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Note, however, not all courts have been receptive to social worker testimony offered as expert opinion on the diagnosis of PTSD, e. Miller Brewing Co. Ohio , Blackshear v. Werner Enters. May 19, For more restrictive approaches to testimony by non-Ph. Bricker, Md. People v. McDarrah, Ill. Parker v. Barnhart, 67 F. Earls v. Sexton, U. May 28, allowing a nurse practitioner to testify in a negligence action concerning whether a motor vehicle accident caused psychiatric injuries.

To qualify for a DSM diagnosis, persons must meet a set of criteria that are characteristic of the disorder.


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An alternative nomenclature and set of criteria used internationally can be found in the International Classification of Diseases, now in its 10th edition ICD , published by the World Health Organization. Although the DSM-IV-TR and ICD nomenclature and criteria are generally similar, there are differences that can result in diagnostic variations in particular cases, depending on which criteria are applied.

At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it e.

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More than one condition may be indicated on Axes 1—4; for example, major depressive disorder and alcohol abuse may coexist on Axis 1, and more than one personality disorder may be noted on Axis 2. The disturbance is not due to the direct physiological effects of a substance e. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1 depressed mood or 2 loss of interest or pleasure.

Note: In children, consider failure to make expected weight gains. The DSM approach has been criticized on a number of grounds, at least one of which is relevant to the evidence likely to be presented in legal proceedings. By requiring that persons being evaluated meet a certain number of particular criteria e.

Suggestions that a more dimensional approach to diagnosis be adopted, that is, one that recognizes a spectrum of extent and severity of symptoms along a continuum associated with a given disorder, 82 have so far been rejected in favor of continuing with the current categorical system. The goal of the DSM is to provide a typology that is useful to clinicians and researchers and that reflects the latest psychiatric understanding of mental disorders. Hence, the process is sometimes criticized as reflecting social or political biases, as opposed to science.

In addition, the DSM itself recognizes—in a cautionary statement in the introduction to the text—that diagnostic criteria that are appropriate for clinical or research purposes may not map directly onto legally relevant categories.

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Harold A. Pincus et al. Phillips et al. See the papers on dimensional approaches to psychiatric diagnosis published in the International Journal of Methods in Psychiatric Research, vol. Widiger, supra note 40, at 25— Anne E. Given that the anticipated publication of DSM-5 is not due until , 88 it is not possible at this writing to specify the changes that will appear in the new edition.

However, current indications are that the major categories of diagnoses described in the following section will be retained, although specific changes may be made to individual diagnostic criteria. Some hint of the number and diversity of mental disorders embodied in the current diagnostic typology is provided by the fact that DSM-IV-TR is approximately pages long. However, the characteristics of the major categories of disorders that are likely to be relevant in legal proceedings can be summarized more concisely.

It is to be understood that inclusion here, for clinical and research purposes, of a diagnostic category such as Pathological Gambling or Pedophilia does not imply that the condition meets legal or other nonmedical criteria for what constitutes mental disease, mental disorder, or mental disability. The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency.

These brief summaries of complex and variable conditions are meant to provide an orientation to the nature and course of major mental disorders. The current edition of the DSM itself or standard psychiatric textbooks should be consulted for more complete descriptions. Psychotic conditions involve some degree of detachment from reality, characterized by delusional thinking and hallucinatory perceptions.

Additional disorders that may have special legal relevance include anxiety disorders including post-traumatic stress disorder PTSD , dissociative disorders such as dissociative identity disorder, formerly multiple personality disorder , impulse control disorders such as kleptomania and pyromania , sexual disorders especially the paraphilias, such as pedophilia , delirium, and mental retardation.


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The causes of mental disorders remain to be elucidated. However, as a general proposition, it appears that many mental disorders may derive from a genetic predisposition that is activated by particular environmental circumstances. For example, a genetic variant in an enzyme that regulates neurotransmitter reuptake has been shown to predispose to depression, but only when the susceptible person has been exposed to stressful life events. Matthew B. Smoller et al. Rebrook v. Astrue, WL N. Holsey, F. Bell, 89 F. Miller, F. McBroom, F. Silleg, F. Lyng, F. Warr, F. Gigante, F. City of Cincinnati, 39 F.

Ohio estate of man who died from police restraint during a seizure sued the city under 28 U.

City of Westland, WL E. Southwestern Bell Tel. Jordan W. Ezra Susser et al. Avshalom Caspi et al. The solicitation of symptoms and the observation of signs necessary for a mental disorder diagnosis can be accomplished with a variety of techniques. Direct clinical examination of the person whose condition is at issue is still the core of most mental health evaluations.

A typical sequence of clinical examination involves exploring with the person being evaluated: the current presenting problem, including the specific symptoms experienced and the duration of such symptoms; past history of similar symptoms or other disorders and of treatment for those disorders; developmental history; social and occupational history; family history; medical history, including a review of current medical symptoms, medications taken, and substances used e.

Examinations may take from one to several hours, sometimes spread over multiple sessions.

When previous records of contact with mental health professionals are available, the clinician will ordinarily want to review them prior to the clinical examination, so that questions can be targeted more efficiently, and previous conclusions confirmed or. Margit Burmeister et al. Genetics For an overview of the evaluation of mental health problems, see Linda B. Hales et al. Psychiatry 7 [hereinafter Psychiatric Evaluation of Adults].

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Paula T. When a diagnosis is based solely on a clinical examination, which is still most frequently the case, the clinician is being relied upon to conduct a complete evaluation and to apply the diagnostic criteria accurately. Studies that showed considerable variation in the results of clinical evaluations motivated the development, largely for research purposes, of structured diagnostic interviews.

Hence, they tend to show increased reliability over unassisted clinical evaluations.

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More complete diagnostic interviews may allow consideration of a large number of diagnostic categories; focal interviews clarify whether a single disorder e. The disadvantages of structured diagnostic assessments include the time that may be required i. Psychiatric Evaluation of Adults, supra note , at Psychiatry See generally Michael B.

First et al. See , e. Goodman et al. Sadock, Virginia A. Although structured diagnostic interviews do not reflect the current standard of care for clinical purposes, there may be some value in their use for purposes of forensic evaluation in cases with particularly difficult diagnostic questions.

Diagnostic interviews should be distinguished from instruments that assess the nature and extent of psychiatric symptomatology. As with diagnostic interviews, symptom measures may be broad in their scope or assess a single type of symptom. Formal testing of psychological functions may be used to complement the clinical diagnostic process, but often it is not necessary for a diagnosis to be made.

Beck et al. See discussion in John F.