diagnosing mhd (classification systems)

Question 1

what is a classification system?

Answer 1

a checklist of signs and symptoms which helps a clinician to reach a diagnosis of a specific disorder, often by process of elimination

Question 2

what are the two classsification systems we look at?

Answer 2

• dsm
• icd

Question 3

who is the dsm published by?

Answer 3

american psychiatric association (APA)

Question 4

where is the dsm used?

Answer 4

in the us and around the world

Question 5

what is the current version of the dsm?

Answer 5

updated to DSM-5 in 2013

latest version DSM-5-TR published in 2022

Question 6

describe the dsm

Answer 6

describes symptoms, features and risk factors of over 300 mental disorders

disorders are arranged into 22 categories

DSM 5 has three sections:
* Section one: offers guidance on using the manual
* Section two: info about disorders (symptoms, features, risk factors)
* Section three: suggestions for new disorders, also includes info about the impact of culture on the presentation of symptoms and how they’re communicated

DSM 5 has replaced five separate subtypes of SZ (paranoid, catatonic etc.) with SZ on a dimension, so the level, number and duration of symptoms can be assessed on a spectrum.

Question 7

making a diagnosis using the dsm

Answer 7

Contains guidelines for clinicians to make diagnosis:

• gather data using clinical interview, observation etc.
• rule out disorders which do not match symptoms
• then find ‘best fit’ for the individual

Question 8

who is the icd published by?

Answer 8

World Health Organisation (W.H.O)

Question 9

what is the current version of the icd?

Answer 9

ICD 11 published in January 2022

Question 10

describe the icd

Answer 10

Includes both physical and mental disorders

Multilingual, freely available, used globally

Available in appropriate forms for different cultures

Chapter 5 titled ‘Mental and Behavioural Disorders’

Each disorder has a code starting with ‘F’
eg. Subcategory for schizophrenia = F20 which is further divided;
Paranoid SZ = F20.0
Hebephrenic SZ = F20.1
Catatonic = F20.2

Question 11

compare the icd and dsm

Answer 11

Similarities
* both are used for diagnosing mhd

• both are under constant update and revision to reflect latest research findings and clinical experience, the DSM is currently in its 5th edition whereas the ICD is in its 11th edition

Differences
* Structure/ content

• DSM is published by the APA whilst the ICD is published by the WHO

Question 12

making a diagnosis using icd

Answer 12

Guidance on diagnosis:
* clinician selects key words relating to symptoms from clinical interview e.g. hallucinations, delusions

• clinician can look these up in index to find section eg. Schizophrenia
• then uses other symptoms to identify a subcategory eg. paranoid SZ.

Question 13

what is reliability in clinical psychology?

Answer 13

• consistency of diagnosis
• if the same individual went to two different clinicians they should reach the same diagnosis using the same tools (Four D’s, DSM, ICD) and hearing the same information

Question 14

what is inter-rater reliability in clinical psychology?

Answer 14

• means showing two or more clinicians one person’s case history and assessing the level of agreement between them
• If all the clinicians (raters) agree then there is said to be good inter-rater reliability.

Question 15

what is validity in clinical psychology?

Answer 15

• refers to how accurate a diagnosis from a clinician is based upon information given by a patient in clinical interviews and observations
• if not, the individual may risk receiving the wrong treatment

Question 16

what is concurrent validity

Answer 16

the amount of agreement between different classification systems

Question 17

define ‘test-retest reliability’ in terms of diagnosing a mental disorder

Answer 17

whether the diagnosis of a patient is consistent when being re-diagnosed at a later date

Question 18

what is a type 1 error in clinical psychology?

Answer 18

when the null hypothesis is rejected and the alternative hypothesis accepted when the effect was not real

(diagnosing someone as having a mental health disorder (MHD) when they do not)

Question 19

what is a type 2 error in clinical psychology?

Answer 19

when the alternative hypothesis is rejected and the null retained when there was actually a real effect
(diagnosing someone as not having a MHD when they do).

Question 20

who found that classification systems are or are not reliable?

Answer 20

reliable
* rosenhan
* goldstein
* andrews et al
* brown

not reliable
* spitzer & fleiss
* beck
* andrews et al
* brown

Question 21

reliability of classification systems - rosenhan

Answer 21

Rosenhan (1973) suggests the DSM II was reliable as there was consistent diagnosis of pseudopatients 11/12 SZ in remission and 1 bipolar, based on the same symptoms (empty, hollow, thud)

however validity is low

Question 22

reliability of classification systems - goldstein

Answer 22

Goldstein (1988) looked at 189 patients along with 2 other clinicians and found high levels of inter-rater reliability when patients were diagnosed for SZ using the DSM.

Question 23

reliability of classification systems - andrews

IS reliable

Answer 23

Andrews et al (1999) found high inter-rater reliability on diagnosis for depression, substance dependence and anxiety disorders.

Question 24

reliability of classification systems - brown

IS reliable

Answer 24

Brown (2001) tested the reliability and validity of DSM IV for anxiety and depression, found them to be ‘good’ to ‘excellent’

Question 25

reliability of classification systems - spitzer and feiss

Answer 25

Spitzer & fleiss (1974) claimed reliability for diagnosing schizophrenia and psychosis was only ‘fair’ rather than ‘good’

Question 26

reliability of classification system - beck

Answer 26

Beck (1954) found poor levels of inter-rater reliability of early editions of diagnostic manuals. Out of 193 patients who had the same set of symptoms, only about half were diagnosed with the same disorder (54% agreement).

Question 27

reliability of classification systems - andrews

is NOT reliable

Answer 27

Andrews et al (1999) found only 68% agreement between diagnoses using both the ICD and the DSM on an assessment of 1500 patients.

Question 28

reliability of classification systems - brown

is NOT reliable

Answer 28

Brown (2001) suggests reliability of diagnosis depends on type of disorder - it is worse for PTSD due to overlap of symptoms with other disorders (eg. depression).

Many disorders are comorbid with each other (more than one disorder present in the same person and the same time) eg. the majority of those suffering with depression also have anxiety disorders.

Question 29

who found that classification systems are or are not valid?

Answer 29

valid
* jansson
* hoffman
* (predictive validity)

not valid
* rosenhan
* hoffman
* aboraya
* (culture)

Question 30

validity of classification systems - jansson

Answer 30

Jansson (2002) checked for how much agreement there was between the ICD-10 and DSM-IV. Found a high rate of agreement for the same disorders between the two suggesting they have concurrent validity.

Question 31

validity of classification systems - hoffman

IS valid

Answer 31

Hoffman et al found agreement in the DSM IV and the ICD 10 in a study of alcoholism involving over 7000 prisoners. Both classification systems agreed in diagnosis of severe alcoholism proving concurrent validity in these systems because despite using different systems the same exact diagnosis was concluded.

Question 32

validity of classification systems - predictive validity

Answer 32

Predictive validity: the DSM & ICD can accurately predict future behaviour. If a patient genuinely has depression then an improvement in mood is expected within eight weeks if they are prescribed antidepressants.

Question 33

validity of classification systems - rosenhan

Answer 33

Rosenhan (1973) Staff made Type 1 and 2 errors across two experiments. In experiment 1 they diagnosed 12 sane participants as insane and in Experiment 2, 41 real patients were thought to be fake by at least one member of staff and 19 of those were classified as fake by two members of staff.

Question 34

validity of classification systems - hoffman

is NOT valid

Answer 34

Hoffman et al found that in diagnosis of mild to moderate alcohol use disorders the ICD 10 and DSM IV concluded differing diagnoses of MHDs. About a third of those with mild alcoholism according to the DSM IV were not seen to have a MHD at all according to the ICD 10.

Therefore disagreement in diagnosis shows low validity in mild to moderate MHD diagnosis.

Question 35

validity of classification systems - aboraya

Answer 35

Aboraya (2006)
Patient factors- inaccurate info because of problems with memory, denial or shame, disorganised thoughts, psychosis or manipulative tendencies.

Clinician factors- despite some standardised questions a clinical interview is fairly unstructured. Clinicians may be biased based on experience, background and training when asking ques/ diagnosing.

Question 36

validity of classification systems - culture

Answer 36

Culture: behaviour which may be common in one culture may not be common in another and would be interpreted as a mental health disorder.