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Discuss the Validity and reliability of diagnosis


I. Di Nardo (1993) A. Studied the reliability of DSM-III for anxiety disorders B. 2 clinicians separately diagnosed 267 individuals seeking treatment for anxiety and stress disorders C. They found high reliability for OCD (.80) but very low reliability for assessing generalized anxiety disorder (.57), mainly due to problems with interpreting how excessive a persons worries were. II. Lipton and Simon (1985) A. Randomly selected 131 patients in a hospital in New York and conducted various assessment procedures to arrive at a diagnosis for each person B. Of the original 89 diagnosis of schizophrenia, only 16 received the same diagnosis on reevaluation C. 50 were diagnosed with a mood disorder, even though only 15 had been diagnosed with such a disorder initially. D. Protection from harm 1. Ethical consideration III. Rosenhan (1973) A. Aim: To investigate the reliability of psychiatric diagnoses/to investigate if abnormal individuals could be classied as normal B. Method: Field experiment C. Procedure: Eight healthy people, ve men and three women, who were researches tried to gain admission to 12 different psychiatric hospitals. They complained that they had been hearing voices which were unclear, unfamiliar of the same sex and said fairly simple words such as thud and empty. These were the only symptoms in which they reported/Rosenhan told the staff at a psychiatric hospital that pseudo-patients would try to gain admittance. No pseudo-patients actually appeared. D. Findings: Seven of them were diagnosed as suffering from schizophrenia. After the individuals had been admitted to the psychiatric wards, they all said they felt ne, and that they were no longer experiencing the symptoms. However, it took an average of 19 days before they could be discharged. As for seven of them, the psychiatric classication for them at the time of their discharge was schizophrenia in remission. This meant that the schizophrenia might come back/ 41 real patients out of 193 people were judged with great condence to be pseudo-patients by at least one member of staff. Out of the genuine patients, 19 our of 193 were suspected of being frauds by one psychiatrist and another member of the staff. He concluded that it was not possible to distinguish between sane and insane in psychiatric hospitals. Demonstrates the lack of scientic evidence on which medical diagnoses can be made - also raises the issue of treatments, that is, if they are always properly justied. E. Principle: F. Connection: Discuss the Validity and Reliability of Diagnosis G. Gender: In the rst experiment, more men were used than women, it was not specied in the second experiment. H. Method: Field experiment, this experiment took place in psychiatric hospitals. I. Ethics: In some considerations, the people considered normal might have felt that something was actually wrong with them in fact that they were admitted to the psychiatric ward for having schizophrenia. This goes against the leave-as-they-came policy. There is assumed depersonalization in the pseudo-patients. In psychiatric hospitals there is most likely no privacy due to fear of harm to themselves, such as doors removed in the toilet, medical records being open to staff, and their views being considered valueless. The hospital staff was also deceived. J. Cultural: Experiment was across ve states in psychiatric hospitals in the US. IV. DSM- Diagnostic & Statistical Manual of Mental Disorders A. Most widely used diagnostic system. B. Often reviewed to be kept up to date with changes in diagnosing diseases. C. Lists symptoms required to diagnose a disease.

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This is done along with a subjective evaluation. Encourages clinicians to use a more holistic diagnostic system. Each person is analyzed according to a bio psych- social frame work. Encourages on holistic observation of everything that could effect the person Assumes clinicians are able to look deeper into a patient Up to date- Updated to make sure diagnosis is as easy as possible Multi axial approach, not only if they have symptoms. Includes medical conditions, psychological and environmental problems, and how well they are functioning. V. ISD - International Classication of Diseases A. More commonly used internationally than the DSM B. Originally intended by the WHO to be a means of standardizing recording of causes of death C. Covers a wide range of diseases and conditions 1. Classication rather than diagnosis D. One chapter categorizes mental disorders 1. Looks similar to DSM-IV System E. Strengths: 1. Covers a wide range of diseases and conditions, giving a complete classication instead of a diagnosis. 2. More internationally recognized than the DSM F. Weaknesses: 1. Some chapters look similar to the DSM-IV system 2. With each revision, differences between the ICD and DSM are becoming fewer. D. E. F. G. H. I. J.

Discuss the cultural and ethical considerations in diagnosis


I. Conrmation Bias Phenomena: A. Conrmation Bias: Clinicians tend to have expectations about the person who consults them, assuming that if the patient is there in the rst place there must be some disorder to diagnose. B. It is the job of a clinician to diagnose abnormality so they may overreact and see abnormality wherever they look. C. Link to Rosenhan: Participants in this study did not have any psychological disorder; however when describing their symptoms doctors searched for ones that correlated to schizophrenia. Also, when the participants in the institutions were admitted, any behavior from them was considered to be a symptom of the disease. II. Institutionalization inuences HOW the nursing staff views the patients: A. Dene institutionalization: To make into, treat as, or give the character of an institution. B. Explain how institutionalization can also be a confounding variable 1. Once admitted, it was very difcult for the pseudo-patients to get out. 2. This could be because once one is admitted, all behaviour is perceived as being a symptom of the illness. 3. Powerlessness & depersonalization a) Produced in institutions through lack of rights, constructive activity, choice, and privacy. C. Use examples from Rosenhan (1973) to explain how this occurs. 1. All behaviours of Rosenhans participants were seen as being symptomatic of schizophrenia. a) Pseudo-patients would take notes, this would be recorded by the nurses as patient engages in writing behaviour b) Participants would never be asked why they were taking notes, but instead, the nurses would take their behaviour as paranoid behaviour, etc. instead. III. Racial / Ethnic Issues: A. Jenkins-Hall and Sacco [1991] AMPFPC and Brief Evaluation Aim:

PSL. To study the effect of client race and depression on evaluation by European American therapists Method: Case study Procedure: European American therapists were asked to watch a video of a clinical interview and to evaluate the female patient Four conditions representing the possible combinations of race and depression: non-depress; African American and non-depressed; European American and non depressed; African American and depressed; European American and depressed Findings: Although the therapists rated the non depressed African American and European American in the same way, their ratings of the depressed women differed, in that they rated the African American woman with more negative terms and saw her as less socially competent than the European American Woman B. GMECGender: Gender was not taken into consideration because all were females Method: Case study No controlled variables Ethics: No ethical considerations stand out in this investigation because it was a case study Cross Cultural Validity: Cross cultural validity was present but it was limited The participants ethnicities differed however they were all American citizens Tolerate uncertainty: Female participants may have varied in their portrayal of depression Alternate results: Therapists may have been unfamiliar to body language of African American participants, contributing to a more negative diagnosis