Mental Health Diagnosis

Question 1

4Ds

Answer 1

• deviance
• dysfunction
• danger
• distress

Question 2

Deviance

Answer 2

Unusual, far different from norms, extreme behaviours, cognitions, feelings and desires

Question 3

Distress

Answer 3

The subjective experience of feeling upset and/or anxious (consider intensity and duration of stress)

Question 4

Dysfunction

Answer 4

Inability to conduct everyday activities
E.g. getting up, completing tasks

Question 5

Danger

Answer 5

At risk of causing physical or psychological harm to self or others

Question 6

Factors to take into account when assessing deviance

Answer 6

• culture (different social norms)
• history (what’s abnormal at one time may be normal in another e.g. homosexuality)
• situation (what’s normal in one place is abnormal in another e.g. nudist beach)
• age and gender

Question 7

Rosenhan and Seligman (1989) - characteristics that define failure to function adequately

Answer 7

• unpredictability and loss of control
• irrationality and incomprehensibility
• cause discomfort to others
• suffering or distress
• maladaptiveness (you’re a risk to yourself and others)
• violate moral standards

Question 8

Davis (2009) - the 5th D - Duration

Answer 8

• clinicians need to consider how long a person has been experiencing symptoms before making a diagnosis
• patient must show symptoms for 13 days to be diagnosed with clinical depression
• diagnosis requires symptoms to be present for a specific amount of time

Question 9

Strengths of the 4Ds

Answer 9

• Davis (2009) - 4Ds can be used with the DSM-IV-TR and 5th D has practical application which is useful for professionals diagnosing
• 4Ds support validity of the DSM
• helps to avoid erroneous diagnosis

Question 10

Weaknesses of 4Ds

Answer 10

• subjectivity in application - what a professional views as dysfunctional may not be considered dysfunctional to the individual
• lack of objectivity - problems with reliability as 2 professionals may have different conclusions about a diagnosis
• by Davis (2009) adding another D, it suggest the 4Ds is insufficient in themselves as a tool
• 4Ds diagnosis could lead to labelling people with mental health disorders e.g. “danger” could lead to “dangerous” stigma which is unethical

Question 11

Strengths of 4Ds as proposed by Davis (2009)

Answer 11

• paedophilia clearly demonstrates deviance, distress and dysfunctions - validity
• danger from smoking- related diseases due to 10% of smokers having smoking related chronic diseases - validity
• people labelled as a danger have a 25% higher chance of dying from unnatural causes

Question 12

Classification systems

Answer 12

Clusters of symptoms which define disorders which have been complied from clinical practice, trials and expert opinion. Checklist of signs and symptoms to help clinicians reach a diagnosis

Question 13

What is the DSM?

Answer 13

Diagnostic and statistical manual. Created by APA to help psychiatrists to communicate using a common system

Question 14

DSM-1 (1952)

Answer 14

• 1st DSM made for military doctors
• 102 diagnostic categories
• Freud dominated DSM-1 classifications

Question 15

DSM-2 (1968)

Answer 15

• some Freud dropped and more emphasis on “ordinary” mental illnesses people experience in everyday life
• homosexuality was now considered a “sexual deviance” and not a “sociopathic disturbance”
• 182 disorders

Question 16

Rosenhan (1973) opposition to DSM-2

Answer 16

Couldn’t tell the sane from insane so DSM-2 unreliable

Question 17

DSM-2 (revised 1974)

Answer 17

• spitzer and flass (1974) compared 18 investigations into the reliability of DSM-2 and showed psychiatrists coming up with different diagnosis for same symptoms
• removed offensive diagnosis of homosexuality

Question 18

DSM-3 (1980)

Answer 18

• development in psychometric testing and mood altering drugs to treat mental disorders
• popular, widely used, turned its back on Freud
• standardised language produced a boom in research into mental health on the 80s and 90s
• 256 diagnosis

Question 19

Spitzer (1987) critism towards DSM-3

Answer 19

It led to 20-30% of population who may not have had any serious mental problem

Question 20

DSM-4 (1994 revised in 2000)

Answer 20

• 297 categories
• 5 axes = psychiatric diagnosis, personality problems, general medical conditions, environmental stress, global functioning
• trying to be more holistic
• included culture bound syndromes and recognised mental health is understood differently in different cultures

Question 21

DSM-5 (2013)

Answer 21

• current edition
• 157 diagnosis
• abolished 5 axes
• removed unnecessary diagnoses
• changes to DSM-5 reflect changes in society e.g. wars in Iraq = PTSD
• reflects more tolerant attitudes e.g. no longer “retarded” but now “failure to function appropriately”

Question 22

Comorbid diagnosis

Answer 22

More than one diagnosis
e.g. depression and anxiety

Question 23

The BLANK of diagnosis, BLANK behaviour

Answer 23

Proliferation (majority), Pathologises (gives a medical reason for)
^ this is a criticism of DSM-5 as eccentricities in everyday life doesn’t mean you have a mental health disorder

Question 24

Strengths of DSM

Answer 24

• demonstrates impressive levels of agreement between clinicians - RELIABLE
• Brown (2001)= studied anxiety and mood disorders in 326 patients who underwent 2 clinical interviews. Found high agreement levels of most DSM-5 categories - RELIABLE
• Kim-Cohen (2005) = concurrent validity of conduct disorder by interviewing child, observing behaviour and using questionnaires by teachers- accurate - VALID

Question 25

Weaknesses of DSM

Answer 25

- tells us nothing about what is causing a disorder- NOT VALID - Cooper (2014)= DSM-5 task force classified levels as low as ‘0.2-0.4’ as “acceptable” for diagnosis (should be more than 0.7) - NOT RELIABLE - encourages the over-medicalisation of mental health e.g.normal grief being diagnoses as Major Depressive Disorder as the bereavement exclusion criterion was removed

Question 26

ICD

Answer 26

International Statistical Classification of Disease - most popular diagnostic manual - supported by WHO - 1994 ICD-10 - provides a common lanaguage

Question 27

ICD-10

Answer 27

- includes 10 groups of mental disorders - each disorder has a code, the more digits the more specific subtype of disorder e.g. F30.0 = mild depression - comprehensive enough to include all known conditions whilst avoiding repetition - alphabetic index, clear and logical - available in different languages

Question 28

Reliability of ICD - Ponizovsky (2006)

Answer 28

- compared reliability between ICD-9 and 10 with 3000 patients - measured by positive predictive value (PPV) - proportion of pps wotj same diagnosis when reassessed - for schizophrenia, PPV increased from 68% to 94.2% showing improved reliability with ICD-10

Question 29

Reliability of ICD - Rosenhan

Answer 29

- diagnosis wasn’t valid as people receiving diagnosis weren’t mentally ill - reliability of diagnosis system doesn’t mean diagnosis is valid

Question 30

Reliability of ICD - Galeazzi (2004)

Answer 30

- two researchers conducted a join interview to assess 100 clients - kappa value ranged from 0.69 to 0.97 so high agreement - ICD-10 = inter rater reliability

Question 31

Validity of ICD- strengths

Answer 31

- DSM-5 has referred consistently to ICD - concurrent validity - clinicians could look at persons family history to support diagnosis if there is a known genetic component to a disorder - aetiological validity - if the future of the diagnosis is known then it can be applied to the person so diagnosis can be checked against the outcome e.g. treatments - predictive validity

Question 32

Validity of diagnosis - Kim and Berrios (2001)

Answer 32

- in some Asian countries schizophrenia translates to “disease of the disorganised mind” - in Japan psychiatrists are reluctant to diagnose due to stigma - only 20% of people with schizophrenia are diagnosed