By Dinesh Bhugra, Gin S. Malhi
Difficult Disguises examines psychiatric stipulations which aren't inevitably unusual, infrequent or unique yet are hard for the clinician who might fight to arrive a analysis and to establish administration strategies.
However, with familiarity, those stipulations can and may be regarded. This re-creation is an workout in consciousness-raising in addition to a caution to watch out for diagnostic structures which, regardless of their many virtues, may possibly turn into too influential and will perpetuate error that are to the detriment of patients.
For the clinician suffering to appreciate and deal with sufferers who fail to slot the standard diagnostic different types, tricky Disguises offers clever guideline within the advantage of exciting doubts, in addition to functional recommendation for the evaluate and administration of unusual situations.
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Additional info for Troublesome Disguises: Managing Challenging Disorders in Psychiatry
Sample text
A return to the premorbid level of functioning would “usually” occur within a day or two. A maximum disease duration of 2 weeks was the upper limit. Of note, one of Jaspers’s original criteria, namely that the psychotic state must resolve quickly once the stressor was removed, was not included, but a maximum duration time criterion was introduced [2]. As exclusion criteria, DSM-III mentions that no period of increasing psychopathology may have preceded the psychosocial stressor and no organic mental disorder, manic episode, or factitious disorder with psychological symptoms may have been present.
In particular he highlighted the similarities between paraphrenia con fabulans and mania and paraphrenia phantastica and paranoid forms of dementia praecox. However, he maintained that his observations of these patients over many years (often over 10 years or more) indicated that there were subtle differences, particularly the preservation of emotion, volition, and intellect, that justified the separate description of these disorders. A follow-up study of the 78 patients that Kraepelin had diagnosed as hav ing paraphrenia cast doubt on the validity of paraphrenia as a diagnosis [6].
Only few studies have addressed whether these similar clinical conceptualizations lead to a concordance of diagnoses in clinical practice. Comparing ICD9, ICD-10, DSM-III-R and DSM-IV criteria, Pitta and Blay [19] found that the number of patients in the different categories was highly different, and that the results of the different classification systems in relationship to the original concept as laid down in ICD-9 was limited. The published tables show that there was apparently a good agreement between the classification systems for the brief reactive psychoses, but the interpretation of these results was limited by the fact that it was not shown whether these diagnostic agreements were in identical patients.
