Given a numerical / Dimensional Diagnostic Classification System and a prototype scale for Substance Dependence Disorders
Introduction
What do you think of when you hear the words: fool, idiot, moron and too! These are words that we might (I'm the only one), common (or I think) when I drive on the freeway and I see someone driving faster or slower, so I am. We hear these derogatory terms in the heat of the debate when an angryPeople have run out of rational and logical arguments. But did you know that these words were once as scientific terms used in England during an official diagnostic classification system for persons who were mentally retarded described. A definition of "fool", it says:
"A person with a degree of intellectual disability, between an idiot
and an idiot, is in a former classification of mentally handicapped person
applied to a person with an adult mentalAge of four to eight years,
and an IQ of 26 to 50.
In the United States, was the initial impetus for the development of a classification of mental disorders, the need to collect statistical information. What would be the first official attempt to gather information about mental illnesses to ... was to assess the frequency of one category - "idiocy / insanity" in the census of 1840 (DSM-IV-TR).
Although today negative terms such as: fool, idiot,are moron and are no longer used because of their scientific and pejorative connotations, we are unfortunately still with a categorical diagnostic classification system (DSM-IV-TR) in 2007, people with terms like Labels: schizophrenic, bipolar, and borderline. To date, we continue to diagnose people with mental disorders in a categorical manner, as either present or absent encrypted - although the DSM-IV-TR explicitly states that "there is no assumption that each category of mentalDisorder is a completely discrete entity with absolute boundaries, which it from other mental disorders or from which no mental disorder.
, Is given the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) this article is a timely overview of some of the growing frustrations and limitations caused by the DSM-IV-TR categorical model. He holds a 7 - dimensional holistic alternative approach to the categorical model.Finally, it proposes a three-dimensional prototype scale for substance dependence disorders for the DSM-V may promote as an interim supplement to the traditional categorical classification for further research in this area.
Categorical models and constraints
DSM-IV-TR is a categorical diagnostic classification system that divides mental disorders into types based on criteria sets with characteristic features of the foundation. This type of system classifies clinical presentations based onAssignment to categories and works best described phenomena that have clear boundaries. However, it is clear that the DSM-IV is rich with problematic border disputes, which seem to be too many the result of an arbitrary categorical distinctions. It is also obvious that the DSM-IV-nature problems with: stigmatization, stereotyping and labeling. Categorical models indirectly to promote the stigma of receiving a psychiatric diagnosis and the fear that the diagnosis will lead toadverse social and / or professional consequences.
These models can on stereotypes when others automatically and wrong that anyone who has a mental disorder can contribute to derive, is unpredictable and / or violent. For example, we diagnosed could assume that since "Bob" has been with - schizophrenia, he may be violent and unpredictable. This is the same argument that assumed that because someone lives in Iowa, he must be a farmer. They increase the "labeling"Problem (enter a name for a group) of symptoms that can be difficult to shake, even if the person has made a full recovery. Although the text of the DSM-IV indicates that it classifies mental disorders - not people, and it avoids that the use of terms such as "schizophrenic" or "an alcoholic, the reality that real people are categorized as mental disorders to be - and people are not diseases, disorders and / or disabilities, but people are people - like you and I can, the problem ofwith these problems.
Our current health care system is set up to focus on acute care rather than chronic
Diseases. It focuses on a single syndrome or a three-dimensional model in which the
the sole indicator for treatment success is raised, or specific symptom-reduction. Similarly,
Although the multi-axial system of the third edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-III, 1980), as was atheoretical in its
Approach toDiagnosis, classification and promotion of bio-psychosocial model,
DSM-IV-TR is heavily dependent on the medical model with its biologically reasonable prospect
of mental illness and resistance to the psychoanalytic approach of Sigmund Freud.
The medical model goes back to the work of Emil Kraepelin, a German prosecuted
Psychiatrists who believed that mental illness could reduce all organic
Diseases of the brain, but as a disordered feelings, behaviors,or psychological /
Environmental stressors.
Kupfer, First, & Regier, however, report that "has remained in the more than 30 years since the introduction of the DSM-III, the goal of validating these syndromes and discovering common causes heavy. Despite many proposed candidates was not a laboratory marker found in order to identify any of the specific DSM-defined syndromes. Epidemiological and clinical studies have shown extremely high comorbidity amongDisorders affecting the hypothesis that the syndromes represent different causes. In addition, epidemiological studies have shown a high degree of short-term diagnostic uncertainty have shown for many diseases. With regard to treatment, lack of treatment specificity is the rule rather than the exception "(2002, p. xviii).
Dimensional Models
It was suggested that the DSM-IV classification by a three-dimensional model used rather than the categorical model are organizedDSM-III-R. A one-dimensional system classifies clinical presentations on quantification of attributes as the assignment to the categories based and works best in describing phenomena that are continuously distributed and that no clear boundaries. Dimensional systems increase reliability and communicate more clinical information (report, because they have clinical attributes that may be) sub-threshold in a categorical system, they also have serious limitations and so far have been lessmore useful than categorical systems in clinical practice and in the promotion of research. Numerical dimensional descriptions are much less known and more alive than the categorical name for mental disorders. In addition, there are still using no agreement on the choice of optional dimensions for classification. However, it is possible that the intensification of research on, and familiarity with, may eventually dimensional systems in their greater acceptance both as a method of the resultConveying clinical information and as a research instrument (DSM-IV-TR, xxxi).
Dimensional models more reliable scores, help, symptom heterogeneity and the lack of clear boundaries between categorical diagnoses to explain. They also retain important information about the sub-threshold characteristics and symptoms, be of clinical interest, and enable the integration of scientific knowledge about the distribution of trains and related maladaptivity in a classification system.Dimensional models recognize that mental disorders on a continuum with normal behavior and are easily disturbed, rather than qualitatively different. For example, the Axis II personality disorders and are regarded as more extreme variants of common personality traits. Geometrical models were patient identity at a specific level or dimension of the cognitive and affective capacity rather than place them in a "categorical field."
A joint committee of the AmericanPsychiatric Association and the National Institutes of Mental Health charged with identifying the most pressing problems for the DSM - Fifth Edition (DSM-V) concluded that "there is a clear need to develop three-dimensional models and compared for their usefulness to the existing are typologies.
7 - Dimensions "Therapeutic" Model
Healthcare consumers are increasingly advocating for a multidimensional model that takes into account a variety of life domains, the operation ofProgress in the treatment of the patient influence. Evidence-based meta-analysis studies also determine the predictive power of life to predict functional outcome variables and their importance for treatment planning on a single model, which had hardly any empirical evidence. Accurate diagnosis is also dependent on a thorough assessment of multidimensional process to help with the question of the treatment of a multidisciplinary team approach. Behavioral Medicine practitioners have recognized thatAlthough primarily a disorder can be physical or primarily psychological in nature, it is always a failure of the whole person - not just the body or the mind.
They pretend that there will be a holistic approach to mental disorders needs to ensure that places equal emphasis on evaluation of all food and / or weight of the functioning of the individual. It is a curative potential in the assessment and treatment of patients as a whole person and not as isolated collections of nervous tissue with chemical imbalances. TheThe main task in the assessment and treatment of mental illness is social roles and identities, again, that a focus on the person and building a sense of responsibility and self-determination.
In 2004, the Addiction Recovery Measurement System (ARMS) publish, - describes the following seven life-functioning therapeutic efficacy measures of progress outcome measurements.
1. Social / Cultural - Dimension
2. Medical / Physical - Dimension
3. Mental /Emotional - Dimension
4. Educational / Occupational - Dimension
5. Spiritual / Religious - Dimension
6. Legal / Financial - Dimension
7. Abstinence / Relapse - Dimension
The 7 - Dimension recovery model was originally developed to patients therapeutic advances, which measure the assessment of life-functioning activities. Explored, it may prove to be a generalized model for the evaluation and treatment of all pathological diseases, disorders, and effectiveDisabilities. It is multidimensional assessment / treatment includes the internal interconnection of multiple dimensions from biomedical to spiritual - taking into account the effects of feedback and the existence of mutual influence of each dimension to each other simultaneously. Due to the complexity of human nature, progress, treatment should first be cut and by an individual treatment plan based on a comprehensive bio-psychosocial assessment that identifies guidedspecific problems, goals, objectives, methods and timetables for achieving the objectives and goals of treatment.
Life-style addiction can affect many aspects of a person's functioning and frequently require multi-modal treatment.
Note: These seven dimensions are in the book entitled, Poly-behavioral Addiction and delineation of Addiction Recovery Measurement System (Slobodzien, 2005). The following are the 7 (life-function)-dimensional scale with theirindividual assessment criteria:
Social / Cultural Functioning Scale (1)
9 - No or only minimal environment stressors. Interested and involved in a wide range of activities.
8 - Transient pollution (difficulty concentrating after family argument)
7 - Mild acute/stressors- some difficulty in social functioning. Has contexts.
6 - Moderate difficulty in social functioning. Has conflicts with colleagues and some friends.
5 - SeriousImpairment in social functioning. Has no friends
4 - a major impairment in several dimensions (family relationships) avoids friends / family neglect
3 - Severe environmental stressors threat to patient, family and others (stay all day in bed).
2 - Gross environmental stressors are dangerous to patients, family and others. Gross impairment in communication (incoherent).
1 - Dangerous environmental stressors are life threatening to patients, family and other
Medical /Physical Functioning Scale (2)
9 - No disorder / disease symptoms - a stable health condition
8 - Transient - Joint Disorder / disease symptoms
7 - Acute-Common Disorder / disease symptoms
6 - Moderate - Clinically Marked medical condition
5 - Clinically significant medical condition
4 - primary chronic disease
3 - Very Important chronic diseases
2 - Very SevereMedical Conditions
1 - Terminal Medical Conditions
Mental / Emotional Functioning Scale (3)
9 - Absent or minimal symptoms - good functioning in all areas
8 - Transient / expected symptoms - reactions to psychosocial stressors
7 - Mild symptoms - depressed mood / mild insomnia
6 - Moderate - Clinically significant symptoms - affecting real estate, some panic attacks
5 - Severe symptoms - suicidal ideation, obsessionalRituals
4 - The main symptoms - some reality testing impairment & illogical speech
3 - Severe - impairments in communication / Case Delusions / Hallucinations
Violating 2 - Very Severe - a danger to self / others / suicide attempts
1 - Persistent danger of severely injured self / others
Educational / Occupational Functioning Scale (4)
9 - not undermine good functioning in all areas of education / vocational
8 - Slight --Impairment temporarily falling behind in school / work projects.
7 - Mild Impairment - Some difficulties with the school / work functioning
6 - Moderate - Clinically Marked impairment conflicts with colleagues / staff.
5 - severe impairment failing in school / work
4 - Unable to keep a major impairment job / school for more than one dimension
To work 3 - Severe Impairment Inability almost all dimensions
2 - Gross Impairment can notTo function independently, all dimensions
1 - Dangerous impairment can not work without harm to themselves or others,
Spiritual / Religious Functioning Scale (5)
9 - Absent or minimal symptoms - good functioning. Involved a wide range of healthy spiritual / religious activities.
8 - Transient / expected symptoms - reactions to minor injuries of their own moral values and standards.
7 - Mild symptoms - depressed mood / mild insomnia. Neglecting somemental relations.
6 - Moderate - Clinically significant symptoms - guilt / shame feelings due to the moderate violations of moral standards
5 - Severe symptoms - suicidal ideation, compulsive rituals for serious breaches of ethics.
4 - Major symptoms - a reality impairment & illogical speech. Avoids healthy spiritualilty.
3 - Severe damage verdict. Spiritual / religious delusions and hallucinations.
2 - Very Severe - a certain danger of hurt self / others / suicide attempts. Violent behavior
1 - Persistent danger of severely injured self / others
Legal / financial Functioning Scale (6)
9 - None or minimal - the legal and financial problems. Participating in the Community / charity programs.
8 - Transient - financial / legal stressors (credit card debt / parking tickets)
7 - Minor violations of law - some legal / financial difficulties, acceleration, etc.
6 - Moderate - Clinically> Mark. Misdemeanor arrests / fines / penalties for late payments
5 - clinically relevant - legal / financial problems Felony arrests (gambling)
4 - Major Major - the legal and financial problems - jail time / large debts belong.
3 - Severe - legal / financial problems. Criminal activities chosen.
2 - Very Severe - legal / financial problems jail time / Insolvency
1 - Dangerous - legal / financial problems Suicidal /Murder
Abstinence / Relapse Functioning Scale (7)
9 - no degradation of Self-Control - good functioning no relapse potential
8 - Slight - Impairment of self-control. Very low potential for relapse.
7 - Mild impairment of self-control low-relapse potential
6 - Moderate - Impairment of Self-control marks clinical Moderately High - relapse potential
5 - Severe Impairment of Self Control Clinically significant High --Relapse potential
4 - Major Impairment of self-control. Very High - relapse potential of more than one dimension
3 - Severe Impairment Inability to Control Self. Severely high - R / P nearly all dimensions
2 - Gross Impairment - Unable to Control Self Regardless Stark High R / P. All measurements
1 - Dangerous Impairment - Unable to Control Self without harming himself / others. Dangerously high
Functioning / Impairment Severity Levels of Self-control
9 - no degradation of Self-Control-Good way of working
8 - Slight - Impairment of Self-control
7 - Mild Impairment of Self-control
6 - Moderate - Impairment of Self-control marks clinical
5 - Severe Impairment of Self Control - clinically relevant
4 - Major Impairment of self-control. More than one dimension.
3 - Severe Impairment Inability to Control Self-Fast (all sizes)
2 - Gross Impairment Unable to Control Self Regardless, all dimensions ()
1 - Dangerous Impairment Unable to Control Self without harming himself / others
Note: The 7 - shape-scales can be individually evaluated and the scores can be averaged to determine a functioning / impairment score or level of functioning.
The 7 - Dimensions model is a numerical, nonlinear, dynamic, non-hierarchical model that focuses on interactions between multiple risk factors areFactors and situational factors, such as catastrophe and chaos theories in predicting and explaining addictive behavior and relapse. Multiple influences trigger and operate in high-risk situations and influence the global multidimensional functioning of an individual. To put it simply, small changes in the behavior of an individual to a large qualitative changes at the global level and patterns at the global level only arise from a system of many small interactions.The clinical utility of the 7 - Dimensions recovery model is its ability to assist healthcare providers to quickly assess detailed information about a person's personality, background, history of substance use, mood, self-efficacy and coping strategies in prognosis, diagnosis, treatment planning, actions and results.
Substance Dependence (Prototype) - Measuring scale
The 7 - Dimensions model acknowledges that family genetics and bio-psycho-social,are historic and Development conditioning factors are difficult and sometimes impossible to change in detail. Many healthcare consumers of addiction recovery services have a genetic pre-dispositions history for addiction. They have suffered and will continue from the past traumatic experiences (for example, suffer physical, sexual and emotional abuse, etc.) and often associated with psychosocial stress (eg, workplace stress, family / marital problems, etc.), they leave intenseand confusing emotions (eg anger, fear, bitterness, fear, guilt, sadness, loneliness, depression and feelings of inferiority, etc.) that reinforce their already low self-esteem. The complex interplay of these factors can leave the individual with much deeper psychological problems with self-loathing, to punish himself, the self-denial, low self-esteem, low self-esteem, low self-esteem and a severe condition, with an overall (sometimes hidden) negative self-identity.
Moreover, if wethe view that addiction unbalanced lifestyle, within semi-stable equilibrium force fields, which include 7 - Dimensions philosophy promotes that there is a supernatural and spiritually synergistic effect that, if several people are a "life functioning dimensions in a human body homeostasis increase occurs. This bilateral spiritual connectedness reduces chaos and increases resistance to an individual harmony, bringing wellness, and productivity.
Although there is a three-dimensionalSystem can provide many of the problems associated with the presence of DSM improve - categorical system, there are still many problems that must be addressed if you try to integrate dimensions in the current classification. The following - Substance Dependence scales were developed to launch a prototype and to stimulate research for the future integration of categorical and dimensional diagnostic classification systems.
Symtom Tolerance Levels (1)
9 - NoTolerance Symptoms
8 - Minimum Tolerance Symptoms
7 - Mild symptoms of tolerance
6 - Moderate - Clinically Marked symptoms of tolerance
5 - Clinically significant tolerance significantly increased amounts of the substance used to achieve desired effect
4 - Major clinically significant symptoms of tolerance
3 - Severe clinically significant symptoms of tolerance
2 - Gross clinically significant symptoms of tolerance
1 - ClinicalSignificant symptoms hazardous Tolerance
Withdrawal symptoms levels (2)
9 - no withdrawal symptoms
8 - Low withdrawal symptoms
7 - Mild withdrawal symptoms
6 - Moderate - Clinically Marked withdrawal symptoms
5 - Clinically significant substance is taken to relieve or avoid withdrawal symptoms
4 - primary withdrawal symptoms - need help
3 - Clinically severe withdrawal symptoms-NeedsPartial Hosp
2 - Clinical Gross withdrawal symptoms - - Medical Monitoring Needs
1 - Clinically dangerous withdrawal symptoms - Needs Medical Management
Quantity / Duration Levels (3)
9 - No Progressive Use
8 - Minimal amounts irregularly taken over a short period
7 - Minimal amounts taken regularly over a short period
6 - Clinically marked amounts taken regularly over a long period of reflectionTime
5 - Larger amounts tend to be clinically significant over a longer period should be taken
4 - Large amounts were often carried out over a longer period, very
3 - Strong harmful amounts were often carried out over a longer period, very
2 - Gross amounts were often carried out over a longer period, very
Carried out 1 - Lethal often runs over a longer period were very
Efforts to control levels of use (4)
9 - no effort trying to reduce down / control (because there is noidentified problem)
Tries 8 - minimal effort, cut down / control
7 - Some successful effort attempting to cut down / control
Tried 6 - several unsuccessful efforts to cut down / control
5 - Continued efforts tried unsuccessfully to cut down / control
4 - Unable to down / cut control independently and without assistance
3 - can not be used to help control Residential Treatment / medication, etc.
2 - CanTo use control without 1:1 Medical Monitoring
1 - can not be used without 24-hour supervision. Medical Management
Time with Substance Use Activities (5)
9 - No time for the procurement / substance (s) issued
8 - time spent in obtaining an irregular / with / recovering from - substance (s)
Spent 7 - Minimum time for the procurement / with - substance (s)
6 - Moderate amount of time spent in obtaining / using / recovering from - substance (s)
5 - Muchspent much time in obtaining / using / recovering from - substance (s)
4 - A major amount of time spent in obtaining / using / recovering from - substance (s)
Spent 3 - A difficult time in the procurement / with the recovery from substance (s)
2 - The free time spent in obtaining / using / recovering from - substance (s)
Spent 1 - All the free time in obtaining / using / recovering from - substance (s)
Life-functioning activities given up or Reduced(6)
9 - No reduction in social, occupational, recreational activities because of substance use
8 - Minimum periodically reducing the social, professional new. Activities, substance use
7 - Low reduction in social, occupational, recreational activities because of substance use
6 - Clinically significant reduction in social, occupational, recreational activities because of substance use
5 - Important social, occupation or recreational activities are given upor reduce substance use
4 - Clinically significant reduction in life-functioning activities due to substance use
3 - Heavy amounts of life-functioning activities given up - due to substance use
Abandoned 2 - The most life-functioning activities - because of substance use
Abandoned 1 - All life-functioning activities - because of substance use
Continued use despite knowledge of the consequences (7)
9 - No Substance Use
8 - Lowirregular use despite knowledge of the consequences
7 - Minimal use despite knowledge of the consequences
Are 6 - Clinical marked, use despite knowledge of the consequences
5 - Continued use despite knowledge of the consequences
4 - Major use despite knowledge of the consequences
3 - Heavy use despite knowledge of the consequences
2 - Gross use despite knowledge of the consequences
1 - Mortal use despite knowledge of theFollow
Patterns / Impairment / Distress Levels
9 - No proper functioning Pattern / Impairment / Distress of Substance Use
8 - Light maladaptive pattern / disability / distress
7 - Mild irregular pattern Impairment / Not
6 - Moderate regular pattern marked clinical Impairment / Distress
5 - Serious clinically significant Pattern / Impairment / distress - one dimension
4 - Major clinicallysignificant patterns Impairment / Not more than one dimension
3 - Severe clinical adverse effect pattern / Not Nearly all dimensions
2 - Clinical Gross Pattern / Impairment / Distress-all dimensions
1 - Clinically dangerous Pattern / Impairment / Distress-all dimensions
Note: By using a one-dimensional approach to assess each specific criteria and scored determine the clinical significance and the subtle symptoms can be treatedas well. The overall results can then be averaged and defining appropriate cut-off values for the effective planning of treatment.
The 7 - Dimensions model combines a multidimensional force field analysis to identify the specific problems of individuals, positive force prognostic factors, with behavioral contracting, and a token "how" - economic point system in order to accomplish this task. Determine force field analysis is a process that must be assessed at the individual behavior, whichare the main driving forces of the addictive behavior and reduce the most important forces are the addictive behavior. It is implemented a plan to identify the positive force of inhibiting factors somehow manipulate the forces in order to increase the likelihood of moving an individual behavior in a pro-social recovery direction.
Kurt Lewin (1947) developed, initially argued for the Force Field Theory, that a problem is in equilibrium by the interaction of two opposing types of forces to keep- Those who facilitate change (driving forces) and the attempt to maintain the status quo (braking force). Given social event occurs at a given frequency in a given social context, and the frequency of the event is on forces to improve on the event and strength of the event fall off. At a certain point, there is a "semi-stable equilibrium", whereby the frequency of social events will remain the same, so long as there is neitherChange in the number or strength of the forces acting on the social event not to increase or decrease any change in the forces acting on the event. The balance in both directions by increasing the frequency or intensity of the driving or braking forces, thus creating a corresponding increase or decrease in the rate of a person "addicted altered" behavior.
Conclusion
Dimensional approaches may not be the panacea for the problems of the DSM-IV, but they are aStep in the right direction. It is our hope that changes in the DSM-V, the gradual integration of a numerical / spatial classification reflected system. The challenge will be always the clinician in the way they decided to amend the practice by rendering plant systems that incorporate evidence-based research on effective diagnosis-dimensional evaluation of policies and measures to a new and improved DSM-V.
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References
AmericanPsychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000, p. 787 & p. 731st American Society of Addiction Medicine's (2003), "Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd edition, starting from 18 June 2005:
. asam.org / Arthur Aron, Ph.D., professor, psychology, State University of New York, Stony Brook, Helen Fisher, research professor,Department of Anthropology, Rutgers University, New Brunswick, NJ, Paul Sanberg, Ph.D., professor, neuroscience, and director, Center of Excellence for Aging and Brain Repair, University of South Florida College of Medicine, Tampa, June 2005, the Journal of Neurophysiology Gorski, T. (2001), Relapse Prevention In The Managed Care Environment. GORSKI CENAPS Web publications. From 20 June 2005, from: tgorski.com Lienard, J. & Vamecq, J. (2004), Presse Med, 23 October 33 (18 Suppl) :33-40. MorganDG, and Fox, BJ encourage the cessation of tobacco use. The physician and sports medicine. Vol 28 - No. 12, December 2000. Kupfer, DJ, First, MB & Reigi, DE (2002) Introduction. Pp.xv In DJ Kupfer, MB First & EN Reigi (ed.), a research agenda for DSM-V (-xxiii). Washington, DC, American Psychiatric Association.
Slobodzien, J. (2005). Poly-behavioral Addiction and Addiction Recovery Measurement System (ARMS), Booklocker.com, Inc., p. 5 U.S. Department ofHealth and Human Services. Healthy People 2010 (Conference Edition). Washington, DC: U.S. Government Printing Office, 2000.
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