Chapter 3: Classification and Diagnosis

Question 1

What are the two key aspects of the adequacy (satisfactoriness) of classification systems?

Answer 1

validity and utility

Question 2

What is validity? What is utility?

Answer 2

validity is the extent to which the principles used in classifying an entity are effective in capturing the nature of the entity (how accurate principles are)

Utility is the usefulness of the resulting classification scheme

Question 3

What is categorical approach?

Answer 3

categorical approach is when the entity is determined to be either a member of a category or not

theres a qualitative (non-numerical) difference between entities that are members of the category and those that are not

the person is judged to either have the disorder or not have the disorder even though there may be overlapping categories but those within a category are perceived as all the same

Question 4

What is dimensional approach?

Answer 4

based on the assumption that entities differ in the extent to which they possess certain characteristics or properties

reflects that all entities can be arranged on a continuum to indicate the degree of membership in a category

the different dimensions may or may not be related but it is essential that the dimensions reflect significant higher order constructs rather than simple descriptive features

Question 5

What was the two dimensions found in Thomas Achenbach’s research on children’s difficulties?

Answer 5

1. internalizing problems: acting out behaviours like yelling, stealing, outwardly showing aggression
2. Internalizing problems: feelings of sadness, worry, and withdrawn behaviour

Question 6

What is a diagnostic system and a diagnosis?

Answer 6

a diagnostic system is a classification based on rules used to organize and understand diseases and disorders

a diagnosis is what a classification system yields that describes the symptoms that comprise the persons condition

Question 7

What is a prototype model?

Answer 7

members of a diagnostic category may differ within the category in the degree to which they represent the concepts underlying the category

i.e. not all people receiving the same diagnosis have exactly the same set of symptoms

Question 8

What are two factors that determine if a behaviour is abnormal?

Answer 8

1. age

2. cultural background

Question 9

What is developmental psychopathology?

Answer 9

examines problem behaviour in relation to milestones that are specific to each stage of development

emphasizes the importance of major developmental transitions as well as disruptions to normal patterns of development

huge reliance on empirical knowledge of normal development

can be used to predict how a untreated disorder can present itself later in life

Question 10

What do classification systems for mental disorders rely on?

Answer 10

almost entirely on the observation of symptoms and rely on client self report data

Question 11

How does the DSM-5 describe the definition of a mental disorder?

Answer 11

describes it as what it is and what it is not

it states that there has to be a co-cooccurance of a set of statistically rare symptoms and behaviours but also requires that there is something wrong and dysfunctional and dysfunction in this case causes harm to the individual or to those around them (harmful dysfunction)

Question 12

What is dyscontrol?

Answer 12

means the resulting impairment must be involuntary or at least not readily controlled

Question 13

According to the WHO study of mental health prevalence across countries, which mental illness was most common? what was the general trend of mental illness across countries?

Answer 13

anxiety disorders were the most common and mood disorders second common in all countries except ukraine

Countries that had the lowest per capita income also had the most highest and lowest total prevalence rates

Question 14

What did the Wittchen et al study in 2011 conclude about mental illness in the EU?

Answer 14

38% of the EU population suffers from mental disorder and or neurological disorder with the most frequent disorder being anxiety disorders

Question 15

What are the percentages of physical disorders being treated in low income countries vs. mental disorders?

Answer 15

53% physical

8% mental

Question 16

What are the percentages of physical disorders being treated in high income countries vs. mental disorders?

Answer 16

65% physical

24% mental

Question 17

What was the research done on life stress and risk of developing anxiety or depressive disorder done by Turner and Lloyd (2004)?

Answer 17

illustrated how build up of life stress places people at risk of developing a disorder in 18-23 yr olds

examines links between stress and first episodes of anxiety or depressive disorders

of the 33 stressors examined, 26 were associated with increased risk of developing anxiety or mood disorder

the more number of stressors experience the higher the odds of developing a disorder

Question 18

What was the research done on interpersonal stress model use to se link between genetics and depression by Hammen, Shih, and Brennan (2004)?

Answer 18

examined the intergenerational transmission of depression among 800 australian adolescents and their mothers

results showed that depression in maternal grandmothers predicted maternal depression and interpersonal stress

The poor social competence and high interpersonal stress in children (placed by their mom’s similar symptoms) predicted their own development of depressive symptoms

Question 19

What was the research done by Cole et al (2002) on investigation of individual differences in emergence of psychological disorders?

Answer 19

he collected at a from grades 4 to 11 to investigate normal developmental shifts in the rate at which depressive symptoms emerge

found that depressive symptoms occurred around grades 6 and 7 and then it stabilizes

symptoms increase more rapidly for girls than boys between grades 5 to 7

this shows that theres a critical period where depression emerges

Question 20

What was the research done by Sutin et al. to see depression symptoms across the lifespan?

Answer 20

used data of participants to estimate the trajectory of depressive symptoms across the adult lifespan

found that depressive symptoms were highest in young adults, decreased during middle adulthood and then increased in older adulthood

Question 21

What was the results of depressive symptoms across the lifespan by eaton et al. in 2008?

Answer 21

he collected data on 3,500 adults in 1981 and obtained a follow up 23 years later

92 people had their first episode during the 23 years and out of the 92, 15% kept having depressive episodes every year after, and 50% of them who experienced a first episode of depression recovered and had no subsequent episodes of depression

Question 22

What was the Bongers, Koot, Van der ende and Welhulst research study done on the normative data in 2003?

Answer 22

They examined if behaviour presented in children or adolescents were normal or abnormal

they collected normal levels of problems like anxiety, somatic complaints, aggressive behaviour etc.. on 2000 dutch children and came up with results that are used across in clinical settings and other research as useful normative data for comparison of children between 4 and 18 years old

Question 23

When was the first edition of DSM first published? what did it heavily emphasize?

Answer 23

it was first published by APA in 1952 and emphasized psychodynamic etiological factors and had vague descriptions

Question 24

When was the second edition of DSM published and what did include that was different from the first?

Answer 24

Published in 1968 and included new treatment options like drug treatments, and psychiatric aspects of mental disorders… there was less psychodynamic orientation and more precision in terminology

Question 25

When was the third edition of DSM published and what are 4 big differences between the other two?

Answer 25

it was published in 1980

three differences included

1. explicitly theoretical –> allowed for the possibility of greater acceptance within mental health field and for the introduction of concrete behavioural descriptions of most disorders
2. diagnostic criteria were much more explicit than they were before with list of symptoms provided for each diagnosis
3. thousands of field trials were done for the diagnostic system
4. shifting towards greater attention to scientific literature and classification principles

Question 26

When was the DSM 4 published and what were some of the differences from the previous?

Answer 26

it was published in 1994 and it was more collaborative and scientifically informed than the ones before and the text- revision version was published in 2008 which went over some textual errors n the dam 4

Question 27

When did the planning for DSM 5 begin? and when was it released?

Answer 27

it began in 1999 and not released till 2013

Question 28

what are 5 criticism of the DSM-5?

Answer 28

1. lack of transparency in the developmental process and a lot of secret information
2. diagnostic inflation –> putting a lot of diagnostic criteria for a disorder more than it can handle and making it super broad
3. over representation of medical/biological views on mental disorders and treatment due to 70% of the people being involved with pharm companies
4. personality disorders were altered and inconsistent with scientific evidence
5. field trials yield very poor results for the reliability of diagnosis for common disorders like depression and GAD (hard to make a replica of experiments)

Question 29

What kind of approach to classification is the DSM? what does this mean?

Answer 29

DSM-5 is a categorical approach to classification

classes of disorders are clustered with similar disorders which are separated by internalizing and externalizing factors

internalizing factors like anxiety, depression and somatic symptoms are grouped together and externalizing factors like impulsive, disruptive conduct and substance use symptoms are grouped together

The DSM-5 also adopted the lifespan approach where disorders in younger children are in the beginning and disorders of older people are at the end

Question 30

What are 3 ways that the DSM-5 includes emphasis placed on ethnic and cultural considerations?

Answer 30

1. information on the scientific evidence (prevalence rates, ..etc..) for cultural/ethnic variation in clinical presentations of a mental disorder is within the text accompanying the diagnostic criteria
2. a limited number of cultural symptoms (culture-bound symptoms) are described in an appendix of DSM-5
3. A section on cultural formulation provides info to assist the clinical in making a culturally sensitive and appropriate diagnosis and over clinical formation like directing the attention to the cultural identity of the person being evaluated, cultural explanations for the disorder…etc..

Question 31

What is the ICD? How is it different from DSM?

Answer 31

ICD is the International Statistical Classification of Diseases and Related Health Problems
and it shows statistical classifications of all health conditions adopted by the WHO

its free and public unlike DSM

used for bulling purposes in the USA

differences include the way some diagnoses are described and conceptualized (i.e. ASD and PTSD)

Question 32

What was Kessler et al (2003) study on extent to which diagnostic data predicted psychosocial functioning?

Answer 32

he used epidemiological data to examine the extent to which diagnostic data predicted psychosocial functioning 10 years later

he classified individuals by the severity of their disorder (moderate and mild)

looked at hospitalization, severity increase, and work disability in those people in 10 years

found a linear relation between disorder severity and subsequent problems in psychosocial functioning
those at mild risk were 2.4 times more likely to develop significant psychosocial problems

this tells us that even mild mental disorders are associated with substantial subsequent frisk for impaired functioning and should be represented within a diagnostic research (this is pro-dimensional classification system)

Question 33

What is diagnostic reliability? What are two types?

Answer 33

In terms of inter-rater reliability is the numerical value of how many people agree on a disorder together

two types:

1. independent evaluators provide diagnosis that falls within same general category (big broad) which as kappa stat of 0.70 !! which is high
2. Reliability studies have examined extent to which independent evaluators agree on the same specific diagnosis and found that the kappa stat was very low 0.18 and extremely high 1.0 at the same time showing inconsistency in the classification system

Question 34

What is kappa statistic? What is the cut off of kappa value in many cases? and what is the relationship between kappa statistic and mental disorders?

Answer 34

Kappa stat is the measurement of inter-rater reliability

the cut off is said to be below 0.6 being the cause for concern in how clinicians diagnose mental disorders

The rarer/less frequent the mental disorder the lower the odds of kappa stat or inter-rater reliability (more likely clinicians will disagree about its presence during a diagnostic interview)

Question 35

What is a polythetic disorder? what are some drawbacks? and what are some attempts to address the limitations in polythetic approach?

Answer 35

present in both DSM and ICD where their disorders have the seamed diagnosis that can be applied to dindiivudals with a range of identical and different symptoms which causes problems with reliability

this lowers inter rater reliability

Also the response to treatment can be because of the difference across symptoms instead of diagnosis

attempts to address it is to establish subtypes but that doesn’t have enough scientific support

Question 36

What is validity and how is it described?

Answer 36

is how accurately the symptoms represent the diagnosis

wendell 2003 states that diagnostic validity is an indication that a disorder is a discrete entity that has clear boundaries with other disorders

examples of acute stress disorder and PTSD raises questions about its diagnostic validity

Question 37

What is comorbidity?

Answer 37

occurs when a person meets criteria for two or more disorders at a specific time

Question 38

How many percent of american adults seeking services for stress and anxiety disorders met the criteria for another disorder?

Answer 38

57%

Question 39

how many people with panic disorder met criteria for another anxiety disorder and how many of them met criteria for a mood disorder

Answer 39

36% for another disorder and 17% for a panic disorder

Question 40

how many percent of youth aged 3-18 met criteria for one or more disorders?

Answer 40

40%

Question 41

What is the evidence for depression being a specific condition (following a categorical approach of diagnosis) by Santor and Coyne (2001)?

Answer 41

they compared differences between adults who had clinical depression and the ones who were non-clinically depressed but were distress and noted that there were specific symptoms

depressed mood, anhedonia and sucides were more common in clinically depressed people

and

hypochondriasis and insomnia were more common for distressed people

argued that the use of continuum model might mask these differences in diagnostically relevant gorups

Question 42

What is evidence for depression being both categorical and dimensional?

Answer 42

beach and amir in 2006 –> found out that things like analysis of self report items expressing distress like loss of interest, discouragement… appear to have a dimensions perspective on the continuum of subclinical to clinical depression

analysis of self report items of somatic symptoms like weight gain/loss, sleep problems…etc.. were best understood as a categorical/discrete disorder