Psych Exam 1
What is recommended prior to administration of the Diagnostic Interview for Personality Disorders (DIPD-IV)?
a full screening for Axis I disorders
Provide the definition of a mental disorder given in the DSM-5.
a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
How is differential diagnosis defined in the text?
a systematic way of discriminating among numerous possible disorders to identify specific ones for which the client meets the diagnostic threshold
What additional feature is incorporated in the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) that distinguishes it from the SCID-I?
also covers 10 standard DSM-IV personality disorders, depressive personality disorder, passive-aggressive personality disorder
Why do no computer scoring applications currently exist for the SADS?
because of the complex nature of the diagnostic process and the strong reliance on clinical judgment
How does DSM-5 incorporate developmental and lifespan issues into its overall organization?
begins with diagnoses that reflect developmental processes that manifest early in life, followed by diagnoses that manifest in adolescence and young adulthood, and ends with diagnoses relevant to adulthood and later life.
Dual diagnosis affects which areas of psychopathology research?
diagnosis sample selection interpretation of research findings
What is the primary reason that 5 of the 10 personality disorders have been offered up for deletion?
excessive diagnostic co-occurrence
DSM-III unsuccessfully attempted to force differential diagnosis through the inclusion of what criteria?
exclusionary criteria
What is required prior to the administration of the Structured Interview for DSM-IV Personality (SIDP-IV)?
full evaluation of current mental state or Axis I conditions
Why are reliable diagnoses essential? List four reasons.
guiding treatment recommendations identifying prevalence rates for mental health service planning identifying patient groups for clinical and basic research documenting important public health information such as morbidity and mortality rates
What are the strongest predictors of cognitive impairment among a sample of individuals with mixed psychiatric diagnoses and substance use disorders?
lifetime use of alcohol or cocaine
Substance abuse is highly comorbid with what two affective disorders?
major depression and bipolar disorder
What effect does eliminating dual diagnosis patients have on samples?
makes them atypical, less impaired than they should be
How did patients with dual diagnoses compare to those with only substance abuse disorders in a 1-year follow-up?
more negative outcomes
What was the DSM designed to facilitate?
more reliable diagnoses of disorders
What fraction of patients in psychiatric treatment meet criteria for multiple diagnoses?
more than half
What four principles guided draft revisions?
must be feasible for routine clinical practice should be guided by research evidence continuity should be maintained with previous versions no a priori restraints should be placed on the degree of change between IV and 5
List 3 of the ways the DSM is intended to serve
practical, functional, and flexible guide
What are some of the difficulties in terms of providing services for pregnant women with dual disorders?
receiving adequate prenatal care use of substances and psychiatric medications while pregnant lack of coordinated treatment planning and provision among medical, psychiatric, and addictions professionals
How do authors define reliability and validity in relation to diagnoses?
reliability - consistency or agreement about diagnoses assigned by different raters validity - meaningfulness or usefulness of the diagnosis
List the three broad areas in which structured and semistructured interviews are utilized.
research clinical practice clinical training
List 3 of the diagnoses covered in the Schedule for Affective Disorders and Schizophrenia (SADS).
schizophrenia manic disorder hypomanic disorder
What is one reason for the addition of new diagnostic categories to the nomenclature?
so clinicians don't rely on "Not Otherwise Specified" so much
What does the term comorbidity refer to? Why have researchers argued for the abandonment if this term in favor of co-occurrence?
someone has at least 2 distinct diagnoses; co-occurrence is more descriptive
Individuals experiencing PTSD show high rates of comorbidity with what disorder(s)?
substance abuse and dependence
What are subtypes and specifiers as the terms are used in the DSM-5?
subtypes - define mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis specifiers - not intended to be mutually exclusive or jointly exhaustive, so more than one can be given
What does the DSM-IV say about categorical classifications of mental disorders, and why is this disclaimer somewhat hollow?
the different categories of mental disorders are not very clearly divided in actuality. It's hollow because the DSM-IV is by definition a categorical classification system.
What general diagnostic criterion continues to be used in the DSM-5 to establish disorder thresholds?
the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Briefly summarize the three reasons why harmonization with the ICD-11 was thought to be important.
the existence of two major classifications of mental disorders hinders statistics, clinical trial design, treatment development, and global application complicates attempts to replicate scientific results across national boundaries DSM-IV and ICD-10 diagnoses did not always agree
What does a prototypic case of a disorder refer to and what serves as an example in the text?
the most severe case, exhibiting all known symptoms; alcohol dependence
While some of the instruments mentioned in the chapter cover current as well as past symptoms, the DIPD-IV covers what period of time in the client's life?
the past 2 years of the client's life
What have researchers discovered about individuals with schizophrenia and comorbid substance abuse?
they show a poorer and more chaotic course of disorder, with more severe symptoms
In data from NESARC, which groups were found to have higher rates of suicide attempts?
those with dual bipolar disorder and alcohol use disorders
According to the text, what is the aim of all personality assessment measures?
to rate the respondent's typical, habitual, and lifelong personal functioning rather than acute or temporary states
What factors influence varying meanings of the term 'dual diagnosis?'
type of problematic substance abuse assessed the measures that are used the specific substances that are included in the assessment
What can replications of prevalence rate studies demonstrate?
whether the high rates found in the first studies persist over time
What are the 5 broad domains of the Five Factor Model (FFM) of personality?
1 Neuroticism 2 Extraversion versus introversion 3 Openness versus closedness 4 Agreeableness versus antagonism 5 conscientiousness versus undependability
In the Schedule for Affective Disorders and Schizophrenia, ancillary coverage is provided for what four aspects?
1. anxiety symptoms 2. substance abuse 3. psychosocial treatment history 4. antisocial personality features
What are the odd ratios...
2.3; 4.5
According to the requirements of the International Personality Disorder Examination (IPDE), a trait must be prominent for what duration of time to be considered a part of the respondent's personality?
5 years
What happened to Axes 3, 4, and 5 in the DSM-5? How is this information to be coded or conveyed when using the DSM-5?
?
List the three advantages and three disadvantages associated with structured and semistructured interviews.
Advantages - 1. increased reliability 2. increased validity 3. utility as training tools Disadvantages - 1. may hinder rapport 2. limited by the validity of the classification system itself 3. the tradeoff of breadth versus depth
What are the two primary areas of focus that structured and semistructured interviews can be broken into? Provide an example of one instrument that falls into each category.
Axis I - Anxiety Disorders Interview Schedule Axis II - Diagnostic Interview for DSM Personality Disorders
List the five fundamental phases of the principle model for validation of mental disorder diagnostic categories as provided by Robins and Guze.
Clinical description laboratory study delimitation from other disorders follow-up family studies
Structured and semistructured interviews were integrated into the mental health field with the primary purpose of addressing what concerns?
Clinicians and researchers had difficulty making consistent and accurate diagnoses with unstructured interviews.
List the 3 concepts offering greater clinical utility that replaced the culture-bound syndrome in the DSM-5.
Cultural Syndrome Cultural idiom of distress Cultural explanation or perceived cause
Which instrument is unique among the multidisorder diagnostic interviews in that it is a fully structured interview?
Diagnostic Interview Schedule for DSM-IV (DIS-IV)
Give the complete name of the DSM. Who publishes it?
Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association
What does Kendell offer as the reason we have made so little progress in dimensional classification?
Discrete clusters of psychiatric symptoms are a mirage; disorders are not found in discrete little packages - they bleed into one another and share traits.
What is an issue highlighted in epidemiological studies regarding dual diagnosis?
Even with changes in diagnostic criteria and attitudes about psychological distress, rates of dual disorders remain high.
Following the administration of the ADIS-IV, the examiner utilizes which two scales to assess current depressive and anxious symptoms?
Hamilton Rating Scale for Depression Hamilton Anxiety Rating Scale
List the advantages of the FFM of personality disorder over the categorical approach.
Helps with the stigmatization of personality disorder diagnosis provides a more precise description and complete picture
List the three main benefits associated with the use of structured interviews as noted by the author.
Increases coverage of many mental disorders that otherwise might be overlooked enhances the diagnostician's ability to accurately determine whether particular symptoms are present or absent reduces variability among interviewers, which improves reliability
describe Berkson's Fallacy and its impact on clinical samples
Individuals with multiple disorders are more likely to seek treatment, so estimates for occurrence of comorbidity are inaccurate.
What do the acronyms ICD and WHO stand for?
International Classification of Diseases World Health Organization
Based on the rubric of Robins and Guze, authors of the DSM emphasize that validity of a diagnosis rests in large part on what characteristic?
Its delimitation from other disorders
How might 'very sad persons' differ from individuals experiencing major depressive disorder? What is the diagnostic criteria for MDD?
MDD symptoms are just more severe; depressed mood loss of interest or pleasure weight loss or gain
How are mood disorders and personality disorders defined differently?
Mood - similar in content; personality - similar in form
Was there a meaningful distinction separating early onset dysthymic disorder and depressive personality disorder? Why was depressive personality disorder included in the mood disorders section of DSM-III?
No; it resembled mood disorders more than personality disorders
What 2 phrases have replaced NOS diagnoses in the DSM-5? Briefly describe.
Other specified disorder - allows clinician to specify why diagnosis doesn't fit Unspecified disorder - clinician chooses not to specify
How are the terms Principle Diagnosis and Provisional Diagnosis used in the DSM-5?
Principle - the condition established to be chiefly responsible for occasioning the admission of the individual Provisional - suggests the full criteria will be met when sufficient information is gathered
List the 4 stages of the DSM-5 Revision Process.
Proposals for Revisions DSM-5 Field Trials Public and Professional review Expert Review
Describe the DSM-5 Research Planning Conference proposal regarding the reclassification of personality disorders.
Replace the diagnosis of personality disorder with early-onset and chronic variants of existing Axis I mental disorders.
List five of the enhancements incorporated into the DSM-5.
Representation of developmental issues related to diagnosis Streamlined classification of bipolar and depressive disorders Transition in conceptualizing personality disorders Section III: new disorders and features online enhancements
How has alcohol abuse generally been considered?
Simply a residual category and/or less severe form of dependence
Why is the diagnosis of psychopathology in the presence of substance abuse and dependence especially difficult?
Symptoms of substance abuse and withdrawal can resemble psychiatric disorders.
