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PSYC3018 > Classification and Diagnosis > Flashcards

Classification and Diagnosis Flashcards

1
Q

Historically, “mental illness” = similar to today’s diagnosis of..

A

Psychosis, schizophrenia and dementia

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2
Q

What did mental healthcare look like in 18th-19th century?

A

Small number of patients treated in mental asylums by ‘mad doctors’ or ‘alienists’

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3
Q

To ascertain the prevalence of mental disorders, why is it not sufficient to look at no. of people seeking/receiving treatment?

A

Help-seeking is influenced by cultural or financial reasons, education, knowledge and beliefs.

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4
Q

What is the different between point-prevalence and one-year prevalence?

A

P-P: ‘right now, X percent of Australians have Y disease’

1-year prev.: ‘in 2007, X percent of Australians had Y disease’

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5
Q

What is incidence?

A

What proportion of healthy individuals will develop Y disease within a specified time period? (new cases)
- ‘every year, X percent of Australians develop Y disease for the first time’

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6
Q

What is the lifetime prevalence of mental disorders in adults?

A

32-48%

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7
Q

What is the lifetime prevalence of mental disorders before age 21?

A

35-49%

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8
Q

DSM definition of MD pt 1:

A clinically significant….?

A

behavioural or psychological syndrome or pattern.

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9
Q

DSM definition of MD pt 2:

associated with…

A

present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.

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10
Q

DSM definition of MD pt 3:

It must not be merely…

A

an expectable and culturally sanctioned response to a particular event, eg death of a loved one.

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11
Q

DSM definition of MD pt 4:

Whatever its original cause, it must currently be considered…

A

a manifestation of a behavioural, psychological or biological dysfunction in the individual.

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12
Q

What are the four elements of abnormality?

A

Statistical rarity, deviance or norm violation, distress, and dysfunction.

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13
Q

Why is statistical rarity problematic for classifying mental illness?

A

People known for their musical or scientific genius can be considered abnormal. Also there is a high prevalence of mental illness.

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14
Q

The criterion of ‘deviance’ or norm violation includes..

A

a value component, according to which a behaviour is considered to be abnormal if it is deemed to be socially unacceptable.

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15
Q

Why can using norm violation as the sole requirement to define abnormality be dangerous?

A

Can be used to oppress any non-conformist behaviours, eg homosexuality, masturbation - people seen engaging in these behaviours need punishment or treatment.

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16
Q

Which element of abnormality allows the individual to self-define their behaviours as abnormal or not?

A

Distress

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17
Q

What are the 2 limitations of ‘distress’ as a criterion for abnormality?

A
  1. Some individuals cause themselves large amounts of personal suffering eg starving themselves to near death for religious, political or other cultural reasons.
  2. Many people whose behaviours come to the attention of mental health professionals do not experience distress, eg manic episode in bipolar disorder.
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18
Q

What word is often used interchangeably with dysfunctional?

A

Maladaptive

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19
Q

What is the definition of dysfunctional/maladaptive?

A

Does the behaviour interfere with the person’s ability to meet the requirements of everyday life?

20
Q

Why would someone with an extreme snake phobia who never leaves the city not be considered abnormal?

A

Their fear of snakes does not interfere with the ability to meet the requirements of everyday life; it is not dysfunctional.

21
Q

What are the limitations of the dysfunction criterion?

A
  1. highly overlaps with the concept of norm violation: how functional an individual is considered to be is often based on how well she meets social expectations (may be the social expectations that are wrong rather than the individual)
22
Q

What is drapetomania and what does it illustrate?

A

Mental disorder characterised by a pathological need to run away. Applied to African American slaves who repeatedly attempted to run away from slavery. This behaviour was thought to be inconsistent with the normal function of African Americans in society.
Shows how a particular society’s values influence the idea of what is dysfunctional.

23
Q

What does ‘clinically significant’ mean?

A

Disorder causes substantial impairment in social, occupational or other areas of functioning.

24
Q

Wakefield’s ‘harmful dysfunction’ analysis proposes that the concept of mental disorder involves both…

A

a factual component (dysfunction) and a value component (harmful).

25
Q

What does Wakefield’s factual component (dysfunction) entail? Give an example.

A

There is an internal dysfunction present: a psychological mechanism has failed to carry out its natural evolutionary function.
Eg: evolutionary function of anxiety may be to warn the individual of objective danger. When anxiety occurs in the absence of objective danger, this psych. mechanism has failed to perform its natural function.

26
Q

How does the ‘internal dysfunction’ specification help to demarcate instances of mental disorder from instances of social deviance, non-conformity or crime?

A

Starving oneself = not internal dysfunction but as a means of effecting political change. However, anorexics limit food as a result of internal psych. dysfunction: internal mechanisms that contribute to maintaining a minimum healthy weight do not perform their natural function.

Violent crimes: can be as a result of internal dysfunction (eg lack of impulse control, inability to feel empathy - Antisocial Personality Disorder) or may occur as a result of belonging to a gang, easier to earn living by illegal means (no internal dysfunction)

27
Q

Why would hallucinating that results from an internal dysfunction not necessarily be seen as a disorder in certain societies according to Wakefield?

A

In certain societies hallucinating is evaluated positively, perhaps as a sign of psychic abilities. It does not meet the ‘harmful’ specification as it causes no harm or social disadvantage to the person.

28
Q

What are the criticisms of Wakefield’s conceptualisation of mental disorder?

A

Difficult to ascertain the normal evolutionary function of psychological processes such as depression. Some cognitive abilities like reading have been acquired too recently to be regarded as natural functions designed by evolution (dyslexia could not be considered a disorder).

29
Q

The DSM and ICD currently reflect which model?

A

Medical model. Was previously influenced by psychoanalysis.

30
Q

Why might the prevalence of mental disorder be overestimated when using DSM-5?

A

Diagnosis is based on symptoms only, ignoring the question of internal dysfunctions. Nothing that states the list of symptoms are reflective of an internal dysfunction which causes depression eg.

31
Q

Why do we have a proliferation of disorders described at the symptom level?

A

Unhappy marriage between psychoanalytic model and medical model.

32
Q

The medical model assumes that different illnesses are:

A
  1. Clearly distinguishable from each other
  2. Occur independently from each other
  3. Have specific, identifiable causal agents
  4. Respond to specific treatment
33
Q

Early examples of aetiologically based classification?

A

Hippocrates: hysteria caused by ‘dry uterus’
16th century: lunacy caused by failures of the moon
1867: Masturbatory insanity
If proposed cause is wrong then treating that cause will not help.

34
Q

The medical/biological model which became popular in the 19th ce. believed that eventually all mental illnesses will be identified according to their underlying biological causes, eg:

A
  1. Bacterial or viral infections
  2. Localised brain damage
  3. Heredity
  4. Toxins
35
Q

The loss of motivation for biological model made room for…

A

Freud and the psychoanalytic model

36
Q

When did psychoanalysis become the prominent model of mental illness?

A

1940-70s

37
Q

What are the three ways that the psychoanalytic model revolutionalised the concept of mental illness?

A
  1. no clear dividing line between normal and abnormal (instead the pathological is an extreme manifestation of the normal)
  2. Inclusion of ‘neurotic’ (not just psychotic) states: anxiety, depression, various phobias
  3. no clear dividing line between different categories of mental disorder
38
Q

The psychoanalytic model postulated that all our behaviours (normal and abnormal) are caused by the same underlying processes…

A

Unresolved Conflicts between the id, ego and superego - so no point for looking for specific causal agents

39
Q

DSM-I (1952) conceptualised depression as…

A

a way of dealing with the anxiety from the intra-psychic conflict. eg turning anger towards your father onto yourself and becoming depressed

40
Q

2 main problems with DSM-I and DSM-II (which were heavily influenced by psychoanalytic theory)?

A
  1. Problematic reliability - doesn’t provide enough info to effectively diagnose/differentiate between people - clinicians cannot agree
  2. Problematic validity - based on unproven theories about aetiology - is depression really a defence from unacceptable unconscious ambivalent feelings?
41
Q

Who is Emil Kraepelin?

A

The father of modern psychiatric classification

42
Q

DSM-III (1980) and beyond reflect the _______ model

A

medical

43
Q

DSM-III and beyond’s relationship with causation?

A

No theoretical assumptions made about causation / if cause unknown, then description of symptoms - an empirical approach.

44
Q

How did DSM-III and beyond improve reliability?

A

Clear, explicit criteria and decision rules for diagnosis. Symptoms needed to be verifiable (observable and measurable) - no intra-psychic conflict allowed

45
Q

At the moment, the approach/aim is to…

A

identify independent groups of symptoms (syndromes) which each reflect a specific cause

46
Q

What are the problems with our current approach to classification and diagnosis?

A
  1. Comorbidity is more common than not - suggests common causation between disorders
  2. Diagnostic instability is high - people tend to switch between disorders - again indicates a single underlying cause
  3. Lack of treatment specificity - eg antidepressants
47
Q

What does the current research suggest about the direction we should be heading in?

A

We need a different model where different disorders aren’t seen as separate entities

Idea that there is more quantitative rather than qualitative difference between mental disorders - medical model isn’t applicable

PSYC3018 (15 decks)

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