Psychology assessment unit IV - abnormal psychology

diagnosis

The four D’s used to discuss abnormal behaviour

The four D’s used to discuss abnormal behaviour

1. Danger

2. Deviance

3. Distress

4. Dysfunction

State in which individuals become likely to harm themselves or others, representing a threat safety

Danger

Any behaviour that differs significantly from what is considered appropriate or typical for a social group

Deviance

Unpleasant feelings or emotions that impact one's level of functioning. Results of maladaptive coping with stress

Distress

When behaviours or cognitive patterns interfere in an individual’s ability to carry out daily activities

Dysfunction

CCMD

Chinese Clarification of Mental Disorders

DSM-5 (By American Psychiatric Association)

Diagnostic and Statistical Manual of Mental Disorders

ICD (By WHO)

International Classification of Diseases

Checklist of questions to ask each patient

Clinical interview

The assumption that if a person is seeking assistance, s/he must have a mental disorder

Sick role bias

Patient being observed or asked personal questions may increase anxiety and therefore change or intensify behaviour

Reactivity

ABC’s of describing symptoms of a disorder

• Affective

• Behavioural

• Cognitive

• Somatic

Emotional elements: i.e. fear, sadness, anger

Affective

Observational behaviors: i.e. crying, physical withdrawal from others, pacing

Behavioural

Ways of thinking: i.e. pessimism, personalization, self-image

Cognitive

Physical symptoms: i.e. facial twitching, stomach cramping, changes in weight

Somatic

Whether the diagnosis is correct and leads to a successful treatment

Validity

Whether two or more psychiatrists using the same classification system make the same diagnosis

Reliability

Solutions of making a valid and reliable diagnosis as a psychiatrist

Source triangulation and researcher triangulation

• Overly focusing on the initial symptoms reported when making the diagnosis

• Basing diagnosis on the first impression

• Sticking with an initial diagnosis

Anchoring bias

• Not being willing to contradict a diagnosis made by a doctor who has more authority or prestige than you do

• Form of anchoring bias

The prestige effect

• Linked to anchoring bias and prestige effect

• When the doctor prefers evidence that confirms a diagnosis, but dismisses or ignores information that disconfirms it

Confirmation bias

• Perceiving a relationship between two variables, even when no relationship

  exists

• Dispositional or situational factors influence a diagnosis

Illusory correlation

The tendency to favour one gender over another in psychological research, theory, or practice

Gender bias

Emphasises the psychological differences between men and women

Alpha bias

Minimises the psychological differences between men and women

Beta bias

Male behaviour is judged to be the norm, more acceptable and desirable

Androcentrism

When a theory is tought to apply to all people the same way despite gender differences

Universality

Studies for normality vs abnormality

Parker et al (2001) + Rosenhan (1973)

Studies for classification systems

Bolton (2002) + Parker et al (2001)

Studies for biases in diagnosis

Friedlander and Stockman (1983) + Temerlin (1970)

Studies for validity and reliability of diagnosis

Rosenhan (1973) + Temerlin (1970)

Parker et al (2001)

• All participants were out-patients who had been diagnosed only with Major Depressive Disorder

• First, a set of mood and cognitive

  items common in Western diagnostic tools for depression. Secondly, a set of somatic symptoms commonly observed by Singaporean psychiatrists.

• Asked to judge how they had experienced the 39 symptoms in the last week: all the time, most of the time, some of the time, and not at all. They were also asked to rank the symptoms that they experienced in order of how distressing they were.

• Which symptom led to seek help, 60% of the Chinese participants identified a somatic symptom, only 13% of the Australian sample

• No significant difference in number of somatic symptoms indicated by each group (linked to their depression) However, the Chinese participants were significantly less likely to identify cognitive or emotional symptoms as part of their problem. Culture: Western, it is more appropriate to discuss one's emotions, and depression is seen as linked to a lack of emotional well-being, China, it is less appropriate and even stigmatized if one speaks about a lack of emotional health.

Rosenhan (1973)

• 1. Pseudo-patients told doctor at hospital that they were hearing voices that were often unclear, but used words like "empty" and "thud”

• After being admitted, they acted completely normal talking to patients and staff until the staff would deem them “sane”

• All but one were released with diagnosis of "schizophrenia in remission," and one with "manic depressive psychosis."

• 7 to 52 days, with an average of 19 days.

• Conclusions drawn by Rosenhan was anchoring bias

• Challenged the validity of diagnosis

• 2. The hospitals were told that one or more pseudo-patients would try to be admitted to their hospital over three months.

• Asked to rate all patients who came in on a 1 - 10 scale for "likelihood of being a pseudo-patient."

• Of 193 patients none were pseudo-patients.

• 41 people were judged to be pseudo-patients by one staff member and 23 by one psychiatrist.

• This shows that validity can be affected when a doctor's credibility is at risk. They were less likely to make a diagnosis, fearing that they would make a mistake.

Bolton (2002)

• Three interview styles: 1, free listing = Interviewers generated free lists by asking 40 local people to name all the problems that had resulted from the

  genocide. Then, using inductive content analysis, they pulled out symptoms that

  were related to mental health.

• Guhahamuka + Agahinda gakabije

• Next, key informant interviews provided more info about these disorders. People knowledgeable of problems named = when mental health issues were identified. Seven people were identified as knowledgeable; they were traditional healers and local leaders.

• Pile sorts confirmed relationships between symptoms and disorders. After interviews a set of cards was created which included the mental health symptoms that were identified in the initial interview + depression as outlined in DSM. The healers were asked to sort the cards based on similarity = included three symptoms with the DSM diagnosis of depression: lack of trust in others, loss of intelligence, and mental instability.

  They then used these local symptoms as part of their questionnaire which they developed to determine prevalence levels of depression in the community.

• Interviewees described the diagnostic symptoms of depression and ptsd as results of the genocide without "local" symptoms included.

• Divided symptoms into a "mental trauma" syndrome and a grief syndrome that included other depression and local symptoms. After the questionnaire established, 93 people had mental health issues in the community. 70 were diagnosed by local healers as showing the symptoms of agahinda gakabije. When given the newly standardized questionnaire, 30 of those then tested positive for signs of depression. The relationship between agahinda and depression was the same as that between grief and depression in the Western world. When the test was administered to the larger community, 368 adults were interviewed. 17.9 percent met the DSM criteria for depression and 41.8 percent described themselves as having agahinda gakabije.

Friedlander and Stockman (1983)

• Clinicians were a combination of psychiatrists, psychologists, and social workers from private practice, university, and community clinics.

• The researchers used a repeated measures design. The research question was whether giving significant evidence of mental illness in an early interview would have more influence on a final diagnosis and prognosis than giving that same evidence in a later interview.

• 1. Joanne was a severe case of depression with a rather dramatic suicide attempt, 2. Gina was less severe with some symptoms of anorexic behaviors. Each participant read five consecutive interviews per case.

• Participants were asked to evaluate the level of functioning and the prognosis after each interview.

• The score after the final interview is what was compared.

• The study was counter-balanced = some read Joanne first, some Gina.

• Conditions: 1. the "early" condition, information about Joanne's suicide attempt or Gina's disordered eating was discussed in the first interview. 2. "late" condition, this information was revealed in the fourth interview.

• The findings were that in the less severe condition, the participants that read the evidence of mental illness in the first interview indicated a lower level of functionality and a poorer prognosis than the clinicians that received the information later. It appears that the early exposure to the symptoms and the subsequent rating of the client influenced the final diagnosis. However, in the group that had more mild symptoms in the first interview, the

  rating that they gave also served as an anchor which resulted in a less severe diagnosis and a better prognosis.

• In the more severe case, although the initial diagnosis ratings were also different, they did not show a significant anchoring effect.

• In other words, regardless of when they read about the suicide attempt, there was no effect on their final diagnosis and prognosis.

Temerlin (1970)

• Participants: clinicians, including psychologists, psychiatrists, and social workers.

• Stimulus: Participants watched a video of a psychologically healthy man having a standard conversation

• Experimental Group: Half of the clinicians were exposed to an authoritative comment from a respected psychiatrist before watching the video, suggesting that the man was "a very interesting person because he looked neurotic, but actually was quite psychotic."

• Control Group: The other half of the clinicians did not hear this authoritative suggestion.

• After viewing the video, all participants were asked to diagnose the individual from a list of 30 possible diagnoses, which included options for mental illness and also an option for "normal or healthy."

• The results showed that the clinicians in the experimental group, who had heard the authoritative suggestion, were significantly more likely to diagnose the individual with a mental disorder. Specifically, 60% of the experimental group diagnosed the person with some form of mental illness, while only 28% of the control group did the same. This finding illustrated the strong influence of the psychiatrist's suggestion on clinical judgment, even when the individual in the video was clearly healthy.