Ch. Diagnosis & Assessment Flashcards
1
Q
diagnosis
A
- consensus-based definitions and classifications based on symptoms and signs
- far from ideal; opposite of medical field
- DSM-5-TR
- diagnostic categories have evolved over time
2
Q
advantages of diagnosis
A
- first step in good clinical care
- facilitates communication among professionals
- advances research for causes and treatments
- comorbidity
3
Q
reliability
A
- consistency of measurement (0-1.0)
- 0.6-1.0 is good
- 0.65-0.7 is the standard
- assessment scores during the day should be similar
types: - inter-rater
- test-retest
- alternate forms
- internal consistency
4
Q
interrater
A
two clinicians assess the same individual that make the same diagnosis
5
Q
test-retest
A
pre and post test situation; when test scores are compared, they should correlate
6
Q
alternate forms
A
multiple types of assessments for disorders and can be used to test for symptoms that correlate similar findings; converge on one diagnosis
7
Q
internal consistency
A
scales may be multiple items and answers should cluster together from each question on the scale
8
Q
validity
A
- are the tools we are using measuring what they are supposed to be measuring?
- unreliable measures → questionable validity
- reliability does not guarantee validity
- mental illness is like a moving target; it is always changing and needs constant assessment
-types:
content
construct
9
Q
content validity
A
measure adequately represents the domain of interest (i.e., all symptoms of disorder)
10
Q
construct validity
A
measure accurately represents the phenomenon
- multiple measures of the same domain
ex. sadness and depression
- distinguished from measures it should not be related to
ex. happiness and depression
11
Q
diagnostic system of the american psychiatric association: DSM-5-TR
A
- diagnostic and statistical manual of mental disorders
- first edition published in 1952
- five revisions
- current edition: released in 2022
- continual refinement
12
Q
what the DSM-5-TR provides
A
- diagnostic criteria
- description of associated features
- summary of research literature
- defines diagnosis on basis of symptoms
13
Q
diagnostic criteria
A
each revision → more detailed and concrete
14
Q
description of associated features
A
laboratory findings and results of physical exams
ex. scan of person who has possible schizophrenia has enlarged ventricles
15
Q
summary of research literature
A
age of onset, course, prevalence, risk and prognosis factors, cultural and gender factors, differential diagnosis
16
Q
defines diagnosis on basis of symptoms
A
our knowledge is not strong enough to organize around etiology
- chapters organized to reflect patterns of comorbidity (dual diagnosis) and shared causes
17
Q
culture can influence
A
-risk factors
individualistic vs. collectivist
- symptom experience
invalidation
- stigma
less developed parts of the world
- willingness to seek help
men do not want to get help
- availability of treatments
18
Q
DSM-5-TR cultural sensitivity
A
- discussion of culture-related issues for most disorders
- cultural formation interview questions for clinicians
- descriptions of how symptoms present across cultures
19
Q
cultural concepts of distress
A
- DSM-5-TR Appendix 9
9 syndromes observed in specific cultures
shenjing shuairuo (China)
weakness, mental fatigue, negative emotions, sleep problems - cross-cultural approach
syndromes that can be identified across cultures - culture-specific approach
cultural concepts of distress are key in understanding disorders
20
Q
criticisms of DSM
A
- too many diagnoses
- categorical vs. dimensional diagnosis
21
Q
too many diagnoses
A
- comorbidity
- many risk factors increase risk for multiple disorders
- should common reactions be pathologized?
22
Q
research domain criteria (RDoC)
A
- investigation of psychological variables relevant for many conditions
- use of basic science to develop a new classification system
23
Q
hierarchical taxonomy of psychopathology (HiTOP)
A
syndromes that frequently co-occur → subfactors → higher-order dimensions
24
Q
categorical
A
- do symptoms fit a category or not?
- one threshold with actual, hard boundaries
- threshold can provide help treatment guidance
25
dimensional
- severity (included in DSM-5-TR)
- sub-threshold symptoms
26
negative effects of diagnosis
- life changing event; period of adjustment
- stigma
- deindividuation
27
stigma of diagnosis
- BUT–labels serve to provide explanations for behaviors that people perceive as negative
- avoidance-based
- serve to provide explanations; perceived as a consequence of a mental disorder
28
deindividuation of diagnosis
- “schizophrenic” versus “person with schizophrenia”
- all unique individuals not just mental illnesses
29
clinical interviews
- establish rapport
- empathize with client experiences
- encourage client to elaborate on concerns
30
structured clinical interviews
standardized interview
- same questions in the same order
- maximize ability of high interrater reliability for most categories
- used in research settings; ability to replicate
most clinicians asses DSM symptoms informally
- a weakness overall; use own discretion and judgment
31
hans seyle & general adaptation syndrome (GAS)
- stress is connected to overall functioning
- an approach to understanding pattern of stress
- outlines evolutionary adaptation
- provides insight when stressor endures longer than is maintainable
32
GAS phase 1
the Alarm Reaction
- ANS activated by stress; more oxygen to brain, blood to vessels
33
GAS phase 2
resistance
- damage occurs or organism adapts to stress
- stress in a small amount is good for people
34
GAS phase 3
exhaustion
- organism dies or suffers irreversible damage
- damage to soft tissues, bones, cardiovascular system
35
stress
- subjective experience of distress in response to perceived environmental problems
- biopsychosocial perspective
36
life stressors
- environmental problems that trigger stress
- could be positive or negative
ex. graduating from high school; car crash, loss of job
37
Bedford College Life Events and Difficulties Schedule (LEDS)
- semi-structured interview covering 200+ stressors; open for discussion
- evaluates importance of an event in the context of a person’s life circumstances; how was the event experienced in an individual at a certain time
- excludes life events that are consequences of symptoms
family crisis in responses of delusional experiences
- carefully dates when life stressors occur
- genes are sensitive to stress in the environment
38
personality tests: inventories- self-report questionnaires
standardized (i.e., comparable with statistical norms)
39
Minnesota Multiphasic Personality Inventory-2-Restructured Format (MMPI-2-RF)
- personality test
- profile of psychological functioning with validity scales to detect over/under reporting of symptoms
- needs to be given by a professional to correctly assess scores
40
Rorschach Inkblot Test
- apperception tests; how they view ambiguous images allow for us to obtain insight how they view the world
- not as easily scored, a lot of personal judgment, responses are subjective
- perceive threat, danger, sexuality
41
Thematic Apperception Test (TAT)
- ask to tell story of the individual in the drawings
- recurring theme of threat or anxiety show how they view the world
- not to be used in isolation
42
Big Five Inventory-2 (BFI-2) and NEO Personality Inventory (NEO-PI)
- OCEAN traits
openness to experience, conscientiousness, extraversion, agreeableness, neuroticism
- both assess the five broad domains of personality
43
cognitive tests
- cognitive ability
currently used to predict school performance
- diagnose learning and intellectual disabilities with neuropsychological examinations
highly reliable and good validity, but explains very little school performance
impacted by stereotype threat
ex. a woman shows up to take a math test who has an experimenter that is a male and could inhibit her performance from distracted from knowledge of stereotype
44
neuropsychological tests
- pinpoints cognitive impairment
assumption: cognitive functions are supported by physical structure of the brain
- brain imaging techniques used to identity where “brain damage” may be
damage → performance deficit
- neuropsychological batteries
45
observational method
assess (problematic) behavior as it occurs
- frequency & form; antecedent and consequences
go in with a theory
46
methods of observation
- direct observation
ex. verbal dialogue, behaviors
- interviews
- self-report measures
- laboratory structured
researcher is on one side of a one-sided mirror observing interactions of children playing with an adult
47
experience sampling: daily diaries
- self-monitoring / tracking of behavior
- moods, events, thoughts
- notifications are sent randomly assigned times to participants
48
Computerized axial tomography (CT or CAT)
- brain structure → brighter is more dense tissue
- detects tissue density differences and structural abnormalities
49
Magnetic resonance imaging (MRI)
- brain structure
- higher quality than CT
- electromagnetic signals
50
Functional MRI (fMRI)
- brain structure and function
- blood flow in brain is proxy for neural activity
do not actually see activity
BOLD signal (blood oxygenation level dependent)
51
Positron emission tomography (PET)
- invasive
- uses radioactive glucose in the bloodstream
- if it is metabolizing sugar, then area is active
52
connectivity
- structural (white matter)
- functional (BOLD signals)
- effective (direction and timing of BOLD activations)
53
psychophysiology
- bodily changes associated with psychological events
- eye training with schizophrenia → disjointed, not smooth
54
brain stimulation (noninvasive)
- transcranial magnetic stimulation (TMS)
- transcranial direct current stimulation (tDCS)
55
autonomic nervous system reveals aspects of emotion
- electrocardiogram (EKG)
- electrodermal responding (skin conductance)
anxiety, fear, anger
looking at the activation
56
things to keep in mind regarding neurological assessment
- measures do not distinguish between emotional states
- scanning environment → change
- unable to manipulate brain activity and then measure change in behaviors
i.e., no “proof” that brain activity causes change in behavior
57
things to generally keep in mind
- alternative explanations
- complete assessments require multiple methods
- pre existing abilities prior to diagnosis affect consequences of dysfunction
58
cultural & ethic diversity in assessment
- assessments are developed within cultures; culturally bound
- cultural bias = over/under estimation of problems
mistakes based on assumptions about culture and emotion
59
avoiding bias
- ongoing professional development in cultural awareness
- ensure that research participants understand tasks
- distinguish “cultural responsiveness” from cultural stereotyping
