Week 1 Lecture 1b - Diagnosis & Classification Systems (Caff) Flashcards
To provide a revision 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 researcher:
- enables clinical researchers to develop improved clinical strategies, using between group designs for example
- enables epidemiological studies
for clinician:
- 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
for 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 and PTSD 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
- core features are determined by symptoms that are statistically rare
- Subjective Distress Model
- Psychological distress as it’s core feature
- Biological Model
- Biological Disadvantage as it’s core feature
What are the difficulties with each of the approaches to classification of mental disorders?
The statistical model does not address:
- 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 & anxiety
Subjective Distress Model does not address:
*it does not distinguish between ego-dystonic conditions (conflict with self-concept) and ego-syntonic conditions (consistent with self-concept)
Biological Model does not address:
*Each disorder can be defined in terms of impairment in lifespan ability to reproduce or increased morbidity
What texts do we use to classify a mental disorder?
- ICD-10 - part of a broader medical classification system
- provides diagnostic guidelines
- the main system used by health professionals/ health services
- ICD-10 codes are used in Australian health services
- DSM-5 is a dedicated system for mental disorders
- provides explicit diagnostic criteria
- the main system used in research
The 2 systems used to be broadly aligned.
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?
- before 1950’s no classification system
- 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
- DSM-III-R retained the features of DSM-III and provided increased detail: including over 900 pages with over 350 diagnosis
- DSM-IV included an appendix for culture-bound disorders, such as Koro
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)
What are the key changes with DSM-5?
- Released in June 2013
- Shift towards rationalisation of diagnosis and dimensionality:
- controversies exist over removal (Aspergers) and addition of certain diagnosis
- critiques abouts utility in research
What is the DSM definition of a Mental Disorder?
*A clinically significant behaviour, or psychological syndrome, or pattern that occurs in an individual and that is associated with:
*Distress - painful symptom
or
*Disability - impairment in one or more important areas of functioning
or
*A significant increased risk of suffering death, pain, disability
or
*An important loss of freedom
What other factors are crucial in determining whether a presentation meets the DSM definition of a Mental Disorder?
- The behaviour must not be merely an expectable & culturally sanctioned response to a particular event (e.g. death of a loved one)
- Whatever its original cause, it must currently be considered a manifestation of a behavioural, psychological, or biological dysfunction in the individual
- Neither deviant behaviour (political, religious, sexual) nor conflicts that are primarily between the individual & society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual
What are the Axis I: Clinical Disorders in DSM-5?
- Disorders usually first diagnosed in childhood
- Delirium, dementia, & other cognitive disorders
- Substance Related disorders
- Schizophrenia & other psychotic disorders
- Mood Disorders
- Anxiety Disorders
- Somatoform Disorders
- Factitious Disorders
- Dissociative Disorders
- Sexual & gender Identity Disorders
- Eating Disorders
- Sleep Disorders
- Impulse-Control Disorders NOS
- Adjustment Disorders
What are the Axis II: Pervasive Disorders in DSM-5?
- Personality Disorders/traits
- Cluster A: schizoid. schizotypal, paranoid
- Cluster B: borderline, narcissistic, histrionic, antisocial
- Cluster C: avoidant, dependent, obsessive-compulsive
- Intellectual Disability
- Mild, moderate, severe categories
- includes “Borderline Intellectual Functioning”
What are the Axis III: General Medical Conditions in DSM-5?
Any medical condition can be listed here
- includes neurological/medical diseases causing mental disorder e.g.
- Axis I - Dementia in Huntington’s disease
- Axis II - Mental Retardation
- Axis III - Huntington’s Disease, Down’s Syndrome
