Lesson 6 - Classification and Assessment in clinical psych

Question 1

What is the taxonomic approach

Answer 1

Disorders can be branched into multiple different disorders - broader disorders
Can distinguish that
There are higher order disorders of classes of disorders and within that there are specific disorders that we can distinguish from each other

Question 2

Why do we classify psychological disorders?

Answer 2

Classification and diagnosis are essential if we hope to
-Understand causes
-Identify most appropriate treatment(s)
-Determine if treatment has been effective (or not)
-Practical consequences e.g,
-is this person fit to stand trial
-does this person deserve compensation?

Question 3

What are the 4 objectives of classification systems?

Answer 3

1. Provide necessary and sufficient diagnostic criteria for correct differential diagnosis
2. Permit distinction of ‘true’ psychopathology from non-disordered ‘problems in living’
3. Diagnostic criteria can be systematically applied, by different clinicians in different settings
4. Diagnostic criteria should be theoretically neutral

Question 4

What is the DSM? 5

Answer 4

The Diagnostic and Statistical Manual of Mental Disorders

Question 5

What is the ICD? ICD 11

Answer 5

International Classification of Diseases

International list of causes of death at first then became broader to international classification of diseases, implimented to 11 in 2022

Question 6

What are the 3 first problems with classification approaches and diagnostic manuals?

Answer 6

1. Describe observable symptoms rather than explain causes
2. Diagnoses (labels) can be stigmatising
3. Diagnoses are categorical (yes/no)
   eg - you are either depressed or youre not
   -however severity of disorder can be quantified

Question 7

What are the other 3 problems with classification approaches and diagnostic manuals?

Answer 7

4. Homogeneity of sufferers
   - many different combinations of symptoms could warrant diagnosis of eg schizophrenia or substance use disorder
5. Disorders are distinct from each other
   -but comorbidity is the norm. e.g, anxiety and depression
6. A “hodgepodge” collection of disorders, with much historical “baggage”
   - short term problem vs lifelong personality?
   -misery vs bad behaviour?
   -origins in infancy or old age?
   -clear biological origin, or not?
   -extremely rare vs very common, slight exaggerations of normal variations in mood/ behaviour?

Question 8

What are the 3 goals of assessment?

Answer 8

1. What problems does this person have?
2. Which psychological disorder(s) should they be diagnosed with? (not essential; see case formulation)
3. Did our treatment work?

Question 9

What are some specific criticisms of DSM-5?

Answer 9

-Proliferation of disorders with each revision
-Gradual lowering of thresholds
^favours over - rather than under diagnosis
^overprescription of psychiatric medication bc of overdiagnosis
^medicalise normal experiences
-Disproportionately influenced by biological models
-Most psychological disorders are dimensional, ie, they have a continuum of severity
^DSM 5 Does explicitly acknowledge this
^However this means that any cut-off score or threshold is somewhat subjective

Question 10

What are the methods of assessment?

Answer 10

CCPB
Clinical interviews
Clinical observations
Psychological tests
(such as questionnaires, intelligence tests, projective tests)
Biologically based assessments
(such as psychophysiology and neuroimaging)

Question 11

Diagnosis is almost always reliant on subjective judgement. What 2 methods could be used for this?

Answer 11

Clinicians use clinical interviews and clinical observation

Question 12

How can you test reliability?

Answer 12

Test-retest reliability
Inter-rater reliability
Internal Consistency (cronbachs a)

Question 13

How can you test validity?

Answer 13

Concurrent validity
Face validity
Predictive validity
Construct validity

Question 14

What is the definition of Test-retest reliability?

Answer 14

The extent that a test will produce roughly similar results when the test is given to the same person several weeks or even months apart

Question 15

What is the definition of Inter-rater reliability?

Answer 15

The degree to which two independent clinicians agree when interpreting or scoring a particular test

Question 16

What is the definition of concurrent validity?

Answer 16

A measure of how highly correlated score of one test are with scores from other types of assessment that we know also measure that attribute

Question 17

Define predictive validity

Answer 17

The degree to which an assessment method is able to help the clinician predict future behaviour and/ or symptoms

Question 18

What are Structured clinical interviews? (SCID-5-CV)

Answer 18

Structured clinical interviews for DSM (SCID)

-Questions are predetermined

–Client’s response to one question determines the next question to be asked

–High inter-rater reliability for many disorders

Question 19

What are limitations of clinical interviews?

Answer 19

Reliability ofunstructuredinterviews is low, probably because of different skills and personalities of clinicians!

2.Some disorders characterized by poor self-awareness

3.Some clients may intentionally mislead (e.g. some personality disorders)

4.Interviewers prone to biases (e.g. primacy effect)

Question 20

What are clinical observations?

Answer 20

E.g., in a school context, observer could use ABC chart to identify–What happens before the targetbehaviour (Antecedents)
–What the individual did (Behaviour)
–The consequences of thatbehaviour(Consequences)

Uses and advantages:
-Can identify practical treatment options
–Can capture number of targetbehaviours
–Better ecological validity than self-reports

Question 21

What are some limitations of clinical observations?

Answer 21

Very time-consuming, observers need a lot of training

–Observations normally limited to one context

–Presence of observer may influencebehaviour(could be overcome by video recording)

–Inter-observer reliability can be poor unless both are intensively trained

Question 22

What are psychological tests useful for?

Answer 22

-Assessing a specific trait/characteristic
Self-report questionnaires, e.g. personality tests

Rigid response requirements so they can be scored objectively, easily and without bias–

Many (e.g. Minnesota Multiphasic Personality Inventory; MMPI) have good internal reliability and concurrent validity with diagnostic status, assessments from family
Statistical norms can be established, permits standardisation, enabling clinician to estimate if client is likely to meet diagnostic criteria

Question 23

What are some Limitations of self-report questionnaires?

Answer 23

1.Time consuming

2.Can be faked, although some (such as the Minnesota Multiphasic Personality Inventory; MMPI) have ‘lie’ scales and scales that capture social desirability and so on (see Davey, 2014)

Question 24

What are some examples of Projective tests? (3)

Answer 24

–Rorschach inkblot Test

–Thematic Apperception Test

–Sentence Completion Task

Question 25

What is one strength and weakness of using a Projective test?

Answer 25

All have low inter-rater reliability and validity; may not reveal any more than self-report measures or clinical interview.

However, may be useful (valid) in some circumstances, such as detection of thought disorder in schizophrenia.

Question 26

What is the function of Intelligence tests, e.g. Wechsler Adult Intelligence Scale (WAIS)? (Psychological test)

Answer 26

Can aid diagnosis of intellectual and learning disability

Question 27

What is a strength of the psychological test?

Answer 27

–Extensively studied and developed over decades. Most arestandardisedwith a mean score of 100, SD of 15.
–High internal consistency, test-retest reliability and predictive reliability

Question 28

What are some biologically based assessments?
Psychophysiology e.g,

Answer 28

Electrodermalresponding (’skin conductance’)

Electromyogram (EMG) (muscle activity, can detect ’smiling’ and ‘frowning’)

Electrocardiogram (ECG) (heart activity)
Electroencephalogram (EEG) (brain activity)

–Neuroimaging
^Structural (C(A)T. MRI)
^Functional (fMRI, PET, SPECT)

Question 29

What are some limitations of Intelligence tests e.g WAIS?

Answer 29

The underlying construct are still hypothetical
Culturally biased
They do not capture other, equally important aspects of intelligence such as emotional intelligence, musical ability, motor skill etc

Question 30

What are some cultural biases in assessment?

Answer 30

Most tests developed and validated on white European or American populations

In the USA, differential rates of diagnosis in different ethnic groups.

In the UK, Caribbean immigrants in the 1970s more likely to be diagnosed with schizophrenia.

Clinicians tend to view people of lower SES as more disturbed than those w higher SES, attributable to influence from stereotypes during unstructured interviews.

Question 31

What is Case formulation?

Answer 31

Clinicians gather information about clients in order to draw up a psychological explanation of the client’s problems and to develop a plan for therapy
Often used alongside assessment and also an alternative

Assumes that each client is unique, and therefore anindividualisedapproach is needed.

Does not require a psychiatric diagnosis (but not incompatible with diagnostic approach).

Question 32

What are 5 explanations for cultural bias?

Answer 32

1. Mental health symptoms manifest differently in different cultures
2. Language differences between clients and clinician
3. Cultural and religious differences in expression and perception of mental health problems
4. Client- clinician relationships
5. Cultural stereotypes

Question 33

What does a CBT formulation identify?

Answer 33

Antecedents (causes)
Beliefs (psychological determinants)
Consequences (symptoms)

Question 34

What are the 6 components of case formulation?

Answer 34

1.Create a listof the client’s problems

2.Identify & describeunderlying psychological mechanisms

3.Understandhow those mechanisms generate the client’s problems

4.Identifythe kinds of events that precipitate the problems

5.Identifyhow those the underlying psychological mechanisms mediate the antecedent > symptoms

Question 35

What are the advantages of case formulation?

Answer 35

No need for a diagnosis, so reduced stigma

Collaborative, and gives the patient input into the best solution

Client is treated as unique (not a label), and the solution is tailored to them
Based on a theoretical understanding of the causes and consequences of disorder

Question 36

What are the disadvantages of case formulation?

Answer 36

Subjective: explanation of psychological mechanisms will be based on therapist’s background and approach (e.g. psychoanalytic vs. CBT).

Relies on a lot of assumptions that are not tested. For example, causes of most disorders are not well understood.
How can we share knowledge and learn from ‘what worked’ in similar cases?