neuro: classification and assessment

Question 1

what are the two diagnostic criteria?

Answer 1

DSM-5 and ICD-10

Question 2

what do classification systems do?

Answer 2

help us understand things that are related to each other and are distinct from each other

Question 3

why do we classify psychological disorders?

Answer 3

→ system to impose structure and knowledge
→ understand causes
→ identify most appropriate treatment(s)
→ determine if treatment has been effective
→ practical consequences

Question 4

what are the objectives of classification systems?

Answer 4

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

Question 5

problems with classification approaches/diagnostic manuals

Answer 5

→ 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

Question 6

what are the specific criticisms of DSM-5?

Answer 6

→ 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

Question 7

what are the consequences of the DSM5 lowing their disorder thresholds?

Answer 7

→ favours over diagnosis than under
→ medicalising normal experiences
→ overprescription of psychiatric medication

Question 8

when is ICD-11 relating ICD-10?

Answer 8

currently in consultation stage but implemented by 2022

Question 9

what are the different methods of assessment?

Answer 9

clinical interviews, clinical observation, psychological tests (projective, questionnaires, intelligence tests), neuroimaging, psychophysiology

Question 10

what are the 3 different types of reliability?

Answer 10

inter-rater, test-retest, internal consistency

Question 11

what are the 4 different types of validity?

Answer 11

concurrent, face, predictive, construct

Question 12

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

Answer 12

test-retest reliability

Question 13

the degree in which 2 independent clinicians agree when scoring/interpreting a particular test

Answer 13

inter-rater reliability

Question 14

measures whether several items that propose to measure the same general construct produce similar scores

Answer 14

internal consistency

Question 15

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

Answer 15

concurrent validity

Question 16

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

Answer 16

predictive validity

Question 17

what are the strengths of clinical interviews?

Answer 17

structured interview for DSM5 → questions are predetermined (clients response to 1 Q determines next Q asked) → higher inter-rater reliability

Question 18

what are the limitations of clinical interviews?

Answer 18

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

Question 19

describe the ABC chart used in observation

Answer 19

A=antecedents (what happens before)
B=behaviour
C=consequence

Question 20

what are the strengths of clinical observation?

Answer 20

captures frequency of target behaviours, better ecological validity, can identify practical treatment options

Question 21

what are the limitations of clinical observations?

Answer 21

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)

Question 22

what are the strengths of self report questionnaires?

Answer 22

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

Question 23

what are the limitations of self report questionnaires?

Answer 23

time consuming

can be faked (although some have lie scales and social desirability scales)

Question 24

rorschah inkblot test
thermatic apperception test
sentence completion task
what type of tests are these?

Answer 24

projective tests

Question 25

what are the strengths and weaknesses of projective tests?

Answer 25

→ low inter-rater reliability and validity
→ don’t reveal more than self report measures, interviews

→ maybe useful in detection of thought disorder like schizophrenia

Question 26

what do intelligence tests do?

Answer 26

aids diagnosis of intellectual and learning disability

e.g. WAIS

Question 27

what are the strengths of intelligence tests?

Answer 27

extremely studied and developed

high internal consistency,
high test-retest reliability,
high predictive validity,

standardised

Question 28

what are the limitations of intelligence tests?

Answer 28

culturally biased, underlying constructs are still hypothetical, doesn’t test other measures of intelligence (emotional, music ability, motor skills)

Question 29

give examples of psychophysiology

Answer 29

→ electrodermal responding → skin conductance
→ electromyogram (EMG) → muscle activity smiling and frowing
→ electrocardiogram (ECG) → heart activity
→ electroencephalogram (EEG) → brain activity

Question 30

give the structural and functional techniques of neuroimaging

Answer 30

structural = CT and MRI

functional = fMRI, PET, SPECT

Question 31

describe some of the cultural biases in assessment of psychopathology

Answer 31

→ 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

Question 32

what are the explanations for cultural biases?

Answer 32

→ 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

Question 33

how does a case formulation work?

Answer 33

clinicians → gather client info → draw up psychological explanation of problems → develop therapy plan

Question 34

what does a case formulation assume?

Answer 34

every client is unique → individualist approach

Question 35

what does a case formulation not require?

Answer 35

a psychiatric diagnosis

Question 36

what are the advantages of a case formulation?

Answer 36

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)

Question 37

what are the disadvantages of case formulation?

Answer 37

subjective → based on therapists approach

relies on assumptions that are not tested

difficult to share knowledge and learn what worked in similar cases