Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 PowerPoint  Lecture Notes Presentation Chapter 3 Diagnosis and Assessment Abnormal Psychology, Twelfth Edition, DSM-5 Update by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

Chapter Outline Chapter 3: Diagnosis and Assessment 4/22/2017 Chapter Outline Chapter 3: Diagnosis and Assessment I. Cornerstones of Diagnosis and Assessment II. Classification and Diagnosis III. Psychological Assessment IV. Neurobiological Assessment V. Cultural and Ethnic Diversity and Assessment © 2012 John Wiley & Sons, Inc. All rights reserved.

Diagnosis and Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Diagnosis and Assessment Diagnosis 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 © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Reliability Consistency of measurement Inter-rater Observer agreement Test-retest Similarity of scores across repeated test administrations or observations 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 © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Validity How well does a test measure what it is supposed to measure? Content validity Extent to which a measure adequately samples the domain of interest, e.g., all of the symptoms of a disorder Criterion validity Extent to which a measure is associated with another measure (the criterion) Concurrent Two measures administered at the same point in time Predictive Ability of the measure to predict another variable measured at some future point in time © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Validity Construct validity (Cronbach & Meehl, 1955) A construct is an abstract concept or inferred attribute Involves correlating multiple indirect measures of the attribute e.g., self-report of anxiety correlated with increased HR, shallow breathing, racing thoughts Important for validating our theoretical understanding of psychopathology Method for evaluating diagnostic categories © 2012 John Wiley & Sons, Inc. All rights reserved.

Classification and Diagnosis Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Classification and Diagnosis Diagnostic and Statistical Manual of Mental Disorders (DSM) published by American Psychiatric Association First edition published in 1952 Previous edition: DSM-IV-TR (fourth edition, revised) Published in 1994, text revised in 2000 Many texts and research articles will continue to use DSM-IV terminology for a period of time Current edition: DSM-5 Published summer of 2013 © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.1: Timeline for DSM-5 Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.1: Timeline for DSM-5 © 2012 John Wiley & Sons, Inc. All rights reserved.

Multiaxial Classification System in DSM-IV-TR and DSM-5 © 2012 John Wiley & Sons, Inc. All rights reserved.

Categorical Classification Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Categorical Classification DSM-IV-TR and V based on categorical classification If you have minimum number of symptoms, you are diagnosed with disorder. If one short, you are not. Little research support for this diagnosable threshold NOS (“Not Otherwise Specified”) remains in use for subthreshold cases © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.4: Categorical Versus Dimensional Systems of Diagnosis Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.4: Categorical Versus Dimensional Systems of Diagnosis Categorical Presence/absence of a disorder Either you are anxious or you are not anxious. 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? © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Changes in DSM-5 Changes in multiaxial system Five axes in DSM-IV-TR changed to two axes in DSM-5 Clinical Syndromes Psychosocial and Environmental Problems Changes in organization of diagnoses DSM-IV-TR clusters diagnoses on similarity of symptoms DSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared etiology OCD moved from anxiety cluster to new cluster that also includes hoarding and body dysmorphic disorder © 2012 John Wiley & Sons, Inc. All rights reserved.

Table 3.1: Descriptions of Mania in DSM-II vs. DSM-IV-TR Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.1: Descriptions of Mania in DSM-II vs. DSM-IV-TR © 2012 John Wiley & Sons, Inc. All rights reserved.

Chapters in DSM-IV-TR and DSM-5 Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Chapters in DSM-IV-TR and DSM-5 © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Changes in DSM-5 Personality Disorder Diagnoses Remain Unchanged from DSM-IV Proposed revisions included in Section III For further study New Diagnoses Disruptive mood dysregulation, Premenstrual Dysphoric Disorder, etc. Renaming of Diagnoses Mental Retardation to Intellectual Disability Dysthymia to Persistent Depressive Disorder Combining Diagnoses Substance use disorder replaces substance abuse and substance dependence, etc. Clearer Criteria © 2012 John Wiley & Sons, Inc. All rights reserved.

Ethnic and Cultural Considerations Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Ethnic and Cultural Considerations Mental illness universal Culture can influence: Risk factors Types of symptoms experienced Willingness to seek help Availability of treatments DSM-IV-TR includes: Enhanced cultural sensitivity Appendix of 25 culture-bound syndromes Amok, Drat, Koru, Taijin kyofusho, Hikikomori, etc. © 2012 John Wiley & Sons, Inc. All rights reserved.

Cultural Concepts of Distress Cultural Formulation 9 Concepts of Distress Replaces 25 separate diagnoses Focus on influence of culture on disorder presentation

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.2: Twelve- Month Prevalence Rates of the Most Common Diagnoses by Country © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Criticisms of the DSM Too many diagnoses? Should relatively common reactions be pathologized? Comorbidity Presence of a second diagnosis 45% of people diagnosed with one disorder will meet criteria for a second disorder Reliability in everyday practice © 2012 John Wiley & Sons, Inc. All rights reserved.

Table 3.3 Number of Diagnostic Categories per Edition of DSM Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.3 Number of Diagnostic Categories per Edition of DSM © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.6: Interrater Reliability Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.6: Interrater Reliability Extent to which clinicians agree on the diagnosis © 2012 John Wiley & Sons, Inc. All rights reserved.

Construct Validity of Diagnostic Categories Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Construct Validity of 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 Possible etiological causes (past) Clinical characteristics (current) Predict treatment response (future) © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.7: Construct Validity of Diagnostic Categories Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.7: Construct Validity of Diagnostic Categories © 2012 John Wiley & Sons, Inc. All rights reserved.

Criticisms of Classification Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 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. © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.4: Rates of Marital Distress and Missed Work Days Among People with Mental Illness in the Past Year © 2012 John Wiley & Sons, Inc. All rights reserved.

Psychological Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Psychological Assessment Techniques employed to: Describe client’s problem Determine causes of problem Arrive at a diagnosis Develop a treatment strategy Monitor treatment progress Conducting valid research Ideal assessment involves multiple measures and methods Interviews, personality inventories, intelligence tests, etc. © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Clinical Interviews Informal/less structured interviews Interviewer attends to how questions are answered Is response accompanied by appropriate emotion? Does client fail to answer question? Good rapport essential to earn trust Empathy and accepting attitude necessary Reliability lower than for structured interviews Structured interviews All interviewers ask the same questions in a predetermined order Structured Clinical Interview for Axis I of DSM (SCID) Good interrater reliability for most diagnostic categories © 2012 John Wiley & Sons, Inc. All rights reserved.

Table 3.5: Interrater Reliability of Selected DSM-IV-TR Diagnoses Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.5: Interrater Reliability of Selected DSM-IV-TR Diagnoses © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.8: Sample Item from SCID Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.8: Sample Item from SCID © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Assessment of Stress Stress Subjective experience of distress in response to perceived environmental problems Bedford College Life Events and Difficulties Schedule (LEDS) Semi-structured interview Evaluates stressors within the context of each individual’s circumstances Self-Report Stress Checklists Faster way to assess stress Test-retest reliability low © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Psychological Tests Personality Tests Self-reported Personality Inventories Minnesota Multiphasic Personality Inventory (MMPI) Yields profile of psychological functioning Specific subscales to detect lying and faking “good” or “bad” Projective Tests Rorshach Inkblot Test and Thematic Apperception Test (TAT) Projective hypothesis Responses to ambiguous stimuli reflect unconscious processes © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.11: Hypothetical MMPI-2 Profile Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.11: Hypothetical MMPI-2 Profile © 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 3.12: Sample Inkblots Similar to Rorschach Test Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Figure 3.12: Sample Inkblots Similar to Rorschach Test © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Psychological Tests Intelligence tests (IQ tests) Assess current mental ability Wechsler Scales Wechsler Adult Intelligence Scale, 4th ed. (WAIS-IV) Wechsler Intelligence Scale for Children, 4th ed. (WISC-IV) Wechsler Preschool and Primary Scale for Children, 3rd ed. (WPPSI-III) Stanford-Binet, 5th ed. (SB5) Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder (mental retardation), identify gifted children, as part of a neuropsychological examination Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB) Lower IQs associated with higher psychopathology and mortality Performance on IQ tests impacted by Stereotype Threat © 2012 John Wiley & Sons, Inc. All rights reserved.

Blocks used for WAIS/WISC © 2012 John Wiley & Sons, Inc. All rights reserved.

Behavioral and Cognitive Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Behavioral and Cognitive Assessment Focus on aspects of environment Characteristics of the person Frequency and form of problematic behaviors Consequences of problem behaviors © 2012 John Wiley & Sons, Inc. All rights reserved.

Behavioral and Cognitive Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Behavioral and Cognitive Assessment Observe behavior as it occurs Sequence of behavior divided into segments Antecedents and consequences Behavioral Assessments often conducted in lab setting e.g., mother and child interact in a lab living room Interaction observed through one-way mirror or videotaped for later coding © 2012 John Wiley & Sons, Inc. All rights reserved.

Behavioral Observation © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Self-Observation Self-monitoring Individuals observe and record their own behavior e.g., moods, stressful events, thoughts, etc. Ecological Momentary Assessment (EMA) Collection of data in real time using diaries or smart phones Reactivity The act of observing one’s behavior may alter it Desirable behaviors tend to increase whereas undesirable behaviors decrease © 2012 John Wiley & Sons, Inc. All rights reserved.

Cognitive-Style Questionnaires Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Cognitive-Style Questionnaires Use to help plan treatment targets Format often similar to personality tests Dysfunctional Attitude Scale (DAS) Identifies maladaptive thought patterns “People will think less of me if I make mistakes” © 2012 John Wiley & Sons, Inc. All rights reserved.

Table 3.7: Psychological Assessment Methods Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.7: Psychological Assessment Methods © 2012 John Wiley & Sons, Inc. All rights reserved.

Table 3.8: Neurobiological Assessment Methods Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Table 3.8: Neurobiological Assessment Methods © 2012 John Wiley & Sons, Inc. All rights reserved.

Neurobiological Assessment: Brain Imaging Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 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 higher quality fMRI (functional MRI) Images reveal function as well as structure Measures blood flow in the brain (BOLD=blood oxygenation level dependent) Positron Emission Tomography (PET scan) Brain function © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 CT Scans fMRI Images PET Scans © 2012 John Wiley & Sons, Inc. All rights reserved.

Neurobiological Assessment: Neurotransmitter Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Neurobiological Assessment: Neurotransmitter Assessment Postmortem studies Metabolite assays Metabolite levels Byproducts of neurotransmitter breakdown found in urine, blood serum or cerebral spinal fluid May not reflect actual level of neurotransmitter Correlational studies © 2012 John Wiley & Sons, Inc. All rights reserved.

Neurobiological Assessment: Neuropsychological Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Neurobiological Assessment: Neuropsychological Assessment Neuropsychologist Studies how brain abnormalities affect thinking, feeling, and behavior Neuropsychological Tests Reveal performance deficits that can indicate areas of brain malfunction Halstead-Reitan battery Tactile Performance Test-Time Tactile Performance Test-Memory Speech Sounds Perception Test Luria-Nebraska battery Assesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc. © 2012 John Wiley & Sons, Inc. All rights reserved.

Psychophysiological Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 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 © 2012 John Wiley & Sons, Inc. All rights reserved.

Biofeedback © 2012 John Wiley & Sons, Inc. All rights reserved.

Cultural and Ethnic Diversity and Assessment Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Cultural and Ethnic Diversity and Assessment 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 © 2012 John Wiley & Sons, Inc. All rights reserved.

Strategies to Avoid Bias Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 Strategies to Avoid Bias Increase graduate students’ sensitivity to cultural issues Insure participants’ understanding of task Establish rapport Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994) Conclusions should be tentative and alternative hypotheses should be entertained © 2012 John Wiley & Sons, Inc. All rights reserved.

Kring Ch3 Diagnosis and Assessment.ppt 4/22/2017 COPYRIGHT Copyright 2014 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. © 2012 John Wiley & Sons, Inc. All rights reserved.