Download DSM-5: The Future of Psychiatric Diagnosis

DSM IV-New Developments-Clinical and
Multicultural Applications
“A System in Transition”
SW 223
Dr. Demetral, Ph.D., & LCSW
e-mail address: [email protected]
Weekend Class
CSUS Phone #: 916-278-7168
Fall 2010
SUNDAY COURSE OUTLINE
Course Dates: September 12th; October 10th; October 31st; November 21st;
& December 12th, 2010.
Time: 8 to 5
Room: ARC (Academic Resource Center) 1007
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 as well as consider the proposed transition to the proposed DSM V. 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 & the proposed DSM V to persons experiencing emotional
disorder within a culturally sensitive context.
DSM-5: The Future of Psychiatric Diagnosis
Publication of the fifth edition of Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) in May 2013 will mark one the most anticipated events in the mental
health field. As part of the development process, the preliminary draft revisions to the
current diagnostic criteria for psychiatric diagnoses are now available for public review.
SWRK 223 will critically analyze the proposed changes in the areas of the disorders and
disorder criteria that have been proposed by the DSM-5 Work Groups. This course will
analyze the research base for the proposed changes in DSM V, the structural, crosscutting, and general classification issues that arise in the construction of the DSM V, and
involve each student in a critique of the proposed “new classifications” of the major
mental disorders.
-2Course 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 infusing culture and gender into a culturally and gender
sensitive form of diagnostic practice;
3. Display written and verbal competence in the articulation of the biological-socialpsychological-cultural etiological dimensions of schizophrenia and psychosis, mood
disorders, anxiety disorders, personality disorders, substance abuse and childhood
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;
6. Display written and verbal competence in the articulation and critique of the
transition from DSM IV-TR into the newly proposed DSM V system of diagnosis for
each diagnostic category being studied (i.e. Schizophrenia and other disorders that
present with Psychosis).
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”,
competency tests, and Critique papers between each class that will be used in the small
and full class 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. Pomeroy, Elizabeth, & Wambach, Kathryn, The Clinical Assessment
Workbook: Balancing Strengths and Differential Diagnosis, ThomsonBrookes/Cole, 2003, ISBN # 0-534-57843-8. (Required) Amazon: $90.00 new &
$70.00 used;
2. DSM-IV or DSM-IVTR, American Psychiatric Publishing Co. Amazon: $5.00
used
3. Morrison, James, DSM IV Made Easy, The Guilford Press, 1995, ISBN #: 089862-568-8. (Required). Amazon: New: $54.00 & used $26.00.
Due to the fact that the Division of Social Work is limited in Xeroxing class
handout(s), there is a $7.50 cost per student to cover the cost of clinical handouts
used throughout the semester. You can pay this cost at the first class.
-3Recommended Texts:
1. Preston & Johnson, Clinical Psychopharmacology Made Ridiculously Simple,
ISBN # 9780940780880
2. Morrison, James, Diagnosis Made Easier, The Guilford Press, 2007, ISBN 13 #
978-1-59385-331-0; ISBN 10 #1-59385-331-91. Required
3. Dziegielewski, Sophia, F. DSM IV In Action, Wiley, 2002, ISBN #: 978-0-47141441-4.
4. Morrison, James, The First Interview: Revised for the DSM-IV, The Guilford
Press, Third Edition, 2008, ISBN 13 # 978—1-59385-636-6. (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.)
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 Text. 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 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 and discuss the
content. There will be one in-class quiz as well in session three (50 points)
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 questions 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 and Mental Health Roundtable Discussion: You are to go to the
web-sites indicated on the October 10th, 2010 session (session #2) and read the
material on culture and the diagnosis of mental illness. A) You are then to
develop a critical thinking question that requires some “in depth” critical
thinking to answer based on the readings; B) Type out your answer. Make
seven copies of your typed question and typed answer, with references. You
will dialogue in your small groups about your critical thinking culture and
mental illness question(s). 35 points
4. DSM V Critique: For each class you will notice a “critique” assignment. You
are to go to the Home APA DSM-5 website www.dsm5.org . You are expected
to read and critique the “proposed” changes between the DSM IV-TR and the
proposed DSM 5. Your typed critique must reflect your comparison between
the DSM IV and the DSM V classification; the APA “sub-group” research
reasoning behind the changes to the category; and your opinion of whether you
feel the change “advances” the “process of differential diagnosis”, is more
inclusive of race, culture, and gender, and your personal opinion. Minimum 2
pages each.
5. 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 be 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: September 12th, 2010
Mental Status Examination; Multi-Axial & Differential Diagnosis; The Bio-Psycho
Interface & Schizophrenia & Other Psychotic Disorders
Please pay attention to the materials that are being e-mailed to
you. You have a competency test to complete and bring to class, and the
assignment(s) that must be completed and brought to class.
A. Morning Session: “The Healing Science Within the DSM-IV-TR”
*Evolution of the DSM System
*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 & In-Class Exercise/Quiz
* Review of proposed changes in the “Multi-Axial System for DSM V”
B. Afternoon Session:
*Schizophrenia & Other Psychotic Disorders
*Schizophrenia Competency Test: Discussion
*APA Diagnostic Training Tapes & Discussion
*Pomeroy Vignette “practice”
-5*Proposed changes in DSM V for “Disorders that present with
Psychosis”
Readings:
 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 through and including 5.4
 DSM IV sections on Multi-Axial Assessment, DSM IV Classification, and
Schizophrenia and other Psychotic Disorders
 APA DSM –5 Web Site on Proposed changes to Schizophrenia & other
Psychotic disorders
What is the Mental Status Examination
General Appearance & Behavior
Mood
Flow of Thought
Insight & Judgment Outcome Informed
We will have an In Class Clinical Exercise on Mental Status Examination
To prepare you for that please take some time and review the following web-site
references:
Please read (click Ctrl and left click your mouse to view), down-load the following
excellent resource materials prior to coming to class. We will be referencing these
materials and processing them in our in class exercise(s):
 The Mental Status Exam
The Mental Status Exam is the basis for understanding the client's presentation and
beginning to conceptualize their functioning into a diagnosis. ...
www.psychpage.com/learning/library/assess/mse.htm - Cached - Similar  [PDF]
Mental Status Examination
File Format: PDF/Adobe Acrobat - Quick View
Mental Status Examination. 1. Appearance, attitude and motor activity – dress, grooming,
signs of illness and behavior. 2. Mood and affect - range, ...
www.psychsign.org/psych_cards.pdf - Similar [PDF]
Mini-Mental Status Examination
File Format: PDF/Adobe Acrobat - Quick View
Mini-Mental Status Examination. The Mini-Mental Status Examination offers a quick
and simple way to quantify cognitive function and screen for cognitive ...
www.nmaging.state.nm.us/pdf_files/Mini_Mental_Status_Exam.pdf - Similar -
-6-
Key DSM-IV Mental Status Exam Phrases
Key DSM-IV Mental Status Exam Phrases. This material draws strongly on David .....
For example, in response to the statement “That will probably remain a ...
www.gatewaypsychiatric.com/.../key_dsmiv_mental_status_exam_ph.htm - Cached Similar
Mental Status Exam
File Format: Shockwave Flash
Clang Associations. Thought Process is the manner in which thoughts are connected or
associated. Examples of Thought Process. Mental Status Exam ...
aitlvideo.uc.edu/aitl/MSE/MSEkm.swf - Similar
[PDF]
Mental Status Exam Ideas:
File Format: PDF/Adobe Acrobat - Quick View
mini-mental status exam, which she missed one point for recall of one of the three
objects, one point for sentence writing, and one point for repetition of ...
www.usuhs.mil/icm/MentalStatusExam.pdf -
NAMI: National Alliance on Mental Illness | Mental Illnesses
Schizophrenia is a serious and challenging medical illness, an illness that affects ...
However, when a doctor observes the symptoms of schizophrenia and ...
www.nami.org/Template.cfm?Section=By_Illness... - Cached
Recommended Reading for session one:
 The First Interview, Chapters 1-4; & 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) for Session One:
1. Differential Diagnosis Case Write ups -this will be used for our
practice in class in Pomeroy. Page 125 through 141, cases 5.1
through 5.4 are to be completed prior to coming to class. 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 emailed with the course outline. (Bring to class)
3. Schizophrenia & Other Psychotic Disorders Critique Paper.
-710th,
Session Two: October
2010
Mood Related Disorders
A. Morning & Afternoon Session:
*Discussion & feedback on Psychosis Case Vignettes
*Final thoughts and considerations on Psychotic Disorders
*Cultural Influences on the Diagnosis of Mental 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
*Proposed changes between DSM IV & DSM V
Readings:
 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.
 APA DSM-5 Web-Site: Proposed changes on Mood Disorders
Assignment(s):
1. Differential Diagnosis Case Write ups for two (2) DSM Cases in
Pomeroy. Page 149 through 166, cases 6.1 and 6.2. 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 e-mailed
to you. (Bring to class)
3. Cultural Considerations when Diagnosing “Disorders” across cultures
“roundtable dialogue question)
4. DSM V Critique Paper.
1. Culture and Mental Illness
Washington Post staff writer Shankar Vedantam discusses his series about how
culture influences the diagnosis, treatment and outcome of mental illness.
http://www.washingtonpost.com/wpdyn/content/discussion/2005/06/27/DI2005062701082.html
2. Unit 9, Online Readings in Psychology and Culture, Center for ...
While various cultures have unique treatments for mental illness, no culture
claims to have all the answers. The chapters in this unit address some of the ...
http://www.ac.wwu.edu/~culture/unit9.htm - 10k
3. Online Readings in Psychology and Culture, Unit 9, Chapter 1
The mutual embeddedness of culture and mental illness. .... Culture does not
just influence mental health and illness, but rather it is a constituent of ...
http://www.ac.wwu.edu/~culture/Sam_Moreira.htm - 42k
4. Medical Anthropology: Culture Specific Diseases
Dec 14, 2007 ... What is defined as a mild form of mental illness in one culture
may be defined as normal behavior in another. ...
-8http://anthro.palomar.edu/medical/med_4.htm - 27k
5. Mental Health: Culture, Race, Ethnicity
MENTAL HEALTH: CULTURE, RACE, AND ETHNICITY A Supplement to.
Mental Health: A Report of the ... Mental health and mental illness are points on
a continuum. ...
http://www.surgeongeneral.gov/library/mentalhealth/cre/execsummary-1.html 11k 6. In other countries, symptoms of mental illness vary, with ...
Mar 24, 2008 ... The American Psychiatric Association's diagnostic manual
includes a glossary of "culture-bound syndromes" - forms of mental illness
reported ...
http://www.boston.com/news/health/articles/2008/03/24/culture_gap/ - - Cached Similar pages
Depression and Bipolar Support Alliance: About Mood Disorders
Feb 5, 2009 ... The majority of people with mood disorders are able to find treatments
that work. Talk therapy, medication or a combination of both help ...
www.dbsalliance.org/site/PageServer?pagename=about... - Cached [PDF]
National Institutes of Health Fact Sheet Mood Disorders
File Format: PDF/Adobe Acrobat - Quick View
that are involved in mood disorders and yielding a new way to study the effectiveness of
... quality of care for people with mood disorders, including ...
www.nih.gov/about/researchresultsforthepublic/MoodDisorders.pdf - Similar
NAMI: National Alliance on Mental Illness | Mental Illnesses
Bipolar disorder, or manic depression, is a medical illness that causes extreme ... Over 10
million people in America have bipolar disorder, and the illness ...
www.nami.org/Template.cfm?Section=By_Illness... - Cached - Similar
 Bipolar Videos
Watch bipolar disorder videos.
Are you Bipolar, Bipolar Meds.
www.RealMentalHealth.com
Session Three: October 31st, 2010 Adjustment and Anxiety/Stress Disorders
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
-9*APA Diagnostic Training Tapes
In class differential diagnosis quiz
Readings:




Morrison, DSM-IV Made Easy, Chapter 6.
Pomeroy & Wambach, The Clinical Assessment Workbook, Chapter 7.
(pages 173-208)
DSM IV sections on Anxiety.
APA DSM V Web-Site on proposed changes to anxiety disorders
Assignment(s):
1. Differential Diagnosis Case Write ups for three (3) DSM Cases in
Pomeroy. Page 179 through 197, cases 7.1 to 7.3. 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. DSM V Critique Paper
www.webmd.com/anxiety.../mental-health-anxiety-disorders - Cached - Similar -
 Mental Health: A Report of the Surgeon General - Chapter 4
The anxiety disorders are the most common, or frequently occurring, ... The anxiety
disorders include panic disorder (with and without a history of ...
www.surgeongeneral.gov/library/mentalhealth/.../sec2.html - Cached - Similar
 Generalized Anxiety Disorder - Watch WebMD Video
Everyone worries now and then and that's healthy. But for some people, unrelenting
worry interferes with their ability to enjoy life.
www.webmd.com/video/generalized-anxiety-disorder - Cached - Similar -
 Social Anxiety Disorder (SAD) - Watch WebMD Video
We follow Becky Bruno, a teenager suffering from social anxiety disorder, as she
explains how she learned to start enjoying her life.
www.webmd.com/video/too-scared-social-anxiety-disorder - Cached - Similar -
 Stories and Video on Anxiety Disorders From ABC News - ABC News
Get the latest news articles and watch videos on anxiety disorders from ABCNews.com
and the OnCall+ Anxiety Center. The content in this section is divided ...
abcnews.go.com/Health/AnxietyNews/ - Similar -
 Video results for anxiety disorders videos
Social Anxiety Disorder (Health & Wellbeing ...
www.videojug.com
Generalized Anxiety Diso
www.videojug.com
-10-
Session Four: November 21st , 2010
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
*Full class discussion and critique of “proposed changes in the DSM V
Personality disorders by classification and diagnosis”
Afternoon Session
*Cultural Influences on the Diagnosis of Childhood Disorders
*Disorders Diagnosed in Infancy, Childhood, and Adolescence
*Full class discussion and critique of “proposed changes in the DSM V
Infant, Child, & Adolescent Disorders”
Readings:




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.
APA DSM V Web-Site on “proposed changes” in Personality &
Childhood Disorders
Assignment(s):
1. Differential Diagnosis Case Write ups for the four (4) Cases in
Pomeroy. Complete case 14.1 & 14.2 (pages 311 to 319) on
Personality Disorders. Then complete case 2.1 & case 2.2 (pages 27
to 37) on Childhood Disorders. 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 competency Quiz on Personality Disorder. (Bring to
class)
3. Personality Disorder & Childhood Disorder Critique Paper(s) one for
each.
Video results for personality disorders videos
Paranoid Personality Disorder (Health ...
www.videojug.com
Borderline Personality Disorder
23 min - May 15, 2006
www.youtube.com
-11Borderline Personality Disorder (Health ...
www.videojug.com
Video results for obsessive compulsive personality disorder ...
Obsessive-Compulsive Personality Disorder ...
www.videojug.com
Obsessive Compulsive Personality Disorder
7 min - Sep 14, 2007
www.youtube.com
Session Five: December 12th, 2010
Alcohol and Drug Related Disorders &
Cognitive Disorders and Neurological Disorders Due to a Medical Condition
A. Morning Session:
*Course Evaluation
*Alcohol & Drug Related Disorders
*APA Training Tapes
*APA DSM V-“Proposed changes in the Substance-Related Disorders
B. Afternoon Session
*Cognitive Disorders & Neurological Disorders Due to a Medical Condition
*APA Training Tapes
*APA DSM V- “Proposed changes in the Delirium, Dementia, Amnestic, and
Neurological disorders:
Readings:
 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 (4) DSM Cases in
Pomeroy. Complete case 4.1 & 4.2 (pages 95 to 103) on Drug and
Alcohol Related Disorders. Then complete case 3.1 & case 3.2 (pages 75
to 83) on Cognitive Disorders. 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 competency Quiz on Cognitive Disorders. Bring to class.
-12-
3. Critique Paper on Proposed changes for each disorder.
Substance Abuse and Mental Health Services Administration (SAMHSA ...
SAMHSA works to improve the quality and availability of substance abuse
prevention, alcohol and drug addiction treatment, and mental health services.
http://www.samhsa.gov/ - 37k - Cached
Click on and read
Definitions, Terminology, Classification
Screening and Assessment
Treatment Planning and Approaches
Evidence and Consensus Based Practices
Video results for delerium depression and dementia
Geriatrics: Dementia Delirium and Depression
49 min - Aug 15, 2008
www.youtube.com
Depression, Delirium and Dementia
48 min - Mar 4, 2009
www.researchchannel.org
[PDF]
RECOGNIZING DELIRIUM, DEPRESSION AND DEMENTIA (3D's)
File Format: PDF/Adobe Acrobat - Quick View
Screening for Delirium, Dementia and Depression in Older Adults. Toronto, Canada:
Registered Nurses' Association of Ontario. ...
www.opadd.on.ca/.../LocalProjects-Educ.Training-3Dscomparisonchart.pdf -
Overcoming Drug and Alcohol Addiction Video
A video about one person's battle with Alcohol Addiction. A young girl who loses
everything to alcohol addiction. She lost her family, job and home but was ...
www.myaddiction.com › Videos - Cached - Similar
YouTube - Alcohol and Drug Addiction Educational PSA Video
31 sec - Jul 1, 2008 Anti-Alcohol Video PSA. Public domain public service announcement. Alcoholism is a
chronic disease that makes your body dependent on alcohol.
www.youtube.com/watch?v=_Xq13_vg_qA - Related videos
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Dr. David Demetral, Ph.D., & LCSW
Social Work 223
Fall 2010
Schizophrenia and Other Psychotic Disorders
Competency Test One
Multiple Choice Questions:
1. Zoë, aged twenty-two, gave birth to her first child, Alexia, four days ago. Zoë’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 disorder
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:
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 Cameron 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
Rule out Delirium
No diagnosis
13. Josette's mother, Erlange St. Villien, (age 79) has had a sudden onset of 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. Josette
tried to convince her mother that the radio transmitter really did not exist. However,
Josette has become increasingly worried as these bizarre statements and behaviors have
gone on for three days. Your first differential diagnosis that must be considered is:
a)
b)
c)
d)
Schizophrenia, NOS
A brief psychotic episode
Delirium
Schizophrenia, disorganized type
True/False Questions:
14. Schizophreniform disorder refers to prodromal, active, and residual schizophrenic
symptoms that have existed for less than six months duration, but more than one month.
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 have a
significant mood disturbance lasting for more than two weeks should be diagnosed as
Schizoaffective disorder.
18. During your intake interview with Sylvia Martin you notice that it takes a very long
time for her to respond . Sylvia is displaying avolition.
Definition:
19. The negative symptoms of Schizophrenia include affective flattening, alogia, or
avolition. Describe and define these terms, and how they may be clues to a co-morbid
mood disorder.
Critical Thinking question(s)
20. Symptoms of schizophrenia are divided into both "positive" and "negative"
categories. Please describe the three positive symptoms that are experienced by persons
with schizophrenia. (Hint: Define, describe, and share what to be aware of when you are
interviewing)
21. Delusional Disorder is one of the differential diagnosis” that must be considered
when diagnosing Schizophrenia. Describe how you would make the differential diagnosis
between Schizophrenia and Delusional disorder.
22. Matching Items:
a)
b)
c)
d)
Echopraxia
Echolalia
Tardive dyskensia
Delusions
e) Dysphoria
1.Pathological imitation of another person’s movements
2. Pathological repeating of the same cluster of words
3. False beliefs
4. Abnormal, involuntary irregular movement of the
head, limbs and trunk muscles
5. Individuals believe they are persons of exalted
position (Jesus or the President of the U.S.)
f) Delusions of grandeur
6. Anger, depression and increased anxiety are common
emotional reactions to ensuing psychosis
g) Persecution
7. This subtype includes delusions and
hallucinations that are less prominent than negative
symptoms and disorganized speech and behavior
h) Shared psychotic disorder 8. This disorder includes at least one of the basic psychotic
symptoms and lasts less than one month
i) Brief psychotic disorder
9. Symptoms include motoric immobility, excessive motor
activity, extreme negativism (or mutism), or
peculiar posturing
j) Disorganized type
10. Individuals feel they are being pursued when they are
not
k) Catatonic type
11. Previously known as Folie a Deux
l) Schizoaffective disorder
12. These individuals have met the criteria for
schizophrenia, however the symptoms have lasted for
less than six months
m) Schizophreniform
13. Individuals have all the symptoms of schizophrenia; at
the same time they have prominent symptoms of
mania or depression