diagnosing mhd (classification systems) Flashcards
what is a classification system?
a checklist of signs and symptoms which helps a clinician to reach a diagnosis of a specific disorder, often by process of elimination
what are the two classsification systems we look at?
- dsm
- icd
who is the dsm published by?
american psychiatric association (APA)
where is the dsm used?
in the us and around the world
what is the current version of the dsm?
updated to DSM-5 in 2013
latest version DSM-5-TR published in 2022
describe the dsm
describes symptoms, features and risk factors of over 300 mental disorders
disorders are arranged into 22 categories
DSM 5 has three sections:
* Section one: offers guidance on using the manual
* Section two: info about disorders (symptoms, features, risk factors)
* Section three: suggestions for new disorders, also includes info about the impact of culture on the presentation of symptoms and how they’re communicated
DSM 5 has replaced five separate subtypes of SZ (paranoid, catatonic etc.) with SZ on a dimension, so the level, number and duration of symptoms can be assessed on a spectrum.
making a diagnosis using the dsm
Contains guidelines for clinicians to make diagnosis:
- gather data using clinical interview, observation etc.
- rule out disorders which do not match symptoms
- then find ‘best fit’ for the individual
who is the icd published by?
World Health Organisation (W.H.O)
what is the current version of the icd?
ICD 11 published in January 2022
describe the icd
Includes both physical and mental disorders
Multilingual, freely available, used globally
Available in appropriate forms for different cultures
Chapter 5 titled ‘Mental and Behavioural Disorders’
Each disorder has a code starting with ‘F’
eg. Subcategory for schizophrenia = F20 which is further divided;
Paranoid SZ = F20.0
Hebephrenic SZ = F20.1
Catatonic = F20.2
compare the icd and dsm
Similarities
* both are used for diagnosing mhd
- both are under constant update and revision to reflect latest research findings and clinical experience, the DSM is currently in its 5th edition whereas the ICD is in its 11th edition
Differences
* Structure/ content
- DSM is published by the APA whilst the ICD is published by the WHO
making a diagnosis using icd
Guidance on diagnosis:
* clinician selects key words relating to symptoms from clinical interview e.g. hallucinations, delusions
- clinician can look these up in index to find section eg. Schizophrenia
- then uses other symptoms to identify a subcategory eg. paranoid SZ.
what is reliability in clinical psychology?
- consistency of diagnosis
- if the same individual went to two different clinicians they should reach the same diagnosis using the same tools (Four D’s, DSM, ICD) and hearing the same information
what is inter-rater reliability in clinical psychology?
- means showing two or more clinicians one person’s case history and assessing the level of agreement between them
- If all the clinicians (raters) agree then there is said to be good inter-rater reliability.
what is validity in clinical psychology?
- refers to how accurate a diagnosis from a clinician is based upon information given by a patient in clinical interviews and observations
- if not, the individual may risk receiving the wrong treatment
what is concurrent validity
the amount of agreement between different classification systems
define ‘test-retest reliability’ in terms of diagnosing a mental disorder
whether the diagnosis of a patient is consistent when being re-diagnosed at a later date
what is a type 1 error in clinical psychology?
when the null hypothesis is rejected and the alternative hypothesis accepted when the effect was not real
(diagnosing someone as having a mental health disorder (MHD) when they do not)
what is a type 2 error in clinical psychology?
when the alternative hypothesis is rejected and the null retained when there was actually a real effect
(diagnosing someone as not having a MHD when they do).
who found that classification systems are or are not reliable?
reliable
* rosenhan
* goldstein
* andrews et al
* brown
not reliable
* spitzer & fleiss
* beck
* andrews et al
* brown
reliability of classification systems - rosenhan
Rosenhan (1973) suggests the DSM II was reliable as there was consistent diagnosis of pseudopatients 11/12 SZ in remission and 1 bipolar, based on the same symptoms (empty, hollow, thud)
however validity is low
reliability of classification systems - goldstein
Goldstein (1988) looked at 189 patients along with 2 other clinicians and found high levels of inter-rater reliability when patients were diagnosed for SZ using the DSM.
reliability of classification systems - andrews
IS reliable
Andrews et al (1999) found high inter-rater reliability on diagnosis for depression, substance dependence and anxiety disorders.
reliability of classification systems - brown
IS reliable
Brown (2001) tested the reliability and validity of DSM IV for anxiety and depression, found them to be ‘good’ to ‘excellent’
