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  • DSM
    • What is it
      • ICD is the european alternative to the DSM
        • If different diagnostic systems like the DSM and ICD come up with the same diagnosis, then it can beconsidered realiable
      • Multi-axial diagnosticsystem (5 axes)
        • 1) represents the actual clinical disorder
        • 2) Looks at personality disorders
        • 3) Person's general medical condition
        • 4) Psychosocial or environmental problems
        • 5) Gives GAF score giving an idea for howurgent someone's treatment is
      • APA attempted to make itmore reliable and valid witheach new vesion.
        • DSM-5 (most recent version) takes cultural issues in diagnosis into account
          • DSM-5 designed to be more comprehensive than previous versions aiming to make diagnosis easier for doctors. This increses reliability and validity
    • Issues
      • Validity
        • Refers to the DSM's ability to appropriately diagnose a mental illness: Can it differentiate between pseudo patients and "normal" patients.
          • Concurrent: showing symptoms related to the MD diagnosis
          • Etiological: if a group of people diagnosed with a MD have the same causal factors
          • Predictive: predicts how a person will behave in the future and how they will respond to certain treatments
          • If a person diagnosed with a mental disorder but does not show any symptoms or respond to treatment then the diagnosis lacks validity
            • Issues may also arise if the family or other mental health staff disagree with the diagnosis
          • Rosenhan's study showed that the DSM-III was not valid. The pseudo-patients who did not have SZ were still diagnosed with it while in the second study. real patients with SZ were not all diagnosed with it.
      • Cultural
        • The way someone's gender, race, culture or religion might lead to diferent diagnoses. Language barriers may also affect diagnosis
          • There may also be cases of mistrust of mainly white, middle class psychiatrists.
            • Cinnerella and Lowethal (1999)compared cultural influences on mental disoreders between white Catholics, black christians, Muslims Pakistanis, Orthodox Jews and Indian Hindus. They found that all groups except the white Catholics had a fear of health professionalsmisunderstanding them . This means that crtain groups may be less likely to seek help or talk about their issues openly to a psychiatrist.
              • African Americans are also less likely to seek help from mental health professionals than white Americans(Sussman, Robins and Earls, 1987)
            • Casas (1995)found that a lot of African Americans do not like to share their personal information with people of a different race so this can lead to problems with diagnosis.
          • Different cultures may interpret people's behaviour in different ways E.g. Hearing voices in Britain = MD, but hearing voices in a different culture may prove as a sign of divinity / spirituality
            • Neighbors et al (2003) found that African Americans are more likely to be diagnosed with SZ where as Americans are more likely to be dianosed with mood disorders =bias in diagnosis
          • DSM-V aims to take into account people's cultural background when making a diagnosis. It highlights how some poeple of different cultures display simptoms of the MD's differently.
            • DSM-V provides clinicians with deatiled information about how people from different cultures think and talk about psychologicalproblems.
      • Reliability
        • There can be test-retest reliability which refers to the degree to which test results are consistent overtime.
          • Goldstein (1988) used DSM-III to rediagnose 199 paients who had originally been diagnosed with SZ using the DSM-II. 169 patients were rediagnosed so there is high test-retest reliability.
            • Then used a single blind trial and asked two experts to re-diagnose 8 of the already rediagnosed patients and found a high level of agreement.
        • When a clinician gives a diagnosis and another gives the same diagnosis: inter rater-reliability
          • Brown et al(2001) found good inter-rater agreement for anxiety and mood disorders with DSM-IV
          • Rosenhan's sudy found that DSM-III was reliable for diagnosing SZ as all the pseudo-patients who said they had SZ symptoms were diagnosed with it


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