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BlackPuma

does anyone know if we can get online access to the DSM -IV. One of my patients keeps on asking if she has Alzheimer's.....she is worried about having AD just because she is "forgetting things and names"...I wanted to look up the different diagnostic criteria, to firmly establish whether or not she has AD....from the things I know, and what she has told me. It is highly unlikely that she suffers from AD, but this is the 3rd time she has asked and I wanted to give something on paper to give her...
 

Arginine

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I haven't been able to find DSM-IV on line, but perhaps someone in the hospital has one you can borrow? Another great book is Sadock & Sadock's "Synopsis of Psychiatry" which includes diagnostic criteria for DSM-IV disorders but also discusses additional features in a very detailed, descriptive manner. This book also has great sections on geriatric depression and conducting a geriatric mental status exam. In general, here's what I know from having been a psychiatric social worker for almost 10 years:

1. confusion and decline of memory in the elderly can have many contributing factors. some medications and medical conditions (even something as small as vitamin deficiency!) can cause cognitive decline that looks like dementia. geriatric depression has symptoms of cognitive decline that also look like dementia.

2. in geriatric depression, it's not uncommon for someone to easily forget stuff, seem "absent-minded", have difficulty concentrating, etc. but usually, the person is less likely to have problems with language impairment and less likely to confabulate (e.g. to make up answers to questions they don't remember the answer to, etc). if uncertain about the answer, the depressed person is more likely to say "i don't know". also more likely to admit there are problems with confusion & memory loss.

3. dementia (there are lots of different types, including alzheimer's) progresses slowly and usually starts with memory and language deficits (can't learn & recall new info, can't remember the names of things/people) and visuospatial problems (can't copy figures). behavioral disturbances are also common: agitation, restlessness, wandering, impulsiveness; personality changes (depression, obsessiveness, suspiciousness) and loss of initiative. people who have dementia are much less likely to admit there are problems with confusion & memory loss.

And if you want the actual diagnostic criteria from DSM-IV:

DEMENTIA OF THE ALZHEIMER'S TYPE
A. The development of multiple cognitive deficits manifested by both:
1) memory impairment (impaired ability to learn new information or to recall previously learned information)
2) one (or more) of the following cognitive disturbances:
a) aphasia (language disturbance)
b) apraxia (impaired ability to carry out
motor activities despite intact motor
function
c) agnosia (failure to recognize or
identify objects despite intact
sensory function)
d) disturbance in executive functioning
(i.e. planning, organizing,
sequencing, abstracting)

B. The cognitive deficits in A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning

C. The course is characterized by gradual onset and continuing cognitive decline.

D. The cognitive deficits in A1 and A2 are not due to the following:
1) other central nervous system conditions that cause progressive deficits in memory & cognition (i.e. cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor)
2) systemic conditions that are known to cause dementia (e.g. hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
3) substance-induced conditions

E. The deficits do not occur exclusively during the course of a delirium

F. The disturbance is not better accounted for by another Axis I disorder (e.g. Major Depressive Disorder, Schizophrenia)
 

aphistis

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If you have access to StatRef through your school, you can view it there.
 
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