Chapter 4—Clinical Assessment
Chapter 4—Clinical Assessment PSY240
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This 9 page Class Notes was uploaded by Jen Ferrante on Tuesday February 3, 2015. The Class Notes belongs to PSY240 at University of Miami taught by Dr. Zwibelman in Fall. Since its upload, it has received 44 views. For similar materials see Abnormal Psychology in Psychlogy at University of Miami.
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Date Created: 02/03/15
Chapter 5 Anxiety 0CD 63 Related Disorders 0 A varied group of clinical presentations that all have anxiety as an essential feature 0 O 0 May or may not recognize that their anxiety is excessiveunreasonable Rationally know that there is little to be afraid of in anxiety provoking situations but are afraid anyway anxiety is g of proportion to the actual threat or danger of the situation Might not know how their fears began but some do Continuum dimensional paradigm between normality and abnormality mildly anxious severely anxious Anxiety Vs Fear Anxiety Fear Alarm moodemotional I39m ream t Tension ex muscle tension elevated heart rate somatic Restlessnessfidgeting motor Worry cognitive of 0 Anxiety Normal vs Abnormal O 0000 O l intensity D duration F frequency J justi cation C consequences Anxiety is a selfperpetuating cycle 0 6 Anxiety Disorders 0 00000 1 Generalized Anxiety 2 Panic Disorder 3 Agoraphobia 4 Speci c Phobia 5 Social Anxiety 6 ObsessiveCompulsive Disorder OCD be careful of quotmedical school syndrome when students learn about disorders and start to diagnose themselvesfriendsfamiy 1 Generalized Anxiety disorder 0 O 0 Excessive or ongoing anxiety about every day events across many situations for at least 3 months Increased restlessnessmuscle tension Behavior may be affected by anxietyworry 0 Signi cant distress or impairment 2 Panic Disorder 0 Panic attack 0 O Abrupt experience of intense fear Appears at inappropriate times not associated with an actual threat Heart palpitations trembling chest pains etc Surprisingly common in successful people who sometimes believe their success has been all luck and fear it will eventually end Feelings of detachment After rst panic attack Anxiety about the possibility of another attack Persistent 1 month or more Symptoms can include Palpitations pounding heart accelerated heart rate Sweating Tremblingshaking Shortness of breathchoking Nauseaabdominal distress Feeling detached from oneself Fear of dying of heart attack Chillshot ashes Urge to eeescape 3 Agoraphobia fear of large crowds O 0 0 0 Anxiety about and avoidance of places and situations from which escape might be difficult or in which help might not be available in the event of a panic attack agora literally means quotmarket placequot in ancient Greek and phobia means fear People systematically avoid crowded situations and their lives are often disrupted Some forms are so extreme that people never leave their homes 4 Speci c Phobia persistent and irrational fear of particular objects activities or situations 0 O 0 Ex heights ying public speaking spiders Anxiety is out of probortion to the actual threat or danger of the situation Maymay not recognize their anxiety is unreasonable or how their fears started 5 Social Anxiety fear of being around other people based on extreme discomfort in being noticed by others or potential embarrassment 6 ObsessiveCompulsive Disorder 0CD o 2 components Obsessions unwanted persistent intrusive thoughts ideas or images Compulsions repetitive speci c behaviors irrational and excessive feel they must perform to reduce anxiety but does not bring pleasure greatly disrupts their lives 0 Obsessivelike concerns quotChecking behaviorquot an individual will go back many times to ensure they have done something locked the door turned the stove off etc checking reduces the anxiety caused by fear of something bad happening 0 Repetitiveactions compulsions Reduce anxiety but do not produce pleasure o 4 obsessivecompulsive related disorders 1 Hoarding Disorder 2 Trichotillomania hairpulling disorder 3 Excoriation Disorder skinpicking disorder 4 Body Dysmorphic Disorder preoccupation with imagined or misperceived defect in one s appearance usually in the face and strictly the individual s dissatisfaction Generalized Anxiety Disorder Explanations o 1 Societal and Multicultural factors 2 Psychodynamic perspective 3 Humanistic perspective 4 Cognitive perspective 5 Biological perspective OOOO Agoraphobia amp speci c phobias behavioral perspective Social Anxiety disorder cognitive perspective Panic disorder biological and cognitive perspective Obsessivecompulsive disorder psyc h ody na mic perspective behavioral perspective cognitive perspective biological perspective F Anxiety Disorders Treatments 0 1 Avoid avoidance fear must be confronted to be resolved avoidance reinforces the fearful behaviors OOOO o 2 Systematic Desensitization Associating deep relaxation with visualizations of anxietyprovoking situations replacement of anxiety with more comfortable images hierarchy of fears visualizing the situation is key start w least anxietyprovoking situation and then implement relaxation techniques 0 3 Exposure amp Response Prevention ERP Chapter 4 Clinical Assessment Diagnosis amp Treatment Purposes of assessment amp diagnosis 0 Assessment the collecting of relevant information in an effort to reach a conclusion 0 Purpose of assessment Description of client s abnormal behavior Why does the client behave abnormally Is it a clinically signi cant requires treatment dysfunction Be careful not to overdiagnose people who are simply eccentric o Diagnosis the process of determining whether a set of symptoms meets the criteria for a particular disorder does the person s symptoms match a known disorder Diagnostic and Statistical Manual or DSM sets the exact criteria for diagnosis in precise language DSM5 a diagnostic classi cation system for all recognized psychological disorders and the criteria for each there are 400 0 Clinical assessment a systematic evaluation of various factors in a person presenting w a possible disorder to determine if the person has a disorder and if so what are the disorders 0 Clinical presentation 4 types of symptoms Mood Cognitive Motor Physical 0 Remember 1 No two people with the same mental disorder appear exactly the same symptoms vary from person to person 2 Just because a behavior is common in a mental disorder it doesn t mean everyone who has the disorder will behave that way 0 3 primary methods of clinical assessment clinical interviews tests amp observations 0 1 clinical interviews structured therapist has set list of questions helps therapist make sure all bases are covered but clients can be put off by this somewhat sterile approach unstructured more sensitive to client s needsemotions important to develop rapport with a client developing a trusting relationship assuring con dentiality being a goodactive listener o 2 clinical tests 6 types Personality inventories 0 Can be a written booklet answering truefalse questions etc 0 Ex MMPI Minnesota Multiphasic Personality Inventory Projective tests 0 Ex Rorschach inkblot test asks individual to project thoughts to ambiguous form requires a lot of experience to interpret Response inventories 0 Ex Beck Depression Inventory Psychophysiologicaltests 0 Ex heart rate blood pressure thyroid problem etc 0 These tests are for research purposes only we do not rely on these tests for psychological diagnosis Neurological tests 0 Ex CT scan PET scan MRIfMRI EEG 0 Again for research purposes only after an individual has already been diagnosed Intelligence tests 0 Not always necessary not every test is needed routinely To be useful tests must be standardized reliable amp valid Remember diagnosis in abnormal psychology is based only on observable patterns of behavior 0 3 Observations direct naturalistic observation this is the best way to observe young children Standardization reliability and validity o Standardization measure has been extensively tested norms have been established 0 Reliable every time you administer the test to an individual you get the same results 0 Valid measures what it claims to measure 0 Clinical presentation the totality ofphysical appearance thoughts speech feelings behaviors complaints past history signs amp symptomsin a person being evaluated for a possible disorder 0 Clinical assessment quotRule outsquot 0 Rule 1 Rule out medical don t initiate psychological treatment if problems are strictly medical o Ruling inout the assessment process in which a particular diagnosis is either included ruling in or excluded ruling out from the nal diagnosis 0 Differential diagnosis the process of determining the speci c disorder when the diagnosis is not readily apparent Comorbidity the presence of two or more disorders in an individual at the same time ex 60 of individuals w schizophrenia also have depression Subclinicalsubthreshold presence of symptoms that are often found w disorders but to a lesser degree so a diagnosis label is not used 0 Again the only method psychologistspsychiatrists use to diagnose clients is overtobservable beha vior o Prevalence how many people in a particular population have the disorder including gender differences 0 Oneyear prevalence vs lifetime prevalence Incidence how many new cases of a disorder appear in a particular population during a speci c time period 0 Course pattern of development ex changes in intensity over time change in symptoms how long it lasts whether it recedes if it is recurrent Prognosis predicted pattern of development of a disorder over time looking forward rather than backward o Etiology the study of all the factors pertaining to how a disorder begins all the factors biological psychological social that contribute to its development How Shall we Classify Abnormal Behavior 0 3 ways to classify abnormal behavior categorical dimensional amp protoype o 1 categorical classi es sets of symptoms into disorders allornone symptom is either present or absent 0 2 dimensional symptoms occur on a continuum such as mild to severe rather than present or absent mildquotclinically signi cant distress or impairmentquot severe o 3 prototypical approach identi es certain essential characteristics quotbest examplequot 2 persons w the same diagnosis can have diff sets of symptoms but both maintain the same prototype individuals w the same disorder actually may share few common features DSM5 2013 All currently recognized psychological disorders and the criteria for each 0 Diagnostic and statistical manual of mental disorders 0 Empirically based No statements of cause No statements of personality theories No treatments 0 For a classi cation system to be useful it must be both reliable and valid Validity how accurate the diagnosis is in a diagnostic system the most important kind of validity is predictive validity Bene ts and Problems of Classifying People Bene ts 4 memorize for exam 0 1 useful method of organizing information o 2 helps people realize when they should seek professional help 0 3 communicating among professionals 0 4 Treatment planning most important Problems 5 o 1 Arti ciality categories are basically labels constructs for a cluster of symptoms 0 2 oversimplify uniqueness of individual is lost and hisher strengths may be overlooked o 3 prejudice negative connotation of labels 0 4 tends to take on a life of its own which follows the person throughout life 0 5 selfimage tendency to ful ll diagnosis ex quotThey say I m depressed so I must be depressedquot quotOn Being Sane in Insane Placesquot by David Rosenhan research question Are mental health professionals able to tell the difference between those who are normal and those who are not 8 people 5 men 3 women were instructed to pretend to have mental disorders and try to gain admittance into a psychiatric hosptal all were admitted to the hospitals and all but one were diagnosed with schizophrenia immediately after being admitted to the hospitals the subjects psuedopatients stopped showing symptoms of abnormality length of hospitalization 752 days average of 19 days 0 powerlessness depersonalization each diagnosed w quotschizophrenia in remissionquot importance the expectations produced by labeling can alter Qercegtion
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