assesment, diagnosis and modern treatments Flashcards

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1
Q

assesment: the clinical interview

what do they usually ask?

A
  • Used by psychologists, psychiatrists, mental health professionals
  • Current and past behaviour, attitudes, and emotions
  • Detailed history of individual’s life in general and presenting problem
  • Current and past interpersonal/social history
  • Information on upbringing, sexual development, religious attitudes, cultural factors

The clinical interview is used by psychologists, psychiatrists, and other mental health professionals. The interview gathers information on current and past behaviour, attitudes, and emotions, as well as a history of the individual’s life in general and of the presenting problem. Clinicians determine when the presenting problem first started and identify other events (e.g., life stress, trauma, physical illness) that might have occurred about the same time. In addition, most clinicians gather at least some information on the patient’s current and past interpersonal and social history, including family makeup (e.g., marital status, number of children, student currently living with parents), and on the individual’s upbringing. Information on sexual development, religious attitudes (current and past), relevant cultural concerns (such as stress induced by discrimination), and educational history are also routinely collected. To organize information obtained during an interview, many clinicians use a mental status exam.

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2
Q

assesment: the clinical interview

the mental status exam

In essence, the mental status exam involves the systematic observation of somebody’s behaviour. In the mental status exam, clinicians organize their observations in a way that gives them sufficient information to determine whether a psychological disorder might be present. For the most part, the exams are performed relatively quickly by experienced clinicians in the course of interviewing or observing a patient.

The exam covers five categories:

A

1) Appearance and behaviour: any overt behaviours, such as leg twitching, dress, general appearance, posture, and facial expression.

2) Thoughts/thought processes: When clinicians listen to a patient talk, they’re getting a good idea of that person’s thought processes. They might look for several things here. For example, does the person talk really fast or really slowly? Do the patients make sense when they talk or are ideas presented with no apparent connection? In some patients with schizophrenia, a disjointed speech pattern, referred to as looseness of association, may be noticed. In addition to rate or flow and continuity of speech, what about the content? Is there any evidence of delusions (distorted views of reality)?

3) Mood/affect: ood is the predominant feeling state of the individual, as we noted in Chapter 2. Do the patient appear to be down in the dumps or continually elated? Do they talk in a depressed or hopeless fashion? Are there times when the depression seems to go away? Affect, by contrast, refers to the feeling state that accompanies what we say at a given time. If a friend told you their mother has died and is laughing about it, or if your friend has just won the lottery and is sobbing, you would think it inconsistent. A mental health clinician would note that your friend’s affect is inappropriate.

4) Intellectual functioning: linicians make a rough estimate of others’ intellectual functioning just by talking to them. Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors (as most of us do much of the time)? How is the person’s memory? We usually make some gross or rough estimate of intelligence that is noticeable only if it deviates from what is typical, such as concluding the person is above or below average intelligence.

5) Sensorium: Sensorium is our general awareness of our surroundings. Does the individual know what the date is, what time it is, where they are, who they are, and who you are? People with permanent brain damage or dysfunction—or temporary brain damage or dysfunction, often caused by drugs or other toxic states—may not know the answer to these questions. If the patient knows who he or she is and who the clinician is and has a good idea of the time and place, the clinician would say that the patient’s sensorium is clear and is oriented times three (to person, place, and time).

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3
Q

clinical interview approaches

what are the different interview structures?

A

in general interviews will ask about symptoms to get a sense of what is going one, ask questions about developmental history, educational background, social life, medication, symptom, gather information from all those areas

unstructured interviews: follows no systematic format and would ask questions above

Problem with unstructured: very easy to miss things, overlook potential explanations, confirmation bias (this sounds like xyz, they would ask questions things that will confirm their beliefs, so they overlook any potential explanations) practitioners often overvalue their expertise

semistructured: Semistructured interviews are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner, so clinicians can be sure they have inquired about the most important aspects of particular disorders. Clinicians may also depart from set questions to follow up on specific issues

  • basically a general guideline to follow that they can deviate off of as needed, series of questions u go through and the ycan go off with those gudielines if necessary. See more in a therapy session
  • disadvantage: The disadvantage, of course, is that it robs the interview of some of the spontaneous quality of two people talking about a problem. Also, if applied too rigidly, this type of interview may inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked.

structured: step by step interviews, intensive, lots of details, full coverage, structure interviews are rigid stepby step that are designed high accuracy. Good for research.

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4
Q

physical examination

A

f the patient presenting with psychological problems has not had a physical exam in the past year, a clinician might recommend one, with particular attention to the medical conditions sometimes associated with the specific psychological problem. Many problems presenting as disorders of behaviour, cognition, or mood may, on careful physical examination, have a clear relationship to a temporary toxic state. This toxic state could be caused by bad food, the wrong amount or type of medicine, or the onset of a medical condition. For example, thyroid difficulties, particularly hyperthyroidism (overactive thyroid gland), may produce symptoms that mimic certain anxiety disorders, such as generalized anxiety disorder. Hypothyroidism (underactive thyroid gland) might produce symptoms consistent with depression. Certain psychotic symptoms, including delusions or hallucinations, might be associated with the development of a brain tumour. Withdrawal from cocaine often produces panic attacks, but many patients presenting with panic attacks are reluctant to volunteer information about their addiction, which may lead to an inappropriate diagnosis and improper treatment.

Usually, psychologists and other mental health professionals are well aware of the medical conditions and drug use that may contribute to the kinds of problems described by the patient. If a current medical condition or drug use situation exists, the clinician must ascertain whether it is merely co-existing or causal, usually by looking at the onset of the problem. If a patient has experienced severe bouts of depression for the past five years but within the past year also developed hypothyroid problems or began taking a sedative drug, then we would not conclude the depression was caused by the medical or drug condition. If the depression developed simultaneously with the initiation of sedative drugs and diminished considerably when the drugs were discontinued, we would be likely to conclude the depression was part of a substanceinduced mood disorder.

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5
Q

assessment: the clinical interview

which part of mental status exam is being assessed?

A
  1. During the interview, the clinician pays close attention to the client’s speech pattern, noting things like speed, content, and continuity. There were no indications of delusions. -> THOUGHT PROCESSES

2.The clinician made observations about the patient’s disheveled attire, noting that the man frequently averted his gaze and appeared to be irritable. -> APPEARANCE AND BEHAVIOUR

  1. After an athlete sustained a serious head injury, the clinician asked the athlete to report the date, time, and her name. -> SENSORIUM
  2. While describing a near-fatal accident, the client laughed and was noted by the clinician to appear elated. -> MOOD AND AFFECT
  3. The clinician asked the client to recall details of some recent events and also noted the client had an adequate vocabulary. -> INTELLECTUAL FUNCTIONING
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6
Q

behavioural assesment

A

The mental status exam is one way to begin to evaluate how people think, feel, and behave and how these actions might contribute to or explain their problems. Behavioural assessment takes this process one step further by using direct observation to formally assess an individual’s thoughts, feelings, and behaviour in specific situations or contexts; this information should explain why the person is having difficulties at this time.

linical interviews sometimes provide limited assessment information. Young children or individuals who are not verbal because of the nature of their disorder or because of cognitive deficits or impairments are not good candidates for clinical interviews. As we already mentioned, sometimes people deliberately withhold information because it is embarrassing or because they aren’t aware that it is important. In addition to talking with a client in an office about a problem, some clinicians may go to the person’s home or workplace or even into the local community to observe the person and the reported problems directly. Others set up role-play simulations in a clinical setting to see how people might behave in similar situations in their daily lives.

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7
Q

assessment: behavioural assessment

direct observations

Abc’s of observation

create measurable goals for treatment

self-monitoring and reactivity

A

Direct observation to gather information – we may directly observe the person to gather information abt thoughts feelings and behaviours, in their sort of environment

In behavioural assessment, traget behaviours are identified and observed with the goal of determining the factors that seem to influence those behaviours.

ABC’s of observation – primarily interested in this. Antecedent, behaviour and consequence of the behaviour and this can form a lot of intervention

Advantage is it allows us ti gather information abt people who may not be able to verbalize their issues (example: children who has verbal deficits,autism, cognitive deficits) another advantage is we can gather information abt people who maybe withholding info or just not aware (we can observe ppl in the workplace, at home, memory is starting to diminish, parents not wanting to report their children’s behaviour, )

In this case behavioral assessment can be useful for phobias, anxiety disorders (they can engage in that situation and look at the abc set)

Self monitoring is godo for phobias

Reactivity – change in a behaviour due to monitoring it , thoughts and emotions may shift just by having awreness

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8
Q

The ABCs of Observation

Observational assessment is usually focused

A

1) Antecedents: Immediate behaviour, its antecedents (what happened just before the behaviour)

2) Behaviour

3) Consequences: what happened afterward

To use the example of the young boy, an observer would note that the sequence of events was: (1) his parent asking him to put his glass in the sink (antecedent), (2) the boy throwing the glass (behaviour), and (3) his parent’s lack of response (consequence). This sequence (the ABCs) might suggest that the boy was being reinforced for his violent outburst by not having to clean up his mess. And because there was no negative consequence for his behaviour (his parent didn’t reprimand him), he will probably act violently the next time he doesn’t want to do something

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9
Q

assessment: psychological testing

projective tests

A

Still commonly used despite poor theoretical and psychometric support

Rorschach Inkblot Test

Projective tests – not reliable or valid

Based on psychoanalytic theory – premises that ppl will project our true personality, unconscious fears and thoughts onto the ambiguous test stimuli and therefore reveal these hidden unconscioys thoughts

through these poctures Reveals unconscious thoughts to ur therapist

Generalkly does not work , does not relate to any measures of personality, low reliability overtime (multiple assesos interpreting the findings and u will mosy likely not get the same results) , doesn’t help diagnose people

At best can be a pount of discussion but not for any meaningful interpretations

Do not rely on these ti establish osychopatjology

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10
Q

projective testing

A

We saw in Chapter 1 how Freud brought to our attention the presence and influence of unconscious processes in psychological disorders. At this point we should ask, “If people aren’t aware of these thoughts and feelings, how do we assess them?” To address this intriguing problem, psychoanalytic workers developed several assessment measures known as projective tests. They include a variety of methods in which ambiguous stimuli, such as pictures of people or things, are presented to a person who is asked to describe what they see. The theory here is that people project their own personality and unconscious fears onto other people and things—in this case, the ambiguous stimuli—and, without realizing it, reveal their unconscious thoughts to the therapist.

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11
Q

assessment: psychological testing

projective tests

A

1) Thematic Apperception Test (TAT)

  • tell story about ambiguous picture

perhaps the best-known projective test, after the Rorschach. It was developed in 1935 by Morgan and Murray (Bellak, 1975). The TAT consists of a series of 31 cards: 30 with pictures on them and 1 blank card, although only 20 cards are typically used (see ■ Figure 3.5). Unlike the Rorschach, which involves asking for a straightforward description of what the test taker sees, the instructions for the TAT ask the person to tell a dramatic story about the picture. The tester presents the pictures and tells the client, “This is a test of imagination, one form of intelligence.” The person being assessed is asked to “let your imagination have its way, as in a myth, fairy story, or allegory” (Stein, 1978, p. 186). Again like the Rorschach, the TAT is based on the notion that people will reveal their unconscious mental processes in their stories about the pictures (Nissley & DeFreese, 2020).

  • can be used as an icebreaker, for getting people to open up and talk about how they feel about things going on in their lives
  • Their relative lack of reliability and validity, however, make them less useful as diagnostic tests. Concern over the inappropriate use of projective tests should remind you of the importance of the scientist–practitioner approach. Clinicians not only are responsible for knowing how to administer tests but also need to be aware of research evidence about their usefulness as a means of diagnosing disorders.

2) Draw-a-Person Test

They all present ambiguous picture and asked to tell a story (beginning, middle in the end)

Someone will interpret ur stiry with no guidelines to the test administrator, so its not reliable, not valid it may be able to predict a need for achievement

There’s nothing here to substantaiate it

Draw a person test – ask someone to draw ur family, then someone would interpret it, no guidelines to make valid measures, could be use as a discussion starter / conversation starter, but not useful to understand psychopathology or someone’s personality, do not use for any meaninglful interpretation

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12
Q

psychological testing

multidimensional instruments

A

Many types of symptoms (200-600 items)

Often include validity scales
> Positive impression management
>Negative impression management
> Random responding

Comparison to norms

Personality tests in the textbook – pretty inaccurate, they are measures of psychopathology

Multidimensional instruments - Ask questions related to many types od symptoms, they can asses an individual’s response pattern to see whether or not they are leaning towards ___ to gather info

Positive impression – when ppl try to obhere better than they are, series of questions on scenarios, and they have baseline for how ppl typically respond, superhuman, never report having diffuclty, challenges when the general population experience this

Negative impression – that’re malingering , trying to make their actual symptoms far worse, (when trying to prove insanity in court, gain access to services prescriptions and therapy)

Random responding – is this person just randomly

Overall they are long, can induce fatigue in clients, they can detect protocol validity, they can detect malingering and concealment and theres liteaturtu to support

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13
Q

psychological testing

multidimensional instruments

MMPI-3

A

Developed using the empirical method

8 Restructured Clinical Scales

26 Specific Problems Scales (somatic/cognitive, internalizing, externalizing, & interpersonal

10 validity scales

335 T/F Items

Good reliability and predictive validity

No underlying theory, item overlap amongst scales

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14
Q

MMPI-3 notes

A

MMPI-3

New – know abt it

Original mmpi was developed on a scale scale basis on the 1930s – early 1940s

This one was based on an empirical method to develop clinical scales – derive tby selecting items/ questions that wwre endorsed by patients known to have been diagnosed with a disorder

despression for example

They typically have a question that depressed people would say yes to that question

Look at the general population and the ydecide what symptoms they endorse, what they have (very a-theoretical) what do people say in the population say they have, wasn’t based on a theory instead look at people with psychopatholgy

This type od development – questions are meaningful

In this new version, just know that the;res a lot of validity scales, they cut down on questions, t/f questions is unique

Predictive validity –

Mmp1 3 has advnatges now, expanded on normative people, a greater representation of the adult population, more arranged on demographic, gender diversity,

No underlying theory, item overlap amongst scales – items overlap (synptoms of anxiety and depression may overlap) there is some overlap in questiins

Item iverlap may be Problematic because it may be difficukt at times, not be clear on interpretatiins

not really a personality scale because the main focus is on psychopathology and not personality

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15
Q

psychological testing

multidimensional instruments

PAI

A

Developed using a construct validation approach

344 items, 4-point scale

11 symptom scales, 4 validity scales

Good reliability, predictive validity, construct validity, and discriminant validity

Extensive psychometric testing and theoretical support

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16
Q

PAI notes

A

PAI

This would be the biggest competitor to the

This asses psychopathology like mmpi

Construct validation approach – theory driven, the researches had constructs or theory about depression and all of those aspects related to thoughtsm heaviours, and then make questions of how they view depression oppose to asking people

Come up with a construct first then create questions

Lots of symptom scales, some of validity scales, but has good reliability and validity

Similar to the other test, u wont get people to do both – can be exhausting

PIA has advanatges – has 4 point likert scale, give u more information that way

*** No item overlap – big advantage, if someone endorses tha tquestion its only applkying to one symptom scale, its easier to interpret bu thas pure validity indicators which can be a disadvantage

** BASED ON A CONSTRUCT VALIDATION APPROACH, VERY A THEORETICAL

multidimensional tests - exhausting but can give lots of information

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17
Q

psychological testing

brief scales

A

More depth, but less breadth

Multiple symptoms (e.g., IDAS-II)

Specific symptoms (e.g., BAI & BDI)

Etiological factors (e.g., WW-II)

Brief scales to diagnose or look for symptoms

Overall they measure a few clases of symprtoms, much easier for clients to complete and a lot easier,

Less breadth (they go deeper not wider)

IDAS – for multiple symptoms, much shorter, they don’t typically have validity measures, useful for treatment progrwss as oppose to diagnosing

Bai ans bdi –focused in very specific symotomps,

Etiological factors – things that are leading to the symptoms, measuring beliefes abt theirworry (ww11), most useful for monitong sympotoms overtime

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18
Q

explain the benefits of administering neuropsychological testing, neuroimaging, and psychophysiological assessment to individuals with psychological disorders.

A

see tectbook

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19
Q

assessment: neuropsychological testing

A

Language, attention, memory, motor skills, perception, etc.

Intelligence testing
> E.g., WAIS, WISC, WPPSI

The Bender-Gestalt
> Brain trauma, perceptual distortions, psychotic disorders

Neurpsych testibg will look at receptive and experessive languange, attention and concentration, motor skills, perceptual abilities, intelligence testing

Intelligence measures are typically used for diagmosing LD, can also be used when an individual is trying to asses brain trauma, effect of drugs,

Bedner-gestalt – was used to asses brain trauma, psychotic disorder, individual is given pcitures of geographic visual figures sand they try to recreate it , are they paying attention, not good for diagnosting, no reliability, low validity, can be useful as a screening tool, otherwise not super useful

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20
Q

neuropsychological testing

sport concussion assessment tool (SCATS)

A

Used to evaluate injured athletes for concussion

Pre-season baseline results typically established for comparison

Measures: Immediate memory, concentration, delayed recall, balance, and orientation

To get a sense of any sorts of effects related to immediate memory, delayed recall, balance,

To see if there was any difference from the baseline

21
Q

neuropsychological testing

neuroimaging

A

1) brain structures
> CAT or CT scan
> MRI

2) brain functioning
> PET
> fMRI

Neuroimaging involves laking at brain structure and or brain functioning

Repeated xrays Looks at the structure for brains – brain damage, tumors,

mri – identify lesions, damage and gives precise layering

Pet – what areas in the brain are firing more than others, inject tracers into the brain

22
Q

diagnosis

overview

A

Classification Issues

Categorical Approach

Dimensional Approach

Prototypical Approach

DSM-5-TR

Multi-axial Diagnosis

first u assess them and gather them and then figure out if u can make a diagnosis

diagnosis - process of determining wether or not a problem meets critera

23
Q

diagnosis: purpose

A

For ease of communication (communicate between professionals)

Influences treatment decisions

To provide clients with a name for their experience

issues with labelling: a lot of stigma, people may over-identify and then it becomes part of their identity

24
Q

diagnosis: utilozation

A

Who can diagnose?
Anyone can say “it sounds like you are depressed”

Only selected professionals can make AN OFFICIAL diagnosis
- Psychologists, nurses, and medical doctors
-Assumed to be a DSM label

25
Q

diagnosis: careful considerations

A

can cause serious problems
- health care practitioners
- government agencies

can also help
- legitimize their experiences
- access to services


Diagnosis – applying diagnosis have serious consequences – may change how they view themselves, stigma associated, misdiagnoses, can change how individuals are treated

Diagnosis in the government agency – gaining access to services

Diagnosis can help by getting treatment that they need, access to services that support their needs, separate sense of self from the disorder,

26
Q

diagnosis issues

A

Classification is at the heart of any science, and much of what we have said about it is common sense. If we could not order and label objects or experiences, scientists could not communicate with one another and our knowledge would not advance. Everyone would have to develop a personal system, which, of course, would mean little to anyone else. In a biology or geology course, when studying insects or rocks, classification is fundamental. Knowing how one species of insects differs from another allows us to study its functioning and origins.

When we are dealing with human behaviour or human psychological disorders, however, the subject of classification becomes controversial. Some people have questioned whether it is proper or ethical to classify human behaviour. Even among those who recognize the necessity of classification, major controversies have arisen. Within psychopathology, for example, definitions of typical and atypical are questioned and so is the assumption that a behaviour or cognition is part of one category or disorder and not another. Some would prefer to talk about behaviour and feelings on a continuum from happy to sad or fearful to nonfearful, rather than to create such categories as mania, depression, and phobia. Of course, for better or worse, classifying behaviour and people is something we all do. Few of us talk about our own emotions or those of our friends by using a number on a scale (where 0 is totally unhappy and 100 is totally happy), although this approach might be more accurate. (“How do you feel about that?” “About 65.”) Rather, we talk about being happy, sad, angry, depressed, fearful, and so on.

27
Q

diagnosis: classification issues

categorical approach **

A

every disorder:

  • Clear underlying pathophysiological cause
  • Unique
  • One set of causative factors
  • One set of defining criteria

(either you are in this category or not)

Useful in medicine

Not useful in diagnosing psychopathology - we know that what causes psychopathology is multifaceted (bio, psycho, environmental)

Here we assume that every diagnosis has a clear underlying pathophysiological cause, such as a bacterial infection or a malfunctioning endocrine system, and that each disorder is unique. When diagnoses are thought of in this way, the causes could be psychological or cultural, instead of pathophysiological, but each disorder has only one set of causative factors that do not overlap much with other disorders. Because each disorder is fundamentally different from every other, we need only one set of defining criteria, which everybody in the category has to meet. If the criteria for a major depressive disorder are (1) the presence of depressed mood, (2) significant weight gain or weight loss when not dieting, and (3) diminished ability to think or concentrate, and six additional specific symptoms, then, to be diagnosed with depression, an individual would have to meet all nine criteria.

Classical categorical approaches are quite useful in medicine. It is extremely important for a physician to make accurate diagnoses. If a patient has a fever accompanied by stomach pain, the doctor must determine quickly if the cause is food poisoning or an infected appendix or something else. This distinction is not always easy to make, but physicians are trained to examine the signs and symptoms closely, and they usually reach the correct conclusion. To understand the cause of the symptoms (infected appendix) is to know what treatment will be effective (surgery). But if someone is depressed or anxious, is there a similar type of underlying cause? As we saw in Chapter 2, probably not. Most psychopathologists believe biological, psychological, and social factors interact in complex ways to produce a disorder. Therefore, despite the beliefs of Kraepelin and other early biological investigators, the mental health field has not achieved the promise of a classical categorical model of psychopathology.

28
Q

diagnosis: classification issues

dimensional approach

A

All symptoms can range from high to low

No cut-offs (they can see the severity of someone’s symptoms)

How many continuums are needed? (it is difficlut to communicate this way)
- continuum for sadness? anger? anxiety?

useful to assess severity of symptoms

second strategy is a dimensional approach, in which we note the variety of cognitions, moods, and behaviours with which the patient presents and quantify them on a scale. For example, on a scale of 1 to 10, a patient might be rated as severely anxious (10), moderately depressed (5), and mildly manic (2) to create a profile of emotional functioning (10, 5, 2). Although dimensional approaches have been applied to psychological disorders in the past—particularly to personality disorders (e.g., Blashfield et al., 2014; Krueger et al., 2014; Widiger & Samuel, 2005)—they have been relatively unsatisfactory (Brown & Barlow, 2009; Frances, 2009; Widiger & Edmundson, 2011). Most theorists can’t agree on how many dimensions are required; some say one dimension is enough; others have identified as many as 33 (Millon, 1991, 2004).

29
Q

diagnosis: classification issues

prototypical approach

A

Must have core features, with other symptoms varying (every disorder must have core features)

Creates many “subtypes” for each disorder (some symptoms within those can vary - subtypes)

A third strategy for organizing and classifying behavioural disorders has found increasing support as an alternative to classical categorical or dimensional approaches. It is a categorical approach but with the twist that it combines some of the features of each of the other approaches. Called a prototypical approach, this alternative identifies certain essential characteristics of an entity so you (and others) can classify it, but it also allows for certain non-essential variations that do not necessarily change the classification.

see textbook for more

30
Q

the DSM-5-TR uses what approach?

A

DSM uses the prototypical approach

(DSM-5-TR)

Atheoretical

Sets the criteria/key symptoms

Few big revisions compared to DSM-IV/DSM-5

Trying to be more dimensionally-based

Removed multi-axial diagnosis

DSM5 - it is atheoretical which means looking at the population, look at the symptoms they report, they are much more descriptive “here are what people typically report”

In the past dsm were explained by the psychoanalytic theory

31
Q

prototypical approach classify abnormal behaviour on a assumption that?

A

**We classify abnormal behavior on a assumption that there’s combinations of characteristics or prototypes that tend to occur together regularly

And there are variations within

It is trying to be both categorical and dimensional. How?

We have a category and within that there’s a lot of room for variations in symptoms

We have a core features but there’s variations in size, colors, sounds they make for example

32
Q

criticisms of DSM-5

A

Comorbidity
> Multiple disorders co-occurring
>Problems with diagnostic criteria?
>Should we create more disorder categories?
>Is comorbidity natural?

Key one is issue of comorbidity – people don’t typically present one disorder, there are multiple disorders that are occurring

Ex: its very common to have depression and anxiety, they usually go together (higgly comorbid)

Why are these disorders overlapping so much? Is it distinct disorders?

Generally, comorbidity is primarily caused by the true nature of the disorders** – the individual is truly experiencing both the disorders , we don’t necessarily need new categories or a new disorder,

Comorbidity, in terms of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), refers to the presence of two or more distinct psychiatric disorders or conditions in an individual at the same time. It suggests that the individual is dealing with multiple mental health issues concurrently. The concept of comorbidity recognizes that mental health disorders often co-occur, and the presence of one disorder may increase the risk of developing another.

For example, an individual diagnosed with major depressive disorder may also be diagnosed with an anxiety disorder. This coexistence of disorders is considered comorbidity. Comorbidity can involve a combination of various mental health conditions, such as mood disorders, anxiety disorders, substance use disorders, and more.

33
Q

MODERN TREATMENTS

A

overview

Biological therapies

Psychodynamic therapies

Humanistic-existential therapies

Cognitive-behavioural therapies

Computer-assisted therapy

34
Q

biological therapies

medications (psychopharmacology)

There has been a lot of research that looks at therapies in comparison to medications –

Medications combines with CBT together is more effective in some cases but not all (not the case every time) it very much depends on the medication, type of CBT and the disorder

** know what it is and what they treat, no need to memorize the medications itself

A

1) Anxiolytics

  • Benzodiazepines (e.g.,
    Xanax, Valium, Ativan)

-Effective only in short-term (extremely addictive , so they are only prescribed for short term because it can cause rebound anxiety)

  • primarily treats anxiety by increasing GABA in our system
  • GABA agonist (increases the effect of a neurotransmitter)

2) Antidepressants

  • SSRIs (e.g., Prozac, Zoloft, Paxil)

-SNRIs (e.g., Effexor, Cymbalta)

-Effective, but takes 2-6 weeks (around that time you see differences in the system)
> indicator that the chemical imbalance theory is not legitimate

  • often prescribed with people with anxiety, depression and eating disorders
35
Q

biological therapies

Medications (psychopharmacology)

A

3) Mood Stabilizers

  • Lithium and anticonvulsants
  • Effective in calming frequency & duration of mania
  • Typically treats indviduals that have bipolar disorders
  • Lithium and – type of mood stabilizer, lithium has significant side effects –easy to overdose individuals
  • Anticonvulsants – more common bcos they have fewer side effects
  • Effective in calming frequency & duration of mania – manic episodes
36
Q

biological therapies

medications (psychopharmacology)

A

4) antipsychotic drugs

1st wave (e.g., chlorpromazine, haloperidol)
Treat the ‘positive’ symptoms of schizophrenia

2nd wave (e.g., clozapine, risperidone)
Treat both ‘positive’ and ‘negative’ symptoms

– 1st wave – conventional , positive symptoms of shizo are changes of thoughys and hebavuous, delusions, hallucinations, change in yhe behaviour

2nd wave – atypicals – treat positive and negative symptoms of schizo, negative symptoms are lack of speech, asociality, apathy, limited speech, lack of interest in things

positive symptoms: experiences or behaviors that are added to the person’s normal repertoire of functioning. These symptoms are often seen as excesses or distortions of normal functioning.

  • hallucinations, delusions, disorganized thinking

Negative symptoms involve a decrease or loss of normal functioning or abilities. They reflect deficits or disruptions in emotional, social, and cognitive processes.

  • social withdrawal, neglect daily task and personal hygiene
37
Q

biological therapies

neurosurgery and ECT

A

(Neurosurgery)

  • Extremely rare, only done for most extreme disorders
  • poorly studied because it is rare

Electroconvulsive therapy (ECT)

  • Stimulating the brain with 800 milliamps
  • Sedatives used to control seizures
  • Effective for severe depression

Much more minor compared to what it was historically

Stimulates brain with electricity – inducing seizures, to minimize the damage

Usually treated for severe depression likely with a combination of suicidal traits – when individuals don’t respond to therapy or medication

Side effects: minor amnesia

38
Q

psychodynamic therapies

brief psychodynamic therapies

A

Examining defence mechanisms, transference, and current relationship issues

Origins in psychoanalytic theory

Psychodynamic is an approach that dives in the human mind- interested in the unconscious mind

How the uncosncius mind influences thoughts emotions and behaviour

Defence mechanisms – they engage in it because we experience intrapsychic conflict – id and superego conflict creates anxiety so we use defence mechanisms

Transference – interested in how the client is projecting emotional response onto the therapist (they may treat the therapist as like a pareny, parent) , transference is significant component of psychodynamic therapies

Alleviate tension , bring forward repressed feelings,

39
Q

psychodynamic therapies

interpersonal psychotherapy (IPT)

A

Work on interpersonal relationships through the therapeutic alliance

Focuses on relieving symptoms by improving interpersonal relationships/ functioning

Helps recognize dysfunction between – addresses current relationship rather than past experiences

Therapist is quite active, supportive and give advise on how to improve relationships

Examining a relationshio and woreking to improve them and through that it alleviates their symotons

40
Q

humanistic-existential therapies

motivational interviewing (MI)

A

Helps client to resolve ambivalence regarding treatment

Particularly big on addiction treatments and teens

Very collaborative approach – working with a client to help establish goals (goal oriented), purpose is to help strengthen clients inner motivation for change

41
Q

humanistic-existential therapies

emotion-focused therapy (EFT)

A

Increase awareness and acceptance of emotions

Emotion-shifting techniques

Based on a premise that emotions are key critical to identify and emotions are our guide for individuals choices and decision making

Assumes that an individual lack of emotional awareness or avoiding unpleasant emotions can cause harm **

Helping to cultivate awareness of emotions to develop more comfort with experiencing emotuons and help them shift their emotions

Primary and secondary emotions – maybe they are acting angry because they are actually sad

42
Q

cognitive-behavioural therapies

variations of Beck’s CBT

A

Identifying automatic thoughts/faulty beliefs

Challenge beliefs through in-therapy exercises and homework

Lots of research – initially developed to treat depression

Type of therapy that lends itself to being studied, very structured,

Lots of variation but at core, its short term, present oriented, very structured and help individuals build awareness of their dysfunctional thinking and behaviour to help solve current problems

Examinibg beliefs that they have – faukty beliefs that needs to be addressed,

Focuses on challenging those automatical thoughts, faulkty beliefes, and help them cope with challenging situations

Much mor standardized, a layout of how u approach clients which makes it study to study

43
Q

cognitive-behavioural therapies

Exposure/exposure & response prevention (ERP)

A

Engaging in the activity you are avoiding, without use of anxiety-reduction strategies

Also challenge cognitive distortions

Exposure therapy use to treat ocd and now ptsd, phobias,

Engage activities that they are avoiding – expising them of what they are scared of

Expose tgem to what they are scared of and prevent them with what hey want to do regarding their obsessive thoughts (ocd – they cant wash their hands, they cant do their usual rituals )

44
Q

cognitive-behavioural therapies

Acceptance-and-commitment therapies (ACT)

A

Accepting thoughts rather than challenging them

Commit to make changes

Separating thoughts from “self”

Defining values and goals

Being sued for a lpt of mood disorders / emotional disorders

Action oriented approach – heavily emphasized that acceptanve of their thoughts rather than fighting them

Encourage them to feel that fear and be accepting of it

Separating thoughts – ur thoughts are just ur thoughts

In addition to accepting, there;s a commitment to some behaviour, to go do it or take action

45
Q

cognitive-behavioural therapies

mindfulness-based therapies

A

Promoting greater awareness in the moment

Observe and accept streams of thought

Very much bringing attention to the present moment –

Can go hand in hand with act

Very much about buikfing that bring ur attention to just ur breathing for example

Orienting urself to the present momeny so it takes u bacl from ur anxious thoughts

When ur thoughts come back in – u accept it, and now I will bring back my awareness to the present moment

46
Q

computer-assister therapies

computer-assisted CBT

A

Effective with mild-moderate cases
May be part of a stepped care approach

47
Q

computer-assisted therapies

Cognitive bias modification therapy

A

Targets implicit cognitions associated with anxiety and depression

Their implicit biases are shifted

Fear of being judged socially – they will be asked to llook at a screen and when theu see words they press a button

Graduallu shifiting tgheir focused or bias to bringing more positive stimuku tgroughy words or faces (ignore / avoid that has negavtive words or faces)(

Theyre designed to draw attention to neutral or positive stimuli and avoid negative or threatening stimuli

48
Q
A