CP: Lecture 15 Diagnostics and Assessment II Flashcards
3 types of judgement
layman judgement (heeft er geen verstand van, ongeleerd)
clinical judgement
psychological assessment PA
Method clinical judgement=
Unstructured interview and observation
heuristics of clinical judgement
- Clinicians using clinical judgment evaluate only about 50% of the key
criteria of structured interviews (Miller et al. 2001) - Symptoms that had been described as forming part of a causal relation are weighed more heavily (Wakefield et al. 1999; Kim & Ahn
2002) - Clinicians using clinical judgement often form diagnoses by
comparing clients to ‘prototypes’ (e.g. Evans et al. 2002).
stereotyping bias clinicians voorbeeld
Experienced diagnosticians
over-classify antisocial pd and
under-classify depression
>100% in homeless people
using clinical judgement
(North et al, 1997)
bias (un)availability
Experienced diagnosticians
under-classify social phobia,
body dysmorphia, obsessive-
compulsive disorder and
somatoform disorders in
psychiatric patients when
using clinical judgement
premature closure
Especially comorbid classifications are missed.
Diagnosticians using clinical judgement tend to stop after
1 classification.
why PA?
To reduce bias in the decision-making processes inherent to
clinical judgement
pa instrument soorten
- Structured interviews
- Self- and informant-report questionnaires
- IQ tests and neuropsychological tests
- Observational rating scales
- (Projective tests)
not yet in pa
- Psychophysiological assessment
- Neuro-imaging techniques
- EMA: Ecological Momentary Assessment
illusory correlation bias
perceing a relationship that does not actually exist
accuracy vs meaningfullness
excessive data collection bias=
large unfocused data collection leads to false positive results
self response bias
Bias created by the respondent due to i.e.
social desirability, self-perception, mood states etc.
confirmation bias
The tendency to search for, interpret, favor and recall information in a way that confirms or strengthens one’s initial belief
how to conduct a good pa
▪ In advance, draw up multiple, conceptually sound hypotheses and convert them to empirically supported testable predications. Take both verification and falsification into account
▪ Apply reliable and valid instruments in a focused manner. Consider a multimethod and multi-informant approach. Examine all hypotheses.
▪ Base your conclusions on the testable predictions. Weigh the empirical support of your findings appropriately. Be honest about test results vs. interpretations
▪ Stay critical about your own reasoning and the limitations of PA. Use (re-)training, intervision and supervision
dus samenvatting how to conduct a good pa
- multiple hypotheses
- multimethod and multi informant approach, of all hypotheses
- weigh empirical support of all findings
- be honest about results
- stay critical of own reasoning
welke bias is het als therapist stopt na 1 diagnose
premature closure
welke bias als je een relatie ziet die er niet is
illusory correlation
welke bias bij veel te veel data verzamelen (waardoor er een vals positief resultaat komt)
excessive data collection bias
bias: The tendency to search for, interpret, favor and recall
information in a way that confirms or strengthens one’s initial belief
confirmation bias
the diagnostic cycle
observation
induction
deduction
testing
evaluation
5 basic questions
- recognition
- explanation
- prediction
- indication
- evaluation
REPIE
recognition =
what are the (level of) problems
- Does the client meet DSM criteria for a depressive disorder?
- What is the client’s personality profile?
- Is the psychotic episode currently in full remission?
explanation=
why do the problems exist or perpetuate
- What are factors causing the client to relapse in drug abuse?
- Does client’s personality affect the persistent course of his anxiety
problems?
prediction =
how will problems develop in the future
- What is the risk that the client will recommit a violent crime?
- Will the client be able to resume his job later this year?
indication =
how can problems be resolved
- Which type of therapy is best suited for the client?
- Is assisted living indicated?
evaluation =
have the problems been adequately resolved by the intervention
- Was the group therapy successful in treating client’s phobia?
- Is there a significant improvement in client’s mood?
pa and the empirical cycle works well for..
Most recognition questions, based on criteria, norms, old
scores
Evaluation using norms, reduction scores etc.
Indication using diagnosis-treatment combi, flow chart etc.
Prediction using the mechanical method
when does it work less well
Evaluation, indication and prediction without (sufficient) models or data
Most explanation questions –> rely on clinical judgement
Holt: ‘there is an intrinsic need for developing a theory on the
causes of problems
Observation / Exploration:
exploration and first thoughts about creation and persistence of problem behaviour
Induction:
formulation of a theory and the hypotheses
Deduction:
derivation of testable predictions from the hypotheses
Testing:
application of relevant diagnostic measurements
Evaluation:
determination whether the testable predictions are met
differential diagnosis =
A differential diagnosis occurs when your symptoms match more than one condition and additional tests are necessary before making an accurate diagnosis. Tests will narrow down potential conditions on your healthcare provider’s differential diagnosis list.
limitations of pa
The ideal PA is often not possible: available information, subjective reports, experimental fase of instruments, causality problem
