Diagnosis

1. Diagnosis 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.

2. Diagnostic & Statistical Manual of Mental Disorders (DSM) • Compiled by the American Psychiatric Association • Editions: 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.

3. Assumptions of the DSM • Medical Model – psychological disorders as “diseases” • Atheoretical Orientation – descriptive rather than explanatory • Categorical Approach – disorders are grouped into discrete categories • Prototypical Approach – identifies certain essential characteristics, while allowing for nonessential variations • Multiaxial System – assesses 5 axes or areas of functioning

4. The 5 Axes Axis I: Clinical Disorders - all major disorders and adjustment disorders Axis II: Personality Disorders & Mental Retardation - lifelong, chronic conditions Axis III: General Medical Conditions - causes, consequences, or coincidental Axis IV: Psychosocial & EnvironmentalStressors - causes, consequences, or coincidental Axis V: Global Assessment of Functioning – rating of overall level of functioning

5. Developmental/Childhood Disorders Cognitive Disorders (Delirium, Dementia, Amnesia, etc.) Substance-Related Disorders Schizophrenia & Other Psychotic Disorders Mood Disorders Anxiety Disorders Disorders due to a General Medical Condition Axis I

6. Axis I continued • Somatoform Disorders • Factitious Disorders • Dissociative Disorders • Sexual & Gender Identity Disorders • Eating Disorders • Sleep Disorders • Adjustment Disorders • Impulse Control Disorders • “V” Codes

7. Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive Axis II Mental Retardation Personality Disorders:

8. Primary support group Social environment Educational Occupational Housing Financial Access to health care services Legal system/ crime Axis IV: Psychosocial & Environmental Problems

9. Axis V: Global Assessment of Functioning 91-100 no sx, superior functioning 81-90 absent or minimal sx, good functioning 71-80 slight, transient sx or impairment in functioning 61-70mild sx & impairment in functioning 51-60 moderate sx & impairment in functioning 41-50 serious sx & impairment in functioning 31-40 major impairment in functioning, difficulties with reality testing or communication 21-30 serious impairment in communication & judgment, psychotic sx, inability to function 11-20 danger to self or others, gross impairment in communication 1-10persistent danger to self or others, inability to maintain hygiene

10. Issues to Consider in Diagnosis • Culture & Ethnicity • Gender • Age • Social Class • The Danger of Labeling • Stigmatization

11. 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.

12. Clinical Interview • Psychological symptoms: current & past • Family history of psych problems • Coping strategies • Life events: recent & significant • Social support and functioning • Culture, ethnicity, religion, SES • Medical conditions & medications • Drug & alcohol use • Intellectual and cognitive functioning • Motivation for treatment

13. 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

14. Mental Status Exam • Appearance & Behavior – appearance, grooming, attire, mannerisms, posture, expressiveness, activity level, bodily movements • Thought Processes – rate, flow, & continuity of speech, thought content, obsessions, delusions • Mood & Affect– expression, intensity, appropriateness, reactivity, range, & personal experience of emotion. • Intellectual Functioning– rough estimate of cognitive strengths & weaknesses based on vocabulary, memory, attention, insight, knowledge. • Sensorium – general awareness of surroundings in terms of person, place, & time.

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

16. Personality & Diagnostic Testing: Self-Report Inventories/Questionnaires • Purpose: -to assess symptoms & diagnose disorders -to assess one’s typical ways of thinking, feeling, and behaving Examples: • 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)

17. Projective Tests Purpose: assesses person’s underlying concerns, conflicts, and desires Examples: Rorschach Inkblot Test; Thematic Apperception Test; Sentence Completion Test; Draw-A-Person Test Strengths: doesn’t rely on person’s level of self-insight or willingness to share Weaknesses: usefulness for diagnosis, reliability and validity, subjective interpretation

18. Intelligence Testing • Purposes: • 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

19. 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

20. 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

21. 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

22. Problems in Assessment Self-Report Issues • Lack of self-awareness • Discomfort with self-disclosure Cultural Bias • Language barriers • Cultural differences in the manifestation of disorders & presentation of symptoms