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PSY341H1 Lecture 3

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Hywel Morgan

PSY341H1S L3; July 10, 2013  Now use DSM V (Diagnostic & Statistical Manual) Diagnosis & Assessment o More clinically derived (derived by consensus) than empirically or statistically derived Diagnosis  This problem w ICD too o Published by American Psychiatric Association A) Introduction o Only ppl who are licensed, can use DSM to diagnose  One of the most contentious issues in applied psychology o Used commonly in USA, Canada, UK, Japan  Requires giving an indiv client or patient  The statistics are taken from America o Ppl still use DSM IV-TR categories  Required for treatment in US & Canada – so that insurance covers it o The term “mental retardation” has been removed, o In Ontario, government pays for treatment, put changed to “intellectual disability/disorder” – due to requires a diagnosis – a Label (-)ve stigma o A lot of symptom overlap – not what Kraepelin B) What makes a good classification system? wanted (father of categorizing psychiatric disorders)  A diagnostic system is classifying, grping a set of symptoms  Disorders have separate unique symptoms  Syndromes (grps of symptoms) occur in together  When these symptoms occur together & interfere w your daily categories living and enjoyment of things  give label o Calling things Spectrum Disorders instead of dif types of the disorder 1. Categories are clearly defined  Ex. Schizophrenias – dif symptoms occur in a. DSM 4,5: very clearly say what the symptoms must be & for how long, frequency, intensity, duration, high dif degrees in dif ways in dif ppl degree of specificity o Eliminated the childhood section  put into other categories since adults can have them too b. ICD: very highly defined 2. Categories exist (Symptoms have to occur together  Ex. Pica (eating inappropriate objects regularly) now in eating disorder category since can occur at any age – tends to spontaneously a. Important for treatment b. DSM V: Spectrum Disorders (ex. schiz, autism) remit (go away) 3. Reliability – get same diagnoses from dif psychologists,  Ex. we now know that kids don’t grow out of and on same person if still untreated ADHD: As you grow older, adults learn strategies to cope for their deficits – partially a. DSM IV,V: successful in selecting treatments, however there is a high degree of misdiagnosis – because of neurodevelopment since LOW validity  For hyperactivity & attention, but not for impulsivity i. Gives ICD codes along w DSM (compatibility) b. ICD: same as above 4. Validity  ICD – International Classification of Diseases a. Symptom overlap  got rid of ___-like disorders o Developed by World Health Organization (WHO) i. Can be easily misdiagnosed  Part of the UN ii. Ex. Major symptom for both depression & o Mostly used the in rest of the world bipolar disorder is sad affect – in BP 2, the  Statistics taken from around the world o In version 10 mood swing is so quick & mild that you can miss it o Version 11 in 2014 b. Clinically derived  low validity, low reliability o Significant overlap btwn the 2 diagnostic systems 5. Clinical utility a. Useful  2 main reasons for developing DSM V b. However significant misdiagnosis o Make 100% compatible w ICD (was already 95%) o Make more statistical  increase validity  Gathering more data, thru Factor Analysis C) Clinically derived systems  Haven’t collected enough data yet, so not Two Major Classification Systems successful  so use Spectrums  Info from experts, non-experts, clinical  DSM – 1952 o 2 child categories: Child schizophrenia & Mental nurses, patients, etc... but ended up being retardation clinically derived  DSM2 – 1962 o Failed at both  DSM 3- 1977  Then DSM 3r (revision) – changed criteria DSM IV – TR  DSM 4  Multi-axial system – diagnosis provided along 5 axes o 1, 2, 3 – most important for immediate presenting  DSM IV – TR (text revision) – made it easier to understand o Separate section – disorders usually diagnosed in complaint childhood or adolescence  What diagnosis is based on  Eliminated in DSM V  10 diagnostic categories  Must usually occur in childhood or o 1 – Existing mental or developmental disorder adolescence  Frequent comorbidity (2 or more disorders in same person) – ex. ADHD & Conduct  Ex. depression doesn’t need to be there, but disorder often comorbid due to impulsivity children can still be diagnosed w it o 2 – Personality Disorders & Mental Retardation o Ex, call ppl “Schizophrenics”  Acknowledgement that can’t be treated & are relatively permanent Assessment  All of the personality disorders remain on  Usually comes before Diagnosis DSM V  3 types: Interview, Testing, Observation  Depressive personality disorder was  Usually done by Psychologists on DSM II, didn’t get to DSM V o Testing: Collecting data about norms  o 3 – Relevant physical conditions comparing indivs to norms  Frequently, psychopathology can be  Encyclopedia published every 2 yrs since late 1940s w new misdiagnosed as a physical condition thousands of new psychological tests  Ex. Hallmark of autism is a child that is not  Psychiatrists – interview, observation interacting socially w indivs around them in anyway, interact w inanimate objects – not A) Referral antisocial, but asocial – makes them seem  1 part of assessment process deaf  Can be done by dif health professionals (GP, teacher, nurse, o 4 – Severity of psychosocial stresses psychologist, psychiatrist, school psychologist)  Nurture – primary contributing factor is o School psychologist – specialized in diagnosing & stress o 5 – Measurement of Global Assessment of Fn’ing treating children at school  Only need a masters degree in the Past Year  Cut from many school due to budgets  GAF o Can be court-ordered  Score from (low fn’ing – ex don’t see point of  The initial interaction of the child w some kind of professional, tying shoelaces) 1 – 100 (high fn’ing – can typically because there is a problem that has become work, have relationships) significant in the child’s development & affects others  Lower GAF score  lower prognosis  Parents – afraid of stigma, uninformed, in denial, don’t want to  Not in DSM V pay, etc. o So children usually brought when situation is dire DSM V  When child affects others: ex. withdrawal,  Section 1: How diagnosis is constructed acting out, not going to school  Section 2: Diagnostic categories  Initial assessment, triage o No axes 1-3, 5  Referral gives us clues about what to ask in an interview, o List all the disorders how to go about the testing, parent & child’s motivation o Have section on Neurodevelopmental Disorders (first got seeking help and treatment section) – autism, mental retardation  Strong belief that autism & mental o Ex. if Court-ordered assessment of conduct disorder – low motivation of child; incentive = not going to jail retardation occur together o Low motivation if child feels like damaged goods  Dr. Donnelan’s facilitated communication – debunked; doesn’t exist in severely autistic (mistreated by parents) o Low motivation is seen right away – aggressive children o Anxiety – needs to be addressed immediately so  Give dif Qs to autistic child & that the child can interact socially and give data facilitator  the facilitator’s Qs were  Ex. toys  develop (+)ve relationship answered (report) w child  Can’t use IQ tests for autism since asocial –  Looking at affect hard to determine if autism is a type of  If don’t develop a report  won’t get good info, won’t get good mental retardation therapeutic relationship, won’t respond (+)vely to  Section 3: Potential new diagnosis psychotherapy o So technically DSM V isn’t finished o Don’t have enough info yet  Orientation of major problems, basic info (primary symptoms, duration, onset, medical status)  formal  Developed in secrecy assessment D) Factor analysis B) Clinical Methods (Formal Assessment)  Very sophisticated statistical analysis  Collecting lots of data 1. Clinical observation  Finding trend of symptoms that go together regularly  Children – usually doesn’t require verbal interaction  What they do, how they present themselves, what they natural E) Advantages & disadvantages of diagnosis do in dif envts  Major benefit: selection of treatment  Natural bhvr of 6 yr old is playing – testing new bhvrs, o If diagnosis accurate, treatment more likely to be modelling bhvrs they’ve seen successful o Ppl might be nicer to you  Give child toys  observe
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