Classification Of Psychopathology

Question 1

Diagnosis

Answer 1

The identification of a disease or disorder by means of its signs & symptoms
Type of assessment will depend on type of clinician
Assessments aid diagnosis & help evaluate treatment efficacy

Question 2

Why diagnose?

Answer 2

To understand causality
To develop effective treatments & prevention strategies; >diagnosed=> to study
To organise services & support for sufferers
To test the efficiency of treatments
Legal & other state based issues
To gain access to the most effective treatment pathway

Question 3

Clinical Interviews

Answer 3

Assessed symptoms
Evaluation & measurement of psychological, social & biological factors in an individual with a possible PD
Measures used to asses should be reliable, valid & standardised

Question 4

Origins of diagnosis

Answer 4

Kraeplin (1893-1923); developer concept of psychiatric symptoms
WHO (1939); international causes of death
APA (1952); DSM

Question 5

Timeline of classification

Answer 5

1939; WHO adds mental disorder to ICD
1952; DSM (108 categories)
1968; DSMI (185)
1980; DSMIII (265)
1994; DSMIV (297)
2013; DSM 5 (>300)

Question 6

DSMIII

Answer 6

1980
Criteria based diagnostic system
Limited scientific evidence
Clinician agreement
A theoretical; based on a medical model view of MD, psychological constructs & social context largely ignored
Multiaxial system; axis I-V e.g. overall level of functioning, social stressors, psychiatric symptoms

Question 7

RD Laing & the anti-psychiatry movement

Answer 7

The divided self (1960)
An existential study into sanity & madness
Revolutionised the way we perceive mental illness
Using case studies, argued that psychosis is not a medical condition but an outcome of tension between 2 personas within us (authentic, private identity & false, sane self presented to world)

Question 8

Anti-psychiatry past & present

Answer 8

Sasz (1920-2012); psychiatrist, published ‘the myth of mental illness’ (1960)
Bentall (2007): ‘madness explained’, firmly opposed the biomedical model, argues that no clear distinction exists between those diagnosed with mental illnesses & the well, schizotypal experiences are common
May; heading voices network, organisation for schizophrenic people to meet

Question 9

Rosenhan experiment part 1 method

Answer 9

1972; done to determine validity of psychiatric diagnosis
Healthy associates faked auditory hallucinates to gain admission to 12 different psychiatric hospitals in US
All admitted & diagnosed with PD
then acted normally, told staff felt fine

Question 10

Rosenhan experiment part 1 results

Answer 10

All forced to admit having mental illness & take antipsychotic drugs as condition of their release
Average time spent was 19 days
All but one diagnosed with schizophrenia in remission before release

Question 11

Rosenhan experiment part 2 method

Answer 11

Offended hospital administration challenged Rosenhan to send pseudo patients in
Wanted staff to detect them
None were actually sent

Question 12

Rosenhan experiment part 2 results

Answer 12

193 patients, 41 identified as potential pseudopatients
19 received suspicion from atleast 1 psychiatrist & 1 other staff member

Concluded it was clear we can’t distinguish sane from insane in psychiatric hospitals
Promoted used if community mental health facilities which concentrated on specific problems & behaviours rather than psychiatric labels

Question 13

Today’s diagnostic system

Answer 13

Mental illness stigma still prevalent
Labelling affects identity
Labelling positions people; dehumanised, power relationships
Led to categorisation of mental illness in a more quantifiable way; pathological (high temp, drug induced), cultural (religious), shouldn’t discount just because they’re outside our understanding or frame of reference

Question 14

DSM-IV-TR

Answer 14

2000
Only made changes if there was an evidence base by which to do it
Conducted systematic reviews & primary clinical research on new diagnostic measures to measure reliability & construct validity
Major changes made to autism, ADHD, adult bipolar disorder & paraphilia’s

Question 15

DSM-5

Answer 15

2013
Aimed to; provide necessary & sufficient criteria for correct differential diagnosis, provide a means a distinguishing true psychopathology from non-disordered human conditions often labelled as everyday problems of living, provide a disgnostic criteria in a way that allows systematic application by different clinicians in different settings
Diagnostic criteria should be theoretically neutral- not speak about origins

Question 16

DSM content

Answer 16

Essential features of disorder 
Associated features
Diagnostic criteria 
Info on differential diagnosis 
No mention of causation; diagnosis made based entirely on observable behavioural symptoms

Question 17

Criticisms of the DSM

Answer 17

Problems with categorical nature of classification; were all different 
Loss of info by crude classification
Labelling of patients 
Reliability of diagnosis
Validity of constructs 
Dimensionality vs discrete entity 
Drug company influences 
ethnic & cultural issues

Question 18

Main risks for future diagnostic inflation

Answer 18

Bereavement related depression
Adult ADHD
Somatic symptom disorder
Disruptive mood dysregulation disorder 
Mild neurocognitive disorder

Question 19

DSM 5 main changes

Answer 19

Axial coding eliminated; reduces confusion, ratings based on continuum scale instead
Mental retardation renamed intellectual disability
Possible stigmatising terminology changed
Schizophrenia subtypes eliminated due to limited diagnostic stability, low reliability
ASD not autistic & Asperger disorder
PTSD part of Trauma & stress related disorders

Question 20

New diagnostic categories

Answer 20

Binge-eating disorder
OCD now in own group instead of anxiety disorders
Hoarding disorders

Question 21

Criticisms of changes

Answer 21

Reduction in number of criteria necessary to establish diagnosis; increase in diagnosis, false-positive epidemic
Aims to identify at risk populations
Inclusion of mild cognitive impairment; normal age-related changes
Broadening diagnoses, inclusion of bereavement depression

Question 22

Spectrum disorders

Answer 22

Dimensional aspects of psychopathology may result in over inflation of diagnosis
When does normal become abnormal?
GAD, psychosis, depression, autism, bipolar II
“Medical research has made such enormous advances that there are hardly any healthy people left”- Huxley

Question 23

Co-morbidity

Answer 23

Distinct categorisation of symptoms often does not work in practice
Comorbidity is high; the norm, up to 70%

Question 24

Emotional disorders

Answer 24

Bipolar disorders
Stress disorders
Fear disorders

Question 25

Legal dimensions

Answer 25

Increasing influence of diagnosis on sentencing in legal system
Societal choice not medical
Does diagnostic over-inflation mean we tend to not blame criminality over mental health problems
“I would rather be hung as a man than acquitted as a fool”- Guiteau

Question 26

Influence of big pharma

Answer 26

Direct consumer marketing legal in US since 80’s
Prozac
Primary care physicians treating patients
Mild disorders treats with psychotropic medication with limited side effects

Question 27

The future

Answer 27

Develop a research classification system for MD based on dimensions of neurobiology & observable behaviour
Mechanistic emphasis (rather than symptoms)
Dimensional approach to determine MD components
Reliable measures of fundamental MD components
Integrate fundamental genetic, neurobiological, behavioural, environmental & experiential components