Diagnosis and Assessment Flashcards
What is the psychiatric dictionary called?
THE DSM-5
Comment on the progression of psychiatric disorders
DSM-1 in 1952 had 106 disorders
DSM-5 from 2022 has 297 disorders
What type of criteria does DSM use
Polythetic criteria
Having many, but not all properties shared
What’s the issue with a polytheistic criteria?
It introduces heterogeneity/ diversity
Example: There are more than 100 different ways to meet the criteria for bipolar disorder
Two patients with schizophrenia can have no overlapping symptoms
It’s very complicated to give diagnosis because we are trying to put a frame on the disorders
They’re not based on biological observations, the idea that people have these characteristics seem to be more evident in this category
If the categories of polytheistic criteria are wrong, then why are they used?
People like to have a name for what’s happening to them
Allows better explanation and less isolation
Important but imperfect guidance for treatment
Allows for consistent communication between clinicians/ researchers: standardisation
Allow for medical insurance and disability claims
What were the key changes in DSM 5
- New disorder
prolonged grief disorder- grief that lasts for a long period of time
2.Other conditions of clinical attention
suicidal behaviour and non-suicidal self-injury
In the past, for these behaviours to exist they needed to be in another diagnostic category
- New names for old disorders
Functional Neurological Symptom Disorder (formerly ‘conversion disorder’)
Intellectual Developmental Disorder (formerly Intellectual Disability) - Changes to reduce cultural and ethnic bias
“race” was replaced with “racialized” to call out that race is socially constructed.
The terms “minority” and “non-White” are not used because they imply that whiteness is prioritized over other social groups.
Should we be adding new diagnoses?
There has been a call for new disorders when a person’s symptoms aren’t being adequately explained by existing behaviours.
Example: 2013- premenstrual dysphoric disorder which is a relatively rare and severe emotional disturbance presence during the majority of premenstrual phases
What’s co-morbidity
Having 2 or more disorders at the same time
Why is there so much co-morbidity amongst disorders?
Shared genetic risks
certain genes confer a risk for multiple disorders, ie. bipolar and schizophrenia
Shared environmental risk- stress, trauma and neglect increase the risk for many disorders
Shared treatment efficacy- Some can be controlled by the same hormone or drug,ie. Serotonin effects MDD, OCD, GAD, EDs and PTSD
Shared neurobiological profile- changes to the prefrontal cortex functioning and size are common in many disorders
What’s the Research Domain Criteria Project RDoC
The National Institute of Mental Health (NIMH) in the USA, in 2013 changed research funding from a categorical to a dimensional approach.
New framework for research- can’t change the diagnostic categories cuz they work but the way research is done will change.
Not a diagnostic label that matters, its the colours and schemat that link to the biological and cognitive impact they have
How are psychological disorders assessed?
Clinical interview- most used using the DSM criteria
Stress
Personality
Intelligence
Behavioural and Cognitive
Brain imaging
Neurotransmitters
Neuropsychological
What do all of the types of assessment require
Reliability
Variability
What’s reliability
Gives the same answer consistently across time and raters
What are the 2 types of raters in terms of reliability?
Test retest reliability
Iner rater reliability
What is test-retest reliability?
If you give the same test to the same person on different days test should get same result
What’s inter rater reliability?
2 different clinicians looking at same person and see if they come up with the same diagnosis
DSM diagnoses assed by a clinician are mostly unreliable
What’s validity
Measures what its supposed to
Ie: star signs are reliable but not in a valid way of predicting traits and future events
What are the purposes of using so many methods of psychological assessment?
Understand the individual
Differential diagnosis
Predict behaviour
Prescribe treatment
Evaluate outcomes
Measurement is crucial for research
How do most clinicians assess psychological disorders and why?
Unstructured interviews
Only method they have time for
What’s a clinical interview
An evaluation of the current level of functioning and the presence of symptoms.
Look at:
History: onset and duration of symptoms
Family history
Life stress/pass history
Focus on resources, ie. coping strategies and social supports
The goal is to build an understanding of the individual
What is case formulation
Building an understanding of an individual
What does the mental state exam focus on
Appearance- are they dressed in a certain way/ bathed/ are they making eye contact
Though processes
Mood
Affect- the tone of their voice
Speech- are they not able to say a lot of words/demonstrate too many ideas/words
Perception- if they’re experiencing hallucinations
Disorientation of person/place/time
Insight- do they think anything is wrong
Risk- suicide
Less insight makes treatment more challenging, ie. hoarding disorder
How is stress assessed
Self report- history and current, ie. College and money
Psychophysiology
Heart rate and skin conductance
Biofeedback is used as an aid in exposure therapy
What is personality?
A characteristic pattern of thinking, feeling and behaving
It varies from person to person on a continuum
How is personality assessed
Self report tests, ie. fill in servers
Projective personality tests
What are projective tests and give examples
Projection is the idea that the client interprets the stimulus in line with their current concerns and feelings, their relationships with others, and conflicts or desires.
Examples
Thematic Apperception. to describe the picture and tell a story
Draw a person test
Rorschach test- look at ink block and say what you see
Sentence completion test
Why do clinical interviews, stress tests and personality tests cause issues?
Subjectivity of the clinician
Confirmation bias: we end to seek out evidence that confirms our pre-conceived notions
Different clinicians with different specialities will favour their speciality
Lack of standardised rules for scoring and administration
Reliability and validity is poor
What is intelligence testing
Intelligence Quotient
Why is IQ testing important?
Its predictive of important outcomes, ie. grades, achievement, income
Necessary for the diagnosis of intellectual development disorder
Why does IQ testing remain controversial?
General intelligence omit other forms of intelligence like emotional and interpersonal intelligence
Aim to be culture free but iq tests may be biased towards middle and upper class educated individuals
Bad connotations to history- iq lower than 70 was used to justify forced sterilisation in North Carolina
How are behaviours and cognitions assessed?
Observation by assessor
Self monitoring of their alcohol consumption, mood, sleep, anxiety, exercise
However, observing a behaviour may cause it to change
What’s EMA
The diary of ecological momentary assessment, used to self monitor
Brain imaging and psychological disorder
What are the techniques
Brain imaging helps psychiatrist with differential diagnosis, ie. ruling out other causative factors
Tehcniques
Computerised Axial Tomography- CAT
Magnetic Resonance Imaging- MRI
Positron Emission Tomography- PET
What is Computerised axial tomography?
CAT scan
Xray machine rotating around the head/body
detects differences in tissue density
fast test
What is Positron Emission Tomography
PET scan
Measures structures and function
Invasive- radioactive isotope injected into the blood stream
Different tracers/injections allow us to see different things
What’s Magnetic resonance Imaging
Magnet that causes hydrogen atoms in the body to line up
The time taken for the atoms to return to the original position creates an image
What’s a functional MRI
Measures brain function
Uses blood flow for neural activity
Relies on difference in resonance between oxygenated and deoxygenated blood
Not as useful clinically
MAin difference between CAT and Pet scans v MRI
CAT AND PET ARE RADIOACTIVE BUT TAKE SHORTER TIME
MRI NOT INVASIVE AND NO RADIATION BUT TAKE A LOT OF TIME
Sensationalised findings in the brain
Brains done actually light up
They’re just statistics represented in a colour map
What are the issues with FMRI
Lots of data making it statistic-heavy
Studies are very expensive so researchers are pushed to publish them
What are the ways in which neurotransmitter assessments are carried out?
Post mortem- in vitro
In living organisms- in vivo
How are neurotransmitters assessments carried out post mortem
Infuse the substance
Look across individuals to see how much the receptors are binding with certain agents
How are neurotransmitters assessments carried out in living organisms?
Example: PET scan
Can measure the byproducts of neurotransmitters in cerebrospinal fluid
Or change neurotransmitter levels by giving a drug,ie. depleting tryptophan, which is needed to make serotonin
Remitted depressed patients relapse when tryptophan is depleted
What’s neuropsychological assessment?
Tests that measure problems in behaviour and thought arising form brain dysfunction
Examples:
Memory tests
Perception
Language
Executive function- Stroop tasks, say colour and not word
What’s electroencephalography/EEG?
measures the electrical signals in the brain
Good job of measuring brain activity but doesnt know where the brain activity is taking place
Used to understand sleep disorders, seizures etc.
Difference between EEGS and MRIS
FMRI is more precise
EEG is faster
What are the limitations of assessment
Expensive
Many are subject to interpretation, confirmation bias, and have issues with validity
Many are more objective, but still not reliable (e.g., skin conductance, some fMRI measures)
The clinical value is not proven in many cases
Tests take time and money
Cultural and ethnic bias- many instruments based on white Americans of European descent
Example: some cultures believe in spirits and some think its hallucination
What are the ways in which the limitations of assessment can be reduced?
Be aware of bias
No generalising or stereotyping - consider culture and test the theory before concluding
Use multiple types of measurement
Establish norms appropriate to specific groups/cultures
