Lecture 1: Assessment and Diagnosis of Psychopathology

What is the definition of a psychological disorder according to the DSM-V?

A syndrome characterized by disturbance in cognition, emotion regulation, or behavior.

What are the three processes underlying mental functioning that can be dysfunctional in a psychological disorder?

Psychological, biological, and developmental processes.

What are the criteria for a mental disorder according to the DSM-V?

Clinically significant disturbance in cognition, emotion regulation, or behavior.

What is not considered a mental disorder according to the DSM-V?

An expectable or culturally approved response to a common stressor or loss.

What is not considered a mental disorder unless it results from a dysfunction in the individual?

Socially deviant behavior or conflicts primarily between the individual and society.

What is a syndrome?

A complex of symptoms indicative of a specific condition.

What is the difference between a syndrome and a disease/illness?

A syndrome does not have a known causal agent, while a disease/illness does.

Why does the DSM-V use the term 'syndrome' in its definition of a psychological disorder?

Because the underlying causes of most psychological disorders have not yet been fully understood.

What is meant by 'clinically significant disturbance'?

A disturbance that is significant enough to cause distress or disability in social, occupational, or other important activities.

When and why was the term 'clinically significant disturbance' introduced?

• Introduced in DSM-III to raise diagnostic threshold.

• To reduce diagnosis of 'healthy' people as having a psychological disorder.

Did the term 'clinically significant disturbance' have the same impact for all disorders?

No, it had different impacts for different disorders.

Has an operational definition of 'clinically significant disturbance' been provided?

No, it has not been provided.

How has 'dysfunction' been defined in DSM-V?

Deviation from statistical norm or failure of internal mechanism.

What is the significance of the term 'usually' in DSM-V?

Harm is no longer required, disorders only need to 'usually' be associated with harm.

What is the argument for using the term 'usually' in DSM-V?

Improves reliability of diagnosis and avoids issues of determining distress or disability.

Why is cultural sensitivity important in DSM?

To consider different definitions of mental health and well-being.

How is mental health defined for Aboriginal and Torres Strait Islander peoples?

Within the scope of social and emotional well-being (SEWB).

What factors are considered in SEWB?

Connection to Country, culture, spirituality, family, community, physical and mental health.

What do ATSI peoples consider when someone becomes unwell?

Cultural and/or spiritual causes for mental illness.

What approach does the DSM-V use for diagnostic criteria?

Dimensional and categorical approach

What are the dimensional axes used in the DSM-V?

Severity, intensity, and frequency or duration

What is the gold-standard for classification of disorders?

Aetiology or pathophysiology

Why is the DSM-V classification based on phenomenology?

Lack of complete understanding of aetiology or pathophysiology

Why is diagnostic reliability important?

To achieve diagnostic agreement and understand causal mechanisms

What does polythetic diagnostic criteria mean?

Multiple ways to meet the requirements for a diagnosis

Why are polythetic criteria used in the DSM?

To handle heterogeneity without sacrificing reliability

What is the purpose of assessing diagnostic reliability in the DSM-V?

• To ensure accurate identification, treatment, and prognosis

• Achieving high diagnostic agreement among different raters

What does the DSM-V use to assess diagnostic reliability?

Assessment methods and criteria

What are the benefits of diagnostic reliability?

Effective treatments and accurate prognosis

What is the significance of a polythetic approach in the DSM?

Allows for flexibility in diagnosing heterogeneous clinical presentations

What is the main approach to classification in the DSM-V?

Categorical approach

What is the primary focus of the DSM-V classification?

Phenomenology

What is the role of aetiology or pathophysiology in the DSM-V classification?

Still ongoing and not fully incorporated

What is the DSM-V's approach to classification based on?

Empirical evidence and research

What is diagnostic reliability?

Degree of agreement on diagnosis after correcting for chance.

How is diagnostic reliability measured?

Operationalized as kappa.

What are field trials in the DSM-5 development process?

Assessments of diagnostic reliability conducted by two clinicians.

What is the reliability bar for diagnostic procedures?

Usually between 0.6 and 0.8.

What are some potential benefits of diagnosing a psychological disorder?

Communication, additional information, treatment guidance.

What are some potential drawbacks of diagnosing a psychological disorder?

Stigma, labeling.

What was the Rosenhahn Study?

Experiment where fake patients were admitted with false symptoms.

What diagnoses were given to the fake patients in the Rosenhahn Study?

Schizophrenia in remission or manic depression in remission.

What are the purposes of assessment in clinical psychology?

Diagnosis, treatment planning, treatment evaluation, forensic and personnel selection applications.

What should the diagnostic criteria within the DSM be treated as?

Guidelines for making diagnoses, informed by clinical judgement.

What is the reliance of clinicians on in diagnosing psychological disorders?

Complementary approaches such as clinical interviews, questionnaire data, behavioral observation, reports from other professionals.

What information is gathered in a clinical interview?

Current symptoms, degree of distress and functional impairment, development and course of the problem, personal and family history, goals for treatment.

What are the different types of clinical interviews?

Unstructured, structured, and semi-structured.

What is the purpose of the opening of a clinical interview?

Convey essential information, obtain informed consent, alleviate anxiety, develop rapport, set the tone.

What is the body of a clinical interview?

The variable section where information is gathered, hypotheses are formed, and a complete picture of the client is developed.

What should be done at the close of a clinical interview?

Summarize main themes, address questions or concerns, discuss next steps.

What is confirmation bias?

A thinking error that influences decision-making.

What are open questions?

Questions that start with how or what.

What are closed questions?

Questions that start with who, where, and when.

What are swing questions?

Questions that ask the person to tell about something.