Wake Forest University Department of Counseling CNS 770: Classification of Mental Health Disorders Fall 2011 1:45 – 4:15pm (w/exceptions) Mondays Location: DeTamble Instructor: Office Hours:
Monday: 11:00am-1:45pm or by appointment
Course Overview and Methods of Instruction:
This course will provide students with an overview brain structure and function, normal personality and personality disorders, the DSM-IV-TR classification and description of mental health disorders, the ICD-10 classification of mental health disorders, psychotropic medications, and common medical illnesses that can mimic mental health disorders or have prominent mental health symptoms. It will combine reading of the required texts, elective books, journal articles and other selected publications, lectures, discussion, small group activities, student presentations, and use of various audiovisual media to help students learn and assimilate the key principles in the described areas of instruction necessary to successfully complete the Masters in Counseling program and practice as professional mental health or school counselor. Course Content and CACREP Standards: This content of the course is designed to meet the Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards detailed in Section III, Professional Practice: “Professional practice, which includes practicum and internship, provides for the application of theory and the development of counseling skills under supervision. These experiences will provide opportunities for students to counsel clients who represent the ethnic and demographic diversity of their community.” Under the subheading “Diagnosis”, the following standards are described: Knowledge
• Knows the principles of the diagnostic process, including differential diagnosis,
and the use of current diagnostic tools, such as the current edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM).
• Understands the established diagnostic criteria for mental and emotional
disorders, and describes treatment modalities and placement criteria within the
• Knows the impact of co-occurring substance use disorders on medical and
• Understands the relevance and potential biases of commonly used diagnostic tools with multicultural
• Demonstrates appropriate use of diagnostic tools, including the current edition of
the DSM, to describe the symptoms and clinical presentation of clients with
• Is able to conceptualize an accurate multi-axial diagnosis of disorders presented
by a client and discuss the differential diagnosis with collaborating professionals.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders
(4th ed., Text Revision). Washington, DC: Author. Referred to as “DSM” for reading assignments.
Morrison, J. (2007). Diagnosis Made Easier (1st ed.). New York: Guilford Press. Referred to as “DME” for
Supplemental (Optional) Texts, Books, and Internet Resources:
Badenoch, B. (2008). Being a Brain-Wise Therapist (1st ed.). New York: Norton. PDR (2007). Drug Guide for Mental Health Professionals (3rd ed.). Montvale, NJ: Thompson. Note – this is also an excellent resource for the class on Addictions Counseling. National Institutes of Health (NIH) internet resources
• National Institute of Mental Health (NIMH):
• National Institute of Neurologic Diseases and Stroke (NINDS):
• National Institute on Alcohol Abuse and Alcoholism (NIAAA):
• National Institute on Drug Abuse (NIDA):
• National Mental Health Information Center
• Wikipedia(Be careful and beware … content is not peer-reviewed)
Databases (all can be accessed through the ZSR webpage)
• Kreisman, J.J. & Strauss, H. (1989). I Hate You, Don’t Leave Me (1st ed.). New York:Avon.
• Mason, P.T. & Kreger, R. (2010). Stop Walking on Eggshells - Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. Oakland, CA:New Harbinger.
Student performance evaluation criteria:
• Class Participation and Attendance (10% of grade): Class participation is required. One absence
will be excused without penalty, two absences will result in a 2 point deduction in the class participation/attendance component of your final grade, three absences will result in a 3 point deduction, and four or more absences will result in a 4+ point deduction and may result in failure to receive credit for the course. Excessive tardiness and/or unprofessional behavior (e.g., use of unrelated technology such as cell phones and other handheld devices, your laptop computer for internet access, etc. during class) also will negatively impact your grade. In order to participate effectively, you must complete the assigned readings prior to class. Written assignments due on a given day should be turned in as paper copies (i.e., not electronic copies) on the day they are due, preferably prior to the beginning of class. Papers submitted electronically will result in a half grade deduction (i.e., A to A-) and those submitted late will result in a half grade deduction for each tardy
day. In general, you will find it helpful to have the required textbooks in class. Unless instructed otherwise, you will not need your computer for class.
• The Soloist Movie Review (10% of grade) – due Sept. 12 (Week 2): the purpose of this assignment is
to introduce you to diagnosis of mental health disorders and think about it from multiple perspectives. Work in small groups of 3-4 and watch the movie “The Soloist” (several copies available to borrow, you can check out from library, or rent/buy a copy from Blockbuster). Answer the following questions in a 5 to maximum 10 page group paper, 1-2 written pages per question (Arial or Times New Roman font, size 11 or 12, double spaced, standard MS Word document margins). CMHC: A.3.8; C.188.8.131.52.7; D.1.2; E.3.5.6; G.1.3; H.1; I.3; J.1; K.1.2; L.1.2.3
o Does Nathaniel Ayers meet the criteria for 295.xx schizophrenia and a schizophrenia subtype?
As best as you can, provide the multi-axis (i.e., Axis I-V) diagnosis for him. See DSM-IV-TR textbook.
o Describe the relationship between Nathaniel and the reporter Steve Lopez. What is healthy or
helpful in the relationship; what is unhealthy or unhelpful?
o Steve has a different notion of how Nathaniel should be helped than David Ellis, the director of
the homeless shelter. How are their views of helping Nathaniel different? How are they similar? Who is more correct in how they view Nathaniel’s potential for recovery? What does the movie make you think about regarding “the diagnosis controversy” in counseling?
o If Steve got his wish and successfully got Nathaniel to see you, what would your therapeutic
approach be (include meds, counseling, and anything else that might help)?
• Powerpoint Presentation for Personality Disorders (15% of grade) – due Sept. 26 (Week 4): the
purpose of this assignment is to familiarize you with normal personality and the spectrum of personality disorders as well as to teach you to present topical information clearly and concisely in a relatively short defined period of time. The total presentation length must be precisely 30 minutes in length, including up to 5-10 minutes for questions at the end of the presentation (you must manage the Q&A portion of the presentation so you don’t go over the allotted time). There will be 3 personality disorder presentations; group size should be adjusted accordingly (i.e., 6/group, 2/disorder). CMHC: C.184.108.40.206.9; D.3; E.3.4; G.1.2.3; I.1.3; J.1; K.1.2.3; L1 Topics for the groups include:
o Cluster A (Mature) Personality Disorders – paranoid, schizoid, schizotypal o Cluster B (Immature) Personality Disorders – antisocial, histrionic, narcissistic (borderline
personality disorder is also in this cluster, but I will cover it in class)
o Cluster C (Anxious) Personality Disorders – avoidant, dependent, obsessive-compulsive
o In general, figure one slide per minute o At least one slide should provide background information (e.g., incidence, risk factors, etc.) o At least one slide should describe the DSM-IV-TR criteria for the personality disorder o Several slides should summarize information on the personality disorders from the Lester
handout, including the associated drama triangle(s)
o At least one slide should describe brain and neurochemical abnormalities for the personality
o At least one slide should describe medications used to treat the disorder o Several slides should describe counseling approaches for the disorder o One slide should discuss how the DSM-V is handling the disorders o One to two slides should list key references o Please provide a hard copy of your presentation to classmates (and professor)
• Prozac Nation Movie Review (10% of grade) – due Oct. 10 (Week 8): the purpose of this assignment
is to expose you to coexisting Axis I and Axis II disorders, drama triangles, and the impact of substance use on mental health disorders. Work in small groups of 3-4 and watch the movie “Prozac Nation”
(several copies available to borrow, you can
check out from library, or rent/buy a copy). Answer the
following questions in a 5 to maximum 10 page group paper, 1-2 written pages per question (Arial or Times New Roman font, size 11 or 12, double spaced, standard MS Word document margins). CMHC: A.3.6; C.220.127.116.11; D.8; E.3; G.18.104.22.168; H.4; J.1; K.1.2.3; L.1.2.3
o What is (are) your Axis I diagnosis (-es) for Elizabeth Wurtzel, if any? Support your answer
using DSM-IV-TR diagnostic criteria.
o What is (are) your Axis II diagnosis (-es) for Elizabeth, if any? Support your answer using
o Describe a scene in the movie which demonstrated a “Drama Triangle”. What were the triggers
that initiated or escalated the drama? How did the drama end?
o Describe and critique the therapeutic relationship between Elizabeth and Dr. Sterling. If you
were Elizabeth’s counselor, how would your approach to Elizabeth have been similar to Dr. Sterling’s, and how would have it been different?
• Personality Profile Paper (20% of grade) – due Oct. 24 (Week 8): the purpose of this assignment is
to better understand your own personality. This assignment will be due after we have covered the personality disorders in class via lecture and class presentations as well as personality assessments you have done on yourself using the Myers-Briggs (from 1st year), Enneagram (from 1st year), and NEO-PI (either for this class or as done for Assessment class with Dr. Newsome). CMHC: D.9 After completing and scoring the NEO-PI in class and reviewing the diagnostic criteria of the 10 personality disorders, write a 9-14 page paper (Arial or Times New Roman font, size 11 or 12, double spaced, standard MS Word document margins) with the following components:
o Describe your Myers-Briggs personality type. Does it fit you well? Why does/doesn’t it? (1
o Describe your Enneagram personality type. Does it fit you well? Why does/doesn’t it? (1-2
o Describe the five domains of your personality from the NEO-PI. Do you think these
characterize your personality accurately? Which positive and negative adjectives within each personality domain best represent your personality? (2-3 pages)
o Describe personality traits/types of yours that are similar to the described diagnostic criteria for
the personality disorders. You only need to describe the traits/types that apply to you, not the ones that don’t. Be specific, provide examples. (2-3 pages)
o Provide a summary of your personality based on what you’ve written in the paper thus far (1
page). How have your personality traits impacted your relationships with family, friends, and co-workers, positively and negatively? Be specific, provide examples. How might they impact the professional counseling relationship you will have with clients, positively, negatively? (1-2 pages)
o How would you conceptually describe personality … is it dichotomous (normal or abnormal) or
does it exist on a continuum (range from normal to abnormal)? Describe what you perceived as the benefits and challenges of writing this paper? (1-2 pages)
• Powerpoint Presentation for Anxiety Disorders (due Oct. 31 - Week 9) and Common Disorders Presenting in Childhood and Adolescence (due Nov. 7 - Week 10) (15% of grade): the purpose of this assignment is to familiarize you with the spectrum of anxiety disorders and to teach you to present topical information clearly and concisely in a relatively short defined period of time. The total presentation length must be precisely 20 minutes in length, including 5 minutes for questions at the end of the presentation (you must manage the Q&A portion of the presentation so you don’t go over the allotted time). There will be 5 anxiety disorder and 4 childhood/adolescent presentations on the following topics; students should work in pairs. CMHC: C.22.214.171.124.8.9; D.3; E.3.4; G.1.2.3; I.1.3; J.1; K.1.2.3; L1
Topics for the groups include: Anxiety Disorders
o Panic Disorder o Agoraphobia o Generalized Anxiety Disorder o Post-Traumatic Stress Disorder o Obsessive-Compulsive Disorder
o Attention-Deficit/Hyperactivity Disorder o Conduct Disorder and Oppositional Defiant Disorder o Autistic Disorder and Asperger’s Disorder o Anorexia Nervosa and Bulimia Nervosa
o In general, figure 1 slide per minute. o At least one slide should provide background information (e.g., incidence, risk factors, etc.) o At least one slide should describe the DSM-IV-TR criteria for each anxiety disorder o At least one slide should describe brain and neurochemical abnormalities for the disorder (if
o At least one slide should describe medications used to treat the disorder o Several slides should describe counseling approaches for the disorder o Include a demonstration of one counseling approach (or an aspect of one counseling approach).
This may be accomplished through role play, class engagement, or a movie or YouTube clip (i.e., be creative!).
o At least one slide should describe areas of current research o One slide should contain references, including the relevant pages from the DSM-IV-TR, one or
several books on the topic, one or more review articles from the medical (PubMed) and psychosocial (PsycINFO, ERIC) literature, and one or more online resources.
• Midterm Exam (10% of grade) (Oct. 17) and Final Exam (Dec. 5) (10% of grade): Each
closed-book exam will contain 30-50 multiple choice questions in NCE format and a written case study (midterm exam) or actual case study (final exam). The content will be as follows:
o Midterm exam: brain structure/function, psychotropic medications, medical illnesses, and multi-axis
o Final exam: DSM-IV-TR diagnoses and diagnostic criteria for the mental health and personality
disorders covered in class, movie reviews, and powerpoint presentations.
CMHC: A.2.6; C.126.96.36.199.7.8.9; D.2; E.3; G.1.2.3; H.1; I.1; K.188.8.131.52.5; L.1.2.3
Grading Scale: A Schedule of Classes and Assignments: What will be covered in class Assignments Due (Presentations Due) Reading Assignments
Assignment Discussion – The Soloist Movie Review 731-743
The Soloist Movie
Normal Personality and Personality Assessment
Assignment Discussion – Personality Disorders
Overview of the Personality Disorders/The Drama
Optional - books on BPD (see pg. 2 of syllabus)
Personality Disorders Presentations
Assignment Discussion – Personality Profile Paper
Mood Disorders I (Depression) and Adjustment
Written case study/discussion (in class)
Assignment Discussion – Prozac Nation Movie Review
Prozac Nation Movie
Mood Disorders II (Mania, Bipolar I and Bipolar II
• 1st Hour – Multiple Choice (Closed book)
• 2nd Hour – Written Case Study (can use
Personality Profile Paper due
Assignment Discussion – Anxiety Disorder
Dissociation and the Dissociative Disorders
Anxiety Disorder Presentations Childhood/Adolescent Disorders Presentations
Schizophrenia and Other Psychotic Disorders
Disorders of Thinking/Memory I – Delirium and
Medical Illnesses/Mental Health Disorders/Sympt.
Disorders of Thinking/Memory II – Dementia
Assessing a Patient With Symptoms of Dementia
1st Year Students’ Poster Displays/Discussion
• 1st Hour – Multiple Choice (Closed book)
• 2nd Hour – Actual Case Study (can use
COUNCIL REGULATION (EEC) NO. 1768/92 IN THE MATTER OF Application Nos. SPC/GB/96/030, SPC/GB/96/031, SPC/GB/96/032, SPC/GB/96/033, SPC/GB/96/034 and SPC/GB/96/035 in the name of Takeda Chemical Industries Limited DECISION The issues Takeda Chemical Industries Limited (“the applicant”) filed six requests for the grant of aSupplementary Protection Certificate (“certificate”) on