L01 - Intro to Psychopathology Flashcards
conceptual models - assessment, classification, and diagnosis
medical models/syndromes of psychopathology
syndrome borrowed from medical models of illness
taxonic
medical models have evolved over time
acknowledge illness as multifactorial/multiply-determined
Clinical Psychology working to catch up
According to Wakfefield, what is harmful dysfunction?
dysfunction: “an organ system performing contrary to its design”
- importantly, not at the peak of its design
- Wakefield argues that the brain is designed to perform a number of functions
– thinking
– feeling
– emotion regulation
- problems with any other these functions indicates a disorder
- presumes we understand the function and design of the brain, personality, emotions, etc.
What is Lillienfeld’s critique to Wakefields argument?
What is “natural function”?
natural selection depends on variability
some disorders may represent adaptations, not maladaptations
What was Widiger’s proposal to Wakefield and Lillienfeld’s thoughts?
mental disorders are constructs
What are the purposes of a classification system?
diagnosis and diagnostic systems
Description: highligh critical features of a diagnosis
- e.g., schizophrenia: what are the important symptoms?
Prediction: may tell you something about course, treatment response, etiology
Theory: provides a set of postulates about relationships of different elements to one another
Communication: e.g., between clinicians
What are the 5 criteria proposed for valid classification of disorders?
- Clinical Description: the disorder has to be characterized by a common set of symptoms that cluster together and are characteristic of the disorder
- Course: people with the disorder should follow a common trajectory, and have a similar onset
- Treatment response: if a disorder is valid, most people will respond similarly to similar treatments
- Family history: does the disorder run in families? if so, speaks to validity of a diagnosis
- Laboratory studies: look for biological and psychopathological associations
What are the limitations of a classification system?
and what is a procrustean bed?
Loss of uniqueness: diagnosis implies that common features are more important than the ways in which individuals vary
Difficulty of boundary cases: what do you do about the people who are on the boundary? Do we arbitrarily decide which group they’re more similar to? (sometimes we do both)
procrustean beds: we fit people to our diagnosis rather than fitting
diagnosis to the people in front of us
What are categorical and dimensional systems?
Categorical
- presence/absence of a disorder
– either you are anxious or you are not anxious
Dimensional
- rank on a continuous quantitative dimension
– degree to which a symptom is present
– How anxious are you on a scale from 1 to 10?
Dimensional systems may better capture an individual’s functioning
Categorical approach has advantages for research and understanding
What are the advantages of a categorical approach vs. a dimensional one?
Categorical
- simplifies communication
- in dimensional model, everybody falls SOMEWHERE
- natural preference among people to employ categories in speech
- categories better-suited for clinical decision-making:
– hospitalize or don’t?
– Treat or don’t?
– Dimensional: arbitrary cut-offs
Dimensional
- preserves more information
- greater reliability - inter-rater, test re-test
- cutoffs in categorical system tend to magnify small differences
In what year was DSM-I published, and how many diagnostic categories did it include?
1952
106 categories
In what year was DSM-II published and how did it differ from DSM-I?
1968
- few categories (182 categories)
- no requirements for # of symptoms
- psychoanalysis was the dominant paradigm
In what year was DSM-III published and how did it differ from DSM-II?
1980
- 265 categories
- demand for a more biological, empirical approach
Inclusion criteria: what symptoms do you need to have, and how many?
Duration criteria: how long do you need to exhibit these symptoms?
Exclusion criteria: what symptoms rule out a diagnosis?
Multi-axial classification
What is the mulit-axial classification?
(DSM-III)
- Major Clinical Disorders (e.g., MDD, PTSD)
- Personality Disorders (e.g., BPD, NPD)
- Medical conditions that might contribute or be relevant to treatmetn
- Psychosocial Stressors - something with which to record environmental contexts
- GAF - a simple rating of function/summary score for severity
How many diagnostic categories did DSM-III-R have?
292
How many diagnostic categories did DSM-IV-TR have?
297
How many diagnostic categories does DSM-5 have?
157
What were the assumptions introduced in DSM-III?
symptoms are the most useful basis for assessment
- nosology based on behaviour and symptoms
locus of pathology is in the individual
- what about family systems?
- social systems?
When was DSM-IV published and what did it introduce?
1994
introduced “clinicall significant distress or impairment in social, occupational, or other important areas of functioning”
When was DSM-IV-TR published and how did it differ from DSM-IV?
2000
did not introduce new diagnoses or specific criteria
provided more information on each diagnosis
provided a broad definition of mental illness
When did DSM-5 come out and how does it differ from DSM-IV-TR?
2013
removed multi-axial system
introduced dimensional assessment criteria for some diagnoses
re-classified some disorders
removed others
What are some challenges to categorical classification?
Heterogeneity
- same diagnoses, but different symptoms
Comorbidity
- of people who currently meet criteria for one disorder, 50% qualify for more than one
– over the course of their lifetime, 75%
– comorbidity affects course, development, presentation, treatment response, etc.
– comorbid patients tend to have poorer outcomes
- research implications: anything you find to be associated with one disorder may actually be a result of the comorbid disorder
– if you don’t consider any comorbidities they might have, you are missing a huge part of the diagnosis
Why does Comorbidity exist?
Chance
- odds of MDD for adult females = 20%
- odd of anxiety disorder for adult females = 20%
– 4% will have both
– some comorbidity is just chance
- but comorbidity greater than chance alone would indicate
Sampling bias
- each disorder associated with a chance of being treated
- individuals with more disorders (i.e., more severe individuals) are more likely to seek treatment
- clinical samples, likely biased samples
- BUT, we find high rates of comorbidity in community samples as well
– not just clinical samples
– sampling bias doesn’t account for all
Problems with diagnostic criteria: many criteron sets overlap
- suicidal ideation in MDD, schizophrenia, BPD, AUD, SUD
- sleeplessness in MDD and GAD
- Worry in GAD and MDD, etc.
- still can’t totally account for high rates of comorbidity
Poorly-drawn diagnostic boundaries
- Multiformity:
– possible that some disorders manifest themselves in the same way
– people with MDD frequently have panic attacks
– comorbid disorders may in fact reflect a 3rd, independent disorder
- Causal explanation: one disorder is a risk factor for another disorder
– Conduct disorder in youth may lead to adult Substance Use Disorder by affecting the peers youth is exposed to
- Shared etiological risk factors:
– etiology: the origins of the disorder
– may also explain some of the comorbidities
What are some alternative, dimensional/hierarchical models to diagnosis?
- one early attempt
– factor analysis: you put a bunch of variables in a dataset together, and then you run a factor analysis to see which symptoms/diagnoses clump together (share variance) and which ones do not to identify factors in this structure of psychopathology
- Internalizing:
– MDD, GAD, and Panic Disorder all load onto internalizing
– people who cause distress to themselves (FALSE, but people do mention this)
- Externalizing:
– ODD, SUD, Psychopathy load onto externalizing
– they are distinct and relatively independent
– people who cause distress to others (FALSE, but people do mention this) - HiTOP
- RDoC
Why are MDD and GAD more like one another?
because they are more related to anxious misery and load onto internalizing
