Over the past 15 years, awareness of the earlier unreliability of psychiatric diagnosis guided the development of operational criteria for separate and distinct mental disorders. These rules allow researchers and clinicians to agree on the presence or absence of a particular disorder. In addition, the criteria are based on observable signs and the patient's report of symptoms, not on unconscious psychic mechanisms. This simplifies the task of diagnosis for emergency physicians and other nonpsychiatrists because extensive knowledge of pathophysiology and unconscious mental processes is not essential.
The current official diagnostic nomenclature, published in 1994 by the American Psychiatric Association, is the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, commonly known as DSM-IV. A copy of DSM-IV should be available for reference in the emergency department because it contains both the list of criteria for each disorder, and additional material on demographics, associated symptoms and syndromes, and differential diagnosis. Future revisions of DSM-IV will likely be based to a greater degree on biologic criteria as more is learned about biochemical, structural, and genetic features of various psychiatric illnesses.
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