DSM I- influenced by psychoanalytic theory, theoretical 

DSM II- not a lot changed

• More explicit criteria
• Descriptive, ATHEORETICAL
• multiaxial diagnosis
• more elaborate descriptions of mental disorders
• field guide

• Axis 1: Clinical disorders
• Axis 2: mental retardation, personality disorders
• Axis 3: general medical conditions
• Axis 4: psychosocial & environmental problems
• Axis 5: Global Assessment of functioning (GAF)

Heart as the pump

Psychiartrist problem: a medical discipline without a Harvey -cannot explain how the brain causes mental state

• state hospital psychiatry
• Meyer Epoch 
• Psychoanalytic 
• empirical psychiatry epoch 

• Psychobiology: 
• Mental disorders do not "strike" a life so much as "emerge" from it
• Psychiatrists formulate patients (bottom-up)
• Recognize importance of patient history

• These studies showed the discrepancy between US and UK psychiatrists in the rates of diagnoses of Schizophrenia (use different definitions)
• US-Bleulerin
• Europeans -Kraepelinian

Meyerian -Observe

Psychoanalytic - interact

Empirical - identify

1. Locations of the injury in the body      (explains the signs and symptoms of an illness)
2. the nature of a "process" generating injury     (explains the course of illness and determines treatment) 

• The disorders are organized according to their shared phenomenological features -> (what they look like)
• reliable 
• top-down

Has: disease perspective

Is: dimenstion perspective

Does: behavioral perspective

Encountered: life story

• What the patient has
• "Intrinsic" cerebral faculties 

• What the patient is
• Constitutional "self dimensionals"

• What the patient does
• goal-oriented, motivations

• personal life developments
• what the person encounters

• Take a history
• Perform a mental status exam
• make diagnostic formulation
• make a treatment plan
• Treatment

• Any morbid phenomenon or departure from the normal in function, appearance or sensation, experienced by the patient and indicative of disease
• Subjective-felt 

• Any abnormality indicative of a disease, discoverable by a physican on his (her) examination of the patient
• Sign is objective

• Observation
• Interpretation
• Clinical Judgment

• Symptoms
• Signs
• Course over time
• Etiopathology

Does the patient have disrupted cerebral faculties?

• Psychic Anxiety
• Somatic Anxiety

• apprehensive expectation
• viligance and scanning

• Autonomic hyperactivity
• motor tension

1. Facility surveys with diagnoses from medical records
2. Community Surveys with overall caseness ratings
3. Structured Interview Surveys with Diagnoses

Sensitivity (low): .28

Specificity (high): .99

Kappa (not great): .4

Interviewers 

• female
• middle-aged
• less than college educated
• articulate

• Interviewer attrition during training > 50%
• Pay by the hour and not by piece
• 10% validation 
• 7-15 interviewers per supervisor
• 1-2 weeks training