Abnormal, basics, classification and diagnosis Flashcards
Define syndrome disease disorder
Syndrome = clump of symptoms that often stick together, implying same cause Disease = when you know the underlying cause, and defined by that cause
Empirical philosophy of Abnormal psych because;
- its ethical
- once we know cause we can attempt treatment
- maintaining factors also good to know to stop them and stop the disorder
Medical Model history
dichotomous health versus sickness, sanity and insanity
old argument was were all mental illnesses deviations on the same theme i.e ‘insanity’ - one singular disease
one ‘mad doctor’ as opposed to now with psychologists psychiatrists etc
Prevalence and Incidence
point prevalence how many people suffer now
one year prevalence how many have suffered at all in the past year
life prevalence how many have suffered at all in there lives
Incidence is about how many new cases there have been, say in a year, in Australia the incidence of depression and anxiety is exponentially growing, there and more and more each year
Important to assess incidence for prevention assessment and planning, we are obviously failing atm
Psychiatric epidemiology
counting the number of people who seek treatment is problematic and under-reports
sampling 10’s of thousands via phone email surveys better epidemiological project
we can also ask how many sought help and whether it was helpful and plan public health works around that
How many people with lifetime prevalence of mental illness in Australia
30-50%
Is this a huge public health problem or is it an overestimation??
this is the problem of diagnosis
about a third of those sought treatment
(for schizophrenia its nearly half though)
DSM conditions for something being an illness not wellness
- clinically significant
- causes distress/disability/suffering to the person or surrounding people
- Not culturally sanctioned
- Is a dysfunction ie a miss-firing of a normal process
Major depression in the DSM necessary and sufficient
must have 5 from the list for over 2 weeks including one of the first 2
excludews grief and med issues
symptoms particularly when only looking at the past two weeks
Current DSM model
Medical model, initially influenced by psychoanalysis, now an uneasy marriage of the two.
Now a symptom cluster approach, rather than eatiological
The medical model assumptions
- illness qualitativly different to wellness
- illnesses are distinguishable from each other
- they occur independantly and have specific identiyable causes
- therefore should respond to specific treatments, which are aimed at the causes
history of psych models
Hypocrates; medical model origins, looked for causes
hysteria = wandering womb
paracleasus lunacy = moon (external, but still causal modal)
Louis Pasteur - germ theory, cemented medicine in medical model/biological
Brain physiology focus in psych, iw weinicke and broca on brain geography (1800s)
continued until various unproven treatments were causing so much harm ie removing organs to treat insanity, labotomy
ENTER FREUD, a new safer solution
anti-medical model, psychologiical rather than physical causality, psychological fixes
What did psychoanalysis give to psych models?
- dimensionality, normal/abnormal de-dichotomised
- added low level illnesses to the field ie anxiety (not just psychotic illnesses)
- no clear line between diseases, comorbidity compexifies
- proliferation and specification of psychologocial field (not just ‘mad’ doctors who were unqualified, begin the profession)
- DSM came out of this proliferation, began the practise of quantifying disorders and catagorising/treating seriously
What caused the DSM I - III general model to come under fire in the 1980s
- no inter rater reliability, is guilt from ego wars necessary for diagnosis? many dont present with guilt
- introduction of behaviourism and empiricism philosophy
- obvi no evidence for ego super ego and id
What then? DSM 4 and 5 diagnoses by…
symptom clusters, pragmatic approach
clear explicit diagnostic criteria approach to improve inter rater reliability and the consistancy of the field
Without underlying cause however, can we really say validity has increased?
the modern aim; clearly bound up symptom clusters (“descriptive approach”) and hopefully eventually find underlying causes
problems with current dsm
- comorbidity implies no clear diferentiation between diseases, problem for medical model
- lack of treatment specificity also as a result, CBT for everything, again doesnt fit the med model
- dimensionality of diseases is a thing, anxiety clearest example, normal abnormal, no clear line, this goes against med model
the history of strict criteria for treatment analysis
all theorys and there respective treatments are linked ie
humanism - unconditional positive regards
psychoanalysis - ego war resolution
Cog behavioural theory - CBT therapy
Eysenck 1952 found evidence people were no better after psychoanalysis
Shapino 1982 found a little better after SOME treatment, no difference between them though (non specific factors, ie just having a shoulder to lean on, probably at play)
ENTER criteria for good treatment
How to test treatments
need at least 2 good RCT studies proving it is better than placebo or other treatment (OR equivilant to current treatment)
GOOD RCT
need control group,
need to control for extraneous variables
randomised allocation
double blind
specific treatment manual, administrator training, very closely administered and acurately
sample exclusion criteria must be carefully and closely established
effects must be found by mmultiple administrators within a single trial
To prevent against publication bias, trials must be pre-registered and negative results reported (abnormal psych is preemininat in psychology in this way)
Expirimental treatments
have only pre and post evidence, have not been ‘manualised’ adequately and all those good RCT things
Evidence based treatment for anxiety
exposure
cbt
Evidence based treatment for depression
cbt
interpersonal
behavioural activation
some for mindfullness and psychanalysis
Evidence based treatment for OCD
exposure and response preventino
cbt
Evidence based treatment for ADHD
parent management training
Evidence based treatment for child anxiety
parent CBT training(dont reinforce anxious behaviours ie through attention)
Criticisms of DSM diagnosis
- dehumanising
- de-individualised (but has to be to find the universals to have something, manualised treatments also better for young clinicians
- cant generalise research findings as fully as we are ie external validity
- small effect size
- treatments effective under highly controlled conditions, but in the real world…
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