DSM diagnosis have a way of pointing us toward medications, but understanding the patient's

temperament opens up other avenues.

Welcome to the Carlisat Psychiatry Podcast, keeping psychiatry on us since 2003.

I'm Chris Haken, the editor-in-chief of the Carlat's Psychiatry Report.

And I'm Kelly Newsom, a psychiatric N.P. and a dedicated reader of every issue.

Last week, we spoke with Margaret Chisholm about the Perspectives' method of assessment in psychiatry.

This is a pragmatic approach that looks at the patient's problem through four different lenses.

1. Diagnosis. This is the medical model, including categorical diagnosis in DSM.

2. Dimensions. These are traits that occur on a spectrum, such as introversion,

extraversion, risk-taking, perseverance, and IQ.

Three, behaviors. This is everything the patient does, but particularly the stuff that becomes a

habit or an addiction. The behavioral lens helps us understand eating disorders, addictions,

and many sleep and sexual disorders.

Four. Finally, there is the life story perspective. Here we are interested, not just in the narrative story, but in what it means to the patients. This lens is a natural fit for grief,

trauma, and job burnout. These four perspectives overlap a lot.

Well, let's take bipolar disorder.

At its core, bipolar is clearly a psychiatric disorder.

It's a diagnosis, level one.

But 50% of people with bipolar disorder have affective temperaments, a dimensional lens here

that affects their life as they continue

with dysthymic, hyperthymic, irritable, or cyclothymic traits outside of their episodes.

Now, for the behavioral lens in bipolar, well, mood episodes can pull people into behaviors

...