CLP 6169, Week 3 Notes
CLP 6169, Week 3 Notes CLP 6169
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This 3 page Class Notes was uploaded by Jadenole on Wednesday January 6, 2016. The Class Notes belongs to CLP 6169 at Florida State University taught by Dr. E in Spring 2016. Since its upload, it has received 20 views. For similar materials see Adult Development and Psychopathology in Language at Florida State University.
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Date Created: 01/06/16
Lecture 3: Diagnosis and the DSM-5 Using the DSM-5: Symptoms are what the client reports or complains about Signs are what the therapist observes Diagnosis - Is it Necessary? Insurance often requires diagnosis o However, if diagnosis does not impact treatment, it may not be necessary Clinical significance: symptoms or dysfunction that warrant diagnosis What is Abnormal? Pay attention to the client’s affect: emotions, moods, facial expressions, and nonverbals Ask yourself, what is the client getting with these thoughts, feelings, or behaviors? o Maladaptive: Not doing what you should to get what you want or need Social expectations: may not be a good measure of normal vs. abnormal. Social expectation are culturally exclusive o It was not until the late 1960’s that homosexuality was removed from the DSM Be aware of distress or discomfort towards self or others in the environment Additions and Revisions to the DSM-5: The DSM-IVTR did not include the advanced research we have now – more empirical evidence, assessments, and genetic test information was added ICD-10-CM: coding used for medical and mental diagnoses across various fields o The DSM-5 aligns with these because we don’t want competing diagnostic tools o Facilitates communication between different professions and is necessary for research The DSM-5 was almost not released because the American Psychiatric Association couldn’t come to a vote Consider the impact of pressure from major pharmaceutical companies (big $) o Example: wanting certain symptoms to be added to fit their medication Two codes listed for each disorder: one in bold font and one in parentheses o Parentheses code is the ICD-10-CM code Categorical: you either have a diagnosis or not (presence or absence) o Better for research purposes – easier to analyze data Dimensional: classify on quantitative continuum; diagnosing on a spectrum or range o Example: mild, moderate, or severe o Example 2: Pain scale 1-10 It was discovered that about 30% of diagnoses were NOS (not otherwise specified) – from the DSM-IV o Meeting some, but not all of criteria – enough to give a diagnosis Neurodevelopmental disorders used to be known as childhood disorders because they manifest early in life o The organization of the DSM-5 starts with disorders that develop early Definition of a Mental Disorder: “Usually associated with significant distress or disability in social, occupational, or other important activities.” (PowerPoint) o This is not always the case - some clients flourish with diagnosis Social deviance: engaging in criminal activity does not mean you have a mental disorder If the deviance or conflict results from the dysfunction caused by a disorder, the diagnosis is necessary (Ex: A client with a substance abuse disorder constantly gets into fights) Recording a Diagnosis: Example: F33.2 (pg 162) Major Depressive Disorder, recurrent episode (PowerPoint) Subtypes: you can’t be in more than one – must be in a type. Mutually exclusive and jointly exhaustive subgroupings within a diagnosis Specifiers – including features, giving more specific information about the diagnosis Provisional diagnoses: used in place of “rule out” system. Use when you are pretty sure that a client will meet the criteria for a certain disorder Other specified and unspecified disorders used in place of “Not Otherwise Specified” o Other Specified: Insufficient symptoms to meet full criteria, but mostly fit within that category o Unspecified: more vague, not explaining symptoms as much Cultural Factors: Example of cultural phenomenon: “roots” or being “rooted”: form of southern voodoo bringing on mental illness o Treatment was not effective when “roots” were not incorporated or acknowledged Certain behaviors may be seen as acceptable in the individual’s culture, but the practitioner may see it as requiring diagnosis o Ex: Having visions, enduring a certain amount of suffering, etc. Culture impacts what is extreme and what is not, and could be the reason behind what we cannot seem to understand (why someone did what they did, or behaves a certain way) DSM-V Disorders: Not empirically proven: DMDD, PDD, Asperger’s Disorder, and Substance Abuse o Not enough evidence to add the disorders o Asperger’s Disorder and Substance Abuse were retired after the DSM- IV o Substance Abuse is now broken into several “substance use” categories The number of diagnostic categories and the number of disorders have increased over the different versions of the DSM o There are now 20 categories and 365 disorders in the DSM-V (PowerPoint) The NIMH voted not to include the DSM-V in their research – may be a sign that we could be moving away from the DSM in the future Differential Diagnosis: Eliminate alternative disorders, do a complete case history and medical history o Rule out substance use, which could be causing the symptoms Malingering: client is trying to manipulate practitioner into giving them a certain diagnosis to get something from it (Example: obtaining medication, or getting out of criminal charges) o Using language that is overly clinical, saying they have all symptoms There are cases where drug use (even one time) can trigger mental illness – these individuals may have a genetic predisposition for mental illness and substance use brings it out o The drug wears off (out of the person’s system), but the abnormal behavior and/or cognitions are still present and stick with the individual Substance use and other forms of mental illness can be comorbid – dual diagnoses. These clients are often the hardest to treat Before Diagnostic Interview: Read the case files – any background information that you already have Brush up on the DSM criteria, so you know what to look for However, you want to avoid asking questions that will confirm diagnosis (Confirmatory Bias Effect) and using your first impressions of the client (Halo Effect) Preparing for an Interview: Maintain professional distance when conducting interview – not appearing to be a friend or like you are on a “first date.” Know your needs, problems, biases, and blind spots as a counselor. Also be sure not to work with family or loved ones (cannot be objective) Be aware of environmental factors that could be dangerous or distracting when working with inpatient clients People with psychiatric issues can be hypersensitive to nonverbal behavior Be aware of abrupt changes in a person’s demeanor
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