Classification systems Flashcards
Issue classification systems
There are many ways of diagnosing disorders. One of which is different classification systems
It is important that we find a good way of classifying different disorders.
Classification systems provide checklists of affective, behavioural, cognitive and somatic symptoms which guide the diagnostic process. But determining which symptoms is not enough to make a diagnosis. Both the intensity and the duration of the symptoms are important.
As there are many different ways of defining disorders, how we judge this becomes very important. We need a standardised way to diagnose behaviors
As these different ways of classifying disorders, differnet clinicians may have different ideas. This is a serious problem, as if people are being treated incorrectly, with society judging what is considered normal, this could lead to unfair standards, or the under or overdiagnosis of disorders like depression and anxiety
Classification systems are nased on the medical model of abnormality, which may offer a solution, as disorders are diagnosed using symptoms. This prevents clinciian’s different ideas abt the causes of the disorders to affect the ultimate diagnosis.
Classification systems we usually use
The two major classification systems used by western psychiatrists today are based largely on abnormal experiences and beliefs reported by patients, as well as agreement among a number of professionals as to what criteria should be used. A Chinese Classification of Mental Disorders [CCMD] has also been developed but Chinese psychiatrists also use the ICD-10 manual. A key difference between the CCMD and the Western classification systems is that it contains diagnostic criteria for disorders that are specific to Chinese culture.
DSM changes over time
DSM 1
Included several categories of “personality disturbances”
E.g homosexuality, which was listed as mental disorder
Heavily grounded in psychoanalytical traditions
Made clinicians look for orgiins of abnormal behavior in childhood traumas
DSM 2
Made as a result of attacks on psychiatric practices and concepts of mental illness
DSM 1’s use of constructs that are unobservable such as “trauma” and “motivation” were critcised
Emergence of anti-psychiatry- idea that psychiatry might ust be another way of social control and conformity
DSM 2 was similar to 1- retained psychoanalytical approach, was explanatory rather than descriptive
Homosexuality as disorder removed
DSM 3
Creation of the multi-axial approach
Created in response to people such as ROsenhan
Abandoned psychatric approach, shift from explaining disorders to describing them.
Focused on set of observable symptoms to decrease disagreement and interpretation, less subjectvie
Criticized for too many ppl meeting the criteria for medical illnesses
DSM 4
Change in clinical significance criterion
To be diagnosed with a disorder, ppl ahd to exhibit symptoms that created clinically significant distress/ impacts daily function. To reduce overmedicalisation
5 axes described and highlights diff aspect of disorders
Clinical disorders- includes patterns of behavior that impair functioning, e.g schizophrenia, depression
Peronality disorders- involve rigid patterns of maladaptive behavior, e,g antisocial, paranoia, narcissism
General med conditions
psychosocial/ environmental problems that contirbute to disorders, e.g job loss, death of loved one
Global assessment of functioning (GAF) on a scale of 1 to 100. Scale used to see how much patient needs treatment
Axes eant to provide broad range of info abt patient’s mental state
DSM 5
They planned to update more frequently w minor changes (5.1, 5.2, etc)
Multi axial system was elminated in response to ppl who said they were artifical and that in many cases, similar disorders were artifically brought aprat
CCMD
Chinese classification of mental disorders - CCMD
Similar to dsm and ICD, both in terms of structure and diagnostic categories
Some of diagnoses modified to better reflect cultural realisites
Focuses on issues in chinese culture
Disorders that are in ICD and DSM that arent common in china are left out
eval of using classificaition systems
using a classification system is that it provides a standardized process of diagnosis that should lead to reliable results.
BUT, this isnt always true
it provides a standardized, operationalized definition on which research can be based
E.g when doing research on depression, if we know that the depression diagnosis was based on DSM 4, then we can know how that disorder was defined, and we can assume all ppts in the study would have met the certain criteria
Without this, it wouldnt be possible to carry out valid and reliable research in abnormal psych
Other factors could influence diagnosis, regardless of the use of such a system
E.g, the process of diagnosis could make clients uncomfortable, and they could react in distress, which makes psychiatrist think they have disorder
Self report data
Even tho classification systems are trying to be standardized, reliability of diagnosis is hard to achieve.
A shift to description allows clinicans to be more consistent in diagnosis. But this also leaves less interpretations for indv circumstances, so diagnosis might be less valid
Disorders diagnosed on basis of set of symptoms, but these can overlap
Neurasthenia
Illness classified by fatigue, headache, irritability, dizziness, memory loss
Neurasthenia in asian cultures
A major reason that neurasthenia has survived as a common diagnosis in Asian cultures is that it is considered an acceptable medical diagnosis that conveys distress without the stigma of a psychiatric diagnosis.
Health care professionals working with Asian American patients find that many patients from Asian countries describe their symptoms as neurasthenia, although they may meet DSM diagnostic criteria for other disorders.
Lots of clinicians in US see neurasthenia symptoms as similar to chronic fatigue syndrome
chronic fatigue syndrome & neurasthenia overlap in their focus on physical symptoms, neurasthenia has a broader scope of symptoms, and has important cultural connotations
Lots of ppl in asian countries consider neurasthenia a core diagnosis, even though patients might have other more severe problems, e.g psychosis
More recently, people in Japan have used neurasthenia as a “camouflage” to cover serious mental disorders, such as schizophrenia and affective illnesses.
This use makes the patient’s role more socially acceptable and allows biologically focused Japanese psychiatric professionals to apply their treatments.
dsm5 for depression VS chinese CCMD 3
insomnia / hypersomina (dsm) VS low energy
many symptoms for two weeks, talks about how frequent symptoms are VS four symptoms, with a focus on events instead of frequency
Chinese ppl more often express somatic complaints
In china, neurasthenia is listed as neurosis. It can reduce stigma of mental illness, and be a better account for symtpoms in the chinese
Severity ratings (from mild to severe) VS a a separate diagnosis for neurasthenia
CCMD has diff diagnosis for depressive episodes, similar to DSM 5 depressive disorders, but some diffs reflecting chinese culture
Person must be depressed for reasons other than life circumstances
Must include symptoms from a list, whihc are refered to as a single episode of depression
COMPARE how depression diagnosis is similar and different, dsm and chinese
Chinese have a low rate of diagnosing depression. 0.8% prevalance rate
Might be bc of social sitgma, but also bc other disorders similar to depression were more culturally valid for the chinese were used instead
Chinese tend to deemphasize depressive symptoms as defined by western standards
In the west, they may be over emphasized
neurasthenia - hysteria, stress, neurosis, NOT depression
more of a physical focus
is neurasthenia a cultural bound symptom, different disorder, so diff manual?
symptoms are diff bc society views are different, so they use a diff classification system and manual, but maybe not actually diff disorders
rosenhan method and conc
PROC:
8 mentally healthy subjects (including rosenhan)
seek admission to psychiatric hospitals in 12 hospitals in the US
standardized instructions, complained of hearing voices that said 3 words EMPTY HOLLOW THUD (if asked, say unfamiliar voice, same sex, voice unclear except for three words), other than this act normally, truth infuo about self (except name and occupation to protect future employment)
get out by own means, convince staff of sanity
after admission , they ceased simulating symptoms. after they were diagnosed they acted normally, they couldnt be released
ppt said they were fine and no longer experiencing any symptoms when asked by staff how they feel
RESULTS
hospital records describe behaviour friendly n cooperative
all but one ppt admittted to hospital w schizophrenia
discharged w schizo in remission
no one detected by any hospital staff :o other patients more observant + voiced suspicions → ur not crazy, ur journalist, check up on hospital
normal behaviour misinterpreted as symptoms illness
taking notes “engaging in writing beaviour”
waitign outside cafeteria b4 lunch “oral acquisitive syndrome”
ppt largely ignored by staff after admission
ppt test staff by ask innocent qqs “when am i ilikely to be discharged” → minimal response → psychiatrists ignored q 71% time, stopped n talked only 4%; 90% nurse stay in ward office, avg time staff spend w patient less than 7mins per day
FOLLOW UP STUDY
hospital n staff aware of first study
next 3 months, more pseudo patients seek admission to hosp
hopsital challenged rosenhan to send more patients - hospital thought they found 40+ fakes, rosenhan sent none
staff use 10 point scale w each new ppt to rate likelihood of pseudo
REUSLTS
out of 193 patients judged, 41 confidently rated as pseudo by at least one staff
19 patients “Detected” by both psychi n one other staff
CONCLUSION
psuchiatrists not reliable, couldnt distinguish nornal from mental ill
everytingt the person does is perceived thru label/ diagnostic symptoms
schema formation, they had a schema of mental illnesses
label self confirming effect - if everyone consistenly expect u behave, u might actually behave like that
EVAL
8 subjects quite small sample
low ecological validity, not many people actively lie and try to get into mental facility
standardized instructions, complained of hearing voices that said 3 words (if asked, say unfamiliar voice, same sex, voice unclear except for three words), other than this act normally, truth infuo about self (except name and occupation to protect future employment)
medical model used was DSMII, this manual is much improved now, DSM IV : if u hear voice at least 1 month b4 diagnosis of schizo
cost benefit analysis - outcry is real patient let out of hospital n get in trouble, hospital blamed - safer to admit healthy than discharge mentally ill
ethical considerations: deceive hospital staff
ppt observations may be biased bc pseudo patients diff from real patients who knew symptoms were tue
Experiences of patients different from fake patients. So observatios from doctors/ ppt would have been biased
Culture
only 5 diff US states
Ethics
Deception
Informed consent- hospitl staff didnt agree to be in study
