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DSM IV-New Developments-Clinical and
Multicultural Applications
SW 223
Dr. Demetral, Ph.D., & LCSW
Weekend Class
Spring 2008
e-mail address: [email protected]
CSUS Phone #: 916-278-7168
SATURDAY COURSE OUTLINE
Course Dates: January 26; February 16, March 15, April 12, and May
10, 2008.
Time: 8 to 5
Room: ARC 1007 except February 16th when we are in ARC 3006.
Course Overview:
Social Work 223 is designed to serve as a context of investigation and
advanced study of a targeted advanced practice topic of interest to the Social
Work graduate student. This three-unit elective will focus on the advanced
understanding of the clinical application of the DSM IV. This class will consider
the bio-psycho-social etiological base for the major psychological disorders (i.e.
Axis I disorders- thought disorder, mood disorders, and anxiety disorders), as
well as Axis II or personality disorders as well. Rigorous biological determinism
has long been the cultural fashion in general medical and even
counseling/clinical practice. However, a holistic view of pathology and treatment
is now becoming more widely accepted. This trend is very obvious in the
diagnosis and treatment of mental disorders. Even though there is a new and
expanding (and very important) biomedical paradigm, it is being expanded to
include a more holistic view that includes social and cultural factors in both
diagnosis and treatment of mental illness.
This class will present a client-centered model of differential assessment and
diagnosis, using the DSM IV as the base of exploration, based on a holistic
paradigm that integrates known biological, psychological, social, and cultural
factors. Cross-cultural studies and their implications for the assessment and
diagnosis of mental illness will provide the student of this class with the basis for
understanding a new direction in the application of DSM IV to persons
experiencing emotional disorder.
Course Objectives:
At the conclusion of this class, the student will be able to display mastery of
the following clinical social work practice concepts:
1. Advanced understanding and accurate use of the DSM IV when performing
differential diagnosis;
2. Integrate cross cultural studies and their implications for the assessment
and diagnosis of mental illness;
3. Display written and verbal competence in the articulation of the biologicalsocial-psychological-cultural etiological dimensions of schizophrenia and
psychosis, mood disorders, anxiety disorders, personality disorders;
4. Display practice application understanding of specific medications for
specific disorders and intervention concerns with special populations.
5. Display advanced competence in the development of differential diagnosis
using the DSM IV as a context of accurate diagnosis.
Course Format
This course is structured like a professional seminar, or workshop on this vital
clinical area of practice. You will be responsible for reading and preparing
“response sets” between each class that will be used in the small clinical
dialogue groups. Differential diagnosis is a very serious clinical cluster of skills
with major legal, ethical, and social implications. I have a responsibility to teach
you to use and respect this diagnostic process. This course is a great deal of
work, and yet you will find there is no other way to learn the skills needed to
accurately diagnosis.
Required Course Texts:
1. Morrison, James, DSM-IV Made Easier, The Guilford Press, 2007. ISBN #
10 1-59385-331-9 or ISBN-13 978-1-59385-331-0. Amazon used $32.79;
2. Pomeroy, Elizabeth, & Wambach, Kathryn, The Clinical Assessment
Workbook: Balancing Strengths and Differential Diagnosis, ThomsonBrookes/Cole, 2003, ISBN # 0-534-57843-8. Amazon used $82.27
3. DSM-IV or DSM-IVTR, American Psychiatric Publishing Co. Amazon used
$48. 94 (Note: You can buy or use the DSM IV-Amazon used $33.00);
4. Morrison, James, DSM-IV Made Easy, The Guilford Press, 1995. ISBN #
0-89862-568-8. Amazon used $42.00;
Recommended Texts:
1. Morrison, James, The First Interview: Revised for the DSM-IV, The
Guilford Press, 1995, ISBN # 0-89862-569-6. Amazon Used $10.56 (This
is an AWESOME book if you have not had a great deal of exposure to
person’s with a mental illness, and/or have not conducted initial interviews,
or mental status examinations, and are thus unsure of what you are
looking for and how to ask the questions to solicit vital information.)
2. Fauman, Michael A., Study Guide to DSM-IV-TR, American Psychiatric
Publishing Company, 2002, ISBN # 1-585-62-046-7. (This book is not as
good as the Morrison Text in providing you with the format for decision
making when using the DSM IV).
Note: You will find that there is a large array of books that are designed to help
you with the “process of differential diagnosis” and “the mechanics of the DSM IV
(or DSM-IV-TR)”. You will find that they are very redundant, and most add little to
your ability to do either task. The best instructor’s manual is experiential or just
using the manual, as well as the Morrison Texts. There is no better way to learn
the subtleties of differential diagnosis than trial and error and group processing!
Course Assignments:
1. Psychiatric Diagnosis Competency Quizzes: There will be a
competency test of your knowledge of each of the disorders being
discussed. These quizzes are made up of essential material on the
disorder (i.e. schizophrenia). These quizzes are broken up into multiplechoice clinical case descriptions, true/false; fill INS, and matching items.
You must have the test done prior to the class that the content is being
discussed. We will grade these in class and discuss the content. 50
point each.
2. DSM-IV Differential Diagnosis Probes: You will be assigned DSM-IV
cases related to the diagnostic area being considered (i.e. Thought
Disorders) from the Pomeroy & Wambach Text “The Clinical
Assessment Workbook”. You are expected to answer the short
answers for each disorder group. You are to type these answers up.
These probes are used in “clinical roundtable” during each session
devoted to that diagnostic category. These will be handed in and
graded on the following scale:
 Minimal effort/quality = D (65)
 Average effort/quality = C (75)
 Above average effort/quality = B (85)
 Excellent effort/quality= A (95)
To determine your grade on these sets, simply multiply your total by the
number of question sets (i.e. 6 x 95= 570 A+). NOTE: if you do not have your
sets (which are required per class, you will get a zero for each. No late sets
will be accepted no exceptions).
3. Culture Roundtable Critical Thinking Question: You are to go to the
web-sites indicated on the February 16th session and read the material
on culture and mental illness. You then are to develop a critical thinking
question that requires some in depth thinking to answer based on the
readings. Then bullet points your “points of consideration” or your
answer. Make seven copies of your question/answer and distribute your
question/answer to your other members of your group. You discuss
your question in your small group roundtable.
4. Attendance: Because this is a weekend class with only five sessions
you cannot miss a class without severe consequence. Each class is
equivalent to three (3) sessions in a fifteen (15) week class. So, if you
miss one full day, you will not be given credit for the class, and
must see Dr. Demetral. If you miss one half day your final grade
will be lowered one full grade.
Course Outline
Session One: January 26th, 2008 ARC 1007 (We start at 8:00)
General Issues & Schizophrenia & Other Psychotic Disorders
Please pay attention to the materials which are being emailed to you (or that you downloaded from the SW web site. You have a
competency test to complete and bring to class, and the assignments that
must be completed and brought to class.
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A. Morning Session: “The Healing Science Within the DSM-IV-TR
The Basics of Diagnosis
The Diagnostic Method
The Building Blocks of Diagnosis
The Multi-Axial System
The Notion of Multi Axial Assessment
Sample vignettes exercise & Discussion
The Initial Interview:
The Mental Status Definitions
The Mental Status Examination Simulation
B. Afternoon Session:
*Schizophrenia & Other Psychotic Disorders
*Schizophrenia Competency Test: Discussion
*APA Diagnostic Training Tapes & Discussion
*Pomeroy Vignettes
Readings:
 Morrison, DSM IV Made Easier, Chapters 1-10 (pages 3-127)
 Morrison, DSM-IV Made Easy, Chapter 4 (Real important), and
Chapter 18 especially pages 544 through 548, & Appendix A, B, &
C.
 Pomeroy & Wambach, The Clinical Assessment Workbook,
Chapter 5. (Pages 118-143) Case 5.1, 5.2, 5.3, 5.4
 DSM IV sections on Multi-Axial Assessment, DSM IV Classification,
and Schizophrenia and other Psychotic Disorders.
 The First Interview, Chapters 11-14. Review Appendix A. (This
set of readings is real critical if you have not had a great deal of
experience with mental disorders, interviewing persons with mental
disorders, or with the process of “structuring” your interview elicit
the necessary information and impression to help make your
differential diagnosis. Although this seems like a great deal of
reading, you will appreciate the pragmatism).
Assignment(s):
1. Differential Diagnosis Case Write ups for the four (4) DSM
Cases in Pomeroy. Page 125 through 141, cases 5.1, 5.2,
5.3, & 5.4. Read the case(s) and type up your answers to
the short questions and the differential diagnosis. I want
you to defend your diagnostic impression with the specific
criteria that are met or not met directly quoted from the
DSM IV. (Bring to Class).
2. Completed Schizophrenia competency Quiz. This is being
e-mailed with the course outline or you will see it attached
to the course outline if you are downloading it from the SW
web site. (Bring to class)
Session Two: February 16, 2008
Mood Related Disorders
Location: ARC 3006
A. Morning & Afternoon Session:
*Discussion & feedback on Psychosis Case Vignettes
*Final thoughts and considerations on Psychotic Disorders
*Cultural Influences on the Diagnosis of Mood Related
Disorders
*Affective Disorders/Mood Disorders/Other Depressive
Disorders Competency Probe
*Suicide Considerations & Assessment-In Class Exercise
*Using the DSM in the differential diagnosis of Mood Disorders
* APA Diagnostic Training Tapes
* Roundtable Discussion of Cultural Formulations and
Diagnosis
Readings:
 Morrison, DSM IV Made Easier, Chapter 11;
 Morrison, DSM-IV Made Easy, Chapter 5. (Real important).
 Pomeroy & Wambach, The Clinical Assessment Workbook,
Chapter 6. (Pages 143-173)
 DSM IV sections on Mood.
Go to http://www.surgeongeneral.gov/library/mentalhealth/cre/execsummary-6.html
read the summary, main findings, main message, & each of the chapter summaries
and conclusions; then go to:
http://mental health.samhsa.gov/cre/ch2_culture_of_the_patient.asp and read
“Culture Counts: The Influence of Culture and Society on Mental Health, Mental
Illness”
Assignment(s):
1. Differential Diagnosis Case Write-ups for the four (4) DSM
Cases in Pomeroy. Page 149 through 166, cases 6.1, 6.2, 6.3, 6.4.
Read the case(s) and type up your answers to the short questions
and the differential diagnosis. I want you to defend your diagnostic
impression with the specific criteria that are met in the DSM IV.
(Bring to Class).
2. Completed Mood Disorders competency Quiz. This will be
handed out at session one. (Bring to class)
3. Culture Roundtable Critical Thinking Question: You are to go to
the web-sites indicated on the February 16th session and read the
material on culture and mental illness. You then are to develop a
critical thinking question that requires some in depth thinking to
answer based on the readings. Then bullet points your “points of
consideration” or your answer. Make seven copies of your
question/answer and distribute your question/answer to your other
members of your group. You discuss your question in your small
group roundtable.
Session Three: March 15, 2008 Adjustment Disorders, Anxiety/Stress
Disorders, & the V Codes
Location: Mendocino Hall 1005
Morning Session & Afternoon Session
*Feedback and Discussion of Mood Cases
*Final thoughts regarding Mood Disorders
*Cultural Influences on the Diagnosis of Anxiety Disorders
*Anxiety Disorders Competency Probe
*Anxiety Disorders: Conceptual Overview
*Panic Attacks and Panic Disorders
*Obsessive-Compulsive Disorder
*APA Diagnostic Training Tapes
Readings:
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Morrison, DSM IV Made Easier, Chapter 12
Morrison, DSM-IV Made Easy, Chapter 6 & Chapter 14 & 17.
Pomeroy & Wambach, The Clinical Assessment Workbook,
Chapter 7. (Pages 173-208) & Chapter 15 (pages 329-360)
DSM IV sections on Anxiety & Adjustment disorders.
Assignment(s):
1. Differential Diagnosis Case Write-ups for the six (6) DSM
Cases in Pomeroy. Page 179 cases 7.1, 7.2, 7.3; & page 335
cases 15.1, 15.2, 15.3. Read the case and type up your answers
to he short questions and the differential diagnosis. I want you to
defend your diagnostic impression with the specific criteria that
are met in the DSM IV. (Bring to Class).
2. Completed Anxiety competency Quiz. This will be handed
out at session two. (Bring to class)
Session Four: April 12, 2008
Location: ARC 1007
Personality Disorders
&
Disorders Usually Diagnosed in Infancy, Childhood, & Adolescence
Morning Session:
*Cultural Influences on the Diagnosis of Personality Disorders
*Personality Disorders Competency Probe
*Personality Disorder APA Diagnostic Training Tapes
Afternoon Session
*Cultural Influences on the Diagnosis of Childhood Disorders
*Disorders Diagnosed in Infancy, Childhood, and Adolescence
Competency Probe
Readings:
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Morrison, DSM IV Made Easier, Chapter 16;
Morrison, DSM-IV Made Easy, Chapter 15 & 16.
Pomeroy & Wambach, The Clinical Assessment Workbook,
Chapter 14 & 2.
DSM IV sections on Disorders usually first diagnosed in Infancy,
Childhood, or Adolescence, and Personality Disorders.
Assignment(s):
1. Differential Diagnosis Case Write ups for the six (6) DSM
Cases in Pomeroy. Complete case 14.1 & 14.2 & 14.3 (pages 311
to 319) on Personality Disorders. Then complete case 2.1 & case
2.2 & 2.3 (pages 27 to 37) on Childhood Disorders. Read the
case and type up your answers to the short questions and the
differential diagnosis. I want you to defend your diagnostic
impression with the specific criteria that are met in the DSM IV.
(Bring to Class).
2. Completed competency Quiz on Personality Disorder. This will
be handed out at session three. (Bring to class)
Session Five: May 10, 2008
Alcohol and Drug Related Disorders &
Cognitive Disorders and Neurological Disorders Due to a Medical Condition
Location: ARC 1007
A. Morning Session:
*Course Evaluation
*Alcohol & Drug Related Disorders
*APA Training Tapes
B. Afternoon Session
*Cognitive Disorders & Neurological Disorders Due to a Medical
Condition
*APA Training Tapes
Readings:
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Morrison, DSM IV Made Easier, Chapters 14 & 15;
Morrison, DSM-IV Made Easy, Chapter 1, 2, & 3.
Pomeroy & Wambach, The Clinical Assessment Workbook,
Chapter 3 & 4.
DSM IV sections on Alcohol and Drug Related Disorders &
Delirium, Dementias, and other cognitive disorders.
Assignment(s):
1. Differential Diagnosis Case Write ups for the four (5) DSM
Cases in Pomeroy. Complete case 4.1 & 4.2 & 4.3 (pages 95 to
104) on Drug and Alcohol Related Disorders. Then complete case
3.1 & 3.2 & 3.3 (3.3 is extra credit)-(pages 75 to 86) on Cognitive
Disorders. Read the case and type up your answers to the short
questions and the differential diagnosis. I want you to defend
your diagnostic impression with the specific criteria that are met in
the DSM IV. (Bring to Class).
2. Completed competency Quiz on Cognitive Disorders. This will
be handed out at session four. (Bring to class)
Have an excellent summer and congratulations to the graduates!
Dr. David Demetral, Ph.D., & LCSW
Social Work 223
Spring 2007
Schizophrenia and Other Psychotic Disorders
Multiple Choice Questions:
1. Zoe, aged twenty-two, gave birth to her first child, Alexa, four days ago. Zoe's initial
complaints included insomnia, restlessness, and emotional labiality that progressed to
confusion, irritability, delusions, and thoughts of wanting to kill her baby. Which
diagnosis would you consider first?
a)
b)
c)
d)
Induced delusional disorder
Brief psychotic disorder, post-partum onset
Autoscopic psychosis
Conversion disorder
2. Ozell Turner has been re-hospitalized with schizophrenia. The social worker indicated
on his chart that he had been pathologically repeating the same cluster of words over, and
over, and over again. This is an example of:
a)
b)
c)
d)
Verbigeration
Neologism
Echolalia
Echopraxia
3. The following factor is most closely related to relapse in persons with schizophrenia.
a)
b)
c)
d)
Whether or not the person is gainfully employed
The age and gender of the person
Compliance with psychotherapy
Lack of adherence to psychotropic medications
4. Morgan Carpenter once met the full criteria for schizophrenia. However, she no longer
has pronounced symptoms of catatonic behavior, delusions, hallucinations, or
disorganized speech or behavior. She occasionally exhibits odd beliefs and peculiarities
of behavior. What would be the correct diagnosis?
a)
b)
c)
d)
Schizophrenia, disorganized type
Schizophrenia, residual type
Schizophrenia, NOS
Schizoaffective disorder, NOS
5. Eighteen year-old Patricia Wilson was taken to the North Shore emergency room by
her family after she complained that she couldn't sleep because of the “voices” she heard.
She couldn't really say what the voices were saying but the family reported that Patricia
went on rambling and they could not understand her conversations. For the past six
months Patricia's family tried to ignore these symptoms but became more worried as the
symptoms continued. Their concerns became more emergent when Patricia started
talking gibberish, giggled inappropriately, made silly faces, and neglected her hygiene
and appearance.
a)
b)
c)
d)
Schizophrenia, disorganized type
Schizoaffective disorder
Schizophreniform
Schizophrenia, undifferentiated type
6. Alphonso de la Portia has been experiencing abnormal, involuntary, irregular
movements of the muscles of his head, limbs and trunk. His symptoms include twisting,
chewing, and thrusting movements of his tongue. The only other relevant information
the social worker knows is he has been on long-term anti-psychotic medication
(Thorazine). This disorder is known as:
a)
b)
c)
d)
Huntington's disease
Tardive dyskensia
Ataques de Nervios
Hydrangiea Chorea
7. Johann Wojcik emigrated from Poland ten years ago. His past mental health history is
unknown. According to the police, he was found sitting motionless in the middle of the
highway. The mobile crisis unit took him to the state mental hospital where he refuses to
make eye contact, is mute, and resists attempts to be moved and does not interact or
participate in any way. Which of the following would be your beginning diagnosis?
a)
b)
c)
d)
Schizophrenia, paranoid type
Schizophrenia, residual type
Schizophrenia, disorganized type
Schizophrenia, catatonic type
8. In order to meet the diagnostic criteria for schizophrenia, those characteristic
symptoms of the active phase need to be present in the individual for at least:
a)
b)
c)
d)
Six months
Three months
One month
Two weeks
9. Sue Anne Brinkley is an eighteen-year old college freshman enrolled at Camyron State
University. She presents herself at the campus-counseling center following the
unexpected death of her best friend. She exhibits the following symptoms --- disturbance
in her thought process (tangential thinking) as well as delusions of grandeur (she believes
herself to be Joan of Arc) and bizarre behaviors (repeatedly cleaning her sorority house
stove with a toothbrush). According to her roommate, Alison, these symptoms started
about eight or nine days ago (approximately 36 hours after hearing the news of her best
friend's death). Sue Anne has no prior history of mental illness and her level of
premorbid functioning was noted as "excellent". Based on this information, what do you
believe is Sue Anne's most likely diagnosis?
a)
b)
c)
d)
Hypomania, with psychotic features
Schizoaffective disorder
Brief psychotic disorder
Schizophrenia, residual type
10. Georgio Ferrari displays loose associations, tangentiality, inappropriate affect and
disorganized behavior. Georgio is most likely diagnosed with:
a)
b)
c)
d)
Schizophrenia, disorganized type
Schizophrenia, hebephrenic type
Schizophrenia, catatonic type
Schizophrenia, residual type
11. Sammie Arnold Carvey has the major symptoms of schizophrenia but she does not
meet the criteria for one of the specific sub types of schizophrenia. How would you list
her diagnosis?
a)
b)
c)
d)
Undetermined
Schizophrenia, NOS
Schizophrenia, residual type
Schizophrenia, undifferentiated type
12. Tom Wang has experienced disorganized speech and delusions for the past three
months. After this time period, his symptoms quickly disappeared without any treatment.
Tom would most likely receive a diagnosis of:
a)
b)
c)
d)
Schizophrenia, residual type.
Schizophreniform disorder
Both Schizophrenia and Bipolar disorder
Delusional disorder
13. Josette's mother, Erlange St. Villien, (age 79) has been having delusional beliefs that
some kind of highly specialized radio transmitter was inserted into her tooth filling as
part of an experiment being conducted by aliens from the planet Mars. Up until five
months ago, Josette tried to convince her mother that the radio transmitter really did not
exist. However, Josette has changed her mind and now believes that her mother's story
may well be true. Josette’s mother is most likely experiencing:
a)
b)
c)
d)
Schizophrenia, NOS
A brief psychotic episode
Delirium
Schizophrenia, disorganized type
True/False Questions:
14. Schizophreniform disorder refers to prodomal, active, and residual schizophrenic
symptoms that have existed for less than six months duration.
15. Tardive dyskinesia includes the voluntary movement of one's head, neck and limbs
manifested by long-term antipsychotic medication.
16. Schizophrenia, catatonic type, describes a person who can sit for hours on end
virtually motionless, refuses to make eye contact and resists attempts to be moved.
17. Persons who meets the full criteria for a diagnosis of schizophrenia, and also has a
significant mood disturbance lasting for more than two weeks should be diagnosed as
schizoaffective disorder.
18. When you tell a client that his cat was just hit by a car and died, he falls down and
rolls around on the ground laughing. He is displaying derailment.
19. During your intake interview with Sylvia Martin you notice that it takes a very long
time for her to respond. Sylvia is displaying avolition.
Fill in the Missing Answer:
20. Symptoms of schizophrenia are divided into both "positive" and "negative"
categories. Please list three positive symptoms that are experienced by persons with
schizophrenia.
21. Symptoms of schizophrenia are divided into both "positive" and "negative"
categories. Please list three negative symptoms that are experienced by persons with
schizophrenia.
22. Matching Items:
a) Echopraxia
b) Echolalia
c) Tardive dyskensia
d) Delusions
e) Dysphoria
Pathological imitation of another person’s movements
Pathological repeating of the same cluster of words
False beliefs
Abnormal, involuntary irregular movement of the
head, limbs and trunk muscles
Individuals believe they are persons of exaulted
position (Jesus or the President of the U.S.)
f) Delusions of grandeur
Anger, depression and increased anxiety are common
emotional reactions to ensuing psychosis
g) Persecution
This subtype includes delusions and
hallucinations that are less prominent than negative
symptoms and disorganized speech and behavior
h) Shared psychotic disorder This disorder includes at least one of the basic psychotic
symptoms and lasts less than one month
i) Brief psychotic disorder
Symptoms include motoric immobility, excessive motor
activity, extreme negativism (or mutism), or
peculiar posturing
j) Disorganized type
Individuals feel they are being pursued when they are not
k) Catatonic type
Previously known as Folie a Deux
l) Schizoaffective disorder
These individuals have met the criteria for schizophrenia,
m) Schizophreniform
however the symptoms have lasted for less than six
months
Individuals have all the symptoms of schizophrenia; at
the same time they have prominent symptoms of
mania or depression