Chapter 3 Flashcards
Diagnosis
Determination or identification of the nature of a person’s disease or condition or a statement of that finding
Diagnostic System
a system of rules for recognizing and grouping various types of problems. Provides a number of criteria for a disorder
Assessment
is a procedure through which information is gathered systematically in the evaluation of a potential disorder or disorders; this assessment procedure yields information that serves as the basis for diagnosis
Mental Health Assessment Example
interviews with the patient or the patient’s family, medical testing, psychophysiological or psychological testing, and the completion of self-report scales completed by the patient or other-report rating scales completed by others who know the patient well
Perfect Diagnostic System
Presenting systems (patterns of experiences and behaviours)
Etiology (history of the development of symptoms and underlying cause)
Prognosis (future development or maintenance of symptoms
Response to treatment (how well different treatments work to reduce synptoms)
Criteria for Strong Diagnostic System
1)Reliability= give the same measurement for a given thing everytime
2)Inter-rater reliability= refers to the extent to which two clinicians agree on the diagnosis of a particular patient.
3) Validity= whether a diagnostic category is able to predict mental disorders accurately.
4)Concurrent Validity= refers to the ability of a diagnostic category to estimate an individual’s present standing on factors related to the disorder but not themselves part of the diagnostic criteria.
5)Predictive Validity= the ability of a test to predict the future course of an individual’s development. The key to a clear understanding of a disorder is its progression
History of Classification of Mental Disorders
1)International List of the Causes of Death
2)International Statistical Classification of Diseases, Injuries, and Causes od Death
3)Diagnostic and Statistical Manual (DSM)
-DSM I and DSM II= brief, and vague descriptions of the diagnostic categories
4)DSM III
5) DSM-III-R
Atheoretical
They moved away from endorsing any one theory of psychology or psychopathology
DSM-III-R was developed to be Polythetic
-meaning that an individual could be diagnosed with a certain subset of symptoms without having to meetall criteria
-required to provide substantial patient information, evaluating and rating patients on five different axes, or areas of functioning.
Most widely known, updated Diagnosis in US and Canada
DSM-5-TR
Most used in Eurpean Union
International Classification of Diseases (ICD-11)
Flaws of DSM-1 and DSM II
were also greatly influenced by psychoanalytic theory, focused on internal unobservable processes, were not empirically based, and contained few objective criteria.
Section 1: Introduction and Use of the Manual (DSM-5-TR)
provides a historical background of the DSM, a summary of its development, an introduction to relevant issues, and guidelines for proper use of the diagnostic system
Section II: Diagnostic Criteria and Codes
-are the psychological disorders that have been recognized for centuries because of their bizarre symptoms (e.g., schizophrenia) or the difficulty they pose in the everyday life of individuals (e.g., mood disorders).
-personality disorders, which are long-term disturbances that interfere with a person’s life.
-collects information on the patient’s life circumstances, recognizing that individuals live within a social milieu and that stressful social circumstances might contribute to symptom onset.
Section III: Emerging Measures and Models
-optional measures to aid clinical decision making and increase sensitivity to patients’ cultural context
-WHO Disability Assessment Schedule 2.0 (WHODAS), a self-report questionnaire that assesses a person’s level of functioning and impairment across six domains, including understanding and communicating, getting around/mobility, basic self-care, getting along with other people, life activities (at home, work, or school), and participation in society.
-Outline for Cultural Formulation, which provides a framework for assessing the cultural features of an individual’s clinical presentation.
-Cultural Formulation Interview (CFI)
Outline for Cultural Formulation- SECTION III
emphasizes the importance of assessing the cultural identity of the individual (e.g., racial, ethnic, or cultural reference groups, migrant status, language abilities and preferences, religious affiliation, socio-economic status, sexual orientation, gender identity)
-cultural conceptualizations of distress (i.e., how culture influences how the individual understands, experiences, and communicates problems to others and their help-seeking choices, including use of traditional sources of care)
-psychosocial stressors and cultural features of vulnerability and resilience (i.e., stressors and supports such as religion, family, and social networks)
-and cultural features of the relationship between the individual and the
-clinician (i.e., differences in culture, language, and social status that may influence communication and the therapeutic relationship).
Cultural Formulation Interview (CFI)- SECTION III
Cross Cutting Symptom Measures- SECTION III
for evaluating problems across mental health domains. These are aimed at assisting clinicians in identifying additional problems that patients may be experiencing and that may be important for determining diagnosis, treatment, and prognosis.
Neurodevelopment Disorders
intellectual, emotional, and physical disorders that typically begin before maturity
-ADHD, Intellectual Disability, Autism, communication disorders, motor skills, tic disorders
Attention Deficit Hyperactivity Disorder
individual displays maladaptive levels of inattention, hyperactivity, or impulsivity, or a combination of these.
Intellectual Disability
deficits in intellectual and adaptive functioning with impairments in social adjustment, identified at an early age
Autism Spectrum Disorder
child can experience severe impediments in several areas of development, including social interactions and communication; restricted or repetitive patterns of thought and behaviour
Learning disorders
person’s functioning in particular academic skill areas is significantly below what is expected based on their intelligence
Communication Disorders
individual experiences significant difficulty with the reception, expression, or social use of language
Motor Skills Disorder
which the individual experiences developmental problems with coordination and which include the tic disorders, in which the body moves repeatedly, quickly, suddenly, and/or uncontrollably (tics can occur in any body part or can be vocal).
Schizophrenia Spectrum and Other Psychotic Disorders
-Debilitation in thinking and perception
-Psychosis= delusions (false beliefs, believing that people are tring to hurt them)
-Hallucinations (false perceptions, such as hearing voices)
-Cannot care for themselves, relate to others, and inability to function at work
Thought Disorder= Schizophrenia
-Incoherent speech, loose associations (dosconnected thoughts), inappropriate affect (smiling and laughing while watching an upsetting/violent scene)
-Disorganzied Behaviour (public masterbation)
Mood disorders
Major depressive disorders, bipolar disorder, cyclothymia
Major depressive disorder
-occurrence of depressive mood episodes in which a person is extremely sad and discouraged and displays a marked loss of pleasure in usual activities
-Over/under sleeping
-Weight loss/gain
-lack of energy to do things
-Difficulty concentrating
-Worthless, guilty, suicidal
Mania
-Person is extremely elated, more active than usual, needs less sleep, and experiences rapid flight of ideas and grandiosity (illusion of personal importance
Cyclothymia
-Less severe varient of bipolar disorder
-Fluctuates between more mild bouts of mania and less severe depressive symptoms
Anxiety
experience excessive fear, worry, or apprehension; the excessive fear usually produces a maladaptive pattern of avoidance.
Specific phobia
A person can have an intense fear of a specific object or situation, which is referred to as a specific phobia
Social Anxiety Disorder
Some individuals have an extreme fear of social situations
Panic Disorder
experience panic attacks and fear that they will go crazy, have a heart attack, or die
Agoraphobia
may avoid public places due to fear of being unable to escape the situation or get help if needed
Generalized Anxiety Disorder
Difficulty controlling excessive worry
Obsessive Compulsive Disorder
obsessions (recurrent, unwanted, and intrusive thoughts) and compulsions (repetitive behaviours or mental acts) which, when not performed, cause overwhelming distress
Body Dysmorphic disorder
re overly preoccupied with an imagined defect in their appearance.
Hoarding Disorder
characterized by difficulty and distress associated with parting with belongings, regardless of their value, and an overaccumulation of possessions.
Trichotillomania
experience intense urges to pull out their own hair.
Acute stress disorder/Post Traumatic Stress Disorder/Adjustment Disorder
may also experience long-standing anxiety and distress subsequent to extraordinarily traumatic events or to challenging life events
DSM-5-TR
Anxiety has three sections:
1) Anxiety Disorders: specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder
2)Obsessive Compulsive and Related Disorders: obsessive-compulsive disorder, body dysmorphic disorder, hoarding disorder, trichotillomania
3) Trauma and Stress Related Disorders (post-traumatic stress disorder, acute stress disorder, adjustment disorder)
Comorbidity
defined as the presence of more than one disorder in the same individual
Dissociative Disorders
dissociation is characterized by a sudden and profound disruption in consciousness, identity, memory, and perception.
Dissociative Amnesia
may forget their entire past or, more selectively, lose their memory for a particular time period.
Dissociative Identity Disorder
They may suddenly and unexpectedly leave their home and travel to a new locale, start a new life, and forget their previous identity.
-Posess two or more distinct personality states
Depersonalization/derealization Disorder
involves a severe and disruptive feeling of self-estrangement or unreality
Somatic Symptom and Related Disorders
physical symptoms of somatic disorders have no known physiological cause but seem to serve a psychological purpose.
Somatic Symptom Disorder
characterized by the experience of one or more persistent physical symptoms accompanied by excessive thoughts, feelings, or behaviours related to the symptom(s).
Conversion Disorder
the person reports altered motor or sensory function, for example, paralysis, seizures, or blindness.
Illness Anxiety Disorder
involves extreme anxiety about health in the absence of somatic symptoms; individuals become preoccupied with the fear that they have a serious illness.
Factitious Disorders
are diagnosed when individuals intentionally produce or complain of either physical or psychological symptoms due to a psychological need to assume the role of a sick person.
Eating Disorders
characterized by disturbances in eating behaviour. This can mean eating too much, not eating enough, or eating in an extremely unhealthy manner (such as repetitively bingeing and purging).
Anorexia Nervosa
the individual does not maintain a minimally normal weight for their age and height. Such people avoid eating and become emaciated, often due to an intense fear of becoming fat.
Bulimia Nervosa
there are frequent episodes of binge eating coupled with compensatory activities such as self-induced vomiting or the use of laxatives
Binge Eating Disorder
there are frequent episodes of eating large amounts of food in a discrete period of time
Pica’s Disorder
involves eating substances that have no nutritional value, such as sand and feces, on a persistent basis.
Elimination Disorders- Enuresis and encopresis
Diagnosed in childhood or adolescence
Enuresis
involves the repeated voiding of urine in inappropriate places,
Encopresis
Defecating/pooping where you shouldn’t
Insomnia
Not getting enough sleep
Hypersomnolence
Excessive sleepiness
Narcolepsy
Suddenly lapsing into sleep. Brain’s inability to regulate sleep wake cycles, and they experience excessive daytime sleepiness, and sudden, uncontrollable episodes of falling asleep during the day, such as working, driving, or a conversation
Breathing-related sleep disorders
Related to the amount, timing, and quality of sleep
Parasomnias
Relate to abnormal behaviours, movements, emotions, perceptions, or dreams during sleep that occur during the process of sleep or sleep wake transitions- sleepwalking, night terrors, nightmares, sleep talking
Sexual dysfunction
Disturbance in sexual desire or in the psychophysiological changes that accompany the sexual response cycle
-Inability to maintain an erection, premature ejactulation, and inhibition of orgasm
Paraphilic disorders
Sexual urges, fantasies, or behaviours, such as exhibtionism, voyeurism, sadism, and macochism that cause significant distress or impairment
Gender Dysphoria
Feel extreme and overwhelming distress association with their anatomical sex and an incongruity between their biological sex and gender identity
Intermittent explosive disorder
The person has episodes of violent behaviour that result in the destruction of property or injury to others
Oppositional defiant disorder
There is a recurrent pattern of negativist, defiant, disobedient, and hostile behaviour toward authority figures
Conduct disorder
Children persistently violate societal norms, rules, or the basic rights of others
Disruptive, Impulse-Control, and Conduct Disorders
Failure or extreme difficulty in controlling impulses, despite negative consequences
Substance Related and Addictive Disorders
Brought by excessive use of a substance, which can be defines as anything that is ingested in order to produce a high, alter one’s senses, or otherwise affect functioning
-Unable to control or stop their use of substances and may become physically addicted to them
-Alcohol related disorders, hallucinogen-related disorders, opiod-related disorders, sedative-, hypnotic, or anxiolytic-related disorders
Neurocognitive disorders
Refer to conditions in which there is a decline in cognitive functioning
Delirium
clouding of consciousness, wandering attention, and an incoherent stream of thought. It may be caused by several medical conditions as well as by poor diet, exposure to a toxin, or substance intoxication or withdrawal. Major and mild neurocognitive disorders are a deterioration of mental capacities, are typically irreversible, and are usually associated with Alzheimer’s disease, stroke, or several other medical conditions, or with substance abuse
Personality Disorders
enduring, pervasive, inflexible, and maladaptive pattern of behaviour that has existed since adolescence or early adulthood, markedly impairs functioning, and/or causes subjective stress.
Antisocial personality disorder
in which the person displays a history of continuous and chronic disregard for and violation of the rights of others
Dependent Personality Disorder
a person manifests a pattern of submissive and clinging behaviour and fear of separation.
Conditions not considered mental disorders but they still focus on attention or treatment:
academic problems, marital problems, occupational problems, and being physically or sexually abused. For example, a student’s academic performance may decrease for a significant period of time even though the student does not have an anxiety disorder, clinical depression, learning disability, or any other mental disorder that would account for underachievement.
Key reason why the system of Classification was revised to create the DSM-5-TR
-New empirical evidence about mental disorders= new addition of the hoarding disorder
-Took development into greater consideration= distinct criteria were created for diagnosing young children
-Change in the organization= which reinforces our current understanding of the development of, and associations among mental disorders
Flaw in DSM-5-TR: Categorical approach
an individual is deemed to either have a disorder or not have a disorder, with no in-between
Dimensional approach
to diagnosis based on a continuum for mental disorders from non-existent or mild to moderate and to severe.
Against Classification: Medical Model
Medical disorders are legitimate, they argue, because they have a clear indication, such as a lesion, that serves as a recognizable deviation in anatomical structure, whereas most mental disorders involve no such anatomical deviations. Diagnosis of “mental illness,” these critics suggest, is simply a de facto means of social control
Spectra
the recognition of a “schizophrenia spectrum” that includes schizophrenia as well as disorders that share genetic and neurobiological facets with schizophrenia, such as schizoaffective disorder or schizotypal personality disorder.
- diagnostic criteria for many disorders include the option for clinicians to specify current severity as mild, moderate, or severe
Clinical Unity
refers to the extent to which a diagnostic system assists clinicians in performing functions such as communicating clinical information to patients, their families, and other health care providers; selecting effective interventions; and predicting the course of a disorder
Stigmitization
Another argument against diagnosis is that it unfairly stigmatizes individuals. A person diagnosed with schizophrenia, for instance, is often seen simply as “a schizophrenic,” rather than as a complex individual with skills and interests.
-Discourages them to get any help
Loss of Information
-A frequent charge against diagnosis is that inherent in any label is a loss of information
-EX: Similarly, an individual with depression is characterized by many other qualities, not just their depression. The label alone can give us a false sense of confidence in understanding the person and making assumptions about their personhood and life that are not valid.
-Once the pseudo-patients were seen as having the label of a psychiatric disorder, all their subsequent behaviour was seen through the prism of this diagnosis. Thus, if the pseudo-patients did not display symptoms, the mental health professionals working with them interpreted this to mean that their symptoms were being managed well, not that there might have been a mistake in the original diagnosis or that the diagnosis might no longer apply.
