Assessment and Pathology (Quiz 1)

What two types of overreach exist in the DSM?

* Classifying conditions with a clear biological etiology (ex. Alzheimer's) * Classifying temporary conditions caused by brief abnormal states (ex. alcohol intoxication).

How do gender and sex differences influence illness?

* Determines whether an individual is at risk for a disorder * It may indicate the overall risk of development of a disorder * It may influence the likelihood of particular symptoms * Reproductive life cycle events

Diagnostic criteria and descriptors

* Diagnostic features describe the criteria for a diagnosis * A diagnosis may require a subtype and a specifier (ex. severity, descriptive feature, course)

subtype

Mutually exclusive and jointly exhaustive subgroupings within a diagnosis.

Who was involved in the development of the DSM-5?

Physicians, psychologists, social workers, nurses, counselors, statisticians, neuroscientists, etc. Patients, families, advocacy groups, lawyers, etc.

What are the parts of a treatment plan?

Problems Goals Interventions Duration of treatment

symptomatic treatment

Rather than giving medication or a non-specific therapy that's meant to "cure" the entire diagnosis (ex. PTSD), the client and clinician work on the symptom that is most troubling and use evidence-based practice to alleviate that symptom. Treatment proceeds by tackling a symptom at a time.

When is the CFI particularly helpful?

* Difficulty in diagnostic assessment because of differences between clinician and individual * Uncertainty about the fit between cultural distinctive symptoms and diagnostic criteria * Difficulty in judging illness severity or impairment * Disagreement on course of care * Limited engagement in and adherence to treatment by the individual.

Online enhancements of the DSM-5

* additional assessment measures

What have been used to validate diagnostic categories?

* antecedent validators (ex. genetics, environment) * concurrent validators (ex. similar symptoms) * predictive validators (ex. similar outcomes)

outline of cultural formulation

* cultural identity of the individual *cultural conceptualization of distress * psychosocial stressors and cultural features of vulnerability and resilience * cultural features of the relationship between the individual and the clinician * overall cultural assessment

How are DSM codes used?

* data collection * billing

What are some alternatives to the DSM-5?

* denialism * symptomatic treatment * functional behavioral assessment * international classification of diseases * psychodynamic diagnostic manual (like anything psychodynamic, bullshit) * person in environment system

What are the elements of a diagnosis

* diagnostic criteria and descriptors * subtypes and specifiers * principal diagnosis * provisional diagnosis * coding and reporting procedures

Why are cultural concepts important to diagnosis?

* to avoid misdiagnosis * to obtain clinical info * to improve therapeutic efficacy * to guide clinical research * to clarify cultural epidemiology

Why is cultural formulation important?

*It helps avoid misdiagnosis *Useful clinical information *Builds rapport *Helps with research *Helps with treatment planning

How else is culture relevant to diagnosis and pathology?

*It may affect internalized stigma or stigma experienced from others *It may influence acceptance or rejection of a treatment plan *It affects the clinical encounter

What are some problem with syndrome grouping as it exists in the DSm-5?

*There's no similar grouping of features * Population with the same diagnosis could present completely differently with no symptom overlap.

What are some criticisms of the DSM-5's definition of mental disorder?

*What's the difference between a behavioral and psychological manifestation? *Circular reasoning. A mental disorder is caused by a disturbance in mental functioning (ex. a particular type of rock is brittle because it is easily broken)

What sort of review did the DSM-5 undergo?

*public and professional review *expert review

Why do we have diagnoses?

*treatment recommendations * prevalence rates for mental health service planning *identifying patient groups for clinical research *gathering public health info like morbidity and mortality rates

Other conditions that may be a focus of clinical attention.

Conditions such as medication-induced movement disorders that aren't mental disorders unto themselves but may be encountered by mental health clinicians.

susto ("fright")

A cultural explanation for distress and misfortune used by Latinx people in the US and some people in Mexico, Central America, and South America. An illness that is attributed to an event that caused the soul to leave the body. It results in unhappiness and sickness as well as impaired social functioning. Three syndromatic types *interpersonal *traumatic event *somatic

maladi moun ("human caused illness" or "sent sickness")

A cultural explanation in Haitian communities for diverse medical and psychiatric disorders that are caused by interpersonal envy and malice. A person's gain is another person's loss so visible success makes one vulnerable to attack.

What four principles guided DSM revisions?

1) The DSM is meant to be a manual used by clinicians and so revisions must be feasible for clinical practice 2) Recommendations for revisions must be guided by research evidence 3) Continuity should be maintained with previous editions of the DSM 4) No a priori constraints should be placed on the degree of change

What four ways are cultural concepts related to DSM-5 classification?

1) There's not a one to one comparison between a cultural concept and a DSM diagnosis 2) Cultural concepts can apply to a wide range of severity, including sub clinical severity. 3) The same cultural term can be used to mean multiple cultural concepts (ex. depression is a diagnosis but also an idiom of distress) 4) Cultural concepts change over time

Which four domains are included in the CFI?

1) cultural definition of the problem 2) cultural perception of cause, context, and support 3) cultural factors affecting self coping and past help seeking 4) cultural factors affecting currently help seeking

Which three concepts replaced "culture bound syndrome" in the DSM 5?

1) cultural syndrome 2)cultural idiom of distress 3)cultural explanation or perceived cause

What are the three types of cultural concepts of distress?

1) cultural syndromes 2) cultural idioms of distress 3) cultural explanations or perceived causes

What two fundamental errors in reasoning have been identified by critics of the DSM-5?

1) reification: attributing reality status to a hypothetical construct, absent credible evidence of the genuine existence of the construct. (ex. Freud's ego, id, superego). 2) circular reasoning: A behavior is used to explain a behavior. (ex. Why do you run away from dogs? I have a phobia. How do I know I have a phobia? I run away from dogs.) Why does the person have this behavioral problem? Because of a particular diagnosis. How do you know they have that diagnosis? Because of their behavioral problem

How long did it take to make the DSM-5?

12 years

taijin kyofusho ("intepersonal fear disorder")

A cultural syndrome characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, or conviction that one's appearance or actions in social situations are inadequate or offensive to others. *olfactory reference syndrome (offensive body odor in the US) * blushing * inappropriate gaze * body deformity *awkward facial or bodily movements In addition to performance anxiety, can be a sensitive type (Sensitive to social interactions and anxiety) or an offensive type (Concerned about offending others). It has been found in societies that place a strong emphasis on the self conscious maintenance of appropriate social behavior in hierarchical interpersonal relationships (ex Korea, Japan)

shenjing shuairuo ("weakness of the nervous system")

A cultural syndrome that integrates conceptual categories of traditional Chinese medicine with the Western diagnosis of neurasthenia (an ill-defined medical condition characterized by lassitude, fatigue, headache, and irritability, associated chiefly with emotional disturbance). A syndrome composed of three out of five symptoms. *weakness *emotions (feeling vexed) * excitement * nervous pain * sleep It can be preceded by an acute sense of failure or work and/or family stressors.

race

A culturally constructed category of identity that divides humanity into groups based on a variety of physical traits attributed to a hypothetical intrinsic characteristic

provisional diagnosis

A diagnosis can be provisional if there is a strong presumption that the full criteria will ultimately be met by an individual but there's not enough info to make a full diagnosis. ex. A person can't give a reliable or adequate history. The diagnosis relies on time frame.

ethnicity

A group identity used to define peoples and communities that usually have a shared history, language, geography, etc.

cultural syndrome

A group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context. It may not be recognized as an illness within the culture, but it may be recognized as a pattern of distress or feature of illness by an outside observer. ex. ataque de nervios

cultural idiom of distress

A linguistic term, phrase, or way of thinking about suffering among individuals of a cultural group. Shared concepts of pathology and shared ways of expressing, communicating, or naming features of distress. These are not necessarily related to a specific diagnosis or illness. They can be used to convey a wide range of discomfort. ex. kufungisisa

How do you write a cultural formulation?

A narrative that is not more than two pages and includes five paragraphs P1 Cultural identity of the individual P2 Cultural conceptualization of distress P3 Psychosocial supports and stressors P4 The therapeutic relationship P5 Overall cultural assessment

Cultural formulation interview (CFI)

A set of sixteen questions that helps clinicians to obtain information during a mental health assessment about the impact of culture on an individual's clinical presentation and care. semi-structured interview person centered

khyal cap ("wind attacks")

A syndrome found among Cambodians in the United States and Cambodia. Symptoms include ... * dizziness * palpitations * shortness of breath * cold extremities * catastrophic cognitions that khyal (a windlike substance) may rise in the body and cause a variety of physiological effects.

cultural explanation or perceived cause

An explanatory model that provides a culturally conceived etiology for symptoms, illness, or distress. ex. maladi moun

nervios ("nerves")

An idiom of distress among Latinx people in the US and Latin America. It includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function.

kufungisisa ("thinking too much")

An idiom of distress and a cultural explanation for distress among the Shona of Zimbabwe. As an explanation, the cause of anxiety, depression, and somatic problems. As an idiom, interpersonal and social difficulties. It's usually characterized by rumination.

person in environment system

By the NASW and is used for classifying common life problems of adult social work clients. It allows for the appraisal of four "operationalizing factors," with Factor I describing the client's social role and functioning, Factor II addressing the client's current environment, Factor III being used to provide a DSM diagnosis, if appropriate, and Factor IV provides for describing one or more ICD-10-defined medical diagnoses, if known. There's no studies about reliability or validity.

denialism

Denies the existence of mental disorders entirely. Thomas Szasz criticized psychiatric care as being a form of social control usually used on those deemed "socially unacceptable." Person-centered theory is opposed to diagnostic classification Family systems therapists do not believe in individual psychopathology but instead interpersonal problems and behavioral disorders with their origins in past and present family dynamics. Solution focused therapy looks at client's strengths and potential solutions, not problems and diagnosis.

cultural features of the therapeutic relationship

Differences in culture, language, status, etc. between the person and the clinician. ex. experiences of racism in the larger society may preclude establishing trust in a trans racial therapeutic relationship.

The DSM-5 begins with __________.

Disorders that are thought to manifest early in life. The DSM itself and each chapter is organized so that disorders are considered in the context of lifespan and development.

True or false. The DSM-5 uses a multi-axial system.

False.

True or false. The DSM-5 includes the full range of psychopathology.

False. That's why there's other specified disorder and unspecified disorder.

True or false. The DSM-5 can be used by legal professionals.

False. The DSM was developed to meet the needs of clinicians, public health professionals, and researchers and not the technical needs of courts or legal professionals. HOWEVER, the DSM can be used to facilitate legal decision makers' understanding of the relevant mental disorder. The DSM has risks and limitations in forensic settings.

True or false. The organization of the disorders in the DSM-5 is significant.

False. The groupings and the orders of the diagnoses are not scientifically significant

Are DSM categories fluid or rigid?

Fluid. A single symptom can occur in many disorders and disorder categories are fluid over the life course.

In a study by Kirk and Hsieh, what was found when more context was given to clinicians reading case histories?

If a client's behavioral, affective, cognitive problems could be attributed to their lived experiences ... * Not as likely to be given a formal diagnosis * Not as likely to be given meds * Treatment would usually emphasize person in environment interactions

The DSM-5 and ICD-11 organize disorder according to __________.

Internalizing (ex. depression, anxiety) or externalizing (ex. disruptive conduct, impulsivity) factors.

The __________ is an international counterpart to the DSM

International Classification of Disorders (ICD-11)W

Why is there controversy about the DSM-5 including obstructive sleep apnea-hypopnea?

It has a physical cause and the treatment is usually something physical.

psychosocial stressors and cultural features of vulnerability and resistance

Stressors and supports in the person's environment and the role of religion, family, social networks in providing emotional, instrumental, informational support.

overall cultural assessment

Summarize the implications of the cultural formulation for diagnosis and intervention.

functional behavioral assessment

The clinician uses social learning theory to explain the cause of a client's presenting problem. The behavior is measured. Hypotheses are made as to what function the behavior is serving for the client. Treatment is done through removing averse conditions, providing new consequences, changing the client's conditions.

cultural conceptualization of distress

The cultural constructs that influence how an individual experiences, understands, and communicates his/her/their symptoms. How severe is the distress in relation to the norms of the cultural reference group? How do coping and help-seeking patterns compare to the cultural reference group?

cultural identity of the individual

The person's race, ethnicity, or culture. For immigrants and racial or ethnic minorities, the degree and type of involvement with culture of origin and host culture are noted separately. (ex. language abilities, religious identification)

Specifiers

These are not mutually exclusive and are not exhaustive. These can include severity, course (ex. partial remission or full remission), and descriptive features (ex. with poor insight, with medical comorbidity).

What is the primary purpose of the DSM-5?

To help trained clinicians in diagnosis as part of a case formulation that leads to a fully informed treatment plan.

True or false. Critics of the DSM contend that a mental disorder must have a mental etiology, not just adversely effect mental functioning.

True

True or false. The DSM-5 includes nine pathways of mental disorder and three potential sources of disturbance in its definition of mental disorder that are UNSUPPORTED by current research evidence.

True

True or False. Clinical training and expertise is needed to use the DSM because one must be able to distinguish between a disorder and normal life variation and responses to stress.

True.

True or false. The Cultural Formulation Interview can be given to an informant.

True.

True or false. The DSM and the ICD have been separating the concepts of mental disorder and disability.

True.

True or false. The case formulation for any give client must involve a clinical history and summary of factors that may have contributed to the development of a disorder.

True.

True or false. Attention to situational context and to surrounding environments is also largely ignored in the DSM-5

True. For example, previous versions of the DSM advised that conduct disorder not be diagnosed if the client is exposed to a high risk living situation or pathological environment. If aberrant behavior can be attributed to external causes, there's less support that something is caused by a problem within the individual.

True or false. Culture is relevant when examining the criteria for diagnosis.

True. Sociocultural norms vary and so what is abnormal in one location or community may be normal in another.

True or false. The DSM uses field trials.

True. The DSM used field trials with two distinctive designs: one in large medically-academic settings and the other in routine clinical practices.

The DSM-5 replaces the previous Not Otherwise Specified (NOS) with ... ?

Two options for clinical use: other specified disorder and unspecified disorder. Other specified: The clinician communicates why the presentation does not meet the criteria for any specific category within a diagnostic class Unspecified: The clinician does not communicate why the presentation does not meat the criteria for any specific category within a diagnostic class.

Sex differences

Variations attributable to an individuals reproductive organs or chromosomes.

Gender differences

Variations attributable to biological sex as well as an individual's self representation.

Prognosis

What is the likelihood of this particular outcome for a patient with this disorder?

principal diagnosis

When one or more diagnosis is given, the condition that is primarily responsible for the individual's admission (in an inpatient setting) or the reason for seeking treatment (in an outpatient setting). The principal diagnosis is listed first and then the other diagnoses are listed in order of focus of attention and treatment.

dhat syndrome

Young male patients in South Asia attributed various symptoms to semen loss. It's a cultural explanation for distress.

International Classification of Disease

a comprehensive system of medical diagnosis that includes sections on mental and behavioral disorders, but includes biologically caused disorders and has poor inter-rater reliability.

Ataque de nervios ("attack of nerves")

a syndrome among Latinx people that is characterized by... *Generally, a sense of being out of control * intense emotional upset including anxiety, anger, or grief * screaming or shouting uncontrollably * attacks of crying * trembling * heat in the chest or head * verbal and physical aggression It can also include fainting, dissociation, suicidal gestures. It may clinical or sub clinical (ex. at a funeral) Cultural syndrome

mental disorder

a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning These DO NOT include socially deviant behavior or behavior that is abnormal in one culture but not abnormal in another culture.

Major Premise People with social anxiety disorder avoid crowds. Minor Premise Bruce avoids crowds. Conclusion Bruce has social anxiety disorder. This is an example of which reasoning error?

affirming the consequent

Prognosis includes _________ factors and __________ factors.

prognostic, risk

culture

systems of knowledge, concepts, rules, and practices that are learned and transmitted across generations. (ex. language, religion)

cultural concepts of distress

ways in which cultural groups experience, understand, and communicate suffering