Diagnosis and Assessment Flashcards
What is the psychiatric dictionary called?
THE DSM-5
Comment on the progression of psychiatric disorders
DSM-1 in 1952 had 106 disorders
DSM-5 from 2022 has 297 disorders
What type of criteria does DSM use
Polythetic criteria
Having many, but not all properties shared
What’s the issue with a polytheistic criteria?
It introduces heterogeneity/ diversity
Example: There are more than 100 different ways to meet the criteria for bipolar disorder
Two patients with schizophrenia can have no overlapping symptoms
It’s very complicated to give diagnosis because we are trying to put a frame on the disorders
They’re not based on biological observations, the idea that people have these characteristics seem to be more evident in this category
If the categories of polytheistic criteria are wrong, then why are they used?
People like to have a name for what’s happening to them
Allows better explanation and less isolation
Important but imperfect guidance for treatment
Allows for consistent communication between clinicians/ researchers: standardisation
Allow for medical insurance and disability claims
What were the key changes in DSM 5
- New disorder
prolonged grief disorder- grief that lasts for a long period of time
2.Other conditions of clinical attention
suicidal behaviour and non-suicidal self-injury
In the past, for these behaviours to exist they needed to be in another diagnostic category
- New names for old disorders
Functional Neurological Symptom Disorder (formerly ‘conversion disorder’)
Intellectual Developmental Disorder (formerly Intellectual Disability) - Changes to reduce cultural and ethnic bias
“race” was replaced with “racialized” to call out that race is socially constructed.
The terms “minority” and “non-White” are not used because they imply that whiteness is prioritized over other social groups.
Should we be adding new diagnoses?
There has been a call for new disorders when a person’s symptoms aren’t being adequately explained by existing behaviours.
Example: 2013- premenstrual dysphoric disorder which is a relatively rare and severe emotional disturbance presence during the majority of premenstrual phases
What’s co-morbidity
Having 2 or more disorders at the same time
Why is there so much co-morbidity amongst disorders?
Shared genetic risks
certain genes confer a risk for multiple disorders, ie. bipolar and schizophrenia
Shared environmental risk- stress, trauma and neglect increase the risk for many disorders
Shared treatment efficacy- Some can be controlled by the same hormone or drug,ie. Serotonin effects MDD, OCD, GAD, EDs and PTSD
Shared neurobiological profile- changes to the prefrontal cortex functioning and size are common in many disorders
What’s the Research Domain Criteria Project RDoC
The National Institute of Mental Health (NIMH) in the USA, in 2013 changed research funding from a categorical to a dimensional approach.
New framework for research- can’t change the diagnostic categories cuz they work but the way research is done will change.
Not a diagnostic label that matters, its the colours and schemat that link to the biological and cognitive impact they have
How are psychological disorders assessed?
Clinical interview- most used using the DSM criteria
Stress
Personality
Intelligence
Behavioural and Cognitive
Brain imaging
Neurotransmitters
Neuropsychological
What do all of the types of assessment require
Reliability
Variability
What’s reliability
Gives the same answer consistently across time and raters
What are the 2 types of raters in terms of reliability?
Test retest reliability
Iner rater reliability
What is test-retest reliability?
If you give the same test to the same person on different days test should get same result
What’s inter rater reliability?
2 different clinicians looking at same person and see if they come up with the same diagnosis
DSM diagnoses assed by a clinician are mostly unreliable
What’s validity
Measures what its supposed to
Ie: star signs are reliable but not in a valid way of predicting traits and future events
What are the purposes of using so many methods of psychological assessment?
Understand the individual
Differential diagnosis
Predict behaviour
Prescribe treatment
Evaluate outcomes
Measurement is crucial for research
How do most clinicians assess psychological disorders and why?
Unstructured interviews
Only method they have time for
What’s a clinical interview
An evaluation of the current level of functioning and the presence of symptoms.
Look at:
History: onset and duration of symptoms
Family history
Life stress/pass history
Focus on resources, ie. coping strategies and social supports
The goal is to build an understanding of the individual
What is case formulation
Building an understanding of an individual
What does the mental state exam focus on
Appearance- are they dressed in a certain way/ bathed/ are they making eye contact
Though processes
Mood
Affect- the tone of their voice
Speech- are they not able to say a lot of words/demonstrate too many ideas/words
Perception- if they’re experiencing hallucinations
Disorientation of person/place/time
Insight- do they think anything is wrong
Risk- suicide
Less insight makes treatment more challenging, ie. hoarding disorder
How is stress assessed
Self report- history and current, ie. College and money
Psychophysiology
Heart rate and skin conductance
Biofeedback is used as an aid in exposure therapy
What is personality?
A characteristic pattern of thinking, feeling and behaving
It varies from person to person on a continuum
