Chapter 3: Classification and Diagnosis

ICF

- International Classification of Functioning, Disability, and Health - companion for the ICD - moves beyond the classification of disease and illness and provides a system for describing health and health-related conditions - eg. Impairments in daily activity, factors that affect a person's heath functioning

Diagnostic system

- a classification system based on rules used to understand diseases and disorders - yields diagnoses that describe the symptoms that comprise the patient's conditions PURPOSE: - provide a concise description of essential aspects of the patient's condition - reflects best current scientific knowledge of psychopathology - provide a common language for clinicians and researchers to use across different locations and backgrounds - indicate possible etiology - indicate possible prognosis - provide guidance on treatment options - provide a key term that can be used by clinicians to search the scientific literature for the most current info - provide a framework for determining reimbursement of health services and eligibility for special programs or services

What was the Christchurch Health and Development Study?

- a natural, longitudinal experiment of 1,265 individuals who have been followed since birth - the city of Christchurch suffered a series of earthquakes - the researchers had access to health data proper to and after the earthquakes

What is diagnostic validity?

- an indication that a disorder is a discrete entity that has clear boundaries with other disorders - in other words, the degree to which

How is a mental disorder defined?

- characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning - usually associated with significant distress or disability in social or occupational activities

Hoarding vs collecting

- collecting involves a systematic process for choosing what objects to keep and for organizing them - collectors may be in contact with others who share the same interest and may trade items to improve their collection - collection is not associated with impairment in functioning whereas those who hoard find it difficult to discard almost any item

Describe the limitation of diagnostic reliability

- different clinicians may not give the same person the same diagnosis - the level of inter-rater reliability on the assigning of diagnoses falls below what has usually been seen as acceptable levels

Dimensional approach

- entities differ in the extent to which they possess certain characteristics or properties - focuses on quantitative differences among entities - entities can be arranged on a continuum to indicate the degree of membership in a catgeory

What is diagnostic interrater reliability? Why is this an issue?

- how reliability is actually evaluated

Describe the limitation of the definition of abnormality

- if what is considered abnormal is not strict enough, then there will be overdiagnose and over pathologizing of normal behaviours - "medicalization of ordinary life?"

What are the factors that may cause a diverse range of symptoms?

- internalizing factors - externalizing factors - psychotic factors - overarching general psychopathology factor labelled "p" - predictive of poor developmental histories, poor academic achievement, greater adult psychopathology, and more life impairment

What were some criticism of the DSM-V

- lack of transparency in the development process - growth in new disorders planned for inclusion ("diagnostic inflation") - flaws in the rationales used to support the expansion of what constitutes a mental disorder - criticized for pathologizing normal behaviour and challenges - over-representation of medical/biological views on mental disorders and their treatment (with many members of the task force having a financial association with pharmaceutical companies) - field research on the new diagnoses in the DSM-5 reported very poor results with regards to the reliability of diagnoses and inter-rater reliability

What are factors that characterize resilient individuals?

- presence of supportive relationships - ability to flexibly adapt to change when required - expressing more positive emotions than negative emotions - tendency to overestimate one's own abilities and positive qualities

Describe the limitation of heterogeneity of symptom profiles

- problem with reliability may be caused by the POLYTHETIC NATURE of most of the disorders - this refers to the fact that the same diagnosis can be given to individuals with a range of different symptoms - Variability in response to treatment, whether psychological or pharmacological, could be related to variability in symptom profiles among treated patients. - simply knowing that the symptoms of 55% of depressed patients improve when using a certain medication tells us nothing about why the medication helps many, but not all, patients. - it would be more helpful to relate certain treatments to certain types of symptoms within a disorder (eg. Physical symptoms vs cognitive symptoms of depression

ICD vs DSM

- the ICD has a greater focus on clinical utility; it emphasizes research on how clinicians conceptualizer mental disorders and how they understand interrelations among disorders

Harmful dysfunction

- the behaviours associated with a mental disorder are dysfunctional, and the dysfunction causes harm to the individual or to those around him or her - the pathology is both EVIDENT and causes IMPAIRMENT in the person's life

What are some limitations of diagnostic systems?

- the definition of abnormality - diagnostic reliability - heterogeneity of symptom profiles within a disorder - the validity of diagnoses - use of a categorical approach

How was the third edition of the DSM a dramatic departure from the first two editions and how did it shift the entire field of mental health?

- the manual became ATHEORETICAL which allowed for the possibility of acceptance and openness in the mental health field - the diagnostic criteria were much more explicit and clear cut, with lists of symptoms provided for each diagnosis - thousands of patients and clinicians were involved in field research in order to improve the reliability of diagnoses - this lead to a shift towards scientific literature and principles

How is PTSD often manifested in children?

- they withdraw from the world and become mute

What are two key aspects of a classification system?

1. Classification validity - the extent to which the principles/criteria used in classifying an entity are effective in capturing the nature of the entity - is making money really an accurate way to operationalize happiness and life satisfaction? 2. Classification utility - refers to the usefulness of the resulting classification scheme - some critics argue that the categorical nature of the DSM is not very useful in capturing mental suffering

Developmental psychopathology

A framework for understanding problem behaviour in relation to the milestones that are specific to each stage of a person's development - central to this approach is reliance on empirical knowledge of normal development

Research Domain Criteria (RDoC)

A long-term project by the National Institute of Mental Health to develop new ways of classifying psychological disorders based on dimensions of observable psychological behavior and neurobiological measures rather than the DSM (due to lack of validity) - this framework is designed to integrate data from multiple levels including those that are... - biochemical - cognitive - self-report - to advance research on mental disorders

Categorical approach

An entity is determined to be either a member of a category or not - eg. You either have depression or you don't - underlying assumption is that there is an important qualitative difference between entities that are a member of a category and those that are not

What is the most common set of mental disorders?

Anxiety disorders

Classifying entities as living or non-living is an example of the ____________ approach

Categorical

Thomas Achenbach

Child psychopathology researcher - proposed two broad dimensions (dimensional approaches) of problems in children: 1. Externalizing problems - acing-out behaviours 2. Internalizing problems - feelings (eg. Sadness, worry, withdrawn behaviour) - developed the Achenbach system of empirically based assessment, a family of empirically derived assessment tools to measure competence and problems across the lifespan

Determination of whether a behaviour is abnormal requires knowledge of the _______ in which the behaviour occurs.

Context

What are the two main diagnostic systems for mental disorders?

Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association - the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO).

Weight and height are examples of the ____________ approach

Dimensional

The impact of genetic factors that influence fear intensity during childhood tend to ____________(increase/diminish) over time whereas the impact of life experiences ____________ over time

Diminish; increase

modern attempts to classify and diagnose abnormal human behaviour began with the work of ____________

Emil Kraeplin - viewed each diagnosis as a mental illness - emphasized the importance of diagnostic reliability - strict new-Kraepelinian assumptions hold that all people who have the same diagnoses have the exact same set of symptoms and cn be treated in the same way

Yelling, destroying things, and stealing things would be examples of ___________ problems

Externalizing

T or F: those with a mild disorder are not likely to have problems in psychosocial functioning and should therefore not have been diagnosed in the first place

F; compared with people with no diagnosable condition, those suffering from a mild disorder were 2.4 times more likely to develop significant psychosocial problems. Accordingly, the researchers argued that although mental disorders, like physical disorders, vary in severity, even mild mental disorders are associated with substantial subsequent risk for impaired functioning and should therefore be represented within a diagnostic system.

T or F: The DSM IV was created using only data from American organizations

F; international organizations were also consulted

T or F: the DSM-5 is largely based on the dimensional approach to classification

F; it is a categorical approach

T or F: DSM-V was met with the least criticism and controversy since it was developed with the most accurate tools to date

F; on the contrary, it was the most controversial edition, sparking unparalleled criticism

T or F: there is less disagreement among clinicians about the presence of a RARE disorder

F; there is more disagreement (lower interrater reliability) the rarer the potential condition is

T or F: there is strong association between meeting DSM criteria for ASD and, after more time has passed, meeting DSM criteria for PTSD

F; there is only a WEAK association between meeting DSM criteria for ASD and, after more time has passed, meeting DSM criteria for PTSD

T or F: the Christchurch health and development study found that the earthquake caused people to have a much higher risk of developing a mental disorder

F; they found that those who were exposed to the earthquake had mental disorder rates that were 1.4 times higher than that of people who were not living in the area affected by the earthquake - this is a SMALL to MODERATE increase in risk

T or F: in a classification system, categories may not overlap

F; they may but those assigned to a category Gould be very similar to one another

T or F: a majority of expel who experience an episode of depression have a depressive episode every year aftewards

F; this only happened to 15% of people in a longitudinal study. For 50% of the people, they recovered and never had an episode again

T or F: many disorders demonstrate diagnostic validity

F; very few disorders do meaning they often overlap - eg. PTSD and acute stress disorder - is acute stress disorder really a separate diagnosis from PTSD? - it is not justifiable to distinguish between two diagnoses with comparable symptoms simply on the basis of symptom duration

Disorders with anxiety, depressive, and somatic symptoms are grouped together due to their ___________ features and disorders with impulsive, disruptive conduct, and substance use symptoms are grouped together due to their ____________ features

Internalizing; externalizing

Hoarding used to be a considered a symptom of which other mental disorder? Why were they distinguished from each other?

OCD; OCD and hoarding disorder are different in that those with hoarding disorder do not experience compulsions - additionally, those with OCD are usually aware that their thoughts are unusual whereas those with hoarding disorder see their behaviour as reasonable

The first edition of the DSM published by the American Psychiatric Association in 1952 heavily emphasized _______________ etiological factors for the majority of the disorders and provided only vague diagnostic descriptions

Psychodynamic - this is because at the time, only one form of treatment was available - psychoanalysis

Who is the task force chair for the development of the revolutionary DSM-III?

Robert Spitzer

According to the psychoanalytic models, depression is a disorder of the _________

Superego - since children's superegos purportedly do not emerge until adulthood, according to psychoanalytic theory, childhood depression is impossible

T or F: Across many countries, mental disorders are found to be more disabling than physical disorders such as chronic pain, heart disease, cancer, and diabetes

T

T or F: across different genders and ethnicity, the odds of developing a disorder increased with the number of stressors experienced

T

T or F: those with comorbid conditions are more severely impaired in daily life functioning, are more likely to have a chronic history of mental health problems, have more physical health problems, and use more health care services than those with single disorders

T

T or F: the ICD is free and available onine

T - it is mainly used to provide population level data on different illnesses and causes of death - it is also used to inform specific healthcare service s

T or F: there are no comparable lab tests available for mental disorders

T; classification systems for mental disorders rely almost entirely on observation of symptoms (ie. client self-report), not on etiology, when determining on diagnosis

T or F: developmental psychopathology includes the study of older people too

T; it can help us to understand the challenges of later life

T or F: in DSM-5, for many conditions, it would be acceptable to find a level of agreement between raters that is only somewhat better than chance agreement. (Kappa value of 0.2)

T; many critics argue argue that a kappa value lower than 0.6 is a cause for concern

T or F: you can diagnose depression in an individual who is bereaved

T; this was allowed in the DSM 5 and is one of the points of controversy

Dyscontrol

The impairment resulting from a disorder must be INVOLUNTARY or not readily controlled

How does the rate at which depressive symptoms occur during childhood differ from during adolescence?

There is a significant increase in the rate of depressive symptoms between grades 6 and 7 (11 to 12), with the rates of change before and after this period - it increases much more rapidly for girls than for boys, starting at the period between grades 5 and 7

Why would intentional and willful sexual abuse of a child not be considered psychopathological?

There is not evidence of dyscontrol; the person is voluntary in their actions

one out of every ______ Canadian adolescents and adults reported symptoms consistent with a diagnosis of a mental disorder such as alcohol or illicit drug dependence, a mood disorder (major depressive disorder or bipolar disorder), or a generalized anxiety disorder at some point in their lives.

Three

Cognitive remediation

Training efforts designed to help patients improve their neurocognitive (e.g. memory, vigilance) skills. The hope is that this will also help improve patients' overall levels of functioning. - focuses on helping people acquire skills that were never fully enveloped (habilitation)

Which country had the highest prevalacne rate of mental disorders according to the WHO World Mental Health Survey Consortium?

United States

Depressive symptoms are highest in _____adulthood, decreased during _________ adulthood, and then increased in _________ aduthood

Young, middle, older

What may explain the abundance of comorbidity in the diagnosis of mental disorders?

it seems that there are a number of core pathological processes that underlie the overt expression of a seemingly diverse range of symptoms - eg. Internalizing symptoms seem to be cooccur - therefore, anxiety, depression, and withdrawal may be caused by the same factors

Prototype model

members of a diagnostic category may differ in the degree to which they represent the concepts underlying the category (how close are the members of the category to the "prototype") - in contrast to new-Kraepelin approach - dogs are more prototypic of th catgeory "mammals" than platypuses are - Applying the prototype model to psychiatric diagnosis implies that not all people receiving the same diagnosis have exactly the same set of symptoms.

Interrater method vs test retest method of reliability

this is an issue because interrater reliability is evaluated by comparing different clinicians' diagnose derived from a video interview of a client - this is faulty because this implies that clinicians receive exactly the same info from clients during their interviews - in order to address this, a a test-retest approach to reliability was used in which the clinicians interviewed a client in real life within a few hours or days of each other