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Lecture 3

PSY341H1 Lecture Notes - Lecture 3: American Psychiatric Association, Diagnostic And Statistical Manual Of Mental Disorders, Dsm-5

Course Code
Hywel Morgan

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Lecture 3
- in chronological order, assessment, diagnosis and treatment this is the
order in which these occur usually
- in child clinical psych we will talk about assessment, dag, and treatment
- this process is somewhat like the process like adults, but certainly during
assessment the process changes
- during diagnosis there is a separate section in DSM that CAN be used for
disorders that can show up childhood
- doesn’t mean that children can’t show symptoms outside of these diagnostic
- uses the same tool, medical tool, that you would with adults, just a different
sections of it DSM IV TR
- there are only 2 professions that can do this physicians and psychologists
- this is the tool that is used here in north America
- it is published by American psychiatric association a group of physicians,
mostly psychiatrists it’s a MEDICAL tool
- devised for the American psychiatric association
- there were psychologists involved in constructing it
- this is the tool that is widely used in north America Canada & US
- the rest of the world does not use this tool
- the rest of the world uses the ICD 10: international classification of diseases
- there is a significant overlap
- when you report a disorder for OHIP purposes, they use ICD-10
- there is significant overlap between the 2 systems the goal since 1995 has
been to make these 2 tools completely compatible
- they are not right now
- ICD 10 published by WHO a division of the UN
- There are disorders that DSM recognizes and ICD does not and vice versa
- DSM IV: American psychiatric association, used widely and extensively in
US & Canada
- ICD 10: WHO, rest of world and US and Canada when reporting for
insurance purposes in ICD 10 codes
- Trying to move people away as being diagnosed as __________ ic
- Rather we want something like person has this disorder
- In mental health the label tends to stick with you and can be stigmatizing
- #1 harm of a diagnosis is stigma
- 1 of the major disadvantages of being diagnosed with DSM IV is the poor
validity this can lead to misdiagnosis (negative correlation) the chance
of misdiagnosis is pretty high because of the poor validity

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- even though the validity is not so great, reliability is pretty good
- DSM IV does have utility although the validity is not great, it is useful
this is because when it does get it right, get the right treatments!
- Major disadvantage of a diagnosis = stigmatizing
- Major benefit = selection of treatment
- Each of the categories of DSM IV, the last category is called NOS not
otherwise specified
- Its very easy to identify abnormal behaviour but difficult to categorize it
- NOS problem decreased validity = misdiagnosis
- there have been concerted efforts to make other systems i.e. only for
children, not widely used
b. introduction
c. what makes a good classification system
1. the categories are clearly defined: DSM does do a good job of these;
what symptoms are necessary to provide a diagnosis for said
category the problem with DSM is a significant overlap in
categorical symptoms from one disorder to another which again
can lead to misdiagnosis
2. the categories exist: the person who is being given the diagnosis has
those set of symptoms the features/symptoms are observed to
occur together regularly statistically we can do this factor
analysis or consensus/opinion (DSM has been derived like this)
3. there is reliability: test-retest and inter-rater; because of the clearly
defined categories, the reliability must be there makes DSM quite
4. there is validity: categories are clearly discriminable from one
another DSM IV has greater reliability than validity there is
significant symptom overlap so validity not the greatest
5. clinical utility: its useful the DSM is useful
d. clinically derived systems
- the systems that are derived from consensus
- the other types of systems are empirically derived derived from
- DSM IV is a clinically derived system
- 1st introduced in the 1950s
- had only 2 categories relating specifically to child disorders which were
expanded on each new version
- today, DSMIV has 10 categories of disorders relating to mental health
issues for children
- there will be a significant change in childhood disorders for DSM V
- DSMIV 1 of the reasons it has a lot of utility is because it provides a
diagnosis on 5 axis/dimensions
- There are 5 dimensions that the physician has to look at to provide a

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- Axis 1: primary presenting complaint what are you hear for today
look at these in the context of the other 4 axis, DSM IV does permit you
from diagnosing on axis 1 a comorbid disorder allows for comorbid
disorders on axis 1 treat in the context of the other 4 axis
- Axis 2: disorders that generally we have acknowledged are relatively
permanent they can be treated, but relatively permanent conditions
for adults these are usually referred to as personality disorders (you’re
stuck with them) but they can be treated, but typically they don’t go
away- once you’re diagnoses with ASPD its not going anywhere – 1
childhood disorder on axis 2: mental retardation, can’t cure it
- Axis 3: *relevant physical conditions behaviour of abnormal children
that exhibit symptoms of autism for ex infants of autism aren’t
interacting with people in a normal way, may be misdiagnosed as deaf
so we want to know the physical condition of that person!
- Axis 4: the severity of psychosocial stresses: stress in environment is
one of the leading causes of mental disorders - #1 condition that will
lead to that expression of vulnerability is stress we assess what those
stressors are specifically i.e. removal of caregiver primary psych job
of an infant is to attach itself to a caregiver and if that’s not
accomplished the consequences are dire
- Axis 5: global assessment of functioning over a 1 year period what
does their global functioning look like occupation, relationships,
recreational how are you functioning in your environment
(responding to stressors) in your entire environment, school, home,
work, social how are you doing everywhere? Abnormal if its impeding
functioning OR intensity/duration/frequency
- Grade them on a scale from 1-100 1= poor, 100 = high
- The lower the number, the poorer the functioning, the poorer
the prognosis (outcome)
- Functioning sometimes requires support
- If you’re not getting support the prognosis is not very good
- What’s you level of functioning and the level of support in
your environment
- BUT some of these conditions fluctuate i.e. BP
- Axis 2-5 Providing context for the axis 1
e. factor analysis empirically derived system
- derived wholly on factor analysis what symptoms go together
- very poor utility
- a lot of these syndromes have symptoms in common, so these
empirically derived systems often have poor utility
- not sophisticated enough yet
f. advantages and disadvantages of diagnosis
- advantages
- selection of treatment
- helps in the research of mental disorders
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