Lecture VI: Classifications & Diagnosis cont. and Mood DisordersLast LectureOutlineLectureMood DisordersPSY 2301 1st Edition Lecture 5Lecture VI: Classifications & Diagnosis cont. and Mood DisordersLast LectureHistory/Development cont. and Classification & DiagnosisOutlineI. 4 Criteria for Evaluating Categorical SystemsII. Rates of Psychological DisordersIII. Dimensional SystemsIV. What does the CBCL tell you?V. Categorical vs. Dimensional Systems: Advantages and DisadvantagesVI. Axis IVII. Axis IIVIII. Axis IIIIX. Axis IVX. Axis VMood DisordersI. What we will look atII. Major DepressionIII. Developmental DifferencesIV. Gender DifferencesV. Electroconvulsive TherapyVI. ECT ProcedureVII. Placement of ElectrodesLectureI. 4 Criteria for Evaluating Categorical SystemsA. Categories should be defined by several features of behaviors that are:1. Measurable2. Clearly defined 3. Regularly occurring together B. Categories should be reliable:1. Between raters in a single setting 2. Between raters in different settings (Interrater reliability)3. Within a developmental phase (test-retest reliability)C. Categories should have good validity (construct, concurrent, predictive, discriminative validity)D. The system should be economical (i.e., should not have more categories than are necessary or too few categories)II. Rates of Psychological DisordersA. Disorder PercentageB. Alcohol abuse 5.2C. Generalized anxiety 4D. Phobias 7.8E. Obsessive-compulsive disorderF. Mood disorderG. SchizophreniaH. Antisocial personalityI. Any mental disordersJ. ---III. Dimensional SystemsA. Best example of this is the Child Behavioral Checklist (CBCL) developed by Thomas Achenbach (University of VT)1. Has 150 items which fall into two broad domains, the competence scales and the clinical scales2. Completed by parents, teachers, and older childrenIV. What does the CBCL tell you?A. Takes all items, and through cluster analysis, divides them into eight dimensions of behavior (related clusters) 1. Internalizing to Externalizinga. Withdrawnb. Somatic complaintsc. Anxious/depressedd. Social problemse. Thoughts problemsf. Attention problemg. Delinquent behaviorh. Aggressive behavior2. Leaves out phobiasV. Categorical vs. Dimensional Systems: Advantages and DisadvantagesA. Dimensional systems tend to be more developmentally sensitive (e.g., CBCL profiles differ according to age and gender of child)B. Categorical systems tend to cover a much wider range of disorders, including more uncommon disordersC. Dimensional systems give much more information about the degree of impairment versus the yes/no approach of categorical systemsD. Neither systems provides information about the etiology of the disorderE. Neither approach is particularly sensitive to cultural differences (i.e., behaviors in one culture may be seen as pathological while not in another culture)VI. Axis IA. Clinical Disorders and Other conditions that may be the focus of clinical attention:1. Mood Disorders2. Anxiety Disorders3. Psychotic Disorders (e.g., Schizophrenia)4. Substance Use Disorders5. Cognitive Disorders (e.g., Dementias)6. Pervasive Developmental Disorders (e.g., Autism)7. Eating DisordersVII. Axis IIA. Mental Retardation (IQs _<_ 70)B. Adults: Personality Disorders1. Cluster A: asocial, odd, eccentric2. Cluster B: Flamboyant, emotional, erratic3. Cluster C: anxious, fearfulVIII. Axis IIIA. General Medical Conditions*1. Infectious and parasitic diseases2. Cancer3. Endocrine, metabolic diseases, etc.4. Diseases of the nervous system5. Complications of pregnancy, childbirth6. Injury, poisoning7. *to be used for medical conditions that are RELEVANT to the understanding or management of the Axis I and/or Axis II disorder(s) (e.g., breast cancer, TBI)IX. Axis IVA. Psychosocial and Environmental Problems1. Problems with primary support group2. Problems related to the social environment3. Educational, occupational problems4. Housing problems5. Economic/financial problems6. Legal problems7. Other psychosocial/environmental problemsX. Axis VA. Global Assessment of Functioning (GAF) Scale1. Objective, numerical measure of overall psychological, social, and occupational functioninga. 91-100 Superior functioning, no symptomsb. 81-90 Absent or minimal symptoms, good functioning in all areasc. 71-80 Slight, expected impairment in functioning tied to psychosocial stressorsd. 61-70 Mild symptoms OR mild difficulty in functioning, has meaningful relationshipse. 51-60 Moderate symptoms OR moderate difficulty in functioningf. 41-50 Serious symptoms OR serious impairment in functioningg. 31-40 Impairment in reality testing/communication OR major impairment in h. functioning i. 21-30 Delusions or hallucinations OR serious impairment in communication/judgment OR inability to function in all areas j. 11-20 Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication k. 1-10 Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death. l. 0 Not enough information available to provide GAFMood DisordersI. What we will look atA. Major Depressive Disorder1. ECT2. Post-Partum DepressionB. Dysthymia1. Aka minor depressionC. Bipolar DisorderD. Cyclothymia1. Aka minor BipolarII. Major DepressionA. 5 or more symptoms for 2 weeks (at least 1 of 5+ must be *)1. Depressed mood*2. Loss of interest or pleasure*3. Appetite/Weight change4. Insomnia or hypersomnia5. Psychomotor agitation or retardation6. Fatigue or loss of energy7. Feelings of worthlessness or excessive guilt8. Poor concentration/indecisiveness9. Suicidal ideationB. Symptoms cause significant distress or impairment in social, occupational, or other functioningC. Symptoms are not the direct physiological effects of a substance or medical conditions1. Mid-20s, common age of onsetIII. Developmental Differences++++++++++++Important+++++++++A. Infancy1. “anaclitic depression”a. Lack of attempts at expression, apathetic2. Toddlerhooda. Aggression, hyperactive3. Preschoolersa. Irritability, social withdrawal4. School Agea. Withdrawal, not liking to play, not liking to talk to their families, feeling that they would never get what they want, thinking that they would not have a good time5. Adolescentsa. 12 year oldi. Pessimistic about future, won’t be happier when older, sleep problems, and decreased appetiteb. 17 year oldi. Nightmares and