KHA713 Lecture Notes - Lecture 1: Brain, Nosology, Orbitofrontal Cortex
25 Jun 2018
School
Department
Course
Professor
Adult Psychopathology
The DSM: a series of working hypotheses
Week One lecture:
- Pros and Cons of Diagnosis:
oSymptom:
A subjective sensation, discomfort, or change in functioning
that a patient or informant complains about
oSign:
An indication of disease that can be noticed by others
Observable and objective? Although they can be faked so not
entirely objective
Often not verbalized by the client
oGenerally: signs trump symptoms
Not always coherence between symptoms and signs
If there is a discrepancy
oSyndromes:
Each diagnosis
Signs and symptoms are insufficient for making a diagnosis
Collection of signs and symptoms
Events as well
That occur in a recognizable pattern, or imply the presence of a
particular disorder
There is something similar between depressed
individuals
Because this collection of symptoms indicate that;
serotonin etc etc. underlying pathology
Aim to identify a homogenous group of individuals
Reliably: replicable across individuals
oImportant for multi-disciplinary team
oInter-rater
Validly: in a meaningful way
oPredicting treatment response
oA course of treatment
oValidity is important for using information in a
practical way
Why do we diagnose:
Facilitate communication between professionals
Reliability get the same diagnosis
Not wasting resources:
oResearch definitions- systematic research
oDiagnosis
If diagnosis is right then
The underlying cause treatment prognosis
Evidence based treatments and predictive outcomes
Helps us guide how were intervene with clients
Down side to diagnosis:
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We can lose information
Lose what is unique about the individual
oStigma
oMissing information that can help with treatment
Thinking in terms of a category fit
Bias against attention/identification of extra-category
issues?
Looking at pathologic symptoms, and miss peripheral
information that indicates a differential diagnosis
oWe don’t know which are the important
symptoms and which aren’t
Biases:
oNeed to self-reflect to prevent this black and
white thinking and labeling
Stigma:
Effects of label on relationship, self-concept, future
opportunity
Life guided by statistics (probability of recurrence,
recovery forensic problems)
Label leads to obsession with prevalence rates and
statistics… newspaper articles etc. not a nice feeling
Mental disorders almost unique in medicine in that, for the
majority of categories, these are just descriptive CONCEPTS,
with no/little knowledge of actual underlying cause so?
We don’t know what is valid and what isn’t
oAnti-psychiatry:
Movement questioning notions of:
Be aware of these questions
The existence of a mental illness- labeling and what is
normal
Legal privilege to detain and treat individuals
oOften against their will
Appropriateness of psychopharmacology to change
behaviour and emotion
oTo ‘be more normal’
Lots of thinkers:
RD Laing:
oMental disorders as an understandable response
of sensitive individuals to a mad world
oCure: when people feel free to make choices and
deal with realities of existence
Thomas Szasz
Franco Basaglia
David Cooper
Michael Focault
Think carefully about the broader context
- Introduction to DSM and ICD:
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oNeed to learn both: key frameworks
Both started as general epidemiology tools
oICD: hospital contexts and led by the WHO
New edition coming
They will be considerable differences between DSM and ICD
oDSM: US psychiatric association
DSM-5 2013- constantly evolving
ICD-10:
- Open access
oGood for developing countries
- Codes for everything that could happen
- One chapter dedicated to mental and behavioural disorders
- Multi-axial system:
oGood way of remembering that the presenting issues are not just the
result of biology
oSocial aspects to it
oBiopsychosocial framework
oRate people across 3 axes:
Clinical diagnosis: axis one
Disability: axis 2
Level of functioning
How much condition impacts
Contextual factors: axis 3
That influence presentation
DSM-4:
- Not the current one, but supervisors are still very familiar with this so will still
refer to it
oIf not referring to it, still influencing
- Axis 1: State disorders
oClinical disorders
oTreatable
- Axis 2: Trait disorders
oPersonality disorders
oMental retardation
oDementia
oImplication: if you have one of these it is unchangeable
People still think of these as stable, which is a problematic
approach
Often dismissive
- Axis 3: general medical conditions
oThat are potentially relevant to clinical states
- Axis 4: psychosocial and enviornemntal factors
oSame codes as ICD
- Axis 5: numeral
oRating out of 100
DSM-5:
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
A subjective sensation, discomfort, or change in functioning that a patient or informant complains about: sign: An indication of disease that can be noticed by others. Although they can be faked so not entirely objective. Often not verbalized by the client: generally: signs trump symptoms. Not always coherence between symptoms and signs. Signs and symptoms are insufficient for making a diagnosis. That occur in a recognizable pattern, or imply the presence of a particular disorder. There is something similar between depressed individuals. Because this collection of symptoms indicate that; serotonin etc etc. underlying pathology. Aim to identify a homogenous group of individuals. Reliably: replicable across individuals: important for multi-disciplinary team, inter-rater. Validly: in a meaningful way: predicting treatment response, a course of treatment, validity is important for using information in a practical way. Not wasting resources: research definitions- systematic research, diagnosis. The underlying cause treatment prognosis. Helps us guide how were intervene with clients.
