week 2 cue cards psych disorders

Reliability

consistency of measurement – e.g. wooden ruler (reliable) vs stretchy ruler (unreliable)

Interrater reliability

2 independent observers/clinicians agree on what they see/diagnose

Test–retest reliability

same test twice → similar scores; only makes sense if the trait is stable (high for IQ, low for mood)

Alternate-form reliability

2 versions of a test give consistent scores → avoids people remembering answers

Internal consistency

items on a test relate to each other – e.g. dry mouth + muscle tension items on anxiety scale

Validity

whether a measure measures what it's supposed to

Content validity

measure covers the whole domain of interest – e.g. social anxiety test covers many social situations

Criterion validity

measure relates as expected to another measure (the criterion)

Diagnosis

clinical judgement about the underlying condition causes + symptoms

Why diagnosis matters

lets clinicians/researchers communicate,

drives research

Rosenhan study Shows that -

psychiatric diagnoses may be influenced by the hospital setting and staff expectations, rather than a person's actual behaviour alone.

Historical development of psychiatric classification Kraepelin

syndroms are clusters of symptoms each w/ own biological cause, course + outcome;

classified by how disorder develop and change overtime

Kraepelin's 3 groups

dementia praecox (schizophrenia),

manic-depressive insanity (bipolar),

paranoia

Kraepelin's impact

established common language;

focused on prototypical cases;

shaped current categories

Ash reliability problem

3 psychiatrists interviewing 52 patients agreed only ~20% of the time → reliability crisis

Reliability problem, early dsm

'symptom checklist' solution to poor reliability → first DSM 1952 (APA)

DSM growth

number of diagnoses keeps rising each edition (DSM-I → DSM-5-TR)

How dsm organises disorders, Symptom-based diagnosis -

Diagnoses are based on symptoms because we don't know enough about the causes to classify disorders by cause.

How dsm organises disorders Chapters reorganised

Disorders are grouped by shared symptoms, comorbidity (occurring together) + shared causes

How dsm organises disorders Developmental focus

Disorders are organised to reflect development across the lifespan

New DSM-5 diagnoses

Disruptive mood dysregulation disorder (DMDD), Hoarding disorder, Binge-eating disorder, Premenstrual dysphoric disorder (PMDD), Gambling disorder

New DSM-5-TR diagnosis

prolonged grief disorder (only new one)

Combined diagnoses

Substance use disorder: replaced the separate categories of substance abuse and substance dependence, Autism spectrum disorder (ASD): combined autism and Asperger’s disorder into one diagnosis.

Dsm -5 new Severity ratings

added for nearly all disorders → first step toward dimensions

Prototype

typical example of a category that people use to classify disorders

Depression prototype

low mood, anhedonia, worthlessness

Schizophrenia prototype

auditory hallucinations, delusions of reference, blunted affect

What Diagnostic taxonomies do (eg dsm, icd)

classify disorders by describing their typical symptoms, but don't fully define what makes something a psychological disorder in general.

Criticisms of the DSM, Too many diagnoses

pathologises/medicalises common experiences (normal sadness, anxiety)

Criticisms of the DSM Shared risk factors -

different disorders can share causes and treatments, suggesting the DSM's categories may be too separate.

Criticisms of the DSM Lumping vs splitting

debate on if we should combine disorders into broader categories or keep them separate. Lumping: Combining similar disorders into one broader category, Splitting: Treating disorders as separate diagnoses.

Proposed Solutions to DSM Limitations Cross-cutting symptom measure

that measures symptoms that can occur across different disorders, Identifies symptoms that might be missed when focusing only on one diagnosis.

Proposed Solutions to DSM Limitations RDoC

Focuses on brain function, genetics and underlying processes rather than classifying disorders based only on symptoms.

Case conceptualisation

a process of making sense of a person's disorder: what caused it and what keeps it going

• Collaborative: the client is involved, not just the clinician.

• Personalised: tailored to that one person.

• Based on theory and research.

Diagnosis vs conceptualisation

diagnosis = what is wrong; conceptualisation = why

The Five Ps-

Presenting problem, Predisposing factors, Precipitating factors, Perpetuating factors, Protective factor

Presenting problem

the problems the client comes in with

Predisposing factors

background contributors – biological, genetic, environmental, psychological, past trauma

Precipitating factors

events that trigger the onset

Perpetuating factors

current things maintaining the problem

Protective factors

personal strengths + external support to help someone cope

Limitation of Five Ps

low interrater reliability (different clinicians may identify different factors) → improves with training and experience.

Clinical interview

considers not just what the person says, but how they say it (e.g. emotional expression, tone of voice and behaviour).

Rapport in interviews

trust + empathy + non-judgemental stance → helps disclosure

Unstructured vs Structured- Unstructured interview

flexible, relies on intuition → less reliable, misses comorbid diagnoses, Structured interview – set questions in set order → more reliable

SCID (Structured Clinical Interview for DSM)

uses branching questions (answers determine the next question); symptoms rated on a 3-point scale.

Define Stress

subjective distress in response to perceived environmental problems

Life stressors

environmental problems that trigger stress

General adaptation syndrome (Selye)

body's response to sustained stress

3 stages- alarm, resistance, exhaustion

1, Alarm

autonomic nervous system activated

2, Resistance

tries to adapt + cope

3, Exhaustion

if stress continues → death or irreversible damage

Ways to Define Stress, Response-based definition

defines stress by the body's physical responses, but these responses can also occur during non-stressful situations (e.g. excitement).

Ways to Define Stress Stimulus-based definition

defines stress by the event itself, but the same event affects people differently; stressors can be major/minor, acute/chronic, or even pleasant.

Ways to Define Stress Appraisal

stress depends on how a person perceives and interprets the event.

Measuring Stress, LEDS (Life Events and Difficulties Schedule)

semi-structured interview, MANY stressor types; rates events in context of person's life; excludes events caused by symptoms; dates events carefully → stressors predict anxiety, depression, schizophrenia

Measuring Stress, Self-report stress checklists

quick → but people view events differently, recall problems, mood bias → low test–retest reliability

Personality Tests, self report Personality inventory

questionnaire where people report their usual personality traits and behavioural tendencies

Standardisation

giving a test to a large group of people to establish norms, so an individual's results can be compared with the general population.

Personality test, MMPI

self-report personality test used to detect psychological problems, with scales developed from clinical groups, good reliability + validity

MMPI Validity scales

detect faking – Lie (L) = trying to look good; Infrequency (F) = trying to look abnormal; Correction (K) = defensive

MMPI Revisions

more representative samples MMPI-3 newest

MMPI Limitation

people who know about the validity scales may still be able to fake their responses.

Projective test

uses ambiguous stimuli to reveal unconscious motives and feelings (projective hypothesis); based on Freud's ideas. less used today due to poor validity

Projective test Thematic Apperception Test (TAT)

person tells stories about pictures → limited reliability and validity, with small normative samples.

Projective test Rorschach

person interprets 10 inkblots, assesses perceptual and cognitive patterns → mixed validity and may add little beyond an interview.

Intelligence Tests, IQ test

measures current mental ability; developed to identify children's educational needs.

Common IQ tests

WAIS (adults), WISC (children), WPPSI (preschool), Stanford–Binet

IQ uses -

identify intellectual impairment and learning needs, identify gifted children, track cognitive decline in dementia.

IQ strengths

highly reliable + good criterion validity (predicts school + job success)

IQ limitations

explains only small part of school performance; motivation, family, anxiety also matter

IQ Stereotype threat

awareness of a negative stereotype about your group can reduce test performance (e.g. women perform worse on maths tests when told men score higher).

Behavioural/cognitive assessment

looks at environment, person's thoughts, frequency of problem behaviours + their consequences

Direct observation in Behavioural/cognitive assessment

observes behaviour by identifying antecedents (what happens before) and consequences (what happens after), often in lab or clinic settings

Type of behave/cog tests, Self-monitoring

person tracks own moods, thoughts, behaviours

Type of behave/cog tests, Ecological momentary assessment (EMA)

reporting experiences in real time when prompted by your phone several times a day.

Effect of observation, Reactivity

your behaviour changes because you know you're being observed.

Neurobiological Assessment, Structure Scans- CT/CAT scan, MRI

Structural scans-CT/CAT scan-

uses X-rays to examine brain structure,

Structural scans - MRI -

uses magnets to examine brain structure; produces better-quality images than CT, no radiation.

Neurobiological Assessment, Function Scans- fMRI, PET scan

fMRI, PET scan

fMRI

measures brain activity indirectly through changes in blood flow, also provides structural images.

PET scan

radioactive tracer to measure brain function; more invasive and expensive, so used less often.

Functional connectivity

how different brain areas communicate

Neurotransmitter assessment , Indirect methods

neurotransmitters mostly assessed indirectly

Indirect methods Postmortem studies

measure neurotransmitters and their receptors in the brains of deceased people.

Metabolites

substances produced when neurotransmitters break down, measured in urine, blood or CSF, limitations, reflect activity across the body and spinal fluid, not specific brain areas; show correlations, not cause and effect

Imaging + diagnosis

brain scans cannot yet diagnose most psychological disorders reliably because brain differences are not specific enough to a particular disorder.

Neurologist vs Neuropsychologist- Neurologist

physician treating nervous system diseases (stroke, Alzheimer's), Neuropsychologist – psychologist studying how brain dysfunction affects thoughts, feelings, behaviour

Neuropsychological tests, why?–

assess different brain functions to help identify where brain damage may be located.

Psychophysiological Assessment–

measures bodily changes linked to psychological processes; not sensitive enough to diagnose disorders.

methods of psychophysiological assessment.- Heart rate

measured by EKG, Skin conductance – measures changes in sweating caused by sympathetic nervous system activity; indicates emotional arousal, EEG – scalp electrodes record brain electrical activity; used to assess seizures, lesions and alertness.

Neurobiological Assessment measurement limitations:

biological measures don't identify specific emotions; e.g. skin conductance increases with happiness as well as fear.

Scanner effects limitations

scanners can be noisy and stressful, affecting results.

Interpreting Results, No one-to-one link

an abnormal test result doesn't automatically mean dysfunction; coping skills and social environment also matter.

Interpreting Results, Pre-existing ability

need to know the person's abilities before the disorder to identify what has changed.

Culture in Diagnosis, Within-Group Differences

more variation within cultural groups than between groups → avoid stereotyping.

Cultural Group Differences, Healthy Migrant Hypothesis

first-generation, non-English-speaking migrants have fewer common disorders than Australian-born people; not seen in the second generation.

Cultural Assessment, CFI

DSM-5 tool assessing how culture influences symptoms and experiences