PSY1003 WEEK 5 Flashcards
what use is classification systems
helps us understands relations between different conditions, understand cause and identify appropriate treatments, determine if effective, real-world applications (compensation, fit to stand on trial)
state 4 goals of classification systems
- provide necessary and sufficiant criteria for differential diagnosis
- permit distinction of ‘true’ psychopathology from non-disordeded normal behaviours
- diagnostic criteria can be systemically applied by different clinicians in settings
- it should be theoretically neutral
what are the 3 goals of assessment
- current problems
- diagnosis/none of a psychological disorder
- did the treatment work
what are some problems with diagnostic manuals which impact in real world
leads to stigma, carries historical baggage which may no longer be true such as idea all mentally ill are severely distressed (not applicable to ASPD)
give some weaknesses for diagnostic manuals
- describes observable symptoms but not cause
- categorical (depressed or not) - however severity of disorders cannot be quantified
- homogeneity - many different symptom combinations can warrant multiple conditions diagnosis
- comorbidity is norm despite disorders being very distinct - GAD and depression usually co-exist, so are they actually 1 condition?
what does the DSM-5 attempt to do (also, what info can DSM provide)
classify psychopathology using emphasis of distress and disability, providing =
a) essential defining features of disorders
b) associative features
c) diagnostic criteria
d) differential diagnosisw
what does DSM-5 avoid
suggestions about causes of disorders unless cause has definitely been established so diagnosis is fully based on observable physical symptoms, meaning DSM categories are descriptive construct
give some specific weaknesses for just DSM
- proliferation of disorders (keep on adding)
- lowering thresholds - favour overdiagnosis, medicalises normality, overprescribing
- disproportionate influence from biological model, ignoring socio-cultural factor
- many disorders have a severity continuum (cut-off is subjective)
- introduced categories designed to identify future populations at risk (attenuated psychosis syndrome - precursor for a psychotic episode) risks medicalising normality
give criticisms of the DSM development process
- many experts developing DSM are worried about false negatives (missed diagnosis, patient not fitting boxes exactly) meaning more inclusive diagnostic criteria, over-diagnosing
- political and economic factors can shape medical model (pharmaceutical industries/sales) meaning profit depends on medical model influence
state 4 alternatives to diagnostic manuals
Research domains criteria
hierarchical taxonomy of psychopathology
network analysis
power threat meaning framework
explain research domain criteria
2009 US National Institute of Mental Health
classify via cause, then relate to an observable symptom,
units of analysis: cells, circuits, genes, physiology, behaviour
corresponding to constructs like negative (threat, loss) and positive valence (responsiveness to reward), social process, arousal
give limitations of research domains criteria
based on psychopathology as brain circuit disorder - reductionism
focuses on intra-individual variables ignoring social, developmental, cultural contexts
explain Hierarchical taxonomies of psychopathology
evidence-based taxonomy model for symptoms, predicting comorbity using higher-order dimensions to reflect association with lower-order dimension
5 levels: specific symptoms on bottom to broad heterogeneous constructs at top
explain network analysis (alternative to diagnostic)
explains symptom cooccurance by assuming there is a underlying connecting cause
assumes disorders emerge from causal symptom interactions (depression not causal entity, just name for symptom network interacting to cause depressions)
interacting symptom network identified via stat methods measuring association strengths and codependence
explain power threat meaning framework
BPS 2018: promote discussion and debate by providing different POV of origin, experience, expression of MHI
not medical model, people inseparable from material, social, environmental and cultural context
a natural reaction to stress
event indicative of ‘Powers’ that can pose ‘threat’
ask what has happened, how it affected and what sense was made, what they had to do to survive event
explain structured clinical interview (assessment method)
predetermined question with response determining next
questions relate to symptom nature, past history, current living and working circumstances
clinician gains trust and rapport, convince clients of value of clinicians theoretical stance, emphathise, encourage elaborating
high-inter rater reliability for many disorders
give limitations of clinical interviews (assessment method)
low reliability for unstructured interview
depends on clinicians views - psychodynamic asks about childhoods
some disorders results in low self-awareness
some client intentionally mislead
biased clinican - primacy effect meaning first info shapes rest of perspectives
explain clinical observation (assessment method)
ABC Charts:
Antecendent: what happened before target behaviour
Behaviour
Consequences
what are strengths of clinical observations (assessment method)
captures frequency of target behaviours, better ecological validity than self-report, can identify practical treatment options
give 3 examples of psychological test (assessment method)
questionnaires, projective tests, intelligence tests
give limitations of clinical observations (assessment method)
time consuming, alot of training, observation limited to single context, observer presence influences behaviour, poor inter-observers reliability
what does self-report do (assessment method)
assesses specific characteristics, rigid response requirement allows objective, easy and non-biased scoring
establish statistical norm to standardise and allow clinican to see if client meets diagnoses
give strengths of self-reports (assessment method)
high internal reliability and concurrent validity with diagnostic status and others observations
give weaknesses of self-reports (assessment method)
time consuming, social desirability bias
give some examples of projective tests
Inkblot, Thematic Apperception, Sentence Completion tasks
give weakness for projection tests (assessment method)
low inter-rater reliability and validity - doesn’t reveal more than self-report or clinical interview
unlikely to be interpreted same by 2 clinician
give one strength for projective tests (assessment method)
may have validity in some circumstances eg: detecting thought disorder in Sz
give positives of intelligence tests (assessment method)
have been studied and developed over decade
very standardised (using mean 100 scores)
high internal consistencies
give weaknesses of intelligence tests (assessment method)
underlying constructs hypothetical
culturally biased
ignores other intelligent aspects (emotional intelligence, musical ability, motor skills)
give some examples of biologically based assessment (assessment method)
psychophysiology: electrodermal response, EMG, EEG
neuroimaging: CAT, MRI, fMRI, PET, SPECT
give a weakness of biologically based assessment in general (assessment method)
any biological test alone cannot be used for diagnosis as there is little hetergeneity (difference) between ppts
Sz causes most brain changes in structure but cannot use scans to diagnose
one exception is in dementia
summarise a case formulation
clinician gathers info and draws up psychological problems explanation, develops therapeutic plans
assumes client as unique so needs an individualised approach
no need of psychiatric diagnosis
give an example for a CBT case formulations
ANTECEDENTS, BELIEF, CONSEQUENCE
1. create problems list
2. identify describe underlying psychological mechanism
3. understand how this generates problems
4. identify events precipitates problem
5. identify how psychological mechanisms mediate A-C link
6. draw up treatment plans
give advantages of case formualtion
no diagnosis, reduce stigma
collaborative (patient contribute)
unique to client, tailored solution
based on theoretical cause/consequence understanding
empirical research finds good therapeutic benefit
give limitations of case formulation
subjective: based on clinician background
relies on untested assumption
how can we share knowledge to learn from experience
what are some cultural bias in assessment
mostly developed and tested on European pop
USA has differential diagnostic rate in different ethnicities
clinicians view lower socio-economic status as greater disturbed due to stereotype
define test-retest reliability
extent test will produce roughly similar results when given to same ppt on different occasion
define inter-rater reliabiliy
the degree to which two independent clinician agree interpreting tests
define internal consistency
extent to which all items in test consistently relate to one another - Cronbach alpha
define Cronbachs alpha
statistical test used to assess internal consistency of questionnaires or inventory
define concurrent validity
measure of how highly correlated scores of one test are with scores from other types of assessment that we know also measure specific attribute
define predictive validity
a degree to which the assessment method helps clinican predict future behaviour
define construct validity
independent evidence showing measure of construct relates to other similar measure6
