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Differential Diagnosis in Psychiatry

By S. Peters

Social, Genetic & Developmental Psychiatric Research Centre, Institute of Psychiatry, Denmark Hill, London SE5 8AF

Footnotes

Sheffield: Sheffield University Television. 1998. £35.00 (1 video), £180.00 (all 7 videos)

The introduction included on each video stated that they provided "an overview of mental illness based on the ICD-10 classification". The diagnoses selected covered the main ‘F’ categories in the ICD-10 (organic disorders, psychoactive substance use, schizophrenic disorders, mood disorders, neurotic, stress-related and somataform disorders and personality disorders). The last video was called ‘Challenging Cases’.

All but the last video consisted of the same format. First, text is displayed against a monochrome sagittal section of a brain with a voice over to introduce the clinical features of each diagnosis. This was followed by a brief clinical interview with the psychopathological features outlines at the beginning and captioned as the interview proceeded. Last, the differential diagnosis for the disorder was again outlined in text according to the ICD-10 diagnostic hierarchy. The seventh video ‘Challenging Cases’ presented four interviews of difficult presentations for group discussion.

The videos have been professionally produced, financed by pharmaceutical companies, and provide a clear introduction to the basis of differential diagnosis in psychiatry. In my opinion they are probably best suited to undergraduates rather than a postgraduate audience and should be shown separately. The patients included in the interviews seemed somewhat unreal, and I assumed that they were actors following a script. Also the credits indicated that the tapes were "written by Dr Steve Peters" whom I assumed had also ‘acted’ as the interviewer.

I thought it unfortunate that the differential diagnoses followed the hierarchical ordering of ICD-10 with organic causes being listed first. While in some respects this is logical in other ways it is not so. The reason relates to the old adage that "if I see a bird flying past my window it is more likely to be a sparrow than a canary". clearly in terms of organic disorders, hypothalamic tumour is a possible differential diagnosis for mania. However, substance misuse is much more common as a cause of manic symptomatology. There was also one ‘howler’: phaechromocytomatosis is given as the first differential diagnosis of panic symptoms, even before thyrotoxicosis! Examiners would not be impressed by such ordering.

In spite of these reservations, used in conjunction with other teaching methods and in short segments, the videos provide a good adjunct to the teaching of basic psychiatry.

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