Week 1 Lecture 1b Diagnosis & Classification of Disorders Caff Flashcards Preview

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What are the main reasons for having a classification system?

*To identify specific differences from normal functioning
*To compare problems with commonly seen patterns (diagnosis)
*To consider interactions between a person's experience, behaviour and the environment (formulation)
*To develop & utilise models to treat individuals appropriate to their needs (treatment options)


What are the practical benefits of a classification or diagnosis system for a researcher?

A classification system:
*enables clinical researchers to develop improved clinical strategies, using between group designs for example
*enables epidemiological studies


What are the practical benefits of a classification or diagnosis system for a clinician?

A classification system:
*enables clinicians to identify signs & symptoms that cluster together (clinical syndrome or disorder)
*enables communication between health professionals
*provides information about the likely course of a mental health disorder with or without treatment
*assists in the selection of appropriate treatment


What are the practical benefits of a classification or diagnosis system for an individual?

A diagnosis can help people make sense of their symptoms


Why do we classify a mental disorder?

*a classification system must be able to determine whether a given condition is a disorder
-there are disputes about whether ADHD (overdiagnosis) and PTSD (a normal reaction to traumatic events?) are really disorders
*we need to decide the boundaries of a disorder: where does one disorder end and another disorder start?


How do we classify a mental disorder?

*Statistical Model
*Subjective Distress Model
*Biological Model


What are the core features of the Statistical Model of Classification?

The statistical model identifies:
*core features are determined by symptoms that are statistically rare

*how do we determine what is rare?
*where are the cut offs?
*Some behaviours are statistically rare (giftedness, altruism) but not viewed as disordered
*some relatively common behaviours are regarded as disorders: depression (1 in 5) & anxiety (1 in 4)


What are the core features of the Subjective Distress Model of Classification?

The Subjective Distress Model identifies:
*Psychological distress as it's core feature

*it does not distinguish between ego-dystonic conditions (conflict with self-concept) and ego-syntonic conditions (consistent with self-concept)
e.g. hallucinations of religious nature may cause one person distress (Catherine) yet a religious person may find this ego-syntonic & not cause distress


What are the core features of the Biological Model of Classification?

The Biological Model identifies:
*Biological Disadvantage as it's core feature

*Each disorder can be defined in terms of impairment in lifespan ability to reproduce or increased morbidity
depression doesn't necessarily fit into this model (unless suicidal) doesn't incorporate enough disorders as only considers those that limit life span & reproduction


What texts do we use to classify a mental disorder?

International Classification of Diseases, Injuries & Causes of Death
- The ICD-10 Classification of Mental & Behavioural Disorders: Clinical Descriptions & Diagnostic Guidelines

Diagnostic & Statistical Manual for Mental Disorders
American Psychiatric Association - fifth edition

The 2 systems used to be broadly aligned. There are some differences in terminology & conceptualisation of specific disorders however.


What are the core features of the ICD-10 Model of Classification?

*The ICD-10 is part of a broader medical classification system
*ICD-10 provides diagnostic guidelines
*ICD-10 is the main system used by health professionals/ health services
*ICD-10 codes are used in Australian health services


What are the core features of the DSM-5 Model of Classification?

*The DSM-5 is a dedicated system for mental disorders
*The DSM-5 provides explicit diagnostic criteria
*The DSM-5 is the main system used in research


What is particularly good about the DSM-5?

the DSM-5 is:
-decisions are made by working groups
-information is based on scientific data
*it's a Resource book using:
-criteria, trends (age, culture, gender), prevalence, risk, course, complications, predisposing conditions, family patterns
*Offers Categorical & Dimensional:
-recent changes consider dimensionality
-it is not purely categorical:
-prototypical: each disorder has certain essential characteristics & has certain nonessential variations


What is the history of the DSM?

*no classification system prior to the 1950's

*DSM-I was published in 1952
-100 pages describing major psychiatric disorders

*DSM-II was published in 1968 with more detail:
-global vague descriptions
-generally low inter-rater reliability
-Psychoanalytic approach using Freudian concepts

*DSM-III was published in 1980:
-Radical change: detailed guidelines with algorithms or decision guidelines for each diagnosis
-multiaxial system


What are the key aspects of the Multiaxial system first seen in DSM-III?

The Multiaxial System introduced in DSM-III:
*Axis I - clinical/mental disorders
*Axis II - pervasive disorders (Personality Disorders, Intellectual Disability)
*Axis III - Medical disorders
*Axis IV - Psychosocial stressors
*Axis V - Overall Level of Adaptive Function (0-100)


What were the key changes between DSM-III-R & DSM-IV?

*DSM-III-R retained the features of DSM-III and provided increased detail: including over 900 pages with over 350 diagnosis
*DSM-IV included an appendix for culture-bound disorders, such as Koro


What are the key changes with DSM-5?

*Released in June 2013
*Shift towards rationalisation of diagnosis and dimensionality:
-controversies exist over removal (Aspergers) and addition of certain diagnosis
-critiques abouts utility in research


What is the DSM definition of a Mental Disorder?

*A clinically significant behaviour, or psychological syndrome, or pattern that occurs in an individual and that is associated with:
*Distress - painful symptom
*Disability - impairment in one or more important areas of functioning
*A significant increased risk of suffering death, pain, disability
*An important loss of freedom


What other factors are crucial in determining whether a presentation meets the DSM definition of a Mental Disorder?

*The behaviour must not be merely an expectable & culturally sanctioned response to a particular event (e.g. death of a loved one)
*Whatever its original cause, it must currently be considered a manifestation of a behavioural, psychological, or biological dysfunction in the individual
*Neither deviant behaviour (political, religious, sexual) nor conflicts that are primarily between the individual & society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual


The Multiaxial System introduced in DSM-III has been changed for DSM-5, what are the main changes on the axis now?

The Multiaxial System introduced in DSM-III:
*Axis I -
previously: clinical/mental disorders
now: clinical disorders & other conditions that may be a focus of clinical attention

*Axis II -
previously: pervasive disorders (Personality Disorders, Intellectual Disability)
now: Personality Disorders, Intellectual Disability

*Axis III -
previously: Medical disorders
now: general medical conditions

*Axis IV -
previously: Psychosocial stressors
Now: psychosocial & environmental problems

*Axis V -
Previously: Overall Level of Adaptive Function (0-100)
Now: Global Assessment of functioning


What are the Axis I: Clinical Disorders in DSM-5?

*Disorders usually first diagnosed in childhood
*Delirium, dementia, & other cognitive disorders
*Substance Related disorders
*Schizophrenia & other psychotic disorders
*Mood Disorders
*Anxiety Disorders
*Somatoform Disorders
*Factitious Disorders
*Dissociative Disorders
*Sexual & gender Identity Disorders
*Eating DIsorders
*Sleep Disorders
*Impulse-Control Disorders NOS
*Adjustment Disorders


What are the Axis II: Pervasive Disorders in DSM-5?

*Personality Disorders/traits
-Cluster A: schizoid. schizotypal, paranoid
-Cluster B: borderline, narcissistic, histrionic, antisocial
-Cluster C: avoidant, dependent, obsessive-compulsive

*Intellectual Disability
-Still referred to as mental retardation in DSM-IV-TR
-Mild, moderate, severe categories
-"Borderline Intellectual Functioning" is coded here


What are the Axis III: General Medical Conditions in DSM-5?

Any medical condition can be listed here

*includes neurological/medical diseases causing mental disorder e.g.
-Axis I - Dementia in Huntington's disease
-Axis II - Mental Retardation
-Axis III - Huntington's Disease, Down's Syndrome


What are the Axis IV: Psychosocial & Environmental issues in DSM-5?

*Problems with primary support group
*Problems related to social environment
*Educational problems
*Occupational problems
*Housing problems
*Economic Problems
*Problems with access to health care services
*Problems with legal system/crime
*Other psychosocial & environmental problems


What are the Axis V: Global Assessment of Functioning in DSM-5?

*Rating on a 0-100 scale (100 is optimal functioning)
*Can be rated for:
-current functioning
-functioning on admission
-highest/lowest in a specified time frame
-confound between symptoms and functioning
-problems with inter-rater reliability


Give an example of a Multiaxial diagnosis from DSM-5

Axis I: major depressive disorder, single episode, severe without psychotic features (F32.2)

Axis II: Dependent Personality Disorder (F60.7)

Axis III: Hypothyroidism

Axis IV: Unemployment, family discord, childhood sexual abuse

Axis V: GAF = 35 (on admission), 45 (Current)


What are some of the inherent issues with the DSM classification systems?

*Comorbidity - overlap among distinct conditions or variations in the same disorder?

*Heterogeneity within disorders - ideal classification system yields mutually exclusive categories with no overlap

*Overlap with Normal - arbitrary cut-offs: there is some improvement with dimensionality

*Distinction between Axis I & Axis II is not clear: this has been removed in DSM-5


What are some of the social issues with the DSM classification systems?

*Problems of labelling:
-negative connotations: 'schizophrenic' versus 'person experiencing schizophrenia'

*Reflects social/cultural/political bias:
-historical examples: homosexuality, PTSD
-Gender biases: premenstrual dysphoric disorder, hysteria

*Over pathologisation:
-Inclusion of everyday issue: mathematics disorder, caffeine intoxication, bereavement, sadness

*Illusion of explanation:
(Sam deliberately lights fires, therefore he must be a pyromaniac, how do I know, because he lights fires, why does he light fires, because he has pyromania)


What is the overall view of DSM-5 so far?

Clinicians and researchers are reviewing the changes and looking at the applications
-it's improved some problems, however, there remains considerable debate abouts its utility
-Numerous critiques & large research bodies are recommending not to use it