classification systems for mental health, including reliability and validity of diagnoses

Question 1

what is the DSM-5

Answer 1

Provides a criteria from which mental disorders can be diagnosed

Question 2

describe how the DSM-5 works

Answer 2

• section 1: offers guidance about using the new system
• section 2: gives actual diagnostic criteria and codes for example for neurodevelopment disorders
• section 3: talks about the future of diagnoses and includes disorders which may need further research before they are included in section 2

Question 3

what are the advantages of the DSM-5

Answer 3

• the 5 axes have been abolished, previously critics said these were artificial and made it hard to find links between different symptoms. The DSM-5 is able to draw links between different symptoms and conditions.
• it has removed unnecessary diagnoses, for example with schizophrenia spectrum disorder. The old sub-types of paranoid, catatonic and disorganised schizophrenia have been merged together.
• Having a single diagnosis can be applied to a lot of people so it makes diagnoses a lot easier

Question 4

what are the applications of the DSM-5

Answer 4

• can be applied to a reflection on social change
• the wars in Iraq and Afghanistan have given us a lot more insight into post-traumatic stress disorder
• DSM-5 covers more symptoms of this such as flashbacks

Question 5

what is the ICD-10

Answer 5

aims to improve healthcare across the world, includes all diseases and disorders

Question 6

describe how the ICD-10 works

Answer 6

• contains section F which is specific for mental health disorders
• ICD groups each disorder as being a part of a family
• these disorders are coded “F” and by a digit to represent the family, followed by another digit to represent the specific disorder
• so clinician can identify the family of the disorder, then the type of disorder and then its subtype

Question 7

what is the advantage of the ICD-10

Answer 7

• its coding allows the clinician to convey to diagnosis early in a specific way, going from the general to the specific
• the clinician can use the system to guide their diagnosis through a clinical interview with the patient
• so it makes diagnosis much easier

Question 7

what is the advantage of the ICD-10

Answer 7

• its coding allows the clinician to convey to diagnosis early in a specific way, going from the general to the specific
• the clinician can use the system to guide their diagnosis through a clinical interview with the patient
• so it makes diagnosis much easier

Question 8

what is the advantage of using classification systems

Answer 8

• high reliability
• DSM-5 field trials demonstrated impressive levels of agreement for a variety of disorders
• Regier et al reported that for 3 disorders including PTSD, had kappa values ranging from 0.60-0.79 which is very good
• whilst seven more diagnosis like schizophrenia had kappa values of 0.40-0.59 which is good

Question 9

what is the disadvantage of the supporting evidence from classification systems

Answer 9

• what counts as an acceptable level of agreement has decreased over the last 35 years
• Cooper explains that DSM-5 task force classified levels as low as 0.2-0.4 as acceptable
• according to cooper schizophrenia had a reliability estimate of 0.81 in the DSM-3 and just 0.46 in the DSM-5
• so the DSM-5 may be in fact less reliable than previous versions

Question 10

what is the disadvantage of using classification systems?

Answer 10

• low validity
• studies from Everad has shown that culture affects diagnosis
• symptoms that are seen in Western countries as characteristic schizophrenia such as hearing voices can be interpreted in other countries as showing possession by spirits, which is not considered to be negative
• so depending on cultural expectations on what is being measured, the DSM is not always valid

Question 11

valuate the reliability of DSM and ICD for diagnosing patients (4 marks)

Answer 11

• Regier et al. 2013 found that for patients diagnosed using DSM-V and were diagnosed with schizophrenia the reliability was 0.46 so unreliable
• If PTSD/binge eating disorder was diagnosed then the reliability is good to very good according to APA 2012
• If DSM-IV was for mood/anxiety disorder then the reliability would be good to excellent
• If ICD 10 was used because there was found to be only a 36% agreement for eating disorders by Nicholls et al. 2000