Diagnostic Issues: Week 4 Flashcards
Discussion Issues: One Flew Over the Cukoo’s Nest
Ethical Issues (sedation, heroic interventions, confidentiality)
Effect of institutional setting
Reliability and validity of psychiatric diagnoses
Social control vs a therapeutic social environment
Future of Psych Epi (Robins, 1978)
the improvement of diagnosis by interview
the study of the relationship between physical and mental disorders
the identification of barriers to care
the conduct of cross-national comparisons
the research use of clinical records
the epidemiological study of the course of psychiatric disorders
the development of instruments for assessing environmental factors
the conduct of prospective studies of anticipatable life events
the development of data banks of rare disorders
Major Trends in Assessment
The Second World War
President Carter’s Mental Health Commission (emphasizing the need for improved epi research)
Global Burden of Disease project – WHO, which highlighted the burden imposed by psychiatric disorders (1994- )
Dimensions
A quantitative gradient representing symptom severity or frequency
Presence is a matter of degree
Preferred measurement instrument:
a rating scale
Syndrome
A pattern of inter-related symptoms that occur together during a given period of time.
Components include essential features, associated symptoms, duration, distress and disability.
Elements of Diagnostic Assessment
Look for severity, not necessarily the cause
Look for age of onset, family history, etc.
Meds and demographic info
Structured Interviews
Used for:Major syndromes
Fixed questions
Fixed response categories
Scoring algorithm to decide diagnosis
Lay interviewers
More appropriate for community surveys
Semi-structured Interviews
Suggested questions and probes allow open-ended responses until clinician decides whether patient fits symptom description and severity
Clinician judgment overrules patient response if there is a difference between the two
World Mental Health Survey Discovered?
Mental disorders have early ages of onset
Long delays in seeking treatment
Mental disorders generally antecedents of substance use in adolescence
