Topic 5 Clinical - Content Flashcards
What is Deviance?
Behaviour that is rare and unusual going against social norms
What is Dysfunction?
Behaviour that interferes with everyday life/activities
What is Distress?
Behaviour causes anxiety and pain
What is Danger?
Causing physical or psychological harm to themselves or others
What are the Strengths for the diagnosis of mental disorders?
Using all 4D’s may help avoid errors in diagnosis
What are the Weaknesses for the diagnosis of mental disorders?
Subjective
- Ratings are being made of feelings - biased by situational, cultural, and historical factors - affects reliability
Labelling
- End up with labels for people with mental health issues (using “danger” assumes mental illness is dangerous - leading to stereotypes - meaning is distorted through the media)
What is a Classification System?
MHD (Mental Health Disorder)
Describe clusters of symptoms that define disorders, which should lead to better quality diagnosis.
What’s DSM?
DSM = Known as DSM-V (V = 5th edition, DSM-5) or DSM-IV-TR (IV = 4th edition, TR = text revised):
- DSM-V:
- Current
- Linked disorders grouped together
- Use info from interview + records (like ICD) Sections:
1. Introductions to the manual with instructions on its use
2. Classification of main MHD
3. Future + Other assessment measures, e.g. help diagnoses from diff cultures
- DSM-IV-TR - Multi-axial tool because of its 5 axes/chapters
- Mental Health Disorders (anxiety)
- Described symptoms related to personality disorders
- Described medical conditions (brain damage) to explain the start of clinical issues.
- Described psychosocial/environmental problems that could be involved with MHD’s (loss of housing/employment)
- Scale to assess global functioning of an individual (how much a persons symptom affects their day) = score helps with diagnosis + assess need for treatment
What’s ICD?
ICD = Currently ICD-10 (10th version):
- All diseases
- Section F specific to MHDs
- Groups each disorder as part of a family, e.g family: mood (affective) disorders includes: depression in all its forms
- Code: F32 (F=MHD section) (3=Family of MHD) (2=specific disorder, e.g. 2 is depression, 1 is bipolar)
- Decimal points make categorisation even more specific
- Guide diagnosis through interview
What’s Reliability of Diagnosis?
Reliability - Clinicians agree on the same diagnosis for the same patient
Inter Rater Reliability Test:
- Showing 2+ clinicians the details of a patients case history - Assess level of agreement between them - if all raters (clinicians) agree on the same diagnosis, high inter rater reliability. - Early diagnostic symptoms had low inter-rater reliability
Patient Factors:
- Patients give inaccurate info because of memory problems, denial or shame - Specific issues - disorganised thoughts cause issues
Clinician Factors:
- Subjective judgment - interpretation affected by different background/training or experience - Unstructured nature of interview - Lead to clinicians focusing on different symptoms (nightmares or traumatic past event) - Thus different info gathered - different diagnosis
What’s Validity of Diagnosis?
Validity - A diagnosis genuinely reflects the underlying disorder
- Construct Validity - Whether a measure is actually measuring the thing its supposed to
- Concurrent Validity - Comparing a new test with an existing test to see if they have similar results, which is done at the SAME time.
- Predictive Validity - Results from a test such as DSM or a study can predict future behaviour
- Convergent Validity - 2 tests have a strong relationship that measure the same thing
Convergent - 2 measures measure the same thing whilst Concurrent/Predictive there can be a different way of measuring each studies.
What’s the strengths for Validity of Diagnosis on DSM?
Kim Cohen et al. (2005)
- Looked at the behaviour of children diagnosed with conduct disorder to see whether those children were more likely to report their own antisocial behaviour and be disruptive during assessment. - These behaviours would be expected if their diagnosis was valid. The results of the study did find validity in the diagnosis.
Lee (2006):
- Teachers opinion about a child was compared with an ADHD diagnosis using the DSM-IV-TR - Was found that there was a match between the measures, so the DSM was valid - However, boys fit the DSM criteria better than girls - ---- - Studies show that the DSM is valid in diagnosis. Different mental health issues were chosen in the different studies cited, which reinforces this conclusion. - Claim that the DSM is valid is supported by the claim its reliable, as reliability and validity go together. If the DSM is not reliable, it will not be valid.
What are the weaknesses for validity of diagnosis using DSM?
Co-morbidity = having more than one mental disorder/illness or disease
Reductionist/ism = breaking down a complex phenomenon into simpler components
- Co-morbidity is hard to diagnose using the DSM, a system which relies on the user choosing the closest match from lists of symptoms and features
- Splitting a mental disorder into symptoms & features is reductionist & studied as a whole may be more valid
Implicit Bias: Preconceived ideas
e.g. women can’t have schiz, more likely to have depression as they are emotional
FINISH What’s the strengths for reliability of diagnosis using DSM?
- Brown et al. (2001) tested the reliability of the DSM-IV. They studied anxiety and mood disorders in 326 out-patients in Boston, USA. The patients underwent two independent clinical interviews and there was high level agreement for most of the DSM-IV categories.
- high level of agreement between two psychologists in two separate interviews.
- Wilson (1993) -> DSM-III developed to precisely tackle the unreliability of the previous manuals
What’s the weaknesses for reliability of diagnosis using DSM?
- The reception to the new DSM-5 has been mixed. The British Psychological Society (BPS) published a largely critical response in which it attacked the whole concept of the DSM. It argued that the diagnosis should fit the patient, but the DSM-5 tries to make the patient fit the diagnosis
- Andrews et al, 1999: There has been found to be only a 68% agreement between the ICD-10 and DSM-IV on an assessment of 1500 patients.
What’s the strengths for Reliability for ICD?
Jakobsen et al (2005)
- Looked at in-patients with schizophrenia & out-patients with a history of psychosis (to look at reliability of the ICD-10 focus on schizophrenia)
- 93% sensitivity & 87% predicted value to a diagnosis of schizophrenia & good agreement between ICD-10 & other diagnosis using another measure
- Concluded: gave a reliable diagnosis of schizophrenia
Hiller et al (1992):
- Compared DSM-III-R & ICD-10 - used both on same set of patients who were suffering from affective & psychotic disorders
- ICD-10 gave higher reliability for all disorders except bipolar
- Moderate agreement for schizophrenia (between DSM-III-R & ICD-10) but not for schizoaffective disorder (lack reliability)
Cheniaux et al (2009)
- Aim: looked at reliability of diagnosis between DSM-IV & ICD-10
- Concluded: Schizophrenia found more when ICD-10 was used than DSM-IV, Bipolar disorder most reliability diagnosed
- ICD-10 is a reliable measure of schizophrenia & compares well with DSM-III-R (Hiller et al 1992) & (Jakobsen et al 2005)
- Use of inter rater reliability - means more than one person uses the classification system/s with the same patients & when they come up with the same diagnosis - reliability - Also careful controls for the raters to work independently - avoid bias
What are the weaknesses for reliability of diagnosis using ICD?
- Schizophrenia diagnosed more when ICD-10 used than DSM-IV used (Cheniaux et al 2009) - lack of reliability - could be due to the differences in duration (6 months = DSM, 1 month = ICD)
- Schizoaffective disorder not reliably diagnosed (Cheniaux et al 2009) & (Hiller et al 1992) - lack of reliability of disorders relating to schizophrenia
- Reliability figures around 0.50 agreement, lack of agreement to be considered
What’s the studies for Validity of ICD for schizophrenia?
Pihlajamaa et al (2008)
Validity of SZ diagnosis tested using DSM-III-R and the ICD-10. 807 SZ patients from Finland diagnosed with both books. Validity for DSM was 75% and ICD was 78%. The high level of agreement makes the diagnosis more reliable.
Jansson et al (2002)
- compared ICD-10 & DSM-IV - Data gathered by interviews then compared to check validity of the diff classification systems - Concluded: Diagnostic agreement between ICD-10 & DSM-IV (0.823) - Generally diagnostic classification is valid but in depth there is differences - ------ - When the ICD-10 is used to diagnose schizophrenia the diagnosis matches a diagnosis using a different system, suggests ICD-10 is valid (Pihlajamaa et al 2008)
- (Jansson et al 2002) ICD-10 & DSM-IV gave 80% agreement in diagnosis - high validity
What are the weakness for validity of diagnosis using ICD?
- (Jansson et al 2002) different classification systems focused on different features & symptoms in schizophrenia (ICD-10 & ICD-9) - lack validity
ICD-9 = ‘more conservative’
ICD 10 = ‘more liberal’ - Complexity of disorders:
- schizophrenia spectrum disorder
- schizoaffective disorder (both psychotic & mood disorders are present)
- Bipolar disorder has symptoms of schizophrenia.
How do cultural issues affect diagnosis?
- Symptoms of schizophrenia (hearing voices) in Western countries can be interpreted in different countries as possession of spirits, special & unique - positive view
- Evrard (2014) - hearing voices is either a mental disorder or an individual difference/interpreted as an experience. Cultural Interpretation = DSM not always valid. Clinician from one culture must be aware of a patient from a diff culture to be influenced by their culture.
- Malgady - costa rica - hearing voices is your ancestors talking to you
How do cultural issues not affect diagnosis?
- Mental disorders (depression or schizophrenia) are clearly & scientifically defined with specific symptoms/features, that present the same all over the world - DSM not only used in America but also else where
- Study: Lee (2006) used DSM-IV-TR in korea to see if it was valid and found valid
What is Schizophrenia?
Characterised by abnormalities; distortion of thoughts, perception & emotion & social withdrawal
What is Positive (Type 1) symptom?
Additions to behaviour (symptoms that can be seen & noted)
What is Negative (Type 2) symptom?
Lack of normal behaviour/functioning
What are examples of Positive Symptoms & what do they mean?
- Hallucinations
Seeing/Hearing/Smelling on something that’s not there - Delusions
False beliefs that conflict with reality (thinking their movements are being controlled by someone) - Thought Insertion
Individual thinks someone else is putting thoughts into their head - Disorganised Thinking
Thoughts are not in logical order - doesn’t make sense - Catatonia
Abnormality of movement & behaviour - not a lot of physical movement
