Presentation Chapter 3 Diagnosis and Assessment Abnormal Psychology Thirteenth Edition by Ann M Kring Sheri L Johnson Gerald C Davison amp John M Neale 2015 John Wiley amp Sons Inc All rights reserved ID: 814452
Download The PPT/PDF document "PowerPoint Lecture Notes" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
PowerPoint Lecture Notes Presentation Chapter 3 Diagnosis and Assessment
Abnormal Psychology, Thirteenth Editionby Ann M. Kring,Sheri L. Johnson, Gerald C. Davison,& John M. Neale
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide2Chapter OutlineChapter 3: Diagnosis and Assessment I. Cornerstones of Diagnosis and Assessment II. Classification and Diagnosis
III. Psychological Assessment IV. Neurobiological Assessment V. Cultural and Ethnic Diversity and Assessment© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide3Diagnosis and AssessmentDiagnosis The classification of disorders by symptoms and signs. Advantages of diagnosis:Facilitates communication among professionalsAdvances the search for causes and treatments
Cornerstone of clinical care© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide4Reliability
Consistency of measurementInterraterObserver agreement
Test-retest
Similarity of scores across repeated test administrations or observations
Alternate Forms
Similarity of scores on tests that are similar but not identical
Internal Consistency
Extent to which test items are related to one another
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide5ValidityHow well does a test measure what it is supposed to measure?Content validity
Extent to which a measure adequately samples the domain of interest, e.g., all of the symptoms of a disorderCriterion validityExtent to which a measure is associated with another measure (the criterion)Concurrent Two measures administered at the same point in timePredictiveAbility of the measure to predict another variable measured at some future point in time© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide6Validity
Construct validity (Cronbach & Meehl, 1955)
A construct is an abstract concept or inferred attribute
Involves correlating multiple indirect measures of the attribute
e.g., self-report of anxiety correlated with increased HR, shallow breathing, racing thoughts
Important for validating our theoretical understanding of psychopathology
Method for evaluating diagnostic categories
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide7Classification and Diagnosis Diagnostic and Statistical Manualof Mental Disorders (DSM) published by American Psychiatric
AssociationFirst edition published in 1952Previous edition: DSM-IV-TR (fourth edition, revised)Published in 1994, text revised in 2000Many texts and research articles will continue to use DSM-IV terminology for a period of timeCurrent edition: DSM-5Published summer of 2013© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide8Figure 3.3: Timeline for DSM-5© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide9Multiaxial Classification System in
DSM-IV-TR and DSM-5© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide10Figure 3.5: Categorical
Versus Dimensional Systems of Diagnosis
Categorical
Presence/absence of a disorder
Either you are anxious or you are not anxious
Dimensional
Rank on a continuous quantitative dimension
Degree to which a symptom is present
How anxious are you
on a scale of 1 to 10?
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide11Changes in DSM-5Changes in multiaxial systemFive axes in DSM-IV-TR changed to two axes in
DSM-5Clinical SyndromesPsychosocial and Environmental ProblemsChanges in organization of diagnosesDSM-IV-TR clusters diagnoses on similarity of symptomsDSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared etiologyOCD moved from anxiety cluster to new cluster that also includes hoarding and body dysmorphic disorder© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide12Table 3.1: Descriptions of Mania in DSM-II vs. DSM-5© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide13Chapters in DSM-IV-TR and DSM-5© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide14Changes in DSM-5Personality Disorder DiagnosesRemain unchanged from DSM-IVProposed revisions included in Section IIIFor further study
New DiagnosesDisruptive mood dysregulation, premenstrual dysphoric disorder, etc.Renaming of DiagnosesMental retardation to intellectual disabilityDysthymia to persistent depressive disorderCombining DiagnosesSubstance use disorder replaces substance abuse and substance dependence, etc.Clearer Criteria© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide15Ethnic and Cultural ConsiderationsMental illness universalCulture can influence:
Risk factorsTypes of symptoms experiencedWillingness to seek helpAvailability of treatments© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide16Cultural Concepts of DistressCultural Formulation9 Concepts of DistressReplaces 25 separate diagnosesE.g., Amok, Drat, Koru, Taijin
kyofusho, Hikikomori, etc. Focus on influence of culture on disorder presentation© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide17Table 3.2: Twelve- Month Prevalence Rates of the Most Common Diagnoses by Country
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide18Criticisms of the DSMToo many diagnoses?Should relatively common reactions be pathologized?ComorbidityPresence of a second diagnosis45% of people diagnosed with one disorder will meet criteria for a second disorder
Reliability in everyday practice© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide19Table 3.3 Number of Diagnostic Categories per Edition of DSM© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide20Figure 3.6: Interrater Reliability
Extent to which clinicians agree on the diagnosis
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide21Construct Validity of Diagnostic CategoriesConstruct validity of highest concernDiagnoses are constructsFor most disorders, no lab test available to diagnose with certainty
Strong construct validity predicts wide range of characteristicsPossible etiological causes (past)Clinical characteristics (current)Predict treatment response (future)© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide22Figure 3.1:Construct Validity of Diagnostic Categories
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide23Criticisms of Classification
Stigma against mental illness.Treated differently by othersDifficulty finding a job
Categories do not capture the uniqueness of a person.
The disorder does not define the person.
She is an individual with schizophrenia,
not
a “schizophrenic”
Classification may emphasize trivial similarities
Relevant information may be overlooked.
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide24Table 3.5: Rates of Marital Distress and Missed Work Days Among People with Mental Illness in the Past Year
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide25Psychological AssessmentTechniques employed to:Describe client’s problemDetermine causes of problemArrive at a diagnosis
Develop a treatment strategyMonitor treatment progressConducting valid researchIdeal assessment involves multiple measures and methodsInterviews, personality inventories, intelligence tests, etc. © 2015 John Wiley & Sons, Inc. All rights reserved.
Slide26Clinical InterviewsInformal/less structured interviewsInterviewer attends to how questions are answered
Is response accompanied by appropriate emotion?Does client fail to answer question?Good rapport essential to earn trustEmpathy and accepting attitude necessaryReliability lower than for structured interviewsStructured interviewsAll interviewers ask the same questions in a predetermined orderStructured Clinical Interview for Axis I of DSM (SCID)Good interrater reliability for most diagnostic categories© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide27Figure 3.7: Sample Item from SCID
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide28Assessment of StressStressSubjective experience of distress in response to perceived environmental problems
Bedford College Life Events and Difficulties Schedule (LEDS)Semi-structured interviewEvaluates stressors within the context of each individual’s circumstancesSelf-Report Stress ChecklistsFaster way to assess stressTest-retest reliability low © 2015 John Wiley & Sons, Inc. All rights reserved.
Slide29Psychological TestsPersonality TestsSelf-reported Personality InventoriesMinnesota Multiphasic Personality Inventory (MMPI)
Yields profile of psychological functioningSpecific subscales to detect lying and faking “good” or “bad”Projective TestsRorshach Inkblot Test and Thematic Apperception Test (TAT)Projective hypothesisResponses to ambiguous stimuli reflect unconscious processes© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide30Figure 3.10: Hypothetical MMPI-2 Profile
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide31Figure 3.11: Sample Inkblots Similar to Rorschach Test
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide32Underreporting of Stigmatized BehaviorsFace-to-face interviews can have low validity for stigmatized and illegal behaviorsE.g., drug use, sexual behavior, violenceRespondents are more likely to endorse behavior on a computer questionnaire
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide33Psychological TestsIntelligence tests (IQ tests)Assess current mental abilityWechsler Scales
Wechsler Adult Intelligence Scale, 4th ed. (WAIS-IV)Wechsler Intelligence Scale for Children, 4th ed. (WISC-IV)Wechsler Preschool and Primary Scale for Children, 3rd ed. (WPPSI-III)Stanford-Binet, 5th ed. (SB5)Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder (mental retardation), identify gifted children, as part of a neuropsychological examinationMean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB)Lower IQs associated with higher psychopathology and mortalityPerformance on IQ tests impacted by Stereotype Threat© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide34Behavioral and Cognitive AssessmentFocus on aspects of environment Characteristics of the personFrequency and form of problematic behaviorsConsequences of problem behaviors
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide35Behavioral and Cognitive AssessmentObserve behavior as it occursSequence of behavior divided into segmentsAntecedents and consequencesBehavioral assessments often conducted in lab setting
e.g., mother and child interact in a lab living roomInteraction observed through one-way mirror or videotaped for later coding© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide36Behavioral Observation
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide37Self-ObservationSelf-monitoringIndividuals observe and record their own behaviore.g., moods, stressful events, thoughts, etc.Ecological Momentary Assessment (EMA)
Collection of data in real time using diaries or smart phonesReactivityThe act of observing one’s behavior may alter itDesirable behaviors tend to increase whereas undesirable behaviors decrease© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide38Cognitive-Style QuestionnairesUse to help plan treatment targetsFormat often similar to personality testsDysfunctional Attitude Scale (DAS)Identifies maladaptive thought patterns“People will think less of me if I make mistakes”
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide39Table 3.7: Psychological Assessment Methods
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide40Table 3.8: Neurobiological Assessment Methods
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide41Neurobiological Assessment: Brain ImagingComputerized Axial Tomography (CT or CAT scan)Reveals structural abnormalities by detecting differences in tissue density
e.g., enlarged ventricles Magnetic Resonance Imaging (MRI)Similar to CT but higher qualityfMRI (functional MRI)Images reveal function as well as structureMeasures blood flow in the brain (BOLD=blood oxygenation level dependent)Positron Emission Tomography (PET scan)Brain function© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide42CT Scans
fMRI Images PET Scans© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide43Neurobiological Assessment: Neurotransmitter AssessmentPostmortem studiesMetabolite assaysMetabolite levels
Byproducts of neurotransmitter breakdown found in urine, blood serum or cerebral spinal fluidMay not reflect actual level of neurotransmitterCorrelational studies© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide44Neurobiological Assessment: Neuropsychological Assessment NeuropsychologistStudies how brain abnormalities affect thinking, feeling, and behavior
Neuropsychological TestsReveal performance deficits that can indicate areas of brain malfunction Halstead-Reitan batteryTactile Performance Test-TimeTactile Performance Test-Memory Speech Sounds Perception TestLuria-Nebraska batteryAssesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc. © 2015 John Wiley & Sons, Inc. All rights reserved.
Slide45Psychophysiological AssessmentPsychophysiologyStudy of bodily changes that accompany psychological characteristics or eventsElectrocardiogram (EKG)
Heart rate measured by electrodes placed on chestElectrodermal responding (skin conductance)Sweat-gland activity measured by electrodes placed on hand Electroencephalogram (EEG)Brain’s electrical activity measured by electrodes placed on scalp© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide46Biofeedback
© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide47Cultural and Ethnic Diversity and AssessmentCultural bias in asessmentMeasures developed for one culture or ethnic group may not be valid or reliable for another. Not simply a matter of language translation
Meaning may be lost Cultural bias can lead to minimizing or exaggerating psychological problems© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide48Strategies to Avoid BiasIncrease graduate students’ sensitivity to cultural issues Insure participants’ understanding of taskEstablish rapport
Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994)Conclusions should be tentative and alternative hypotheses should be entertained© 2015 John Wiley & Sons, Inc. All rights reserved.
Slide49COPYRIGHT Copyright 2015 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner.
© 2015 John Wiley & Sons, Inc. All rights reserved.