Differential Diagnosis Quotes

(I)f you try to treat the medical problem you *think* you see without fully exploring the differential diagnosis -- call(ed) "speculation on a foundation of assumption" -- you can kill your patient.

Ritual abuse diagnosis research – excerpt from a chapter in: Lacter, E. & Lehman, K. (2008).Guidelines to Differential Diagnosis between Schizophrenia and Ritual Abuse/Mind Control Traumatic Stress. In J.R. Noblitt & P. Perskin(Eds.), Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, pp. 85-154. Bandon, Oregon: Robert D. Reed Publishers. quotes: A second study revealed that these results were unrelated to patients’ degree of media and hospital milieu exposure to the subject of Satanic ritual abuse. “In fact, less media exposure was associated with production of more Satanic content in patients reporting ritual abuse, evidence that reports of ritual abuse are not primarily the product of exposure contagion.” Responses are consistent with the devastating and pervasive abuse these victims have experienced, so often including immediate family members.

000-x02 Dissociative reaction This reaction represents a type of gross personality disorganization, the basis of which is a neurotic disturbance, although the diffuse dissociation seen in some casts may occasionally appear psychotic. The personality disorganization may result in aimless running or "freezing." The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc. The diagnosis will specify symptomatic manifestations. These reactions must be differentiated from schizoid personality, from schizophrenic reaction, and from analogous symptoms in some other types of neurotic reactions. Formerly, this reaction has been classified as a type of "conversion hysteria.

Several recent studies (Bliss, 1980; Boon & Draijer, 1993a; Coons & Milstein, 1986; Coons, Bowman, & Milstein, 1988; Putnam et al., 1986; Ross et al., 1989b) are largely consistent in terms of the general trends that they demonstrate. At the time of diagnosis (prior to exploration) approximately two to four personalities are in evidence. In the course of treatment an average of 13 to 15 are encountered, but this figure is deceptive. The mode in virtually all series is three, and median number of alters is eight to ten. Complex cases, with 26 or more alters (described in Kluft, 1988), constitute 15-25% of such series and unduly inflate the mean. Series currently being studied in tertiary referral centers appear to be more complex still (Kluft, Fink, Brenner, & Fine, unpublished data). This is subject to a number of interpretations. It is likely that the complexity of the more difficult and demanding cases treated in such settings may be one aspect of what makes them require such specialized care. It is also possible that the staff of such centers is differentially sensitive to the need to probe for previously undiscovered complexity in their efforts to treat patients who have failed to improve elsewhere. However, it is also possible that patients unduly interested in their disorders and who generate factitious complexity enter such series differently, or that some factor in these units or in those who refer to them encourages such complexity or at least the subjective report thereof.

Instead of being experienced consciously (either diffusely or displaced, as in phobias) the impulse causing the anxiety is "converted" into functional symptoms in organs or parts of the body, usually those that are mainly under voluntary control. The symptoms serve to lessen conscious (felt) anxiety and ordinarily are symbolic of the underlying mental conflict. Such reactions usually meet immediate needs of the patient and are, therefore, associated with more or less obvious "secondary gain." They are to be differentiated from psychophysiologic autonomic and visceral disorders. The term "conversion reaction" is synonymous with "conversion hysteria." Dissociative reactions are not included in this diagnosis. In recording such reactions the symptomatic manifestations will be specified as anesthesia (anosmia, blindness, deafness), paralysis (paresis, aphonia, monoplegia, or hemiplegia), dyskinesis (tic, tremor, posturing, catalepsy).

Early identification of patients who suffer from dissociative symptoms and disorders is essential for successful treatment, because these disorders do not resolve spontaneously. In addition, dissociative disorders are not alleviated by treatment directed toward an intercurrent disorder. However, because the dissociative disorders are among the few psychiatric syndromes that appear to respond favorably to appropriate treatment (Spiegel, 1993), improved accuracy in differential diagnosis is critical.

Terminology and classification Leukaemias are traditionally classified into four main groups: • acute lymphoblastic leukaemia (ALL) • acute myeloid leukaemia (AML) • chronic lymphocytic leukaemia (CLL) • chronic myeloid leukaemia (CML). In acute leukaemia there is proliferation of primitive stem cells leading to an accumulation of blasts, predominantly in the bone marrow, which causes bone marrow failure. In chronic leukaemia the malignant clone is able to differentiate, resulting in an accumulation of more mature cells. Lymphocytic and lymphoblastic cells are those derived from the lymphoid stem cell (B cells and T cells). Myeloid refers to the other lineages, i.e. precursors of red cells, granulocytes, monocytes and platelets (see Fig. 24.2, p. 989). The diagnosis of leukaemia is usually suspected from an abnormal blood count, often a raised white count, and is confirmed by examination of the bone marrow. This includes the morphology of the abnormal cells, analysis of cell surface markers (immunophenotyping), clone-specific chromosome abnormalities and molecular changes. These results are incorporated in the World Health Organization (WHO) classification of tumours of haematopoietic and lymphoid tissues; the subclassification of acute leukaemias is shown in Box 24.47. The features in the bone marrow not only provide an accurate diagnosis but also give valuable prognostic information, allowing therapy to be tailored to the patient’s disease.

The differential diagnosis of catatonia According to an old story, there are three different types of baseball umpires. The first says: "I call them lballs and strikes] as they are"; the second says: "I call them as I see them"; and the third says: "What I call them is what they become.

What is the differential diagnosis of septic shock? Non-infective disorders, such as acute myocardial infarction, pulmonary embolism or drug reactions, must be excluded. Toxic shock (e.g. toxic shock syndrome) can also present in a similar manner. What would be your

Transdiagnostic approaches are one way of avoiding a process of differential diagnosis that assumes a specificity that does not exist.

Near-Psychotic Symptoms in Obsessive-Compulsive Disorder Despite clear-cut differences in psychopathology between schizophrenia and OCD, there is a substantial overlap, a “gray zone,” between the two disorders. Thus, unusual and “bizarre” obsessive themes exhibited by a subgroup of otherwise typical OCD patients might complicate the distinction between the obsessions and delusions. The difference between OCD-related pathologic slowness and the restrictive motor output associated with negative symptoms of schizophrenia or with catatonic motor disturbances is not straightforward. The differential diagnosis between OCD-related indecisiveness and pathologic doubt and schizophrenic ambivalence is also challenging. Patient insight into the senseless nature of OC symptoms is one of the hallmarks of the disorder. According to the DSM-5, at some point in the course of the illness, the patients must recognize that their obsessive beliefs are “definitely or probably not true.” Indeed, in typical OCD cases, patients readily acknowledge that their OC symptoms are illogical and pathologic. On the other hand, a significant majority of schizophrenia patients either do not believe that they are ill, or even if they do acknowledge symptoms, they misattribute them to other causes.6 Nevertheless, a significant subset of OCD patients can sometimes present without insight, or with conviction that their obsessions are true, thus complicating the differential diagnosis of obsessions from delusions. Overall, from the psychopathologic perspective, schizophrenia and OCD are distinct, despite their partially overlapping characteristics. Some symptoms, such as delusions and obsessions, pathologic doubt and ambivalence, rituals and motor stereotypy, may represent a continuum of OCD impairments, while others, such as negative and disorganized symptoms, are more schizophrenia-specific (Fig 3.1).