Making the Mind–Body Connection
By:
SOPHIA F.
DZIEGIELEWSKI
In using the DSM-5, several issues need to be explored.
Perhaps most important is remembering
the importance of linking the mind and the body. People are complex beings. When a categorical approach
to identifying and classifying disorders is utilized, the temptation is great
to apply concrete and discrete criteria that do not include the full range of
an individual’s existence or situation.
Adding the concepts of the
dimensional assessment and crosscutting of symptoms enables considering a
greater range of symptomology without a formal diagnosis. It also allows
factors related to another medical condition to be considered.
Making the connection
between mind and body and studying the resulting relationship is crucial to a comprehensive diagnostic assessment. A medical disorder can
clearly affect individual functioning, and vice versa. The medical disorder and
its subsequent symptoms as reported by the client can easily become confused.
Just having a medical disorder can affect the mental disorder, which in turn
can influence the course of many diseases
leading to short-term or long-term disability.
In addition, mental health
conditions can influence
other medical conditions, such as cardiovascular disease, diabetes, HIV/AIDS,
tuberculosis, and malaria. According to Prince et al. (2007), mental health
conditions and the behaviors that are characteristic can influence reproductive and
sexual health with the development of conditions such as dysmenorrhea
(disturbed menstrual cycles) and dyspareunia (genital pain during intercourse
and other sexual activities).
In professional practice,
it is easy to see how the line between what constitutes good physical health and what
constitutes good mental health might be blurred (Dziegielewski, 2010). Separating the mind from
the body is impossible, and the concept of wholeness must be considered. Achieving
healthy outcomes requires positive and healthy mental health, and vice versa.
Integrating these medical
components into diagnostic assessment can increase the application of this connection.
For example, for a client who has all the symptoms of depression but was
recently diagnosed with cancer, a mental health diagnosis of this nature could
be premature if not simply inaccurate. A diagnosis alone is never enough, and
each practitioner must also assess a situation completely, taking into account
system variables that include a person’s physical
health.
The DSM-5 no longer uses the
multiaxial diagnostic system that was previously clearly delineated and coded on Axis III; however, listing a medical condition still
remains relevant when it affects or compounds the mental health diagnosis. Listing a medical
condition remains relevant when the mental disorder appears to have a
physiological relationship or bearing on the mental health diagnosis listed.
It is also important to
note when the medical condition actually causes, facilitates, or is part of the
reason for the development and continuation of the mental health condition. In
this situation, according to the ICD, the medical condition that causes the mental health condition
would be listed first as
the reason for visit.
One sure way to establish
whether the medical condition is the reason for visit is when the relationship
between the medical and mental disorder is such that when the medical condition
is resolved, the mental health condition is resolved as well.
This premise sounds easy to
the beginning professional, but for those more experienced, it is clear this simple distinction is not always so simple. Although
conclusive, this relationship can be complicated, and there is often no simple pathway,
especially when the damage from the general medical condition may not be
curable.
Regardless, it is important
to document all related medical conditions that are important or can influence forming the mental
diagnosis (APA, 2013). (See Quick Reference 3.15.) For the coding and specific categories of such
disorders, see the ICD-10 and most probably after 2015 the ICD-11.
QUICK
REFERENC Quick
Reference 3.15E 3.15
|
General Categories for Medical Diseases and Conditions
Diseases of the nervous system Diseases of the circulatory system Diseases of the respiratory system Neoplasms Endocrine diseases Nutritional diseases Metabolic diseases Diseases of the digestive system Genitourinary system diseases Hematological diseases Diseases of the eye Diseases of the ear, nose, and throat Musculoskeletal system and connective tissue diseases Diseases of the skin Congenital malformations, deformations, and chromosomal abnormalities Diseases of pregnancy, childbirth, and the puerperium Infectious diseases Overdose Additional codes for the medication-induced disorders *ICD medical codes are no longer listed in DSM-5. Source: List of topics reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Copyright 2000 by the American Psychiatric Association. |
When assessing medical
conditions, non-medically trained mental health practitioners may find it helpful to receive
support from an interdisciplinary or multidisciplinary team that includes medically trained professionals (Dziegielewski, 2013).
Individuals who have training in the medical aspects of disease and illness can be valuable
resources in understanding this mind–body
connection. (See Quick Reference 3.16.)
QU Quick Reference 3.16ICK
REFERENCE 3.16
|
Important Questions in Assessing Medical Symptoms
Has the client had a recent physical exam? If not, suggest that one be ordered. Does the client have a summary of a recent history and physical exam that can be reviewed? If not medically trained, does the practitioner have someone to consult and review these with?
Be sure
to examine whether the etiology could be medically related.
Are there any laboratory findings, tests, or diagnostic reports that can assist in establishing a relationship between the mental and physiological consequences that result? If not medically trained in this area, does the practitioner have someone medically trained to consult or refer? |
When medical conditions are
listed and recorded as part of the diagnostic assessment, there should always
be hard evidence to support its inclusion. The
practitioner should query whether a recent history and physical exam has been conducted and, when one is
available, review the written summary, which can be helpful in identifying medical
conditions that may be related to the symptoms and behaviors a client is exhibiting.
As stated earlier, if a
physical exam has not been conducted prior to the assessment, it is always a
good idea to refer the client for a physical or suggest that the client see a
physician for a routine examination. A review of the medical information
available, such as lab reports and other findings,
as well as consulting with a medical professional, may be helpful in
identifying disorders that could complicate or prevent the client from achieving
improved mental health.
When looking specifically at the relationship
between the mental and the medical disorder, mental health practitioners should
be prepared to inquire into the signs and symptoms of these conditions and to
assist in understanding the relationship of this medical condition to the
diagnostic assessment and the planning processes that evolve.
References
SOPHIA F.
DZIEGIELEWSK, 2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
Read Also
Medication-Induced Movement Disorders and Other Adverse Effects of Medication
Brief History of the DSM
The Person-in-Environment Classification System (PIE)
The official nomenclature used in mental health and other health-related facilities
The International Classification of Diseases (ICD)
Brief History of the DSM
The Person-in-Environment Classification System (PIE)
The official nomenclature used in mental health and other health-related facilities
The International Classification of Diseases (ICD)
No comments:
Post a Comment