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Lecture 3

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University of Toronto St. George
Hywel Morgan

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 - doesnt mean that children cant show symptoms outside of these diagnostic categories CLASSIFICATION AND ASSESSMENT DIAGNOSIS - 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 its 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 - 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 reliable 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 - DMS IV/ICD 10 - the systems that are derived from consensus - the other types of systems are empirically derived derived from statistics - DSM IV is a clinically derived system - 1 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 - CATEOGORIES OF DISORDERS WILL NOT BE ON THE MIDTERM - 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 diagnoses- 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 (youre stuck with them) but they can be treated, but typically they dont go away- once youre diagnoses with ASPD its not going anywhere 1 childhood disorder on axis 2: mental retardation, cant cure it - Axis 3: *relevant physical conditions behaviour of abnormal children that exhibit symptoms of autism for ex infants of autism arent 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 thats not accomplished the consequenc
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