ABNORMAL PSYCHOLOGY- Classification systems and clinical biases | Quizlet

Classification systems

identify patterns of behavioral or mental symptoms that consistently occur together to form a disorder

Two Classification Systems

Diagnostic and Statistical Manual of Mental Disorders (DSM)

International Classification of Diseases (ICD)

DSM

- Commonly used in the USA.

- Standardized system for diagnoses based on a person's clinical and medical conditions, psychosocial stressors and the extent to which a person's mental state interferes with his life.

ICD

World Health Organization has published the International Classification of Diseases.

A multidisciplinary and multilingual approach. Identifies causes rather than JUST symptoms.

The ABCS'

Affective symptoms: emotional elements

Behavioural symptoms: observational behaviours

Cognitive symptoms: ways of thinking

Somatic symptoms: physical symptoms

Andrews and Slade (aim)

Evaluate the level of agreement between ICD-10 and DSM-IV diagnostic criteria for: depressive disorders, dysthymic disorder, substance dependence, substance harmful use/abuse disorders

Andrews and Slade (procedure)

- sample of community members and clinical cases

- participants were assessed using the Composite International Diagnostic Interview (CIDI)

- This structured interview facilitated the identification of discrepancies between ICD-10 and DSM-IV diagnoses for the specified disorders.

Andrews and Slate (results)

- diagnostic concordance between ICD-10 and DSM-IV was found to be excellent for depressive disorders, dysthymic disorder, and substance dependence disorder

- The agreement was considerably lower for substance harmful use, abuse disorder.

Andrews and Slate (implications)

variation in agreement raises questions about the universality of diagnostic systems, especially in how they might overlook cultural and contextual factors.

Andrews and Slade evaluation

Strengths:

- Large Sample Size: enhancing the generalizability of its findings.

- Broad range of disorders

Limitations

- The sample includes both community members and clinical cases, but it may not fully represent individuals from diverse backgrounds or those with less common mental health disorders, affecting the generalizability of the results.

- Without a longitudinal approach, the study cannot determine whether diagnostic concordance remains consistent over time.

Parker (AIM)

Compare how Chinese patients and Caucasian patients identified cognitive and somatic symptoms of depression.

Parker (PROCEDURE)

All participants were out-patients who had been diagnosed with Major Depressive Disorder who would answer a questionnaire.

The questionnaire was based on two sets of symptoms.

- mood and cognitive items common in Western diagnostic tools for depression.

- Somatic symptoms commonly observed by Singaporean psychiatrists.

Patients were asked to judge the extent to which they had experienced each symptom in the last week and were told to rank them in how distressing they were.

Parker (RESULTS)

When looking at which symptom led them to seek help, 60% of the Chinese participants identified a somatic symptom, compared to only 13% of the Australian sample.

The chinese also rated the somatic symptoms higher than the affective symptoms. Chinese participants were significantly less likely to identify cognitive or emotional symptoms as part of their problem.

Parker (IMPLICATIONS)

- shows how cultural factors influence the classification of disorders

- In Western culture, it is more appropriate to discuss one's emotions, and depression is seen as linked to a lack of emotional well-being

- in Chinese culture, it is less appropriate and even stigmatized if one speaks about a lack of emotional health.

- highlights that classification systems like the DSM may not be fully universal, as they can fail to account for cultural variations in symptom expression and perception

Parker (EVALUATION)

Strengths:

- The study developed a questionnaire based on cultural evidence relevant to participants, ensuring that the tool was more appropriate and valid for the population being studied.

- The questionnaire was backtranslated to establish credibility, helping ensure that the translation was accurate, adding reliability

Limitations:

- DSM criteria for depression reflects a western view (bias)

- Excluded participants who did not fit the Western view of depression, limiting generalizability.

Bolton (AIM)

to investigate the local validity of western mental illness concepts

determine the extent to which local people experienced depression as a result of trauma.

Bolton (PROCEDURE)

Case study on two rural areas in Rwanda after a genocide.

Three interview styles:

free listing, key informant interviews, pile sorts

free listing provided a list of local terms for mental symptoms and disorders. They asked local people to name all the problems that had resulted from the genocide. Using inductive content analysis, they pulled out symptoms that were related to mental health.

After this, Key informant interviews:

Participants were asked for the names of people in the community who were knowledgeable of these problems - and further interviews were then carried out. Local healers where seen as knowledgable.

After this, Pile Sorts:

A set of cards was created which included the mental health symptoms that were identified in the initial interview as well as the symptoms that identify depression as outlined in the DSM.

- The healers were asked to sort the cards based on similarity

- They then used these local symptoms as part of their questionnaire which they developed to determine the prevalence levels of depression in the community.

Bolton (RESULTS)

- After the questionnaire was established, 93 people were identified as having mental health issues in the community.

- When interviewed, 70 were diagnosed by local healers as showing the symptoms of agahinda gakabije.

- Local symptoms not included in the DSM were identified.

- When given the newly standardized questionnaire, 30 of those then tested positive for signs of depression.

- The relationship between agahinda and depression was the same as that between grief and depression in the Western world.

Bolton (IMPLICATIONS)

- challenges the universal application of Western diagnostic tools like the DSM and ICD

- The study questions the cross-cultural validity of Western classification systems for mental disorders.

- hows that local constructs, may not align perfectly with DSM-defined depression.

- suggests that classification systems need to account for cultural differences

Bolton (EVALUATION)

Strengths:

- Back Translation: Ensures accuracy by translating interviews back into the original language, enhancing credibility.

- Data Triangulation: Uses multiple data sources to strengthen the credibility of findings.

- Emic Approach: Focuses on local resources and cultural understanding, considering how culture shapes an individual's mental health and treatment.

Limitations:

- Reliance on Western Disorders: The approach compares local symptoms to Western definitions (e.g., DSM), which may overlook culturally specific mental health issues.

- Limited Generalizability: Emic approaches are often limited to the specific community studied, reducing the ability to generalize to other cultures.

Clinical biases

errors in diagnosis, treatment, or medical judgment caused by subjective factors such as stereotypes, personal beliefs, or external influences.

CULTURAL BIAS

The tendency to judge or interpret behaviors, values, and norms through the lens of one's own culture

ANCHORING BIAS

The tendency to rely too heavily on the first piece of information encountered (the "anchor") when making decisions or judgments.

Friedlander and stockman AIM

Investigate whether giving significant evidence of mental illness in an early interview would have more influence on a final diagnosis and prognosis than giving that same evidence in a later interview.

Friedlander and stockman PROCEDURE

-Sample of US clinicials who read two case studies.

-Case study 1: severely depressed woman with a suicide attempt (Joane)

-Case study 2: less severe symptoms of anorexic behavious and depression (Gina)

- Clinicians read 5 consecutive interviews per case with key information revealed either early or late.

- After each interview, clinicias were asked to evaluate the level of functioning and the prognosis

Friedlander and stockman RESULTS

- When symptoms were revealed early, clinicians gave a worse prognosis and more negative evaluations to the milder case

- in the more severe case, the timing of the information didn't affect the diagnosis

Friedlander and stockman IMPLICANTIONS

.- Shows how anchoring bias influenced the clinicians diagnosis

- early information about the patient can shape their judgement, especially in less severe cases

- demonstrates how the timing of critical information can shape diagnostic outcomes, even when a case does not need a severe diagnosis

Friedlander and stockman EVALUATION

strengths:

- experienced clinicians adds reliability as clinicians were professional and can reflect realistic diagnostic practices.

limitations

- small sample limits generalizability of findings to a larger population of clinicias,

- limited to just two disorders, reducing applicability to other mental conditions who may have other parameters, symptoms and diagnostic tests.