Lecture 1-2 Intro & Conceptual Issues

Question 1

Methods of measuring prevalence

Answer 1

Point-prevalence: right now, X percent have …

One-year prevalence: in 2018, X percent have …

Lifetime prevalence: X percent have … during lifetime

Incidence: every year, X percent developed … for first time

Question 2

Lifetime prevalence of any mental disorder

Answer 2

32-48%

Question 3

12-month prevalence in Australia and how many seek help

Answer 3

20%, 1/3

Question 4

DSM definition of mental disorder (4 pt)

Answer 4

• clinically significant behavioural or psychological syndrome or pattern
• present distress or disability or significantly increased risk of suffering death, pain, disability, or important loss of freedom
• must not be merely an expectable and culturally sanctioned response to a particular event
• currently manifestation of a behavioural, psychological, biological dysfunction

Question 5

Single most serious flaw in current psychiatric thinking

Answer 5

Failure to consider if symptoms of psychiatric disorders are actually harmful internal dysfunction

Diagnosis based on symptoms only

Question 6

What is ICD

Answer 6

International Classification of Diseases and Health Related Problems

World Health Organisation (1948)

11th edition

Question 7

What is DSM

Answer 7

Diagnostic and Statistical Manual of Mental Disorders

American Psychiatric Association (1952)

5th edition

Question 8

Current model of mental disorder

Answer 8

medical model

Question 9

Assumptions of medical model

Answer 9

illness qualitatively different from health

different illnesses are

• clearly distinguishable
• independent
• specific, identifiable causal agents
• respond to specific treatment

Question 10

Ultimate goal of medical classification

Answer 10

diagnosis based on known causation

i.e. to identify diagnostic categories (syndromes) that have their own specific causes, lead to specific treatments

Question 11

Biological causes of early medical/biological model

Answer 11

• bacterial or viral infection
• localised brain damage
• toxin
• heredity

Question 12

Revolutionary concepts of psychoanalytic model

Answer 12

• no clear divide between normal and abnormal
• include neuroses other than psychotic states
• no clear divide between different categories of mental disorder

Question 13

Problems with DSM-I, II

Answer 13

Reliability
-inter-rater reliability: can we agree on diagnosis? how often, what qualifies

Validity

• unproven theories about ethology
• is this what depression is

Question 14

Father of modern psychiatric classification

Answer 14

Emil Kraepelin

Question 15

DSM-III and beyond

Answer 15

• reflects medical model
• applied to new disorders introduced by psychoanalysis
• no theoretical assumptions about causation
• if causation unknown: description of symptoms based on measurement, observation, report; clear explicit criteria and rules
• ->improved reliability

Question 16

Validity aim of DSM-III

Answer 16

identify independent groups of symptoms, each reflecting a specific cause

Question 17

Problems with DSM-III validity

Answer 17

• comorbidity very common
• high diagnostic instability
• lack of treatment specificity

Question 18

Historical changes in DSM

Answer 18

• hysteria, homosexuality out
• GAD, BED in
• Asperger’s Disorder in then out
• Psychopathy out but sneaking in
• attempts at dimensional approach

Question 19

Difference of ICD and DSM

Answer 19

• GAD, BED only in DSM

- Mixed anxiety-depression only in ICD