Chapter 1 Flashcards
What are the purposes of classification?
- description→ highlight critical features, provide surplus info regarding patient
- prediction→ diagnosis can be predictive
- theory→ explore relationships of different elements to one another
- communication→ between clinicians
What are th 5 key crtieria for a valid diagnosis?
- clinical description→ consistent commun set of symptoms clustering together (ex: depression= insomnia + sadness BUT not mania)
- course→ should follow a common trajectory and have similar onset
- treatment response→ people with same disorder should respond similarly to treatments (debatable)
- family history→ does it run in the family
- laboratory studies→ look for biological and psychophysiological associations
Additional validating indicator→ Endophenotypic
- biomarkers or laboratory indicators, that is, “measurable components unseen by the unaided eye along the pathway between disease and distal genotype”
What is the Procrustean beds myth and how is it relevant to the limits of the classification system?
Difficulty of boundary cases
- Procrustean beds myth
- try to adapt people to the category rather than adapting the cases
What is the internal consistency of a mental disorder?
extent to which the signs and symptoms comprising a diagnosis hang together
What are the pros and cons of a categorical system?
Categorical→ nowadays
- presence OR absence of disorder
- need a threshold
- ex: either you are anxious or you are not
- speak to our natural preference to employ categories
Advantages
- easier for research
- simplify communication
- better fitted for clinical decison-making
Disadvantages
-not good at communicating nuances
-need a threshold
What are the pros and cons of a dimensional system?
Dimensional→ rank on quantitative dimension
- degree of symptoms
Advantages
- may capture functioning better/ higher correlations with external validating variables
- preserves more information (how high/low on the scale the person is)
- greater reliability (inter-rater, test re-test)
—>most personality disorder seems to be dimensional as opposed to taxonic in nature
Disadvantages
- but arbitrary cut-offs
What are the dates of the DSM-I and II and their novelty?
DSM-I→ 1952
- first attempt to write down common definitions for everyone
- standardization of diagnosis
DSM-II→1968
- few categories
- psychoanalysis was dominant at that time
What are the novelty brought by the DSM-III?
DSM-III→1980
- more biological and empirical approach
- inclusion criteria→ nature and numbers of symptoms needed to be diagnosed
- Duration Criteria
- Exclusion Criteria→ symptoms ruling out specific diagnosis
Multi-Axial Classification
1. Major Clinical Disorders (PTSD, MDD)
2. Personality Disorders (BPD, NPD)
3. Medical conditions that might be relevant to treatment
4. Psychosocial Stressors→ something with which to record environmental contexts
5. GAF (Global adaptive functioning)→ a simple rating of function/summary score for severity (0-100)
Assumptions introduced
- symptoms are most useful basis for assessment
- Nosology based on behavior and symptoms
- Locus of pathology is in the individual
What is the novelty of the DSM-IV?
DSM-IV→ 1994
- Introduced “clinically significant distress or impairment in social, occupational, or other important areas of functioning” as criteria
- added culture-bound syndrome
DSM-IV-TR→ 2000
- define broadly mental illness
What are the novelty of the DSM-V?
DSM-5→ 2013
- removed multi-baxial system
- introduced dimensional assessment criteria→ only for a small number of diagnosis
- re-classified some disorders (only 157 categories left)
What are the two mains challenges of categorical classification?
Heterogeneity
- people within boundaries of specific disorders look different from one another
- hard to find homogeneous essence of a disorder
Comorbidity→ disorders might not be distinct from each other
- ex: if diagnosed with MDD, odds are high that will be diagnosed with Anxiety disorder
- problem in research because if exclude comorbidity, don’t represent the general population of people with that disorder
- among people with DSM diagnosis, 50%qualify for more than one
- over course of lifetime→ 75%
- comorbidity have a lot of important repercussion on development, treatment…
- poorer outcomes for comorbid patients
—>it is the norm to present more than one diagnosis
What are the different explanations of comorbidity?
Chance
- MDD adult females→ 20%
- Anxiety disorders→ 20%
- just by chance→ 4% will have both
Sampling bias→ people with more disorders are more likely to seek treatment
- clinical samples are likely biased samples
- more likely to seek treatment for AUD when develop MDD
- BUT don’t account for all comorbidity
- Berksonian bias→ selection bias resulting from the tendency of people with multiple conditions to be selected for research.
Problems with Diagnostic Criteria→ criterion sets overlap
- ex: suicidal ideation in MDD, Schiz, BPD, AUD, SUD
- BUT still don’t account for totality of comorbidity
Poorly-drawn diagnostic boundaries
- multiformity→ same disorders might take different forms
- comorbid disorder might be 3rd independent disorder
- Causal explanation→ one disorder is risk factor for other disorder
Shared etiological risk factors
- ex: child maltreatment associated with every psychopathology
What is the difference between Prevalence, Incidence and Risk factor?
Prevalence→ % of people in a population with a disorder at a particular point in time
- ex: past month, year, or lifetime
Incidence→ the % of people who develop a disorder for the 1sttime during a specific time period
- 1st onset cases
Risk Factor→ for epidemiologists, a correlate (most often demographic variables) associated with different disorders / predictor, or cause
What are the lifetime prevalence of the different categories of disorder
Mood disorder-> 21%
Anxiety Disorders-> 27%
Substance Use Disorders-> 15%
Any Disorder-> 46%
What are the refrigerator and schizophrenogenic mothers?
Especially present in Freudian theories
- schizophrenogenic mother→ inconsistent mother could cause schizophrenia was popular idea
- refrigerator mother→ lack of warmth from mother caused autism
What does polygenic mean?
Polygenic→ influenced by many genes
- how many genes determined where you fall on dimension
What is the Diathesis-Stress Model?
Diathesis→ underlying predisposition or vulnerability to develop a disorder
- genetically influenced
- not enough to get the disorder
- make the disorder more likely to emerge under certain conditions
Stress
- trigger the disorder’s development
What is the etiological heterogeneity?
Etiological heterogeneity→ same disorders can come from different causes
- ex: MDD might be due to high levels of stress but not diathesis and vice versa
—>assume that diathesis and stress are independent which is not true
—> Gene-Environment Correlations
What is the vulnerability-Stress correlations?
Vulnerability-Stress Correlations
- non independent in important ways
- Stress generation
- Scars as vulnerability→ previous disorders can become a vulnerability and a stress
- ex: cognitive vulnerabilities following MDD
—>Vulnerability may shape perception of the stress
—>Stress can influence the development of the diathesis
What is the difference between equifinality, Final common pathway and multifinality?
Equifinality→ getting to same disorder via different pathways
- etiological heterogeneity
Final common pathway
- how does equifinality merge into homogenous phenotypes?
- ex: different things can shape reward processing which then lead to MDD
Multifinality→ same life events can lead to very different outcomes
- ex: child abuse can lead to many psychopathologies
What are the different types of longitudinal designs and their characteristics?
Retrospective→ collect sample of people with disorder
- ask people about past experience
- ex: interview people with schizophrenia about their adolescence
- use self-report (not always reliable) or existing archival data (cannot control the quality of data you have/ not standardized)
Follow up→ follow the same people over many years
- already-ill sample
- difficult to derive etiological explanations
High-Risk→ follow people at high risk for disorders BUT before they develop the disorder
- variant to follow up
- better for etiological explanations
- identify people at risk→ Offspring of people with a disorder, biological abnormality, behavioral variable
Cons
- very costly because need lot of participants to make sure to have people developing the disorder
- attrition problem
- need to find people with the disorder and have children which can be rare
- biological risk markers are not well-proven
- behaviors→ might be a risk factor or early manifestation of the disease
What is the sampling issue with using clinical populations to study a disorder?
clinical populations tend to be more severe cases and more likely to be women
How do researchers study the genetic epidemiology using family studies?
Want to know if run in family
- identify proband→ people with disorder
- then assess family members
- can use Family study with interviews OR Family history study with informant report
- have to find higher rates in proband family than in general population
—>many disorders do run in families
—>can also look at symptoms and not disorder itself
—>problem of coaggregation in family
What is an adoption study and what are its limits?
Parent or adoptee used as proband
- cross fostering design
- look at adoptive parents and biological parents as well
- but adoption is a rare event AND selective placement bias
