L5 L5:Classification and Assessment in Clinical Psychology

Question 1

taxonomic approach

Answer 1

Classification systems help us understand things that are related to each other and what is distinct from each other
Essential to understand causes, identify treatments, determine if its been effective, practical consequence e.g. is a person fit to stand trial- can do if broken down into

Question 2

objectives of classification systems

Answer 2

Provide necessary and sufficient diagnostic criteria for correct differential diagnosis
Permit distinction of ‘true’ psychopathology from non-disordered ‘problems in living’ e.g. everyone experiences low mood, should distinguish between this experience and MDD
Diagnostic criteria an be systematically applied, by different clinicians in different settings
Diagnostic criteria should be theoretically neutral

Question 3

DSM-5 APA

Answer 3

Categories of disorders:
1.Neurodevelopmental disorders
2.Schizophrenia spectrum and other psychotic disorders
3.Bipolar and related disorders
4.Depressive disorders
5.Anxiety disorders
6.Obsessive-compulsive and related disorders
7.Trauma and stressor-related disorders
8.Dissociative disorders
9.Somatic symptoms and related disorders
10.Feeding and eating disorders
11.Elimination disorders
12.Sleep-wake disorders
13.Sexual dysfunctions
14.Gender dysphoria
15.Disruptive, impulse-control and conduct disorders
16.Substance-related and addictive disorders
17.Neurocognitive disorders

Question 4

ICD-11

Answer 4

used in the UK

Question 5

what do manuals describe

Answer 5

observable symptoms rather than explain causes, by themselves not too much in explaining how disorder developed

Question 6

diagnosis are categorical

Answer 6

however severity can be quantified

Question 7

homogeneity of sufferers

Answer 7

many diff combinations of symptoms could warrant disorders e.g. schizophrenia or substance use disorder, two people with same disorder can have different symptoms and completely different experiences

Question 8

disorders are distinct form each other

Answer 8

comorbidity is the norm, at what point are they the same disorder

Question 9

critiques of DSM-5

Answer 9

Proliferation of disorders with each revision - more and more disorders
Gradual lowering of thresholds- prefer over diagnosis over under, medicalising normal experience, overprescription of psychiatric medication
Disproportionately influenced by bio models
Most psychological disorders are dimensional, continuum of severity, DSM-5 acknowledge but that makes any cut-off score or threshold arbitrary and subjective

Question 10

clinical interviews

Answer 10

Structured interview for DSM (SCID)
Questions predetermines
Clients response determines next question to be asked
High inter-rater reliability for many disorders

Question 11

limits of clinical interviews

Answer 11

Reliability for unstructured interview is low- skill, beliefs and personalities of clinicians
Some disorders characterised by poor self awareness, can’t just ask someone to reflect
Some clients may intentionally mislead e.g. some PD
Interviews prone to biases e.g. primacy effect- first bit of info shapes the rest of the opinion

Question 12

clinical observations

Answer 12

E.g. in school context use ABC chart to identify what happens before target behaviour (Antecedents), whats was the Behaviour, Consequence of behaviour
Use and advantage- capture frequency of behaviours, better eco validity tha self reports, identify practical treatment options

Question 13

limitations of clinical observations

Answer 13

Time consuming
Observers need training
Limited to one context
Observer influence cause hawthorne effect
Inter-observer reliability can be poor unless intensively trained

Question 14

self report questionnaires

Answer 14

Assess specific characteristic or trait
Rigid response requirement- scored objectively
Many have good internal reliability and concurrent validity with diagnostic status
Statistical norms established, standardise results, enables clinician to estimate if client likely to meet diagnostic criteria

Question 15

limits of SRQ

Answer 15

Time consuming
Can be faked - some have lie scales and scales that capture social desirability

Question 16

projective test

Answer 16

ambiguous images and project element of selves on answer
Rorschach inkblot test

Question 17

thematic apperception test

Answer 17

Have low inter-rater reliability and validity
- valid in some circumstances e.g. detection of thought disorder in schizophrenia

Question 18

intelligence test

Answer 18

Useful for diagnosis of intellectual and learning disabilities
Studies over decades
Standardised at 100, SD of 15
Internal consistency, T-R reliability and predictive

Question 19

limit of IQ test

Answer 19

Underlying construct is hypothetical
Culturally biased
Don’t capture other important aspects of intelligence

Question 20

psychophysiological

Answer 20

Electrodermal responding - skin sonductance
Electromyogram EMG- muscle activity e.g. smiling
ECG- heart
EEG- brain

Question 21

test-retest reliability

Answer 21

same person over few weeks

Question 22

inter-rater reliability

Answer 22

two clinicians agree when interpreting score from test

Question 23

concurrent validity

Answer 23

how highly correlated scores of one tests are with scores from other assessments that measure that attribute

Question 24

predictive validity

Answer 24

Predictive validity- degree to which an assessment method is able to help clinician predict future behaviour and symptoms

Question 25

CF 2

Answer 25

Identify and describe underlying psychological mechanisms

Question 25

explanation for CB

Answer 25

Symptoms cumulate differently in different cultures
Language differences
Cultural and religious difference, perception of mental health problems
Client-clinician relationship
Cultural stereotypes

Question 25

CF 4

Answer 25

Identify events that precipitate the problem

Question 25

cultural biases in assessment

Answer 25

Mosts tests developed on white european or american populations
USA different rates of diagnosis in different ethnic groups
UK- caribbean immigrants 70’s more likely to be diagnosed as schizophrenia
Clinicians view people with lower SES as more disturbed than those with higher SES, stereotypes influence for unstructured interviews

Question 25

case formulation

Answer 25

Clinicians gather info about clients in order to draw up a psychological explanation of the clients problems and to develop a plan of therapy
Assumes each client unique and so needs individualised approach
Doesn’t request diagnoses but isn’t incompatible
E.g. CBT formulation identifies the ABC model

Question 25

CF 1

Answer 25

Create a list of the clients problems

Question 25

ADVANTAGES OF CF

Answer 25

No diagnosis, reduced stigma
Collaborative, patient gives input
Treat client as unique, tailor solution to them
Based on theoretical understanding of causes and consequences of disorder rather than only on presenting symptoms

Question 25

CF 5

Answer 25

Identify how the underlying psychological mechanisms mediate the antecedent> symptoms links

Question 25

CF 3

Answer 25

Understand how those mechanisms generate the clients problems

Question 25

CF 6

Answer 25

Develop a treatment plan based on the above

Question 25

DISADVANTAGES OF CF

Answer 25

Subjective- explanation will be based on therapists background
Rely on some untested assumptions
Difficult to share knowledge or what worked in similar cases