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Flashcards in Classification and Diagnosis Deck (15):

What are the 4 criteria the DSM has for a mental disorder?

1. Clinically significant behavioural or psychological syndrome or pattern
2. Associated with significant distress or disability, or significantly increased risk of such
3. Must not be expectable or a culturally sanctioned response
4. Must be considered a manifestation of a behavioural, psychological or biological dysfunction


What is the difference between point prevalence, one-year prevalence and lifetime prevalence?

Point-prevalence: “right now, X percent of Australians have Y disease”
One-year prevalence: “in 2007, X percent of Australians had Y disease”
Lifetime prevalence: “during their lifetimes, X percent of Australians have Y disease”


What is incidence and how does it differ from prevalence?

Incidence refers to what proportion of healthy individuals will develop the disorder within a specified time period ( new cases)
Prevalence is total proportion of people with the disorder


What is the lifetime prevalence of mental disorders?

◦ in adults 32-48 %
◦ before age 21: 35-49 %
◦ Life-time prevalence of any mental disorder: 45%
◦ Only about 1/3 of these people received help


What are the key characteristics of the medical model?

Aetiologically based diagnosis is the ultimate goal of
medical (psychiatric) classification (like DSM)

Different illnesses are
- clearly distinguishable from each other
- occur independently from each other
- have specific, identifiable causal agents
- respond to specific treatment


What is the medical/biological model?

Began largely in 1850 with the germ theory of disease, mostly ended early 1900s

Mental illnesses are classified and identified by underlying biological causes (ie infection, hereditary, toxins)

Involved removal of damaged tissue (lobotomies)


What is the psychoanalytical model and its key principles?

Started by Freud, most popular between 30s-70s

1. No clear dividing line between normal and abnormal. 'Pathological’ is extreme manifestation of 'normal’.

2. Include conditions other than psychotic states ‘neuroses’: anxiety, depression, various phobias

3. No clear dividing line between different categories of mental disorder (neuroses and psychoses).


Describe the early versions of the DSM

DSM-I (1952), DSM-II (1968)
Strongly influenced by psychoanalytic theory

Problems; reliability and validity
no consistent standards for diagnosis, based on unproven theories about etiology


Who was Emil Kraepelin?

Emil Kraepelin (1856-1926) is considered the father of modern psychiatric classification

Kraepelin suggested that the classification of psychiatric diseases should be based on common patterns of symptoms, instead of the mere similarity of symptoms

Laid groundwork for DSMIII & IV


Describe the features of the newer DSM (3 onward)

DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013)

Reflects the medical/biological model
No theoretical assumptions about causation
If causation is not known: Description of symptoms

- commorbidity is very high
- lack of diagnostic stability
- lack of treatment specificity


What arguments are there to say anger’s a ‘clinical’
or ‘abnormal’ issue?

- People seeking mental health services present with problematic anger reactions at the same frequency as they do with depression and anxiety.
- Critical mediator in various forms of aggression, from domestic violence through to assault, murder and rape
- Consistently identified as a risk factor in hypertension and heart-related illness.
- Anger interferes with judgment, problemsolving, negotiating; leads to risky behaviours


What are the common commorbidities of abnormal anger?

- high levels of comorbid drug and alcohol issues (over 50%)
- anxiety disorders (about 33%)
-Depression and dysthymia (about 15%) (Note well: vast majority of angry individuals not depressed
-Bipolar (about 5%)


How does anger currently fit into the DSM?

Anger is not currently a disorder but is a symptom in many including:
- Mania (and hence Bipolar Disorder);
- (Pediatric) Major Depressive Disorder (MDD);
- Premenstrual Dysphoric Disorder (PDD).
- Posttraumatic Stress Disorder (PTSD);
- Generalised Anxiety Disorder (GAD); and
- Borderline, Antisocial & Paranoid PDs

Also there are behavioural aggression disorders; IED, ODD & DMDD


What is Intermittent Explosive Disorder?

The disorder most commonly diagnosed to people
presenting with anger issues—even without aggression

A. Recurrent behavioural outbursts representing a failure to control aggressive impulses
B.The aggression is disproportionate to the provocation
C. The outbursts are not premeditated and are not committed toachieve some tangible objective
D. These outbursts cause distress and/or impairment
E. The individual must be at least six years old
F. The outbursts are not better explained by another mental disorder or medical condition


What is not covered by current DSM anger related problems?

angry adults who are not especially violent or impulsive (IED), don’t commit defiant or malicious acts against authority (ODD), and haven’t been a perennial brat since childhood (DMDD)

this is most clients presenting with anger