DIAGNOSIS AND TREATMENT OF PSYCHOPATHOLOGY
Course: CED 5979Presenter: John Grady, LPC, LCADC, CCS, ACS, NCCClass #: Two
TODAY’S OBJECTIVES Checking in…
DSM 5 General Format
Diagnostic Report Assignment (Clinical Interview & Assessment)
Scheduling:
Treatment Team Presentations – DSM 5 Disorders
Case Study Presentations (fixed dates)
Tx Team Exercise
… Checking out (Summary)
QUESTIONS FOR THE CLASS“CHECKING IN…”
From DSM-5 text: The DSM-5 features a major structural change (the 1st since 1980’s DSM-III) – how does this affect counselors?
Some diagnostic thresholds have been lowered – what makes this important?
How can the following quote be helpful to clients?....
INSPIRATIONAL QUOTE
FORMAT:SECTION II – DIAGNOSTIC CRITERIA & CODES
There are 22 ”main categories” or “families of disorders” E.g. Neurodevelopmental Disorders
Under some “families”, we may (or may not) have a smaller group of similar disorders E.g. Intellectual disabilities; communication disorders
Under these clusters (or directly under the main category), we have specific disorders (i.e. those that have diagnostic codes) E.g. F88 Global Developmental Delay
(under Intellectual Disabilities)
E.g. F72 Social (Pragmatic) Communication Disorder (under Communication Disorders)
SO, WE HAVE …
22 large DSM 5 “Families”
Some “families” have divisions, each with specific
disorders (“Family Members”)
Most “families” do not have divisions, only the specific
disorders (“family members”)
DSM DISORDER “FAMILIES”
EXAMPLE: DSM-5 FORMAT, W/SMALLER
“GROUPS” Neurodevelopmental Disorders
Intellectual Disabilities
F88 Global Developmental Delay
F72 Intellectual Developmental Disorder, Severe
Communication Disorders
F80.89 Social (Pragmatic) Communication Disorder
EXAMPLE: DSM-5 FORMAT, W/O SMALLER
“GROUPS”Bipolar and Related
Disorders
F31.13 Bipolar I, current or most recent episode
manic, severe
F31.81 Bipolar II, current episode depressed,
moderate severity, with mixed features
HERE ARE THE DSM “FAMILIES” AGAIN…
IN EACH “FAMILY” ARE INDIV. DISORDERS (“MEMBERS”)
EACH “FAMILY MEMBER” HAS DIAGNOSTIC CRITERIA
STRUCTURE SUMMARY
Family (Group of Disorders) Family (Group of Disorders)
Divisions (some, not all)
Family Members (Specific Disorder) Family Members (Specific Disorder)
THAT’S ALL FOR NOW… Next week, we’ll talk about the specific diagnosis process
And screens that can help us
Let’s talk about the first step to gathering the information needed to diagnose –
The diagnostic interview
EFFECTIVE ASSESSMENTS One opinion: We are always assessing whenever in contact w/ct.
New information can be a new “puzzle piece” to explain client’s current condition
Attributes of semi & fully structured assessments Streamline info-gathering process Bolster credibility & validity of counseling process ID client motivation (Stages of Change) Clarify if challenges (i.e. pathology) exist ID client strengths, leisure, interests, etc. Create data to determine clinical needs, which helps us generate
relevant evidenced based interventions
ASSESSMENT FOCUS EXAMPLES
Behaviors General or specific (e.g. sleeping, substance use)
Personality/Affect Mood, emotions
Interpersonal Relationships Family, relationship themes, conflicts, strengths
Cognitive Thinking, awareness of reality
Physical Medical conditions (WHODAS 2.0)
Social & Multicultural Socioeconomic level, cultural beliefs, values
SUMMARY – INTERVIEW COMPONENTS (FOR DIAGNOSTIC REPORT & REFLECTION
ASSIGNMENT)
Mental Status Exam pgs. 135-138 in Seligman text For our project, only appearance, behavior, attitude, mood is required
Rest of components (below) are on pages 138-141
Identifying Info (e.g. age, gender)
Presenting Problem
Additional Problems & Previous Challenges
Present Life Situation
Family of Origin
Current Family
Developmental History
SUMMARY, CONT. Infancy
Early Childhood
Middle and Late Childhood
Adolescence
Adulthood
Medical and Counseling History and Treatments
Additional Info Important to Client
Assessment – which diagnosis is indicated given the presenting information (observed and reported)?
FOR THE DIAGNOSTIC REPORT & REFLECTION PAPER… Role play with your Tx Team partner or use w/ real client (if in
Practicum/Internship) Time will be provided next week (& the following if needed)
Gather the information outlined in previous slides Specific components are on pgs. 138-141 (Seligman text) You do not need to answer each question but generate good data Come to class prepared to ask questions of your partner
Assessment component (not in book) Consider which “family” of diagnoses might be indicated Identify a specific diagnosis if possible (give it some effort!) Do your best – this is an introductory exercise used to generate feedback
for you (& the class)
MENTAL STATUS EXAM COMPONENTS
Appearance Behavior Attitude Level of consciousness Orientation Speech & Language Mood Affect Thought Process Thought Content Suicidality and Judgement Attention Span Memory Intellectual Function
For our project, simply identify the components in red – more, if you wish
MSE, CONT.
MSE, CONT..
MSE, CONT.
QUESTIONS?
CASE STUDY SCHEDULING Week 13: Groups 1,2
Week 14: Groups 3, 4, 5
Week 15: Groups 6, 7
As we work in our groups, I will provide a sign up sheet for your group’s DSM 5 presentation…
Please put your TEAM # and your NAME on the sheet.
DSM 5 PRESENTATION SCHEDULING
As we work in our groups, please sign up for your DSM 5 presentation. Options include:
Anxiety Disorders
Mood Disorders
Gender Dysphoria
Trauma & Stressor Related Disorders
SA/Addiction Disorders
Obsessive Compulsive & Related Disorders
The dates are fixed, but you can choose your topic of interest
TX TEAM EXERCISE As you watch the clip, please put on your clinical cap and consider
the following: Appearance, Behavior, Attitude Presenting Problem (chief complaint) Present Life Situation (e.g. relationships, leisure) Key Symptoms
TONIGHT’S SUMMARY
Today’s important topic: DSM 5 General Format Clinical interview components
Upcoming Responsibilities: Prepare for interviewing your partner next week Read: Seligman Chapter 5
RESOURCESAmerica Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Dailey, S.F., Karl, S.L., Gill, C.S., & Barrio-Minton, C.A. (2014). DSM-5 learning companion for counselors.
Alexandria, VA: American Counseling Association.
Jongsma, A. E., Peterson, L.M., & Bruce, T.J. (2014). The complete adult psychotherapy treatment
planner (5th ed.). New York, NY: Wiley.
Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The
Guilford Press.
Preston, J., & Johnson, J. (2015). Clinical psychopharmacology made ridiculously simple (8th ed.).
Miami, FL: MedMaster, Inc.