Psych 410 Chapter 3
Psych 410 Chapter 3 PSYC 410 002
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This 9 page Class Notes was uploaded by Molly Hart on Wednesday February 10, 2016. The Class Notes belongs to PSYC 410 002 at University of South Carolina taught by Jeffrey C. Schatz in Spring 2016. Since its upload, it has received 31 views. For similar materials see Survey of Abnormal Psychology in Psychlogy at University of South Carolina.
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Date Created: 02/10/16
Psych 410 notes Chapter 3 Clinical Assessment for Mental Health Concerns: What to do when symptoms arise? o People start to go in to the doctor when mental health symptoms start affecting their life in a big way o Physical exam/ General Health check up o Recommendation for specialist Ex: Neurologist Does this specialist help the condition? Does the treatment work? The Clinical Process o Assess what is going ontreatmentAssess the treatmentAlter treatment Asses altered treatment What is assessment? o Methods of gathering information How to get information Not enough to get good quality assessments It isn’t straight forward o Methods of organizing information Taking what you gathered and put it together for diagnosis or treatment Pick what is important and what isn’t o Key concepts ReliabilitySomething that can be used over and over again and is reliable to other doctors or scientists. Consistency ValidityThe results are correct due to the correct experiment or assessment Cant have validity without reliability Results can’t be correct Standardization How a assessment thing should be done and should be the same from one person to the next. EX: IQ test has a standard IQ of the world Types of Assessment o I. Biological Assessments o II. Psychosocial Assessments US Mental Health Care Systems o Mildmoderate conditions Private pay Health insurance “Indemnity insurance” This caused health care professionals to continuously make money as long as they diagnosed and treated people, which led to corruption. Health maintenance organizations (HMO’s) Corporate wellness programs o Severe conditions Asylums/Inpatient care They were like warehouses for people Most people were in and out all the time May be a stressful environment for people who need a stress free environment. It’s like jail where they can’t get by in the world by themselves again when released. Homelessness Community mental health movement HMO’s Day treatment centers Not enough beds for severe mental illness Homelessness Many have serious mental illness Hospital Emergency rooms If no one else will take you, hospitals have to take you. Jails/Prisons Many people have mental illness in jail and prisons. Assessment Biological Factors o Physical Exam/ General health checkup Clinical interview and history Doctor takes your history What are your concerns? Talks about life, medications, history Physical exam Physical problems and mental problems may be connected Blood work Looks for organ dysfunction Metabolites of neurotransmitters o Neurological Exam Issues: emphasizes lower systems Tries to rule out other causes like neurologic problems History Mental status a way of assessing cognitive functions by observing behavior Cranial nerves are the parts of the nervous system intact Motor tone Sensory Coordination Reflexes o Brain imaging used to rule out neurological problems Electroencephalogram (EEG) Measures electrical activity Primary in clinical practices Sensors on scalp Temporal sensitivity electrical activity over time (time course). Relatively poor spatial sensitivity o Might not know where the source is. Clinically used to rule out seizure disorders Structural Imaging (CT, MR) Water/hydrogen concentration inside of thing (started with rocks). Good spatial resolution (very detailed) Differentiates types of tissue Clinically used for brain damage (stroke or tumor) Functional Imaging (PET, fMR) The things that seem more active, are actually taking up more blood, which can be used to identify a response from a cognitive activity. Measure changes in blood flow or oxygen use (vascular supply Good spatial resolution entire brain Relatively poor temporal resolution Clinically used to rule out medical causes o Can’t be used to make inferences about individual people. o Neuropsychological Assessment A combination of behavioral neurology and psychological assessment WWII veterans brain /head injuries Problems with higher level cognitive functions Problems with emotional states Brain functioning as a cognitive profile higher mental functions Mapping process Sensitive, but not very good at localizing dysfunction Describes functional capabilities. Clinically used for functional abilities EX: problems with memory Assessment of Psychosocial factors o Clinical interview Includes mental statues exam Organizing observations of a patient 3 types Unstructured free flowing, openended o High efficiency but low reliability Semistructured set questions with freedom to modify the followup o Medium efficiency and medium reliability Structured set questions, closedended o Next question is predetermined o Low efficiency but high reliability o Behavioral assessment ABC’s A Antecedents (something that happens before a key behavior) O Organismic variable (Other things that are important) B Behavior (The key behavior that is watched) C Consequences Behavioral observation Try to understand environment, look for before and after of key behaviors. Behavioral interviewing/questionnaires People in the room tell us about the behavior Frequency of different behaviors. Selfmonitoring The person themselves will give the assessment. o Personality test Projective Rorschach Inkblot Test Rooted in psychodynamic tradition Ambiguous stimuli Make people come up with a situation to fill in the blank People project out their thoughts Objective MMPI2 Most commonly used personality measure Measures selfreported psychopathology and personality features Originally designed through criterion validity Clear cut answers Validity scales Advantages o Number of scales and their utility o Validity scales o Reliability o Validity Disadvantages o Poor test construction process o Cultural validity is poorly understood o Awkward to administer o Good enough is the enemy of better o Symptom Questionnaires Have you felt sad or down recently? Do you have difficulties sleeping? Is it hard for you to concentrate Yes/no answers o Cognitive/Intelligence Tests Cognitive abilities (attention skills, language skills) Cognitive style/problem solving How people approach problems Behavioral sample with cognitive challenges Difficult behaviors may come out during challenging times. o Cultural differences in Assessment People thought things were universal and nothing was different between cultures Cultural validity Intelligence is different from culture to culture. Communication/language barrier Might not translate from one language to another Cultural constraints on behavior Some cultures may think it is taboo to seek mental help but others it may be the norm Lack of trust/credibility Stereotypes Generating it in your head Doesn’t affect your work How to minimize the negative impact of cultural difference for assessment Awareness be aware of how culture affect people and the environment Knowledge get information of different cultures Dynamic sizing don’t make categories/assumptions Flexibility in methodsmore flexible in assessments. Diagnosis and Classification of Abnormal Behavior o Diseaseabnormal condition with identified cause, symptoms, and method of diagnosis o Syndromea common set of symptoms that cooccur frequently. Causes may be partially understood. PSYCHOLOGY uses it. EX: Alzheimer’s disease is due to brain atrophy from senile plaques and neurofibrillary tangles. (autopsy). Syndrome is Probable DAT general declines in memory and other areas of cognitive ability. When diagnosing, you can group symptoms together Can have more than one way to divide things up/organize it Core symptoms are most important for diagnosis Associated problems are not that important but may be around the other symptoms Then you need to label things Equifinality Syndromes may have multiple causes EX: The flu and Ebola have many of the same symptoms Symptoms may fall under the same category/ different illnesses o Classification systems I. Diagnostic and Statistical Manual of Mental Disorders (DSMV) Mostly in America Goals of DSM o INCREASE RELIABILITY OF DIAGNOSIS Doesn’t tell you the treatment that will work for certain people!!!!!! Field trials did not apply to people that well at first o Still not that impressive o Moderate reliability o May not agree on a specific disorder but may think it is all a mood disorder. Definition of Mental Disorder o Clinically significant disturbance of cognition, emotion, or behavior in an individual. o Cause significant distress or disability o Not an expected or culturally approved response to a common stressor o Not primarily a conflict between the individual and society DSM diagnosis o Categorical system EX: mood disorders Have something or don’t have something o Tries to be atheorteical (not based on/ concerned with theory). Don’t want people fighting on theoretical views. o Does not address specific etiology Nothing about what caused the syndrome o May or may not aid in treatment planning Take the best guess on what the diagnosis is statistically Major Depressive Episode o 5 symptoms for at least 2 weeks o One symptom must be depressed mood or loss of interest o NOT GRIEF The symptoms o Depressed mood o Markedly diminished interest or pleasure in all or almost all activities o Significant weight loss or gain, or increase or decrease in appetite. o Insomnia or hypersomnia o Psychomotor agitation or retardation o Fatigue or loss of energy o Feelings of worthlessness or inappropriate guilt o Diminished concentration or indecisiveness o Recurrent thought of death or suicide Dimensional systems o Concerned with the amount or degree of a problem o Requires quantifying the problem on a scale Dimensional approach o A group at a level of severity that are considered abnormal for treatment. II. The International Classification of Diseases (ICD10) Internationally III. Dimensional Approaches Not that different from ICD10 Key research paradigms for mental health research o Experimental designs Randomized control trials (RCTs) Demonstrates the efficacy of a treatment o DOES THE TREATMENT WORK? Random assignment to groups At least two conditions Compare groups on primary and secondary outcomes as defined a priori. Randomization o Bias in assignment Blind experiments? o Unknown confounds/variables Can’t tell participants which group is which Conditions o Control conditions Keep doing what you’re doing o Treatment conditions Something more like education or placebo Outcomes o A priori Looking retrospectively at the outcome which can influence the actual results o Single or multiple? How many outcomes do you measure? How likely you are to get an outcome? Analogue studied/models Experimental induction that mimics a clinical condition o Mood o Beliefs o Brain function Correlational designs o Epidemiological research methods Incidence Prevalence Determine how important diseases are. Distribution more may occur in different genders (Biological?) Correlates as potential causal factors o Single case experimental designs Withdrawal designs (ABAB) See if first treatment even works A baseline over a meaningful period of time Implement a treatment and see if it works Does the symptom go down? Remove treatment and see if they get worse to see if the treatment actually works. Multiple baseline designs
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