Pre-Recorded Lectures
Lecture 1: Diagnosis in Context
Severe Mental Illness (SMI)
The National Institute of Mental Health – defined SMI using the following criteria:
1) A major diagnosis of non-organic psychosis or personality disorder
2) Duration of at least 2 years
3) At least three of the five categories of functional disabilities
Diagnosis
A major affective, non-organic psychotic disorder – or a disorder that may lead to a chronic
disability such as BPD
Duration
Treatment history meets one or both of the following criteria:
1) Has undergone psychiatric treatment more intensive than outpatient care more than
once in a lifetime
- E.g., crisis response services, alternative home care, partial hospitalization, or
inpatient hospitalization
2) Has experienced an episode of continuous, supportive residential care – other than
hospitalization – for a period long enough to have sig disrupted the normal living
situation
Disability
Severe recurrent disability resulting from mental illness – the disability results in functional
limitations in major life activities
Individuals must meet at least two of the following criteria on a continuing or intermittent
basis:
1) Is unemployed, is employed in a sheltered setting or supportive work situation – or
has markedly limited skills and a poor work history
, 2) Requires public financial assistance from out-of-hospital maintenance – and may be
unable to procure such assistance without help
3) Has difficulty in establishing or maintaining a personal social support system
4) Exhibits inappropriate social behavior – which results in intervention by the mental
and/or judicial system
The SIDDD Dimensions of Definition of SMI
Dimension Components
Safety Unintentional self-harm – e.g., self-neglect
Intentional self-harm
Safety of others
Abuse by others – e.g., physical, sexual, emotional, financial
Informal and Formal Help from informal carers – including friends and relatives
Support
Help from formal services – such as day centers, paid staff, voluntary services,
hospital admissions, medication and detention under the Mental Health Act
Diagnosis Psychotic illness
Dementia
Severe neurotic illness
PDs
Developmental Disorder
Disability Disability with impaired ability to function effectively in the community – which
may include problems with:
Employment and recreation
Personal care
Domestic skills
Interpersonal relationships
Duration of any of the above – for periods which may vary between 6 months to 2 years
“Difficult to Treat Patients”
(Urban) contextual factors – include:
1) Poverty 3) Unemployment
2) Low SES 4) Hopelessness
, 5) Criminal/inappropriate social
behavior
Dual diagnosis:
1) In combination with substance use
2) Childhood trauma, abuse, attachment problems
3) Depressive or anxiety symptoms
Perspective on SMI
For much of the 20th century – severe mental illness was considered chronic and
deteriorating – requiring institutional tertiary care or high-intensity secondary care
This approach changed in the 60s – with the advent of anti-psychotic drugs – and
subsequent deinstitutionalization
- Which gave new hope to patients with SMI who were discharged into the
community
From Care to Cure
Severe Mental Illness:
1) Drug-based treatment
2) Disease model
3) Term implies medical discourse of cure
Definitions
Ontology State/way of being – what we assume the world is like
With cancer we can look into the body – and see its cause (e.g., tumor)
With psychology – it is more difficult to touch and grasp what a psych
disorder is – and what its cause is (difficult and vague)
Epistemology How we can know, understand, describe reality
“If we want to understand disorders – we have to describe symptoms as
clearly as possible”
Nomothetic Approach Regular, lawful approach
Is after universal laws – things that go for everyone
, Very big in the medical world
Idiographic Approach Looks to the individual
Dimensional, developmental, subjective, gradual
Diagnosis in context – diagnosis is not an explanation but an
understanding and it has to have a utility
More holistic approach – interaction and person-oriented
Variation and change in individuals
Effects of specific interventions – key elements
The therapist and the patient as individual persons – and their interactions
Nomothetic Approach
The nomothetic approach – i.e., explanation of symptoms by underlying diseases
- Focus on universal/lawful disease states
When person X has disease Y – the disease causes
symptoms x, y, z
The Cure-Paradigm in Psychiatry
Ontology – Theory of Being
Ontology – i.e., theory of being – is a casual disease model
1) Symptoms – are observable signs of the underlying cause
2) Treatment Goal – is to eliminate the cause
3) Treatment Outcome Monitoring – is to observe reduction of symptoms as signs of
elimination of cause
4) End Result – no more symptoms interpreted as no more disease
Epistemology – Theory of Knowledge
Lecture 1: Diagnosis in Context
Severe Mental Illness (SMI)
The National Institute of Mental Health – defined SMI using the following criteria:
1) A major diagnosis of non-organic psychosis or personality disorder
2) Duration of at least 2 years
3) At least three of the five categories of functional disabilities
Diagnosis
A major affective, non-organic psychotic disorder – or a disorder that may lead to a chronic
disability such as BPD
Duration
Treatment history meets one or both of the following criteria:
1) Has undergone psychiatric treatment more intensive than outpatient care more than
once in a lifetime
- E.g., crisis response services, alternative home care, partial hospitalization, or
inpatient hospitalization
2) Has experienced an episode of continuous, supportive residential care – other than
hospitalization – for a period long enough to have sig disrupted the normal living
situation
Disability
Severe recurrent disability resulting from mental illness – the disability results in functional
limitations in major life activities
Individuals must meet at least two of the following criteria on a continuing or intermittent
basis:
1) Is unemployed, is employed in a sheltered setting or supportive work situation – or
has markedly limited skills and a poor work history
, 2) Requires public financial assistance from out-of-hospital maintenance – and may be
unable to procure such assistance without help
3) Has difficulty in establishing or maintaining a personal social support system
4) Exhibits inappropriate social behavior – which results in intervention by the mental
and/or judicial system
The SIDDD Dimensions of Definition of SMI
Dimension Components
Safety Unintentional self-harm – e.g., self-neglect
Intentional self-harm
Safety of others
Abuse by others – e.g., physical, sexual, emotional, financial
Informal and Formal Help from informal carers – including friends and relatives
Support
Help from formal services – such as day centers, paid staff, voluntary services,
hospital admissions, medication and detention under the Mental Health Act
Diagnosis Psychotic illness
Dementia
Severe neurotic illness
PDs
Developmental Disorder
Disability Disability with impaired ability to function effectively in the community – which
may include problems with:
Employment and recreation
Personal care
Domestic skills
Interpersonal relationships
Duration of any of the above – for periods which may vary between 6 months to 2 years
“Difficult to Treat Patients”
(Urban) contextual factors – include:
1) Poverty 3) Unemployment
2) Low SES 4) Hopelessness
, 5) Criminal/inappropriate social
behavior
Dual diagnosis:
1) In combination with substance use
2) Childhood trauma, abuse, attachment problems
3) Depressive or anxiety symptoms
Perspective on SMI
For much of the 20th century – severe mental illness was considered chronic and
deteriorating – requiring institutional tertiary care or high-intensity secondary care
This approach changed in the 60s – with the advent of anti-psychotic drugs – and
subsequent deinstitutionalization
- Which gave new hope to patients with SMI who were discharged into the
community
From Care to Cure
Severe Mental Illness:
1) Drug-based treatment
2) Disease model
3) Term implies medical discourse of cure
Definitions
Ontology State/way of being – what we assume the world is like
With cancer we can look into the body – and see its cause (e.g., tumor)
With psychology – it is more difficult to touch and grasp what a psych
disorder is – and what its cause is (difficult and vague)
Epistemology How we can know, understand, describe reality
“If we want to understand disorders – we have to describe symptoms as
clearly as possible”
Nomothetic Approach Regular, lawful approach
Is after universal laws – things that go for everyone
, Very big in the medical world
Idiographic Approach Looks to the individual
Dimensional, developmental, subjective, gradual
Diagnosis in context – diagnosis is not an explanation but an
understanding and it has to have a utility
More holistic approach – interaction and person-oriented
Variation and change in individuals
Effects of specific interventions – key elements
The therapist and the patient as individual persons – and their interactions
Nomothetic Approach
The nomothetic approach – i.e., explanation of symptoms by underlying diseases
- Focus on universal/lawful disease states
When person X has disease Y – the disease causes
symptoms x, y, z
The Cure-Paradigm in Psychiatry
Ontology – Theory of Being
Ontology – i.e., theory of being – is a casual disease model
1) Symptoms – are observable signs of the underlying cause
2) Treatment Goal – is to eliminate the cause
3) Treatment Outcome Monitoring – is to observe reduction of symptoms as signs of
elimination of cause
4) End Result – no more symptoms interpreted as no more disease
Epistemology – Theory of Knowledge
