 Symptom - refers to an observable behavior or state  Syndrome - term applied to a cluster of symptoms that occur together or co-vary over time  Disorder - a syndrome that is not accounted for by a more pervasive condition  Disease - a disorder where the underlying etiology is known

 “Pseudo-patients” try to get themselves admitted to mental hospitals  Told psychiatrists they were hearing voices that said “empty”, “hollow”, or “thud.”  All were admitted, 11 of 12 diagnosed with schizophrenia  Despite stopping symptom complaints, none were suspected of faking by hospital staff  Real patients did suspect pseudo-patients were faking.  How to interpret these findings? (Class discussion)

 Seven real patients (with histories of chronic schizophrenia) in acute exacerbation of their illness present at intake interview at outpatient managed behavioral healthcare clinics, describing their real symptoms truthfully  Six of the seven were denied treatment  Details of their experiences  How do we interpret these findings? (Class Discussion)

 False Positive - incorrectly accepting a false instance as true (Type II error)  False Negative - incorrectly rejecting a true instance as false (Type I error)  True Positive - correctly accepting a true instance  True Negative - correctly rejecting a false instance  Importance of carefully specifying diagnostic decision rules to identify homogeneous disorders  Examples: Autism (Volkmar et al., 1988); schizophrenia (Fenton et al., 1988)

 Diagnostic systems assume that abnormality can be detected and classified by clusters of symptoms and signs ◦ Each cluster is thought to reflect a different disorder ◦ Each cluster may require a different treatment Ch 3.1

 DSM-IV (Diagnostic and Statistical Manual) is a revised diagnostic classification system created by the American Psychiatric Association  DSM-IV makes use of 5 distinct axes to classify a disorder  DSM-IV was designed to more accurately classify psychiatric disorder (relative to earlier DSM versions) Ch 3.2

AXISDESCRIPTION IAll categories except personality disorder and mental retardation IIPersonality disorders and mental retardation IIIGeneral medical conditions IVPsychosocial and environmental problems VCurrent level of functioning Ch 3.3

 Disorders usually first diagnosed in infancy, childhood or adolescence ◦ Involve early emotional/intellectual disorder  Substance-related disorders ◦ Ingestion of a drug impairs social/occupational functioning  Schizophrenia ◦ Involves faulty contact with reality ◦ May involve delusions (disordered thoughts) Ch 3.4a

 Mood disorders ◦ Involve large swings in emotional affect  Anxiety disorders ◦ Involve some form of irrational or overblown fear  Somatoform disorders ◦ Involve physical symptoms that have no known physiological cause  Dissociative disorders ◦ Involve a sudden alteration of consciousness that affects memory and identity Ch 3.4b

 Sexual/gender identity disorders ◦ Involve dysfunction or discomfort with sexual function or identity  Sleep disorders ◦ Involve disturbance in amount of sleep or events during sleep  Eating disorders ◦ Involve under- or over-eating  Factitious disorder ◦ Involved in persons who produce or complain of psychological symptoms (sick role) Ch 3.4c

 Impulse control disorder ◦ Involve several conditions in which a person’s behavior is inappropriate or out of control  Personality disorders ◦ Involve enduring, inflexible and maladaptive patterns of behavior and inner experience  Other conditions that may be the focus of clinical attention Ch 3.4d

 Classification systems do not always capture the uniqueness of a person  Classification systems may emphasize trivial similarities between abnormal conditions  Classification may result in a label that is harmful to the person Ch 3.5

 Scribner, C. M. (2001). Rosenhan revisited. Professional Psychology: Research and Practice, 32(2), doi: / , psycARTICLES database.