Lecture 5 - Classification and Diagnosis Flashcards
Diagnosis
The classification of disorders by symptoms
and signs
Can be an important first step
– Treatment
– Good clinical care
A correct diagnosis
– Description of base rates
– Causes
– Treatments
Development of Classification Systems
Emil Kraepelin (1883)
– Influential classification system
Syndromes -> Dementia praecox (chemical imbalance)
-> Manic-depressive psychosis (irregularity in metabolism)
Theories not entirely correct but influential
2 Classification Systems
– International Classification of Diseases
(ICD-11) – WHO (Ch 6)
– Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) – APA
ICD history
WHO (1939)
– Psychological disorder included in
International List of Causes of Death (ICD)
1948:
– List expanded to become International
Statistical Classification of Diseases, Injuries
and Causes of Death
* Included classification of psychological disorder
– Not widely accepted
ICD Revisions
WHO (1969)
– New classification system more widely accepted
– In UK, a glossary of definitions produced to
accompany WHO system (General Register Office, 1968)
Various revisions
ICD-10 (1992)
ICD-11 (June 2018)
– Use from Jan 202
DSM
APA (1952)
– First version of Diagnostic and Statistical
Manual (DSM) (106 diagnoses)
1968: DSM-II
1980: DSM-III (sig revision)
2000: DSM-IV-TR
2013: DSM-5
2022: DSM-5-TR (300+ diagnoses)
DSM-5-TR
Section I– Basics
Section II– Diagnostic criteria and codes
Section III– Emerging measures and models
DSM IV to DSM-5
Axis I: Clinical Disorders
Axis II: Personality Disorders, Mental
retardation
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental
problems
Axis V: Global Assessment of Functioning
DSM-5 and DSM-5-TR
A non-axial system
– Clinical syndromes
* ‘The multiaxial distinction among Axis I, Axis II, and Axis III disorders does not imply that there are fundamental differences in their conceptualization, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioural or psychosocial
factors or processes’ (APA, 2013, p. 16).
– Notations for important psychosocial and/or
contextual factors and functioning/disability
DSM-5-TR: Section II & III
II: Organised according to the relationships
between disorder groups
III: Assessment measures
Cultural formulation
Alternative DSM-5 model for personality
disorders
Conditions for further study
Assessment Measures
Cross-Cutting Symptom Measures
Clinician-Rated Dimensions of Psychosis
Symptom Severity
World Health Organization Disability Assessment
Schedule 2.0 (WHODAS 2.0)
Cultural Formulation
Culture
– ‘refers to systems of knowledge, concepts,
rules and practices that are learned and
transmitted across generations’ (APA, 2013, p.
749).
– ‘includes language, religion and spirituality,
family structures, life-cycle stages, ceremonial
rituals, and customs, as well as moral and legal
systems’ (APA, p. 749).
Cultural Formulation Interview (CFI)
16 questions, semi-structured format
A person-centred approach to assessment
Focuses on
– Individual’s perspective and experience of the clinical problem
– Role of others in influencing the course of the problem
Intention to avoid stereotyping
No right or wrong answers to the Qs
‘to obtain information during a mental health assessment
about the impact of culture on key aspects of an individual’s
clinical presentation and care’ (APA, 2013, p. 750).
CFI Questions
Domain:
Cultural definition of the problem
Cultural perceptions of cause,
context and support
Cultural factors affecting self-coping
and past help seeking
Cultural factors affecting current
help seeking
Alternative DSM-5 Model for Personality Disorders
‘The inclusion of both models in DSM-5 reflects
the decision of the APA Board of Trustees to
preserve continuity with current clinical practice, while also introducing a new approach that aims to address numerous shortcomings of the current approach to personality disorders’ (APA, 2013,
p.761).
Reliability and Validity
Reliability -> Consistency of measurement
Validity -> How well does a test measure what it is supposed to measure?
Inter-rater Reliability
Extent to which clinicians agree on the diagnosis
For most DSM diagnostic categories, reliability is good, Avoidant PD .97, Panic Disorder .65
Validity
Construct validity of highest concern
Diagnoses are constructs
– For most disorders, no lab test available to
diagnose with certainty
Strong construct validity predicts wide
range of characteristics
To diagnose or not to diagnose?
Not all mental health professionals diagnose
Typically associated with medical model
Consistently rejected by PC practitioners
(Mearns, 1997). E.g.:
– Diagnosis prioritises therapists’ knowledge and expertise over the client…it draws heavily on a clients’ difficulties, thus detracting from the client’s own experiencing and perceptions in favour of the knowledge of the therapist
(Gillon, 2007)
To diagnose or not to diagnose cont.
However, Rogers (1957) did acknowledge
there is some utility of diagnosis regarding
the therapeutic relationship
– Increase understanding of client’s difficulties,
consequently enhancing empathy and congruence
(Berghofer, 1996; Binder & Binder, 1991; Schmid, 1992)
This highlights advantages and drawbacks
Considerable debate…
Experiences of Mental Health Diagnosis Positives
Help service users to understand their
diagnosis
Provide a sense of relief, control and
containment
Offer hope for recovery
Improve relationships with services
Reduce uncertainty
Perkins et al. (2018)
Experiences of Mental Health Diagnosis Negative
Feelings of hopelessness, disempowerment
and frustration
Stigma and discrimination
Exacerbated symptoms
Disengagement from services
How diagnoses are decided, communicated
and used by services important
