L1- Clinical Psychology

How does the DSM-5 define a mental health condition?

A syndrome characterised by a clinically significant disturbance in cognition, emotion regulation, or behaviour, reflecting dysfunction in psychological, biological, or developmental processes underlying mental functioning.

What two types of behaviour does DSM-5 specifically say are not necessarily mental disorders?

1. An expectable or culturally approved response to a common stressor (e.g grief)

2. Socially deviant behaviour or conflicts with society (unless results from dysfunction in the individual)

What is ‘not typical’?

1. Statistically rare

2. Extreme departure from social norms

3. Faulty perception of reality

4. Significant personal distress

5. Maladaptive (self-sabotaging) behaviour

6. Dangerousness

What’s the issue with ‘statistically rare’?

-Uncommon doesn’t mean disordered (Usain Bolt)

-Alone not sufficient

What’s the issue with ‘extreme departure from social norms’?

Cultural standards vary hugely between contexts and people

What’s the issue with ‘faulty perceptions of reality’?

-Compared to what and who?

-Inherently subjective

What’s the issue with ‘significant personal distress’?

Some people don’t report this symptom

What’s the issue with ‘maladaptive / self-sabotage’?

What’s the threshold for this and who decides it?

What was Rosehan’s (1973) study?

-3 women + 5 men (including self) told GP having auditory hallucinations

-All pseudo-patients admitted to psychiatric hospital + diagnosed

-Behaved normally (said no hallucinations + feel fine)

-To leave, had to accept ‘schizophrenia in remission’ diagnosis + antipsychotic drugs (average 19 days)

What are the critiques of Rosehan’s (1973) study?

-Difficult to verify accounts (identities of pseudo-patients unclear + inconsistent)

-Rosehan’s medical records = more severe symptoms reported than paper

-Participants dropped from study if didn’t fit narrative + mis-quotes

-Colleagues questioned Rosehan’s integrity

-Schizophrenia in remission very rare then + likened to being ‘cured’

What are the issues with Classification?

-Fallible

-Social, cultural and structurally constructed

-Scientific psychologists should regard diagnostics critically

What do diagnostic categories do?

-Allow predicability

-Help identify symptoms, treatment + prognosis (course of illness)

Who is Robert Spitzer?

-Father of the DSM

-Led DSM III, first edition to be vast + widely used

-Moved away from Kraeplin neuropathological + psychodynamic approach to more on the symptoms, not cause + empirical method

Who is Allen Frances?

-Made DSM IV (1994) + established core definition of mental health (emphasis on functional impairment + clinically significant distress)

-Used ‘field tests’ to test diagnosis reliability

-Some dimensional phenomena but fundamentally categorical

How is the DSM 5?

-Mental health defined in even broader terms

-Classifies conditions, not people (person with “schizophrenia”)

-Categorical system with some dimensionality

-More diagnoses in scope of normal behaviour (541 v 128 diagnosis 1952)

What are issues with the DSM?

-Potential over-reliance on medical model

-Categories, not dimensions but with no clear line

-Pathologising normal human behaviour? (over-diagnosis)

-Psychiatrists don’t always agree on correct diagnosis for people

What does “Incidence” mean?

Number of new or newly diagnosed cases of a condition / symptom in specified population over specified time 

What does “Cure / Remission” mean?

Rate at which condition / symptom ceases to be present in individuals who previously shown it 

What does “Recurrence” mean?

Rate at which condition / symptom occurs again in individuals who previously had it 

What is “Point Prevalence”?

Proportion of a population with symptom / condition at specific point in time 

What is “Period Prevalence”?

Proportion of a population with the symptom / condition at any point during a given time period of interest 

What is “Lifetime Prevalence”?

Proportion of a population who, at some point in life has ever had the symptom / condition 

What is “Aetiology”?

Process by which a disorder develops

What does “Course” mean?

Progression of a disorder over time (remission, cure relapse, likely duration)

What does “Comorbidity” mean?

Concurrent condition or difficulty alongside the primary condition

What does “odds ratio” mean?

The probability of an event happening compared to an alternative event (1 means 50/50 equal odds)