Chapter 4 Abnormal Psychology Notes PDF

Preview

Summary

Thorough notes for the 4th chapter we covered....

Description

CHAPTER 4 ABNORMAL PSYCHOLOGY NOTES Psychological assessment - refers to a procedure by which clinicians, using psychological tests, observation, and interviews, develop a summary of the client’s symptoms and problems. Clinical diagnosis - the process through which a clinician arrives at a general ‘summary classification’ of the patient’s symptoms by following a clearly defined system such as DSM-5. 4.1 - Identify the basic elements in assessment - Presenting problem - major symptoms and behavior the client is experiencing, must be identified. Situational problem precipitated by some environmental stressor. The Relationship Between Assessment and Diagnosis - It is essential to know the range of diagnostic problems that are presented in the client population and for which treatment facilities need to be available. Taking a Social or Behavioral History - For most clinical purposes, assigning a formal diagnostic classification per se is much less important than having a clear understanding of the individual’s behavioral history, intellectual functioning, personality characteristics, and environmental pressures and resources. - Assessment should include a description of any relevant long-term personality characteristics. It is also important to assess the social context in which the individual functions. What kind of environmental demands are placed on a person etc. - Some clinicians refer to the picture given by theses assessments are “dynamic formulation” because it not only describes the current situation but also includes - hypotheses about what is driving the person to behave in maladaptive ways. - When feasible decisions about treatment are made collaboratively with the consent and approval of the individual. Ensuring Culturally Sensitive Assessment Procedures - It is critical for the psychologist to be informed of the issues involved in multicultural assessment (often referred to as cultural competence) and to use testing procedures that have been adapted and validated for culturally diverse clients. Reliability, Validity, and Standardization

4.2 - Describe the factors involved in the assessment of the physical organism - Psychologists who use tests in a culturally competent manner must bear in mind a range of issues and factors involved with culturally and linguistically diverse clients. - The most widely used personality measure, the Minnesota Multiphasic Personality Inventory (MMPI-2) (discussed later in this chapter), has been widely evaluated both in international applications with translated versions and in diverse subcultural groups in the United States. The Influence of Professional Orientation - For example, a biologically oriented clinicians typically a psychiatrist or other medical practitioners likely to focus on biological assessment methods aimed at determining any underlying organic malfunctioning that may be causing the maladaptive behavior. - A psychodynamic or psychoanalytically oriented clinician may choose unstructured personality assessment techniques, such as the Rorschach inkblots or the Thematic Apperception Test. - Basically, orientation matters a lot. Reliability, Validity, and Standardization - Reliability is a term describing the degree to which an assessment measure produces the same result each time it is used to evaluate the same thing. - Validity is the extent to which a measuring instrument actually measures what it is supposed to measure. - Standardization is a process by which a psychological test is administered, scored, and interpreted in a consistent or “standard” manner. - Many psychological tests are standardized to allow the test user to compare a particular individual’s score on the test with a reference population, often referred to as a normative sample. A large normative population can enable the user to evaluate whether the individual’s score is low, average, or high along the distribution of scores (referred to as a T score distribution). Trust and Report Between the Clinician and the Client - The clinician should explain what will happen during assessment and how the information gathered will help provide a clearer picture of the problems the client is facing. - Clients need to be assured that the feelings, beliefs, attitudes, and personal history that they are disclosing will be used appropriately, will be kept in strict confidence, and will be made available only to therapists or others involved in the case. - People being tested in a clinical situation are usually highly motivated to be evaluated and like to know the results of the testing. - When persons who were not provided psychological test feedback were compared with

those who were provided with feedback, the latter group showed a significant decline in reported symptoms and an increase in measured self-esteem as a result of having a clearer understanding of their own resources. 4.2 - Describe the Factors involved in the assessment of the physical organism The General Physical Examination - In cases in which physical symptoms are part of the presenting clinical picture, a referral for a medical evaluation is recommended. A physical examination consists of the kinds of procedures most of us have experienced when getting a “medical checkup.” - This part of the assessment procedure is of obvious importance for disorders that entail physical problems, such as a psychologically based physical condition, addictive disorders, and organic brain syndromes. The Neurological Examination Examination - Electroencephalogram (EEG) to assess brain wave patterns in awake and sleeping states. An EEG is a graphical record of the brain’s electrical activity (Yamada & Meng, 2011). It is obtained by placing electrodes on the scalp and amplifying the minute brain wave impulses from various brain areas. An EEG may reveal a dysrhythmia, or irregular pattern, in the brain’s electrical activity. For example, recent research has supported a link between resting frontal EEG asymmetry and depression and anxiety. - Anatomical Brain Scans - CAT Scans - Computerized axial tomography (CAT) scan, is one of these specialized techniques (Mishra & Singh, 2010). Through the use of Xrays, a CAT scan reveals images of parts of the brain that might be diseased. This procedure has aided neurological study in recent years by providing rapid access, without surgery, to accurate information about the localization and extent of anomalies in the brain’s structural characteristics. - Magnetic resonance imaging (MRI) - The images of the interior of the brain are frequently sharper with MRI because of its superior ability to differentiation subtle variations in soft tissue. In addition, the MRI procedure is normally far less complicated to administer than a CAT scan and does not subject the patient to ionizing radiation. - PET Scans - Whereas a CAT scan is limited to distinguishing anatomical features such as the shape of a particular internal structure, a PET scan allows for an appraisal of how an organ is functioning. - The PET scan may be able to reveal problems that are not immediately apparent anatomically. - The Functional MRI

-

-

-

fMRI most often measures changes in local oxygenation (i.e., blood flow) of specific areas of brain tissue that in turn depend on neuronal activity in those specific regions. A number of studies have provided support for this optimism. Research using fMRI has explored the cortical functioning that underlies various psychological processes; for example, one study showed that psychological factors or environmental events can affect brain processes as measured by fMRI. One study of treatment for aphasia, a disorder in which there is a loss of ability to communicate verbally, showed that changes in behavioral performance and the brain activation pattern were disclosed as affecting the brain’s reorganization.

The Neuropsychological Examination - Neuropsychological assessment - involves the use of various testing devices to measure a person’s cognitive, perceptual, and motor performance as clues to the extent and location of brain damage. - The Halstead-Reitan battery for adults is made up of a group of tests such as the following: - Halstead category test: Measures a subject’s ability to learn and remember material and can provide clues as to his or her judgment and impulsivity. - Tactual performance test: Measures a subject’s motor speed, response to the unfamiliar, and ability to learn and use tactile and kinesthetic cues. - Rhythm test: Measures attention and sustained concentration through an auditory perception task. It includes 30 pairs of rhythmic beats that are presented on a tape recorder. - Speech sounds perception test: Determines whether an individual can identify spoken words. - Finger oscillation task: Measures the speed at which an individual can depress a lever with the index finger. - Neuropsychological testing provides a clinician with important behavioral information on how organic brain damage is affecting a person’s present functioning. However, in cases where the psychological difficulty is thought to result from non organic causes, psychosocial assessment is used. 4.3 - Explain the interview process, clinical observation, and testing in psychosocial assessment Assessment Interviews - an assessment interview, often considered the central element of the assessment process, usually involves a face-to-face interaction in which a clinician obtains information about various aspects of a client’s situation, behavior, and personality.

-

-

Structured interviews - yields far more reliable results than the flexible format. Structured interviews follow a predetermined set of questions throughout the interview. Unstructured interviews are typically subjective and do not follow a predetermined set of questions. Thus, the use of unstructured interviews in mental health research is limited. On the positive side, clients may view unstructured interviews as being more sensitive to their needs or problems than more structured procedures. The reliability of an assessment interview may be enhanced by the use of rating scales that help focus inquiry and quantify the interview data. Clinical interviews can be subject to error because they rely on human judgment to choose the questions and process the information.

The Clinical Observation of Behavior - One of the traditional and most useful assessment tools that a clinician has available is direct observation of a client’s characteristic behavior. - Some practitioners and researchers use a more controlled, rather than a naturalistic, behavioral setting for conducting observations in contrived situations. These analogue situations, which are designed to yield information about the person’s adaptive strategies, might involve such tasks as staged role-playing, event reenactment, family interaction assignments, or think-aloud procedures. - Self-monitoring: self-observation and objective reporting of behavior, thoughts, and feelings as they occur in various natural settings. - Rating scales - As in the case of interviews, the use of rating scales in clinical observation and in self-reports helps both to organize information and to encourage reliability and objectivity. That is, the formal structure of a scale is likely to keep observer inferences to a minimum. - Brief Psychiatric Rating Scale (BPRS) - provides a structured and quantifiable format for rating clinical symptoms such as over concern with physical symptoms, anxiety, emotional withdrawal, guilt feelings, hostility, suspicious- ness, and unusual thought patterns. - The Hamilton Rating Scale for Depression (HRSD), a similar but more specifically targeted instrument, is one of the most widely used procedures for selecting research subjects who are clinically depressed and also for assessing the response of such subjects to various treatments Psychological Tests - Interviews and behavioral observation are relatively direct attempts to determine a person’s beliefs, attitudes, and problems. Psychological tests are a more indirect means of assessing psychological characteristics. - Among the characteristics that these tests can measure are coping patterns, motive patterns, personality characteristics, role behaviors, values, levels of depression or anxiety, and intellectual functioning.

-

Their value often depends on the competence of the clinician who interprets them. - Intelligence tests - The Wechsler Intelligence Scale for Children–Revised (WISC-IV) and the current edition of the Stanford-Binet Intelligence Scale are widely used in clinical settings for measuring the intellectual abilities of children. - Probably the most commonly used test for measuring adult intelligence is the Wechsler Adult Intelligence Scale–Revised (WAIS-IV). It includes both verbal and performance material and consists of 15 subtests. - Vocabulary (verbal) - this subtest consists of a list of words to define that are presented orally to the individual. - Digit span (performance) - In this test of short-term memory, a sequence of numbers is administered orally. The individual is asked to repeat the digits in the order administered. - Moreover, information about cognitive functioning or deterioration can provide valuable clues to a person’s intellectual resources in dealing with problems

Projective Personality Tests - It is customary to group tese personality tests into projective and objective measures. Projective personality tests are instructed in that they rely on various ambiguous stimuli such as inkblots or vague pictures rather than on explicit verbal questions, and in that the person’s responses are not limited to then variety. - The Rorschach Inkblot Test - The test uses 10 inkblot pictures, to which a subject responds in succession after being instructed. The extremely violent content of this response was not common for this particular blot or for any other blot in the series. Although no responsible examiner would base conclusions on a single instance, such content was consistent with other data from this subject, who was diagnosed as an antisocial personality with strong hostility. - The Rorschach was shown to “overpathologize” persons taking the test—that is, the test appears to show psychopathology even when the person is a “normal” person randomly drawn from the community. Thematic Apperception Test - The TAT uses a series of simple pictures, some highly representational and others quite abstract, about which a subject is instructed to make up stories. - Several scoring and interpretation systems have been developed to focus on different aspects of a subject’s stories such as expressions of needs, the person’s perception of reality. - Even though the THAT remains popular among practicing clinicians, clinical training programs have reduced the amount of time devoted to teaching graduate students about the TAT, and relatively few contemporary training resources (such as books and manuals)

exist. Sentence Completion Test - A number of such tests have been designed for children, adolescents, and adults. - Sentence completion tests, which are related to the free-association method, a procedure in which a client is asked to respond freely, are somewhat more structured than the Rorschach and most other projective tests. They help examiners pinpoint important clues to an individual’s problems, attitudes, and symptoms through the content of her or his responses. - The great strengths of projective techniques— their unstructured nature and their focus on the unique aspects of personality—are at the same time their weaknesses because they make interpretation subjective, unreliable, and difficult to validate. Objective Personality Tests - Objective personality tests - are structured — that is, they typically use questionnaires, self-report inventories, or rating scales in which questions or items are carefully phrased and alternative responses are specified as choices. - One of the major structured inventories for personality assessment is the Minnesota Multiphasic Personality Inventory (MMPI). - Each of the 10 clinical scales measures tendencies to respond in psychologically deviant ways. Raw scores on these scales are compared with the corresponding scores of the normal population, many of whom did (and do) answer a few items in the critical direction (suggesting psychological problems), and the results are plotted on the standard MMPI profile form. - The MMPI also includes a number of validity scales to detect whether a patient has answered the questions in a straightforward, honest manner. Advantages and Limitations of Objective Personality Tests - Self-report inventories such as the MMPI have a number of advantages over other types of personality tests. They are cost effective, highly reliable, and objective; they also can be scored and interpreted (and, if desired, even administered) by computer. A number of general criticisms, however, have been leveled against the use of self-report inventories. As we have seen, some clinicians consider them too mechanistic to portray the complexity of human beings and their problems accurately. - Computer-based MMPI interpretation systems typically employ powerful actuarial procedures In such systems, descriptions of the actual behavior or other established characteristics of many subjects with particular patterns of test scores have been stored in the computer. - Computerized personality assessment is no longer a novelty but an important, dependable adjunct to clinical assessment. Computerized psychological evaluations are a quick and efficient means of providing a clinician with needed information early in the decisionmaking process.

4.4 - Evaluate the case study of a women who experienced violence in the workplace. - Andrea suffered a number of physical injuries and recurring symptoms from the assault and was hospitalized for 8 days following the attack. - After recovery from the physical injuries she was fearful to return to work, and she applied for disability as a result of her injuries. The company for which she worked rejected her request, and she filed a lawsuit for personal injury disability. - As a central part of the evaluation, the MMPI-2 was administered by the psychologist hired by the defense to appraise Andrea’s personality and symptoms (see the validity, clinical, and supplementary profiles shown in Figures 4.1 and 4.2). The MMPI-2 clinical scale pattern shows clear mental health problems. The jury awarded Andrea substantial damages as a result of the injuries and the trauma that she experienced from the assault. 4.5 - Discuss how practitioners integrate assessment data in treatment planning - In a clinic or hospital setting, assessment data are often evaluated in a staff conference attended by members of an interdisciplinary team who are concerned with the decisions to be made regarding treatment. - New assessment data collected during the course of therapy provide feedback on the therapy’s effectiveness and serve as a basis for making needed modifications in an ongoing treatment program. Ethical Issues in Assessment - 1) Potential cultural bias of the instrument or the clinician - 2) Theoretical orientation of the clinician - 3) Underemphasis on the external situation - 4) Insufficient validation - 5) Inaccurate data or premature evaluation 4.6 - Explain the process of classifying abnormal behavior - In abnormal psychology, classification involves the attempt to delineate meaningful subvarieties of maladaptive behavior. Like defining abnormal behavior, classification of some kind is a necessary first step toward introducing order into our discussion of the nature, causes, and treatment of such behavior. Differing Models of Classification - The Categorical Approach - The categorical approach, like the diagnostic system of general medical diseases, assumes (1) that all human behavior can be divided into the categories of “healthy” and “disordered,” and (2) that within the latter there exist discrete, non overlapping - classes or types of disorder that have a high degree of within-class homogeneity in both symptoms displayed and the underlying organization of the disorder identified.

-

-

-

The dim...