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UW-Madison PSYCH 202 - Introduction to Psychopathological Conditions

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Psych 202 1st Edition Lecture 23Introduction to Psychopathological Conditions of Adulthood and their TreatmentNosology: the study of classification-The value and danger of labels - categorization and psychiatric diagnosis:oFacilitates professional communicationoLeads to shorthand description, rich with implicative meaningoEntails predictive/postdictive probabilistic implications-Before and after-Good diagnosis might tell you what could happen in future with and without treatmentoCan assist planning maximally relevant treatmentsoCan trick us into thinking we understand when we don’toCan 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:oCritique-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 patientoImpact 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 episodesoMajor depressive episodeoManic episode-If had, will not be diagnosed with depressionoHypomanic episode-If had, will not be diagnosed with depression-Psychotic features as an episode-specifierThese 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.oHallmarks 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)oPresence of psychotic features in mood disorders is seen in:-Mood-congruent (mood is congruent with their delusions) delusions (depressivedelusions of utter worthlessness/repulsiveness of self; manic delusions of grandeur, unlimited power and influence)-Hallucinations (typically auditory)oAudio 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:oManic 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)oThe 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?"oSee manic episode severity discussion above-Clip #5: "Latiffa: goddess of Wind and Rain"oManic depressionoManiaoDiscussion:-No sleep-Talkative-Pressure to keep talking-Won't stop moving around-Distractibility-Inflated self esteemoDiagnosis: bipolar 1 disorderoEtiology and treatment:-What is a "major depressive episode?" DSM diagnostic criteria:oProfound, 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:oDepressive 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 moreof 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,


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UW-Madison PSYCH 202 - Introduction to Psychopathological Conditions

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