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zz Abnormal Psychology week by week > Week 1 Chapter 3 - DN (incomplete) > Flashcards

Week 1 Chapter 3 - DN (incomplete) Flashcards

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1
Q

Learning Goal 1.

Describe the purposes of diagnosis & assessment

A

Diagnosis

  • enables accurate communication between clinicians about cases & scientists about research
  • important for research on causes & treatments

Assessment

  • helps make a diagnosis
  • provides information beyond the diagnosis

p.63

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2
Q

Learning Goal 2.

Distinguish the different types of reliability & validity

A

Reliability - Consistency of measurement

  • Internal Consistency reliability
  • Interrater reliability
  • Test-retest reliability
  • Alternate-form reliabiltiy

Validity - degree to which an instrument measures what it is supposed to measure

  • Content validity - how well test items relate to domain of interest
  • Criterion validity - compared current measure to some other measure in an expected way
    • Concurrent validity - measured at same time
    • Predictive validity - future measurement
  • Construct validity - *theory related - compares particular attribute with existing data (or theory) of the same construct (e.g., anxiety) *
    • Convergent validity - data aligns with existing as expected
    • Divergent validity - data differs from existing as expected
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3
Q

Learning Goal 3.

Identify the basic features, historical changes, strengths & weaknesses of the DSM

A
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4
Q

Learning Goal 4.

Describe the goals, strengths, weaknesses of psychological & neurobiological approaches to assessment

A
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5
Q

Learning Goal 5.

Discuss ways culture & ethnicity impact diagnosis & assessment

A
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6
Q

What important concepts play a key role in diagnosis & assessment?

A
  • Reliability
  • Validity

p.63-64

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7
Q

How does the focus of Reliability differ to that of Validity?

A
  • Reliability
    • group of scores (are they consistent or repeatable)
  • Validity
    • the test (does it measure what it says it measures)
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8
Q

Describe the relationship between Reliability & Validity?

A
  • a measure with poor reliability will also have poor validity
    • as an unreliable measure is inconsistent, it will not relate strongly to other measures (i.e., as required in construct validity (convergent/divergent)

on the other hand

  • good reliability does not guarantee good validity
    • (i.e., a measure could be consistently innacurate)

p.64

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9
Q

Contrast convergent validity and discriminant validity? What are both of these used for?

A
  • Both are indicators of Construct validity which is ‘theory related’ (i.e., data from a new instrument/measure is compared to that of an existing instrument/measure)
    • Convergent validity shows a relationship where one is expected
      • (based on existing theory/evidence)
    • Discriminant validity shows little/no relationship where little/no relationship is expected
      • (again based on existing theory/evidence)
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10
Q

How do Construct validity & Criterion validity differ?

A

Construct validity

  • a test is evaluated against a wide variety of data
  • multiple sources

**Criterion validity **

  • a test is evaluated against one piece of data
    p. 65
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11
Q

What has DSM-IV-TR’s, Axis V (Global Assessment of Functioning Scale GAF) been replaced with in the new DSM-5?

A
  • Rating scales of severity along a continuum (specific to each disorder)
    p. 69
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12
Q

Why does the DSM-5 continue to use symptoms as the basis for disgnosis?

A
  • Our knowledge base is not yet strong enough to make diagnoses based on etiology
  • No laboratory tests, neurobiological markers or genetic indicators are yet available for use in diagnosis

p.69

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13
Q

Give an example of one way DSM-5 reflects our growing knowledge of etiology/comorditiy?

A

OCD has been moved from the Anxiety disorder grouping and a new chapter has been introduced including:

  • Obsessive-compulsive disorder
  • Hoarding disorder
  • Body dysmorphic disorder

This was done based on etiology seeming to involve distinct genetic & neural influences (differing to other anxiety disorders)

p. 69

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14
Q

What are the broad changes in DSM-5

A
  • Changes to Multiaxial System
  • Organising Diagnoses by Causes
  • Inclusion of Continuous Severity Rating (supplementing Categorical Classification)
  • Changes in Personality Disorder Diagnoses
  • New Diagnoses
  • Combining DSM-IV-TR Diagnoses
  • Clearer Criteria
  • Ethinic & Cultural Considerations in Diagnoses

p.69-73

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15
Q

How has the Muliaxial system changed in the DSM-5?

A
  • 5 axes of DSM-IV-TR are reduced to one for psychosocial & environmental problems
  • Codes for this axis have changed to be more similar to ICD
    • International Classification of Diseases (World Health Organisation)
  • Axis V removed
    • instead severity scale developed for each disorder

p.69

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16
Q

How does a dimensional system of diagnosis differ to a categorical classification system?

Which of these systems is used in the DSM-5?

A
  • A dimensional system describes the degree of an entity that is present
    • (e.g., 1-to-10 of anxiety, 1 represents minimum & 10 the extreme)
  • A classification system - considers presence or absence of a condition
    • it does not consider continuity between typical - atypical behaviour
  • DSM-5 incorporates the dimensional system but has also preserved the categorical approach to diagnosis
    • i.e., the categories are supplemented by a severity rating for each disorder

p.71

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17
Q

Why are categorical systems so popular?

A
  • the cut-offs provide a threshold (although arbitrary)
  • offering doctors guidance for treatment

p.71

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18
Q

Why are severity ratings so useful?

A
  • they provide a more precise estimate of how serious an illness is
    p. 71
19
Q

Why have some of the DSM-IV-TR diagnoses been combined in the DSM-5?

Give some examples….

A
  • not enough evidence for differential etiology, course, or treatment response to justify separate labels
    e. g.,
  • ‘substance abuse’ and ‘dependence’ are replaced with ‘substance use disorder’
  • ‘hypoactive sexual desire disorder’ and ‘female arousal disorder’ are replaced with ‘sexual interest/arousal disorder in women’

p.71

20
Q

What are some crticisms of the DSM?

A
  • The question of whether there are too many diagnoses
  • Reliability of the DSM in everyday practise
  • Validity of diagnostic categories

p.77-78

21
Q

What is one side effect of having such a large number of diagnostic categories?

A
  • Comorbidity (i.e., the presence of a second category)
    p. 77
22
Q

What percentage of people meet the criteria for a second diagnosis?

Why is this overlap likely to reflect?

A
  • 45%
  • this overlap may be a sign that we are dividing syndromes too finely

p.77

23
Q

What is a subtle issue with the large number of possible diagnoses?

A
  • Different diagnoses do not seem to be distinct in
    • etiology or
    • treatment
24
Q

What is the dilemma when it comes to such a large number of categories?

A
  • To lump them all together or to split into finer distinctions
25
Q

What does the DSM specify must be present to meet criteria for a diagnosis?

A
  • impairment or distress

DN is wondering if this applies to others as well as to self

  • (e.g., a person with hoarding disorder may not be distressed by the hoarding but others are)
  • can someone be classified as disordered when they are ignorant to the distress their behaviour is causing others and are not experiencing distress themselves

another thought - perhaps potential distress (masked by the behaviour) should be considered or

unconscious distress - a person with these behaviours would have to be experiencing distress at some level, but may not be conscious of it.

p.78

26
Q

How does reliability of diagnoses compare in practise with that in research?

A
  • reliability may not be as high in practise as it is in research studies
    p. 79
27
Q

What are some inherent problems in diagnosing people with mental illness?

A
  • tendency to ignore a persons strengths when focussing on diagnosis
  • labelling the person as schizophrenic rather than a person with schizophrenia
  • while stigma can be increased with labels - it can also relieve stigma by aiding understanding of symptoms

p.80

28
Q

How can we provide the best possible psychological assessment?

A

Use multiple techniques & multiple sources of information:

  • Clinical Interviews
    • Structures Interviews
  • Assessment of Stress
    • Semi-structured interview (LEDS)
    • Self Report Stress Checklists (poorer reliability than LEDS)
  • Personality Tests
    • Self Report Personality Inventories (MMPI-II)
    • Projective Personality Tests (Rorschach - TAT)
  • Intelligence Tests
  • Behavioural & Cognitive Assessment
    • Direct Observation
    • Self-Observation
      • self monitoring or EMA (ecological momentary assessment)
    • Cognitive Style Questionnaires (DAS dysfunctional attitude scale)
29
Q

What are 4 Neurobiological Assessment Methods?

A
  • Brain Imaging
    • CT (CAT) & MRI scans - brain structure
    • PET - brain function & to a lesser extent structure
    • fMRI - brain structure & function
  • Neurotransmitter Assessment
    • postmortem analysis of neurotransmitters & receptors
    • Assays of metabolites of neurotransmitters
    • PET scans of receptors
  • Neuropsychological Assessment
    • Behavioural tests (e.g., Halstead-Reitan & Luria-Nebraska - to assess motor speed, memory & spatial ability)
      • deficits on particular tests help point to an area of brain dysfunction
  • Psychophysiological Assessment
    • Measures of electrical activity in the
      • ANS (autonomic nervous system e.g., skin conductance)
      • CNS (central nervous system e.g., EEG)

p.94

30
Q

What is a CT or CAT scan?

A
  • Computerised axial tomography - assesses structural brain abnormalities
  • 1. Moving beam passes into a horizontal cross section of the brain
    • scanning 360 degrees
    • a moving X-ray detector measures radioactivity that penetrates
    • detecting subtle differences in tissue density
  • 2. Computer used to construct two-dimensional image of cross-section
    • detailed with optimal contrasts
  • 3. Then machine scans another cross-section of brain
    • resulting images can show
      • enlargement of Ventricles (sign of degeneration
      • location of tumours/blood clots
31
Q

What device can be used to view the ‘living’ brain?

A
  • MRI (Magnetic Resonance Imaging)
  • superior to CT
  • produces higher quality pictures

PROCESS

  • large circular magnet causes hydrogen atoms in the body to move
  • magnet force turned off, the atoms return to their original positions
    • producing an electromagnetic signal
  • signals read by computer & translated into pictures of brain tissue

ADVANCES

  • has enabled location of delicate brain tumours previously deemed inoperable
    p. 94
32
Q

What is fMRI?

A
  • functional Magnetic Resonance Imaging
  • allows measurement of both brain structure & brain function
  • measures blood flow in the brain (BOLD signal)
  • it takes pictures so quickly that metabolic changes can be measured
    • provides a picture of the brain at work
    • rather than of its structure alone

p.95

33
Q

What is the BOLD signal?

A
  • in fMRI
  • BOLD = blood oxygenation level dependent
  • As neurons fire, blood flow increases to that area
  • Thus blood flow in a particular region can reflect neural activity in that region

p.95

34
Q

What is a PET scan?

A
  • Positron Emission Tomography
  • more expensive & invasive than MRI & fMRI
  • measure both structure & function
  • but brain structure is not as precise as in MRI & fMRI

PROCESS

  • substance used by the brain is labelled with a short-lived radioactive isotope & injected into the bloodstream
  • radioactive molecules of the substance emit a particle called a positron
    • positron quickly collides with an electron
  • a pair of high-energy particles shoot out from the skull in opposite directions
    • detected by the scanner
  • Computer analyses millions of such recordings & converts them into a picture of the functioning brain
  • Images are in colour, fuzzy spots of lighter & warmer colours are areas where the substance has higher metabolic rates
35
Q

Why is PET scan used a lot less than MRI & fMRI nowadays?

A
  • because it is more invasive (injecting radioactively charged substance)
  • more expensive
36
Q

How can visual images of the ‘working’ brain be useful?

A

indicate sites of

  • seizures
  • brain tumours
  • strokes
  • trauma from head injury
  • distrubution of psychoactive drugs in the brain

p.95

37
Q

How are some current neuroimaging studies utilising these new technologies in studies of psychopathology?

A
  • fMRI & PET being used to study abnormal brain processes linked to various disorders
    • e.g., schizophrenia - failure of prefrontal cortex to become activated when performing cognitive tasks
  • attempting to identify dysfunctional areas of the brain
    • as well as deficits in communication between areas of the brain (called functional connectivity analysis)

p.95

38
Q

What is a metabolite?

A
  • commonly analysed in neurotransmitter assessment
  • typically an acid produced when a neurotransmitter is deactivated
    • high level of a particular metabolite indicates a high level of a neurotransmitter
    • low level metabolite indicates low level of a neurotransmitter
39
Q

What are two problems with using blood or urine metabolites to investigate brain function?

A
  • these measures are not direct reflections of brain levels of neurotransmitters
    • a more specific measure can be taken from metabolites in CSF drawn from spinal cord
    • even still not a direct measure as levels here include the spinal cord
  • these studies are correlational
    • causality, directionality, third variable
    • experimental evidence is needed

p.96

40
Q

What is the difference between a neurologist & a neuropsychologist?

A
  • Neurologist - physician specialising in diseases or problems affecting the nervous system
    • e.g., stroke, muscular dystrophy, cerebral palsy, or Alzheimer’s disease
  • Neuropsychologist - psychologist who studies how dysfunction of the brain affects the way we think, feel, & behave
  • work differently, but often collaboratively
    • to learn how the NS functions & how to treat problems caused by disease or injury to the brain
41
Q

What idea are neuropsychological tests based on?

A
  • that different psychological functions (motor speed, memory, language)
    • rely on different areas of the brain
  • so by looking at these functions may provide clues about the area/location of damage to the brain

p.97

42
Q

What are two neuropsychological tests?

A
  • **Halstead-Reitan **
    • Three of the H-R tests
      • Tactile Performance Test - Time
      • Tactile Performance Test - Memory
      • Speech Sounds Perception Test
    • valid for detecting behaviour changes linked to brain dysfunction
    • from various conditions - stroke, tumours, head injury
  • Luria-Nebraska
    • based on work of Aleksandr Luria (1902 - 1977)
    • 2.5 hours to complete - scoring is highly reliable
    • Criterion validity established - correctly distinguish 86% patients & controls
    • reveals potential damage to frontal, temporal, sensorimotor, or parietal-occipital area of either hemisphere
    • 269 items divided into 11 sections designed to determine
      • basic & complex motor skills
      • rhythm & pitch anbilities
      • tactile & kinaesthetic skills
      • verbal & spatial skills
      • receptive speech
      • expressive speech ability
      • writing
      • reading
      • arithmetic
      • memory
      • intellectual processes

p.97

43
Q

What are two advantages of the Luria-Nebraska neurological test?

A
  1. it can control for educational level
  2. a version for 8-12 year olds helps pinpoint brain damage in children & evaluate educational strengths & weaknesses early in development

p.97

zz Abnormal Psychology week by week (39 decks)

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