Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SOC363 > SOC363: 2. Disorder vs. Distress, Category vs. Continuum > Flashcards

SOC363: 2. Disorder vs. Distress, Category vs. Continuum Flashcards

1
Q

DSM – IV Definition of Mental Disorder (Stein et al., 2010)

A

A) A clinically significant behavioral or psychological syndrome or pattern that
occurs in an individual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DSM – IV Definition of Mental Disorder (Stein et al., 2010)

A

B) Associated with present distress (painful symptom) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DSM – IV Definition of Mental Disorder (Stein et al., 2010)

A

C) Must not be merely expectable + culturally sanctioned response to a particular event (like stressors?)
problematic diff to interpret without cultural definitions of normal
diff to tell what appropriate response to stressors is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DSM – IV Definition of Mental Disorder (Stein et al., 2010)

A

D) manifestation of a behavioral, psychological or biological dysfunction in the individual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DSM – IV Definition of Mental Disorder (Stein et al., 2010)

A

E) Neither deviant behavior nor conflicts that are primarily betw indiv + society are mental disorders unless deviance or conflict is symptom of a dysfunction in the individual
hard to define dysfunction objectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DSM – IV Definition of Mental Disorder (Stein et al., 2010)

A

No definition adequately specifies precise boundaries

concept lacks consistent operational definition that covers all situations - malleable and changes historically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Starting Points: Wakefield

A

exists in indiv
condition is sign of dysfunction in some respect – a cognitive, motivational, behavioral, emotional, or other psychological mechanism that does not function properly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Starting Points: Wakefield

A

requirement of real harm to self or others – forms of distress + disability (impairment of functioning)
Not due to social disapproval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Starting Points: Allan Horowitz

A

internal dysfunction - non-normal responses to
environmental inputs
Response to external stress must be disproportionate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Starting Points: Allan Horowitz

A

Distress: “normal”, expectable responses to environmental challenges + threats
Sociological studies: ‘expectable + culturally sanctioned responses’ that DSM excludes because they arise in response to social stressors + only persist as long as these stressful social conditions endure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Starting Points: Allan Horowitz

A

Distress is naturally self-limiting
from proportionate responses to stress or threat..
If removal of stressor results in abatement of symptoms, it is a “normal” response, not disorder. (Why?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Starting POINTS: Distress (Wheaton, 1982)

A

extent of anxiety + depression symptomatology…indicating affectively based impairment in social functioning capacities. range of impairment is from none through lower levels of severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Starting POINTS

A

Langner Index useful as a proxy indicator of variation in probability of … a diagnosis in the realm of anxiety and depression disorders. (1982: 29)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mainpoints:

A
  1. Related to certain kinds of disorders – not all.
  2. continuum (a scale).
  3. Stable differences.
  4. Not “normal” or necessarily moderate.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mainpoints:

A

NB: If distress is persistent, getting to severe at higher scores, with behavioural impairments, then measuring important problems that overlap with disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Brief History

A

Horwitz and others (Wakefield) cite problems that led to the “DSM” movement resulting in version 3 circa 1980.
DSM: Diagnostic and Statistical Manual of the American Psychiatric Association

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Brief History: Problems of DSM

A

No specific agreed on “rules” for diagnosis
Unreliability in diagnosis – little replication across clinicians
Symptom-based definitions preferred but often defined by causes. Not theory-neutral.
Ignored basic rules of measurement - unstandardized interviews vs. standardized protocols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Brief History

A

1970’s – attempts to move towards standardization
Appointed panel of psychiatrists decide symptom universe
Semi-standardized instruments administered by clinicians
Define diagnoses by symptom qualifications
DIS (Diagnostic Interview Schedule), usable by lay interviewers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Brief History 2: Community and National Studies

A

NIMH funded the now-famous ECA (Epidemiological Catchment Area) studies
First time a standard diagnostic instrument was used in a general population.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Brief History 2: Community and National Studies

A

Kessler’s NCS (National Co-morbidity Study) (1994), which applied a new instrument called the CIDI (Composite International Diagnostic Interview), and the NCS-R, a replication in 2005.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Brief History 2: Community and National Studies

A

controversy about process due to two issues:
Prevalence rates too high (50% have at least one lifetime disorder)
Differences in rates across studies (but explainable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DSM-IV Criteria for Major Depression

A

Five/more symptoms present during same two week period + represent change from previous functioning

  1. Depressed most of day, every day subjective report or observation by others (e.g., appears tearful)
  2. diminished interest or pleasure in all activities most of day, nearly every day.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DSM-IV Criteria for Major Depression

A
  1. weight loss not dieting, weight gain, change in appetite every day
  2. Insomnia or hypersomnia everyday
  3. Psychomotor agitation/retardation (observable by others)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DSM-IV Criteria for Major Depression

A
  1. Fatigue/loss of energy
  2. Feelings of worthlessness or excessive or inappropriate guilt
  3. Diminished ability to think or indecisiveness
  4. Recurrent thoughts of death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

DSM-IV Criteria for Major Depression: Exclusion of other causes of symptoms

A
  1. symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  2. symptoms not due to direct physiologic effects of substance or general medical condition
  3. symptoms due to bereavement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DSM V: Substance Use Disorder

A

Dependence - (2 or more in 12-month period)
Tolerance (increase in amount; marked decrease in effect)
Characteristic withdrawal symptoms; substance taken to relieve withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

DSM V: Substance Use Disorder

A

Substance taken in larger amounts + longer period than intended
Persistent desire or repeated unsuccessful attempt to quit
Much time/activity to obtain, use, recover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

DSM V: Substance Use Disorder

A

Important social, occupational, or recreational activities given up or reduced
Use continues despite knowledge of adverse consequences

29
Q

Fundamental Difference

A

Disorder (categorical):
questions asked, criteria met are tallied to decide whether the person qualifies for a diagnosis or not - yes/no
Distress (continuous):
total score derived, varying from 0 to all symptoms

30
Q

Fundamental Difference

A

Disorder presumed to measure more serious problems, distress more moderate problems
Prevalence: % of pop with given disorder in given time period - requires a threshold, thus categorical approach

31
Q

Clinical prevalence

A

counts of patients in treatment
bias due to 1) bias in selection of who gets treated; 2) barriers to treatment; 3) availability of services; 4) “friends of psychotherapy”, “worried well” 5) “Clinician’s Illusion”

32
Q

Clinical prevalence

A

Estimate: 3-1 ratio of untreated cases to treated cases.

before 1980: We knew very little about the actual social patterns of mental health

33
Q

True Prevalence:

A

actual percent in the population
Requires random samples of populations in surveys.
Diagnostic instruments have to be administered in standardized interviews, so same info is used to decide each diagnosis

34
Q

A Digression: The Psychology and Politics of Prevalence

A

negotiation between science + politics…
Politics - goals of interest groups; science by principle of objectivity and the truth
“too much” prevalence is not a good thing

35
Q

SES and Mental Health by Treatment Site

A

Relation between SES (Socioeconomic Status) + Mental Illness by Treatment Site
Public Hospitals - / Private Hospitals +
Clinics − / Therapists +
Paid access leads to positive relationship; overall access leads to a negative relationship

36
Q

Diagnostic Interviews

A

Screening questions: Unique sets of defining symptoms for each disorder

37
Q

Diagnostic Interviews

A

Exclusion criteria–two kinds:
1) if you have this, you can’t have that.
2) “understandable” or “normal” explanations of responses, such as grief after death, physical illness, or reaction to drugs
Wakefield’s basic problem – the issue of false positives

38
Q

Effect of Structure

A

DIS - Screening at Beginning of each Section
lower rates for disorders later in sequence than in CIDI
CIDI: all screening questions at front – increase rate because denials less likely at beginning of interview

39
Q

Validity of Measures

A

“gold standard” of measurement — perfectly valid

assess given measure against it to see how well it detects “true cases”

40
Q

Validity of Measures

A

Two criteria:
Sensitivity: ability to detect “true cases”
Specificity: ability to exclude “true non-cases”

41
Q

Tricky Problem

A

Suffer false positives in community survey or underestimation in a clinical survey?
high number of false positives among detected cases by the test instrument as the problem - increase specificity

42
Q

Tricky Problem

A

Is it justifiable to think of disorder as a clear category?
“Taxometrics” – the study of whether the underlying phenomenon measured is continuous or categorical.
Often most prevalent ones is continuous.
Difference in use of measures for causation vs. treatment

43
Q

An Argument for the Importance of Distress Scales (Wheaton, 2007)

A

A: No disorder, but distressed.
B: Disorder, but still functioning
C: Different from A, but both have no diagnosis
D: More severe than B, but both have diagnosis

44
Q

An Argument for the Importance of Distress Scales (Wheaton, 2007)

A

miss diff of actual experience from A and C, and B + D
on DSM V on the verge of acknowledging disorders are gradients
A + B are more similar in experience

45
Q

Arguments for Distress Studies: Problem with defining “expectable” or “normal” response to stress

A

differential vulnerability to all stressors
grief exclusion a “slippery slope”
Favors biological causation automatically

46
Q

Arguments for Distress Studies

A

Cannot define or measure something by citing its causes. Have to measure defining signs and symptoms.
Disorder not defined by persistence after stressor occurs or precipitating problem is removed. So what is the natural period for grief?

47
Q

Arguments for Distress Studies

A

Location of problem as internal dysfunction– rather than behavioural, social, or interpersonal

48
Q

Arguments for Distress Studies: problem with “Normal”

A

Historical, cultural, socially patterned variation due to social location: varies with situational demands, threat, complexity
problem with “Expectable”:
What do we expect after divorce? Anger or joy?

49
Q

Arguments for Distress Studies continued

A

3 issues: Stability vs. transience
Impairment, consequences
Overlap with disorder

50
Q

Is distress stable or transient? Estimates of stability: correlation with itself over time

A

level of stability is high enough to suggest that distress describes persistent + fundamental differences in mental health in the population
same diff in distress over time

51
Q

distress accompanied by impairment of functioning?

A

Distress predicts losses in income + social status
has effects on educational performance.
Psychological problems experienced by age 16 associated with a 28% lower household income by age 50

52
Q

distress accompanied by impairment of functioning?

A

Psychological problems in childhood associated with 35% reduction in adult family incomes
Effects on marital stability: higher score higher odds of divorce, depends upon years of marriage
as years of marriage pass, weakens relevance of depression

53
Q

Does distress measure disorder anyway?

A

prevalence cannot be interpreted as evidence of false positives, because there is no “gold standard”
When evidence argues with experience or expectation, we think our experience trumps evidence that we get

54
Q

Does distress measure disorder anyway?

A

uncomfortable impression that clinical practice is not an adequate standard against which to measure the validity of a research instrument.
psychiatrists are gold standard is circular.
no other criterion to use

55
Q

Does distress measure disorder anyway?

A

Results using SADS, an instrument given by trained psychiatrists and only partially standardized:

56
Q

Does distress measure disorder anyway?

A

Langner Index approximates the SADS diagnoses very closely.

Optimal weighting VERY important—means symptoms are weighted by their predictive relevance, rather than the same.

57
Q

Effect of Optimal Weighting

A

increase in sensitivity measures of overall association with SADS resulting from optimal weighting

58
Q

Another Approach (Schnittker, 2013):

The “Proximity” of Common

A

Takes different approach – judging distinction between distress + disorder by assessing unique role of
predictors at extreme vs. more moderate levels of distress measures

59
Q

Logic of this Approach

A

Detect any change in effects of social determinants of mental health across full range of symptom measures, from none, to “common” unhappiness (middle-range), to severe levels of distress, corresponding to reported experience of diagnosed cases of depression/anxiety disorders.

60
Q

Logic of this Approach

A

If effects dont change, role of social determinants cannot be assumed to be limited to mild to moderate mental
health problems + severity left to biological or genetic causation.

61
Q

Data and Method

A

NCS-R

K-10, 10 item distress scale with maximized fit to both major depressive disorder + generalized anxiety disorder

62
Q

Data and Method

A

“continuation ratio model”. series of comparisons across levels of a scale + assesses similarity vs. change in coefficients for the effects of predictors
study effects of passing through series of thresholds standing for level of depression (none, mild, moderate, serious, severe)

63
Q

Continuation Ratio Compariso

A

Divide K-10 into quintile study“regions”of depression

Effects sizes equal across levels means no difference in impact across regions

64
Q

Results: First Look at Standard Risk Factors 1

A

number of effects do not change across levels - suggesting social determinants important at severe end as at low end
social factors as important in predicting more severe problems as moderate problems

65
Q

Happiness vs. Distress: Are They Distinct or Simple Opposites

A

Positive and Negative Affect as distinct concepts.
Could be a methods artifact of positive + negative statements, not separate factors
factor analysis, depression and happiness appear as polar opposites, suggesting a single factor

66
Q

Predicting Happiness vs. Depression in the NSFH: Are They Mirrored Models?

A

If only opposite ends of the same continuum, you should see inverse effects for same predictors
If effects not mirrored, but best evidence suggests a single continuum, then the ultimate specification of well-being has nuances not generally realized

67
Q

Mirror Image Not Clear

A

Predicting happiness + depression concurrently
Some risk factors reflected, some not: Age, marital status, education, Stress and resources - yes
Gender, race, Religious beliefs - no

68
Q

Over Time Effects Very Different

A

Depression captures much that missed by happiness
we have to be careful in concluding that depression will directly lead to less happiness
depression more stable

69
Q

A Complex Continuum

A

Beware of studying happiness only
Even though continuum, does not mean same inputs act the same way in reverse
Differentially sensitive to proximal, situational causation Confounds valence of affect with affect per se

SOC363 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions