DiagnosisDiagnosis

Diagnosis: Labeling a set of symptoms. Does the problem meet the criteria for a psychological disorder?

Syndrome: a set of behavioral or psychological symptoms that tends to occur together.

Diagnostic & Statistical Diagnostic & Statistical Manual Manual of Mental Disorders (DSM)of Mental Disorders (DSM)

Compiled by the American Psychiatric AssociationEditions: DSM (1952), II (1968), III (1980), III-R (1987), IV (1994), IV-TR(2000)The official manual for diagnosing psychological disorders in U.S. since 1952.Provides specific, concrete criteria for each disorder.

Assumptions of the DSM

Medical Model – psychological disorders as “diseases”Atheoretical Orientation – descriptive rather than explanatoryCategorical Approach – disorders are grouped into discrete categoriesPrototypical Approach – identifies certain essential characteristics, while allowing for nonessential variationsMultiaxial System – assesses 5 axes or areas of functioning

The 5 AxesThe 5 Axes

Axis I: Clinical Disorders - all major disorders and adjustment disordersAxis II: Personality Disorders & Mental Retardation - lifelong, chronic conditions

Axis III: General Medical Conditions - causes, consequences, or coincidentalAxis IV: Psychosocial & Environmental Stressors - causes, consequences, or coincidentalAxis V: Global Assessment of Functioning – rating of overall level of functioning

Axis I Developmental/Childhood DisordersCognitive Disorders (Delirium, Dementia, Amnesia, etc.)Substance-Related DisordersSchizophrenia & Other Psychotic DisordersMood DisordersAnxiety DisordersDisorders due to a General Medical Condition

Axis I continuedSomatoform Disorders Factitious DisordersDissociative DisordersSexual & Gender Identity DisordersEating DisordersSleep DisordersAdjustment DisordersImpulse Control Disorders“V” Codes

Axis II

Paranoid Schizoid SchizotypalAntisocialBorderline

Histrionic NarcissisticAvoidant DependentObsessive-Compulsive

Mental Retardation

Personality Disorders:

Axis IV: Psychosocial & Environmental Problems

Primary support groupSocial environmentEducationalOccupationalHousingFinancialAccess to health care servicesLegal system/ crime

Axis V: Global Assessment of Functioning

91-100 no sx, superior functioning81-90 absent or minimal sx, good functioning71-80 slight, transient sx or impairment in

functioning61-70 mild sx & impairment in functioning51-60 moderate sx & impairment in functioning41-50 serious sx & impairment in functioning31-40 major impairment in functioning, difficulties

with reality testing or communication21-30 serious impairment in communication &

judgment, psychotic sx, inability to function11-20 danger to self or others, gross impairment in

communication1-10 persistent danger to self or others, inability to

maintain hygiene

Issues to Consider in Issues to Consider in DiagnosisDiagnosis•Culture & Ethnicity

•Gender

•Age

•Social Class

•The Danger of Labeling

•Stigmatization

Psychological Assessment

The systematic evaluation and measurement of the psychological, biological, and social factors that have the most influence on the person’s functioning.In an individual presenting with a possible psychological disorder, information is gathered about the person’s symptoms.

Clinical InterviewPsychological symptoms: current & past Family history of psych problemsCoping strategiesLife events: recent & significantSocial support and functioningCulture, ethnicity, religion, SESMedical conditions & medicationsDrug & alcohol useIntellectual and cognitive functioningMotivation for treatment

The Clinical Interview

Unstructured Interviews

Semi-Structured & Structured Interviews Structured Clinical Interview for the DSM (SCID) Diagnostic Interview Schedule (DIS)

Limitations Resistance to being assessed or disclosing

information Biased presentation of information – omission,

distortions, outright lying

Mental Status Exam1) Appearance & Behavior – appearance,

grooming, attire, mannerisms, posture, expressiveness, activity level, bodily movements

2) Thought Processes – rate, flow, & continuity of speech, thought content, obsessions, delusions

3) Mood & Affect – expression, intensity, appropriateness, reactivity, range, & personal experience of emotion.

4) Intellectual Functioning – rough estimate of cognitive strengths & weaknesses based on vocabulary, memory, attention, insight, knowledge.

5) Sensorium – general awareness of surroundings in terms of person, place, & time.

BEHAVIORAL ASSESSMENTPurpose: To identify & monitor target behaviors and to determine the factors that influence them.Methods:Behavioral Observation – naturalistic vs. analogue, structured vs. unstructuredBehavioral Self-Report & Behavioral Self-Monitoring – assessing one’s thoughts, feelings & behaviors in specific situations & contextsLimitations: reactivity

Personality & Diagnostic Testing:Self-Report

Inventories/QuestionnairesPurpose: -to assess symptoms & diagnose disorders-to assess one’s typical ways of thinking, feeling, and behavingExamples:•Beck Anxiety Inventory (BAI)•Hamilton Rating Scale for Depression (HRSD)•Minnesota Multiphasic Personality Inventory (MMPI-2)•Millon Clinical Multiaxial Inventory (MCMI-III)•Myers Briggs Type Indicator (MBTI)

Projective Tests

Examples: Rorschach Inkblot Test; Thematic Apperception Test; Sentence Completion Test; Draw-A-Person Test

Purpose: assesses person’s underlying concerns, conflicts, and desires

Strengths: doesn’t rely on person’s level of self-insight or willingness to shareWeaknesses: usefulness for diagnosis, reliability and validity, subjective interpretation

Intelligence TestingPurposes: •Assess cognitive strengths and weakness•Detect mental retardation or brain damage•Identify special needs or gifted children•Screening in occupational or military settings

Examples:•Wechsler Intelligence Scales (WAIS-III, WISC-III)•Stanford-Binet Intelligence Test (SB-IV)Limitations:•Differing conceptions of intelligence•Cultural and class bias

Psychophysiological Assessment

Electroencephalogram (EEG) – measures brain wave patterns & electrical activity in the brain

Electrocardiogram (EKG) – measures cardiovascular functioning

Electromyography (EMG) – measures muscular tension

Galvanic Skin Response (GSR) – measures electrodermal response, e.g. sweat gland activity

Neuropsychological Assessment

Purpose: • Assess motor skills, sensory &

perceptual abilities, language, attention, concentration, memory, & learning

• Detect brain abnormalities, damage, & deterioration

Examples:• Halstead-Reitan Neuropsych Battery• Luria-Nebraska Neuropsych Battery

Neuroimaging Techniques

Purpose: to test for brain activity, structure, & damage, e.g. injury or tumor

Computerized Tomography (CT/CAT scan) – produces an x-ray image of the structure of the brain

Magnetic Resonance Imaging (MRI) – produces high resolution pictures of brain anatomy, activity, and functioning

Positron Emission Tomography (PET) -displays brain activity & metabolism

Problems in Assessment

Self-Report IssuesLack of self-awarenessDiscomfort with self-disclosure

Cultural BiasLanguage barriersCultural differences in the manifestation of disorders & presentation of symptoms