Rule Out General Medical Conditions
There are various conditions in which depression is a symptom. It is very important to rule these out because it may require treatment beyond psychotherapy or an antidepressant medication to remove or mitigate the underlying causes of depression.
To do this, clinicians will ask about previously diagnosed conditions. They are particularly interested in those that may have begun around the same time as depression. Lab tests may be ordered to screen for conditions commonly associated with the symptoms of depression.
Some conditions commonly mistaken for depression include:
- Attention-deficit/hyperactivity disorder
Which Mnemonic Is Best For Developing A Good Differential Diagnosis
Ultimately, thats up to you and whichever one you remember best. If memorization is a challenge for you or if you are struggling to keep up in your medical education program, then learn to study smarter.
Be sure to improve your clinical thinking with our differential diagnosis tool. Below, you can view the infographic with all three techniques together along with some helpful bonus tips.
That was just part of my medicolegal conversation with PA Blumm. You can also learn his insightful take on the medico-legal importance of a good differential diagnosis.
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What Is The Six Step Differential Diagnosis Tool
The six-step differential diagnosis tool is an approach to properly diagnosing mental health disorders. Differential diagnosis ensures that doctors consider all possibilities before they make a diagnosis for a patients illness. It involves making a list of all possible explanations for a patients symptoms and eliminating each one until only
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Take A Medical History
When preparing for differential diagnosis, a doctor will need to take a persons full medical history. Some questions they may ask include:
- What are your symptoms?
- How long have you been experiencing symptoms?
- Do you have a family history of certain conditions?
- Have you traveled out of the country recently?
It is important that a person answers all questions honestly and in as much detail as possible.
Study Design And Condition Severity Can Influence Outcomes
Interpretation of test metrics is also highly dependable on the quality of the evidence about the test. For example, the Thessaly test for meniscal tears was initially developed in a study with a low-quality design and the results were not replicated afterward., , Clinicians should look closely at study designs, reference standards and how the tests were described as these have most commonly influenced biases in diagnostic accuracy studies. Further, the severity of the population group may influence outcomes. Conditions that are advanced and have high degrees of disability and pain will exhibit test results that are more sensitive and less specific. Conditions with low disability and pain will exhibit lower sensitivity and higher specificity.
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Overuse Of Diagnostic Tests And Overdiagnosis In Musculoskeletal Disorders
Most fields in medicine have relied on diagnostic tests and metrics to inform clinical decision-making. However, it is now recognized that this overreliance on diagnostic labeling in medicine is a driver of overuse of diagnostic tests and overdiagnosis. Overdiagnosis occurs when a patient receives a diagnostic label that may have never caused them harm, such as when diagnostic tests identify abnormalities or risk factors that most often will not cause symptoms or impairments. Thus, the core of overdiagnosis is strongly related to the definition of diagnostic labeling and interpretation of test metrics.
When a patient presents with symptoms of pain to the spine, knee, hip or shoulder, clinicians often initiate a cascade of history questions, physical examination tests, clinical measures and imaging tests in order to diagnose the sources of the symptoms. Musculoskeletal care is plagued by overuse of diagnostic tests. Up to 50% of all imaging test referrals are considered inappropriate. Musculoskeletal disorders are particularly prone to overdiagnosis given the documented high prevalence of asymptomatic structural deficits seen on imaging. Examples of such labels include lumbar degeneration, disk bulges,disk herniation,degenerative meniscal tears,degenerative labral tears,subacromial bursal thickening or rotator cuff tendinosis.
Previous Research On The Differential Diagnosis Of Religious Experiences And Psychopathology
Starting in the 1980s, seminal work by Grof and Grof identified ten varieties of spiritual emergency.1 This approach was positioned as a challenge to the culturally insensitive and narrow definitions of mental health in mainstream psychology that ignored or pathologized non-ordinary states of consciousness. The Grofs and others in the transpersonal psychology movement were adamant that these experiences reflected access to legitimate realities and sacred knowledge that would result in healing, but only if they were properly supported, i.e., were allowed to follow their natural course and were not suppressed by medication . The concern then was with normative judgements and prescriptions for clinical responses that would facilitate rather than interfere with positive spiritual growth.
The Grofs descriptions of these experiences either relied upon specific associated phenomenology or conflated phenomenology with appraisals of outcomes . In this approach, most of the emphasis is placed on the specific phenomenological features of spiritual emergencies or on their positive impacts on the persons spiritual life, although additional scholarship has identified other distinguishing features such as an absence of comorbidities or the ability to maintain a critical attitude toward the experience .
Thus, key criteria that serve as possible exceptions to the cultural caveats include prolonged duration, loss of control, and distress.
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What Is Differential Diagnosis Process
Differential diagnosis is a process wherein a doctor differentiates between two or more conditions that could be behind a persons symptoms. When making a diagnosis, a doctor may have a single theory as to the cause of a persons symptoms. They may then order tests to confirm their suspected diagnosis.
Problems For Diagnostic Explanation
Idealisation and explanatory pluralism are promising strategies for disease explanation in psychiatry. When we want to understand what causes depressive symptoms in general, we can conjure up an idealised general representation of the syndrome and model the causal factors that are known to contribute to the phenomena described in the representation. The resulting model can then illuminate statistical generalisations and causal regularities at a population level, in spite of the heterogeneity seen in individual cases. However, I argue that heterogeneity remains problematic for diagnostic explanation when we try to apply the model to the individual cases.
As noted in , there is a possibility that a psychiatric disorder like MDD does not involve a single invariant pathology that is instantiated in every case, but a vast range of diverse factors, none of which is universally present across all cases. Hence, as noted by Murphy, the same set of symptoms may be produced by different sets of causes:
It seems unlikely that the same underlying causes explain an irritable adolescent who sleeps late, diets frantically, and lies around the house all day threatening to commit suicide on the one hand, and a sad middle-aged man who can not settle down to any of his normal hobbies, hardly sleeps, eats more and more, can not make love to his wife, and feels worthless.
Similarly,
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How To Interpret The Results
A person may require multiple in-office examinations and diagnostic tests before they receive a definitive diagnosis.
Some patients may have multiple negative test results before they get a diagnosis. However, each negative test result brings the doctor one step closer to figuring out the cause of a persons symptoms.
Some people may need to begin treatment before a doctor has confirmed their diagnosis. This may be the case if one of the potential causes of a persons symptoms requires prompt treatment to prevent further complications.
A persons response to a particular treatment can itself provide valuable insights into the cause of their symptoms.
Limitations And Future Directions
The qualitative retrospective design of the current study and the lack of systematic inquiry into decision-making processes limit the generalizability of findings and our ability to establish the accuracy, utility, and reliability of particular criteria. The VCE study is based upon a non-representative population of Western Buddhists purposely selected for their ability to report on meditation-related challenges, their interpretation, and their management. Thus, these data may not generalize to other religious traditions, to mindfulness-based interventions, to clinicians without backgrounds in mindfulness or Buddhism, or to Buddhist communities in other cultures. Future studies should systematically explore differential diagnosis criteria for different types of experiences and investigate the degree to which there is a hierarchy of criteria, where certain criteria are reliably superseded by others. Prospective studies with longitudinal follow-up and quantitative measures can establish which criteria are predictive of outcomes.
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The Varieties Of Contemplative Experience Project
The VCE study documented 59 discrete meditation-related challenges and 26 influencing factors that could affect the nature, duration, or trajectory of those challenges. Reports of meditation experiences were organized into seven higher-order domains: cognitive perceptual affective somatic conative sense of self and social. Some important meditation-related challenges that will be discussed below include: delusional, irrational, or paranormal beliefs change in executive functioning hallucinations, visions, or illusions somatosensory changes fear, anxiety, panic, or paranoia re-experiencing of traumatic memories somatic energy sleep changes change in sense of embodiment and social impairment. Influencing factors identified potentially significant variables associated with the meditation practitioner, their meditation practice, their social relationships, and their health behaviors.
Although the VCE study interview protocol did not include a question on criteria for differential diagnosis or determining need for intervention, when appropriate interviewers sometimes asked follow-up questions such as: What was she saying that made you think this is mental illness this is not a spiritual experience that shes having? The topic arose explicitly or implicitly in all but two practitioner interviews and all but one expert interview 2.
What Do My Results Mean
Your results may include information about conditions you don’t have. It’s important to learn this information to narrow down the possibilities of potential disorders. The results may also help your provider figure out which additional tests you need. It can also help determine which treatments might help you.
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A Restless Boy Means It’s Adhd
In my work providing diagnostic assessments for the juvenile justice system, it often holds true that diagnostic evaluation is intervention. This is because the child has been misdiagnosed for years, getting improper treatment, and getting in trouble for it. It’s not unusual to encounter a case like Tommy :
Tommy’s parents explained to a therapist that he was often restless and had low frustration tolerance an ADHD diagnosis ensued. The therapy attempt zeroed in on calming and focus techniques to no avail. ADHD medications from his pediatrician just made him lose weight. Meanwhile, Tommy began skipping school a lot so as not to have to deal with the frustrations of learning and feeling cagey. Chronic truancy brought him to the court’s attention.
Upon evaluation, I discovered Tommy not only didnt have an early history typical of those with ADHD, but he also harbored significant signs of depression. Tommy confessed to feeling he had no chance at a solid future and that he was carrying a weight. This was not noted in months’ worth of documentation, only that he says his mood is irritated.
Tommy actually suffered from persistent depressive disorder, dysthymic type, with anxious distress. Irritability, low frustration tolerance, problems focusing, and hopelessness are a classic representation of the disorder, and it is not unusual for there to be superimposed anxiety symptoms .
Rule Out Malingering And Factitious Disorder
According to First, a doctor’s initial step should be an attempt to determine whether patients are faking their symptoms. In general, there are two possible reasons for this: malingering and factitious disorder.
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When people feel they have something to gain from a particular diagnosis. For example, they may want to avoid certain responsibilities.
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When people derive psychological benefits from taking the role of a sick person.
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Formulate A Differential Diagnosis With Mnemonics
We decided to create this differential diagnosis tool after a conversation with one of our colleagues, who kind of a big deal in the medmal world. He is also the author of Surgery for the Physician Assistant.
Robert Blumm, PA and I discussed the importance of the differential diagnosis from a patient care and medicolegal perspective, which really got me thinking.
What Is A Working Diagnosis
Working diagnosis is a term used to refer to the leading contender in a list of two or more potential diagnoses.
What is the difference between a diagnosis and a differential diagnosis?, A differential diagnosis means that there is more than one possibility for your diagnosis. Your doctor must differentiate between these to determine the actual diagnosis and appropriate treatment plan. Unfortunately, there are currently no lab tests to identify depression.
Furthermore, What are the steps to diagnosis?, Steps to diagnosis
Finally, What does this diagnosis mean?, 1a : the art or act of identifying a disease from its signs and symptoms. b : the decision reached by diagnosis the doctors diagnosis. 2a : investigation or analysis of the cause or nature of a condition, situation, or problem diagnosis of engine trouble.
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Practical Issues In Differential Diagnosis
There are other circumstances in which the critical diagnosis in the differential diagnosis between brain disease and psychiatric disorder is the latter rather than the former. Dementias are common in old age and most are associated with progressive decline to dependency and death. Sometimes, however, depressive illnesses present with such widespread evidence of intellectual impairment that they closely resemble a dementia. Because depressions are eminently treatable it is vital that these depressive pseudodementias are quickly recognized and treated, and depression is therefore an important part of the differential diagnosis of dementia. Similar considerations apply to rare curable dementias, such as those associated with a deficiency of thyroid hormone or vitamin B12.
F.M. Reischies, in, 2001
Ruling Out Conditions For A Mental Health Diagnosis In Teens
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
The term “rule out” is used by mental health professionals who are trying to make an accurate diagnosis. The symptoms of many mental health conditions are similar or overlap so before a clear diagnosis can be made, clinicians must rule out a variety of other conditions.
If your teen is having trouble concentrating, a therapist may want to rule out ADHD or PTSD. Or, if your teen seems depressed, a mental health professional may want to rule out bipolar disorder before making a depressive disorder diagnosis.
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Why Differential Diagnosis Is Important
Generating a differential diagnosis that is, developing a list of the possible conditions that might produce a patients symptoms and signs is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.
What Is Meant By Differential Diagnosis In Psychology
What Is a Differential Diagnosis? A differential diagnosis means that there is more than one possibility for your diagnosis. Your doctor must differentiate between these to determine the actual diagnosis and appropriate treatment plan. Unfortunately, there are currently no lab tests to identify depression.
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How A Diagnostic Label May Overcomplicate Care
The creation of diagnostic codes from a patho-anatomical viewpoint has led to focus on tissue based musculoskeletal disorders. Here we argue that identifying and classifying patients based on this model can lead to overcomplicated or asymptomatic diagnostic labeling that may not translate into better patient outcomes.
What Is Differential Diagnosis Dsm5
4.8/5DSM5 differential diagnosis5more on it
The process of DSM–5 differential diagnosis can be broken down into six basic steps: 1) ruling out Malingering and Factitious Disorder, 2) ruling out a substance etiology, 3) ruling out an etiological medical condition, 4) determining the specific primary disorder, 5) differentiating Adjustment Disorder from the
Similarly, what is the difference between diagnosis and differential diagnosis? A differential diagnosis means that there is more than one possibility for your diagnosis. Your doctor must differentiate between these to determine the actual diagnosis. Only after that is done can he choose the best method for treating you. Instead, the diagnosis is based on your medical history and your symptoms.
Furthermore, what is differential diagnosis mental health?
Many mental health disorders cause sadness, anxiety, and sleep problems. A differential diagnosis looks at the possible disorders that could be causing your symptoms. It often involves several tests. These tests can rule out conditions and/or determine if you need more testing.
How do you do a differential diagnosis in psychology?
Six Steps to Better DSM-5 Differential Diagnosis
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Usage Apart From In Medicine
Methods similar to those of differential diagnostic processes in medicine are also used by biological taxonomists to identify and classify organisms, living and extinct. For example, after finding an unknown species, there can first be a listing of all potential species, followed by ruling out of one by one until, optimally, only one potential choice remains.Similar procedures may be used by plant and maintenance engineers and automotive mechanics and used to be used in diagnosing faulty electronic circuitry.