DSM4, The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), is a manual published by the American Psychiatric Association with revisions from time to time. The DSM4 is the official collection of diagnostic standards for mental disorders in the United States . It is also known as DSM4, DSM-4, DSMIV, DSM3R, and DSM-3-R.

The rationale of the decision trees in DSM4 is to assist the medical practitioners to know the structure of the DSM-IV Classification. Each decision tree starts with a set of diagnostic criteria, which is nothing but narration of signs and symbols. When one of these aspects is a major part of portraying the diagnostic framework, the practitioner may resort to a set of queries to decide about existence of different disorders. It should be noted that queries are only pointers of the diagnostic measures and are not intended to substitute them.

The structure of The Psychotic Disorders decision tree is such that only one disorder can be diagnosed from that particular segment in a given person for a specific incident. Regarding other decision trees, refer to the individual conditions lists to decide number of diagnoses.

DSM4 Criteria for Major Depressive Disorder

Generally, there is greater prevalence of major depressive disorder in people. Its characteristic symptoms are chronic sadness, despondency, lack of enjoyment, etc. It can also affect a person’s daily life and responsibilities. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM4) has a list of criteria (list of symptoms) one can employ to correctly make out major depression.

Stage 1:

To apply DSM4 correctly, try to know from the person, who is reported for suspected depression, the duration of the symptoms that are prevalent in a person. As per the DSM4 criteria, major depression is possible only if the symptoms have been prevalent for longer than 2 weeks.

Stage 2:

The person has to be screened to know the presence of only those symptoms that are relevant for major depression. As per DSM4, a person has to go through either a depressed mood or a loss of fascination for pleasurable activities, for major depression to be considered as a possible diagnosis.

Stage 3:

The person whose symptoms are suspect for depression has to be watched for any alcoholism and drug dependency. If the person is found to be habituated with alcoholism and drugs, then the suspected symptoms are due to the result of addictions, not due to any major depression. As per DSM4 criteria, major depression is not likely.

Stage 4:

Look out for likely negative impact that the depression symptoms may have on a person's work abilities and responsibilities, school or family life conditions. Depression that messes up things in any of these aspects of life comes under the DSM4 criteria for major depression.

Stage 5:

The person’s mood may change with major happenings that may occur in person’s life. Death in the family, marital discord, a divorce, loss of job etc., may all cause stressful conditions and it may, over a time, culminate in short-term depression. The DSM4 criteria says the depression caused by such factors does not fall under the category of major depression.

Stage 6:

There is a relation between number of depression symptoms and their recurrence. Change of appetite, weight loss not related to diet, insomnia, fatigue, persistent low self-esteem feelings, suicidal ideations, loss of focus and indecision, etc., are some of the symptoms that are associated with major depression. For a major depression to be diagnosed, DSM4 says that at least five symptoms of the above must be prevalent in a person for more than two weeks.

The practical utility of the DSM 4 goes beyond the making diagnoses of depressions. It is used as a guide by psychologists for cross-checking data. The DSM 4 also lets psychologists to reach general professional agreement on signs and symptoms that precede disorders.

Doctors should not follow DSM4 blindly. The criteria says that at least five conditions of mood and behavioral symptoms should last for longer periods in a person to be diagnosed as suffering from major depressed disorder. If, unfortunately, only four conditions of symptoms that meet with the DSM4 criteria exist in a person, then the person is diagnosed as not depressed, which may not be the case with the person’s current physical and mental condition. Prudent adherence of DSM4 criteria coupled with practical experience should be the approach for diagnosing a person for depression.