Lecture 1 Diagnostic concepts (severe mental health)

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  • Created by: Cruick96
  • Created on: 07-12-17 19:20
what are the earliest origins of mental ill health?
kraepelin system - bipolar disorder traces back to as early as 1st century (arateus of cappadocia). ancient greeks and romans responsible for mania and melancholia
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how did Falret and Baillarger's views differ about bipolar disorder? (19th century)
baillarger = recurrent oscillations between excitement and depression (1850's). falret = similar condition but noted periods of symptom free recovery between these oscillations. He also noted that the illness appeared to be clustered in fams - genes?
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what did Kraepelin believe about diagnosis?
believed that diagnosis by examining the pattern of symptoms would be a rosetta stone that would lead to understanding of aetiology
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what is the kraepelin dichotomy?
dementia praecox and manic depressive psychosis
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what is kraepelin's dementia praecox?
occurred in the young and had a poor outcome - progressive neurogenerative disease without remission. assumed it was a product of gross deficits in cog processes caused by underlying neuropathology
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what is kraepelins manic depressive psychosis?
(included all affective disorders) noted the relatively symptom free intervals described by falret - better prognosis and functioning than dementia praecox
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how did Eugene Bleuler define schizophrenia?
believed the central characteristics to be the product of a process of splitting between the emotional and intellectual functions of the personality
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how did Bleuler's definition of schizophrenia relate to previous kraepelins ideas?
agreed they were fundamentally physical in origin and that no one was fully cured - remaining weakness in remission
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how did Bleulers definition of schizophrenia differ from that of kraepelins?
disagreed that it was chronic and progressive - hence a shift away from the term dementia to remove this association
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what were bleuler's fundamental symptoms of schizophrenia?
ambivalence, inappropriate affect, loosening of associations and autism
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what were bleuler's accessory symptoms of schizophrenia?
hallucinations (sensory perception in absence of stimulus) and delusions (idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument)
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what did Kurt Schneider believe about diagnosis of schizophrenia?
distinguished between form and content of disorders - look for the how not what. not what the voices are saying but how they came to get there etc
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how did Kurt Schneider characterise symptoms of schizophrenia?
in terms of first rank symptoms (different types of delusions and hallucinations). pragmatic but denied 1st rank symptoms were most important. encouraged modern assumption that SZ should be mainly defined in terms of positive symptoms
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what were schneiders first rank symptoms?
audible thoughts, voices heard arguing, voices commenting on one's actions, experience of influences playing on the body, thought withdrawal, thoughts ascribed to others who intrude their thoughts upon the patient, thought diffusion, delusional, impu
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how did karl kleist contribute to knowledge on mental health?
coined term bipolar disorder. distinguished between unipolar and bipolar disorders
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what is the DSM?
diagnostic and statistical manual of mental disorders - developed for psychiatric uses only
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what is the ICD?
international classification of diseases - includes non-fatal diseases and psychiatric diagnoses (since 1952)
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what did the international pilot study of schizophrenia show?
WHO 1973. rates of locally diagnosed schizophrenia higher in US and Russia - different classifications of the illness between countries
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what was rosenhan's experiment on being sane in insane places? (1973)
researchers reported hearing a voice saying empty or thud were diagnosed w/ SZ. all admitted to hospitals and all had issues being discharged despite behaving normally. clear need to increase reliability between clinicians
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why were discrete categories if disorder required?
to meet various external needs - to record diagnostic categories to be reimbursed by insurance companies. for pharmaceutical reasons
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what are the DSM 5 criteria for SZ?
2 or more of following: delusions, hallucinations, disorganised speech, grossly disorganised/catatonic behaviour, negative symptoms. must have 1, 2 or 3
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what are some examples of activism over science relating to the DSM?
removal of homosexuality in 1974, making of post traumatic stress disorder following military trauma
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what are the different functions of psychiatric diagnosis?
clinical (communication shorthand, management & treatment, organisation of services), research, personal (meaning & understanding patient and family, communication & understanding from others, access to care, access to support (benefits)
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what are the problems w/ psychiatric diagnosis?
personal & moral (pathologisation of normal responses, language & labelling, stigma, power imbalance) technical (reliability, validity, comorbidity)
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how does the DSM contribute to the pathologisation of normal responses?
defines mental health problems as abnormal so defines how we describe normal. includes removal of grief exclusion and psychosis risk syndrome. this widens the net of who can be considered disordered. more meds.
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what are the issued of language and labelling of SZ?
lang from biomed model (disorder, symptoms) - seen as deficits within indivs. mentally ill - constructs particular social position - leads to disadvantage. when recover from mental illness also have t recover from being labelled mentally ill
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what is the issue of stigma in SZ?
perceptions of dangerousness and unpredictability, fear and desire for social distance
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what is the issue of power imbalance?
clinician redefining another's reality, psychiatry as means of social control, diagnosis difficult to challenge as a service user (difficult, manipulative, lacking insight)
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what is the issue of reliability in SZ?
issue w/ interrater reliability - whether 2 clinicians will assess the same person and assign same diagnostic category. determined by kappa stat (measure of agreement w/ 1 as perfect agreement). aim 0.7 above. 0.6 = acceptable. dsm = 0.4-0.6.
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what are the issues of validity in SZ?
fuzzy boundaries between disorder and normality. lack of zones of rarity between diagnostic categories (diag cats overlap, not discontinuous categories w/ separation between them)
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what are the issues of comorbidity within mental ill health?
more than 50% of people diagnosed w/ mental disorder in given year meet criteria for multiple disorders. raises q's of underlying structure & assumptions of classification
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what are internalising and externalising dimensions?
internalising - anxiety and mood disorders, externalising - behaviour and substance disorders.
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what does evidence show about the relationship between symptoms of SZ?
don't correlate w/ each other. studies show there are 3 different types of SZ symptoms - positive (hallucinations & delusions), cog disorganisation, negative
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what is the 5 dimensions model of psychosis?
bipolar, SZ and schizoaffective disorder can be explained by liddle's 3 dimension model plus depression and mania
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what are the causal networks in SZ?
half symptoms described in DSM 4 connected through common bridge symptoms which are shared across diagnostic criteria. symptoms seen as interrelated due to causal links between experiences
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what are the research domain criteria?
aims to develop a more precise diagnostic system based on mechs rather than symptoms. pos & neg emotional fear, cog systems, social processes, arousal/modulatory systems (responsiveness to reward). aims to explore emo, behav, neurobio functioning
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what is the symptom level & problem list approach?
rejects idea of discrete categories disorder causing symptoms. bentall argues an understanding in indiv symptom, concept of underlying disorder will become redundant. using scientific method - identifying problems & using scientific lit
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what is psychological formulation?
summarises indiv core problems, suggests how persons difficulties may relate to one another (draw on psych theories), aims to explain development & maintenance of persons difficulties, indicates plan of intervention w/ is based in psych processes
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what is open dialogue?
systematic assessment, less focus on categorisation & classification of probs, doesn't seek to identify deficits within indiv, probs identified when emerge from social network. emphasises ways indivs construct themselves in response to others.
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what are the 7 principles of open dialogue?
1. provision of immediate help 2. social network perspective 3. flexibility & mobility 4. responsibility 5. psych community 6. tolerance of uncertainty 7. dialogism
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what is provision of immediate help?
immediate help within 24 hours of referral/contact w/ team
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what is flexibility and mobility according to the 7 principles of open dialogue?
includes need-based adaption of of therapeutic response and/or location of meetings
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what is responsibility according to the 7 principles of open dialogue?
responsibility of staff team who works w/ family across course of intervention
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what is psychological continuity?
meetings continue to be held for as long as necessary and across outpatient and inpatient care if necessary
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what is tolerance of uncertainty?
safe space is created for team, indiv and their network - premature decisions and conclusions are avoided
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what is dialogism?
promote it as primary concern, empowering families w/ sense of agency
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how did Falret and Baillarger's views differ about bipolar disorder? (19th century)

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baillarger = recurrent oscillations between excitement and depression (1850's). falret = similar condition but noted periods of symptom free recovery between these oscillations. He also noted that the illness appeared to be clustered in fams - genes?

Card 3

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what did Kraepelin believe about diagnosis?

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Card 4

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what is the kraepelin dichotomy?

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what is kraepelin's dementia praecox?

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