Preface xxxi
individual in a case that was presented in a From the Inside or From the Outside
section. Students are asked to reread the case carefully and determine which DSM-
IV-TR criteria are met and are not met and whether there is enough information to
warrant a diagnosis. If the students would like more information in order to make
a diagnosis (or to decide whether a diagnosis is not appropriate), we ask them to
describe what information—specifi cally—they want and to explain how it would
inform their diagnosis. The Making a Diagnosis feature can be used as homework
or as a springboard for small-group or class discussions.Making a Diagnosis
- Reread Case 12.1 about Emilio, and then determine whether or
not his symptoms met the minimum criteria for a diagnosis of
schizophrenia. Specifi cally, list which criteria apply and which
ones do not. If you would like more information to determine
his diagnosis, what information—specifi cally—would you want,
and in what ways would the information influence your deci-
sion? If you decide that a diagnosis of schizophrenia is appro-
priate for Emilio, do you think he has the defi cit or nondefi cit
subtype, and why?
End-Of-Chapter Review: Summing Up
The end-of-chapter review, called Summing Up, has three elements, each of which is
designed to help students further consolidate the material in memory and to foster
their critical thinking about the material (which itself furthers learning):
- Section summaries. These summaries repeat the important information in the end-
of-section summaries, allowing students to review what they have learned in the
broader context of the entire chapter’s material.SUMMING UP
Summary of Depressive
Disorders
A major depressive episode (MDE) is the build-
ing block for a diagnosis of major depressive
disorder (MDD); when a person has an MDE,
he or she is diagnosed with MDD. Symptoms
of an MDE can arise in three areas: affect,
behavior, and cognition.
Depression is becoming increasingly prev-
alent in younger cohorts. Depression and anxi-
ety disorders have a high comorbidity—around
50%. MDD may arise with melancholic fea-
tures, catatonic features, or psychotic features.
Symptoms may also fall into less common pat-
terns, as in atypical depression and chronic
depression.
A diagnosis of dysthymic disorder re-
quires fewer symptoms than does a diagnosis
of MDD; however, the symptoms of dys thymic
disorder must persist for a longer time than do
symptoms of MDD. People who have both
dysthymic disorder and MDD are said to have
double depression.
Neurological factors related to depression
include low activity in the frontal lobes, and
abnormal functioning of dopamine, serotonin,
and norepinephrine. The stress–diathesis
model of depression highlights the role of in-
creased activity of the HPA axis and of excessThinking like a clinician
Suppose that a friend began to sleep through
morning classes, seemed uninterested in go-
ing out and doing things together, and became
quiet and withdrawn. What could you con-
clude or not conclude based on these observa-
tions? If you were concerned that these were
symptoms of depression, what other symp-
toms would you look for? What if your friend’s
symptoms did not appear to meet the criteria
for an MDE—what could you conclude or not
conclude? If your friend was, in fact, suffering
from depression, how might the three types of
factors explain the depressive episode? What
treatments might be appropriate?
Summary of Bipolar
Disorders
The four building blocks for diagnosing bipolar
disorders are major depressive episode (MDE),
manic episode, mixed episode, and hypomanic
episode. Symptoms of a manic episode include
grandiosity, pressured speech, fl ight of ideas,
distractibility, poor judgment, decreased need
for sleep, and psychomotor agitation. A mixed
episode is characterized by symptoms of both
an MDE and a manic episode and may include
psychotic features and suicidal thinking. A
hypomanic episode involves mood that is per-Social factors that are associated with
bipolar disorders include disruptive life
changes and social and environmental stres-
sors. The different factors create feedback
loops that can lead to a bipolar disorder or
make the patient more likely to relapse.
Mood stabilizers are one treatment that
targets neurological factors; when manic,
patients may receive an antipsychotic medica-
tion or a benzodiazepine.
Treatment that targets psychological
factors—particularly CBT—helps patients
recognize warning signs of mood episodes,
develop better sleeping strategies, and, when
appropriate, stay on medication.
Treatments that target social factors
include interpersonal and social rhythm ther-
apy (IPSRT), which can increase the regularity
of daily events and decrease social stressors;
family therapy and education; and group ther-
apy or a self-help group, which is intended to
decrease shame and isolation.
Thinking like a clinician
You get in touch with a friend from high school
who tells you that she recently had a hypo-
manic episode. What are two possible DSM-
IV-TR diagnoses that she might have had (be
specifi c)? What will determine which diagno-
sis is most appropriate? What are a few of the
t tht hll k f h i