Diagnosis Flashcards
What makes a classification system reliable?
One where different clinicians studying one person’s set of symptoms should lead to a common diagnosis and offer the same treatment.
If different clinicians give different diagnosis for the same set of symptoms, then the diagnosis is not reliable and treatment may not work.
How is reliability in the diagnosis of a mental disorder measured?
Reliability is measured using inter rather reliability, which is the extent to which two or more clinicians agree on the same diagnosis.
What are the issues around reliability when diagnosing mental disorders?
👎🏼Patient factors: information provided by the patient to the clinician maybe inaccurate because of problems with memory, denial or shame. Other issues such as disorganised thoughts, psychopathy or manipulative tendencies can make consistent diagnosis between clinicians.
👎🏼Clinicians conduct unstructured interviews which can lead them to focus on certain symptom presentations e.g. One might focus on nightmares whilst another might focus on a traumatic past event. Clinicians might also interpret symptoms differently depending on their training and experience. E.g. A psychodynamic trained clinical might emphasis early childhood experiences whereas a medically trained psychiatrist might focus on an imbalance of neurotransmitters in the brain.
State two pieces of research that support the reliability of diagnosis
👍🏼Goldstein (1988) used the single-blind technique (where clinicians did not know the hypothesis) to test the reliability of the DSM III. Two experts re-diagnosed 8 patients who had previously been diagnosed with schizophrenia using the DSM II. The experts only had copies of case histories and no reference to the original diagnosis. Goldstein found a high level of agreement and inter rather reliability suggesting that the DSM III was a reliable tool.
👍🏼Jakobsen et al (2005) looked at the use of the reliability of the ICD-10 when diagnosing schizophrenia. He found 0.93 inter rather reliability when it came to diagnosis and good agreement between the ICD-10 and diagnosis using another measure suggesting high reliability.
State two pieces of research evidence that show low reliability of diagnosis
👎🏼Cooper (2014) stated schizophrenia had a reliability estimate of 0.81 in the DSM III trail and just 0.46 in the DSM V trail suggesting that the DSM V is not as reliable. 🥊However the DSM V is not easily compared to older versions as the diagnoses are more fine tuned and more specific e.g. Eating disorder has become binge eating.
👍🏼👎🏼Kupfer suggests that some disorders have symptoms that vary a lot over weeks so it is harder to find reliability for those diagnoses e.g. Autism spectrum and binge eating disorder in adults have v good reliability in trails using the DSM V whereas major depressive disorder and generalised anxiety disorder had rather low reliability scores.
Describe the 4 D’s
Clinical psychologists need to decide at what point a behaviour displayed by an individual becomes abnormal and in need of clinical diagnosis and treatment. One method is the four D’s.
What are the 4 D’s?
Deviance
Dysfunction
Distress
Danger
Describe deviance in terms of the 4 D’s
Behaviour and emotions that are not the norm in society e.g. a person behaves in a way that is different to how we expect them to behave.
Behaviour deviates from social and cultural norms and is seen as unacceptable by society.
Describe dysfunction in terms of the 4 D’s
When the behaviour means a person is not able to cope with the demands of everyday life and everyday tasks. E.g. Not being able to maintain standards of nutrition and hygiene.
Dysfunctional behaviour can be deliberate and must occur in more than one area of the persons life to receive a diagnosis.
Describe distress in terms of the 4 D’s
When the behaviour is causing upset to the individual.
The subjective experience of the person is important. Eg a person may be feeling distressed yet still be able to function whereas another person might not be feeling distressed but is unable to function.
Describe danger in terms of the 4 D’s
Behaviour is assessed as either dangerous to themselves or others.
If the person their own life or others in considerable danger then this may indicate an intervention is needed.
State two strengths of using the 4 D’s to identify abnormal behaviour
👍🏼Practical applications as they are useful for professionals when considering when a patients symptoms or issues become a clinical diagnosis.
👍🏼Reliability as a clinician can assess a patients behaviour across four dimensions before making a decision about further care. This is important especially when considering the concept of ‘deviance’ as some problematic behaviours are not actually that rare e.g. depression.
State two weaknesses of using the 4 D’s to identify abnormal behaviour
👎🏼Potential for subjectivity in the interpretation by the clinician and also the individual patient. What is considered dysfunctional by one will be differently by another.
👎🏼There may be low inter rather reliability if the four D’s are being used by two different clinicians. This means that fire to issues of subjectivity the clinicians may not reach the same conclusion about the mental disorder.
🥊However to be relatable the clinicians should they explore all four of the D’s with every patient to ensure everyone is measured in a standardised way.
State a conclusion of using the 4 D’s to identify abnormal behaviour
Over time psychologists have learnt that they should not classify people as abnormal based on one definition alone. As a result of these improvements, the 4 D’s are an effective tool to help clinicians decide when a characteristic or trait is problematic enough for further investigation and clinical diagnosis.
However there is no clear scale between normal and abnormal only issues of judgement.
What is the DSM-V?
It is a diagnostic system used to classify mental disorders based on symptoms shown. It is divided into 3 sections:
1) introduction to how the manual is organised, how it has changed from the DSM IV and how it is used.
2) diagnostic criteria of the main mental health disorders such as schizophrenia spectrum and depressive disorders.
3) looks at other assessment methods to aid diagnosis e.g. measures of disability or how cultural context may influence how a mental disorder may be presented by a client.
