Chapter 4 - Diagnosis and Assessment of Mental Disorders PDF

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Dr. Hoff...

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Dimensions and Categories o Dimensional approach  Refers to defining abnormal behavior along a continuum. o Category  Large class of frequently observed syndromes or mental disorders. DSM-5 o Categorical Information  The clinician must decide whether the person is displaying one of the hundreds of disorders listed in the manual o Dimensional Information  Diagnosticians also are required to assess the current severity of the client’s disorder  For each disorder, various rating scales are suggested  Example: Severity of Illness Rating Scale o Additional Information  Clinicians also have the opportunity to provide other information, including relevant medical conditions and special psychosocial problems Advantages of Diagnosis o Enhanced communication o Improved definition and understanding of mental disorder o Coordinated research o Ideas about which treatment is likely to be most effective for a given disorder. Disadvantages of Diagnosis o Poor reliability and validity o Diagnosis can stigmatize people Classifying and Assessing Abnormal Behavior and Mental Disorder o Clinical assessment involves evaluating a person’s strengths and weaknesses as well as understanding a problem to develop treatment Reliability, Validity, and Standardization o Reliability refers to consistency of scores or responses and includes test-retest, interrater, and internal consistency reliability o Validity is the extent to which an assessment technique measures what it is supposed to measure and includes content, predictive, concurrent, and construct validity o Standardization refers to administering and conducting clinical assessment measures in the same way for everyone Interview o Most common form of assessment  Unstructured  The interview determines the relevant questions  Semi-structured  Guided by a general outline or series of questions

Structured  Fairly standard series of questions o Limitations  May lack validity or accuracy  Interviewers may be biased or may make mistakes in judgment  Interviews, particularly unstructured ones, may lack reliability Intelligence Tests o used to assess cognitive aspects but must be viewed with caution, especially when comparing scores across cultures o typically comprised of a series of tests assessing both verbal and nonverbal skills o General score is an intelligence quotient (IQ) o Strengths:  among the most carefully produced tests o Weaknesses  Performance can be influenced by nonintelligence factors (e.g., motivation, anxiety, test-taking experience  may contain cultural biases in language or tasks  Members of minority groups may have less experience and be less comfortable with these types of tests, influencing their results Personality Tests o Objective personality measures involve administering a standard set of questions or statements to which a person responds using set options.  Minnesota Multiphasic Personality Inventory (MMPI)  Millon Clinical Multiaxial Inventory (MCMI)  Beck Depression Inventory-II (BDI-II) o Strengths and weaknesses:  Easier, cheaper, and faster to administer than projective tests  Objectively scored and standardized  Display greater test-retest reliability than projective tests  Appear to have greater validity than projective tests  Tests fail to allow for cultural differences in responses Projective Tests o Presentation and interpretation of ambiguous stimuli  Rorschach Inkblot Test  Thematic Apperception Test (TAT)  Draw-A Person (DAP) o Strengths and weaknesses:  Helpful for providing “supplementary” information  Have not consistently demonstrated much reliability or validity  May be biased against minority ethnic groups Behavioral Assessment 

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o measures overt behaviors or responses and is often conducted via functional analysis of antecedents and consequences of behavior o methods include naturalistic and controlled observation and self monitoring o Strengths and weaknesses:  Useful in assessing infrequent behaviors  Useful for observing overly frequent behavior  Provides a means of measuring private thoughts or perception  Validity is often a problem  Clients may not record information accurately  When people monitor themselves, they often change their behavior Biological Assessment o Includes neuroimaging techniques as well as procedures for assessing neurochemistry and body physiology o Neuroimaging  fMRI, PET, CAT, MRI o Neurochemical Assessment  assess the level of neurotransmitters indirectly through metabolites in urine, blood, CSF Biological tests o Psychophysiological tests  Galvanic Skin Response  Electroencephalograph (EEG) - electrical activity in the brain  Electrocardiogram - heart rate o Strengths and weaknesses:  Require expensive equipment that must be tuned and maintained  Can be inaccurate and unreliable Neuropsychogical Assessment o Indirectly evaluates brain function via performance on standardized tests and tasks that indicate brain-behavior relationships o Battery vs. process approach (focal testing)  Luria-Nebraska Neuropsychological Battery  Halstead-Reitan Neuropsychological Battery  California Verbal Learning Test  Benton Visual Retention Test  Assess immediate memory, spatial perception, and perceptualmotor coordination o Strengths and weaknesses:  Can be very accurate  At best, though, these tests are general screening devices Culture and Clinical Assessment

o Mental health professionals must overcome a language barrier if one exists, obtain information about a client’s culture, be culturally sensitive, and be aware of cultural variations in psychological problems

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o o Cultural identity of the client  Note the client’s ethnic or cultural reference groups as well as language abilities and preferences o Cultural explanations of the client’s problems  Note how the identified cultural group might explain the present symptoms and how these symptoms compare to those experienced by those in the cultural reference group o Cultural factors related to the social environment  Note how the cultural reference group might interpret the social stresses, as well as availability of social supports and other resources that may aid treatment. o Cultural influences on the relationship between the client and the mental health professional  Indicate differences in cultural and social status between the client and mental health professional that might influence diagnosis and treatment. o Overall cultural assessment  Summarize how cultural factors and considerations are likely to influence the assessment and treatment of the client. Research Design o Variables  Independent  Dependent o Dependent variable o Randomization

Experimental/control Double-blind studies  neither the experimenter nor the participants know who received a placebo or an active treatment.  Triple-blind studies  participants, experimenters, independent raters of outcome, and even data managers are unaware of who received a placebo or active treatment. o Validity  Internal  extent to which a researcher can be confident that changes in the dependent variable (depression symptoms) truly resulted from manipulation of the independent variable (medication  External  extent to which results can be generalized to the whole population. Research Design o Correlational studies  -1.00 to +1.00 o Quasi-Experimental designs  Mixed designs do not randomly assign people to experimental and control groups like a true experiment does. An experimenter instead examines groups that already exist. o Developmental designs  Longitudinal  examining the same group of people over a long period of time.  Cross-sectional  examining different groups of people at one point in time.  Sequential  begins as a cross-sectional study, but the groups are examined over a short time frame  2-, 7-, 12-, and 17-year-old children whose parents had schizophrenia may be examined now and over a 5-year period  Case study  makes careful observations of one person over time o  

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