LATE-LIFE PSYCHIATRIC DIAGNOSIS IN DSM-IV - 11/09/11
Résumé |
There can be little debate that age is an important variable in the consideration of virtually any psychiatric condition as to characteristic age at onset, variation in presentation and associated features, and course and prognosis.3 Even the approach to differential diagnosis will vary for the probabilities of various psychiatric disorders change with age. Consider how differently a psychotic episode would be appraised diagnostically depending on whether the age at onset was 5, 18, 35, 65, or 85 years.1
The Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV),2 the official psychiatric nomenclature for use in the United States since January 1995, and, although not the official, perhaps the most influential diagnostic system worldwide, makes a more concerted effort to consider age relative to psychiatric diagnosis than its DSM predecessors. DSM-IV gives credence to the diagnostic importance of age, along with culture and gender by stating in its first chapter (“Use of the Manual”) that “variations in the presentation of the disorder … may be attributable to the individual's cultural setting, developmental stage (e.g., infancy, childhood, adolescence, adulthood, late life), or gender,” as well as noting the “differential prevalence rates related to culture, age, and gender.” Age (as for gender), however, does not receive special attention in DSM-IV comparable to that devoted to culture.16 Although an extensive advisory group on cross-cultural issues was appointed by the DSM-IV Task Force, with their deliberations reviewed in a publication,11 no such panel was appointed for age or gender. Also, an appendix, “Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes,” was included in DSM-IV.
Although aging occurs throughout the life cycle, the focus of this article is on age as it pertains to psychiatric illness in geriatric patients, that is, in late life. DSM-IV age observations for the various diagnostic classes and disorders are reviewed, and specific statements in DSM-IV regarding the elderly are evaluated relative to other information. The clinical applicability of age observations are underscored.
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Address reprint requests to Ronald L. Martin, MD, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine–Wichita, 1010 North Kansas Street, Wichita, Kansas 67214 |
Vol 20 - N° 1
P. 1-14 - mars 1997 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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