Lecture 7 - Key issues in clinical psychology Flashcards
(14 cards)
What do diagnostic categories do?
According to BPS:
- describe patters of experiences or behaviours that may be causing distress and/or seen as difficult to understand
- imply that these distressing symptoms are the symptoms of a medical illness
- this can lead to people to think that the main cause for distress is that something has gone wrong in the brain or body
Korsakoff’s syndrome
Disturbance in memory cause by alcohol
Ability to learn new Information in impaired
- decline in cognitive functioning not explained by other causes
- Vitamin B1 (thiamine deficiency), Werknicke’s encephalopathy
Psychiatric vs physical diagnosis
Differences
- there are not always physical tests for psychiatric diagnoses:
~ no firm evidence mental distress caused by biochemical imbalances, genes, or the brain (except e.g. dementia)
~ out brains are involved in everything we do but not always the cause of abnormal behaviour
~ the theory that mental distress is best understood as kind of physical illness, like diabetes or cancer, is not full supported
Problems with the DSM
Over reliance on ‘medical’ model
Categories not dimensions
Some propose categories should have:
- biological explanation and specific therapy to treat it
- not the case with the DSM 5
People often get more than one diagnosis
- shift categories over time
People can have ‘sub-thresholds’ problems but experience more impairment than those who meet full criteria
Psychiatrists often do not agree on the diagnosis, particularly for common disorders
- depression
- anxiety
Challenges to effective diagnoses
Hope should criteria capture mental health issues?
- several mental health problems have multiple interacting causes
Are the relevant phenomena categorical or dimensions?
Where should threshold be placed which set the boundaries between disorder or non-disorder?
How should we deal with comorbidity?
- when individuals with mental health problems meet diagnostic requirements for multiple conditions
Questions about diagnostic categories
Does it diagnose normal functioning?
Are there oivelraps between behaviours/cogntion that exist in everyday life and the symptoms of the disorder?
Are the overlaps between symptoms or multiple disorders?
- comorbidity
Comorbidity and addiction
Regier et al (1990)
If an alcohol use disorder
- 36% also had a psychiatric disorder
If a drug use disorder
- 53% also has a psychiatric disorder
If a psychiatric disorder
- 29% also has a substance use disorder
Overlap between addiction and other disorders
- disruption of social or recreational activities
- social or interpersonal problems
- hazardous/risky situations
- failure to fulfil work, school, or home obligations
What is to blame?
Chicken or the egg?
- does addiction cause development of other mental disorders
- does a mental disorder lead to developing addiction?
- or do they develop independently?
Why is comorbidity a problem?
What should be treated?
- if addiction is responsible for depression/anxiety due to withdrawal, then treatment should focus on addiction
- treating depression/anxiety alone would rather alleviate the root cause
- if depression/anxiety is responsible for addiction, via coping mechanism or self-medication, treatment should focus on depression/anxiety
- treating addiction alone would not alleviate the root cause
Do psychologists agree?
Field trials of the DSM-5 (Friedman et al, 2013):
- two clinicians interviewed there same patients used the diagnostic and interview methods
- levels of agreements indicated using kappa
Arguments for categories
Fundamental part of clinical psychology
Helps identify useful interventions
Validates the patient’s experiences
Do diagnostic categories help people?
A diagnosis can help people”
- feel like their experiences make sense
feel less alone
feel worthy of (and ask) for help and care
- feel less guilt or self-blame for their difficulties
- feel hope fro treatment and recovery
- find a language to explain their difficulties to others
Diagnostic labels and stigma
- for some diagnoses (e.g. sz), it increased
- for others (e.g. depression), there’s no effect
- degree to which people believe a diagnosis is biological does not reduce storage
Some feel that diagnosis is a barrier to recovery
- self-fulfilling prophecy
Diagnosis might make people feel “different” and feel more alone or isolated
Diagnosis may nor capture experiences that have causes current difficulties (e.g. childhood trauma)
Other issues with DSM
Includes some conditions that are too “normal” to be considered
Uses arbitrary cutoffs
Gender bais
Insufficient sensitivity to cultural diversity
Changes considered in DSM-V but nor made
- use of biological markers as diagnostic tools
- rating of disorders/symptoms on a scale
- dimensional approach toward a disorder
Rejections of new disorders in DSM-V
- attenuated psychosis syndrome
- mixed anxiety-depressive disorder
- Internet gaming disorder
Revised disorders in DSM-5
- bereavement exclusion
- autism spectrum disorder
- ADHD
~ increased age of symptoms from before 7 to 12
~ minimum number of symptoms in adults increased to 5
- Bulimia nervosa
~ frequency of binge easting reduced to once a week
- anorexia nervosa
~ reduction of less than 85% of the body weight
- learning disabilities in maths, reading and writing combined as specific learning disorder
- OCD removed from anxiety disorders to new category
Criticisms of DSM-5
Many “group work” members quit midway
Leaders of mental health organisations boycotted DSM-5
Most vocal critic was Allen Frances
- led development of previous DSM
Allen Frances:
- changes unsafe and scientifically unsound
- medical illnesses diagnosed as somatic symptom disorder
- DSM-5 will mislabel normal people, promote diagnostic inflation, encourage inappropriate medical use
Diagnostic over expansion
Transparency of the revision process
Background of the DSM-5 authors
Field trial problems
- testing of DSM-5 criteria not very reliable
Price
- $199 USD hardback, $149 USD eBook
- required by all students, practitioners, etc
Breadth off coverage
Controversial cutoffs
Cultural bias
Little input from practitioners
Strengths of DSM-5
Emphasis on empirical research
Use of explicit diagnostic criteria
Inter-clinician reliability (sort of)
Atheoretical langage
Facilitated communication between researchers and clinicians
