clinical

• The 4 "D's" Of Diagnosis

  • Deviance
  • Dysfunction
  • Distress
  • Danger
• The 5th D can be seen as duration, as all of these criteria if experienced/visible over a long period of time,may call for psychiatric intervention
• Subjectivity in diagnosis

  • The individual patient's experience is entirely personal and unique, so what may be seen as dysfunctional by one person,may not be seen the same by another
• Reliability in diagnosis

  • The decision on whether behaviour is diagnosed or not depends on the interactions/discussion between the individual and clinician- therefore when diagnosing things such as "deviance" it must be based on a standardised measure
• Some behaviours are not actually that rare (eg depression) so clinicians must take the 4 dimensions into consideration before the patient requires further psychiatric care
• Classification Systems

  The 2 important western systems that are used are the DSM-5 and the ICD-10
• DSM-5

  Published by the American Psychiatric Association, has been revised several times - the most recent version is the DSM-5, which was published in 2013, Theres over 150 disorders listed - many subdivisions, Aimed to harmonise with the ICD-10
• ICD-10

  Includes all diseases - section F is mental health disorders, Published by the WHO in 1893, Groups disorders as a family - then lists those under that category , then further subdivided, Uses a coding system - eg F20.2 , F is the section, 2 is the family of disorders, and 0.2 is the subdivision
• Similarities between DSM-5 and ICD-10

  • Both help aid with the diagnosis of mental health disorders
  • Both published around the same time
  • Both have been revised numerous times
  • Both group disorders into families,then subcategories
• Differences between DSM-5 and ICD-10

  • The DSM is American and the ICD is European
  • The DSM takes into account cultural and individual differences, and potential future diagnosis in this era (eg phone addict)
  • The ICD includes a lot of non mental health related diseases and how to diagnose them through symptoms and descriptions
• Reliability issues in diagnosis

  • Information provided by the client may be impacted by patient vulnerability; they're often not of sound mind and so they can't explain what's wrong with them/describe potential symptoms
  • The clinician interview is unstructured ; this lowers reliability as if repeated, same questions/tone may not be used
  • Clinicians use their own subjective judgement ; this may lead to bias as different clinicians may have different opinions on diagnoses - they must try not to input their own opinions
  • Symptoms can overlap and so diagnoses may not always be accurate which lowers reliability
• Validity issues in diagnosis

  • Concurrent validity - compares evidence from several studies to see if they agree with each other ; this may be an issue as some disorders may have limited research on them, so giving a diagnosis may be difficult and inaccurate
  • Predictive validity - if results from tests can predict future behaviour/disorders ; with certain disorders,like schizophrenia, symptoms vary among patients and so it may be hard to predict disorders based on symptoms
  • Implicit bias from the clinician may also impact validity of diagnosis
  • Any information from the patient,that may be inaccurate (knowingly,or unknowingly) may impact the interpretation of symptoms/diagnosis
  • Comorbidity may also impact the validity, as with mental disorders, many can exist simultaneously (eg depression and schizophrenia)
• Clinician variables, such as training and focus on acute symptoms, may lead to them overlooking other symptoms. This is exacerbated by patient variables such as state of mood, leading to errors in diagnosis.
• Robert Spitzer recognised the need for a more scientific approach to diagnosis and heavily influenced the DSM-3, eg making it so a hallucination had to repeat several times before a diagnosis of schizophrenia could occur. This helped define mental illnesses more clearly using firm guidelines.
• Classic Study (Rosenhan) - Being Sane In Insane Places

  Aim: To test the reliability of mental health diagnosis to see if medical professionals could distinguish the mentally ill from the healthy

  Procedure: 8 pseudopatients who weren't mentally ill called hospitals saying they've been experiencing schizophrenic symptoms, were admitted, and then exhibited normal behaviour

  Results: Every patient was diagnosed with a mental health disorder, and the staff were unable to identify that they were faking their symptoms

  Conclusion: Medical professionals cannot distinctly differentiate between who is mentally ill and who isn't
• Evaluation of Classic Study

  • Strengths: Generalisable, had real world applications, ecological validity, ethical

  Weaknesses: Not generalisable, not reliable, low ecological validity, low construct validity, ethical issues
• Schizophrenia: Features

  • The likelihood of developing schizophrenia is 0.3% to 0.7%

  There are many factors that may affect the chance of developing it; genetic,cultural, etc…

  It impacts men more than women, and men are more likely to suffer from negative symptoms for longer durations

  Schizophrenic episodes tend to appear between adolescence (16) to 30 ; for males it's usually the early 20s and for women their late 20s
• Schizophrenia: Prognosis

  It's very difficult to predict the course of illness, only 20% of those diagnosed are likely to respond well to treatment ; the rest of them will likely need support for the rest of their lives and face chronic illness
• Schizophrenia: Symptoms

  • Positive symptoms: Disorganised thinking, Abnormal motor behaviour

  Negative symptoms: Avolition, Apathy
• Biological Causes: Neurotransmitters

  An increase in neurotransmitters,especially dopamine, can cause schizophrenia

  Excess dopamine in the mesolimbic pathway can cause positive symptoms

  Abnormal functioning of dopamine in the mesocortical pathways can cause negative symptoms
• Biological Causes: Genetics

  There is strong evidence suggesting that there's a heritable factor in the development of schizophrenia

  If you have a first degree relative with schizophrenia it increases the risk of developing it to 6-17%

  If you have a second degree relative with schizophrenia it increases the risk of developing to between 2-6% (instead of the regular 1%>)

  The biggest risk of inheriting it is seen in MZ twins, where there's a 48% that if ones diagnosed with schizophrenia the other will be too
• Cognitive Causes

  Schizophrenia can be caused by problems with cognitive processing, and not being able to process info properly can cause disordered thoughts

  Schizophrenics may have a disruption to a damaged filter mechanism, which means they're unable to filter out unnecessary cognitive 'noise' ; this could cause the symptom of thought disturbances as sufferers become overwhelmed with the noise

  Reduced STM function might account for the distractibility of some schizophrenics

  Schizophrenics may have problems with supervisory attention symptoms which is having the ability to label actions and thoughts 'as mine' ; for example auditory hallucinations could be the result of not recognising that inner speech is self-generated
• Schizophrenics

  May have a disruption to a damaged filter mechanism, which means they're unable to filter out unnecessary cognitive 'noise'
• Disruption to filter mechanism

  Causes thought disturbances as sufferers become overwhelmed with the noise
• Reduced STM function

  Might account for the distractibility of some schizophrenics
• Positive symptoms

  May be due to biological factors, eg excess stress and and whilst trying to make sense of symptoms they then suffer other symptoms of the illness
• Schizophrenics

  May have problems with supervisory attention symptoms which is having the ability to label actions and thoughts 'as mine'
• Auditory hallucinations


  Could be the result of not recognising that inner speech is self-generated
• Bizarre delusions


  Can be a result of faulty information processing
• Reduced dopamine

  Causes the brain to struggle more in processing info
• Schizophrenics show deficits in tasks requiring a 'theory of mind' (a cognitive skill)
• It is difficult to measure whether problems with cognition are a cause of Sz or whether these problems are the result of having SZ
• SZ could be caused by the interaction of different factors (genes,cognition,environment,etc…)
• Relatives of people with SZ,who don't have the disorder often show similar cognitive deficits
• Schizophrenics score lower on tests of memory,attention,etc.. In comparison to similar people without the disorder
• Antipsychotic medication

  Often given to SZ patients to help alleviate symptoms associated with a psychotic episode, eg hallucinations
• Typical antipsychotics

  Developed in the 1950's, eg Chlorpromazine - however these had many unpleasant side effects
• Atypical antipsychotics

  Developed later, eg Risperidone - they had reported less side effects whilst still being effective
• Clozapine

  An atypical AP, has been highly effective in treating the positive symptoms such as hallucinations + some negative symptoms such as emotional withdrawal
• Antipsychotics

  Reduce the level of dopamine in areas of the brain associated with the symptoms - they block dopamine receptors, which prevents dopamine binding to receptors in the synapse and so depolarises the neurons - this calms them down