Chapter 3 Diagnosis and Assessment

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Presentation transcript:

Chapter 3 Diagnosis and Assessment 982 變態心理學

Diagnosis and Assessment The classification of disorders by symptoms and signs. Advantages of diagnosis: Facilitates communication among professionals Advances the search for causes and treatments Cornerstone of clinical care: e.g.bipolar disorder

Cornerstones of Diagnosis & Assessment : Reliability Consistency of measurement Interrater Observer agreement Test-retest Similarity of scores across repeated test administrations or observations

Cornerstone of Diagnosis & Assessment : Reliability 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

Cornerstone of Diagnosis & Assessment : Validity How well does a test measures what it is supposed to measure? Content validity Extent to which a measure adequately samples the domain of interest.

Cornerstone of Diagnosis & Assessment : Validity Criterion validity( ): Extent to which a measure is associated with the criterion Concurrent Two measures administered at the same point in time Hopelessness scale and diagnosis of depression Predictive Ability of the measure to predict another variable measured at some future point in time College GPA and annual salary after graduation

Cornerstone of Diagnosis & Assessment: Validity Construct validity A construct is an abstract concept or inferred attribute Involves correlating multiple indirect measures of the attribute Important method for evaluating diagnostic categories

Classification and Diagnosis Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 4th edition revised Published by American Psychiatric Association Multiaxial system Diagnosis based on 5 axes or dimensions.

Five Axes of DSM-IV AXIS DESCRIPTION I All diagnostic categories except personality disorders and mental retardation II Personality disorders and mental retardation III General medical conditions IV Psychosocial and environmental problems V Global assessment of functioning scale (GAF)

Example: Multiaxial Diagnosis of Carol S. Axis I Major Depressive Disorder Axis II Borderline Personality Disorder Axis III Thyroid disease Axis IV Problems with primary support group: marital separation Axis V GAF = 60 Moderate difficulty in social and occupational functioning

Improvements in the DSM-IV-TR Specific diagnostic criteria Less vague, more explicit and concrete than DSM-II More extensive descriptions Essential features Associated features (e.g., lab findings) A summary of the research literature (age of onset, course, prevalence and sex ratio, familial pattern, and differential diagnosis)

Improvements in the DSM-IV-TR Increasing number of diagnostic categories Issues and possible diagnostic categories in need of further study (Focus on discovery 3.2)

Ethnic & Cultural Considerations Culture can influence: Risk factors Types of symptoms experienced Willingness to seek help Availability of treatments The language used to describe distress Clinicians are advised to be constantly mindful of how culture and ethnicity influence diagnosis and treatment.

Specific Criticisms of the DSM Too many diagnoses? Comorbidity: The co-occurrence of two disorders. Categorical diagnoses v.s. Continuum Reliability of the DSM How valid are diagnostic categories?

Categorical vs. Dimensional Systems Presence/absence of a disorder Either you are anxious or you are not anxious. advantages for research and understanding 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? better capture an individual’s functioning

Copyright 2010 John Wiley & Sons, NY

Figure 3.2 Interrater Reliability Extent to which clinicians agree on the diagnosis. Copyright 2010 John Wiley & Sons, NY

Inter-Rater Reliability of Selected DSM Diagnoses Diagnosis Kappa Bipolar Disorder .84 Major Depression .80 Schizophrenia .79 Alcohol Abuse 1.0 Any Eating Disorder .77 Panic Disorder .65 Avoidant PD .97 Dependent PD .86 For most DSM diagnostic categories, reliability is good Reliability in everyday settings may be lower than in formal research settings

How valid are diagnostic categories? Construct validity of highest concern Diagnoses are constructs For most disorders, no lab test available to diagnose with certainty Strong construct validity predicts wide range of characteristics

Copyright 2010 John Wiley & Sons, NY

Criticisms of Classification Stigma against mental illness Treated differently by others Difficulty 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.

Psychological Assessment Techniques employed to: Describe client’s problem Arrive at a diagnosis Determine causes of problem Develop a treatment strategy Monitor treatment progress Ideal assessment involves _________________________________

Clinical interviews Characteristics of clinical interviews Interviewer attends to how questions are answered Does client fail to answer question? Is response accompanied by appropriate emotion? Paradigm influences information sought CBT interviewer focuses on ________, rather than early childhood, events. Good rapport Structured vs. Unstructured Structured interviews All interviewers ask the same questions in a predetermined order Structured Clinical Interview for Axis I of DSM (SCID)

Copyright 2010 John Wiley & Sons, NY Sample Item from SCID Copyright 2010 John Wiley & Sons, NY

Copyright 2010 John Wiley & Sons, NY Assessment of Stress Social Readjustment Rating Scale (SSRS) Holmes & Rahe (1967) Stressfulness ratings fixed Copyright 2010 John Wiley & Sons, NY

Copyright 2010 John Wiley & Sons, NY Assessment of Stress -Sample of Assessment of Daily Experience (ADE) -Stone & Neale (1982) -Monitor and record thoughts and events Copyright 2010 John Wiley & Sons, NY

LEDS Life Events Timeline -Bedford College Life Events and Difficulties Schedule (LEDS) -Semi-structured interview -Evaluates stressors within the context of each individual’s circumstances Copyright 2010 John Wiley & Sons, NY

Three Types of Psychological Tests Self-report personality inventories Minnesota Multiphasic Personality Inventory (MMPI) Designed to detect a number of psychological problems MMPI-2 (Butcher et al., 1989)

Copyright 2010 John Wiley & Sons, NY

Hypothetical MMPI-2 Profile Copyright 2010 John Wiley & Sons, NY

Three Types of Psychological Tests Projective Personality Tests Projective hypothesis Responses to ambiguous stimuli reflect unconscious processes Rorschach Inkblot Test Thematic Apperception Test (TAT)

Copyright 2010 John Wiley & Sons, NY

Three Types of Psychological Tests Intelligence tests Assesses current mental ability Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV,2008); Wechsler Intelligence Scale for Children, 4th edition (WISC-III, 2003) Wechsler preschool and primary scale of intelligence, 3rd edition (WPPSI-III, 2002)

Behavioral and cognitive assessment Aspects of the environment that might contribute to symptoms Characteristics of the person The frequency and form of problematic behaviors Consequences of problem behaviors

Behavioral and cognitive assessment Direct observation of behavior Observe behavior as it occurs Sequence of behavior divided into segments Antecedents and consequences Observation often conducted in lab setting e.g., romantic partners discuss relationship problem Interaction observed through one-way mirror or videotaped for later coding

Behavioral and cognitive assessment Self-Observation Self monitoring Individuals observe and record their own behavior e.g., moods, stressful experiences, etc. Ecological Momentary Assessment (EMA) Collection of data in real time Reactivity The act of observing one’s behavior may alter it

Behavioral and cognitive assessment Cognitive-style questionnaires Format often similar to personality tests Dysfunctional Attitude Scale (DAS) Identifies maladaptive thought patterns Articulated Thoughts in Simulated Situations (ATSS) Assesses immediate thoughts in specific situations

Copyright 2010 John Wiley & Sons, NY

Neurobiological Assessment: Brain Imaging Computerized 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 _____________ fMRI (functional MRI) Images reveal function as well as structure Positron Emission Tomography (PET scan) Brain function

Neurobiological Assessment: Neurotransmitter Assessment Postmortem studies Metabolite Metabolite levels may not reflect actual level of neurotransmitter in the brain Correlational nature of metabolite studies limits understanding of causation

Neurobiological Assessment: Neuropsychological Assessment Neuropsychologist Psychologist who studies how brain abnormalities affect thinking, feeling, and behavior Not a neurologist Neuropsychological Tests Different psychological functions (memory, language…) rely on different areas of the brain Halstead-Reitan battery Luria-Nebraska battery Assesses motor skills, tactile & kinesthetic skills, verbal & spatial skills, expressive & receptive speech, etc.

Psychophysiological Assessment Psychophysiology Study of bodily changes that accompany psychological characteristics or events Electrocardiogram (EKG) Heart rate measured by electrodes placed on chest Electrodermal responding (skin conductance) Sweat-gland activity measured by electrodes placed on hand. Electroencephalogram (EEG) Brain’s electrical activity measured by electrodes placed on scalp.

Copyright 2010 John Wiley & Sons, NY

Cultural Bias in Assessment Measures 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

Strategies to Avoid Bias Increase graduate students’ sensitivity to cultural issues Modify assessment procedures to insure understanding of test takers Establish rapport Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994)