Clinical Psychology- Diagnosis and Treatment

what is “clinical assessment” for?

answering questions like “what problem does this person have, what causes the issue, what is the best way to treat their problems, were our support/intervention enough?”

why we want to classify or define psychopathology at all?

to understand the cause of the problem

to come up with a treatment plan

to prevent the problem before it present its effects

first person to developed a comprehensive classification system for psychopathology is…

Emil Kraepelin

• like physical illnesses, psychopathology also can be classified into different categories, and each have its own distinct symptoms that he called “syndrome”

The first extensive system for classifying psychopathology, after Emil Kraepelin is from…

WHO (world health organization)

• added psychological disorders to the International List of Causes of Death (ICD), however mental disorder section in ICD was not widely accepted.

• Currently ICD 10 is the latest version

• mostly diagnosis purposes

When did APA published the first DSM? What is the publishment order based on years?

1) In 1952, because ICD section about mental disorders were not widely accepted.

2) 1968 APA publsihed the second version of DSM

3) 1980 DSM 3

4) 2013 DSM 5

dsm = diagnosis and research purposes

What terms are crucial when definin psychopathology?

distress and disability

What kind of info DSM classification system provides?

• essential features of disorder

• associated features (not always present features)

• diagnostic criteria

• differential diagnosis

It avoids suggestion and all criteria is based on observation

Problems with the classification of DSM?

• diagnosis is based on symptoms not based on causes

• diagnosis can be stigmatizing

• diagnostic classification tends to define disorders as discrete entities - separate, distinct subjects - , but in reality they could be dimensional.

comorbidity/ hybrid disorder/ disorder spectrum

comorbidity: co-occurrence of two + psychological disorders

hybrid disorder: disorders that contain elements of a number of different disorders.

disorder spectrum ( or syndrome) : range of conditions or symptoms that can vary from mild to severe.

Comments of DSM-5?

• reduced number of criteria necessary to established a diagnosis = lead easy and fast diagnose = medicalisation

• Focus on false negatives

• • Political and economical influences

Monothetic meaning?

list of symptoms that are both necessary and sufficient for diagnosis

Polythetic

list of symptoms + the number of symptoms a person must have to be diagnosed

what are some assessment methods?

• Clinical interview

Unstructured

(Semi)structured

• Questionnaires

• Projective tests

• Intelligence and neuropsychological tests

• Clinical observation

Definition of reliability and variability?

• reliability: same result if the experiment is being done again and again

• Validity: method actually measures what is intented to measure

Reliabilty methods?

• test-retest reliability: same person, same test different times

• interrater reliability: two different clinician actually agree when interpreting or scoring a test.

• ınternal consistency: all items on the test relate to each other.

• cronbah’s a : statistical test used to assess the internal consistency of a questionnary or inventory

validity methods?

• concurrent validity: how highly correlated scores of one test are with scores from other types of assessment that we know also measure that attribute

• face validity:

• predictive validity: help clinician predict future behavior and future symptoms

• construct validity:how well a test or questionnaire actually measures what it is supposed to measure.

what are the 2 types of clinical interviews?

• Structured interviews: questions and order of them is predetermined. SCID (structured clinical interview for DSM-5 = client’s respond determine the next question will be asked)

• unstructured interview

!!!! limitations: low reliability, prone to biased thoughts by interviewer, client may lie ☹

Psychological Test features? pros and cons ?

• usually a written form

• sometimes verbally, to person or a computer

• pros: usually assess one or more specific traits / usually have very rigid response requirement / statistics can be applied on to responses or data / based on psychometric approach - the idea that assumes that there are stable undelrying characteristics traits that exist in different levels in everyone -

what is projective test?

• test consist of standard fixed set of stimuli that are presented to the client, but which are ambiguous enough for clients to put their own interpretation on what the stimuli represent.

• rorschach inkblot test, thematic apperception test (tat), sentence completion test

!!!!low reliability- cultural biased in interpretation

what is a ABC chart?

• an observation method that requires the observer to note what happens before the target behavior occurs (A), what the individual did (B), what the consequences of the behavior were (C)

what does treatment for psychopathology possess ( have) in common?

• they can provide relief from distress caused by symptoms

• they can provide the client with self-awareness and insight into problems

• they provide coping and problem solving skills

• they attempt to identify and resolve the causes of psychopathology

what is the aim of psychodynamic therapies?

• reveal unconscious conflict, and understand the cause of conflict then resolve it.

What are some psychodynamic treatment techniques?

• FREE ASSOCIATION: client is encouraged to verbalize all of the thoughts

• TRANSFERENCE: analyst is used as a target person, and the client behave in a way that they would behave towards that person who is the subject but in reality to the analyst.

• DREAM ANALYSIS:

• INTERPRETATION: with the help of all techniques and session, therapist interpret the info about the client and help them to identify underlying conflict.

!!!!16 week is current recommendation!!!!

What are some behavioral therapy techniques?

• FLOODING: patient is being exposed to highly distressing stimuli

• COUNTER-CONDITIONING: use conditioning techniques to establish a respond that is antagonistic ( block or neutrailized) to the psychopathology

• SYSTEMATIC DE-SENSITISATION: used in anxiety or phobic situation and the client being exposed gradually.

• all above collective come to known as “EXPOSURE THERAPY”

what is “aversion ( strong dislike) therapy”?

A treatment based on classical conditioning which attempts to condition an aversion to a stimulus or event to which the individual is inappropriately attracted. ( putting vomit pill into alcohol )

A carefully studying a behavior to find out what rewards or consequences keep it going = ?

functional analysis

A reinforcement procedure that is used to develop new behaviors =?

response shaping

Rational Emotive Therapy ( RET) by Albert Ellis ?

A cognitive therapy technique which address how people interpret themselves, their life, and the world.

• people carry set of asuumptions in every aspect, and those assumptiions determines how they jugde themselves, life and others. And when those assumptions does not match with reality that creates distress, anxiety, depressin.

How does Beck’s Cognitive Therapy works?

• depression occurs due to schemas that the individual already has. Beck challenge that schemas and change the with positive ones. The way is to ask for evidence of their beliefs in real world.

Today we have the third wave of CBT, explain.

• first wave 1950 1960 == used behavioral techniques ( learning + conditioning)

• second wave 1970 1980 == they add cognition ( how we think) to the picture.

• Third wave == last one, emphasise on mindfullnes, acceptance, and relationship with psychopathology experiences and aim to reduce distress by changing the function of the experience.

Mindfulness-Based Cognitive Therapy (MBCT) ??

A therapy that combines mindfulness and cognitive therapy to help people become aware of their thoughts and feelings without judging them.

Acceptance and Commitment Therapy (ACT) ??

A therapy that teaches people to accept difficult thoughts and feelings while taking action towards what matters to them.

Behavioral Activation (BA) ??

A therapy that encourages people to do positive and meaningful activities to improve their mood and reduce depression.

• person feels sad and stays in bed all day. They start going for walks, meeting friends and doing activities they enjoy, even when they don't feel motivated. === Take action first; your mood may improve afterwards.===

what does these therapy methods have in common?? ( gestalt therapy-existential therapy-primal therapy-narrative therapy-transpersonal therapy- client centred therapy)

a) they support the need for the therapist to develop a more personal relationship with the client in order to help the client reach a state of realisation that they can help themselves.

b) they were holistic therapies, they consider person as whole rather than bits

c) therapy should be seen as a way of enabling the individual to make their own decisions

d) incrising emotional awareness is the key

what is the purpose of antidepressant drugs?

deal w/ depression symptoms and mood disorders

what is the purpose of anxiolytic drugs?

deal w/ anxiety and stress

what is the purpose of antipsychotic drugs?

deal w/ psychosis and schizophrenia

what are some “alternatives to individual therapy” methods?

• Couples therapy

• Family therapy

• Group therapy

• Mediation therapy for caregivers

what was the first developed depression drug for treatment?

• (1960)s Tricyclic antidepressants = increase the amount of norepinephrine and serotonin avaliable for synaptic transmission.

• MAOIs ( monoamine oxidase inhibitors) = such as phenelzine and tranylcypromine, is written for people who do not respond to antidepressant, and sometimes for panic and bipolar disorder.

• SSRIs (selective serotonine reuptake inhibitores) = “designer drugs”, such as prozac, lustral, cipramil, called selective cause they only affect the uptake of only one neurotransmtter, usually serotonine.

• SNRIs ( serotonine norepinephrine reuptake inhibitors) = block the reuptake of serotonine and nore…

What benzodiazepines is used for?

to treat anxiety / however not treat the issue, but gives reliefs from the symptoms /

they increase the amount of GABA in brain

they usually prescribed for short amount of time cause they can be addictive

The first generation of psychotic drugs?

1940-50

reduced many positive and disorganized symptoms , but little effect on negative symptoms

side effects: blood sugar problems, tremmor or slurred speech

what is a “dodo bird verdict”?

The Dodo bird verdict is the hypothesis that different psychotherapies tend to be similarly effective because they share important therapeutic ingredients. It does not necessarily mean that every therapy works equally well for every person or every condition