Running head: DIFFERENTIAL DIAGNOSIS 1 DIFFERENTIAL DIAGNOSIS 2 Differential Diagnosis PSY 645 Psychology Ashford University October 21st, 2018 Differential Diagnosis Introduction Differential diagnosis is defined as the method which is used to systematically identify a disorder, condition, or a syndrome which result into different signs and symptoms. This method of diagnosis has been used extensively in the diagnosis and determination of mental disorders (Barbui & Cipriani, 2008). As suggested by Emil Kraepelin, the method is more systematic and effective than the old-fashioned method gestalt diagnosis (impression diagnosis). The term differential is derived from “difference”, which speaks to the practice used in the process of diagnosis where a list is made of all possible diagnoses (Wilson, 2007). It is then followed by removing diagnosis from the list by elimination till two or one diagnosis are left, where further diagnosis is done to arrive at the most and highly possible diagnosis (Barbui & Cipriani, 2008). Certain cases may end up leaving not particular diagnosis, which is an indication that the physician may have made an error or that the possible or true diagnosis is not known by the medication process being used (Guzofski, 2007). When removing diagnoses from the list, several tests and observations are made showing different results as pertains the diagnosis being undertaken. In undertaking differential diagnosis, different conditions or circumstances, known as the presenting problems or the chief complaints, are assessed and examined in regard to the underlying factors causing the problems, the concurrent phenomenon which are observed appropriate perspectives of the discipline, as well as according to different theoretical frames or paradigms, which are then compared to the known types of pathology (Guzofski, 2007). In the process of differential diagnosis, a physician is able to do the following: · Understand more clearly the circumstance · Assess the most probable prognosis · Remove all the imminent conditions which could be life-threatening · Plan for the treatment of the arising condition · Enable the patient and the family to understand and integrate the condition in their lives. In the event that the diagnosed condition has not improved, the process of diagnosis is reassessed in order to arrive at the correct diagnosis (Wilson, 2007). Patient description The patient in this case study had memory loss which began as a mild condition. He later started forgetting major events like marriage anniversary as well being nit able to control himself in certain instances. He presented himself to a psychiatrist for diagnosis. The psychiatrist had to go through differential diagnosis in order to correctly arrive at the problem as presented by signs and symptoms (Barbui & Cipriani, 2008). Steps in the DSM-5 Differential Diagnosis Patients appear in hospitals with different circumstances or conditions which require pro.

1. Running head: DIFFERENTIAL DIAGNOSIS 1
DIFFERENTIAL DIAGNOSIS 2
Differential Diagnosis
PSY 645 Psychology
Ashford University
October 21st, 2018
Differential Diagnosis
Introduction
Differential diagnosis is defined as the method which is used to
systematically identify a disorder, condition, or a syndrome
which result into different signs and symptoms. This method of
diagnosis has been used extensively in the diagnosis and
determination of mental disorders (Barbui & Cipriani, 2008). As
suggested by Emil Kraepelin, the method is more systematic and
effective than the old-fashioned method gestalt diagnosis
(impression diagnosis).
The term differential is derived from “difference”, which speaks
to the practice used in the process of diagnosis where a list is
made of all possible diagnoses (Wilson, 2007). It is then

2. followed by removing diagnosis from the list by elimination till
two or one diagnosis are left, where further diagnosis is done to
arrive at the most and highly possible diagnosis (Barbui &
Cipriani, 2008). Certain cases may end up leaving not particular
diagnosis, which is an indication that the physician may have
made an error or that the possible or true diagnosis is not known
by the medication process being used (Guzofski, 2007). When
removing diagnoses from the list, several tests and observations
are made showing different results as pertains the diagnosis
being undertaken.
In undertaking differential diagnosis, different conditions or
circumstances, known as the presenting problems or the chief
complaints, are assessed and examined in regard to the
underlying factors causing the problems, the concurrent
phenomenon which are observed appropriate perspectives of the
discipline, as well as according to different theoretical frames
or paradigms, which are then compared to the known types of
pathology (Guzofski, 2007). In the process of differential
diagnosis, a physician is able to do the following:
· Understand more clearly the circumstance
· Assess the most probable prognosis
· Remove all the imminent conditions which could be life-
threatening
· Plan for the treatment of the arising condition
· Enable the patient and the family to understand and integrate
the condition in their lives.
In the event that the diagnosed condition has not improved, the
process of diagnosis is reassessed in order to arrive at the
correct diagnosis (Wilson, 2007).
Patient description
The patient in this case study had memory loss which began as a
mild condition. He later started forgetting major events like
marriage anniversary as well being nit able to control himself in
certain instances. He presented himself to a psychiatrist for
diagnosis. The psychiatrist had to go through differential
diagnosis in order to correctly arrive at the problem as

3. presented by signs and symptoms (Barbui & Cipriani, 2008).
Steps in the DSM-5 Differential Diagnosis
Patients appear in hospitals with different circumstances or
conditions which require proper diagnosis, but the path for the
diagnosis is usually not a straight one from symptom to
diagnosis (Guzofski, 2007). There are many disorders which
could have the same symptoms as those of a person suffering
from depression. For the clinician, his work is using different
methods in order to figure-out the right disorder from the
symptoms being presented by the patient. This is essential
because it defines the kind of treatment to be used for the
condition (Barbui & Cipriani, 2008). This is basically because
patients do not understand what is ailing them in most cases and
may describe many signs and symptoms which could be related
or associated with other similar disorders.
A patient will not be able to say “I have depression, plan a
treatment for me”. On the contrary patients come to the
hospitals ti seek relieve from the symptoms or pain in their
bodies (Guzofski, 2007). It is therefore the work of the clinician
to determine the right disorder from the DSM chart. The
diagnostic processes of these disorders are usually broken down
to 6 steps (Guzofski, 2007). This makes it easier for the
clinician because the success of the diagnostic depends on good
collaboration between the patient sand the clinician. When the
patient does not give the right information, or is not honest, the
process of diagnosis may not give the right outcome. The
collaboration between the clinician and patient usually depend
in good faith (Guzofski, 2007). The following are the steps
which are used in determining a particular disorder from the
presenting symptoms:
Step 1: Ruling out Malingering and Factitious Disorder
In the process of diagnosing a problem, the malingering
disorder will differ from the factitious disorder in the basis of
the available motivation. Malingering achievement usually
depend on goals which are clearly recognizable such as
avoiding responsibilities or compensation through insurance,

4. which is most cases is not a mental disorder (Guzofski, 2007).
On the other hand, factitious disorder presents symptoms related
sicknesses which are usually derived from psychological
reasons.
Step2: ruling out substance etiology.
Clinicians should also consider the symptoms presented by the
patients in relation to substance abuse. It is noted that many of
the psychiatric problems could be associated with substance
abuse. In making this determination, the clinician can ask
questions to the patient regarding the past life, check the family
line for possible substance abuse, look for any signs of
substance abuse, or undertake laboratory tests which aim at
screening for substance abuse (Guzofski, 2007). The side
effects of any medication should also be considered.
If there is evidence of substance abuse, the clinician should
consider the etiological relationship between psychiatric and
substance disorders (Wilson, 2007). The psychiatric signs and
symptoms may be resulting from direct effects of
drug/substance abuse, or they could be through consequences as
a result of primary psychiatric disorders as well as abuse of
substances (Guzofski, 2007). The psychiatric symptoms could
also be independent and completely comorbid. The fact that
these psychiatric symptoms and substance use are completely
independent does not mean they cannot influence each other.
Step3. Ruling out disorder due to a general medical condition
It is important that clinicians take direct examinations of the
conditions which are commonly present because they could
account for the emerging psychiatric symptoms such as mental
problems which result from dysfunctional thyroid. In the case
that the general medical condition has contributed to the
psychiatric problem, it is prudent for the clinician to encounter
various etiological relations (Guzofski, 2007). The psychiatric
symptoms may have been caused by medication, in which case
they will cause adverse effects of the general medical condition,
or there may be a coincidence between the general medical
condition and the psychiatric symptoms.

5. Additionally, the general medical condition may result into
symptoms of mental health through direct effects of psychology,
hence affecting the brain either through stroke or other related
psychological mechanisms (Barbui & Cipriani, 2008). This is
usually observed when patients have depressive symptoms as a
result of cancer medication or diagnosis. In cases where
depression is caused by other conditions such as cancer, the
diagnosis on the patients will be characterized by depressive or
adjustment disorder (Guzofski, 2007). When a clinician is
looking for any clues which may determine the general
medication factor, a complete assessment is done temporary on
the relationship of the conditions such as whether the
psychiatric problem was triggered by the presence of the
general medication disorder, if there is variation between the
psychiatric symptoms and the general medical condition, or the
symptoms go down when the general medical condition resolves
(Wilson, 2007).
There other patterns in patients which may cause such
symptoms such as age onset, which may also require check up
from a clinician. For instance, the onset of manic issues in
elderly patients could trigger psychiatric symptoms on the
patient and could lead to memory loss or weight loss as a result
of accompanying depression.
Step 4: determination of primary disorders
If the clinician has been careful in following up the problem
presented, he should be able to pinpoint the possible primary
disorder. This is because many of the problems which are
presented in the DSM-5 show within the common daily
symptoms (Guzofski, 2007). Considering the manual of DSM-5,
it is possible follow up from the decision tree and arrives at the
problem. The manual makes it easy to choose from the
presented primary disorders (Guzofski, 2007). Additionally,
using differential diagnosis can aid in getting the right
diagnosis for the possible disorders. This is achieved through
ensuring that all other likely possible disorders have been ruled
out

6. Step 5: Differentiate adjustment disorder from residual other or
unspecified categories.
Clinicians should think using different ways which could help
them in deciding the right condition. In the case where patients
have presented different thresholds of symptoms which may be
severe to cause distress or impairment, the physicians should
explore the adjustment disorder in relation to the use of other
specified or unspecified disorders. Symptoms could be
maladaptive in responding to the psychological stressors
(Guzofski, 2007). In this case, adjustment disorders should be
considered. If there are no adjustment disorders, the appropriate
residual category is given. For example, a physical may use
specified or unspecified in establishing the reason for not
arriving at the criteria or choose not to give a reason in case
there condition is unknown (Guzofski, 2007)
Step 6: Establishing boundary with no mental disorder
The final result from the clinician should be the evaluation of
the possibility of the symptoms of the patient to cause any
clinical distress which is significant or which can cause social
or occupational impairment, among other many things. The
determination in the hands of the clinician is to determine what
can constitute clinical significance or whether the problem was
picked in the process of giving primary care (Guzofski, 2007).
Additionally, presented problem should constitute psychological
or biological dysfunctions in the patient. In this case, the
clinician should be able to differentiate the psychological
distress may be caused by mourning a close family member
because this may not qualify to be in the category of mental
disorders.
Looking at the symptoms of the patient in the case study, he
may be suffering from depression disorder because he loses
from internal distresses which are not associated with substance
abuse. It is important to note mental disorders are one of the
hardest disorders to diagnose because they do not present
symptoms such as swollen limb or sore throat (Guzofski, 2007).
Another problem which encountered in these situations is in

7. determining the presence of personality disorders. In this
determination, there is possibility of other disorders to be
present such as psychopathy, Asperger’s syndrome or bipolar
disorder
Risk factors
Looking at the complaints of the patient, there are number of
risk factors which could have contributed to the problem. In this
case, age could be a factor. Research shows that the onset of
manic episode could lead to problems of memory loss as well as
other depression (Guzofski, 2007). This is because of the
alteration of the hormone systems in the body triggering the
change in the way the body has been conditioned to operate.
More importantly, the conditions are not easily recognizable
and the patient may take a long time to realize that there are
internal problems. The systems result into delayed coordination
of the nerves in the brain (Jha & Prakash, 2016). Additionally,
when the brain is unable to coordinate its functions well, the
patient will not be able to remember important things due to
memory loss. In other instances, the changes may result into
anxiety or stress because the patient may become uncomfortable
to what is happening to him, triggering depression and other
related disorders (Guzofski, 2007).
Another factor which could result in depression is economic
problems. A person who has been enjoying the good life
brought about good income and the conditions change abruptly
he may not be able adapt or adjust in a very short time
(Guzofski, 2007). This triggers many thought in the brain,
leading to constant stress due to inability to provide for the
family, and as a result, the person develops psychiatric
symptoms which could be escalated by age.
Evidence based and non-evidence based treatment options.
Evidence based treatment
The growing number of patients who are able to monitor their
quality of life, health and functioning, as well as other
important outcomes in life, they acquire a pool of information

8. which they can use to handle their life’s outcome, as well as
contribute to practical knowledge base. This works when the
monitoring is reliable, friendly and systematic (O’Hare, 2014).
The results of the monitoring can be useful in developing ways
which can be used to handle other upcoming problems (O’Hare,
2014). Registers belonging to patients who have undergone
similar treatment are useful in the development of new drugs as
well as gathering information about certain mental conditions
and their related signs and symptoms. The patients are then
given treatment based on the symptoms such as describing the
appropriate medication to deal with the cause of the depression
(O’Hare, 2014). The patients may also undergo therapy in order
to alleviate the problems, which should be followed until the
desired outcome is achieved.
Non-evidence based treatment.
Psychiatrists who deal with patients having mental problems
focus on helping the patients with the right interventions which
have been proven to be beneficial to them. there are many levels
of treatments which can be used in treating mental health such
as meta-analyses based on observable data, randomized, double-
blind trials, controls, among many others (Jha & Prakash,
2016). Treatment decisions for people with mental problems
may be more difficult when using evidence based treatments.
Psychiatrists are able to help patients because they have
information on the possible outcomes than physicians who treat
patients who handle patients with multiple medical conditions.
Psychiatrists are able to use different interventions in order to
help patients overcome the disorders (Jha & Prakash, 2016).
The options presented to the patient by the psychiatrist in order
to help the patient with the mental problems may include the
patient taking charge of his life in order to monitor anything
that may cause stress to the patient. It would also involve the
patient being able to monitor the changes that are in his life and
dealing with them early enough before they cause any
psychiatric symptoms (Guzofski, 2007).

9. Annotated Bibliography
Geddes, J., Reynolds, S., Streiner, D., Szatmari, P., & Haynes,
B. (2009). Evidence-based practice in mental health. Evidence-
Based Mental Health, 1(1), 4-5. doi:10.1136/ebmh.1.1.4
This book describes the procedures which can be used by
clinicians in keeping up-to-date with the appropriate clinical
research for the treatment of mental health. It summarizes
research which has been done in the area of mental health by
giving the best ways if deal with patient with psychiatric
problems and answering different kind of questions regarding
mental health.
Jansson, L., & Nordgaard, J. (2016). Mental State Examination:
Signs. The Psychiatric Interview for Differential Diagnosis, 53-
90. doi:10.1007/978-3-319-33249-9_5
This is a research book which gives different approaches of
examining the causes of mental health in order to arrive at
proper diagnosis of the problems through differential diagnosis.
It stipulates ways in which psychiatrist may ask relevant
questions in order to get the required information
Rozzini, R., & Trabucchi, M. (2017). Mental health:
Epidemiology, pathophysiology, diagnosis, and
management. Oxford Medicine Online.
doi:10.1093/med/9780198701590.003.0134

10. This is a detailed study of mental health in terms of the causes,
signs and symptoms, the best method of diagnosis, and the most
appropriate treatment for patients in order to alleviate the
problems. It gives step to step methods of recognizing the
problems
Schwartz, R., Lent, J., & Geihsler, J. (2011). Gender and
Diagnosis of Mental Disorders: Implications for Mental Health
Counseling. Journal of Mental Health Counseling, 33(4), 347-
358. doi:10.17744/mehc.33.4.914g2n123u771316
This article deals with mental health as observed in different
genders, as well as what psychiatrist should consider in
counseling the patients. It outlines the ways in which counselors
should deal with mentally sick people
Wykes, T., & Callard, F. (2010). Diagnosis, diagnosis,
diagnosis: Towards DSM-5. Journal of Mental Health,19(4),
301-304. doi:10.3109/09638237.2010.494189
This article describes the diagnosis processes which are used by
psychiatrists in ensuring proper diagnosis of mental disorders
using the DSM -5 manual. It places major concern on the best
way to utilize the manual when trying to get the solution to
mental problems.
References
Barbui, C., & Cipriani, A. (2008). Cognitive improvements with
antipsychotics: Real or practice effect? Evidence-Based Mental
Health, 11(2), 42-42. doi:10.1136/ebmh.11.2.42

11. Guzofski, S. (2007). Differential Diagnosis Made Easier:
Principles and Techniques for Mental Health
Clinicians. Psychiatric Services, 58(4), 572-572.
doi:10.1176/appi.ps.58.4.572
Jha, S., & Prakash, O. (2016). Differential diagnosis for
cognitive decline in elderly. Journal of Geriatric Mental
Health, 3(1), 21. doi:10.4103/2348-9995.181911
O’Hare, P. (2014). Evidence-Based Practice. Approved Mental
Health Practice, 171-186. doi:10.1007/978-1-137-00014-9_12
Wilson G. T. (2007). Treatment manuals in clinical
practice. Behave Res Ther;35:205–10