Diagnosis of mental disorders 8 Marker plan
STRENGTH WEAKNESS
The 4Ds are useful in diagnosis and determining if a mental health INTRODUCTION:
issue becomes a disorder. Competing argument
Mental health can be diagnosed using the four Ds
Help avoid erroneous
There is no hard rules about how (deviance,dysfunction,distress and danger)
diagnosis
Deviance the Ds should be combines tk
All 4Ds might help to avoid
Are behavior and emotions viewed as unacceptable. They can be PARAGRAPH 1: STRENGTH
errors in diagnosis. This Lack of objectivity
measured statistical or in terms of social norms. AO1: Dysfunction,distress and danger is
important as a valid system The 4Ds are not completely AO3: Application in diagnosis
should neither be over or objective. Various methods are
A behavior can be considered abnormal if it occurs relatively rare in
under inclusive. Tk used to be objective, however
the population.Deviance can be reliably assessed based on rating are bing made of feelings,
PARAGRAPH 2: STRENGTH
standard deviation from the mean. Someone in the top or bottom which is subjective and lacks AO1: Function used WHODAS II questionnaire and
Application to diagnosis
2.1% of the population may be diagnosed as abnormal. reliability. Deviance uses statistics
The 4Ds coincides with
The 4Ds involve making
classification manuals like comparison of individuals between
There are also social norms that are unwritten rules about AO3: help avoid erroneous diagnosis ( validity)
ICD-10 to help decide others in society - decision could
acceptable behavior,which differ from culture,situation,history and
whether making a diagnosis is be made better if the comparison
age. When people violate social norms their behavior is considered PARAGRAPH 3: WEAKNESS
appropriate and if so which to a reference group, rather than a
abnormal, however this is subjective. clinician subjective view
AO1: Diagnosing using the 4Ds can be
one
subjective.Deviance Are behavior and emotions viewed
Dysfunction Labelling as unacceptable.
Weakness
Symptoms which interferes with a person's ability to carry out their Diagnosis is that we end up with
Spitzer & Fleiss carried out labels for people with mental
unusual roles and responsibility. AO3: Spitzer & Fleiss carried out a meta-analysis of 6
a meta-analysis of 6 studies health issues. Eg. using danger as
Psychologists can use objective measures to assess function eg. studies and concluded there were significant differences
and concluded there were a criteria for mental health
WHODAS II questionnaire - uses factors like understanding of what’s between how clinicians diagnosed disorders.
significant differences disorder leads people to equate
going on around them mental illness with being
This is backed up by Rosenhan's study, which
between how clinicians
dangerous. concludes we cannot reliably tell the sane from the
diagnosed disorders.
Distress Fazel et al - most people with insane in psychiatric hospitals.
This is backed up by
When symptoms causes emotional pain or anxiety. A clinician will schizophrenia are not actually
Rosenhan's study, which more dangerous than people
consider the intensity or duration of the distress PARAGRAPH 4: WEAKNESS
concludes we cannot reliably without this diagnosis AO1: Labelling and SFP - impact on individual lives and
tell the sane from the insane SFP stereotype leads to people
Danger their treatment by society
in psychiatric hospitals. acting the way predicted - cause
At risk of using physical or psychological harm to themselves or harm to person or others
others.A person can be detained under the mental health act, with or AO3: Fazel et al study
without their consent to a mental health hospital, under the Deviance
agreement of three professionals Diagnosing a mental disorder CONCLUSION:
based on statistical frequency has Making a diagnosis of mental disorders is full of
Reliability means consistency. A diagnosis is reliable if it would be the problem that some disorders problems The 4Ds have a subjective side to diagnosing
(like depression) are growing more
given to the same symptoms by different clinicians. mental disorders that makes them unreliable but
common
Reliable diagnosis is helped by diagnostic classification systems like systems like the DSM have helped improve this
the DSM and ICD.
,Classification systems: The DSM 8 Marker plan - : 8 marker for validity for
ICD and DSM
What is the DSM?
- A manual with classifications of mental disorders produced by American STRENGTH WEAKNESS
INTRODUCTION:
psychiatric association.
- They describe symptoms and features of over 300 behavior disorders
Reliability Reliability
arranged into 22 categories PARAGRAPH 1: STRENGTH
DSM-5 in field trials has Falling standard in what
- They are used by psychiatrists to decide whether someone is mentally ill and AO1:
shown impressive levels of counts as an acceptable level
what kind of illness they suffer from
agreement between clinicians of agreement in the last 35
for a variety of disorders years AO3:
The DSM-5
Regier et al - schizophrenia Cooper- DSM-5 task force
It is the most recent edition, published in 2013 PARAGRAPH 2: WEAKNESS
has a kappa value 0f 0.40 classifieds levels as low as
The manual is divided into 3 sections: AO1:
-0.59 ( good) and PTSD 0.2-0.4 as acceptable.
Section 1: Explains what the DSM is
0.60-0.79 (very good) Regier- the least reliable
Section 2: Diagnostic criteria and codes for disorder AO3:
diagnosis is major depressive
Section 3: About the future of diagnosis and includes disorders that need to be further
Validity disorder with 0.28
researched before going into section 2 PARAGRAPH 3: STRENGTH
DSM is supported by the
validity of certain disorders Suggest hat DSM is less AO1:
What does a diagnosis involve?
reliable than previous version
Assess the patient symptoms and whether they meet the criteria for a disorder by ruling AO3:
Kim-cohen et al - and that cases have been
out disorders that don’t match the symptoms
Demonstrated concurrent missed
validity of conduct disorder PARAGRAPH 4: WEAKNESS
Research methods AO1:
(CD) - interviews on children Validity
Observation and interviews - structured interview like the beck’s depression inventory
and mother, observation of It tells us nothing about the
(containing 21 questions with 4 responses) AO3:
children and questions for causes of the disorder -
teachers. diagnosis are just labels that
How reliability and validity can be assessed CONCLUSION:
tell us nothing but the can
Specific risk factors were lead to a SFP
Reliability
found eg. male and low
Spitzer introduced the use of Cohen's Kappa - this refers to the portoption of people who
income - aetiological validity Cultural difference
receive the same diagnosis when assessed and then re-assessed at a later time (test
Language acts a barrier
retest reliability) and by another psychiatrist (inter-rater reliability) - A score on 0.7 would
Predictive validity shown - 5 Different cultural have
indicate a good agreement
year old with CD were more different social norms
likely to show behavioural and DSM may not be valid
Validity
educational difficulties aged 7 because it based on
Descriptive Validity: When two people with the same diagnosis exhibit similar symptoms
American studies and social
Aetiological Validity: When they share similar causal factors
Accurate diagnosis is norms
Concurrent Validity : When a clinician uses more than one method to reach a diagnosis
important as it recedes adult
Predictive Validity: we are able to accurately predict outcomes for an individual form
mental health problems
their diagnosis
, The ICD
INTRODUCTION: 8 marker for reliability for ICD and DSM
STRENGTH WEAKNESS Reliability refers to consistency. Reality means that it can to be repeated and give
What is the ICD?
similar results each time.
- The ICD includes both physical and mental
disorder
Test retest reliability Competing argument PARAGRAPH 1: STRENGTH
- The world health organisation become involved
Ponizovsky study - longitudinal Ponizovsky Results for childhood AO1: One way to check the reliability is by using the Cohen kappa
in 1948 and the ICD has seen many revisions
study, found that PPV score (the and personality disorder PPV value,introduced by the DSM III taskforce. The kappa value refers to the
over the years, the most recent is ICD-11
proportion of people who retain scores were low as 55% . The proportion who receives the same diagnosis when reassessed.
- The ICD is available in many different the same diagnosis when PPVs score seem higher in
reassessed) Increased by 26% for comparison to DSM but the ICD AO3: Regier reports that three disorders including post-traumatic stress disorder
languages and in appropriate cultural form. It
schizophrenia and 8% for anxiety figures is based on agreement at a had a high kappa value of 0.60-0.79 (very good agreement). This suggest there is
provides a common language so that the data
category level, where as DSM is high agreement suggests that the DSM is useful in diagnosing disorders.
collected in different countries can be usefully
compared. This makes the ICD clear,simple Inter rater reliability for more specific diagnosis . The
Good consistency when two ICD is not reliable for specific PARAGRAPH 2: WEAKNESS
and logically organised
clinicians assess the same clients diagnosis AO1: However, it can only be applied to some disorder and the acceptable level of
using the ICD-10. agreement for the kappa value- standards has fallen.
ICD Codes
Galeazzi - arranged for two ICD 10 - only a 36% agreement AO3: Cooper says the DSM-5 task force classified levels as low as 0.2-0.4 as
- Chapter 5 of ICD :mental and behavioural
researcher to conduct a joint for eating disorders (Nicholls et al. acceptable. One of the least reliable diagnoses for regier study was 0.28 for
disorders
interview to assess 100 2000) major depressive disorder, this suggest that DSM may be less reliable than
- Each disorder has a code,starting with F
consecutive clients for previous versions.
- F20 contains the subcategories for
schizophrenia psychosomatic symptoms.The ICD 10 was used Philip is right to
kappa value ranged from be concerned because there was PARAGRAPH 3: STRENGTH
- Each section has few leftover does allowing
0.69-0.97 found to be only a 36% agreement AO1: ICD is another diagnostic system that is use worldwide.If a clinician gives
new disorder to be added, without having to
for eating disorders (Nicholls et al. one diagnosis for one person presenting with a set of symptoms and features, and
recode.
Predictive validity for 2000) then another person with the same presenting issues with the same clinician gets
- The code are used for indexing medical
schizophrenia the same diagnosis, this shows inter rater reliability in the diagnosis too.
records,making it easy when conducting
research to find example of people with Mason et al compared different Jakobsen et al. (2005) found there
ways of making a diagnosis . The was good agreement in the AO3: Galeazzi arranged 2 researchers to conduct a joint interview to accesses
specific conditions
ICD-9 and ICD-10 were good at diagnosis of schizophrenia 100 consecutive clients for psychosomatic symptoms.The Kappa value 0.69-0.97
predicting diagnosis of SZ in 99 between ICD 10 and other high agreement
Making a diagnosis
The ICD is a diagnostic system that includes all diseases, ppl , 13 years later.This shows that classification systems (1), showing
the initial diagnosis was useful and that ICD 10 is reliable as it has PARAGRAPH 4: WEAKNESS
physical and mental used by clinicians to diagnose clients
meaningful in terms of its ability consistent diagnoses with other AO1: PPV is the portion of people who retain the same diagnosis when reassess -
accurately reducing future classification systems another way to measure reliability.
If the clients presents with a possible mental health
disorder the clinician would use the section that focuses on outcome tk
AO3: Ponizovsky found that childhood and personality disordered had a PPV
mental and behavioural disorders
Application to diagnosis low as 55%. Figure in ICD seem high in comparison to DSM but ICD looks at
The WHO conducted a survey and agreement in a category level and DSM is for more specific diagnosis -ICD may
For each mental health disorder, it gives a clinician the
found that ICD has become more not be reliable for specific diagnosis
main features and the symptoms needed to make a
diagnosis user friendly because of its
simplicity and flexibility. It is easier CONCLUSION:
to use and improve validity of ICD and DSM are distinct differences in these as the diagnosis depends on which
for example, the ICD 10 states that paranoid schizophrenia
diagnosis system is used, therefore reducing the reliability of diagnosis. It is important to
is dominated by relatively stable, paranoid delusions, often
check the reliability in order for the patient to receive the right treatment
with hallucinations
STRENGTH WEAKNESS
The 4Ds are useful in diagnosis and determining if a mental health INTRODUCTION:
issue becomes a disorder. Competing argument
Mental health can be diagnosed using the four Ds
Help avoid erroneous
There is no hard rules about how (deviance,dysfunction,distress and danger)
diagnosis
Deviance the Ds should be combines tk
All 4Ds might help to avoid
Are behavior and emotions viewed as unacceptable. They can be PARAGRAPH 1: STRENGTH
errors in diagnosis. This Lack of objectivity
measured statistical or in terms of social norms. AO1: Dysfunction,distress and danger is
important as a valid system The 4Ds are not completely AO3: Application in diagnosis
should neither be over or objective. Various methods are
A behavior can be considered abnormal if it occurs relatively rare in
under inclusive. Tk used to be objective, however
the population.Deviance can be reliably assessed based on rating are bing made of feelings,
PARAGRAPH 2: STRENGTH
standard deviation from the mean. Someone in the top or bottom which is subjective and lacks AO1: Function used WHODAS II questionnaire and
Application to diagnosis
2.1% of the population may be diagnosed as abnormal. reliability. Deviance uses statistics
The 4Ds coincides with
The 4Ds involve making
classification manuals like comparison of individuals between
There are also social norms that are unwritten rules about AO3: help avoid erroneous diagnosis ( validity)
ICD-10 to help decide others in society - decision could
acceptable behavior,which differ from culture,situation,history and
whether making a diagnosis is be made better if the comparison
age. When people violate social norms their behavior is considered PARAGRAPH 3: WEAKNESS
appropriate and if so which to a reference group, rather than a
abnormal, however this is subjective. clinician subjective view
AO1: Diagnosing using the 4Ds can be
one
subjective.Deviance Are behavior and emotions viewed
Dysfunction Labelling as unacceptable.
Weakness
Symptoms which interferes with a person's ability to carry out their Diagnosis is that we end up with
Spitzer & Fleiss carried out labels for people with mental
unusual roles and responsibility. AO3: Spitzer & Fleiss carried out a meta-analysis of 6
a meta-analysis of 6 studies health issues. Eg. using danger as
Psychologists can use objective measures to assess function eg. studies and concluded there were significant differences
and concluded there were a criteria for mental health
WHODAS II questionnaire - uses factors like understanding of what’s between how clinicians diagnosed disorders.
significant differences disorder leads people to equate
going on around them mental illness with being
This is backed up by Rosenhan's study, which
between how clinicians
dangerous. concludes we cannot reliably tell the sane from the
diagnosed disorders.
Distress Fazel et al - most people with insane in psychiatric hospitals.
This is backed up by
When symptoms causes emotional pain or anxiety. A clinician will schizophrenia are not actually
Rosenhan's study, which more dangerous than people
consider the intensity or duration of the distress PARAGRAPH 4: WEAKNESS
concludes we cannot reliably without this diagnosis AO1: Labelling and SFP - impact on individual lives and
tell the sane from the insane SFP stereotype leads to people
Danger their treatment by society
in psychiatric hospitals. acting the way predicted - cause
At risk of using physical or psychological harm to themselves or harm to person or others
others.A person can be detained under the mental health act, with or AO3: Fazel et al study
without their consent to a mental health hospital, under the Deviance
agreement of three professionals Diagnosing a mental disorder CONCLUSION:
based on statistical frequency has Making a diagnosis of mental disorders is full of
Reliability means consistency. A diagnosis is reliable if it would be the problem that some disorders problems The 4Ds have a subjective side to diagnosing
(like depression) are growing more
given to the same symptoms by different clinicians. mental disorders that makes them unreliable but
common
Reliable diagnosis is helped by diagnostic classification systems like systems like the DSM have helped improve this
the DSM and ICD.
,Classification systems: The DSM 8 Marker plan - : 8 marker for validity for
ICD and DSM
What is the DSM?
- A manual with classifications of mental disorders produced by American STRENGTH WEAKNESS
INTRODUCTION:
psychiatric association.
- They describe symptoms and features of over 300 behavior disorders
Reliability Reliability
arranged into 22 categories PARAGRAPH 1: STRENGTH
DSM-5 in field trials has Falling standard in what
- They are used by psychiatrists to decide whether someone is mentally ill and AO1:
shown impressive levels of counts as an acceptable level
what kind of illness they suffer from
agreement between clinicians of agreement in the last 35
for a variety of disorders years AO3:
The DSM-5
Regier et al - schizophrenia Cooper- DSM-5 task force
It is the most recent edition, published in 2013 PARAGRAPH 2: WEAKNESS
has a kappa value 0f 0.40 classifieds levels as low as
The manual is divided into 3 sections: AO1:
-0.59 ( good) and PTSD 0.2-0.4 as acceptable.
Section 1: Explains what the DSM is
0.60-0.79 (very good) Regier- the least reliable
Section 2: Diagnostic criteria and codes for disorder AO3:
diagnosis is major depressive
Section 3: About the future of diagnosis and includes disorders that need to be further
Validity disorder with 0.28
researched before going into section 2 PARAGRAPH 3: STRENGTH
DSM is supported by the
validity of certain disorders Suggest hat DSM is less AO1:
What does a diagnosis involve?
reliable than previous version
Assess the patient symptoms and whether they meet the criteria for a disorder by ruling AO3:
Kim-cohen et al - and that cases have been
out disorders that don’t match the symptoms
Demonstrated concurrent missed
validity of conduct disorder PARAGRAPH 4: WEAKNESS
Research methods AO1:
(CD) - interviews on children Validity
Observation and interviews - structured interview like the beck’s depression inventory
and mother, observation of It tells us nothing about the
(containing 21 questions with 4 responses) AO3:
children and questions for causes of the disorder -
teachers. diagnosis are just labels that
How reliability and validity can be assessed CONCLUSION:
tell us nothing but the can
Specific risk factors were lead to a SFP
Reliability
found eg. male and low
Spitzer introduced the use of Cohen's Kappa - this refers to the portoption of people who
income - aetiological validity Cultural difference
receive the same diagnosis when assessed and then re-assessed at a later time (test
Language acts a barrier
retest reliability) and by another psychiatrist (inter-rater reliability) - A score on 0.7 would
Predictive validity shown - 5 Different cultural have
indicate a good agreement
year old with CD were more different social norms
likely to show behavioural and DSM may not be valid
Validity
educational difficulties aged 7 because it based on
Descriptive Validity: When two people with the same diagnosis exhibit similar symptoms
American studies and social
Aetiological Validity: When they share similar causal factors
Accurate diagnosis is norms
Concurrent Validity : When a clinician uses more than one method to reach a diagnosis
important as it recedes adult
Predictive Validity: we are able to accurately predict outcomes for an individual form
mental health problems
their diagnosis
, The ICD
INTRODUCTION: 8 marker for reliability for ICD and DSM
STRENGTH WEAKNESS Reliability refers to consistency. Reality means that it can to be repeated and give
What is the ICD?
similar results each time.
- The ICD includes both physical and mental
disorder
Test retest reliability Competing argument PARAGRAPH 1: STRENGTH
- The world health organisation become involved
Ponizovsky study - longitudinal Ponizovsky Results for childhood AO1: One way to check the reliability is by using the Cohen kappa
in 1948 and the ICD has seen many revisions
study, found that PPV score (the and personality disorder PPV value,introduced by the DSM III taskforce. The kappa value refers to the
over the years, the most recent is ICD-11
proportion of people who retain scores were low as 55% . The proportion who receives the same diagnosis when reassessed.
- The ICD is available in many different the same diagnosis when PPVs score seem higher in
reassessed) Increased by 26% for comparison to DSM but the ICD AO3: Regier reports that three disorders including post-traumatic stress disorder
languages and in appropriate cultural form. It
schizophrenia and 8% for anxiety figures is based on agreement at a had a high kappa value of 0.60-0.79 (very good agreement). This suggest there is
provides a common language so that the data
category level, where as DSM is high agreement suggests that the DSM is useful in diagnosing disorders.
collected in different countries can be usefully
compared. This makes the ICD clear,simple Inter rater reliability for more specific diagnosis . The
Good consistency when two ICD is not reliable for specific PARAGRAPH 2: WEAKNESS
and logically organised
clinicians assess the same clients diagnosis AO1: However, it can only be applied to some disorder and the acceptable level of
using the ICD-10. agreement for the kappa value- standards has fallen.
ICD Codes
Galeazzi - arranged for two ICD 10 - only a 36% agreement AO3: Cooper says the DSM-5 task force classified levels as low as 0.2-0.4 as
- Chapter 5 of ICD :mental and behavioural
researcher to conduct a joint for eating disorders (Nicholls et al. acceptable. One of the least reliable diagnoses for regier study was 0.28 for
disorders
interview to assess 100 2000) major depressive disorder, this suggest that DSM may be less reliable than
- Each disorder has a code,starting with F
consecutive clients for previous versions.
- F20 contains the subcategories for
schizophrenia psychosomatic symptoms.The ICD 10 was used Philip is right to
kappa value ranged from be concerned because there was PARAGRAPH 3: STRENGTH
- Each section has few leftover does allowing
0.69-0.97 found to be only a 36% agreement AO1: ICD is another diagnostic system that is use worldwide.If a clinician gives
new disorder to be added, without having to
for eating disorders (Nicholls et al. one diagnosis for one person presenting with a set of symptoms and features, and
recode.
Predictive validity for 2000) then another person with the same presenting issues with the same clinician gets
- The code are used for indexing medical
schizophrenia the same diagnosis, this shows inter rater reliability in the diagnosis too.
records,making it easy when conducting
research to find example of people with Mason et al compared different Jakobsen et al. (2005) found there
ways of making a diagnosis . The was good agreement in the AO3: Galeazzi arranged 2 researchers to conduct a joint interview to accesses
specific conditions
ICD-9 and ICD-10 were good at diagnosis of schizophrenia 100 consecutive clients for psychosomatic symptoms.The Kappa value 0.69-0.97
predicting diagnosis of SZ in 99 between ICD 10 and other high agreement
Making a diagnosis
The ICD is a diagnostic system that includes all diseases, ppl , 13 years later.This shows that classification systems (1), showing
the initial diagnosis was useful and that ICD 10 is reliable as it has PARAGRAPH 4: WEAKNESS
physical and mental used by clinicians to diagnose clients
meaningful in terms of its ability consistent diagnoses with other AO1: PPV is the portion of people who retain the same diagnosis when reassess -
accurately reducing future classification systems another way to measure reliability.
If the clients presents with a possible mental health
disorder the clinician would use the section that focuses on outcome tk
AO3: Ponizovsky found that childhood and personality disordered had a PPV
mental and behavioural disorders
Application to diagnosis low as 55%. Figure in ICD seem high in comparison to DSM but ICD looks at
The WHO conducted a survey and agreement in a category level and DSM is for more specific diagnosis -ICD may
For each mental health disorder, it gives a clinician the
found that ICD has become more not be reliable for specific diagnosis
main features and the symptoms needed to make a
diagnosis user friendly because of its
simplicity and flexibility. It is easier CONCLUSION:
to use and improve validity of ICD and DSM are distinct differences in these as the diagnosis depends on which
for example, the ICD 10 states that paranoid schizophrenia
diagnosis system is used, therefore reducing the reliability of diagnosis. It is important to
is dominated by relatively stable, paranoid delusions, often
check the reliability in order for the patient to receive the right treatment
with hallucinations
