Assessment and Classification of Mental Disorders

1. 3 Assessment and Classification of Mental Disorders

2. Reliability • Degree to which a test or procedure yields the same results repeatedly under the same circumstances • Test-retest reliability • Same results when given at two different points in time • Internal consistency • Various parts of measure yield similar or consistent results

3. Reliability (cont’d.) • Interrater reliability • Consistency of responses when scored by different test administrators

4. Validity • Extent to which a procedure actually performs its designed function • Predictive validity • How well a test predicts a person’s behavior or response • Construct validity • How well a test or measure relates to the characteristics or disorder in question

5. Validity (cont’d.) • Content validity • How well a test measures what it is intended to measure • Assesses all areas known to be associated with a particular disorder

6. Standardization • Standard administration • Professionals administering a test must follow common rules or procedures • Standardization sample • Group of people who initially took the measure • Performance is used as standard or norm • Test-takers should be similar to the standardization sample for test to be valid

7. Assessment and Classification of Mental Disorders • Psychological assessment • Gathering information and drawing conclusions • Traits, abilities, emotional function, and more • Four main assessment methods • Observations • Interviews • Psychological tests and inventories • Neurological tests

8. Observations • Controlled (analogue) observations • Made in laboratory, clinic, or other contrived setting • Naturalistic observations • Informal observations made in a natural setting (schoolroom, office, hospital ward, home) • Usually in conjunction with an interview • Observe appearance and behavior

9. Interviews • Observe client and collect data about the person’s life history, current situation, and personality • Analyze • Verbal behavior • Nonverbal behavior • Content • Process of communication

10. Types of Interviews • Interviews vary in degree of structure and formality • Structured interviews • Common rules and procedures • Standard series of questions • Disadvantage: limit conversation • Advantage: collect consistent and comprehensive information

11. Mental Status Examination • Objective: evaluate client’s cognitive, psychological, and behavioral functioning • Uses questions, observations, and tasks • Clinician considers the appropriateness and quality of the client’s responses • Forms tentative opinion of diagnosis and treatment needs

12. Psychological Tests and Inventories • Standardized tools • Measure characteristics such as personality, social skills, and more • Projective personality tests • Test taker presented with ambiguous stimuli and asked to respond in some way • Rorschach Technique • Thematic Apperception Test (TAT) • Sentence-completion test • Draw-a-person test

13. Problems with Projective Personality Tests • Do not meet reliability and validity standards • Analysis and interpretation of responses subject to wide variation • May have limited cultural relevance

14. Self-Report Inventories • Used to assess depression, anxiety, or emotional reactivity • May involve completion of open-ended sentences • Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2) • Interpretation is complicated • Beck Depression Inventory (BDI)

15. The Ten MMPI-2 Clinical Scales and Sample MMPI-2 Tests (Partial)

16. Intelligence Tests • Primary functions • Obtain intelligence quotient (IQ), or estimate of current level of cognitive functioning • Provide clinical data • Wechsler scales • Used for ages 16 and older • Stanford-Binet scales • Used for ages 2 to 85

17. Criticisms of Intelligence Tests • Fail to consider the effects of culture, poverty, discrimination, and oppression • Do not consider multidimensional attributes of intelligence • Have a poor level of predictive validity • Do not accurately predict future behaviors or achievement • Motivation and work ethic may matter more

18. Tests for Cognitive Impairment • Bender-Gestalt Visual-Motor Test • Involves copying geometric designs • Halstead-Reitan Neuropsychological Test Battery • Differentiates patients with brain damage • Can provide valuable information about the type and location of the damage

19. The Nine Bender Designs

20. Neurological Tests • Allows noninvasive visualizations of brain structures • Electroencephalograph (EEG) • Computerized axial tomography (CT) • Magnetic resonance imaging (MRI) • Functional MRI (fMRI) • Diffusion tensor imaging (DTI) • Magnetoencephalography (MEG) • Positron emission tomography (PET)

21. Diagnosing Mental Disorders • Psychiatric classification system • Similar to a catalogue, with detailed descriptions of each disorder • Patterns of behavior are distinctly different • Each category accommodates symptom variations

22. Diagnostic and Statistical Manual of Mental Disorders (DSM) • Widely used classification system • DSM-I (1952): Identified 106 mental disorders • DSM-II (1968): Identified 182 disorders • Revisions (DSM-II, DSM-III, DSM-III-R, DSM-IV, DSM-5) increase reliability and validity

23. DSM-5 Disorders – Categories and Features

24. DSM-5 Disorders – Categories and Features (cont’d.)

25. Interrater Reliability of DSM-5 Diagnostic Categories

26. Interrater Reliability of DSM-5 Diagnostic Categories (cont’d.)

27. Dimensional Perspective • DSM-5 is a categorical model • Some professionals believe ineffective for diagnosis • Dimensional classification system • Disorders reside on a continuum from normal to severe forms of a disorder

28. Final Version of the DSM-5 • Remains a categorical system with exceptions • Exceptions to DSM-5 categorical system • Autism spectrum disorder • Risk syndromes • Indicate milder forms of well-established disorders • Enhanced assessment procedures • Allowing more than a “yes or no” answer

29. Other Attributes of the DSM-5 • Subtypes • Specifiers • Remission • Cost-cutting measures • Comorbidity • Presence of two or more disorders in the same person

30. Cultural Factors in Assessment • Determining whether a behavior is consistent with cultural norms • Responsibility of the clinician • Bias • DSM-5 includes guidelines for conducting a cultural assessment • 16 questions

31. Changes in the DSM-5 Classification System • Changes in the criteria for some disorders • May increase the number of individuals receiving a diagnosis • Addition of some disorders • Example: gambling disorder • Bereavement removed as an exclusionary criteria when diagnosing depression

32. Objections to Classification and Labeling • Labeling a person can lead to overgeneralization, stigma, and stereotypes • Labeling may lead a person to believe they possess characteristics associated with the label • Label are required by social systems • Do not provide precise information required by health care organizations

33. Contemporary Trends and Future Directions • Current trends • Increased reliance on the biological model • Advances based on biological and neurological research • Effort to discover specific biomarkers associated with different conditions • Increased consideration of psychological, social, and sociocultural factors • Growing consensus that mental health professionals not merely objective observers

34. Review • How do we know if psychological tests and evaluation procedures are accurate? • How do mental health professionals evaluate a client’s mental health? • How do professionals make a psychiatric diagnosis? • What changes are occurring that will affect assessment?