LECTURE NOTES 2 : Diagnosis and the DSM

DIAGNOSIS

Definition: Is the process of determining whether the particular problem afflicting the individual meets all the criteria for a possible psychological disorder.

We need to use clinical information and research information in order to make inferences about what will happen next and what treatments may work.

I Questions useful to answer to make appropriate prognosis

What in the past did people come in with as similar problems or similar psychological profiles?

1 how did these problems begin for other individuals?

2 What factors seemed influential?

3 How long did the problem or disorder last?

4 did the problem for others just go away on its own? And, if not what kept it going?

5 What treatment seemed to relieve the problem?

Therefore we can then determine the PROGNOSIS.

II- In order to make some initial DIAGNOSIS we attempt to classify the disorder based on accumulated information which is a label we attach to a set of symptoms that go together.

Most mental health professionals use the classification system known as the Diagnostic And Statistical Manual Of Mental Disorders.- from this we get a set of symptoms thought to be observable manifestations of an underlying disorder which we refer to as a SYNDROME.

THE DSM

1 started in 1952

2 DSM IV final revision 1994

3 DSM IV- has improved reliability - review text p.51 table 2.8

a it identifies the number of symptoms necessary for it to be a legitimate disorder.

b Stipulates the length of time that one must experience the symptoms.

c Symptoms must interfere with occupational and social functioning as well as personal interference.

d It stipulates how to make a Differential Diagnosis i.e. which of two or more disorders are possible.- related to the prevalence and course of the disorder.

PREVALENCE

Definition: the number of people who have a disorder during a specific period of time in a specific population

Point prevalence- number of people who have a disorder at one given time.

Lifetime prevalence- number of people who will have a disorder at some time in their lives.

Incidence- is the number of new cases that develop during a specific period of time (usually 6-12 months).- present the prevalence chart in class as examples.

The most comprehensive study in the U.S. regarding 30 major mental disorders- in L.A., St. Louis, New Haven, Baltimore , and Durham. With 20,000 subjects. Findings were as follows;

1 Lifetime prevalence of any disorder-32%

2 One of 5 people had an active disorder in prior year.

3 Higher rates associated with being poor,not finishing high school.

4 Rates- 41% Baltimore, 28% New Haven.

5 Most common phobias and alcohol abuse.

6 38% of people with history in remission

7 1 half of people with major disorders free of symptoms prior year.

8 Most likely undeserved were children, elderly, minorities, poor, physical disabilities.

9 Average age of first symptoms was 16.

10 Expressed needed programs focusing on children and adolescents.

COURSE - length of time that a disorder typically lasts and the likelihood for a relapse following the current episode.

THE MULTIAXIAL SYSTEM (5 axes ).

Refer to p.56 HOEKSAMA table 2.14

Axes I and II for diagnosis

Axes I: 1. does not include mental retardation or personality disorders

2. does not include chronic or acute problems- chronic refers to long term or lifelong, and acute is recent or abrupt symptoms which could be more severe.

Axes II: Includes mental retardation or personality disorders- usually chronic or pervasive or lifelong.

Axes III: Includes medical conditions or physical diseases.

1 look to see if they may or may not be related to the mental disorder

2 if they are causing mental distress helps understand origins of the problem e.g. accidents, diseases leading to depression.

Axes IV : Psychosocial and environmental stressors

Axes V : GAF - Global Assessment of Functioning.

1 severe or mentally debilitating

2 suicide and related stages- ideation to plans and or attempts

stages: ideations to plans to attempts

The multiaxes system allows us to integrate social and cultural influences on the diagnosis. Cultural expressions and life styles are considered. Additionally it considers the impact from disabilities on ones mental state.

Cultural and Gender Bias also exist in diagnosis- e.g. are women or men's roles biased by labels as in Dependent personality disorder.