Psychosocial Rehabilitation Mid term

DSM 1

Published in 1952

DSM 2

Published 1968

DSM 3

Published 1980

DSM 3-R

Published 1987

DSM 4

Published 1994, described 297 disorders, consists of 886 with 41 NOS diagnoses, and required impairment in functioning in social, occupational, and occupational or other functional area of life

DSM IV-TR

Published 2000, "primary goal of the DSM 4 TR was to maintain the currency of the DSM IV text by reflecting the empirical literature up to 1992

DSM 5

Published 2013

DSM 5TR

March 2022 and added the prolonged grief disorder

Two major changes to the DSM 5

Elimination of the Multiaxial system and

Changing the order of the chapters in the DSM 5 from previous editions

Elimination of the multiaxial system in the DSM5

GAF was removed and WHDOAS (World Health Organization Assessment Schedule) was implemented

and

WHODAS has 6 categories: mobility, personal care, getting along, activities of life, and participation

Goals of the DSM V

Severity scales were developed to clarify diagnoses, emphasize that transient responses are not necessarily considered dysfunctional, & eliminate the vague diagnoses that emerges from NOS classification.

Changing the order of the chapters in the DSM 5 from previous editions

Diagnoses were reordered to reflect the development perspective (lifespan), Lifespan information is use to better inform diagnosis, & Parallels the WHODAS structure of diagnosis

Emil Krapelin (1856-1926)

Authored an influential early classification system in his textbook if psychiatry first published in 1883.

Krapelin (Syndrome)

certain symptoms clustered together as a

Kraplen labeled a set of syndromes

hypothesized each had it sown biological cause, course, and outcome.

Kraeplin proposed two major groups of severe psychological disorders

dementia praecox and manic-depressive psychosis.

Dementia praecox

early term for schizophrenia

manic-depressive psychosis

early term for bipolar disorder

Comborbidity

refers to the presence of a second diagnosis.

Intellectual Disabilities

Intellectual Disability (Intellectual Developmental Disorder), Global Developmental Delay, & Unspecified Intellectual Disability (Intellectual Developmental

Disorder)

Intellectual disability affects what and when

deficits in cognitive functioning with onset during development period.

intellectual disability Criteria

neurodevelopmental disorders

Intellectual disability, Autism spectrum disorder, ADHD, Tic Disorder, & Speech/Communication Disorder

Neurodevelopment Disorder

These disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.

Criteria for Intellectual Disability

Deficits in intellectual functions,

Deficits in adaptive functioning that results in failure to meet development sociocultural standards for personal independence and social responsibility

Onset of intellectual & adaptive deficits in developmental period:

Criteria for Intellectual disability, Onset of intellectual & adaptive deficits in development period is defined on

the basis of adaptive functioning and not by IQ. Adaptive function determines the level of supports required and are less valid in the lower end of the IQ range.

Adaptive function determines

the level of supports required and are less valid in the lower end of the IQ range

Vineland Adaptive behavior Scale (VABS)

measures social skills from birth to 19 y/o. test given to caregivers not child

The Diagnostic Adaptive Behavior Scale (AAIDD, 2013)

measures adaptive behavioral skills and helpful in determining intensity of diagnosis and what support is needed.

Three main categories of behavioral skills

conceptual, social, and practical life skills

IDD levels of Severity:

Conceptual domain, Social domain, and Practical domain.

IDD, Conceptual Domain

Language, reading, writing, math, reasoning, knowledge, and memory

IDD, Social Domain

empathy, social judgement, interpersonal communication skills, ability to make and keep friendships

IDD, Practical Domain

self-management in areas of personal care, job responsibilities, money management, recreation, and organization of tasks

Speech diagnoses

Communication disorder, Language Disorder, Speech Sound Disorder(Phonological), Childhood-Onset Fluency Disorder, & Social(Pragmatic) Communication Disorder

Language disorder

difficulties of acquisition and use of language due to deficits in comprehension of production of vocabulary, sentence structure, and discourse.

Criteria of Language disorder

A. Persistent difficulty w/acquisition & use of language across modalities: Reduced vocabulary, Limited sentence structure, Impairment in discourse

B. Language abilities sig. below those expected for age, resulting in functional impairments in communication, social participation, academic/occup perform.

C. Onset in early developmental period

D. Not attributable to hearing or other sensory impairment or other sensory or medical condition.

Speech Sound Disorder

(previously known as Phonological disorder) deficits in social use of verbal communication for social purposes, impaired communication in social contest, problems with nonliteral or implied meanings.

Speech Sound disorder has persistent difficulty with

specs sound production that interferes with speech intelligibility prevents verbal communication or messages.

Speech Sounds Disorder disturbance causes limitation

in effective communication that interferes with social participation, academic achievement, or occupational performance

Speech Sounds Disorder Onset of symptoms happen

in Early developmental period

Speech Sounds disorder is not due to

congenital or acquired conditions

Speech Sound Disorder criteria

A. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication or messages.

B. Disturbance causes limitation in effective communication that interferes with social participation, academic achievement, or occupational performance

C. Onset of symptoms in early developmental period

D. Not due to congenital or acquired conditions

Childhood-Onset Fluency Disorder

(previously known as stuttering) disturbances in normal fluency and time patterning of speech uncharacteristic of developmental level

Childhood-Onset Fluency Disorder criteria

A. disturbances inappropriate for the individual's age and language skills, persists over time, and characterized by frequent an marked occurrences( one or more of following)

Sound and syllable repetitions, Sound &prolongations of consonants & vowels. Broken words, audible or silent blocking, circumlocutions, words produced with excess of physical tension, and monosyllabic whole word repetitions

B. Causes anxiety about public speaking and limitations in effective communication

C. Early developmental period (later onset is adult-onset fluency disorder)

D. Not speech-motor or sensory deficit or neurological insult.

Disturbances inappropriate for the individual's age and language skills, persists over time, and characterized by frequent and marked occurrences:

Sound and Syllable repetitions, Sound & prolongations of consonants & vowels, Broken Vowels, Audible or silent blocking, Circumlocutions, Words produced with excess of physical tension, & Monosyllabic whole word repetitions

Social (Pragmatic) Communication Disorder

Difficulty with pragmatics or the social use of language and communication as manifested by deficits in understanding and following social rules of verbal and nonverbal communication

Social(Pragmatic) communication Disorder criteria

A.Persistent difficulty in the social use of verbal & nonverbal communication

1. Deficits in using communication for social purposes

2.Impairment of the ability to change communication to match the context of listener

3. Difficulties following rules for conversation or story telling.

4. Difficulties in understanding what is not explicitly state & non stated & nonliteral or ambiguous meanings of language (idioms, humor, metaphors)

B. Deficits in functional limitations in effective communication, social participation, social relationships, academic achievement or occupational performance

C. Onset in early developmental period

D. Not attributable to neurological or medical disorder

E. Not autism, intellectual disability, or other mental disorder

Autism Spectrum Disorder

The essential feature of autistic disorder is persistent deficits in social communication and social interaction across a number. of contexts.

Autism Spectrum Disorder replaced:

Autistic disorder(autism), Asperger's disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder NOS

Autism Spectrum Disorder Criteria

A. Deficits in functional limitations in effective communication, social participation, social relationships, academic achievement or occupational performance

B. Onset in early developmental period

C. Not attributable to neurological or medical disorder

D. Not autism, intellectual disability, or other mental disorder

Autism Spectrum Disorder specifiers

· With accompanying intellectual impairment

· Without accompanying intellectual impairment

· With accompanying language impairment

· Without accompanying language impairment

· If associated with another neurodevelopmental, mental, behavioral disorder

· With catatonia

Specifiers of Severity : Level 1- requiring support Level 2- requiring substantial support Level 3- Requiring very substantial support.

Attention Deficit/Hyperactivity Disorder:

A. A persistent parrern of inattention and/or hyper-activity-impulse that interferes with functioning or development

1. Inattention: 6 or more of the following have persisted for at least 6 months

(Children 6 symptoms for 6 months, adolescents/adults 5 symptoms for 6 months)

· Fails to give close attention to details or makes careless mistakes

· Difficulty sustaining attention in tasks or play activities

· Does not seem to listen when spoken to directly

· Does not follow through on instructions or fail schoolwork

· Difficulty organizing tasks and activities

· Avoids, dislikes or is reluctant to engage in tasks that require sustained efforts

· Loses things necessary for tasks or activities

· Easily distracted by extraneous stimuli

· Forgetful in daily activities

ADHD

· Fidgets with or taps hands or feet/ squirms in seat

· Leaves seat in situations when remaining seated is expected

· Runs about or climbs in situations where it is inappropriate

· Unable to play or engage in leisure activities quietly

· Often on the go as if driven by a motor

· Talks excessively

· Blurts out answer before question has been completed

· Difficulty waiting for turn

· Interrupts or intrudes on others

ADHD time frame

1. Hyperactivity: 6 or more of the following have persisted for at least 6 months

(Children 6 symptoms for 6 months, adolescents/adults 5 symptoms for 6 months)

ADHD specifiers

Combined presentation (Evidence of inattentive and hyperactive/impulsive)

Predominantly inattentive presentation

Predominantly hyperactive/impulsive presentation

In partial remission

The most dramatic change to the schizophrenia spectrum in DSM5 was

the elimination of the subtypes of schizophrenia such as (paranoid, disorganized, cationic, undifferentiated, and residual type)

William Battie wrote

the first book on mental illness Treatise on Madness

Jean-Etienne Dominique Esquirol

Attempted to differentiate cognitive deficit and psychosis

Philippe Pinel

Removed chains and shackles in Bicêtre insane asylum

Dorothea Dix

Advocated for the humane treatment of mentally ill

Benjamin Rush

Father of psychiatry in the U.S.

Emil Kraepelin

In 1878, created the name "Dementia Praecox" for the combined various diseases of the mind to mean early or premature deterioration. Kraepelin was the one who created the four categories (simple, paranoid, hebephrenic, catatonic)

Eugen Bleuler

Swiss psychiatrist who created the name schizophrenia from the Greek words "schizo" (split) and "phrene" (mind) - Bleuler also created the 4 A's - 1) blunted Affect 2) loosening of Associations 3) Ambivalence 4) Autism

Kurt Schneider

divided into first-and second-rank symptoms

John F. Kennedy created

the 1963 Community Mental Health Centers Act contributed to deinstitutionalization

Community Mental Health Centers Act

helped Medicare and Medicaid increase responsibility of mental health

Supplemental Security Income Program

1974

Thought Withdrawal

belief that one's thought have been "removed"

Thought Insertion

that alien thoughts have been put into one's mind

Thought Control

one's body or actions are being acted on or manipulated by some outside force

Disorders of form of thought

Loose Associations, Neologism, Poverty of Content, Poverty of content, Perseveration, and blocking

Disorders form of thought, Loose associations

patient's responses do not relate to the interviewer's questions, or one paragraph, sentence, or phrase is not logically connected to those that occur before or after

Disorders form of thought, Incoherence

Disorder form of thought, poverty of content

general lack of additional, unprompted content seen in normal speech

Disorder form of thought, Perseveration

Uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus.

Blocking

A cessation of speech or a thought process without an immediate observable cause, sometimes considered a consequence of repression (mental block)

Hallucinations:

a sensory experience of something that does not exist outside of the mind caused by various physical and mental disorders or by reaction to certain toxic substances, and usually manifested as visual or auditory images

Delusions

a belief that is clearly false and that indicates an abnormality in the affected person's content of thought. The false belief is not accounted for by the person's cultural or religious background or his or her level of intelligence

Types of delusions

persecutory, referential, grandiose, erotomaniac, nihilistic, somatic, and jealous

Persecutory Delusions

belief that one is going to be harmed, harassed, and so forth by an individual, organization, or any other group

Referential delusions

belief that certain gestures comments, environmental cues, and so forth are directed at oneself

Grandiose Delusions

when an individual believes that he or she has exceptional abilities, wealth, or fame

Erotomaniac delusions

when an individual believes faslely that another person is in love with him or her

nihilistic delusions

involve the conviction that a major catastrophe will occur

Somatic Delusions

Focus on preoccupations regarding health and organ function

Jealous Delusions

delusions that the individual's sexual partner in unfaithful

Negative Symptoms

Deficits or absences in behavior or expression

What are the negative symptoms of schizophrenia

affective flattening, alogia, avolition, and anhedonia

Negative Symptom, Affective flattening

restricted range of expressed emotions

Alogia

Poverty of speech, general lack of content seen in normal speech

Avolition

decrease in the motivation to initiate and perform self-directed purposeful activities

Anhedonia

loss of the capacity to experience pleasure

Schizotypal disorder

IN schizophrenic spectrum because of the social and interpersonal deficits. May develop in adolescence or even childhood

Schizotypal disorder criteria

pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for social relationships has 5 or more of the following: · Ideas of reference

· Magical thinking and odd beliefs

· Unusual perceptual experiences

· Odd thinking and speech

· Suspiciousness and paranoia

· Inappropriate affect or constriction of affect

· Odd, eccentric or peculiar behaviors or appearance

· Lack of close friends or confidants

· Excessive social anxiety with paranoid fear

· Cognitive distortions, eccentricities of behavior

Not in the Course of schizophrenia, bipolar or psychotic disorder, or autism spectrum disorder

Delusional disorder criteria

A. Presence of one or more delusions with a duration of 1 month or longer

B. Hallucinations if present are not prominent and are related to delusional theme

C. Functioning is not markedly impaired or behavior not obviously bizarre or odd

D. No marked manic or depressive episodes, if so brief duration

E. Nor attributed to OCD, Body Dysmorphic Disorder

Delusional Disorder specifier

with bizarre content - clearly implausible / cannot understand and specify severity levels

Brief Psychotic Disorder criteria

A. Presence of one or more: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior

B. Duration of one day- but less than month and returned to premorbid function

C. Not better accounted for by psychotic features of BP or MDD

Brief Psychotic Disorder specifier

with marked stressors, w/out marked stressors, w/ postpartum onset, w/ catatonia

Schizophreniform Disorder Criteria and Timeframe

A. Presence of two or more in a 1 month period

a. Delusions

b. Hallucinations

c. Disorganized speech

d. Grossly disorganized or catatonic behavior

e. Negative symptoms

B. Episodes lasts at least 1 month but less than 6 months

C. Able to rule out Schizoaffective Disorder, Depressive or Bipolar Disorder

The disturbance is not attributed to substance use or a medical condition