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Lecture 3

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Department
Psychology
Course
PSYB32H3
Professor
Konstantine Zakzanis
Semester
Fall

Description
PSYB32- Lecture 3  Classification and Diagnosis- Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)  Specific diagnostic criteria for each disorder is found in the DSM  Classification was based on the medical model, and not until 1948, when the ICD (international classification of diseases) came out; it names all the different medical disorders out there and includes all the psychiatric disorders but did not do a good job spelling out psychiatric disorder  Thus, the first DSM was developed in 1952; the first couple issues did not really have any reliability or validity because there was no specific diagnostic criteria (only included names of disorders), very difficult for two different clinicians to come to the same diagnostic opinion for the same person  Not until 1980 and the introduction of DSM-III, that the multi-axial classification was developed  Specific symptoms that went with each disorder were provided; certain number of symptoms for a certain period of time  Goal was to improve the reliability of a diagnosis; the problem that still persists today is that it is still based on the medical model, symptoms listed are markers for the disease  Issue with DSM and psychiatric disorders is that there are no markers for disorders, thus some argue that we are really dealing with hypothetical constructs  Thus reliability is still an issue when it comes to making a diagnosis according to the DSM  A great deal of subjective opinion is also involved because DSM is based on categorical model of diagnosis (certain number of symptoms to be something)  DSM-V has proposed a dimensional approach to psychopathology and diagnosing it, in other words, a host of different symptoms that can or may not be present in terms of breadth and severity  Three forces that take disorders away from the DSM: generational, political, awareness  DSM-IV definition of mental disorder: a clinically significant behavior or psychological syndrome or pattern that occurs in an individual; includes present distress or disability, or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom  Personal distress, disability or dysfunction, violation of norms, unexpectedness, statistical infrequency  DSM excludes an expectable and culturally sanctioned response to a particular event such as bereavement, also excludes deviant behavior (political, religious, sexual), and conflicts that are primarily between the individual and society (unless the deviance or conflict is a symptom of a dysfunction in the individual  Diagnostic system of the APA: Five dimensions of classification  Axis I- all diagnostic categories (front inside cover of your textbook), major mood disorders, those who meet diagnostic criteria on axis I are typically those who seek treatment  Axis II- personality disorders and retardation, those who don’t usually seek treatment  Axis III- general medical conditions because they often moderate the breadth and severity on axis I or II (cancer patient with depression)  Axis IV- psychosocial and environmental problems that can also be moderating the breadth and severity of the axis I diagnosis (losing a job, divorce)  Axis V- current level of functioning, gives us a more qualitative description on how well the person is engaged in the actions of daily living  To make a diagnosis, only the first two are required and usually the thorough clinicians list axis 3,4,5 information on here  Global Assessment of Functioning (GAF)  Disorders usually first diagnosed in infancy, childhood, or adolescence: separation anxiety disorder, conduct disorder, ADHD, mental retardation, pervasive developmental disorders, learning disorders ; all of these disorders can moderate clinical presentation and test findings later on in life  Substance-related disorders- substance abuse diagnosis and a substance dependence diagnosis; key to understanding the difference between the two is that if someone is dependent it must impair on their social or occupational functioning, in other words, there must be a disability present; also present in dependence would be tolerance and withdrawal  Schizophrenia is characterized by someone who has lost touch with reality, and symptoms are both positive and negative symptoms, basically people who experience hallucinations, delusions, the belief of that something that is impossible, and negative symptoms are something that are taken away from their personality such as lack of motivation and inability to enjoy anything that is pleasurable  Mood disorders: there are two different kinds that we will talk about in this course- major depressive disorder which is somebody who’s mood is characterized by depressed feelings, helplessness, hopelessness, lack of motivation, suicidality – mania is quite opposite of depression, heightened sense of energy, thought disorder, - bipolar disorder is the shuffling between both of these extremes, experience depression and manic like symptoms  Anxiety disorders- have the greatest incidence/prevalence rate, all have some form of irrational or overblown fear as the central disturbance, and there is awareness of this irrationality  Person will recognize that it is unreasonable and unwarranted, and it disrupts their life in some way  Panic disorder- when there is a heightened sense of anxiety to the extent that you will see physiological symptoms of anxiety (tremor, perspiration, etc), intense, sudden  Agoraphobia- fear of leaving your home or any other kind of familiar place  Generalized anxiety disorder is when the sense of panic is not sudden, but just a pervasive, always present sense of anxiety, worry that something bad is going to happen,
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