PowerPoint Lecture Notes Presentation Chapter 2 Current Paradigms in Psychopathology

Chapter 3: Diagnosis and AssessmentI. Cornerstones of Diagnosis and AssessmentII. Classification and DiagnosisIII. Psychological AssessmentIV. Neurobiological AssessmentV. Cultural and Ethnic Diversity and AssessmentChapter Outline Lecture Handout9/3/201311. _________________

2. _________________

3. _________________

4. _________________4 Goals of ScienceDiagnosis

The classification of disorders by symptoms and signs.

Advantages of diagnosis:

Facilitates _________________ among professionals

Advances the search for _______________ and ______________

Cornerstone of clinical careDiagnosis and AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/20133Reliability_________________ of measurement

Inter-raterObserver agreement

Test-retestSimilarity of scores across repeated test administrations or observations

Alternate FormsSimilarity of scores on tests that are similar but not identical

Internal ConsistencyExtent to which test items are related to one anotherKring Ch3 Diagnosis and Assessment.ppt9/3/20134How well does a test measure what it is supposed to measure?

_________________ validityExtent to which a measure adequately samples the domain of interest, e.g., all of the symptoms of a disorder

_________________ validityExtent to which a measure is associated with another measure (the criterion)

_________________Two measures administered at the same point in time

Predic _________________ tiveAbility of the measure to predict another variable measured at some future point in timeValidityKring Ch3 Diagnosis and Assessment.ppt9/3/20135Validity_________________ validity (Cronbach & Meehl, 1955)

A construct is an abstract concept or inferred attribute

Involves correlating multiple indirect measures of the attributee.g., self-report of anxiety correlated with increased HR, shallow breathing, racing thoughts

Important for validating our theoretical understanding of psychopathology

Method for evaluating diagnostic categoriesKring Ch3 Diagnosis and Assessment.ppt9/3/20136Construct Validity of Diagnostic CategoriesConstruct validity of highest concern

Diagnoses are constructsFor most disorders, no lab test available to diagnose with certainty

Strong construct validity predicts wide range of characteristicsPossible etiological causes (past)Clinical characteristics (current)Predict treatment response (future)

Kring Ch3 Diagnosis and Assessment.ppt9/3/20137_________________ and _________________ Manual of Mental Disorders (DSM)

published by American ___________________ Association

First edition published in 1952

Current edition: DSM-5 Published in 2013!

Classification and Diagnosis Kring Ch3 Diagnosis and Assessment.ppt9/3/20138Axis IV is replaced by descriptors used by the World Health Organization (WHO) in the International Classification of Diseases (ICD)

Axis V is replaced by the World Health Organization Disability Assessment Schedule (WHODAS)Full Interviewer Administered Versionhttp://www.who.int/classifications/icf/WHODAS2.0_36itemsINTERVIEW.pdf12-item version, self-administeredhttp://www.who.int/classifications/icf/WHODAS2.0_12itemsSELF.pdf DSM-5 removes multiaxial dxGrowth in Number of DiagnosesDSM- I 106DSM-II 182DSM-III 265DSM-III-R292DSM-IV-TR 297

DSM-5 _______10Cultural Concepts of DistressCultural ___________________

9 Concepts of DistressReplaces 25 separate diagnoses

Focus on influence of culture on disorder presentation

11Mental illness ___________________

Culture can influence:Risk factorsTypes of symptoms experiencedWillingness to seek helpAvailability of treatments

Ethnic and Cultural ConsiderationsKring Ch3 Diagnosis and Assessment.ppt9/3/201312Multi-Axial SystemDSM-IV-TR used a 5-axis system

DSM-5 uses 2 axesPsychiatric & Medical Diagnoses

Psychosocial and Contextual FactorsRenamed from Psychosocial and Environmental Problems

(Anticipated severity index NOT included)13Diagnosis Names ChangedNames changed to better align with the WHO and the ICD

___________________ DisabilityReplaces Intellectual Developmental Disorder

Somatic Symptom & Related DisordersReplaces Somatic Symptom Disorder

Substance-Related & Addictive DisordersReplaces Substance Related Disorders

14DSM-IV-TR based on ___________________ classificationIf 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 subthreshold cases

DSM-5 was to add a ________________ Severity RatingDimensional system describes degree of severity of disorder, but relegated to an appendix (still too controversial!!!)Changes made & not made in DSM-5Kring Ch3 Diagnosis and Assessment.ppt9/3/201315Note DSM-5 almost changed approach from organizing disorders based on symptoms to organizing disorders based on etiologies

But we dont know enough about ___________________ yetDidnt happen in DSM-5:Kring Ch3 Diagnosis and Assessment.ppt9/3/201316Too many diagnoses?Should relatively common reactions be pathologized?ComorbidityPresence of a second diagnosis45% of people diagnosed with one disorder will meet criteria for a second disorderEmphasis on categorical rather than continuous measurement of symptoms

Reliability in everyday practiceCriticisms of the DSMKring Ch3 Diagnosis and Assessment.ppt9/3/201317Criticisms of Classification ___________________ against mental illness.Treated differently by othersDifficulty finding a job

Categories do not capture the uniqueness of a person.The disorder does not define the person. She is an individual with schizophrenia, not a schizophrenic

Classification may emphasize trivial similaritiesRelevant information may be overlooked. Kring Ch3 Diagnosis and Assessment.ppt9/3/201318Techniques employed to:Describe clients problemDetermine causes of problemArrive at a diagnosisDevelop a treatment strategyMonitor treatment progressConducting valid research

Ideal assessment involves multiple measures and methodsInterviews, personality inventories, intelligence tests, etc. Psychological AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/201319Informal/less structured interviewsInterviewer attends to how questions are answeredIs response accompanied by appropriate emotion?Does client fail to answer question?Good rapport essential to earn trustEmpathy and accepting attitude necessaryReliability lower than for structured interviews

Structured interviewsAll interviewers ask the same questions in a predetermined orderStructured Clinical Interview for Axis I of DSM (SCID)Good interrater reliability for most diagnostic categoriesClinical InterviewsKring Ch3 Diagnosis and Assessment.ppt9/3/201320StressSubjective experience of distress in response to perceived environmental problems

Bedford College __________ Events and Difficulties Schedule (LEDS)Semi-structured interviewEvaluates stressors within the context of each individuals circumstances

Self-Report Stress ChecklistsFaster way to assess stressTest-retest reliability low

Assessment of StressKring Ch3 Diagnosis and Assessment.ppt9/3/201321Personality TestsSelf-reported Personality InventoriesMinnesota Multiphasic Personality Inventory (MMPI)Yields ___________________ of psychological functioningSpecific subscales to detect lying and faking good or bad

Projective TestsRorshach Inkblot Test and Thematic Apperception Test (TAT)Projective hypothesisResponses to _________________________ stimuli reflect unconscious processes

Psychological TestsKring Ch3 Diagnosis and Assessment.ppt9/3/201322Intelligence tests (IQ tests)Assess current mental ability

Wechsler ScalesWechsler Adult Intelligence Scale, 4th ed. (WAIS-IV)Wechsler Intelligence Scale for Children, 4th ed. (WISC-IV)Wechsler Preschool and Primary Scale for Children, 3rd ed. (WPPSI-III)

Stanford-Binet, 5th ed. (SB5)Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder (mental retardation), identify gifted children, as part of a neuropsychological examinationMean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB)Lower IQs associated with higher psychopathology and mortalityPerformance on IQ tests impacted by ___________________ Threat

Psychological TestsKring Ch3 Diagnosis and Assessment.ppt9/3/201323Focus on aspects of ___________________

Characteristics of the person

Frequency and form of ___________________ behaviors

___________________ of problem behaviorsBehavioral and Cognitive AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/201324Observe behavior as it occurs

Sequence of behavior divided into segments

___________________ and ___________________

Behavioral Assessments often conducted in lab settinge.g., mother and child interact in a lab living roomInteraction observed through one-way mirror or videotaped for later coding

Behavioral and Cognitive AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/201325Self-monitoringIndividuals observe and record their own behaviore.g., moods, stressful events, thoughts, etc.

Ecological ___________________ Assessment (EMA)Collection of data in real time using diaries or smart phones

ReactivityThe act of observing ones behavior may alter itDesirable behaviors tend to increase whereas undesirable behaviors decreaseSelf-ObservationKring Ch3 Diagnosis and Assessment.ppt9/3/201326Use to help plan treatment targets

Format often similar to personality tests

Dysfunctional Attitude Scale (DAS)

Identifies ___________________ thought patternsPeople will think less of me if I make mistakesCognitive-Style QuestionnairesKring Ch3 Diagnosis and Assessment.ppt9/3/201327Computerized Axial Tomography (CT or CAT scan)

Reveals ___________________ abnormalities by detecting differences in tissue densitye.g., enlarged ventricles Magnetic Resonance Imaging (MRI)Similar to CT but higher quality

fMRI (___________________ MRI)Images reveal function as well as structureMeasures blood flow in the brain (BOLD=blood oxygenation level dependent)

Positron Emission Tomography (PET scan)Brain functionNeurobiological Assessment: Brain ImagingKring Ch3 Diagnosis and Assessment.ppt9/3/201328Postmortem studies

Metabolite assaysMetabolite levels ___________________ of neurotransmitter breakdown found in urine, blood serum or cerebral spinal fluidMay not reflect actual level of neurotransmitterCorrelational studies

Neurobiological Assessment: Neurotransmitter AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/201329NeuropsychologistStudies how brain abnormalities affect thinking, feeling, and behavior

Neuropsychological TestsReveal performance deficits that can indicate ______ of brain malfunction Halstead-Reitan batteryTactile Performance Test-TimeTactile Performance Test-Memory Speech Sounds Perception TestLuria-Nebraska batteryAssesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc. Neurobiological Assessment: Neuropsychological Assessment Kring Ch3 Diagnosis and Assessment.ppt9/3/201330PsychophysiologyStudy 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)Brains electrical activity measured by electrodes placed on scalpPsychophysiological AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/201331Cultural __________ in AssessmentMeasures developed for one culture or ethnic group may not be valid or reliable for another. Not simply a matter of language translationMeaning may be lost Cultural bias can lead to minimizing or exaggerating psychological problems

Cultural and Ethnic Diversity and AssessmentKring Ch3 Diagnosis and Assessment.ppt9/3/201332Increase graduate students sensitivity to cultural issues Insure participants understanding of task

Establish rapport

Distinguish cultural ___________________ from cultural stereotyping (Lopez, 1994)Conclusions should be tentative and alternative hypotheses should be entertainedStrategies to Avoid BiasKring Ch3 Diagnosis and Assessment.ppt9/3/201333