Classification Of Psychopathology Flashcards
Diagnosis
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
Why diagnose?
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
Clinical Interviews
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
Origins of diagnosis
Kraeplin (1893-1923); developer concept of psychiatric symptoms
WHO (1939); international causes of death
APA (1952); DSM
Timeline of classification
1939; WHO adds mental disorder to ICD 1952; DSM (108 categories) 1968; DSMI (185) 1980; DSMIII (265) 1994; DSMIV (297) 2013; DSM 5 (>300)
DSMIII
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
RD Laing & the anti-psychiatry movement
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)
Anti-psychiatry past & present
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
Rosenhan experiment part 1 method
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
Rosenhan experiment part 1 results
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
Rosenhan experiment part 2 method
Offended hospital administration challenged Rosenhan to send pseudo patients in
Wanted staff to detect them
None were actually sent
Rosenhan experiment part 2 results
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
Today’s diagnostic system
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
DSM-IV-TR
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
DSM-5
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
DSM content
Essential features of disorder Associated features Diagnostic criteria Info on differential diagnosis No mention of causation; diagnosis made based entirely on observable behavioural symptoms
Criticisms of the DSM
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
Main risks for future diagnostic inflation
Bereavement related depression Adult ADHD Somatic symptom disorder Disruptive mood dysregulation disorder Mild neurocognitive disorder
DSM 5 main changes
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
New diagnostic categories
Binge-eating disorder
OCD now in own group instead of anxiety disorders
Hoarding disorders
Criticisms of changes
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
Spectrum disorders
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
Co-morbidity
Distinct categorisation of symptoms often does not work in practice
Comorbidity is high; the norm, up to 70%
Emotional disorders
Bipolar disorders
Stress disorders
Fear disorders
Legal dimensions
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
Influence of big pharma
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
The future
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
