Oxford Text pg 269-279

diagnosis

diagnosis

relating a pattern of behaviour to a certain category

reliablility

precision - being consistent across clinicians

validity

accuracy - corresponding to the actual disorder

inter-rater reliablity

different clinicians using the same classification system should arrive at the same diagnosis for the same patient

audio-/video recording method

way to establish inter-rater reliability - clinical interview gets recorded, other clinician must come to the same results

test-retest reliability

way to establish inter-rater reliability - tow separate interviews with two separate clinicians

predictive validity

the ability to predict how the disorder will respond to the treatment

inverse

reliability and validity have an _______ relationship

Beck et al (1962)

found 54% reliability for DSM-I

Kendall (1974)

found consistency of diagnoses are poor over time - maybe due to changes in patients’ patterns of behaviour or inconsistent psychiatrists

Carl Hempel

philosopher of science influential in suggesting a shift to observational criteria

Di Nardo et al (1993)

found excellent inter-rater reliability for OCD and phobias, but low for GAD

structured clinical interview for DSM (SCID)

diagnostic interview that included a standardized set of questions for clinicians to ask

Williams et al (1992)

conducted test-retest reliability study - found reliability coefficients for different disorders vary within the same diagnostic manual

Chmielewski et al (2015)

claims reliability to a large extent depends on the method with which it was established

Regier et al (2013)

summarized the results of field trials of the DSM-5 in the US and Canada, finding “mixed” results - but DSM-5 has improved reliability

heterogeneity of clinical presentation

key problem related to validity of diagnosis: the same disorder can manifest itself differently in different patients

symptomological rather than etrological classification

key problem related to validity of diagnosis: relying on symptoms means there will be overlaps between disorders

comorbidity

key problem related to validity of diagnosis: co-occurrence of diagnoses (anxiety and depression frequently co-occur)

stability

key problem related to validity of diagnosis: diagnoses are valid if inferred disorder is stable over time

cut-off point

key problem related to validity of diagnosis: when is something “clinically significant” vs “clinically insignificant”

selecting treatment

key problem related to validity of diagnosis: the type of treatment depends on the type of disorder

Cooper (1972)

compared diagnoses between American and British psychiatrists - Americans more likely to diagnose depression, British more for schizophrenia

systematic bias in clinical judgement

a way to assess validity - compare two sets of diagnoses that should not differ if diagnosis is valid

objectively known

way to assess validity - disorder is established but not known to psychiatrists