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Chapter 3

TEXTBOOK Chapter 3 - Classification and Diagnosis

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Hywel Morgan

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Notes From Reading C HAPTER  3: CLASSIFICATION AND D IAGNOSIS (PGS. 48­64) Why Do We Need a Classification System for Mental Disorders? - Adiagnostic system for mental disorders provides a description of a disorder. It allows for the use of universal vocabulary so that clinicians can effectively communicate. - An assessment is the procedure through which information is gathered systematically in the evaluation of a condition; this assessment procedure yields information that serves as the basis for a diagnosis. - Amental health assessment may include interviews, psychophysiological or psychological testing, and the completion of self-report scales or other report rating scales. The Perfect Diagnostic System - The perfect diagnostic system would classify disorders on the basis of: o Presenting symptoms: the patterns of behaviour o Etiology: the history of the development of these symptoms and underlying causes o Prognosis: the future development of this pattern of behaviour o Response to treatment Characteristics of Strong Diagnostic Systems - Reliability: a diagnostic system must give the same measurement for a given item every time o Inter-rater reliability: the extent to which two clinicians agree on the diagnosis of a particular patient. - Validity: validity is determined by whether a diagnostic category is able to predict behaviour and psychiatric disorders accurately. o Concurrent validity: the ability of a diagnostic category to estimate and individual’s present standing on factors related to the disorder but not themselves o Predictive validity: the ability of a test to predict the future course of an individual’s development The History of Classification of Mental Disorders - The interest in the classification of psychopathology dates back to at least the middle ages. - The International Statistical Classification of Disease, Injuries, and Causes of Death was formed in 1948 - The American PsychiatricAssociation published the Diagnostic and Statistical Manual (DSM) in 1952. - The first and second edition of the DSM was atheoretical; they moved away from endorsing any one theory of abnormal psychology, becoming more pragmatic as they moved to more precise behavioural descriptions. Notes From Reading C HAPTER  3: CLASSIFICATION  AND  DIAGNOSIS  PGS . 48­64) - DSM III was developed to be polythetic, meaning that an individual could be diagnosed with a certain subset of symptoms without having to meet all criteria. - The multiaxial addition required diagnosticians to provide substantial patient information, evaluating and rating patients on 5 axes of functioning. - The DSM-IV-TR (text revision) was previously used in Canada, and the DSM-5 is used now. DSM-IV-TR: AMultiaxialApproach Axis I Clinical Disorders: included inAxis I are the psychological disorders that have been recognized for centuries because of their bizarre nature (ex. schizophrenia) or the difficulty they pose in the everyday life of individuals (ex. mood disorders) Axis II Personality Disorders: focuses on the presence of generally less severe long-term disturbances, which nevertheless may interfere with a person’s life. WhileAxis I reflects what a person has, Axis II reflects who the patient is Axis III General Medical Conditions: covers any medical disorder that might be relevant to understanding or managing the case. This axis recognized that medical disorders may cause psychological disorders, or they may affect future development or treatment (ex. a person becomes paralyzed in a car accident and developed depression) Axis IV Psychological and Environmental Problems: collects information on the patient’s life circumstances, recognizing that individuals live within a social milieu and that stressful social circumstances might contribute to symptom onset. Axis V GlobalAssessment of Functioning: measures how well a person is able to cope with the circumstances related to his or her problems. This information can be indicative of the need for treatment and of the person’s coping mechanisms and can assist in planning interventions. Categories of Disorder in DSM-IV-TR Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence - Included here are the intellectual, emotional, and physical disorders that typically begin before maturity. - Attention deficit/hyperactivity disorder: children display maladaptive levels of inattention, hyperactivity, or impulsivity - Oppositional defiant disorder: child displays a reoccurring pattern of negative, defiant, disobedient, and hostile behaviour towards authority figures - Conduct disorder: children persistently violate societal norms, rules, or the basic rights of others - Separation anxiety disorder: child becomes excessively anxious over the separation from parents and caregivers - Mental retardation: below-average intelligence with impairments in social adjustment - Autistic disorder: child shows severe impediments in several areas of development, including social interactions and communication Notes From Reading C HAPTER  3: CLASSIFICATION AND  DIAGNOSIS  (PGS. 48­64) - Motor skills or communication disorder: individual experiences developmental problems with coordination and the reception or expression of language - Feeding and eating disorders: involves eating substances with have no nutritional value (ex. sand or feces) - Tic disorders: the body moves repeatedly, quickly, suddenly, and uncontrollably (can be physical or vocal) - Elimination disorders: the repeated passage of urine or feces at inappropriate times and places Delirium, Dementia,Amnesia, and Other Cognitive Disorders - Delirium: a clouding of consciousness, wandering attention, and an incoherent stream of thought.Associated with poor diet and substance abuse - Dementia: a deterioration of mental capacities, is typically irreversible, and is usually associated withAlzheimer’s disease, stroke, several other medical conditions, and substance abuse - Amnestic syndrome: impairment in memory when there is no delirium or dementia, and is linked to alcohol abuse Substance-Related Disorders - These disorders are caused by the excessive use of a substance, which is anything that is ingested in order to produce a high, alter one’s senses, or otherwise affect functioning. - Included in this category are alcohol use disorders, opioid use disorders, amphetamine use disorders, cocaine use disorders, and hallucinogen use disorders Schizophrenia and Other Psychotic Disorders - Schizophrenia: severe debilitation in thinking and perception. People with schizophrenia suffer from a state of psychosis, often characterized by delusions (false beliefs) and hallucinations (false perceptions). - Thought disorder is often prominent, characterized by incoherent speech, loose associations (unconnected pieces of thought), inappropriate affect (ex. laughing at a funeral), and disorganized behaviour (ex. public masturbation) Mood Disorders - Major depressive disorder: a person is extremely sad and discouraged, and displays a marked loss of pleasure in usual activities. Depressed people often have severe problems sleeping, experience weight loss or gain, lack energy to do things, have difficulty concentrating, and feel worthless, hopeless, and sometimes suicidal. Notes From Reading C HAPTER  3: CLASSIFICATION  AND  D IAGNOSIS  PGS . 48­64) - Mania: a condition in which a person seems extremely elated, more active, and in less need of sleep, and displays flights of disconnected ideas, grandiosity (an illusion of personal importance), and impairment in functioning - Bipolar disorders: both depression and mania are exhibited - Dysthymia: chronic low-grade depression - Cyclothymia: the person fluctuates between more mild bouts of mania and less severe depressive symptoms. Anxiety Disorders - Individuals experience excessive fear, worry, or apprehension; the excessive fear usually produces a maladaptive pattern of avoidance - Phobia: intense fear of a specific object or situation - Obsessions: recurrent, unwanted, and intrusive thoughts - Compulsive: strongly repetitive behaviours - Acute Stress Disorder or Post Traumatic Stress Disorder: experience long-standing anxiety subsequent to exradordinary traumatic events - Social Phobia: extreme fear of social situation - Panic Disorder: experience panic attacks and fear that they will go crazy, have a heart attack, or die - Generalized Anxiety Disorder: difficultly controlling excessive worry - Anxiety disorders and mood disorders are often diagnosed in the same individuals at the same time Somatoform Disorders - Physical symptoms have no known physiological cause - Somatization Disorder is characterized by a long history of bodily problems, including symptoms of pain, gastrointestinal function, sexual function, and pseudoneurological symptoms - Conversion Disorder: person reports the loss of motor or sensory function - Pain Disorder: experience severe, prolonged and unexplained pain believed to stem in part from psychological factors - Hypochondriasis: the misinterpretation of minor physical sensations as abnormal - Body Dysmorphic Disorder: preoccupied with an imagined defect in their appaearance Factitious Disorders - This diagnosis is given to individuals who intentionally produce or complain of either physical or psychological symptoms - Due to a psychological need to assume the role of a sick person Dissoc
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