This chapter explores how differing expectations and experiences manifest in diagnostic interactions in the memory clinic. We do this by microanalysing communication in dementia diagnosis feedback meetings, focusing on instances of misalignment between doctors and the person living with dementia. We examine three videos from a dataset of 101 recordings from two areas in the UK, collected as part of the ShareD study. We present different interactional contexts where the person receiving a dementia diagnosis choose to align or misalign with the doctors’ interactional projects of diagnosis delivery, prescribing medication and recommending support. Examination of these instances suggests that misalignment between the assessment of symptoms may, at least in part, reflect interactional facework in the face of dementia as a challenge to self-identity.

This chapter looks at Alzheimer’s disease, the most common cause of dementia. Incidence and prevalence figures are reviewed, along with an explanation of the two abnormal proteins involved in the development of the disorder, and the ‘amyloid cascade’ hypothesis. Cognitive assessment of Alzheimer’s disease is considered in terms of where this fits within the diagnostic process and diagnostic criteria. The bulk of the chapter focuses on the typical form of Alzheimer’s disease, and the chapter concludes with discussion of some atypical variants, such as posterior cortical atrophy (PCA), logopenic primary progressive aphasia (lvPPA), and frontal variant.

The process of diagnosing dementia and MCI is considered in depth in this chapter, drawing on criteria outlined in the DSM-V and ICD-11. This covers ways of assessing the two central components of a dementia diagnosis, namely the extent to which there has been a change in cognitive ability and whether there has been a change in everyday function. The contribution of neuropsychological assessment is explained, along with the use of cognitive screening measures. The difference between dementia and MCI is covered, along with how you differentiate between the two. There is also discussion of what background information to record, specifically in relation to factors which could affect cognitive function. The chapter finishes with a decision tree outlining the process involved in distinguishing between the two presentations. Having established whether dementia is present, how to determine the likely type of dementia is discussed in subsequent chapters.

In the late 1970s, queer parents increasingly fought to maintain custody of their children from different-sex relationships. These mothers and fathers were responding in part to the gay liberation movement, which inspired them to come out and demand their rights. Also important was that the American Psychiatric Association declassified homosexuality as a mental illness, which eliminated what had been an all-but-impenetrable barrier to custody. Courts were nevertheless reluctant to grant these petitions, fearing that the children would learn to be gay or lesbian from the adults in their lives. In response to these court cases, social scientists developed research studies that concluded parental homosexuality had no effect on the future sexual orientation of children. Based on that work, family courts around the country granted custody to lesbian mothers and gay fathers in the late 1970s and early 1980s, creating the first wave of visible queer-headed families.

Alzheimer’s Disease International highlighted in 2016 the role of primary care in dementia. With overly specialised healthcare systems and stretched specialist workforce, dementia is currently under-diagnosed and under-managed. While various service models have been trialled in different parts of the world, several barriers remain; among them are a lack of a gatekeeping role for primary care in highly stretched healthcare systems and a perception that primary care is of a lower quality. In this chapter, we briefly review and outline the possible roles of primary care, including the gatekeeping role, based on the concepts and practices of task-shifting and task-sharing in dementia care. Examples of primary care models in dementia are given, followed by a basic overview of the work-up, diagnosis, and management related to simple, uncomplicated Alzheimer’s disease in line with gatekeeping and task-shifting/sharing. With this background, we then move on to the rationales and evidence of integrated health and social care services, with an example of community primary care-based integrated health and social care services, from which the cases provided in this book were drawn.

Major depressive disorder (MDD) is manifested by mood, behavioural, cognitive, and somatic symptoms. This is reflected in the diagnostic criteria of both DSM-5 and ICD-10. Differential diagnosis typically includes the consideration of other mood and psychiatric disorders, neurological, medical and genetic conditions, as well as bereavement. Diagnostic investigations are commonly combined with the evaluation of functioning since the vast majority of MDD patients experience functional impairment. Suicidality is a major challenge in the management of MDD. Rigorous risk assessment, minimisation of risk factors, and promotion of protective factors are essential in suicide prevention. Treatment strategies can be split into acute, continuation, and maintentance phases. Depending on depression severity and other specifiers (e.g., psychosis, risk) both pharmacotherapy and psychotherapy can be efficacious first-line treatment options. Switching or augmenting initial treatment can be considered for non-responders. For continuation and maintenance phases, the primary aim of treatement is prolonging remission, preventing episode recurrence, and restoring psychosocial functioning.

The concept of abnormal mood has been a matter of a millennia-long debate in philosophy and medicine, while the diagnosis and classification of mood disorders remains a complex and controversial issue even in modern psychiatry. A centrepiece of this debate is the conceptualisation of mood and, by extension, mood disorders as a multi-dimensional spectrum with transdiagnostic symptoms (i.e., a continuous diagnostic classification) or as discrete nosological entities (i.e., a categorical diagnostic classification). Theoretical models and arguments based on empirical evidence have been proposed for both the distinct categorisation of abnormal mood states and the affective continuum perspective, which may also encompass psychosis and psychotic disorders. Although the conceptualisation of mood as a spectrum ranging from unipolar depression to unipolar mania may be the most suitable, this approach requires further evidence before it can replace the categorical classifications firmly employed in clinical practice for more than a century.

In his book General Psychopathology, first published in 1913, Jaspers presented a methodological framework for exploring the phenomenology of symptoms of psychiatric disorders as well as relating experimental psychology and nosology to phenomenology. This chapter briefly introduces the phenomenological approach to symptoms and how this has influenced symptom- as opposed to diagnostic criterion-based assessment instruments, such as those based on the diagnostic statistical manual. A transcultural and historical perspective is employed to identify relevant symptoms of mood disorders and their temporal course. Descriptions and definitions of classical symptoms are provided and extended based on modern evidence to include changes in self-imagery, moral emotions, self-blame-related action tendencies, as well as mood-congruent biases in the representation of the past and future. Lastly the contribution of psychopathology to future subsyndrome discovery, translational cognitive neuroscience, and network-based approaches to the psychopathology of mood disorders is discussed.