Ch. 3 Notes for Hirsh Abnormal Psych
Ch. 3 Notes for Hirsh Abnormal Psych Psy-B 380
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This 7 page Bundle was uploaded by Candice Kelso on Friday January 29, 2016. The Bundle belongs to Psy-B 380 at Indiana University Purdue University - Indianapolis taught by Dr. Hirsh in Spring 2016. Since its upload, it has received 41 views. For similar materials see Abnormal Psychology in Psychlogy at Indiana University Purdue University - Indianapolis.
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Date Created: 01/29/16
2116 Chapter 3: Diagnosis and Assessment Diagnosis and Assessment Diagnosis The classification of disorders by symptoms and signs Advantages of diagnosis: Facilitates communication among professionals Advances the search for causes and treatments Cornerstone of clinical care (figure out what to do and how to monitor) Reliability Consistency of measurement Interrater a) Observer agreement Testretest a) Similarity of scores across repeated test administration or observations Alternate Forms a) Similarity of scores on tests that are similar, but not identical Internal consistency a) Extent to which test items are related to one another Validity How well does a test measures what it is supposed to measure? Content validity Extent to which a measure adequately samples the domain of interest; e.g., all of the symptoms of a disorder Criterion validity Extent to which a measure is associated with another measure (the criterion) a) Concurrent i. Two measures administered at the same point in time 1. Hopelessness scale and diagnosis of depression b) Predictive i. Ability of the measure to predict another variable measured at some future point in time 1. College GPA and annual salary after graduation Construct Validity A construct is an abstract concept or inferred attribute Involves correlating multiple indirect measures of the attribute a) Selfreport of anxiety correlated with increased HR, shallow breathing, racing thoughts Important method for evaluating diagnostic categories Reliability puts a cap on validity Similar but not the same thing If something is random it can’t zone in on one thing You can be consistent but that doesn’t make it valid Classification and Diagnosis Diagnostic and statistical manual of mental disorders Published by American Psychiatric Association First published in 1952 DSM5 a) Changes to axes b) Organizing diagnoses by etiology and comorbidity c) Changes to names of some diagnoses d) Personality disorders changes not adopted e) 347 diagnoses (DSMIVTR had 297) MultiAxial System DSMIVTR uses a 5axis system Diagnosis based on 5 axes or dimensions DSM5 uses 2 axes Psychiatric and medical diagnoses Psychosocial and contextual factors DSM5 Changes Renaming of diagnoses to better align with the WHO and ICD Combining diagnoses Clearer criteria Unadopted Changes Proposed diagnosis not included Mixed anxiety/depressive disorder Personality disorders Specific diagnoses retained from DSMIVTR Proposed revisions included in section III a) For further study Ethnic and Cultural Considerations Mental illness universal Culture can influence: Risk factors Types of symptoms experienced and/or expressed Willingness to seek help Availability of treatments Examples of the above? Cultural Concepts of distress Previous editions criticized for lack of attention to cultural and ethnic variations DSM5 Culturebound syndromes relabeled as cultural concepts of distress Includes a cultural formulation interview a) 16 questions to understand how culture shapes clinical presentation 9 concepts of distress to describe diagnoses likely to be seen within specific regions a) Replaces 25 separate diagnoses Criticisms of the DSM Too many diagnoses? Should relatively common reactions be pathologized? Comorbidity a) Presence of a second diagnosis b) 45% of people diagnosed with one disorder will meet criteria for second disorder c) Are we dividing syndromes too finely? Reliability in everyday practice Number of Diagnostic Categories per edition of DSM # of diagnostic categories per edition of DSM DSM 1= 106 DSMII= 182 DSMIII= 265 DSMIIIR= 292 DSMIVTR= 297 DSM5= 347 Is this a good or bad thing? Good: acknowledging that it’s real, better understanding. People are getting help. Bad: over diagnosed, giving unnecessary treatment Categorical vs. Dimensional Systems Categorical Presence/absences of a disorder a) You are either anxious or not anxious Dimensional Rank on a continuous quantitative dimension a) Degree to which a symptom is present b) How anxious are you from 110? Dimensional systems may better capture an individual’s functioning Categorical approach has advantages for research and understanding Interrater Reliability Extent to which clinicians agree on the diagnosis Interrater reliability of selected DSM Diagnoses For most DAM categories, reliability is good Reliability in everyday settings may be lower than in formal research settings Validity of Diagnostic Categories Construct validity of highest concern Diagnoses are constructs For most disorders, no lab test available to diagnose with certainty Strong construct validity predicts wide range of characteristics Diagnoses often help organize different observations Criticisms of classification Stigma against mental illness Treated differently by others Difficulty finding a job Categories do not capture This disorder does not define the person Classification may emphasize trivial similarities Relevant information may be overlooked Psychological Assessment Techniques employed to: Describe a client’s problem Determine causes of problem Arrive at a diagnosis Develop a treatment strategy Monitor behavior Ideally, involves multiple measures and methods Interviews, personally inventories, etc. Characteristics of Clinical Interviews Interviewer attends how questions are answered Is response accompanied by appropriate emotion? Does client fail to answer question? Paradigm influences information sought CBT interviewer focuses on current, rather than early childhood, events Good rapport essential Empathy and accepting attitude Formal (structured) vs. informal Structured interviews a) All interviewers ask the same questions in a predetermined order b) Structured clinical interview for Axis 1 of DSMIVTR (SCID) Assessment of Stress Stress Subjective experience of distress in response to Social readjustment rating scale (SSRS) Holmes and Rahe (1967) Retrospective ratings Stressfulness ratings fixed < 150 low stress 150299 medium stress 300+ high stress, ~80% chance of getting sick in near future Assessment of Daily experience (ADE) Stone and Neale (1982) Monitor/record thoughts and events on daily basis Avoids problems with retrospective Bedford College Life Events and difficulties Schedule (LEDS) Semistructured interview Evaluates stressors within the context of each individual’s circumstances a) Eg. Pregnancy for single 16 year olds vs. married 30 year olds Psychological Tests Selfreport personally inventories Minnesota Multiphasic Personality Inventory (MMPI) a) Yields profile of psychological functioning b) Specific subscales to detect lying and faking “good” or “bad” c) Empirically derived (ex. Mechanics magazine) Projective Tests Rorshach inkblot test and thematic Apperception Test (TAT) Projective hypothesis a) Responses to ambiguous stimuli reflect Intelligence tests Wechsler Adult Intelligence Scale, 4 Ed (WAISIV); Wechsler Intelligence scale for th children, 4 Ed (WISCIV) Assesses current mental ability Intelligence Tests (IQ tests) Assess current mental ability Wechsler Scales rd a) Wechsler Preschool and Primary scale for Children, 3 Ed (WPPSIIII) StanfordBinet, 5 Ed (SB5) Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder, identify gifted children, as part of neuropsychological examination Mean IQ= 100, SD= 15 (Wechsler) or SD= 16 (SB) Lower IQs associated with higher psychopathology and mortality Performance on IQ tests impacted by stereotype Threat Behavioral Observation Observe behavior as it occurs Sequence of behavior divided into segments Antecedents and consequences Observation often conducted in lab setting E.g. partners discuss relationship problem a) Interaction observed through oneway mirror or videotaped for later coding Common with kids and dev disorders SelfObservation Selfmonitoring Individuals observe and record their own behavior a) Eg. Moods, stressful events, thoughts, etc. Ecological Momentary Assessment (EMA) Collection of data in real time using diaries of PDAs Reactivity The act of observing one’s behavior may alter it Selfreport inventories and Cognitive Assessment Format often similar to personality tests Dysfunctional Attitude Scale (DAS) Identifies maladaptive thought patterns a) People will think less of me if I make mistakes b) Influence of paradigm Articulated Thoughts in Simulated Situations (ATSS) Assess immediate thoughts in specific situations a) Listen to recording and pretend you are being criticized by boss Neurobiological Assessment: Brain Imaging Computerized Axial Tomography (CT or CAT scan) Reveals structural abnormalities by detecting differences in tissue density a) Tumor, stroke Magnetic Resonance Imaging (MRI) Similar to a CT but higher quality fMRI a) images reveal function as well as structure b) measures blood flow in the brain c) focused on increased activity (what areas “light up”) positron Emission Tomography (PET Scan) primarily shows brain function Neurobiological Assessment: Neurotransmitter Assessment Postmortem studies Measure NT levels in decreased Metabolite assays For living persons Metabolite levels are measured a) Byproducts of neurotransmitter breakdown found in urine, blood serum or CSF May not reflect Correlational studies Neuropsychologist Studies how brain abnormalities affect thinking, feeling, and behavior Neuropsychological Tests Reveal performance deficits that can indicate areas of brain malfunction HalsteadReitan battery LuriaNebraska battery Psychophysiological Assessment Psychophysiology Study of bodily changes that accompany Electrocardiogram (EKG) Heart rate measured by electrodes placed on chest Electrodermal responding (skin conductance) Sweatgland activity measured by electrodes placed on hand Electroencephalogram (EEG) Brain’s electrical activity measured by electrodes placed on scalp BiologicallyBased Assessments What do they mean? Cultural Bias in Assessment Measures developed for one culture or ethnic group may not be valid or reliable for another Not simply a matter of language translation a) Meaning may be lost b) Differences in culturallysanctioned thoughts/behaviors Crosscultural scoring norms sometimes needed Cultural bias can lead to Strategies to Avoid Bias Increase students’ and professionals’ sensitivity to cultural issues Insure participants’ understanding of task Establish rapport distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994)
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