Instructor s Manual. Bette R. Bonder, PhD, OTR/L, FAOTA Dean, College of Science Cleveland State University Cleveland, Ohio. and.

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1 Instructor s Manual Bette R. Bonder, PhD, OTR/L, FAOTA Dean, College of Science Cleveland State University Cleveland, Ohio and Jordan Bray

2 Copyright 2010 by SLACK Incorporated All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for brief quotations embodied in critical articles and reviews. The procedures and practices described in this book should be implemented in a manner consistent with the professional standards set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of the information presented and to correctly relate generally accepted practices. The authors, editor, and publisher cannot accept responsibility for errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied warranty of this book or information imparted by it. Care has been taken to ensure that drug selection and dosages are in accordance with currently accepted/recommended practice. Due to continuing research, changes in government policy and regulations, and various effects of drug reactions and interactions, it is recommended that the reader carefully review all materials and literature provided for each drug, especially those that are new or not frequently used. Any review or mention of specific companies or products is not intended as an endorsement by the author or publisher. SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide important feedback on the content that we publish. We welcome feedback on this work. Published by: SLACK Incorporated 6900 Grove Road Thorofare, NJ USA Telephone: Fax:

3 Contents Introduction... iv Chapter 1. Psychiatric Diagnosis and the Classification System...1 Chapter 2. DSM-IV-TR and Occupational Therapy...6 Chapter 3. Disorders of Infancy, Childhood, and Adolescence Chapter 4. Delirium, Dementia, Amnestic, and Other Cognitive Disorders...16 Chapter 5. Substance-Related Disorders...21 Chapter 6. Schizophrenia and Other Psychotic Disorders...26 Chapter 7. Mood Disorders...31 Chapter 8. Anxiety Disorders...36 Chapter 9. Personality Disorders...40 Chapter 10. Other Disorders...45 Chapter 11. Psychopharmacology...50 Resources...55 Appendix A: Gathering Information for Referral Resource Guide...58 Appendix B: Case Studies...59

4 Introduction Psychiatric disorders are as old as time and as ubiquitous as air. Throughout history and around the world there are descriptions of behaviors and feelings that are outside normal expectations. The interpretation of those behaviors and feelings has varied greatly. People with psychiatric disorders have been thought of as saints and witches, lazy or foolish. Although we now understand that most of these conditions are biological in nature, there is still some confusion about how to characterize individuals who struggle with unwelcome symptoms that place them outside of societal norms. The struggle is not restricted to the lay population; health care providers have some of the same confusion. Are these conditions of daily living? Moral failings? Rational responses to an irrational world? Faulty neurological wiring? Research evidence continues to grow, increasingly showing the physiological basis of many (though not all) psychiatric disorders. But even so, there is some lack of clarity; that lack of clarity is particularly pronounced in the varying approaches to the treatment of mental disorders. Psychopathology and Function, Fourth Edition, is designed to bring some clarity to the discussion and to provide occupational therapists with sufficient understanding to offer their very unique contributions to the care of individuals coping with psychological conditions. The Instructor s Manual is intended to facilitate student learning and to make it as easy as possible for you, the instructor, to provide rich and meaningful elaboration on the contents of the text. The Instructor s Manual is organized to provide: An overview and key points for each chapter In-class activities Out-of-class activities and assignments Supplemental resources A test bank that can assist in student evaluation You will also find Resources and Appendices. These include an array of case studies that can enrich class presentations and can be used for purposes of assessment as well. There is a list of popular movies that depict psychiatric disorders, some more accurately than others. Students might be encouraged to rent and watch any of the movies on the list and to discuss them in class. One in-class activity that is always appropriate is a straight lecture on the chapter s topic. Use the PowerPoint slides we ve developed as a basis for this, or use those identified in the resource list at the end of this Instructor s Manual. An out-of-class activity that always makes sense is an update on the evidence. Because of the lead time involved in publishing a textbook, it s inevitable that the most current research will not be included. Having students spend some time finding that information is valuable both to ensure they have the most current information and to reinforce the importance of evidence-based practice. The dearth of occupational therapy-related research may convince at least a few students to consider a career in research. Disclaimer: The multiple-choice questions in this text have not been field-tested. Your input about their effectiveness would be appreciated.

5 1 Psychiatric Diagnosis and the Classification System Overview Because psychiatric illness can be invisible, and because it still carries a stigma, students tend to know less about mental disorders than physical illness, and what they do know may be distorted by inaccurate portrayals in the media. This chapter provides context for subsequent discussion of the specific disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), including information about how our understanding of psychiatric disorders has evolved. Key Points The diagnostic classification system has evolved greatly as understanding of psychiatric disorders has increased Diagnostic classification is based on both scientific and political considerations A revision of the current system is underway at present As is true in physical disorders, evidence-based practice is increasingly valued The DSM-IV-TR has five axes, not all of which are used consistently In-Class Activities Review of history. Have students watch this brief video clip: video/ /mental-illness-a-brief-history-of-psychiatric-centers/ (7 min.), called Mental Illness: A Brief History of Psychiatric Centers. This is an interview with Dr. Roger Christenfeld from the Hudson River Psychiatric Center. Ask students to discuss ways in which care has changed since the time described in the video.

6 Chapter 1 Does mental illness exist? In this YouTube clip: watch?v=hwaahbmf5s4 (4:39 min.), Matt Lauer interviews Tom Cruise about his views on psychiatry. Ask students what they think of the ideas presented by Cruise. Case study. Appendix B of this Instructor s Manual includes a list of online resources for case studies. Students particularly enjoy focusing on cases, since this tends to make real the more theoretical aspects of the text. Every chapter contains a case study you might discuss in class. Or go to Appendix B and select a case to review and discuss. You can also have students work in small groups on different case studies and then present to their classmates. Out-of-Class Activities Search for news stories. Throughout the course, it is helpful to have students search the news media for stories with a psychological twist. These may include many stories that are not specifically focused on psychiatric disorders, but that might lead students to wonder about the motivations and behaviors of the stories players. Philandering politicians? Hollywood celebrities picked up for DUI? Reality show stars? Perpetrators of financial fraud? Ask students to reflect on why these individuals may have behaved as they did, and whether psychological factors might explain (or excuse) their behavior. Supplemental reading. Have students choose from the materials below, and write brief summaries. Ask them to analyze the ways in which this information supports, elaborates, or refutes what is in the text. Political aspects of psychiatric diagnosis. Have students read a news story emphasizing the divisions that characterize understanding of psychiatric disorders at html. Psychiatry s Civil War published in New Psychiatry.com. Supplementary Materials Reading A discussion of associated stigma. The harm suffered by many people because of a psychiatric diagnosis is a well kept secret. A site maintained by Paula J. Caplan, Research Associate at Harvard University s DuBois Institute. Depression Simmers in Japan s Culture of Stoicism New York Times article, August 10, History of psychology. Resources on the history of psychiatry from the National Library of Medicine.

7 Psychiatric Diagnosis and the Classification System Sam, D.L., & Moreira, V. (2002). The mutual embeddedness of culture and mental illness. In W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler (Eds.), Online Readings in Psychology and Culture (Unit 9, Chapter 1): Center for Cross- Cultural Research, Western Washington University, Bellingham, WA. Surgeon General of the United States. (1999). Mental health: Culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. Washington DC: Department of Health and Human Services U.S. Public Health Service. Retrieved December 20, 2009 from summary-1.html Web Sites National Alliance on Mental Illness Cultural_Competence/Cultural_Competence.htm The NAMI site provides a wealth of information. This particular page focuses on cultural issues and cultural competence. Thomas Szasz Cybercenter for Liberty and Responsibility Focuses on the work of Thomas Szasz, who held that psychiatric disorder was a mislabeling of behavior that did not conform to societal norms. A comprehensive discussion of the draft of DSM-V, released in February The public is encouraged to comment. Evaluation Multiple-Choice Questions (Note: Correct answers are in bold, page number for information is in parentheses next to the correct answer.) 1. The first diagnostic system for mental disorders had how many categories? a. One. (p. 2) b. Three. c. Ten. d. Twenty. 2. The first edition of the DSM to be based on clinical research was: a. DSM I. b. DSM II. c. DSM III. (p. 3) d. DSM IV. 3. Thomas Szasz argued that mental illness was: a. Always caused by biological factors. b. A result of inadequate or ineffective parenting. c. Caused by faulty learning. d. A societal label for deviant behavior. (p. 3)

8 Chapter 1 4. The system of five axes for diagnosis was introduced in which edition of DSM? a. DSM I. b. DSM II. c. DSM III. (p. 4) d. DSM IV. 5. A new factor introduced in DSM-IV was: a. Recognition of cultural factors in mental disorders. (p. 5) b. An axis focused on accompanying physical illness. c. Descriptive psychopathology. d. Interrater reliability. 6. On which of the following psychological/psychiatric theories is DSM-IV based? a. Psychoanalysis. b. Behavior modification. c. Cognitive/behavioral theory. d. It is atheoretical. (p. 5) 7. Which of the following is NOT a consideration in terms of modification for the upcoming DSM-V? a. It should be more comprehensive. b. It should change the entire classification structure. (p. 7) c. It should deal better with clinical significance. d. It should have higher reliability. 8. Increased understanding of the biological basis of many psychiatric disorders has posed a challenge in deciding how DSM-V should deal with what kind of disorder found in DSM-IV? a. Situational disorders like adjustment disorder. (p. 8) b. Bipolar and other mood disorders. c. Gender dysphoric disorders. d. Developmental disorders like mental retardation. 9. Which of the following is the most accurate statement about the impact of cultural factors on psychiatric diagnosis? a. Culture influences both symptoms and help-seeking behavior. (p. 8) b. Culture is not relevant to biologically based disorders. c. Culture is relevant only to biologically based disorders. d. Culture is most significant in developmental disorders. 10. Axis V is particularly important for occupational therapists because it: a. Focuses on individuals perceptions of their disorder. b. Identifies the individual s level of function. (p. 12) c. Provides a detailed description of symptoms. d. Emphasizes lifespan considerations.

9 Psychiatric Diagnosis and the Classification System Essay Questions The process of developing the DSM is affected by political considerations. Support or refute this statement, giving examples to support your position. Why is evidence-based practice important in mental health, and what has interfered with its implementation? Discuss the relevance of culture in diagnosing mental disorders.