Ch 3 Flashcards
diagnosis
the classification of disorders by symptoms and signs
advantages of diagnosis (3)
- 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
reliability
consistency of measurement
types of reliability
- interrater reliability
- test-retest
- alternate forms
- internal consistency
interrater reliability
degree to which two observers agree on their observations
test-retest reliability
similarity of scores across repeated test administrations
alternate forms reliability
similarity of scores on tests that similar but not identical
Internal Consistency reliability
extent to which test items are related to one another
how is reliability measured?
on a scale of 0 - 1.0
validity
how well a test measures what it’s supposed to
can unreliable measures have good validity?
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.
types of validity
content validity
criterion validity
construct validity
content validity
extent to which a measure contains all of the pieces of the domain of interest
criterion validity
extent to which a measure is associated w. another measure (the criterion)
Neumonic- this old movie is like this old movie
forms of criterion validity
- 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
construct validity
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
construct
abstract concept or inferred attribute- needs to be operationalized
what is construct validity important for
important for validating our theoretical understanding of psychopathology
method for evaluating diagnostic categories
DSM-5
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
Emil Kraepelin
1856-1926
- early classification of psychiatry
- noted symptoms cluster as a syndrome
Neumonic: cluster of crepes as a syndrome, with medicine sprinkled on top
WHO and DSM
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
Multi-Axial System- 5 axial
- 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
DSM-5 axes
uses 2 axis
- Psychiatric and Medical Diagnoses (combo of 1,2, and 3 from previous)
- Psychosocial and Contextual Factors (previously psychosocial and environmental problems)
what are the DSM-5’s diagnoses organized by?
symptoms- knowledge base not yet strong enough to organize by causes (etiology)
- chapters are organized to reflect patterns of comorbity and shared causes
features of DSM-5 to enhance cultural sensitivity (3)
- 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
what does the DSM-5 caution clinicians re: culture?
not to diagnose symptoms unless atypical and problematic w/in a person’s culture
focus on influence of culture on disorder presentation
9 cultural concepts of distress
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
Criticisms of the DSM (2)
- 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
externalizing and internalizing disorders
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
Research Domain Criteria (RDoC)
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
interrater Reliability in relation to diagnosis
extent to which clinicians agree on the diagnosis
in research studies, interrater reliabilty for DSM is pretty good, not as much in everyday practice
categorical classification
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
dimensional diagnostic system
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
Construct Validity of Diagnostic Categories
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
what does strong construct validity (of diagnoses) predict? (Past present future)
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)
criticisms of diagnosing psychological disorders
- 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)
psychological assessment techniques are used to:
- describe clients problem
- determine causes of problem
- arrive at diagnosis
- develop treatment strategy
- monitor treatment progress
- conduct research
ideal assessment involves
multiple measures and methods (interviews, personality inventories, intelligence tests, etc.)
psychological assessment methods (5)
- 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
types of interviews
- clinical interview
- structured interviews
clinical interviews
- 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
Structured interviews
- 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
Structured Clinical Interview for Axis I of DSM (SCID)
- structured interview
- BRANCHING interview- response to one question determines next question asked
- THREE POINT SEVERITY scale that translates ratings to diagnosis
Stress
subjective experience of distress in response to perceived environmental problems
life stressors: environmental problems that trigger the subjective sense of stress
Bedford College Life Events and Difficulties Schedule (LEDS)
- 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
assessments of stress
- Bedford College Life Events and Difficulties Schedule (LEDS)
- Self-Report Stress Checklists
Self-Report Stress Checklists
- faster way to asses stress
- test-retest reliability low
General Adaption Syndrom (GAS)
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
two most common types of psychological tests
- personality tests
- intelligence tests
Personality tests
- self-reported personality inventories
- projective tests
Personality inventory
self-report questionnaire indicating wther habitual tendencies apply
Minnesota Multiphasic Personality Inventory (MMPI)
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
critism of the MMPI (Minnesota Multiphasic Personality Inventory) and how they check for it
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
standardization
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
Projective tests
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
most famous projective tests
- Rorschach Inkblot Test
- Thematic Apperception Test (TAT): black and white pictures, tell a story related
Exner scoring system
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
Big Five Inventory-2
Personality test that assesses 5 domains of personality
acronym “OCEAN”
- Oppenness to experinece
- Conscientiousness
- Extraversion
- Agreeableness
- Neuroticism
Neumonic: a big 5 in the ocean
Intelligence tests
assess current mental ability (language skill, abstract thinking, nonverbal reasoning, visual-spatial skills, attention and concentration, and speed of processing)
Common IQ tests (2 main)
- 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
what are IQ tests used to predict?
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
what is unclear about IQ tests? what are they impacted by?
While correlations btwn IQ and. school performance are statistically significant, IQ tests only explain a small part of school performance.
stereotype threat
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
information necessary for behavioral and cognitive assessment (4)
- 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
purpose of behavioral and cognitive assessment
treatment based- what kind of thoughts/ behaviors are they having and how can we change them
formal behavioral observation
- observer divides sequence of behavior into various parts including antecedents and consequences of behavior
- try to observe behavior as it occurs
how is direct observation done?
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
self-monitoring
cognitive behavior therapists + researchers ask people to monitor and track their own behavior and responses
ecological momentary assessment (EMA)
type of self-monitoring that collects data in real time
signaled via phone and asked to enter responses
Cognitive-Style Questionnaires
similar to personality tests
- used to help plan targets for treatment
- and to determine whether clinical interventions are working to change thought patterns/emotions
Dysfunctional Attitude Scale (DAS)
- 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
reactivity
the act of being observed may alter someone’s behavior (usually increase in desirable behavior)
areas of Neurobiological Assessment
- brain imaging
- neurotransmitter assessment
- neuropsychological assessment
- psychophysiological assessment
Brain Imaging
- 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
Computerized Axial Tomography (CT or CAT scan)
- helps to assess structural brain abnormalities by detecting differences in tissue density
Magnetic Resonance Imaging (MRI)
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
fMRI (Functional MRI)
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)
BOLD signal (Blood oxygenation level dependent)
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
PET Scan
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
SPECT scan
less expensive that PET scan but still invasive way to measure neurotransmitter activity
also involves injecting radioisotope into the bloodstream
connectivity
the ways different areas of the brain communicate and connect w/ eachother
three types of connectivity
- structural (anatomical) connectivity
- functional connectivity
- effective connectivity
Neumonic: for your brain to connect choose one- it can be functional, structural, or effective
structural (anatomical) connectivity
how different structures of the brain are connected via white matter
functional connectivity
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
Effective connectivity
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
what are clinicians and researchers using brain-imaging assessment techniques for?
- to discover preivously undetectable brain problems
- to conduct inquiries into the neurobiological contributions to thought, emotion, and behavior
can neuro-imaging techniques assess all brain abnormalities/ diagnose?
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)
Neurotransmitter assessment
- postmortem studies
- metabolite assays
Neumonic: neurotransmitters - some dead, some have a fast metabolism
postmortem studies
analysis of neurotransmitters and receptors done after you die, so not done for psychiatric diagnosis
involved w/ research on psychiatric disorders
Metabolite assays
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
neuropsychologist
psychologist, not medical doctor
studies how brain abnormalities affect thinking, feeling, and behavior
focuses not on structure of brain but functions of the brain
neuropsychological tests
- reveal performance deficits that can indicate areas of brain malfunction
- based on idea that different psychological functions rely on different areas of the brain
types of neuropsychological tests
- Halstead Reitan battery
- Luria-Nebraska battery
Neumonic: Halsey ramen and Luriel Nebraska
Halstead-Reitan Battery
- 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
is the Halstead-Reitan Battery valid?
it is valid for detecting behavior changes linked to brain dysfunction resulting from a variety of conditions
Luria-Nebraska Battery
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
Psychophysiology
study of bodily changes that accompany psychological characteristics or events
Electrocardiogram (EKG)
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
Psychophysiological measures
- Electrocaridogram (EKG)
- Electrodermal responding (skin conductance)
- Electroencephalogram (EEG)
Electrodermal responding (skin conductance)
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
Electroencephalogram (EEG)
Brains electrical activity measured by electrodes placed on scalp
possible drawbacks of neurobiological assesment
- 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
Cultural Bias in Assessment
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
translation process for psychological tests
involves several steps including
- multiple translaters
- back-translating
- testing w/ multiple native speakers
Guidelines for Translating and Adapting Tests- what does it cover (4)
covers
- context of a test
- development and adaptation of a test to a different language
- administration
- scoring interpretations
Guidelines for Translating and Adapting Tests- has this approach been successful?
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)
what can cultural bias lead to?
can lead to minimizing or exaggerating psychological problems
what does the DSM-5 have to combat cultural bias?
- inclusion of cultural factors in the discussion of every category of disorder
- new cultural formulation interview
strategies to avoid bias (4)
- 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
Three points on cultural bias that should be taught in graduate programs (Lopez 2002)
- learn about basic issues in assessment- reliability and validity
- become informed about specific ways culture/ethnicity may impact assessment instead of relying on stereotypes
- must consider that culture/ethnicity may not impact assessment in every individual case
