PowerPoint Lecture Notes Presentation Chapter 2 …€¦ · PPT file · Web view ·...
Transcript of PowerPoint Lecture Notes Presentation Chapter 2 …€¦ · PPT file · Web view ·...
PowerPoint Lecture Notes Presentation Chapter 2 Current Paradigms in Psychopathology
PowerPoint Lecture Notes Presentation Chapter 3 Diagnosis and Assessment
Abnormal Psychology, Twelfth Edition
by Ann M. Kring,
Sheri L. Johnson,
Gerald C. Davison,
& John M. Neale
Copyright 2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
1
Chapter Outline
Chapter 3: Diagnosis and Assessment
I. Cornerstones of Diagnosis and Assessment
II. Classification and Diagnosis
III. Psychological Assessment
IV. Neurobiological Assessment
V. Cultural and Ethnic Diversity and Assessment
2012 John Wiley & Sons, Inc. All rights reserved.
8/16/2013
2
Diagnosis and Assessment
Diagnosis
The classification of disorders by symptoms and signs.
Advantages of diagnosis:
Facilitates communication among professionals
Advances the search for causes and treatments
Cornerstone of clinical care
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
3
Reliability
Consistency of measurement
Inter-rater
Observer agreement
Test-retest
Similarity of scores across repeated test administrations or observations
Alternate Forms
Similarity of scores on tests that are similar but not identical
Internal Consistency
Extent to which test items are related to one another
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
4
Validity
How well does a test measure what it 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
Criterion validity
Extent to which a measure is associated with another measure (the criterion)
Concurrent
Two measures administered at the same point in time
Predictive
Ability of the measure to predict another variable measured at some future point in time
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
5
Validity
Construct validity (Cronbach & Meehl, 1955)
A construct is an abstract concept or inferred attribute
Involves correlating multiple indirect measures of the attribute
e.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 categories
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
6
Classification and Diagnosis
Diagnostic and Statistical Manualof Mental Disorders (DSM) published by American Psychiatric Association
First edition published in 1952
Current edition: DSM-IV-TR (fourth edition, revised)
Published in 1994, text revised in 2000
New edition expected in 2013: DSM-5
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
7
Figure 3.1: Timeline for DSM-5
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
8
Figure 3.2: Multiaxial Classification System in DSM-IV-TR and Likely DSM-5
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
9
Table 3.1: Descriptions of Mania in DSM-II vs. DSM-IV-TR
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
10
Likely Changes in DSM-5
Changes in multiaxial system
Five axes in DSM-IV-TR changed to two axes in DSM-5
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
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
11
Figure 3.3: Chapters in DSM-IV-TR and DSM-5
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
12
Figure 3.3: Chapters in DSM-IV-TR and DSM-5
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
13
Likely Changes in DSM-5
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 subthreshold cases
DSM-5 adds a Continuous Severity Rating
Dimensional system describes degree of severity of disorder
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
14
Figure 3.4: Categorical Versus Dimensional Systems of Diagnosis
Categorical
Presence/absence of a disorder
Either you are anxious or you are not anxious.
Dimensional
Rank on a continuous quantitative dimension
Degree to which a symptom is present
How anxious are you on a scale of 1 to 10?
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
15
Figure 3.5: DSM-5 Severity Rating Scale for Depression
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
16
Likely Changes in DSM-5
Personality Disorder Diagnoses
DSM-IV-TRs 10 different personality disorders will likely be reduced to 5 types in DSM-5
New Diagnoses
Disruptive mood dysregulation, mixed anxiety depressive disorder, language impairment disorder, etc.
Combining Diagnoses
Substance use disorder replaces substance abuse and substance dependence, etc.
Clearer Criteria
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
17
Ethnic and Cultural Considerations
Mental illness universal
Culture can influence:
Risk factors
Types of symptoms experienced
Willingness to seek help
Availability of treatments
DSM-IV-TR includes:
Enhanced cultural sensitivity
Appendix of 25 culture-bound syndromes
Amok, Drat, Koru, Taijin kyofusho, Hikikomori, etc.
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
18
Table 3.2: Twelve- Month Prevalence Rates of the Most Common Diagnoses by Country
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
19
Criticisms of the DSM
Too many diagnoses?
Should relatively common reactions be pathologized?
Comorbidity
Presence of a second diagnosis
45% of people diagnosed with one disorder will meet criteria for a second disorder
Reliability in everyday practice
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
20
Table 3.3 Number of Diagnostic Categories per Edition of DSM
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
21
Figure 3.6: Interrater Reliability
Extent to which clinicians agree on the diagnosis
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
22
Construct Validity of Diagnostic Categories
Construct validity of highest concern
Diagnoses are constructs
For most disorders, no lab test available to diagnose with certainty
Strong construct validity predicts wide range of characteristics
Possible etiological causes (past)
Clinical characteristics (current)
Predict treatment response (future)
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
23
Figure 3.7:Construct Validity of Diagnostic Categories
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
24
Criticisms of Classification
Stigma against mental illness.
Treated differently by others
Difficulty 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 similarities
Relevant information may be overlooked.
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
25
Table 3.4: Rates of Marital Distress and Missed Work Days Among People with Mental Illness in the Past Year
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
26
Psychological Assessment
Techniques employed to:
Describe clients 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.
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
27
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
Structured Clinical Interview for Axis I of DSM (SCID)
Good interrater reliability for most diagnostic categories
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
28
Table 3.5: Interrater Reliability of Selected DSM-IV-TR Diagnoses
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
29
Figure 3.8: Sample Item from SCID
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
30
Assessment of Stress
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 individuals circumstances
Self-Report Stress Checklists
Faster way to assess stress
Test-retest reliability low
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
31
Psychological Tests
Personality Tests
Self-reported Personality Inventories
Minnesota Multiphasic Personality Inventory (MMPI)
Yields profile of psychological functioning
Specific subscales to detect lying and faking good or bad
Projective Tests
Rorshach Inkblot Test and Thematic Apperception Test (TAT)
Projective hypothesis
Responses to ambiguous stimuli reflect unconscious processes
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
32
Figure 3.11: Hypothetical MMPI-2 Profile
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
33
Figure 3.12: Sample Inkblots Similar to Rorschach Test
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
34
Psychological Tests
Intelligence tests (IQ tests)
Assess current mental ability
Wechsler Scales
Wechsler 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 examination
Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB)
Lower IQs associated with higher psychopathology and mortality
Performance on IQ tests impacted by Stereotype Threat
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
35
Behavioral and Cognitive Assessment
Focus on aspects of environment
Characteristics of the person
Frequency and form of problematic behaviors
Consequences of problem behaviors
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
36
Behavioral and Cognitive Assessment
Observe behavior as it occurs
Sequence of behavior divided into segments
Antecedents and consequences
Behavioral Assessments often conducted in lab setting
e.g., mother and child interact in a lab living room
Interaction observed through one-way mirror or videotaped for later coding
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
37
Self-Observation
Self-monitoring
Individuals observe and record their own behavior
e.g., moods, stressful events, thoughts, etc.
Ecological Momentary Assessment (EMA)
Collection of data in real time using diaries or smart phones
Reactivity
The act of observing ones behavior may alter it
Desirable behaviors tend to increase whereas undesirable behaviors decrease
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
38
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
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
39
Table 3.7: Psychological Assessment Methods
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
40
Table 3.8: Neurobiological Assessment Methods
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
41
Neurobiological Assessment: Brain Imaging
Computerized Axial Tomography (CT or CAT scan)
Reveals structural abnormalities by detecting differences in tissue density
e.g., enlarged ventricles
Magnetic Resonance Imaging (MRI)
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
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
42
CT Scans
fMRI Images PET Scans
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
43
Neurobiological Assessment: Neurotransmitter Assessment
Postmortem studies
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
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
44
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.
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
45
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)
Brains electrical activity measured by electrodes placed on scalp
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
46
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
Meaning may be lost
Cultural bias can lead to minimizing or exaggerating psychological problems
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
47
Strategies to Avoid Bias
Increase graduate students sensitivity to cultural issues
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
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
48
COPYRIGHT
Copyright 2012 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner.
2012 John Wiley & Sons, Inc. All rights reserved.
Kring Ch3 Diagnosis and Assessment.ppt
8/16/2013
49