L6 - Ethics of Psychiatric Diagnosis

What is defined as a Disease?

something that we collectively agree on

Discuss the Ethical, Legal and Social implications of Psychiatric Diagnosis - (4)

• who has access to care

• how are they perceive in the society

• how it changes their self image

• where they stand in the community

Name the 2 popular Classifications of Psychiatric Disorders & How they differ?

DSM (Diagnostic and Statistical Manual of Mental Disorders)

• categorical (checklist)

• from American Psychiatric Association (APA)

• for US psychiatrists

• generate revenue for APA

ICD (International Classification of Diseases)

• from World Health Organization

• for Global audience

• free online, access to large public, low cost

Explain the history of the DSM (before DSM-I TO DSM-II)

BEFORE DSM-I

• increase in psychiatric needs after WWII

• PTSD from war and suicide rate increase

• need to find a standardization for psychiatric diagnoses

DSM-I

• symptoms were sorted into 3 classes:

  • psychotic

  • neurotic

  • behavioural

• disorders were classified as

  • organic (brain) → related to damage to brain tissue

  • functional (mind) → no physical change in brain so psychogenic cause

Between DSM-I and DSM-II

• period of stigma around mental illnesses

DSM-II

• combining sociological and biological knowledge

• lack of boundary between what is normal VS abnormal

• questioning reliability

Discuss the Rosenhan Experiment : its purpose + the takeaway/conclusion

• AFTER DSM-II : test for the reliability of the psychiatric diagnoses

• 8 patients with NO history of mental illnesses show up at the psychiatric hospital faking some symptoms

• TAKEAWAY: unable to distinguish the sane from the insane in psychiatric hospitals

Explain the history of the DSM (between DSM-II TO DSM-IV)

Between DSM-II and DSM-III

• want to match with ICD

• need to change things up for reliability (based on Rosehan Experiment)

• shift from psychological theories => observable symptoms & statistics

DSM-III

• BIG CHANGEEE → in scale and reach

• adding more disorders

• heavier focus on categorical & biological pov of mental health (checklist)

Between DSM-III and DSM-IV

• questioning clinical significance

• acknowledge flaws in disorders definitions

• want more to be in harmony with ICD

Explain what changed from DSM-IV to DSM-V + What makes DSM-5-TR so novel?

DSM-IV

• additions of criteria for clinical significance

• addition of qualifiers of symptoms (mild-moderate-severe)

• more disorders categories

• refinement of definitions

• consideration of insurance applied to diff disorders

DSM-V

• more rigorous revisions

• changes in defining disorders => schizophrenia & autism considered as spectrum

• updates on qualifiers of illness severity

DSM-5-TR

• integrating patients & public inputs into revisions to diagnoses & classification

Discuss the benefits of including patients into psychiatric classification and research - (3)

• enhance trust of the public on research and classification

• increase funding + addition of novel research questions (from public)

• fairness in production & use of knowledge

Discuss the benefits of DSM classification reforms - (3)

For clinicians

• better informed on treatments to give

• criteria of disorder based on practices rather than theories

• better communication to patients

For scientific research

• harmonization of measured results

For industry

• more clarity for insurance companies

• pharm companies (how to improve the drugs)

Discuss some criticisms of Diagnostic Classifications (DSM-V) - (2)

Theoretical inconsistency

• heterogeneity across diagnostic criteria => diff people show diff symptoms for same disorders

• no defined categorical boundaries => overlap of symptoms for diff illnesses

Issue of causation

• comorbidity => what if patient has more than 2 conditions SO hard to diagnose and differentiate

• implying issues are caused by disorder => you have this disorder therefore you have these symptoms

What is the Research Domain Criteria Project (RDoC) + Why was it put into place?

• DSM but for research

• specifically for researchers and NOT Doctors

• continuum of normal VS abnormal (NOT Checklist like DSM)

Discuss AI technology for psychiatric diagnosis including

1) Inputs

2) Outputs

3) Ethical Considerations

• INPUTS : tracking your tech usage

• OUTPUTS : results from that tracking of your info

• ETHICS : induce stigma and privacy issues

identify some factors that shape our understanding of psychiatric disorders - (6)

• scientific criteria

• political pressure/views

• financial choices (insurance/pharm)

• public opinion

• social constructs

• normative assumptions/judgments

Explain Nomative vs Descriptive content

Normative

• subjective / debatable

• evaluate something

Descriptive

• objective

• fact (DOES NOT HAVE TO BE TRUE! ex: The sky is green)