Assessment and Diagnosis Flashcards
semistructures clinical interview
questions carefully phrased and tested to elicit useful info in a consistent manner
clinicians can depart from questions to follow up on a specific issue
spontaneity missing
can be too rigid = patient less liekly to volunteer info
anxiety disorder interview schedule DSM 5
patient bothered by thoughts, images or impulses
9 point rating scale
physical examination
if no physcial in past year = recommended
eg toxic state, medication, hyperthyroidism
co-existing depresion and substance abuse, must look at onset
behavioural assesment
measuring, oerving and systematically evalutating (not infering) the clients thought, feelings and behvaiour in the actual problem situation occuring
may be more appropriate for individuals who are not old r skilled enough to report their problems and experiences
target behaviours identified and observed
goal = detremining factors that influence them
ABC of behaviours
antecedent
behavoiur
consequence
operational defintion
clear behaviour descrition
self-monitoing
action by which clients observe and record their own behaviours as either as assessment of a problem and its change or a treatment procedure that make them more aware of their responses
also known as self observation
could just be write down every time you have a cigarette
or more formla behaviour rating scales
psychiatric rating scale
assess 18 general areas of concern (0-6severe end)
screens for moderate to severe psych disorders
-somatic concerns = health
-guilt feelings
-grnadiosity
psych testing must be….
reliable - same score each time
valid - measure what it says is measruing
neuropsychological tests determines
possible contribution of brain damag or dysfunction to the pateints condition
projective tests
psychoanalytically based measure that presents ambiguous stimuli to clients on the assumtion that their responses can reveal their unconscious conflicts
they are inferential and lack reliability and validity
theory = people project their own personality and unconscious fears onto other people and things
rorschach inkblot test
thematic apperception test
sentence-completion mehtod
personality inventories
self-report questionnaire that assess personal traits by asking respondents to identiy descriptors that spply to themselves
face validity
wording of a question seems to fit type of information required but is this correct
eg we dont care about whether a schizophrenic has been in love before, what matters is a group they regularly respond they havent ever been in love
content of question = irrelevant, importance relies in what the question predicts
minesota multiphasic personality inventory explain
based on empirical evidence
true or false response
550 items originally, now 567 = boring!
pattern of response is reviewed to see whether groups has have a particular disorder
each group is presented on separate standard scales
computerised so no reliability issues
contains lie scale
contains infrequency scale - measures false claims about psych problems and determines whether person is answering randomly
subtle defensiveness scale - does person see themself realistically
new version = update removing sexism, racism and considers contemporary issues
history of intelligence tests
french
test to identify slow learners who would benefit from remedial help
stanford-binet test - provded as score known as intelligence quotient
-estimated a persons deviation from average test performance
-mental age / chronological age x100 (problematic with young so use deviation IQ instead)
wechsler test
all include verbal sclaes, performace scales, knowledge of facts, short term memory, nonverbal reasoning and ability to learn new relationships
IQ does not equal intelligence as what does constitute intelligence
neuropsychological testing
assessment of brain and nervous system funcitoning by testing an individuals performance on behavioural task
eg bender visual-motor gestlt test
=child to copy drawing on card
= lots more errors than children their age = brain dysfunciton suspected
eg Luria-Nebraska neuropsychological battery = test brain damage can locate which region is damaged (about 80% accurate)
note false positives
pscyhosocial assesment
measurement of changes in the nervous system reflecting psychological or emotional events such as anxiety, stress, sexual arousal
electrodermal response
galvanic skin response
bio feedback
levels of physiological responding (eg blood pressure) are fed back to the patient so they can try regulate their responses
idiographic strategy
close and detailed investigation of an individual emphasising what makes that person unique
so tailor treatment to the person
nomothetic strategy
identification and examination of large groups of people with the same disorder to note similarities and develop general laws
define classification
assignment of objects or people to categories on the basis of shared characteristics
define taxonomy
system of naming and classification in science
define nosology
classification and naming system for medical and pscyhological phenomena
nomenclature
in a naming system or nosology the actual labels or names that are pplied
classification issues
is it ethical to classify human behaviours
continuum or groups
classical categorical approach (pure)
classification method founded as the assumtpion of clear sut differences among disorders, each with a different known cause
assumes every dignosis has a clear underlying pathophysiological cause/ psychological/cultural but only one set of causative factors per disorder
also clear conditions set to meet each disroder
useful in medicine
not adopted in mental health
dimensional approach
method of categorizing characteristcs on a continuum rather than on a binary either all or nothing approach
variety of cognitive models and behaviours and quantify them on a scale
used in the past with personality scales and not particularly successful
couldnt agree on number of dimensions we need
prototypical approach
system for categorizing disorders using both essential defining charactersitcs and a range of variation on other caharcateristics
not perfect as there is blurring at the boundaries of categories and some symptoms occur in more than one disorder
but does fit well with our current knowledge of psych disorders
DSM 5 uses this
most unreliable classiciation area is currently
personality disorders
subject to bias of therapist
construct validity
can discriminate one disroder from another
familial aggregation
extent to which a disorder would be found among a patients relatives
prediction/ creiterion validity
predict the course of the disorder and liekly effect of one treatment or another
content validity
need to get the label right/ fit with what other scientists are calling it
explain the early attempts to classify psychopathology
came out of bio tradition
Kraeplin - first identified schizophrenia (dementia paradox)
brain pathology as cause
described psych disorders as bio disorders
Pinel working at same time - pscyh disorders are separate identities
when did separate psych disorders start appearnig in classifications
1948 ICD 6th edition = first time
how was the DSM 3 radically different from its predessessors
atheoretical approach to diagnosis
became a tool for clinicians
specificity and detial to criteria = can now test reliability and validity
multiaxial system
explain the mulitaxial system implemented in DSM 3
1 disorder itself
2 chronic disorders of personality
3 physical disorders and conditions which may be present
4 amount of psychosocial stress the person reports
5 current level of adaptive functioning
multiaxial changes to DSM 4
only personality and intellectual disorders on axis 2, otherwise 1
axis 4 now psychosocial environment problems that might impact disorder
what does culture refer to in context of DSM
values, knowledge and practices that individuals derive from membership in different ethnic, religious or other social groups as well as how membership of these groups may affect the individuals perspective on their experience with the pscyhological disorder
so now a cultural formation interview but no evidence supporting it yet
define analogue model
approach to research that employs subjects who are similar to clinical clinets allowing replication of clinical problem under controlled conditions
criticisms of DSM5
most advanced one so far (helped as worked with ICD 11)
should always be considered a work in progress
still fuzzy categories
comorbidity
strong emphasis on reliability at the expense of validity?
labelling
define labelling
applying a name to a phenomenon or a pattern of behaviour. the label may aquire negative connotations or be applied eroneously to the person rather than the persons behaviours
define testability
ability of a hypothesis to be subjected to scientific scrutiny and be accepted or rejected, a necessary condition for this hypothesis to be useful
purpose of lcinical assessment
funnel understand predict treatment planning treatment outcome
define standardisation
application of certain standards across different measurements
5 aspects to the mental status exam
appearance and behaviour thought processes mood and affect intelectual functioning sensorium
neuropsychological testing
assess broad range of abilities motor sensory language memory higher congitive fucntioning personality not routinely used in mental health settings
cateogircal approach to classification and diagnosis
if x then y
if not x then not y
dimensional approach to classification and diagnosis
how much of x
prototypical approach to classification and diagnosis
how much of x does it take for y
organization of dsm5
neurodevelopmental internalizing externalizing neurocognitive other
reification
abstract concept and treating it as if it is real
