Understanding Abnormal Behavior - Cengage Learning

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248 Chapter 14: Cognitive Disorders progression. Finally, encourage the rest of the class to try some of these activities on their own and report their experiences to the class. Remember to leave time at the end to clean up the glasses of volunteers. That’s what the water, dishwashing liquid, and tissues are for. 5. The fact that many cognitive disorders have similar symptoms and that these overlap with symptoms of noncognitive disorders presents problems for the diagnostician. Show students the thought processes that diagnosticians use to rule in or rule out various cognitive and affective disorders. Present this very sketchy portrait of a person who may have a cognitive disorder: Mrs. W. is 68 years old and lives alone. She moves very slowly and does not respond verbally to what others say. She sometimes mumbles to herself. Her face is expressionless. She seems confused by her surroundings. She is accompanied by her daughter, who is highly observant and an accurate reporter of Mrs. W.’s past medical and psychosocial history. First, provide students with the handout so they can think through the potential cognitive and affective disorders that might be appropriate for Mrs. W. Assure them that no one, not even you, knows what disorder Mrs. W. really has. The object is to brainstorm for legitimate, likely cognitive and noncognitive disorders. These include Parkinson’s disease, Alzheimer’s disease, multi-infarct dementia, stroke, depression, and possibly negative symptom schizophrenia. Ask students to report the disorders they wrote down and put a list on the board. Next, ask students what information they need to make a firm, differentiating diagnosis. Their first decision should be whether the disorder is cognitive or noncognitive. Have them write down the information they would want. If they need assistance, suggest that interviews, psychological testing, and neurological assessments might help. Observations and a medical and social history supplied by Mrs. W.’s daughter should be considered highly accurate information. When they have worked on the cognitive-noncognitive issue, ask them to refine their diagnoses to differentiate among the cognitive disorders. You can help by reminding them that some cognitive disorders involve dementia and that others involve delirium. Some are chronic, whereas others are acute. Have them think about the potential causes of the cognitive impairment, too. When they have finished this portion of the activity, ask for the information they listed for each of the disorders you have listed on the board. Correct any mistaken impressions and add your own thoughts on how to perform a differential diagnosis. Remember to mention that this task is extremely complex and difficult and that misdiagnosis is all too common. As an example, ask how they would differentiate Alzheimer’s disease from vascular dementia.. Alert them to the fact that many professionals are stumped by this question. Finally, discuss the value of making a specific diagnosis. In some cases (such as Alzheimer’s disease versus multi-infarct dementia), there is little difference in treatment of the condition. In others (such as Alzheimer’s versus depression), differential diagnosis makes a huge difference in appropriate treatment. Internet Site: http://www.merck.com/pubs/mmanual. This site defines and discusses dementia, delirium, and depression in elderly populations. 6. Screening for dementia can involve asking patients and their relatives for information on their recent cognitive, emotional, and behavioral functioning. A more standardized procedure is to ask questions from a mental status examination. A brief mental status exam developed by Glasko et al. (1990) is provided in the Handout for Demonstration 6. It will give students an idea of how to define orientation and the kind of short-term memory that is impaired by dementia. Caution students not to see this as a definitive diagnostic instrument. Further, since no cutoff scores or norms are provided, there is no way to evaluate responses. However, this screening device is available on the Internet at http://teri.bio.uci.edu/forms/short.html. Responses are scored and Copyright © Houghton Mifflin Company. All rights reserved.
Copyright © Houghton Mifflin Company. All rights reserved. Chapter 14: Cognitive Disorders 249 given in the form of probability that the patient is “normal.” These results are not explained: “normal” goes undefined, there are no age-graded norms used, and the normative sample is not described. You can use this opportunity to discuss (again) the need for critical thinking when people are consumers of mental health materials. Source: Glasko, D., Klauber, M. R., Hofstetter, C. R., Salmon, D. P., Lasker, B., & Thal, L. J. (1990). The mini-mental state examination in the early diagnosis of Alzheimer’s disease. Archives of Neurology, 47, 49–52. Copyright © 1990, American Medical Association. Reprinted by permission. Internet Site: http://www.merck./com/pubs/mm_geriatrics/figures/38fl.htm. A screen for dementia. 7. The Alzheimer’s Association developed a list of warning signs for the disease. Because normal forgetfulness and early dementia are not easily distinguished, mistaken worry about Alzheimer’s is commonplace. Also common is ignoring the early signs of the disease. A handout is provided with the association’s warning signs for Alzheimer’s disease. Caution students that this information does not qualify them to engage in amateur diagnostics. Nevertheless, it can help them determine whether an impairment is of potential concern or not. Source: The Alzheimer’s Association, Inc., Chicago, Illinois. Reprinted by permission. Internet Site: http://www5.biostat.wustl.edu/alzheimer/. The site is an educational service created and sponsored by the Washington University Alzheimer's Disease Research Center. 8. Have the students form small groups of 4-7 individuals depending on your class size and space limitations. The task of the group is to develop suggested policies or laws related to doctorassisted suicide. There should be at least one policy in favor of doctor-assisted suicide and one policy against doctor-assisted suicide. The students need to discuss whether there is a difference between doctor-assisted suicide and turning off life support systems. Should spouses who help their loved one commit suicide be prosecuted? In the process of developing the policies or laws, the students have to debate many issues related to doctor-assisted suicide. 9. Invite an official from your local Council on Aging organization or Alzheimer's support group to talk to the class about the many problems that face the elderly in the areas of health and mental health. The speaker should also discuss the kinds of services available in your area for individuals with Alzheimer's and their families, as well as other services for the elderly. Internet Site: http://www.sfcrc.com/html/alzheimers.htm. The San Francisco Alzheimer's and Dementia Clinic. 10. The treatment of mental retardation usually involves some combination of psychoactive medication (phenothiazines and antidepressants, for the most part) and behavior therapy. <strong>Behavior</strong> therapy techniques have become widely used (and misused) in public institutions, group homes, sheltered workshops, and home environments. When used consistently and ethically, contingent positive reinforcement and modeling can help people with mental retardation control their emotions, learn self-care and daily living skills, and acquire job-related skills. Time out from reinforcement is the most common method of reducing inappropriate behavior, but it can be used inappropriately. Explain that behavioral principles are neutral—in the hands of staff members who want to work less or who have disdain for people with retardation, they can be abused. Capricious use of point systems, excessive time outs, and even the use of physical punishment are considered behavior therapy by those who do not truly value their patients. Unfortunately, behavior therapy, undoubtedly the most effective means of helping people with retardation when correctly employed, has acquired a bad reputation in some circles because it is so easily misused.
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Instructor’s Resource Manual Unde
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Contents PREFACE...................
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vi Preface Video Resources An annot
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The Case of Steven V. A NOTE ABOUT
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x The Case of Steven V. THE CASE OF
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xii The Case of Steven V. During th
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xiv The Case of Steven V. the mothe
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xvi The Case of Steven V. depressio
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xviii The Case of Steven V. Steve
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xx The Case of Steven V. As I look
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xxii The Case of Steven V. angry at
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xxiv The Case of Steven V. Steve: Y
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xxvi The Case of Steven V. This sys
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CHAPTER 1 Abnormal Behavior CHAPTER
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VII. Some closing thoughts Copyrigh
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Copyright © Houghton Mifflin Compa
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CHAPTER 2 Models of Abnormal Behavi
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CHAPTER 3 Assessment and Classifica
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HANDOUT FOR DEMONSTRATION 5: SEXUAL
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8. Do you feel inadequate, like a f
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