Diagnosis Made Easier Chapters Critique - Essay Example

? Diagnosis Made Easier by James Morrison Chapter The Road to Diagnosis Major Objectives Morrison (2006) begins the development of his text by presenting the audience with an overview of a patient’s case. The primary purpose which the presentation of this case serves is that it marks the beginning of the journey towards a successful and critical diagnosis. The foremost objectives of this chapter thus include: providing an explanation of the foundations of diagnosis, introducing the reader to the levels of diagnosis which are expounded upon later in the succeeding chapters of the book and establishing the basics of diagnosis to equip the audience with an awareness and background information to assist the comprehension of the remaining components of the book. Key Points Morrison (2006) highlights that the roadmap for conducting an effective diagnosis of physical ailments is essentially based on the successful acquisition of three sources of information which are categorized as: symptoms, signs and history. Consequently, the journey to diagnosis with regards to mental health problems follows Level I to Level VIII. This notion postulates that a mental health clinician must be prepared to acknowledge the comprehensiveness of the task ahead which demands a thorough understanding of each of these phases. Brief Reflection of the Chapter In accordance with the recommendations of this chapter, the procedure for diagnosis which must be adopted by mental health clinicians essentially follows a systematic process whereby, each level in the path to diagnosis follows the analysis of a range of information. Chapter 2 – Getting Started with the Roadmap Major Objectives The underlying objective in the discussion that has been conducted in this chapter fundamentally emphasizes upon the significance of information and data in the process of diagnosis. This information is critical to the comprehension of the patient’s mental history, personal and social history and family history (Morrison 2006). The purpose of this chapter is to introduce and highlight the distinction between the concepts of history, symptoms, signs and syndromes while, introducing the notions of validity and reliability. Key Points The clinical history of a patient is not limited to the identification of information that is exclusive to the mental health of the individual (Morrison 2006). In fact, the comprehensiveness of patient history encompasses the back story, personal and social history and family history all of which play a critical role in assisting the establishment of pertinent evaluations regarding the patient. Morrison (2006) understands that the distinction between signs and symptoms must be acknowledged before a clinician can hope to achieve a sound diagnosis, as symptoms and signs are characterized by subjectivity and objectivity respectively. Brief Reflection of the Chapter The procedure of collecting patient history must include the involvement of the individual’s friends and family as only collateral information can provide the patient’s mental picture in its entirety. The successful completion of this stage permits the clinician to transition to the later stages of diagnosis. Chapter 3 – The Diagnostic Method Major Objectives The main objective of this chapter is to introduce the practical application of the theoretical concepts that have been assessed thus far. This practical application is identified as the diagnostic method. Accordingly, the chapter also examines the essential behaviors or devices that can be utilized by clinicians in order to achieve an accurate diagnosis. These behaviors essentially allow the creation and assessment of alternative hypotheses through the devices of differential diagnosis and the decision tree (Morrison 2006). Key Points Morrison (2006) suggests that clinicians should initiate the exploration of alternative diagnoses from their introductory meeting with a patient. The adoption of a differential diagnosis postulates that a clinician should thoroughly explore the various possibilities that maybe responsible for the symptoms that a patient is experiencing. On the contrary, the development of a decision tree follows the execution of systematic steps which are undertaken for the serving the ultimate purpose of either treatment or diagnosis (Morrison 2006). Brief Reflection of the Chapter The implementation of the aforementioned devices requires clinicians to consider certain key factors. For example, in the case of differential diagnosis clinicians should abide by the approach of various diagnostic principles whereby, all possible diagnosis are categorized in accordance with a safety hierarchy which places the conditions that require urgent treatment and have the greatest possibility of reacting positively to the treatment at the top. Chapter 4 – Putting It Together Major Objectives The analyses of the previous chapters are representative of the unequivocal importance of following a systematic procedure in order to achieve an accurate diagnosis. Once, a clinician has thoroughly explored all the alternative hypotheses after examining patient information the next step in the process demands the evaluation of data. Therefore, the primary objective of this chapter is to communicate the framework which must be implemented by a clinician to classify information for the establishment of an initial diagnosis. Key Points Morrison (2006) identifies the variables which can be utilized to evaluate the information and data that has been acquired in prior stages. The first factor in this regard relates to the value and significance of information and information sources for the establishment of an initial diagnosis. Morrison (2006) notes that a clinician must be prepared to tackle the issue of conflicting information and follow certain standards in case this problem emerges. For example, patient history must be favored over the current state of the patient given a scenario in which both assessments present a contrasting picture. Brief Reflection of Chapter Unless clinicians are aware of the steps which can be undertaken to prevent the presence of conflicting information from harming the creation of an initial diagnosis, the course of the process can essentially be misled. These factors include the detection of contrasting data and recognition of red flag information to ensure that validity and reliability is maintained. Chapter 5 – Coping With Uncertainty Major Objectives The major objectives of this chapter include: the presentation of certain ways and methods that can be adopted to tackle the emergence of uncertainty and an examination to highlight the reasons which signify the importance of this notion in achieving an accurate diagnosis. Key Points Morrison (2006) relates that uncertainty in the process of medical diagnosis is unavoidable because certain scenarios limit the possibility of acquiring suitable information while, in cases such as Alzheimer’s the patient’s ability to communicate information may be entirely tainted. This observation emphasizes further upon the importance of obtaining collateral information by obtaining the assistance of friends and family. The diagnostic principles which guide the resolution of this uncertainty include assessments of past behavior, symptoms and identification of typical features and reactions to prior treatments (Morrison 2006). Consequently, another factor which contributes to the understanding of uncertainty is the acknowledgement of aspects that hinder certainty in the first place such as unusual features or emotional behaviors that are of a multifaceted nature (Morrison 2006). Brief Reflection of the Chapter This chapter establishes a link between the concept of uncertainty in diagnosis, the reasons behind the occurrence of this uncertainty and the measures that can be undertaken to limit the impact of this concept to develop an accurate diagnosis. Chapter 6 – Multiple Diagnoses Major Objectives This component of the text redirects the examinations on diagnosis towards the concept of multiple diagnoses. Therefore, the purpose of this chapter is to present an analysis of the scenarios which ultimately lead to development of a variety of symptoms. Consequently, the component also discusses the factors which must be addressed by diagnosticians in establishing multiple diagnoses or eliminating them. Key Points According to Morrison (2006) the term which defines the existence of multiple diagnoses is known as comorbidity. The widespread consensus in relation with the concept states that comorbidity involves diagnoses which are not dependent of the other such that comorbid complaints may only share the symptoms with one another (Morrison 2006). Morrison (2006) claims that the identification of comorbidity enhances the clinician’s ability to establish the course of treatment, predict the occurrence of prospective problems and reflect upon the fundamental psychopathology. Brief Reflection of the Chapter Once a clinician acknowledges the immense benefits that the identification of comorbidity can serve in accurate diagnosis, treatment and prognosis, he/she would be more likely to adopt a framework which allows the establishment of a comorbid diagnosis. This framework relates the notions of principal diagnosis and additional diagnosis to explain symptoms and arrive at pertinent conclusions regarding the proposed comorbid disorder. Chapter 7 – Checking Up Major Objectives As this chapter marks the end of Part I, the discussions of this component aim to revisit and review the concepts that have been communicated by the help of case studies in the text thus far. Henceforth, this chapter provides an overview of prior examinations by linking the identified concepts through a case example to promote an unambiguous understanding of the literature. Key Points The case example which acts as the focal point of this chapter is that of Veronica. The development of this case follows the collection of information from the three sources that were identified previously including the present MSE of the patient. Accordingly, the differential diagnosis of the patient recognizes various disorders (e.g. Anorexia nervosa) and medical conditions (e.g. Cancer) that have been categorized in accordance with the safety hierarchy. Furthermore, the chapter also applies the concept of comorbidity in the creation of the working diagnosis by eliminating various choices to arrive at Anorexia nervosa and major depression. Morrison (2006) comments that even when a working diagnosis has been created by a clinician the notion of uncertainty must not be ignored and the betterment of diagnosis should remain a priority by assessing other relevant factors that may have been overlooked previously. Brief Reflection of the Chapter According to Morrison (2006), there are two reasons which demand the reassessment of diagnosis and these factors essentially address previous blunders of clinicians and the changing condition of the patient. This notion implies that new information and diagnoses that are not false positives must always be welcomed and integrated within the existing diagnosis effectively rather than being ignored due to the clinician’s hesitancy at the expense of the patient’s well-being. Chapter 8 – Understanding the Whole Patient Major Objectives This chapter outlines the significance of assessing patient information comprehensively by introducing an aspect which essentially states that there exists a correlation between environmental and historical information and the comprehension of emotion and behaviors (Morrison 2006). Key Points While, uncovering each and every possible source of information is fundamental to understanding the emotional and behavioral state of a patient this consideration plays an equally important role in identifying the state of individuals who believe they have a mental health issue when the real case is that it cannot be diagnosed (Morrison 2006). Morrison (2006) categorizes the aspects which constitute of a patient’s mental health history in the phases of childhood and adult life. For example, the questions that are to be addressed with regards to a patient’s childhood include losses through divorce, religious beliefs and education amongst numerous other components. Consequently, the inquiries that are associated with the patient’s adult life include current religion, sexual preferences, any experience of homelessness and suicide attempts to state a few. Accordingly, analysis of family history recalls mental health issues in family members and the state of the relationship that the patient currently shares with his/her immediate family members (Morrison 2006). Brief Reflection of the Chapter: This chapter encompasses an examination of the sources and resources of patient information to develop a comprehensive picture of a patient’s current mental health. This framework of assessing information essentially creates a correlation between the patient’s childhood, adult life and family history as one of the most fundamental diagnostic principles. Chapter 9 – Physical Illness and Mental Diagnosis Major Objectives This component of the text integrates observations regarding physical illness, the presence of which has the potential to impact or even aggravate mental illness. The objective of this chapter is to assist the identification of ways through which physical illness prolongs the symptoms of mental illness. Furthermore, the component also aims to expound upon the role of physical illness in the establishment of an accurate mental health diagnosis. Key Points The relation between physical illnesses and mental disorders is described by understanding the impact of physical illness on the symptoms that a patient may experience. Morrison (2006) states that physical illnesses can lead to the emergence of medical symptoms and even aggravate current symptoms. Consequently, the side-effects of medications can also enhance the possibility of such symptoms. However, the association between physical illness and medical illness is not definite. This notion implies that clinicians should not ignore physical diseases in psychiatric patients when they are causing no apparent harm to their mental state (Morrison 2006). A particular case which reflects the incidence of physical symptoms to alert the clinician regarding the patient’s mental state is known as the somatization disorder (Morrison 2006). Brief Reflection of the Chapter The identification of physical illnesses which may be the root cause for the occurrence of mental symptoms can be performed by following the framework which advises the recognition and evaluation of signs, symptoms and historical information (Morrison 2006). This observation is indicative of the fact that physical symptoms can be integrated during the course of mental diagnosis. Chapter 10 – Diagnosis and the Mental Status Examination Major Objectives The aim of this chapter is to explore the role of Mental Status Examination (MSE) in the procedure of accurate diagnosis. This part of the literature evaluates the contribution of the MSE in depicting the mental state of the patient to advance the development of the overall framework. Key Points Morrison (2006) describes the MSE as a straightforward assessment which does not involve the initiation of in-depth interviewing. The key components of the MSE are defined under the categories which examine the overall appearance and demeanor of the patient, the extent to which the patient displays attentiveness and activity during the session, the behavior and speech of the patient and the type of information that the patient provides (Morrison 2006). Accordingly, it is also significant to comprehend the state of the patient’s cognitive abilities, ability to provide an insight and present opinions regarding his/her current state (Morrison 2006). The effective combination of these factors is fundamental to an accurate diagnosis. Brief Reflection of the Chapter The second part of the text provides the entire scope of data and information that must be acquired by a clinician to progress to the next stages of the diagnostic cycle. The MSE can be viewed as a constituent of the information that is needed to correctly diagnosis the health of a psychiatric patient. Even though, certain researchers claim that the importance of this tool is valued too highly it must be stated that for a clinician to determine the course of action, he/she must be thoroughly aware of the individual’s current state to determine a starting point. Chapter 11 – Diagnosing Depression and Mania Main Objectives The application of diagnostic techniques, methodologies and tools demands an understanding of mental health disorders to ensure the implementation of relevant and suitable procedures for attaining an accurate diagnosis. Morrison (2006) recommends that once the challenges of diagnosing mood disorders are tackled, the remaining mental health problems can be addressed without much difficulty. Thus, the objective of this chapter is to assess the diagnostic procedures that are associated with mood disorders. Key Points An examination of mood disorders succeeds a thorough analysis of several other factors to effectively determine the mental health of a patient. Before addressing the complexity of the issue clinicians should gather information regarding various depressive syndromes to establish a differential diagnosis (Morrison 2006). Consequently, the same framework must also be implemented by a clinician to develop a differential diagnosis for manias. The creation of these contrasting diagnoses must then be viewed under the light of comorbidity (Morrison 2006). Accordingly, the comprehensiveness of a diagnosis for mood disorders is completed once a clinician examines sources of patient history to assess the possibility of issues such as loss, grief and associated problems. Brief Reflection of the Chapter The diagnostic procedures which have been outlined in this chapter signify the importance of conducting differential diagnosis which is highly favored by clinicians in comparison with decision trees. The diagnosis for mood disorders is of a multifaceted and multidimensional nature which implies that clinicians cannot afford to ignore the possibility of mania and depression with regards to a patient’s mental health state. Chapter 12 – Diagnosing Anxiety and Fear Major Objectives The primary objectives that this chapter aims to fulfill aspire to provide a framework for assisting the diagnosis of anxiety and fear by highlighting the difference between the concepts of fear, phobia and anxiety amongst other related notions. Key Points The incidence of panic attacks and the existence of phobias are viewed as usual occurrences which do not require the assistance of a clinician. However, if these conditions begin to intervene in the daily activities of an individual by limiting his/her ability to lead a normal life then medical assistance should be sought immediately. The designated course of action for diagnosing anxiety follows the creation of a differential diagnosis in which varying hypotheses are categorized in accordance with a safety hierarchy (Morrison 2006). For example, when anxiety is viewed to be a consequence of a medical condition, a disorder or a phobia. The development of decision trees as a possible device for conducting a diagnosis for anxiety postulates that all pertinent data and information should be used to progress to the next hypothesis. This observation is applicable for the diagnosis of PTSD and ASD amongst other conditions. Brief Reflection of the Chapter The case examples which have been provided in the chapter outline the distinct family history and personal and social histories of patients. Diagnosing anxiety, phobia and fear demands that clinicians should first acquire the ability to distinguish amongst these terms as the comorbidity of diagnosis is an imminent possibility in the assessment of these factors. Chapter 13 – Diagnosing Psychosis Major Objectives This chapter covers the framework for diagnosing psychosis by defining the concept and describing the terms that are associated with it and creating a differential analysis and decision tree for a patient who has displayed psychotic symptoms. Key Points Psychosis is defined as a state in which an individual loses touch with reality (Morrison 2006). The division of symptoms which are indicative of this mental state is performed on the basis of five categories which include: hallucinations, delusions, disorganized speech, disorganized behavior and negative symptoms. A patient only fulfils the primary criteria for psychosis if he/she experiences one of the aforementioned symptoms; consequently, experiencing more than one of these symptoms is indicative of schizophrenia (Morrison 2006). An interesting point with regards to the diagnosis of psychosis relates to the changes in behavior of young adults which may be mistaken for rebellion (Morrison 2006). Furthermore, an organic psychosis is indicative of physical diseases that can lead the patient to display symptoms of psychosis (Morrison 2006). A differential diagnosis or decision tree assists the diagnostic process by eliminating irrelevant hypotheses. Brief Reflection of the Chapter The diagnosis of psychosis and schizophrenia must be conducted thoroughly, because in certain cases the clinician may commit the mistake of relating these terms which could essentially harm the validity of the diagnosis. Therefore, a clinician’s evaluation of psychosis should take into account various factors such as family history, confusions and substance abuse amongst others to establish the mental issue that is being experienced by the patient. Chapter 14 – Diagnosing Problems of Memory and Thinking Major Objectives The purpose of this chapter is to examine the diagnostic procedures for disorders of cognition. Furthermore, the component also addresses the possibility of multiple diagnoses with regards to the mental health issue by assessing delirium, dementia and other cognitive disorders. Key Points The immense significance of cognition in the lives of human beings is highlighted by comprehending the relationship that the concept shares with sensation and perception. Morrison (2006) comments that cognitive disorders hamper a person’s ability in numerous spheres of life which include language, problem solving, judgment and praxis amongst several others. The differential diagnosis for cognitive disorders encompasses delirium, dementia and PTSD all of which may cause an individual to lose his/her cognitive abilities to function in life. While, the diagnosis of the aforementioned disorders is believed to be complex in nature other illnesses essentially display single symptoms the identification of which can be undemanding for the clinician. Another key point that has been highlighted in this chapter relates to symptoms which are caused by ARCD (Age-related cognitive decline) that is not a disorder in itself. According to Morrison (2006), these scenarios request the creation of a diagnosis of exclusion. Brief Reflection of the Chapter Cognitive disorders can be consequence of comorbidity but in certain cases the loss of cognitive abilities may occur due to other reasons which are not essentially mental illnesses. This observation postulates that clinicians should take into account factors such as age and physical illness in order to identify cognitive disorders in an accurate manner. Chapter 15 – Diagnosing Substance Misuse and Other Addictions Major Objectives This chapter aims to explore the foundations of substance misuse and addiction and how the concepts are of relevance to mental health clinicians today. The chapter also discusses the mental disorders that can arise when an individual is experiencing intoxication or withdrawal. Key Points Morrison (2006) states that substance misuse is prompted by dependence, which affects the dependent individual physiologically and also leads to a failure to control one’s self. As highlighted in previous discussions collateral information in the creation of a working diagnosis is of immense significance because they patient may not be able to communicate to the clinician the true extent of his/her condition. This notion holds even more importance with regards to substance misuse patients because they are most likely to hide the magnitude of their addictive behavior (Morrison 2006). Consequently, patients of substance misuse and addiction are also likely to be associated with various disorders such as delirium, dementia, psychosis and anxiety (Morrison 2006). Brief Reflection of the Chapter While, the association between substance misuse and mental disorders has been established by several scholarly works and literatures some mental health issues may share no association, whatsoever, with the patient’s misuse of substances (Morrison 2006). A clinician must be fully aware of this possibility during the process of diagnosis and identify several factors such as which issue emerged first and the existence of other symptoms (Morrison 2006). Chapter 16 – Diagnosing Personality and Relationship Problems Major Objectives This purpose of this chapter is to examine the categorization of personality disorders or PDs in relation to the issues that individuals experience regarding self or others. This chapter discusses the dimensions of describing personalities by assessing the features of PDs to present a diagnostic framework. Key Points A highly important feature which clearly distinguishes the diagnosis for PDs in comparison with other mental disorders and issues relates to a characteristic of the disorder itself. Morrison (2006) states that trends of PDs suggest that they start early and continue to persist through an individual’s entire lifespan. Therefore, clinicians are required to assess the constant patterns of behavior which have progressed throughout a patient’s life rather than noticing a sudden pattern of behavior which has displayed change or inconsistency. Additionally, another distinguishing feature of a PD diagnosis is that patients should be examined for other mental conditions before a clinician can transition to later stages. Morrison (2006) comments that mania and even long-term substance abuse can cause a patient to experience severe changes in personality traits which have not been brought about by a PD. Brief Reflection of the Chapter PD diagnosis is a matter of recognizing boundaries and limitations which can permit a clinician to conduct an effective diagnosis. These boundaries are associated with relational problems and understanding the difference between normalcy and disorders. Chapter 17 – Beyond Diagnosis Major Objectives In this chapter the author sheds light on three problems which escape the parameters of conventional diagnostic procedures. These issues are identified as compliance, suicide and violence. Key Points The scope of the literature which addresses compliance, suicide and violence has addressed various nuances of the topic however; the application of these works is limited. Noncompliance and nonadherence encompasses the questions which inquire the failure of treatment in various scenarios and the causes which promote the emergence of compliance issues. Morrison (2006) suggests that clinicians can adopt certain measures to diminish the occurrence of noncompliance, these recommendations range from discussing the matter with the patient and family members and exploring the external factors which may be hindering compliance. Another issue which surpasses the boundaries of diagnosis is suicide, because it is extremely difficult to recognize individuals who may attempt or commit suicide (Morrison 2006). Case examples have proved to be particularly helpful in assisting clinicians to associate certain behaviors and traits with suicidal individuals; furthermore, patients with certain mental health disorders such as PDs and those having exposure to certain individual factors such as gun ownership are more likely to commit suicide (Morrison 2006). Accordingly, the researcher which aims to describe the motivations behind violence is largely based on conjecture however; mental disorders such as mania, sociopathy and schizophrenia have been associated with the act (Morrison 2006). Brief Reflection of the Chapter The issues of compliance, suicide and violence do not demonstrate any apparent correlations. However, the mental disorders which may act as underlying causes behind suicide and violence are indicative of the possibility that once a mental illness is diagnosed, clinicians can be in a better position to predict whether an individual is likely to attempt suicide or commit a violent act. Chapter 18 – Patients, Patients Major Objectives The last chapter of the text aims to apply the learned principles, theories, techniques and tools of diagnosis to develop a comprehensive diagnostic framework for each unique patient. The objective of this component is to enhance practical skills and abilities to promote accurate diagnosis. Key Points The differential diagnosis of patients must be developed after acquiring relevant information and data. However, in certain cases the availability of these sources may be limited due to a range of factors. For example, in the case of 19th century poet John Clare the analysis of his mental health can only be created by comprehending the data that is known. On the contrary, the differential analysis of a patient named Scott is much more comprehensive in nature because of the host of information that is available for the clinician regarding the individual. Morrison (2006) favors the creation of a comprehensive differential analysis because it ultimately assists the achievement of an accurate diagnosis by thoroughly examining the condition of the patient. Brief Reflection of the Chapter A successful, accurate and effective diagnosis can only be conducted once the procedures which precede its establishment have been undertaken by a clinician in the prescribed manner. These processes involve data collection and gathering collateral information to understand the patient’s history, family history and personal and social history. This notion is represented by the fact that the comprehensiveness of gathered information correlates with the thoroughness of a differential diagnosis which is regarded by Morrison (2006) as the foundation of an accurate diagnosis. References Morrison, J. (2006). Diagnosis made easier: Principles and techniques for mental health clinicians. Guilford Press. Read More