Lecture 2: Intro to psychopathology and Diagnostic Systems - II Flashcards
REFERRAL:
5 Types of referral questions include: (FECTD)
Diagnostic (“Does the client meet criteria for ADHD”?)
Cognitive (“Does the client have an ID”)?
Forensic or Legal (“Is this client fit to stand trial”)?
Educational/work (“Does this student need special education services”)?
Treatment (“What interventions are likely to be effective for this client”?)
REFERRAL:
What are the 6 key considerations when reviewing a referral? (SPAACC)
- Source and purpose (why has it been made, and by who?
- Potential biases in referral
- Assess urgency
- Assess feasibility (“can the question be answered with ax tools and within ethical/legal guidelines)
- Client expectations/consent
- Clarify referral questions
SOURCES OF CLIENT DATA:
What are the 5 Main sources of client data: (CCMAP)
- Client interview (client’s perspective on symptoms and impact on functioning)
- Collateral info: Reports from family, teachers, or others
- Medical & psychiatric history: (prev diagnoses, tx, med conditions that could influence psych functioning)
- Academic and occupational records
- Previous Ax (psych, neuropsychological, psychiatric)
COMMON PITFALLS
What are 4 common pitfalls for psychologists when generating hypotheses about the client’s presenting issues? (COIL)
- Confirmation bias
- Over-reliance on referral source
- Ignoring sociocultural context (cultural, social, and environmental factors contributing to symptoms)
- Lack of rapport building
Explain what hypothesis formulation requires of the psychologist
- It’s an iterative process which evolves as new information is obtained.
- think critically, id potential explanatory models, and adapt as new information is collected.
- consider several plausible explanations for the client’s difficulties.
- use a structured approach to consider a broad scope of inquiry, while also prioritising formulation to inform treatment.
STRUCTURED HYPOTHESIS GENERATION
What 3 things does the structured hyp gen approach emphasise (as crucial)? (M.C.G)
- Multiple active hypotheses
- Continuous revision
- Guided decision-making
What are the 5 domains, in the correct order, in the structured hyp gen approach? (B N S P B)
- Biological and neurophysiological
- Neurodevelopmental and cognitive
- Social and environmental (external factors)
- Psychological
- Behavioural
- BIOLOGICAL / NEUROPHYSIOLOGICAL FACTORS
Key considerations (3)
Indicators for med referral (4)
Key considerations:
1. Could symptoms be linked to a medical condition (hormones/neuro)
- Has the client seen the GP, had a physical ax, had any blood tests?
- Is the client on any medications that could affect their presentation?
What are the 4 indicators for a medical referral?
- Sudden onset (mood/cog/py changes)
2.Chronic fatigue, sleep disturbances, sensory issues, pain - Neurological symptoms (memory loss, tremors, motor difficulties)
- History of concussion, traumatic BI, seizures
- NEURODEVELOPMENTAL / COGNITIVE
Key considerations (3)
Possible presentations (3)
Key considerations
1. Are there longstanding patterns (inattention, impulsivity, sensory, communication)?
- Does the client struggle with executive functioning (planning, emotional regulation)?
- Are difficulties lifelong or context-dependent?
Possible presentations:
1. ADHD (inattention/executive dysfunction)
2. AUTISM (social/sensory)
3. LEARNING DISABILITIES (dyslexia, processing speed deficits)
- SOCIAL & ENVIRONMENTAL FACTORS
Key considerations (3)
Possible supports (2)
Key considerations:
1. Are symptoms linked to stressors?
2. Is the client experiencing discrimination or systemic barriers?
3. Are there protective factors that influence resilience?
Possible Supports:
1. Financial, legal, housing
2. Relationship conflict / DV
- PSYCHOLOGICAL & MENTAL HEALTH FACTORS
Key considerations (3)
Action (1)
Key considerations
1. Does the client’s symptoms fit a DSM-5 disorder?
2. Could the symptoms be instead explained by trauma response, chronic stress, neurodiversity?
3. Are the symptoms primary (independent disorder) or secondary (caused by another condition)?
Action: Review DSM criteria closely and consider differential diagnoses
- BEHAVIOURAL & LEARNED FACTORS
Key considerations (3)
Action (1)
Key considerations:
1. Are maladaptive coping strategies contributing to distress (avoidance, self-sabotage, compulsions)?
2. Are symptoms reinforced by short-term relief (but long-term harm)
3. Has the client developed rigid or automatic behaviours?
Action: Behavioural intervention or skill development (behavioural activation; emotional literacy; assertive communication) may help disrupt unhelpful patterns.
CASE FORMULATION
(Why did they develop, what’s maintaining them, what protective factors can aid recovery?)
What are the 5 key factors (5Ps)?
- Presenting issues
- Predisposing
- Precipitating
- Perpetuating
- Protective
What is a trans diagnostic formulation
Understanding the underlying mechanisms that are common across a range of mental health difficulties (rather than focusing on specific diagnoses. Can help to develop tx that targets shared vulnerabilities and maintaining factors.
What is diagnostic overshadowing?
A psychologist’s tendency to attribute symptoms to a known diagnosis (e.g., an ID or mental health condition) rather than exploring other causes. This can lead to missed or delayed diagnoses of co-occurring conditions.
What are sub-threshold traits?
When the client exhibits some of the core diagnostic symptoms but does not meet full diagnostic criteria.
- PRESENTING PROBLEM
Purpose (1)
Key questions (4)
Purpose: To id the client’s main difficulties and impact on functioning
Key Questions:
1. What symptoms or concerns brought the client to treatment?
2. How severe are they?
3. How do they affect daily life (work/relationships, wellbeing)
4. How does the client understand their own distress?
- PREDISPOSING
Purpose (1)
Key Questions (3)
Long-term vulnerabilities
key questions:
1. Are there early-life experiences that shaped current difficulties?
2. Are there genetic, neurodiverse, or personality traits that contribute?
3. how does family history (e.g., MH, trauma) play a role?
- PRECIPITATING
Purpose (1)
Key questions (2)
To determine recent triggers/stressors that led to, or worsened, symptoms
Key Questions:
1. Was there a specific event that led to symptom onset? E.g., life transition, trauma, relationship breakdown
- Is the client aware of what caused symptoms to worsen?
- PERPETUATING FACTORS
Purpose (1)
Key questions (3)
To explore what’s keeping symptoms going, preventing recovery
Key questions:
1. Are behavioural patterns reinforcing (avoidance, rumination)
- Are there social/environmental stressors affecting recovery? (eg., workplace/financial)
- Are there systemic barriers affecting recovery efforts (e.g., lack of support, stigma)
- PROTECTIVE FACTORS
Purpose (1)
Key questions (3)
Strengths and supports that can aid recovery
Key questions:
1. What are the client’s personal strengths
- Does the client have relationships, skills, coping strategies to help?
- How has the client overcome challenges in the past?
Develop possible hypotheses of what is contributing to Jasmine’s presenting issue. Phrase as questions.
“Jasmine, 23, presents with low mood, poor concentration, and irritability. She reports difficulties focusing at work, exhaustion, and feeling ‘on edge.’ She recently started avoiding
social events, citing a lack of energy. She has no formal history of mental illness but mentions that growing up, her family placed a strong emphasis on emotional resilience and not
dwelling on problems. She moved cities six months ago and started a new, demanding job. Sleep has been inconsistent. No reported substance use.”
- Biological/neurophysiological:
Have any family members been diagnosed with any mental health conditions?
Has she seen a GP about her sleep disturbances, exhaustion, or irritability? Has her GP ordered any blood tests to rule out medical conditions? Is she taking any prescribed medications? Is she taking any OTC or alcohol to cope with the stress/symptoms?
- Neurodevelopmental/Cognitive?
Did she experience difficulties focusing on tasks when she was a child? Did she have poor concentration when she was younger? Are her concentration difficulties occurring at work only or in other life domains? - Social/Environmental:
Was her move to a new city and job impulsive or well-thought out and planned? Were there any significant events or transitions occurring prior to her decision to move cities? Has she developed any friendships or support networks in her new city? How often is she communicating with her family and friends back home? Could a sense of isolation be contributing to her low mood? Are the demands of her job impacting her mood and stress levels? - Psychological?
Could her low mood be related to a mood disorder?
Could her poor concentration be connected to a NDD such as ADHD. Was her move planned or impulsive (i.e. impairment in executive functioning)? Are her high stress levels influencing her mood? - Behavioural/learned? Is avoiding social events contributing to her symptoms of low mood in the longer-term, or vice versa?
Do her family beliefs about emotional resilience influence her coping strategies?
Is there a history of perfectionism or high-achievement for her or in her family?
How has she coped with stressful events in the past, what has worked for her previously?
Consider how to answer hypotheses using the 5Ps?
“Jasmine, 23, presents with low mood, poor concentration, and irritability. She reports difficulties focusing at work, exhaustion, and feeling ‘on edge.’ She recently started avoiding
social events, citing a lack of energy. She has no formal history of mental illness but mentions that growing up, her family placed a strong emphasis on emotional resilience and not
dwelling on problems. She moved cities six months ago and started a new, demanding job. Sleep has been inconsistent. No reported substance use.”
- Presenting problem:
Jasmine’s presenting concerns include low mood, poor concentration, irritability, and feeling ‘on edge’. She reports difficulties focusing at work, and feeling exhausted, with a lack of energy. - Predisposing: Jasmine’s family beliefs growing up about emotional resilience could be influencing her coping strategies. The family’s beliefs about emotional resilience might have impaired Jasmine’s coping skills, and tendency toward perfectionism and high achievement.
- Precipitating:
Jasmine’s new demanding job in addition to the stress of moving cities could have precipitated or triggered her symptoms. - Perpetuating;
Jasmine’s avoidance of social events could be perpetuating her symptoms such as low energy and feeling ‘on edge’ as she may be lacking in immediate practical and emotional support. The short-term comfort from avoiding events may be part of this maladaptive coping strategy. Jasmine may have a maladaptive ‘high-achieving’ thought style which includes self-criticism. - Protective: Jasmine’s family may be a supportive factor. Her accomplishments in work indicate she is intelligent and skilled, which could be strengths to draw on. She is likely to be a motivated person, and has demonstrated a willingness to seek support by attending therapy.
