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PSYC 300
Lawrence Walker

9/12/2011 3:14:00 PM Multiaxial classification -Used in making a DSM diagnosis Axis I Clinical condition Mental disorder- same as DSM with exception of 2 (PERSONAL DISORDER, MENTAL RETARTATION) More than 1 diagnosis = comorbidity (not common) Axis II 1.Personality Disorders 2. Mental retardation tend to be ―life long‖ tend to be treatment resistant tend to affect all areas of functioning Axis III General medical condition Physical condition causes psychology problems General medical condition potentially relevant to understanding or management of the case. Axis IV Psychosocial and environmental problems 1. lack of housing 2. divorce 3. recent loss of job 4. legal problem (check-list) Axis V Global assessment of functioning (GAF) Rate 2 different domains 1 Psychopathology symptoms 1-100 2. Social and occupational functioning 1-100 lowest score of the two rating is the GAF Persistent danger of severe ….. On Axis I you may also list psychosocial + environmental problem Axis IV repeated IF the focus of current treatment NOS= Not otherwise specified ―Wastebasket‖ diagnosis NYD= not yet diagnosis Diagnosis deferred Case study Mr A and Mr B DSM Different possible classification system 1. Classical categorical system Not DSM, depression diagnosed if meet all of the following Sad checked, sleep checked, suicidal, energy down 2. Dimensional system Not necessary to assign a diagnostic label- just rare problem areas sad- severe, suicide-absent, energy- mild not in DSM 3. Prototypical DSM Is diagnosed if 2 of 4 are present 1.sad 2.suicidal 3. sleep What is considered a mental disorder changes over time - as our scientific understanding - as our social values changes - epilepsy is moved out, schizophrenia is probably moving out - homosexuality- sexual deviation, paraphilia ego-dystonic, homosexuality remains a diagnosis ego-dystonic, people don’t like their sex orientation (probably due to social pressure.) ego-syntonic: person likes the attribute identity with - - Egosyntonic is a psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self- image. - Egodystonic is the opposite of egosyntonic and refers to thoughts and behaviors (e.g., dreams, impulses, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person's ideal s[1]-image: 'some of the literature uses the term "ego alien"'. - 1987 DSM-III-R homosexual is gone. - - - Phrenology Early form if psychological assessment Mental health professions ―therapist‖ Psychologist PhD, Psy.D Psychiatrist MDs Medication Clinical psychologist Counseling psychologist Social, developmental -------------------------Psychotherapy Assessment methods of today 1. Presenting problem 2. Physical systems review 3. Mental status exam 4. History + current stressors 5. Medical exam+ current 6. Lifestyle past and present substance use profile 7. Tests 8. Clinical formation 9. Multiaxial diagnosis 10. Clinical preference and personal goal where possible background, interviews structured clinical interview (DSM) SCID The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) is a diagnostic exam used to determine DSM-IV Axis I disorders (major mental disorders) and Axis II disorders (personality disorders). Drawback: Not good for engagement Good for research purposes Semi-structured Unstructured 1. Engaging 2. time consuming 3. miss things Observation -clinical -self-monitoring -others- parents and teachers ADHD Tests Intelligence testing Intelligence quotient Wechsler Adult Intelligence Scales (WAIS) Wechsler intelligence for children (WISC) Individualized takes 2-3 hours A. verbal vocab, arithmetic, digit spam, information B. performance, block design, picture completion, picture arrangement verbal performance 9/12/2011 3:14:00 PM Wechsler Memory scale Cognitive function, dementia test, 1.Objective test - test has face value - obvious what eh test is asking about MMPI-2,MMPI-A Minnesota multiphasic personality inventory -most widely used -very good reliability+validity 500+ True/False questions 2 main types of scales  clinical scale  validity scale faking bad, a. for trail, malingering, b. forensic populations faking good Rating scales Most are self-report E.g. Beck depression inventory  quantify severity  objectively monitor progress some completed by others E.g. children behavior checklist Strengths of objective test o Most have good reliability and validity o Good for research as well as clinical practice Weakness Not useful for children and individuals with cognitive impairment Used by clinician with a cognitive or behavioral theoretical Orientation 2.Projective test  responses to an ambiguous stimuli Rorschach Inkblot test The dragon fly - may use a structured scoring system (e.g extern system) - forensic setting have moderate reliability validity(when formal scoring system is used) a lot of clinicians don’t use scoring – hypothesis generation  Thematic apperception test  Draw a house-tree-person Strength of projective test 1. good with certain population (e.g. kids, forensic) 2. good for hypothesis generation weakness - Little if any reliability and validity - In general, preferred by psychodynamic clinician The Mental status exam MSE  Seim-structured interview, interview----symptom  Observation--- signs Signs and symptom of current mental status Not Diagnostic For diagnosis -You need history, context, +possible causal factors Appearance dressing, skin, face, hypothesis generation Behavior, 1. Agitation (psychomotor) - movements that stem form mental stress - physical restlessness - psychological + physical tension - may see in depression, anxiety, dementia, psychosis - increase suicidal risk 2. Hyperactivity - increase movement - no psychological or physical tension - ADHD, manic, drug states 3. Akathisia - increase movement - state of inner restlessness. subjectively painful to stop - drug induced state antipsychotics antidepressants - highly suicidal risk 4.Psychomotor retardation - slowness of movement, often - depression, dementia, psychosis Cooperation 1.Speech  pressure of speech  manic state  stimulant use 2.Thought content and process Delusion- fixed false belief  inconsistent with cultural norms  not altered with proof to the contrary  Possible --------------------------------- impossible  Non-bizarre bizarre  Ego-dystonic-------------------------- ego-syntonic  (Dislike it) (like it)  type of delusion - paranoid delusion - grandiose delusion - jealous delusion - erotomanic delusion - somatic/body - thought broadcasting - thought insertion - thought withdrawal - action control - first develop ―idea of reference‖- ―delusion of reference‖- ―more systematic‖ like paranoid Obsession  recurrent+ persistent thoughts  always ego-dystonic  recognized as own thought  recognized as irrational  often followed by compulsions (some kind of ritualized behavior) Thought-process  normal Q—A  circumstantiality Q>>>>_____-----A digressive professions teacher, salesman, lawyers  Tangentialtiy Politicians, may also reflect start of thought process disorder  Flight of ideas, Bosely connected ideas Manic states Drug induced states high Often pressure of speech Ideas often thought to have great importance  Loose association No connection between thought Psychosis; dementia  Word salad: very severe states dementia psychotics  Clang association, base on sound e.g. rhyme, can be creative, can also be seen as personality disorder psychosis, bipolar  Echolalia, autism more severe dementia, psychosis etc. Echolalia is the automatic repetition of vocalizations made by another person. Affect Mood Perception Level of consciousness Insight + judgment Cognitive functioning Knowledge base Ending – suicidal, violence, homicide Reliability of the information - PSYC300A 9/12/2011 3:14:00 PM Psyc300A DSM-IV-TR th Diagnosis statistical manual 4 edition Developed by APA (American Psychiatric Association) Other system (almost all other countries) ICD-10 (international classification of diseases 10 ed) Developed by world health organization (WHO) DSM definition of a mental disorder 1. Clinically significant behavioral or psychological pattern 2. Associated with distress and disabilities 3. Considered to reflect dysfunction within individual (psychological or biological) 4. Not an expected culturally sanctioned response to a particular event (e.g. grief following by death of loved one) 5. Must consider what is the ―norm‖ within one’s culture. Example is the Chief in New Guinea tribe. 16 main categories of mental disorder Need to know 1. Disorder is usually diagnosed in infancy, childhood or adolescence Autism (pervasive development disorders) - Social interaction problems - Language development communication - Restricted+ ritualized behavior ADHD (attention deficit hyperactivity disorder) Mental retardation deficit intelligence + impairment in daily living 2. Delirium, dementia, amnesia, and other cognitive disorder Delirium- rapid onset disorientation Dementia- gradual onset of memory impairments and other cognitive disorder Amnesia: memory lost 3. Mental disorders due to as general medical condition (GMC) not else classified 4. Substance related disorders Disorder of use, - Abuse, - Dependence, - Disorders caused by use - Substance induced, after withdrawal still prominent 5. Schizophrenia and other psychotic disorder 6. Mood disorders - Major depressive disorder - Bipolar disorder 7. Anxiety disorders - Obsessive-compulsive disorder OCD - Social phobia 8. Somatoform disorders People have varied physical symptoms that have no identified physical origin. 9. Factitious disorder Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their care.Münchausen syndrome is an older term for Factitious disorder. People with this condition may produce symptoms by contaminating urine samples, taking hallucinogens, injecting themselves with bacteria to produce infections, and other such similar behaviour. They might be motivated to perpetrate factitious disorders either as a patient or by proxy as a caregiver to gain any variety of benefits including attention, nurturance, sympathy, and leniency that are unobtainable any other way. Somatoform disorders are characterised by multiple somatic complaints. [1] 10. Dissociative disorder AKA= multiple personality disorder DID= dissociative identity disorder 11. Sexual gender identity disorder - Sexual dysfunction - Paraphilia – fetishism - Pedophilia 12. Eating disorder - Anorexia (restricting distorted body image) –Bulimia (binge purge) 13. Sleep disorder -insomnia 14. Impulse control disorder -Pyromania -Kleptomania 15. Adjustment disorders Reaction is beyond what is expected (longer or more severe) In psychiatry, adjustment disorder (AD) is a psychological response to an identifiable stressor or group of stressors that cause(s) significant emotional or behavioral symptoms that do not meet criteria for anxiety disorder, PTSD, or acute stress disorder. The condition is different from anxiety disorder, which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder, which usually are associated with a more intense stressor. 16. Personality disorder Lifetime prevalence of mental disorder More common mental disorder Mood disorder (esp.: depression) Anxiety disorders Impulse control disorder Substance related disorder Age of onset Teens turn 20s 20% in the age of 15-29 experiences a mental disorder
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