Download DSM IV- New Developments-Clinical and Multicultural Applications

DSM IV- New Developments-Clinical and Multicultural Applications
SW 223
Dr. David Demetral
Wednesday Evenings
Spring 2008
Time: 6:30 - 9:15
e-mail: [email protected]
Phone: (916) 278-7168
WEDNESDAY COURSE OUTLINE
Room: As of 12/18/2007 it is listed as EUR 109. I have arranged Lib 1522, as EUR 109 will
not work for us. I will e-mail you if we can get a better room than the Lib 1522 room.
Course Overview:
Social Work 223 is designed for the Social Work graduate student as a context of investigation
and advanced study of a specific advanced practice topic of interest. This three unit elective course
will focus on and ultimately require an advanced understanding of the clinical application of the
DSM IV. This class will consider the bio-psycho-social and etiological base for major
psychological disorders (example Axis I disorders: mood, thought and anxiety disorders), as well
as Axis II (personality) disorders as well. Mental health, medical diagnostics and
counseling/clinical practice have been dominated by biological determinism over the past few
decades. There is however currently a move towards a holistic view of pathology and treatment
where a wider range of “cause and effect” are taken into consideration. The new and expanding
biomedical paradigm is also in many instances including other factors such as 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 the application of DSM IV to persons experiencing emotional disorders.
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 biological-socialpsychological-cultural etiological dimensions of mood, anxiety, personality disorders,
schizophrenia and psychosis.
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 workshop, or professional seminar on this critical 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. Also weekly quizzes will be
given to clarify reading materials as well as encouraging students to keep up with assigned
materials. Differential diagnosis is a very serious clinical cluster of skills with social, ethical,
and legal implications. The course will emphasize the teaching of respect for the diagnostic
process and the great responsibility this process entails. This course is a great deal of work
for students, but I believe you will find there is no other way to gain the mastery needed to
accurately diagnose. There is no better way to learn the subtleties of differential diagnosis
than trial and error and group processing.
Required Course Texts:
1. Morrison, James, DSM-IV Made Easier, The Guilford Press, 2007. ISBN # 10 159385-331-9 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 # 089862-568-8. 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-IVTR)”. 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. Three Psychiatric Diagnosis Competency Quizzes: There will be a
competency test of your knowledge of each of the disorders being discussed.
These are take home so you can take them when you are doing the readings for
that section. These quizzes are made up of essential material on the disorder
(i.e. schizophrenia). These quizzes are broken up into multiple-choice 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 (self-grade) and discuss the content. 50 point each (You may drop
your lowest one).
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 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 March 5, 2008 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. 50 points.
4. Attendance: Because of the nature of this class it is difficult to make
up for the experiences missed during class time, therefore coming to class is a
critical responsibility. If you miss more than two (2) classes your final grade
will be lowered one full grade. Three (3) classes or more will mean you will not
receive credit for the course.
Course Outline
Session One: January 30, 2008
“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
Readings:
 Morrison, DSM IV Made Easier, Chapters 1-10 (pages 3-127)
 Morrison, DSM-IV Made Easy, Chapter 18 especially pages 544 through
548, & Appendix A, B, & C.
 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
Note: The first class session per disorder will be devoted to an in-depth dialogue
about differential diagnostic considerations, review and dialogue about
DSM IV APA video presentations, and the competency test. The second
session will be focused on the small group discussions of your Pomeroy
differential diagnosis, and a small group exercise and clinical dialogue.
Session Two: February 6, 2007 Schizophrenia and Other Psychotic Disorders.
 Schizophrenia
 Schizophrenia like disorders
 Disorders with Delusions
 Other Psychotic Disorders
APA Diagnostic Training Tapes & Practice Case Discussion
Readings:
1. Morrison, DSM-IV Made Easier, Chapter 13;
2. Morrison, DSM IV Made Easy, Chapter 4.
3. Assignment: Schizophrenia Competency Test Discussion
4.
DSM IV TR pages 297-344
Session Three: February 13, 2008
Schizophrenia and Other Psychotic Disorders Part II
 Schizophrenia
 Schizophrenia like disorders
 Disorders with Delusions
 Other Psychotic Disorders
APA Diagnostic Training Tapes & Discussion
Pomeroy Vignettes (small group discussion)
Reading:
1. Pomeroy & Wambach, The Clinical Assessment Workbook,
Chapter. 5;
2. Assignment: Differential Diagnosis Case Write ups for the three (3) 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).
Session Four: February 20, 2008 Mood Disorders: Part I
 Mood Episodes
 Mood Disorders
 Other Mood Disorders
 Other causes of Depressive and Manic Symptoms
 Specifiers
APA Diagnostic Training Tapes & Practice Case Discussion
Readings:
1. Morrison, DSM IV Made Easy, Chapter 5;
2. Morrison, DSM IV Made Easier, Chapter 11;
3. Assignment: Mood Disorder Competency Test
3. DSM IV TR pages 345-428
Session Five: February 27, 2008 Mood Disorders: Part II
 Mood Episodes
 Mood Disorders
 Other Mood Disorders
 Other causes of Depressive and Manic Symptoms
 Specifiers
APA Diagnostic Training Tapes & Discussion
Pomeroy Vignettes (small group discussion)
Readings: Pomeroy & Wambach, Chapter 6.
1. Assignment: Differential Diagnosis Case Write-ups for the three (3)
DSM Cases in Pomeroy. Page 149 through 166, cases 6.1, 6.2, 6.3. 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).
Session Six: March 5, 2008 Culture & Psychiatric Diagnosis
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: You are to go to the web sites indicated 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 will
discuss your question in your small group roundtable.
Also read: Appendix I in the DSM IV TR page 897-905
Session Seven: March 12, 2008 Anxiety Disorders Part I
*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:




Morrison, DSM IV Made Easier, Chapter 12
Morrison, DSM-IV Made Easy, Chapter 6
DSM IV sections on Anxiety pages 429-484
Anxiety Disorder Competency Test
Session Eight: March 19, 2008 Anxiety Disorders Part II
*Differential Diagnosis Small Group Roundtable discussion
Reading(s):
1. Pomeroy & Wambach, The Clinical Assessment Workbook, Chapter 7. (Pages
173-208) & Chapter 15 (pages 329-360)
2. Assignments: Differential Diagnosis Case Write-ups for the four (4) DSM
Cases in Pomeroy. Page 179 cases 7.1, 7.2, 7.3 & 7.4. I want you to defend your
diagnostic impression with the specific criteria that are met in the DSM IV. (Bring
to Class).
Session Nine: March 26, 2008 Personality Disorders Part
 Quick Guide to Personality Disorders
 Generic Criteria for Personality Disorders
 Coding notes
 Clusters & Differential Diagnostic Considerations
APA Training Tapes & Class Discussion
Readings:
1. Morrison, DSM IV Made Easy, chapter 15;
2. Morrison, DSM IV Made Easier, Chapter 16.
3. DSM IV sections on Personality Disorder, pages 685-730
Assignment: Differential Diagnosis Case Write ups for the three (3) DSM Cases in
Pomeroy. Complete case 14.1 & 14.2 & 14.3 (pages 311 to 319) on
Personality Disorders.
April 2, 2008 Spring Break
Session Ten: April 9, 2008 Disorders Usually First Diagnosed in Infancy,
Childhood, or Adolescence
 Autism
 Mental Retardation
 The ADHD Debate
 Learning Disorders
Readings:
1. Morrison, DSM IV Made Easy, Chapter 16;
2. DSM IV TR, pages 39-134
Assignment:
1. 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).
Session Eleven: April 16 & April 23, 2008 Substance-Related Disorders
 Quick guide to the Substance-Related Disorders
 Substance Use Disorders
 Substance-Induced Disorders
Readings:
1. Morrison, DSM IV Made Easy, Chapter 3;
2. Morrison, DSM IV Made Easier, Chapter 15.
3. DSM IV TR pages 191-296
4. Assignment due on April 23, 2008. Differential Diagnosis Case Write ups for the
three (3) DSM Cases in Pomeroy. Complete case 4.1 & 4.2 & 4.3 (pages 95 to 104)
on Drug and Alcohol Related Disorders.
Session Twelve: April 30 Delirium, Dementia, and Amnestic
and other Cognitive Disorders
 Complex Differential diagnostic considerations
 Medical Disorders that present with dementia, delirium
Readings:
1. Morrison, DSM IV Made Easy, Chapter 1;
2. DSM IV TR pages 135-180
3. DSM IV Made Easier, chapter 14.
Assignment: 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).
Session Thirteen: May 7, 2008
In Class Differential Diagnosis Group Exercise
Reading:
1. Morrison, DSM IV Made Easier, chapter 18.
Session Fourteen: May 14th, 2008
Have a great summer and congratulations graduates!