• Subject Name : Nursing

Psychiatric Diagnostic Classification Approaches

Mental health is considered to be an important aspect of the health and it is an essential component when it comes to health wellbeing. Mental health directly contributes toward the individual ability to perform different activities to sustain life (World Health Organization, 2018). The prevalence of the mental disorder has increased globally that account about 13% and different factors directly impact mental health. The increasing prevalence of mental disorder needs to be accurately diagnosed and treated to decrease the complication of the patient (Thyloth et al., 2016). Mental disorders are misdiagnosed due to the unclear borderline that directly negatively impact the patient and family. The essay will critically analyse the two aspects of the mental disorder that includes controversies with psychiatric diagnostic classification systems and medicalization of behaviour.

There are two classification systems when it comes to mental health disorders and they categorise the mental disorders as per the framework. One of the classification systems is Diagnostic and Statistical Manual of Mental Disorders (DSM) and other is the International Classification for Diseases (Surís et al., 2016). In the article presented by Gambrill (2013) author has described that different controversies are associated with the psychiatric diagnostic classification systems and they increase the stress of the normal individual regarding the mental illness. The researcher has described accurately that due to lack of proper diagnosis features in the classification it lead to hyperinflation of the diagnostic that leads to a misdiagnosis that is followed by inappropriate treatment. The researcher also highlighted another controversy with the classification that is lack of the boundary between the two disorders.

The article presented by Martinhago & Caponi, (2019) discussed the two major controversies that have been highlighted in the DSM. The author discussed one of them that are related to the disturbance in the DSM due to the direct benefits from the pharmaceutical companies. The author has discussed that healthcare is considered to be one of the biggest markets and mental health treatment is one of the highest spending sectors. The direct link of the task force with the pharmaceutical company has increased the reason for the controversy. Another study is presented by Kriegler et al., (2014) describe that another controversies that are related to the DSM are the increase medicalise pattern of the behaviour and mood of the individual. The author discussed that decrease diagnostic threshold for the different disorders in the categories that increase the chances of inappropriate medical treatment. The author also discussed that lack of proper classification leads to inappropriate use that directly impacts the diagnosis of the disorder.

The research presented by Timimi, (2014) describe that there is an issue with the psychiatric diagnostic classification systems and the diagnosis only worsen the long term condition of the patient. The author discussed that one of the issues with the classification system is related to the disconnection between the diagnostic and aetiological process which lead to lack of physical test. One of the studies presented by North & Suris (2017) discussed the controversy related to the psychiatric diagnostic classification systems related to bipolar disorder. The author has stated about the three controversies that include the concept of mood, potential subtypes and prevalence in children or adolescent. The author also discussed some other controversy that is related to substances use, posttraumatic stress disorder and somatization disorder. The lack of neurobiological element in the psychiatric diagnostic classification systems is also an issue it is also discussed by the author in the research.

The study presented by Correia, (2017) describe that medicalization is the concept that aims to address the individual issue based on the behavioural aspect. The author discussed that it is considered to be the sociocultural aspect that treats human behaviour as an issue and provide treatment. One of the controversies that are associated with the medicalization is human behaviour is under pressure due to the medicalization that negatively impacts the population. Moreover, the study presented by Dijk et al., (2016) discussed that medicalization is considered to be essential but it can lead to over-diagnosis that is harmful to the patient health status. The author discussed that medicalization is directly affected by the social norms and values that directly increase healthcare consumption. The issue arises with the medicalization due to its focus over the identification of the illness concerning the behavioural aspect of the individual. The author also discussed that controversy related to medicalization arise due to the tag that is put over the person that directly impact the mental status of the patient.

One of the researches presented by Johnstone, (2017) enlightens that there are different criteria over which the psychiatric diagnostic classification systems have been criticized. The author describes that classification lack different aspects that increase the chances of controversy and it has also increased risk for the populations. The research also depicts that some of the aspects that are not covered in the classification system includes decreasing reliability, debar of the social context and leading to stigma. One of the major reason for the controversy its real-life effect over the services user. 

One of the studies presented by Hameed, (2020) discussed that medicalization has both negative and positive aspects that are increasing concern. One of the issues that are related to the medicalization includes normal behavioural change into a hype disorder that can lead to a complex issue. The heightened diagnosis can lead to psychological distress that is labelled as the stigma for the disorders. Some of the issues that are discussed by the author include sadness can be considered as mild depression, breast drooping post-pregnancy can be diagnosed as mammary ptosis and the physiological premature syndrome is related to the premenstrual dysphoric disorder.

Moreover, the study presented by Lancet Psychiatry, (2016) discussed that medicalization is associated to apply the labels to the individual facing issue by naming them diagnosis that can be harmful to the patient. The author also discussed that one of the controversies that are related to the medicalization is that it views the human being as a subject rather than a body that directly decrease our subjectivity. There are both aspects of the medicalization but the controversial aspect as overpowered due to its negative impact over the population that needs to be diminished.

There is a need to improve the understanding concerning the mental disorder and health care associates should improve their understanding concerning the disorder with its different aspect. Nursing and Midwifery Board, (2017) proposed different standards to improve the clinical practice of the registered nurse. One of the standards is 1.1 that state nurses are expected to utilize the best evidence that can be used to deliver the safe and quality practice to the patient. One of the studies presented by Reid et al., (2017) discussed that evidence-based practice is considered to be important in nursing as it helps the nurses to deliver the quality care by utilizing the best evidence. Evidence-based practise helping the nurse to use relevant resources to improve the professional practice by incorporating the clinical knowledge with updated technology and information. 

The nurses are expected to improve the equity in the care that is important to improve the quality of care and decrease the recovery time of the patient. One of the nursing standards is 6.1 that state that nurses are expected to deliver the safe and quality care that helps to achieve the goal and outcome concerning the need of the patient. The clinical practise should be as per the standard to improve the clinical practice and deliver the quality care to the patient (Nursing and Midwifery Board, 2017). Nurses are expected to follow the duty of care and a code of conduct that is important for delivering safe and quality practice. There are different attributes of the care and health care professional are expect to follow them during the clinical practice (Allen-Duck et al., 2017).

The essay has discussed that the lack of the proper classification of the psychiatric disorder has increased the complication. The wrong diagnosed is one of the major issue faced by the patient suffering from a mental disorder that needs to be improved to reduce the chances of inappropriate treatment. The controversy related to the psychiatric diagnostic classification systems arises due to the close impact over the pharmaceutical company that holds one of the major shares in the economy. The lack of boundary between the different disorders is also one of the reasons for the controversy associated with psychiatric diagnostic classification systems. Medicalization has also been associated with the controversy related to normal behavioural change are marked as hype disorder that has a negative impact over the population. Nursing standards are considered to be important for better clinical practise and quality of care. The two important standards that can be used to improve practise includes 1.1 and 6.1. These nursing standards will help to improve the diagnosis and treatment process by considering the evidence that is related to patient health status.

References for Behavioural Perspective of Mental Health

Allen-Duck, A., Robinson, J. C., & Stewart, M. W. (2017). Healthcare quality: A concept analysis. Nursing Forum, 52(4), 377–386. https://doi.org/10.1111/nuf.12207

Correia, T. (2017). Revisiting medicalization: a critique of the assumptions of what counts as medical knowledge. Frontiers in Sociology, 2(14), 1-9. https://doi.org/10.3389/fsoc.2017.00014

 Dijk, W., Faber, M. J., Tanke, M. A., Jeurissen, P. P., & Westert, G. P. (2016). Medicalisation and overdiagnosis: What society does to medicine? International Journal of Health Policy and Management, 5(11), 619–622. https://doi.org/10.15171/ijhpm.2016.121

Gambrill, E. (2013). The diagnostic and statistical manual of mental disorders as a major form of dehumanization in the modern world. Research on Social Work Practice, 24(1), 13–36. https://doi.org/10.1177/1049731513499411

Hameed, S. (2020). Medicalization – A growing problem. J Sci Soc, 46(3), 75-78. http://www.jscisociety.com/text.asp?2019/46/3/75/276995

Johnstone, L. (2017). Psychological formulation as an alternative to psychiatric diagnosis. Journal of Humanistic Psychology, 58(1), 30–46. https://doi.org/10.1177/0022167817722230

Kriegler, S., & Bester, S. E. (2014). A critical engagement with the DSM-5 and psychiatric diagnosis. Journal of Psychology in Africa, 24(4), 393–401. https://doi.org/10.1080/14330237.2014.980629

MARTINHAGO, F., & CAPONI, S. (2019). Controversies about the use of DSM for mental disroders diagnoses. Physis, 29(2), 1809-4481. https://doi.org/10.1590/s0103-73312019290213.

Nursing and Midwifery Board. (2017). Registered nurse standards for practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of evidence based practice through undergraduate nurse education. BMC Nursing, 16(58), 1-8. https://doi.org/10.1186/s12912-017-0251-1

Surís, A., Holliday, R., & North, C. S. (2016). The evolution of the classification of psychiatric disorders. Behavioral Sciences (Basel, Switzerland), 6(5), 1-10. https://doi.org/10.3390/bs6010005

The Lancet Psychiatry. (2016). Medicalisation and its discontents. The Lancet Psychiatry, 3(7), 591. https://doi.org/10.1016/s2215-0366(16)30120-1

Thyloth, M., Singh, H., & Subramanian, V. (2016). Increasing burden of mental illnesses across the globe: Current status. Indian J Soc Psychiatry, 32, 254-256. http://www.indjsp.org/text.asp?2016/32/3/254/193208

Timimi, S. (2014). No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished. International Journal of Clinical and Health Psychology, 14(3), 208–215. https://doi.org/10.1016/j.ijchp.2014.03.004

World Health Organization. (2018). Mental health: strengthening our response. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

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