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8/26/2018

Using caution when using the DSM V

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An issue I would like to address is the over reliance on the DSM V. Too many doctors in and out of the office rely on the DSM criteria for diagnosing and treating patients. When I did my time in county, I had doctors who literally looked at the DSM and check the boxes for the symptoms. This lead to my misdiagnosis. DSM-5 criteria for: Bipolar I disorder: These doctors find themselves so rushed that they cannot take the time to really think about the patient's history and circumstances. All of these play a role in mental illness and indicate the genesis of the behaviour. 

Take for example bipolar disorder. Many people will receive an incorrect diagnosis of bipolar disorder due to isolation of symptoms. The doctor will treat the patient based on what they observe in the now. During a psych eval, the doctor will question the patient about their symptoms and what they are. 

"Have you slept too much or finding yourself sleeping too little?"
"Do you find yourself feeling hopeless or down?"
"Are you more goal driven recently?"
"Have you been more sexually active in the last few weeks?"
"Do you feel unusually elated or euphoric?"
"Do you hear voices or see things that aren't there?"
There are the common barrage of questions asked during a psych intake. The patient may lie or give simple answers such as yes or no. Not often do I hear clinicians probe the issue farther such as asking "what are your living conditions, have any tragic events happened recently, or have you suffered domestic violence." "How does this affect you." 

These secondary questions can provide valuable as they might uncover other reasons for the behaviour. Even though a great deal of symptoms are best answered by a organic mental illness that comes from the brain, some of them may stem from conditions. Some conditions such as abuse or trauma lead to irrational behaviour or emotions. It has been well documented that children who suffer from abuse demonstrate erratic behaviour unrelated to mental illness. It would be termed mental disordered behaviour.  For example when I lost my child, on the outside, I displayed behaviours consistant with a mixed episode. There were moments of crying, yelling, depressive moments, and irrational thoughts. Prima facie this would present as a bipolar mixed episode with psychotic features. However, the disqualifying factors are time, isolated incidence, and lack of impairment in daily life. This reaction did not halt my life or create issues with the law. It was an isolated incident that perhaps needed talk therapy but did not necessitate hospitalization nor consevatorship. I personally believe that a small number of psych patients need to be reevaluated to ensure that their mental illness is primarily organic and not simply a one time reaction to stress or trauma. Like there is situational DV I strongly believe in situational mental illness. disorders.


For reference: DSM V criteria for bipolar I.
Characterized by the occurrence of 1 or more manic or mixed episodes
  • Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and increased goal-directed activity or energy lasting ≥1 week (any duration if hospitalized), present most of the day, nearly every day
  • During the mood disturbance and increased energy or activity, ≥3 (or 4 if irritable mood only) of the following:
    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • Pressured speech
    • Racing thoughts or flight of ideas
    • Distractibility
    • Increased activity
    • Excess pleasurable or risky activity.
  • Marked impairment not due to a substance or medical condition
  • In addition, these symptoms:
    • Do not meet criteria for a mixed episode
    • Cause functional impairment, necessitate hospitalization, or there are psychotic features
    • Are not related to substance misuse
    • Are not due to a general medical condition
    • Are not caused by somatic antidepressant therapy



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Phone: LPS (213) 974-0527
(213) 974- 0407
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5925 Hollywood Blvd 
Los Angeles, California 90028 
Fax: (442) 247-3972


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Phone: (619) 844-2700



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Phone: (858) 694-3500 ext 2
© 2017 LPS Conserved   ALL RIGHTS RESERVED.
  • LPS CONSERVATORSHIPS FOR THE GRAVELY DISABLED
    • LPS Conservatorship Court Overview >
      • Public Conservator >
        • Los Angeles Public Guardian
        • CONSERVATORSHIP INVESTIGATION REPORT
        • CAREER >
          • Continuing Education
          • Public Conservator County Numbers '16
          • San Diego Public Conservator '19
        • LPS Conservatorship for Dependent Parents and Minors
      • WHY ARE LPS CONSERVATORSHIP AND PROBATE CONSERVATORSHIPS DIFFERENT
      • Court of Appeals >
        • In re Ben C- Wende Brief no issue writ
      • Trial Court Transcript
      • Conservatorship Legal Documents
      • INITIAL INVOLUNTARY PROCEEDINGS >
        • Grave Disability >
          • Present Grave Disability
        • Venue
        • Conservator's Bond
        • When the Conservatee Goes AWOL
        • Involuntary Commitment
        • Conservatorship Factors
        • Riese Hearing >
          • Riese Hearing
        • Supplemental Security Income/ SSI >
          • Applying for SSI
          • Documents for SSI
          • Process and Appeal
          • Award Letter
          • Rep Payee
          • SSI Amounts 2018/2019
  • LPS Conservatorship Case Law
    • THE ABSOLUTE STATE OF THE COURT OF APPEALS
    • Conservatorship of Isaac O- court report omission and jurisdiction
    • Disparate Treatment- Conservatorship of E.B
    • Conservatorship of KW- hearsay and jury instructions
    • Peremptory Challenges and Conservatorship of Gordon
    • Conservatorship of Sorenson privacy rights and LPS matters
    • Imposition of special disabilities- Conservatorship of Walker
    • Continuing Jurisdiction/Jury Instruction and Conservatorship of McKeown
    • Hearsay and conservatorship of Manton
    • Conservatorship of the Person of S.A.
    • Writ of Habeas Corpus burden of proof
    • Conservatorship of Roulet- burden of proof
    • Special disabilities and due process- Conservatorship of K.G and Donna H.
    • Conservatorship of Davis and Third party assistance
    • Marsden hearings/ due process Conservatorship of David
    • Conservatorship of Torres and admissibility
    • Jury Instruction and Conservatorship of Law
    • Conservatorship of George H- jury instruction
    • Public Conservator's Exclusive Power to Initiate LPS Conservatorship Kaplan v. Superior Court
    • Constitutionality of LPS conservatorship- Conservatorship of Delay
    • Investigation report- Conservatorship of Ivey
    • Conservatorship of Jesse G
    • Grave Disability Standard and Jury trial notice Conservatorship of Benvenuto
    • Conservatorship of Kennebrew vs Conservatorship of Karriker
    • Jury Trial Delays - Conservatorship of Joanne R.
    • Conservatorship of Hofferber- criminal incompetence and LPS
    • "Discretionary abuse" Conservatorship of G.H.
    • In re Elizabeth R- LPS Conserved Parent with a concurrent dependency case
    • Conservatorship of C.O. - Waiver of Jury Trial
    • Conservatorship of Smith and strange behaviour
    • Jury Trials- ​Conservatorship of Jose B
    • Conservatorship of Baber and Double jeopardy and third party evidence >
      • WIP- Conservatorship of Tedesco
      • Conservatorship of Symington (1989)
      • Effective Counsel
      • Faretta and Marsden
      • Exceptions: Third Party Evidence
      • Exclusionary Rule WIP
      • Fifth Amendment Rights
  • LIFETIME PROHIBITOR WELF & INST CODE § 8103 SUBD. (F)(1)(B) 18 U.S.C. § 922 (G) (4)
    • CA MHRS >
      • Armed and Prohibited Person System
    • National Instant Criminal Background Check System (NICS)
    • Registration
  • For LPS Conservatees
    • RIGHT TO APPEAR IN COURT
    • JUDICIAL REVIEW >
      • WRIT OF HABEAS CORPUS
    • NOTICE
    • MEDICATION
    • PLAN OF CARE IF DISCHARGED
    • RIGHT TO COUNSEL
  • BUILDING A STRONG CASE FOR CONSERVATORSHIP
    • POWERS OF CONSERVATOR >
      • Placement Powers
      • Medication powers
    • WHY ONLY THE PUBLIC CONSERVATOR IS ALLOWED TO FILE FOR LPS CONSERVATORSHIP
    • SERVING AS CONSERVATOR
    • DSM V DIAGNOSIS LIMITS
    • CONSERVATEE INTERVIEW
    • HISTORY OF DECOMPENSATION AND LACK OF INSIGHT
    • WRAPPING IT ALL TOGETHER AND CREATING THE NEXUS BETWEEN SYMPTOMS, HISTORY, COMPLIANCE, THIRD PARTY ASSISTANCE TO PROOF OF CURRENT GRAVE DISABILITY BEYOND A REASONABLE DOUBT
  • JUVENILE DEPENDENCY
    • FAST TRACK DEPENDENCY
    • DEPENDENCY APPEALS
    • DETENTION
    • JURISDICTION DISPOSITION (JURIS/DISPO)
    • §366.26 Hearing: Selection and Implementation
    • 730 Evaluators
    • Case Plan
  • New Updates
    • Right to Choose