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Chapter 3 Notes

by: Rebecca Cue

Chapter 3 Notes CLP4143

Rebecca Cue
GPA 3.6

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About this Document

These are the comprehensive notes from 1/21/16 and 1/26/16 when we covered Chapter Three. The black text are the notes based off of the power points and the notes posted on blackboard, and the purp...
Abnormal Psychology
Dr. Natalie Sachs-Ericsson
Class Notes
Abnormal psychology, Psychology
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This 11 page Class Notes was uploaded by Rebecca Cue on Friday January 29, 2016. The Class Notes belongs to CLP4143 at Florida State University taught by Dr. Natalie Sachs-Ericsson in Spring 2016. Since its upload, it has received 166 views. For similar materials see Abnormal Psychology in Psychlogy at Florida State University.


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Date Created: 01/29/16
Chapter 3: Diagnosis and Assessment If we can’t diagnose, how will we know how to help the patient? I. Cornerstones of Diagnosis and Assessment II. Classification and Diagnosis III. Psychological Assessment IV. Neurobiological Assessment V. Cultural and Ethnic Diversity and Assessment Diagnosis and Assessment Diagnosis • Definition of diagnosis: The classification of disorders by symptoms and signs. • Advantages of diagnosis(why do we need a diagnosis?): o Facilitates communication among professionals o Advances the search for causes and treatments o Cornerstone of clinical care Reliability vs. Validity: **just because something is reliable, doesn’t necessarily mean that it is valid** Reliability (consistency) (Even a broken clock is right twice a day) Reliability is very important. Consistency of measurement (we just need it to be VALID) • Consistency of measurement o Consistency of measurement is assessed by these different types of reliabilities • Inter-rater o Observer agreement • Test-Retest o Similarity of scores across repeated test administrations/observations • Alternate Forms o Similarity of scores on tests that are similar but not identical (e.g. Form A, Form B: a teacher makes two types of tests, but regardless of the form, a student should get the same score to ensure consistency. Validity • How well does a test measure what it is supposed to measure? • Validity is the TRUTH! Measuring what a test 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 • Example: The items on the test represent the entire range of maternal, not just all on one chapter. Criterion validity • Extent to which a measure is associated with another measure (the criterion) • Two types: o Concurrent § Two measures administered at the same point in time o Predictive § Ability of the measure to predict another variable measured at some future point in time § Gold standard: in medicine and statistics, gold standard refers to a diagnostic test or benchmark that is the best available. Validity • Classification and Diagnosis • Construct validity: a construct is an abstract concept or inferred attribute o Involves correlating multiple indirect measures of the attributes (e.g. depression) o E.g. the construct of ‘depression’ Classification & Diagnosis: Diagnostic and Statistical Manual of Mental Disorders (DSM) published by American Psychiatric Association • First edition published in 1952 • Current edition: • New edition May 2013: DSM-5 Five axes in DSM-IV-TR – No Axis in DSM 5 *Clinicians liked this a lot. DSM is basically a categorical system. It causes great argument, however. Clinicians will argue that people are on a great spectrum, not categories. **The following that is italicized was not really discussed in class—but could potentially still be on a test!** Clinical Syndromes • Psychosocial and Environmental Problems • Changes in organization of diagnoses DSM-IV-TR clusters diagnoses on similarity of symptoms DSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared etiology • OCD moved from anxiety cluster to new cluster that also includes hoarding and body dysmorphic disorder DSM-IV-TR based on categorical classification • If you have minimum number of symptoms, you are diagnosed with disorder. If one short, you are not. • Little research support for this diagnosable threshold • DSM-5 preserves categorical approach • NOS (“Not Otherwise Specified”) likely to remain in use for sub threshold cases Figure 3.4: Categorical Versus Dimensional Systems of Diagnosis • Categorical (DSM) o Presence/absence of a disorder § Either you are anxious, or you are not anxious. • Dimensional (NOT DSM) o Rank on a continuous quantitative dimension § Degree to which a symptom is present • How anxious are you on a scale of 1-10? DSM-5 Severity Rating Scale for Depression New Diagnoses • Disruptive mood dysregulation, language impairment disorder, etc. • Combining Diagnoses Substance use disorder replaces substance abuse and substance dependence, etc. • Clearer Criteria Ethnic and Cultural Considerations • Mental illness universal Culture can influence: • Risk factors • Types of symptoms experienced • Willingness to seek helpàTremendous difference. Stigma/bias against getting treatment. • Availability of treatmentsàBetter in some communities compared to others DSM-IV-TR includes: • Enhanced cultural sensitivity • Appendix of 25 culture-bound syndromes o **Highest rates of disorders are in the U.S. Not 100% clear why. But one possibility could be that this is a more stressful environment to live in. Amok Running “amok”, sometimes referred to as simply amok(\from the Malay meaning "mad with uncontrollable rage") is a term for a killing spree perpetrated by an individual out of rage or resentment over perceived mistreatment. Drat, Koru, and Taijin, and hikkimori are other examples. • Koru: Cultural specific syndrome in which an individual has an overpowering belief that his/her genitals are shrinking. Common in Africa, Asia, and Europe. • Taijin Kyofushu: is  a  Japanese  culture-­‐specific  syndrome.    Taijin  kyofusho  literally   means  the  disord er  (sho)  of  fear  (kyofu)  of  interpersonal  relations  (taijin).  A  vicious   cycle  of  self-­‐examination  and  reproach  which  can  occur  in  people  of   hypochondriacal  temperament.    Is  a  form  of  social  anxiety, However, instead of a fear of embarrassing themselves or being harshly judged by others because of their social ineptness, sufferers of taijin kyofusho report a fear of offending or harming other people. The focus is thus on avoiding harm to others rather than to oneself. Criticisms of the DSM • Too many diagnoses? • Should relatively common reactions be pathologized? o Example: depression over the death of a spouse • Comorbidity o Presence of a second diagnosis o 45% of people diagnosed with one disorder will meet criteria for a second disorder • Reliability in everyday practice Construct Validity of Diagnostic Categories Construct vaility is of highest concerns, that we have it with doing diagnoses. o Diagnoses are constructs o For most disorders, no lab test available to diagnose with certainty o Strong construct validity predicts wide range of characteristics o Possible etiological causes (past) o Clinical characteristics (current) o Predict treatment response (future) o A lot may be unknown about a future. Hard to tell family members. Criticisms of Classification § Psychological Assessment o Stigma against mental illness § Treated differently than others § Difficulty finding a job o Categories do not capture the uniqueness of the person. § The disorder does not define the person. Techniques employed to: • Describe client’s problem • Determine causes of problem • Arrive at a diagnosis • Develop a treatment strategy • Monitor treatment progress • Conducting valid research • Ideal assessment involves multiple measures and methods • Interviews, personality inventories, intelligence tests, etc. • 1 in 4 people have a mental disorder. Clinical Interviews § Informal/less structured interviews § Interviewer attends to how questions are answered § Is response accompanied by appropriate emotion? § Does client fail to answer question? § Good rapport essential to earn trust § Empathy and accepting attitude necessary § Reliability lower than for structured interviews Structured interviews § All interviewers ask the same questions in a predetermined order o How you determine the depression levels of the patient Structured Clinical Interview for Axis I of DSM (SCID) Good interrater reliability for most diagnostic categories\ § Some patients are harder to diagnose and have more reliability Figure 3.8: Sample Item from SCID (you hit a couple of key items, so then go and assess them) **don’t need to really memorize the table, just a good resource to have to understand SCID Assessment of Stress § Subjective experience of distress in response to perceived environmental problems § Bedford College Life Events and Difficulties Schedule (LEDS) Semi-structured interview § Evaluates stressors within the context of each individual’s circumstances Self-Report Stress Checklists § Faster way to assess stress § Test-retest reliability low Psychological Tests § Personality Tests § Self-reported Personality Inventories § Example of a psychological test: When Dr. Sachs-Ericsson fell of her horse, her doctor engaged her in a conversation about her leather boots instead of running a set test. This gave him idea of how aware she was. It is important as a psychologist/doctor to be aware and sensitive of where the person is at § Psychoanalysis: you have unconscious conflicts. Tests are used to get the patient to unconsciously admit their conflict. Minnesota Multiphasic Personality Inventory (MMPI) Has “lie detector” scales § MMPI: is primarily intended to test people who are suspected to have mental health or other clinical issues. • Yields profile of psychological functioning • Specific subscales to detect lying and faking “good” or “bad” • Lie scales: there are 10 different scales (1-9, 0), K scale, F scale. We won’t need to define the scales, just be familiar with what they are as a whole. Projective Tests § Rorshach Inkblot Test and Thematic Apperception Test (TAT) (The TAT is a test that gives a picture and then the patient explains what the story behind the picture is.) § The Rorchach inkblot test, also known as the Rorschach technique, is a psychological test where participants are shown inkblots and their perceptions of them are recorded and then analyzed using psychological interpretation, complex algorithms, or both. § Sample inkblots similar to what would be given on the test: § Projective hypothesis § Responses to ambiguous stimuli reflect unconscious processes Figure 3.11: Hypothetical MMPI-2 Profile In relation to other scales: here we can see where a person was high on certain symptoms. Psychological Tests Intelligence tests (IQ tests) assess current mental ability: • Wechsler Scales th • Wechsler Adult Intelligence Scale, 4 ed. (WAIthIV) • Wechsler Intelligence Scale for Children, 4 ed. (WISC-IV) • Wechsler Preschool and Primary Scale for Children, 3 ed. (WPPSI-III) th • Stanford-Binet, 5 ed. (SB5) o Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder (mental retardation), identify gifted children, as part of a neuropsychological examination • Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB) o 100 IQ is normal with +/- 15 standard deviation. So a person with an IQ of 86 is technically still “normal” but very low. • Lower IQs associated with higher psychopathology and mortality o Discrepancy on IQ of people with color • Performance on IQ tests impacted by Stereotype Threat o Women perform worse on math tests when they think that the test will produce gender differences. White men perform worse on math tests when they think that they are competing with an Asian man. o Stereotype can affect the outcome. Behavioral and Cognitive Assessment • Focus on aspects of environment • Characteristics of the person • Frequency and form of problematic behaviors • Consequences of problem behaviors Observe behavior as it occurs o Sequence of behavior divided into segments o Antecedents and consequences Behavioral Assessments often conducted in lab setting o e.g., mother and child interact in a lab living room o Interaction observed through one-way mirror or videotaped for later coding Self-Observation o Reporting on your symptoms have a huge impact that is positive Self-monitoring Individuals observe and record their own behavior e.g., moods, stressful events, thoughts, etc. Example: a group of people who record what they eat in a food diary vs. a group who don’t keep track of their food will have more weight loss due to their observations. They are more aware of how unhealthy they are eating, and will try to make a conscious effort to do better. Ecological Momentary Assessment (EMA) Collection of data in real time using diaries or smart phones Reactivity The act of observing one’s behavior may alter it Desirable behaviors tend to increase whereas undesirable behaviors decrease Cognitive-Style Questionnaires • Use to help plan treatment targets • Format often similar to personality tests Dysfunctional Attitude Scale (DAS) Identifies maladaptive thought patterns “People will think less of me if I make mistakes” Neurobiological Assessment: (Some are done post-mortum) Brain Imaging Computerized Axial Tomography (CT or CAT scan) • Reveals structural abnormalities by detecting differences in tissue density o e.g., enlarged ventricles Magnetic Resonance Imaging (MRI) Very popular, looking at pictures of the brain. • Similar to CT but higher quality fMRI (functional MRI) • Images reveal function as well as structure • Measures blood flow in the brain • (BOLD=blood oxygenation level dependent) Positron Emission Tomography (PET scan) Brain function CT Scans Neurobiological Assessment: Neurotransmitter Assessment Postmortem studies **The following that is italicized was not really discussed in class—but could potentially still be on a test!** Metabolite assays Metabolite levels • Byproducts of neurotransmitter breakdown found in urine, blood serum or cerebral spinal fluid • May not reflect actual level of neurotransmitter Correlational studies Neurobiological Assessment: Neuropsychological Assessment Neuropsychologist Studies how brain abnormalities affect thinking, feeling, and behavior Neuropsychological Tests Reveal performance deficits that can indicate areas of brain malfunction Halstead-Reitan battery Tactile Performance Test-Time Tactile Performance Test-Memory Speech Sounds Perception Test Luria-Nebraska battery Assesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc. Psychophysiological Assessment Psychophysiology Study of bodily changes that accompany psychological characteristics or events Electrocardiogram (EKG) Heart rate measured by electrodes placed on chest Electrodermal responding (skin conductance) Sweat-gland activity measured by electrodes placed on hand Electroencephalogram (EEG) • Brain’s electrical activity measured by electrodes placed on scalp Cultural and Ethnic Diversity and Assessment 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 o Meaning may be lost • Cultural bias can lead to minimizing or exaggerating psychological problems o If you’re tied to stereotypes, you may overcompensate and may not give the person exactly what they need Strategies to Avoid Bias • Increase graduate students’ sensitivity to cultural issues o Culturally competent counselors acknowledge their own assumptions and biases about other cultures. o Next, they must cultivate the willingness and ability to acquire knowledge of their clients’ cultures. o This involves learning about and respecting client worldviews, beliefs, values, and attitudes toward mental health, help-seeking behavior, substance use, and behavioral health services • Insure participants’ understanding of task • Establish rapport • Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994) • Conclusions should be tentative and alternative hypotheses should be entertained. Cultural Responsiveness: • Make allowances for variations in the use of personal space. • Are respectful of culturally specific meanings of touch (e.g., hugging). • Explore culturally based experiences of power and powerlessness. • Adjust communication styles to the client’s culture. • Interpret emotional expressions in light of the client’s culture. • Expand roles and practices as needed.


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