Week 1 Lecture 1b Diagnosis & Classification of Disorders Caff Flashcards
To provide flashcards of the contents of Lecture 2: Diagnosis & Classification of Disorders
What are the main reasons for having a classification system?
- To identify specific differences from normal functioning
- To compare problems with commonly seen patterns (diagnosis)
- To consider interactions between a person’s experience, behaviour and the environment (formulation)
- To develop & utilise models to treat individuals appropriate to their needs (treatment options)
What are the practical benefits of a classification or diagnosis system for a researcher?
A classification system:
- enables clinical researchers to develop improved clinical strategies, using between group designs for example
- enables epidemiological studies
What are the practical benefits of a classification or diagnosis system for a clinician?
A classification system:
- enables clinicians to identify signs & symptoms that cluster together (clinical syndrome or disorder)
- enables communication between health professionals
- provides information about the likely course of a mental health disorder with or without treatment
- assists in the selection of appropriate treatment
What are the practical benefits of a classification or diagnosis system for an individual?
A diagnosis can help people make sense of their symptoms
Why do we classify a mental disorder?
- a classification system must be able to determine whether a given condition is a disorder
- there are disputes about whether ADHD (overdiagnosis) and PTSD (a normal reaction to traumatic events?) are really disorders
- we need to decide the boundaries of a disorder: where does one disorder end and another disorder start?
How do we classify a mental disorder?
- Statistical Model
- Subjective Distress Model
- Biological Model
What are the core features of the Statistical Model of Classification?
The statistical model identifies:
*core features are determined by symptoms that are statistically rare
However:
- how do we determine what is rare?
- where are the cut offs?
- Some behaviours are statistically rare (giftedness, altruism) but not viewed as disordered
- some relatively common behaviours are regarded as disorders: depression (1 in 5) & anxiety (1 in 4)
What are the core features of the Subjective Distress Model of Classification?
The Subjective Distress Model identifies:
*Psychological distress as it’s core feature
However:
- it does not distinguish between ego-dystonic conditions (conflict with self-concept) and ego-syntonic conditions (consistent with self-concept)
e. g. hallucinations of religious nature may cause one person distress (Catherine) yet a religious person may find this ego-syntonic & not cause distress
What are the core features of the Biological Model of Classification?
The Biological Model identifies:
*Biological Disadvantage as it’s core feature
*Each disorder can be defined in terms of impairment in lifespan ability to reproduce or increased morbidity
depression doesn’t necessarily fit into this model (unless suicidal) doesn’t incorporate enough disorders as only considers those that limit life span & reproduction
What texts do we use to classify a mental disorder?
*ICD-10
International Classification of Diseases, Injuries & Causes of Death
- The ICD-10 Classification of Mental & Behavioural Disorders: Clinical Descriptions & Diagnostic Guidelines
*DSM-5
Diagnostic & Statistical Manual for Mental Disorders
American Psychiatric Association - fifth edition
The 2 systems used to be broadly aligned. There are some differences in terminology & conceptualisation of specific disorders however.
What are the core features of the ICD-10 Model of Classification?
- The ICD-10 is part of a broader medical classification system
- ICD-10 provides diagnostic guidelines
- ICD-10 is the main system used by health professionals/ health services
- ICD-10 codes are used in Australian health services
What are the core features of the DSM-5 Model of Classification?
- The DSM-5 is a dedicated system for mental disorders
- The DSM-5 provides explicit diagnostic criteria
- The DSM-5 is the main system used in research
What is particularly good about the DSM-5?
the DSM-5 is:
- Atheoretical:
- decisions are made by working groups
- information is based on scientific data
- it’s a Resource book using:
- criteria, trends (age, culture, gender), prevalence, risk, course, complications, predisposing conditions, family patterns
- Offers Categorical & Dimensional:
- recent changes consider dimensionality
- it is not purely categorical:
- prototypical: each disorder has certain essential characteristics & has certain nonessential variations
What is the history of the DSM?
*no classification system prior to the 1950’s
- DSM-I was published in 1952
- 100 pages describing major psychiatric disorders
- DSM-II was published in 1968 with more detail:
- global vague descriptions
- generally low inter-rater reliability
- Psychoanalytic approach using Freudian concepts
- DSM-III was published in 1980:
- Radical change: detailed guidelines with algorithms or decision guidelines for each diagnosis
- multiaxial system
What are the key aspects of the Multiaxial system first seen in DSM-III?
The Multiaxial System introduced in DSM-III:
- Axis I - clinical/mental disorders
- Axis II - pervasive disorders (Personality Disorders, Intellectual Disability)
- Axis III - Medical disorders
- Axis IV - Psychosocial stressors
- Axis V - Overall Level of Adaptive Function (0-100)
