Chapter 3 in class notes Flashcards
Assessing psychological disorders (DOs)
- Clinical assessment
- Diagnosis
- Systematic evaluation
- organized
- structured
- consistent across people and time - Process of determining if someone meets DSM-5 criteria for a disorder.
Interrater reliability
[Key concepts in assessment]
2 different people give same person an assessment - should have same scores
Test-retest reliability
[Key concepts in assessment]
for evaluations or assessments - do not expect to change. Score should be relatively the same. (i.e. IQ shouldn’t change between 20 and 40 years old)
Validity - Q
[Key concepts in assessment]
is it measuring what it’s supposed to measure?
Concurrent validity
two measures measuring the same thing - will they measure the same?
Predictive validity
Depression scale and the client measures 24/30. Other people at 24/30 are suicidal - can I predict that the client is suicidal since they also measured 24/30?
Will you be comparable to others that also scored that?
Content validity
Based on experts. When I look at content of your measure - items - based on my experience it looks like this ___.
Standardization
norms and consistency
Clinical Interview Steps
1) Gather information (verbal)
2) Mental Health Exam
3) Semistructured clinical interviews
Gathering information
> Historical and current
Family and individual
Major events in life - divorce, having child, job changes (changing schools for kids)
Mental health exam
Systematic observation of a person (nonverbal)
Sensorium
Clinician uses senses to observe whats happening to client.
> smell - hygiene
> dress - is it weather appropriate? put together outfit/make sense? are buttons aligned? Dress with sweatpants under?
> Do they answer directly? How long does it take them to respond?
Semistructured clinical interviews
- Partially structured
* Broad questions - allowing clinician’s discretion for follow up questions.
Physical exams
blood work, thyroid test (hypothyroid for a person will look like depression)
Behavioral assessments
direct observation more than verbal.
ABCs of observation
Antecedent - behavior - Consequence
Antecedent - trigger
Behavior - reinforced or punished?
Consequence of behavior
Self-monitoring
have clients see how often they engage in behavior.
Self monitoring reactivity
just by having someone track the behavior - the behavior will increase or decrease
Psychological Testing
Specific tools to determine cognitive, emotional or behavioral responses possibly associated with a specific disorder
Built into many psychological tests are ways to detect if
client is faking good or faking bad
> Fake good - self preservation, family put them into assessment
Fake bad - plea insanity, want medication, attention, disability
Projective Testing - based in
Freud psychodynamic - projecting into unconscious
Projective Testing
> Access unconscious
Controversial
Rorschach inkblot
Thematic Apperception Test (TAT)
Rorschach Inkblot
10 inkblots presented and asked “what might this be?”
Thematic Apperception Test (TAT)
31 cards (don't administer all) Use of ambiguous stimuli and people will project their own personalities, biases and unconscious fears and experiences onto the stimuli.
Presented a card - [i.e. a boy is sitting at a table looking at a violin that’s been placed in front of him] - tell therapist a story based on the picture - how much they project or put into the card.
Personality Inventories
> Questions have face validity
Self-report inventories
Theory is less relevant, it’s based on empirical model
Minnesota Multiphasic Personality Inventory (MMPI)
- derived
- how many items
- how many items to detect validity
- empirically derived
- True or false to 567 items
- 150-200
- supposed to answer instinctively - no thinking
- supposed to take 1.5 hours - 2 hours if not trying to hide anything. longer or shorter time = red flag
- examine patterns of responses
Intelligence Testing
> Who started and when
> Why did it start
> IQ stands for
> Alfred Binet and Theodore Simon in 1904
World War 1 - to figure out who should be in front lines of battle (more disposable)
Intelligence Quotient
Neuropsychological Testing
Method
Assessing
Non verbal testing
Assessing:
> expressive language
> Memory, attention and concentration
> Motor skills - walking a straight line slowly (balance)
> Perceptual ability - depth, distance between one object to next.
> Sounds - at what frequency not detected
> Learning ability
Bender-Visual Gestalt Test
Picture embedded in another
Strength of grip test
both hands same strength
Neuroimaging and Psychophysiological Assessment
> Images of brain structure
Images of brain functioning
Psychophysical Assessment
Images of brain structure
> CAT scan
MRI
Still pictures
Images of brain functioning (activity)
> PET
> fMRI
Psychophysical Assessment
EEG electroencephalogram
Diagnosing
> Idiographic
Nomothetic
Classification Issues
Idiographic
Unique data to individual
Nomothetic
Normative/average data
Classical (pure) categorical approach
Severely depressed and mildly depressed - SAME CATEGORY
Dimensional approach [TEST]
How severe, not just Yes/no. Everyone has depression to a degree
Prototypical approach [TEST]
Combination of Classical and Dimensional
First categorize and then rate. Cuts a person off (into the group or not) and if in the group, rates them.
Diagnosing before 1980
Who is the “father of diagnosis?”
Emil Kraepelin
Dementia precox
Emil Kraepelin’s name for schizophrenia
Emil Kraepelin
Discovered schizophrenia, ADHD, etc. Developed classification system
World Health Organization (1940)
International Classification of Diseases and Related Health Problems (ICD)
Currently on edition 10
Entire world uses ICD except for US.
Diagnostics and Statistical Manual (DSM-I) released in
1952
DSM created by
American Psychiatric Association – medical doctors mostly
DSM-II release year
1960s
DSM-III release year
1980
DSM-III-R release year
1987
DSM-III
Changes
> Radically changed from DSM-I and DSM-II
Atheoretical approach - didn’t give a theory of why a DO occurred to try decrease bias
Specifity and detail in diagnostic criteria
Multiaxial system
DSM-III multiaxial system 1 2 3 4 5
> Axis 1: come and go disorders (bipolar, depression and anxiety)
Axis 2: developmental (early childhood), pervasive (constant) i.e. Down’s Syndrome
Axis 3: general medical condition - heart attack complications
Axis 4: psychological - social support
Axis 5: global functioning
DSM IV (1994) and DSM-IV-TR
A) increased compatibility with
B) much more based on ___
C) increased recognition
A) ICD
B) clinical trials - research
C) of biopsychosocial causal factors - more integrative approach
DSM-5
> Axis
> Ratings of disorders
> ____ Formation
> Eliminated Axis I, II, and III, combined into one diagnostic axis
Dimensional ratings of disorders - no one is completely depression-free
Cultural
Criticisms of the DSM-5
> Fuzzy categories leading to comorbidity (maybe over diagnosing)
Overemphasis on reliability?
Re-packaging of the old may not be the best way to think about the nosology of disorders
Nosology
The branch of medicine that deals with the classification of diseases
Comorbidity
The presence of one or more disorders (or diseases) in addition to a primary disease or disorder.
