A2-2023 DSM V
Chapter Introduction
Course: NCM 117
Focus: Care of Clients with Maladaptive Patterns of Behaviour, both Acute and Chronic.
Instructor: Phyllis Alsiken-Breboneria, MAN, IFSU-CHS Clinical Instructor
Learning Outcomes
Clinical assessment and methods.
Standardized diagnosis of mental disorders by mental health professionals.
Reasons to seek treatment and the relevance of psychotherapy.
Module Outline
Clinical Assessment of Abnormal Behavior
Diagnosing and Classifying Abnormal Behavior
Overview of Treatment of Mental Disorders
Clinical Assessment of Abnormal Behavior
Definition of Clinical Assessment
Process of gathering information about the client’s issues through:
Observation
Psychological tests
Neurological tests
Interviews
Aims to identify:
Client's skills and capabilities
Personality characteristics
Cognitive and emotional functioning
Social context, including environmental stressors and cultural factors
Characteristics of Clinical Assessment
Clinical assessment is ongoing and occurs throughout treatment phases:
Initial need for treatment determination
Best treatment approach identification
Evaluation of treatment effectiveness
Key Concepts in Assessment
Reliability
Consistency of assessments is paramount.
Interrater Reliability: Consistency among different raters or tools.
Test-Retest Reliability: Consistency when the same test is repeated over time.
Validity
Tests must accurately measure what they claim to.
Concurrent Validity: Correlation with established measures.
Predictive Validity: Accuracy in predicting future outcomes.
Standardization
Ensures a uniform assessment experience across different patients and occasions.
Achieved through clear rules, norms, and procedures.
Methods of Assessment
Observation
Used to circumvent potential biases in evaluations.
Naturalistic Observation: In the individual's natural environment.
Laboratory Observation: In a controlled setting, often with the aid of technology.
Clinical Interview
Face-to-face meetings to gather data on:
Behaviors
Attitudes
Current situations
Types of interviews:
Unstructured: Open-ended questions.
Structured: Specific question sets.
Semi-Structured: Pre-set questions, with room for follow-ups.
Mental Status Examination
Systematic review through specific questions assessing:
Appearance and behavior
Thought processes and content
Mood and affect
Intellectual functioning
Awareness of surroundings
Psychological Tests & Inventories
Attempts to evaluate the client's:
Personality
Social skills
Cognitive abilities
Emotions
Behavioral responses
Types of tests include:
Projective Tests: Ambiguous stimuli inviting diverse responses.
Thematic Apperception Test: Story completion based on imagery.
Sentence Completion Test: Completing provided sentences.
Personality Inventories
Individuals assess long lists of statements regarding personal feelings and behaviors. Examples include:
MMPI (Minnesota Multiphasic Personality Inventory)
NEO-PI-R: Assesses five major personality domains (Neuroticism, Extroversion, Openness, Agreeableness, Conscientiousness).
Neurological Tests
Identify cognitive impairments due to:
Tumors
Infections
Head injuries
Types of imaging used include:
PET Scans: Brain chemistry studies.
MRI: 3D brain imaging via magnetic fields.
CT Scans: X-ray imaging from various angles.
Physical Tests
General physical examinations recommended to rule out conditions mimicking mental disorders (e.g., hyperthyroidism).
Behavioral Assessment
Focuses on measuring specific behaviors using the ABC model:
Antecedents: Triggers of behavior.
Behaviors: Responses displayed by the individual.
Consequences: Outcomes that reinforce or discourage future behaviors.
Intelligence Tests
Assesses cognitive functioning through various tasks. Example:
Stanford-Binet Intelligence Test: Evaluates reasoning, knowledge, and memory.
Diagnosing and Classifying Abnormal Behavior
Learning Outcomes for Diagnosis
Understanding clinical diagnosis, terminology, classification systems, and major disorder categories in DSM-5 and ICD-10.
Clinical Diagnosis Process
Use of assessment data to align symptoms with diagnoses in established classification systems (e.g., DSM-5, ICD-10).
Importance of clinical utility to support prognosis and treatment planning.
Medical Terminology in Diagnosis
Syndrome: A cluster of symptoms typically indicating a specific disorder.
Characteristic symptoms often follow a predictable course.
Classification System Importance
Provides empirical agreements on disorders with clear diagnostic criteria and distinct categories, e.g., DSM-5 and ICD-10.
DSM Classification System History
Current DSM-5 was published in 2013, evolving from the DSM-IV-TR.
Developed through four editions post-World War II for broader usage in mental health diagnoses.
Key Elements of DSM Diagnosis
Diagnostic Criteria and Descriptors: Specific guidelines for diagnosing various conditions.
Subtypes and Specifiers: Differentiation within diagnoses; allows for more than one specifier but only one subtype.
Principal Diagnosis: Primary focus in treatment when multiple conditions are noted.
Provisional Diagnosis: Temporary designation when further information is required for a definitive diagnosis.
DSM-5 Disorder Categories Overview
Neurodevelopmental, schizophrenia, bipolar, depressive disorders, anxiety, obsessive-compulsive, trauma-related, and many others.
Each category describes characteristics and common conditions associated with it.
ICD-10 Overview
Brief History of ICD
Established by WHO in 1948; ICD-10 endorsed in 1990.
Serves as a global inventory for health statistics and clinical classifications.
Classification of Mental Disorders in ICD
Lists various types including organic disorders, substance-related issues, personality disorders, and more.
Hierarchical structure of diseases and disorders aids in comprehensive diagnosis.