neuro: classification and assessment Flashcards
what are the two diagnostic criteria?
DSM-5 and ICD-10
what do classification systems do?
help us understand things that are related to each other and are distinct from each other
why do we classify psychological disorders?
→ system to impose structure and knowledge
→ understand causes
→ identify most appropriate treatment(s)
→ determine if treatment has been effective
→ practical consequences
what are the objectives of classification systems?
1) provide necessary/sufficient diagnostic criteria for correct DIFFERENTIAL diagnosis,
2) permit distinction of ‘true’ psychopathology from non disordered problems of living,
3) criteria can be systematically applied by different clinicians in different settings,
4) criteria should be theoretically neutral
problems with classification approaches/diagnostic manuals
→ labels = stigmatising
→ describes observable symptoms rather than explains causes
→ disorders are distinct but comorbidity is the norm
→ homogeneity of sufferers
→ slight exaggerations of normal variations in mood/behaviour
what are the specific criticisms of DSM-5?
→ gradual lowering of thresholds
→ disproportionally influenced by biological models
→ most psychological disorders = dimensional (have a continuum of severity) → DSM5 doesn’t explicitly acknowledge this → any score/threshold = arbitrary, subjective
what are the consequences of the DSM5 lowing their disorder thresholds?
→ favours over diagnosis than under
→ medicalising normal experiences
→ overprescription of psychiatric medication
when is ICD-11 relating ICD-10?
currently in consultation stage but implemented by 2022
what are the different methods of assessment?
clinical interviews, clinical observation, psychological tests (projective, questionnaires, intelligence tests), neuroimaging, psychophysiology
what are the 3 different types of reliability?
inter-rater, test-retest, internal consistency
what are the 4 different types of validity?
concurrent, face, predictive, construct
the extent the test will produce roughly similar results when the test is given to the same person several weeks or even months apart
test-retest reliability
the degree in which 2 independent clinicians agree when scoring/interpreting a particular test
inter-rater reliability
measures whether several items that propose to measure the same general construct produce similar scores
internal consistency
measure of how highly correlated scores of one test are with scores from other types of assessment that we know also measure that attribute
concurrent validity
degree to which an assessment method is able to help the clinician predict future behaviour/symptoms
predictive validity
what are the strengths of clinical interviews?
structured interview for DSM5 → questions are predetermined (clients response to 1 Q determines next Q asked) → higher inter-rater reliability
what are the limitations of clinical interviews?
unstructured = low reliability → different skills/personalities of clinicians
some clients may intentionally mislead
interviewers prone to biases → primacy effect
some disorders characterised by poor self awareness → addiction, schizophrenia
describe the ABC chart used in observation
A=antecedents (what happens before)
B=behaviour
C=consequence
what are the strengths of clinical observation?
captures frequency of target behaviours, better ecological validity, can identify practical treatment options
what are the limitations of clinical observations?
subjective, time consuming, observers need a lot of training, observations normally limited to one context, presence of observer may influence behaviour, poor inter-rater reliability (unless both clinicians intensively trained)
what are the strengths of self report questionnaires?
assess specific characteristic/trait
rigid response requirements so can be scored objectively and easily without bias
many tests have good internal reliability and concurrent validity
statistical norms can be established → permits standardisation → enables clinician to estimate if client is likely to meet diagnostic criteria
what are the limitations of self report questionnaires?
time consuming
can be faked (although some have lie scales and social desirability scales)
rorschah inkblot test
thermatic apperception test
sentence completion task
what type of tests are these?
projective tests
what are the strengths and weaknesses of projective tests?
→ low inter-rater reliability and validity
→ don’t reveal more than self report measures, interviews
→ maybe useful in detection of thought disorder like schizophrenia
what do intelligence tests do?
aids diagnosis of intellectual and learning disability
e.g. WAIS
what are the strengths of intelligence tests?
extremely studied and developed
high internal consistency,
high test-retest reliability,
high predictive validity,
standardised
what are the limitations of intelligence tests?
culturally biased, underlying constructs are still hypothetical, doesn’t test other measures of intelligence (emotional, music ability, motor skills)
give examples of psychophysiology
→ electrodermal responding → skin conductance
→ electromyogram (EMG) → muscle activity smiling and frowing
→ electrocardiogram (ECG) → heart activity
→ electroencephalogram (EEG) → brain activity
give the structural and functional techniques of neuroimaging
structural = CT and MRI
functional = fMRI, PET, SPECT
describe some of the cultural biases in assessment of psychopathology
→ most tests developed + validated on white european/american populations
→ In USA, differential rates of diagnosis in different ethnic groups
→ In the Uk, caribbean immigrants in the 70s → more likely to be diagnosed with schizophrenia
lower socialE status = more disturbed than higher socialE status
→ influence from stereotypes during unstructured interviews
what are the explanations for cultural biases?
→ mental health symptoms manifest differently in different cultures
→ language differences between client and clinician
→ client clinician relationships
→ cultural and religious differences in expression and perception of mental health
→ cultural stereotypes
how does a case formulation work?
clinicians → gather client info → draw up psychological explanation of problems → develop therapy plan
what does a case formulation assume?
every client is unique → individualist approach
what does a case formulation not require?
a psychiatric diagnosis
what are the advantages of a case formulation?
no diagnosis = no label = no stigma
collaborative with clients input
client is treated as unique
based on theoretical understanding of causes and consequences of disorder (unlike diagnosis)
what are the disadvantages of case formulation?
subjective → based on therapists approach
relies on assumptions that are not tested
difficult to share knowledge and learn what worked in similar cases
