chapter 15 16 diagnoses of mental illness 12 14 2012 DSM IV diostic and statistical manual used to diagnose mental illnesses Has 5 axial system or 5 dimensions 1 Major clinical syndromes mood disorders schizophrenia 2 Personality and developmental disorders 3 Physical disorders 4 Severity of the psychosocial stressors 5 GAF global assessment of functioning o reliability varies axis 1 is highly reliable and high validity o axis 2 low reliability o axis 3 4 5 low reliability low validity Issues with diagnosis o David chong Chinese immigrant with tb spoke chinese no one could understand which was an indication for mental illness placed in hospital for 30 years until finally a man came in and spoke to him language was a localized dialect Chong released but could not function alone reinstated to the hospital o Rosenhan sent people to hospital saying they were hearing voices in their head lead to schizophrenia diagnosis this was the only lie people told they were all admitted and diagnoses as expected acted normal in hospital and were released between 7 52 days average time 19 days Diagnosis better now but much room for improvement Doctors inadequately trained diagnosis depends more on person making it not the patient Very inaccurate because we don t know much about the cause of mental illness Validity means that the diagnostic categories should accurately capture the essential features of the various disorders Reliability means that clinicians using the system should show high levels of agreement in their diagnostic decisions Misconceptions Stigma attached with mental illnesses but not physical illnesses o Mental illness means personal weakness o Mental illnesses aren t curable o Mentally ill people are violent o Mentally ill means bizarre behavior Criteria for being abnormal Content context consequences DSM axes 1 represents current clinical symptoms the deviant behaviors or thought processes that are occurring at the present time 2 reflects long standing personality disorders or mental retardation both of which can influence the persons behavior and response to treatment 3 notes any medical conditions that might be relevant such as high blood pressure or a recent concussion 4 the clinician rates the intensity of psychosocial or environmental problems in the persons recent life 5 the persons coping resources as reflected in recent adaptive functioning problems with DSM many of the categories are so detailed as many as 50 of people don t fit neatly into a certain category people who receive same diagnosis may share only symptoms but look very differently from one another the system does not capture the severity of disorders cant capture symptoms that are adaptively important but not severe enough to meet the behavioral criteria for the disorder Psychical therapies Humanistic Psychotherapies between therapist and patient Person centered therapy created by rogers focuses on the relationship Empathetic genuine and have unconditional positive regard Gestalt therapy goal is to bring important wishes feelings and thoughts that have been blocked from ordinary awareness back into the immediate awareness so the client can be whole once again Typically occurs in groups Empty chair technique client may have a conversation with mother who is in empty chair client plays both himself and mother which brings about hidden feelings and emotions Cognitive therapies focus on the role of irrational and self defeating thought patterns therapists try to help clients discover and change the cognitions that underlie these problems Rational emotive therapy embodied in ABCD model o A the activating event that seemed to trigger the emotion o B the belief system that underlies the way in which a person o C the emotional and behavioral consequences of that appraises an event appraisal o D the key to changing maladaptive emotions and behaviors Disputing or challenging an erroneous belief system Beck s cognitive therapy point out errors of thinking and logic that underlie emotional disturbance and to help clients identify and reprogram their overlearned automatic thought process Behavior Therapies classical conditioning procedures Aversion therapy the therapist pairs a stimulus that s is attractive to the client with a noxious UCS in an attempt to condition an aversion to the CS o Ex giving an alcoholic a drug to make him nauseous and then making him drink so that he throws up Exposure therapy exposure to the feared CS in the absence of the UCS while using response prevention to keep the operant avoidance response from occurring o Ex man is bitten by a dog and fears dogs after he now avoids dogs each time he avoids his avoidance response is strengthened through anxiety reduction o Client may be exposed to a real life dog or asked to imagine scenes involving interactions with dogs o Anxiety will occur but will diminish over time if the person remains in presence of the CS dog exposed to or imagined and the UCS original dog who bit him does not occur Systematic desensitization a learning based treatment for anxiety disorders o Eliminates anxiety by using counterconditioning procedure a new response that is incompatible with anxiety is conditioned to the anxiety arousing CS o Client taught voluntary muscle relaxation and then imagines a scene from a stimulus hierarchy 10 20 scenes arranged in roughly equal steps in levels of anxiety and the relaxation overpowers the anxiety replacing CR Behavioral activation behavioral treatment for depression that increases positively reinforcing behaviors Case studies vs Clinical outcome studies Psychotherapy researchers favor clinical trials it is difficult to generalize conclusions from individual case studies outcome measures Randomized clinical trial RCT clients are randomly assigned to treatment or control conditions and the treatment and control groups are compared on Evaluating therapy effectiveness Meta analysis allows researchers to combine the statistical results of many studies to arrive at an overall conclusion Problem studies lumped together can differ in many ways o Combining good studies with less adequate ones can produce misleading results Validitity and reliability of mental illness testing and diagnosis
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