Assessment, Classification, and Diagnosis Flashcards
Our current system has its origins in ___________ with the concept of _______.
medical models; syndromes
Who are the 2 researchers who rly contributed to today’s vision of psychopathology?
Thomas Sydenham & Emil Kraepelin
Thomas Sydenham core ideas (2)
British physician from the 1600s. Tried to identify physical syndromes or diseases to better treat physical ailments.
(1) To him, Disease/syndrome = measurable entity.
(2) Expresses itself as clusters of symptoms that present together. => All symptoms hang together in some way, present at the same time, predictable course, go together.
Emil Kraepelin core ideas (2)
Psychiatrist from the 19th century. Among the first to try to apply Sydenham’s ideas to mental health.
(1) Distinct forms of mental illness are defined as a syndrome. I.e. With clusters of correlated symptoms all/largely present together
(2) Mental disorders are TAXONIC in nature. I.e. mental disorders are CATEGORIES that exist in the real world (either you have it or you don’t).
=> Differentiated psychological conditions based on their signs, symptoms, and natural histories.
Wakefield’s Harmful dysfunction
Looks at natural selection as a basis to define psychopathology.
Disorders have both a biological/evolutionary component & a social component.
What is “Dysfunction” in Harmful dysfunction?
“An organ system performing contrary to its design.” Importantly,notat the peak of its design.
What is “Harmful” in Harmful dysfunction?
[Subjective] Has to cause problems within the environmental context in which the individual is situated.
-> What is adaptive varies across contexts. What’s adaptive will look different. Bound by societal norms (in part).
In the concept of “Harmful dysfunction”, is it still harmful if the person is NOT suffering from the dysfunction?
A person doesn’t THEMSELVES need to perceive that they are suffering from this dysfunction. Can be that dysfunction causes harm to other people
Lillienfeld critique of harmful dysfunction (2)
(1) It’s really hard to differentiate between adaptations (math/arts) & secondary adaptations (feathers). If can’t do math doesn’t mean that something’s wrong
(2) So what are the core features of this organ system that we’re looking at to define psychopathology?
=> Some disorders may represent adaptations, not maladaptations.
Widiger Proposal core idea (2)
(1) Forms of pathologies are constructs.
=> Because mental disorders are constructs, there’s not going to be any single definitions that entirely captures it. Constantly evolving.
(2) We need to consider all of these different ways of thinking (e.g. statistical, harmful dysfunction…) to understand the whole construct of mental illness/psychopathology.
Construct def
Things that we think exist that we cannot measure directly. Way of organizing the world.
=> Idea or theory containing various conceptual elements, typically one considered to be subjective and not based on empirical evidence.
Purposes of a Classification System (4)
(1) Description: Highlight critical features of a diagnoses.
(2) Prediction:May tell you something about course, treatment response, etiology.
(3) Theory: Provides a set of postulates about relationships of different elements to one another. How/why do some symptoms hang together?
(4) Communication:e.g., between clinicians. You want every clinician to have the same definitions.
5criteria (Robins & Guze) proposed for valid classification of disorders
(1) Clinical Description:The disorder has to be characterized by a common set of symptoms that cluster together and are characteristic of the disorder.
(2) Course:People with the disorder should follow a common trajectory, and have a similar onset.
(3) Treatment Response:If a disorder is valid, most people with that disorder will respond similarly to similar treatments.
(4) Family/Natural History:Does the disorder run in families? Considers the course and outcome of the disorder. People with the disorder should follow a common trajectory, and have a similar onset.
(5) Laboratory Studies:Involves data from psychological, biological, and laboratory tests. Look for biological and psychophysiological associations
Limitations of a Classification System (2)
(1) Loss of Uniqueness: common features are more important
(2) Difficulty of boundary cases
Categorical model def
Presence/absence of a disorder. You have the disorder or not.
Categorical model Pros (3)
(1) Advantages for research and understanding.
(2) Simplifies communication. Natural preference among humans to employ categories in speech (not: they’re 3/10 on mood).
(3) Categories better-suited for clinical decision-making: Hospitalize or don’t? Treat or don’t? (3)
Dimensional model def
Rank on a continuous quantitative dimension. Everybody falls SOMEWHERE on the dimension.
Dimensional model Advantages (4)
(1) Better capture an individual’sfunctioning
(2) Give more info about the person
(3) Preserves more information
(4) Greater reliability–inter-rater, test re-test
Cons of Categorical (1)
Cutoffs in categorical system tend to magnify small differences
Cons of Dimensional
Taking a dimensional approach: Would need a threshold. Cut tend to be arbitrary. Looks a lot like categorical model.
When was the DSM-1introduced?
- Not that long ago. Shows how young the science of clinical psychology is.
DSM-II Characteristics (4)
1968.
(1) Few categories (I and II). Broad descriptions of the disorder.
(2) No requirements for number of symptoms.
(3) Psychoanalysis was the dominant paradigm
(4) Problem for epidemiological research bc no standardized definition. =→ If you care about how frequently things occur in the world across countries, you want to have a standardized definition.
DSM-III Changes (7)
1980.
(1) Define many more forms of psychopathology
(2) Inclusion Criteria:What symptoms do you need to have, and how many?
(3) Duration Criteria:Howlongdo you need to exhibit these symptoms?
(4) Exclusion Criteria:What symptomsrule outa diagnosis?
(5) Multi-Axial Classification
(6) Structured interviews
(7) Theoretical agnosticism
Multi-Axial Classification in DSM-III
Axis I: Presence/Absence - Major Clinical Disorders(e.g., MDD, PTSD)
Axis II: Presence/Absence - Personality Disorders(e.g., BPD, NPD)
Axis III: Medical conditions that might contribute or be relevant to treatment
Axis IV: Psychosocial Stressors (environment)
Axis V: Global Assessment of Functioning (GAF)
