Psych 155 Part 7

psychopathology

the process of clinical assessment and diagnosis are central to the study of _________ and ultimately, to the treatment of psychological disorders

clinical assessment

systemic evaluation and measurement of psychological, biological, and social factors in an individuall presenting with a possivle psychological disorder

reliability, validity, standardization

CLINICAL ASSESSMENT

• to understand the different ways clinician assess psychological problems, we need to understand three basic concepts that help determine the value of our assessments

reliability

the degree to which a measurement is consistent

• if the three psychologists assess the same client and all consistently arrive at the same diagnoses, that demonstrates this

• about the consistency not necessarily if diagnosis is correct

validity

degree to which a measurement measure what it purports to measure

• in clinical assessment, it asks wheter our assessment is actually telling us what we think its telling us

  • am i measuring the right thing accurately?

standardization

degree to which a measurement administered, scored, and interpreted using the same procedures for exveryone

clinical interview

gathers information on current and past behaviors, attitudes, and emotions, as well as detailed history of the individual’s life in general

mental status exam

to organize obtained interview, the clinicians may use

mental status exam

exam involves systemic observation of an individual’s behavior

• this type of observation occurs when any one person interacts with another

appearance

MENTAL STATUS EXAM

• clinician notes any overt physical behaviors as well as the individual’s dress, general appearance, posture and facial expression

• slow and effortful motor behavior may indicate depression

thought process

MENTAL STATUS EXAM

• assess rate of speech

• flow and continuity

• meaning (ideas connected vs illogical)

• ideas seem unrelated or jump without clear links

• common in some patients with schizophrenia

mood

MENTAL STATUS EXAM

• predominant feeling state of the individual

  • more prolonged

affect

MENTAL STATUS EXAM

• refers to the feeling state that accomanies what we say at a given point

  • changes quickly

mood and affect

MENTAL STATUS EXAM

• not is the affect matches the mood that you are in

intellectual functioning

MENTAL STATUS EXAM

• clinicians form a rough estimate of intellectual functioning through conversation

vocabulary

MENTAL STATUS EXAM

• intellectual functioning

  • appropriate and varied vs very limited

  • avility to use abstractions and metaphors

  • memory during the interview

sensorium

MENTAL STATUS EXAM

• refers to the general awareness of our surroundings

• clinicians checks if the person knows what the date and time is

semi-structured clinical interviews

interviews are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner so that clinicians can be sure they have inquired about the most important aspects of particular disorders

physical examination

many problems presenting as disorders of behavior, cognition or mood may have a clear relationship to a temporary toxic state

• toxic state could be caused by bad food, the wrong amount or type of medicine, or onset of a medical consition

behavioral assessment

uses direct observation to assess formally an individual’s thoughts, feelings and behavior in specific situations or context

• more appropriate than an interview in terms of asssesing individuals who are not old enough or skilled enough to report their problems and experiences

antecedent, behavior, consequence

ABC’s of observation

• observational assessment is usually focused on the here and now

  • A

  • B

  • C

self-monitoring

the goal here is to help clients monitor their behavior more consistently

• when behaviors occur only in private, it is essential

reactivity

mere fact of being observed can change behavior

• this means that observational data can be distorted if we can’t consider this

psychological testing

include specific tools to determine cognitive, emotional, or behavioral responses that might be associated with a specific disorder and more general tools that assess long standing personality features, such as tendency to be suspiscious

projective tests

include a variety of methods in which ambiguous stimuli, such as pictures of people or things, are presented to people who are asked to describe what they see

• people project their own personality ang unconscious fears onto other people and things (ambiguous stimulu, reveal their unconscious thoughts

personality inventories

structured psychological tools designed to measure and evaluate a candidate’s personality traits

intelligence test

to predict who would do well in school

• develop a test that would identify “slow learners” who would benefit from remedial help

neuropsychological testing

assess brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks

neuroimaging pictures

used procedures are capable of measuring actual functioning of the brain, as opposed to its structure

clinical assessment

the process of gathering and organizing information about a person’s psychological functioning

diagnosis

process of determining wheter the particular problem afflicting the individual meets all criteria for a psychological disorder, as set forth in the fifth edition of DSM-5

idiographic strategy

determines what is unique about an individual’s personality, cultural background or circumstances

• allows the clinician to tailor the treatment to the person

nomothetic strategy

determines a general class of problems to which the presenting problem belongs

• clinician is attempting to name or classify the problem

classification

referring simply to any effort to construct groups or categories and to design objects or people to these categories n the basis of their shared attributes or relations

taxonomy

classification of entities for scientific purposes, such as insects, rocks or if the subject is psychology behaviors

nosology

application of taxonomic system to psychological or medical phenomena or other clinical areas

• these diagnostoc system used in healthacre settings, such as those for infectious diseases

nomenclature

describes the names or lables of disorders that make up the nosology

• international classification of diseases

classification issues

when dealing with human behavior or human behavioral disorders, the subject of classification becomes controversial

• some people have questioned whether it is proper or ethical to classify human behavior

Classical approach

APPROACH

• originates in the work of Emil Kraeplin and the biological tradition in the study of psychopathology

• every diagnosis has a clear underlying pathophysiological cause, sych as bacterial infection or a malfuntioning endocrine system and that each disorder is unique

• also called pure categorical approach

dimensional approach

APPROACH

• variety of cognitions, moods, and behaviors with which the patient presents and quantify them on a scale

• relatively unsatisfactory

• most theories have not been able to agree on how many dimesions are required

prototype approach

APPROACH

• identifies certain essential characteristics of an entity so that you can classify it, but it also allows certain nonessential variations that do not necessarily change the classification

• many possible features or properties of disorders are listed and any candidate must meet enought of them to fall into that

• DSM-5 is based on this approach

low precision

LIMITATIONS OF EARLIER SYSTEM

• diagnoses often relied on unproven etiological theories that were not universally accepted

poor reliability

LIMITATIONS OF EARLIER SYSTEM

• two clinicians could evaluate the same patient and reach different diagnoses using the same nosology

landmark shift

DSM-III, led by Robert Spitzer

• broke sharply from earlier editions

atheoretical approach

it emphasized precise, observable descriptions of disorders as presented to clinicians, avoiding commitment to specific psychoanalytic or biological theories of cause

ICD-10

WHO’S 10th edition was published in 1992

• the IS is treaty-boud to used this codes for health related matters

DSM-IV

developed to be as compatible as possible with ICD-10

• key change

  • removed the older distinction between organically based and psychologically based disorders found in previous editions

DSM-5, ICD-11

______-_ was created alongside _______-__

• with international experits embedded in each disorder workgroup to enhance global alignment

reliabiliity

CRITICISMS OF DSM-5

• system strong emphasize _______, sometimes at the expense of validity

  • it is so difficult to achieve unless you are willing to sacrifice validity

nosology

CRITICISMS OF DSM-5

• methods of constructiong _________ of mental disorders have a way of perpetuating definition handed down to us from past decades, even if they might be fundamentally flawed

labelling

Categorizing people can lead to?

• if disorder is associated with an impairment in cognitive or behavioral functioning, the label itself has negative connotations and contributes to stigma

  • combination of stereotypic negative beliefs, prejuices and attitudes

• resulting in reduced life opportunities

interdependent

clinical assessment and diagnosis are ___________ processes that transform observed symptoms into coherent, communicable understanding of a client’s difficulties