Abnormal Psychology Ch.3
Abnormal Psychology Ch.3 Psych 433
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This 8 page Class Notes was uploaded by Derek Schrick on Saturday February 13, 2016. The Class Notes belongs to Psych 433 at University of Missouri - Kansas City taught by K. Harry in Spring 2016. Since its upload, it has received 51 views. For similar materials see Abnormal Psychology in Psychlogy at University of Missouri - Kansas City.
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Date Created: 02/13/16
Ch. 3 Clinical Assessment and Diagnosis Assessing Psychological Disorders Purposes of clinical assessment o Clinical assessment- systematic evaluation of psychological, biological, and social factors in an individual presenting with a possible psychosocial disorder To understand the individual To predict behavior To plan treatment To evaluate treatment outcome o Diagnosis- process of determining whether the particular problem afflicting the individual meets all criteria for a psychosocial disorder Analogous to a funnel o Starts broad o Multidimensional in approach o Narrow to specific problem areas Reliability- the degree to which a measurement is consistent o Consistency in measurement o Examples include test-retest and inter-rater reliability Test-retest- take a test and get 80%... take test again a week later and should expect similar result Inter-rater-when two or more psychologists see same patient and get same result Validity- the degree to which a technique measures what it is designed to measure o What an assessment measures and how well it does so Standardization- Application of certain standards to ensure consistency across different measurements o Ensures consistency in the use of a technique o Provides population benchmarks for comparison o Examples include structured administration, scoring, and evaluation procedures The Clinical Interview and Physical Exam Clinical Interview o Most common clinical assessment method o Structures or semi-structures Example of semi-structures interview- Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5) has modules pertaining to anxiety, mood, and related disorders, designed to assess DSM-5 criteria Mental Status Exam o Trick for clinicians is to organize their observations of other people in a way that gives them sufficient information to Ch. 3 Clinical Assessment and Diagnosis determine whether a psychological disorder might be present o Components of Mental Status Exam: Appearance and behavior- overt behavior, attire, appearance, posture, expressions, hygiene, groomed, twitch/fidgety Thought processes- rate of speech, continuity of speech, content of speech Mood and affect- predominant feeling state of the individual, showing same emotions that person is saying (sad but smiling) Intellectual functioning- Type of vocabulary, use of abstractions and metaphors Sensorium- Awareness of surroundings in terms of person (self + clinician), time, and place-“oriented times three” *ON EXAM Physical exam o First pit stop because many individuals visit family physician first and are given a physical Behavioral Assessment and Observation Behavioral Assessment- takes one step further than mental status exam by using direct observation to assess formally an individual’s thoughts, feelings, and behavior in specific situations or contexts. o Focus on the present- here and now o Direct observation of behavior-environment relations o Purpose is to identify problematic behaviors and situations o ABCs- identify antecedents, behaviors, and consequences Behavioral observation and behavioral assessment o Can be either formal or informal o Self-monitoring vs. being observed by others o Problem of reactivity using direct observation Psychological Testing: Projective Tests Psychological testing o Must be reliable and valid Projective tests o Rooted in psychoanalytic tradition o Used to assess unconscious processes o Project aspects of personality onto ambiguous test stimuli o Require high degree of inference in scoring and interpretation o Examples: Ch. 3 Clinical Assessment and Diagnosis The Rorschach inkblot test; Thematic Apperception Test Reliability and validity data tend to be mixed CBT Thought Record- way to track though processes; in order to get person to use automatic thought processes (for anxiety, depression) Objective Tests and Personality Tests Objective tests o Roots in empirical tradition o Test stimuli are less ambiguous o Require minimal clinical inference in scoring and interpretation in scoring and interpretation Personality Tests- used if people aren’t aware of their unconscious thoughts and feelings o Minnesota Multiphasic personality Inventory (MMPI) o Extensive reliability, validity, and normative database Psychological Testing and Objective Tests Intelligence tests o Nature of intellectual functioning and IQ Originally developed as a measure of degree to which children’s performance diverged from others in their grade o The deviation IQ Compare a person’s scores against those of other people who are the same age o Verbal and performance domains Neuropsychological Testing Purpose and goals o Measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning o Assess broad range of skills and abilities o Goals is to understand brain-behavior relations Examples o The Luria-Nebraska and Halstead-Reitan batteries Designed to assess for brain damage Test diverse skills ranging from grip strength to sound recognition, attention, concentration *KNOW function and what is used for Problems with neuropsychological tests o False positive: mistakenly shows a problem where there is none Ch. 3 Clinical Assessment and Diagnosis o False negatives: fails to detect a problem that is present Neuroimaging and Brain Structure Neuroimaging: Pictures of the brain o Two objectives Imaging brain structure o Computerized axial tomography (CAT or CT scan) Utilizes X-rays Magnetic resonance imaging (MRI) o Utilizes strong magnetic fields o Better resolution than CT scan Neuroimaging and Brain Function Imaging brain function o Positron emission tomography (PET) o Single photon emission computed tomography (SPECT) o Both involve injection of radioactive isotopes Isotopes react with oxygen, blood, and glucose in the brain o Functional MRI (fMRI)- brief changes in brain activity Psychophysiological Assessment Psychophysiological assessment o Assess brain structure, function, and activity of the nervous system Psychophysiological assessment domains o Electroencephalogram (EEG)- brain wave activity. ERP- Event related potentials = brain response to a specific experience (e.g., hearing a tone) o Heart rate and respiration- cardiorespiratory activity o Electrodermal response and levels- sweat gland activity Uses of routine psychophysiological assessment o Disorders involving a strong physiological component Examples o PTSD, sexual dysfunctions, sleep disorders o Head aches and hypertension Diagnosing Psychological Disorder: Foundations in Classification Diagnostic classification o Classification is central to all sciences o Assignment to categories based on shared attributes or relations Ch. 3 Clinical Assessment and Diagnosis Idiographic strategy- what is unique about an individuals personality, cultural background, or circumstances Nomothetic strategy- often used when identifying a specific psychological disorder, to make a diagnosis Issues with Classifying and Diagnosing Psychological Disorders Categorical and dimensional approaches o Classical (or pure) categorical approach – strict categories (e.g., you either have social anxiety disorder or you don’t) o Dimensional approach – classification along dimensions (e.g., different people have varying amounts of anxiety in social situations) o Prototypical approach – combines classical and dimensional views Widely used classification systems o Diagnostic and Statistical Manual of Mental Disorders (DSM) Updated every 10-20 years Current edition: DSM-5 Previous edition called DSM-IV-TR ICD-10 o International Classification of Diseases (ICD-10) o Published by the World Health Organization (WHO) History of the DSM Prior to 1980, diagnoses were made based on biological or psychoanalytic theory Introduction of DSM-III in 1980 revolutionized classification o Classification newly relied on specific lists of symptoms, improving reliability and validity o Diagnoses classified along five “Axes” describing types of problems (e.g. disorder categories, health problems, life stressors) DSM-IV introduced in 1994 o Eliminated previous distinction between psychological vs. organic mental disorders o Reflected appreciation that all disorders are influenced by both psychological and biological factors DSM-IV-TR (“text revision” of DSM-IV) incorporated new research and slightly altered criteria accordingly The DSM-5 Basic characteristics o Removed axial system Ch. 3 Clinical Assessment and Diagnosis o Clear inclusion and exclusion criteria for disorders o Disorders are categorized under broad headings o Empirically-grounded, prototypic approach to classification Unresolved Issues in DSM-5 The problem of comorbidity o Defined as two or more disorders for the same person o High comorbidity is extremely common o Emphasizes reliability, maybe at the expense of validity (i.e., may artificially “split” diagnoses that are very similar) Dimensional classification: o DSM was intended to move toward a more dimensional approach, but critics say it does not improve much from DSM-IV Labeling issues and stigmatization o Some labels have negative connotations and may make patients less likely to seek treatment Summary of Clinical Assessment and Diagnosis Clinical assessment and diagnosis o Aims to fully understand the client o Aids in understanding and ameliorating human suffering o Based on reliable, valid, and standardized information Conducting Research in Psychopathology Questions driving a science of psychopathology o What problems cause distress or impair functioning? o Why do people behave in unusual ways? o How can we help people behave in more adaptive ways? Basic Components of Research Starts with a hypothesis or “educated guess” o Not all hypotheses are testable o Hypotheses in science are formulated so that they are testable Research design o A method to test hypotheses o Independent variable The variable that causes or influences behavior o Dependent variable The behavioral influenced by the independent variable (change) Ch. 3 Clinical Assessment and Diagnosis Considerations in Research Design Internal validity vs. external validity o Internal validity: Extent to which results of a study are due to the independent variable o External validity: Extent to which results of a study are generalizable to the population it’s studying Ways to increase internal validity by minimizing confounds o Use of control groups o Use of random assignment procedures o Use of analog models Studying Individual Cases Case study method o Extensive observation and detailed description of a client o Foundation of early historic developments in psychopathology Limitations o Lacks scientific rigor and suitable controls o Internal validity is typically weak o Often entails numerous confounds Summary of Research Methods Nature of research o Establishing and testing hypotheses Research design o Varies depending on the questions posed o Each has unique benefits and drawbacks Abnormal psychology is founded in the scientific method o Understand the nature of abnormality and human suffering o Understand the causes of psychological disorders o Understand the course of psychological disorders o Understand how to prevent and treat psychological disorders Replication is the cornerstone of science and programmatic research Research must occur in the context of ethical considerations and values Jack suffered head injury in car accident. What tests and methods of assessment should you use for your evaluationi? - CAT scans, neuropsychological assessment, Exam Questions: Ch. 3 Clinical Assessment and Diagnosis 1. In a mental status exam, it is important to determine if the individual is “oriented times three”. This refers to? a. Person place and time 2. When observation data are being collected, the observers presence may cause a person to behave differently, a phenomenon known as a. reactivity