SOWO 758
Spring 2014
THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF SOCIAL WORK
COURSE NUMBER:
COURSE TITLE:
SEMESTER & YEAR:
TIME:
LOCATION:
INSTRUCTOR:
OFFICE HOURS:
SOWO 758
Differential Diagnosis of Mental Health Disorders
Spring 2014 (January 13 – March 3)
Mondays 2-4:50pm
Tate-Turner-Kuralt Building, Room 101
Betsy (Sarah E.) Bledsoe-Mansori
School of Social Work
Tate-Turner-Kuralt Building, Campus Box 3550
Phone: (919) 843-6543
E-mail: bledsoe@email.unc.edu
by appointment (524c)
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, 5th 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 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.
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EXPANDED DESCRIPTION: This course is designed for students who are interested in psychiatric assessment and
diagnosis. It builds on the foundation HBSE course and the advanced practice/HBSE course by furthering
students’ knowledge of psychiatric disorders and how to complete a differential diagnosis using the DSM.
Students will read, view, and discuss cases throughout the semester and gain confidence in using the DSM to
complete a formal psychiatric diagnosis.
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 psychiatric 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. Nussbaum, A.M. (2013). The Pocket Guide to the DSM-5 Diagnostic Exam. American Psychiatric
Publishing, Washington, DC
This short guide is designed for interviewers at all levels of experience and as a companion for using the
DSM-5. It is useful for beginners in learning to conduct a diagnostic interview but is not intended to replace
the DSM-5.
RECOMMENDED TEXTS/READINGS:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition.
Washington, D.C.: American Psychiatric Press.
As a UNC student, you can access a free online version of DSM 5 at the following website:
http://www.psychiatryonline.com.libproxy.lib.unc.edu/resourceTOC.aspx?resourceID=1. Each week there will
be readings drawn from the DSM 5
Andreason, N.C., & Black, D.W. (2006). Introductory textbook of psychiatry (4th ed). Washington, DC:
American Psychiatric Association.
Sadock, B.J., & Sadock, V.A. (2008). Kaplan and Sadock’s concise textbook of clinical psychiatry. Lippincott
Williams & Wilkins, Philadelphia, PA.
RESOURCE READINGS: A list of resource reading is provided under each class topic and a more comprehensive
list of resource reading is provided at the end of this syllabus. Resource readings are not required. However,
additional readings may be assigned during the course of the semester and some of these may come from the
resource readings lists. Students may earn 1 bonus point to be added to the final grade for turning in notes taken
on any resource reading. Notes are due by 2pm on the day of the class the resource reading is covered. Notes
should be turned in at the beginning of class.
TEACHING METHODS: This class will use a variety of teaching and learning styles to cover the content. These
different styles include: small group activities; lectures; role-plays; and videos. 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 which 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.
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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. Midterm Exam
3. Video Diagnostic Exam
CLASS PARTICIPATION: The contributions of all students are central to the success of this class. Class sessions
will consist of a mix of lecture, discussion, and exercises. The participation of each student is essential, and
responsibility for class discussion is shared. Class participation includes attendance, being prepared to discuss
readings and assignments, sharing opinions on the topic at hand, facilitating the participation of other students,
and engaging with the instructor.
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 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.
Attendance is crucial to the learning experience of all students. Students with any absences cannot earn an H.
Students with more than one absences cannot earn a P.
Reading assignments: Students are responsible for reading all assigned material before the class date for which
the readings are assigned, with the exception of material assigned for Week 1.
As this course is designed, participation in class activities is essential for learning course material and is
therefore required. Attendance and participation in discussion, role play, group work, and case presentation is
mandatory. To recognize the importance of attendance and participation in this course and the commitment
expected from students, attendance and active participation will be counted as 30% of the course grade. 94-100
(H) is assigned to those students who have attended all classes and have been regular and active participants in
discussion, class activities, and in presenting past or current case scenarios. 80-93 (P) is for students who have
missed one class but who regularly and actively participate or for students who have attended all classes but do
not fully participate in class discussion and activities on a regular basis. 70-80 is for students who do not
participate actively in class and have missed one class. Under 70 means that the student has: 1) missed two or
more classes; 2) that a student has demonstrated through class discussion and activities that s/he has not done
the readings to prepare for class; or 3) for a student who actively disengages from class activities.
GRADING SYSTEM: Grades are assigned pursuant to the grading system adopted by the UNC Graduate School,
as follows:
H
Clear Excellence
94-100 points
P
Entirely Satisfactory
80-93 points
L
Low Passing
70-79 points
F
Failed
<70 points
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POLICY ON INCOMPLETES AND LATE ASSIGNMENTS:
Written assignments are to be handed in to the instructor
and submitted electronically to bledsoe@email.unc.edu by 2pm on the day they are due. Late papers, including
those needing substantial revisions, will be reduced by 10% for each 24-hour period for which they are late,
without exception. 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.
Mobile PHONE POLICY:
Mobile phones can be disruption to the learning process. Most students are expected to turn off their phones
during class. Students who are on-call or have personal/family responsibilities that necessitate having access to
a mobile phone or pager are asked to adjust phones or pagers to vibrate. To be respectful of other students, if
you must answer a page or call by stepping out of class PRIOR to answering the call.
Students are expected to complete assigned and independent readings,
contribute to the development of a positive learning environment, and demonstrate learning through written
assignments and class participation. Original written work is expected and required. The University of North
Carolina has a rich and longstanding tradition of honor. Carefully read the Student Code of Honor. All
submitted work must conform to the Honor Code of the University of North Carolina as follows: I have neither
given nor received any unauthorized assistance on this assignment.
POLICY ON ACADEMIC DISHONESTY:
POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: To obtain disability-related academic
accommodations, students with disabilities must contact the instructor and the Department of Disability
Services as soon as possible. Students may reach the Department of Disability Services at 919-962-8300
(Voice/TDD) or http://disabilityservices.unc.edu. Pursuant to UNC policy, instructors are not permitted to give
accommodations without the permission and direction of the Department of Disability Services. Students must
obtain such permission in advance of the due date for the first assignment.
POLICY ON INCOMPLETES AND LATE ASSIGNMENTS: Written assignments are to be handed in to the instructor
and submitted electronically to bledsoe@email.unc.edu by 2pm on the day they are due. Late papers, including
those needing substantial revisions, will be reduced by 10% for each 24-hour period for which they are late,
without exception.
ASSIGNMENTS
Assignments
Mid-Term Examination: Multiple Choice Exam to be given in Class 4
Final Examination: Video Exam Completing a Psychiatric Assessment to
be given in Class 7
Class Attendance and Participation
4
Due Date
February
March 10
%
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35
Ongoing
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Spring 2014
COURSE CALENDAR
Class 1, January 13: Syllabus Review, Introductions, Introduction to DSM 5 and Differential Diagnosis;
DSM-5 Classification ; Diagnostic Criteria and Codes;
January 20:
University Holiday, No Class
Class 2, January 27: Bipolar and Related Disorders ; Depressive Disorders
Class 3, February 3: Anxiety Disorders; Obsessive-Compulsive and Related Disorders; Trauma- and
Stressor-Related Disorders
Class 4, February 10: Substance-Related and Addictive Disorders ; Mid-Term Exam
Class 5, February 17: Schizophrenia Spectrum and Other Psychotic Disorders; Neurocognitive Disorders
(Dementia)
Class 6, February 24: Personality Disorders (Borderline/Antisocial); Feeding and Eating Disorders
(Anorexia/Bulimia/Binge Eating Disorder)
Class 7, March 3:
Disruptive, Impulse-Control, and Conduct Disorders (ODD/Conduct Disorder) /Video
Exam/Completing a Psychiatric Assessment
DETAILED CLASS SCHEDULE
WEEK 1 – JANUARY 13
Topic:
Syllabus Review, Introductions, Introduction to DSM 5 and Differential Diagnosis; DSM-5
Classification ; Diagnostic Criteria and Codes; Neurodevelopmental Disorders (ADHD; Autism
Spectrum)
Readings:
Nussbaum Section I, Chapters 1-5 (pp.1-54); Section II, Chapter 6 (pp.180-189); Section III Chapters 7-9
(pp.193-206), Chapter 11 (pp.209-214), Chapter 13 (pp.243-245)
McQuaide, S. (1999). A social worker’s use of the diagnostic and statistical manual. Families in Society, 80(4),
410-416.
Poland, J. & Caplan, P. (2004). The deep structure of bias in psychiatric diagnosis. In P. Caplan & L. Cosgrove
(Eds.), Bias in psychiatric diagnosis (pp. 9-23). NY: Jason Aronson.
Optional Readings:
Andreason & Black – chps. 1 and 2
JANUARY 20 – UNIVERSITY HOLIDAY – NO CLASS
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WEEK 2 – JANUARY 27
Topic:
Bipolar and Related Disorders; Depressive Disorders
Readings:
Swartzberg Case 4: Bipolar Disorder (p.46); Case 3: Dysthymic Disorder (p.31)
Nussbaum Section II, Chapter 6 (pp.57-59 stop at Neurodev. Disorders; 72-81)
Sachs, G.S. (2001). A 25-year-old woman with bipolar disorder. Journal of the American Medical Association,
285, 454-462.
Frye, M.A. (2011). Bipolar disorder—A focus on depression. New England Journal of Medicine, 364, 51-59.
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.
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.
Optional Readings:
DSM 5: Mood Disorders, pp. 429-484.
Sadock & Sadock: Chapter 12: Mood Disorders, pp. 200-235.
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.
Kroenke, K. (2002). A 75-year-old man with depression. Journal of the American Medical Association, 287,
1568-1576.
Andreason & Black – chp. 8
Kennedy, N. Boydell, J. Van Os, J. & Murray, R.M. (2004). Ethnic differences in the presentation of bipolar
disorder: Results from an epidemiological study. Journal of Affective Disorders, 83, 161-168.
Tsai, J. & Chentsova-Sutton, J. (2002). Understanding depression across cultures. In I. Gotlib & C. Hammen
(Eds.), Handbook of depression (pp. 467-491). NY: The Guilford Press.
WEEK 3 – FEBRUARY 3
Topic:
Anxiety Disorders; Obsessive-Compulsive and Related Disorders; Trauma- and Stressor-Related
Disorders
Readings:
Swartzberg Case 2: Panic Disorder with Agoraphobia (p.16); Case 1: Posttraumatic Stress Disorder (p.1)
Nussbaum Section II, Chapter 6 (pp.82-94)
Katon, W.J. (2006). Panic disorder. New England Journal of Medicine, 354, 2360-2367.
Jenike, M.A. (2004). Obsessive-compulsive disorder. New England Journal of Medicine, 350, 259-265.
Schneier, F.R. (2006). Social anxiety disorder. New England Journal of Medicine, 355, 1029-1036.
Fricchione, G. (2004). Generalized anxiety disorder. New England Journal of Medicine, 351, 675-682.
Optional Readings:
DSM 5: Anxiety Disorders, pp. 485-512.
Sadock & Sadock: Chapter 13: Anxiety Disorders, pp. 236-272.
Andreason & Black – chp. 7
Barlow, D. (2002). The experience of anxiety: Shadow of intelligence or specter of death? In Anxiety and its
disorders: The nature and treatment of anxiety and panic (1-36). NY: The Guilford Press.
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Stamm, B.H. & Friedman, M.J. (2000). Cultural diversity in the appraisal and expression of trauma. In A.Y.
Shalev, R. Yehuda, & A.C. McFarlane (Eds.), International handbook of human response to trauma (pp.
69-85). Dordrecht, Netherlands: Kluwer Academic Publishers.
WEEK 4 – FEBRUARY 10
Topic:
Substance-Related and Addictive Disorders ; Mid-Term Exam
Readings:
Swartzberg Case 10: Heroin (Opioid) Dependence (p.137)
Nussbaum Section II, Chapter 6 (pp.129-158)
Schuckit, M.A. (2009). Alcohol-use disorders. The Lancet, 373, 492-501.
Hodgins, D.C., Stea, J.N., & Grant, J.E. (2011). Gambling disorders. The Lancet, 378, 1874-1884.
Optional Readings:
DSM 5: Substance-Related Disorders, pp. 191-296.
Sadock & Sadock: Chapter 9: Substance-Related Disorders, pp. 85-155.
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.
Knight, J.R. (2004). A 35-year-old physician with opioid dependence. Journal of the American Medical
Association, 292, 1351-1357.
Hatsukami, D.K., et al. (2008). Tobacco addiction. The Lancet, 371, 2027-2038.
Due:
Mid-Term Examination: Multiple Choice Exam
WEEK 5 – FEBRUARY 17
Topic:
Schizophrenia Spectrum and Other Psychotic Disorders; Neurocognitive Disorders (Dementia)
Readings:
Swartzberg Case 13: Schizophrenia, Paranoid Type (p.181); Case 14: Dementia of the Alzheimer’s Type
(p.197)
Nussbaum Section II, Chapter 6 (pp.67-71; 159-164)
Goff, D.C. (2002). A 23-year-old man with schizophrenia. Journal of the American Medical Association, 287,
3249-3257.
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.
Mitchell, S.L. (2007). A 93-year-old man with advanced dementia and eating problems. Journal of the
American Medical Association, 298, 2527-2536.
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.
Optional Readings:
DSM 5: Schizophrenia and Other Psychotic Disorders, pp. 297-344.
Sadock & Sadock: Chapters 10 & 11: Schizophrenia, pp. 156-177, and Other Psychotic Disorders, pp. 178-199.
Schwartz, M. (1997). Family secret. The New Yorker, 90-107. 8
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.
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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, 185-186.
Jordan, H.W., et al. (2006). Erotomania revisited: Thirty-four years later. Journal of the National Medical
Association, 98, 787-793.
Andreason & Black – chp. 5
Poland, J. (2004). Bias and schizophrenia. In P. Caplan & L. Cosgrove (Eds.), Bias in psychiatric diagnosis (pp.
149-161). NY: Jason Aronson.
van Meijel, B., van der Gaag, M., Sylvain, R., & Grypdonch, M. (2004). Recognition of early warning signs in
patients with schizophrenia: A review of the literature. International Journal of Mental Health Nursing, 13,
107-116.
DSM 5: Delirium, Dementia, and Amnestic and Other Cognitive Disorders, pp. 135-180.
Sadock & Sadock: Chapter 7: Delirium, Dementia, Amnestic and Other Cognitive Disorders and Mental
Disorders Due to a General Medical Conditions, pp. 46-79.
Mosqueda, L., & Dong, X. (2011). Elder abuse and self-neglect: “I don’t care anything about going to the
doctor, to be honest….”
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.
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.
WEEK 6 – FEBRUARY 24
Topic:
Personality Disorders (Borderline/Antisocial); Feeding and Eating Disorders
(Anorexia/Bulimia/Binge Eating Disorder)
Readings:
Swartzberg Case 8: Narcissistic Personality Disorder (p.106); Case 9: Borderline Personality Disorder (p.121);
Case 7: Bulimia Nervosa (p.90)
Nussbaum Section II, Chapter 6 (pp.101-104; 165-175); Section III, Chapter 12 (pp.215-242)
Oldham, J.M. (2002). A 44-year-old woman with borderline personality disorder. Journal of the American
Medical Association, 287, 1029-1037.
Mehler, P.S. (2003). Bulimia nervosa. New England Journal of Medicine, 349, 875-881.
Yager, J., & Anderson, A.E. (2005). Anorexia nervosa. New England Journal of Medicine, 353, 1481-1488.
Optional Readings:
DSM 5: Personality Disorders, pp. 685-730.
Sadock & Sadock: Chapter 23: Personality Disorders, pp. 375-392.
Stewart, J.B. (1997). Professional courtesy. The New Yorker, 90-105.
Andreason & Black – chp. 10
Calliess, I.T., Sieberer, M., Machleidt, & Ziegenbein, M. (2008). Personality disorders in a cross-cultural
perspective: Impact of culture and migration on diagnosis and etiological aspects. Current Psychiatry
Reviews, 4(1), 39-47.
Paris, J. (2003). Personality disorders over time: Precursors, course and outcome. Journal of Personality
Disorders, 17(6), 479-488.
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WEEK 7 – MARCH 3
Topic:
Neurodevelopmental Disorders (ADHD; Autism Spectrum); Disruptive, Impulse-Control, and
Conduct Disorders (ODD/Conduct Disorder) /Video Exam/Completing a Psychiatric Assessment
Readings:
Swartzberg Case 15: Attention-Deficit Hyperactivity Disorder (p.227)
Nussbaum Section II, Chapter 6 (pp.59-67; pp.124-128)
Rapin, I. (2001). An 8-year-old boy with Autism. Journal of the American Medical Association, 285, 17491757. 11
FINAL EXAM DUE NO LATER THAN MARCH 10, ONE WEEK FOLLOWING OUR FINAL CLASS
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