PROVISIONAL DIAGNOSIS

What Is a Provisional Diagnosis? A provisional diagnosis means that your doctor is not 100%
sure of a diagnosis because more information is needed. With a provisional diagnosis, your
doctor makes an educated guess about the most likely diagnosis.

Differential diagnosis is a process wherein a doctor differentiates between two or more
conditions that could be behind a person's symptoms. When making a diagnosis, a doctor
may have a single theory as to the cause of a person's symptoms. They may then order tests to
confirm their suspected diagnosis.

Example:

Many mental health disorders cause sadness, anxiety, and sleep problems. A differential
diagnosis looks at the possible disorders that could be causing your symptoms.

Psychological Test Battery

A test battery consists of a series of tests administered to assess different facets of a
child's or adult's functioning (e.g., psychological functioning). ... Test batteries often consist
of norm-referenced measures and informal assessments.

 Personality Tests.
 Achievement Tests.
 Attitude Tests.
 Aptitude Tests.
 Emotional Intelligence Tests.
 Intelligence Tests.
 Neuropsychological Tests.
 Projective Tests.
 What does a full psychological evaluation consist of?
 A psychological assessment can include numerous components such as norm-
referenced psychological tests, informal tests and surveys, interview
information, school or medical records, medical evaluation and
observational data. A psychologist determines what information to use based
on the specific questions being asked.
  Intelligence tests.
 Personality tests.
 Attitude tests.
 Achievement tests.
 Aptitude tests.
 Neuropsychological tests.
 Vocational tests.
 Direct observation tests.
A battery approach to neuropsychological assessment is the administration of multiple
measures that cover a wide range of cognitive abilities to fully characterize an
individual's neuropsychological strengths and weaknesses.

Prognosis

Prognosis is a term for the predicted course of a disease. People commonly use the word to
refer to an individual's life expectancy, how long the person is likely to live.

Does prognosis mean death?

Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for
predicting the likely or expected development of a disease, including whether the signs
and symptoms will improve or worsen (and how quickly) or remain stable over time;
expectations of quality of life, such as the ability to carry out daily ...

The term prognosis refers to making an educated guess about the expected outcome of any
kind of health treatment, including mental health, in essence making a prediction of the
process an individual may have to go through in order to heal, and the extent of healing
expected to take place.

Diagnosis

To determine a diagnosis and check for related complications, you may have:

 A physical exam. Your doctor will try to rule out physical problems that could
cause your symptoms.

 Lab tests. These may include, for example, a check of your thyroid function or a
screening for alcohol and drugs.
  A psychological evaluation. A doctor or mental health professional talks to you
about your symptoms, thoughts, feelings and behavior patterns. You may be asked
to fill out a questionnaire to help answer these questions.

Determining which mental illness you have

Sometimes it's difficult to find out which mental illness may be causing your symptoms.
But taking the time and effort to get an accurate diagnosis will help determine the
appropriate treatment. The more information you have, the more you will be prepared to
work with your mental health professional in understanding what your symptoms may
represent.

The defining symptoms for each mental illness are detailed in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric
Association. This manual is used by mental health professionals to diagnose mental
conditions and by insurance companies to reimburse for treatment.

Classes of mental illness

The main classes of mental illness are:

 Neurodevelopmental disorders. This class covers a wide range of problems that

usually begin in infancy or childhood, often before the child begins grade school.
Examples include autism spectrum disorder, attention-deficit/hyperactivity disorder
(ADHD) and learning disorders.

 Schizophrenia spectrum and other psychotic disorders. Psychotic disorders

cause detachment from reality — such as delusions, hallucinations, and
disorganized thinking and speech. The most notable example is schizophrenia,
although other classes of disorders can be associated with detachment from reality
at times.

 Bipolar and related disorders. This class includes disorders with alternating

episodes of mania — periods of excessive activity, energy and excitement — and
depression.

 Depressive disorders. These include disorders that affect how you feel

emotionally, such as the level of sadness and happiness, and they can disrupt your
 ability to function. Examples include major depressive disorder and premenstrual
dysphoric disorder.

 Anxiety disorders. Anxiety is an emotion characterized by the anticipation of

future danger or misfortune, along with excessive worrying. It can include behavior
aimed at avoiding situations that cause anxiety. This class includes generalized
anxiety disorder, panic disorder and phobias.

 Obsessive-compulsive and related disorders. These disorders involve

preoccupations or obsessions and repetitive thoughts and actions. Examples
include obsessive-compulsive disorder, hoarding disorder and hair-pulling disorder
(trichotillomania).

 Trauma- and stressor-related disorders. These are adjustment disorders in

which a person has trouble coping during or after a stressful life event. Examples
include post-traumatic stress disorder (PTSD) and acute stress disorder.

 Dissociative disorders. These are disorders in which your sense of self is

disrupted, such as with dissociative identity disorder and dissociative amnesia.

 Somatic symptom and related disorders. A person with one of these disorders
may have physical symptoms that cause major emotional distress and problems
functioning. There may or may not be another diagnosed medical condition
associated with these symptoms, but the reaction to the symptoms is not normal.
The disorders include somatic symptom disorder, illness anxiety disorder and
factitious disorder.

 Feeding and eating disorders. These disorders include disturbances related to

eating that impact nutrition and health, such as anorexia nervosa and binge-eating
disorder.

 Elimination disorders. These disorders relate to the inappropriate elimination of

urine or stool by accident or on purpose. Bed-wetting (enuresis) is an example.

 Sleep-wake disorders. These are disorders of sleep severe enough to require

clinical attention, such as insomnia, sleep apnea and restless legs syndrome.

 Sexual dysfunctions. These include disorders of sexual response, such as

premature ejaculation and female orgasmic disorder.

 Gender dysphoria. This refers to the distress that accompanies a person's stated

desire to be another gender.
  Disruptive, impulse-control and conduct disorders. These disorders include
problems with emotional and behavioral self-control, such as kleptomania or
intermittent explosive disorder.

 Substance-related and addictive disorders. These include problems associated

with the excessive use of alcohol, caffeine, tobacco and drugs. This class also
includes gambling disorder.

 Neurocognitive disorders. Neurocognitive disorders affect your ability to think

and reason. These acquired (rather than developmental) cognitive problems
include delirium, as well as neurocognitive disorders due to conditions or diseases
such as traumatic brain injury or Alzheimer's disease.

 Personality disorders. A personality disorder involves a lasting pattern of

emotional instability and unhealthy behavior that causes problems in your life and
relationships. Examples include borderline, antisocial and narcissistic personality
disorders.

 Paraphilic disorders. These disorders include sexual interest that causes

personal distress or impairment or causes potential or actual harm to another
person. Examples are sexual sadism disorder, voyeuristic disorder and pedophilic
disorder.

 Other mental disorders. This class includes mental disorders that are due to
other medical conditions or that don't meet the full criteria for one of the above
disorders.

Treatment

Your treatment depends on the type of mental illness you have, its severity and what
works best for you. In many cases, a combination of treatments works best.

If you have a mild mental illness with well-controlled symptoms, treatment from your
primary care provider may be sufficient. However, often a team approach is appropriate
to make sure all your psychiatric, medical and social needs are met. This is especially
important for severe mental illnesses, such as schizophrenia.

Your treatment team

Your treatment team may include your:

  Family or primary care doctor

 Nurse practitioner

 Physician assistant

 Psychiatrist, a medical doctor who diagnoses and treats mental illnesses

 Psychotherapist, such as a psychologist or a licensed counselor

 Pharmacist

 Social worker

 Family members

Medications

Although psychiatric medications don't cure mental illness, they can often significantly
improve symptoms. Psychiatric medications can also help make other treatments, such
as psychotherapy, more effective. The best medications for you will depend on your
particular situation and how your body responds to the medication.

Some of the most commonly used classes of prescription psychiatric medications

include:

 Antidepressants. Antidepressants are used to treat depression, anxiety and

sometimes other conditions. They can help improve symptoms such as sadness,
hopelessness, lack of energy, difficulty concentrating and lack of interest in
activities. Antidepressants are not addictive and do not cause dependency.

 Anti-anxiety medications. These drugs are used to treat anxiety disorders, such

as generalized anxiety disorder or panic disorder. They may also help reduce
agitation and insomnia. Long-term anti-anxiety drugs typically are antidepressants
that also work for anxiety. Fast-acting anti-anxiety drugs help with short-term relief,
but they also have the potential to cause dependency, so ideally they'd be used
short term.

 Mood-stabilizing medications. Mood stabilizers are most commonly used to treat

bipolar disorders, which involves alternating episodes of mania and depression.
Sometimes mood stabilizers are used with antidepressants to treat depression.
  Antipsychotic medications. Antipsychotic drugs are typically used to treat
psychotic disorders, such as schizophrenia. Antipsychotic medications may also be
used to treat bipolar disorders or used with antidepressants to treat depression.

Psychotherapy

Psychotherapy, also called talk therapy, involves talking about your condition and
related issues with a mental health professional. During psychotherapy, you learn about
your condition and your moods, feelings, thoughts and behavior. With the insights and
knowledge you gain, you can learn coping and stress management skills.

There are many types of psychotherapy, each with its own approach to improving your
mental well-being. Psychotherapy often can be successfully completed in a few months,
but in some cases, long-term treatment may be needed. It can take place one-on-one,
in a group or with family members.

When choosing a therapist, you should feel comfortable and be confident that he or she
is capable of listening and hearing what you have to say. Also, it's important that your
therapist understands the life journey that has helped shape who you are and how you
live in the world.

Brain-stimulation treatments

Brain-stimulation treatments are sometimes used for depression and other mental
health disorders. They're generally reserved for situations in which medications and
psychotherapy haven't worked. They include electroconvulsive therapy, repetitive
transcranial magnetic stimulation, deep brain stimulation and vagus nerve stimulation.

Make sure you understand all the risks and benefits of any recommended treatment.

Hospital and residential treatment programs

Sometimes mental illness becomes so severe that you need care in a psychiatric
hospital. This is generally recommended when you can't care for yourself properly or
when you're in immediate danger of harming yourself or someone else.
Options include 24-hour inpatient care, partial or day hospitalization, or residential
treatment, which offers a temporary supportive place to live. Another option may be
intensive outpatient treatment.

Substance misuse treatment

Problems with substance use commonly occur along with mental illness. Often it
interferes with treatment and worsens mental illness. If you can't stop using drugs or
alcohol on your own, you need treatment. Talk to your doctor about treatment options.

Participating in your own care

Working together, you and your primary care provider or mental health professional can
decide which treatment may be best, depending on your symptoms and their severity,
your personal preferences, medication side effects, and other factors. In some cases, a
mental illness may be so severe that a doctor or loved one may need to guide your care
until you're well enough to participate in decision-making.

Description of the intervention

Mental health and psychosocial support interventions are becoming a standard part of
humanitarian programmes. Although this was previously an ideologically divided field, there
appears to be growing agreement on best practices, as evidenced by international consensus‐
based documents (IASC 2007; The Sphere Project 2011). These documents advocate for multi‐
layered systems of care, to address the diversity of mental health and psychosocial needs in
humanitarian settings. Such recommended multi‐layered systems of care are envisioned to
include interventions to address the broad range of mental health needs in populations affected
by humanitarian crises. Furthermore, consensus documents recommend interventions across a
range of sectors, not just the health sector, including implementing basic services and security in
a way that prevents further exposure to human rights violations and harm, and strengthening the
capacity of families and communities to support their members (e.g., through self‐help,
continued cultural, religious, and spiritual practices; strengthening social supports for vulnerable
populations) (IASC 2007; Tol 2013a).
In this review we will follow the classification of interventions described by the Institute of
Medicine (IOM) report on preventing mental disorders in children and adolescents (Institute of
Medicine 1994; Institute of Medicine 2009).
Prevention is an approach aimed at reducing the likelihood of future disorder with the general
population or with people who are identified as being at risk for a disorder (Eaton 2012; Tol
2015). Prevention is further subdivided on the basis of the population targeted, as follows.
Universal prevention, which includes strategies that can be offered to the full population, based
on the evidence that it is likely to provide some benefit to all (reduce the probability of disorder),
which clearly outweighs the costs and risks of negative consequences. The most common
universal prevention interventions include:
 providing access to information on the humanitarian crisis, ongoing humanitarian response,
and legal rights of the affected population (IASC 2007);
 community‐wide provision of information on positive coping methods (IASC 2007), to help
people feeling safe and hopeful;
 protection against human rights violations;
 community‐wide efforts to improve livelihoods as a key protective factor for mental health,
working on lifting restrictions of movement and employment for everyone in a refugee camp.
Selective prevention, which refers to strategies that are targeted to subpopulations identified as
being at elevated risk for a disorder, includes:
 mentoring programmes aimed at children with behavioural problems;
 psychological first aid for people with heightened levels of psychological distress after
exposure to severe stressors, loss, or bereavement. These interventions involve human,
supportive, and practical help covering both a social and a psychological dimension. They
work through communication (asking about people needs and concerns; listening to people
and helping them to feel calm), practical support (i.e. providing meals or water), and with a
psychological approach including teaching stress management skills and helping people to
cope with problems (WHO 2011);
 facilitation of community support for vulnerable individuals by activating social networks
and communication;
 structured cultural and recreational activities supporting the development of resilience
(Institute of Medicine 2009), such as traditional dancing, art work, sports, and puppetry.
These activities take place in equipped settings with the aim of increasing the children's
sense of connectivity and safety (Tol 2011).
Indicated prevention includes strategies that are targeted to individuals who are identified (or
individually screened) as having an increased vulnerability for a disorder based on some
individual assessment. These interventions include:
 psychosocial support for school children with subclinical levels of PTSD, anxiety,
depression, or somatic symptom and related disorders. This includes, for example,
classroom‐based interventions that emphasize the importance of integrating Cognitive
Behavioral Therapy (CBT) techniques with cooperative play and creative‐expressive
exercises (drama, dance, and music) within a structured phased programme (Tol 2008);
 prevention of postnatal depression in women with heightened levels of prenatal symptoms
(Institute of Medicine 2009). These interventions may be delivered at individual or group
level. They include antenatal and postnatal classes, parenthood classes, and continuity of care
(home visits, follow‐ups).
Selective and indicated prevention strategies might involve more intensive interventions and thus
involve greater cost to the participants, since their risk and thus potential benefit from
participation would be greater (Institute of Medicine 1994; Institute of Medicine 2009; Tol
2015).
How the intervention might work

Prevention of mental disorders in populations affected by high levels of adversity is commonly

aimed at targeting modifiable causal factors or determinants of mental health (Hobfoll
2007; Dückers 2013; Marmot 2014). In general, preventive interventions are aimed at decreasing
risk factors for the development of mental disorders or symptoms (e.g., through preventing
exposure to further violence and other human rights violations, reducing poverty, preventing
social exclusion) (Hobfoll 2007), or at building resilience and increasing a sense of hope and
safety to protect against psychological symptom development (e.g., supporting parents to lower
the levels of anxiety or depressive symptoms in children) (Tol 2013b). Such types of
interventions have often been termed 'psychosocial' interventions by agencies in humanitarian
settings, and are implemented in diverse humanitarian sectors including child protection,
nutrition, and education. In the present review we refer to a wide range of preventive
interventions. Preventive psychological interventions may offer supportive and practical help to
improve coping strategies, and a sense of hope and focus on existing sources of individual
resilience. Preventive social interventions may be aimed at strengthening social support systems
and the sense of connectedness (Tol 2015).
A growing body of research has aimed to identify modifiable risk and protective factors for
psychological symptoms and mental disorders in humanitarian settings. For example, research
has focused on the importance of ongoing more chronic forms of adversity, such as poverty,
intimate partner violence, and social marginalization, as determinants of mental health. In
addition, research on protective factors has often focused on the important role of individual
coping methods and social support from family and community members. Research on risk and
protective factors commonly examines variables at diverse levels of the affected person's social
ecology, including individual, family, community, and wider societal levels (Tol 2013b). More
broadly, these variables are defined as "social determinants" of mental health (Allen 2014).