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Psychological disorder > Diagnosis and Assessment > Flashcards

Diagnosis and Assessment Flashcards

1
Q

What is the psychiatric dictionary called?

A

THE DSM-5

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2
Q

Comment on the progression of psychiatric disorders

A

DSM-1 in 1952 had 106 disorders

DSM-5 from 2022 has 297 disorders

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3
Q

What type of criteria does DSM use

A

Polythetic criteria

Having many, but not all properties shared

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4
Q

What’s the issue with a polytheistic criteria?

A

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

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5
Q

If the categories of polytheistic criteria are wrong, then why are they used?

A

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

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6
Q

What were the key changes in DSM 5

A
  1. 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

  1. New names for old disorders
    Functional Neurological Symptom Disorder (formerly ‘conversion disorder’)
    Intellectual Developmental Disorder (formerly Intellectual Disability)
  2. 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.

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7
Q

Should we be adding new diagnoses?

A

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

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8
Q

What’s co-morbidity

A

Having 2 or more disorders at the same time

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9
Q

Why is there so much co-morbidity amongst disorders?

A

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

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10
Q

What’s the Research Domain Criteria Project RDoC

A

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

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11
Q

How are psychological disorders assessed?

A

Clinical interview- most used using the DSM criteria
Stress
Personality
Intelligence
Behavioural and Cognitive
Brain imaging
Neurotransmitters
Neuropsychological

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12
Q

What do all of the types of assessment require

A

Reliability

Variability

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13
Q

What’s reliability

A

Gives the same answer consistently across time and raters

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14
Q

What are the 2 types of raters in terms of reliability?

A

Test retest reliability

Iner rater reliability

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15
Q

What is test-retest reliability?

A

If you give the same test to the same person on different days test should get same result

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16
Q

What’s inter rater reliability?

A

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

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17
Q

What’s validity

A

Measures what its supposed to

Ie: star signs are reliable but not in a valid way of predicting traits and future events

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18
Q

What are the purposes of using so many methods of psychological assessment?

A

Understand the individual
Differential diagnosis
Predict behaviour
Prescribe treatment
Evaluate outcomes
Measurement is crucial for research

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19
Q

How do most clinicians assess psychological disorders and why?

A

Unstructured interviews

Only method they have time for

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20
Q

What’s a clinical interview

A

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

21
Q

What is case formulation

A

Building an understanding of an individual

22
Q

What does the mental state exam focus on

A

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

23
Q

How is stress assessed

A

Self report- history and current, ie. College and money

Psychophysiology

Heart rate and skin conductance

Biofeedback is used as an aid in exposure therapy

24
Q

What is personality?

A

A characteristic pattern of thinking, feeling and behaving
It varies from person to person on a continuum

25
Q

How is personality assessed

A

Self report tests, ie. fill in servers

Projective personality tests

26
Q

What are projective tests and give examples

A

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

27
Q

Why do clinical interviews, stress tests and personality tests cause issues?

A

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

28
Q

What is intelligence testing

A

Intelligence Quotient

29
Q

Why is IQ testing important?

A

Its predictive of important outcomes, ie. grades, achievement, income

Necessary for the diagnosis of intellectual development disorder

30
Q

Why does IQ testing remain controversial?

A

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

31
Q

How are behaviours and cognitions assessed?

A

Observation by assessor

Self monitoring of their alcohol consumption, mood, sleep, anxiety, exercise

However, observing a behaviour may cause it to change

32
Q

What’s EMA

A

The diary of ecological momentary assessment, used to self monitor

33
Q

Brain imaging and psychological disorder

What are the techniques

A

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

34
Q

What is Computerised axial tomography?

A

CAT scan

Xray machine rotating around the head/body
detects differences in tissue density
fast test

35
Q

What is Positron Emission Tomography

A

PET scan

Measures structures and function

Invasive- radioactive isotope injected into the blood stream

Different tracers/injections allow us to see different things

36
Q

What’s Magnetic resonance Imaging

A

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

37
Q

What’s a functional MRI

A

Measures brain function
Uses blood flow for neural activity
Relies on difference in resonance between oxygenated and deoxygenated blood

Not as useful clinically

38
Q

MAin difference between CAT and Pet scans v MRI

A

CAT AND PET ARE RADIOACTIVE BUT TAKE SHORTER TIME

MRI NOT INVASIVE AND NO RADIATION BUT TAKE A LOT OF TIME

39
Q

Sensationalised findings in the brain

A

Brains done actually light up
They’re just statistics represented in a colour map

40
Q

What are the issues with FMRI

A

Lots of data making it statistic-heavy
Studies are very expensive so researchers are pushed to publish them

41
Q

What are the ways in which neurotransmitter assessments are carried out?

A

Post mortem- in vitro

In living organisms- in vivo

42
Q

How are neurotransmitters assessments carried out post mortem

A

Infuse the substance
Look across individuals to see how much the receptors are binding with certain agents

43
Q

How are neurotransmitters assessments carried out in living organisms?

A

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

44
Q

What’s neuropsychological assessment?

A

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

45
Q

What’s electroencephalography/EEG?

A

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.

46
Q

Difference between EEGS and MRIS

A

FMRI is more precise
EEG is faster

47
Q

What are the limitations of assessment

A

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

48
Q

What are the ways in which the limitations of assessment can be reduced?

A

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

Psychological disorder (20 decks)

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