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Chapter 2. Differential Diagnosis by the Trees

DOI: 10.1176/appi.books.9781585629992.442507

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Excerpt

Differential diagnosis is at the heart of every initial clinical encounter and is the beginning of every treatment plan. The clinician must determine which disorders are possible candidates for consideration and then choose from among them the disorder (or disorders) that best accounts for the presenting symptoms. The biggest problem encountered in differential diagnosis is the tendency for premature closure in coming to a final diagnosis. Studies in cognitive science have indicated that clinicians typically decide on the diagnosis within the first 5 minutes of meeting the patient and then spend the rest of the time during their evaluation interpreting (and often misinterpreting) elicited information through this diagnostic bias. Forming initial impressions can be valuable in helping to suggest which questions need to be asked and which hypotheses need to be tested. Unfortunately, however, first impressions are sometimes wrong—particularly because the patient’s current state may not be a true reflection of the longitudinal course. Accurate diagnosis requires a methodical consideration of all possible contenders in the differential diagnosis.

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Decision trees organized by DSM-5 diagnostic grouping
Decision trees organized by mental status examination domain

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