Introduction to Classification, Diagnosis and Formulation

Question 1

1) What are some definitions of disease/illness?

Answer 1

1)
-Necessary cause with replicable morbid anatomy
(Sydenham 1696;
Szasz, 1960)
-A purely human invention… there are no illnesses or diseases in nature
(Sedgwick, 1981)
-Sufferers have common characteristic that gives them a biological disadvantage (function)
(Scadding, 1967)
-Disease as imperfection – quantitative /qualitative deviations from a current norm
(Cohen, 1953)

Question 2

1) What is the process/intent of a medical diagnoses?

2) Does diagnosis in psychiatry differ from other areas of medicine?

Answer 2

1) -The process of discerning/ distinguishing one from another (Dia) using existing knowledge (Gnosis) – from the Greek
-The identification and naming of a disease in order to guide management and predict its course
-Made on the basis of observation of symptoms, signs, investigation findings in the context of the patient’s history
Can (and should) be honed from an initial list of differential diagnosis

2) Does this apply to psychiatric illness?
Largely syndromes
Based on subjective experience/ behaviour rather than objective abnormalities
Involves non-absolute value judgements
Atheoretical in nature – underlying causes not proven/ no biomarkers

Question 3

1) How does the DSM-5 define a mental disorder?

2) If a mental health response occurs when is it considered a normative response?

3) What is meant by classification?

Answer 3

1) A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.

2) An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

3) A process of arrangement into groups according to established criteria, applied in many fields (biology, linguistics, mathematics etc)

Question 4

1) What is the ICD, who runs it and what’s it’s main use?

2) What are the main changes to the ICD - 11 made in 2022?

Answer 4

1) World Health Organisation (WHO) International Classification of Diseases (ICD)
Provides coded diagnosis (across the medical spectrum) for clinical use, but also for healthcare management and epidemiological research

2) Mental, behavioural and neuro-developmental disorders’ coded in Chapter 6 (6A-6E) under an expanded catalogue

Not a paradigm shift though definitions now more detailed and nuanced

Some diagnostic sub-categories removed (e.g. some schizophrenia sub-types) and some incorporate an element of dimensionality e.g. personality disorder

Now includes fixed diagnostic requirements

Question 5

Describe the DSM 5