Mental Health Dot Point: “systems of classification of mental conditions and disorders: underlying principles of classification; strengths and limitations of discrete categorical (DSM-IV and ICD-10) and dimensional (graded and transitional) approaches to classification of mental disorders”

Mental Health
Dot Point: “systems of classification of mental conditions and disorders: underlying principles of classification; strengths and limitations of discrete categorical (DSM-IV and ICD-10) and dimensional (graded and transitional) approaches to classification of mental disorders”

Categorical approach

The ICD-10 (International classification of diseases and related health problems)
. Categorical system for diagnosing and classifying mental disorders based on recognisable symptoms that are precisely described for each disorder
. Only 1 chapter dedicated to mental health but is still detailed
. Distinguishes between mental and behavioural disorders (unlike DSM)
. Less detailed in terms of prevalence, course and prognosis of each disorder

Categorical vs Dimensional approach : refer to Edrolo table in summary (Figure 1)

Dimensional approach

Principles and Assumptions:
. A ‘yes/no’ approach (you either have the disorder, or you don’t) to classification that fits people into a specific category of mental disorder
. Consists of identifying a disorder(s) that best matches or reflects the symptoms presented by an individual
. Assumes that:
a mental disorder can be diagnosed from specific symptoms reported or shown by an individual
thoughts, feelings and behaviour can be representative of a disorder, and that these characteristic patterns of symptoms that represent the disorder do not represent any other disorder
disorder categories allow for wide variation in patterns of thoughts, feelings and behaviour described for a disorder
valid and reliable:

validity = classification system actually organises mental disorders into distinct and discrete disorders
reliability = classification system produces the same diagnosis each time it is used in the situation

Strengths and Limitations of dimensional approaches:

EPQ-R / MMPI / Big Five Inventory:
Refer to p497-499 Grivas for graphs and explanations, or to extra pages in summary \
. Underlying assumption is that everyone possesses every dimension to some degree, just at different points along the continuums

EPQ-R (Eysenck Personality Questionnaire - Revised): an inventory
. Measures 3 dimensions: extraversion-introversion / neuroticism-emotional stability / psychoticism
. Scores show ‘how much’ or ‘how little’ a person has of each dimension and degrees of psychological dysfunction

MMPI (Minnesota Multiphase Personality Inventory)
. Uses 10 dimensions
. 10 dimensions in study that both people were tested on, comparing a non-aggressive male who had never committed a crime to the Hillside Murderer - MMPI-2 (Figure 12.21 in summary)
. Scores before and after treatment (of depression in Figure 12.22 in summary)

Big Five Inventory
. The big five traits: openness to experience, agreeableness, conscientiousness, extraversion and neuroticism (in relation to age)
. Refer to diagram 12.20 in summary

The DSM-IV (Diagnostic and statistical manual of mental disorders)
. 365 mental disorders, classified into 16 categories and one additional section titled “Other conditions that may be a focus of clinical attention”
. Categorical system for diagnosing and classifying mental disorders based on recognisable symptoms that are precisely described for each disorder

. Consists of 5 Axes: Refer to Edrolo table in summary along with extra details
Axes I,II&III address the individual’s present condition, and Axes IV&V provide additional info about the individual’s situation and functioning in everyday life.
Axis I: Clinical disorders and other conditions
Axis II: Personality disorders and mental retardation
Axis III: General medical conditions
Axis IV: Psychosocial and environmental problems
Axis V: Global assessment of functioning (GAF score out of 100 with 50 being normal)

. Provides info on typical courses of disorders, age of onset, degree of impairment, genetic basis, prevalence, whether the disorder is likely to effect others in the family and the relationship of the disorder to gender, age and culture
. Does not cover causes or treatment options of disorders

. Inclusion criteria: the symptoms that must be present in order for the disorder to be diagnosed
. Exclusion criteria: the symptoms, conditions or circumstances that must not be present in order for the disorder to be diagnosed
e.g.:If suffered death of loved one, cannot be diagnosed with depression for 6 months are the event
. Polythetic criteria: a list of diagnostic criteria in which only some symptoms, not all, need to be present in order for the disorder to be diagnosed

Example of DSM-IV-TR diagnosis: Specific Phobia: Social anxiety
Axis I: Social anxiety
Axis II: antisocial personality disorder
Axis III:
Migraines: makes the person want to stay inside more
Suffered burns from a bush fire in the past
Suffers from anorexia
Axis IV:
social connections are weak
existing social connections are abusive
Axis V: 55 (using GAF scale)
Where 55 out of 100 entails “moderate symptoms (eg. occasional panic attacks) or moderate difficulty in social, occupational or school functioning (eg. few friends, problem with social connections)”, as defined by Grivas.

DSM-IV example 2:
Barry (p490-491 Grivas)
Axis I: Clinical syndrome: drug and alcohol abuse
Axis II: Antisocial personality disorder
Axis III: Physical disorder: lung damage and cirrhosis
Axis IV: Psychological and environmental problems: (1) problems with primary support group (divorce) and (2) workplace problems
Axis V: Current GAF = 51 (moderate symptoms)

Strengths and Limitations of categorical approaches:

Strengths

Limitations:

low inter-rater reliability: different mental health professionals who interviewed same client often reached different conclusions (as much as 30% disagreement)
some terms such as schizophrenia tended to be used in different ways in different countries
amount of overlap between symptoms of some disorders undermines the assumption that the classification systems has categories that are discrete and distinct from one another - this can make diagnosis difficult and even lead to misdiagnosis
uniqueness and individuality is overlooked when a person’s thoughts, feelings and behaviour are classified into categories
labelling can lead to social stigma, often involving shame or disgrace of a person. Can also lead to misunderstandings and bias people’s perceptions of the individual with a disorder

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very comprehensive in terms of number of disorders included and the amount of info provided about them

‘user friendly’: consistent with decisions mental health professionals have to make every day

enhances communication between mental health professionals by providing a common language

shared understanding of client between professionals without having to specifically spell out each individual symptom

Principles and assumptions:
. Quantifies a person’s symptoms or other characteristics (eg: narcissism) in terms of ‘how much’, by representing each with numerical values on a scale or continuum
. Does this through questionnaires or standardised inventories (statement rating extent of agreement or disagreement or closed ended questions requiring yes/no answers)
. Grades a person in terms of magnitude, degree or severity on particular dimensions rather than assigning them to diagnostic categories
. Grades an individual and then shows that they can move along the continuum at different stages of their life (grade and transitional)
. Assumes that:

normality and abnormality are end points on the same continuum with no clear dividing line between them
that many independent dimensions exist
that all people possess all dimensions to some degree

Strengths:
. Takes into account wider range of a person’s symptoms and characteristics / Reflects unique combination of symptoms, features and traits of each individual
. Avoids ‘slotting’ into categories that fail to recognise unique characteristics of person
. Avoids labels (avoiding social stigma)
. Allows person to see improvements in their condition much more easily

Limitations:
. More difficult for mental health professionals to communicate with one another
. Hard to work out how many dimensions there should be (rating client on too many can overcomplicate diagnosis)