L5 L5:Classification and Assessment in Clinical Psychology Flashcards
taxonomic approach
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
objectives of classification systems
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
DSM-5 APA
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
ICD-11
used in the UK
what do manuals describe
observable symptoms rather than explain causes, by themselves not too much in explaining how disorder developed
diagnosis are categorical
however severity can be quantified
homogeneity of sufferers
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
disorders are distinct form each other
comorbidity is the norm, at what point are they the same disorder
critiques of DSM-5
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
clinical interviews
Structured interview for DSM (SCID)
Questions predetermines
Clients response determines next question to be asked
High inter-rater reliability for many disorders
limits of clinical interviews
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
clinical observations
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
limitations of clinical observations
Time consuming
Observers need training
Limited to one context
Observer influence cause hawthorne effect
Inter-observer reliability can be poor unless intensively trained
self report questionnaires
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
limits of SRQ
Time consuming
Can be faked - some have lie scales and scales that capture social desirability
projective test
ambiguous images and project element of selves on answer
Rorschach inkblot test
thematic apperception test
Have low inter-rater reliability and validity
- valid in some circumstances e.g. detection of thought disorder in schizophrenia
intelligence test
Useful for diagnosis of intellectual and learning disabilities
Studies over decades
Standardised at 100, SD of 15
Internal consistency, T-R reliability and predictive
limit of IQ test
Underlying construct is hypothetical
Culturally biased
Don’t capture other important aspects of intelligence
psychophysiological
Electrodermal responding - skin sonductance
Electromyogram EMG- muscle activity e.g. smiling
ECG- heart
EEG- brain
test-retest reliability
same person over few weeks
inter-rater reliability
two clinicians agree when interpreting score from test
concurrent validity
how highly correlated scores of one tests are with scores from other assessments that measure that attribute
predictive validity
Predictive validity- degree to which an assessment method is able to help clinician predict future behaviour and symptoms
CF 2
Identify and describe underlying psychological mechanisms
explanation for CB
Symptoms cumulate differently in different cultures
Language differences
Cultural and religious difference, perception of mental health problems
Client-clinician relationship
Cultural stereotypes
CF 4
Identify events that precipitate the problem
cultural biases in assessment
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
case formulation
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
CF 1
Create a list of the clients problems
ADVANTAGES OF CF
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
CF 5
Identify how the underlying psychological mechanisms mediate the antecedent> symptoms links
CF 3
Understand how those mechanisms generate the clients problems
CF 6
Develop a treatment plan based on the above
DISADVANTAGES OF CF
Subjective- explanation will be based on therapists background
Rely on some untested assumptions
Difficult to share knowledge or what worked in similar cases
