Psychopathology Class 2 March 21, 2014

1. Psychopathology Class 2 March 21, 2014 Dr. Funto Oluwafemi

2. Models of Abnormality • 4 models • Biological • Psychosocial • Sociocultural • Spiritual • There is a need for integration • Psychopathology is multiply maintained • “Biopsychosocial” model • One model alone cannot sufficiently explain all aspects of abnormality. • Looking at mental illness through just one model can impact the care of souls adversely. • People are more than the sum of their problems.

3. Need for integration • About 1/3 of all Americans will suffer a serious mental problem at some point in their life. • To ignore the reality that a large number of the congregation is suffering results in further isolating or hurting already hurting people. • Prevention is needed “The greatest untapped mental health resource in this country are the churches and synagogues that are empty six and a half days a week.” (Albee, as quoted in Yarhouse et al., 2005).

4. Preventative Care • Primary Prevention: Anything done to improve mental health. • Early detection & screening, employment, housing, strong social support systems. • Secondary Prevention: efforts to identify high-risk groups and intervene as soon as possible. • Victims of abuse & violence, people experiencing losses, etc. • Tertiary Prevention: facilitation of access to competent caregivers in therapeutic settings and restoration of health and wholeness.

5. Classification of Mental Disorders • Diagnostic classifications • Provides communication • Provides a means for organizing and retrieving information • Provides a template for describing similarities and differences between individuals • Provides a means of making predictions about course and outcome • Provides a source of concepts for use in theory and experimentation.

6. Pastoral Care & DSM • Focus of the field of mental health is on organized understanding and categorization of problems people experience in their psychological health. • Provides basis for diagnostic categories • Pastoral care providers seek to appraise psychopathology in light of the truth of the Scriptures and the teachings of the church. • Need for integration not segregation.

7. The DSM • One of the classification systems used by mental health professionals • International Classification of Diseases (ICD) – Published by WHO. • The DSM is a classification of mental disorders with associated criteria designed to facilitate reliable diagnoses. • Practical, functional, and flexible guide for organizing information. • Aids accurate diagnosis and treatment of mental disorders. • Reference for researchers. • Successive editions over the past 60 years. • Standard reference for clinical practice in the mental health field. • Note: Symptoms in respective diagnostic criteria set do not constitute comprehensive definitions of underlying disorders. Rather, they are intended to summarize characteristic developmental history, biological and environmental risk factors, neuropsychological and physiological correlates, and typical clinical course. (APA, 2013).

8. The DSM • Does not fully describe the range of mental disorders that individuals experience and present to clinicians throughout the world. • Impossible to capture the full range of psychopathology in the current diagnostic categories. • The necessity of the inclusion of “other specified/unspecified” disorder options. • Designed for: • Clinical assessment • Case formulation • Treatment planning

9. DSM-5 • Current edition of the DSM • Published May, 2013 • Incorporates years of research about the brain, genetics and human behavior. • Divided into 3 sections • Section I - basic introduction on how to use the manual • Section II – provides 20 classifications of disorders that focus on diagnostic criteria and codes. • Section III – focuses on emerging measures and models • Uses a nonaxial system • Shift from the multiaxial system of DSM-IV • Combines axes I, II, and III (consistent with ICD) • Lists as many diagnoses as necessary to provide the clinical picture • Principal diagnosis is listed first • Then list psychosocial and environmental problems

10. DSM-5 • Sample Diagnoses using the nonaxial system • Woman who makes an appointment for treatment of moderate depression related to bipolar disorder and also meets criteria for obsessive-compulsive personality disorder. Her symptoms of depressions have become exacerbated due to being placed on probation due to low performance at work. 296.52 Bipolar I disorder, moderate, most recent episode depressed 301.4 Obsessive-Compulsive Personality Disorder V62.29 Other Problem Related to Employment

11. DSM-5 • Dimensional approach to diagnosis versus categorical system of the DSM-IV • Separate disorders can be related conditions on a continuum of behavior. • Spectrum concept (e.g. substance abuse, autism, schizophrenia) • Inclusion of specifiers to enhance diagnosis and increase clinical utility. • Apply to the client’s current presentation and only when the full criteria for a disorder have been met. • Course (e.g. in partial remission) • Severity (e.g. mild, moderate, severe) • Frequency (e.g. once a week) • Duration (e.g. minimum duration of 6 months) • Descriptive features (e.g. with poor insight)

12. DSM-5 • Use of “Other specified” and “Unspecified” disorders • Available for all disorders • Other specified disorder – symptoms are clinically significant but do not meet the full criteria for a disorder. (e.g. a client with a history of a major depressive disorder who now meet all criteria for hypomania except the duration criterion – at least 4 consecutive days). • Unspecified disorder – clinically significant presentation and does not meet full criteria for a disorder and the clinician choses not to specify the reason that the criteria have not been met. (e.g. insufficient information in an emergency room setting). • Developmental & Lifestyle Approach • Classifies disorders into 20 sections based on relatedness and similarities in characteristics

13. DSM-5 • More cultural considerations • Disorders defined in relation to cultural, social and familial norms and values • Considers key aspects of culture relevant to diagnostic criteria • Culture provides interpretive frameworks that influence the experience and expressions of diagnostic criteria (behaviors, symptoms, signs). • Cultural factors influence symptomatology , clinical presentation, help-seeking, expectations of treatment, treatment response.

14. DSM -5 • More gender considerations • Indicates when particular symptoms may be informed by the individual’s gender. • Identify potential differences between men and women in the expression of mental illness. • Influence of gender on illness: • Can exclusively determine whether an individual is at risk for a disorder (e.g. premenstrual dysphoric disorder). • May moderate the overall risk for the development of a disorder • Influences the likelihood that particular symptoms of a disorder will be experienced by an individual.

15. DSM-5 • Harmonizes with the ICD-10 (and ICD-11) • Same codes. • ICD-10-CM (Clinical Modification) – used specifically for medical coding and reporting in the United States. • ICD provides code numbers and limited diagnostic information. DSM-5 provides more specific and detailed diagnostic criteria.

16. Purpose of Diagnosis • Clinical utility • Help to determine prognosis • For treatment planning • Potential treatment outcomes • Need for treatment should take into consideration: • Severity of symptoms • Symptom salience • Distress associated with the symptoms • Disability related to the patient’s symptoms • Risks and benefits of available treatments • Other factors

17. Clinical Case Formulation • Clinical case formulation: • Careful clinical history • Social, psychological, biological, and spiritual factors that may be contributing. • Consider severity and valence of symptoms • Avoid simply checking off symptoms in diagnostic criteria to validate a diagnosis. • Ultimate goal is to use the available contextual and diagnostic information to develop an appropriate treatment plan informed by the individual’s cultural and social context.

18. Elements of a Diagnosis • Diagnostic criteria/descriptors • Guidelines for making diagnoses • Informed by clinical judgment • Where available: • Define disorder severity • Identify descriptive features • Specify course (DSM-5 allows for multiple diagnoses for presentations that meet criteria for more than one DSM-5 disorder) • Subtypes and specifiers • Allow for increased specificity • Principal diagnosis • When there is more than one diagnosis • The condition chiefly responsible for help seeking

19. Elements of a Diagnosis • Provisional diagnosis • When there is a strong presumption that the full criteria will be ultimately met but not enough information. • (Provisional) • Coding and reporting procedures • Each disorder is identified with a diagnostic and statistical code • Data collection and billing purposes

20. References • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. • Clinebell, H. (2011). Basic Types of Pastoral Care and Counsleing-Resources for the ministry of healing and growth (3rd ed.). Nashville. • Reichenberg, L.W.(2014). DSM-5 Essentials. The Savvy Clinician’s Guide to the Changes in Criteria. Hoboken, NJ: John Wiley & Sons, Inc.