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Adult Psychopathology 1 ADULT PSYCHOPATHOLOGY (PSYC 355; Psychopathology II) Fall 2007 Instructor: Phone: E-mail: Office: Kelly Rohan, Ph.D. (802) 656-0798 [email protected] 224 John Dewey Hall Meeting Time: Classroom: Office Hours: Wednesdays 9:05 – 11:40 am 342 John Dewey Hall Wed. 11:45 am – 1:15 pm, by appointment, or any time the door is open I. Course Description and Goals Using a scientific approach to psychopathology, this course will review concepts, theory, controversies, and research in adult psychopathology. The course will emphasize descriptive psychopathology (see definition below) and issues of etiology rather than treatment. The focus is not on memorizing diagnostic criteria. Instead, the content of this course is designed to foster a sophisticated understanding of adult psychopathology and an ability to think clearly and critically about contemporary issues in the field. Students are expected to master ideas and concepts that they will apply now and in the future to be both educated consumers of psychopathology research and critical readers of our diagnostic system. Students should also be able to apply what they learn in this course to how they conceptualize individual clinical cases and to their own research. Objectives for the course include an increased understanding of and the ability to critically evaluate: a. Definitions and diagnostic systems for adult psychological problems. b. Descriptive psychopathology (e.g. phenomenology, epidemiology, risk factors, and course of the disorder). c. Theoretical models for the onset and maintenance etiology of adult psychological problems. d. Issues of diversity across gender, culture, and race as they pertain to adult psychopathology. e. The empirical literature on adult psychopathology. II. Required Texts and Selected Readings American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Edition Text Revision). Washington, DC: American Psychiatric Press, Inc. (ISBN 0-89042-061-0) Adult Psychopathology 2 Maddux, J. E., & Winstead, B. A. (2005). Psychopathology: Foundations for a contemporary understanding. Mahwah, NJ: Lawrence Earlbaum Associates, Publishers. (ISBN 0-8058-4077-X) (This is the first psychopathology textbook designed specifically for clinical psychology graduate students. The beginning chapters lay the necessary groundwork on crucial issues such as the definition of psychopathology, the influences of gender and culture, and the utility of traditional psychiatric diagnosis. The remaining chapters provide indepth information about common psychological problems and disorders. The chapter authors, who are active researchers in their respective areas of specialization, highlight challenges to traditional assumptions and theories for the featured psychological disorder). Additional selected readings will be assigned for each topic area. These readings will supplement the breath of the textbook readings with an in-depth look at recently published reviews, chapters, meta-analyses, and studies in the literature. The selected readings will include both theoretical papers and cutting-edge experimental psychopathology studies. Additional readings for each topic will be made available to students at least 1 week before the scheduled class meeting. If available, PDF copies of readings will be emailed to students. Otherwise, a master copy of the readings will be placed in 208 Dewey for students to photocopy. III. Course Format A combination of didactic lecture and seminar formats will be employed during our class meetings. Accordingly, some of our class time will be devoted to informal lecture (with questions and comments welcome) and some class time will consist of seminar discussion. Each student will also have the opportunity to give a formal in-class presentation, as described below. IV. Class Participation and Attendance The course, as a whole, will be interactive, and its success is dependent upon active preparation, involvement, and discussion by the students. Given that a large portion of this course will be taught in seminar format, students are expected to complete the assigned readings and to come to class prepared to discuss them. Students will be asked to respond to questions that have arisen from the readings. This is your opportunity to share your reactions and thoughts about the readings. Students are expected to attend all class meetings and to participate fully. If a student must miss a class meeting due to an illness, emergency, or Departmentapproved travel; he or she should contact Dr. Rohan in advance. If a student misses a class meeting, he or she should compose a reflection paper that demonstrates critical thinking and integration across the various readings assigned for the missed class as well as a discussion question (see below). Reflection papers should be no more than 3 double-spaced, typed pages in length, and submitted in hard copy to Dr. Rohan by no later than the next class meeting. Extensions on assignments will be permitted only in the case of a documented medical or family emergency with the period of extension determined on a case-by-case basis. Adult Psychopathology 3 V. Discussion Questions Each student will write at least one thought-provoking discussion question based on the readings in preparation for each class meeting. Discussion questions should integrate across various readings for each week (or even across weeks). Each student should email his or her discussion question to Dr. Rohan and to the rest of the class before each class meeting. VI. Examinations There will be two examinations: a mid-term and a final. Both examinations will consist of take-home essay questions. The questions will be distributed 1 week before the exam answers are due. Students will have 1 week to compose short (i.e., no more than 5-6 double-spaced, typed pages using 12-point font for each question) responses to 2-3 essay questions covering the course content. Some questions will require thoughtful integration across the various reading assignments and seminar discussions. The exams are open-book, but must be completed alone. Each student should write his or her student ID number (i.e., full 950#) on the back of the last page of the essays so that exams can be evaluated blind to identity. The final exam will be cumulative. Submit a hard copy of your answers, not an email attachment. VII. In-Class Presentation Each student will give an in-class presentation and lead a discussion on a disorder or important construct in adult psychopathology for approximately 60 minutes (45 minutes of lecture and 15 minutes of seminar discussion). The presenting student should prepare a Power Point presentation and several questions to stimulate discussion. Your presentations should cover a description of the condition of interest, symptoms, epidemiology, diversity issues, risk factors, course, theories of etiology, and important issues (areas of controversy, recent lines of research), but should not focus on treatment. At least 1-week prior to the presentation, the presenting student should provide the other students and Dr. Rohan with 1-2 representative readings on the topic (e.g., a chapter or review that summarizes important issues) and a more comprehensive reference list. At the time of presentation, the presenter should distribute an outline or a Power Point handout of the presentation material. Potential topics are relatively open, but should not focus on a major disorder covered in this course. Students should discuss their topic choices with Dr. Rohan by no later than our second class meeting and obtain her approval for a specific topic selection. Possible topics include: anxiety sensitivity construct, trichotillomania, premenstrual dysphoric disorder, postpartum depression, body dysmorphic disorder, schizoaffective disorder, factitious disorder, dissociative fugue, one of the sexual disorders, etc. As soon as topics are selected, we will incorporate the presentations into our class schedule. Adult Psychopathology 4 VIII. Student Evaluation Points earned in each domain will be summed to determine the final course grade. You will be most satisfied with your grade if you work hard and consistently from week to week by learning as much as you can from the readings, participating in the class discussions, composing a thoughtful discussion question, and selecting and presenting your topic of interest. This method will pay off with systematic accrual of points. 100 - 94 A 93 - 90 A- 89 - 87 B+ 86 - 84 B 83 - 80 B- Component 79 - 77 C+ 76 - 74 C 73 - 70 C- 69 - 67 D+ 66 - 64 D 63 - 60 D- 59 and below F Potential Points Class Participation* 30 In-Class Presentation 20 Examinations Mid-Term Exam Final Exam 50 (25) (25) Total 100 *Class participation will be based on your contributions to the class discussions and your written discussion questions. IX. Feedback Students will receive written feedback on their performance at specified times throughout the course. Personalized feedback memorandums will be provided subsequent to the in-class presentation to comment on the content and style of these presentations. At mid-term, each student will receive more general feedback regarding the quality of his or her class participation as well as a summary of grades to date. All feedback is meant to be constructive and helpful. Students should see Dr. Rohan with any questions or to review their progress in person. X. Course Evaluations Dr. Rohan likes receiving feedback even more than she likes giving it. Completed course evaluations and informal discussions and/or emails about how her course may be improved are always welcome and appreciated! XI. Special Needs Any student who has a need for accommodation based on the impact of a disability should contact Dr. Rohan as soon as possible to discuss the specific situation. Adult Psychopathology 5 Students who believe that there is something Dr. Rohan needs to know that might improve his or her learning environment in the classroom should contact her as soon as possible. Adult Psychopathology XI. Class Schedule and Critical Dates Class Date Topic August 29 Course Introduction September 5 Classification, Conceptual Issues, Role of Theory *Finalize Presentation Topic September 12 Anxiety Disorders: Panic Disorder, Specific Phobias September 19 Anxiety Disorders: Post-Traumatic Stress Disorder and ObsessiveCompulsive Disorder September 26 Anxiety Disorders: Generalized Anxiety Disorder and Social Anxiety Disorder October 3 Mood Disorders: Phenomenology, Subtypes, Course, Epidemiology, Suicide October 10 Mood Disorders: Unipolar Depression October 17 Mood Disorders: Bipolar Disorder and Seasonal Affective Disorder *Mid-Term Questions Distributed October 24 Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder *Mid-Term Exam Due (submit hard copy no later than class time) October 31 Personality Disorders November 7 Schizophrenia and Psychotic Disorders November 14 Substance-Related Disorders November 21 No class—Thanksgiving Recess November 28 Dissociative Disorders: Amnesia, Dissociative Identity Disorder, Depersonalization, Fugue December 5 Somatoform Disorders: Hypochondriasis, Somatization Disorder, Conversion Disorder, Body Dysmorphic Disorder Sexual Disorders and Dysfunctions *Final Exam Questions Distributed (December 12) (No Class) *Final Exam Due (submit hard copy by 4:00 pm to Dr. Rohan’s box) 6 Adult Psychopathology Reading Assignments Classification, Conceptual Issues, Role of Theory In DSM-IV-TR: pp. xxiii-xxxvii; 1-37 In Maddux & Winstead (2005): Chapter 1: Maddux, J. E., Gosselin, J. T., & Winstead, B. A. Conceptions of psychopathology: A social constructionist perspective. (pp. 3-18). Chapter 2: Regeser López, S., & Guarnaccia, P. J. Cultural dimensions of psychopathology: The social world’s impact on mental illness. (pp. 19-37). Chapter 3: Winstead, B. A., & Sanchez, J. Gender and psychopathology. (pp. 39-61). Chapter 4: Widiger, T. A. Classification and diagnosis: Historical development and contemporary issues. (pp. 63-83). Anxiety Disorders: Panic Disorder, Specific Phobias In DSM-IV-TR: pp. 429-450. In Maddux & Winstead (2005): Chapter 7: Lloyd Williams, S. Anxiety disorders. (pp. 127154). Bouton, M. E., Mineka, S., & Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review, 108, 4-32. Casey, L. M., Oei, T. P. S., & Newcombe, P. A. (2004). An integrated cognitive model of panic disorder. Clinical Psychology Review, 24, 529-555. Craske, M. G., & Waters, A. M. (2005). Panic disorder, phobias, and generalized anxiety disorder. Annual Review of Clinical Psychology, 1, 97-225. Merckelbach, H., de Jong, P. J., Muris, P., & van den Hout, M. A. (1996). The etiology of specific phobias: A review. Clinical Psychology Review, 16, 337-361. Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder In DSM-IV-TR: pp. 456-472. Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339-376. Doron, G. & Kyrios, M. (2005). Obsessive-compulsive disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, 25, 415-432. 7 Adult Psychopathology McKay, D., Abramowitz, J. S., Calamari, J. E., Kyrios, M, Radomsky, A. Sookman, D., Taylor, S., & Sabine, W. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24, 283-313. McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229-252. Salkovskis, P. M., Thorpe, S. J., Wahl, K., Wroe, A. L., & Forrester, E. (2003). Neutralizing increases discomfort associated with obsessional thoughts: An experimental study with obsessional patients. Journal of Abnormal Psychology, 112, 709-715. Shalev, A. Y., & Freedman, S. (2005). PTSD following terrorist attacks: A prospective evaluation. American Journal of Psychiatry 162, 1188-1191. Generalized Anxiety Disorder and Social Anxiety Disorder In DSM-IV-TR: pp. 450-456; 472-484. Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. (pp. 77-108). In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice. New York: Guilford. Hofmann, S. G, Heinrichs, N., & Moscovitch, D. A. (2004). The nature and expression of social phobia: Towards a new classification. Clinical Psychology Review, 24, 769-797. Turk, C. L., Heimberg, R. G., & Luterek, J. A. (2005). Emotional dysregulation in generalized anxiety disorder: A comparison with social anxiety disorder. Cognitive Therapy and Research, 29, 89-106. Turk, C. L., Lerner, J., Heimberg, R. G., & Rapee, R. M. (2001). An integrated cognitivebehavioral model of social anxiety. (pp. 281-303). In S. G. Hofman & P. M. Bibartolo (Eds.), From social anxiety to social phobia: Multiple perspectives. Needham Heights, MA: Allyn & Bacon. Wells, A., & Carter, K. (2001). Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behavior Therapy, 32, 85-102. Mood Disorders: Phenomenology, Subtypes, Course, Epidemiology, Suicide In DSM-IV-TR: pp. 345-428. In Maddux & Winstead (2005): Chapter 8: Ingram, R., & Trenary, L. Mood disorders. (pp. 155-177). Bouland, R. J. & Keller, M. B. (2002). Course and outcome of depression. (pp. 43-60). In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression. New York: Guilford Press. 8 Adult Psychopathology McCullough, J. P., Klein, D. N., Borian, F. E., Howland, R. H., Riso, L. P., Keller, M. B., & Banks, P. L. C. (2003). Group comparisons of DSM-IV subtypes of chronic depression: Validity of the distinctions, part 2. Journal of Abnormal Psychology, 112, 614-622. Shankman, S. A., & Klein, D. N. (2003). The relation between depression and anxiety: An evaluation of the tripartite, approach-withdrawal, and valence-arousal models. Clinical Psychology Review, 23, 605-637. Sprock, J., & Yoder, C.Y. (1997). Women and depression: An update on the report of the APA task force. Sex Roles, 36, 269-303. The following epidemiological report is provided for your reference only (do not expect you to read for class): Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., Wang, P. S. (2003). The epidemiology of Major Depressive Disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289, 30953105. Mood Disorders: Unipolar Depression Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, B. (1979). An overview. (pp. 8-20). Cognitive therapy of depression. New York: Guilford Press. (NOTE: The specified pages present an overview of the cognitive model of depression). Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293319. Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28, 857870. Joiner, T. E. Jr. (2002). Depression in its interpersonal context. (pp. 295-313). In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression. New York: Guilford Press. Scher, C. D., Ingram, R. E., & Segal, Z. V. (2005). Cognitive reactivity and vulnerability: Empirical evaluation of construct activation and cognitive diathesis in unipolar depression. Clinical Psychology Review, 25, 487-510. Thase, M. E. (2002). Biological aspects of depression. (pp. 192-218). In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression. New York: Guilford Press. Mood Disorders: Bipolar Disorder and Seasonal Affective Disorder Alloy, L. B., Abramson, L. Y., Urosevic, S., Walshaw, P. D., Nusslock, R., & Neeren, A. M. (2005). The psychosocial context of bipolar disorder: Environmental, cognitive, and developmental risk factors. Clinical Psychology Review, 25, 1043-1075. Cueller, A. K., Johnson, S. L., & Winters, R. (2005). Distinctions between unipolar and bipolar depression. Clinical Psychology Review, 25, 307-339. 9 Adult Psychopathology Newman, C. F., Leahy, R. L., Beck, A. T., Reilly-Harrington, N. A., & Gyulai, L. (2002). Chapter 1: Bipolar disorder: Diagnostic, epidemiologic, etiologic, and prognostic issues (pp. 3-23). Bipolar disorder. Washington, DC: American Psychological Association. Partonen, T., & Lönnqvist, J. (1998). Seasonal affective disorder. The Lancet, 352, 13691374. Rohan, K. J., Sigmon, S. T., & Dorhofer, D. M. (2003). Cognitive-behavioral factors in seasonal affective disorder. Journal of Consulting and Clinical Psychology, 71, 22-30. Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder In DSM-IV-TR: pp. 583-595; 785-787. In Maddux & Winstead (2005): Chapter 11: Polivy, J., Herman, C. P., & Boivin, M. Eating disorders. (pp. 229-254). Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509-528. Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes?: Implications for conceptualizing their etiology. Psychological Bulletin, 129, 747-769. Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology, 53, 187-213. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848. Personality Disorders In DSM-IV-TR: pp. 685-; 785-729. In Maddux & Winstead (2005): Chapter 10: Coker, L. A., & Widiger, T. A. Personality disorders. (pp. 201-227). Cale, E. M., & Lilienfield, S. O. (2002). Sex differences in psychopathy and antisocial personality disorder: A review and integration. Clinical Psychology Review, 22, 11791207. Haslam, N. (2003). The dimensional view of personality disorders: A review of the taxometric evidence. Clinical Psychology Review, 23, 75-93. Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. The Lancet, 364, 453-461. Skodol, A. E. et al. (2005). Dimensional representations of DSM-IV personality disorders: Relationships to functional impairment. American Journal of Psychiatry, 162, 19191925. 10 Adult Psychopathology Trull, T. J., & Durrett, C. A. (2005). Categorical and dimensional models of personality disorder. Annual Review of Clinical Psychology, 1, 355-380. The following epidemiological report is provided for your reference only (do not expect you to read for class): Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S. P., Ruan, W. J., & Pickering, R. (2004). Prevalence, correlates, and disability of personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 65, 948-958. Schizophrenia In DSM-IV-TR: pp. 297-343. In Maddux & Winstead (2005): Chapter 9: Walker, E., Bollini, A., Hochman, K., & Kestler, L. Schizophrenia. (pp. 179-200). Beck, A. T., & Rector, N. A. (2005). Cognitive approaches to schizophrenia: Theory and therapy. Annual Review of Clinical Psychology, 1, 577-606. López, S. R., Hipke, K. N., Polo, A. J., Jenkins, J. H., Karno, M., Vaughn, C., & Snyder, K. S. (2004). Ethnicity, expressed emotions, attributions, and course of schizophrenia: Family warmth matters. Journal of Abnormal Psychology, 113, 428-439. Reichenberg, A., Rieckmann, N., & Harvey, P. D. (2005). Stability in schizophrenia symptoms over time: Findings from the Mount Sinai Pilgrim Psychiatric Center Longitudinal Study. Journal of Abnormal Psychology, 114, 363-372. Rosenfarb, I. S., Bellack, A. S., Aziz, N., Kratz, K. M., & Sayers, S. (2004). Race, family interactions, and patient stabilization in schizophrenia. Journal of Abnormal Psychology, 113, 109-115. Substance-Related Disorders In DSM-IV-TR: pp. 191-295. In Maddux & Winstead (2005): Chapter 14: Fals-Stewart, W. Substance use disorders. (pp. 301-324). Chassin, L., Flora, D. B., & King, K. M. (2004). Trajectories of alcohol and drug use and dependence from adolescence to adulthood: The effects of familial alcoholism and personality. Journal of Abnormal Psychology,113, 483-498. Higgins, S. T., Heil, S. H., & Lussier, J. P. (2004). Clinical implications of reinforcement as a determinant of substance use disorders. Annual Review of Psychology, 55, 431-461. Holahan, C. J., Moos, R. H., Holahan, C. K., Cronkite, R. C., Randall, P. K. (2003). Drinking to cope and alcohol use and abuse in unipolar depression: A 10-year model. Journal 11 Adult Psychopathology of Abnormal Psychology, 112, 159-165. Nolen-Hoeksema, S. (2004). Gender differences in risk factors and consequences for alcohol use and problems. Clinical Psychology Review, 981-1010. Sher, K. J., Grekin, E. R., & Williams, N. A. (2005). The development of alcohol use disorders. Annual Review of Clinical Psychology. 1, 493-523. Dissociative Disorders In DSM-IV-TR: pp. 519-533. Elzinga, B. M., Phaf, R. H., Ardon, A. M., & van Dyck, R. (2003). Directed forgetting between, but not within, dissociative personality states. Journal of Abnormal Psychology, 112, 237-243. Gleaves, D. H., & May, M. C. (2001). An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychology Review, 21, 577-608. Huntjens, R. J. C., Postma, A., Peters, M. L., Woertman, L., & van der Hart, O. (2003). Interidentity amnesia for neutral, episodic information in dissociative identity disorder. Journal of Abnormal Psychology, 112, 290-297. Kihlstrom, J. F. (2005). Dissociative disorders. Annual Review of Clinical Psychology, 1, 227253. Merckelbach, H., Devilly, G. J., & Rassin, E. (2002). Alters in dissociative identity disorder: Metaphors or genuine entities? Clinical Psychology Review, 22, 481-497. Somatoform Disorders Sexual Disorders and Dysfunctions In DSM-IV-TR: pp. 485-517 and pp. 535-582. In Maddux & Winstead (2005): Chapter 12: McConaghy, N. Sexual dysfunctions and disorders. (pp. 255-280). In Maddux & Winstead (2005): Chapter 13: Eifert, G. H., & Zvolensky, M. J. Somatoform disorders. (pp. 281-300). Brown, R. J. (2004). Psychological mechanisms of medically unexplained symptoms: An integrative conceptual model. Psychological Bulletin, 130, 793-812. 12