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SEM 2 Mental Health and Distress > The classification of Mental Health > Flashcards

The classification of Mental Health Flashcards

1
Q

What is a psychiatric diagnosis?

A

The act of classifying an ‘illness’ or ‘disorder’

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2
Q

How do we classify an ‘illness’ or ‘disorder’? List 3 requirements

A

1) Each disorder category is divided into types and subtypes and should be distinct from other disorders (i.e. a categorical system)

2) A set of rules or criteria which defines each diagnosis

3) A minimum threshold must be met for someone’s experiences to fit the criteria for a diagnosis

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3
Q

What are the examples of minimum thresholds that must be met for someone’s experiences to fit the criteria for a diagnosis?

A
  • A minimum number of symptoms
  • Experience occurs within a certain timeframe
  • Symptoms typically require a change from usual functioning / an impact on daily life
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4
Q

The most commonly used classification systems in psychiatry are…? List 2

A

1) Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM-5)

2) International Classification of Diseases 11th Revision (ICD-11)

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5
Q

Who published the DSM-5?

A

American Psychiatric Association (APA)

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6
Q

Who published the ICD-11?

A

World Health Organization (WHO)

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7
Q

Who uses the DSM-5?

A

Professionals who diagnose people with disorders (psychiatrists especially)

Used internationally

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8
Q

Who uses the ICD-11?

A

Used by the NHS mostly and in effect from Jan 2022

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9
Q

When was the first version of the DSM published?

A

1952

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10
Q

When was the latest version of the DSM published?

A

2013

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11
Q

How many diseases are listed in the DSM-5?

A

293

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12
Q

The DSM-5-TR contains revised criteria for more than ….. disorders and includes a new one (prolonged grief disorder)

A

70

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13
Q

Which of these currently lists all of the recognised mental disorders and all characteristic features/symptoms that are required for an individual to be diagnosed with a specific disorder?

a) DSM-5
b) ICD-11

A

a) DSM-5

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14
Q

What is inside the DSM-5?

A

A lists all of the recognised mental disorders and all characteristic features/symptoms that are required for an individual to be diagnosed with a specific disorder

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15
Q

Which of these is the standard manual used for the classification of mental disorders by mental health professionals in the United States

a) DSM-5
b) ICD-11

A

a) DSM-5

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16
Q

What is the DSM-5 used for?

A

Used for classification of mental disorders by mental health professionals in the United States

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17
Q

Which of these is free to use?

a) DSM-5
b) ICD-11

A

b) ICD-11

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18
Q

Which of these only mentions mental disorders and how to classify them?

a) DSM-5
b) ICD-11

A

a) DSM-5

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19
Q

Which of these contains codes for all physical diseases, illnesses, and mental health problems, but also some descriptive ones too?

a) DSM-5
b) ICD-11

A

b) ICD-11

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20
Q

What does the ICD-11 contain?

A

Codes for all physical diseases, illnesses, and mental health problems, but also some descriptive ones too

e.g. acute intoxication from alcohol – F10.0; bitten by a crocodile/alligator – W58

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21
Q

Which of these mentions every single disorder, disease, illness and mental health problem that you can think of?

a) DSM-5
b) ICD-11

A

b) ICD-11

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22
Q

Can psychiatric diagnoses be useful? List the 5 reasons why it CAN be useful for HEALTH SERVICES AND CLINICIANS

A

1) To facilitate clinical assessment (mainly psychiatrists; less so for clinical psychologists)

2) To aid communication (common language for all professionals)

3) To guide treatment decisions

4) To help organise mental health services

5) To facilitate research (in order to research something, we need to agree on how to define it)

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23
Q

Can psychiatric diagnoses be useful? List the 6 reasons why it CAN be useful for INDIVIDUALS WHO RECIEVE A DIAGNOSIS.

A

1) Gives a name to difficulties

2) Allows individuals to look it up online

3) Offers meaning, understanding, relief and explanation

4) Facilitates communication with and understanding from others

5) Provides access to care and support (e.g. benefits)

6) Facilitates the process of finding and forming peer/carer support groups

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24
Q

Who conducted the Rosenhan experiment?

A

David Rosenhan

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25
Q

Who conducted the Rosenhan experiment?

A

David Rosenhan

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26
Q

What did David Rosenhan do in his study?

A

Being sane in insane places

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27
Q

Describe the Rosenhan Experiment

A
  • 8 pseudo-patients (including Rosenhan himself) faked one symptom in order to gain access to 12 different psychiatric hospitals in the US between 1969-1972
  • These 8 people claimed to hear a voice that said “empty”, “dull”, “thud” in their head
  • They all received severe psychiatric diagnoses (mostly schizophrenia) despite faking their symptoms
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28
Q

What was the purpose of Rosenhan’s experiment?

A

The experiment was during a time when psychology and psychiatry were at odds

The experiment was an attempt to discredit psychiatry and provide evidence that psychiatric diagnoses are inaccurate and unreliable

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29
Q

What happened in the Rosenhan experiment once the pseudo-patients acted normal again and claimed their symptoms were gone?

A
  • The patients were not allowed to leave (kept in for 8-52 days)
  • Anything they did was taken as evidence of psychiatric disorder
  • They were discharged with “remitted paranoid schizophrenia” - showing how diagnostic labels ‘stick’
  • Treatment? Psychiatric staff were just ignoring patients
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30
Q

Why did Rosenhan perform a follow-up study of his original experiment?

A

Because hospitals challenged Rosenhan to send more pseudo-patients, claiming that they would identify them

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31
Q

In Rosenhan’s follow-up experiment, what did the results show?

A

The hospital claimed to have identified 41/193 patients as pseudo-patients (fake patients)

But actually, Rosenhan never actually sent anyone

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32
Q

What did Rosenhan’s experiment conclude overall?

A

We cannot reliably distinguish the sane from the insane

Because:
- People feigning mental illness all gained admission to psychiatric units
- After they stopped faking symptoms, remained there for long periods without any treatment (being ignored)

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33
Q

How can we evaluate diagnostic systems? List 3 ways

A

1) Are they reliable?
2) Are they valid?
3) Are they accurate?

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34
Q

What does a reliable diagnostic system imply?

A

To what extent experts can agree about who has what diagnosis?

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35
Q

What does a valid diagnostic system imply?

A

To what extent the diagnostic system is useful for the purpose intended?

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36
Q

What does an accurate diagnostic system imply?

A

Can the diagnosis predict the course and outcome of illness and response to treatment?

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37
Q

You have depression and are given a treatment of social therapy.

The diagnosis of your disorder can predict the course and outcome of the disorder as well as your response to the treatment.

This is known as…?

a. Reliability
b. Validity
c. Accuracy

A

c. Accuracy

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38
Q

How do we test whether the DSM is reliable for psychiatric diagnosis?

A

Inter-rater reliability

Can two clinicians assess the same person and assign the same diagnostic category?

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39
Q

In DSM field trials, diagnoses are made under (…….) circumstances (trained raters using a standardised interview schedule)

A

Ideal

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40
Q

Inter-rater reliability of the DSM is determined by (……….) statistic

A

Kappa

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41
Q

What is kappa statistic?

A

Kappa statistic is a measure of agreement ranging from -1(complete disagreement) to 1 (perfect agreement)

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42
Q

What is the range of possible values of the kappa statistic?

A

The range of possible values usually falls between 0 (agreement no better than expected by chance) and 1

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43
Q

What kappa value is commonly accepted as substantial/excellent agreement during the DSM-5 field trials?

A

0.75

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44
Q

What kappa value is ideal during the DSM-5 field trials?

A
  • 0.75 excellent agreement
  • 0.6 acceptable agreement
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45
Q

After testing the inter-rater reliability of diagnoses from the DSM-5 during the DSM-5 field trials, were the kappa values acceptable or not acceptable?

A

Many of the diagnoses had kappa values that would be normally regarded as unacceptable/unreliable

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46
Q

Many of the diagnoses had kappa values that would be normally regarded as unacceptable/unreliable during the DSM-5 field trials

What does this say about reliability?

A

Many of the professionally trained individuals in the inter-rater reliability test could not agree on a diagnosis

Suggests that people do well in creating the criteria of disorders that one must meet to be diagnosed and categorising patients

However, professionals are still unable to agree on the same diagnosis (unable to apply to categorise patients in the same, consistent way)

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47
Q

What kappa value is commonly accepted as excellent agreement after the DSM-5 field trials?

A

0.6-0.8 excellent

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48
Q

What kappa value is ideal/ a realistic goal after the DSM-5 field trials?

A

0.4-0.6 realistic goal

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49
Q

What kappa value is commonly accepted as perfect/miraculous agreement after the DSM-5 field trials?

A

above 0.8 perfect/miraculous

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50
Q

What kappa value is commonly accepted as an acceptable agreement after the DSM-5 field trials?

A

0.2-0.4 acceptable

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51
Q

Why do highly trained professionals often fail to agree on a diagnosis?

A

Because the diagnostic criteria is narrow

If the diagnostic criteria is wider, there would be more unique diagnoses that have less overlap with other disorders/diagnoses

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52
Q

The extent to which the diagnostic - system is useful for the intended purpose

This is known as…?

A

Validity

53
Q

True or False?

Reliably identifying a category automatically indicate usefulness

A

False

Reliably identifying a category does not automatically indicate usefulness

54
Q

What does it mean for the classification system of diagnosis to be valid?

A

To be valid, the classification system should be useful in predicting the course and outcome of a particular condition

55
Q

What did Hanlon do in his data analyses on the validity of diagnostic systems?

A

Hanlon et al (2018) analysed data collected from people diagnosed with schizophrenia, bipolar disorder, or schizoaffective disorder (all diagnoses with overlapping features) and a control group with no diagnoses

56
Q

What did Hanlon find in his data analyses on the validity of diagnostic systems?

A

Receiving a specific diagnosis had little impact on the “real-life functioning” of participants (i.e. managing daily tasks, engaging in education/employment)

However, the presence and severity of the symptoms were more important/relevant to the participants

57
Q

Why do generalised anxiety disorder and major depressive disorder have low inter-rater reliability/kappa value?

A

Because they are mainly diagnosed by GPs who didn’t train as much as psychiatrists, thus, the diagnoses tend to be inaccurate

58
Q

True or False?

Specific diagnoses are the best predictor of outcomes under many circumstances

A

False

specific diagnoses are not the best predictor of outcomes under many circumstances

59
Q

What does construct validity mean in diagnostic systems?

A

Do the symptoms of specific psychiatric diagnoses correlate with each other?

60
Q

Do the symptoms of specific psychiatric diagnoses correlate with each other?

A

Most likely not

  • Different clusters within the same diagnosis
  • e.g. studies have shown that there are at least 3 clusters of symptoms of schizophrenia/psychotic symptoms (first demonstrated by Liddle in 1987 and much replicated since)
  • Individuals diagnosed with schizophrenia/psychotic symptoms could come under any of those clusters
  • But their presenting problems could be very different
61
Q

What are the implications of the validity of diagnostic systems?

A

People who receive the same diagnosis have very different problems and need different treatments

62
Q

Hallucinations and delusions are known as…?

a. Positive symptoms
b. Cognitive Disorganisation
c. Negative symptoms

A

a. Positive symptoms

63
Q

Flat affect and lack of motivation are known as…?

a. Positive symptoms
b. Cognitive Disorganisation
c. Negative symptoms

A

c. Negative symptoms

64
Q

Cognitive and attentional deficits are known as…?

a. Positive symptoms
b. Cognitive Disorganisation
c. Negative symptoms

A

c. Negative symptoms

65
Q

What are positive symptoms?

A

Any change in behaviour or thoughts

66
Q

What is cognitive disorganisation?

A

Reflects a disorganization of thought and is defined by the presence of bizarre behaviour, alogia, and impaired attention.

67
Q

What are negative symptoms?

A

Where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat

68
Q

What makes diagnosing a patient difficult?

A

Patients may have the same disorder but may show different symptoms

Also the symptom of a particular disorder could overlap with the symptom of another similar disorder

69
Q

What is comorbidity?

A

Meeting the criteria for more than one
diagnosis

70
Q

Meeting the criteria for more than one
diagnosis

This is known as…?

A

Comorbidity

71
Q

True or False?

The norm rather than the exception- more than 50% of people diagnosed with a mental disorder in a given year, meet the criteria for multiple disorders

A

True

72
Q

How many people with disorders carry only a single diagnosis?

A

55%

73
Q

How many people with disorders carry 2 diagnoses?

A

22%

74
Q

How many people with disorders carry 3 or more diagnoses?

A

23%

75
Q

Are diagnoses distinct, separate entities or are they interrelated?

A

They are interrelated

76
Q

The problem of comorbidity raises significant questions about ….?

A

The underlying structure & assumptions of classification

77
Q

In order for the classification system to be valid, it must…?

A

Be able to predict response to treatment

78
Q

True or False?

Different illnesses should respond to different treatments

A

True

79
Q

What is supposedly the treatment for Schizophrenia?

A

Neuroleptics

80
Q

What is supposedly the treatment for Manic depression?

A

Lithium carbonate

81
Q

Lithium carbonate is supposedly the treatment for what disorder?

A

Manic depression

82
Q

Neuroleptics are supposedly the treatment for what disorder?

A

Schizophrenia

83
Q

What did Johnstone et al. discover about treatments and drugs?

A

The drug response was symptom-specific but not diagnosis-specific

e.g. Delusions and hallucinations were successfully treated using neuroleptics

Mood difficulties were successfully treated using lithium carbonate

84
Q

The drug response was symptom-specific but not diagnosis-specific

Who proposed this?

A

Johnstone et al.

85
Q

What did Johnstone et al. do in their study investigating whether different illnesses should respond to different treatments?

A

Randomly assigned patients to pimozide (a neuroleptic), lithium carbonate, both or neither.

86
Q

Do diagnoses predict treatment response?

A

Not really. The drug response was symptom-specific but not diagnosis-specific.

87
Q

True or False?

Most NHS services use diagnoses as inclusion criteria.

A

False

However, most NHS services do not use diagnoses as inclusion criteria.

88
Q

Instead of using diagnoses as inclusion criteria, what do most mental health services (in the UK; NHS) use to accept or decline clients?

A

Most services accept referrals on the basis of need, severity/complexity of distress, and the specialist skills of their staff

89
Q

What did Allsopp & Kinderman do in their study?

A

They did a freedom of information request to services in the North of England to find out to what extent psychiatric diagnoses were used to offer clients services

90
Q

Who did a freedom of information request for services in the North of England to find out to what extent psychiatric diagnoses were used to offer clients services?

A

Allsopp & Kinderman

91
Q

In Allsopp & Kinderman’s study, what were the 4 types of services used to offer clients services?

A

1) Services that used diagnosis
2) Services that responded to specific needs/severity (largest category)
3) Services that worked with specific problems but were non-diagnostic
4) Services that supported specific life circumstances

92
Q

Which health service helped individuals with eating disorders and learning difficulties?

A

Services that used diagnosis

93
Q

Which health service involves ‘Improving Access to Psychological Therapies’ (IAPT) services (for mild to moderate mental health problems), secure services, crisis teams?

A

Services that responded to specific needs/severity (largest category)

94
Q

Which health service helped individuals with traumatic stress, alcohol and drug misuse, and early intervention in ‘psychosis’?

A

Services that worked with specific problems but were non-diagnostic

95
Q

Which health service helped individuals with military veterans, homeless & traveller teams and perinatal mental health?

A

Services that supported specific life circumstances

96
Q

What is the main implication for the individual following a diagnostic system?

A

Language, labelling & stigma

Simply = Language from the biomedical model (disorder, symptoms) means difficulties are seen as problems belonging within the individual

97
Q

Labelling mental health problems as illness & using biomedical causal theories (Read et al., 2006) is associated with….? List 2 things

A

1) perceptions of dangerousness & unpredictability

2) fear and desire for social distance

98
Q

True or False?

Diagnoses contribute to power imbalance between clients & clinicians (clinicians giving diagnoses)

A

True

99
Q

True or False?

Diagnoses can pathologise/regard “normal” behaviour to a particular event as a mental disorder

e.g. You might be diagnosed with BPD but actually, you react this way because of your past abuse trauma. There is no disorder; it is a trauma response.

A

True

100
Q

Do diagnoses relate to racism, sexism and minority discrimination? If so, how?

A

Yes

Psychiatry is ethnocentric and is related to the ideologies of Western culture, including racism

The practice of psychiatry, including its ways of diagnosing, is influenced by the social ethos and the political system

101
Q

True or False?

African American and Hispanic patients are less likely to receive a diagnosis of schizophrenia than white patients

A

False

African American and Hispanic patients are more likely to receive a diagnosis of schizophrenia than white patients

102
Q

True or False?

White psychiatric inpatients were more likely than African Americans to be diagnosed with bipolar disorder, and less likely to be diagnosed with schizophrenia

A

True

103
Q

White psychiatric inpatients were more likely than African Americans to be diagnosed with bipolar disorder, and less likely to be diagnosed with schizophrenia

Why is this?

A

Racism

Bipolar disorder is less severe compared to schizophrenia. Because western society is biased towards white people over other ethnic minorities, their disorders are perceived as less extreme because they are “less problematic”

104
Q

In England (from 2017-2018) amongst the five broad ethnic groups, Black or Black British were over (….) times more likely to be detained in hospital under the Mental Health Act than those who identified as white

A

4 times

105
Q

Around (….)% of those given the diagnosis of ‘borderline personality disorder’ are female

Despite clear evidence of a causal relationship between childhood trauma and later diagnosis of borderline personality disorder, particularly for sexual trauma

A

75%

106
Q

Some researchers have argued that instead of seeing women’s distress as symptoms of a ‘borderline personality disorder’ we should …?

A

Understand their difficulties as a response to societal sexual violence and oppression

107
Q

True or False?

Psychiatric diagnoses take into consideration the context of a person’s life experiences

A

False

Psychiatric diagnoses do not take into consideration the context of a person’s life experiences

108
Q

True or False?

A person’s background, history and context are needed to meaningfully understand a person’s distress

A

True

109
Q

Adverse or traumatic life experiences include a wide spectrum of experiences

List at least 5 examples

A
  • Childhood sexual or physical abuse
  • Neglect
  • Losing a parent
  • Bullying
  • Job loss
  • Poverty
  • Homelessness
  • Healthcare workers during COVID-19
  • Systemic oppression (e.g. racism; misogyny; homophobia; islamophobia)
  • Trauma resulting from mental health services and the criminal justice system
110
Q

Other than adverse/traumatic life experiences, what other factor is linked to post-traumatic stress disorder (PTSD)?

A

Strong associations with many other forms of distress

e.g. Depression and Anxiety

111
Q

What are the 3 limitations of focusing only on diagnostic symptoms?

A

1) Does not consider trauma as much as it should. Trauma is only mentioned in one specific chapter of diagnostic (DSM) manuals
e.g. post-traumatic stress disorder (PTSD)

2) Focuses on symptoms, not context. Therefore, for people with diagnoses that don’t come under this chapter, wider factors about their life may be missed

3) People do not always receive support and treatment that address underlying issues

112
Q

Instead of using the DSM to diagnose people, what other health manuals can we use?

A

Clinicians could use ICD psychosocial codes to record adversity

e.g. neglect and abandonment (Y06 and Y07); homelessness, poverty, discrimination, and negative life events in childhood, including trauma (Z55-Z65)

113
Q

Current classification systems for mental health problems…

A

a) Are still unreliable in diagnosing patients

b) Do not inform patterns of symptoms

c) Do not predict the outcome

d) Do not predict treatment response
i.e. do not demonstrate reliability or validity

114
Q

The Division of Clinical Psychology (DCP) of the British Psychological Society (BPS) (2013) has criticised the value of diagnostic classification systems and called for a …?

A

“Paradigm shift” towards new conceptual systems that are no longer based on diagnoses or disease/medical models

115
Q

What are the 6 limitations of Clinical Psychology?

A

1) Limited clinical and research utility (due to poor reliability and validity)

2) Limited cross-cultural applicability

3) Encourages labelling

4) Excessive biological emphasis

5) Little consideration of the context of people’s life stories and social circumstances

6) Exclude the possibility of finding meaning in people’s experiences, disempowering people, and preventing them from understanding how they might use their own resources to address their difficulties

116
Q

What is the Power Threat Meaning Framework?

A

They represent a shift from diagnostic to narrative-based understandings

The Framework sees people as actively making choices and creating meaning in their lives

It recognises that emotional distress and troubled or troubling behaviour are intelligible responses to a person’s history and circumstances that can only be understood with reference to the cultures in which they occur

117
Q

A new perspective on why people sometimes experience a whole range of forms of distress, confusion, fear, despair, and troubled or troubling behaviour.

This is known as…?

A

The Power Threat Meaning Framework

118
Q

The main aspects of the Power Threat Meaning Framework have been summarised into 4 questions, which can apply to individuals, families or social groups.

What are the questions?

A
  • What has happened to you?
  • How did it affect you?
  • What sense did you make of it?
  • What did you have to do to survive? (understand coping mechanisms to deal with difficulties)
119
Q

What are 4 other possible solutions to the problems of diagnoses and clinical psychology?

A

1) Develop more reliable categorical classification systems

2) Develop ‘dimensional systems’

3) Trans-diagnostic approaches

4) Psychological interventions

120
Q

Clinical psychology encourages labelling. Why is this bad?

A

Naming someone by their illness can lead to stigma, passivity and hopelessness in people with mental health difficulties (the “sick role”)

121
Q

Clinical psychology excessively emphasises biology. Why is this bad?

A

Diagnoses convey the idea that people’s difficulties can be understood in the same way as bodily diseases

People will over-rely on medication as the ‘answer’ to their diseases

121
Q

Clinical psychology considers very little of the context of people’s life stories. Why is this bad?

A

We need to understand illness in the context of the patient’s life story and social circumstances

e.g. child sexual abuse/adversities can be a strong feature of schizophrenia

122
Q

Clinical psychology has limited clinical and research utility. Why is this?

A

Due to poor reliability and validity

123
Q

One alternative solution to diagnoses and clinical psychology is to develop ‘dimensional systems’. What does this mean?

A

Where people are seen as varying in the severity of mental health difficulties, rather than either having one or not having one.

124
Q

One alternative solution to diagnoses and clinical psychology is to develop more reliable categorical classification systems. What is the limitation of this approach?

A

It is unlikely to improve the validity

125
Q

The diagnosis systems do not distinguish symptom patterns or predict outcomes or responses to treatment.

Does this mean the systems have…?
a. Insufficient accuracy
b. Insufficient reliability
c. Insufficient validity

A

c. Insufficient validity

126
Q

True or False?

Although diagnoses present some strengths, there are many limitations that undermine their clinical utility

A

True

127
Q

True or False?

The diagnosis systems distinguish symptom patterns or predict outcomes or responses to treatment.

A

False

The diagnosis systems do not distinguish symptom patterns or predict outcomes or responses to treatment

128
Q

True or False?

Considerable work is being done to develop other ways of thinking about mental distress

A

True

SEM 2 Mental Health and Distress (10 decks)

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