Clinical psychology Flashcards
what are the 4ds of diagnosis
Deviance
Dysfunction
Distress
Danger
what does deviance mean in the 4 d model
behaviours that are unusual, undesirable or bizarre
failure to conform to social or statistical norms
what does dysfunction mean in the 4d model
symptoms which distract, confuse or interfere with a persona ability to perform normal tasks
WHODAS ii questionnaire measures dysfunction
what does distress mean in the 4d model
when symptoms cuase emotional pain or anxiety
may be manifested as physical symptoms like aches and pains
distress can be sometimes considered normal e.g. if person has just lost their job
clinician considers length and distress
what does danger mean in the 4d model
careless, hostile or hazardous behaviour which threatens safety of person or others
in the UK if a person is considered a danger to themselves or others they can be sectioned under the mental health act
what is a strength of the 4d model (four criteria)
using all four might help to avoid errors in diagnosis
e.g. if deviance was the only part considered then those who eccentric yet harmless may be seen as abnormal while those with common debilitating symptoms of depression may be missed
why might a weakness of the 4d model be lack of objectivity
ratings are being based off of the clinicians own views of what they deem to be abnormal, this may be affected by culture
for example a clinician from a different cultural background may see someones behaviours from a different culture alien while others do not - in some cultures hearing voices is viewed as communicating with god but a non religious clinician may see this as a symptom of SZ
why is possible labelling a weakness for the 4d model
end up with negative labels for people with mental illness
e.g. using danger as a criterion leads people to associate mental illness with danger
most people with SZ are no more dangerous than people without a diagnosis (Fazel et al)
could cause self fulfilling prophecies
what is a counter arguement for labelling being a weakness of the 4d model
labelling does not neccessarily lead to a self fulfilling prophecy, some people even attempt to rid themselves of negative labels by acting the complete opposite e.g. study done on baby faced boys who are frequently called cute - more aggressive than mature faced boys
what is an application for the 4d model
used by clinicians in conjuction with dsm -5 and icd 10 to help make appropriate diagnosis
different disorders tend to display different combos of the 4ds e.g. deviance from stats norms normally associated with intellectual disability vs the other ds being present in anti social personality disorder
what is the DSM
the diagnostic statistical manual,
describes symptoms, features and assocaited risk factors of over 300 mental and behavioural disorders
22 categories
where is the DSM primarily used and is it free
USA
not free, makes revenue for the american psychiatric association
what version of the DSM are we on now
the DSM-5
what is in section one of the DSM-5
guidance on how to use the new system
what is in section 2 of the DSM-5
details the disorders and categorises them according to current understanding of causes and similarities of symptoms
what is in section 3 of the DSM-5
suggestions for new disorders e.g. internet gaming disorder
also includes info of the impact of culture on diagnosis
how does a clinician make a diagnosis using the DSM-5
-gather info about individuall through observation
- most gathered through unstructured interviews
- also many structured interview schedules like the beck depression inventory
-process often involves ruling out possible disorders before deciding which one is the “best fit”
-complicated cases may take weeks or months
how is reliability of the DSM assessed
- Kappa score for reliabilty
- refers to proportion of people who receive the same diagnosis when assessed and reassessed either at a later time (test-retest) or by another practitioner (inter rater)
how is validity of the DSM assessed (different types of validity ?)
descriptive validity - when two people with the same diagnosis exhibit similar symptoms
aetiological validity- same causal factors
concurrent validity- when a clinician uses more than one method for diagnosis and both methods lead to the same diagnosis
predictive validity- if we are able to accurately predict outcomes for an individual after their diagnosis e.g. prognosis and reaction to treatment
why is the DSM reliable
good level of agreement between clinicians shown in field trials
Regier found that PTSD had a kappa score ranging from 0.6 to 0.79 which is deemed very good and seven other disorders including SZ ranged from 0.4 to 0.59 which is deemed as good
Shows that clinicians have adapted well to changes with the DSM and diagnostic criteria for some disorders
why is the DSM less reliable
what counts as acceptable levels of agreement has diminished over the years
Cooper explained that the DSM-5 task force classified levels as low as 0.2-0.4 as acceptable - suggests that the DSM-5 may be less reliable than previous versions
why is the DSM ethnocentric
made in and for America
also have private healthcare in America which may lead to more frequent diagnosis as they will gain revenue form someone needing care - therefore less valid
why is diagnosis using a best fit approach an issue ?
may be diagnosing with wrong disorder
may be a complex disorder - possible comorbidity
each best fit will be subject to each clinicians norms and values
why is the DSM-5 more reliable than other versions
DSM-5 has fewer diagnostic categories than the previous version. In the past, patients who “ticked the boxes” automatically qualified for a diagnosis. For example, having an IQ under 70 meant you were “mentally retarded”. DSM-5 encourages clinicians to look at other factors, like functioning or distress.
what is the ICD
diagnostic manual like DSM used produced by WHO
current version is the ICD-10
includes both physical and mental disorders
freely available around the world
how is a diagnosis made using the ICD-10
clinician selects key words from an interview with a client that relate to their symptoms - e.g. hallucinations or delusions
clinician can then look up these symptoms in an alphabetic index or go straight to an obvious disorder
clinician then uses other symptoms to locate a sub category
how has the ICD been improved
presentation, communication and interpretation of symptoms is shaped by language and culture and culture bias meant that one clinician may give a different diagnosis from clinicians in another culture because of differences in language and cultural norms
The ICD-10 is now as a result available in many languages with appropriate cultural forms
what is a strength of the icd 10 compared to the icd 9 (reliability)
Ponizovsky - compared reliabilty of the two , 3000 patients assessed at each time point
was measured using positive predictive value (ppv) - this i sthe proportion of people who get the same diagnosis when reassessed, for SZ PPV increased from 68% to 94.2% in 2003
what is a counter argument for the icd-10 having high reliability
high reliability is meaningless without validity. a demonstration of a high stability of diagnoses i.e. reliability of a certain diagnostic system doesnt mean the system is valid. reliability on its own tells us nothing about the meaning of the diagnosis
why does the ICD-10 have high inter-rater reliability
has good consistency when two clincians assess the same clients using the ICD-10
Galeazzi- arranged for two researchers to conduct a joint interview to assess 100 consecutive clients - got kappa scores ranging from 0.69 to 0.97 showing high agreement
why does the ICD-10 have high predictive validity for SZ
Mason- did a study that compared different ways of making a diagnosis- ICD-9 and ICD-10 were reasonabley good at predicting disability in 99 people with SZ 13 years later - using global assessment of functioning questionnaire
what is the application to diagnosis in regards to the development of the ICD-11
- aim to improve clinical utility of the system - conducted a huge survey of clinicians and found a preference for simplicity and flexibility, suggesting the ICD-11 task force will be cautious of adding new disorders and are likely to merge existing ones that are difficult to diagnose - system should be more user friendly improving the validity.
what is schizophrenia
a psychotic disorder characterised by positive symptoms (added on) such as delusions and hallucinations , negative symptoms can also be present such as alogia (poverty of speech) or flat effect
what is a symptom
subjective experiences reported by the individual that cannot be observed
what is a feature
info about prevalence , age of onset, gender differences, prognosis etc
what are the four key symptoms of SZ
thought insertion
hallucinations
delusions
disordered thinking
explain thought insertion
when a person believes their thoughts do not belong to them and have been implanted by an external force
blurring of boundary between self and others and feel barrier is permeable
explain hallucinations
perceptual experiences which do not correspond with reality
can be visual , olfactory , somatosensory and auditory (most common)- often experienced with hearing voices
explain delusions
fixed beliefs that are not amendable to change in the light of conflicting evidence
may be related to everyday life (believing your movement is being tracked by the government) or bizarre (believing an alien is trying to get in your brain)
can take many forms - persecutory , referential, grandiose
explain disordered thinking
inferred by someones speech - characterised by derailment (unrelated ideas) or tangentiality (going completely off topic)
word salad- refers to apparently random strings of ideas
only symptomatic if it leads to dysfunctional communication
what are some key features of SZ
lifetime prevalence- 0.3-0.7%
onset- slightly earlier in males (early to mid twenties ) than females (late twenties)
males tend to have poorer prognosis
prognosis is variable and harder to predict
females are over-represented in late onset cases
why is SZ often reliably diagnosed
can be made with a high degree of consistency with both DSM-5 and ICD-10
has a good kappa value of 0.46 after field trials of dsm-5 which is consodered good
only 3.8% of clinicians said they lacked confidence in their diagnosis of SZ using the ICD-10
suggests descriptors of SZ are sufficentky detailed to allow clinicians to distiguish it from other conditions
why is the reliability of diagnosis for SZ not easy
it shares symptoms with other disorders e.g. hallucinations can be experienced by people with depression or caused by drug withdrawal , stress , sleep deprivation etc
why do cultural differences make diagnosis harder in SZ
difficult if client is of a different culture than clinician
e.g. rastafarians often use neologisms (new words) which are a play on english words such as overstand instead of understand
a clinician unaware of these may see this as a sign of disordered thinking
suggests that diagnosis of SZ requires awareness and sensitivity to cultural and linguistic differences
what is hyperdopaminergia
excessive dopamine in the mesolimbic pathway or the rewards centre of the brain
linked to positive symptoms of SZ
what are some possible causes of hyperdopaminergia
low levels of beta hydroxylase - the enzyme which breaks down dopamine may be responsible for build up of excess dopamine in the synapse
too may D2 receptors on postsynaptic neuron
what is hypodopaminergia
dopamine deficiency in the mesocortical pathway
linked to negative symptoms such as flat effect and alogia
