THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF SOCIAL WORK
COURSE NUMBER:
COURSE TITLE:
SEMESTER & YEAR:
INSTRUCTOR:
OFFICE HOURS:
CLASS HOURS:
SOWO 758.01
Differential Diagnosis of Mental Health Disorders
SPRING, 2013
Matthew O. Howard, Ph.D.
Office 563A, Tate-Turner-Kuralt Building
919-932-8732 or 314-330-3479 (cell)
mohoward@email.unc.edu
Monday, 12:00-2:00 p.m. or by arrangement
Monday, 2:00-4:50 p.m., Room 300
COURSE DESCRIPTION: This course focuses on the process of conducting a differential diagnosis
of mental health disorders using the current Diagnostic and Statistical Manual of Mental
Disorders.
COURSE OBJECTIVES:
At the conclusion of this course:
1. Students will be able to use the Diagnostic and Statistical Manual of Mental Disorders,
4th Edition to identify major mental health conditions.
2. Students will be able to distinguish between different disorders to complete a differential
diagnosis, including issues of comorbidity, and write a diagnostic multi-axial statement
for a client.
3. Students will understand the impact of race, ethnicity, gender, age, culture, sexual
orientation, and socioeconomic status on mental health diagnosis, particularly on
symptom presentation, assessment, and access to care.
4. Students will be able to articulate the psychological and behavioral indicators and course
of a range of mental health conditions that can affect functioning and development.
5. Students will be sensitive to the potential use of personal data in mental health
assessments for persons who may be in vulnerable and oppressed situations.
6. Students will demonstrate an understanding of ethical issues in assessment and diagnosis
of mental health conditions.
EXPANDED DESCRIPTION:
This course is designed for students who are interested in mental health assessment and
diagnosis. It builds on the foundation HBSE course and the advanced practice/HBSE course by
furthering students’ knowledge of mental disorders and how to complete a differential diagnosis
using the DSM. Students will read, view, and discuss more than 120 cases throughout the
semester and gain confidence in using the DSM to complete a formal multi-axial diagnosis.
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REQUIRED TEXTS/READINGS:
1. Schwartzberg, S.S. (2000). Casebook of psychological disorders: The human face of
emotional distress. Allyn & Bacon, Needham Heights, MA
This is the best book of mental health case studies I have read. The author is a Clinical Professor
of Psychology in the Department of Psychiatry at Harvard Medical School. The case studies
included in this book are interesting, informative, and easy to digest.
2. Collected case studies (to be distributed by Professor). I will provide each student with a
binder of collected case studies. Whereas the Schwartzberg book provides introductory-level
case formulations, the binder of case studies includes recent professional-level case discussions
selected from the very best professional journals.
OPTIONAL TEXTS/READINGS:
3. Sadock, B.J., & Sadock, V.A. (2008). Kaplan and Sadock’s concise textbook of clinical
psychiatry. Lippincott Williams & Wilkins, Philadelphia, PA.
This text is derived from the classic text: Synopsis of Psychiatry, 10th edition. Given that we will
already be reading many case studies, only the most ambitious students should purchase this
book. Each week there will be optional readings drawn from this text for interested students.
4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders, fourth edition-text revision. Washington, D.C.: American Psychiatric Press.
I have not made DSM-IV a required text for a number of reasons. First, DSM-5 will be out in
the not-too-distant future and may be considerably different than DSM-IV. Second, I will
present critical information about DSM-IV in class. Third, we will learn a great deal about the
DSM-IV diagnostic system by reading case studies, but will also gain important substantive
knowledge with regard to assessment and treatment of many important mental health disorders.
As a UNC student, you can access a free online version of DSM-IV at the following website:
http://www.psychiatryonline.com.libproxy.lib.unc.edu/resourceTOC.aspx?resourceID=1. Each
week there will be optional readings drawn from the DSM-IV for interested students.
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TEACHING METHODS
This class will use a variety of teaching and learning styles to convey course content including
lectures, videos, and small group diagnostic work. The development of a supportive learning
environment, reflecting the values of the social work profession, is essential for the success of
this class. A supportive learning environment is fostered by listening to the ideas and views of
others, being able to understand and appreciate a point of view that is different from your own,
articulating clearly your point of view, and linking experience to readings and assignments. I will
appreciate your contributions to making this a safe and respectful class for learning and growth.
CLASS ACTIVITIES
1. Class Attendance and Participation (minimal acceptable attendance = 6 of 7 classes,
unless permission is sought and received to miss more than one class)
2. Annotated Case Studies
3. Video Diagnostic Exam
CLASS PARTICIPATION
I conduct this class like a graduate clinical seminar. Each week I open the class by discussing
current events in mental health and distribute additional readings/case studies to students at that
time. Students who bring to class and present one current event relevant to mental health can
earn one point. I then devote approximately 30 minutes to a mini-lecture. The class then
reviews select video cases of actual patients evidencing a range of conditions relevant to the
topic of discussion for that class session. We then break into small groups to apply what we
have learned to diagnostic exercises. My goal is to present at least 120 cases over the 7 weeks of
the course in a range of formats including published case studies, video vignettes of real cases,
and diagnostic exercises designed to hone the skills of student practitioners. It is critically
important that students read assigned cases from the prior week and are present in class. Please
attend all 7 classes and try to interact to some degree.
NUMBER OF ANNOTATED CASE STUDIES COMPLETED
Students should read and take careful notes on at least 3 case studies per week. Each annotated
case study is worth 3 points. To complete an annotated case study, simply read the case study
and make brief notes or record questions on the case study itself as well as underline or highlight
as you read. It is important that you indicate to me, through these notes and/or questions, that
you have carefully read the case in question. That said, it is not critical that the notes be
voluminous. If you are uncertain as to whether you are annotating enough, please show me one
or more of your case annotations and I will give you feedback. You will turn in your binder of
annotated cases and annotated case studies in the Schwartzberg book to me at the end of the
class. We will then schedule a personal meeting during which I will review your binder and
book, answer any questions you have raised, and assign you the proper grade for the class. It is
important that you read at least 3 case studies per week, so that you can participate meaningfully
in class discussions and garner sufficient points. If you do not wish to mark up your book and/or
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binder, you can choose to prepare your annotations by writing up your notes/questions in longhand or you can word process your notes. Completion of 0 to 13 annotated cases = F,
completion of 14-20 annotated cases = L, completion of 21-27 annotated cases = P, completion
of 28-34 annotated cases = H, and completion of 35+ annotated cases = H+.
You are free to read any case study in the Schwartzberg book and any case study in the binder of
case studies and to annotate them and count them for 3 points each. I allow students to do this so
that students with different clinical interests (e.g., mental health disorders in the elderly, anxiety
disorder, etc.) can explore those interests in additional depth. But I do list suggested readings for
each class session below. Typically, you will want to read the assigned Schwartzberg case study
and several case studies from the binder each week. This will help you develop diagnostic
expertise across the full range of mental health disorders.
GRADING SYSTEM
In accordance with the Graduate school, letter grades are assigned to the following numeric
ranges:
H+ = 35+ completed annotated cases
H = 28-34 completed annotated cases
P = 21-27 completed annotated cases
L = 14-20 completed annotated cases
F = 0-13 completed annotated cases
An H+ grade will also earn you a personalized letter attesting to your outstanding performance in
this class.
POLICY ON INCOMPLETES AND LATE ASSIGNMENTS
If students encounter unavoidable obstacles to meeting class assignments, the student should
discuss the circumstances with the instructor to determine if an initial grade of incomplete (INC)
would be appropriate. I prefer not to give an incomplete grade and will give incompletes only in
compliance with University policy.
POLICY ON ACADEMIC DISHONESTY
At the end of the course, when you are turning in your annotated case studies, please include a
signed pledge stating that, "I have not given or received unauthorized aid in preparing this
written work." In keeping with the UNC Honor Code, if reason exists to believe that academic
dishonesty has occurred, a referral will be made to the Office of the Student Attorney General for
investigation and further action as required.
POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES
Students with disabilities which affect their participation in the course may notify the instructor
if they wish to have special accommodations in instructional format, examination format, etc.
Please contact the University’s Disability office to request the paperwork necessary for approved
accommodations.
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USE OF LAPTOPS OR OTHER ELECTRONIC DEVICES
Please turn off all cell phones or other devices that would disrupt the learning environment of the
classroom.
Course Calendar
Class 1: January 14th –Syllabus Review, Introductions, Introduction to DSM-IV and
Differential Diagnosis
Class 2: January 28th – Delirium, Dementia, Mild Cognitive Impairment/Medical Disorders that
Can Produce Mental Health Symptoms
Class 3: February 4th – Substance Use Disorders
Class 4: February 11th – Schizophrenia, Schizophreniform, Schizoaffective, Delusional, and
Brief Psychotic Disorders/Schizoid, Paranoid, and Schizotypal Personality Disorders
Class 5: February 18th – Mood Disorders/Ethical Issues
Class 6: February 25th – Anxiety Disorders/Diversity Issues
Class 7: March 4th – Personality, Eating, Impulse Control, Sleep, Sexual, Childhood Onset,
Somatization, Dissociative, Adjustment, and Factitious Disorders/Video
Exam/Completing a Multi-Axial Assessment
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COURSE OUTLINE
Class 1: January 14th –Syllabus Review, Introductions, Introduction to DSM-IV and Mental
Health Diagnosis, Elements of the Mental Health Interview and Mental Status
Examination
Case Readings for Next Week: Read the one Schwartzberg case listed below and a suggested 2 to
4 additional case studies, depending on how many points you want to earn.
1. Schwartzberg, SS. Case 14: Dementia of the Alzheimer’s Type
2. Breitbart, W., & Alici, Y. (2008). Agitation and delirium at the end of life: “We couldn’t
manage him.” Journal of the American Medical Association, 300, 2898-2911.
3. Widera, E., et al. (2011). Finances in the older patient with cognitive impairment: “He didn’t
want me to take over.” Journal of the American Medical Association, 305, 698-706.
4. Mitchell, S.L. (2007). A 93-year-old man with advanced dementia and eating problems.
Journal of the American Medical Association, 298, 2527-2536.
5. Ellison, J.M. (2008). A 60-year-old woman with mild memory impairment: Review of mild
cognitive impairment. Journal of the American Medical Association, 300, 1566-574.
6. Ritchie, C.S., Roth, D.L., & Allman, R.M. (2011). Living with an aging parent: “It was a
beautiful invitation.” Journal of the American Medical Association, 306, 746-753.
7. Mosqueda, L., & Dong, X. (2011). Elder abuse and self-neglect: “I don’t care anything about
going to the doctor, to be honest….”
8. Differential Diagnosis Chapter, pages 1-14.
Optional Readings:
1. DSM-IV: Delirium, Dementia, and Amnestic and Other Cognitive Disorders, pp. 135-180.
2. Sadock & Sadock: Chapter 7: Delirium, Dementia, Amnestic and Other Cognitive Disorders
and Mental Disorders Due to a General Medical Conditions, pp. 46-79.
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Class 2: January 28th – Delirium, Dementia, Amnestic Disorder, Mild Cognitive
Impairment/Medical Disorders that Can Produce Mental Health Symptoms
Case Readings for Next Week: Read the one Schwartzberg case listed below and a suggested 2 to
4 additional case studies/review articles, depending on how many points you want to
earn.
1. Schwartzberg, S.S. Case 10: Heroin (Opioid) Dependence
2. O’Brien, C.P. (2008). A 50-year-old woman addiction to heroin: A review of the treatment of
heroin addiction. Journal of the American Medical Association, 300, 314-321.
3. Knight, J.R. (2004). A 35-year-old physician with opioid dependence. Journal of the
American Medical Association, 292, 1351-1357.
4. Schuckit, M.A. (2009). Alcohol-use disorders. The Lancet, 373, 492-501.
5. Hatsukami, D.K., et al. (2008). Tobacco addiction. The Lancet, 371, 2027-2038.
6. Hodgins, D.C., Stea, J.N., & Grant, J.E. (2011). Gambling disorders. The Lancet, 378, 18741884.
Optional Readings:
1. DSM-IV: Substance-Related Disorders, pp. 191-296.
2. Sadock & Sadock: Chapter 9: Substance-Related Disorders, pp. 85-155.
Class 3: February 4th – Substance Use Disorders
Case Readings for Next Week: Read the one Schwartzberg case listed below and a suggested 2 to
5 additional case studies/articles, depending on how many points you want to earn.
1. Schwartzberg, S.S. Chapter 13, Schizophrenia, Paranoid Type
2. Goff, D.C. (2002). A 23-year-old man with schizophrenia. Journal of the American Medical
Association, 287, 3249-3257.
3. Schwartz, M. (1997). Family secret. The New Yorker, 90-107.
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4. Onishi, H., et al. (2003). Brief psychotic disorder associated with bereavement in a patient
with terminal-stage uterine cervical cancer: A case report and review of the literature.
Support Care Cancer, 11, 491-493.
5. Akahane, T., et al. (2009). Extremely grotesque somatic delusions in a patient of delusional
disorder and its response to risperidone treatment. General Hospital Psychiatry, 31, 185186.
6. Jordan, H.W., et al. (2006). Erotomania revisited: Thirty-four years later. Journal of the
National Medical Association, 98, 787-793.
Optional Readings:
1. DSM-IV: Schizophrenia and Other Psychotic Disorders, pp. 297-344.
2. Sadock & Sadock: Chapters 10 & 11: Schizophrenia, pp. 156-177, and Other Psychotic
Disorders, pp. 178-199.
Class 4: February 11th – Schizophrenia, Schizophreniform, Schizoaffective, Delusional, and
Brief Psychotic Disorders/Schizoid, Paranoid, and Schizotypal Personality Disorders
Case Readings for Next Week: Read the 2 Schwartzberg cases and a suggested 1 to 6 additional
case studies/articles, depending on how many points you want to earn.
1. Schwartzberg, S.S. Case 3, Dysthymic Disorder
2. Schwartzberg, S.S. Case 4, Bipolar Disorder
3. Sachs, G.S. (2001). A 25-year-old woman with bipolar disorder. Journal of the American
Medical Association, 285, 454-462.
4. Schroeder, S.A. (2009). A 51-year-old woman with bipolar disorder who wants to quit
smoking. Journal of the American Medical Association, 301, 522-531.
5. Frye, M.A. (2011). Bipolar disorder—A focus on depression. New England Journal of
Medicine, 364, 51-59.
6. Kroenke, K. (2002). A 75-year-old man with depression. Journal of the American Medical
Association, 287, 1568-1576. (Look in “Remaining Disorders” section of readings binder)
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7. Viguera, A.C., et al. (2008). Case 24-2008: A 35-year-old woman with postpartum
confusion, agitation, and delusions. New England Journal of Medicine, 359, 509-515.
8. Salzman, C. (2006). A 60-year-old woman who has felt sad for much of her life. Journal of
the American Medical Association, 295, 318-323. (Look in “Remaining Disorders” section of
readings binder)
Optional Readings:
1. DSM-IV: Mood Disorders, pp. 429-484.
2. Sadock & Sadock: Chapter 12: Mood Disorders, pp. 200-235.
Class 5: February 18th – Mood Disorders/Ethical Issues
Case Readings for Next Week: Read the 2 Schwartzberg cases and a suggested 1 to 4 additional
cases/articles, depending on how many points you want to earn.
1. Schwartzberg, S.S. Case 1, Posttraumatic Stress Disorder
2. Schwartzberg, S.S. Case 2, Panic Disorder with Agoraphobia
3. Katon, W.J. (2006). Panic disorder. New England Journal of Medicine, 354, 2360-2367.
4. Jenike, M.A. (2004). Obsessive-compulsive disorder. New England Journal of Medicine,
350, 259-265.
5. Schneier, F.R. (2006). Social anxiety disorder. New England Journal of Medicine, 355,
1029-1036.
6. Fricchione, G. (351). Generalized anxiety disorder. New England Journal of Medicine, 351,
675-682.
Optional Readings:
1. DSM-IV: Anxiety Disorders, pp. 485-512.
2. Sadock & Sadock: Chapter 13: Anxiety Disorders, pp. 236-272.
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Class 6: February 25th – Anxiety Disorders/Diversity Issues
Case Readings for Next Week: Read the 2 Schwartzberg cases and a suggested 1 to 4 additional
cases/articles, depending on how many points you want to earn.
1. Schwartzberg, S.S.: Case 8, Narcissistic Personality Disorder
2. Schwartzberg, S.S.: Case 9, Borderline Personality Disorder
3. Oldham, J.M. (2002). A 44-year-old woman with borderline personality disorder.
Journal of the American Medical Association, 287, 1029-1037.
4. Stewart, J.B. (1997). Professional courtesy. The New Yorker, 90-105.
5. Mehler, P.S. (2003). Bulimia nervosa. New England Journal of Medicine, 349, 875-881.
6. Yager, J., & Anderson, A.E. (2005). Anorexia nervosa. New England Journal of Medicine,
353, 1481-1488.
Optional Readings:
1. DSM-IV: Personality Disorders, pp. 685-730.
2. Sadock & Sadock: Chapter 23: Personality Disorders, pp. 375-392.
Class 7: March 4th – Personality, Eating, Impulse Control, Sleep, Sexual, Childhood Onset,
Somatization, Dissociative, Adjustment, and Factitious Disorders/Video Exam/Multi-Axial
Assessment
Optional Case Readings for Next Week: Consider reading the 3 Schwartzberg cases and the
additional case studies listed below, depending on how many points you want to earn.
1. Schwartzberg, S.S.: Case 5, Conversion Disorder
2. Schwartzberg, S.S.: Case 6, Dissociative Identity Disorder
3. Schwartzberg, S.S.: Case 7, Bulimia Nervosa
4. Rapin, I. (2001). An 8-year-old boy with Autism. Journal of the American Medical
Association, 285, 1749-1757.
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5. Jacobs, D.G. (2000). A 52-year-old suicidal man. Journal of the American Medical
Association, 283, 2693-2699.
6. Kurlan, R. (2010). Tourette’s syndrome. New England Journal of Medicine, 363, 23322338.
Optional Readings:
1. DSM-IV: Somatoform Disorders, pp. 485-512, Dissociative Disorders, pp. 519-535.
2. Sadock & Sadock: Chapter 14: Somatoform Disorders, pp. 273-286, and Chapter 16:
Dissociative Disorders, pp. 293-302.