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Introduction and Diagnosis 1. Defining Abnormality. 2

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Introduction and Diagnosis 1. Defining Abnormality. 2 Week one: Introduction and diagnosis 1. Defining abnormality. 2. Historical context. 3. Diagnostic systems 4. Treatments and treatment providers • Challenge for psychopathologists; many definitions: personal distress, harmful dysfunction, and statistical abnormality. • Seligman 7 elements of abnormality; suffering, maladaptiveness, irrationality, unpredictability and loss of control, rareness and unconventionality, observer discomfort and violation of standards. • Psychological dysfunction (impairment of functioning); cognitive, behavioral, emotional, interpersonal. • Personal distress: DSM criteria specify that disorder must cause significant distress. • Major depressive episode: symptoms cause clinically significant distress/impairment in social, occupational, or other important areas of functioning. • Dissociative amnesia: symptoms cause clinically significant distress/impairment in social, occupational, or other important areas of functioning. • A typicality/culturally unexpected: considerable cross-cultural variation in acceptable behavior, Abnormality of behavior must be judged in the context of the cultural group to which the individual belongs (Note that cultures are made up of diverse subcultures). • Accessing abnormality: clinical interviews (structured/unstructured), psychological testing, observations (behavioural assessments), psychophysiological assessments, and neuroimaging. • Syndromes: A syndrome refers to a collection of symptoms that are frequently observed together (Certain symptoms are known to co-occur). • History of diagnosis: Greek medicine: melancholia, hysteria, mania, paranoia. • Purpose of classification; 1. Forming a nomenclature so that mental health professionals have a common language, 2. Serving as a basis of information retrieval, 3. Providing a shorthand description of the clinical picture of the patient, 4. Stimulating useful prediction about what treatment approach will be best and, 5. Serving as a concept formation system for a theory of psychopathology. • Problems with diagnosis: 1. Reliability, 2. Validity, 3. Self-fulfilling prophecy and, 4. Diagnostic bias. • Categorical vs. dimensional: • Categorical: 1. Discrete syndromes 2. Distinct boundaries with other disorders 3. Distinct boundaries between normal and abnormal • Dimensional: 1.Traits occur along a spectrum of intensity 2. Traits occur in a finite proportion of the general population • Categorical methods: • Formulation approach: alternative to diagnostic approach, used in clinical psychology and, focuses on etiology and maintaining factors relating to a persons psychopathology. • Case formulation: “…a hypothesis that relates all of the presenting complaints to one another, explains why these difficulties have developed and provides predictions about the patient’s condition.” • Case formulation involves: “elicitation of appropriate information and the application and integration of a body of theoretical psychological knowledge to a specific clinical problem in order to understand the origins, maintenance and development of that problem.” • Aims of case formulation: 1. Integration of information 2. Explanation of current and historic problems 3. Provides a blueprint for guiding therapy 4. Provides predictions about future challenges 5. Enhances understanding and empathy • What is included in formulation: 1. Presentation (symptoms and problems) 2. Precipitating stressors or events 3. Predisposing life events or stressors 4. A mechanism that links the preceding categories together and offers an explanation of the precipitants and maintaining influences of the individual’s problems. • History of DSM: 1. Emil Kraepelin (1855-1926) trained under Wundt, 1902: psychiatric textbook (6th ed), dementia praecox and manic-depressive insanity. 2. 1917- American Psychiatric Association adopts Kraepelinian diagnostic system 3. 1932- APA adopts Standard Classified Nomenclature of Disease (APA, 1933) 4. 1939-1945- Second World War resulted in 10% of discharges for psychiatric reasons and Different diagnostic systems used by different US services. 5. DSM-I- APA (1952); 128pp, 106 diagnoses, Created as a consensus of contemporary American psychiatric thought and Adopted by vote of APA members (i.e. professional/clinical consensus). 6. DSM-II- APA (1968); 134pp, 108 diagnoses, parallel with ICD-8 and constructed via consensus of clinicians in similar method to DSM-I. 7. Feighner criteria: (1972): diagnostic criteria for use in psychiatric research, 15 mental disorders with sufficient research support to establish credibility, argued that previous problems due to lack of clear criteria and most cited paper since the 1970’s, sometimes called neo- Kraepelinian approach. 7.1 Diagnoses of Feighner et al.: • Primary affective disorder: depression and mania • Secondary affective disorder • Schizophrenia • Anxiety neurosis • Obsessive compulsive neurosis • Phobic neurosis • Hysteria • Antisocial personality disorder • Alcoholism • Drug dependence (excluding alcoholism) • Mental retardation • Organic brain syndrome • Homosexuality • Transsexualism • Anorexia nervosa 8. Spitzer, Endicott & Robins (1978): expanded Feighner (1972) diagnoses into sub categories, accompanied by SADS clinical interview, appointed to develop DSM-III using RDC as a template. 9. DSM-III: APA (1980): 494pp, 265 diagnoses, change in philosophy & content, introduced multiaxial diagnoses, based on scientific evidence, specific criteria for each diagnosis, term “neurosis” excluded, led to formation of American Psychiatric Press” 10. DSM-III-R: APA (1987): 567pp, 292 diagnoses, update on DSM-III due to large amount of research in 1980, controversial diagnoses included/excluded in appendix. 11. DSM-IV: APA (1994): 886pp, 365 diagnoses, work commenced in 1988, concept of clinically significant impairment introduced, average of 8 criteria per diagnosis, attempted to address criticism of lack of referencing in earlier editions. 12. DSM-IV-TR: APA (2000): 943pp, 365 diagnoses, and revision of text without diagnostic criteria. 13. DSM-5: APA (2013): 947pp • Why is DSM successful? 1. Atheoretical approach 2. Provision of diagnostic criteria 3. Provision of descriptive text for each disorder 4. Empirically informed revision process • Alternative Diagnostic systems: 1. ICD-10-AM: use of codes. 2. PDM: Psychodynamic Diagnostic Manual. 3. CCMD-3: Chinese Classification of Mental Disorders. 4. CFTMEA: French Classification of Child and Adolescent Mental Disorders. 5. GC-3: Third Cuban Glossary of Psychiatry. 6. GLADP: Latin American Guide for Psychiatric Diagnosis. • Ancient attempts at psychopathology therapy: 1. Earliest known attempts in Stone Age. 2. Demonic possession ideas shred by many ancient cultures. 3. Trephining: use of stone tools to chip a hole in the skull (evidence of survival by some). • Early Rational Psychiatry: 1. Rejected notion of demonic possession. 2. First classificatory system of mental illness 3. Treatments: vegetarian diet, exercise, sexual abstinence, bloodletting. • Middle-ages Psychiatry: 1. Return of demonic possession ideas due to decline of civilization. 2. Treatments taken over by priests, holy water, prayer and exorcism. 3. Mental illness was associated with witchcraft. • Renaissance Psychiatry: 1. Rediscovery of scientific method. 2. Rise of humanitarianism. 3. Belief in demonic possession and witchcraft declined. 4. Movement into asylums (little effective treatment). • Old treatment methods: 1. Restraint 2. Hydrotherapy 3. Solitude 4. Physical treatment (bleeding, blistering etc.) • Moral treatment: 1. Philippe Pinel (1775-1826): took control of Bicetre and Saltpetiere asylums near Paris in 1794 and enacted major changes in treatment of patients (removal of chains, cessation of treatments such as bleeding, removal from dark rooms to open areas and engagement in productive work). 2. Dorothea Dix (1802-1887): separation of mentally ill from criminal prisoners in US and Europe. Week two: Signs and Symptoms of Psychopathology 1. Mental Status Examination (MSE) 2. Signs, symptoms and Syndromes • Intake interview: .
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