2. Principles of assessment, classification & treatment Flashcards
what do categorical approaches assume?
assume that the distinctions between categories are qualitative - does the person have this characteristics or not?
what do dimensional approaches consider?
characteristics/qualities as varying along continuum - how much of this characteristic does this person exhibit?
how are diagnoses in psychopathology descriptive?
it identifies a particular problem is present based on a collection of features. the cause of explanation is not inherent in the diagnosis - associated features of possible explanations can be identified, but are not essential to the diagnosis
DSM-classification
categorial, polythetic and descriptive classification system
polythetic
each disorder is defined by a number of symptoms, and not all need to be present to meet the criteria
categorical
classifications are binary
descriptive
describes a pattern
how many diagnoses does the DSM 5 system have and under how many primary headings?
200 specific diagnoses and 22 primary headings
inclusion criteria
the symptoms that must be present to establish a diagnosis
exclusion criteria
diagnoses that can be ruled out if certain conditions prevail
how does the DSM-5 help provide a diagnoses?
lists specific criteria for each diagnostic category - a person can be assigned more than one diagnosis if criteria for more than one disorder is met
why diagnose?
clinical utility
access to funding/service/resources - diagnosis can be the qualifie
research
formalisation of natural cognitive processes
other reasons
clinical utility of diagnoses
informs treatment decision making
prognostic information - likely course and outcome
communication
what does the clinical utility of a diagnosis rely in?
relies on that diagnostic category measuring something meaningful with some consistency
reliabiltiy of clinical diagnosis
consistency of measurements
- interrater reliability - can multiple clinicians apply the classification system and reach the same conclusion?
validity of clinical diagnosis
the meaning or importance of the measurement
- does the diagnosis tell us anything useful
- can we make informed decisions from this information?
- does it meaningfully differentiate amongst similar problems?
purpose of assessment
- To determine if psychopathology is present
- To characterise (or formulate) the ‘problem’
- To inform treatment planning/priorities
- To predict likelihood of risk and guide decision making
- To establish a baseline against which ‘change’ might be monitored
- To establish a shared language from which to progress
principle of assessment
as well as the reliability and validity of diagnostic entities, we should consider the reliability and validity of the methods we use to gather information
best practice of assessment
- a mix of data/methods - consider patters and inconsistencies
- use something with known psychometric properties
the clinical interview
involves client (and if consent permits, corroborators)
clinical interview enables the collection of:
– A wide variety of information (client’s view of problem/symptoms; subjective distress/impairment)
– Different types of information (clinical observations, signs, behavioural assessment)
– Can be structured, semi-structured or unstructured (e.g. SCID)
– Focus can be broad or narrow
what might be covered in a clinical interview?
– Subjective experience of the problem – History of the problem - onset and course – Context of the problem – Impact on functioning – Family and marital history – Social, educational and occupational history – Family history – Medical history – Risk assessment
Observation
may be formal or information primarily qualitative often part of clinical interview can occur in specific contexts - i.e. naturalistic observation at a home, school etc self-monitoring
Mental status examination
key part of clinical interview - documents the clinician’s observations of the person’s presentation during the interview considering factors such as:
– Appearance and behaviour
– Mood and Affect
– Speech and language
– Thought content and process
– Perception
– Cognitive functions – attention, concentration, orientation
Psychological tests
rating scales, inventories, questionnaires, checklists.
features of psychological tests
standardisation and normative data; higher relaibility
normative data can be used for:
generative baseline information and tracking change and assessing severity relative to “normal” or “clinical” levels of functions (normative comparisons)
Examples of psychometric tests
• DASS21 – Depression, Anxiety and Stress Scales
• BDI - Beck Depression Inventory
• MMPI – Minnesota Multiphasic Multiaxial
Inventory
• Y-BOCS – Yale-Brown Obsessive Compulsive Scale
reliability as a psychometric consideration
measurement consistency including of diagnostic decisions (e.g. interrater reliability/agreement, kappa)
validity as a psychometric consideration
degree to which a test/system measures what it is intended to measure (e.g. convergent validity, predictive validity, divergent validity)
standardisation as a psychometric consideration
a fixed procedure (or prescription) for the application of methods to ensure or increase measurement consistency (affects how we give the test, score it, and handle (and report) the data
physiological (or biological assessment)
e.g. blood tests, MRI, CT, fMRI.
– Tests not typically performed by psychologists, but results might be taken into consideration.
– Important to exclude pathology due to medical condition for correct diagnosis/treatment
– many psychological problems have a physical component.
– The relation may be: causal, correlational, or indirect; there may be comorbid condition/s]
what will assessment methods depend on in practice?
– Goals of assessment - to make a diagnosis, to inform treatment, forensic reporting, decision making (e.g. risk) – Time – Availability of resources – i.e. tests – Training and experience – Context • inpatient or outpatient • emergency or routine
role of relationship
quality of assessment data obtained will depend on the quality of the relationship formed
time
quality assessments can take time - often multiple occasions of assessment are needed. Cross-sectional assessments can be misleading
assessment is onging
assessment informs diagnosis; diagnosis informs treatment; treatment informs assessment; and so on
treatment
the application of techniques to relieve the symptoms associated it the disorder and provide better adaptive functioning in the individual
spiritual cause of mental illness from historical views
– Exorcism of spirits
– Trephining
– Witchcraft that needed to be “treated”
physical cause of mental illness from historical views
– Rest or exercise
– “Asylums” to provide isolation & rest
Lobotomy
Controversial:
Lobotomy is a type of psychosurgery. Irrevocable severing of parts of brain
However, research concludes that there is still a role for ablative neurosurvery for mental disorders (OCD) in 21st century
what are the controversial physical therapies
lobotomy
insulin coma therapy
electro convulsive therapy
what are the 4 paradigmatic approaches?
biological
psychodynamic
cognitive-behavioural
humanistic
