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Diagnosis and Assessment - DSM (Classification & Diagnosis…
Diagnosis and Assessment - DSM
Classification & Diagnosis
First edition published in 1952
Newest edition DSM 5 published in May 2013
DSM 4 published in 1994
Categorical vs Dimensional Systems
DSM 4 and 5 based on categorical systems, must meet minimum number of symptoms or else not diagnosed, DSM 5 includes severity rates for disorder, basically disorder is present or not (either you're anxious or not)
Dimensional - rank on a continuous quantitative dimension, degree to which symptom is present
Changes in DSM 5
Removal of multiaxial system
Removes patient 'labelling'
Recognises individual differences in disorders
Organisation of diagnoses
Previously clustered diagnoses on similarity of symptoms
DSM 5 reorganise to preference comorbidities and shared etiology
Addition of new diagnoses (e.g. binge eating disorder, cannabis withdrawal) and combining diagnoses (Autism and Asperger's = ASD)
Ethnic and cultural considerations, renaming diagnoses (mental retardation --> intellectual disability)
Criticisms of DSM/Classification
Too many diagnoses, overdiagnosing (e.g. how will this help people?), common reaction being pathologised
Reliability in everyday practice, importance of inter-rater reliability
Construct validity - does it diagnose what it should?
Stigma, over pathologisation, illusion of explanation (Sam lights fires because he has pyromania
Prevalence Rates of Mental Illness
[YEARLY] In Australia, 1 in 5 have experienced mental illness, anxiety (14%), mood disorders (6%, 20% lifetime), substance use 5%, schizophrenia (1% lifetime)
Women (22%) are more likely to experience mental disorders than men (18%)
Younger people are more at risk
Mental disorders are the third leading cause of disability burden in Australia
Assessments
Psychological Assessment
Informal interviews (identifying non-verbal cues, body language, etc), structured interviews, self-observation, observation of behaviour, self-report inventories, projective tests (inkblot), IQ tests
Neurobiological Assessment
Brain imaging (CT, MRI, PET, fMRI)
ECG, EEG
Neuropsychological - comprehensive cognitive characterisation
Culture and Ethnic Diversity
From DSM 4, general framework was provided to evaluate role of culture/ethnicity, cultural factors described for each disorder, culture-bound syndromes in appendix
How culture affects symptoms, langauge to describe distress (e.g. "I am sick in my heart" is in physical terms rather than psychological)
Culture-bound syndromes: ghost sickness (found in Native American tribes where people are obsessed with death), koru (found in South and East Asia, an episode of intense anxiety that the penis or nipples will recede into the body, possibly leading to death), drat (india, anxiety about discharge of semen