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Abnormal Psychology - Chapter 3
Clinical assessment - Systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with a possible psychological disorder. Diagnosis - Process of determining whether a presenting problem meets the established criteria for a specific psychological disorder. Reliability - Degree to which a measurement is consistent—for example, over time or among different raters. Validity - Degree to which a technique measures what it purports to measure. Standardization - Process of establishing specific norms and requirements for a measurement technique to ensure it is used consistently across measurement occasions. This includes instructions for administering the measure, evaluating its findings, and comparing these to data for large numbers of people. Mental status exam - Relatively brief preliminary test of a client's judgment, orientation to time and place, and emotional and mental state; typically conducted during an initial interview. Behavioral assessment - Measuring, observing, and systematically evaluating (rather than inferring) the client's thoughts, feelings, and behaviour in the actual problem situation or context. Self-monitoring - Action by which clients observe and record their own behaviours as either an assessment of a problem and its change or a treatment procedure that makes them more aware of their responses. Also called self-observation. Projective tests - Psychoanalytically based measures that present ambiguous stimuli to clients on the assumption that their responses will reveal their unconscious conflicts. Such tests are inferential and lack high reliability and validity. Personality inventories - Self-report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them. Intelligence quotient (IQ) - Score on an intelligence test estimating a person's deviation from average test performance.
Neuropsychological test - Assessment of brain and nervous system functioning by testing an individual's performance on behavioral tasks. False positive - Assessment error in which pathology is reported (that is, test results are positive) when none is actually present. False negative - Assessment error in which no pathology is noted (that is, test results are negative) when one is actually present. Neuroimaging - Sophisticated computer-aided procedures that allow nonintrusive examination of nervous system structure and function. Psychophysiological assessment - Measurement of changes in the nervous system reflecting psychological or emotional events such as anxiety, stress, and sexual arousal. Electroencephalogram (EEG) - Measure of electrical activity patterns in the brain, taken through electrodes placed on the scalp. Idiographic strategy - Close and detailed investigation of an individual emphasising what makes that person unique (compare with nomothetic strategy). Nomothetic strategy - Identification and examination of large groups of people with the same disorder to note similarities and develop general laws (compare with idiographic strategy). Classification - Assignment of objects or people to categories on the basis of shared characteristics. Taxonomy - System of naming and classification (for example, of specimens) in science. Nosology - Classification and naming system for medical and psychological phenomena. Nomenclature - In a naming system or nosology, the actual labels or names that are applied. In psychopathology, these include mood disorders and eating disorders. Classical categorical approach - Classification method founded on the assumption of clear-cut differences among disorders, each with a different known cause.
Predictive Clinical assessment can include 4 procedures, name them -
- Clinical interview - including a mental status exam which can be administered either formally or informally
- Physical examination
- Behavioral observation and assessment
- Psychological tests (if needed). The mental status exam covers 5 categories, name them -
- Appearance and behaviour
- Thought processes
- Mood and affect
- Intellectual functioning
- Sensorium The clinician notes any overt physical behaviour, dress, general appearance, posture, and facial expression. For example, slow and effortful motor behaviours, sometimes referred to as psychomotor retardation, may indicate severe depression. What category of the mental status exam does this pertain to? - Appearance and behaviour "Can you think clearly, or is there some problem putting your thoughts together?" If a clinician was taking note of the continuity and speed of speech, what category of the mental status exam are they covering? - Thought processes This may be deemed appropriate, inappropriate, blunted or flat by a clinician. When assessing this category, a clinician notes the emotion of the client during the mental status exam - Mood and affect Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors? How is the person's memory? A clinician asking these questions is assessing which category of the mental status exam? - Intellectual functioning If the patient knows who he is and who the clinician is and has a good idea of the time and place, the clinician would say that the patient's sensorium is "__________" and is "________ __________ __________" (to person, place, and time). - clear, oriented times three Does the patient know what the date is, what time it is, where he or she is, who he or she is, and who you are? A clinician asking these questions is assessing which category of the mental status exam? - Sensorium Information provided by patients to psychologists and psychiatrists is protected by laws of "___________ ______________" or confidentiality, that is, even if authorities want the information the therapist has received from the patient, they cannot have access to it without the expressed consent of the patient. Exception is if ____________ ______________ is present -
privileged communication, imminent harm Name a disadvantage of a semistructured interview - It robs the interview of some of the spontaneous quality of two people talking about a problem Semistructured Interviews - Are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner so that clinicians can be sure they have inquired about the most important aspects of particular disorders Why are fully structured interviews rarely used? -
- applied rigidly and does not allow the patient to elaborate on information that could be relevant
- cannot depart from set questions to follow up on specific issues
- reduced spontaneity of conversation Many problems presenting as disorders of behaviour, cognition, or mood may, on careful physical examination, have a clear relationship to a temporary toxic state. List the mimicked symptoms the following conditions can produce: A. Hyperthyroidism B. Hypothyroidism C. Brain tumor D. Cocaine withdrawal - A. Anxiety B. Depression C. Psychotic symptoms D. Panic attacks Clinical interviews sometimes provide limited assessment information. In what situation would a behavioural assessment be more effective than a clinical interview? - If the client is not old enough or skilled enough to report their problems and experiences. Young children or individuals who are not verbal because of the nature of their disorder or because of cognitive deficits or impairments are not good candidates for clinical interviews List techniques that are types of behavioural assessments: -
- talking with a patient in an office about a problem
- go to the person's home, workplace or local community to observe the person and the reported problems directly
- role-play simulations in a clinical setting to see how people might behave in similar situations in their daily lives. A complete picture of a person's problems requires direct observation in naturalistic environments. But going into a person's home, workplace, or school isn't always possible or practical, so clinicians sometimes arrange _____________ - Analogue What are the ABCs of observation? -
Rorschach specifies how the cards should be presented, what the examiner should say, and how the responses should be recorded - Reliability, validity, comprehensive system Thematic Apperception Test - Patients are asked to tell a dramatic story about each picture (usually 20 cards), using their imagination. What do the TAT and Inkblot have in common? - Based on the notion that people will reveal their unconscious mental processes in their stories about the pictures Researchers have developed formal scoring systems for TAT stories, including the Social Cognition and Object Relations Scale. The tests has been adjusted in three ways: -
- Cultural changes
- Childrens' Apperception Test
- Senior Apperception Test Projective tests may be helpful to use as an ____________. Concern over the inappropriate use of projective tests should remind you of the importance of the __________________________ _______________ - Icebreaker, scientist-practitioner approach. What is a major difference between projective tests which rely heavily on theory for an interpretation, and the MMPI? - The MMPI is based on the empirical approach What is a problem of the MMPI? - Time it takes to respond to the 550/567 items Individual responses on the MMPI are not examined; instead, the pattern of responses is reviewed to see whether it ___________ __________ ____________ ____________ ___ ________ _______ _______ ______________ ______________ - resembles patterns from groups of people who have specific disorders The MMPI is excellent in terms of _____________, but problematic as it may not improve or change outcomes for clients - Reliability A person's score is compared only with scores of others of the same age. The IQ score, then, is an estimate of how much a child's performance in school will deviate from the average performance of others of the same age, what is this type of IQ called? - Deviation IQ The Wechsler tests include versions for ________, ___________ and ______ _____________. All these tests contain ____________ scales and __________ scales - Adults, children, young children, verbal, performance
In general, IQ tests tend to be __________, and to the extent that they predict academic success, they are valid assessment tools. - Reliable Bender Visual-Motor Gestalt Test - A fairly simple neuropsychological test often used with children
- A child is given a series of cards on which are drawn various lines and shapes.
- The task is for the child to copy what is drawn on the card.
- The errors on the test are compared with test results of other children of the same age; if the number of errors exceeds a certain figure, then brain dysfunction is suspected. Two of the most popular advanced tests of organic (brain) damage that allow more precise determinations of the location of the problem - Luria-Nebraska Neuropsychological Battery and the Halstead-Reitan Neuropsychological Battery Name 3 tests included in the Halstead-Reitan Neuropsychological Battery -
- Rhythm Test (which asks the person to compare rhythmic beats, thus testing sound recognition, attention, and concentration)
- Strength of Grip Test (which compares the grips of the right and left hands)
- Tactile Performance Test (which requires the test taker to place wooden blocks in a form board while blindfolded, thus testing learning and memory skills) One study found that the Halstead-Reitan and the Luria-Nebraska test batteries were equivalent in their abilities to detect damage and were about ___% correct - 80 Neuroimaging can be divided into two main categories: -
- Structure
- Function Computerized axial tomography (CAT) scan or CT scan -
- Proved useful in identifying and locating abnormalities in the structure or shape of the brain
- CT scans are particularly useful in locating brain tumors, injuries, and other structural and anatomical abnormalities.
- Difficulty is that these scans, like all X-rays, involve repeated x-radiation, which poses some risk of cell damage Nuclear magnetic resonance imaging (MRI). -
- Commonly used scanning technique
- The patient's head is placed in a high-strength magnetic field through which radio frequency signals are transmitted.
- These signals "excite" the brain tissue, altering the protons in the hydrogen atoms.
Thought processes Andrew arrived at the clinic accompanied by police, who had found him dressed only in shorts although the temperature was. He was reported to the police by someone who saw him walking slowly down the street, making strange faces, and talking to himself - Appearance and behaviour When Lisa was brought to Dr. Miller's office, he asked if she knew the date and time, her identity, and where she was. - Sensorium Dr. Jones viewed as inappropriate Tim's laughter after discussing his near-fatal incident and noted that Tim appeared to be elated - Mood and affect Holly's vocabulary and memory seemed adequate, leading Dr. Adams to estimate that she was of average intelligence. - Intellectual functioning EEG to show electrical activity in the brain of someone who has seizures. Is this R (reliable), NR (not reliable), V (valid), or NV (not valid) - R, V Rorschach inkblots Is this R (reliable), NR (not reliable), V (valid), or NV (not valid) - NR, NV Structured interviews with definite answers Is this R (reliable), NR (not reliable), V (valid), or NV (not valid) - R, V Structured interviews with definite answers Is this R (reliable), NR (not reliable), V (valid), or NV (not valid) - NR, NV Both these strategies are essential in the study and treatment of psychopathology. If we want to determine what is unique about an individual's personality, cultural background, or circumstances, we use what is known as an _______________strategy. But to take advantage of the information already accumulated on a particular problem or disorder, we must be able to determine a general class of problems to which the presenting problem belongs. This is known as a _______________ strategy. - idiographic, nomothetic
- A broad term, refers to any efforts to construct groups, is a __________ strategy
- The classification in a scientific context, e.g, insects, rocks, behaviours
- If you apply a taxonomic system to psychological or medical phenomena or other clinical areas, you use the word ____________.
- The term ____________describes the names or labels of the disorders that make up the nosology, e.g. mood disorders -
- Classification, nomothetic
- Taxonomy
- Nosology
- Nomenclature In what traditional approach to psychopathology did the classification approach originate? - Biological tradition (Emil Kraepelin) Despite the beliefs of Kraepelin and other early biological investigators, the mental health field has _______ adopted a classical categorical model of psychopathology. The classical categorical approach is clearly ________________to the complexity of psychological disorders - Not, inappropriate Disadvantage of dimensional approach - Most theorists have not been able to agree on how many dimensions are required: some say 1 dimension is enough; others have identified as many as 33 Dimensional approaches have been applied to psychopathology in the past—particularly to _________________ disorders - Personality Name the 3 strategies for organising and classifying behavioural disorders: - Classical categorical approach, dimensional approach, prototypical approach What is an advantage of the prototypical approach? -
- It fits the best wit the current state of our knowledge of psychopathology
- It is relatively user-friendly
- It offers an alternative to the categorical and dimensional approaches What approach is the DSM-5 based on: categorical, dimensional, or prototypical? - Prototypical Which category of disorders is the most unreliable? Determining the presence or absence of this disorder during one interview is difficult - Personality disorders Morey and Ochoa (1989) asked 291 mental health professionals to describe an individual with a personality disorder they had recently seen, along with their diagnoses. What were some findings? -
- Substantial bias in making diagnoses
- Less experienced/female clinicians diagnosed BPD more often
- More experienced/ male clinicians diagnosed BPD less often -Patients who were white, female, or poor were diagnosed with BPD more often Although bias among clinicians is always a potential problem, the ________ reliable the nosology, or system of classification, the _______ likely bias is to creep in during diagnosis - more, less What does the lack of agreement among clinicians when diagnosing personality disorders indicate? - That more reliable criteria are needed
- Atheoretical approach to diagnosis, relying on precise descriptions of the disorders as they presented, rather than on psychoanalytic or biological theories of etiology
- Specificity and detail with which the criteria for identifying a disorder were listed made it possible to study their reliability and validity
- Multiaxial system was adopted, this allowed individuals with possible psychological disorders to be rated on five dimensions, or axes The precise descriptive format of the DSM-III-R, neutrality with regard to presuming a cause for diagnosis, and the multiaxial format which emphasised the individual rather than disorder are all listed as reasons for what? - More clinicians around the world used DSM-III-R at the beginning of the 1990s than the ICD system designed to be applicable internationally What was one of the most substantial changes in the DSM-IV from previous versions? - The distinction between organically based disorders and psychologically based disorders was eliminated List the 3 sections in the DSM-5 -
- Introduces the manual and how to use it
- Presents disorders
- Unofficial disorders (that need further research before they can qualify as official diagnoses) In the DSM-5, the multiaxial system was ____________, and the use of dimensional scales was _____________. - Removed, expanded The criteria for disorders include the provision that the disorder must cause clinically significant ___________or _________________ in social, occupational, or other important areas of functioning. Individuals who have all the symptoms but do not cross this "threshold" of impairment could not be diagnosed with a disorder. - Distress, impairment Many times, disorders such as obsessive-compulsive disorder would be rated a 2 or 3, meaning that all of the symptoms are there but in too mild a form to impair functioning; in this case, the disorder would be termed, __________________ the impairment must be rated a _____ to meet the criteria for a psychological disorder - Subthreshold, 4 In the DSM-5, allows the disorder to be described from the perspective of the patient's personal experience and in terms of his or her primary social and cultural group, such as Hispanic or Chinese - Cultural formulation In what area do we have more research to do within the DSM-5 and to improve nosology? - Cultural considerations
Name some criticisms of the DSM-5 and ICD-11 -
- The systems strongly emphasize reliability, sometimes at the expense of validity
- Methods of constructing a nosology of mental disorders have a way of perpetuating definitions handed down to us from past decades, even if they might be fundamentally flawed To avoid the negative consequences of labeling, a recent development is to categorise intellectual disabilities in terms of levels of support needed by the individual, name the 4 levels: - intermittent, limited, extensive, pervasive Hinshaw and Stier (2008) note that stigmatisation of individuals with mental disorders is increasing or decreasing? - Increasing Why are family physicians' offices, clinics, hospitals, and so on, called primary care settings? - Because they are where a person goes first with a problem Results of research around mixed anxiety-depression indicated that people with a mix of anxious and depressed symptoms (who did not meet criteria for an existing anxiety or mood disorder) were common in primary care settings. They were substantially __________, and people appeared both anxious and depressed, so the potential new category possessed ______ validity. - impaired, content Where did the DSM-IV task force decide to place the mixed anxiety-depression diagnosis? - The appendix What is the general conclusion as to why mixed anxiety-depression should not be included in the DSM- 5 lead to it not being included (even in section three)? -
- It is relatively rare in the absence of a current or previous anxiety or mood disorder
- Symptoms do not last long
- Difficult to identify the condition in a reliable fashion What are the arguments for and against the inclusion of premenstrual dysphoric disorder in the DSM? - For
- Would provide women with higher level of care
- Would propel more research in the area Against
- Bias and stigmatization
- Lack of scientific evidence
- Similar to former category of Hysteria Support for PMDD became sufficient enough that is was moved from the _____________ in the DSM- IV to being included as a distinct psychological disorder in the DSM-5, under the _________ disorders chapter. - Appendix, mood
