Diagnosis (pack 1)

Question 1

What are the four D’s of diagnosis?

Answer 1

Deviance, distress, dysfunction and danger

Question 2

What does deviance, distress, dysfunction and danger mean?

Answer 2

1. deviance- behaviours that are unusual in society
2. distress- individual finds their behaviour emotionally upsetting
3. dysfunction- the extent to which the behaviour interferes with their day to day life
4. Danger- behaviour that could harm themselves or others.

Question 3

Two strengths to evaluate the 4 D’s diagnosing system?

Answer 3

1. Provide a holistic way to assess someone’s mental health as it covers a range of symptoms
2. DAVIS suggests a fifth D is needed which increases the validity

Question 4

Two weaknesses to evaluate the four D’s diagnosing system?

Answer 4

1. Distress is subjective and difficult to measure. Also not all those with MHD are distressed by it- sociopaths content, lacks VALIDITY
   2.subjectivity means it lacks reliability, do not arrive at the same diagnosis, lowers validity.

Question 5

What are classification systems?

Answer 5

used to help practitioners make diagnosis and establish appropriate treatment regimens

Question 6

What is the medical model of abnormality?

Answer 6

A biological approach which assumes that the major source of abnormal behaviour is some form of medical illness.

Question 7

What do supporters of the medical model of abnormality assume psychological symptoms are a sign of?

Answer 7

outward signs of the inner physical disorder.

Question 8

Two problems with using the medical model for diagnosis of mental disorders?

Answer 8

1.symptoms are subjective as they are mental. clinician makes decision based upon experience.
2. Medical model heavily criticised by anti-psychiatry movement, authors such as THOMAS SZASZ and R.D LAING, who suggested that these symptoms are a reaction to coping with our sick society.

Question 9

What are the two major classification systems?

Answer 9

DSM-5 and ICD-10

Question 10

Where is the ICD-10 mainly used?

Answer 10

Britain and other parts of the world

Question 11

Where is the DSM-5 mainly used?

Answer 11

North America

Question 12

How do the classification systems stay inclusive?

Answer 12

Regularly update to take into account people changing cultural views.

Question 13

What improves the systems when they are regularly updated?

Answer 13

inconsistencies can be removed, increasing both validity and reliability.

Question 14

Why may the classification systems be criticised as reductionist?

Answer 14

Both rely on checklists for behaviours.

Question 15

What are the classification systems based off of and why is this a criticism?

Answer 15

Use the medical model
Belief that mental health issues should be treated in the same way as physical illnesses

Question 16

Why may the DSM be considered less reductionist than the ICD?

Answer 16

it takes into account psychosocial factors and disabilities

Question 17

How many categories does the ICD-10 have?

Answer 17

100
for example, dementia with similar disorders strung together too

Question 18

What is the DSM-5 criteria to diagnose depression?

Answer 18

Five or more symptoms persisting within the same two week period
At least one symptom must be 1) depressed mood or 2) loss of interest or pleasure

Question 19

When is diagnosis considered reliable?

Answer 19

if different practitioners arrive at the same diagnosis (inter-rater reliability)

Question 20

What did SPITZER AND WILLIAMS find out was wrong with the reliability of the DSM

Answer 20

found that psychiatrists only agree on diagnosis 50% of the time

Question 21

What did BROWN find that supported the reliability and validity of the DSM?

Answer 21

diagnosis for anxiety and mood disorders and found them to be good to excellent

Question 22

What factors impact reliability of diagnosis?

Answer 22

1. Patient factors
2. clinician factors
3. classification systems

Question 23

What is an example of patient factors? (reliability)

Answer 23

patients may give psychiatrists different information for some reason

Question 24

What is an example of clinician factors? (reliability)

Answer 24

practitioners are not completely objective

Question 25

What research shows that both the DSM-5 and ICD-10 have both significantly improved in reliability for depression?

Answer 25

PEDERSON found 71% of psychiatrists agreed with the ICD-10 definition of depression when assessing 116 people.

Question 26

What is a weakness of patient factors?

Answer 26

May not disclose all relevant information because they are embarrassed or ashamed…therefore clinician cannot arrive at accurate diagnosis.

Question 27

What is a weakness of clinician factors?

Answer 27

implicit bias (positive or negative attitudes that a person may hold at an unconscious level) in the clinician can reduce the validity of diagnosis.

Question 28

What is a weakness of the classification systems?

Answer 28

if the classification system is biased itself

Question 29

What did COCHRAN find out was a weakness with the classification systems?

Answer 29

the classifications themselves lead to practitioners to take on a euro centric bias

Question 30

what did MASON AND COLLEAGUES show was a strength in the classification systems?

Answer 30

the diagnosis of schizophrenia using the ICD-10 has good predictive validity

Question 31

What did the anti-psychiatry movement believe diagnosis could be used for?

Answer 31

An agent of social control

Question 32

What did DAVID ROSENHAN critique?

Answer 32

The medical model

Question 33

What are the two things Rosenhan believed about diagnosis?

Answer 33

1. Diagnosis not accurate
2. Being given a diagnosis would negatively affect a persons life as they are given a label so others would judge them

Question 34

What were the two aims for Rosenhan’s first study?

Answer 34

1. Wanted to see if sane people would be found out to be sane after being admitted
2. He wanted to see what it was like to live in a psychiatry hospital and to be viewed as insane

Question 35

3 points within the procedure of Rosenhan’s first study?

Answer 35

1. Took 8 sane confederate pseudo-patients and asked them to call the hospital requesting an appointment
2. went to 12 varied hospitals, patients claimed to hear voices saying words such as ‘hollow’ or ‘thud’. All participants diagnosed with schizophrenia.
3. Resumed normal behaviour once admitted

Question 36

What were three results of Rosenhan’s first study?

Answer 36

1. No pseudo-patients were detected as being confederates

2.Average stay was 19 days

3. staff had no doubts of authenticity of patients BUT 35/118 patients expressed doubts.

Question 37

What were three conclusions of Rosenhan’s first study?

Answer 37

1. Once labelled schizophrenic, it is very difficult to get rid of that label
2. diagnosis of mental & behavioural disorders is unreliable and subjective
3. Doctors more likely to treat a healthy person as sick, then a sick person as healthy

Question 38

3 strengths of Rosenhan’s first study?

Answer 38

1. generalisability- large and varied sample of institutions, good generalisability as individual differences of institutions have less impact
2. Used standard procedures as all patients came to the institutions with the same ‘symptoms’, and then all resumed normal behaviour after admission. This increases reliability and replicability.
3. Good ecological validity because the study took place in real institutions, so the findings can be applied to a real life setting.

Question 39

3 weaknesses of Rosenhan’s first study?

Answer 39

1. Validity- Pseudo-patients deceived psychiatrists of their sanity, and professionals were misinformed in the second study so internal validity is reduced as deception guided the results.
2. In study 2 staff had to rate patients sanity on a scale of 1-10, and this can vary based on the interactions staff had with patients.

3Staff did not receive a full debrief, so staff had no opportunity to discuss their distress.

Question 40

Why did Rosenhan create a second study?

Answer 40

An institution challenged them to send pseudo-patients as they believed they wouldn’t make the same mistakes as the others.

Question 41

What was the aim of Rosenhan’s second study?

Answer 41

To see if the hospitals would be able to differentiate between the sane and the insane, when told pseudo-patients would approach

Question 42

What was some of the procedure for Rosenhan’s second study?

Answer 42

1.hospital told over next 3 months, pseudo-patients would try to be admitted

2.Staff asked to rate on scale of 1-10 how likely patients would be fake.

3.no pseudo patients admitted.

Question 43

conclusion of Rosenhan’s second study?

Answer 43

staff unable to detect insanity.

Question 43

Two results from Rosenhan’s second study?

Answer 43

1. 41 rated as a pseudo-patient (by two patients)
2. 23 rated as pseudo-patient by a psychiatrist

Question 43

What was the aim of Rosenhan’s third study?

Answer 43

To investigate patient/staff contact

Question 44

what were two parts of the procedure for Rosenhan’s third study?

Answer 44

Some of the pseudo-patients asked staff “Pardon me, Mr/Mrs/Dr X, could you tell me when I will be eligible for ground privileges?”

Compared this to responses given to a student at Stanford university

Question 45

What were the results of Rosenhan’s third study

Answer 45

71 psychiatrists moved on with head averted
Only 4 stopped and talked

Question 46

What was the conclusion for Rosenhan’s third study?

Answer 46

Rosenhan concluded that psychiatric patients are treated differently to non-psychiatric patients.

Question 47

What did Rosenhan suggest after the third study?

Answer 47

Patients powerless while on mental ward and lack of eye contact depersonalises the patients.

Question 48

What research supported Rosenhan’s study?

Answer 48

Lauren Slater- went to emergency stops and said she heard ‘thud’ and was diagnosed with depression and psychosis

Question 49

What research challenges Rosenhan’s studies?

Answer 49

Spitzer et al- suggested they were flawed and sensationalist
causing harm by creating doubt about the treatment of mental health.