mongolism”.
  20. Some subtances can cause permanent brain damage.
  21. Specification is also needed if the problem began after a medical procedure.
  22. Brain problems can spawn after electric shock.
  23. Same goes with radiation.
  24. DSM-I used the term “manic-depressive disorder” (for what is now called “bipolar disorder”).
  25. Types of schizophrenic disorder:
    1. Simple.
    2. Hebephrenic.
    3. Catatonic.
    4. Paranoid.
    5. Acute undifferentiated.
    6. Chronic undifferentiated.
    7. Schizo-affective.
    8. Childhood.
    9. Residual.
  26. A mental disorder may cause reactions in the body (somatization).
  27. Anxiety, depression, dissociation, convertion, phobia and obsessive-compulsive disorder may have completely psychological causes, but sometimes we can’t point the cause at all.
  28. Passive-aggressive behavior is, sometimes, an illness.
  29. Sexual deviance and addictions are classified as sociopathic personality disturbances.
  30. The revisions in the nomenclature follow the scientific discoveries of that time.
  31. Even if a mental disturbance is related to a biological element, such as brain damage, the biologic element must be diagnosed separately, that is, the psychologist or psyquiatrist has no authority to give a diagnosis on a biological problem.
  32. Not every psychologic disorder is rooted in brain problems, meaning that a person can have a mental disturbance despite having a perfectly healthy brain.
  33. Section two introduces a fourth modifier, “with mental deficiency”, which can be mild, moderate or severe.
  34. Mental deficiency may be a symptom of a bigger problem.
  35. The DSM-I makes a warning that “mental deficiency” is a vague legal term, but that is used because they found no better term.
  36. “With mental deficiency” can not be primary diagnosis.
  37. The three types of psychotic disorders: affective, schizophrenic, paranoid.
  38. They could spawn when the mind struggles to adapt to the ambient (internal and external pressure).
  39. Psychotic modifiers can only be applied in symptomatic cases.
  40. Neurotic modifiers can only be applies in cases where anxiety is the prevalent feeling, either directly felt and expressed, or automatically suppressed by defense mechanisms or rituals.
  41. Neurotic symptoms can also spawn from poor adaptation between mind and ambient.
  42. A homosexual may feel anxiety when they feel desire, while also being forbidden of satisfying it.
  43. “Acute” is a reversible situation, while “chronic” is forever.
  44. Do not mistake a symptom for a disorder.
  45. A chronic brain problem may become milder, but it doesn’t mean it can’t worsen.
  46. When using the “mental deficiency” modifier, make sure to include the patient’s IQ in the diagnosis.
  47. Carbon monoxide may cause permanent brain damage.
  48. Alcohol consumption also can cause such damage.
  49. Differential diagnosis can be a challenge.
  50. For example, it’s not always possible to tell the difference between chronic brain disorder associated with cerebral arteriosclerosis and chronic brain disorder associated with senile sclerosis.
  51. Aggravated by the fact a single person may have both conditions.
  52. Convulsions can be a sign of syphilis, intoxication, trauma, cerebral arteriosclerosis or intracranial neoplasm.
  53. In “childish emotionality”, the word “childish” is between quotes.
  54. Some brain diseases grow to the point of making the person live like a plant.
  55. Bipolar disorder (manic-depressive) exists in three types: predominantly manic, predominantly depressive and other.
  56. Hypochondria is a form of paranoid schizophrenia.
  57. Schizophrenic symptoms may disappear after some weeks, but they often come back.
  58. Paranoia develops slowly and is logically built upon an incorrect interpretation of something that indeed happened.
  59. Other than that, however, the paranoid is normal.
  60. Paranoia isn’t the same as “paranoid state”, because paranoia is logical, despite being grounded in an erroneous interpretation of a fact, while paranoid state has little to no logic.
  61. A psychophisiologic reaction is an exaggerated or completely made-up bodily state rooted in a mind (for example: people with emetophobia may feel so worried about throwing up that they may feel nausea for no reason).
  62. That’s the case of people who feel itchy when scared.
  63. Also the case of people who have headaches when angry…
  64. If the reaction is repeated, the damage may become a real physical problem.
  65. “Anxiety” is a signal of danger noticed by conscious mind.
  66. The signaled danger, however, comes from within, sometimes without external input.
  67. Depending on how the person handles the anxiety, they may or may not be ill.
  68. “Common” anxiety is a state of “expectation” that isn’t exactly associated with any specific thing, unlike phobias, which are triggered by a clear input.
  69. The repressed impulse that causes anxiety may start a dissociative process.
  70. A compulsion is often seen as unreasonable by the very patient, but he can’t help it, he has to do it.
  71. For example: touching wood, kissing a cross several times a day, washing hands, doing things in a certain order (my case, I admit)…
  72. Depression relieves some anxious tension through means of self-depreciation.
  73. Depression often, but not always, is associated with feelings of guilt.
  74. The intensity of the depression, when reactive and grounded on loss, depends on the importance of the lost element and the circunstances that surrounded the loss.
  75. The clinical name of low emotional control is “emotionally unstable personality”.
  76. “Passive-dependent” is a person who feels like they need support from a stronger or more experienced person, developing an emotional attachment to a “fatherly” figure.
  77. Living in a “morally abnormal” environment may lead a person to “pathologically” question the morals of a society that is “normal”.
  78. The DSM-I includes homosexuality, transvestism, pedophilia, fetichism and sexual sadism as illnesses (reminder: the book was written in the fifties).
  79. Substance addiction isn’t the illness, but a symptom, which could explain why people who recover from an addiction end up addicted again, to the same substance or to another substance.
  80. Babies also can develop psychological problems, specially when parents are absent.
  81. The degree of success in a given task depends on emotional stability, intellect, physical condition, attitudes, motivation, training, but also depends on their psychiatric ailments (the flaws limit the qualities).
  82. That means that someone who is better trained, but has a moderate psychiatric ailment, can still be more succesful that someone who has a no ailment, but is poorly trained.
  83. There’s a diagnosis called “inadequate personality”.
  84. There’s a diagnosis called “antisocial personality” and another called “asocial personality”.
  85. Some conditions previously seen as disorders were reclassified as symptoms.
  86. “Exhaustion delirium” is a thing.
  87. “Healthy” also is a diagnosis, indicating that the patient doesn’t need treatment.
  88. “Cruelty” is a supplementary term for diagnostic.
  89. As also is “disobedience”.

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