Diagnosis of mental disorders and classification systems

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Deviance
Extent to which behaviour is rare within society- if considered rare enough from the norm-suggests clinical disorder present
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Dysfunction
behaviour significantly interfering with someone's everyday life, e.g. work -mental illness present
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Distress
extent to which behaviour causing upset to the Individual- (still possible to function completely normal in other areas of life-could face extreme difficulty in life but feel no distress-subjective)
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Danger
harm to self or others-intervention needed-scale of severity-some behaviour; dangerous, but if extremely risky and not addressed-diagnosis necessary
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5th D
duration (Davis)- four D's present short term- but if persist-problem seen as symptom of mental illness- requires psychiatric attention
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Patient
receiving biological treatment; e.g. on prozac (antidepressant)
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client
receiving psychological treatment e.g. CBT
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Issue of subjectivity
interpretation of Individual patient's experience- what's seen as dysfunctional by one clinician will be different to another
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Issue of reliability
decision on whether behaviour requires further diagnosis-discussed by clinician and patient; ensure explore all 4 D's- everyone measured in same, standardised way, inc level of deviance
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Why use standardised tests
assess symptoms of many disorders- avoid personal judgement
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Issue with concept of deviance
some problematic behaviours are not rare e.g. depression- important clinicians weigh up all 4 D's- to see whether further psychiatric care needed
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How are mental disorders described?
a collection of symptoms by medical profession just like any other illness
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ICD
International Classification of Diseases- list of mental disorders and diseases
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DSM
Diagnostic and Statistical Manual of Mental disorders- APA
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Why is reliable diagnosis essential?
guiding treatment recommendations-ensure patient receives correct treatment for their condition and accurate prognosis is given
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Prognosis
the likely course of a medical condition
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Why does diagnose of MHD depend on interpretation?
MHD don't have obvious physiological signs e.g. raised blood pressure
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Therefore, issues of...
reliability and validity-not an exact science
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How does ICD and DSM ensure better quality diagnoses?
describe cluster symptoms that define disorders-derided from clinical practice, field trials and pooled expertise (not universal)
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How does ICD classify MDHs
groups each disorder as part of family, e.g. mood disorders inc depression in all forms, e.g. bipolar,-disorder coded- F; then digit for specific disorder, e.g. F31;depresion
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further categorisation
follows decimal point, seriousness; e.g. F32.0 is mild depression
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Specific categorisation
another decimal point and digit- F33.0.00-mild depression with somatic (psychical) symptoms e.g. pain
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Coding allows Clinician
go from general to specific in easy systematic way
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How does ICD guide diagnosis?
via clinical interview with patient- requires expertise as MHD not always clear
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DSM IV-TR
Updated DSM-IV; 'multi-axial' tool-5 axis
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Axis 1
describes major MHD e.g. schizophrenia
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Axis 2
describes symptoms related to personality disorders
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Axis 3
describes medical conditions, e.g. brain damage-used to explain/mediate the onset of clinical issues
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Axis 4
describes psychosocial and environmental issues-implicated in the onset/course of MHD e.g. bereavement-trigger depression
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Axis 5
scale to assess global functioning of an Individual; used to assess how well an indiv was able to go about normal activities e.g. socialising and dressing
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Why is functioning score given to Individual?
help with diagnosis and used to assess the need for treatment & type of treatment necessary
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Reliability of diagnosis
extent to which clinicians agree on the same diagnosis for the same patient
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Why is diagnosis unreliable?
it's complex-same symptoms can occur across different disorders thus 2 clinicians might see the same symptoms but assign their cause to different disorders
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Ward et al (1962)
studied 2 psychiatrists diagnosing the same patient-found disagreement-inadequacy of classification system
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Ward et al -stat
62.5%; suggests main reliability issue was the diagnostic tool used
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Ensure diagnosis system to be reliable
pass inter-rater reliability test- show 2+ clinicians details of person's case history and assassin level of agreement between them- if they agree on same diagnosis-DS has high inter-rater reliability
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Beck (1954)
same set of symptoms only diagnosed as same disorder-50% of cases; early DS-low reliability
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Brown (2001)
reliability and validity of DSM IV diagnosis for anxiety and mood disorder-good-excellent; reliability of DS improved through the years
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PTSD
high degree of symptom overlap with other psychiatric disorders- thus under diagnosed; so reliable diagnosis harder to obtain
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Patient factors
lead to unreliable diagnosis; information provided; inaccurate due to memory problems, shame or denial- along with disorganised thoughts, psychopathy or manipulative tendencies-makes diagnosis difficult/differ from clinician
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Clinician factors
unstructured nature of clinical interview; some clinicians focus on symptom presentation, e.g. nightmares vs different course of questioning e.g. traumatic events-thus different info gathered and diff. diagnosis
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Clinician factors 2
use subjective judgement-how interpret symptoms; dependent on background, training and experience
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Clinician factors 2 e.g.
psychodynamic clinician-emphasise importance of early childhood, mistaken hallucinations as past trauma, vs medically trained psychiatrist-explain hallucinations due to excess dopamine in brain
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Valid diagnosis
must select the disorder (accurate)-serious consequence for misdiagnosis
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Concurrent validity
checked by looking another diagnostic tool, eg. compare DSM vs ICD- broad agreement-which symptoms constitute which disorder-broad CV
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Aetiological validity
examining what's known about causes of the disorder and matching them to ppts history, e.g. if known genetic component to disorder-clinician-look for family history to support diagnosis
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Predictive validity
future course of disorder is known and can be applied to person-diagnsosi can be checked against outcome-see if it's valid e.g. if patient legit has depression-improvement might be expected within eight weeks if they're prescribed antidepressants
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issues that affect reliability and validity on interpersonal level
implicit bias-interpretation of info given to clinician; e.g. more ready to diagnose female patient with depression-more prevalent in women- more likely to see same symptoms-depression
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many disorders are
comorbid with each other-valid reliable diagnosis difficult, e.g. majority of those suffering with depression also have anxiety disorders
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Other cards in this set

Card 2

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Dysfunction

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behaviour significantly interfering with someone's everyday life, e.g. work -mental illness present

Card 3

Front

Distress

Back

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Card 4

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Danger

Back

Preview of the front of card 4

Card 5

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5th D

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