Psych 202 1st Edition Lecture 23 Introduction to Psychopathological Conditions of Adulthood and their Treatment Nosology the study of classification The value and danger of labels categorization and psychiatric diagnosis o Facilitates professional communication o Leads to shorthand description rich with implicative meaning o Entails predictive postdictive probabilistic implications Before and after Good diagnosis might tell you what could happen in future with and without treatment o Can assist planning maximally relevant treatments o Can trick us into thinking we understand when we don t o Can stigmatize and lead to self fulfilling prophesies Can create actual damage They treat themselves and others treat them like they are damaged or disabled When you think of someone one way they start to become that person David Rosenhan s Classic Study On Being Sane in Insane Places Critique and Impact of Development of DMS s o Critique Was it unreasonable to label them insane After admitted we acted the way we usually behaved Kept a journal Workers could think the patient writing is just paranoid Their behavior was perceived in ways of a schizophrenia patient o Impact of study on the DSM and diagnostic practice Single symptoms are inadequate bases for diagnosis DSM s subsequently articulated detailed diagnostic criteria See pg 86 Jamison for list of diagnostic questions the answers to which form the basis for the clinical judgment about presence absence of criteria Self reports observations and interviews all lead to assessment diagnosis treatment ongoing assessment which circles back to treatment There are overlaps with symptoms and diagnosis Diagnosis of a mood disorder begins with assessing present mood episodes o Major depressive episode o Manic episode If had will not be diagnosed with depression o Hypomanic episode If had will not be diagnosed with depression Psychotic features as an episode specifier These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute o Hallmarks of psychosis delusions and hallucinations Delusions fixed beliefs they believe are true that everyone else knows is absolutely not true Hallucination experiences that happen in a variety of senses that aren t occurring mainly hearing voices o Presence of psychotic features in mood disorders is seen in Mood congruent mood is congruent with their delusions delusions depressive delusions of utter worthlessness repulsiveness of self manic delusions of grandeur unlimited power and influence Hallucinations typically auditory o Audio example manic mood episode with delusions of grandeur and power Well I stand up next to a mountain and I chop it down with the edge of my hand it is possible to change the world Repeat but irritable insistent demanding You know I pick up all the pieces and make an island I might even raise a little sand Illness or art Art with a dash of political empowerment and Freudian sublimation to take subconscious sexuality and feelings and put it into real world art etc See table on defense mechanisms What is a manic episode DSM Diagnostic Criteria o Manic mood episodes show as a distinct period of abnormally and persistently elevated expansive and or irritable mood indicated by three or more of following Inflated self esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing pg 82 KRJ Distractibility i e attention too easily drawn to unimportant or irrelevant external stimuli Increase in goal directed activity or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences e g unrestrained buying sprees sexual indiscretions foolish business investments o The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning functional impairment or in usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self or others or there are psychotic features Note that this criterion distinguishes hypomanic episodes from manic episodes In a hypomanic episode there is NOT marked impairment NOR are there ever psychotic features low level of mania In manic episodes there is always marked impairment and sometimes psychotic features Thus the Sx s are more severe more interfering with adaptive functioning in mania in hypomania What is a hypomanic episode o See manic episode severity discussion above Clip 5 Latiffa goddess of Wind and Rain o o o Manic depression Mania Discussion No sleep Talkative Pressure to keep talking Won t stop moving around Distractibility Inflated self esteem o Diagnosis bipolar 1 disorder o Etiology and treatment What is a major depressive episode DSM diagnostic criteria o Profound persistent period of depression that exists for two or more weeks as indicated by presence of 5 or more see pg 44 45 in KRJ for personal specific examples Depressed mood most of the day everyday Markedly diminished interest and pleasure in almost all activities Lack of pleasure anhedonia Significant weight loss or weight gain Insomnia or hypersomnia Psychomotor agitation see pg 45 KRJ or psychomotor retardation see video example below Emotionless Fatigue or loss of energy Feelings of worthlessness or excessive and inappropriate guilt Diminished ability to think concentrate and make decisions Recurrent thoughts of death or recurrent suicidal ideation I felt as though only dying would release me from the overwhelming sense of inadequacy and blackness that surrounded me Pg 44 45 KRJ From episodes to disorder o Depressive orders William Styron Persistent depressive order Previously called dysthymia and neurotic depression Chronic 2 years low grade depression doesn t meet criteria for major depression though still very serious debilitating indicated by 2 or more of the following Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor concentration or difficulty making decisions Feelings of hopelessness Major depression One or more major depressive episodes without any history of mania or hypomania It is NEVER major depression if there has ever been mania of hypomania Major depression single episode Major depression recurrent