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Abnormal Psych > Ch 3 > Flashcards

Ch 3 Flashcards

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1
Q

diagnosis

A

the classification of disorders by symptoms and signs

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2
Q

advantages of diagnosis (3)

A
  • facilitates communication among professionals
  • advances the search for causes and treatments
  • cornerstone of clinical care- leads us to how we are going to treat/work with that client
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3
Q

reliability

A

consistency of measurement

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4
Q

types of reliability

A
  • interrater reliability
  • test-retest
  • alternate forms
  • internal consistency
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5
Q

interrater reliability

A

degree to which two observers agree on their observations

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6
Q

test-retest reliability

A

similarity of scores across repeated test administrations

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7
Q

alternate forms reliability

A

similarity of scores on tests that similar but not identical

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8
Q

Internal Consistency reliability

A

extent to which test items are related to one another

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9
Q

how is reliability measured?

A

on a scale of 0 - 1.0

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10
Q

validity

A

how well a test measures what it’s supposed to

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11
Q

can unreliable measures have good validity?

A

no, because a measure needs to be consistent in order to properly test what it’s supposed to

good reliability does not necessarily mean good validity, though.

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12
Q

types of validity

A

content validity

criterion validity

construct validity

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13
Q

content validity

A

extent to which a measure contains all of the pieces of the domain of interest

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14
Q

criterion validity

A

extent to which a measure is associated w. another measure (the criterion)

Neumonic- this old movie is like this old movie

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15
Q

forms of criterion validity

A
  • concurrent
    • two measures administered at same point in time

-predictive
- ability of the measure to predict
another variable measured at a future point in time

Neumonic: criterion collection- konkurro can predict the future

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16
Q

construct validity

A

the extent to which the test or measure accurately assesses what its supposed to- was the construct operationalized well?

  • involves correlating multiple indirect measures of the attribute
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17
Q

construct

A

abstract concept or inferred attribute- needs to be operationalized

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18
Q

what is construct validity important for

A

important for validating our theoretical understanding of psychopathology

method for evaluating diagnostic categories

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19
Q

DSM-5

A

Diagnostic and Statistic Manual of Mental Disorders, published by American Psychiatric Association

first one published in 1952, current 2013

provides specific diagnostic criteria- symptoms for a given diagnosis

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20
Q

Emil Kraepelin

A

1856-1926
- early classification of psychiatry

  • noted symptoms cluster as a syndrome

Neumonic: cluster of crepes as a syndrome, with medicine sprinkled on top

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21
Q

WHO and DSM

A

World Health Organization had International Classification of Disease (ICD), DSM not on same page of symptoms for a given disorder

over time, getting closer to a consensus

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22
Q

Multi-Axial System- 5 axial

A
  • DSM-5 used 5-axis system
    contained:
  • clinical disorders
  • relevant physical disorders
  • psychosocial and Environmental problems
  • global assesment of fuctioning

Neumonic - 5 axes - clinical, body, social and environment, a globe assessing functioning

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23
Q

DSM-5 axes

A

uses 2 axis
- Psychiatric and Medical Diagnoses (combo of 1,2, and 3 from previous)
- Psychosocial and Contextual Factors (previously psychosocial and environmental problems)

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24
Q

what are the DSM-5’s diagnoses organized by?

A

symptoms- knowledge base not yet strong enough to organize by causes (etiology)

  • chapters are organized to reflect patterns of comorbity and shared causes
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25
Q

features of DSM-5 to enhance cultural sensitivity (3)

A
  • culture-related issues discussed in the text for almost all disorders
  • cultural formulation interview provides 16 questions clinicians can use to help understand how culture may be shaping the clinical presentation
  • appendix describes syndromes that appear in particular cultures, culturally specific ways of expressing distress, and cultural explanations about cause of symptoms, illness, and distress
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26
Q

what does the DSM-5 caution clinicians re: culture?

A

not to diagnose symptoms unless atypical and problematic w/in a person’s culture

focus on influence of culture on disorder presentation

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27
Q

9 cultural concepts of distress

A

appendix in DSM-5 includes 9 cultural concepts of distress to describe syndromes that are observed w/in specific regions/ cultural groups

replaces 25 seperate diagnoses from DSM-IV

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28
Q

Criticisms of the DSM (2)

A
  • too many diagnoses
    • relatively common reactions pathologized
    • comorbidity: presence of a second diagnosis - 45% of ppl diagnosed w/ one disorder will meet criteria for another
      (some people prefer externalizing and internalizing disorders as labels)

-reliability in everyday practice - clients not so easily pigeonholed

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29
Q

externalizing and internalizing disorders

A

externalizing: childhood conduct disorder, adult antisocial personality disorder, alcohol/ substance use disoder

internalizing: anxiety disorders, ptsd, depressive disorders

people with one are at higher risk for another

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30
Q

Research Domain Criteria (RDoC)

A

National Institute of Mental Health adressing problem of OVERLAP in RISK FACTORS

refer to psychological variables that are relevant for many conditions

trying to create NEW SYSTEM based on NEUROSCIENCE and GENETIC data instead of just clinical systems

Neumonic : doctor into neuroscience and genetic data

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31
Q

interrater Reliability in relation to diagnosis

A

extent to which clinicians agree on the diagnosis

in research studies, interrater reliabilty for DSM is pretty good, not as much in everyday practice

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32
Q

categorical classification

A

in the DSM-5 diagnoses are based on categorical classification

must have a certain amount of symptoms - demarcates a particular point where treatment is recommended

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33
Q

dimensional diagnostic system

A

describes degree of symptoms

provide a way to describe subthreshold symptoms, and symptoms that are particularly severe

Neumonic: the 4th dimension is all about degrees of things

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34
Q

Construct Validity of Diagnostic Categories

A

diagnoses are constructs- because there is no lab test available to diagnose disorders w/ certainty

we have to operationalize the diagnoses properly in order for them to measure what they’re supposed to

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35
Q

what does strong construct validity (of diagnoses) predict? (Past present future)

A

a wide range of characteristics including

  • possible etiological causes (past)
    ( biological vulnerability and psychosocial triggers)
  • clincical characteristics (current)
  • predict treatment response (future)
    ( - treatment response
    • course of symptoms
    • social functioning)
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36
Q

criticisms of diagnosing psychological disorders

A
  • stigma against mental illness
    (being treated differently, hard to find a job)
  • categories can’t capture uniqueness of a person
    (disorder doesn’t define the person- person w/ schizophrenia vs schizophrenic).
  • classification can emphasize trivial similarities
    (relevant info (that may not be as statistically prevalent) may be overlooked)
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37
Q

psychological assessment techniques are used to:

A
  • describe clients problem
  • determine causes of problem
  • arrive at diagnosis
  • develop treatment strategy
  • monitor treatment progress
  • conduct research
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38
Q

ideal assessment involves

A

multiple measures and methods (interviews, personality inventories, intelligence tests, etc.)

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39
Q

psychological assessment methods (5)

A
  • interviews
  • stress measures
  • psychological tests
  • direct observation
  • self- observation

Neumonic:
A ruler that says psychological
-rulers interviewing for a job
- ruler taking a test
-ruler w magnifying glass
- ruler meditating on self

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40
Q

types of interviews

A
  • clinical interview
  • structured interviews
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41
Q

clinical interviews

A
  • learns about patient’s problems through conversation- how are q’s answered
  • PARADIGM of interviewer shapes interview
  • involves establishing RAPPORT
  • involves EMPATHIZING, using REFLECTION
  • less reliable b/c relies on intuition and general experience, informal
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42
Q

Structured interviews

A
  • collect standardized info by asking same q’s in predetermined ORDER
  • used for DIAGNOSTIC purposes
  • Structured Clinical Interview for Axis I of DSM (SCID)
    • good interrater reliability for most diagnostic categories
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43
Q

Structured Clinical Interview for Axis I of DSM (SCID)

A
  • structured interview
  • BRANCHING interview- response to one question determines next question asked
  • THREE POINT SEVERITY scale that translates ratings to diagnosis
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44
Q

Stress

A

subjective experience of distress in response to perceived environmental problems

life stressors: environmental problems that trigger the subjective sense of stress

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45
Q

Bedford College Life Events and Difficulties Schedule (LEDS)

A
  • semi-structured interview
  • evaluates stressors w/in context of individuals circumstances

-excludes events that are consequences of disorder symptoms

  • includes set of strategies to date when a life stressor occurred

Neumonic: college stress interview

46
Q

assessments of stress

A
  • Bedford College Life Events and Difficulties Schedule (LEDS)
  • Self-Report Stress Checklists
47
Q

Self-Report Stress Checklists

A
  • faster way to asses stress
  • test-retest reliability low
48
Q

General Adaption Syndrom (GAS)

A

Hans Selye
- describes biological response to sustained high levels of stress

phases:
1- the alarm reaction: autonomic nervous system activated by stress

2- resistance: damage occurs to organism or adapts to stress through available coping mechanisms

3- Exhaustion: Organism dies or suffers irreversible damage

Neumonic: you get gassy when you have stress for too long

49
Q

two most common types of psychological tests

A
  • personality tests
  • intelligence tests
50
Q

Personality tests

A
  • self-reported personality inventories
  • projective tests
51
Q

Personality inventory

A

self-report questionnaire indicating wther habitual tendencies apply

52
Q

Minnesota Multiphasic Personality Inventory (MMPI)

A

multiphasic- designed to detect several psychological problems

provides profile of psychological functioning
to see if they align with the answers of those in diagnostic groups

reliable and has adequate validity

Neumonic: Minnesota multi-faces- lots of joe peras w different disorders

53
Q

critism of the MMPI (Minnesota Multiphasic Personality Inventory) and how they check for it

A

very face valid, so it may be too clear to those taking the test what is being measured- easy to fake

introduced specific subscales to detect lying or faking good or bad

54
Q

standardization

A

tests are administered to many people to analyze how certain kinds of people tend to respond, so that statistical norms can be established

Neumonic: your all going to get tested- it’s standard

55
Q

Projective tests

A

set of standard stimuli (inkblots/ drawings) are presented to a person

projective hypothesis: b/c unstructured/ambiguous, responses are unconscious, reveal attitudes, motivations, modes of behavior

freudian orientation

poor validity

56
Q

most famous projective tests

A
  • Rorschach Inkblot Test
  • Thematic Apperception Test (TAT): black and white pictures, tell a story related
57
Q

Exner scoring system

A

scoring system for Rorschach test

created norms for the test, but sample was small/ didn’t represent different ethnicities/cultures

Neumonic: big x over Rorschach blot

58
Q

Big Five Inventory-2

A

Personality test that assesses 5 domains of personality

acronym “OCEAN”
- Oppenness to experinece
- Conscientiousness
- Extraversion
- Agreeableness
- Neuroticism

Neumonic: a big 5 in the ocean

59
Q

Intelligence tests

A

assess current mental ability (language skill, abstract thinking, nonverbal reasoning, visual-spatial skills, attention and concentration, and speed of processing)

60
Q

Common IQ tests (2 main)

A
  • Weschler scales
    • Weschler Adult intelligence Scale, 4th ed. (WAIS-IV)
    • Weschler Intelligence Scale for Children, 5th ed. (WISC-V)
    • Weschler Preschool and Primary Scale of Intelligence (WPPSI-IV)
  • Standford-Binet, 5th ed (SB5)

mean IQ = 100, SD 15 (Weschler) or SD= 16 (SB)
means 67% of population has IQ btwn 85 and 115

Neumonic: Westly, standford-bidet

61
Q

what are IQ tests used to predict?

A

used to

  • predict school performance,
  • diagnose learning disabilities or intellectual developmental disorder,
  • identify gifted children, as part of neuropsychological exam

lower IQs associated with higher psychopathology and mortality

62
Q

what is unclear about IQ tests? what are they impacted by?

A

While correlations btwn IQ and. school performance are statistically significant, IQ tests only explain a small part of school performance.

63
Q

stereotype threat

A

performance on IQ tests impacted by Stereotype threat- if person providing test is caucausion and person taking is a minority, less likely to do well

if told certain races/genders/ etc. perform less well on the tests, they will

Neumonic- white person with a gun to Asian person taking iq test

64
Q

information necessary for behavioral and cognitive assessment (4)

A
  • aspects of environment that may contribute to symptoms
  • characteristics of the person
  • frequency and form of problematic behaviors (e.g procrastination > missing deadlines)
  • consequences of problem behaviors
65
Q

purpose of behavioral and cognitive assessment

A

treatment based- what kind of thoughts/ behaviors are they having and how can we change them

66
Q

formal behavioral observation

A
  • observer divides sequence of behavior into various parts including antecedents and consequences of behavior
  • try to observe behavior as it occurs
67
Q

how is direct observation done?

A

usually contrive situations in consulting rooms or lab setting to observe how a person or family acts under certain conditions

sometimes through a one-way mirror

68
Q

self-monitoring

A

cognitive behavior therapists + researchers ask people to monitor and track their own behavior and responses

69
Q

ecological momentary assessment (EMA)

A

type of self-monitoring that collects data in real time

signaled via phone and asked to enter responses

70
Q

Cognitive-Style Questionnaires

A

similar to personality tests

  • used to help plan targets for treatment
  • and to determine whether clinical interventions are working to change thought patterns/emotions
71
Q

Dysfunctional Attitude Scale (DAS)

A
  • Identifies maladaptive thought patterns
  • based on Beck’s theory

-construct valid- shown that it can differentiate people w/w/out depression

Neumonic: das maladaptive! Beck

72
Q

reactivity

A

the act of being observed may alter someone’s behavior (usually increase in desirable behavior)

73
Q

areas of Neurobiological Assessment

A
  • brain imaging
  • neurotransmitter assessment
  • neuropsychological assessment
  • psychophysiological assessment
74
Q

Brain Imaging

A
  • CT and MRI scans reveal structure of the brain.
  • PET reveals brain function and a bit of structure
  • fMRI used to assess both brain structure and Function
75
Q

Computerized Axial Tomography (CT or CAT scan)

A
  • helps to assess structural brain abnormalities by detecting differences in tissue density
76
Q

Magnetic Resonance Imaging (MRI)

A

similar to CT but produces higher quality images and doesn’t rely on any radiation

uses large magnet to produce an electromagnetic signal that is translated into a picture of the brain

77
Q

fMRI (Functional MRI)

A

measures function as well as structure by taking images quickly so that metabolic changes can be measured

measures blood flow in the brain , which can be read as neural activity in that brain region (BOLD signal - blood oxygenation level dependent)

78
Q

BOLD signal (Blood oxygenation level dependent)

A

an fMRI measures blood flow in the brain , which can be read as neural activity in that brain region since blood flow increases where neurons fire

79
Q

PET Scan

A

looks at brain function- looks at metabolic activity , is more expensive and invasive, and not as precise as MRI or fMRI

involes injecting a radio-isotope into bloodstream

80
Q

SPECT scan

A

less expensive that PET scan but still invasive way to measure neurotransmitter activity

also involves injecting radioisotope into the bloodstream

81
Q

connectivity

A

the ways different areas of the brain communicate and connect w/ eachother

82
Q

three types of connectivity

A
  • structural (anatomical) connectivity
  • functional connectivity
  • effective connectivity

Neumonic: for your brain to connect choose one- it can be functional, structural, or effective

83
Q

structural (anatomical) connectivity

A

how different structures of the brain are connected via white matter

84
Q

functional connectivity

A

connectivity btwn brain regions based on correlations btwn BOLD signal (blood oxygen level dependent)

measured usig fMRI

Neumonic: remember fMRI- functional MRI, and you have to be BOLD to function

85
Q

Effective connectivity

A

combines both types of connectivity

reveals correlations between BOLD activations in different regions,

AND the direction and timing of those activations

Neumonic: to be effective, you have to be functional and structurally sound

86
Q

what are clinicians and researchers using brain-imaging assessment techniques for?

A
  • to discover preivously undetectable brain problems
  • to conduct inquiries into the neurobiological contributions to thought, emotion, and behavior
87
Q

can neuro-imaging techniques assess all brain abnormalities/ diagnose?

A

not strong enough for theses methods to be used in diagnosing psychopathology

  • many brain abnormalities involve alterations to subtle to see in direct examination
  • the problems in some disorders are too widespread to find the contributing brain disfunction (Ex: schizophrenia affects thinking, feeling and behavior)
88
Q

Neurotransmitter assessment

A
  • postmortem studies
  • metabolite assays

Neumonic: neurotransmitters - some dead, some have a fast metabolism

89
Q

postmortem studies

A

analysis of neurotransmitters and receptors done after you die, so not done for psychiatric diagnosis

involved w/ research on psychiatric disorders

90
Q

Metabolite assays

A

metabolite levels are byproducts of neurtransmitters breakdown found in urine, blood serum or cerebral spinal fluid

metabolite levels can be looked at in metabolite assays, which are correlational studies because

  • they may not reflect actual level of neurotransmitters

not usually done for diagnosis purposes

91
Q

neuropsychologist

A

psychologist, not medical doctor

studies how brain abnormalities affect thinking, feeling, and behavior

focuses not on structure of brain but functions of the brain

92
Q

neuropsychological tests

A
  • reveal performance deficits that can indicate areas of brain malfunction
  • based on idea that different psychological functions rely on different areas of the brain
93
Q

types of neuropsychological tests

A
  • Halstead Reitan battery
  • Luria-Nebraska battery

Neumonic: Halsey ramen and Luriel Nebraska

94
Q

Halstead-Reitan Battery

A
  • Tactile Performance Test-Time
  • Tactile Performance Test-Memory
  • Speech Sounds Perception Test

Neumonic: Halsey eating ramen with hands (tactile) , with timer, a memory test, and a microphone

95
Q

is the Halstead-Reitan Battery valid?

A

it is valid for detecting behavior changes linked to brain dysfunction resulting from a variety of conditions

96
Q

Luria-Nebraska Battery

A

assesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc.

highly reliable and valid, can control for educational level

97
Q

Psychophysiology

A

study of bodily changes that accompany psychological characteristics or events

98
Q

Electrocardiogram (EKG)

A

Heart rate measured by electrodes placed on chest

heartbeat generates electrical changes, recorded by electrodes placed on chest, that convey siganls to an electrocardiograph or polygraph. signal graphically depicted in EKG

99
Q

Psychophysiological measures

A
  • Electrocaridogram (EKG)
  • Electrodermal responding (skin conductance)
  • Electroencephalogram (EEG)
100
Q

Electrodermal responding (skin conductance)

A

sweat-gland activity measured by electrodes placed on hand

sweat gland activity increased by sympathetic nervous system activation, which can be used as a measure of emotions

101
Q

Electroencephalogram (EEG)

A

Brains electrical activity measured by electrodes placed on scalp

102
Q

possible drawbacks of neurobiological assesment

A
  • many measurements don’t clearly differentiate btwn emotional states
  • being in a scanner itself may increase anxiety, so that has to be taken into account
  • brain imaging techniques do not allow us to manipulate brain activity and then measure change in behavior- keep an eye out for alternate explanations
  • a finding from a neuropsychological test or an FMRI does not directly mean a psychological dysfunction, mostly because there are also social and environmental factors
  • understanding the preexisting abilities a person has prior to diagnosis
103
Q

Cultural Bias in Assessment

A

Measures developed for one culture or ethnic group may not be valid or reliable for another

not simply a matter of language translation, if there is language translation, meaning can be lost

104
Q

translation process for psychological tests

A

involves several steps including
- multiple translaters
- back-translating
- testing w/ multiple native speakers

105
Q

Guidelines for Translating and Adapting Tests- what does it cover (4)

A

covers
- context of a test
- development and adaptation of a test to a different language
- administration
- scoring interpretations

106
Q

Guidelines for Translating and Adapting Tests- has this approach been successful?

A

it has been successful in acheiving equivalence across different cultures and ethnic groups for some instruments (MMPI-2)

however, there are still cultural differences in the MMPI-2 that aren’t likely attributed to differences in psychopathology (asians scoring higher than caucasians, despite not being more emotionally disturbed)

107
Q

what can cultural bias lead to?

A

can lead to minimizing or exaggerating psychological problems

108
Q

what does the DSM-5 have to combat cultural bias?

A
  • inclusion of cultural factors in the discussion of every category of disorder
  • new cultural formulation interview
109
Q

strategies to avoid bias (4)

A
  • increase graduate students sensitivity to cultural issues
  • insure participants understanding of task (language)
  • establish rapport (in testing situations)
  • distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez 1994)
    • conclusions should be tentative and alt. hypotheses should be entertained
110
Q

Three points on cultural bias that should be taught in graduate programs (Lopez 2002)

A
  1. learn about basic issues in assessment- reliability and validity
  2. become informed about specific ways culture/ethnicity may impact assessment instead of relying on stereotypes
  3. must consider that culture/ethnicity may not impact assessment in every individual case

Abnormal Psych (16 decks)

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