WHY IS DIAGNOSIS IMPORTANT

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WHY IS DIAGNOSIS IMPORTANT

• DESCRIPTIVE ? A diagnostic label is a
  description of a Pt.
• 
  condition. It is essential for communication
• 
  the key to all other medically relevant
• 
  information about the Pt.
• AETIOLOGICAL ? Diagnosis are sometimes based on
  but
• 
  always imply information about etiology
• THERAPEUTIC ? Knowledge of symptoms of
  etiology
• is
  the basis for rational decisions about
• 
  treatment other aspect of clinical
• management.
• PROGNOSTIC ? Symptoms etiology , together
  with the
• 
  likely response to treatment , give an
• estimate of prognosis.

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TWO DISTINCT STAGES FOR DIAGNOSIS IN PSYCHIATRY

• A STAGE OF INFORMATION GATHERING ?
• In which data are collected from
  the pt. from others,
• mainly by way of history taking, mental state,
  physical examination
• observation.
• A STAGE OF FORMULATION OR ASSESMENT ?
• In which information collected is
  organized reduced to
• its relevent essential under four heading
  corresponding with the
• four main purpose of diagnosis.
• 1 Discriptive Diagnosis. 3
  Therapeutic.
• 2 Aetiological
  4 Prognosis

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CHILD PSYCHIATRIC EVALUATION

• 1? IDENTIFYING DATA
• a Identified Patient Family Members
• b Source Of Referral.
• c Informants

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• Chief Complaint.
• History Of present Illness.
• Developmental History Milestones
• Psychiatric History.
• Medical History Including Immunization
• Family Social History Parents Marital Status
• Educational History Current School Functioning
• Peer Relationship History
• Current Family Functioning.
• Family Psychiatric Medical Histories.

2 ? HISTORY
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3 ?MENTAL STATUS EXAMINATION FOR CHILDREN

• Physical Appearance
• Parent Child Interaction
• Separation Reunion
• Orientation To Time, Place Person
• Speech Language
• Mood
• Affect
• Thought Process Content
• Social Relatedness
• Motor Behavior
• Cognition
• Memory
• Judgment Insight

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4 ? NEUROPSYCHIATRIC EXAMINATION
5 ? DEVELOPMENTAL, PSYCHOPLOGICAL
EDUCATIONAL TESTING
6 ? FORMULATION SUMMARY
7 ? DIAGNOSIS
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CGS/ HGP

• Memory Sharp
• Suicidal Thoughts

COGNATION
CONATION
AFFECT

• Anxiety
• Wants to seat alone
• Religious
• Beating Self
• Fear Of Crowd
• Beating Destructive
• Irritable, Violent
• Not Following Adults Advise

• Restlessness

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CGS/HGP
AXIAL DIAGNOSIS
Axis I Conduct Disorder Axis II
NONE Axis III Tooth Carries,
Constipation. Axis IV Problem with Primary
Support System Especially Mo.
G Fa. Axis V GAF 31 to 40
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DISRUPTIVE BEHAVIROURAL DISORDERS
OPPOSINATIONAL DEFIANT
DISORDER RECURRENT PATTERN OF
NEGATIVISTIC,DEFIANT, DISOBIDENT, AND HOSTILE
BEHAVIOUR TOWARDS AUTHORITY FIGURES. AT LEAST FOR
6 MONTHS.
CONDUCT DISORDERS REPETATIVE PERSISTENT
PATTERN OF BEHAVIOUR IN WHICH THE BASIC RIGHT OF
OTHERS OR OTHERS MAJOR AGE APPROPRIATE SOCIETAL
NORMS OR RULES VIOLATED.
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CONDUCT DISORDER Conduct disorder is a clinical
term referring to the clustering of persistent
antisocial acts of children and
adolescents EPIDEMIOLOGY The general
population prevalence is estimated somewhere
between 1.5 and 3.4 percent of children and
adolescents. The male-to female ratio has been
found to range between 51 and 31. At any given
time it is estimated that about 1.3 to 4 million
children and adolescents are afflicted with
conduct disorders. ETIOLOGY Most
authorities agree that conduct disorder is a
heterogeneous disorder. It can best be described
as a final common pathway for several initially
divergent developmental trajectories. Genetic
liability triggered by an environmental
adversity, mediated by other factors such as poor
coping..
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• DIAGNOSTIC CRITERIA FOR C.D.
• A.
• A repetitive and persistent pattern of behavior
  in which either the basic rights of others or
  major age-appropriate societal norms or rules are
  violated, as manifested by the presence of three
  (or more) of the following criteria in the past
  12 months, with at least one criterion present in
  the past 6 months
• Aggression to people and animals
• often bullies, threatens, or intimidates others
• often initiates physical fights
• has used a weapon that can cause serious
  physical harm to others (e.g., a bat,
  brick, broken bottle, knife, gun)
• 4. has been physically cruel to people
• has been physically cruel to animals
• has stolen while confronting a victim (e.g.,
  mugging, purse snatching, extortion, armed
  robbery)
• 7. has forced someone into sexual activity
  Destruction of property

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8. has deliberately engaged in fire setting with
the intention of causing serious damage 9. has
deliberately destroyed others' property (other
than by fire setting) Deceitfulness or theft 10.
has broken into someone else's house, building,
or car 11. often lies to obtain goods or favors
or to avoid obligations (i.e., "cons"others) 12.
has stolen items of nontrivial value without
confronting a victim (e.g., shoplifting, but
without breaking and entering forgery) SERIOUS
VIOLATIONS OF RULES 13. often stays out at night
despite parental prohibitions, beginning before
13 years 14. has run away from home overnight at
least twice while living in parental or parental
surrogate home (or once without returning for a
lengthy period) 15. often truant from school,
beginning before age 13 years
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B. The disturbance in behavior causes
clinically significant impairment in social,
academic, or occupational functioning. C. If
the individual is age 18 years or older, criteria
are not met for antisocial personality disorder.
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NORMAL INFANT
R E S P O N D
PEACE WITHIN OUT SIDE
SIMPLE LIMITED
SUITABLE EXPRESSION OF
STATE
COMPLEX ENVIROMENT
ENVY, JEALOUSY, SUSPICION
CONCEPT OF PROPERTY
ADJUSTMENT FOR EFFECTIVE FUNCTIONING
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I N S E C U R I T Y
W I D R A W A L
S I L A N C E
UNKIND WORLD
WAY OF LIFE
RESPONSE
DISPOSITION
DISORIENTED DISTRECTED ERRATIC CHANGEBLE MOODY
WITH WORLD

TENASIOUS INEFFACTIVE
DEVELOPMENT OF ANXITTY
FUNCTIONAL RELATTIONSHIP
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• TOTALITY
• lt 3 Contradiction
• lt 2 Company
• Revengeful
• Anger beating
• Anger Violent
• Anger Destructive
• Aggressive
• Suicidal Thoughts
• Sadism
• Restlessness
• Dream Of Ghost
• Dream Death Of Relatives
• Dreams Of Snakes
• lt 3 Fasting
• Cr. Salt
• Cr. Tea

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FOLLOW UPS T3 STARTED WITH TARENTULA 1M
WEEKLY ON 27.12.02 ADV TO FIND OUT ACTIVITY TO
CHANNALISED HIS ANGER HANDLING OF
UNIT. 10.1.03 MOANGER gt,Br- Br relation
gtfightsgt2 once/wk.h/o daily. Desire for going
school.playing with other children.asked Mo to go
out of city will stay alone with father.h/o
never allowed mo to go alone. Pt. appears happy
fluent talk like normal child.DR MY FACE IS
BEAUTIFUL Looking Confident.

TARENTULA 1M WEEKLY. 7/2/03 INTERVIEW WITH
FA. BETTER IN ALL Br.Br persisting.at times
explosion of anger.yet got Anger on criticism.
school ok.
TARENTULA 1M
WEEKLY
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7/3/02 MONO ATTACKS OF ANGER/BEHAVIOUR
PROBLEMS. SCHOOL TUTIONS REGULAR,PLAYING WITH
OTHER FRIENDS, ROAMING WITH THEM (FIRST
TIME) PT. YET GET ANGER MANE KHABER PADE KI
GUSSO KAM AVVA CHHE.SALU CONTROL NI THY PAN HAVE
BHAILA NE HARAIN NE KARUN.DAILY RECITING PRAYER
IN SCHOOL. ATTENDING MUSIC CLASS. THIS EXAM
FAILED IN 3 SUBJ. MARA PAPPA NA PAIHA NI
BAGADVANO.FEELING GUILTY.HU BAHU VACHAVANO
SARA MARK A PASS THAVANO. EXAM IS ON 18/4

S.L. 8 WEEKS.REPORT
IF IRRITABLE OR CHANGE
IN TEMP. 2/5/02 IRRITABILITY VIOLANCE TWICE.
INTENSITY SAME.FELT GUILTY. REASONS PEOPLE
CALLED HIM BRIJESHBHAI HE FELT BHAI MEANS
GUNDA/MAWALI WARNED EVERYBODY MANE BHAI NI
KEVANO
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CONTINUE.PATIENT. BELIEVES IN GHOST,NOT ABLE TO
GIVE RESPECT TO PARENTS GUILTY.TENSION
.COULD NOT CONTROL ANGER. (GAVE LETTER TO
PHY.).
TARENTULA 1M WKLY
? 10M. ADVISED FOR MORE
ENGANGEMENT 30/6/03MO FAILED IN 4
SUBJ.GUILTY.IRRITABILITY .FOLLOWS COMMANDS.NO
FIGHTS WITH ANY BODY.ATTENDING TUTIONS. GOOD
BEHAVIOUR WITH GUEST/IN MARRIAGE ETC. SEXUAL
BEHAVIOUR.SLEEP POOR.TALKING WITHOUT
RELAVANCE. PTFAILED BECAUSE NOT WORKED
PROPERLY.EXERCISE/ RUNNING/MUSIC CLASSES
REGULAT.IRRITABILITY AT TIMES FIND DIFFICULTY
IN CONTROLLING.THOUGHT OF GHOST.
ADV TO HANDLE FIRMLY ON SEX ASPECT.
TARENTULA 10 M /15 DAYS FOR 2
MONTHS.
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28/7/03. Mo IRRITABILITY OCCASSIONAL.BEHAVIOUR
NORMAL. IMAGE CONSCIOUS ABLE TO PRODUCE GOOD
IMAGE INFRIENDS, TEACHERS,RELATIVES,GRAND
PARENTS..REGULARY ATTENDING SCHOOL/CLASSES/PERSON
ALITY DEVELOPMENT TALK ALWAYS POSITIVE.IF
IRRITABLE GUITY.YET BELIVES IN GHOST AVERS TO
STUDY.
TARENTULA 10M
WEEKLY. 26/9/03 SEE MOS LETTER. FIRST TIME
CAME ALONE TO BARODA. PT.HAPPILY/BEEMINGLY SAID
LIKE TO COME ALONE.I LIKE RESPONSIBILITY.ALL
ARE HAPPY SO I AM HAPPY.NOW I AM NOT DISTURBING
ANY ONE. NANNALA NE TO HAVE HU BAHU DHYAN RAKHU
NE DAILY MUMMY PAPPA NE PAGE LAGU.BHUT BHAGADI
DIDHA.
S.L. SOS TARENTULA 10M