A_PSYC 2285: Chapter 3.2 - Diagnosing Psychological Disorders

Define Classification

Effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations

Classification is considered a __________________ strategy

Classification is considered a Nomothetic strategy

What are the terms associated with Classifications?

- Taxonomy

- Nosology

- Nomenclature

Define Taxonomy

the classification of entities for scientific purposes, such as insects, rocks or behaviours.

Define Nosology

The application of a taxonomic system to psychological or medical phenomena or other clinical areas

Define Nomenclature

the name or labels of the disorders that make up the nosology

Most mental health professionals use the _______________ system contained in the DSM-5 to assist in diagnosis.

Most mental health professionals use the Classification system contained in the DSM-5 to assist in diagnosis.

Other than the DSM-5, what is another system used to assist clinicians in their diagnosis?

ICD-10

International Classification of Diseases and Health Related Problems

Who published the ICD-10?

WHO

World Health Organization

What is the purpose of the ICD?

functions as a public health classification that ensures consistent definitions & conceptualization of diseases such that morbidity and mortality data are comparable throughout the world.

Define Morbidity

rate of disease in a population

Define Mortality Rate

the ratio between deaths and individuals in a specified population, during a particular time period

What is the name of the Specialist version of the ICD-10 that was developed for mental health professionals and whose format resembles that of the DSM-5?

the ICD-10 Clinical Descriptions and Diagnostic Guidelines.

What are the 2 primary Classification issues when diagnosing psychological disorders?

- Classifying human behaviour is controversial

- Distinctions between "Normal" & "Abnormal" are unclear

What are the 3 approaches to Classification of Psychological Disorders?

- Classical Categorical Approach

- Dimensional Approach

- Prototypical Approach

Which approach to classification is used in the DSM-5 today?

Prototypical

Who first developed the Classical Categorical Approach to Classification?

Emil Kraepelin

Describe the Classical Categorical Approach to Classification

Classification method founded on the assumption of clear-cut differences among disorders, each with a different known cause.

Describe the Dimensional Approach to Classification

method of categorizing characteristics on a continuum rather than on a binary (either-or/all-or-none) basis.

Describe the Prototypical Approach to Classification

System of categorizing disorders using both essential, defining characteristics and a range of variation on other characteristics

Describe the reliability problem of psychological disorder classification.

If a disorder is not readily apparent to clinicians, their resulting diagnoses might represent bias.

Describe the validity problem of psychological disorder classification.

The diagnosis must be able to predict the likely course for a prototypical patient.

What are 4 ways assessing the Validity of a Classification System?

- Predictive Validity

- Criterion Validity

- Construct Validity

- Content Validity

Define Predictive Validity (in terms of a Classification System)

when the diagnosis can predict the course of the disorder and the likely effect of one treatment or another

Define Criterion Validity (in terms of a Classification System)

similar to predictive validity, the diagnosis can predict the course of the disorder but specifically when the outcome is the criterion by which we judge the usefulness of the category.

(google definition: measures how well one measure predicts an outcome for another measure)

Define Construct Validity (in terms of a Classification System)

the degree to which the signs and symptoms chosen as criteria for the diagnostic category are consistently associated and what they identify differs from other categories

Define Content Validity (in terms of a Classification System)

the criteria created for a diagnosis, by a clinician, reflects the criteria of the diagnosed disorder (i.e. the criteria set forth in the DSM-5)

As late as 1959, at least how many different systems of classification (of varying usefulness) were use for classifying psychological disorders?

9

How were psychological disorders classified prior to 1980?

by the biological foundations of the disorders

Identified by Emil Kraeplin

Emil Kraeplin first identified what we now know as the disorder schizophrenia. What was his term for the disorder at the time? What does the term mean?

Dementia praecox

deterioration of the brain that sometimes occur with advancing age (dementia)

and develops earlier than it is supposed to, or prematurely (praecox)

Kraeplin was also the first to identify what is now known to be bipolar disorder. What was his label for this disorder?

Manic Depressive Psychosis

What was Phillipe Pinel's term for what we now know as Depression?

Melancholia

What was a notable event of 1948 in terms of the progression of psychological classification of disorders?

the WHO added a section classifying mental disorders to the ICD

What edition of the ICD first included a section for classifying mental disorders?

ICD-6

Which edition of the DMS showed the most radical changes from its predecessors?

DSM-3

T/F the ICD-6 and DSM-1 were incredibly valuable and had great influence of psychological practices at the time

False

The systems of nosology in them had very little influence

What was notable regarding the ICD-8 and DSM-2? Why?

They were all but identical because leaders in mental health began to realize the importance of at least trying to develop a uniform system of classification.

Describe the 2 notable features of the DSM-2's system of classification

- Lacked precision

- Often relied on unproven theories of etiology not widely accepted by all clinicians

What year was the DSM-3 released?

1980

Describe the 2 most notable changes in the DSM-3 (& DSM-3-R)

- attempted to take a an atheoretical approach to diagnosis, relying on precise descriptions of disorders rather than on psychoanalytic or biological theories of etiology

- included significantly more specificity and detail in which the criteria for identifying a disorder were listed

What feature of the DSM-3 made it incredibly popular at the time?

Its multiaxial format

Describe the DSM-3's multiaxial format

it emphasized a broad consideration of the whole individual rather than a narrow focus on the disorder alone

What year was the DSM-4 released?

1994

What realization in clinicians an researchers influenced the publication of the DSM-4? What did this mean for the content & release of the DSM-4?

realized the importance of a consistent, worldwide system of nosology

Work for the DSM-4 was done through the collaboration between the developers of the ICD-10 and DSM-4 so they could be made as compatible as possible

What was the most substantial change in the DSM-4?

the distinction between organically based disorders & psychologically based disorders that was present in previous editions was eliminated

What was the revised version of the DSM-4? What was the ultimate benefit of this version?

DSM-4-TR

helped clarify many issues through updating the research literature and making minor changes to the criteria themselves to improve consistency.

When was the DSM-5 published?

2013

T/F It was through radical changes in the overall system established in the DSM-5 that has made it one of the most useful resources for clinical practitioners

False

The DSM-5 is largely unchanged from the DSM-4

What were 2 of the notable changes with the DSM-5 from the previous version?

- Introduced some new disorders and some reclassified

- Introduced a relatively uniform rating for dimensional axes

The DMS-5 is divided into how many sections? Describe each section

3 Sections:

1. introduces the manual & describes how best to use it

2. Presents the disorders themselves

3. Includes descriptions of disorder or conditions that need further research before they can qualify as official diagnoses.

What were 2 dimensional assessments added or revised in the DSM-5?

- Dimensional Axes

- Cross-Cutting Dimensional Symptom Measures

What are the 4 dimensional axes which were given new, uniform ratings when the DSM-5 was released?

- Severity

- Intensity

- Frequency

- Duration

What is the function of the Cross-Cutting Dimensional Symptom Measures added in the DSM-5?

used to evaluate, in a global sense, important symptoms that are often present across disorders in almost all patients.

What are 3 examples of symptoms included in the Cross-Cutting Dimensional Symptom Measures added in the DSM-5?

- Anxiety

- Depression

- Problems with Sleep

Describe how Cross-Cutting Dimensional Symptom Measures are meant to be used in a clinical sense.

A dimensional rating for a symptom is meant to be provided alongside the primary diagnosis which could influence treatment procedures or outcomes

(i.e. one might diagnose bipolar disorder & provide a dimensional rating of the degree of anxiety also present because a greater degree of anxiety seems to predict a poorer response to treatment and thus may require additional treatment)

Describe the process of how Cross-Cutting Dimensional Symptom Measures are assessed and rated in practice? (use Anxiety measure in your example)

Clinician asks "During the past 2 weeks how much (or how often) have you been bothered by:

(1) feeling nervous, anxious, frightened, worried, or on edge?

(2) feeling panic or being frightened?

(3) avoiding situations that make you anxious?"

Which the clinician ranks on a scale of 0-4 where:

0 = No anxiety

4 = Severe anxiety

T/F Social and cultural considerations were first included in the DSM-5

False

First included in the DSM-4 but remain in the DSM-5

How did the DSM-4 correct for the omission of social & cultural considerations in previous versions?

by including a plan for integrating important social and cultural influences on diagnosis.

What is the term for the plan, relating to social & cultural considerations, included in the DSM-4?

Cultural Formulation Interview

What does the Cultural Formulation Interview do for practitioners?

allows the disorder to be described from the perspective of the patient's personal experience and in terms of the primary social and cultural group

In the DSM-5, "Culture" refers to what?

to the values, knowledge and practices that individuals derive from membership in different ethnic groups as well as how membership in these groups may affect the individual's perspective on their experience with psychological disorders

What is a significant consequence of the DSM-5 containing categories that are still a bit blurred?

individuals are often diagnosed with a comorbidity

Define Comorbidity

diagnosis of more than one disorder at the same time

What are the 2 primary criticisms of the DSM-5?

- Systems strongly emphasize reliability, sometimes at the expense of validity

- Systems are subject to misuse which can be dangerous and harmful

What are 2 consequences of the DSM-5 regarding its classification systems?

Can lead to:

- Labelling

- Stigma

Define Labelling

Categorizing people as individuals with psychological disorders

Define Stigma

a negative connotation attached to individuals with impaired cognitive abilities or behavioural functioning

T/F The classical categorical approach to classification assumes there is only one set of causative factors per disorder with no overlap between disorders, and the prototypical approach uses essential, defining features, as well as a range of other characteristics

True

T/F As in earlier versions, the DSM-IV and DSM-5 retain a distinction between organically and psychologically based disorders

False

T/F The DSM-IV and DSM-5 eradicated the problem of comorbidity, the identification of two or more disorders in an individual at one time, which was previously caused by imprecise categories

False

(still a problem)

T/F If two or more clinicians agree on a patient's classification, the assessments are said to be valid.

False

(Reliable)

T/F A danger in psychological classification is that a diagnostic label might be used to characterize personally the total individual.

True