5.1 Clinical content Flashcards
(100 cards)
List just the names of the 4 Ds of diagnosis.
- Deviance
- Dysfunction
- Distress
- Danger
Some researchers (Davis) have also considered that there may be a possible 5th D - Duration. Many clients could be seen has having all these 4 Ds in the short term but if they persist then this is where the problem may be seen as a symptom of an illness that requires psychiatric attention.
These four dimensions of diagnosis can be used as a tool to decide whether behaviour is ‘abnormal’ and therefore worthy of further investigation and diagnosis.
Describe ‘Deviance’ when referring the the 4 Ds of diagnosis.
Clinicians look at the extent to which the behaviour is ‘rare’ within society. If the behaviour is considered rare enough, and ‘deviant’ from the norm, then this could suggest that a clinical disorder is present.
Describe ‘Dysfunction’ when referring the the 4 Ds of diagnosis.
If the behaviour is significantly interfering with the person’s life then a mental illness may be present.
The clinician should discuss with the patient all aspects of. their everyday life to assess the extent to which the problematic behaviour is disturbing this. Although there may be no obvious day-to-day impact of the behaviour, the clinician should look carefully into all aspects of the patents life because disturbances could be present in areas that are not immediately obvious.
Describe ‘Distress’ when referring the the 4 Ds of diagnosis.
This feature of the diagnostic decision is related to the extent to which the behaviour is causing upset to the individual. This should be treated in isolation from other features of the 4 Ds because the patient may be serenely distressed by their current situation bu still able to function completely normally in other areas of their life. The subjective experience of the patient is very important here because the patient may be facing a great deal of difficulty in. their life but be feeling no distress, and similarly someone else may be very distressed by something that other may view as trivial.
Describe ‘Danger’ when referring the the 4 Ds of diagnosis.
The patients behaviour has to be assessed under two key elements of danger:
Danger to themselves and danger to others. If the person’s saviour is putting their own life or other peoples lives in considerable danger then this may indicate that an intervention is needed. This could be considered on a scale of severity because behaviour is extremely risky and not being addressed then a diagnosis may be necessary
Evaluate the 4Ds if diagnosis.
(see page 284 in the thick blue text book)
What are clinical interviews?
Give some issues and debates about them.
The diagnostic process is often conducted through clinical. interviews with patients by clinicians. These are unstructured or semi-structured interviews.
(see the yellow box on page 284 in the thick blue text book)
Which organisation was the ICD created by?
The World Health Organisation (WHO)
Which organisation was the DSM created by?
The American Psychiatric Association (APA)
Why are reliable diagnoses essential?
Reliable diagnoses are essential for guiding treatment recommendations, to ensure that a patient receives the correct treatment for their condition and an accurate prognosis can be given.
Read the yellow box on page 285 in the thick blue text book.
Understand?
What does the ICD contain?
- Mental health disorders and all diseases.
see the bottom of page 285 in the thick blue text book
What are the cultural differences between the ICD and the DSM?
(see the yellow box on page 286 in the thick blue text book)
The DSM V is a manual divided into three section, what do these three sections contain?
(see the side box on page 286 in the thick blue text book)
What is the reliability of diagnosis?
The reliability of diagnosis refers to the extent to which clinicians agree on the same diagnosis for the same patient.
Diagnosis is complex, especially as the same symptoms can occur across different disorders, such that two clinicians might see the same symptoms but assign their cause to different disorders. This would suggest that the diagnosis is unreliable.
What is some supporting evidence to saying that diagnoses is unreliable?
- Ward et al. (1962)
Studied 2 psychiatrists diagnosing the same patient.
Found:
Disagreement occurred because of,
- inconsistency of the information provided by the patient (5%)
- inconsistency of the psychiatrists interpretation os symptoms (32.5%)
- inadequacy of the classification system (62.2%).
This research suggests that the main reliability issue at the time was with the diagnostic tool being used.
For a system of diagnosis to be reliable what test does it need to pass?
An inter-rater reliability. test.
This involves showing two or more clinicians the details of a persons case history and assessing the level of agreement between them.
If all the clinicians (raters) agree on the same diagnosis then we can say that the system of diagnosis has high inter-rater reliability.
What is some supporting evidence for saying there is low inter-rater reliability in the early diagnostic systems?
Over the years the systems have developed, what further study supports reliability has improved?
- Beck (1954)
Found the same set of symptoms were only diagnosed as the same disorder in about half of cases, suggesting low reliability.
- Brown (2001)
Tested the reliability and validity of DSM IV diagnoses for anxiety and mood disorders.
Found them to be good to excellent.
There are still some disorders, however, for which a reliable diagnosis is harder to obtain, for. example, PTSD has a high degree of symptom overlap with other psychiatric disorders and may be under diagnosed as a result.
How can patient factors cause unreliable diagnosis?
(read the middle section on page 287 in the thick blue text book)
How can clinician factors cause unreliable diagnosis?
(read the bottom section on page 287 in the thick blue text book)
What is inter-rater reliability?
The degree of agreement and consistency between raters about the thing being measured.
Describe some individual differences that can cause problems in diagnosis.
(read the yellow box on page 288 in the thick blue text book)
What us concurrent validity?
A way of establishing validity that compares evidence from several studies testing the same thing to see if they agree.
What is aetiological validity?
The extent to which a disorder has the same cause or causes.
Aetiological validity exists when a diagnosis reflects known causes, such as family history, in a disorder that is known to have a genetic cause.
