Classification and Assessment Flashcards
What causes the access of mental health services to be difficult?
Stigma
What is diagnosis?
Identification of a disorder on the basis of characteristic symptoms (reliability varies)
What does the DSM-5 use to define mental disorders and why?
A series of descriptors-used because a lot of mental disorders are subjective and have no core or sure reality.
What is the only mental disorder with sure reality and diagnosis?
Dementia
Why do we classify? (4 Reasons)
1) To make sense of things (nosology precedes etiology)- we prefer classification before we can understand them
2) To assist in treatment decisions
3) To organize the search for new knowledge-helps us understand disorders more specifically
4) To organize epidemiological research.
What are the 2 classification systems we have?
Diagnostic and Statistical Manual (DSM)
International Classification of Diseases from WHO
What does a patient receive when a psychiatrist gives a formal diagnosis?
DSM number and ICD number
Is the DSM categorical or continuous?
Categorical
What kinds of disorders did the DSM 5 add?
Hoarding as a type of anxiety
What modifications did the DSM 5 make?
Added Schizophrenia as a Spectrum
What category changes did the DSM 5 make?
Created OCD as a category of its own
What category did Body Dysmorphic disorder go to in the DSM 5?
Switched to an anxiety disorder from a somatoform disorder
What other innovations did the DSM 5 make?
Greater alignment with ICD
Greater recognition of age, gender, culture
50 disorders as spectrum/non-spectrum
“not otherwise specified” replaced with other specified and unspecified
Emphasis on clinical utility
What does a typical DSM-5 Diagnosis look like?
Most severe disorder (medical or mental) presented first
Other diagnoses follow in severity and/or implication for quality of life and functioning
Psychosocial, cultural, and other issues follow as comments
What are syndromes?
Clusters of symptoms (these are what mental disorders are)
What are syndromes determined by?
Symptom clusters Exclusion criteria Duration Certain level of distress Level of dysfunction Type of etiology Statistical Deviation Chemistry involved
What is an example of a symptom cluster?
Have to have 5/9 symptoms of depression INCLUDING either or persistent sadness on most days, and/or anhedonia (loss of pleasure in activities)
What is an example of exclusion criteria?
Disturbance cannot be attributed to substance abuse, medications, conditions.
What is an example of a level of duration?
Have to have persistent stress for 3+ weeks to have PTSD.
What determines distress?
How much a person cares or not (essential for sex dysfunctions)
What are the diagnostic criteria for schizophrenia?
A-Characteristic Symptoms B-Social Occupations/Dysfunctions C-Duration D-Exclusion of Certain Disorders E-Exclusion of conditions F-Criteria if another disorder is present
What are some characteristic symptoms of schizophrenia?
1.Delusions. 2.Hallucinations. 3. Disorganized Speech. 4. Disorganized or Catatonic Behaviour. 5.Negative symptoms (have to have two or more of the following, for one month (less if treated)
What is the duration of schizophrenia symptoms?
Continuous signs of disturbance for 6 months, 6 month period must include at least one month of symptoms
What are some of the disorders that must be excluded from the diagnosis of schizophrenia?
Schizoaffective disorder and bipolar disorder.
What is reliability?
Makes classifications and tests reliable across people-classification consistency.
What is inter-rater reliability used for and how does it work?
Classifications-when classifying a disorder, have one interviewer and the raters watching behind a 1 way mirror. Raters rate what is happening and arrive at a diagnosis-correlation then done between raters
What is an example of a disorder with high inter-rater reliability and one with low?
High-Major Depressive Disorder
Low-Personality disorders
What is test-retest reliability used for?
If the diagnosis is supposed to last over a period of time, have 2+ interviews to see if they still have the diagnosis (around 8wks later without intervention)
What is internal consistency?
When you divide the questionnaire into 2 parts and expect the coefficient to be .70 between both parts. No matter how you divide the test, should be the same.
What is internal consistency used for (disorder)?
Personality disorders strictly
What is validity?
The extent to which a test measures what it’s supposed to-comes ahead of reliability
What is criterion validity and the 2 parts of it?
Does the test actually meet certain criterion? Includes concurrent validity and predictive validity
What is concurrent validity?
In two different contexts, do we arrive at the same results?
What is predictive validity?
Are we able to accurately predict the disorder? If they still have the diagnosis in a few months then we predicted it right, if no improvement with intervention, have to ask if there’s something more.
What is face validity?
Used on tests-are you asking questions relative to disorders?
What can peer and significant other reports help with?
Giving more information, and helps with child evaluations as children are UNRELIABLE.
What are some of the unresolved issues with the classification of mental disorders?
- Definitions and criteria are not uniformly scientifically based
- Research underpinning categories in DSM has been severely criticized
- Number of symptoms needed for diagnosis often poorly justified
- Time periods vary arbitrarily.
- Inter-rater reliability is inconsistent
- Dimensional classification based on quantitative deviations from health data better?
- Is comorbidity the result of splitting disorders or is it valid?
- Poor use of longitudinal (historical) info.
What is one of the big, overarching issues associated with the classification of mental disorders?
Pathologizing of behaviour seen as acceptable by some individuals or cultures, and the stigma surrounding classification of mental disorders.
What is a psychological assessment?
The process of collecting and interpreting information that will be used to understand another person
What is construct validity?
Does your test follow the theory you’re testing? Is your test following what it says it does? Compare yours with someone elses.
What do most researchers classify mental disorders on?
Severity rather than category
How did the biological perspective attempt to remedy stigma and did it work?
By classifying mental disorders as chemical imbalances. Did not work.
What are the three major goals of psychological assessment?
1) Making predictions
2) Planning interventions
3) Evaluating interventions
What are some assumptions made about behaviour?
Behaviour is consistent- but consistency over time or setting?
Different levels of analysis used depending on questions needed to be addressed
Assessment procedures vary in usefulness depending on causes.
What are the six possible sources on an individuals personality?
- Psychological Interviews
- Peer and significant other reports
- Behavioural and observational ratings
- Cognitive and neuropsychological testing
- Personality tests and self-report inventories
- Projective tests
What are the 3 major interviewing styles associated with psychological interviews?
Unstructured, semi-structured, and structured
What are unstructured interviews?
When have the freedom to ask whatever you want-have to be aware of bias and the thing you’re looking for (can be unreliable)
What are semi-structured interviews?
Has a set of questions but there is freedom to ask for clarification
What are structured interviews?
Used for more precise diagnosis, specific questions with branches for specific answers-not useful for more information about lifestyle.
What is behavioural observation and ratings used for?
Used on the psychiatric ward and in behaviour modification for adolescents-looks at patterns to see if person is better or worse.
What was the first cognitive and neuropsychological test done?
Asked how can we put children of different abilities into education that is best for them (France, 1910)
What is cognitive and neuropsychological testing?
Intelligence and cognition testing
What is the intelligence battery?
Measures verbal and non-verbal skills, memory, language, puzzles, executive functioning, impulsivity, reaction time
What do personality tests and self-report inventories measure?
What personality “should” look like using a distribution of responses and clinical scales.
What is the logic behind projective tests?
When confronted with vague and imprecise stimuli, people will project what is going on in their lives.
What are some types of projective techniques?
Association, construction, sentence completion, free expression
What is an association test?
An example would be the Ink blot test-associate a random inkblot with a concrete object
What is a type of construction test?
Thematic Apperception- Using a specific deck of cards that show relationships and have people tell a story about it. Good for pulling information out of people who have difficulty expressing themselves.
What is a sentence completion test?
Where you start a sentence and the person is asked to complete it (ex: when I was young, my mother…) in the beginning, people will give trivial information, but at some point you’ll find something.
What is a free expression test?
Ask people to draw things (ex: ask kids to draw their family before cancer and after). Some cases without change and some with HUGE. Gives ideas of preoccupation.
What can we do to assess biological systems?
Psychophysiological tests, brain imaging etc
What can controlled experimental research tell us?
Causality.
What is quasi-experimental research in abnormal psych?
Measuring a population after an event (ex: PTSD levels after Fort Mac fires).
What type of research method is most commonly used in abnormal psych?
Non-experimental, specifically correlational: looks at conditions that relate with disorders, new relationships, case studies, single-subject
What does epidemiological research look at?
Factors in overall population that might influence disorders, segments of population, prevention methods, where government can put money to help.
What do heritability studies look at?
Families, adoption studies, twin studies..
What is one example of a heritability study done at a level of an entire population?
Danish twin study: found that a large proportion of monozygotic twins would commit suicide if the other had also committed.
What are some of the ways that we evaluate research in clinical psych?
Statistical significance
Clinical Significance
Normative comparisons
Where do we do statistical significance?
Moreso at group levels and in research-have to be careful with how it’s applied at individual level (Ex: people of lower SES have more mental health issues BUT this doesn’t mean that high SES people don’t have issues)
What do we look at with Clinical Significance?
Look at treatment, differences between treatments, and how large they are (effect size). Also more research based
What are normative comparisons used for?
Clinical treatments-helpful at both individual and group levels, shows the distribution of scores on a test depending on personal factors (age, gender etc)-helps diagnosis and treatment for people in those groups.
What is one thing that is essential with diagnosing in clinical psych?
Interviews
