BOARD PREP Sample: Diagnosing Psychotic Disorders

In this brief sample, I discuss the diagnosis of psychotic disorders in light of the changes in the new DSM-5. I will soon be partnering with FTP lectures to launch a series of online review lectures for the medical boards. Enjoy!

GW Medical school panel on Spirituality & Medicine

 In this wonderful forum hosted by the Muslim medical student Association, the three of us got to discuss issues on spirituality and medicine.

The overall questions were, what is spirituality, what is its role in our personal lives, and what is its role in the lives of our doctor-patient interaction?

There were a few major things I think that I wanted to drive home. First, is that spirituality is a key part of patient care regardless of how we personally feel about it.This is the simple fact based on evidence-based medicine that takes into account thousands of scholarly article articles that study this issue.

Meeting the President of the APA

First, welcome to Mirhom's Mental health blog. Here, I'd like to address some concerns and questions that exist about mental health that may not be frequently talked about. I will hope to focus on issues of psychiatry and culture and faith, highlighting my own experiences and discussing the challenges that Christians in particular feel when it comes to seeking and keeping good mental health care. If there's something in particular that you'd like me to address, please email me MenaMirhom@gmail.com or comment below. 

APA President Dr. Paul Summergrad

I recently had the opportunity to meet the President of the American Psychiatric Association, Dr. Paul Summergrad (pictured on the left) as well as the CEO of the APA Dr. Saul Levin. They both shared their journey to psychiatry in an inspirational, transparent and candid way. After posting a status about it on facebook, I saw several great comments that I want to share with you here. Some were just kind encouragement and some were half-joking but still legitimate questions. I got to ask Dr. Summergrad about some of the significant challenged that are faced in the field of psychiatry. Through his responses and the responses of many others I met this weekend at the conference, I'd like to share some thoughts about some popular questions. 

One of the things he said that really stuck out to me was that the stigma in mental health is sometimes perpetuated by an internal insecurity that clinicians have, including psychiatrists. That insecurity sometimes causes psychiatrists to feel like they are part of an inferior part of medicine and that alters the way they practice. 

In the opening ceremony of the conference, the outgoing president Dr. Jeffery Lieberman said "There is no health without mental health." And also described that mental health is finally beginning to be a real priority in public policy and health care in general. He joked "they are finally beginning to realize that the brain is important." Go figure. 

"Ask him why they keep adding regular human behaviors as mental disorders"

For it to be in the DSM, there needs to a baseline of functional impairment. A scholar in abnormal pshychology, Jerome Wakefield, said "A disorder is a harmful dysfunction, wherein harmful is a value term based on social norms and dysfunction is a scientific term based on failure of a mental mechanism to perform a natural function. Thus the term disorder combines value and scientific components." 

In other words, for something to be classified as wrong we look at culture and society. Something can be "common" or "regular" and still abnormal. Just because we see it often, doesn't make it normal behavior. 

"ask him why they got rid of the axes in the DSM-V?" 

I attended a full lecture by certified APA trainers on the DSM-5 where they explained several key things about the changes in the manual. The the DSM (Diagnostic and Statistical Manual of mental disorders) 5, is intended to be a "living document" that is updates more frequently than every several decades. That's one of the reasons they are using "5" instead of "V" Psychiatry and neurobiology is simply advancing too quickly to have to wait that long. So the goal is to have a 5.1, 5.2 etc in the same way that we get software updates on our devices. 

The new approach of removing the axis combines axis I, II, and III with separate psychological and contextual factors (which was Axis IV) and disability (which was axis V). It doesn't eliminate any of the diagnostic questions but rather re-orders them. The new approach allows the clinician to rate a disorder on a continuum of severity and eliminate "not otherwise specified" (NOS). This approach correlates better with treatment planning. 

"ask him if selfies are a mental disorder" 

They probably will make in there one day :) but for now, selfie-disorder is not in the DSM. There was a popular article circulating some time ago but it was a hoax. #SelfieAway

"Why are psychiatric medications allowed to have so many side effects and still be FDA approved?" 

Unfortunately, all medications have side effects, even the ones we get over the counter. (Asprin, tylanol etc) A lot of psych meds are very well tolerated especially when they're closely monitored to adjust doses and so on. That being said, like any side effect, if you have a concern, you should speak to your doctor about it as soon as possible. Dr. Summergrad mentioned that psychiatry is now, where general medicine was around the time of discovery of antibiotics. Many diseases that we thought could not be treated, are being managed effectively with the help of many emerging medications. 

APA Opening ceremony