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UNIT 4 BRAIN, BEHAVIOUR & EXPERIENCE AREA OF STUDY 2 MENTAL HEALTH SYSTEMS OF CLASSIFICATION OF MENTAL CONDITIONS & DISORDERS A CATEGORY is a group of items that share a particular set of properties The process of classification places one of these items into a category TWO APPROACHES ARE USED TO CLASSIFY MENTAL DISORDERS: CATEGORICAL APPROACH: classification symptoms category ‘belong’ to A yes/no approach to that classifies a person’s in terms of which specific of mental disorder they DIMENSIONAL APPROACH: classifies a person’s symptoms or other characteristics of interest in CATEGORICAL & DIMENSIONAL APPROACHES The choice between whether a psychologist would use a categorical or a dimensional approach to diagnose a patient is not as clear-cut as it may seem Health professional will generally merge the two and use both approaches to properly diagnose a patient 1.The mental health professional will more than likely begin using a categorical approach to firstly classify the patient’s symptoms as a mental disorder 2.They would then use a dimensional approach to determine the severity of the symptoms CATEGORICAL APPROACHES CATEGORICAL APPROACH: organises and describes mental conditions and disorders in terms of different categories and subcategories, each with symptoms and characteristics that are typical of specific mental disorders ‘YES OR NO’ Categorical approaches are based on a number of assumptions: •A mental disorder can be diagnosed from specific symptoms •Thoughts, feelings and behaviour can be organised into categories representing disorders •Within each disorder category there are distinct (different) and discrete (separate) sub-categories of the disorder, each with a pattern of symptoms CATEGORICAL APPROACHES in terms of subsymptoms are typical disorders organises and describes mental conditions and disorders different categories and categories, each with and characteristics that of specific mental ‘YES OR NO’ A large assumption of a categorical approach is that it must be: VAILD: the classification system actually organises mental disorders into discrete and distinct disorders. The disorder must therefore accurately represent the symptoms that have been assessed RELIABLE: the classification system produces the same diagnosis each time it is used in the same situation CATEGORICAL APPROACHES DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) A categorical system for diagnosing and classifying mental disorders based on recognisable symptoms that are precisely described for each disorder First developed in 1952 it is now in its fifth edition (DSM-V). All explanations in the text-book, however, still relate to DSM-IV 16 MAJOR CATEGORIES (see page 486-487 in text-book) CATEGORICAL APPROACHES DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) DIAGNOSTIC CRITERIA: the symptoms that are characteristic of a enable assessment disorder particular disorder and of the presence of a - INCLUSION CRITERIA: Identify the symptoms that must be present in order for the disorder to be diagnosed - EXCLUSION CRITERIA: identify the symptoms, conditions or circumstances that must not be present in order for the disorder to be diagnosed - POLYTHETIC CRITERIA SETS: a list of diagnostic criteria in which only some symptoms, not all, need to be present in order for the disorder to be diagnosed THE DSM also contains: CATEGORICAL APPROACHES DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) AXIS NAME OF AXIS 1 Clinical disorders II Personality disorders Mental retardation III General medical conditions IV Psychosocial & Environmental problems V Global Assessment of functioning All of the mental disorders in DSM Medical conditions related to disorder Potential stressors in life Overall level of psychological function • All 5 axes must be considered in order to completely evaluate an individual’s mental condition • Each axis refers to different information about a person • Together the 5 axes provide comprehensive and useful information, allowing planning for treatment HOMEWORK LEARNING ACTIVITY 12.5 (pg.491) CATEGORICAL APPROACHES INTERNATIONAL CLASSIFICATION OF DISEASES & RELATED HEALTH PROBLEMS (ICD) A categorical system for diagnosing and classifying diseases and mental disorders based on recognisable symptoms that are precisely described for each disease and disorder First developed in 1893 it is now in its tenth edition. Primarily used in Europe, most psychologists prefer use of the DSM-V CHAPTER V (5) is the one that psychologists use for diagnosing and classifying mental disorders. All other chapters of the book refer to a range of mental and behavioural disorders This is used just like the DSM, a set of diagnostic guidelines identify the symptoms that are characteristic of each disorder HOMEWORK LEARNING ACTIVITY 12.7 (pg.494) CATEGORICAL APPROACHES STRENGTHS & LIMITATIONS OF CATEGORICAL APPROACHES STRENGTHS LIMITATIONS Based on ongoing scientific research and regularly revised on the basis of research findings In the past, low inter-rater reliability was reported, however, this has improved with the latest editions to 70% Very comprehensive in terms of the number of disorders they include and the amount of information presented on each disorder Large degree of overlap with symptoms in the DSM and ICD, making a discrete diagnosis sometimes difficult Promote the growth of a body of expert knowledge about mental disorders Loss of valuable clinical information. Labels mean that uniqueness of case is overlooked Allows professionals to diagnose and then devise a treatment and management plan for those who require it Labels can have a negative effect on the individual who is labelled with a mental disorder Considered to be very ‘user-friendly’ Enhance communication among mental health professionals by providing a common language, the labels in the manual convey a large amount of information quickly and conveniently Can create a ‘stigma’ around someone who is labelled. Friends can treat you differently, you think of yourself differently and employment could be difficult DIMENSIONAL APPROACHES A DIMENSIONAL APPROACH QUANTIFIES A PERSON’S SYMPTOMS OR OTHER CHARACTERISTICS OF INTEREST AND REPRESENTS THEM WITH NUMERICAL VALUES ON ONE OR MORE SCALES OR CONTINUUMS A DIMENSION = a cluster of related psychological and behavioural characteristics that tend to occur together and can be measured A person will get a score on each of the dimensions of interest INVENTORY: this is a ‘test’, typically comprising closed-ended questions requiring a ‘yes or no’ answer, or statements requiring a rating about the extent of agreement or disagreement 2 Assumptions: •Normality and abnormality are end points on the same continuum •Many independent dimensions exist and that all people possess them to • DIMENSIONAL APPROACHES Eysenck Personality Questionnaire-Revised (EPQ-R) Designed to measure three dimensions - Extraversion/Introversion - Neuroticism/Emotional Stability - Psychoticism Each of these dimensions is made up of a number of personality traits It is assumed that each individual possesses each of these dimensions in varying amounts • Big Five Personality Inventory Big Five Traits - Agreeableness - Openess To Experience - Conscientiousness - Extraversion - Neuroticism • Minnesota Multiphasic Personality Inventory (MMPI-2) Ten different dimensions DIMENSIONAL APPROACHES Can also be applied at a more specific level: scale scale - an individual’s functioning or impairment is measured on a of 1-100 - The severity of a symptom could be graded using a 3 point such as 1=absent, 2=mild, 3=severe The focus is on grading a person on the magnitude, degree or severity on particular dimensions, rather than assigning them to a diagnostic category Mental health professionals can then monitor their client at different time levels and measure their transition, or change over time Standardised inventories can also be used to produce a profile DIMENSIONAL APPROACHES STRENGTHS & LIMITATIONS OF DIMENSIONAL APPROACHES STRENGTHS LIMITATIONS Single diagnostic labels (categorical approaches) result in a loss of information whereas dimensional approaches retain that information There is no widely accepted standardised inventory or system that can be used Dimensional approaches take into a wide range of a person’s symptoms and characteristics It is difficult for mental health professionals to know which dimensions are relevant or useful for their clients Provides a richer and more detailed description of an individual’s mental condition in the form of a profile Disagreement on the number of dimensions that would suitably represent the wide range of mental disorder symptoms Helps to reduce the stigma usually associated If there are too many dimensions to assess, with the diagnosis of a specific mental then a mental health assessment could disorder become overcomplicated HOMEWORK LEARNING ACTIVITY 12.9 (pg.502) LEARNING ACTIVITY 12.10 (pg.502)