Additional Conditions That May Be a Focus of Clinical Attention

Title Layout

Additional Conditions That May Be a Focus of Clinical AttentionMANAN, ALMERA O.1Additional Conditions That May Be a Focus of Clinical AttentionMalingeringBereavementOccupational ProblemsAdult antisocial behaviorReligious/ spiritual problemAcculturation problemPhase of life problemNoncompliance with treatment for a mental disorderAge-associated memory decline21.MALINGERINGIntentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military dutyavoiding workobtaining financial compensationevading criminal prosecutionobtaining drugs

DSM-IV-TRMALINGERINGStrongly suspected if any combination of the following is noted:ETIOLOGYDIAGNOSIS AND CLINICAL FEATURESTREATMENTPatient should be monitored as if a real disease is present, but NO treatment shall be offered.Clinical NeutralityTactfully but firmly confronted with the apparent outcomeCOURSE and PROGNOSISPersists as long as the malingerer believes it will likely produce the desired rewards.In military or prison units, ignoring the malingered behavior may result in its disappearance.In children, malingering is most likely associated with a predisposing anxiety or conduct disorder, proper attention to this developing problem may alleviate the childs propensity to malinger.Differential DiagnosisFactitious disorder motivation (sick role), no external incentives2. Somatoform- no conscious volition3. Conversion disorderMalingering vs. Conversion DisorderMALINGERINGCONVERSION DISORDERSuspicious, uncooperative, aloof and unfriendlyFriendly, cooperative, appealing, dependent and clingingAvoid diagnostic evaluations and refuse recommended treatmentWelcome evaluation and treatment, searching for an answerRefuse employment opportunities designed to circumvent their disabilityAccept such opportunitiesProvide extremely detailed and exacting descriptions of events precipitating their illnessReport historical gaps, inaccuracies and vagaries2. BEREAVEMENTNORMAL

DSM-IV-TRMAJOR DEPRESSIVE EPISODETREATMENTGrief therapySleeping medication3. OCCUPATIONAL PROBLEMEntry into the working worldAt times of promotion or transferDuring periods of unemploymentAt retirementOCCUPATIONAL PROBLEMWork choices and changesStress and the workplaceSuicide riskCareer and job problems of womenWorking teenagersWorking within the homeChronic illnessDomestic violenceJob lossOCCUPATIONAL PROBLEMThis category can be used when the focus of clinical attention is an occupational problem that is not due to mental disorder or, if it is due to a mental disorder, is sufficiently severe to warrant independent clinical attention. Examples include job dissatisfaction and uncertainty about career choices.DSM-IV-TR17Practical Symptoms of Job dissatisfactionPsychiatric SymptomsMistakes at workAccident pronenessAbsenteeismSabotage

InsecurityReduced self-esteemAngerResentment at workTREATMENTVOCATIONAL REHABILITATION4. ADULT ANTISOCIAL BEHAVIORCharacterized by activities that are illegal, immoral, or both, antisocial behavior usually begins in childhood and often persists throughout life.DSM-IV-TRThis category can be used when the focus of clinical attention is ADULT ANTISOCIAL BEHAVIOR that is not due to mental disorder (e.g. Conduct d/o, Antisocial Personality d/o or an Impulse-Control D/o). Examples include the behavior of some professional thieves, racketeers, or dealers in illegal substances.ETIOLOGYCLINICAL FEATURESLIFE AREAAntisocial Patients with Significant Problems in Area (%)Work problems85Marital problems81Financial dependence79arrests75Alcohol abuse72School problems71Impulsiveness67Sexual behavior64Wild adolescence62Vagrancy 60Belligerence 58Social isolation 56Military record53Lack of guilt40Somatic complaints31Use of aliases29Pathological lying16Drug abuse15Suicide attempts11LIFE AREAAntisocial Patients with Significant Problems in Area (%)TREATMENTPsychotherapy has not been effective.No major breakthrough with biological treatments, including medications, have occurred.

Therapeutic communities Group treatmentDIFFERENTIAL DIAGNOSISBipolar I DisorderSchizophreniaTemporal Lobe epilepsySubstance related

-Almera Manan27