Mental Health Services and DSM Flashcards
How do you determine if someone has psychopathology?
- Deviation from the norm?
- Causes emotional distress?
- Impairs daily functioning?
- Dangerous?
No feelings of emotional distress in psychopathology
Ego-syntonic Dxs
- Antisocial Personality Dx
- Anorexia
Define harmful and dysfunction in relation to impairment?
Harmful = Negatively valued by society or person Dysfunction = Mental mechanism unable to perform its natural, evolutionary function
When can dysfunction be adaptive?
In cases of trauma as a protective measure
Neurotypical
Style of neurocognitive functioning that falls within dominant societal standards
Neurodivergent
Has a brain that diverges from the dominant societal standards of “normal” in its operations
Neurodiversity Paradigm
The belief that neurodiversity is natural and valuable - Began with autism advocacy
- Stresses society accept them as a diverse way of being versus “curing”
What is a counter to the neurodiversity movement?
Mental health stakeholders feel that the ND movement causes services and money to be pulled away from individuals who need them
Has perception of dangerousness for individuals with mental illness increased or decreased in America?
Increased
~ 20% for life problems
>30% for depression
>60% for schizophrenia and alcohol use dx
How likely is an individual with SMI to be a victim of violence?
10x more likely among severely mentally ill than general public
What are some effects when mass shootings are linked to SMI?
- Money may increase for mental health services
- Distracts from real issues like gun availability, social issues, etc.
- Increased stigma of mentally ill
- Denial of civil liberties for mentally ill
3 broad groupings of 106 Dxs in 1952 DSM-I
- Organic Brain Syndromes
- Functional Dxs
- Mental Deficiency
Influenced by Meyer’s theories
- Mental illness is a reaction to psychological, social, and biological factors
1968 - DSM-II
182 Dxs
Psychoanalytic focus
Prototype Model
1980 DSM-III
265 Dxs
Paradigm Shift
- Explicit, objective criteria
- Tries to be theoretically agnostic
- Increase in inter-rater reliability
- Hierarchy rules
- Multi-axial system introduced
1987 - DSM-IIIR
292 Dxs
- Relaxed some hierarchy rules
- Increase heterogeneity within Dxs
1994 - DSM-IV
297 Dxs
- Relaxed hierarchy rules more
- More focus on empirical findings
2000 - DSM-IV-TR
- Text revision - updated accompanying text
What is a mental Dx?
- Reflects dysfunction in psych, bio, or developmental processes underlying mental functioning
- Significant distress OR disability in social, occupational, or other important activities
- Syndromes characterized by clinically significant disturbances in cognition, emotional regulation, or behavior
What isn’t a mental Dx?
- An accepted or culturally approved response to a common stressor or loss
- Socially deviant behavior
- Conflicts between person and society
When you don’t meet criteria for a specific Dx:
Unspecified
When Sxs consistent with general group but do not make criteria for any 1 Dx and you aren’t specifying why you aren’t making criteria
When you don’t meet criteria for a specific Dx:
Other specified
If Sxs are consistent with general group and want to explain why they don’t make criteria for any 1 Dx
(Example: Other specified Depressive Dx, depressive episode with insufficient Sxs)
When you don’t meet criteria for a specific Dx:
Provisional
You have strong presumption that full criteria will ultimately be met but don’t have enough info currently
When listing a medical condition that is important to understanding or managing a mental disorder…
Medical condition is listed separately before the mental disorder
Often incorporated into the name of the disorder as well
DSM Criticisms:
Categorical
Cutoffs are arbitrary
DSM Criticisms:
Surface Document
Cause is not considered with exception to the Trauma Dxs
DSM Criticisms:
Rules are consistent or inconsistent?
Inconsistent use of their own rules
DSM Criticisms:
Phrasing is too vague or too specific?
Too vague. Example: “often”
DSM Criticisms:
Sensitivity or insensitivity to development?
Insensitive
DSM Criticisms:
Diagnostic Overlap
Sxs not unique to a given Dx (Example: PTSD)
Excessive hierarchy rules
DSM Criticisms:
Too much or too little heterogeneity within a category?
Too much heterogeneity
DSM Criticisms:
Medicalizes normality
Mild Neurocognitive disorders
DSM Criticisms:
Extends into other domains
Obstructive Sleep Apnea - Is this a psychological or biological condition?
DSM Criticisms:
Task group members
- 69% ties to pharmaceutical industry
- Lacked theoretical diversity
Prevalence =
Defined over a period of time - 12 months, lifetime, etc
# of cases divided by all people # of cases/all people
Incidence =
Defined over a period of time - 12 months, lifetime, etc
# of new cases divided by all people # of cases/all people
Prevention Interventions:
Universal (Primary)
Everyone gets the intervention (All 4th graders)
Prevention Interventions:
Selective (Secondary)
Intervenes with higher risk individuals (Children of alcoholics)
Prevention Interventions:
Indicated (Tertiary)
Targets individuals with Dx (Conduct disordered youth
What are the steps to getting mental health treatment?
- Recognize the problem
- Encode as a mental health problem
- Want to change
- Know where to go
- Overcome concrete barriers (money, waitlists, etc.)
- Overcome attitudinal barriers (stigma, distrust, etc.)
How many psychiatric inpatient beds are there in the US?
~37,000 = 12 beds/100,000 people
Fewer beds than US had in 1850
Half of beds are slated and filled with forensic patients
What constitutes the informal services in tertiary levels of care?
- Self-care
2. Informal community care
What are the four higher cost services in tertiary levels of care?
In order from lowest cost and greatest quantity of services needed (2a and 2b are equal)
- Primary care services for mental health
2a. Psychiatric services in general hospitals
2b. Community mental health services - Long-stay facilities and specialist services
Other types of interventions
Residential tx Drug/alcohol tx Outpatient therapy Mobile outreach and wraparound care Hotlines Self-help (AA, support groups, etc.) Medication Day treatment Alternative tx (music, art, animal-assisted, etc.)
How many US adults report experiencing a mental illness in the past year?
1 in 5
Which US age group is most likely to report having a mental disorder?
18-25-year-olds
People almost inevitably have one psychiatric disorder at a time…true or false?
False
What is the most common type of Dx?
Anxiety Dx
Half of all chronic mental illness begins by age _____?
14
Average # of years a child waits to receive mental health services?
10 years
Among US adults, which type of intervention is it more common for them to receive?
Psychotropic medication
Among people globally who had a mental Dx and feel they need treatment, the primary reason they give for not getting Tx is _____
Wanted to handle the problem on their own
Which has a greater impact on individuals not receiving treatment? Attitudinal barriers or concrete barriers?
Attitudinal barriers
Goals of anti-stigma campaigns
- Increased service use
- Increased rights
- Increased pride and self-worth
Anti-stigma campaigns can be either:
Education based
- Can backfire like NAMI - Emphasized bio cause for mental illness to achieve insurance parity coverage
1a. Increased view of mental ill as “other”
1b. Increased social distance/dangerousness
Contact based
- Small to medium effects size
- Unclear mechanisms
