Abnormal Development, Diagnosis, & Psychopharmacology © 2007 Thomson Brooks/Cole, a division of Thomson Learning    Read vignettes, middle of p 323 Reasons to study abnormal developmental, diagnosis, & medication—see 11 reasons p 324 You can’t have one without the other (abnormal behavior, diagnosis, and medication)  If you believe in extreme deviations from the norm (mental disorders and abnormal behavior), then you are going to want to understand it—classify it  If you classify it (diagnose disorders), then you (or the clients) are going to want to be treated  One form of treatment is medication © 2007 Thomson Brooks/Cole, a division of Thomson Learning  Genetic and Biological Explanations  Genetics subset of biology  If disorders are biologically based, it would make sense to treat them biologically  Treating biologically can be broad-based, such as: ▪ Medication ▪ Stress reduction ▪ Exercises ▪ Amount of light we receive ▪ Proper amount of sleep ▪ Etc © 2007 Thomson Brooks/Cole, a division of Thomson Learning  Born all Id  Develop ego and superego as we pass through the psychosexual stages  Experiences through the stages effects personality development  Extremely poor parenting leads to development of maladaptive behaviors as our defense mechanism attempt to control the impulses of our id  Discuss how various parenting styles may affect development ▪ Parents who are obsessively strict ▪ Parents who extensively praise © 2007 Thomson Brooks/Cole, a division of Thomson Learning    Learning occurs through operant conditional, classical conditioning, or modeling Principles of operant conditioning explains many of the ways that individuals develop (see p 330) Major factors that lead to healthy or dysfunctional personality:  Born capable of multiple personality characteristics  Behaviors and cognitions continually reinforced  Reinforcements can be very complex and subtle  Abnormal behavior result of reinforcement  Analysis of reinforcements leads to understanding of person  New behaviors learned by applying principles of learning © 2007 Thomson Brooks/Cole, a division of Thomson Learning    Maslow and Rogers most influential Maslow: We exhibit characteristics based on our placement in need hierarchy (See Figure 10.1, Page 332) Rogers: How significant others treat us results in our personality development (and placement on Hierarchy)  We all need to be loved  Conditions or worth placed on us  To gain love, we respond to others based on conditions of worth—leads to false self  With empathy, genuineness, and unconditional positive regard we can rediscover our “true” selves © 2007 Thomson Brooks/Cole, a division of Thomson Learning    Post-modernism  Questioning of modernism  “Truth” is a construction Social Constructionism  Language creates reality through discourse  Thus, our realities are created through our discourses with others and how “reality” is passed down through society Conclusion  Abnormal behavior is simply a social construction ▪ Perhaps, the mental health field plays a part in continuing this deception © 2007 Thomson Brooks/Cole, a division of Thomson Learning  See Comparison of Models Table 10.1 Page 336  Today, many clinicians integrate the models © 2007 Thomson Brooks/Cole, a division of Thomson Learning      Greek words: Dia (apart) and gnosis (to perceive or know) DSM-I: 1952 DSM-IV-TR: Five Axes  Axis I: All Disorders Except Personality Disorders or Mental Retardation  Axis II: Mental Retardation and Personality Disorders  Axis III: General Medical Conditions  Axis IV: Psychosocial/environmental Problems  Axis V: Global Assessment of Functioning DSM-5 to come out in 2013 Advantages and Disadvantages of DSM © 2007 Thomson Brooks/Cole, a division of Thomson Learning  Offers information on:  Disorder’s main features  Subtypes and variation in client presentations  Typical pattern, course, or progression of symptoms  How to differentiate disorders  See Table 10.2, Page 340  Axis I includes all disorders except personality disorders or mental retardation (in DSM-5, to be called Intellectual Disability)  Axis II is personality disorders and mental retardation © 2007 Thomson Brooks/Cole, a division of Thomson Learning 10        *Disorders usually diagnosed in infancy, childhood, or adolescence Delirium, Dementia, Amnestic, and Other Cognitive Disorders Mental Disorders Due to A General Medical Condition Substance-Related Disorders Schizophrenia and Other Psychotic Disorders Mood Disorders Anxiety Disorders © 2007 Thomson Brooks/Cole, a division of Thomson Learning         *Factitous Disorders Dissociatve Disorders Sexual and Gender Identity Disorders Eating Disorders Sleep Disorders Impulse Control Disorders Not Elsewhere Classified Adjustment Disorders *See pp 339-341 for descriptions 11  Listed on Axis II because treatment has little or no effect  Mental retardation: Intellectual functioning significantly below average  Personality Disorders: Deeply ingrained, inflexible, enduring patterns of behavior ▪ Cluster A: odd or eccentric ▪ Disorders: paranoid, schizoid, and schizotypal ▪ Cluster B: dramatic, emotional, overly sensitive, and erratic ▪ Disorders: antisocial, borderline, histrionic, and narcissistic ▪ Cluster C: anxious and fearful ▪ Disorders: avoidant, dependent, and obsessive-compulsive © 2007 Thomson Brooks/Cole, a division of Thomson Learning 12  Axis III: General Medical Conditions  Use ICD-9-CM for diagnosis  List on Axes I or II also if cause of disorder  Axis IV: Psychosocial and Environmental Problems  List on Axes I or II also if cause of disorder  Axis V: Global Assessment of Functioning Scale  See Table 10.3, p 343 © 2007 Thomson Brooks/Cole, a division of Thomson Learning 13  Example of Multiaxial Diagnosis  Axis I 309.0  Axis II 301.82  Axis III  Axis IV  Axis V © 2007 Thomson Brooks/Cole, a division of Thomson Learning Adjustment Disorder with Depressed Mood Avoidant Personality Disorder No Diagnosis Divorce GAF=60 (current); 75 (highest in past year) 14  Antipsychotics (neuroleptics)  1950s: First wave of antipsychotics  Today: Many different kinds  Today, three types: conventional, atypical, 2nd generation  See Table 10.5, p 345  Side effects are many: anticholinergic, extrapyramidal, tardive dyskinesia, mood disorders, other  Mood-Stabilizing Drugs (e.g., for bipolar disorder)  1950s: Lithium  Today: Lithium, anticonvulsant drugs, benzodiazepines, other © 2007 Thomson Brooks/Cole, a division of Thomson Learning 15  Antidepressants  1930s: amphetamiens  1950s: MAOIs and Tricyclics  More recently: SSRIs and atypical anti-depressants  Anti-anxiety Medications  1960s: Librium, Valium  Later, more benzodiaspenes (Tranzene, Zanax, more  Nonbenzodiaspeines: Buspar , Gepirone, Other  For generalized anxiety disorder, obsessive-compulsive disorder, other © 2007 Thomson Brooks/Cole, a division of Thomson Learning 16    Stimulants  Later 1800s: Cocaine and amphetamines for diet aid, emotional disorders  Today: Mostly used for ADHD  Also used for narcolepsy  Most common: Ritalin, Cylert, and Dexedrine Warning: All have side affects Many different drugs today exist © 2007 Thomson Brooks/Cole, a division of Thomson Learning 17  Misdiagnosis of Minority Clients  Symptomatology may vary as a function of culture  Does DSM-IV-TR truly take into account affects of oppressive society?  Some say: DSM-IV-TR legitimizes the concept of “disorder” thus making it acceptable to oppress those with the disorder © 2007 Thomson Brooks/Cole, a division of Thomson Learning 18  DSM-IV-TRs attempt to address cross-cultural issues  Much greater attention to issues of age, gender, socioeconomic status, and culture  Also has 25 “Culture-bound Syndromes” ▪ E.g.: “Koro” “A term, probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or in females, the vulva and nipples) will recede into the body and possibly cause death .” (APA, 2000, p 900) © 2007 Thomson Brooks/Cole, a division of Thomson Learning 19  Ethics Code:  ACA’s 2005 code addresses a number of important issues relative to diagnosis ▪ Proper diagnosis: B e careful to ensure proper diagnosis ▪ Cultural Sensitivity: Be sensitive to how cultural background can affect the manner in which the client expresses self ▪ Historical and Social Prejudice: Counselors should understand and recognize that some groups have been misdiagnosed and pathologized ▪ Refraining from Making a Diagnosis: Refrain from diagnosing if you think if making a diagnosis will harm client © 2007 Thomson Brooks/Cole, a division of Thomson Learning 20 DSM-5 (probably, 2013)  May collapse Axis I and Axis II  Other?  Challenging Abnormality and Diagnosis  Some say mental illness is a normal response to a stressful situation (e.g., Laing and Szasz)  Glasser believes psychopathology is a client’s clumsy attempt at meeting his or her needs  © 2007 Thomson Brooks/Cole, a division of Thomson Learning 21  Challenging Abnormality and Diagnosing (Cont’d)  Ivey and Ivey suggest diagnosis may be a normal response to developmental issues (see Box 10.3, p 351)  Corey: feasons why clinicians should be careful when diagnosing (see bottom of p 350)  Overdiagnosis of Mental Illness  Because we have DSM, we naturally overly diagnose?  See Box 10.4, p 352: On Being Sane in Insane Places © 2007 Thomson Brooks/Cole, a division of Thomson Learning 22  Confinement Against One's Will  Donaldson v O’Connor (1975): People can’t be held against their will unless there is danger to self or others  Today, usually need a hearing to have people confined against their will  Insurance Fraud  Some diagnoses may not be paid by insurance companies  Some clinicians give alternative diagnoses in order to get paid  Giving an alternative diagnosis is illegal © 2007 Thomson Brooks/Cole, a division of Thomson Learning 23  Dismissing Impaired Graduate Students  Should we dismiss students at all?  Should we view students from DSM?  Should we take a developmental perspective and assist students to strive toward wellness?  ACA code suggests: ▪ Assist students in securing remedial assistance ▪ Seek professional consultation and document decision to dismiss or refer students ▪ Ensure students have recourse in a timely manner to address issues of referral or dismissal © 2007 Thomson Brooks/Cole, a division of Thomson Learning 24 ... “A term, probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or in females, the vulva and nipples) will recede into the body and possibly cause... the norm (mental disorders and abnormal behavior), then you are going to want to understand it—classify it  If you classify it (diagnose disorders), then you (or the clients) are going to want... Sensitivity: Be sensitive to how cultural background can affect the manner in which the client expresses self ▪ Historical and Social Prejudice: Counselors should understand and recognize that some