DSM and ICD Flashcards
(21 cards)
1
Q
what does it stand for
A
diagnostic and statistical manual of metnal illnessess
2
Q
give a general description of the DSM
A
- the manual is published by the american psychiatric association (APA)
- the manual covers all mental health disorders for both children and adults
- lists all known causes of these disorders, statistics in terms of gender, age of onset, and prognosis
- has 5 axes
3
Q
describe the 5 axes
A
- 1- looks at all the clinical disorders and their subcategories, allowing diagnosis, categories include sz or AN
- 2- personality disorders- used to identify long term patterns of impaired functioning
- general medical conditions- identification of physical illnesses that might influence emotional state- diabetes
- psychosocial and enviro problems
- global assessment of functioning- work and leisure rated on a 100 point scale
4
Q
describe dsm 5
A
- abolished axis- critics said artificial and hard to link between symptoms
- focuses on the details of the disroders like underlying causes, similarities between symptoms
- removal of over and unecessary diagnoses- sz is now one category
- reflective of social change- some disorders been updated and more knowledge required about them
5
Q
describe the ICD
A
- international classification of diseases
- includes all diseases, both physical and mental used by clinicians to diagnose service uses
- supported by the WHO
- if the service users presents with a possible mental health disorder, the clinician would use the section that focuses on mental and behaviour disorders
- for each disorder, it gives clinician the main features and the symptoms needed to make a diagnosis= e.g. ICD 10 states that paranoid sz is dominated by relatively stable paranoid delusions, often with hallucinations
- must be assessed with the ICD 10 checklist of symptoms
- checklists are set of semi-structured instruments designed for clinician assessment of mental and behavioural disorders
- checklists are flexible, used as a guide only
6
Q
Similarities between ICD and DSM
A
- both are diagnostic and categorising manuals which require two or more symptoms to be present for a diagnosis to be made
- used by qualified health care professionals as reliable and valid tools
- DSM-5 is now designed to mirror the ICD 10 and follow symptoms and removed the GAF scale to become more objective like the ICD-10, using a symptom based approach
- Jakobsen (2005) found there was good agreement in the diagnosis of sz between the ICD-10 and the DSM, showing that the ICD-10 is reliable as it has consistent diagnoses with other classification systems
7
Q
Differences between the ICD and DSM
A
- the ICD is distributed freely by the WHO and can be viewed online, but the DSM must be paid for and generates an income for the APA
- Andrew’s et al (1999) found only a 68% agreement between the ICD and the DSM on an assessment of 1500 patients.
- Hoffman et al (2015) compared the DSM and the ICD-10 in a study of alcoholism among 7000 prisoners, and found there was differences wen it came to mild-to-moderate alcohol disorders, and about a third of those with a mild alcohol disorder according to the DSM-5 received no diagnosis from the ICD-10
8
Q
Reliability definition
A
- How consistent the ability to diagnose correctly is when using the DSM and ICD.
- Two types= inter rater, test-retest.
- whether the same set of symptoms would get the same diagnosis from different psychiatrists
9
Q
What is inter rater reliability
A
- the consistency of multiple clinicians agreeing on the same diagnosis of a patient using the same diagnostic tool
10
Q
What is test retest reliability
A
- if the diagnosis is consistent over two different time periods for the same patient using the same psychiatrist
11
Q
Ways to measure reliability
A
- % or correlations
- cohen kappa is a statistical calculation of a correlation between two diagnoses
- 1= high agreement
- 0= no agreement
- accepted level is 0.8
12
Q
Study on the level of agreement between disorders
A
- reiger et al showed there is good level of agreement from some disorders
- disorders such as PTSD had cohen kappa values of 0.6-0.79 so good
- whilst some disorders including sz had a kappa value of 0.40-0.59
- some such as anxiety disorders had a kappa value of 0.2- showing reliability is different for different disorders.
13
Q
Culture on the reliability of the DSM/ICD
A
- cooper et al
- showed American and British psychologists hte same video taped interview and asked them to make a diagnosis
- NY psychiatrists said that it was sz 2x as often
- LDN psychiatrists said that it was depression 2x as often
- Copeland ET al
- gave a description of a patient to 134 USA and 194 UK psychiatrists and found that 69% of the US psychiatrists diagnosed sz, but only 2% of the UK did
14
Q
Studies on the low levels of reliability between the two
A
- Andrew’s et al found there was only a 68% agreement between the ICD ans the DSM on an assessment of 1500 patients. This could have consequences for the inviduals treatment as rather may receive incorrect treatment which could impact their recovery speed or even worsen their disorder and so unreliable diagnosis has serious implications to society
- Hoffman et al found that on a study of 7000 prisoners with an alcohol addiction, there was a difference of the diagnosis of mild-to-moderate alcohol disorders- 1/3 of those with a mild acohol disorder according to the DSM received no diagnosis from the ICD
15
Q
Studies on the high levels of reliability between the DSM-II and DSM-III
A
Goldstein tested the reliability of the DSM when re diagnosing 199 patients with sz using a single blind technique, and found that 169 of the 199 were re diagnosed with sz, so reliability within the DSM was seen as good.
16
Q
Define validity when diagnosing a mental health condition
A
- the extent to which a measure of a psychological variable measures what it sets out to measure
- how accurate the DSM and ICD are at diagnosing a mental health disorder and enables a suitable treatment to be identified
- ability to predict a successful treatment
- if the diagnosis leads to a successful treatment, and the patients symptoms improve, it has predictive validity
17
Q
2 studies testing the validity of the DSM and ICD
A
- Sanchez-villages et al
18
Q
Study on the validity of the DSM/ICD (s+v)
A
- 62 depressed patients and 42 non depressed patients
- were re diagnosed
- found that 68% of the 62 depressed patients were diagnosed again
- 81% of the 42 non-depressed patients were confirmed of non having depression
- thus has high validity
19
Q
What did rosenhan find on the validity/reliability of diagnosis in his study
A
- reliability- pseudopatients were consistently diagnosed as having sz 11/12 times
- validity- DSM-II can’t recognise fake patients against real patients, all but one diagnosed with sz despite this not being a symptom of the disorder, so no accuracy in the correct diagnosis
20
Q
Overlapping symptoms
A
- diagnosis may be difficult due to may causes of one disorder and overlapping symptoms
- sz and bipolar both experience similar symptoms
- 2 different clinicians may diagnose different dependent on what symptoms are emphasised
21
Q
What does the validity of diagnosis depend on
A
- successful diagnosis relies on patients being honest and divulging all information to clinicians
- this is something that does not always happen
- this is found by casas (1995) who found that a lot of African Americans do not like to share their personal information with people of a different race
- this can impact diagnosis
- therefore, the classification systems may be inaccurate according to the information received, suggesting we need more accurate ways of obtaining information from a patient, making it difficult to judge if the DSM can be used as a valid diagnostic tool
