DSM-V and ICD-10 Flashcards
What is the DSM-V?
Describes symptoms, features and risk factors of over 300 mental and behavioural disorders arranged into 22 categories. Used in US, developed by APA.
How is the DSM-V organised?
DSM - 3 sections
- Offers guidance about usage
- Details disorders, categorised according to our understanding of causes and similarities between symptoms
- Suggestions for new disorders and the impact of culture on the presentation of symptoms and how they are communicated
How do clinicians make a diagnosis using the DSM-V?
Observation, unstructured clinical interview. Structured interview schedules available based on symptoms e.g. BDI.
Rules out disorders, goes for a ‘best fit’
How is Reliability assessed using the DSM-V?
R-cohen’s kappa, based on assessment and reassessment. Decimal from 0.01-0.99. Closer to 1 the better (Spitzer et al, 0.7 indicates a ‘good agreement’)
How is Validity assessed using the DSM-V?
Descriptive validity- when two people with the same diagnosis exhibit similar symptoms
Concurrent validity- When a clinician uses more than one method to reach a diagnosis and methods lead to same diagnosis
Aetiological validity-When disorders share same causal factors
Predictive validity- The ability to accurately predict outcome for an individual based on their diagnosis
DSM-V reliability + and -
+Regier et al found that 3 disorders including PTSD had kappa values ranging from 0.6-0.79 (very good), 7 more diagnoses including Sz had kappa values of 0.4-0.59 (good)
-Cooper et al falling standards - what counts as an acceptable kappa value has plummeted over time- 0.2-0.4 ‘acceptable’- MDD was just 0.28 (Regier et al)
——–> +However, DSM-V trials likely have low level of reliability as they were field trials in comparison to carefully controlled DSM-III trials, which screen tested clients and trained clinicians. Thats why ‘acceptable’ value has changed over time
DSM-V validity + and -
+Kim-Cohen et al, conduct disorder. CONCURRENT- multiple research methods to gather data (obs, questionnaires, interviews), AETIOLOGICAL as specific risk factors e.g male, low income common in cases. PREDICTIVE - children with CD were more likely to display behavioural difficulties 2 years later.
-Labels tell us nothing about causes. Naming or classifying a disorder doesn’t tell us cause- why are they hearing voice?=Sz, how do we know they are Sz?=hearing voices. Circular
What is the ICD-10?
Includes mental and physical disorders. Multilingual, free source which provides a ‘common language’ for users, so data collected can be compared cross-culturally.
How is the ICD-10 organised?
Chapter 5 is MandB disorders. Each disorder has a code (f), 11 sections. For example, F20 is SZ, F20.0 is paranoid sz, F20.1 is hebephrenic sz
Sections have leftover codes allowing new disorders to be added
Used to index medical records
How do clinicians make a diagnosis using the ICD-10?
Clinician selects key words from clinical interview which relates to their symptoms- for example, hallucinations and delusion for sz
Symptoms can be looked up in alphabetic index , or go to indicative section. Other symptoms identify subcategory
How did the ICD-10 improve diagnosis in terms of culture?
ICD 10 is a universal classification because it’s available in different languages and cultural forms.
- No more cultural influences.
ICD-10 reliability + and -
+Ponizovsky et al- Found that PPV scores increased by 26% for Sz, 16% for anxiety disorders, 8% for mood disorders- reliability improvements from ICD 9 to 10.
+Galeazzi et al- Interrater - 2 clinicians conducted a joint interview to assess clients - kappa values ranged 0.69-0.97 - showing high agreement.
-Pozinovsky’s study less satisfactor PPV values for childhood and personality disorders- 55 and 56%. Suggests ICD-10 not as reliable for specific diagnoses
ICD-10 validity + and -
+Mason et al - Predictive - ‘reasonably good’ prediction for 99 people with Sz 13 years later- Accurately predict future outcomes
+App to diagnosis- WHO’s approach to ICD-11 is aimed to improve ‘clinical utility’- this did happen- ICD-11 (published 2019) has a more sophisticated structure than the ICD-10, with more codes, making it more ‘user-friendly)
-Gurland- Found that New York psychiatrists were more likely to diagnose clients as having Sz compared to London psychiatrists - cultural differences between people.
DSMV and ICD10 criterion for diagnosis Sz
DSMV- 2/4 key symptoms one must be h, d or dt. One month of active symptoms, disturbance to everyday functioning for 6 months
ICD10- Less focus on dysfunction, 6 months of disturbance NOT NECESSARY for diagnosis
