Classification and Diagnosis

Question 1

What are the 4 criteria the DSM has for a mental disorder?

Answer 1

1. Clinically significant behavioural or psychological syndrome or pattern
2. Associated with significant distress or disability, or significantly increased risk of such
3. Must not be expectable or a culturally sanctioned response
4. Must be considered a manifestation of a behavioural, psychological or biological dysfunction

Question 2

What is the difference between point prevalence, one-year prevalence and lifetime prevalence?

Answer 2

Point-prevalence: “right now, X percent of Australians have Y disease”
One-year prevalence: “in 2007, X percent of Australians had Y disease”
Lifetime prevalence: “during their lifetimes, X percent of Australians have Y disease”

Question 3

What is incidence and how does it differ from prevalence?

Answer 3

Incidence refers to what proportion of healthy individuals will develop the disorder within a specified time period ( new cases)
Prevalence is total proportion of people with the disorder

Question 4

What is the lifetime prevalence of mental disorders?

Answer 4

◦ in adults 32-48 %
◦ before age 21: 35-49 %
◦ Life-time prevalence of any mental disorder: 45%
◦ Only about 1/3 of these people received help

Question 5

What are the key characteristics of the medical model?

Answer 5

Aetiologically based diagnosis is the ultimate goal of
medical (psychiatric) classification (like DSM)

Different illnesses are

• clearly distinguishable from each other
• occur independently from each other
• have specific, identifiable causal agents
• respond to specific treatment

Question 6

What is the medical/biological model?

Answer 6

Began largely in 1850 with the germ theory of disease, mostly ended early 1900s

Mental illnesses are classified and identified by underlying biological causes (ie infection, hereditary, toxins)

Involved removal of damaged tissue (lobotomies)

Question 7

What is the psychoanalytical model and its key principles?

Answer 7

Started by Freud, most popular between 30s-70s

1. No clear dividing line between normal and abnormal. ‘Pathological’ is extreme manifestation of ‘normal’.
2. Include conditions other than psychotic states ‘neuroses’: anxiety, depression, various phobias
3. No clear dividing line between different categories of mental disorder (neuroses and psychoses).

Question 8

Describe the early versions of the DSM

Answer 8

DSM-I (1952), DSM-II (1968)
Strongly influenced by psychoanalytic theory

Problems; reliability and validity
no consistent standards for diagnosis, based on unproven theories about etiology

Question 9

Who was Emil Kraepelin?

Answer 9

Emil Kraepelin (1856-1926) is considered the father of modern psychiatric classification

Kraepelin suggested that the classification of psychiatric diseases should be based on common patterns of symptoms, instead of the mere similarity of symptoms

Laid groundwork for DSMIII & IV

Question 10

Describe the features of the newer DSM (3 onward)

Answer 10

DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013)

Reflects the medical/biological model
No theoretical assumptions about causation
If causation is not known: Description of symptoms

Problems:

• commorbidity is very high
• lack of diagnostic stability
• lack of treatment specificity

Question 11

What arguments are there to say anger’s a ‘clinical’

or ‘abnormal’ issue?

Answer 11

• People seeking mental health services present with problematic anger reactions at the same frequency as they do with depression and anxiety.
• Critical mediator in various forms of aggression, from domestic violence through to assault, murder and rape
• Consistently identified as a risk factor in hypertension and heart-related illness.
• Anger interferes with judgment, problemsolving, negotiating; leads to risky behaviours

Question 12

What are the common commorbidities of abnormal anger?

Answer 12

• high levels of comorbid drug and alcohol issues (over 50%)
• anxiety disorders (about 33%)
• Depression and dysthymia (about 15%) (Note well: vast majority of angry individuals not depressed
• Bipolar (about 5%)

Question 13

How does anger currently fit into the DSM?

Answer 13

Anger is not currently a disorder but is a symptom in many including:

• Mania (and hence Bipolar Disorder);
• (Pediatric) Major Depressive Disorder (MDD);
• Premenstrual Dysphoric Disorder (PDD).
• Posttraumatic Stress Disorder (PTSD);
• Generalised Anxiety Disorder (GAD); and
• Borderline, Antisocial & Paranoid PDs

Also there are behavioural aggression disorders; IED, ODD & DMDD

Question 14

What is Intermittent Explosive Disorder?

Answer 14

The disorder most commonly diagnosed to people
presenting with anger issues—even without aggression

A. Recurrent behavioural outbursts representing a failure to control aggressive impulses
B.The aggression is disproportionate to the provocation
C. The outbursts are not premeditated and are not committed toachieve some tangible objective
D. These outbursts cause distress and/or impairment
E. The individual must be at least six years old
F. The outbursts are not better explained by another mental disorder or medical condition

Question 15

What is not covered by current DSM anger related problems?

Answer 15

angry adults who are not especially violent or impulsive (IED), don’t commit defiant or malicious acts against authority (ODD), and haven’t been a perennial brat since childhood (DMDD)

this is most clients presenting with anger