classification of disorders Flashcards
when was DSM 5 introduced
2000 published in 2013
DSM 5 is no longer multi-axial. what does this mean
looks at the individual as a whole in order to diagnose the disorder instead of considering many different aspects as this became too heavily focused on the ideas. therefore the method now used in non-axial
what disorder is no longer controversially classified as a separate disorders and has now been placed on a spectrum
Asperger’s disorder. on a spectrum with ASD
how has the diagnosis of schizophrenia changed
must now be present for 6 months and must include at least one month of active symptoms before a full diagnosis takes place. categorised by delusions, hallucinations, disorganised speech and behaviour and other symptoms that cause social or occupational dysfunction
how has the DSM-V taken culture into account
incorporates a greater cultural sensitivity throughout the manual. gives more detailed and structured information about cultural concepts of distress. different cultures explain symptoms in different ways.
organisation of DSM - V
section 1 - will give an introduction to DSM -V with info on how to use the updated manual
section 2 - will outline the categorical diagnoses according to a revised chapter organisation
section 3 - include conditions that require further research before their consideration as formal disorders, as well as cultural formulations
changes of DSM V
- chapter order restructured based on disorders apparent relatedness to one another as reflected by similarities in disorders underlying vulnerabilities and symptom characteristics. the changes with align DSM-V with the world health organisations ICD
- removal of multiaxial systems
is DSM free
no. provides a large proportion of APA revenue
is ICD free
yes
what does DSM include
covers only mental disorders
what does ICD include
addresses all health issues ->
all diseases
who published DSM
american psychiatric association
who published ICD
world health organisation
who uses DSM
psychiatrists
who uses ICD
countries and front line service providers
what language is DSM in
english
what language is ICD in
all languages
define comorbidity
more than 1 disorder. the presence of one or more disorder co-associated with the primary disorder of the patient
reliability of DSM
GOOD
good –>
GOLD STEIN looked at the effect of gender of diagnosis of schizophrenia. she re-diagnosed 199 patients, originally diagnosed using DSM II some differences - she asked two other experts to re-diagnose a random sample of 8 of the patients using the case histories with all indication of previous diagnoses removed. high level of agreement
reliability of DSM
POOR
poor –> BECK ET AL looked at the inter-rater reliability between 2 psychiatrists when considering the cases of 154 patients. the reliability was only 54% meaning they only agreed on a diagnosis for 54% of 154 patients
ROSENHAN –> of 193 patients that entered into a hospital - 41 were judged as being a pseudo-patient (they were all real patients)
KIRK AND KITCHENS argued that there are methodological problems with the studies used to test the reliability of the DSM up until 92. these limit the generalisability off the findings. they argued that training and supervision of interviews was insufficient and that they lacked the commitment and skills to be accurate. findings might not relate to clinicians in normal clinical settings
validity of DSM
GOOD
HOFFMAN –> alcohol and cocaine dependence and abuse in prison inmates. computerised structured interview. found a high concordance with their interview findings and DSM diagnosis. that dependance was a more severe syndrome than abuse in alcohol and cocaine
has converged validity as there was a correlation found between the drug use and the interview results.
KIM-COHEN had CONCURRENT, CONVERGENT and PREDICTIVE VALIDITY.
interviewed mothers, gave questionnaires to teacher regarding symptoms over last 6 months
predictive validity - 5 yr olds diagnosed with conduct disorder were more likely to have behavioural and educational difficulties
concurrent and convergent validity - mothers responses, questionnaires and child self report all led to diagnosis of conduct disorder
validity of DSM
POOR
NICHOLLS over 50% could not be diagnosed using DSM, but this figure inflated so many raters giving the same rate that the children were not rateable using these criteria
KIRK AND KUTCHINS as an unreliable diagnostic tool also lacks validity, suggested that DSM could also lack validity
ROSENHAN shows that DSM has a low validity as 7/8 pseudo-patients were diagnosed with sz. comorbidity issues
