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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

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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.

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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



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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



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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



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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



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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



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Figure 3.1: Timeline for DSM-5



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Figure 3.2: Multiaxial Classification System in DSM-IV-TR and Likely DSM-5



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Table 3.1: Descriptions of Mania in DSM-II vs. DSM-IV-TR



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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



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Figure 3.3: Chapters in DSM-IV-TR and DSM-5



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Figure 3.3: Chapters in DSM-IV-TR and DSM-5



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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



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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?



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Figure 3.5: DSM-5 Severity Rating Scale for Depression



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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



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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.



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Table 3.2: Twelve- Month Prevalence Rates of the Most Common Diagnoses by Country



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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



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Table 3.3 Number of Diagnostic Categories per Edition of DSM



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Figure 3.6: Interrater Reliability

Extent to which clinicians agree on the diagnosis



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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)



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Figure 3.7:Construct Validity of Diagnostic Categories



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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.



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Table 3.4: Rates of Marital Distress and Missed Work Days Among People with Mental Illness in the Past Year



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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.



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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



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Table 3.5: Interrater Reliability of Selected DSM-IV-TR Diagnoses



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Figure 3.8: Sample Item from SCID



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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



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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



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Figure 3.11: Hypothetical MMPI-2 Profile



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Figure 3.12: Sample Inkblots Similar to Rorschach Test



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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



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Behavioral and Cognitive Assessment

Focus on aspects of environment

Characteristics of the person

Frequency and form of problematic behaviors

Consequences of problem behaviors



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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



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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



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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



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Table 3.7: Psychological Assessment Methods



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Table 3.8: Neurobiological Assessment Methods



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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



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CT Scans

fMRI Images PET Scans



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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



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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.



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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



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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



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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



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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.



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