Classifications and Diagnosis in psychopathology Flashcards
Emil Kraepelin
‘Mental disorders’ can be identified from shared symptoms
Two clusters of symptoms
Dementia praecox
Manic depressive psychosis
Set ‘medical model’ for 20th century psychiatry
DSM
The Diagnostic and Statistical Manual of the American Psychiatric Association
First published in 1952
Now in its fifth edition (2013)
ICD
International Classification of Diseases by the World Health Organisation
Definitions of Disorders
DSM (1994)
“A clinically significant behaviour or psychological syndrome or pattern that occurs in a person and that is associated with present distress (a painful symptom) or disability (impairment of one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable response to a particular example, for instance, the death of a loved one”
WHO (1992)
[Mental disorder is the term used to] “imply the existence of a clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions”
DSM5: 19 major categories
- Neurodevelopmental disorders (inc. ADHD, ASD)
- Schizophrenia spectrum and other psychotic disorders
- Bipolar and related disorders
- Depressive disorders
- Anxiety disorders (inc. panic disorder, phobia)
- Obsessive-compulsive and related disorders
- Trauma and stressor-related disorders
- Dissociative disorders (formerly MPD)
- Somatic symptoms and related disorders (e.g. factitious disorder)
- Feeding and eating disorders
- Elimination disorders (enuresis & encopresis)
- Sleep-wake disorders
- Sexual dysfunctions
- Gender dysphoria
- Disruptive, impulse-control, and conduct disorders (e.g. kleptomania)
- Substance-related and addictive disorders (inc. gambling)
- Neurocognitive disorders (resulting from, e.g. Alzheimer’s, or general brain injury)
- Personality disorders
- Paraphilic disorders (e.g. paedophilic disorder, sexual sadism/masochism disorder)
Diagnosis
The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to another medical condition.
The occurrence of the…episode is not better explained by…[various rival diagnoses inc. schizophrenia, or]…other psychotic disorders
There has never been a manic episode or hypermanic episode.
Diagnostic Coding
Depends on frequency: is it a single, or recurrent episode (with at least 2 months between)
Severity (mild/moderate/severe) – based on number and intensity of symptoms
Presence of psychotic features (e.g. delusion) Remission status (if full criteria not met >2 months: can be partial, or full)
Some of the above measured on specific scales
DSM code for each combination, e.g. 296.21 (mild single episode)
Unspecified when criteria not met and none of the other conditions apply
Beck’s cognitive theory of depression
Thinking dominated by ‘triad’ of negative schemas
Ineptness (expect to fail)
Self-blame
Negative self-evaluation
These are driven by cognitive biases: Arbitrary inference (with no evidence, e.g. it was raining on the day)
Selective abstraction (focus on one element)
Overgeneralisation
Magnification/minimalization
Cognitive behavioural therapy aims to ‘restructure’ these thoughts
Biological Explanations for Depression
Monoamine hypothesis
Depression arises as a result of depleted serotonin, noradrenaline and dopamine, ‘discovered’ in 1950s with users of blood pressure medication
Treated by raising serotonin (SSRIs such as Prozac)
Tendency to work better for women
Now, licence for esketamine, which affects glutamate and can have immediate effects
Seligman (1974)
found that dogs could ‘learn’ passive resignation in electric shock experiment
Attributional model (Abramson, Seligman & Teasdale, 1978):
given situation, e.g. failed exam, assessed in terms of: Locus of control (internal/external)
Stability (stable/unstable)
Global/specific
:)
Female Depression
Major depression affects 26% of women and 12% of men at some point (actual figures vary)
Stoppard (2000): depression as response to ‘insoluble dilemmas’ in women’s lives:
Need to be ‘good mother’, ‘good wife’ etc.
Dual demands for career success and domestic responsibilities
Physically exhausting
Depressive realism (Alloy & Abramson, 1979)
depressed people better judges of how others see them
Critics say samples aren’t clinical enough
General issues with DSM
Categories vs dimensions
Qualitative vs quantitative way of thinking about disorders
Categorical models critiqued for ‘labelling’: Pilgrim (2000) extends this to sick/well dichotomy
Coding of ‘severity’ in DSM5 adds dimensional element to the category approach
Classify or not?
FOR:
Professionals and clients alike welcome clarity provided by labels/discrete syndromes
Makes treatment decisions and prognoses simpler and easier to communicate
Allows intergroup comparison
AGAINST:
Classification by long lists of symptoms far from ideal
Low reliability of accuracy between experts, time and place
Comorbidity the rule rather than the exception
Increasing evidence (inc. neurological) against category validity
