Introduction to Psychopathology

Course Description

Introduction to Psychopathology (PSYC 411) is a 3-credit course presented over 16 weeks as part of the discipline-based Preclinical Science curriculum of St George's University School of Medicine, Grenada. It is designed to provide a fundamental basis for understanding psychopathology. It is one of the final prerequisite courses for the thirdyear Preclinical Sciences students, and a central component of the Charter Foundation Program. 

The course reviews the major psychiatric disorders defined in the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The salient diagnostic features of these disorders are highlighted. Major theories of the etiology of mental illness are reviewed, and neurobiological correlates of abnormal behavior are emphasized. Both psychotherapeutic and biological treatment options for mental illness are covered. Clinical cases and clinical videos illustrating psychopathology are utilized to enhance learning.

The course is divided into four 4-week blocks.  

Goals and Objectives

The Introduction to Psychopathology course embraces the mission of the Doctor of Medicine Program of St George's University School of Medicine and the 4-year outcome objectives pertaining to knowledge, clinical skills, and professional attitudes. These are listed in Appendix A.  

The Introduction to Psychopathology course specifically addresses objectives pertaining to knowledge: 1ai, 1aiii, 1b, 1c, and 1d. Furthermore, the Introduction to Psychopathology course prepares students to meet the AAMC's Entering Medical Student Core Competency pertaining to Human Behavior: "Applies knowledge of the self, others, and social systems to solve problems related to the psychological, socio-cultural, and biological factors that influence health and well-being."

Overall Course Objective

The overall course objectives for Introduction to Psychopathology are for students to be able to:

1. Enumerate the symptoms of the major psychiatric disorders and apply the DSM-5 diagnostic criteria to clinical scenarios to differentially diagnose psychiatric diseases.
2. Describe the psychological/environmental and neurobiological contributions to psychiatric illness.
3. Specify the major biological and psychological treatment approaches for each of the major mental disorders.
4. Develop conversancy in ethical/legal issues relevant to psychiatric patients.

Lecture Objectives

The specific lecture objectives are included in Appendix B. 

Faculty, Staff, and Contact Information

Administrative Questions

For all administrative questions, contact psyc411@sgu.edu

Course Leadership Team

PSYC 411	Department	Email Address
Dr. Alvin Chitterman Co-Course Director	Physiology, Neuroscience, and Behavioral Science	achitte1@sgu.edu
Dr. Randall Waechter Co-Course Director	Physiology, Neuroscience, and Behavioral Science	rwaechte@sgu.edu

Teaching Faculty

 Supporting Staff

PSYC 411	Department	Email Address
Ms. Shennel Boca Executive Secretary	Physiology, Neuroscience, and Behavioral Science	sboca@sgu.edu

Course Material

Copyright

Copyright 2022 St. George's University. All rights reserved.

All course material, whether in print or online, is protected by copyright. Course materials, in part or in their entirety, may not be copied, distributed, or published in any form, printed, electronic or otherwise.

As an exception, students enrolled in the Course are permitted to make electronic or print copies of all downloadable files for personal and classroom use only, provided that no alterations to the documents are made and that the copyright statement is maintained in all copies.

Lecture recordings are explicitly excluded from download and creating copies of these recordings by students and other users is strictly prohibited.

Course Website

The Introduction to Psychopathology course offers a website through Sakai, St. George's University's learning management system. This site is used for COMMUNICATION (including Announcements), COURSE TOOLS (including

Syllabus, Resources, Lessons, Gradebook), access to the link for remote sessions (Zoom Online Classroom) and lecture recordings (Panopto).

To login, go to myCampus Secure Login (Carenage), type in your user ID and password, and click on MyCourses.

Electronic Resources

Distribution of course material is in electronic format. In accordance with Committee for Technology-based Teaching and Learning (CTTL) recommendation, students are provided with unlocked PDF files, which may be annotated for personal use. This format facilitates active learning, as it allows highlighting and annotations, using a variety of platforms, operating systems, and annotation software. Copyright restrictions regarding the duplication of materials apply (see copyright statement above). The Resources folder contains multiple subfolders in which students will find course material.

Recommended Textbook

Abnormal Psychology: The Science and Treatment of Psychological Disorders (2018, 14^th Edition)  by Ann M. Kring and Sheri L. Johnson.  

Required Electronic Equipment

Laptop

Students need a personal laptop as specified by SGU Examination Services. It is the responsibility of each student to ensure his/her laptop is in full working condition, as specified by Examination Services, and ensure that it is up to date and always equipped for the SGU wireless network.

Clickers

An Audience Response System (TurningPoint) is used as a formative assessment method during live sessions. Students are recommended to respond to questions using the web browser (ttpoll.com) or via the TurningPoint app for smart phones to fully participate in live sessions.

 Components of the Course

Lectures

Lectures are an essential component of the PSYC411 Course. They are designed to provide students with an outline of what they are expected to know, to prioritize important aspects of course content, to clarify complex material, and to make relevant connections to clinical contexts. Most lectures will focus more on difficult concepts than on selfexplanatory facts.

Many of the course sessions are delivered through asynchronous on-line recordings of full-length lectures. The delivery of asynchronous on-line lectures allows students greater flexibility for when and where the lectures are viewed and promotes self-directed learning. Content from all lectures, whether live Zoom sessions, live in-persons sessions or asynchronous on-line recordings, are testable material.  

The posted lecture slides may not be comprehensive and do not replace the need to read textbooks. It is an important learning exercise for students to read textbooks and glean valuable information related to course objectives. Lecture slides are not intended to be used in isolation, but rather as a complement to the lecturer's narrative.

Each lecture contains formative assessments, usually in the format of clicker questions.

These questions are not included in the lecture notes and will not be posted on Sakai.

Directed Learning Activities (DLAs)

Prerequisite knowledge or simple content may be presented online as short videos. If used, these videos will be available via the course management site and can be viewed at any time. The videos are designed to focus on key topics that are prerequisite knowledge or where it is beneficial to review core knowledge before its application in lecture. Content from DLAs is examinable.

Interactive Multiple-Choice Question (IMCQ) Sessions

Interactive Multiple-Choice Question (IMCQ) sessions aim to enhance a student's testtaking skills and increase their exposure to USMLE-style-multiple-choice single-bestanswer questions, which is the standard style for all electronic examinations at St George's University School of Medicine. These sessions strive to improve students' approach to answering MCQs and emphasize the link between questions and course objectives. As a learning tool, IMCQs provide students with valuable formative feedback enabling them to modify their approach to learning course content and to identify weaknesses that require remediation.

There are 4 non-credit IMCQs during the semester. They comprise approximately 15 questions. Each question is presented for 90 seconds. The faculty member then thoroughly debriefs the question with an emphasis on the cognitive processes, logic, and rationale used to answer the questions. Debriefing focuses on the salient points within each question that lead to the correct answer choice and on the process of eliminating distracters as viable answer choices.

Questions used during IMCQ sessions are posted with the answer key on the Course Sakai site after delivery. 

Graded ExamSoft Quizzes & Non-graded Sakai Practice Quizzes

Graded ExamSoft (E-Soft) Quizzes

There will be 4 graded E-Soft quizzes throughout the semester. These quizzes will be released and retracted at designated dates and times, typically at 9:00 am on the Monday morning preceding each examination week and closed at 9:00 pm on the Saturday. Students should refer to the official schedule of course activities. E-Soft quizzes are openbook and taken anytime and at any venue within the available window that the quiz is available to complete.

Content: Each E-Soft quiz contains 10 questions. The content of E-Soft quizzes is similar in focus and difficulty as Exam questions. E-Soft quizzes may contain cumulative questions.

E-Soft Quiz Duration:  Students have 20 minutes to answer the questions. 

Scoring of E-Soft Quiz: Students must complete the quiz and upload the results before the specified deadline to earn the 2 points associated with each quiz (2 points x 4 quizzes = 8 possible points). Accuracy is not considered. Quizzes will not be re-opened after the deadline.  

Non-graded Sakai Practice Quizzes

Practice quizzes will be provided on Sakai for each block of material. These questions will be available as a .pdf document. These do not count for credit and can be reviewed as many times as desired. They can be completed at any time or any venue.

Written (Electronic) Examinations

Written electronic examinations are in multiple-choice-single-best-answer format, following the guidelines of the National Board of Medical Examiners (NBME). The NBME offers the United States Medical Licensing Examination (USMLE), a three-step examination for medical licensure in the United States, which is sponsored by the Federation of State Medical Boards (FSMB) and NBME.

Style of Administration: Exams are administered by computer using ExamSoft with ExamMonitor (proctoring software) enabled.  Students must ensure that their laptops conform to the minimum specifications required by ExamSoft.

Question Format: The vast majority of questions are in clinical vignette format. Most questions are higher-order questions rather than first-order questions. The time allocation per question is 90 seconds.

Protocol:  Detailed information about exam protocol is electronically circulated before each exam.  The information should be carefully reviewed upon circulation (see Appendix C for the typical protocol).

Special Consideration for On-line Examinations: With the distance-learning platform, students must pay very close attention to the rules and regulations pertaining to on-line exams. 

1. All students must review the Guide to ExamID and ExamMonitor as published on the course site and complete the Mock Examination in Examplify as released by Examination Services.  
2. For all online proctored examinations, the published scores (and course grades) are preliminary at the time of publication; they are retractable if a subsequent investigation demonstrates a failure to comply with examination regulations or proctoring requirements.
3. Depending on the infraction, the examination score may be nullified, an academic penalty imposed, and/or disciplinary action pursued.
4. Any technical problems, prior to, during, or after completing the examination, need to be documented and reported immediately to

TellExaminationServices@sgu.edu and support@examsoft.com (phone: 866-429-8889)

Quantity: There are 4 exams in this Course. These are held during weeks 4, 8, 12, and 16 of the semester. Each exam has 50 multiple-choice questions for a total of 200 points. 

Content: Exam questions derive from the list of lecture objectives. The focus of exam material is on important concepts and clinically/medically relevant facts discussed in lecture. Emphasis is placed on knowledge regarding the diagnosis, etiology and treatment of mental illness.  

Cumulative Nature of Exams:  Each examination has a cumulative component. The approximate breakdown of cumulative questions is as follows:

Examination	Number of Questions
Exam 2	2
Exam 3	4
Exam 4	6 – 8

Exam Duration:  Each exam is 75 minutes. 

Exam Mastery Reports:  Mastery Reports detailing exam strengths/weaknesses based on topic (e.g., anxiety disorders) and question type (e.g., diagnosis vs. treatment-related) are emailed to students through ExamSoft.

Pre-Examination Question Review by Faculty

Prior to each examination, the Course Director reviews all test items with teaching faculty to help ensure the validity and high quality of all questions.

Post-Examination Review by Faculty

After each examination, the Course Director and teaching faculty review the overall examination statistics, the statistics for each item, and student feedback on each question. A decision is then made about the validity and reliability of each examination item and the overall examination.

Note: For quality control across all courses offered by St George's University School of Medicine, the Assessments Committee regularly monitors and reviews all examination items used in School of Medicine examinations.

Course Assessments & Assessment Points

Course assessments may be summative (counting towards points in the Gradebook), formative (giving feedback to students to optimize their learning strategies with minimal or no points counted toward the Gradebook), or both. Formative assessments in this Course include in-class clicker questions, Sakai practice quizzes, and ExamSoft quizzes.

Summative assessments in this Course include written (electronic) examinations.

The total assessment points that can be earned in the Course are listed in the table below:

Assessment	# Points	Point Breakdown	Approx. % of Course
Exam 1`	50	50 MCQs x 1 point	24%
Exam 2	50	50 MCQs x 1 point	24%
Exam 3	50	50 MCQs x 1 point	24%
Exam 4	50	50 MCQs x 1 point	24%
E-Soft quizzes	8	2 points per E-Soft quiz	4%
Totals	208		100%

Grades are awarded based on percentage scores. The following table is intended to help students determine their letter grade based on raw points earned in the PSYC411 Course:

Raw Points	Percentage (%)	Letter Grade
208	100	A+
187-207	89.5-99.99	A
176-186	84.5-89.49	B+
166-175	79.5-84.49	B
155-165	74.5-79.49	C+
145-154	69.5-74.49	C
135-144	64.5-69.49	D
≤134	<64.5	F

Disclaimer: To protect against any errors in the calculation of the equivalent raw points above, grades will be determined purely based on the officially-published grading scale (in percentage scores) in the Sakai gradebook listed in the scoring and grading policy (see below).

Student Support

Office Hours

Zoom Office hours by the teaching faculty are offered each week as standing office hours or by appointment. The available hours (open or appointments) for the different faculty members will be posted weekly on Sakai. All Zoom appointments should be made directly with the faculty member. Students should contact individual faculty members by email to make appointments (unless otherwise specified).

Directed Self-Study/Group Study

In addition to studying independently, students are encouraged to form their own Zoom study groups of 3 to 5 active members. Study groups are recommended to meet about once a week to discuss difficult course concepts. Active participation in these group study discussions may be useful to students' successful understanding, application, and mastery of course material.

Course and Instructor Critique

Students are expected to view all lectures and complete other related academic activities as defined for each Course by the Course Director. One such academic activity is participation in the St. George's University Course and Instructor Critique Program.

Student participation in the evaluation process is mandatory.

Students enrolled in a course are expected to complete all required faculty and course evaluations. Failure to complete all required course and instructor critiques will mean that students did not fulfill all course requirements. The Critiques Coordinator will notify students when evaluation periods have begun and send periodic reminders to ensure that critiques are submitted within the allotted time frame.

The Importance of Evaluation: Evaluation is a necessary component of any course. Just as students anticipate a fair and accurate evaluation of their performance and achievement in a course, SGU requires that faculty and course evaluations be completed each term. Continual evaluation and assessment of faculty ensures that the instructional program not only remains consistent, but also improves to meet the needs and expectations of students.

Feedback: At the beginning of each term, Course Directors address the class and summarize the results of the course and instructor critiques from the previous term. In this summary, Course Directors report areas that students rated highly and areas that received the lowest ratings. For areas receiving low ratings, the Course Director details what changes were made to address students' concerns, thus ensuring that course evaluation influences course design and delivery.

The Introduction to Psychopathology course embraces the mission of the Doctor of Medicine Program of St George's University School of Medicine:

Mission

St. George's University School of Medicine provides a diverse, multicultural and international environment that empowers students to learn the medical knowledge, clinical skills and professional behaviors to participate in healthcare delivery to people across the world.  

MD Program Objectives

1. Medical Knowledge
   1. Apply the multidisciplinary body of basic sciences to clinical analysis and problem solving using:
   2. The knowledge of normal structure, function, physiology and metabolism at the levels of the whole body, organ systems, cells, organelles and specific biomolecules including embryology, aging, growth and development.
   3. The principles of normal homeostasis including molecular and cellular mechanisms.
   4. The etiology, pathogenesis, structural and molecular alterations as they relate to the signs, symptoms, laboratory results, imaging investigations and causes of common and important diseases.
   5. Incorporate the impact of factors including aging, psychological, cultural, environmental, genetic, nutritional, social, economic, religious and developmental on health and disease of patients, as well as their impact on families and caregivers.
   6. Utilize the important pharmacological and non-pharmacological therapies available for the prevention and treatment of disease based on cellular and molecular mechanisms of action and clinical effects. Identify and explain factors that govern therapeutic interventions such as clinical and legal risks, benefits, cost assessments, age and gender.
   7. Apply the theories and principles that govern ethical decision-making in the management of patients.
   8. Evaluate and apply clinical and translational research to the care of patient populations.
2. Clinical Skills
   1. Communicate effectively with patients, their families and members of the     health care team.
   2. Obtain a comprehensive and/or focused medical history on patients of all categories.
   3. Perform physical and mental status examinations on patients of all categories appropriate to the patient's condition.
   4. Document pertinent patient health information in a concise, complete and responsible way.
   5. Select appropriate investigations and interpret the results for common and important diseases and conditions.
   6. Recognize and communicate common and important abnormal clinical findings.
   7. Develop a problem list and differential diagnosis based on the history, physical findings and initial investigations.
   8. Apply effective problem-solving strategies to patient care.
   9. Perform routine and basic medical procedures.
   10. Provide patient education for all ages regarding health problems and health maintenance.
   11. Identify individuals at risk for disease and select appropriate preventive measures.
   12. Recognize life threatening emergencies and initiate appropriate primary intervention.
   13. Outline the management plan for patients under the following categories of care: preventive, acute, chronic, emergency, end of life, continuing and rehabilitative.
   14. Continually reevaluate management plans based on the progress of the patient's condition and appraisal of current scientific evidence and medical information.
3. Professional Behavior
   1. Establish rapport and exhibit compassion for patients and families and respect their privacy, dignity and confidentiality.
   2. Demonstrate honesty, respect and integrity in interacting with patients and their families, colleagues, faculty and other members of the health care team.
   3. Be responsible in tasks dealing with patient care, faculty and colleagues including health-care documentation.
   4. Demonstrate sensitivity to issues related to culture, race, age, gender, religion, sexual orientation and disability in the delivery of health care.
   5. Demonstrate a commitment to high professional and ethical standards.
   6. React appropriately to difficult situations involving conflicts, non-adherence and ethical dilemmas.   
   7. Demonstrate a commitment to independent and lifelong learning, including evaluating research in healthcare.
   8. Demonstrate the willingness to be an effective team member and team leader in the delivery of health care.
   9. Recognize one's own limitations in knowledge, skills and attitudes and the need for asking for additional consultation.
   10. Participate in activities to improve the quality of medical education, including evaluations of courses and clerkships.

Through consistent and proactive participation during the activities and exercises presented in this Course, a student should be able to:

Block 1

Overview of Psychopathology

• Define the terms "psychopathology" and "mental disorder".
• Describe the array of symptoms displayed by mentally ill people.
• Distinguish between internal and external triggers of symptoms of mental illness.
• List justifications for in-patient hospitalization rather than out-patient treatment.
• Describe the difference in the work performed by a psychiatrist, clinical psychologist, and psychiatric social worker.
• List obstacles to treatment faced by mentally ill people.
• Identify the three major theories of mental illness that have dominated history and describe the treatment approach derived from each theory.
• State the importance of Benjamin Rush in the field of Abnormal Psychology.
• Define "deinstitutionalization" and state the reason for it.
• Describe the historical importance of chlorpromazine.
• Describe the current conceptualization of mental illness, including the biopsychosocial model of illness.
• Describe the diathesis-stress model, and how it explains mental illness.

Theories of Behavior I

• Describe the major principles underlying the biological (organic) perspective of human behavior.
• Describe the major principles underlying the cognitive perspective of human behavior.
• Identify the cognitive distortions of overgeneralization, excessive responsibility, arbitrary inference, selective abstraction, catastrophizing, and dichotomous thinking.
• Describe the major principles underlying the Behavioral perspective of human behavior. 
• Identify each component of a classical conditioning scenario including identifying the unconditioned stimulus and response, the neutral stimulus, and the conditioned stimulus and response. 
• Distinguish between stimulus generalization and stimulus discrimination in classical conditioning.
• Describe the phases of classical conditioning, including acquisition, extinction, spontaneous recovery, re-extinction, and re-learning.
• Distinguish between positive and negative reinforcement and positive and negative punishment.  

Theories of Behavior II

• Explain how timing, frequency, and consistency influence the effectiveness of operant conditioning
• Describe the phenomenon of learned helplessness and explain its relationship to depression.
• Describe the phenomenon of shaping (successive approximations).
• Distinguish between punishment and operant extinction.
• Distinguish between continuous and intermittent schedules of operant conditioning, including the four types of intermittent schedules.
• Describe the major advantage of using a ratio schedule compared to an interval schedule.
• Describe the effect of a variable schedule on the extinction process
• Describe the major principles underlying the social learning perspective of human behavior, including vicarious conditioning.
• Describe the major principles underlying the psychoanalytic perspective of human behavior. 
• Differentiate the actions of the id, ego, and superego.
• Identify the defense mechanism that best explains a given behavior

Treatment Techniques I

• Define psychotherapy.
• Describe the technique of cognitive therapy.
• Describe the techniques of behavioral therapy.
• Distinguish between the techniques of systematic desensitization, exposure therapy, and flooding.
• Describe a token economy and identify the operant principles utilized.
• Describe aversion therapy, including covert sensitization.
• Describe the process of biofeedback.
• Describe vicarious learning.
• Describe the general features of psychodynamic therapy.
• Distinguish between transference and countertransference, both positive and negative.
• Describe techniques for accessing the unconscious and give the rationale for revealing the contents of the unconscious.
• Define the term "catharsis" and identify how catharsis is achieved using psychodynamic therapy.
• Describe the general features of humanistic therapy and explain the term "unconditional positive regard".
• Describe the goals and process of traditional group therapy, family therapy, and marital therapy.
• Describe how self-help (support) groups differ from group therapy.

Treatment Techniques II

• Identify the 4 major classes of psychotropics and the conditions that they are typically used to treat
• Identify the major neurotransmitter(s) affected by each major class of medication
• Identify the common side effects of each major class of medication
• List reasons for medication non-compliance by mentally ill patients
• Describe the general timeframe for psychotropics to have a therapeutic effect
• Describe the process of electroconvulsive therapy (ECT) and the indications for its use
• List the major side effects of ECT
• State the effectiveness of ECT
• Describe other brain stimulation techniques including repetitive transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation, and deep brain stimulation
• Define psychosurgery
• Describe the purpose of a prefrontal lobotomy and state its current status as a treatment procedure

Psychiatric Classification & Assessment

• List the benefits and concerns of psychiatric classification systems
• Describe the basic features of the DSM-5 psychiatric classification system
• Apply the following diagnostic specifiers when diagnosing a patient: "Provisional", "Unspecified", "Prior History" and "In Remission"
• Explain what is meant by a Z-Code condition
• Describe the diagnostic interview
• State the difference between a structured and unstructured interview
• State the purpose of a Mental Status Exam (MSE)
• List the two components of the MSE and identify the type of information that should be included in each
• State the purpose of the WAIS, WISC, and WPPSI and when to use each test
• Describe, in general, how FSIQ is determined on the Wechsler IQ tests
• State the difference between objective and projective psychological tests and describe common tests of each type
• Describe the purpose of neuropsychological testing and list some of the skills assessed
• Distinguish between an MSE and a neuropsychological assessment
• Describe the type of information gathered through behavioral, cognitive, and bodily inventories

Trauma/Stressor-related Disorders

• Describe the typical psychological, behavioral and physiological changes associated with stress.
• Identify the physiological basis underlying a stress reaction.
• Describe treatment approaches for stress-related problems.
• Explain the Yerkes-Dodson law.
• List the essential diagnostic criteria for each Trauma/Stressor-related Disorder (Posttraumatic Stress Disorder [PTSD], Acute Stress Disorder [ASD], Adjustment Disorder, Reactive Attachment Disorder [RAD], and Disinhibited Social Engagement Disorder [DSED]).
• Clinically differentiate between the Trauma/Stressor-related disorders (including any subtypes) based on clinical presentation.
• Identify the causes of the Trauma/Stressor-related disorders and list treatment strategies.
• Describe how RAD differs from DSED. 

Block 2

Mood Disorders & Suicide Management I

• List the essential diagnostic criteria for each Depressive Disorder (Major Depressive Disorder, Persistent Depressive Disorder, Premenstrual Dysphoric Disorder, and Disruptive Mood Dysregulation Disorder).
• Clinically differentiate between the depressive disorders (including subtypes) based on clinical presentation.
• Describe the monoamine hypothesis of depressive disorders.
• Describe the role of the HPA axis in producing mood symptoms.
• List the biological and psychological treatment options for each depressive disorder, including experimental options.
• Identify side effects associated with antidepressant drugs.
• Describe the general age of onset, course, outcome/consequences and differentials for the depressive disorders.

Mood Disorders & Suicide Management II

• List the essential diagnostic criteria for each bipolar disorder (Bipolar I, Bipolar II, and Cyclothymia).
• Clinically differentiate between the bipolar disorders based on clinical presentation.
• Describe the general Course, outcome/consequences and differentials for the bipolar disorders.
• Describe the monoamine hypothesis of bipolar disorders.
• List the pharmacological treatment options for each bipolar disorder.
• List risk factors of suicide.
• In the assessment of suicide risk, identify key questions to ask when somebody appears to be in depressed state.
• State the appropriate Course of action to take with a suicidal patient based on a judgment of low, medium and high risk of suicide.

Anxiety Disorders and Obsessive-Compulsive & Related Disorders

• State the role of the HPA axis in the development of anxiety.
• Describe the role of classical conditioning in the development of anxiety.
• Describe the cognitive-behavioral approach for the treatment of anxiety.
• List the 2 common types of medications used to treat anxiety disorders.
• List the essential diagnostic criteria for each Anxiety Disorder (Panic Disorder, Agoraphobia, Specific Phobia with subtypes, Social Anxiety Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder, and Selective Mutism).
• Clinically differentiate between the Anxiety Disorders (including subtypes) based on clinical presentations.
• Describe a panic attack.
• Describe the biological and psychological treatments for each Anxiety Disorder.
• List the essential diagnostic criteria for Obsessive-Compulsive Disorder (OCD).
• State the difference between an obsession and a compulsion and specify the purpose of the Y-BOCS.
• Describe specific brain abnormalities seen in OCD.
• Describe the specific biological and psychological treatments for OCD.
• Clinically differentiate between OCD and OCD-Related disorders, including Body Dysmorphic (covered in a Disorder, Hoarding Disorder, Trichotillomania and Excoriation Disorder.
• Distinguish Body Dysmorphic Disorder from normal vanity.
• Describe the treatments for each of the OCD-Related disorders.

Eating Disorders

• State the essential diagnostic criteria of the Eating Disorders (Anorexia Nervosa, Bulimia Nervosa and Binge-Eating disorder), including any subtypes.
• Clinically differentiate between the Eating Disorders (including any subtypes).
• Identify the two main components of a "binge" and define "purge" as per the DSM5.
• Describe the general epidemiology of eating disorders (e.g., gender, prevalence, age of onset).
• Describe cultural and biological factors that may contribute to the development of Eating Disorders.
• Describe the treatment approaches, including stating when hospitalization is necessary, for eating disorders.
• Differentiate between Anorexia, Bulimia and Binge-Eating disorder in their initiation of treatment and state the general outcome for Eating Disorders.
• List the potential medical consequences of Eating Disorders.

Sleep-Wake Disorders

• List and describe the stages of sleep
• Describe the physiology and components of REM sleep (i.e., dreaming, paralysis)
• Describe the measures captured by polysomnography
• Describe the etiology and treatment for insomnia disorder
• Describe the etiology and treatment for hypersomnolence disorder
• Describe the symptoms and treatment for narcolepsy disorder
• Differentiate between obstructive sleep apnea and central sleep apnea disorder • Differentiate between the Parasomnia disorders

Block 3

Somatic Symptom & Related Disorders and Dissociative Disorders

• Identify the essential diagnostic criteria for each Somatic Symptom & Related disorder (Somatic Symptom Disorder, Conversion Disorder, Illness Anxiety Disorder, and Factitious Disorder)
• Differentiate between the Somatic Symptom & Related Disorders based on clinical symptomatology
• State the cause of Somatic Symptom & Related disorder
• Describe the major treatment approach for Somatic Symptom & Related Disorders
• Describe the two types of Factitious Disorder
• Identify 5 indicators of factitious illnesses
• Describe the character profile of somebody with a Factitious Disorder
• Define malingering (and malingering by proxy) and contrast these conditions with Factitious disorders
• Describe the concept of dissociation
• List the essential diagnostic criteria for each dissociative disorder (Dissociative
• Amnesia with and without dissociative Fugue, Dissociative Identity and
• Depersonalization/Derealization disorder) and differentiate them based on clinical symptomatology
• Distinguish between the 3 types of memory loss associated with Dissociative Amnesia
• Distinguish between an organically based amnesia and Dissociative Amnesia based on results from a Mental Status Exam
• Describe a fugue state
• Describe the difference between depersonalization and derealization
• State the general cause of dissociative disorders
• Describe the major treatment approach to dissociative disorders

Schizophrenia Spectrum & Other Psychotic Disorders

• List the 5 psychotic domain symptoms and specify which are "core" domain symptoms.
• Clinically differentiate between types of delusions (e.g., a delusion of control versus a delusion of reference) based on clinical presentation.
• Differentiate between the types of loose associations (e.g., word salad versus clang association) based on clinical presentation.
• Distinguish between a positive and negative symptom and give an example of each.
• List the essential diagnostic criteria for schizophrenia.
• Define the "Active Phase" of schizophrenia.
• List Bleuler's 4 As of schizophrenia and contrast those symptoms with Schneider's first-rank symptoms.
• Describe the epidemiology, associated features, onset, Course and outcome of schizophrenia.
• Describe the dopamine hypothesis of schizophrenia and state how it relates to both positive and negative symptoms.
• List the common neurostructural, neurofunctional, and neuropsychological problems seen in schizophrenia.
• Describe the general etiology of schizophrenia.
• List the common medications used to treat psychotic disorders and distinguish between traditional and atypical antipsychotics in their mechanisms of action, clinical benefits and side effects.
• Differentiate between the types of extrapyramidal symptoms (parkinsonism, akathisia, tardive dyskinesia, dystonia and neuroleptic malignant syndrome) based on clinical symptoms and time of onset after initiation of antipsychotic medication.
• Describe the role of ECT and psychotherapy in the treatment of schizophrenia.
• State the current status of the prefrontal lobotomy.
• State the essential diagnostic criteria for the Schizophrenia Spectrum Disorders (Schizophreniform Disorder, Brief Psychotic Disorder, Delusional Disorder and Schizoaffective Disorder), including any subtypes.
• Clinically differentiate between the Schizophrenia Spectrum Disorders (including subtypes) based on clinical presentation (including the time course of symptoms).
• Distinguish between a bizarre and a non-bizarre delusion.
• Differentiate Schizoaffective Disorder from a mood disorder (e.g., Major Depressive Disorder with Psychotic Features).
• Describe the variant of delusional disorder in which a delusion appears to be "socially-transmissible" and how it may be treated.

Personality Disorders

• Define a personality disorder.
• State the general cause of personality disorders and describe the general onset and Course of personality disorders.
• Identify and describe the 3 major clusters of Personality Disorders.
• State the essential diagnostic criteria for the DSM-5 Personality Disorders and differentiate between them based on clinical symptomatology.
• Describe the general treatment approach to Personality Disorders and state the specific treatments (when given) for individual personality disorders.
• Describe the general outcome of Personality Disorders and explain the difference in outcome (and the reason for it) for Dependent personality and Avoidant personality disorders compared to other Personality Disorders.
• State the difference between Antisocial Personality Disorder (ASPD) and a "psychopath".
• State the health hazard associated with Obsessive-Compulsive Personality disorder.
• Identify the psychiatric diagnoses most associated with Borderline, Histrionic and Schizotypal personality disorders.
• Differentiate the following personality disorders from other DSM-5 mental disorders:
  • Paranoid Personality Disorder from Delusional Disorder, Persecutory type. o Schizotypal Personality Disorder from Schizophrenia.
  • Narcissistic Personality Disorder from Bipolar I Disorder and Delusional Disorder, Grandiose type.
  • Avoidant Personality Disorder from Social Anxiety Disorder.
  • Obsessive-Compulsive Personality Disorder from Obsessive-Compulsive Disorder.

Disruptive, Impulse-Control, and Conduct Disorders

• List the essential diagnostic features for the Disruptive, Impulse-Control & Conduct Disorders (i.e., Oppositional Defiant Disorder [ODD], Conduct Disorder [CD], Intermittent Explosive Disorder [IED], Pyromania and Kleptomania).
• Distinguish between ODD, CD, IED, ASPD, Disruptive Mood Dysregulation Disorder and Adjustment Disorder with Disturbance of Conduct.
• Describe the two subtypes of CD.
• Describe the etiology, epidemiology, psychosocial risk factors, onset, Course, treatment and outcome of ODD and CD.
• Differentiate Pyromania vs. arson and Kleptomania vs. shoplifting.
• Describe the typical sequence of events involved in an impulsive act and describe the neurotransmitters involved. 
• List the treatment approaches for impulse control problems.

Neurodevelopmental Disorders I

• List the essential diagnostic symptoms of the Neurodevelopmental Disorders
• (Attention-Deficit/Hyperactivity Disorder [ADHD], Autism Spectrum Disorder
• [ASD], Intellectual Disability [ID], Specific Learning Disorder [SLD], and Tourette's Disorder), including any subtypes of the disorders.
• Describe the general functional abilities of each level of ID.
• List the general causes and management strategies of persons with ID. 
• Describe the development, Course, and management of SLD. 
• Apply the essential criteria to diagnose and differentiate language disorder, speech-sound disorder, social (pragmatic) communication disorder, and childhood-onset fluency disorder 
• Identify the etiology and neuropathology of Tourette's Disorder and describe its management. 
• Classify a tic as motor or vocal and as simple or complex.

Neurodevelopmental Disorders II

• List the essential diagnostic symptoms of the Neurodevelopmental Disorders
• (Attention-Deficit/Hyperactivity Disorder [ADHD], Autism Spectrum Disorder
• [ASD], Intellectual Disability [ID], Specific Learning Disorder [SLD], and Tourette's Disorder), including any subtypes of the disorders 
• State the etiology and neuropathology of ASD.
• Describe the epidemiology, onset, Course, treatment and outcome of ASD. 
• Describe the associated behavioral, physical and cognitive profile of ASD. 
• Define savantism, distinguish between a talented and a prodigious savant, and identify the hypothesized neuroanatomical substrate of savantism. 
• Describe the general conceptualization (including etiology/neuropathology) of ADHD. 
• Describe the epidemiology, onset, course (including commonly associated cognitive and behavioral features), and outcome for ADHD. 
• Describe the assessment tools for ADHD. 
• List the psychological and pharmacological treatments available for ADHD, including side effects and contraindications of medications. 

Block 4

Gender Dysphoria, Sexual Dysfunctions, and Paraphilic Disorders

• List the essential diagnostic features of Gender Dysphoria and clinically differentiate this condition from the Sexual Dysfunctions and Paraphilic Disorders
• Describe the onset, Course, hypothesized cause, and management of GD.
• Describe the difference between the sexual problems seen in disorders classified as Sexual Dysfunctions compared to those classified as Paraphilias.
• State the essential disturbance for a diagnosis of each of the Sexual Dysfunctions and clinically differentiate them.
• Identify the general cause of a Sexual Dysfunction.
• Use the specifiers "life-long", "acquired", "situational" and "global" as they apply to a Sexual Dysfunction.
• State the general treatment approach for Sexual Dysfunctions and give examples of what this treatment involves.
• List specific treatments for Delayed Ejaculation.  
• Describe the general profile of somebody with a Paraphilic Disorder (e.g., gender, age of onset) and the typical Course of these disorders.
• State the essential disturbance for a diagnosis of each Paraphilic Disorder and describe the typical features associated with each deviance.
• State the hypothesized etiology of Paraphilic Disorders.
• State the difference between a Transvestic Fetish and GD behaviors.
• List the treatments for Paraphilic Disorders.
• State the status of homosexuality in relation to DSM-5 classification.

Substance-Related Disorders

• Describe the epidemiology and associated features of substance users.
• Identify the neurocircuitry underlying the reinforcing effects of substances.
• List 5 drug-related brain changes that contribute to drug addiction. 
• List the genetic and psychosocial risk factors of drug addiction.
• Describe the pharmacological and psychological treatment approaches to drug addiction.
• Describe the role of support groups in the treatment of drug addiction.
• List the key symptoms of "Substance Use" disorder. 
• Define intoxication and withdrawal (as per the DSM-5) and describe, in general, the withdrawal syndrome.
• Describe the general symptoms of intoxication and withdrawal for each of the 4 major classes of substances (i.e., sedatives, stimulants, hallucinogens and related substances, and the opioids).
• List the specific treatments for drug addiction for each class of drug. 
• Identify the specific drug that causes a cluster of behavioral symptoms in a clinical scenario.
• List associated cognitive effects of excessive use of sedatives.
• Explain the concept of cross-tolerance of sedatives and apply the concept in clinical scenarios.
• Describe the delirium tremens and state its cause.
• Describe the process of aversion therapy using disulfiram for alcohol dependence.
• Define formication and list drug-related conditions that most likely produces this symptom.
• Distinguish between the effects of classic hallucinogens (LSD), cannabis (e.g., marijuana), and the dissociative anesthetics (e.g., phencyclidine [PCP]).
• List the health risks of opioid use, overdose, and withdrawal.
• Differentiate between methadone and buprenorphine as replacement therapy medications.
• Describe treatment of acute opioid overdose.

Neurocognitive Disorders I & II

• List the essential diagnostic criteria for a delirium.
• Distinguish between an illusion and a hallucination.
• Describe ways to test for symptoms of a delirium.
• Identify common causes of a delirium.
• Describe the general underlying neuropathology of a delirium.
• Describe the general Course of delirium, including the time course, resolution of symptoms, and prognosis.
• Distinguish between the medications used to treat most deliriums compared to treatment of a sedative-withdrawal delirium.  
• List common non-pharmacological methods to manage a delirium.
• List the essential features of an amnesia and differentiate it from a dissociative amnesia.
• Describe the difference between a retrograde and anterograde amnesia.
• Describe the typical memory deficits seen in amnesia, including the temporal gradient.
• Describe short-term memory (capacity and duration) and state how a typical amnestic would perform on short-term memory tests. 
• Name the brain structure most implicated in amnesia.
• Define the term confabulation.
• Describe the importance of Patient H.M. in the scientific understanding of memory.
• State the cause of Korsakoff's amnesia and how to treat it.
• Describe the general treatment of amnestic patients.
• Differentiate between types of internal and external mnemonic strategies.
• Define dementia.
• Describe the design and structure of language
• Describe the development of language in children 
• Differentiate the role of the left hemisphere in language functions compared to the right hemisphere
• Identify the major language functions assessed in an aphasia examination 
• Differentiate Wernicke's aphasia from Broca's aphasia based on the pattern of language impairment
• Identify the region of the brain that is damaged in Broca's aphasia and Wernicke's aphasia
• Describe the typical profile of a demented patient regarding age of onset, Course, and prognosis.
• Differentiate between delirium, amnesia and dementia based on clinical symptoms.
• State the diagnostic criteria for Alzheimer's Dementia (AD)
• Describe the epidemiology and general clinical progression of AD.
• Describe the neuropathology of AD (i.e., common neuroanatomical, neurofunctional, neurochemical and histopathological changes).
• Compare the onset and progress of early-onset AD compared to late-onset AD.
• State the prognostic value of APOE genetic testing.
• List the two major types of medications FDA-approved for AD and describe their difference in action, side effects, efficacy, and target patient population.
• Describe non-pharmacological interventions to help manage AD patients.
• List experimental treatments for AD.
• Describe the major clinical differences between AD and other dementias (Vascular, Frontotemporal [e.g., Pick's], Parkinson's, Lewy Body, Huntington's, and Creutzfeldt-Jakob) based on key differences in symptoms and/or patient history.
• State the DSM-5 definition of a neurocognitive disorder (NCD) and list the 3 possible DSM-5 diagnoses related to NCDs.
• State the difference between a "Major" NCD and a "Mild" NCD, as per DSM-5.
• State how an amnestic disorder and a dementia would be diagnosed using DSM-

Law, Ethics & Mental Illness

• List the three essential components of informed consent with a competent patient.
• Identify the ethical and legal principle(s) that support the process of informed consent.
• State the essential criteria for determining decision-making capacity (competence) of a patient.
• Describe the process of substitute decision making if a patient is deemed incompetent, including the concept of "substituted judgment".
• Describe the professional obligation of confidentiality and the importance of this standard.
• Describe the right of family members to access patient information.
• State two major exceptions to the obligation of confidentiality and give examples of each.
• State the importance of the Tarasoff case and differentiate between the "Duty to Warn" and the "Duty to Protect" verdicts.
• List the steps to take after a patient threatens harm to a specific person.
• Describe the 3 major circumstances under which psychiatric hospitalization (civil commitment) procedures are allowed without a person's consent.
• Describe the concepts of parens patriae and police power and how they provide legal justifications for the involuntary psychiatric hospitalization of patients.
• State the importance of the O'Connor v. Donaldson case.
• Describe the general steps in a civil commitment process.
• Name the standard that a judge uses to determine a person's dangerousness.
• Give an example of treatment in the "least restrictive environment" if a judge who is overseeing a civil commitment hearing determines that a psychiatric patient is dangerous. Describe the sequence of steps in a judicial process after a criminal offense by a mentally ill person.
• Describe the essential features of a competency to stand trial hearing and the consequences of a competent versus incompetent verdict.
• Describe the M'Naghten, Irresistible Impulse, and American Law Institute standards for insanity.
• Describe the consequences of a successful versus unsuccessful insanity plea.
• Describe the insanity defense in terms of its success rate, the crimes its used for, and the consequence of being found insane.
• State the difference in consequence to a patient between a verdict of Guilty but Mentally Ill and an insanity verdict. 
• State how the death penalty applies to individuals with Intellectual Disability compared to other mental illnesses (e.g., Schizophrenia). 
• Describe the essential elements of a Competency-to-be-Executed assessment and state what happens if a patient is found incompetent to be executed.

Banned Items:

Items banned from regular, on-site examinations, are also banned during online examinations. This includes, but is not limited to:

1. Cellular phones
2. Other electronic or communication devices
3. Wrist watches
4. Hoodies
5. Scrap paper, pens, pencils or other writing devices
6. Food or beverages
7. Water bottles

Additional items banned from online examinations are:

1. Headphones, earphones, headsets
2. Ear plugs
3. White boards – you will be able to use the "Notes" function within ExamSoft instead

Requirements for Online Proctoring

• The entire face of the examinee must be visible at all times. Hair long enough to cover the eyes and ears must be pulled back. Hats or other head-wear are prohibited. 
• The eyes of the examinee must be visible at all times. Reading glasses with clear lenses are acceptable, but tinted glasses or sunglasses are prohibited. 
• The examination room must be consistently well-lit, with a plain background, avoiding dark shadows across the examinee's face.
• Students may NOT take bathroom breaks.
• Students may NOT verbalize during the examination.
• Students MUST complete the Exam ID process and activate Exam Monitor.
• Students MUST be sure that their Exam ID and Exam Monitor files are uploaded at the end of the exam.

• DOWNLOAD: The examination download window is 48 hours before the date and time of the examination. 

EXAMINATION DAY:

CHECK-IN TIME: The check-in time is the time posted by the Course as the time of the examination.

START: Students may start the examination immediately after completing EXAMID and activating Exam Monitor

Students should check in at the CHECK-IN TIME. If you check in more than 30 minutes after the CHECK-IN TIME, you may not be able to take the exam, and you will be flagged for exam violation.

Password Announcement: The examination password will be disseminated via Course Sakai announcement and email notification, approximately 15 minutes prior to CHECKIN TIME.

Once you have started the examination, you won't be able to take a bathroom break until you finish the examination.  

REMINDERS ABOUT EXAM PREREQUISITES:

• Students must ensure that their laptop meets the minimum system requirements:
  1. Webcam
  2. Microphone (no headphones)
  3. 2 GB free HD space
  4. 4 GB RAM
  5. 2 Mbps upload speed
  6. CPU equivalent to Intel i3 2+ GHz
  7. MAC OS (10.13, 10.14, 10.15)
  8. Windows 10 (Version 1809 or 1903)
• Students must update to the latest version of Examplify, i.e. version 2.5. Once Examplify is launched, students will be prompted to update to this version.

• Please follow the on-screen steps to do so.

  How to check your Examplify version number: 

  https://examsoft.force.com/etcommunity/s/article/Examplify-Checking-your-ExamplifyVersion-Number

  Permission set up for ExamMonitor and ExamID 

  https://examsoft.force.com/etcommunity/s/article/ExamID-and-ExamMonitorPermission-Setup-for-MAC-users

  https://examsoft.force.com/etcommunity/s/article/ExamID-and-ExamMonitorPermission-Setup-for-Windows-users

  Support and Additional Resources:

• Examination Services will be available to provide assistance for exams. Students who encounter technical issues prior to and especially during an exam should send an email to TellExaminationServices@sgu.edu.
• ExamSoft 24-hour support remains in effect. Students can reach out directly via email (support@examsoft.com) or via the online chat.
• ExamID and ExamMonitor overview video
• https://examsoft.force.com/emcommunity/s/article/ExamID-and-ExamMonitorfrom-the-Student-Perspective

• For a complete list of rules and regulations governing examinations (and any updates), please consult the Student Manual  https://mycampus.sgu.edu/group/mycampus/student-manuals and refer to Announcements posted on the Course Sakai site.