Clinical Assessment, Diagnosis and research Methods Raw data to half baked ideas

Assessing Psychological Disorders Diagnosis is a essential tool Consistent framework and set of criteria for describing mental disorders Helps clinicians develop treatment plans Common language Less vulnerable to law suits 3 rd party payments Diagnosis is a essential tool Consistent framework and set of criteria for describing mental disorders Helps clinicians develop treatment plans Common language Less vulnerable to law suits 3 rd party payments

Assessment…. Useful information for clients Knowing who you can treat and who you need to refer Useful information for clients Knowing who you can treat and who you need to refer

Assessment: Key Concepts Reliability: consistency Validity Measures what it is designed to measure Can be reliable but not valid, but cannot be valid unless reliable Standardization: testing, treatment Reliability: consistency Validity Measures what it is designed to measure Can be reliable but not valid, but cannot be valid unless reliable Standardization: testing, treatment

Clinical interviews Primary tool Past/present behavior Attitudes Emotions History Life circumstances: job, social support, etc Primary tool Past/present behavior Attitudes Emotions History Life circumstances: job, social support, etc

Mental Status Exam Appearance and behavior Thought processes Mood and affect Intellectual functioning Sensorium Oriented in the 4 spheres (date, time, place, person) Appearance and behavior Thought processes Mood and affect Intellectual functioning Sensorium Oriented in the 4 spheres (date, time, place, person)

Physical Examination Multitude of physical problems that show up as mental/emotional problems Drugs Hyperthyroidism: anxiety Hypothyroidism: depression Brain tumors Multitude of physical problems that show up as mental/emotional problems Drugs Hyperthyroidism: anxiety Hypothyroidism: depression Brain tumors

Behavioral Assessment ABC’s: Antecedents, Behaviors, Consequences Both formal and informal Self-monitoring ABC’s: Antecedents, Behaviors, Consequences Both formal and informal Self-monitoring

Psychological Testing Evaluate cognitive, emotional and behavioral functioning Can help in diagnosis Help determine severity (Beck Depression Inventory) Evaluate cognitive, emotional and behavioral functioning Can help in diagnosis Help determine severity (Beck Depression Inventory)

Projective Tests Psychodynamic perspective Ambiguous stimuli leads to projections of unconscious thoughts and fears Controversial: weak psychometric qualities Psychodynamic perspective Ambiguous stimuli leads to projections of unconscious thoughts and fears Controversial: weak psychometric qualities

Projective Testing Rorschach Inkblock Test Thematic Apperception Test (TAT) Rorschach Inkblock Test Thematic Apperception Test (TAT)

Personality Testing MMPI: Minnesota Multiphasic Personality Inventory 549 questions Lots of research on this instrument Looking for patterns of responses Lie factor MMPI: Minnesota Multiphasic Personality Inventory 549 questions Lots of research on this instrument Looking for patterns of responses Lie factor

Myers Briggs Type Indicator Where, primarily, do you direct your energy? How do you prefer to process information? How do you prefer to make decisions? How do you prefer to organize your life? Where, primarily, do you direct your energy? How do you prefer to process information? How do you prefer to make decisions? How do you prefer to organize your life?

Intelligence Tests Stanford-Binet Weschler Intelligence Scale for Children (WISC-R) Weschler Adult Intelligence Survey (WAIS) Stanford-Binet Weschler Intelligence Scale for Children (WISC-R) Weschler Adult Intelligence Survey (WAIS)

Neuropsychological testing Language skills Attention and concentration Memory Motor skills Perceptual abilities Learning Abstract thought Language skills Attention and concentration Memory Motor skills Perceptual abilities Learning Abstract thought

Neuropsych.. Guesses about brain impairment Assess abilities and liabilities Bender Gestalt Luria Halstead Guesses about brain impairment Assess abilities and liabilities Bender Gestalt Luria Halstead

Neuropsych.. Shortcomings: False positives False negatives Very expensive and highly specialized training Shortcomings: False positives False negatives Very expensive and highly specialized training

Neuroimaging Measurements of brain structure and function The new frontier Structural abnormalities, tumors, injuries: MRI, CAT Function: interactions of blood, oxygen and glucose in active parts of brain: PET, SPECT, functional MRI Measurements of brain structure and function The new frontier Structural abnormalities, tumors, injuries: MRI, CAT Function: interactions of blood, oxygen and glucose in active parts of brain: PET, SPECT, functional MRI

Psychophysiological assessment Electroencephalogram: electrical activity in the brain (EEG) Electromyograph: muscle tension (EMG) Heart rate, respiration, skin temperature Used in the assessment of disorders with strong emotional component Electroencephalogram: electrical activity in the brain (EEG) Electromyograph: muscle tension (EMG) Heart rate, respiration, skin temperature Used in the assessment of disorders with strong emotional component

Diagnosing Psychological Disorders “Faced with chaos and pain, we fall back on the human impulse to label as a way of distancing ourselves while giving ourselves the illusion that we are doing something.” Salvador Minuchin “Faced with chaos and pain, we fall back on the human impulse to label as a way of distancing ourselves while giving ourselves the illusion that we are doing something.” Salvador Minuchin

Classification Construct categories and assign people to those categories on the basis of shared attributes Taxonomy: scientific classification Nosology: taxonomic system classifying psychological and medical phenomena Construct categories and assign people to those categories on the basis of shared attributes Taxonomy: scientific classification Nosology: taxonomic system classifying psychological and medical phenomena

DSM IV-TR Diagnostic and Statistical Manual of the American Psychiatric Association, 4 th edition, Text Revision

Approaches to classification Categorical Assumption that conditions are unique. One set of criteria and all must be met. Common in medicine but not psychopathology Dimensional Scales, ratings, degrees of symptoms. Great idea but hard to accomplish Categorical Assumption that conditions are unique. One set of criteria and all must be met. Common in medicine but not psychopathology Dimensional Scales, ratings, degrees of symptoms. Great idea but hard to accomplish

Approaches to classification.. Prototypical approach Categorical but allows for variation. Identifies essential features and then offers a variety of symptoms that person could have. DSM based on this approach. Prototypical approach Categorical but allows for variation. Identifies essential features and then offers a variety of symptoms that person could have. DSM based on this approach.

Diagnosis of Major Depressive Disorder, Single Episode A. The person experiences a single major depressive episode: For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest. A. The person experiences a single major depressive episode: For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.

Diagnosis of Major Depressive Disorder, Single Episode Depressed mood. For children and adolescents, this may be irritable mood. A significantly reduced level of interest or pleasure in most or all activities. A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight. Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia). Behavior that is agitated or slowed down. Others should be able to observe this. Depressed mood. For children and adolescents, this may be irritable mood. A significantly reduced level of interest or pleasure in most or all activities. A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight. Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia). Behavior that is agitated or slowed down. Others should be able to observe this.

Diagnosis of Major Depressive Disorder, Single Episode Feeling fatigued, or diminished energy. Thoughts of worthlessness or extreme guilt (not about being ill). Ability to think, concentrate, or make decisions is reduced. Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide. The persons' symptoms do not indicate a mixed episode. The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder. Feeling fatigued, or diminished energy. Thoughts of worthlessness or extreme guilt (not about being ill). Ability to think, concentrate, or make decisions is reduced. Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide. The persons' symptoms do not indicate a mixed episode. The person's symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

Diagnosis of Major Depressive Disorder, Single Episode The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

Multiaxial system Axis I: Clinical disorder Axis II: Personality Disorders, Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning Axis I: Clinical disorder Axis II: Personality Disorders, Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning

Problems with DSM Fuzzy boundaries Comorbidity Misuse “reification” People who don’t fit categories Exp: Depressive Disorder, NOS Fuzzy boundaries Comorbidity Misuse “reification” People who don’t fit categories Exp: Depressive Disorder, NOS

a. B. Another disorder does not better explain the major depressive episode. C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).

Key Questions for Diagnosis What are the primary symptoms? What is the approximate duration of the disorder? How severe are the symptoms? Has a specific cause or precipitant for the symptoms been identified? Seligman (1996) What are the primary symptoms? What is the approximate duration of the disorder? How severe are the symptoms? Has a specific cause or precipitant for the symptoms been identified? Seligman (1996)