Chapter 2 Flashcards
Assessment
- careful assessment provide a wealth of information about a client’s personality, behavior, and cognitive functioning
- this information helps clinicians acquire a broader understanding of their client’s problems and recommend appropriate forms of treatment
- it is a review of one’s history and current presentation
-most topics that are covered in assessment
-Identifying data, description of the presenting problems, psychosocial history, medical/psychiatric history, medical problems/medications
-mental status examination
-structured clinical interview to determine various aspects of a client’s mental functioning
-Assessment methods must be
reliable and valid
-Internal consistency
-do the items correlate with each other, or are they measuring too broad a set of diverse domains to be useful
-Temporal stability
-test, re-test reliability
-Interrater Reliability
-statement not only about the quality of the instrument but how consistently it’s given without much variation
-Reliability
ultimately a question of correlation
-Validity:
: how well does this thing measure what we think it measures
-Content validity
-how well does thing this sample from a larger domain of similar items
-Criterion validity
-breaks down into 2 parts: predictive and concurrent. How well it does in both cases, is how well does it predict a certain outcome
-Construct validity
-how well does this instrument that you’re using measure that more abstract thing, how well does it correlate with some other measure of that construct that you are trying to measure
Sociocultural and Ethnic Factors in the Assessment of Abnormal Behavior
- assessment techniques may be reliable and valid in one culture, but not in another
- most diagnostic instruments consider cultures to some degree, but most fail to provide adequate norms for different cultural and ethnic groups
- interviewers need to be sensitive to problems that can arise when interviews are conducted in a language other than the client’s mother tongue
-unstructured
-clinician goes into the interview with a goal in mind, but not have too much or no structure to that goal. Better for a natural conversation. Downside, there is always a possibility that you can talk too long about irrelevant
-Semi-structured
-there is a list of questions that you must ask, but are flexible
-Structured
- structured clinical interview for the DSM (SCID)
- very rigid, basically read the questions word for word
- as you move down, you are narrowing the patient’s response options.
-Close ended vs open ended questions
-open ended they can answer any way they want, close ended retrains the answer possibilities
textbook definition of intelligence:
. Global capacity to understand the world and cope with its challenges. 2. Trait or traits associated with successful performance on intelligence tests
-concept of “intelligence”
-most have in common the idea that there is adaptive thing being measured. Whether its about learning, problem solving, performing certain kinds of tasks quickly etc. The best definitions are multifactorial and multidimensional
-Wechsler (1975): intelligence
Comprehension and adaptation
-Terman (1916): Intelligence quotient (IQ)
– IQ = Mental Age / Chronological Age x 100
-Problem: differing level of variance at different ages
-Solution (Wechsler): Deviation IQ Scores
- Personality Tests
- Self-Report Tests:
- multi-dimensional reports meant to determine personality
- also called objective tests: tests that allow a limited, specified range of response options or answers so they can be scored objectively
- they often make use of forced-choice formats: method of structuring test questions that requires respondents top select among a set of possible answers
-Minnesota Multiphasic Personality Inventory (MMPI-II)
- used to rate people against known populations int multiple categories
- uses validity scales: groups of test items that serve to detect whether the results of a particular test are valid or whether a person responded in a random manner or in a way intended to create a favorable outcome
-Millon Clinical Multiaxial Inventory (MCMI)
-supported by a large body of research demonstrating its ability to discriminate between control and psychiatric samples and between groups composed of people with different types of psychological disorders, such as anxiety versus depressive disorders
- Projective Tests:
- Basic assumption is…
-typically offer no clear, specified answers. Called projective because they were derived from the psychodynamic projective hypothesis, the belief that people impose or “project” their psychological needs, drives and motives, much of which may lie in the unconscious, onto their interpretations of unstructured or ambiguous stimuli
-Rorschach Inkblot Test
-ask the patient what they see and what they are suppressing unconsciously is going to be projected into the picture (theoretically)
Thematic Apperception Test (TAT)
-people will eventually present something about themselves the longer they talk. Something they view and interpret the picture; it will say something about that person
-Blacky Test
-meant for children, Oedipal complex in the photo below
Methods of Assessment
-Psychometric approach
the traditional model; method of psychological assessment that seeks to use psychological tests to identify and measure the reasonably stable traits in an individual’s personality that are believed to largely determine his/her behavior
Neuropsychological Assessment
- used to evaluate whether psychological problems reflect underlying neurological damage or brain defects. Functional and autonomically
- Halstead-Reitan Neuropsychological Battery
- Luria-Nebraska Battery
-Behavioral Assessment
-focuses on the objective recording and/or description of behavior
-functional analysis:
-what is the function of that behavior; chances are there is something that perpetuates or reinforces that behavior-stimulus cues that trigger that behavior and consequences or reinforcements that maintain it
-behavioral interview
- like any other clinical interview, tends to focus on the behavior of the individual /
- reactivity
- self-monitoring
- analogue measures
-Cognitive Assessment
-involves the assessment of cognitions (thoughts, beliefs and attitudes)
-Methods of cognitive assessment:
- thought diaries
- cognition checklist
- dysfunctional attitudes scale
Physiological Measurement
-examines people’s physiological responses
-Galvanic skin response (GSR)
-measure of the change in electrical activity of the skin caused by increased activity of the sweat glands that accompanies states of sympathetic nervous system arousal, such as when a person is anxious
-Electroencephalograph (EEG)
-instrument for measuring the electrical activity of the brain (brainwaves)
Electromyograph (EMG)
-instrument often used in biofeedback training for measuring muscle tension
-computerized tomography (CT scans)
-narrow x-ray aimed at the head. Reveals abnormalities in shape and structure that may be suggestive of lesions, blood clots, or tumors. Can find damage that only surgery used to be able to find
-positron emission tomography (PET scans)
-used to study various parts of the brain. Small amount of tracer (radioactive compound) is mixed with glucose and injected into the bloodstream. When it reaches the brain, changes in neural activity are revealed by measurement of the positrons – positively charged particles – emitted by the tracer. Good for finding differences in brain activity for those with schizophrenia
Magnetic Resonance Imaging (MRI)
-placed in a donut shaped tunnel that generates a strong magnetic field. Radio waves of certain frequencies are directed to the head. The brain emits signals from different angles. Good for measuring abnormalities with OCD and schizophrenia
Functional Magnetic Resonance imaging (fMRI)
-yields much more information than a basic MRI and produces static pictures of brain structure. Can show which areas of the brain are active during certain mental activities. Has helps with the study of stress
-Brain electrical activity mapping (BEAM)
type of EEG in which electrodes are attached to the scalp to measure electrical activity in various regions of the brain. Can help identify the differences in brain activity for patients with schizophrenia
-Magnetoencephalography (MEG)
-measures brain activity in real time. Can pinpoint the source of an epileptic seizure more accurately than the traditional method. Surgeons can removed only damaged tissue much more accurately
-Testing (by itself) does not equal
assessment
-proper assessment = clinical history and observation + measurement + expert knowledge + formulation
-strengths must be considered
as equally important: Can’t just focus on pathology
Where does the DSM derive from
out of the work of Kraeplin in the 19th century
-The DSM and Models of Abnormal Behavior
- classifying disorders, not people – descriptive not explanatory
- categorical model of classification, meaning the clinician must make a yes or no response whether the disorder is present
-Features of the DSM
- specific diagnostic criteria are used
- abnormal behavior patterns that share features are grouped together
, the term “disease process” is reserved for conditions with
well understood cause and course
-Goals in Re-Constructing the DSM-5
- Atheoretical
- not tied to any one school of thought
- Descriptive
- what is observable in the patient’s presentation
- Polythetic (flexibility re criteria)
- same condition can look subtly different, we understand that the same condition can look differently in another person
- Good Interrater Reliability
- agreement between clinicians
- Evaluating the DSM System
- Reliability
-the consistency of a measuring instrument such as a psychological test or rating scale. There are various ways of measuring reliability, such as test-retest reliability, internal consistency, and interrater reliability.
-Validity (construct)
- with respect to tests, the degree to which a test measures the traits or constructs that it purports to measure. With respect to experiments, the degree to which an experiment yields scientifically accurate and defensible results
- can be inadvertently sacrificed in the interests of maximizing reliability
-Realism vs Instrumentalism
-realism implies a deeply rich description of what you see, the problem is the finer combed that becomes, the less reliable it becomes, or you have a less clear picture of what you are trying to diagnose
-Predictive validity:
predicting the course of the disorder
-Diagnosis Disease Course. Treatment options and clinical outcomes
Cultural Considerations
-Sociocultural Factors
- reliability and validity of assessment tools may be culture-specific
- disentangling psychopathology from sociocultural factors
- issues of translation
Culture-Bound Syndromes:
patterns of psychological distress that limited to one or only a few cultures
Tajinn-kyofu-sho (TKS) is
is a common disorder seen in Japan, characterized by an excessive fear that one will behave in embarrassing ways or offend people
-psychopharmacology –
examines the effects of drugs on behavior and psychological functioning and explores the use of psychoactive drugs in the treatment of emotional disorders
-anti-anxiety drugs:
drugs that combat anxiety and reduce states of muscle tension. They include mild tranquilizers such as diazepam (valium) and alprazolam (Xanax); barbiturates, such as meprobamate (miltown); sedative-hypnotics, such as triazolam (Halicon) and flurazepam (dalmane). Clonazepam (Rivotril) and lorazepam (Ativan) are widely used in practice and fall into the mild tranquilizer category with Valium
anti-psychotic drugs
also called neuroleptics are commonly sued to treat more flagrant features of schizophrenia or other psychotic disorders such as hallucinations, delusions and states of confusion. These include chlorpromazine (Thorazine), thioridazine (Mellaril) and fluphenazine (Prolixin) belong to the phenothiazine class of chemicals. They help the slow neurotransmission of dopamine at receptor sites.
-anti-depressants
act to relive the symptoms of depression, tricyclics (increase activity of norepinephrine and serotonin by interfering with the reuptake), monoamine oxidase (act to increase the availability of neurotransmitters that typically break down norepinephrine and serotonin), selective-serotonin reuptake inhibitors (prevents serotonin from being taken back up by the transmitting neuron, increasing its action)and serotonin reuptake inhibitors (works specifically on increasing levels of serotonin and norepinephrine by interfering with the reuptake).
-Lithium
– works very well in treating bipolar disorder.
Electroconvulsive Therapy
-used primarily in the treatment of depression. Short burst of electricity through the head
-Deep Brain Stimulation
- electrodes implanted much like a heart pacemaker
- effect depends on location of electrodes
Psychodynamic Therapies
-Free Association
-for about 40-50 mins you lay down and speak your mind and let it wander. The analyst remains silent, only prompting when needed. This goes on for numerous sessions until the analysist gives their interpretation
Psychodynamic Therapies -Transference
- displacement – type of defense mechanism that involves the transferring of impulses toward threatening or unacceptable objects onto more acceptable or safer objects.
- transferring thoughts and emotions felt towards something or someone, onto the analyst.
Modern Psychodynamic Approaches
-still aim to uncover unconscious motives and break down resistances and psychological defenses, yet they focus more the clients present relationships and encourage the client to make adaptive behavior changes.
Behavior Therapy
-Systematic desensitization
technique used for overcoming phobias by means of exposure. Starting small like using the imagination, which increases to more fearful stimuli while one remains deeply relaxed
-Gradual exposure
-increasing exposure to the stimuli to eventual actual exposure to the stimuli that causes fear
-Token economies
-people are reinforced in a controlled environment and receive tokens for good behavior or for the behavior they want reinforced
-Modelling
-modelling the correct behavior after watching someone. Child watching an adult do something and they copy
Humanistic-Existential Therapies
-Person-centered therapy (Rogers)
-emphasizing the establishment of a war, warm, accepting therapeutic relationship that frees clients to engage in a process of self-exploration and acceptance
-Emotion-focused therapy (Greenberg)
Humanistic-Existential
based on the premise that emotion, motivation, cognition and action occur as an integrated response package.
Cognitive-Behavior Therapies
-Ellis’ Rational Emotive Therapy
-believed that the adoption of self-defeating beliefs give rise to phycological problems and negative feelings. This therapy seeks to relieve them of such beliefs
-Beck’s Cognitive Therapy
Cognitive-Behavior Therapies
-focuses on client’s maladaptive cognitions. Recognize and change errors in their thinking and replace them with rational alternatives
-Meichenbaum’s Cognitive-behavioral Therapy
-draws on assumptions that cognitions and information processing play a role in the genesis and maintenance of maladaptive behavior and the impact of external events is filtered through thinking processes
-Eclectic (Integrative) Therapy
-drawing on multiple theories for treatment
Indigenous Healing Perspective
- Mental wellness as balance of physical, mental, emotional and spiritual
- mental wellness as a continuum
- Mental wellness as multileveled: Individual, family, community
Does Psychotherapy Work?
-the results of some 375 controlled studies comparing various types of therapies (psychodynamic, behavioral, humanistic, etc.) against control groups showed that the average psychotherapy client in these studies was better off that 75-80% of the clients who remained untreated
“Dodo bird effect”
even though people cross the finish line at different times, all must receive prizes. Disinclination to declare that some treatments are better than others
-the variable that stands out more than any other as important to successful
psychotherapy is the quality of the therapeutic alliance
-Having a mental disorder alone is not enough!
- Patient must have a mental disorder or appear to be suffering from a mental disorder
- Patient likely to cause harm to themselves or others (imminent)
- unsuitable from admission to a facility other than as a formal patient
-Legal Commitment (NCRMD: Not Criminally Responsible on Account of Mental Disorder)
- Clear evidence
- imminent risk
- limited time
-Unfit to stand trial if:
- incapable of participating in their own defense
- can’t distinguish between pleas
- doesn’t understand the purpose of the trial
- cannot communicate with the counsel rationally or make critical decisions on counsel’s advice
- is unable to take the stand to testify
-Duty to Warn (Tarasoff ruling)
any kind of professional who hears a direct threat being made to a 3rd party by their client must warn the individual who has been threatened not just the authorities
-Patients’ Rights:
- Right to treatment
- Right to refuse treatment
-From 15 treatment Order Criteria:
- likely to improve with treatment
2. likely to get worse without treatment
3. the benefit of treatment outweighs the risks of the treatment
4. the treatment is the least limiting and invading of all possible measure that meet the first three conditions
