DSM-V-TR quiz 1

DSM-5-TR

clear and concise description of each mental disorder created in 1952

ICD

international classification of diseases

Robert Spritzer

introduced a number of important methodological innovations, including explicit diagnostic criteria and a descriptive approach that attempted to be neutral with respect to theories of etiology of mental disorders in the DSM-3

What are the approaches for validating diagnostic criteria?

antecedent validators concurrent validators predictive validators

Who was in charge of making sure there was not risk factors such as racism, nondiscriminatory language, and discrimination?

Ethnoracial Equity and Inclusion group

What is the DSM

medical classification of disorders and as such serves as a historically determined cognitive schema imposed on clinical and scientific information to increase its comprehensibility and utility. The classification provides a higher-level organization for the manual.

What are the eleven indicators that helped with regrouping the DSM-5?

neural substrates, family traits, genetic risk factors, specific environmental risk factors, biomarkers, temperamental antecedents, abnormalities of emotional or cognitive processing, symptom similarity, course of illness, high comorbidity, and shared treatment response.

Each disorder identified in section II of the manual must meet the definition of a mental disorder. what are the elements:

clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects underlying mental functioning. Usually associated with significant distress or disability in social, occupational, or other important activities.

clinical utility

it should help clinicians determine prognosis, treatment plans, and potential treatment outcomes for their patients

What is taken into consideration when deciding treatment?

symptom severity, symptom salience, the individual’s distress, disability related to the symptoms, risk and benefits for treatment, and other factors

If a client does not show all symptoms, do you still treat?

the fact that some individuals do not show all symptoms indicative of a diagnosis should not be used to justify limiting their access to appropriate care.

Are all people with the same disorder alike?

there is no assumption that all individuals described as having the same mental disorder are alike in all important ways

Global Assessment of Functioning (GAF)

rates psychological, social, and occupational functioning on a continuum of mental health/mental illness.

Cultural context of mental disorders

shape the experience and expression of the symptoms, signs, behaviors, and thresholds of severity that constitute criteria for diagnosis

sociocultural contexts of mental disorders

shape aspects of identity (ethnicity and race) that confer specific social positions and differentially expose individuals to social determinants of health, including mental health.

What should clinicians routinely consider in order to assess potential signs and symptoms of psychopathology in regards to culture?

impact of cultural meanings, identities, and practices on the causes and course of illness: levels of vulnerability and the mechanisms of specific disorders, social stigma and support generated by family and community responses to mental illness, coping strategies that enhance resilience in the response to illness or help-seeking pathways to access health care of various types, including alternative and complementary treatments, and acceptance or rejection of a diagnosis and adherence to treatments, affecting the course of illness and recovery.

Cultural idiom of distress

refers to a behavior or linguistic term, phrase, or ways of talking about symptoms, problems, or suffering among individuals with similar cultural backgrounds to express or communicate essential features of distress to communicate a wide range of concerns.

cultural explanation of perceived cause

refers to a label, attribution, or feature of an explanatory model that provides a culturally coherent concept of etiology or cause of symptoms, illness, or distress

cultural syndrome

refers to a cluster or group of co-occuring, distinctive symptoms found in specific cultural groups, communities, or contexts, and may not be considered an illness in the local cultural context

Race

social, not biological construct used to divide people into groups based on superficial physical traits such as skin color.

radicalization

the social processes by which specific categories of identity are constructed on the basis of racial ideologies and practices

what does racism do at the personal level?

gives rise to internalized stereotypes and experiences of threat, devaluation, neglect, and injustice that affect individuals' health and well-being.

what does racism do at the interpersonal level?

overt racism and covert microagressions

Systemic/institutional racism

discrimination is embedded in everyday practices of institutions or organizations, and may not be expressed overtly in racial ideologies but may be maintained by implicit and unintentional biases, habits, and practices that result in misrecognition and inequity.

social structural racism

emphasizes the ways that racism and discrimination are manifested in the organization and norms of society and public policy with pervasive inequities in economic resources, power, and privilege that impact exposure to health risk and access to health care

Racism is an negative factor in health in that

it can lead to hypertension, suicidal behavior, PTSD, and can predispose individuals to substance use, mood disorders, and psychosis

adverse consequences of discrimination include

unequal access to health care and clinician bias in diagnosis and treatment

sex

factors attributable to an individual's reproductive organs and XX or XY chromosomal complement

gender

is a result of reproductive organs as well as an individual's self representation and includes the psychological, behavioral, and social consequences of the individual's perceived gender

What does a case formulation include?

careful clinical history, concise summary of the social, psychological, and biological factors that may have contributed to developing a given mental disorder

subtypes

mutually exclusive and jointly exhaustive phenomenological subgrouping within a diagnosis and are indicated by instruction "specify whether" in the criteria set

specifiers

not intended to be mutually exclusive or jointly exhaustive and as a consequence, more than one specifier may be given

specifiers/subtypes

provide an opportunity to define a more homogenous subgrouping of individuals with the disorder who share certain features and convey information that is relevant to the management of the individual's disorder, such as the "with other medical comorbidity"

"other specified" or "unspecified"

disorder options for presentations that do not fit exactly into the diagnostic boundaries of disorders in each chapter. in the hospital ,e.g., it mat only be possible to identify the most prominent symptom

how is a diagnosis written?

the principle diagnosis is listed first, and then the remaining disorders are listed in order of focus of attention and treatment

when is the modifier "provisional" used?

when there is currently insufficient information to indicate that the diagnostic criteria are met, but there is a strong presumption that the information will become available to allow that determination. also used for situations in which differential diagnosis depends exclusively on whether the duration of illness does not exceed an upper limit as required by the diagnostic criteria

substance/medication-induced mental disorder

symptomatic presentations that are due to the physiological effects of an exogenous substance on the central nervous system, including symptoms that develop during withdrawal from an exogenous substance that is capable of causing physiological dependence

organic mental disorders

Outdated term used to refer to disorders that resulted from some identifiable physical factor

nonorganic mental disorders

outdated term referring to disorders that were purely of the mind, also referred to as functional or psychogenic

medical conditions in ICD have been divided into 17 chapters based on what factors?

etiology, anatomical location, body system, context

why does the DSM-5 use the phrase "another medical condition?"

to emphasize the fact that the mental disorders are medical conditions and that mental disorders can be precipitated by other medical conditions

recording procedures

guidelines for reporting the name of a disorder and for selecting appropriate codes

diagnostic features

provides descriptive text illustrating the use of the criteria and includes key points on their interpretation

associated features

include clinical features that are not represented in the criteria but occur significantly more often in individuals with the disorder than those without the disorder

prevalence

The number or proportion of cases of a particular disease or condition present in a population at a given time.

development and course

describes the typical lifetime patterns of presentation and evolution of the disorder

risk and prognostic factor

includes a discussion of factors thought to contribute to the development of a disorder

Culture-Related Diagnostic Issues

includes information on variations in symptom expression, attributions for disorder causes or precipitants, factors associated with differential prevalence across demographic groups, cultural norms that many affect level of perceived pathology, risk of misdiagnosis when evaluating individuals from socially oppressed ethnoracial groups, and other material relevant to cultural informed diagnosis

sex and gender related diagnostic issues

includes correlates of the diagnosis that are related to sex or gender, predominance of symptoms or the diagnosis by sex or gender, and any other sex- and gender-related diagnostic implication of the diagnosis, such as differences in the clinical course by sex or gender

diagnostic markers

addresses objective measures that have established diagnostic value. these may include physical examination findings, lab findings, or imaging findings

association with suicidal thoughts or behavior

provides information about disorder-specific prevalence of suicidal thoughts or behavior, as well as risk factors for suicide that may be associated with the disorder

functional consequences

discusses how to differentiate the disorder from other disorders that have some similar presenting characteristics

differential diagnosis

discusses how to differentiate the disorder from other disorders that have some similar presenting characteristics

comorbidity

includes descriptions of mental disorders and other medical conditions

culture

system of knowledge, concepts, values, norms, and practices that are learned and transmitted across generations.

culture includes:

language, religion and spiritual understanding of health and illness, moral, political, economic, legal systems, cultures are open and dynamic

ethnicity

culturally constructed group identity used to define peoples and communities. it may be rooted in a common history, ancestry, geography, language, religion, or other shared characteristics of a group, which distinguish that group from others

what is the outline for cultural information?

provided a framework fro assessing information about cultural features of an individual's mental health problem and how it related to a social and cultural context and history

cultural identity of the individual

describes the individual's demographic or other socially and culturally defined characteristics that may influence interpersonal relationships, access to resources, and developmental and current challenges, conflicts, or predicaments

cultural concepts of distress

describe the cultural constructs that influence how the individual experiences, understands, and communicates his or her symptoms or problems to others

psychological stressors and cultural features of vulnerability and resilience

identify key stressors, challenges, and supports in the individual;s social environment. these include social determinants of the individual's mental health such as access to resources, exposure to racism, discrimination, and systemic stigmatization; and social marginalization or exclusion. Also assesses the role of religion, family, and other interpersonal relationships and social networks in causing stress or providing emotional, instrumental, and informational support

Cultural features of the relationship between the individual and the clinician, treatment team, and institution

identify differences in cultural background, language, education, and social status among other aspects of identity between an individual and clinician that may cause difficulties in communication and may influence diagnosis and treatment.

Cultural Formulation Interview (CFI)

a set of protocols that clinicians may use to obtain information during a mental health assessment about the impact of culture on key aspects of an individual's clinical presentation and care that consists of three components: the core CFI, an informant version, and supplementary modules

cultural assessment evaluates

processes both within the individual and social world, assessing the contexts as much as the person

cultural explanations

or perceived causes are labels, attributions, or features of an explanatory model that indicate culturally recognized meaning or etiology for symptoms, illness, or distress

cultural syndromes

are clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of experience

9 cultural concepts of distress that are important to psychiatric diagnosis:

1. to enhance identification of individuals' concerns and detection of psychopathology
2. to avoid misdiagnosis
3. to obtain useful clinical information
4. to improve clinical rapport and engagement
5. to improve therapeutic efficacy
6. to guide clinical research
7. to clarify cultural epidemiology
8. data in updated dsm v tr text for specific disorders
9. other conditions that may need to be a focus of clinical attention

why consider culture?

to understand individual's concerns and facilitate accuracy diagnostic assessment

Ataque de nervios

a syndrome found in Latinx cultural contexts, characterized by symptoms of intense emotional upset, including acute anxiety, anger or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising to the head; and becoming verbally and physical aggressive. (Dissociative experiences, seizure-like or fainting episodes, and suicidal behavior are also prevalent)

Dhat syndrome

South asian term that accounts for common clinical presentations of young men who attributed their various symptoms to semen loss. It is a cultural explanation of distress fro individuals who refer to diverse symptoms, such as anxiety, fatigue, weakness, weight loss, erectile dysfunction,other multiple somatic complaints, and depressed mood. Cardinal feature is anxiety and distress about the loss of dhat in the absence of any identifiable physiological dysfunction. Important to note that this problem can also be found in women, and can also reference STIs

Hikikomori

A Japanese word literally meaning "pull away," it is the name of an anxiety disorder common among young adults in Japan. Sufferers isolate themselves from the outside world by staying inside their homes for months or even years at a time. High internet and virtual social exchanges are common with this.

Khyal cap

Cambodian term for "wind attacks" and common symptoms include those of panic attacks, such as dizziness, palpitations, SOB, and cold extremities, anxiety and autonomic arousal. These attacks include catastrophic cognitions centered on the concern that khyal may rise in the body along with blood and cause a range of serious effects.

Kufungisisa

means thinking too much (cultural idiom of distress and cultural explanation among Shona in Zimbabwe) causative of anxiety, depression, and somatic problems, and is indicative of interpersonal and social difficulties. often rumination on upsetting thoughts

Maladi dyab

(maladi satan\= translated to satan illness or sent sickness) Haitian for diverse medical and psychiatric disorders, or other negative experiences and problems in functioning. interpersonal envy or malice cause people to harm their enemies by having sorcerers send illnesses such as psychosis, depression, social or academic failure and inability to perform activities of daily living.

nervios

(nerves) is a common cultural iodine of distress and causal explanation in Latinx cultural contexts and US. Nervous refers to general state of vulnerability to stressful life experiences and to difficult life circumstances. Can encompass, emotional distress, somatic disturbance, inability to function. most common symptom is headaches (brain aches), irritability, gastrointestinal disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigo-like exacerbations)

Shenjing shuairuo

means weakness of the nervous system in Mandarin Chinese and integrates traditional Chinese medicine and western construction of neurasthenia. composed of three out of five symptom clusters: weakness, emotions, excitement, nervous pain, and sleep. Fan lao (feeling vexed) is a form of irritability mixed with worry and distress over conflicting thoughts and unfulfilled desires.

Susto

(fright) distress or misfortune prevalent in some Latinx cultural contexts and is an illness that is attributed to a frightening event that causes the soul to leave the body that results in unhappiness and sickness, as well as difficulties functioning in key social roles and sx can appear days to years after. some cases result in death. sx include appetite disturbances, inadequate or excessive sleep, troubled dreams or sleep, feelings of sadness, low self-worth, or dirtiness, interpersonal sensitivity and lack of motivation. somatic sx include: muscle aches and pains, cold in the extremities pallor, headache, stomachache, and diarrhea.

Tajin Kyofusho

a fear that one could offend others through eye contact, blushing, perceived body deformation, or bad odor. (Japan and USA) it has two culture related forms: sensitive type and offensive type.