A2 unit 4 Clinical Psychology 4) Content Reliability of the diagnosis of mental disorders Validity of the diagnosis of mental disorders Cultural issues

Pre-reading check By now you should have read pages 234-245 (Brain) You should be thinking about the use of the DSM and how reliable and valid it is, as well as the influence of cultural & gender issues in the diagnosis of mental disorders.

Learning outcomes: a) To be able to describe and evaluate the reliability of the diagnosis of mental disorders. b) To be able to describe and evaluate the validity of the diagnosis of mental disorders. c) To be able to describe and evaluate cultural issues in the diagnosis of mental disorders. (in all three cases using the findings of studies).

DSM- IV The Diagnostic and Statistical Manual of Mental Disorder (Edition 5), was last published in 2013. The DSM is produced by the American Psychiatric Association. It is the most widely used diagnostic tool in psychiatric institutions around the world

ICD - 10 There is also the International Statistical Classification of Diseases (known as ICD). It is produced by the World Health Organisation (WHO) and is currently in it’s 10th edition.

Identification Prognosis Investigate causes Treatment

We are now on DSM V but the exam will allow you to discuss / use / refer to DSM IV – see Blog

4 types of assessment Observation Interview Psych tests Physio tests

Ensure this is in your packs

Overview of DSM Using hand out, highlight key points and complete table in pg. 5 in packs Use text books if there is anything you are unsure about Thought shower in your groups, strengths and weaknesses of the DSM

Evaluation of the DSM Strengths 1. Allows for common diagnosis (although many revisions) because it has stood the test of time When 2 or more doctors use the DSM, they should come close to the same diagnosis. 2. Evidence suggests that it is reliable ~Goldstein looked at the reliability between DSM-II and DSM-III is (1988) She found there was evidence of reliability within the DSM-III (but less so between DSM-II and DSM-III)

Evaluation of the DSM Weaknesses The DSM is seen as a confirmation of the medical state of mental disorder, as suffers are ‘patients’ and ‘treatment’ is suggested. Mental health issues are ‘disorders’ and ‘illnesses’ so ‘cures’ are looked for. However, it might be said that some mental disorders are simply ways of living …. who is to say whether it is ‘illness’ or not. (e.g. schizophrenics may be trying to get back to their normal self)

Reliability and the diagnosis of mental disorders The DSM’s reliability rests on the question of whether one person’s set of symptoms would lead to a common diagnosis by different physicians If different doctors give different diagnosis for the same set of symptoms (e.g. for the same person), then the diagnosis are not reliable and the treatment may not work

Rationale: Why study Goldstein? – so many reasons!! Goldstein (1988) study! Rationale: Why study Goldstein? – so many reasons!! Schizophrenia Gender differences Validity and Reliability of DSM Primary and Secondary data Levels of significance Longitudinal study

Research Questions Do males and females experience schizophrenia in different ways? What part do premorbid factors play? Premorbid factors are those present before onset of the disease Are there differences between the DSM-II and DSM-III?

Studies looking at the reliability of the DSM Goldstein (1988) tested DMS-III for reliability and found that there was reliability looked at the effect of gender on the experience of schizophrenia she re-diagnosed 199 patients, originally diagnosed using DSM–II; some differences she asked two other experts to re-diagnoses (single blind) a random sample of 8 of the patients using the case histories with all indication of previous diagnoses removed high level of agreement/consistency of diagnosis

Goldstein (1988) As she realised that she was aware of her hypothesis it was important that she asked two experts to re-diagnose a random sample of 8 patients She found a high level of agreement and inter-rater reliability. This suggests that DSM-III is a reliable tool

Other research exploring Reliability Using text books and hand out, research other studies that have explored the reliability of the DSM What have these studies shown? look at the information about Kirk and Kutchin’s (1992) study…this is on the handout and on this PP which will be on the Blog

Kirk and Kutchins (K&K) (1992) In their review paper Kirk and Kutchins argued that there are methodological problems with the studies used to test the reliability of the DSM up until 1992… these then limit the generalisability of the findings. The studies outlined used interviews and questionnaires to gather data; K&K argued that training and supervision of interviews was insufficient and that they lacked the commitment and skills to be accurate. They also pointed out that the studies they looked at tended to take place in specialised research settings… meaning that their findings might not relate to clinicians in normal clinical settings. Generally speaking, an unreliable diagnostic tool would lack validity…. K&K suggested the DSM could also lack validity.

Evaluation of K&K (1992) points Points about interviewing - such as that different interviewers may affect the situation and lead to different data – might be important when considering generalising findings from studies Goldstein (1988) did not, however, use interviewing to test reliability – she used re-diagnosis using secondary data, and also found reliability

Evaluation of K&K (1992) points The patients in the studies looked at were not all from research settings The ‘gamblers’ in Stinchfield’s study were on a gambling treatment program, not in a research situation. The patients in Brown et al.’s study were out patients in a hospital = possible ecological validity?

Evaluation of K&K (1992) points K&K’s study took place before Brown et al. and Stinchfield’s studies which showed that DSM-IV-TR could be regarded as reliable. Possible to therefore conclud that further work has been done since DSM-II and reliability has improved. Goldstein (1988), Brown et al. (2003) and Stinchfield (2003) all provide evidence that diagnosis is reliable.

Questions: you also have questions in your pack ~ page 5 that need to be completed 1) What do these studies tell us about the reliability of the DSM in diagnosing mental disorders? 2) How are Kirk and Kutchin’s findings different from the majority of the other studies? What does this tell us about the reliability of the DSM? 3) How can the reliability of the DSM be improved?