NSCI 301: Feb 23

previous understanding of disease

biological event, we try to classify it for public policy and healthcare treatments, but in some ways disease doesn’t exist until we name it

psych diagnosis implications

access

• medical care/insurance coverage

• criminal responsibility

• disability claims

stigma

• employment + education

• human rights

• stigma stress on yourself (right not to know)

personal values

• language we use matters too

DSM-5

• atheoretical

  • not based on one theory of why smth happened

• operationalist

  • checkboxes

• categorical

  • either A or B

• who approves it

  • APA, make money off of it

• designed for

  • US Psychiatrists

ICD-11

• international classification of diseases

• who approves

  • WHO

• designed for

  • global audience

• cost

  • less expensive

DSM I date

1952

DSM I rationale

• psychiatric needs after WW2

• desire for standardization across contexts

DSM I provided:

• Freudian psychodinamics/analytics

• 106 diseases

• 3 class: psychotic (loss of contact w reality), neurotic (maladaptive ways of dealing w anxiety), behavioural (diff behaviour, personality)

• organic (brain) vs functional (mind) disorders

  • impairment of brain tissue vs

  • psychogenic

DSM I criticism

• homosexuality as a disorder

• non-conformity

• mental illness to cover up moral failures

DSM II date

1968

DSM II rationale

• sociological/biological knowledge updates

• criticism about reliability

• no clear boundary between normality and abnormality

DSM II criticism

• need to harmonize w ICD

• address Rosenhan experiment and reliability

• shift away from Freud and towards observable symptoms n stats

Rosenhan Experiment

fake patients that pretended to have auditory hallucinations

• admitted, diagnosed w schizo, manic-depressive psychosis

• identified by patients not staff

• cannot distinguish between sane and insane

• acted completely normal during stay, and relates to first clinical impression, once they label you, they treat all subsequent behaviour as a part of that condition, even if “normal”

ethical issues Rosenhan experiment

• unecessary treatment

• depersonalization

• lie factor: relies on participants lying

• we dont even know if it actually happened, wasnt well documented

DSM III date

1980

DSM III rationale

• increased scale and reach

• 256 diagnostic categories, new disorders (gender identity disorder tho)

• categorical/biological view, away from psychosocial elements

DSM III criticism

• clinical significance

• recognition that existent definitions arent great (checkboxes, all or nothing)

• wna be more w ICD

DSM IV date

1994

DSM IV rationale

• clinical significance criterion added to many categories (need to negatively affect your life in some way)

• qualifiers (mild, moderate, severe)

• 410 diagnostic categories

• refined definitions

• codes used for insurance

DSM IV to DSM V

20+ years of research

DSM V date

2013

DSM V rationale

• extensive revisions

• deletion of subtypes (for schizo) and subsets (for autism)

• severity qualifiers updated

• patients and public input finally integrated with revisions

public integration benefits

• public trust of classification/research

• counterbalance, fund stuff industry isnt interested in

• justice in knowledge

benefits of DSM classification reforms for clinicians

• pragmatic easy to use criteria

• inform treatment

• communication w others

benefits of DSM classification reforms for research

• operationalization, checkbox

• compare results, harmonizaiton

benefits of DSM classification reforms for industry

• insurance companies

• psycho/pharma companies

DSM 5: theoretical inconsistency

• heterogeneity

  • same disorder, can present diff symptoms

  • obscures individual differences

  • symptoms overlap across diagnoses

• discrete categorical boundaries

  • arbitrary cutoff (5/9 checkboxes for example)

  • stigma

    • pro: labeling them seperates them from “normal”

    • counter: if biological reason, decrease stigma bc no control over it

      • but people still hold grudges against it because esp they cant see it, and theres a lot of stigma around psychiatric disorders already

DSM 5: causation issue

• comorbidity

  • patient diagnosed w multiple disorders

  • pure participants dont rly exist, hard to find underlying mechanism

• difficulties caused by disorder

  • medicalization of social problems

  • pathologizing trauma survivors and their normal responses, normal in that situation, but not normal compared to people not in trauma

RDoC rationale

• for research specifically

• looks at underlying mechanisms and dysfunctions rather than symptoms

• NIMH

what RDoC does

• theory driven

• dimensional

• etiology (causation)

• development, risk, prevention

RDoC units of analysis

• microscopic (genes, molecules)

• macroscopic (circuits, behaviour, environemnt)

• diff domains to look at, whats dysregulated

psychiatric disorders

• scientific criteria

  • symptoms

  • mechanisms

  • matching patient to treatment

• political pressure

• public opinion

• industry and treatments

• social constructions of deviance/medicalization

• normative assumptions about behaviour

AI as a diagnostic tool

input:

• digital data

  • scrolling

  • searches

  • biometrics

output:

• diagnosis

• future prediction

ethics:

• privacy

• black box of why it diagnosed you, nobody knows

• legislation gap

• stigma (false positives)

normative

something ought to be or should be fixed/treated, or looked at certain way

descriptive

something just is a certain way

is-ought fallacy

just because something is (descriptive), doesnt mean we need to change it or it should be a different way or its wrong (normative)

Normative assumptions in classification criteria

• manic/hypermanic

  • excessive involvelemtn in high risk activities

  • shopping sprees, risky sexual activity

• ADHD

  • not attention to detail

  • gets out of seat in unexpected situations

• relative so sociocultural environment, typical vs atypical

  • institutionalized intolerance to certain behaviours

DSM 5 normative shift

• uses 3rd person instead of 1st person

  • people with disorder lack insight into their behaviour

capacity is not global phenomenon

• if u have diagnosis ur still capable of certain decisions, even if not all