دانلود کتاب تشخیص آسان تر شد – اصول و تکنیک ها برای پزشکان سلامت روان – ویرایش سوم

When I set out to write about the diagnostic process, I envisioned a text that could both complement classroom teaching and provide a guide for independent study. That was before I undertook a completely unscientific survey of practicing health care professionals, to learn how they had learned about mental health diagnosis. What I found surprised me. For most of the practitioners I surveyed, training in the refined art of diagnosis was—well, no training at all. Most of the professional schools at which my interviewees trained presented no formal course material on diagnosis, and still do not do so. Even in medical schools, students and residents are expected to know the current diagnostic criteria, but they receive little if any exposure to a method for making diagnoses. Almost to a person, my sample endorsed the sentiment “I learned diagnosis through on-thejob training.” Similarly, chapters and books that strive to teach clinicians how to perform a competent clinical evaluation focus on the product, while largely ignoring information about the process. That process is neither simple nor intuitive, and I’d certainly never describe it as easy. But after decades of experience and long consideration, I believe it can be explained in a way that is straightforward and comprehensible— in short, we can make diagnosis easier. In this book, I present a way of thinking about diagnostic problems. The material doesn’t depend much on the vagaries of the latest diagnostic standards or code numbers. Instead, I focus on the essential characteristics of mental disorder, which have been recognized for decades. What’s imperative to learn is the scientific method—yes, and the art—of evaluating patients and arriving at logical diagnoses consistent with the facts. Part I focuses on the process of diagnosis. Learning how to diagnose accurately involves systematically applying logical, easily understood principles to information of several different types, assembled from a variety of sources. Although real life requires us to confront many diagnostic issues at once, for convenience I’ve divided the tasks into chapters. By the end of Part I, you’ll see how seasoned clinicians unite their experience with new information to create a working diagnosis. The three chapters of Part II explore the social and other background data you need to understand each patient’s mental health diagnosis. Of course, this is the stuff you need to have first, so you can make the diagnosis. But when learning new material, you must start somewhere, and I have judged that many (probably most) of my readers already have some familiarity with interviewing and information gathering. That’s why I’ve presented the diagnostic method first. Finally, in the chapters of Part III, we’ll sift through a great deal of clinical material to see how the Part I methods and the Part II data apply to various clinical disorders. We won’t consider every disorder, or even all the varieties of the main disorders; other manuals (including my own DSM-5-TR Made Easy) handle that chore. Rather, we’ll concentrate on the issues and illnesses that mental health clinicians confront every day. To illustrate the diagnostic methods, I’ve included over 100 patient histories. Before you read my analysis of each clinical example, I recommend that you try working through the decision trees and writing up your own list of relevant diagnostic principles. It has been amply proven that we all learn far more efficiently by actively thinking about the solution to a problem than by passively reading what someone else has written. I think you’ll benefit from engaging with the histories to find the clues that will direct you to the diagnosis. And by the way, to preserve privacy while illustrating the teaching points, I have changed personal details of some patients so that their own mothers would not recognize them; but the vast majority I simply made up.