CP: Lecture 15 Diagnostics and Assessment II

Question 1

3 types of judgement

Answer 1

layman judgement (heeft er geen verstand van, ongeleerd)
clinical judgement
psychological assessment PA

Question 2

Method clinical judgement=

Answer 2

Unstructured interview and observation

Question 3

heuristics of clinical judgement

Answer 3

• 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).

Question 4

stereotyping bias clinicians voorbeeld

Answer 4

Experienced diagnosticians
over-classify antisocial pd and
under-classify depression
>100% in homeless people
using clinical judgement
(North et al, 1997)

Question 5

bias (un)availability

Answer 5

Experienced diagnosticians
under-classify social phobia,
body dysmorphia, obsessive-
compulsive disorder and
somatoform disorders in
psychiatric patients when
using clinical judgement

Question 6

premature closure

Answer 6

Especially comorbid classifications are missed.
Diagnosticians using clinical judgement tend to stop after
1 classification.

Question 7

why PA?

Answer 7

To reduce bias in the decision-making processes inherent to
clinical judgement

Question 8

pa instrument soorten

Answer 8

• Structured interviews
• Self- and informant-report questionnaires
• IQ tests and neuropsychological tests
• Observational rating scales
• (Projective tests)

Question 9

not yet in pa

Answer 9

• Psychophysiological assessment
• Neuro-imaging techniques
• EMA: Ecological Momentary Assessment

Question 10

illusory correlation bias

Answer 10

perceing a relationship that does not actually exist

accuracy vs meaningfullness

Question 11

excessive data collection bias=

Answer 11

large unfocused data collection leads to false positive results

Question 12

self response bias

Answer 12

Bias created by the respondent due to i.e.
social desirability, self-perception, mood states etc.

Question 13

confirmation bias

Answer 13

The tendency to search for, interpret, favor and recall information in a way that confirms or strengthens one’s initial belief

Question 14

how to conduct a good pa

Answer 14

▪ 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

Question 15

dus samenvatting how to conduct a good pa

Answer 15

• 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

Question 16

welke bias is het als therapist stopt na 1 diagnose

Answer 16

premature closure

Question 17

welke bias als je een relatie ziet die er niet is

Answer 17

illusory correlation

Question 18

welke bias bij veel te veel data verzamelen (waardoor er een vals positief resultaat komt)

Answer 18

excessive data collection bias

Question 19

bias: The tendency to search for, interpret, favor and recall
information in a way that confirms or strengthens one’s initial belief

Answer 19

confirmation bias

Question 20

the diagnostic cycle

Answer 20

observation
induction
deduction
testing
evaluation

Question 21

5 basic questions

Answer 21

1. recognition
2. explanation
3. prediction
4. indication
5. evaluation

REPIE

Question 22

recognition =

Answer 22

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?

Question 23

explanation=

Answer 23

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?

Question 24

prediction =

Answer 24

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?

Question 25

indication =

Answer 25

how can problems be resolved

• Which type of therapy is best suited for the client?
• Is assisted living indicated?

Question 26

evaluation =

Answer 26

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?

Question 27

pa and the empirical cycle works well for..

Answer 27

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

Question 28

when does it work less well

Answer 28

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

Question 29

Observation / Exploration:

Answer 29

exploration and first thoughts about creation and persistence of problem behaviour

Question 30

Induction:

Answer 30

formulation of a theory and the hypotheses

Question 31

Deduction:

Answer 31

derivation of testable predictions from the hypotheses

Question 32

Testing:

Answer 32

application of relevant diagnostic measurements

Question 33

Evaluation:

Answer 33

determination whether the testable predictions are met

Question 34

differential diagnosis =

Answer 34

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.

Question 35

limitations of pa

Answer 35

The ideal PA is often not possible: available information, subjective reports, experimental fase of instruments, causality problem