Lec 2 Flashcards
What is a diagnostic system?
- a classification system based on rules used to organize and understand diseases and disorders
- categorize them based on clusters of symptoms.
- a certain set of symptoms that only exist for a given disorder.
- outlines decision-making rules for determining diagnoses based on presenting symptoms.
- allows us to make
Why do we diagnose?
- communication: esp. in hospitals- working with multiple people such as nurses, psychiatrists, surgeons, etc., so it is important for them to know everything.
- it helps facilitate research: how things happen, why they happen- if you have a co-occurring diagnosis, research can help us isolate.
- provides a common language and a concise description of the client’s condition
- suggests possible comorbidity, prognosis
- facilitates research by defining experimental groups.
- can investigate potential etiological factors
- suggests potential treatments
- often required to determine eligibility or programs such as for insurance
- can give them diagnoses of MDD (NOS- not otherwise specified) which says there sn;t exact diagnoses, but they don’t meet the criteria, but they do have some sort of label & need insurance.
drawbacks of diagnoses
- ▫ Stigmatization
▫ Potential impact on self-concept
▫ Inaccurate diagnosis = inappropriate treatment
▫ Limitations of current diagnostic systems - categorizing people and forcing them to fit into something.
- experienced psychologists sometimes assume to put people into categories they’re most familiar with (tunnel vision)
- no room for thinking outside the box.
- all psychologists might not give the same diagnoses.
First diagnostic system- who created it?
- Kraeplin created it
- he looked at Dementia praecox (schizophrenia) vs. manic-depressive insanity (bipolar disorder)
- this built the foundation for modern psychiatric diagnostic systems (he started the system- by making cateogires that helped us differentiate between disorders)
- diagnoses as medical illnesses; you can have suicidal ideation but not be depressed, and vice versa.
- use specific criteria to define categories
- emphasis on diagnostic reliability
What does prototype model mean?
- diagnostic system outlines a prototype
- clients may differ in the degree to which they match the prototype
- people with the same diagnosis may have different symptoms and may require different treatments
- more of an issue with certain diagnoses.
- boys & girls are different in how they present their ADHD(get underdiagnosed) -they can have same diagnoses, but how it manifests in you can be different.
DSM: what is it?
Diagnostic and Statistical Manual of Mental Disorders
- Diagnostic system used by many North American mental health professionals
- DSM DSM-II DSM-III DSM-III-R DSM-IV DSM-IV-TR DSM-5DSM-5-TR
- made by psychatrists
DSM 5: what is it
- began planning in 1999
- working groups set by 2008
- finalized information and criteria for each diagnostic category
- reviewed data from field testing
- solicited feedback from stakeholders
- released 2013
- psychology changes- more updates- downfall- expensive updating
- About 10% more diagnoses (approx. 330)
- Categorical
- Research base inadequate to support dimensional approach - Clusters of similar disorders
-Meant to reflect underlying dimensions
Lifespan approach
Aims:
-Effort to maintain continuity
-Revisions to be based on scientific evidence
-Manual to be feasible for use
DSM-5- TR & what were the major changes?
- released March 2022
- Revised text for almost all disorders with updated sections on associated features, prevalence, development and course, risk and prognostic factors, culture, diagnostic markers, suicide, and differential diagnosis.
- addition of the new diagnosis of prolonged grief disorders to Section II
- over 70 modified criteria set with helpful clarifications since the publication of DSM-5
- fully updated “introduction” and “use of the manual” to guide users and provide context for important terminology.
- consideration of the impact of racism and discrimination on mental disorders integrated into the text.
What are the features of the DSM-TR
- provides information on:
- diagnostic features
- subtypes
- associated features and disorder
- prevalence
- course
- familial pattern
- differential diagnosis
- culture, age, and gender features
*alerts the clinician to important information that should be considered.
- shouldn’t always be black & white0 gives supporting evidence.
- if only using DSM for everything, then you’re not doing your job as a clinician.
Is there more or less focus on culture considerations in DSM-TR?
Yes, focuses more on ethnic and cultural considerations.
- Important for validity and relevance
- Considers ethnic and cultural factors relevant to each diagnosis
- Cultural syndromes included in the appendix
- Section on the cultural formulation
- Identity, explanations, factors relevant to the environment, functioning, therapeutic relationship
- Increase cultural sensitivity, appropriateness of clinical formulation
- However, it is not perfect because culture is very diverse; everyone’s interpretation of their own culture is different. Culture is complex - just having black & white diagnostic system isn’t enough.
Which DSM is the most controversial?
- DSM 5
- Increase in public and professional scrutiny
- Concerns with validity of diagnoses, impact on diagnosed
- Spitzer decried lack of transparency
- Negative reaction to proposed changes
- Over-representation of medical/biological views on disorders and their treatment
- Conflict of interest
- Resignation of personality disorders work group members
- Very poor results in field trials
What do health care providers use
- Healthcare providers covered by HIPPA (Medicaid and Medicare) are required to use the ICD (international)
- NIHM announced that they will not fund research based on DSM-5 diagnostic categories
- Lack of validity data
-Encouraging development of a new diagnostic system based on biological markers
what are some controversial changes made in DSM
- Pathologizing bereavement
- Disruptive Mood Dysregulation Disorder
- Mild Neurocognitive Disorder
- Binge Eating Disorder
- Autistic Spectrum Disorder
- Substance Use Disorders (rather than Abuse and Dependence)
- Behavioral Addictions (gambling, exercise addition)
What is ICD
ICD = International Statistical Classification of Diseases and Related Health Problems
- Internationally used diagnostic system
- Main alternative to the DSM
- Developed by WHO
- Classification of all health conditions
- Section on mental and behavioral disorders
What is the ICD-11?
- First edition 1948
- Most recent edition released in 2019
- Over 300 disorders
- International development and field testing
- Available online, updated annually
- Free
- Clinical modification (ICD-CM) provides greater precision about each diagnosis and person’s condition
