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Lecture 3

Lecture 3 on DSM

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University of Toronto Scarborough
Konstantine Zakzanis

 DSM was made to statistically diagnose mental disorders in a biomedical paradigm o Problem: there is nothing statistical about it. It is not reliable, and psychiatric illness does not always have a biological reason. o Different revisions throughout the year o DSM III was used the most, as there were some specific criteria that were set out in it to diagnose illnesses. Allowed reliability for clinicians, allowed people to research disorders and talk about them as they were more reliable now.  DSM-IV definition of mental disorder o A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual. There has to by symptoms present.  Includes present distress or disability, or  Includes a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.  Symptom—experiencing depression or sadness, not really affecting daily lifestyle abilities.  Disability—affects daily lifestyle abilities o Excludes  An expectable and culturally sanctioned response to a particular event.  E.g. grief or mourning brings loss of pleasure, social withdrawal. If these symptoms are taken out of context, they would qualify for mental disorder, but they are an expected reaction to the event.  E.g. fasting and losing weight due to cultural reasons. Losing that much weight can qualify for anorexia nervosa, but since it is culturally accepted, it is not a mental disorder.  Deviant behaviour  E.g. homosexuality. Deviant as it is not the norm, but it is not mental disorder  Conflicts that are primarily between the individual and society (unless the deviance or conflict is a symptom of a dysfunction in the individual)  E.g. abortion activists  E.g. homelessness  Diagnostic system of American psychiatric association (DSM-IV) o Five dimensions of classification  Axis I—all diagnostic categories (front inside cover of textbook)—major mood disorders, psychotic disorders, substance abuse disorders  Patient can have more than one Axis I disorder, making them much harder to treat o E.g. patient may have a pain disorder, an adjustment disorder and post-traumatic stress disorder. o Comorbidity—more than one formal diagnostic disorder present. The more they have, the harder it is to treat the person. The more comorbidity, the more disability the patient has.  Axis II—personality disorders and retardation (front inside cover of textbook)— schizophrenia, personality disorders.  If patient has an Axis I and Axis II disorder, they are much harder to treat  Axis III—general medical conditions—cancer, high blood pressure, previous stroke, etc. important to list these because they may have implications during treatments with medicines.  Some Axis III disorders can mediate Axis I disorders o E.g. if patient has cancer and post-traumatic stress disorder, some of that stress may be coming from cancer issues.  Axis IV—psychosocial and environmental problems (back inside cover of textbook)—homelessness, job loss, financial strain, loss of independence, etc.  These may also mediate Axis I disorders  Axis V—current level of functioning (back inside cover of textbook)—GAF scale goes from 0-100 with respect to person’s disability in daily living  50 means having disabilities in family relationships, etc.  90 means healthy  0 means dead.  Reliability is poor; no two doctors would come up with the same score on the GAF scale.  Diagnostic categories o Disorder usually first diagnosed in infancy, childhood or adolescence  Separation anxiety disorder  Conduct disorder—must be present in order to diagnose anti-social personality disorder.  Attention deficit/hyperactivity disorder  Mental retardation  Pervasive developmental disorders  Learning disorders o Substance-related disorders  One is not diagnosed with substance-related disorder unless the substance use causes the person to have problems at work and in social life.  Difference between abuse and dependence dependence is defined by two key symptoms—tolerance (needing more and more and more to get the same buzz) and withdrawal (once you cut out the substance you start to feel other symptoms). o Schizophrenia  NOT multiple personality disorder  A person who experiences positive symptoms (things that are added onto personality)—e.g. hallucinations, delusions (a strong belief in something that is not based in reality, e.g. where patient thinks they are God, they think they are aliens, they think people around them have been replaced around them, they think they have superhuman powers); and negative symptoms (personality symptoms that are removed from personality—e.g. loss of motivation, speech will be dramatically empty, disorganised thoughts, no pleasure in normally pleasurably things, apathetic and depressed looking.  Disorder has acute episodes (positive symptoms) and remission (negative symptoms). This becomes a cycle.  One of the most crippling disorders o Mood disorders  Major depressive disorder  Characterized by loss of appetite, sadness, and feeling of hopelessness, crying, and loss of sex drive. Five out of ten symptoms need to be present for at least two weeks o Problems: if patient only had four symptoms which were suicide, feelings of worthlessness, depression and starvation due to loss of appetite, should patient be treated? o DSM V has removed these criteria for diagnosing illness.  Mania  Incredibly euphoric feelings, boundless energy, get a lot done, typically doesn’t sleep. Results in person being incredibly disorganized and talking like a maniac. Delusional (but all delusions based in reality, i.e. saying they will become a doctor, then an astronaut, then the president, then a terrorist, then a singer, etc.)  Bipolar disorder  Diagnosis for bipolar evolves over time o E.g. a patient arrives with depression and is given anti- depressants; six months later patient arrives with mania. o Anxiety disorders—most common. Some sort of irrational fear as central feature.  Phobia  Has to be a specific trigger for it  If confronted by stimulus, panic attack occurs  Difference between phobia and panic
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