Is he mentally ill?

Life records—school, police, hospital

• Life records—school, police, hospital

• Interviews

• Observation

• Psychological tests

• Standardized
• Normed
• Several subtypes:
• Rating Scales (specific vs. broad)

Intelligence Tests

• Intelligence Tests

• WISC-IV, WAIS-III, Stanford-Binet

• Neuropsychological testing—measure deficits in behavior, cognition, or emotion that correlate with brain damage

•  Personality Tests

• Projective—Ambiguous stimuli that allow for individual responses
• Rorschach
• TAT/RAT
• Draw A Person
• Objective
• MMPI-2 Revised in 1989, first ed. in 1943 (10 clinical scales, + validity scales and special scales

1) Potential for cultural bias of the instrument or clinician

• 1) Potential for cultural bias of the instrument or clinician

• 2) Theoretical orientation of clinician

• 3) Underemphasis on the external situation

• 4) Insufficient validation

• 5) Inaccurate data or premature evaluation

Efforts go back thousands of years

• Efforts go back thousands of years

• Scientific efforts in 19th century

• Emil Kraepelin—3 categories—dementia praecox (schizophrenia), manic-depressive psychosis, & organic brain disorders (delirium, dementia, amnestic)
• 1917—1st American system, didn’t work
• 30s and 40s—military developed system
• 1948—Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death—now on ICD 10

• 1952--Diagnostic and Statistical Manual of Mental Disorders

• Then DSM-II-in 1968

• DSM-III in 1980, III-R in 1987, IV in 1994, TR in 2000

• DSM I and II lacked consistency, some criteria were based on theories of causation, others on clusters of sx, little effect on tx

Multiaxial

• Multiaxial

• Clearly defined diagnostic criteria,

• Operationally (not theoretically) defined diagnosis

• 5 Axes

• I—Major mental disorders
• II-Developmental and personality disorders
• III-General medical conditions that affect disorders
• IV-Psychosocial stressors—topical, labeled acute or chronic
• V-Global assessment of functioning

• Polythetic approach—must have some # of criteria out of a larger group

• Comorbidity

Labeling produces stereotypes, prejudices, and harm

• Labeling produces stereotypes, prejudices, and harm

• Rosenhan (1973)—voices saying thud, empty, or hollow; kept 7-52 days

• Self-fulfilling prophecies

• Gender/ethnic bias—

• Antisocial PD more often diagnosed in men, histrionic in women
• In a study with randomly assigned gender to APD or HPD criteria, psychologists underdiagnosed women with APD and men with HPD

• People are more likely to diagnose others like themselves with less severe diagnoses, those not like them get more severe diagnoses

• Disorders are on a continuum, not discrete categories

• Why do we use categorical?
• Medical model
• Easy

• No one agrees on personality dimensions 

• Not enough attention to validity

From Opinion Research Corporation, 2004

• From Opinion Research Corporation, 2004

• 67% Am. would not tell their employer that they were seeking mental health treatment
• 51% would hesitate to see a psychotherapist if a diagnosis were required
• 41% believe they should be able to handle psychological problems on their own
• 37% would be reluctant to seek tx because of confidentiality concerns
• 33% would not seek counseling for fear of being labeled mentally ill

1935 Egaz Moniz—prefrontal leucotomy/lobotomy

• 1935 Egaz Moniz—prefrontal leucotomy/lobotomy

• Won the 1949 Nobel Prize in medicine
• Originally 18 patients, 6 cured, 6 improved, 6 same. Idea took off.

• Freeman and Watts—frontal lobotomy—cutting into side of skull and then pivoted

• Transorbital lobotomy—

• In 20 yrs, 40,000 pts had lobotomies

• Side effects—seizures, incontinence, poor judgment, lack of motivation, lethargy, impaired thinking, 5 % died

• All surgeries were blind

• 2 procedures are done today.

• Cingulotomy and stereotaxic subcaudate tractotomy

Convulsions to treat mental illness date back to Paracelsus (1493-1591)

• Convulsions to treat mental illness date back to Paracelsus (1493-1591)

• Today, use of electro shock dates to 1938

• Bilateral vs. unilateral

• About 100,000 per year

• Injuries in 1/1400 tx

• Post tx side effects—temporary memory loss, h/a, confusion

• Used for severe mood disorders—about 80% are severely depressed

Antipsychotics—aka major tranquilizers, neuroleptics

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