Clinical Psychology (diagnosis Of Mental Disorders And Classification Systems) Flashcards
What are we always searching for?
Measurability: can be linked to a unit or objective scale and is usually a checklist or scale of symptoms.
Validity: does something measure what it is intended to measure? This makes a diagnosis more trustworthy
Reliability: can it be repeated to gain similar results? This ensures that all the symptoms match up to the same diagnosis leading to accuracy.
Objectivity: most of the time it’s a good thing to be objective however we must remember that the patients are still people and not lose sight of this.
Describe what is meant by statistical infrequency. Give some strengths and weaknesses.
Any behaviour which is too far away from the average can be considered as abnormal. Approximately 2.5% of behaviour at each extreme of the normal distribution curve is abnormal as it lies outside the range of 2 standard deviations from the mean.
This is a good explanation as it equalises the gap between mental and physical illness as it is objective, scientific and measurable. It also manages to minimise attached stigmas.
Some behaviours/illnesses have an incidence that is too great to fit in to the 2.5%. It also fails to account for the desirability if the behaviour which may be important. For example with IQ you want to be in the top 2.5%.
Describe what is meant by deviation from social norms. Give some strengths and weaknesses.
Norms are the rules of behaviour that set a standard for how most people act in a society. Social norms are not usually legal or moral rules, we don’t usually reflect upon them or feel the need to justify them. We notice that when people’s behaviour goes against social norms and we then judge that behaviour as inappropriate. Either they fail to understand the norms of society or they understand the norms and choose to reject them.
Social norms continue to shift and change over time in order to make them flexible to the era that we live in. This explanation adjusts to the changing social norms.
The explanation doesn’t take in to consideration the individuals behind the behaviour. As they continue to shift and change you can’t pin it on exactly the some thing which poses issues with reliability.
Describe what is meant by failure to function. Give some strengths and weaknesses.
A person should be considered as ‘abnormal’ if they are failing through no choice of their own to fulfil the expected functions of an adult. This is measured primarily through relationships, jobs and significant social interactions.
This explanation really helps to reduce stigmatisation as it says that they aren’t to blame for not being able to cope.
This explanation has problems as it could be said to put all the attention on the individual.
Describe what is meant by social construction. Give some strengths and weaknesses.
The idea that, rather than something having an objective external reality, a feature or issue in society is constructed by that society.
An implication is that there must be some sense in which the construction is beneficial to social cohesion even though it may disadvantage individuals. In order to make society function as a whole, we may ignore those that don’t fit in.
We know mental illness is a social construction as we should see evidence of shifts and changes in the way it is defined depending on demographic features and historical era.
Describe individual differences in the diagnosis of mental illness. Give an example.
Culture bound syndromes:
Behaviour that can be thought of as a disorder in one society may be thought of as an appropriate response or acceptable behaviour in another. Behaviour that doesn’t easily fit into the usual categories and appears only amongst particular groups of people.
‘Running A Mock’ a sudden aggressive and destructive attack against others or the environment typically occurring in an individual after a period of withdrawn behaviour. Considered a syndrome in Malaysia, Singapore and Indonesia.
Describe the DSM(IV) classification of mental illness
DSM-IV is a multi axial system of diagnosis.
Axis I- Clinical disorders, major mental disorders, developmental disorders and learning disorders
Axis II- Underlying personality conditions including mental retardation
Axis III- other medical and physical conditions
Axis IV- psychological and environmental factors
Axis V- assessment of global functioning. How well the patient is coping with friends, family, jobs, general anxiety.
Describe the DSM-V
Fifth full edition of the diagnostic and statistical manual of mental disorders. American manual for classification and diagnosis of mental illnesses
Up to and including DSM-IV-TR the system was multiaxial
Section 1: explains how the new version works and why it isn’t multiaxial
Section 2: all the different orders
Section 3: emerging measures and models relating to social norms and cultural issues
Why is there a need for it to change over time?
Changing norms, for example, mobile phone related mental health conditions
Alignment with other systems, for example ICD
Improvement to keep up with changing society.
Give some conclusions regarding the DSM-V
It is good as it helped to eliminate subtypes and now has two precise domains to help make it more precise and comprehensive.
It has the potential to lead to a change in diagnosis for those already suffering which could mean a change in the amount of services and support they require and are allowed.
It can be argued that any tool is only as good as the person using it.
What are the strengths of the DSM-V?
Lee (2006) showed high concurrent validity for DSM-IV-TR diagnosis of ADHD with a questionnaire completed by 48 primary school children.
Goldstein (1988) found that two expert psychiatrists assessing the same 8 patients using the DSM-III reached very similar diagnosis of the patients. This shows good inter-rater reliability.
Snitchfield (2008) used 803 participants from the general population and 259 participants who had been diagnosed with pathological gambling disorder were rediagnosed by clinicians and it was found that there was good reliability and validity between them.
Goldstein (1988) also discovered that there was a fair level of consistency between a diagnosis of patients with schizophrenia according to DSM-II and a rediagnosis according to DSM-III
What are the weaknesses of the DSM-V?
The DSM and similar diagnostic systems could be seen to add to the processes of labelling, medicalisation and stigmatisation of mental illness.
Lee(2006) also showed that the fit between clinical diagnoses and teacher questionnaire was better for boys than girls. This shows low concurrent validity and also low predictive validity.
An acceptable level for inter rater reliability according to Cooper is 0.6. This means only 6 out of every 10 patients are diagnosed correctly.
Reliability between clinicians could simply be because they have been trained the same way and not because of the reliability of the diagnostic system. This means that they could be reliably wrong.
The process of revising the classification systems is far from transparent. The reviewers of DSM-V had to sign an agreement to say that they would not disclose details of discussions. This suggests that there was only internal coherency and that it didn’t help the public to have a better understanding.
Describe the ICD-10
ICD stands for the International Statistical classification of Diseases and Related Health Problems. It is a European system.
It is published in many different languages and is freely available to anyone online. It is used by around 70% of health professionals whilst the DSM is only used by 23% of health professionals.
It is a system used to monitor general health issues in population as well as having section (f) which is specific to mental health disorders.
The system looks at incidence, morbidity, mortality and prevalence. Incidence- when does a problem occur in society. Morbidity- the number of diseases in a population at a given time. Mortality- the death rate from diseases. Prevalence- how frequently does a problem occur in society.
What are the strengths of the ICD- 10?
Jakobsen et al (2005) used a random sample of danish in-patients diagnosed with schizophrenia and a sample of out patients with a history of psychosis to look at the reliability of the ICD-10. Results found 93% sensitivity and 87% predictive value. It also showed good agreement between ICD-10 and another measure (concurrent validity).
What are the weaknesses of the ICD- 10?
In general it seems that the complexity of the disorders is an issue when it comes to claiming validity of diagnosis. Complexity is further seen in that other disorders have some features of schizophrenia. Ellason and Ross (1995) suggest that people diagnosed with dissociative identity disorder have more features and symptoms of schizophrenia than those with schizophrenia.
Cheniaux et al (2009) used inter-rater reliability to look at reliability to look at reliability of diagnosis using the DSM-IV and the ICD-10. They found that schizophrenia was more frequent using the ICD-10.
Only for schizoaffective disorder did the reliability between the two systems drop below 0.5. They think that this is a strength but really this is still a very poor level of agreement.
