Although bipolar mood episodes may have an inherent episodic rhythm, all three disorders can be chronic, lifelong conditions that cause significant functional impairment. Yet the symptoms of bipolar disorder, but not schizophrenia, are often responsive to mood-stabilizing medications such as lithium and other anticonvulsants. Because of this “top-down” effect in which antipsychotic medications are used to treat both schizophrenia and bipolar disorders, the DSM-5 lists bipolar-related disorders in sequence after schizophrenia disorders. In addition, schizoaffective disorder is listed as the final psychotic disorder in the schizophrenia spectrum disorders chapter because it serves as a bridge to the bipolar-related disorders chapter in the DSM-5.
Traditional psychometrically sound instruments, such as the for adults and adolescents and the for adults and adolescents, can further detect the presence of mania or hypomania and anchor your bipolar and related disorder diagnosis. Regarding differential diagnostic procedures – especially to avoid “double counting” of symptoms toward borderline personality disorder – the DSM-5 requires clinicians to suspend diagnosing a personality disorder during an untreated mood episode (APA, 2013, p. 132). To assist with this important and sometimes complicated process, I recommend Gregory Hatchett’s 2010 article, “Differential diagnosis of borderline personality disorder from bipolar disorder.”
Early intervention in psychosis - Wikipedia
This study demonstrates that there are two sharp peaks of risk for suicide around psychiatric hospitalisation, one in the first week after admission while another in the first week after discharge; suicide risk is significantly higher in patients who had less than median duration of hospital treatment; affective disorders impact suicide at the strongest in terms of both its effect size and population attributable risk; and suicide risk associated with affective and schizophrenia spectrum disorders declines quickly after treatment and recovery while the risk associated with substance abuse disorders declines relatively slower. This study also indicates that an admission history increases suicide risk relatively more in women than in men; and suicide risk is substantial for substance disorders and for multiple admissions in women but not in men.
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To enhance diagnostic specificity, the DSM-5 provides example presentations in which symptoms characteristic of a depressive disorder cause clinically significant distress or impairment but do not meet the full criteria for any of the depressive disorders. This classification is the replacement for DSM-IV-TR not otherwise specified (NOS). The other specified disorder category is provided to allow clinicians to communicate the specific reason that the presentation does not meet the criteria for any specific category within a diagnostic class. This is done by recording the name of the category, followed by the specific reasons. Examples offered in the DSM-5 include:
The Diathesis-Stress Model Essay - 308 Words - …
This model covers specific, well-defined diseases and is based on the assumption that the disease develops through stages that can often be modified and in some cases, stopped or even reversed, which is true for many chronic diseases. The model can be applied with success to cancer, diabetes, chronic obstructive lung disease, cardiovascular diseases, maybe schizophrenia, and a range of other diseases. It might also be a valid assumption to make for the suicidal process, but the pathways to suicide can be very different for different persons and for different groups of persons, and there is no common pathway from stage one to stage three. The suicidal process can in most cases be reversed. Another problem is that this classification of preventive measures is difficult to use in the case of suicide, since it is not a single disease, and the process leading to suicide can follow a range of different pathways. The preventive elements would have to cover a very broad range of interventions. If suicidal behaviour were to be compared with the fully developed disease dealt with in this model, it could for instance be an endpoint after a process with financial and personal problems; it could be a fatal complication of severe affective disorder; or it could be a complication of alcohol or drug abuse or a range of other social, medical and psychiatric conditions. Finally, another problem with the traditional prevention model is that if suicide is considered the target, the issue of tertiary prevention is meaningless. Jenkins [Jenkins and Singh, 2000] has suggested that tertiary prevention should focus on survivors, but they are independent persons themselves and should rather be considered as a risk group. Silverman has suggested that tertiary prevention should be understood as intervention after the first suicide attempt [Silverman, 1996].