Diagnosis and Formulation Flashcards
1
Q
Diagnosis
A
- A diagnosis is a medical term used to describe patterns of experiences or behaviours that may be causing distress.
- Diagnostic classification systems have been constructed to help clinicians make diagnoses.
List of criteria under a diagnosis- if you present with certain criteria you receive a specific diagnosis
- Diagnostic classification systems have been constructed to help clinicians make diagnoses.
2
Q
what are the functions of diagnosis?
A
- Guiding treatment decisions
- Predict clinical outcomes- once you have a diagnosis you can make predictions about how they will cope/recover
- Research (e.g., defining groups of participants) e.g. CBT efficacy in depression- once you have a diagnosis of depression know which group to allocate
- Enable clinical communication for referrals, recommendations and treatment
- Organising mental health services- some services have a criteria where you need a diagnosis e.g. referrals with eating disorders
- Help people to understand what is going on
- Access to support
Point of the lecture- do we need a diagnosis or is there another way of doing things?
3
Q
categorical construction
A
- DSM-5 included over 500 clinicians, 13 work groups, 13 major conferences and hundreds of peer reviewed papers from over the last decade.
- Social influence possible (removal of homosexuality).
Culture and political movements both influence categories, which change over time.
- Social influence possible (removal of homosexuality).
4
Q
causal models
A
- Classification takes a biomedical model (BMM) position towards mental health conditions.
- Mirrors physical healthcare, applying diagnoses based on symptoms (Kinderman, 2014).
- Psychiatry treated as a branch of medicine and uses medical language.
Without biological markers, we can only rely on behaviour as an indicator. - Practice is then predominantly influenced by the BMM and the diagnostic classification systems in place (Johnstone, 2013).
- Like physical health, categories are used to suggest interventions.
In the Uk we have guidelines based on diagnoses and diagnoses=treatment
5
Q
reliability
A
- Diagnosis seen as reliable if two people agree on which category best applies and if the same decision would be reached if the person were reassessed (Johnstone, 2013).
- However, different clinicians have different diagnostic preferences.
Early research showed clinician disagreement about psychiatric diagnosis (Beck et al., 1962; Blashfield, 1973).
- However, different clinicians have different diagnostic preferences.
6
Q
comorbidity
A
- meeting the criteria for more than one diagnosis)
- Kessler et al. (2005) found that 50% of people with one diagnosis in the USA national co-morbidity study had at least one more, and 25% had more than three.
- Service users often acquire a range of diagnoses during their contact with mental health services.
- As so many people meet multiple criteria for different diagnoses, it has been argued that this undermines the categorical system.
Diagnoses are therefore not discrete, separate entities.
7
Q
subjectivity
A
- Criteria are based on subjective norms, which leads to low reliability. There is nothing inherently wrong with subjectivity in clinical judgement, the issue is with presenting it as objectivity (Johnstone, 2013).
- Increasing the amount of diagnostic labels and subtypes is seen as a method to improve diagnostic precision and increase reliability (Johnstone, 2013).
Ignores that new criteria remain subjective and culturally influenced.
- Increasing the amount of diagnostic labels and subtypes is seen as a method to improve diagnostic precision and increase reliability (Johnstone, 2013).
8
Q
validity
A
- Diagnostic classifications should also be valid – scientifically meaningful and representing real ‘things’.
- If a mental health condition were a valid medical category, we should be able to reliably predict outcomes and effective treatments (Johnstone, 2013).
- Diagnosis does not predict outcomes or the course of a condition. For example, the outcome (prognosis) for people with a diagnosis of schizophrenia is extremely variable.
Diagnosis does not predict medication response (Kendell, 1988). This is not to say that medication is not useful or that it should not be offered. But it does suggest that positive effects are non-specific and unpredictable.
9
Q
heterogeneity
A
- Variation within diagnostic categories is very common.
○ Galatzer-Levy and Brynant (2013) found 80,000 symptom combinations for a PTSD diagnosis in DSM-IV and over 600,000 symptom combinations for a PTSD diagnosis in DSM-V.
○ Fried and Nesse (2015) found that combining the symptoms of MDD listed in the DSM can result in over 1000 different combinations of symptoms.- So, people with the same diagnosis lack the same experiences (Johnstone, 2013).
Heterogeneity does not challenge that a phenomena exists, but calls for an acknowledgement of cultural influence and to move away from assumptions that clinical conditions are objective and waiting to be discovered (Botha, 2021).
- So, people with the same diagnosis lack the same experiences (Johnstone, 2013).
10
Q
language, labelling and stigma
A
- Language from the biomedical model (e.g., disorder) means that difficulties are seen as problems within the individual.
○ Pathologises ‘normal’ responses
○ Creates the idea of being ‘disordered’ or different
○ Locates the problem in the person
○ Contributes to power imbalance between clients and clinicians- Pathologies human experience, following the idea that our mental health struggles indicate something is ‘wrong’ with us.
Overlooks meaning behind behaviours or symptoms (e.g., PTSD).
- Pathologies human experience, following the idea that our mental health struggles indicate something is ‘wrong’ with us.
11
Q
is language a blunt tool?
A
- “Instead of seeing people’s difficulties as understandable and natural responses to the terrible things that have happened to them, the person is seen as having something wrong with them – an ‘illness’.” (Kinderman, 2014)
Psychology typically views mental distress as experiences and related struggles which are understandable within the context of a person’s life (Johnstone, 2013).
12
Q
adverse or traumatic life experiences
A
- Adverse or traumatic life experiences include a wide spectrum of experiences, such as sexual or physical abuse, neglect, bullying, job loss, poverty, and homelessness.
- Research clearly shows that distressing life experiences play an important role in mental health difficulties (e.g., Nelson et al., 2017; Varese et al., 2012).
- Specific adversities might lead to specific experiences/symptoms of psychosis (see Bentall et al., 2014).
- Childhood sexual abuse is particularly associated with hearing voices.
Experiences that disrupt attachment (e.g., being brought up in care or neglect) are particularly linked with paranoia.
13
Q
adverse life experiences
A
- By just looking at symptoms, we are not looking at the whole picture.
- In fact, research suggests that the majority of people using mental health services have been exposed to adverse or traumatic life experiences (Mauritz et al., 2013).
- This is why context is very relevant to how we think about mental distress.
Yet, trauma is only mentioned in one specific section of diagnostic manuals (Allsopp et al., 2019).
14
Q
embedded bias: ethnicity
A
- There are marked cultural differences in distress.
○ For example, African Caribbean people living in the UK are up to twelve times more likely to be diagnosed with schizophrenia (Fernando, 2002).
In England from 2017 to 2018, amongst five broad ethnic groups, known rates of detention in hospital under the Mental Health Act for people who identify as Black or Black British were over four times those who identify as white (NHS Digital, 2018).
15
Q
diversity
A
- People who see their experiences as spiritual (e.g., auditory hallucinations or visions) are overlooked and pathologized (Jackson & Fulford, 1997).
- Diagnostic systems risk pathologizing behaviours that are not considered normal in white, western, male, middle-class culture (Cochrane & Sashidharan, 1995).
