The 4D's, Classification Systems & Diagnosis (Clinical Psychology)

Question 1

What are the 4 D’s of Diagnosis?

Answer 1

Deviance Dysfunction Distress Danger

Question 2

What is meant by Deviance (when discussing diagnosis)?

Answer 2

How rare/ infrequent the behaviour is within society Does it break social norms?

Question 3

What is meant by Dysfunction (when discussing diagnosis)?

Answer 3

If their behaviour interferes with their life

Question 4

What is meant by Distress (when discussing diagnosis)?

Answer 4

Does it cause the individual to become upset?

Question 5

What is meant by Danger (when discussing diagnosis)?

Answer 5

Does it cause danger to themselves/others?

Question 6

Is Diagnosis reliable?

Answer 6

Everything is self-reported by the patient: The patient’s recall may be biased Everything is interpreted by the clinician, which may have a biased perspective on the patient’s symptoms.problems The subjectivity weakens reliability

Question 7

What are the Strengths + Weaknesses of the 4Ds of Diagnosis?

Answer 7

The 4D’s of diagnosis is a standardised procedure Therapists will have to cover all 4D’s, which is a long + difficult process that leads to different views

Question 8

What are the Issues + Debates surrounding Diagnosis?

Answer 8

Social Control: Some argue that clinicians have a lot, or even too much power in making diagnoses. Once a person is labelled as ‘mentally ill’ there are serious implications + it can be difficult for them to lose that label. Many individuals who have bee sectioned under the mental health act find it to be a distressing + dehumanising process, as their power to make decisions is removed, and some are treated badly in care Practical Issues: Research into mental health often involves data form the diagnosis of real patients. The diagnosis method of clinical interviews is subjective; due to relying on self report, ad clinician bias. This leads to inaccurate/inconsistent diagnosis between clinicians

Question 9

What are Classification Systems?

Answer 9

Comprehensive and standardised lists of known mental disorders and their symptoms.

Question 10

What 2 Classification Systems are looked at in Clinical Psychology?

Answer 10

DSM ICD

Question 11

When was the ICD first written?

Answer 11

1948

Question 12

When was the DSM first written?

Answer 12

1952

Question 13

What does the DSM stand for?

Answer 13

Diagnostic and Statistical Manual

Question 14

What is the DSM?

Answer 14

The DSM is a multiaxial tool as it examines 5 different aspects of the patient’s behaviour and health. It is an American system.

Question 15

How many Axes does the DSM have?

Answer 15

The DSM is multiaxial - 5 Axis I: The main clinical syndrome/mental disorder Axis II: Personality disorder and retardation- anything wrong with the personality that may influence the main disorder Axis III: Medical conditions that may affect the main disorder Axis IV: Psychosocial stressors - any events in a person’s life that may affect mental disorders + stress Axis V: Global assessment of functioning- a test assessing social + occupational functioning, seeing how well they can carry out everyday activities (e.g. washing)

Question 16

What does the ICD stand for?

Answer 16

International Classification of Diseases

Question 17

What is the ICD?

Answer 17

The ICD-10 lists and categorises all diseases including mental and physical ones. This is a European system.

Question 18

How does the ICD work?

Answer 18

Section F deals with mental health disorders. Each mental health diagnosis is given a code the describes: the family of the disease, the particular disorder, the severity of the disorder, the severity of the disorder and any specific symptoms seen. (This doesn’t have to be learnt)

Question 19

What did Ward et al (1962) find about the diagnostic systems?

Answer 19

Disagreement between psychiatrists is due to inconsistent interpretation and inadequacy of the DSM / ICD-10

Question 20

What is meant by (inter-rater) Reliability of Diagnosis?

Answer 20

The extent to which clinicians agree on the same diagnosis for each patient

Question 21

What is Test-Retest Reliability?

Answer 21

When the same clinician makes the same diagnosis on different occasions.

Question 22

What evidence Supports that Diagnosis is Reliable?

Answer 22

Brown (2001) Hoffmaan (2002) Rosenhan (1973)

Question 23

How does Rosenhan’s (1972) study support the Reliability of Diagnosis?

Answer 23

Although inaccurate, 7 out of 8 pseudopatients were given a diagnosis of schizophrenia

Question 24

How does Brown’s (2001) study support the Reliability of Diagnosis?

Answer 24

He tested the reliability and validity of DSM IV diagnosis for anxiety and mood disorders and found them to be ‘good’ to ‘excellent’.

Question 25

How does Hoffmaan’s study support the Reliability of Diagnosis?

Answer 25

Hoffmaan used a computer to give structured interviews to prison inmate patient who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence, using the DSM-IV. The computer diagnosis were consistent with the DSM- IV Using a computerised diagnostic system eliminates any subjectivity that might take place in a diagnostic interview, making it objective.

Question 26

What evidence Challenges the Reliability of Diagnosis?

Answer 26

Beck (1954) Stetka + Ghaemi Cooper et al Ward et al

Question 27

How does Beck’s study challenge the Reliability of Diagnosis?

Answer 27

Beck found that the same set of symptoms were only diagnosed as the same disorder 50% of times.

Question 28

How does Stetka + Ghaemi study challenge the Reliability of Diagnosis?

Answer 28

S+G suggest that under half of clinicians had started using the DSM-5 one year after its release, due to concerns that led to unreliable diagnosis.

Question 29

How does Cooper et al study challenge the Reliability of Diagnosis?

Answer 29

He reported that trials of the DSM-III showed schizophrenia had a reliability estimate of 0.81 (there’s an 81% chance another will give the same diagnosis), but for the DSM V it was 0.46

Question 30

How does Ward et al study challenge the Reliability of Diagnosis?

Answer 30

He said that disagreement between psychiatrists is due to inconsistent interpretation and inadequacy of the DSM / ICD-10

Question 31

What Patient Factors affect the Reliability of Diagnosis?

Answer 31

Issues with memory, denial and shame Symptoms- e.g. disorganised thoughts Personality disorders - e.g. psychopathy, manipulation

Question 32

What Clinician Factors affect the Reliability of Diagnosis?

Answer 32

Unstructured interview- can lead to clinicians focusing on different specific things (e.g. nightmares, past events, love life, etc); leading to different info being gathered Subjectivity due to background and training; leading to different interpretations A diagnosis may have I-R validity, bu that doesn’t mean its valid (e.g. Rosenhan)

Question 33

What is meant by the Validity of Diagnosis?

Answer 33

Whether the diagnosis given to a patient is accurate or not

Question 34

Why is the Validity of Diagnosis Important?

Answer 34

An inaccurate diagnosis leads to the wrong treatment, delayed recovery, and (in some cases) make things even worse.

Question 35

What is Concurrent Validity?

Answer 35

This could be checked by looking at another diagnostic tool (e.g. DSM with the ICD). If there is broad agreement about which symptoms constitute which disorder, there is broad concurrent validity.

Question 36

What is Aetiological Validity?

Answer 36

When the patients history matches what’s known about the causes of the disorder

Question 37

What is Predictive Validity?

Answer 37

Where the future of the course of the disorder is known, and can be applied to the person; so the diagnosis can be checked against the outcome in order to see if it’s valid. i.e. when the treatment is successful

Question 38

What is Implicit Bias?

Answer 38

A positive or negative mental attitude towards a person, thing or group that a person holds at an unconscious level. Clinicians have this, affecting the interpretation of the info given to them

Question 39

What research supports the Validity of Diagnosis?

Answer 39

Hoffmaan: Hoffmaan used a computer to give structured interviews to prison inmate patient who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence, using the DSM-IV. The computer diagnosis were consistent with the DSM- IV; showing it has concurrent validity

Question 40

What research challenges the Validity of Diagnosis?

Answer 40

Aboraya: Clinicians focus on acute symptoms and overlook others. Also, patients’ mood, memory and shame lead to inaccuracy

Question 41

What is Comorbidity?

Answer 41

When there is a presence of more than one disorder in the same person at one time. Mandy disorders overlap with each other (e.g. depression and anxiety), making a valid + reliable diagnosis difficult.

Question 42

What was the Title of Rosenhan’s (1973) study?

Answer 42

On being sane in insane places

Question 43

What was the Aim of Rosenhan’s (1973) study?

Answer 43

To answer the question “can the sane be distinguished from the insane?” David Rosenhan challenged the diagnostic system; putting the individuals self-reporting being the source of the symptoms compared to the environmental context in which the symptoms arose.

Question 44

Who were the pseudopatients used in Rosenhan’s (1973) study?

Answer 44

8 pseudopatients 1 psychologist 3 psych graduates 1 psychiatrist 1 housewife 1 painter 1 pediatrician

Question 45

What was the Procedure of Rosenhan’s (1973) study?

Answer 45

The 8 pseudpatients called 12 institutes across America; reporting to hear voices saying “empty” “hollow” and “thud”. They were all went under different names to protect their identity They recorded their experiences by taking notes

Question 46

What happened to the pseudopatients whilst in the hospital during Rosenhan’s (1973) study?

Answer 46

Whilst in the hospital; they had to try to convince the staff of their sanity, in order to be let go. Their sanity was never detected by the staff, and they were discharged with a diagnosis of ‘schizophrenia in remission’ 7 out of 8 were diagnosed with schizophrenia, and 1 with manic depression with psychosis All stayed for an average of 19 days; ranging from 9 days to 52.

Question 47

What did the patients think about the pseudpatients whilst they were in the institution in Rosenhan’s (1973) study?

Answer 47

Many patients suspected the pseudopatients were fake. One even asked if the researcher was a journalist

Question 48

How did the staff treat the pseudopatients in Rosenhan’s (1973) study?

Answer 48

The staff treated normal behaviour as symptoms consistent of diagnosis (e.g. note-taking was referred to as ‘writing behaviour’) Patients were dehumanised by staff - when contact was initiated between the pseudopatients and nurses, they were ignored 71% of the time.

Question 49

What was the follow up experiment in Rosenhan’s (1973) study?

Answer 49

Rosenhan tested one leading hospital to a similar study - they were asked to spot the pseudopatients Of 193 admitted over the next 3 months, 41 were thought to be fake by at least one staff member, and 19 by two Rosenhan sent none.

Question 50

What was the Conclusion of Rosenhan’s (1973) study?

Answer 50

There is unreliability in the diagnostic process. The diagnostic label changed the perspective of the person, so that all of their behaviour was interpreted within the context of the diagnosis.

Question 51

What were the Strengths of Rosenhan’s (1973) study?

Answer 51

G: The pseudopatients were both male and female G: The hospitals used included old, new, public + private hospitals; which is representative to an extent R: The pseudopatients claimed to hear voices saying “empty”, “hollow” and “thud”, which is a standardised procedure E.V: The environment was a real life hospital; and the doctors + nurses’ behaviour was natural.

Question 52

What were the Weaknesses of Rosenhan’s (1973) study?

Answer 52

G: There was a small sample size of 8 pesudopatients G: They only used American institutions I.V: They weren’t able able to control any extraneous variables, and Rosenhan wasn’t able to control anything because he wasn’t there, meaning it wasn’t internally valid. I.V: The pseudopatients claimed to have symptoms they did not, which would not usually occur in real life

Question 53

What ethical guidelines did Rosenhan’s (1973) study break?

Answer 53

P: They were kept in the mental hospital for up to 52 days, even though they were mentally sane. There was no way of controlling it; anything could’ve happened P: The doctors had to spend time with the pseudopatients, meaning thy spent less time with the real patients; reducing the quality of their treatment W: They couldn’t withdraw from/ leave the hospital I: No informed consent was gained from hospitals prior to the initial experiment D: The doctors were deceived by pseudopatients, as they believed they were real patients D: There was no formal debrief, even though he wrote abut it in the book

Question 54

What Application did Rosenhan’s (1973) study have?

Answer 54

The study led to improvements in the psychiatry system, as well as the DSM being made multiaxial, thereby having application to society