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					 Classification
    &
Assessment
Systematic
Classification
Why Classify?

 Systematically   show
  relationships
 Need for standardization
 Communication
 Gain respectability
    ICD (International
     Classification of Diseases)
 DSM System
 Diagnostic and Statistical
 Manual of Mental Disorders
  Currently “IV TR”

  Revision “V” in near
   future??
 Developed by American
 Psychiatric Association
DSM SYSTEM….
Evolved  over time
Developed by
 committees/field
 testing
Specific diagnostic
 criteria
Differential diagnosis
              MULTIAXIL SYSTEM
   Mental disorder: symptoms
  (behavioral or psychological)
  causing distress, disability or
  increased risk of pain,
  suffering, death or loss of
  freedom.
 Describes process, not people
  (labeling); individual
  differences in dx
 Not always sharp boundaries
  between disorders
Axis I (Clinical Syndromes)
1. Disorders usually first diagnosed in infancy, childhood, or adolescence. Problems such as
     Tab15_2A
   hyperactivity, childhood fears, abnormal aggressiveness or other notable misconduct, frequent
   bedwetting or soiling, and other problems in normal social and behavioral development.
   Autistic disorder (severe impairment in social and behavioral development), as well as other
   problems in the development of skill in reading, speaking, mathematics,
   or English.

2. Delirium, dementia, amnestic, and other cognitive disorders Problems caused by physical
   deterioration of the brain due to aging, disease, drugs or other chemicals, or other possible
   unknown causes. These problems can appear as an inability to “think straight” (delirium) or as
   loss of memory and other intellectual functions (dementia).

3. Substance-related disorders Psychological, behavioral, physical, social, or legal problems
   caused by dependence on or abuse of a variety of chemical substances, including alcohol,
   heroin, cocaine, amphetamines, hallucinogens, marijuana, and tobacco.

4. Schizophrenia and other psychotic disorders Severe conditions characterized by
   abnormalities in thinking, perception, emotion, movement, and motivation that greatly interfere
   with daily functioning. Problems involving false beliefs (delusions) about such things as being
   loved by some high-status person, having inflated worth or power, or being persecuted, spied
   on, cheated on, followed, harassed, or kept from reaching important goals.

5. Mood disorders (also called affective disorders) Severe disturbances of mood, especially
   depression, over-excitement (mania), or alternating episodes of each extreme (as in bipolar
   disorders).
Axis I (Clinical Syndromes) (continued)

6.   Anxiety disorders Specific fears (phobias), panic attacks, generalized feelings of dread, rituals
     Tab15_2B
     of thought and action (obsessive-compulsive behavior) aimed at controlling anxiety, and
     problems caused by traumatic events, such as rape or military combat (see Chapter 13 for
     more on posttraumatic stress disorder).

7.   Somatoform disorders Physical symptoms, such as paralysis and blindness, that have no
     physical cause. Unusual preoccupation with physical health or with nonexistent or elusive
     physical problems (hypochondriasis, somatization disorder, pain disorder).

8.   Factitious disorders False physical disorders, which are intentionally produced to satisfy some
     psychological need.

9.   Dissociative disorders Psychologically caused problems of consciousness and self-
     identification, e.g., loss of memory (amnesia) or the development of more than one identity
     (dissociative identity disorder).

10. Sexual and gender identity disorders Problems of
    (a) finding sexual arousal through unusual objects or situations (like shoes or exposing
    oneself),
    (b) unsatisfactory sexual activity (sexual dysfunction; see Chapter 11), or (c) identifying with
    the opposite gender.

11. Eating disorders Problems associated with eating too little (anorexia nervosa) or binge eating
    followed by self-induced vomiting (bulimia nervosa). (See Chapter 11)
Axis I (Clinical Syndromes) (continued)

6.   Anxiety disorders Specific fears (phobias), panic attacks, generalized feelings of dread, rituals
     Tab15_2B
     of thought and action (obsessive-compulsive behavior) aimed at controlling anxiety, and
     problems caused by traumatic events, such as rape or military combat (see Chapter 13 for
     more on posttraumatic stress disorder).

7.   Somatoform disorders Physical symptoms, such as paralysis and blindness, that have no
     physical cause. Unusual preoccupation with physical health or with nonexistent or elusive
     physical problems (hypochondriasis, somatization disorder, pain disorder).

8.   Factitious disorders False physical disorders, which are intentionally produced to satisfy some
     psychological need.

9.   Dissociative disorders Psychologically caused problems of consciousness and self-
     identification, e.g., loss of memory (amnesia) or the development of more than one identity
     (dissociative identity disorder).

10. Sexual and gender identity disorders Problems of
    (a) finding sexual arousal through unusual objects or situations (like shoes or exposing
    oneself),
    (b) unsatisfactory sexual activity (sexual dysfunction; see Chapter 11), or (c) identifying with
    the opposite gender.

11. Eating disorders Problems associated with eating too little (anorexia nervosa) or binge eating
    followed by self-induced vomiting (bulimia nervosa). (See Chapter 11)
    ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS

Disorder       Subtypes                Major Symptoms

     InRev15a
Anxiety
disorders
               Phobias                 Intense, irrational fear of objectively nondangerous situations or things,
                                       leading to disruptions of behavior.

               Generalized anxiety     Excessive anxiety not focused on a specific situation or object; free-
               disorder                floating anxiety.

               Panic disorder          Repeated attacks of intense fear involving physical symptoms such as
                                       faintness, dizziness, and nausea.

               Obsessive-compulsive    Persistent ideas or worries accompanied by ritualistic behaviors
               disorder                performed to neutralize the anxiety-driven thoughts.

Somatoform     Conversion disorder     A loss of physical ability (e.g., sight, hearing) that is related to
disorders                              psychological factors.

               Hypochondriasis         Preoccupation with or belief that one has serious illness in the absence
                                       of any physical evidence.

               Somatization disorder   Wide variety of somatic complaints that occur over several years and
                                       are not the result of a known physical disorder.

               Pain disorder           Preoccupation with pain in the absence of physical reasons for the
                                       pain.

Dissociative   Amnesia/fugue           Sudden, unexpected loss of memory, which may result in relocation
disorders                              and the assumption of a new identity.

               Dissociative identity   Appearance within same person of two or more distinct identities, each
               disorder (multiple      with a unique way of thinking and behaving.
               personality disorder)
  SCHIZOPHRENIA

Aspect            Key Features
   InRev15b
Common
Symptoms
Disorders of      Disturbed content, including delusions; and disorganization,
thought           including loose associations, neologisms, and word salad.

Disorders of      Hallucinations, or false perceptions; poorly focused attention.
perception

Disorders of      Flat affect; or inappropriate tears, laughter, or anger.
emotion

Possible Causes
Biological        Genetics; abnormalities in brain structure; abnormalities in
                  dopamine systems; neurodevelopmental problems.

Psychological     Learned maladaptive behavior; disturbed patterns of family
                  communication.
Fig15_5
 Type           Typical Features
 Paranoid       Suspiciousness and distrust of others, all of whom are assumed to be hostile.

 Schizoid Tab15_5
                Detachment from social relationship; restricted range of emotion.

 Schizotypal    Detachment from, and great discomfort in, social relationships; odd
                perceptions, thoughts, beliefs, and behaviors.

 Depedent       Helplessness; excessive need to betaken care of; submissive and clinging
                behavior; difficulty in making decisions.

 Obsessive-     Preoccupation with orderliness, perfection, and control.
 compulsive

 Avoidant       Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism.

 Histrionic     Excessive emotionality and preoccupation with being the center of attention;
                emotional shallowness; overly dramatic behavior.

 Narcissistic   Exaggerated ideas of self-importance and achievements; preoccupation with
                fantasies of success; arrogance.

 Borderline     Lack of stability in interpersonal relationships, self-image, and emotion;
                impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal
                gestures.

 Anitsocial     Shameless disregard for, and violation of, other people's rights.
Type               Frequency                          Prominent Features

Paranoid           40 percent of schizophrenics;      Delusions of grandeur or persecution; anger;
     Tab15_4
schizophrenia      appears late in life (after age
                   25–30)
                                                      anxiety; argumentativeness; extreme
                                                      jealousy; onset often sudden; signs of
                                                      impairment may be subtle

Disorganized       5 percent of all schizophrenics;   Delusions; hallucinations; incoherent speech;
schizophrenia      high prevalence in homeless        facial grimaces; inappropriate
                   population                         laughter/giggling; neglected personal
                                                      hygiene; loss of bladder/bowel control

Catatonic          8 percent of all schizophrenics    Disordered movement, alternating between
schizophrenia                                         immobility (stupor) and excitement. In stupor,
                                                      the person does not speak or attend to
                                                      communication; the body is rigid or can be
                                                      posed in virtually any posture (a condition
                                                      called “waxy flexibility”).

Undifferentiated   40 percent of all schizophrenics Patterns of disordered behavior, thought, and
schizophrenia                                       emotion that do not fall easily into any other
                                                    subtype

Residual           Varies                             Applies to people who have had episodes of
schizophrenia                                         schizophrenia but are not currently displaying
                                                      symptoms
“Atheoretical Approach”
An omitted disorder does
 not mean it does not exist;
 committee work, revisions
Not for amateurs; ethical
 guidelines
Does not account for
 cultures
 *Diagnoses    are not decided by
  criteria; by clinicians using criteria as
  guidelines
 Certainty of dx: provisional, by history,
  by record
 Severity of disorder: mild, moderate,
  severe, partial remission, full remis,
  prior hx
 Medical model of illness: descriptive of
  groups of people sharing symptoms,
  signs
 Make no assumptions regarding
  etiology
 Axis I
 (“Mental Disorders”)

 Based   on impaired
  functioning
 Clinical syndromes
 Criteria based guidelines
 “Primary” diagnosis
 Multiple listings possible
        AXIS II

(Personality      and Mental
 Retardation)
 Personality   disorder
 Mental retardation
 Why separate? Insure not
  overlooked or ignored in regard to
  Axis I
 In some cases, this is the reason
  for referral: Axis I is actually
             AXIS III
         (Physical Conditions and Disorders)


 Physicalillness may have a direct
 bearing on Axis I
     Ex: Hypertensive and psychotic who believes
      food is being poisoned
 Multiple   entries
          AXIS IV
   (Psychosocial and Environmental Problems)


 Events   or conditions might affect
  diagnosis or management
 May be independent events
 Occurred within prior year
 If earlier, how contributed to
  current focus of tx
 Be specific, categories are samples
Axis IV cont’d….
    Economic problems
    Housing problems
    Primary support group
     problems
    Occupational problems
    Educational problems
    Social environment problems
    Problems related to legal
     system/crime
            AXIS V
(Global Assessment of Functioning)

 Overall  occupational, psychological,
  and social functioning
 Does not take into account physical
  limitations or environmental problems
 Single number
 Scale specifies symptoms and
  behavioral guidelines
 Often: Current and Highest in Past Year
  to show changes
15_01




Percentage
            Fig15_1
   35

   30

   25

   20

   15

   10

        5


            Schizophrenia   Panic disorder   Antisocial    Depression   Alcohol abuse   Any disorder
                                             personality
   Hispanic-American
   White non-Hispanic-American
   African-American
57




     Fig147
       Major depression         Bipolar disorder
     80
     70
     60
     50
 Risk 40
     30
     20
     10


           Prevalence in          Prevalence in
           general population     general population
           Fraternal twins        Fraternal twins
           Identical twins        Identical twins
Assessment
and
Evaluation
   Evaluation services fall into two general categories –


    Diagnostic Evaluation
    Interviews
           Psychological Testing
 Usually, a psychological evaluation
 will include both an interview and
 testing
 Psychological evaluations merge
 the art and science of the practice
 of psychology.
 Theclinical interview is a
 subjective assessment of
 observed behavior, verbal
 reports and inferred emotions
 and thought processes.
 Psychological   testing is an
 objective, scientific assessment
 process, based on the application
 of statistical procedures and
 research studies, to quantify and
 categorize human behavior.
  Functions of Psychological Testing
 Sample of behavior
   Make predictions from these
    samples
  Subjects   respond to specific
    stimuli and responses offer
    insight into functioning
 Measure differences between
  individuals
 Assign   categorical levels of
     Tests of Cognitive abilities
   Examine general fund of knowledge
   Explore problem solving capabilities
   Convergent thinking
     presented with problem or stimuli, give
      correct answer
     How far is it from New York to London?

   Divergent thinking
     given a problem, asked to give different
      possibilities
     Name all the places you could reach walking
      from here in one hour.
 Intellectual and Cognitive
 Group and individual tests
 Wechsler Scales
   WPPSI,    WISC, WAIS, Memory scales
 Stanford-Binet
   Binet’s   original test constructed
   1905
 Intelligence  Quotient formulas (generally
  measure verbal skills) to represent
  intellectual ability
 Slosson Intelligence test
    Personality: objective, standardized instruments
   Clear, specific stimuli
   Q-Sort: self-statements grouped by person
     low reliability (defensiveness)

   California Psychological Inventory
     Subscales: flexibility, tolerance, self-control,

        16 PF   (personality factors)
     Reported in Stens
     Outgoingness, tension, shyness, group
      dependence
   Millon Clinical Multiaxial Inventory
   Myers-Briggs Type Indicator
Personality: Projective Techniques
(subjective and usually unstructured)
 Theory:  since impulses censored by
  ego, not available to conscious mind.
  Symbolic representations of
  unconscious conflicts
 Require no literacy or academic skills
 Subject to examiner bias
 Presumably, subject is not aware of
  purpose and cannot “fake” responses
 “Standardized Interpretations” are less
  scientific, amassed and collected data
      Projectives
 Thematic   Apperception Test (TAT) 1935
   vague, ambiguous pictures on cards
   themes expressed by subject reveal
    concerns
   Bellak Response form: hero needs,
    conflicts, defenses
 Word Association test
 Sentence Completion test
 Rorschack Ink Blot Test (1942)
 Draw a Person test, House/Tree/Person
Mental Status Exam
 Based    on client self-presentation,
  response to questions and direct
  observation
 Structured clinical interview
 “Standardized” interview
    Diagnostic Interview Schedule
     (DIS)
    Structured Clinical Interview for
     DSM (SCID)
Commonly assessed areas
               Orientation
               Attention
               Concentration
               Language
               Memory
               Fund of Information
               Reasoning
Common areas (cont’d)

 Social judgment
 Decision making
 Self-image
 Insight
 Sign, symptoms,
  syndromes, behavioral
  patterns
Orientation
To   Person
  What is your name?
  Are you married?

To   Place
  Where are we?
  Where do you live?

  Your address?
To      Time
    How old are you?        Familiar
                           To
    What year is this?
                           Objects
                              Hold up pencil, etc

To
                             other
                           To
Situation                  People
    Why are you              What is your spouse’s
     here?                     name?
                              What is my name?
    Who am I?
                              What are the names of your
                               children?
 Attention             Concentration

   Please say the        Underline a
    alphabet as fast       certain letter in
    as possible            a paragraph
      3 - 10 seconds     Mental
   Repeat your Social     arithmetic
    Security Number       Estimation of
    backwards
                           time
   Digit span
                             Tell me
   Tapping
                              when one
      under table
                              minute has
      3 - 15
                              passed
 Language

Fluency
  Please give me as many
   words as you can that begin
   with the letter......? (30
   seconds)
  Synonyms

  Anonyms
  Memory
Recognition
  identify, select, find

Reproduction
  say, repeat, copy

Recall
  remember without cueing
Reasoning
Similarities
Proverb
SerialSevens
Basic mental
 calculation
Hazard recognition
  Decision Making
 Have  others called you
  indecisive?
 Do you have a difficult
  time deciding?
 How would you rate your
  decision making?
 Tell me about the
  best/worst decision you
  have ever made.
Signs, symptoms,
syndromes
  Abuse
                     Eating disorders
  Delusions
                     Anxiety
  Depression
                     Sleep
  Hallucinations
                     Suicidal ideation
  Mania
                     Sexual identity
  Obsessions
                     Pain
  Organicity
                     Paranoia
  Substance
                     Phobias
  Abuse
End of
DSM

				
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