DIAGNOSIS AND TREATMENT OF PSYCHOPATHOLOGY

Course: CED 5979Presenter: John Grady, LPC, LCADC, CCS, ACS, NCCClass #: Three

TODAY’S OBJECTIVES Checking in…

DSM 5 Criteria – The Process of Diagnosing Modified suggested format Screening instruments

Components of a DSM 5 disorder

Tx Team Exercise – Diagnostic Report interviews

… Checking Out (Summary)

INSPIRATIONAL QUOTE – THE ZONE

SHAUN WHITE, 2X-OLYMPIC GOLD MEDALIST

QUESTIONS FOR THE CLASS“CHECKING IN…”

Let’s review our group #s Note: Treatment Team Case Study Presentation Format (Final Project) review will

be next week

From our Reading: What is are some purposes of the intake interview? When completing an intake interview, how important is establishing a good

connection with your client? What makes securing childhood data (e.g. behavioral issues) important if the client

is an adult?

General What are your thoughts, concerns, ideas, etc. regarding the intake interview

process?

SUGGESTED DIAGNOSTIC PROCESS

Gather data both qualitatively & quantitatively (if possible)

Consult a Jongsma Treatment Planner Look up chapter that seems to apply to your

client’s presenting issue Go to the “diagnostic suggestions” part of the

chapter Identify possible applicable diagnoses

Go to the DSM 5

Review the “Diagnostic Criteria” of the Jongsma-suggested diagnoses

PROCESS, CONT.. Reading concretely from the text, see if the symptoms

reported by client, family, etc. or observed behaviors “fit” the diagnostic criteria

If so, diagnose the disorder – but also continue exploring the Jongsma-suggestions or DSM 5’s “Differential Diagnosis” and “Comorbidity” sections This might lead to additional diagnoses or you to discover a more

appropriate diagnosis

If not, continue exploring the Jongsma-suggestions and/or the DSM 5 “Differential Diagnosis” part of the disorder’s segment

Continue process until solid diagnosis(es) is(are) found

Review with supervisor – be prepared to justify your conclusion using DSM 5 criteria

TWO TYPES OF DATA (INFORMATION) GATHERING Qualitative methods: Through interviews

Quantitative: Through instruments

TESTS AND INVENTORIES Many instruments can be used to help screen for possible

ailments – and help us gain quantitative data

Although some guidelines are less strict, we must –

review ethical guidelines

the screen’s guidebook/instruction manual to ensure we can use the instrument

Responsibilities of Users of Standardized Tests (RUST):

http://aac.ncat.edu/documents/rust.html

Note: Most require one to have a Master’s in Counseling or related field

SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS

Suggestion: Just focus on this resource for now – lots of options

Depression Screens

Drug & Alcohol Screens

Bipolar Disorder Screens

Suicide Risk Screens

Anxiety Screens

Trauma Screens

http://www.integration.samhsa.gov/clinical-practice/screening-tools

QUALITY EXAMPLES: SCREENS General Functioning

World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) Depression

Patient Health Questionnaire (PHQ 9) Bipolar Disorder

Mood Disorder Questionnaire (MDQ) Anxiety

Generalized Anxiety Disorder 7-Item (GAD-7) PTSD

Primary Care PTSD Screen (PC-PTSD) Not on SAMHSA Resource – must look up

Alcoholism The Alcohol Use Disorders Identification Test (AUDIT)

Drug Use Drug Use Questionnaire (DAST -10)

Drug and Alcohol Use NIDA Quick Screen V1.O NIDA-Modified Assist V2.0

OUTCOME QUESTIONNAIRE-45 (OQ-45)

Many use as a quantitative measure for counseling effectiveness

Measures

Symptom Distress (e.g. anxiety disorders)

Interpersonal Relations (e.g. family strife)

Social Role (e.g. worker)

Also provides an overall score that adds up the three subscales above

Provides thresholds for ”indicates symptoms of clinical significance”

COMPONENTS OF MOST DSM 5 DISORDERS

Diagnostic Criteria

Info needed to diagnose the disorder

Diagnostic Features

More detail about key symptoms

Associated Features Supporting Diagnosis

Prevalence

Data regarding how disorder affects gender, age, ethnic populations

Development & Course

Common life span development factors

How and when the disorder challenges a person

COMPONENTS, CONT. Risk and Prognostic Factors

Conditions that are associated with the disorder’s manifestation

Culture-Related Diagnostic Issues Cultural variation in the disorder’s expression

Gender-Related Diagnostic Issues

Functional Consequences of the Disorder

Differential Diagnosis List of disorders that have similar symptoms Provides information on what distinguishes the disorders Great for pointing a clinician to other possibly appropriate disorders

Comorbidity Other disorders that may, or may have in the past, occur in the client with the featured

disorder

TX TEAM EXERCISE We will spend the last hour conducting the diagnostic report exercise Role-playing “Clients” – please provide some quality info for your

partner to decipher

If you are using a client from Practicum/Internship, fantastic – Please be prepared to be a "client"

If both partners are using actual clients for your report the three of us can meet to discuss your experience

When completed, please feel free to discuss experience with me or take the evening off Please review the “checking out” slide for reading assignment

TONIGHT’S SUMMARY

Today’s important topic: DSM 5 disorder components

Upcoming Responsibilities: DSM 5 Presentation (one team)

Read: DSM-5 Chapters 3&4

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.

Seligman, L. (2004). Diagnosis and treatment planning in counseling (3rd ed.). New York, NY: Springer

Science+Business Media.

Preston, J., & Johnson, J. (2015). Clinical psychopharmacology made ridiculously simple (8th ed.).

Miami, FL: MedMaster, Inc.