Flashcards in Week 1 Lecture 1b - Diagnosis & Classification Systems (Caff) Deck (19)
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?
*enables clinical researchers to develop improved clinical strategies, using between group designs for example
*enables epidemiological studies
*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
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 and PTSD 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?
*core features are determined by symptoms that are statistically rare
*Subjective Distress Model
*Psychological distress as it's core feature
*Biological Disadvantage as it's core feature
What are the difficulties with each of the approaches to classification of mental disorders?
The statistical model does not address:
*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 & anxiety
Subjective Distress Model does not address:
*it does not distinguish between ego-dystonic conditions (conflict with self-concept) and ego-syntonic conditions (consistent with self-concept)
Biological Model does not address:
*Each disorder can be defined in terms of impairment in lifespan ability to reproduce or increased morbidity
What texts do we use to classify a mental disorder?
*ICD-10 - part of a broader medical classification system
*provides diagnostic guidelines
*the main system used by health professionals/ health services
*ICD-10 codes are used in Australian health services
*DSM-5 is a dedicated system for mental disorders
*provides explicit diagnostic criteria
*the main system used in research
The 2 systems used to be broadly aligned.
What is particularly good about the DSM-5?
*the DSM-5 is Atheoretical:
-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?
*before 1950's no classification system
*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
*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 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 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
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
*Sexual & gender Identity Disorders
*Impulse-Control Disorders NOS
What are the Axis II: Pervasive Disorders in DSM-5?
-Cluster A: schizoid. schizotypal, paranoid
-Cluster B: borderline, narcissistic, histrionic, antisocial
-Cluster C: avoidant, dependent, obsessive-compulsive
-Mild, moderate, severe categories
-includes "Borderline Intellectual Functioning"
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
*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:
-functioning on admission
-highest/lowest in a specified time frame
-confound between symptoms and functioning
-problems with inter-rater reliability
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