ADIS, CAPS, & Clinical Significance
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Transcript of ADIS, CAPS, & Clinical Significance
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8/13/2019 ADIS, CAPS, & Clinical Significance
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ADIS, CAPS, and Clinical Significance
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DSM-IV-TR Diagnosis & formulation
Diagnoses founded in behavioral descriptors
Behavioral descriptors = behavioral excessesor deficits
Through description of problem, it can be understood
Through understanding, the problem can begin to be
predictedto occur under certain circumstancesandconditions (its lawful)
Prediction lends itself to theoretical control, through thecontrol of conditionsthat predict the problem behavior
Therefore, diagnosis is the foundation for formulationand treatment
Interviewingdescription or formulation of problempredictionintervention or control over problem
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Open/closed-ended questions: Is the writing on the wall?
Unstructured interviewingvalidly obtains info.
What is obtained?
However, is it reliable? reliability vs. validity
Structured interviewing hasbeen established as both
reliable and valid. What about therapeuticrelationship effects?
Research re: Structure-driventherapists
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Structured interviewing: Friend or foe?
Managed care:Limitingtreatment to reduce costs (i.e.,
pencil-pushing/actuarialphenomenon).
Accountability: Practicingwithin supported boundaries(e.g., empirically evaluated,supported, and evidence-based).
Research-needs:Screeningresearch subjects in / out.
This stated / realized: Feelingsabout diagnosis? ( + / - )
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Semi - & structured - interviewing: Benefits
to the beginning interviewer & therapist
With experience structure Provides guidelines for what to
do/say next Improved reliability provides
variance due to chance
Improved hits provide increased
rates correct conceptualization,in turn leading to correct
treatment
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decisions, decisions so many decisions, so
little time what to do oh, what to do?!?!?!?
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ADISIV: Anxiety Disorders
Interview Schedule for DSM-IV
Developed because psychosocial
treatments for anxiety disorders
have become highly specific
SCID lacked depth and detail
Again, systematic/detailed
questioning necessary for a
reliable differential diagnosis
ADIS provides accurate
diagnosis & functional analysis
of problems/symptoms
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Bennies of the ADIS
Asks some dichotomous questions (yes/no answers)
Asks dimensional questions, which are important fordiagnostic clarity, comparativeness, and as an outcome
prognostic indicator Depth of detail assists clinical judgment more than others;
nonetheless, all require not only familiarity with therespective instruments, but also of the DSM-IV since theirdecision-tree line of questions are based upon DSMdescriptors and templates of disorders
ADIS carries added advantage to researchers, especiallyfor anxiety disorders
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ADIS structure & form
Utilizes a semi-structured format, allowing for both a
structured format for accuracy and reliability, but also for
clarification
Incorporates introduction section and summary sections
Provide standard questions, which in the ADIS are bold
Starts with dichotomous questions, and then funnels down
to specific dimensional questions
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ADIS structure
All modules start with the INITIAL INQUIRY questions,
which are typically dichotomous in nature; This allows the
interviewer to decide whether to proceed into the module
At the end of the interview, the Hamilton scales (anxiety
and depression) are administered
Hamiltons are followed by a summary section, where the
patient is asked what the primary issue is they want help
with, as well as whether they feel like there was anything
the interviewer missed and/or didnt ask about
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Clinical significance and reliable change
Question: How do you gauge change? Better Q: What constitutes change?
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How to measure change in psychotherapy
Change used to be artifact of clinical opinion Tx thought or felt pt was better/worse
Reliability non-existent & meaningless validity
No meaningful (statistical) legitimacy
Stronger change indicators demanded by MHC
Pure statistical change not useful either What does 25% or 35% (responder) change mean?
Without a sense of whether it matters, it is useless
More usable ways to monitor change needed
How compare with non-clinicals (normals)?
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What is normal versus not?
Human functioning located
on rangeof instrument of
interest
Typically, hi score worse andlow score better
Monitor score behavior over
treatment and follow-up data
points
Determine how patient
compares to average joes
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Teaching statistics to non-researchers
Labcouch gap
Chasm unacceptable
Average tx is stats
aversive Math anxiety rampant
Simple formulas better
Illustrations critical Use tx own cases
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Clinical decision-making and change indexes
Three easily definable/quantifiable C targets1. Cross clinical threshold C dont stop until
a. Once passed C: Ok to begin to fade
2. Within 1 std dev alright to begin termination/stop
a. Introduce relapse prevention & generalization trainingb. Discuss importance of maintenance & mentor programs
3. At non-clinical (normal) mean, stop
a. Offer booster sessions ( 3 in 6-12 months)
4. Below normal ---just bennie
Reliable change: Dont consider fading, or
discussions of termination until RCI 1.96
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PTSD: Tracking progress for CS and RCI
Clinicals PTCI 1
C PTCI 1
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A scienceof clinical psychology
Since 1600s the cornerstone of testability hasserved as foundation of scientific practice
With increasing specialization/sophistication,
people understand less and less about many
techniques and underlying concepts
Opposition to ESTs not on basis of evidence but by
denial of efficacy of rational inquiryor insistence
upon equal epistemic merit of alternatives
Flight from- and rejection of- reason = danger
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Is psychological science an oxymoron?
Subversion of reason and knowledge is leavingclinical psychology without a formal guiding,
scientific compass/foundation
Snake oil gains acceptability & credibility
Derogation of science is old, and people are
aligning away from logic, reason, and truth
Humanism gains, science loses
Under light of reason, superstition can be burnedaway to reveal a truly rational society
In such rational truth, charlatanism cannot hide
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Beliefs, myths, and behaviors
Inactive / less active ingredients detract from optimalprogress / outcome because detracts time afforded
more active / effective pieces
Worst case, become equivalent of safety bhrs
Faith: A belief not supported by logical proof or
material evidence
Equivalent to superstition, myth, and outright lies
Act in non-scientific/anti-scientific ways Subordinates truth-seeking to subjective preference,
inclination, expediency, or opportunistic consideration
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Dodo-Bird Verdict (1936)
All treatments are effective,
and equally so
Everyonehas won, and allmust have prizes
Should actively ingredient
treatments be held as
equivalents of everything fromless active to sham treatments?
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When a true genius appears in the world, you
may know him by this sign, that the duncesare all in confederacy against him
Jonathan Swift
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Conclusions
Without understanding theissues that bring your patientto see you, you mightmisapply treatment.
Learn how to systematicallyand critically think about your
patients.
Dont be a Prof. Gallagher
Pendant