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Assessing Psychological Disorders. Diagnosis is a essential toolConsistent framework and set of criteria for describing mental disordersHelps clinicians develop treatment plansCommon languageLess vulnerable to law suits3rd party payments. Assessment.. Useful information for clientsKnowing who
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1. Clinical Assessment, Diagnosis and research Methods Raw data to half baked ideas
2. Assessing Psychological Disorders Diagnosis is a essential tool
Consistent framework and set of criteria for describing mental disorders
Helps clinicians develop treatment plans
Common language
Less vulnerable to law suits
3rd party payments
3. Assessment…. Useful information for clients
Knowing who you can treat and who you need to refer
4. Assessment: Key Concepts Reliability:
consistency
Validity
Measures what it is designed to measure
Can be reliable but not valid , but cannot be valid unless reliable
Standardization: testing, treatment
5. Clinical interviews Primary tool
Past/present behavior
Attitudes
Emotions
History
Life circumstances: job, social support, etc
6. Mental Status Exam Appearance and behavior
Thought processes
Mood and affect
Intellectual functioning
Sensorium
Oriented in the 4 spheres (date, time, place, person)
7. Physical Examination Multitude of physical problems that show up as mental/emotional problems
Drugs
Hyperthyroidism: anxiety
Hypothyroidism: depression
Brain tumors
8. Behavioral Assessment ABC’s: Antecedents, Behaviors, Consequences
Both formal and informal
Self-monitoring
9. Psychological Testing Evaluate cognitive, emotional and behavioral functioning
Can help in diagnosis
Help determine severity (Beck Depression Inventory)
10. Projective Tests Psychodynamic perspective
Ambiguous stimuli leads to projections of unconscious thoughts and fears
Controversial: weak psychometric qualities
11. Projective Testing Rorschach Inkblock Test
Thematic Apperception Test (TAT)
12. Personality Testing MMPI: Minnesota Multiphasic Personality Inventory
549 questions
Lots of research on this instrument
Looking for patterns of responses
Lie factor
13. Myers Briggs Type Indicator Where, primarily, do you direct your energy?
How do you prefer to process information?
How do you prefer to make decisions?
How do you prefer to organize your life?
14. Intelligence Tests Stanford-Binet
Weschler Intelligence Scale for Children (WISC-R)
Weschler Adult Intelligence Survey (WAIS)
15. Neuropsychological testing Language skills
Attention and concentration
Memory
Motor skills
Perceptual abilities
Learning
Abstract thought
16. Neuropsych.. Guesses about brain impairment
Assess abilities and liabilities
Bender Gestalt
Luria
Halstead
17. Neuropsych.. Shortcomings:
False positives
False negatives
Very expensive and highly specialized training
18. Neuroimaging Measurements of brain structure and function
The new frontier
Structural abnormalities, tumors, injuries: MRI, CAT
Function: interactions of blood, oxygen and glucose in active parts of brain:
PET, SPECT, functional MRI
19. Psychophysiological assessment Electroencephalogram: electrical activity in the brain (EEG)
Electromyograph: muscle tension (EMG)
Heart rate, respiration, skin temperature
Used in the assessment of disorders with strong emotional component
20. Diagnosing Psychological Disorders “Faced with chaos and pain, we fall back on the human impulse to label as a way of distancing ourselves while giving ourselves the illusion that we are doing something.”
Salvador Minuchin
21. Classification Construct categories and assign people to those categories on the basis of shared attributes
Taxonomy: scientific classification
Nosology: taxonomic system classifying psychological and medical phenomena
22. DSM IV-TR Diagnostic and Statistical Manual of the American Psychiatric Association, 4th edition, Text Revision
23. Approaches to classification Categorical
Assumption that conditions are unique. One set of criteria and all must be met. Common in medicine but not psychopathology
Dimensional
Scales, ratings, degrees of symptoms. Great idea but hard to accomplish
24. Approaches to classification.. Prototypical approach
Categorical but allows for variation. Identifies essential features and then offers a variety of symptoms that person could have. DSM based on this approach.
25. Diagnosis of Major Depressive Disorder, Single Episode A. The person experiences a single major depressive episode:
For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.
26. Diagnosis of Major Depressive Disorder, Single Episode
Depressed mood. For children and adolescents, this may be irritable mood.
A significantly reduced level of interest or pleasure in most or all activities.
A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.
Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).
Behavior that is agitated or slowed down. Others should be able to observe this.
27. Diagnosis of Major Depressive Disorder, Single Episode Feeling fatigued, or diminished energy.
Thoughts of worthlessness or extreme guilt (not about being ill).
Ability to think, concentrate, or make decisions is reduced.
Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.
The persons' symptoms do not indicate a mixed episode.
The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.
The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.
28. Diagnosis of Major Depressive Disorder, Single Episode The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).
29. Multiaxial system Axis I: Clinical disorder
Axis II: Personality Disorders, Mental Retardation
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental Problems
Axis V: Global Assessment of Functioning
30. Problems with DSM Fuzzy boundaries
Comorbidity
Misuse “reification”
People who don’t fit categories
Exp: Depressive Disorder, NOS
31. B. Another disorder does not better explain the major depressive episode.C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).
32. Key Questions for Diagnosis What are the primary symptoms?
What is the approximate duration of the disorder?
How severe are the symptoms?
Has a specific cause or precipitant for the symptoms been identified?
Seligman (1996)