Trabajo
25 de febrero del 2010-
PSICOPATOLOGÍA.
HISTORICAL PERSPECTIVE ON DIAGNOSIS OF CHILDHOOD DISORDERS
• Binet: first psychometric measure of children.
• Kanner’s: description of infantile autism and diagnosis in child psychiatry.
• Findings:
The relative frequency of behavioral disturbance in childhood, the powerful nonspecific association betweenneurological impairments and behavioral disorders, and the association of learning disorders with conduct disorders.
• Assessment tools:
Much effort has gone into validating rating scales and questionnaires and in exploring interview parameters that might predict or reflect stimulant drug effects.
➢ DEFINITION OF DISORDER:
• Most diagnostic categories have been generatedon the basis of what clinicians agree they recognize from clinical descriptions as fitting what they see in their own practice.
• Perception is influenced by their experience.
• Variation degree to which child clinician’s have been trained to be descriptive. Inferential is based on the quality of the clinician’s interaction with the child and his family.
➢ IMPORTANCE OFMULTIPLE DIAGNOSES
• Oppositional deficient disorder if often diagnosed together with attention deficit/ hyperactivity disorder.
• Multiple diagnoses will lead to better categorization.
• A single, highly specific diagnosis does not capture the case.
• Specific symptoms can be accounted for by more than one disorder, the nature of the total symptom picture will determine thediagnosis.
• Diagnostic confusion occurs when children show signs of more than one disorder.
➢ VALIDITY AND RELIABILITY OF DSM IV DIAGNOSES FOR CHILDHOOD DISORDERS.
Validity of axis I and axis II diagnoses.
• Most childhood psychiatric disorders fall under 2 broad categories: behavioral disorders or emotional disorders.
• Work remains to be done in order toclarify differences between hyperactivity and conduct disorders and between anxiety disorders and depression.
➢ Reliability if axis I and axis II diagnoses.
• Problems did indeed focus on axis I disorders, the major problem was differentiating between diagnoses, rather than struggling with detailed criteria as anticipated.
• Differential diagnosis and the handling of mixedcategories were the sources of most discrepancies.
➢ SPECIFIC DIAGNOSTIC ISSUES IN CHILD PSYCHIATRY.
Age specific manifestation of disorder.
• Childhood disorders are uniquely characterized by developmental considerations that are central to many of the diagnostic entities (enuresis at age of 12). Where normal development stops and pathology begins.
• Earl’s work suggestedthat DSM III diagnoses were appropriate even for 3 year old.
➢ ADOLESCENCE AS A DEVELOPMENTAL STAGE.
• Adolescence constitutes a special stage requiring singular diagnostic attention. Much has been written about identity problems in adolescence.
• A substantial proportion of adolescent inpatients previously described as having identity disorder now will probably be consideredto have adjustment, mood, or psychotic disorders.
• The virtue of DSM system is that it provides clear description and definition of disorders so that follow-up, family, and treatment studies can be carried out.
➢ PROBLEMS IN ASSESSMENT
Informants.
• Children under age 15, are self referred. Presenting complaints usually come from their parents, school, community, orprofessionals. As a result, in addition to evaluating the child, the clinician must simultaneously evaluate the sources of referral. Sources data is often minimal.
• Some disorders, such as depression, the child’s report may reveal more “positive” information that the parents; while other symptoms “externalizing” behaviors, are more accurately reported by the parent’s. subjective states...
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