Preface to the Casebook
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# n* t1 i. I. N' P# E5 t: ~4 V. H; b+ CThis collection of cases grew out of our experience in teaching DSM-III and DSM-III-R and participating in the development of DSM-IV. Reading these accounts of real patients, edited to focus on information relevant to differential diagnosis, has proven to be an effective and enjoyable way for clinicians and students to get experience applying the principles of differential diagnosis to a wide range of patients.
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, i: M8 \6 ?8 s9 _% uWe have chosen focused, edited descriptions of patients, since in standard case summaries discussions of diagnosis often get bogged down in a swamp of details not relevant to the purpose of establishing a diagnosis. (Nondiagnostic information, such as details of childhood and family relationships, however, is often necessary in actual clinical records.) In addition, routine case summaries often inadvertently omit crucial diagnostic information, whereas the cases in this book have been prepared to ensure that all available information necessary for mak-ing a diagnosis has been included.
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$ i' v' U5 S/ a6 ]" vThese cases have been drawn from our own experience and from the practices of a large number of clinicians, among them many well-known experts in particular areas of diagnosis and treatment. The identities of the patients have been disguised by altering such details as age and occupation and, occasionally, locale. Often we needed to go back to the contributors of the cases to obtain diagnostically crucial information; we have avoided the temptation to manufacture the missing details. Sometimes, as in the real world, this has led to diagnoses that had to be made provisionally or noted as part of the differential diagnosis.' ^, ?1 d" f& x' _+ g7 [
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Following Freud's example, we have provided names for the cases in order to make them easier to refer to. We have included a number of historical cases from the writings of such great nosologists as Emil Kraepelin, Eugen Bleuler, and Sigmund Freud himself. We have made no effort to disguise the identities of these historical patients; we have, however, taken the liberty of providing appropriate names for those who lacked them.. B0 a4 r! j/ \
& R5 _; n" x4 s+ J& zEach case is followed by a discussion of our differential diagnosis, made according to the diagnostic criteria in the text revision of the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). (To aid the reader we have provided links to the diagnostic criteria in DSM-IV-TR.) These discussions include important diagnostic considerations, such as the rationale for mak-ing each particular diagnosis, other disorders to be considered in formulating each diagnosis, and, in some cases, recognition of diagnostic uncertainty because of inadequate information, ambiguity in the clinical features, or problems in the classification itself.
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These discussions are focused on differential diagnosis, not on the treatment implications of the diagnosis. However, for some of the cases we have been able to obtain follow-up information, which usually includes response to treatment. Often the follow-up information confirms the original diagnosis; occasionally, it raises doubts or leads to a change in diagnosis. (Treatment Companion to the DSM-IV-TR Casebook, published in 2004 and included here, marks an additional step in expanding the original cases to include treatment discussions.)- {}2 r& D! Y/ nThere are five chapters dealing, respectively, with adults, children and adolescents, multiaxial assessment, international cases, and historical cases. The international cases are grouped by geographic region, and the historical cases by their authors.8 }4 I: @+ g: u: V# B% R4 D
8 L$ c: F, U3 S, ]The original DSM-III Case Book was published in 1981, a year after the publication of DSM-III, and revised in 1988, a year after the publication of DSM-III-R. As with the DSM-III-R revision, in the DSM-IV Casebook we eliminated some of the earlier cases and added a large number of new cases (these are the first cases in Chapters 1 and 2). The new cases enabled us to expand the coverage of disorders so that we now have at least one example of virtually every diagnostic category in DSM-IV.
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3 J+ @/ y( ]/ L) q( CPreface to the Treatment Companion
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Next to the DSM manual itself, the most popular books published by the American Psychiatric Association and American Psychiatric Publishing have been the DSM Casebooks, beginning with the DSM-III Casebook in 1981. There are several reasons for this. First of all, the cases, based on actual patients, bring the DSM diagnostic criteria to life. In addition, the inclusion of cases covering virtually all of the diagnostic categories has enabled readers to become familiar with types of patients that they may not encounter in their work or studies. Finally, the discussions of each case are useful for teaching the principles of differential diagnosis.# |4 t7 w1 v* g( {}) V+ o# l3 r" i8 o' [4 S2 x
9 D) I, _& H" w1 _We thank the contributors for providing informative and lively discussions that we enjoyed reading–as we trust the reader will as well.& R4 E" I7 H3 U3 s/ y# x( y: b
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How to Use This Book; H3 [2 E) N8 W4 `: Z- w0 y& @9 L
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The reader who chooses to begin with Chapter 1 and read straight through the book will find cases in no particular diagnostic order. Those who are interested in examples of particular diagnoses (e.g., mood disorders) should consult Appendix D, Index of Cases by DSM-IV-TR Diagnosis. Readers who are interested in cases from any of the following categories should consult Appendix B, Cases by Special Interest: forensic, difficult or unusual differential diagnosis, physical disorder, or medical setting.8 B- I& A$ ^! }! ~& L7 H# S7 `# t
+ b: g. ~: P2 o- }/ y+ R4 j7 ?Appendix A, Index of Case Names, will be useful to the reader who remembers cases by their names. Appendix C, DSM-IV-TR Classification, can be used to see how a particular diagnosis fits into the rest of the classification.9 R1 C) L) `7 h( n
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Our own residents in the Department of Psychiatry at Columbia University, College of Physicians and Surgeons, who reviewed the cases in the previous casebook, tell us that they found the cases not only very educational but also fun to read. We hope you will as well. Thanks are due to Betty Appelbaum, copy editor for DSM-III, DSM-III-R, and the original Case Book, for her meticulous copy editing of this book.
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