Lecture 1

Question 1

Class Structure will deal with psychopathology in terms of the following schema

Answer 1

Diagnostic criteria –> DSM 5 diagnosis

Etiology –> What caused this mental illness using a BioPsychoSocial model

Treatment –> From a BioPsychoSocial perspective

Question 2

Once licensure is obtained what are we allowed to do?

Answer 2

Call yourself a psychologist

Licensed to diagnose and treat mental disorders

Question 3

Who decides who has a mental disorder & how?

Answer 3

A licensed psychologist using the DSM-5

Question 4

DSM I

Answer 4

1952 W.H.O developed a classification for psychiatry

• APA tried to change it for their own
• All terms became psycho-analytic (Freud-influenced)
o Thus a theory-based diagnostic manual → DSM-1
• Everything in it was neurosis or psychosis (i.e. if depressed, it was depressive-neurosis)
-Neurosis: people who have contact with reality but it’s maladaptive
-Psychosis: break with reality

Question 5

World Health Organization (WHO)

Answer 5

Based out of Geneva, Switzerland

Big organization that defines all mental illnesses for the world

Use the ICD (International Classification of diseases)
World uses ICD-10 (will go to ICD-11)
America uses ICD-9 (will go to ICD-10 in Oct)

Question 6

Basic History of Mental Illness

Answer 6

Mental Illness was thought to be a form of demon possession & witchcraft (medieval)

People were throwing into snake pits, dunking tests, and burned/killed

Hysteria (comes from hysterical) was thought to be from the womb –> people believed that the womb had been loosened & was moving around their body

Classified as idiots, imbecil & morons

Question 7

Important information for understanding diagnosis & DSM

Answer 7

• Mid-late 1800: physicians began to give names to symptoms that they would order into syndromes
• Symptom → 1 part of behavior that doesn’t necessary make a diagnoses (i.e. saying you’re depressed does NOT denote clinical depression or major depressive episode)
• Syndrome→ have up to 9 symptoms to classify

Question 8

Major Depression

Answer 8

• 9 symptoms to qualify..
• must have at least 5
• Must have depressed symptoms for a min. of two weeks
• 5 of 9 symptoms – “MILD” (when sx’s aren’t severe)
• More sx’s and/or increased severity → moderate or severe or major depression with psychotic features
o Some may develop delusions or hallucinations

Question 9

Controversy/major issues about DSM-5

Answer 9

• Was promised to be heavy science & research based & include many discoveries in the areas of psychopathology (since ’94) ie. Genetics, brain imaging, etc → didn’t include it
• Some illness are caused by genetics, experience altering brain fcn & structure (PET & fMRI) but none of that information made it in the book
• No longer require IQ test to determine intellectual ability because they’re not really reliable (should also include fcn competency of the person)

Question 10

DSM Diagnoses

Answer 10

All codes will be alpha numeric (next October)
1st three numbers: category of classification (i.e. major depression 296)
After decimal: qualifying codes (i.e. major depression single-episode 296.2)
5th digit: level of severity of disorder (1-7; mild, moderate, severe, severe with psychotic features, partial remission, full remission, etc)

Note: As you get older, you become less resilient … thus older individuals who’s resiliency has diminished tend to have depression with psychotic features 296.34

Question 11

Hallucinations refer to the senses

Answer 11

• Tactile → ie hands touching you
• Auditory
• Verbal
• Olfactory/gustatory → smell & taste

Question 12

Delusions

Answer 12

A psychotic thought process

I.e. people are trying to kill me

Question 13

Psychotic

Answer 13

A break from reality

I.E. people who experience hallucinations & delusions are considered psychotic

Question 14

Emil Kraeplin

Answer 14

began to find words to give names to the different mental disorders that he saw

• provided a number of terms that laid the foundation of diagnostic schemes
• 1st person to call schizophrenia → dementia precaus (precocious dementia .. happens earlier in life)
o When Frued came along … they changed to Greek
o Schizophrenia → Split (schiz)-mind(phren) meaning fcn’s of mind have begun to split off from each other

Question 15

3 primary components of personality

Answer 15

Feelings (Affect)

Behaviors (Volitional)

Thoughts (Cognitions)

Question 16

DSM-II

Answer 16

1972 (Dr. Strozier trained on it)

• spiral bound & very thin
• a little more scientific
• neurosis or psychosis and still theory based

Question 17

DSM-III

Answer 17

• major paradigm shift
• multi-axial diagnosis implemented
• began to move towards evidence/scientific based diagnosis
• left theory of psychoanalysis behind
o no longer had everything only being neurosis or psychosis
o instead included highly specific names for highly specific disorders from psychiatrists
o new diagnoses such as PTSD — typically indicative to combat
• began to develop specific criteria for different mental disorders

Note: before DSM 3 .. if you called someone “crazy” or “having a mental illness” loosely based on variables i.e. diff culture, violate social norms, behave differently, is what they’re doing making them uncomfortable subjectively, is it impairing their fcn in some way
• If something is apart of a cultural norm… it is not a disorder
• Frequently, people feel subjectively uncomfortable …although they may not always be able to tune into that or access that information
 I.e. the example of the man with the fecal matter in his nose…he didn’t FEEL sad (dysphoria)

Question 18

Multi-Axial Diagnosis

Answer 18

Axis I: Psychiatric Diagnosis → what is the reason for people coming (principle disorder)
• Diagnosis based on mental status exam (clinical interview) and any psych testing
• During mental status exam → operationalize diagnosis/symptoms for patients (i.e. have you given up things that used to make you happy…)
• When you assign a diagnosis → you have to put in the notes why you gave the diagnosis (ie symptomatology)

Axis II: Personality Disorder &/or Mental Retardation (no longer exists)→
• What happens when someone has something going on but it’s typically how they’ve always been … aka a state-of-being (instead of an illness progression)
• Mental retardation (no longer exists) ..has become intellectual disabilities (mild, moderate, severe, profound→ are assessed based on scores on scales of competencies)
• Personality Disorder → etiology is not always conclusive
 May have something to do with genetics but mostly to do with life experiences in early formative years
 Not diagnosed until 18 years of age
• Don’t want to label children
• Have to give personality to develop (prefrontal cortex doesn’t mature until 25 years of age)
 Personality → relatively enduring state of traits, behaviors & characteristics of a person
 those with personalities do not learn from experiences

Axis III: Medial or Neurological Problems →
• What disorders, illnesses, accidents, doctors seen, treatments, medications

Axis IV: Psychosocial Stressors → (No longer exists)
• Typically numbered from 0-7 in DSM-III
• DSM-IV categorized them into 8 categories (i.e. primary support group, occupational fcn, access to health-care, finances, etc)
• Imp. To note the types of stressors & the degree of stress they are experiencing

Axis V: Level of fcn → using GAF (global assessment fcn’ing) 0-100 scale (No Longer Exists)
• DSM III it was on 1-90 scale

o Encouraged to think in terms of where are they fcn’ing
o & ADL (activities of daily living) ability (compare to the previous ADL score)
• 91-100 → Superior fcn
• 81-90 → Absent or minimal sx’s
• 71-80 → If sx’s present, they are transient & expectable reactions to psychosocial stressors; no more than slight impairment
• 61-70 → Some mild sx’s or difficulty
• 51-60 → Moderate Sx’s or difficulty
• 41-50 → Serious sx’s or impairment
• 31-40 → some impairment in reality testing or communication or major impairment
• 21-30 → behavior is considerably influenced by delusions or hallucinations
• 11-20 → some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication
• 1-10 → persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death

Question 19

Stress Diathesis Model

Answer 19

• Always keep in mind the stress diathesis model = ppl may be born genetically predisposed to medical or mental conditions & those may or may not occur
o Mixture of genes & stress
o If you’re stressed enough for a long period of time → you may activate the gene
• Have to assume that stress maybe apart of the etiology for the condition

Question 20

Haan Selye’s 3 stages of stress (Father of modern stress research)

Answer 20

• Alarm: martial defenses to deal with it
• Resistance: no longer a shock but becomes apart of your everyday life & you’re doing the best you can to manage … until you either learn how to manage it or get out of it
• Exhaustion (final stage): lose the ability to cope with the stress & the diathesis process takes effect

Stress= non-specific response of an organism to a demand for change

• Discussed eustress & distress

Note: Those with schizophrenia cannot tolerate stress
Note: People have different optimal levels of stress
• SRRS (Social Readjustment Rating Scale) = getting a divorce is only slightly more stressful than getting married

• During mental status exam…it’s important to work quickly for stress management (immediate plan –ie counseling-; treatment plan ; etc)

Question 21

STANDARD OF CARE

Answer 21

every patient seen should have adequate medical care
• i.e. ask who the primary care physician is & when last complete physical exam was
o not AS imp with ppl under 40 but def. 40+
o If they don’t → “therapy is about helping you to learn how to care for yourself better, apart of learning to care for yourself better is learning to care for your body as well as your mind…if you have a PCP that you haven’t seen in a long time I need for you between now & our next appointment to call and schedule an appointment for a physical — if you don’t have one… get a recommendation & become an established patient of them and get a physical”
o “80/20 rule” ←
• Medical masquerade (can disguise themselves as something else)
 Ie. Hyperthyroidism : don’t tend to have sx’s … can often express through psych symptoms … hair can begin to thin, be hot/cold,
• Can be thought to be depression
o If you’re doing a mental status exam & the patient is under 18yo → you must include a developmental history
• Interview & consent from parents
• & dev. History from parents
o You should also get dev. History from adults

Question 22

What regulates our behavior & emotions?

Answer 22

• Central Nervous System (what’s happening with brain & neurons)
• Endocrine System (what’s happening with glands)
o Importance: pituitary/thyroid

Question 23

Split-treatment model

Answer 23

many patients should be seeing both a psychologist/psychiatrist & MD

Question 24

Note about Diagnosing

Answer 24

• If you’re seeing a pt and you feel as though you have a good diagnosis & treatment plan & they should be getting better but they’re not…. ALWAYS look for 3 things

1. Brain damage or disease
2. Substance abuse
3. Personality disorder (one definition = people don’t learn from experience…. Ie hit yourself in the hammer and you should learn not to do it again… someone with PD would continue to do it

Question 25

Cog Testing History

Answer 25

1st IQ test → Binet to sort out children with intellectual problems from children without
Lewis Termin (Standford) → “beefed it up” began Sanford-binet

Wechler (@ Bellview hospital in NY) …took a lot of tests & put them into a standard test battery (some of the sanford-binet & army alpha & army beta)
• Administered across diff. ages & groups
• Used bellcurve & norms