Assessment, psychiatric diagnosis

Verhulst, F. and Koot, H. (1992). Child Psychiatric Epidemiology Concepts, Methods and Findings. Assessment and Diagnosis. London Sage, pp. 42—96. 

Like most psychiatric disorders, diagnostic criteria for ADHD are based on history and behavioral assessment. There are no pathognomonic laboratory or radiologic tests to confirm the diagnosis. 

Pediatric PTSD is a psychiatric disorder that is prone to both under- and overdiagnosis, especially when assessments are superficially or inexpertly conducted. For example, a traumatic exposure history in combination with current externalizing behavioral symptoms does not necessarily imply a diagnosis of PTSD. Conversely, children who present with an externalizing behavioral disorder in conjunction with anxiety symptoms and aggression are often not fully evaluated for PTSD. 

The occurrence of psychiatric disorders has been prospectively investigated in 63 patients who received a 6-month course of interferon alfa (9 MU/week) for hepatitis C (379). All were assessed at baseline with the Structured Clinical Interview for DSM-III-R (SCID) and monitored monthly with the Hopkins Symptoms Checklist (SCL-90). Most had a history of alcohol or polysubstance dependence, and 12 had a lifetime diagnosis of major depression. There were no significant changes in the SCL-90 scores during the 6-month period of survey in the 49 patients who completed the study, even in those who had a lifetime history of major depression. At 6 months, there was probable minor depression in eight patients and major depression in one none had attempted suicide. 

Additional information besides the DSM-IV-TR diagnosis is required before a comprehensive treatment plan can be developed. The American Psychiatric Association Practice Guidelines for Psychiatric Evaluation of Adults offers a more comprehensive approach to patient assessment. It includes a full discussion of the domains needed for a thorough clinical evaluation, including chief complaint history of present illness past psychiatric history general medical history social, family, and occupational history physical and mental status examinations and diagnostic tests. It further describes issues of privacy, evaluations in the elderly, and techniques for working with multidisciplinary teams. ... 

If a social work practitioner suspects that any client, regardless of age, suffers from bipolar disorder, it is critical to confirm this diagnosis using the DSM-IV criteria (American Psychiatric Press, 1994 Meeks, 1999). This requires determining whether the client meets the criteria for depressive, manic, hypomanic, or mixed episodes. In addition, every practitioner should also assess for critical symptoms reflective of other mental health problems (Cassano et al., 1999). 

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