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Flashcards in Diagnosis Of Mental Disorders Deck (62):
1

What are the 4 reasons that’s make it difficult to define abnormal behaviour?

1) There is no clear dividing line separating normal and abnormal behaviour.
2) The concept of abnormality can change over time
3) The concept of abnormality can change between societies and cultures
4)many different types of behaviour can be considered abnormal.

2

What are the four D’s of diagnosis?

1) deviance
2) dysfunction
3)Distress
4) Danger

3

What does Deviance (one of the 4D’s) refer to?

Deviance refers to behaviour that is both statistically rare and disapproved by society. E.g walking around the streets of London nude

4

What does Distress ( one of the 4D’s) refer to?

Distress is the extent to which an individuals behaviours or emotions upsets them. E.g Roger finds his emotions very upsetting visits a counsellor to try and reduce his anxiety.

5

What does Dysfunction ( one of the 4D’s ) refer to?

Dysfunction is the extent to which an individuals behaviour / emotions interferes with their day to day life. E.g Susan not wanting to get out of bed and help her kids get ready for school

6

What does Danger ( one of the 4D’s) refer to?

Danger refers to the harm someone’s behaviour could cause to both others or themselves. E.g Burt refusing to eat can cause many health implications.

7

What is a strength of the four D’s of diagnosis ?

They are useful because they have a practical application in helping professionals decided whether a patients symptoms warrant a clinical diagnosis.

OR

they provide a holistic way to assess someone’s mental health as they consider a wide range of symptoms

8

What is a weakness of the four D’s of diagnosis ?

they are open to subjectivity in the application as the clinician must assess to what extent someone’s behaviour is Distressing/dysfunctional/deviant/dangerous. This reduces the validity because diagnosis may not be accurate. It also reduces reliability as if used by two different professionals they may not arrive at the same diagnosis.
The issue of social control as they are used as a way to discriminate against people whom the majority disapprove of and want removed from society.

9

Why did Davis (2009) suggest the four D’s of diagnosis is incomplete ?

Davis (2009) critised the model for being incomplete and suggested that a fifth “D” needs to be added; Duration. Referring to how long symptoms last for.

10

What is the Medical model of abnormality ?

This model is s biological approach which assumed the major source of abnormal behaviour is a form of medical ‘illness’. Considering psychological symptoms to be outward signs of inner physical disorders. The medical model suggests if symptoms are grouped together and classified as a ‘syndrome’ the true cause can be discovered and allow appropriate physical treatment to be administered.

11

What does ICD stand for? Who published this classification system and who is it commonly used by?

The international standard classification of diseases (ICD 10).

Was published by the world health organisation (WHO).

Most commonly used in Britain and most parts of the world.

12

What does DSM stand for ?
Who published this classification system ?
Who most commonly used the DSM ?

The Diagnostic and Statistical Manual of Mental Disorders ( DSM 5).
Published by the American Psychiatric Association.
The DSM is generally used in North America

13

What is a strength of the classification systems ( ICD and DSM) ?

They are both regularly updated to take into account new research. Both attempt to improve psychiatric diagnosis across cultures and to take into account of people’s changing cultural views. Regular revision of both manuals allows inconsistencies and a ambiguities to be removed to create a clear set of criteria; increasing reliability.

14

What is a weakness of the classification systems ( ICD and DSM) ?

Even though believed to be reliable there is always and element of subjectivity as clinicians must use their own judgement to decided if the list criteria is within normal limits.

OR

Both classification systems rely on checklists of behaviour to diagnose complex mental heath issues and can therefore be criticised for being reductionist.

OR

They have also been criticised for using the medical model which assumes mental health issues are medical illnesses with physical causes

15

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

Unlike physical illness the symptoms mental illness are much more subjective to observe and measure e.g feelings of despair or hearing voices. Therefore these can’t easily be measured, so clinicians must make judgements based on experience.

Diagnosis of physical illness can often relate to causes of the problem e.g measuring blood sugar level to check a diagnosis of diabetes. However causes of mental illness are unknown which in turn effects the treatments based on the medical model as they can be focusing on only the symptoms of mental disorders and not the causes.

16

What 4 things does the DSM assess individuals on ?

1) Type of disorder e.g psychotic disorder, eating disorder, anxiety disorder.
2) co-existing factors like mental retardation and general medical conditions such as diabetes
3) psychosocial and contextual factors such as homelessness and unemployment
4) disability - the overall functioning of the individual

17

How does the ICD work?

The ICD is used to diagnose both physical and mental conditions. The ICD has 100 categories including dementia, schizophrenia and personality disorders , with similar disorders linked together. Each of the categories notes the relevant disorders, each disorder then has a description of characteristics.

18

What are similarities between the DSM and the ICD ?

Both are regularly updated to take into account for new research and changing views in society.

Both try to account for different cultural views.

Both include categories of mental disorder based on patterns of symptoms.

Both use the medical model.

Both can be seen as reductionist as they rely on a checklist of symptoms.

19

What are the differences between the DSM and ICD ?

The DSM is published by the American Psychiatric Association and must be payed for. Whereas the ICD is published the world health organisation and is free to use.

The DSM can only be used to diagnose mental conditions whereas the ICD can be used to diagnose both mental and physical illnesses.

The DSM is considered to be more holistic than the ICD as it uses 4 ways to assess people: (1) type of disorder (2) co-excisiting factors (3) psychological and contextual factors and (4) other disabilities. However the ICD doesn’t look at other aspects which may effect a diagnosis it is pure criterion based.

20

What is inter-rater reliability in clinical psychology ?

The extent to which clinicians agree of diagnosis.

21

Who conducted research on the early version DSM and what did they find that suggested that this version had low reliability ?

Spitzer and Williams (1985) reviewed the process of diagnosis and found experienced psychiatrists only agree on diagnosis about 50% of the time.

22

What lead to the improvement in reliability of diagnosis and who’s research supports this ?

The move to more criterion based system where each disorder has a checklist of symptoms has increased reliability of diagnosis and so more recent version of the DSM can be seen as more reliable as shown in Brown (2002) research who tested the reliability and validity of DSM IV diagnosis for anxiety and mood disorders and found them to be good to excellent.

23

What possible patient factors impact on reliability of diagnosis ?

Patient factors - Patients may give different psychiatrists slightly different information for various reasons which could lead to different practitioners into giving different diagnosis to the same person.

24

What clinician factors could impact on reliability of diagnosis ?

Clinician factors - the practitioners using the classification systems are not completely objective

And

Clinician factors - the practitioner may gather insufficient information or the practitioner may not use the categories of the classification system correctly.

25

When studying inter-rater reliability what did Ward (1962) find ?

Ward (1962) studied 2 psychiatrists diagnosing the same patients and found disagreements occurred because of the inconsistencies of:
The information provided by the patient (5%)
The psychiatrists' interpretation of symptoms (32.5%)
Inadequacy of the classification system (62.5%)

26

What improvements have been made in reliability of diagnosis ?

1) Reliability has been improved with the use of standardised interview which specify the symptoms to ask about and give instructions as to how to rate their severity.
2) Classification systems like the DSM and ICD now have specific diagnostic operationalised criteria for diagnosis to increase objectivity and reliability i.e. clear definitions are given for each disorder and a list of symptoms are given.

27

What research shows that both DSM-5 and ICD-10 have significantly improved in reliability for diagnosis of many mental disorders such as schizophrenia, mood and anxiety disorders ?

Pederson (2001) found 71% of psychiatrists agreed with the ICD-10 definition of depression when assessing 116 patients. this indicates high inter-rater reliability.

28

What is Concurrent Validity in terms of diagnosis ?

A way of establishing validity that compares evidence from different diagnostic tests to see if they agree e.g. the DSM and the ICD ave good concurrent validity.

29

What is Aetiological Validity in terms of diagnosis ?

Aetiological Validity exists when diagnosis reflects its causes.

30

What is Predictive Validity in terms of diagnosis ?

This is where the future course of the disorder is known and can be applied to the person so the diagnosis can be checked against the outcome for its validity.

31

What patient factor may impact the validity of the diagnosis ?

The patient may not want to disclose all relevant information because they might be embarrassed or ashamed. Alternatively they may not remember all relevant details, meaning the clinician may not be able to arrive at an accurate diagnosis.

32

What clinician factors may impact validity of diagnosis ?

a clinician may hold positive of negative attitudes on a unconscious level towards a patient which can cause implicit bias. Implicit bias can reduce the validity because they might arrive at an inaccurate diagnosis.

33

What classification factors can effect the validity of diagnosis and which psychologist argue this ?

If the classification system itself is biased, then the diagnosis with not be valid. Cochran’s et al (1995) blames the classification systems arguing they lead practitioners to take ‘Eurocentric bias’ which means they don’t take account the normal behaviours of other cultures. Similarly Littlewood (1992) questions the international validity of the DSM 4 as he says he says the assumptions it’s makes about nuclear families are not applicable to all cultures.

34

Who conducted your classic study in clinical psychology ?
when was it conducted ?
what was the study titled ?

Rosenhan conducted a study called being sane in insane places in 1973.

35

Why did David Rosenhan feel the need to conduct his study ?

David Rosenhan was a psychiatrist who was one of the many who criticised the medical model, he felt that diagnosis was not accurate and was negatively affecting peoples lives as they would be left with a psychiatric label which would cause others to judge them negatively and misinterpret their behaviour.

36

What was the Aim of Rosenhan's first study ?

The aim was to see if psychiatrists could differentiate between sane and insane people in a clinical setting, testing the reliability of the mental health diagnosis.

37

What classification system was used by psychiatrists during Rosenhan's study ?

The DSM 2

38

What was the sample of Rosenhan's first study ?

the hospital staff and patents in 12 psychiatrists hospitals across 5 different states on the East and West coast of the United States of America.

39

What research method was Rosenhan's study ?

it was a naturalistic observation.

40

Describe Rosenhans's pseudo patients in his first study ?

Rosenhan used 8 fake patients known as pseudo patients in his first study. They consisted of 3 women and 5 men, including a psychology graduate in his 20's, 3 psychologists, a paediatrician, a painter, a house wife and Rosenhan himself. none of the had any history of mental health problems.

41

How did Rosenhan train his pseudo patients ?

Rosenhan trained his pseudo patients how to address psychiatric health workers and how to avoid swallowing medication. Also they were all given fake names and those with occupations relating to psychology were given fake jobs but all other information was kept the same.

42

What was the procedure of Rosenhans first study ?

the pseudo patients contacted 12 psychiatric hospitals for urgent appointments, at these appointments they all reported the same symptoms hearing an unfamiliar voice repeating the words "empty" "hollow" and "thud". However, they described the rest of their live to be a normal healthy lifestyle, with no problems in work or personal relationships nor an deluded or deviant behaviour. once the pseudo patients were admitted to the hospital they stopped simulating any symptoms and took part I ward activities and answered all staff and patient questions honestly. they recorded all there experiences, originally trying to be covert but if staff or patient noticed they didn't disguise the behaviour and continued to take notes.

43

Why did Rosenhan use the symptom of hearing an unfamiliar voice saying the words "empty", "hollow" and "thud" ?

Rosenhan used this symptom because it didn't match up with the diagnosis of any mental illness according the DSM 2, the classification system used at the time.

44

What were the results of Rosenhan's first study ?

All the puesdo patients were diagnosed with a serious mental health disorder on minimal symptoms of either schizophrenia or manic depression with psychosis . There sanity was never detected by the staff instead they were released with their diagnosis in remission. the average stay in the psychiatric hospitals was 19 days. the shortest stay being 7 days and the longest being 52 days.

45

In Rosenhans first study did anyone suspect the pseudo patients to be sane ?

Although the staff didn't, many patients did with one pseudo patients being asked if they were journalists.In three hospitals where records were taken, about one third of patients challenged pseudo patients.

46

In Rosenhan first study how did the pseudo patients describe how the hospital staff treat the patients.

the staff treated the patients in a way which was consistant with their diagnosis as they often treating normal behaviour as abnormal. for instance they referred to note taking as "writing behaviour", pacing the corridors due to boredom as nervousness and waiting outside the lunch early was labelled by one clinician as "oral - inquisitive syndrome".

47

What was the aim of the Rosenhan's second study ?

To see if the hospitals who had been told they were going to be approached by pseudo patients would be able to tell the difference between the sane and the insane patients.

48

Why did Rosenhan complete his second study ?

After the publication of Rosenhan's first study a large teaching hospital challenged Rosenhan as they felt their institution would not make the same mistakes as the psychiatric hospitals in Rosenhan's first study.

49

What was the procedure of Rosenhan's second study ?

A teaching and psychiatric hospital that was aware of the first study was informed over the next 3 months one or more pseudo patients would try to get admitted to their hospital. Each member of staff were asked to rate the likelihood that the patient who sought to be admitted was a pseudo patient. They used a 1 to 10 scale as to how likely the patient was fake. In reality no pseudo patients were sent to the hospital.

50

What were the results to Rosenhan's second study ?

Staff rated 193 new patients on a scale of 1 to 10 as how likely they were to be fake patients.
41 patients were rated as a pseudo patient by at least two members of staff.
23 patients were rated as a pseudo patients by at least 1 psychiatrist.
19 patients were rated as pseudo patients by a psychiatrist and one other member of staff.

51

What was the conclusions of Rosenhan's second study ?

Staff were unable to detect insanity.

52

What was the aim of Rosenhan's third study ?

Rosenhan wanted to investigate how staff interacted with psychiatric patients and compare this to how non- psychiatric patients were treated.

53

What was the sample of Rosenhan's second study ?

The staff at the teaching and psychiatric hospital.

54

What was the sample of Rosenhan's third study ?

4 of the psychiatric hospitals pseudo patients were sent to in study one.

55

What was the procedure of Rosenhan's third study ?

During the first study 4 of the hospitals were used to investigate staff and patient interaction. The pseudo patient would approach a member and staff and ask " Pardon me Mr/ Mrs /Dr could you please tell me when I will be eligible for ground privileges ? ". The pseudo patient did this as normally as possible and avoided asking the same member of staff more than once a day. Rosenhan compared the responses given to the pseudo patients to those given to a student at Stanford University when she asked staff for help to find an area of the campus.

56

What were the results of Rosenhan third study ?

71% of psychiatrist, 88% of hospital nurses, 0% University staff averted their head an moved on.
23% of Psychiatrists, 10% of hospital nurses, 0% University staff made eye contact but didn't engage in conversation.
2% of psychiatrists, 2% of hospital nurses and 0% of University staff paused and chatted but provided no help.
4% of psychiatrist, 0.5% of hospital nurses and 100% of university staff stopped and spoke to the individual answering there question.

57

What were the conclusions of Rosenhan's third study ?

Psychiatric patients were treated differently to non psychiatric patients . patients were powerless while on the metal ward and the lack of communication and eye contact from staff depersonalises the patients.

58

How generalisable are Rosenhan's findings from his studies ?

The generalisability could be deemed high as Rosenhan used a range of psychiatric hospitals, private and state run, old and new, well funded and under funded from the across the United States.

However only 8 hospitals admitted pseudo patents which a small sample lowering the generalisability as it is difficult to represent the whole target population with a small sample.

Furthermore the study took place in 1973 and since then there has been lots of progress in mental health care suggesting the result are 'time-locked' and can't be generalised to the psychiatric diagnosis and care today.

59

How reliable is Rosenhan's studies ?

Certain aspects of of the study were standardised for example in the third study the statment "pardon me Mr/Mrs/Dr can you please tell me when I will be eligible for ground privileges" as well as the description of the single symptom of hearing an unfamiliar voice saying the words "empty" "'hollow" and "thud" in study 1 was standardised. This increases relaibilty of the studies as it makes them more replicable.

Nevertheless the research method was a naturalistic observation this means variables such as patient- staff interaction can't be standardised which makes it difficult to replicate in a consistent way.

60

How applicable are Rosenhan's findings from his studies ?

The study had a huge impact on mental heath care both in America as world wide. It caused psychiatric hospitals to review their admission procedures and how they trained staff to interact with patients. it also helped to reduce abuse of power in mental institutions through the use of cctv. Today the study is a compulsory part of training in psychiatric medicine and nursing.

61

How valid is Rosenhan's studies ?

The ecological validity of Rosenhan's studies are high as the settings of psychiatric hospitals and the tasks of hospital activities and day to day life of a patient was realistic, pseudo patients observed hospital staff and patients in an environment true to real Life improving the experimenter realism.

Additionally the use of a covert observation increased the validity as it reduced the likelihood of demand characteristics as staff and patients were unaware they were being observed therefore behaved as they normally did. this intern increases validity as the studies findings accurately represent their behaviour.

Nevertheless the use partipant observation can lead to bias as the pseudo patients may have wanted the studies findings to represent certain behaviour and could have therefore influenced how they behaved or recorded the behaviour of the hospital staff. This subjective behaviour from the pseudo patients which include Rosenhan himself could reduce the validity as thy are not accurately representing psychiatric hospitals.

62

how ethical was Rosenhan's studies ?

Ethics were low as deception was used in Rosenhan's studies as the participants (hospital staff and patients) were unaware they were taking part in a study, this also caused issues with content snd the right to withdraw.

Furthermore protection of participants wasn't followed as the study required hospital staff the care for and use hospital resources on the pseudo patients who weren't actually mentally ill rather than helping those who are mentally ill.