Practical Criteria

"three D's"

In psychopathology we use this to diagnos people

• Dysfunction
• Distress/discomfort
• Deviance

when a person has a significant impairment in functioning

•  
  • Ex: someone is busy carrying out their normal roles in life then they just don't feel like doing that anymore
  • To help and determine if something is abnormal you have to ask how much are these changes  affecting this person's life

Dysfunction

means that some form of emotional suffering is present

•  
  • The emotional suffering is not always felt by the patient, sometime it’s the others around them 

Distress(discomfort)

refers to differences; means that the person falls out of the norms on the bell curve.

•  
  • The person has weird, strange or bizarre behavior

Deviance

can be observed and documented objectively 

things that are verbally told to the therapist by the client

the perception of somebody or something that is not really there, which is often a symptom of a psychiatric disorder or a response to some drugs

Hallucinations-

a persistent false belief held in the face of strong contradictory evidence, especially as a symptom of a psychiatric condition

Delusions

describes an illness or medical condition that lasts over a long period and sometimes causes a long-term change in the body

Chronic Mental Illness

describes a disease that is brief, severe, and quickly comes to a crisis

Acute Mental Illness

seek the best diagnosis that accounts for all of the available data

•  
  • Ex: a patient may have symptoms that we can attribute to a less server diagnosis but if a more sever diagnosis covers everything then  use that one

disorders exist by the most severe at the top and the less severe at the bottom.

Hierarchy

The most severe disorders are the ones with medical problems

•  
  • Ex: diabetes, brain tumor,

Next most severe are the psychotic disorders

•  
  • Skitzo, pipolar, delusion
  • Usually require hospitalizations

Next mood disporders

•  
  • Depression
  • Because they are not so easily treated
• Anxiety disorders
• Somatic Disorders
• Sexual D/O
• Personality D/O
• Adjustment D/O

Must be theory based! Include strengths and assets, precipitating stress (if any), pertinent background information and history; thoughtful identification of presenting problems; evidence of sophisticated assessment and insight into individual and/or systemic dynamics; sensitive to multicultural factors and diversity issues

CASE CONCEPTUALIZATION

Myths surrounding mental illness

 Mental D/O are not true medical illness; People who are mentally ill are just crazy

 If you have a mental illness you can will it away

MYTH: 

• You can not will away the problem: You need proper treatment and support
• Spirituality can be an important strength but it won't do away with it
  • Recognize the science of our profession

People with skitzo aren’t dangerous

Clinical Syndromes

•  
  • Bipolar, anxiety, skitso
  • When writing down we have to use the code number
    • Ex. Axis I: 309.81 Posttraumatic Stress Disorder
  • Those that represent a distinct change in functioning from the way the person normally functions
  • Usually Diagnosed in infancy, childhood or adolescence

Personality D/o and Mental Retardation pg29

•  
  • So significantly different from axis one that they created its own axis
  • The way they different is that they are long standing problems
    • Ex. With mental retardation people who knew this person as a child could recognize it and with personality d/o people are less likely to  change because it is a developmental thing
    • Person has pretty much always functioned that way

General Medical Condition

•  
  • You have to Defer to Physician
  • The only way you can put a medical condition is to ask the patient for his doctors records but you can't put anything just because the client tells  you

Psycho-Social Stressors 

•  
  • Typically clients come in they we talk to you about problems at home or work with are Psycho Social Stressors…those are NOT disorders
  • No specifics just try to find a catogory
    • Problems with family
    • Problems related to social environment
    • Educational problems
    • Housing problems
    • Economic problems
    • Problems with access to health care services
    • Problems related to interaction w/ legal system/crime
    • Other psychosocial and environmental problems 

Global Assessment of Functioning (GAF Score)

• GAF Present=
• GAF Highest Past Year=
• The Lower the score the more likely of a person to be a danger to himself or others
• You can tell whether a person is getting better or worse

something that is likely to happen

Factors to take into consideration when making a Prognosis

Natural course of the particular D/O.

• Ex. People with PTSD will likely get better over time  without any intervention…w/ intervention they get better faster than if the D/O  takes its natural course.

• Ex. If the person has never been past a 60 and he is 60 then they may get a little better but not a lot

• Because it's a chronic  thing because it's just taken a lot of time

• The More Acute the onset is(comes on suddenly) the BETTER the prognosis

Bio-psychosocial history

clients family, developmental experiences, family experiences military services, drug use, medical history,  marriage, diet, work history, psych history, presenting problem

• Ask Questions about the history because in the waiting room they will fill this all out and you should go over it with them
  •  
    • Ex. If they say they finished high school ask if the got a diploma or GED
• Were they on any or have they ever been prescribed meds for the problem they coming to see you for

Mental status examine

General appearance and behavior, include the person's orientation to time, place and person…know who they are  and where they are and the time and date

• Ex. Write it Oriented Times 3
• Ex. If they are oriented time 2 then put the two they are oriented with
• Pay attention to how their paying attention to you and their mood and affect…do they appear anxious or sad or angry or cooperative.
  • The Affect is the expression they show on their face…if they talk a bout something that should be sad but they have a smile on  their face so it would be inappropriate affect
• Note their perception- how they intake things into their senses
• Note their Cognition- they're thoughts
  • Suicidal and/or homicidal idealation
• Note their judgment - can they look at a reality situation and make a good judgmental situation
• Note their Insight- the better a person is into their feelings usually make good progress

Genetic Theory

Right side of the brain controls our ability to use symbols like letters and numbers and controls the left side

Left side controls right side and controls special l dimensions and street smarts…put a puzzle together

• If something happens to the right side then you may have problems with decision making

In the brain, neurons communicate through chemicals called neurotransmitters. There molecules seep out of one neuron and excite another, triggering electrical signals that produce thoughts, emotions, memories and will.

Psychoanalytic

Behaviors being learned- through classical or operate

Pavlov( the man with the dogs)

• Unconditioned stimulus (the food for the dog)
  • The food makes the dogs salivate naturally which was an unconditioned response
• He paired the food with a bell and every time he presented the food he would ring the bell which is called a conditioned Stimulus  because its not natural to salivate to a bell
• Then he would ring the bell and the dogs salivated so salivation is called he Conditioned response

Skinner

•  
  • Reinforcement increases Conditional response
  • If you positively reinforce a behavior regardless of how it's started than that behavior will be repeated because of it's association with  a reward

A mother takes her child to the store and it cries for candy. The mother buys the child candy and the crying stops. Candy giving has  been ____________ reinforced because we removed the crying(aversive(unpleasant for the mom)). The crying has been _________ reinforced because the mom gave the kid candy

• Pathology develops because of our irrational or maladaptive thoughts and this way of thinking may have started out of the classical conditioning  situation but it has to do with our thoughts have been reinforced by the maladaptive thinking
• Based on the concept that behavior is learned! We learn bad, irrational thoughts and through those being reinforced they just hang in there! 

Ellis' ABCD

A- Activating Event

• Woman getting divorced

• Im a failure, I can't do anything right
• We tend to maximize that faulty belief and make it bigger than it is

• The more you think about it you start to have consequences like
  • Sadness, loss of interest in things, poor self-esteem, feelings of hopelessness
    • Lead to Depression

• Say things like im looking at a woman that has raised three kids, kept a good house, good cook
• Help them to stop maximize those bad thoughts and focus on the reality and what they have to do to move on from that
• Show her that she was basing her whole woman self-esteem on one thing…the marriage

focus on people's experiences and their perceptions. The goal is to free people from their disabling attitudes so they can live fuller  lives.

• All other theories come from a lock in reasoning position

• It says that everything or person in a system affects every other thing so that we can't determine the beginning and the end so we can't determine  what caused something happen

when strivings are forted

• Leads to self-devaluation because you feel like you've failed yourself
• Types of basic ones
  • Handicapped, learning disabilities, lacking any kind of competency
  • Guilt, loss of control

when two or more incomparable needs arise at the same time

stressors that cause us to speed/intensifies our efforts. Seriously affects our coping resources

• Self- imposed
  • Perfectionism
• They are servere when they keep going and going
• The more stressors you have the more your coping resources are weakened

Approach-Approach

• Choose between two desirable goals

• Two things you want to do but you have to do one of them.

• The need to approach and avoid a single goal at the same time
  • Ex: the guy who walks into the party and sees a girl he likes and he wants to ask her to go to the movies but he is  embarrassed
  • The closer you are to the goal the more likely it is you will reach it

Basic ways to cope with stress

Defense oriented pattern

• Things like women who shop or cry and freud's defense mechanism
• These keep you from psychological deterioration

Task orientated pattern

• Directing their behavior towards the stressor
• These are the most healthy. You don't do it completely but the more you are task related the better