NSU PYCL584 2022 April Week 4 Critical Thinking Latest

PYCL584 Diag/Tx of Adult Psych

Week 4 Critical Thinking

Neurocognitive Disorders

As we begin to discuss the actual psychiatric disorders, it is important to differentiate those with known and verifiable organic or physiological etiology from those disorders with psychological bases or more controversial and complex etiologies.  You must keep in mind that most psychiatric symptoms CAN have a physical basis.  Symptoms like depression, anxiety, mania, confusion, memory loss, delusions and hallucinations are often caused by medical conditions or substances including illicit drugs and prescription medications.  It is wrong to immediately assume that your patient has generalized anxiety due to poor coping skills or early childhood trauma when a more thorough evaluation by a physician would reveal that the patient suffered from hyperthyroidism.  The rule, therefore, is to approach each of your patients with this index of suspicion and insure that any possible medical condition has been ruled out before making your diagnosis.  You will notice as you read the DSM-5 that most chapters include a series of diagnoses that I refer to as “diagnoses of exclusion” as well as two other types.  These include diagnoses like “Depressive Disorder due to Another Medical Condition” and “Substance/Medication-induced Anxiety Disorder.”  It is only when medical and substance induced causes have been eliminated that the remaining diagnoses can be validly made.  Hence, the remaining diagnoses are called “diagnoses of exclusion.”  For instance, Schizophrenia, Major Depression and Panic Disorder are all diagnoses of exclusion.  This distinction becomes most relevant when we consider appropriate treatment for your patient.  It would be very inappropriate to treat a 50 year old depressed woman with psychotherapy aimed at dealing with her presumed low self esteem or feelings of loss when , in fact, she suffers from depression due to estrogen deficiency.  In that case her depression would be more successfully treated with estrogen replacement therapy.  Be aware that diagnoses like Major Depression and Schizophrenia that I have termed “diagnoses of exclusion” are not necessary entirely psychologically caused.  We recognized that most disorders have some physical basis and many professional refer to both Depression and Schizophrenia as “brain disorders.”  However, this is a controversial area and the nature of the causation, as you will see in your reading, is not as clear cut as other clearly “organic” illnesses like those that we now consider.

The first group of psychiatric disorders we will address are all based on organic etiologies that can be verified with laboratory and/or radiological evaluation and testing.  They have in common a disruption of our cognitive and intellective functions and include primarily dementias of various etiologies and delirium., all of which are caused by CNS impairments and medical/ substance toxicity of some sort.

READ:  Chapter 15 (B & D)   (Cognitive Disorders)

CRITICAL THINKING EXERCISE:  Discuss the differences between dementia, delirium and amnestic disorder.  How are they similar? Submit a one page, single-spaced response via the Assignment Dropbox (ADB).