Introduction to Clinical and Counselling Psychology 04

7/24/2019 Introduction to Clinical and Counselling Psychology 04

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Diagnosis & Classification

Zoltan Kovary PhD

ELTE PPK

Department of Clinical Psychology and Addictology

20!"# A$t$mn %emester


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%etch for today's lect$re

(ormality & pathology

The theoretical)$estions of ta*onomy

(osologic systems +istrorical ,acgro$nd

Contemporary systems Diagnostic -or & tools

in clinical psychology


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The )$estions of normality& pathology


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(ormality and pathology./

. has different interpretations edical

1$ristic %tatistical oral

./are relative n time n space


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The criteria forpsychological normality

A,illity to adapt A,ility to en3oy

nterpersonalcompetence

ntellect Emotional and

motivational controland stress tolerance

%ocial attit$des4empathy5 intimity

Prod$ctivity A$tonomy and self

confidence Positive self image

ntegrity


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Criteria for a,normal mentalf$nctioning & ,ehavior4 the 6 Ds

ental f$nctioning and

,ehavior are a,normalif it's.Deviant

Ca$sing DistressDisfunctional

Dangerous


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What is dysfunctional in the cases ofdisorders?

Etiological models of mental disorders

7rganic",iological"medicalmodel 8rain f$nctioning

Dynamic model Personality"character

8ehaviorist model 8ehavior

Cognitive model

nformation processing Phenomenological model

%ym,oli9ation of e*periences


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What kind of illneses are mentaldisorders?

Classic /big diseasecategories

%pecific etiology :ell o$tlined

symptomatology Typical clinical co$rse 7$tlined prognosis

;eporta,le changesSomatic illnesses

Small diseasecategories

Diverse etiology %imilar symptomatology %imilar clinical co$rse ore or less predicta,le

prognosis

Detecta,le changes arenot al-ays

Mental illneses/disorders


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Ta*onomy4

the )$estions ofclassification


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Classication of mentaldisorders

Paradigms

Clinical testa,ility

E*plicit criteria for disorders Concentration of informations

Ed$cation5 research5 statistics

Principles Classifia,le

$t$ally e*cl$sive categories %eparated


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Historical development ofdiagnostic categories

+ippocrat

Mania, hysteria

(e$rosis

:illiam C$llen @/th cent/B

?re$d @20th cent$ryB

Actual neuroses Psychoneuroses

Psychosis

Emil Kraepelin @th cent/B Dementia praecox, PMD

E$gene 8le$ler @20th cent/B

Schizophrenia Personality disorder

K$rt %chneider Characteropathia

?ran9 Ale*ander Characterneuroses


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?re$d's contri,$tion

Actual neuroses

(e$rasthenia

An*iety ne$roses

+ipochondria

Psychoneuroses +ysteria 7,sessional ne$roses

An*iety hysteria @pho,iaB

Narcissistic neuroses @paraphreniaB

Paranoia

Dementia praeco* @sch/B

Traumatic neuroses

Characterne$roses @?/ Ale*anderB

Pathone$roses @?erenc9iB


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Contemporary nosologic

systems


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International Classication of

Diseases

CD 4 # A ,rief description of mental

dist$r,ances CD 04 2

($m,er of categories increased Tighter criteria Coding system ,ased on

n$m,ers ore precise differentiation of

s$,gro$ps Class9ic categories

(e$rosis (e$rasthenia

(o itemi9ed diagnosticcriteria

CD is coming in 20


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Categories of mental and,ehavior disorders in CD 0


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D! " I# D% 4 !2 D% 4 0

Descriptive clinical categories temi9ed5 e*plicit5 operational

criteria (e$rosis re3ected

D% 4 6 $ltia*ial diagnostics4

/ Clinical disorder

/ Personality disorders"mental

retardation / %omatic state

/ Psychosocial and environmentalpro,lems

/ =lo,al Assessment of ?$nctioning@=A? FB

D% 4 20G $pdate


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Categories of D%


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$e% diagnostic categoriesin D! #

Comple* posttra$matic stressdisorder

Depressive personalitydisorder

(egativistic @passiveHagressiveB personalitydisorder

7lfactory ;eference %yndrome ;elational Disorder

%in Picing Disorder 8inge Eating Disorder


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=ro$ps of disorders in D%


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Contradictions in psychiatricdiagnosing and their handling

$ltiple diagnosesI $ltia*ial diagnosis

D% J

Comor,idity theory %pectr$m & contin$$m

approaches


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The mood spectr$m & disorders


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The contin$$m hypothesis of eatingdisorders according to andereycen

Anorexia

Hiperoxi

a

&ulimianervosa

Dieting"starving

elf"inducedvomiting

'sing prgative

(lean"fat)persons

ta*lee+tremeo*esity

Extreme leanness Normal weight Extremeobesity

BulimarexiaAnorexiaNervosa


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Psychodynamic approach to clinical diagnosis.

Kernbergs personality organization model

Temperament Introversion vs extraversion

Personality organization

Psychotic psychotic disorders Borderline severe personality disorders!

perversions! addictions

(Intermediate" mild personality disorders

Neurotic symptomatic neuroses

#riteria o$ personality organization

%atureness o$ ob&ect relations 'tability o$ sel$(identity

Personality structure ) $unctions 'uperego*$unctions

+go*$unctions

Id sympotoms


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organi-ations and personalitydisorders


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The diagnostic -or in

clinical psychology


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Diagnosis and diagnostics

Diagnosis The identification of the nat$re

and ca$se of a certain

phenomenon Diagnostics

%cientific discipline

The process of diagnosing Diagnosis and

differentialdiagnosis Prognosis ndication and contraindication


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The differences ,et-een psychaitric andpsychological"psychotherape$tic diagnosis

Psychiatric diagnosis

Diagnostic classification

Treatment plan

Process of treatment

Psychological/psycho-therapeutic diagnosis

st level Psychiatric diagnosis

ndication

2nd level Personality str$ct$re & dynamics

Prognosis H ndication

Grd level ;ating s$ita,ility for

psychotherapy otivational5 relationship5

s$ita,ilty5 matching5 environmentaletc/ diagnoses


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The process of diagnosing inclinical"psychoterape$tic -or

s$ally the first phase of the therape$ticprocess @H! occ/B

The $nity of diagnosis5 prognosis andindication

The role of the psychologist"therapist

The role of the relationship

The role of time

The )$estion of depth

The therape$tic effects of the diagnosticphase

Psychoed$cation 8$ilding relationship %pecific"nonspecific effects

Th t l f li i l


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The tools of clinicalpsychodiagnostics

:hat can -e $seI Depends on the.

nstit$tional ,acgro$nd

Diagnostic targets

Clinical question(sB

Tools of diagnostics ntervie-"e*ploration

8ehavioral diagnostics

Psychological tests

Plan of diagnostic process ntervie-"e*ploration

Test ,attery Performance tests T+E( personality tests


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E*ploration"intervie-

8asic tool of assessment Contains the story of.

the disease @cross sectionB The -hole life @longit$dinal

sectionB 8asic forms

nstr$ct$red %emiHstr$ct$red

%tr$ct$red ersions

?irst intervie- @psychotherapyB

%$rvey intervie- Psychodynamic Cognitive etc/


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8ehavioral diagnostics

7,3ectively o,servea,le ,ehavior 7,servations dentifing -ellHdefined $nits

pro,lem ,ehaviors :hat does he"she doI

:hat doesn't he"she doI

Doesn't identify personality traitsor inner str$ct$re & dynamics

mportance of relationship -ith

the environment Time dynamics of formation

! " (S# $# C# C%


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Tes9tvi9sglato

Performance tests

?oc$sing on partic$lar

f$nctions emory

Attention

ntelligence tests M

;aven Progressive atri* ntelligence str$ct$re

:echsler test

Personality tests

7,3ective tests %cales5 simple inventories

8D

Comple* tests P

Pro3ective tests

Associative @;orschachB Choice @%9ondiB Completion @P?TB Constr$ctive @TATB E*pressive @Dra-ing testsB

Introduction to Clinical and Counselling Psychology 04

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