Lecture 2- DSM-V Classifications and Evidence Based Practice

Question 1

What is the dimensional way to classify?

Answer 1

• Everyone possesses all characteristics to varying degrees. People rated as above or below average.
• Behaviours exist on a continuum

Question 2

What are some issues with the dimensional way of classifying mental disorders?

Answer 2

• Sampling
• Insensitive to contextual effects (different settings)
• Dependent on understanding of normal

Question 3

What is the categorical way of classifying mental disorders?

Answer 3

• Distinctive categories that are “black & white”

- Either meet specific criteria or not.

Question 4

What some issues with categorical classification of mental disorders?

Answer 4

• Behavior seldom falls neatly into categories.
• Subthreshold but impaired?
• Different causes & treatments: often just looking superficially but lots of mental disorders in childhood present the same and will respond differently to different treatments

Question 5

Who was the DSM-5 published by?

Answer 5

The American Psychiatric association

Question 6

Is the DSM-5 categorical or dimensional?

Answer 6

Categorical, so has the critics that come along with that

Question 7

What are some critics of the DSM-5?

Answer 7

• Categorical (people don’t fit into neat boxes)
• Interrelationships and overlap (many disorders share similar symptoms, instead define by problems rather than lots of separate diagnose)
• Individualistic (doesn’t look at strengths + everyone is different)
• Access to treatment (limit individuals access to funding if they don’t tick very set boxes)

Question 8

What is the primary technique used to see if individuals meet DSM-5 categories? What do we try and investigate using this technique?

Answer 8

Interview

• Developmental history (did things develop at normal times)
• Family characteristics (siblings, how much attention parents payed, socio-economic status)
• Family history (history or mental health often makes it more likely for child to have same mental illness as genetic component)
• Collateral information from other sources as sometimes the individual is not the most reliable source (bias)

Question 9

How are children viewed in relation to their families and how does this relate to mental health issues?

Answer 9

Take a systems approach in diagnosing psychiatric disorders. Individuals are part of a wider family/ situation that results in their behaviour/ issues

Question 10

What questions are important to ask in assessing the current problem?

Answer 10

• When did it start?
• How severe is it?
• How often does it occur?
• What makes it worse/better?
• How has it changed/developed over time?
• Impact of the problem on others?

Question 11

What do we have to keep in mind when assessing patients in relation to the purpose of our questioning?

Answer 11

-Ultimately we are trying to treat the individual/ make a difference in their lives

Question 12

What are some types of psychological tests that are used in conjunction with interviews to determine the meeting of DSM-5 criteria?

Answer 12

• Screening (e.g., CBCL) – multiple sources
• Checklists (e.g., CDI)
• Developmental (e.g., Vinelands)
• Personality/Temperament (e.g., CBQ)
• IQ (e.g., WISC-IV)
• Achievement (e.g., WRAT)
• Neuropsychological functioning (e.g., NEPSY)

Question 13

How is evidence-based practice in relation to diagnosing mental health disorders?

Answer 13

• Psychological assessment and treatment techniques must be evidence based.
• Ask yourself: can I justify what I am doing in a court of law?
• “What evidence do I have that this is the best possible intervention for this particular patient?”

Question 14

Just because something is evidence based, does that mean it is the best action for the individual?

Answer 14

No, we are not following a computeristic medical model. All individuals are different and will respond differently to treatment approaches.

Question 15

Keeping in mind individual differences what is evidence based approach?

Answer 15

The integration of the best available
research with clinical experience in the
context of patient characteristics,
culture, and preferences.

Question 16

What do cultures determine?

Answer 16

• What is normal and therefore what is abnormal and needs to be classified as a disorder/ mental illness
• Vital to consider the individual’s context

Question 17

What is the NGC?

Answer 17

• In the USA, the National Guideline Clearinghouse™ (NGC), is a public resource for evidence-based clinical practice guidelines.
• NGC is an initiative of the Agency for Health Care Research and Quality (AHRQ), U.S. Department of Health and Human Services

Question 18

What did the UK develop to ensure evidence based practice in the treatment of psychiatric disorders? How?

Answer 18

• The UK has developed NICE (National Institute for Health and Clinical Excellence) guidelines for evidence based practice.
• NICE is an independent organisation

-NICE guidance is developed by a number of independent advisory groups made up of health professionals, those working in the
NHS, patients, their carers, and the public.

Question 19

What is the NICE hierarchy/ grading scheme?

Answer 19

• Hierarchy (Level 1-4; Grade A - C)

- For some disorders only evidence that is lower down the hierarchy may be available

Question 20

What’s important to remember about the individual in diagnosing psychiatric disorders?

Answer 20

Everyone is different, no one size fits all