ASSESSMENT/ Diagnostic and Statistical Manual (DSM) and
When Assessing symptoms, the
Diagnostic and Statistical Manual (DSM) and the International Statistical
Classification of Diseases (ICD) is the general classification used by the
world to record the diagnosis of all mental health patients. These tools are stated to have similar
attributes; however, ICD is seen as more comprehensive whilst DSM add an
advantage to research and is seen as more accurate in psychiatry. Additionally,
DSM is also favoured by clinicians than ICD (Tyrer, 2014).
When measuring AB’s symptoms an assessment commenced
by two Doctors and two Approved Mental Health Professional (AMHP). The role of
the AMHP is to make legal decisions by coordinating an assessment on a person
that is detained under a section of the Mental Health Act. The professional
will make their decisions based on whether a person’s mental state has
deteriorated and if they could pose a potential risk to themselves or others. The
service user will be interviewed and they will either be offered inpatient care
and put on admission under section 2 or 3. Furthermore, before making their
decisions, they need to ensure that the person has insight on their rights, as
well as having access to an advocate (Mental Health Act, 2007). Due to AB’s
past engagement with the Mental Health services and his current mental state,
it is essential to assess him in relation to his past diagnosis and other
related symptoms he may be presenting when he arrived on the ward. By doing this,
Positive and Negative Syndrome Scale (PANSS) was applied as seen in Appendix B.
Deep et al (2010) stated that it is a clinical interview that is widely used
for service users with Schizophrenia.
Kay et al (1989) also suggested that PANSS was
created so as to deliver a distinct tool which will be used specifically to
assess the positive and negative symptoms of schizophrenia and psychopathology.
The assessment commenced with the Dr’s undergoing a 30-item rating scale, which
is narrowed down into 7 scales which measured positive and 7 scales for
negative syndromes whilst 16 scales are used to measure psychopathology
symptoms. The positive syndrome looked at features such as delusions,
excitement hallucinations, whilst the negative features focused on emotional
and social withdrawal as well as poor rapport.
Additionally, the tool also assessed the general
psychopathology of the patient by looking at depression and anxiety as well as
cognitive features. By the end of the assessment, the result showed that there
were times when AB showcase delusions, hallucination and excitement, which was
observed as Positive syndromes. However, the majority of the time he was
observed to have withdrawal syndromes. He also had difficulty with focusing and
appeared low in mood at times which is a negative syndrome. AB appeared not to
have insight into his current mental health deterioration and was unable to
weigh the risks he poses to self and others when not treated, therefore,
continuous medical treatment in hospital was considered and he was placed under
section, for he has not been compliant with medication and has resulted in him
presenting with distressing psychotic symptoms. When unwell he also tends to
neglect his self-care, and presents risks of self-harm and also to others.
Furthermore, he lacks concentration and gets easily distracted at times. He was
also seen to be paranoid and anxious at times during the assessment process.
When questioned about any suicidal thoughts. AB
avoided the question as much as possible by engaging in another activity
entirely, however when pushed further he possessed passive aggression and built
up a barrier. When using PANSS there are some limitations that are likely to
make the score not clear as kay et al (1989) has stated previously in their
studies. This is because, during the assessment, the tool can be seen as quite extensive
hence why the calculation might be incorrect at times.
A study by Kumari & Malik (2017) shows that
there are doubts about the use of PANSS because it is believed that PANSS lacks
sensitivity when foreseeing cognitive functioning. Furthermore, the study
reveals that the scale fails to distinguish the difference between depression
and negative symptoms when measuring depression. This is a major problem as it
can result in an inappropriate diagnosis. On the other hand, they also argued
that if the scales are minimised it can result in getting incomplete data and
the results will not be reliable.
that could have been considered during the assessment is the Alcohol and
substance misuse tool. This is because in AB’s case study it showed that he was
also dealing with substance abuse. According to Rassool (2009) service users
that deal with polysubstance misuse, require a full assessment, so as to create
an effective treatment plan. Additionally, the assessment will focus on the
Individuals view on their substance abuse, the type of drugs that they use and
the quantity of dosage. Finally, it will look at the pattern as to which the
patient uses the drugs and how dependent they are on the substance. The tool
could potentially be looking at the possibilities that they might be dealing
with substance induce psychosis.
However, studies have shown that when doing an
assessment on those dealing with substance abuse and mental health disorders,
it is very hard to get a valid result, because substance misusers can mask
mental health symptoms. Or misinterpret the diagnosis. Additionally, the inability
to differentiate the substance from the mental health disorder can add
complications to the assessment of the individual (Rassool, 2009).