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Lecture 3

Lecture 3.docx

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Konstantine Zakzanis

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Lecture 3: -DSM (diagnostic statistical manual)  important for following reasons: 1) Allows us to choose proper treatment 2) Allows us to communicate efficiently (describes symptoms & communicates treatment reliably) * has to be inter-rater reliability (2 ppl looking at something should come up with the same diagnosis, therefore enhances reliability) 3) Ability to differentiate between different disorders * clinicians oft asked to make differential diagnosis (overlapping symptoms, and then use symptoms from DSM to help make final diagnosis 4) Important for Research  facilitates the need for a title for the disorders, and allows researchers to use this as a guideline when trying to understand various illnesses/ contribute more information towards it - DSM not very statistical at all. Just has descriptive terms about what constitutes a certain disorder. - DSM clinically significant behavioural or psychological syndrome (a constellation of symptoms that typically occur together -> no one syndrome constitutes an a psychological disorder…number of syndromes which define the disease )or pattern that occurs in an individual. -Can dissect this def further (diff b/w behavioural and psychological impairment) - ex: guy with shirt experiment…should have felt anxious (but didn’t..) but anxiety is generally a psychological disorder (can’t see it) -ex: autism (behavioural disorder, can see it) -DSM specifies that it can be either or both - has to cause distress or disability OR increased risk of suffering death, pain, disability, or impt loss of freedom -DSM excludes: 1) a expectable and culturally sanctioned response to a particular event (ex: death of a loved one, feel depressed, frustration, irritability, loss of life interests) 2) deviant political, religious, or sexual behaviour (ex: fasting) 3) Conflicts primarily b/w indiv and society unless deviance or conflict is a symptom of a dysfunction in the individual -DSM provides 5 dimensions of classification: 1) Axis 1- all diagnostic categories (schizophrenia, major depression etc) – inside of front cover of textbook. 2) Axis 2- Personality disorders and retardation (ex: mental retardation) - inside front cover 3) Axis 3- general medical concerns (impt to know so treatment treats and doesn’t worsen any prior illnesses) also impt b/c it’s not unlikely that the medical condition is moderating the psychological condition (and vice versa) there’s an interplay b/w the 2– inside front cover 4) Axis 4- Psychosocial & environmental problems (ex: occupational/ academic problems that need to be made aware of before undergoing any treatment) 5) Axis 5- Current level functioning…get a GAF reading (a global assessment of functioning..a numerical score to explain the severity of impairment in disability, it’s a score from 1-100) (ex: 30 = really bad, 50= okay, 95= not too bad at all) Problems w/ Dsm- might ask for a display of 5 symptoms over a period of 2 weeks to be classified as something, but may still have that impairment with only 4 symptoms over a shorter period of time (in class example of suicide) -DSM V will discuss the depth and severity of symptoms as opposed to simply numbers (changed from categorical to dimensional) Example of disorders present in DSM Axis I: 1) Developmental disorders (usually diagnosed in infancy, childhood, or adolescence)  Conduct disorder- child who violates social norms more often than not.  Antisocial or psychopathic disorders can’t be diagnosed without the presence of a conduct disorder first. 2) Substance related disorders  Only becomes a formal diagnosis when the substance abuse or dependent (diff b/w dependence and abuse) results in behaviour that is severe enough to interfere with daily activities (person no longer able to meet job demands, getting into trouble with law, or marital problems)  Schizophrenia- ppl who have lost touch with reality particularly when positive symptom is present (ex: hallucination/ delusions) -> ex: vibi from bajans  Positive symptom- something that has been added to a person’s personality that should not be present because doesn’t exist in reality.  Schizophrenia also diagnosed by negative symptoms (something taken away from personality that should be there) ex: lack of motivation or inability to find pleasure in things you used to, or lack of emotion, or inability to speak (difficulty generating words) (etc).  Schizophrenic behaviour waxes and wanes from psychotic episodes (positives in personality) to remission (negatives in personality) 3) Mood Disorders: a. Major Depressive Disorder (ex of symptoms: suicide idolization, lack of motivation, loss of appetite, lack of hope, sadness, bizarre sleep patterns, comorbidity (presence of more than one disorder) more often than not, patients have comorbidity. Comorbidity is crucial because it affects how you would treat someone…likelihood of positive outcome not as good as someone with only one disorder) b. Mania- euphoric sense of ability (feel like they can conquer anything) and have unrealistic aspirations i. Ppl w/ mania are still grounded w/in realms of reality whereas schizo ppl are no longer w/in realms of reality c. Bipolar disorder- ppl who shift in moods quite often from manic to depression 4) Anxiety Disorders (most common): a. Phobia- irrational belief of something & person is aware that it is irrational. avoid wtv you are phobic of, but can cause distress and disability if unable to avoid it (clowns easier to avoid than person phobic of elevators or people) b. Panic disorder- feels like a heart attack (sweating, shaking) often need to be hospitalized i. Agoraphobia- fear of leaving your home b/c you feel like you will have a panic attack c. Generalized anxiety disorder- worried and stressed about everything (irrational belief that something bad is always going to happen) ex: mothers d. OCD- obsession is a reoccurring thought or image that continuously dominates a person’s consciousness. (leads to compulsion which is the urge to perform a stereotypical act with the impossible purpose of relieving the anxiety, only provides one with momentary relief before obsession begins again) e. Post-traumatic stress disorder- feeling a constellation of symptoms after a traumatic event. Ex of symptoms, depression, flashbacks, fear of event happening again, anxiety, dwelling on event, nightmares, inability to talk about it properly. Example of traumatic event: soldiers after war i. Therapists not allowed to place value judgement on traumatic event (ex: wine glass breaking can still be a traumatic event if symptoms of post traumatic stress disorder are still present f. Acute stress disorder-acute means it just happened, very fresh in the mind. Chronic is the opposite, persists over an extended period of time. 5) Somatoform disorders (the physical symptoms patient presents w/ has no known physiological cause) (ex: patient complaining about arm not working, but all tests (xrays) come up negative, default diagnosis= somatoform) a. Somatisation disorder (person w/ a lot of these kinds of physical complaints with no physiological cause) possible reason: attention (lonely?) b. Conversion disorder (person w/ a lot of complaints, but they are neurological in origin loss of sense, paralysis of body part..but again, no physiological causes) c. Pain disorder (somebody who complaints of pain or the perception of pain, but no cause for that pain, pain disorder almost always accompanied with anxiety (what if I do something to make it worse) and depression (life sucks cause I’m in pain) i. Diagnosed as both medical and psychological causes d. Hypochondriasis – someone who reads something and thinks they have the illness they are reading about. (LOL @ former student’s emails to prof. Definitely has
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