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PSYC340 > Chapter 3 - Classification/Diagnosis > Flashcards

Chapter 3 - Classification/Diagnosis Flashcards

1
Q

Uses of classification

A

Helps to better clarify/define problems
Provides basis for communication
Necessary for research and advancing scientific understanding
1st step to decide on treatment

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2
Q

DSM accronym

A

Diagnositc and Statistical Manual

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3
Q

What are some uses of the DSM?

A

Can be used for insurance companies
To give them the exact diagnosis
Can also be used as a guide (important in research - common ground)
In some practices people might use it all the time or not, it depends

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4
Q

First DSM

A

Published in 1952
An attempt to gather as much info as possible about diseases so that people could talk about it
Issues:
Dependent on the paradigm of the time (psychodynamic a lot, start of behavioural stuff)
Description of disorders based on how would someone see it under a certain paradigm (only limited to this view)

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5
Q

DSM-III (1980)

A

Introduced multiaxial classifications
Big milestone when it came out; classification system: depending on the struggle of the person, they could be diagnosed on axes (ex: 1 was a clinical syndrome, 2 was for things that were constant in time (personality disorders), one of them was for daily functioning, etc)
Got rid of those axes in the current DSM; lots of ppl contested that

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6
Q

DSM-IV (1994)

A

Chair: Dr. Allen Frances

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7
Q

DSM-5 (2013)

A

Introduces changes including elimination of multi-axial system
Very careful not to have paradigms involved; focuses on the symptoms so that anyone can recognize it no matter the paradigm they use

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8
Q

Goals of the DSM-5

A

Address gaps in diagnoses
Update criteria based on new research
Reduce the number of Not Otherwise Specified classifications because too generic
Add dimensions to categorical system (did not really do it)
Streamline and simplyfiy diagnoses

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9
Q

Overview of DSM-5 changes

A
  1. New disorders (ex: binge eating)
  2. New criteria for existing disorders
  3. New conceptualizations for current disoders (ex: OCD is no longer anxiety disorder)
  4. New names for existing disorders
  5. New dimensional ratings within some disorders
  6. Combining some disorders into a single bigger category
  7. Suicidal risk now highlighted
  8. Reorganization of age-related considerations
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10
Q

DSM-5 controversies

A
  1. Autism-spectrum disorder
  2. DMDD criticized as “temper tantrum”
  3. Bereavement can no longer exclude Major Depression - over-diagnosis of normal grieving
  4. Personality disorders still classified as categories not dimensions
  5. Some disorders being considered were omitted (ex: non-suicidal self-injury)
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11
Q

ASD controversy in DSM-5

A
  1. ASD: continuum of functioning (high end = very functioning, low end = barely functioning)
    People have disorder but on different levels of the continuum
    Previously, people with Aspergers were not included in this - was a problem
    They did not feel that their problem was the same as people with ASD
    Sub-groups developed for people with Aspergers
    Aspergers doesn’t exists anymore; now they have to fit into the continuum
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12
Q

DMDD controversy in DSM-5

A
  1. DMDD: basically a temper tantrum
    At what point is it normal vs a diagnosis?
    Some people will be treated for a normal behaviour
    Over-prescription of medication to treat this condition
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13
Q

Bereavement controversy in DSM-5

A
  1. Major Depression could not be diagnosed if someone was going through grieving
    Now, it is possible to diagnose depression even though someone is grieving
    Which may cause an over-diagnosis of simple grief as a pathology
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14
Q

Dr. Allen Frances’ critique of the DSM-5

A
  1. its changes will lead to dramatic increase in the number of ppl diagnosed with disorders (aka diagnostic inflation)
  2. pharmaceutical industry will benefit mostly by developing new drugs for new disorders and new people qualifying for reimbursement since they are now being diagnosed
  3. Argued for a retusn to a more cautious approach to diagnostic classification
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15
Q

Epidemiology

A

Study of frequency of disorders in classification

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16
Q

Prevalence

A

Proportion of ppl who have a diagnosis at any given time (has to be defined in terms of years and target pop)

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17
Q

Lifetime prevalence

A

Proportion of ppl who have ever had a diagnosis in their lifetime

18
Q

What is the concern when prevalence rates rise dramatically?

A

Concern that “normal” individuals are being incorrectly diagnosed

19
Q

Example of context influencing diagnostic inflation

A

The context might also be at play; not necessarily because of misdiagnoses
Pandemic: people with a predisposition to particular disorders increased the prevalence of certain disorders (considering that the pandemic was a major stressor)
Example: dissociative identity disorder
A book came out, of the story (written by a psychiatrist) of Sybil; who had multiple personalities
Another book (3 faces of Eve) also on the same topic came out
Diagnoses for this disease spiked; it was the “in” diagnosis - lots of people never had it in the first place

20
Q

Comorbidity

A

Defined as the co-occurence of different disorders in 1 person
Considered a major issue because it makes treatment planning + difficult
When there is high co-morbidity, it raises concerns that the disorder is not distinct enough

21
Q

Go review DSM-5 Diagnostic categories

A

Point to take home

There are lots of umbrella terms that have lots of sub-categories

22
Q

General criticisms about classification

A

Loss of information about the person (person is defined as their disorder)
Stigmatizing

23
Q

Specific criticisms about classification

A

Discrete entity vs continuum: dimensional vs categorical model - no room for levels in discrete categorization (those people that have some, but not all, might not be adequately diagnosed)

The DSM represents a categorical classification - yes/no approach to classification
Continuity between normal and abnormal behaviour are not taken into consideration

24
Q

Advantages of a categorical classification system

A

Useful if we need to know if the person either has or has not the disorder
If we need to know whether to start or not certain treatment

25
Q

Advantages of dimensional classification

A

Most helpful when the disorder has levels (ex: from mild to severe)
Tends to have less comorbidity since measures are on a continuum and not all-or-none

26
Q

Reliability of a diagnostic system

A

Measures consistency, related to inter-rater reliability (will 2 ppl come to the same conclusion about a patient using the same classification system?)

27
Q

Sensitivity (component of reliability)

A

Extent to which there is agreement that the diagnosis is detected as being present

28
Q

Specificity (component of reliability)

A

Extent to which there is agreement that the diagnosis is absent

29
Q

Kappa

A

Statistic used to measure the extent of agreement over and above chance levels (kappa > .7 for reasonable reliability)

30
Q

Reliability of early DSM versions

A

Unreliable (bc of paradigm-specific perspective)
Many diagnostic disagreements
Info provided to make diagnoses depended on what an individual clincian might choose to ask about

31
Q

Reliability of newer versions of DSM

A

More extensive descriptions
More precise diagnositc criteria
Increased use of standardized diagnostic interviews has improves reliability by providing same detailed information

32
Q

Validity of diagnosis

A

How well does the diagnosis relate to other aspects of the disorder?

33
Q

Why is Internet Addiction disorder not in the DSM?

A

Compared to gambling problems
Growing research evidence, especially in post-secondary students
Either
Ppl with substance abuse
Ppl who are depressed, socially anxious, family problems

4 components of IAD, according to Jerald Block
Excessive use (loss of sense of time)
Withdrawal symptoms
Tolerance (need for better equipment, more software, etc)
Negative repercussions (social isolation, fatigue, lying, etc)

Made it complicated because 68% of IAD have other DSM diagnoses
Asia: happens in publics cafes
Western world; happens more at home (harder to detect)

Some argue that it’s only a symptom of other disorders

34
Q

How does the DSM defines mental disorder

A

“Syndrome characterized by a clinically significant disturbance in an individual’s thoughts or behaviour that reflects a dysfunction in the processes underlying mental functioning”

35
Q

3 ways that the DSM was improved to take cultural differences into consideration

A

Discussion of ethnic and cultural factors in the main body of each disorder
Providing a framework to evaluate the role of culture and ethnicity
Describing culture-bound syndromes in an appendix
Culture-bound was modified as cultural idioms or cultural explanations
Ex: koro (in Asia): excessive fear that the penis or nipples will recede into the body (classified as OCD)

36
Q

DSM introduced an Outline for Cultural Formulation

A

Calls for 5 specific assessments
Overall cultural assessment
Cultural identity of the individual
Cultural consideration of distress
Psychosocial stressors and cultural features of vulnerability and resilience
Cultural features of the relationship between the individual and the clinician

37
Q

APA has made the Cultural Formulation Interview (CFI)

A

Semi-structured interview assessing:
Cultural definition of the problem
Cultural perceptions of the cause/context/support
Cultural factors affecting self-coping and past help-seeking
Cultural factors affecting current help-seeking

38
Q

DSM-5 V codes

A

conditions or significant factors that are not disorders per se but can have a strong influence on treatment
Ex: homelessness, child maltreatment, etc (replaces 4th axis)

39
Q

DSM definition of mental disorder

A

“A syndrome characterized by clinically significant disturbance in individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.”

40
Q

2 examples of cultureal issues in clinical practice

A

Language boundaries between clinician and client

The way the client’s culture talks about emotional distress

41
Q

2 examples of cultureal issues in clinical practice

A

Language boundaries between clinician and client

The way the client’s culture talks about emotional distress

PSYC340 (14 decks)

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