THE CLINICAL APPROACH - DIAGNOSIS Flashcards
What are the strengths of diagnosis?
For closure and to make your feelings feel valid
To find which treatments are appropriate
For access to things needed (eg help in education)
To tell others why you behave a certain way
What are the weaknesses of diagnosis?
People can use it in a bad way
Can lead to a self-fulfilling prophecy
Treated with drugs which isn’t always a long term fix (not the cause) and can cause other issues in the form of side effects
Based on self-report which a lot of people don’t do
Can lead to misdiagnosis
People label others based on their diagnosis
What are the four Ds?
At the first point of contact when someone seeks help for a mental illnesses, they establish the 4 D’s
Danger - risk of harm to themselves or others
Distress - are there signs of sadness, anger etc
Dysfunction - has it affected their everyday lives
Deviance - is their behaviour abnormal (but social constructed)
((Duration - how long they have been struggling))
What is the evaluation of the four Ds?
Has a level of subjectivity, as the clinician needs to interpret what the patient says and decide whether it fits into one of the 4D’s
Eg someone may find a certain behaviour dysfunctional that another clinical may not
This could mean the wrong diagnosis could be made
Lacks reliability as it relies on the conversation between the clinician and the patient, which may not be the same if repeated
Eg the patient could express their emotions in different ways
Due to it relying on the rapport between the clinician and the patient, using standard tests may be more effective as they assess symptoms of many disorders
Has more objectivity and empirically measures the patient in the same way
The patient may not tell the truth about their symptoms, or exaggerate/lie which means the process lacks validity
Operationalising deviance can be problematic as attitudes towards social norms and values change, as well as this some signs of distress are actually normal within society which means the behaviour may not be seen as deviant
What is the ICD 10?
MHDs are categorised according to similarities in symptoms which are coded F
This coding allows clinicians to move from general descriptions of symptoms to a more focused analysis and more accurate diagnosis
Enables clinicians to develop their diagnosis as the clinical interview progresses
What is the ICD 10?
A list of mental disorders produced by The World Health Organisation in 1948
MHDs are categorised according to similarities in symptoms which are coded F
This coding allows clinicians to move from general descriptions of symptoms to a more focused analysis and more accurate diagnosis
Enables clinicians to develop their diagnosis as the clinical interview progresses
What is the DSM V?
A version of the mental disorders component of the ICD produced by the American Psychiatric Association
It’s goal was to harmonise with the ICD, which the previous versions didn’t
It dropped the multi-axial approach, and adopts a similar system into grouping disorders into ‘families’, to enable a clinical to go from a general diagnosis into a more specific one
It consists of sections:
Section I - an introduction to the manual
Section II - gives diagnostic criteria and code, and includes the classification of the main MHDs
Section III - about the future of diagnoses (categories that need more research)
It takes more of an integrative approach with greater cultural sensitivity and section III enables self-assessment to give the patient a choice
However it doesn’t link MHDs to biological underpinnings and it requires the clinician to make judgements as it involves social norms which can be subjective
What did Reed et al find?
found that 70% of psychiatrists surveyed used the ICD 10 for diagnosing MHDs, compared to 23% for DSV IV
What is the reliability of diagnosis and what are the key names>
Refers to the extent to which clinicians agree on the same diagnosis for the same patient using the manuals
A diagnosis should pass inter-rater reliability (where multiple clinicians diagnose the patient with the same disorder) and test-retest reliability (if you were to repeat the diagnosis it would get the same result)
The DSM originally had low reliability as Beck found that the same set of symptoms were only diagnosed as the same disorder in about half of the cases, whereas Brown found that the newer versions have ‘excellent reliability’
Ward et al, Beck et al, Cooper et al
What did Ward et al find?
studied two psychiatrists diagnosing the same patient and found that disagreement occurred because of the inconsistency of the patient (5%), inconsistency of the psychiatrists interpretation (32.5%) and the inadequacy of the classification system (62.5%)
What did Beck et al find?
gave 2 psychiatrists the same 153 patients to diagnose, but only found they agreed on the diagnosis 54% of the timE
What did Cooper et al find?
gave US and UK psychiatrists the same video-taped interview and asked them to make a diagnosis, the New York psychiatrists were twice as likely to diagnose schizophrenia as those from London, who diagnosed bi-polar disorder more
What are factors influencing the reliability of diagnoses?
Patient may give different information and respond differently
Patient may provide inaccurate information due to memory loss etc
Subjective interpretation of the information by the clinician
What is the validity of diagnosis and what are the key names?
It must genuinely reflect the underlying disorder, because the consequences of a misdiagnosis can result in the wrong treatment
Must have aetiological validity, concurrent validity and predictive validity
Can be difficult due to comorbidity, as many mental health disorders have similar symptoms
Power et al, Bannister et al, Andrews et al
What did Power et al find?
found that women who had suffered complex post traumatic disorder also had higher levels of alcohol and substance misuse which is predicted by the ICD 11 (high predictive validity)
