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PSYB32 - Lecture 03 Notes.docx

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Konstantine Zakzanis

PSYB32 – Lecture 03 WebOption – Summer 2013  This lecture covers Chapters 3 and 5 o Chapter 5 will be discussed very briefly  This lecture will touch on all the different disorders as briefly as possible Slide 3 – Classification and Diagnosis: DSM  DSM (Diagnostic and Statistical Manual of Mental Disorders) o There’s actually nothing statistical about the DSM o It’s the text that psychiatrists, physicians and psychologists use to render a diagnosis  Why is it important to have a book like this? – 3 reasons o One important reason for having a diagnostic manual is it ensures that the right treatment is prescribed  If you’re a psychiatrist and you diagnose someone with something (ex Schizophrenia), then you’d want to look into the proper research literature to determine what the proper treatments are for the disorder o Two: Allows us for efficient and reliable communication  (efficiency) If a person has hallucinations, delusions, poverty of speech (symptoms of schizophrenia), it would be difficult to describe all of these symptoms. It’s easier to determine that the person has schizophrenia, so the DSM provides a descriptive term which encapsulates all of the symptoms  (reliability) having a book like this allows multiple Drs examining a single patient to reliably agree on a diagnosis  Without the manual, maybe one or two of them come to different conclusions and diagnose the same person differently (low reliability) o Three: Research  DSM allows researchers to conduct more research on the disorders  Again, nothing statistical about the manual. It contains descriptive terms of what constitutes a disorder Slide 4 – DSM-IV Definition of Mental Disorder  Mental Disorder: A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual o A syndrome is a constellation (collection) of symptoms o Important to know what a syndrome not one symptom alone defines a disease/disorder, a syndrome does.  He also notes to know the difference between a behavioural and psychological symptom/impairment o Psychological symptom/impairment: it’s a construct, you can’t see it. It occurs from within the individual  Ex if he asks a student to show their stomach to class they’ll suffer from a large amount of anxiety. The person feels the anxiety (ie hear racing, extreme nervousness), we don’t see it o Behavioural symptom/impairment: an observable symptom  ie someone bashing their head against a wall because they’re autistic  DSM adds that it qualifies as a mental disorder if the symptoms/disorder causes distress or disability o Disability: for ex being unable to go to work  Also, if it presents a significantly increased risk of suffering death, pain, disability, or an important loss of freedom Slide 5  DSM also excludes a few things from the definition of mental disorder  Firstly, if the patient presents an expectable and culturally sanctioned response to a particular event o For ex: death of a loved one. How would you feel if someone you love dies? You’d feel depressed or experience symptoms of it (loss of appetite, low sex drive, lack of enjoyment in doing things, etc) o But because this depression or these symptoms follow such an event where your response is expectable or culturally sanctioned, your symptoms/behaviour don’t qualify as a disorder according to the DSM  Also excludes deviant behaviour (eg political, religious, or sexual) o For ex: fasting, where you severely reduce the amount of food you intake for religious purposes o Although it sounds like anorexia nervosa, it doesn’t qualify under the DSM as a mental disorder because the behaviour is produced for religious reasons  Also excludes conflicts that are primarily b/t the individual and society (unless the deviance or conflict is the symptom of a dysfunction in the individual) o For ex: the occupy wall street movement. Some protestors are living on the street and putting their jobs on hold, but because this behaviour is due to a conflict b/t the individual and society, it’s excluded from the DSM  They’re intentionally choosing to stay on the streets and leave their jobs so there’s no distress or disability involved Slide 6 – Diagnostic System of the American Psychiatric Association (DSM-IV)  DSM provides 5 Axis, or dimensions of classification o In order to render a reliable diagnosis, you must insert something on all of these Axis  ***Important to know what goes on each Axis (hints that it makes a good exam question)  In this class we’ll be talking about Axis I disorders the most o This is where a disorder like Schizophrenia would go  ***Important to know what goes on each Axis (hints that it makes a good exam question)  Axis II: Where Personality disorders are listed o Ex: narcissism, histrionicism  Axis III: General medical conditions o Why is it important to have a category like this? o Because if you’re prescribing medication, you (the psychiatrist etc) want to know that it’s not going to make worse any medical condition the patient might have o Ex if someone were rendering a diagnosis on the prof, they’d want to include “Kidney Transplant” on Axis III so they know not to give him something for his immune system  (because if his immune system wakes up, it’ll recognize he has a foreign kidney) o Another reason, not related to medication, is that there could be an interplay going on b/t any medical and psychological conditions the patient may have  Ex the medical condition could be moderating the psychological condtion, or vice versa  Axis IV: Psychosocial and environmental problems that the patient may be reporting o Ex: Marital problems, occupational problems, etc o The reason to include these is that they may be worsening your condition o Such factors need to be made aware of for proper treatment  Axis V: Current level of functioning o Psychiatrist offers a GAFF (Global Assessment of Functioning) reading of the patient  It’s a numerical score which summarizes the severity of impairment and disability in the patient o It’s a scale from 0-100  Somebody with 50 is likely showing pretty significant symptoms, ie cant go to work, can’t conduct extramarital relations  Someone with 75 or more is in the minimal range (higher is better health wise)  Someone with 30 or less is probably in the catatonic range – debilitated to the extent that they’re in a bed  Some significant limitations of the DSM  In order to render a diagnosis for depression, for example, assume that the DSM states that you need 5 symptoms that are present for a period of 2 weeks  What if the person had only 4 symptoms for 2 weeks and one of those symptoms was “I wanna kill myself, I will kill myself and I have a plan and know exactly how I’m going to kill myself” (some detailed suicidal thoughts) – Are they depressed? Absolutely.  This highlights a major problem with the DSM o There are obvious issues if only the number of symptoms is considered o The newest version of the DSM, the DSM-V (still in the works) will take the severity of symptoms into consideration as well when it comes to diagnosing a patient with a disorder Slide 7 – Diagnostic Categories  Turning now to some of the disorders we’re going to be talking about that can be found in the DSM  These disorders are first diagnosed in infancy, childhood, or adolescence o So they’re developmental disorders  However, we will only be looking at one of these in this class – Conduct Disorder  Conduct Disorder: a child who violates social norms and is generally up to no good more often than not o for ex: getting in trouble with the law at a young age  ***Prof says we’re considering this disorder because later on we’ll be looking into Psychopathy and Antisocial Personality Disorder  ***To be diagnosed with either of these, the presence of a conduct disorder had to be there first (exam question) 30:21 Slide 8 – Diagnostic Categories continued Substance disorder  ***A substance disorder only becomes a formal diagnosis when the substance abuse or dependence results in behaviour that is severe enough to interfere with regular daily activities and functioning o for ex when your alcohol abuse/dependence is significant to the extent that you’re no longer able to meet the demands of your job, it’s gotten you into trouble with the law (DUI), marital problems (physical abuse because of the alcohol) o only when the abuse or dependence reaches this level can it be diagnosed as a substance disorder Schizophrenia  These are ppl who have lost touch with reality, particularly when positive symptoms are present o Positive symptoms: are thoughts, behaviors, or sensory perceptions present in a person with a mental disorder like schizophrenia, but not present in people in the normal population. o Ex of a positive symptom: a hallucination which is a voice or visions which don’t exist in reality o Another ex is delusions: belief in ideas not based on reality o The presence of these positive symptoms is important for being able to differentiate Schizophrenia from Bipolar Disorder  Schizophrenia is also characterized by Negative symptoms o Negative symptoms: something that’s taken away from the patient’s personality that should be there o Whereas in positive symptoms, something is added on (ie visions that aren’t there, or voices) o Ex of Negative symptom: lack of motivation (removal of motivation), being unable to find pleasure in the things you used to do, being unable to speak and generate words, lack of emotion to things that should stir your emotions  Schizophrenics jump from displaying episodes where these positive symptoms are most present, to periods where the negative symptoms take over Mood Disorders – 3 major mood disorders  Major Depressive Disorder: symptoms associated with MDD include suicidal tendencies, loss of appetite/motivation, hopelessness, sadness o A key symptom he names is Comorbidity (the presence of more than one disorder) o Patients with MDD sometimes suffer from other disorders as well so treating them can be tricky o ie the individual could suffer from MDD plus an eating disorder.  Mania: someone suffering from this will have a euphoric sense of ability o In other words, they have unrealistic expectations. They feel like they can conquer anything o ie a Manic could say “well once I’m out of the hospital I’ll become the president, then fly to the moon, then once I come back I’ll become a surgeon, then I’ll go to law school so no one can sue me for any of my surgeries o So their expectations are unrealistic, but it’s important to notice that they aren’t impossible. These goals are unlikely, but still grounded in reality. o In other words, a patient with Mania hasn’t lost touch with reality, whereas someone with Schizophrenia often does  Bipolar Disorder: People who shift (sometimes rapidly) from being in a state of depression to being in a state of mania Slide 9 – Diagnostic Categories continued Anxiety Disorders (most common disorders)  Phobia: a fear that not only causes distress, but disability as well o You completely avoid what it is that you are phobic about o The person with the phobia often understands that their fear (say, of doorknobs) is irrational, but they can’t escape from their fear of it  Panic disorder: characterized by recurring severe panic attacks o Almost feels like you’re having a heart attack. Great number of physiological symptoms (heart racing, perspiration, tremoring) o Agoraphobia: a fear of leaving your home (public spaces) because you’re afraid that you’re going to have a panic attack  Generalized anxiety disorder: a constant worry that is all-encompassing. Worried and stressed about everything, and this worry is typically grounded in irrational thoughts o Similar to how much your mom probably worries about you o This overwhelming belief that something bad is going to happen to you  Obsessive-compulsive disorder: o An obsession is a recurrent thought or idea, or even an image that continuously dominates a person’s consciousness o This qualifies as an anxiety disorder because the fact that we’re obsessing over something, that we HAVE to do it, causes anxiety o To relieve this anxiety you have to fulfill the compulsion (ie wash your hands if that’s what you’re obsessing over) o The compulsion is the urge to perform a stereotyped act with the impossible purpose of extinguishing the anxiety from the obsession  No matter how many times you wash your hands, it won’t relieve the anxiety for good. You’ll obsess again soon after o Again, a lot of ppl with OCD understand their behaviour is irrational but still can’t do anything about it  Post-traumatic Stress disorder: The emergence of symptoms following a traumatic event o Symptoms include: flashbacks of the traumatic event, fear of the event happening again, anxiety of things related to the trauma, nightmares (where you relive the nightmare) o A psychiatrist treating the disorder is unable to place a value judgement on the severity of the patient’s trauma  ie if a patient experiences PTSD symptoms after breaking a wine glass, he or she is treated no differently than, say, a patient who has PTSD after being raped  as long as you suffer from the disorder, the event that caused it is considered a trauma to the patient and is treated as such by the psychiatrist  Acute Stress disorder: Exact same thing as PTSD, but the difference is that it doesn’t last as long Slide 10 – Diagnostic Categories continued Somatoform Disorders – these are interesting disorders because the physical symptoms that a patient will present with have no known physiological cause  So a person will show up at the Drs office, complain that their arm no longer works, but all of the testing that follows (ie x-rays) are negative and show no signs that they should be suffering from anything  In cases like these, the patient is diagnosed with a Somatoform disorder  The symptom then, (ie the non-working arm), is presumed to serve some sort of psychological purpose. The diff types of somatoform disorders are:  Somatization disorder: when a patient has a lot of those kinds of physical complaints o ie someone who’s likely visited their doctor numerous times, each time with a different complaint (ie colon problems, gastrointestinal problems) for which there is never a physiological cause o Why would someone go to the doctors continuously with these complaints? o Because they’re seeking attention. Why? Because they’re lonely. (will explore this more deeply later in course)  Conversion disorder: same as above, but this time it’s when a person presents with symptoms that are neurological, with no apparent cause o ie someone who suffers a paralysis, loss of vision, loss of hearing, etc o the symptoms have to be neurological  Pain disorder: someone who complains about having pain, but there’s no physiological explanation for the pain o ie head, butt, arm, legs, etc all hurt but no physiological reason for that pain o A pain disorder is almost always accompanied by anxiety (about making the pain worse), and depression (life sucks because I’m in pain)  The next one prof says he will spend some time on – probably important to know this one well  **Hypochondriasis: someone suffering from this is known as a hypochondriac. This is someone who is irrationally convinced that they’re suffering from an illness/disorder o ie if you read any of the above disorders and think “oh man I I have that, I know it” to the point that you become preoccupied and stressed about it even if the symptoms you experience are extremely minor o so you fear that minor bodily symptoms may indicate a serious illness to the point that you constantly perform self-examination and self-diagnosis o ie being convinced that you have a phobia of snakes because you would refuse to pet one. And then thinking you have generalized anxiety disorder because you begin to feel unsafe in your apartment after reading about
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