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The purpose of assessment

Posted by Margaret Donohue on November 2, 2014 at 9:30 AM

DSM 5 the Psychiatric Diagnostic and Statistical Manual of Mental Disorders is out and updates are available online.  The problem is that it's moving away from research based epidemiological discussions about diagnoses and moving more into checklist based diagnoses, based on rating scales and observations of "people who know the individual, or the individual themselves."  


So what's the problem?


Here are case examples from just the last couple of weeks (some details are changed to maintain privacy).  

  • A child with a known brain injury is misdiagnosed with ADHD.  They have a known parietal lobe injury.  Medication, especially stimulant medication, is likely to have a negative effect. They have no executive dysfunction.  It certainly won't contribute to rehabilitation, and the trials of medication and side-effects will post-pone or neglect rehabilitation efforts.
  • A child is diagnosed with Autistic Spectrum Disorder (ASD) based on a rating scale.  On formal evaluation, the child has evidence of a brain injury (TBI).  The prognosis and the impact of cognitive rehabilitation are very different between TBI and ASD.
  • A child is diagnosed with Autistic Spectrum Disorder.  What they actually have are absence seizures.
  • An adult is diagnosed with bipolar disorder.  What they actually have is a personality disorder-borderline personality disorder.  Medication may keep some symptoms in check, but it won't change core personality structure like several forms of evidenced based psychotherapy will. 
  • An adult is diagnosed with schizophrenia.  What they actually have is post-traumatic stress disorder. (It would be nice if some physicians actually understood hallucinations, flashbacks, symptoms from sleep disturbance, and medical conditions and took an adequate history).
  • An individual diagnosed with depression actually has a rapidly growing brain tumor.  This is potentially a fatal misdiagnosis.
  • An individual diagnosed with a personality disorder actually has thyroid cancer.  This is a potentially fatal misdiagnosis.
  • An individual diagnosed with depression actually has a massive septic infection. This is potentially a fatal misdiagnosis.
  • An individual diagnosed with anxiety and depression actually has obstructive sleep apnea.  Medication for anxiety and depression will not help until the oxygen levels are improved.

As checklists and brief medical encounters pervade the psychological and psychiatric treatment fields and the field relies more heavily on brain imaging and medication management, the amount of diagnostic error increases exponentially.  So let's take a step back.  

If you went to a physician and your assessment was a mental status examination, or filling out a checklist, or a rating scale, and you've been following the treatment but not getting better, rather than changing medication, increasing the dose, or adding an additional medication, maybe it's time for  a formal evaluation.

Feel free to contact our office.

Categories: General Psychology, Brain Injury, Diagnosis

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