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Clinical Psychology > D’s, ICD, DSM > Flashcards

D’s, ICD, DSM Flashcards

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1
Q

What are the 4 d’s of diagnosis?

A

Deviance, dysfunction, distress and danger

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2
Q

What is the 5th D in diagnosis?

A

Duration

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3
Q

What is deviance?

A

Refers to whether behaviour deviates from the social norm. Rare and uncommon behaviour in society.

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4
Q

What is dysfunction?

A

Refers to whether a behaviour interfere with the persons everyday life. Disturbance and problematic.

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5
Q

What is distress?

A

Refers to the extent of the behaviour causing distress to the individual.

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6
Q

What is danger?

A

Refers to if the behaviour presents a danger to themselves or others in society.

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7
Q

What is duration?

A

The additional D. Has to occur for a long time.

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8
Q

What are strengths of deviance?

A

Using a normal distribution curve to operationalise deviance is objective to aid diagnosis without subjective influence.

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9
Q

What are weaknesses of deviance?

A

Just because behaviours are rare and uncommon, it doesn’t mean it’s abnormal and therefore considered a mental health disorder.

Subjective to cultural bias - social norms differ all over.

27% of older adults experience depression, highlighting a weakness in the use of deviance as some MHD symptoms are common in society.

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10
Q

What are strengths of dysfunction?

A

Considers the impact of MHD on the individuals daily functioning.

Values the importance on maintaining healthy everyday functioning, meaning relevance.

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11
Q

What are the weaknesses of dysfunction?

A

Ideas of what dysfunction is differs on the individual making the judgment. Potentially biased.

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12
Q

What are strengths of distress?

A

It considers the emotional impact of mental health, which can be easy to overlook if the Individual isn’t explicit about their abnormal behaviour.

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13
Q

What are weaknesses of distress?

A

It’s hard to operationalise as it’s an emotional measure (internal). Prone to subjectivity when analysed.

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14
Q

What are strengths of danger?

A

It considers the safety of the patient and society in general.

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15
Q

What are the weaknesses of danger?

A

It can sustain stigmatisation of individuals with MHD as being dangerous in society, therefore can be unethical.

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16
Q

Overall strengths of the D’s of diagnosis:

A

They are useful as effective application can determine whether a clinical diagnosis should be considered. It can save clinician time and resources.

All D’s must be used consistently, with standardised measures in order to lead to a reliable decision on whether a behaviour is normal.

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17
Q

Overall weaknesses of the D’s of diagnosis:

A

Davis 5th D (duration) said that for the disorder to be a MHD, the abnormal behaviour must occur for a long period of time. It highlights the other 4 D’s to be reductionist. Without considering duration, there may be false positive diagnostic errors.

Prone to subjectivity of the professional, particularly deviance and dysfunction.

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18
Q

What are the 2 classification systems?

A

ICD AND DSM

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19
Q

What does ICD stand for?

A

International classification of diseases

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20
Q

What does DSM stand for?

A

The diagnostic and statistical manual of mental disorders

21
Q

Who created the ICD?

A

WHO - world health organisation

22
Q

Who created DSM?

A

APA - American psychiatric association

23
Q

What do classification systems aim to do?

A

Aim to enable professionals to make reliable and valid diagnosis.

They contain classifications of disorders grouped into different clusters and symptoms of the specific disorders to aid accurate diagnosis. Diagnosis is needed so individual can receive appropriate treatment.

24
Q

What is the DSM?

A

The DSM is a diagnostic manual used widely in America.
It’s in its 5th edition.
It groups disorders into families of related disorders which enables the professional to quickly go from a generic diagnosis to a specific one.

25
Q

Why was the DSM created?

A

The US armed forces wanted a guide to diagnose their servicemen. There was a need for a common system to aid a consistent diagnosis.

26
Q

How many sections does the DSM have?

A

3

27
Q

Explain section 1 of the DSM:

A

It is an intro to the manual, with instructions to its use and overview of changes.

28
Q

Explain section 2 of the DSM:

A

It’s the diagnostic criteria for the main mental health disorders:

  • Neurodevelopmental disorders
  • Schizophrenia spectrum and other psychotic disorders
  • Bipolar and related disorders
  • Depressive disorders
  • Anxiety disorders
  • Obsessive compulsive and related disorders
29
Q

Explain section 3 of the DSM:

A

Other assessment measures, including:

  • Information about cultural context to aid diagnosis across different cultures.
  • Clinician-rated and patient-rated measures to give the patient a “voice” in the diagnostic procedure.
  • Information about “new” conditions being assessed for possible future diagnosis in section II, e.g. internet addiction disorder and internet gaming disorder.
30
Q

How is the DAM-5 different from the other DSM versions.

A

Older versions of the DSM used to use 5 axes, which has been abolished in DSM-V.
• Unnecessary and over-used diagnoses were removed.
• Societal changes have been reflected in classifications, e.g. PTSD covers more symptoms based upon increased knowledge gained from wars, dementia has been separated into major and minor due to the increased prevalence and there is more awareness of cultural differences in mental health. “Culture-bound syndromes” (disorders specific to certain cultures) have been replaced by “advice on cultural concepts of distress”.
• It now reflects contemporary attitudes towards mental health, e.g. the term “mental retardation” has been replaced by “intellectual disability”.

31
Q

Main strengths of DSM-5:

A

Standardised and operationalised criteria allow for a common, consistent, reliable diagnosis across different clinicians.

32
Q

Main weaknesses of DSM-5:

A
  • The DSM medicalises mental health, presenting disorders as “illnesses” that need “cures.” However, some argue that mental health disorders such as schizophrenia simply present a different way of living (Laing).
  • The BPS have critiqued the DSM-5 as it considers the role of social norms when making a diagnosis. This means the professional needs to make a judgment about whether a behaviour is “normal” or not, leading to issues of subjectivity in diagnosis. This could mean diagnoses are not reliable between different professionals.
33
Q

What is the ICD?

A
  • The ICD is a diagnostic manual commonly used across the world.
  • It is a comprehensive classification system, covering all diseases and disorders, not just mental health disorders.
  • Similar to the DSM, the ICD groups disorders into “families” of related disorders. This enables the professional to quickly go from a general diagnosis to a specific one, and later, to a very precise sub-type of a disorder.
34
Q

Why was the ICD created?

A

The WHO aimed to improve health are across the world, and produce the ICD free of charge.

35
Q

What’s in the ICD-11?

A

The ICD-11 involves all diseases, but section F “mental and behavioural disorders” is specific to mental health disorders.
Within section F, disorders are grouped together into 10 different families, e.g. mood disorders.
A numerical system is used with each “family” given a number, e.g. F3 relates to mood disorders. The next digit represents an individual specific disorder. E.g. F31 is bipolar disorder and F32 is depression.
Further use of digits tells you to sub-type of the disorder, e.g. F32.0 is mild depression. Some disorders have further digits and decimal places for additional sub-categories, e.g. F32.0.01 is mild depression with somatic symptoms.
This process allows for very specific diagnosis, starting with a general classification to a specific individual disorder. Starting with the family of the disorder, then the disorder, then the sub-type etc.

36
Q

Main strengths of ICD-11:

A
  • Standardised and operationalised criteria allow for a common, consistent, reliable diagnosis across different clinicians.
  • There are very precise sub-types of disorders identified in the classification system, which allow professionals to make valid and accurate diagnoses, consequently resulting in appropriate treatments being delivered to the right patients.
37
Q

Main weaknesses of ICD-11:

A

• The ICD medicalises mental health, presenting disorders as “illnesses” that need “cures.” However, some argue that mental health disorders such as schizophrenia simply present a different way of living (Laing).

38
Q

Overall strengths of classification systems:

A

Leads to a reliable diagnosis (standardised).

ICD: precise sub-types of disorders leading to valid and accurate diagnosis

39
Q

Overall weaknesses of classification systems:

A

Medicalises mental health (Laing – schizophrenia is “a different way of living”

Labelling and stigmatisation

DSM: Subjective – considers the role of social norms Reductionist approach to mental health

40
Q

What does reliability of diagnosis mean?

A

It is the consistency of diagnosis, overtime and between professionals.
It refers to if the patient would get the same diagnosis if they present the same symptoms to professionals at different times or to different professionals.

41
Q

What is inter-rater reliability?

A

Whether two or more professionals give the same diagnosis to the patient.

42
Q

What is positive predictive value?

A

It shows the reliability of the disorders diagnosis.

43
Q

What are the three main reasons for issues with reliability?

A

Patient factors
Clinician factors
Diagnostic system factors

44
Q

What are patient factors?

A

They are unreliable accounts of symptoms.

  • patients may have poor memory recall, or feel denial, shame and fear of judgement/labelling.
  • symptoms that affect cognition may impact reliability of their recall
45
Q

What are clinician factors?

A

They are subjective interpretation of symptoms.

  • unstructured clinical interviews could lead to different professionals focusing on different symptoms.
  • professionals will interpret symptoms subjectively.
46
Q

What are diagnostic system factors?

A

They are lack of standardisation/objectivity in the diagnostic criteria.
- for example, the DSM leads professionals to interpret behaviours in light of social norms, meaning inconsistent interpretation of symptoms.

47
Q

What does validity of diagnosis mean?

A

The extent to which a diagnosis reflects an actual disorder and therefore enables suitable treatment.

If individuals with the same diagnosis have different symptoms and respond differently to treatment, it means low validity of diagnosis.

48
Q

What are the issues of validity for diagnosis?

A
  • classification systems reduce disorder down to finite symptoms, not accurately representing disorder
  • low validity of older versions as there are changes in content
  • co-morbidity is hard to diagnose using classification systems as it relies on choosing the best fit, meaning poor validity

Clinical Psychology (7 decks)

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