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Lecture 3

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Mark Schmuckler

PSYB32 – Lecture 3 Prof’s Speech - Purple Slide 3 – Classification and Diagnosis - Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) o American Psychiatric Association o Nothing statistical about the manual, has descriptive terms of what constitutes particular disorders o Text is used by psychiatrists, psychologists, and physicians to formulate/render a diagnosis o Important to have a text like this:  In order to prescribe the right treatment  It allows us to communicate a diagnosis efficiently and reliably (when 2 people look at something, they should come up with the same term)  allows for differential diagnosis; differentiate between different disorders  differential diagnosis – when a patient comes in, may have a number of disorders that may have a lot of overlap in symptoms; weigh all possible diagnoses  for research Slide 4 – DSM-IV Definition of Mental Disorder - A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual o Syndrome – constellation of symptoms; no one symptom defines a disorder o Causes distress (concern for the individual, makes them feel uneasy, want to do something about it) or disability (disabling you from some sort of activity of daily living) o Causes a significantly increased risk of suffering death, pain, disability, or an important loss of freedom o Psychological impairment: ex. Anxiety; construct – cannot be seen o Behavioural impairment: can see the impairment taking place Slide 5 - Excludes: o An expectable and culturally sanctioned response to a particular event  Ex. Loss of loved one, although you may feel sad, frustrated, it is not a disorder because it is an expected response o Deviant behaviour  Ex. Fasting for religion o Conflicts that are primarily between the individual and society (unless the deviance or conflict is a symptom of a dysfunction in the individual)  Ex. Occupy movement Slide 6 – Diagnostic System of the American Psychiatric Association (DSM-IV) - Five dimensions of classification o Axis I – all diagnostic categories (ex. Schizophrenia, major depressive disorder) o Axis II – personality disorders and retardation (ex. Narcissism, mental retardation) o Axis III – general medical conditions (important because want to know if prescribing medication will affect existing conditions and that it is not likely that the medical condition is regulating the psychological condition and vice-versa) o Axis IV – psychosocial and environmental problems (ex. martial problems) o Axis V – current level of functioning (offer a GAF reading (Global Assessment of Functioning) which is a # score that tries to describe the severity of the impairment) Slide 7 – Diagnostic Categories - Comorbidity: presence of more than one disorder o Almost rare to find someone without comorbid disorder o Likelihood of positive outcome is not as good as if patient only had one disorder - Disorders usually first diagnosed in infancy, childhood, or adolescence (developmental disorders) o Separation anxiety disorder o Conduct disorder  Presence of conduct disorder has to be there first in order to be diagnosed with antisocial personality disorder or psychopathy  When a child violates social norms, up to no good more times than not o Attention-deficit/hyperactivity disorder o Mental retardation o Pervasive developmental disorders o Learning disorders Slide 8 – Diagnostic Categories - Substance-related disorders o Only becomes formal diagnosis when substance abuse/dependence results in behaviour severe enough to interfere with activity of daily living functioning o Abuse ≠ dependence o Can result in martial problems, occupational problems - Schizophrenia o People who have lost touch with reality particularly when positive symptoms are present o Positive symptoms ex.: hallucination; something added to personality that doesn‟t exist in reality, ex. Delusion: belief not based in reality o Negative symptoms characterize periods of remission; something is taken away from personality that should be there, ex. A lake of motivation, lack of ability to speak, lack of emotion - Mood disorders o Major depressive disorder  Symptoms: suicidality, lack of motivation, lack of appetite, hopelessness, abnormal sleeping patterns, sadness, denial  Because of stigma – people may deny saying that they are sad o Mania  Person with mania will have euphoric sense of ability; feel they can conquer anything, have unrealistic expectations but still within realms of reality  Also has „down‟ episodes, but degree to which is the question – high degree could mean a bipolar diagnosis instead o Bipolar disorder  Experience both lows of depression and highs of manic condition  People will shift, sometimes rapidly, sometimes slowly, from the 2 states  A.k.a. manic-depressive disorder - Anxiety disorders – most common o Stress – manifestation of anxiety o Phobia  Fear that causes personal distress and disability; person avoids what it is he/she is phobic about  For more extreme phobias (i.e. people) – the person knows it irrational, but can‟t help trying to escape from it, resulting in disability o Panic disorder  Has panic attacks – like having heart attack to the extent that you feel you have no control over the environment  Agoraphobia  Fear of leaving home because of fear of having panic attack o Generalized anxiety disorder  Constant worry typically grounded in irrational thoughts o Obsessive-compulsive disorder  Obsession – recurrent thought or idea or image that continuously dominates a person‟s consciousness  Compulsion – urge to perform stereotype act with impossible purpose of extinguishing anxiety from the obsession o Post-traumatic stress disorder  Feeling constellation of symptoms after traumatic event  Symptoms: sadness, flashback, fear of event happening again, anxiety  Examples after which post-trauma can occur: war, rape, car accident  Therapist is not allowed to place value judgement on traumatic event o Acute stress disorder  Same as post-traumatic, but does not last as long - Somatoform disorder o Physical symptoms patient has have no known physiological cause, the symptom is there because it presumably serves a psychological purpose o Somatization disorder  Patient has a lot of physical complaints, but no known physiological cause  Go to doctor continuously – seeking attention o Conversion disorder  Patient presents with neurological symptoms (i.e. sense of smell, sight) with no physical cause o Pain disorder  Patient complains of (perceptions of) pain, but no physiological cause, accompanied with anxiety and depression o Hypochondriasis  Someone who reads about the symptoms of a disorder and believes that they are affected by that disorder o Body dysmorphic disorder  Patient is preoccupied with part of body that he/she feels is inadequate - Dissociative disorders o Least common, don‟t know a lot about these disorders o Psychological dissociation or sudden alteration in consciousness that affects memory and
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