Abnormal Psychology Textbook Chapter 3 PDF

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Intensive notes from Abn Psychology (Mr. Drews- UGGSD), covering the textbook for each chapter. Each chapter is guided by learning objectives to make understanding course material better....

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Chapter 3: Clinical Assessment and Diagnosis Learning Objectives: 1. Assessing Psychological Disorders 2. Diagnosing Psychological Disorders

● Clinical Assessment: Clinical assessment is the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. ● Diagnosis: Diagnosis is the process of determining whether the particular problem afflicting the individual meets the criteria for a psychological disorder per the DSM 5

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Assessing Psychological Disorders Reliability: Degree to which a measurement is consistent Validity: Whether something measures what it is designed to measure Standardization: Process by which a certain set of standards or norms is determined for a technique to make its use consistent The Clinical Interview - The interview gathers information on current and past behaviour, attitudes, and emotions, as well as a detailed history of the individual’s life in general and of the presenting problem - To organize information obtained during an interview, many clinicians use a mental status exam. Mental Status Exam - The exam covers five categories: appearance and behaviour, thought processes, mood and affect, intellectual functioning, and sensorium. - Sensorium is our general awareness of our surroundings. Does the individual know what the date is, what time it is, where they are, who they are, and who you are - What we conclude: Allow the clinician to make a preliminary determination of which areas of the patient’s behaviour and condition should be assessed in more detail and perhaps more formally

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Semistructured Clinical Interview - Semistructured interviews are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner, so clinicians can be sure they have inquired about the most important aspects of particular disorders - Clinicians may also depart from set questions to follow up on specific issues—thus the label “semistructured.” - Disadvantage: robs the interview of some of the spontaneous quality of two people talking about a problem. Also, if applied too rigidly, this type of interview may inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked Physical Examination - Many problems presenting as disorders of behaviour, cognition, or mood may, on careful physical examination, have a clear relationship to a temporary toxic state. This toxic state could be caused by bad food, the wrong amount or type of medicine, or the onset of a medical condition. Behavioural Assessment - The mental status exam is one way to begin to sample how people think, feel, and behave and how these actions might contribute to or explain their problems. Behavioural assessment takes this process one step further by using direct observation to formally assess an individual’s thoughts, feelings, and behaviour in specific situations or contexts; this information should explain why he or she is having difficulties at this time. - In behavioural assessment, target behaviours are identified and observed with the goal of determining the factors that seem to influence those behaviours. The ABC’s of Observation - Observational assessment is usually focused on the here and now. Therefore, the clinician’s attention is usually directed to the immediate behaviour, its

antecedents (or what happened just before the behaviour), and its consequences (what happened afterward). - Example: 1. his mother asking him to put his glass in the sink (antecedent), 2. The boy throwing the glass (behaviour), 3. His mother’s lack of response (consequence). Self-Monitoring - People can also observe their own behaviour to find patterns, a technique known as self-monitoring or self-observation - A more formal and structured way to observe behaviour is through checklists and behaviour rating scales, which are used as assessment tools before treatment and then periodically during treatment to assess changes in the person’s behaviour - Reactivity: Any time you observe how people behave, the mere fact of your presence may cause them to change their behaviour Psychological Testing Projective Testing - Include a variety of methods in which ambiguous stimuli, such as pictures of people or things, are presented to a person who is asked to describe what he or she sees. The theory here is that people project their own personality and unconscious fears onto other people and things—in this case, the ambiguous stimuli—and, without realizing it, reveal their unconscious thoughts to the therapist. ● Rorschach Inkblot Test: In its current form, the test includes 10 inkblot pictures that serve as the ambiguous stimuli - To respond to the concerns about reliability and validity, John Exner developed a standardized version of the Rorschach inkblot test, called the Comprehensive System - Exner’s system of administering and scoring the Rorschach specifies how the cards should be presented, what the examiner should say, and how the responses should be recorded ● Thematic Apperception Test: It was developed in 1935 by Morgan and Murray (Bellak, 1975). The TAT consists of a series of 31 cards: 30 with pictures on them and 1 blank card, although only 20 cards are typically used during each administration - The instructions for the TAT ask the person to tell a dramatic story about the picture. - How the stories people tell about these pictures are interpreted depends on the examiner’s frame of reference and on what the patient may say. It is not surprising, therefore, that questions remain about its use in psychopathology ❖ Despite the popularity and increasing standardization of these tests, most clinicians who use projective tests have their own methods of administration

and interpretation. When used as icebreakers, for getting people to open up and talk about how they feel about things going on in their lives, the ambiguous stimuli in these tests can be valuable tools. Their relative lack of reliability and validity, however, make them less useful as diagnostic tests. Personality Inventories - Most widely used personality inventory in North America, the Minnesota Multiphasic Personality Inventory - The administration of the MMPI is straightforward. The individual being assessed reads statements such as “I cry easily,” or “I believe I am being followed,” and answers either “true” or “false.” - Pattern of responses is reviewed to see if it resembles patterns from groups of people who have specific disorders ● Scales of the MMPI-2 Validity Scales

Characteristics of High Scorers

Cannot Say (reported as a raw score) (?CNS)

Reading difficulties, guardedness, confusion and distractibility, depression, rebellion, or obsessiveness

Variable Response Inconsistency (VRIN)

Responding to questions in a manner inconsistent with psychological disorder

True Response Inconsistency (TRIN)

Answering questions all true or all false

Infrequency (F)

Exhibit randomness of responses or psychotic psychopathology

Back F (Fb)

Changing the way the questions are answered at the end of the test

Infrequency—Psychopathology (Fr)

Claiming more psychiatric symptoms than expected

Symptom Validity (FBS)

Trying to appear to have more disabilities but not psychotic

Lie (L)

Dishonest, deceptive, and/or defended

Correction (K)

Person is very guarded and defensive

Superlative Self-Presentation (S)

Believes in human goodness and denies personal flaws

Clinical Scales

Characteristics of High Scorers

Hypochondriasis

Somatizers, possible medical problems

Depression

Dysphoric, possibly suicidal

Hysteria

Highly reactive to stress, anxious, and sad at times

Psychopathic deviate

Antisocial, dishonest, possible drug abusers

Masculinity–femininity

Exhibit lack of stereotypical masculine interests, aesthetic and artistic

Paranoia

Exhibit disturbed thinking, ideas of persecution, possibly psychotic

Psychasthenia

Exhibit psychological turmoil and discomfort, extreme anxiety

Schizophrenia

Confused, disorganized, possible hallucinations

Mania

Manic, emotionally labile, unrealistic self-appraisal

Social introversion

Very insecure and uncomfortable in social situations, timid

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The reliability of the MMPI is excellent when it is interpreted according to standardized procedures, and thousands of studies on the original MMPI attest to its validity with a range of psychological problems Intelligence Testing - Intelligence tests were developed for one specific purpose: to predict who would do well in school. - Test provided an Intelligence Quotient: This mental age was divided by the child’s chronological age and multiplied by 100 to get the IQ score ● Wechsler: The Wechsler tests include versions for adults, for children, and for young children. All these tests contain verbal scales (which measure vocabulary, knowledge of facts, short-term memory, and verbal reasoning skills) and performance scales (which assess psychomotor abilities, nonverbal reasoning, and ability to learn new relationships).

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the WAIS-III—has been shown to tap four distinct intellectual abilities: verbal comprehension, perceptual organization, processing speed, and working memory findings caution against indiscriminate use of these tests with cultural groups outside those on whom the test was originally normed.

Neuropsychological Testing - Neuropsychological Testing: This method of testing assesses brain dysfunction by observing its effects on the person’s ability to perform certain tasks. Although you do not see damage, you can see its effects. - Sophisticated tests have been developed that can pinpoint the location of brain dysfunction - Generally available and relatively inexpensive. - Bender-Motor Visual Gestalt Test: 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 amount, then brain dysfunction is suspected. - Recent evidence suggests that performance on neuropsychological tests may even be useful in predicting the development of certain cognitive disorders. (e.g. Alzheimers) - Performance on tasks such as delayed verbal recall at the initial testing session with initially healthy participants accurately predicted whether or not the test taker developed Alzheimer’s disease five or ten years later - With this use of neuropsychological tests, however, we face the issue of false positives and false negatives. ● False Positive: The test will occasionally show a problem when none exists ● False Negative: Will not find a problem when indeed some difficulty is present - Fortunately, neuropsychological tests are used primarily as screening devices and are routinely paired with other assessments to improve the likelihood that real problems will be found. Neuroimaging: Pictures of the Brain - Neuroimaging can be divided into two categories. One category includes procedures that examine the structure of the brain, such as the size of various parts and whether they are damaged. In the second category are procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic activity. Images of Brain Structure ● Computerized axial tomography (CAT) scan or CT scan: - The first neuroimaging technique, developed in the early 1970s, uses multiple X-ray exposures of the brain from different angles; that is, X-rays are passed directly through the head. As with any X-ray, these are partially blocked or attenuated more by bone and less by brain tissue. The degree of blockage is picked up by detectors in the opposite side of the head. A computer then reconstructs pictures of various slices of the brain. - This procedure, which takes about 15 minutes - It is relatively non-invasive and has proved useful in identifying and locating abnormalities in the structure or shape of the brain.

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CT scans are particularly useful in locating brain tumours, injuries, and other structural and anatomical abnormalities. One difficulty, however, is that these scans, like all X-rays, involve repeated X-radiation, which poses some risk of cell damage

● MRI: - 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. The alteration is measured, along with the time it takes the protons to “relax” or return to normal. Where there are lesions or damage, the signal is lighter or darker. Technology now exists that allows the computer to view the brain in layers, which enables precise examination of the structure - Used to take 45 minutes, now can be done in 10 - Disadvantage of MRI at present is that someone undergoing the procedure is totally enclosed inside a narrow tube with a magnetic coil surrounding the head. People who are somewhat claustrophobic often cannot tolerate an MRI Images of Brain Function ● Positron emission tomography (PET): - Person is injected with an imaging tracer, a chemical attached to a radioactive isotope. The chemical component of a PET tracer is carefully selected to target a specific function in the body—for example, a metabolic process of neurotransmission. The PET scanner uses rings of detectors to measure the radioactive decay of the tracer, which accumulates at certain sites. Images representing the distribution of the tracer in the body are constructed - To obtain clear images, the individual undergoing the procedure must remain motionless for the duration of the scan. - Typical clinical brain PET scans take 30 minutes, while research imaging of processes like neurotransmitter function can take from 60 to 120 minutes - PET images can be superimposed on anatomical MRI images to show the precise location of the active areas. PET scans are also used to supplement MRI and CT scans in localizing the sites of trauma caused by head injury or stroke, as well as in localizing brain tumours. - PET scanning is very expensive ● Single photon emission computed tomography - It works very much like PET, although a different tracer substance is used, and it is somewhat less accurate. It is also less expensive, however, and requires far less sophisticated equipment to pick up the signals. For this reason, it is used more frequently. ● Functional MRI, or fMRI: - Using sophisticated computer technology, these procedures take only milliseconds and, therefore, can actually take pictures of the brain at work, recording its changes from one second to the next Psychophysiological Assessment

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Yet another method for assessing brain structure and function specifically and nervous system activity more generally is called psychophysiological assessment Psychophysiology refers to measurable changes in the nervous system that reflect emotional or psychological events. The measurements may be taken either directly from the brain or peripherally from other parts of the body. Electroencephalogram (EEG): - Measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity, the low-voltage electrical current ongoing in the brain, usually from the cortex. - A person’s brain waves can be assessed in both waking and sleeping states. - In an EEG, electrodes are placed directly on various places on the scalp to record the different low-voltage currents. - When brief periods of EEG patterns are recorded in response to specific events, such as hearing a psychologically meaningful stimulus, the response is called an event-related potential or evoked potential. - EEG patterns are often affected by psychological or emotional factors and can be an index of these reactions. - In a normal, healthy, relaxed adult, waking activities are characterized by a very regular pattern of changes in voltage termed alpha waves. - Many types of stress-reduction treatments attempt to increase the frequency of the alpha waves, often by relaxing the patients in some way. The alpha wave pattern is associated with relaxation and calmness. Sleep: During the deepest, most relaxed stage, typically occurring one to two hours after a person falls asleep, EEG recordings show a pattern of delta waves. These brain waves are slower and more irregular than the alpha waves, which is perfectly normal for this stage of sleep. If frequent delta wave activity occurred during the waking state, it might indicate dysfunction of localized areas of the brain. Extremely rapid and irregular spikes on the EEG recordings of someone who is awake may reflect significant seizure disorders, depending on the pattern The EEG recording is one of the primary diagnostic tools for identifying seizure disorders Electrodermal Responding (Skin Conductance): measure of sweat gland activity controlled by the peripheral nervous system

2. Diagnosing Psychological Disorders ● Classification: any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations—a nomothetic strategy. ● Taxonomy: The classification of entities for scientific purposes, such as insects or rocks or, if the subject is psychology, behaviours ● Nosology: If you apply a taxonomic system to psychological or medical phenomena or other clinical areas ● Nomenclature: The names or labels of the disorders that make up the nosology (e.g., anxiety or mood disorders).

Classification Issues Categorical, Dimensional, and Prototypical Approaches ● Classical Categorical Approach (Emil Kraepelin): We assume that every diagnosis has a clear underlying pathophysiological cause, such as a bacterial infection or a malfunctioning endocrine system, and that each disorder is unique - When diagnoses are thought of in this way, the causes could be psychological or cultural, instead of pathophysiological, but each disorder has only one set of causative factors that do not overlap at all with other disorders. - Because each disorder is fundamentally different from every other, we need only one set of defining criteria, which everybody in the category has to meet - Most psychopathologists believe biological, psychological, and social factors interact in complex ways to produce a disorder. Therefore, despite the beliefs of Kraepelin and other early biological investigators, the mental health field has not adopted a classical categorical model of psychopathology. ● Dimensional Approach: We note the variety of cognitions, moods, and behaviours with which the patient presents and quantify them on a scale - Most theorists can’t agree on how many dimensions are required; some say one dimension is enough; others have identified as many as 33 - Has been found unsatisfactory ● Prototypical Approach: - It is a categorical approach but with the twist that it combines some of the features of each of the other approaches. - identifies certain essential characteristics of an entity so you (and others) can classify it, but it also allows for certain non-essential variations that do not necessarily change the classification. - For example, if someone were to ask you to describe a dog, you could very easily give a general description (the essential, categorical characteristics), but you might not exactly describe a specific dog. Dogs come in different colours, sizes, and breeds (the non-essential, dimensional variations), , but they all share certain doggish characteristics that allow you to classify them separately fr...