3.-Diagnosis-and-assessment.pdf

DIAGNOSIS AND CLASSIFICATION OF PSYCHOLOGICAL PROBLEMS  TOPIC OUTLINE ▪ What is abnormal behavior? ▪ Mental Illness ▪ DSM IV-TR, DSM V & ICD ▪ Causes of Abnormal Behavior and Mental Illness ▪ What is abnormal behavior? ABNORMAL BEHAVIOR ❑ Why abnormal behavior hard to defi...

DIAGNOSIS AND CLASSIFICATION OF PSYCHOLOGICAL PROBLEMS  TOPIC OUTLINE ▪ What is abnormal behavior? ▪ Mental Illness ▪ DSM IV-TR, DSM V & ICD ▪ Causes of Abnormal Behavior and Mental Illness ▪ What is abnormal behavior? ABNORMAL BEHAVIOR ❑ Why abnormal behavior hard to define? ✓ No single descriptive feature is shared by all forms of abnormal behavior, and no one criterion for “abnormality” is sufficient. ✓ No discrete boundary exists between normal and abnormal behavior. ❑many individuals still equate abnormal behavior with: ✓ bizarre behavior ✓ dangerous behavior ✓ shameful behavior ❑three proposed definitions of abnormal behavior a. Conformity to norms b. The experience of subjective distress - c. Disability or dysfunction  The Case of Juanita L. Juanita seemed to have a normal childhood. She made adequate progress in school and caused few problems for her teachers or parents. Although she never made friends easily, she could not be described as withdrawn. Her medical history did not reveal any obvious signs of physical problems. When Juanita entered high school, changes began. She combed her hair in a very severe, plain style. She chose clothing that was quite ill-fitting and almost like that worn 50 years ago. She wore neither makeup nor jewelry of any kind. Although she would have been hard to distinguish from the other girls in her class earlier, she now stood out.  Juanita’s schoolwork began to slip. She spent hours alone in her room reading the Bible. She also began slipping notes to other girls that commented on their immorality when she observed them holding hands with boys, giggling, dancing, and so on. She attended religious services constantly; sometimes on Sundays she went to services at five or six separate churches. She fasted frequently and decorated her walls at home with countless pictures of Christ, religious quotations, and crucifixes. When Juanita finally told her parents that she was going to join an obscure religious sect and travel about the country (in a state of poverty) to bring people Christ’s message, they became concerned and took her to a psychiatrist. Shortly afterward, she was hospitalized. Her diagnosis varied, but it included such terms as schizophrenia, paranoid type; schizoid personality; and schizophrenia, undifferentiated type. 1 CONFORMITY TO NORMS ▪ a person’s behavior becomes patently deviant, outrageous or nonconforming ▪ statistical infrequency or violation of social norms Advantages: 1. Cutoff points 2. Intuitive appeal 1 CONFORMITY TO NORMS Disadvantages 1. Choice of cutoff points 2. The number of deviations 3. Cultural and developmental relativity 2 SUBJECTIVE DISTRESS ▪ subjective feelings and sense of well-being. ▪ crucial consideration: whether the person feels tranquil/ troubled, happy/sad, fulfilled/barren. Advantages: 1. reasonable to expect that individuals has capacity to assess their emotions or behaviors and can share information when asked. Disadvantages: 1. Not everyone that we consider to be “disordered” reports subjective distress. 2. amount of subjective distress necessary to be considered abnormal. 3 DISABILITY, DYSFUNCTION or IMPAIRMENT ▪ for behavior to be considered abnormal, it must create some degree of social (interpersonal) or occupational problems for the individual ▪ whether a behavior causes a dysfunction in everyday activities. Advantages: 1. Little inference is required, problems in the social and occupational spheres often prompt individuals to seek out help. Disadvantages: 1. Who should judge the standard for dysfunction? 2. How to agree on what specifically constitutes an adequate level of functioning? 4 DANGER ▪ Whenever an individual poses a risk of danger to herself or others, then its most likely that she is abnormal. ▪ However, this variable doesn’t occur in every case of abnormality, as many psychological pathologies don’t result in suicide or homicide. ▪ Though its an exception instead of a rule, any threat to kill or harm ones self or others is definitely a vivid red flag. KEY POINTS ▪ Abnormal behavior does not necessarily indicate mental illness. ▪ Mental illness refers to: “a large class of frequently observed syndromes that are comprised of certain abnormal behaviors or features”. DSM IV-TR ▪ …is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability or important loss of freedom. MENTAL ILLNESS (DSM-IV-TR) ▪ In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. MENTAL ILLNESS (DSM-IV-TR) ▪ Neither deviant behavior (e.g., religious, political, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of the dysfunction in the individual as described above. IMPORTANT POINTS: a. The syndrome (cluster of abnormal behaviors) must be associated with distress, disability, or increased risk of problems. b. A mental disorder is considered to represent a dysfunction within an individual. c. Not all deviant behaviors or conflicts with society are signs of mental disorder. IMPORTANCE OF DIAGNOSIS The diagnosis of mental disorders is an expert level of categorization used by mental health professionals that enables us to make important distinctions. Diagnosis consists of two intertwined tasks: -determining the nature and source of a person’s abnormal behavior. -classifying the behavior pattern within an accepted diagnostic system. Advantages: -Communication -Empirical research in psychopathology -Research into etiology of abnormal behavior -Suggest which mode of treatment is most likely to be effective FOUR MAJOR ADVANTAGES OF DIAGNOSIS 1. Communication: A wealth of information can be conveyed in a single diagnostic term. Diagnosis can be thought of as “verbal shorthand” for representing features of a particular mental disorder. Using standardized diagnostic criteria ensures some degree of comparability with regard to mental disorder features among patients diagnosed across situations. FOUR MAJOR ADVANTAGES OF DIAGNOSIS 2. Empirical research in Psychopathology The way diagnostic constructs are defined and described will stimulate research on the disorders’ individual criteria, on alternative criteria sets, and on the comorbidity between disorders. 3. Research into etiology of abnormal behavior 4. Suggest which mode of treatment is most likely to be effective THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS ▪ published by the American Psychiatric Association ▪ DSM-IV (fourth edition) or DSM-IV-TR (fourth edition, text revision) contains descriptions of all psychological disorders/mental disorders THE FIVE AXES OF DSM-IV-TR 1952 DSM (a.k.a. DSM-I) Axis I Clinical Disorders 1968 DSM-II (based on ICD) Axis II Personality Disorders and 1980 DSM-III (more quantitative, objective) Mental Retardation 1987 DSM-III-R Axis III General Medical Conditions 1994 DSM-IV Axis IV Psychosocial and 2000 DSM-IV-TR (multi-axial system) Environmental Problems 2013 DSM V (single line diagnosis with Axis V Global Assessment Functioning specifiers) (helps assess prognosis)  DSM ICD Diagnostic and Statistical Manual of International Classification of Mental Disorders Diseases and Related Health Problems produced by a single national produced by a global health agency professional association (American (World Health Organization) Psychiatric Association) approved by the assembly of the approved by the World Health American Psychiatric Association, a Assembly, composed of the health group much like APA's Council of ministers of all 193 WHO member Representatives countries generates a very substantial portion of distributed as broadly as possible at the American Psychiatric Association's a very low cost, with substantial revenue, not only from sales of the book discounts to low-income countries, itself, but also from related products and and available free on the Internet copyright permissions for books and  DEFINING ABNORMALITY (DSM-V) ▪ ABNORMAL literally “away from the norm”; deviant ▪ Criteria (4 D’s) a. DYSFUNCTION – impairment to conduct daily activities b. DISTRESS – emotional or physical pain; may or may not be present. c. DEVIANCE – different, extreme, unusual, bizarre; differ from the society’s norms about proper functioning CULTURAL RELATIVISM – view that there are no universal standards or rules for labeling a behavior as abnormal d. DANGER – potential to harm self and others  DEFINING ABNORMALITY (DSM-V) ▪ MENTAL DISORDER Syndrome characterized by clinically significant disturbance in one’s cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental processes Issues About Classification Issues About Classification  CAUSES OF ABNORMALITY ▪ Dimensions a. Biological b. Psychological c. Sociocultural ▪ BIOPSYCHOSOCIAL term used by social scientists to characterized the interactions among the three dimensions.  CAUSES OF ABNORMALITY 1. Biological Causes ▪ Genetics ▪ disturbances in physical functioning medical conditions brain damage ingestion of substances environmental stimuli 2. Psychological Causes ▪ troubling life experiences interpersonal – between people (e.g. arguments) intrapsychic – within thoughts and feelings (e.g. irrational interpretations) 3. Sociocultural Causes ▪ immediate circle – people with whom we interact most locally ▪ extended circle of relationships (family back home or friends from high school) ▪ People in our environment with whom we interact minimally  CAUSES OF ABNORMALITY genetic inheritance medical conditions Biological brain damage exposure to environmental stimuli traumatic life experiences learned associations Psychological distorted perceptions faulty ways of thinking disturbances in intimate relationships problems in extended relationships Sociocultural political or social unrest discrimination towards one’s social group  CAUSES OF ABNORMALITY BIOPSYCHOSOCIAL PERSPECTIVE ▪ Diathesis refers to a vulnerability or predisposition to possibly develop a disorder. ▪ Diathesis-Stress Model people are born with a predisposition (or diathesis) that places them at risk for developing a psychological disorder if exposed to certain extremely stressful life experiences. CAUSES OF ABNORMALITY IMPORTANT TERMS TO REMEMBER TERMS RELATED IN THE DIAGNOSIS ❖ NEUROSIS vs. PSYCHOSIS A. NEUROSIS High level of unrealistic reality Symptoms: Distressing and no physical basis Unacceptable by the person who has neurosis Enduring B. PSYCHOSIS Loss of contact with reality Bizarre thoughts and perceptions Disturbed or out of control behaviors TERMS RELATED IN THE DIAGNOSIS  TERMS RELATED IN THE DIAGNOSIS ❖ DISEASE vs. DISORDER ❖ ACUTE vs. CHRONIC A. DISEASE A. ACUTE Mostly organic Short duration. Structural changes High intensity of Lab test symptoms B. DISORDER B. CHRONIC Mostly functional Long duration Functional changes Low intensity of It depends symptoms. A disease is a pathophysiological response to internal or external factors. A disorder is a disruption to regular bodily structure and function.  TERMS RELATED IN THE DIAGNOSIS ❖ SIGNS vs. symptoms vs. syndrome A. SIGNS objective Physician’s observation B. SYMPTOMS subjective patient’s observation C. SYNDROMES cluster of symptoms related must be clinically significant ❑ how can we know? 1. Duration 2. Morbidity vs. premorbid 3. Severity of the symptoms  TERMS RELATED IN THE DIAGNOSIS ❖ SIGNS vs. symptoms vs. syndrome A. SIGNS objective Physician’s observation B. SYMPTOMS subjective patient’s observation C. SYNDROMES cluster of symptoms related must be clinically significant ❑ how can we know? 1. Duration 2. Morbidity vs. premorbid 3. Severity of the symptoms  OTHER TERMS RELATED IN THE DIAGNOSIS 1. ETIOLOGY – study of origins 2. EPIDEMIOLOGY – study of the distribution of diseases, disorders, health-related behaviors in a given population. 3. INCIDENCE – number of new cases that occur over a given period of time 4. PREVALENCE – number of active cases in a population 5. COMORBIDITY – describe the presence of two or more disorders in the same person. 6. DIATHESIS-STRESS MODEL – predisposition toward developing a disorder derive from biological, psychological and sociocultural causal factors ▪ MENTAL DISORDER – product of stressor Distal Causal and Proximal Causal interacts 7. RISK FACTORS – influence that can increase the likelihood of an individual to develop psychological problems 8. PROTECTIVE FACTORS – modify a person’s response to an environmental stressor, lessening the impact of stress 9. RESILIENCE – Adaptation.