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BlackPuma

do any of you know if we can have online access to the DSM IV....one of my patients keeps asking me about Alzheimer's (I'm a 2nd year), and I wanted to get the exact differential diagnosis...from what she describes to me, and from my knowledge of neuro, it doesn't seem like she has Alzheimer's, but I'm wanted to get something concrete and give her a copy....does anyone know if we can have access to the DSM IV? thanks alot!
 

Kalel

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I wouldn't put too much weight on the DSM for diagnosing AD. Despite being the most prevalent cause of dementia, the diagnosis of AD remains a dx of exclusion. Besides the DSM criteria, other sources have tried to put out their own criteria for dx-ing AD (NIH, CERAD), and none of these diagnosing algorithms has really been proven to have a specificity of greater then ~50-80%, which is probably around what you would expect if you called almost everyone who had dementia as having AD. The sensititivity of using such algorithms are better (90-95%), but that's only because any test that picks up demented people will pick up almost all of the the patients with AD. Right now, it probably doesn't matter as much since our treatment modalities for dementia secondary to AD don't differ very much from our treatment for dementia secondary to other organic brain causes (AchE inhibitors, NMDA agonists), but eventually, we may have more specific drugs in our arsenel which will require a firmer diagnosis of AD. On a side note, the DSM isn't a really good medical text IMO, it's more of just a big book of opinions of various "experts" in the field of what they consider diagnostic criteria for certain diseases, subject to personal biases and political pressures. I don't even think that most psychiatrists even use DSM criteria in their practices for diagnosing different disorders.
 
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BlackPuma

Originally posted by Kalel
I wouldn't put too much weight on the DSM for diagnosing AD. Despite being the most prevalent cause of dementia, the diagnosis of AD remains a dx of exclusion. Besides the DSM criteria, other sources have tried to put out their own criteria for dx-ing AD (NIH, CERAD), and none of these diagnosing algorithms has really been proven to have a specificity of greater then ~50-80%, which is probably around what you would expect if you called almost everyone who had dementia as having AD. The sensititivity of using such algorithms are better (90-95%), but that's only because any test that picks up demented people will pick up almost all of the the patients with AD. Right now, it probably doesn't matter as much since our treatment modalities for dementia secondary to AD don't differ very much from our treatment for dementia secondary to other organic brain causes (AchE inhibitors, NMDA agonists), but eventually, we may have more specific drugs in our arsenel which will require a firmer diagnosis of AD. On a side note, the DSM isn't a really good medical text IMO, it's more of just a big book of opinions of various "experts" in the field of what they consider diagnostic criteria for certain diseases, subject to personal biases and political pressures. I don't even think that most psychiatrists even use DSM criteria in their practices for diagnosing different disorders.
so what resource would you suggest to help me diagnose a patient with dementia or with alzheimer's (I know there is a difference between the two. My major in undergrad was neuro, and we referred to DSM IV quite often, and I've heard of psychiatrists and psychologists referring to it as well. Do you know of something better?

thanks a lot dude for all your help? :thumbup: :hardy:


thanks guys for all the links too! they were really good...
 

Kalel

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Originally posted by WatchaMaCallit
so what resource would you suggest to help me diagnose a patient with dementia or with alzheimer's (I know there is a difference between the two. My major in undergrad was neuro, and we referred to DSM IV quite often, and I've heard of psychiatrists and psychologists referring to it as well. Do you know of something better?

thanks a lot dude for all your help? :thumbup: :hardy:


thanks guys for all the links too! they were really good...
The main way that neurologists diagnose alzheimer's disease these days is with a thorough clinical history with complete mental status exam, and most will order a standard battery of tests depending on what the history and physical show. I did my neurology rotation through a VA medical center, and there, the standard w/u for a newly demented patient included depression screening, TSH, RPR, CMP, CBC, and head CT. Basically, if someone had a standard AD hx (progressive dementia) and all of those values came back normal with the head ct showing diffuse cortical atrophy, they got stuck with a label of AD. It wasn't that unusual for patients to have confounding signs and sx though that would bring up the question of whether AD was the right dx (eg multiple old CVA's seen on head CT, but still a question of AD), and of course, sometimes dx were changed as more sx arose. As I was stating in my previous post, the dx of AD must be made by autopsy and histological findings if one wants a confirmed dx of AD. Here's another good link for you:
http://www.vh.org/adult/provider/neurology/alzheimers/guidelinesfinrpt.html
 
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