M4. Lesson 4: Diagnosing and Classifying Abnormal Behaviors

Question 1

What must be done before a treatment needs to be started?

Answer 1

Before starting any type of treatment, the client/patient must be clearly diagnosed with a mental disorder.

Question 2

What is clinical diagnosis?

Answer 2

Clinical diagnosis is the process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder outlined in an established classification system such as the DSM-5 or ICD-10 (both will be described shortly).

Question 3

What should any diagnosis have?

Answer 3

Any diagnosis should have clinical utility

Question 4

What does clinical utility mean?

Answer 4

It means that it aids the mental health professional in determining:

1. prognosis,
2. the treatment plan,
3. and possible outcomes of treatment (APA, 2013).

Question 5

What should be noted about receiving a diagnosis?

Answer 5

Receiving a diagnosis does not necessarily mean the person requires treatment.

Question 6

What is the decision for treatment based upon?

Answer 6

This decision is made based upon the following:

1. how severe the symptoms are,
2. level of distress caused by the symptoms,
3. symptom salience such as expressing suicidal ideation,
4. risks and benefits of treatment,
5. disability,
6. and other factors (APA, 2013).

Question 7

A patient doesn’t need to meet the full criteria for a diagnosis to require treatment. True or False.

Answer 7

True. Likewise, a patient may not meet the full criteria for a diagnosis but require treatment nonetheless.

Question 8

What is a syndrome?

Answer 8

Symptoms that cluster together regularly are called a syndrome.

Question 9

When do symptoms become a characteristic of a specific disorder?

Answer 9

If the symptoms also follow the same, predictable course, we say that they are characteristic of a specific disorder.

Question 10

What are classification systems?

Answer 10

Classification systems provide mental health professionals with an agreed-upon list of disorders falling into distinct categories for which there are clear descriptions and criteria for making a diagnosis.

Question 11

What is the most important keyword in the following definition of classification systems: Classification systems provide mental health professionals with an agreed-upon list of disorders falling into distinct categories for which there are clear descriptions and criteria for making a diagnosis?

Answer 11

DISTINCT is the keyword here.

Question 12

Why is it important to emphasize distinctness in classification systems? Give an example.

Answer 12

People suffering from delusions, hallucinations, disorganized speech, catatonia, and/or negative symptoms are different from people presenting with a primary clinical deficit in cognitive functioning that is not developmental but has been acquired (i.e., they have shown a decline in cognitive functioning over time).

The former suffers from a schizophrenia spectrum disorder while the latter suffers from a NCD or neurocognitive disorder. The latter can be further distinguished from neurodevelopmental disorders which manifest early in development and involve developmental deficits that cause impairments in social, academic, or occupational functioning (APA, 2013).

These three disorder groups or categories can be clearly distinguished from one another.

Question 13

What else do classification systems permit?

Answer 13

Classification systems also permit the gathering of statistics to determine incidence and prevalence rates and conform to the requirements of insurance companies for the payment of claims.

Question 14

What is the most widely used classification system in the United States?

Answer 14

The most widely used classification system in the United States is the Diagnostic and Statistical Manual of Mental Disorders currently in its 5th edition and produced by the American Psychiatric Association (APA, 2013).

Question 15

What classification system is used internationally?

Answer 15

Alternatively, the World Health Organization (WHO) publishes the International Statistical Classification of Diseases and Related Health Problems (ICD) currently in its 10th edition, with an 11th edition expected to be published in 2018.

Question 16

When was the DSM published?

Answer 16

2013

Question 17

What was the DSM’s first name?

Answer 17

DSM IV-TR

Question 18

What does the “TR” in DSM IV-TR mean?

Answer 18

TR means Text Revision; published in 2000

Question 19

Despite first being published in 2013, the DSM’s history goes way back when?

Answer 19

The history of the DSM goes back to 1944 when the American Psychiatric Association published a predecessor of the DSM

Question 20

What was the description for the DSM’s predecessor?

Answer 20

It was a “statistical classification of institutionalized mental patients” and “…was designed to improve communication about the types of patients cared for in these hospitals”

Question 21

From its predecessor, what did the DSM evolve into?

Answer 21

The DSM evolved through four major editions after World War II into a diagnostic classification system to be used by psychiatrists and physicians, but also other mental health professionals.

Question 22

When did revisions for the DSM begin?

Answer 22

The Herculean task of revising the DSM began in 1999 when the APA embarked upon an evaluation of the strengths and weaknesses of the DSM in coordination with the World Health Organization (WHO) Division of Mental Health, the World Psychiatric Association, and the National Institute of Mental Health (NIMH).

Question 23

What did the APA, WHO, World Psychiatric Association, and NIMH collaboration lead to?

Answer 23

This collaboration resulted in the publication of a monograph in 2002 called A Research Agenda for DSM-V.

Question 24

What happened from 2003 to 2008?

Answer 24

From 2003 to 2008, the APA, WHO, NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) convened 13 international DSM-5 research planning conferences

Question 25

Why did the APA, WHO, NIMH, NIDA, and NIAAA convene 13 international DSM-5 research planning conferences?

Answer 25

It was “to review the world literature in specific diagnostic areas to prepare for revisions in developing both DSM-5 and the International Classification of Disease, 11th Revision (ICD-11)” (APA, 2013).

Question 26

What happened in 2006 (DSM history)?

Answer 26

the naming of a DSM-5 Task Force Chair and Vice-Chair occurred

Question 27

What happened in 2007 (DSM history)?

Answer 27

task force members were selected and approved by 2007

Question 28

What happened in 2008 (DSM history)?

Answer 28

workgroup members were approved in 2008

Question 29

What did the workgroup members approved in 2008 do?

Answer 29

This group undertook an intensive process of:

1. conducting literature reviews and secondary analyses,
2. publishing research reports in scientific journals,
3. developing draft diagnostic criteria,
4. posting preliminary drafts on the DSM-5 website for public comment,
5. presenting preliminary findings at professional meetings,
6. performing field trials,
7. and revisiting criteria and text (APA, 2013).

Question 30

What was the result for the formation of the DSM-5?

Answer 30

The result was a “common language for communication between clinicians about the diagnosis of disorders” along with a realization that the criteria and disorders contained within were based on current research and may undergo modification with new evidence gathered “both within and across the domains of proposed disorders” (APA, 2013).