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Modern Psychiatric Epidemiology

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Psychology 2320A/B
Elizabeth Hayden

25/09/2012: Lecture 3 Modern Psychiatric Epidemiology  Prior to 1980s, quality of information was poor  Studies of adults: o 1980 – Epidemiological Catchment Area (ECA) Study o 1994 – National Comorbidity Survey (NCS)  Studies of children are less common and more complicated  When trying to figure out if a child has symptoms of a disorder, who we ask is important – parents, child, etc. Costello et al. (2003) Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence  Longitudinal study of 1420 unselected children aged 9-13  Children were followed-up (generally every year) until age 16  What is the prevalence and incidence of childhood disorder?  What is the heterotypic and homotypic continuity of childhood psychopathology?  KNOW HETEROTYPIC AND HOMOTYPIC FOR EXAM  Childhood and adolescent psychiatric assessment (CPA) used o A structured clinical interview  Child and parent are both asked about the presence of child psychiatric symptoms  If either endorses a symptom, it is counted as present  Three month prevalence of any disorder was 13%  “Lifetime” prevalence (for the duration of the study) of any disorder was 37% (31% of females, 42% of males)  Children with a diagnosis at any time were 3X more likely to have a diagnosis later on  Homotypic continuity significant  Heterotypic continuity significant o Anxiety and depression o ADHD and oppositional defiant disorder  Girls > boys on heterotypic continuity and comorbidity o In other words, although fewer females than males had a disorder, females tended to be more severe when ill What is Classification?  Classification of mental disorders: branch of psychiatry/clinical psychology concerned with description of disorder o Also known as psychiatric taxonomy o Based on symptoms Advantages of Classification  Theory  Description o Essential for research if any kind o Essential for discovering etiological factors  Prediction (e.g. predict treatment response)  Communication Drawbacks of Classification  Labeling  Expectancy fulfillment/self-fulfilling prophecy  Loss of information or uniqueness  Boundary cases – meet criteria of the illness, but don’t fit the prototype  Classification systems such as the DSM-IV are sometimes described as “procrustean” Evolution of DSM  DSM: classification system for mental disorders  Five major versions: o DSM-I (1952) o DSM-II (1968) o DSM-III (1980) o DSM-III-R (1987) o DSM-IV (1994)  Everything since DSM-III have been alike, which were altogether different from the first and second (important transition)  Pre-1970, most clinicians uninterested in diagnosis  Psychoanalytic theory was predominant way of thinking about the field during the time period  Rise of biological psychiatry, attempts to make psychopathology a “modern” science  Diagnosis increasingly viewed as important but reliability was low (agreement between clinicians)  Inter-rater reliability = agreement between raters on a diagnosis  Often measured using Kappa, which accounts for chance agreement o Greater than 0.75 is good, lower than 0.40 is poor  Prior to DSM-III, reliability was low o US/UK Cros
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