Classification: Week 2 Flashcards
Psych Epi Improvements
prevalence and incidence estimation
Genetic epidemiology – twin and family studies
Mental health services research, including economic analysis
Usefulness of Diagnostic Criteria and Classification Systems
Provide prevalence estimates of psychiatric disorders
Allow statistical reporting on local, national and international levels (e.g., International Classification of Diseases)
Understanding etiology
Facilitate scientific communication
Have value in clinical decision-making
Where do psychiatric diagnostic criteria and disorders come from?
WHO and APA
International Classification of Diseases (ICD)
used throughout the world to classify and record medical and psychiatric conditions
Used for statistical purposes, clinical diagnosis and public health planning.
Functions of ICD diagnostic codes
data collection
statistical reporting
billing
research
international communication
based on rule-based criteria
DEFINITION OF MENTAL DISORDER
A syndrome characterized by clinically significant disturbance in cognition, emotion regulation or behavior
Clinical significance criterion for “caseness” in psychiatric diagnoses
Present distress
Disability
A significantly increased risk of suffering death, pain, disability or an important loss of freedom
The Neurobiological Model
Each illness has its own underlying etiology, symptom pattern, natural history (course) and response to treatment
Biological factors (genetic, biochemical), rather than social and environmental stress, explain the causes of different disorders
Categorical approach to mental illness, observable criteria, structured interviews
Social Psychiatry Paradigm
Common etiological factors (social stressors) assumed to underlay the origins of most disorders
Interactions of multiple causes produce degrees of mental health and illness
Prevalence variations due to stress caused by poverty, urban anomie, rapid social change
DSM - A CRITIQUE
Many ‘disorders’ are behavioural manifestations without an organic or physical etiology to support a diagnosis.
A DSM label can carry stigma
Limits of psychiatric diagnosis approach
Lack of a gold standard like lab test results
Reliance on patient’s interpretation of doctor’s questions, and doctor’s interpretation of patient’s answers
The Rosenhan experiment
Evaluated the validity of psychiatric diagnosis
All pseudopatients were admitted and diagnosed with psychiatric disorders.
After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations.
Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness.
CONCLUDED:`It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals”
Whitaker’s Propositions of psychiatric disorders
dramatic increase in the prevalence of psychiatric disorders in the last 50 years due to an iatrogenic epidemic of brain dysfunction (i.e., secondary effects of psychiatric medications)
Many are harmful enough to change the natural history of mental illness from episodic to chronic
Many psychiatric medications are no more effective than placebo
Whitaker’s Propositions of psychiatric disorders hyptheiszed
Side-effects are then treated with other drugs
Withdrawal of drugs produces rebound effects, often confused with “relapse,” resulting in re-administration of medications
Critique of Whitaker
Evidence assembled varies in quality
Difficult to study prevalence changes over 50 years
