Abnormal Psychology 4

CHAPTER 4: CLINICAL ASSESSMENT, DIAGNOSIS, AND TREATMENT

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Six Types of Clinical Tests

1. Projective Tests 2. Personality Inventories 3. Response Inventories 4. Psychophysiological Tests 5. Neuropsychological 6. Intelligence Tests

Limitations of the DSM

1. defining what is normal and abnormal 2. difficult to differentiate-symptoms from one disorder might be present in another 3. fails to address culture-specific disorders

Neuropsychological Tests

: a test that detects brain impairment by measuring a person's cognitive, perceptual, and motor performances.

Psychophysiological Tests

: tests designed to measure a person's physical responses such as heart rate and muscle tension as possible indicators of psychological problems. Often require expensive equipment and can be inaccurate and unreliable.

The Halstead-Reitan Battery

A fixed set of eight tests used to evaluate brain and nervous system functioning in individuals aged 15 years and older. The Halstead-Reitan is typically used to evaluate individuals with suspected brain damage. Evaluates a wide range of nervous system and brain functions, including: visual, auditory, and tactual input; verbal communication; spatial and sequential perception; the ability to analyze information, form mental concepts, and make judgments; motor output; and attention, concentration, and memory.

Classification Systems

A list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses.

Analog Observation

A method for observing behavior in which people are observed in artificial settings such as clinicians' offices or laboratories.

Thematic Apperception Test

A projective test in which people express their inner feelings and interests through the stories they make up about ambiguous scenes.

Projective Tests

A test consisting of ambiguous material that people interpret or respond to. Projective tests fail to show consistency in validity or reliability. Practitioners follow mostly newer models and have less use for projective tests now...

Self-Monitoring

Actively thinking about and controlling our public behaviors and actions

Does Therapy work?

Average person who receives psychotherapy experiences greater improvement than do 75% of all untreated people with similar problems.

Diathesis of Stress

Certain people have a biological vulnerability to developing the disorder brought to the surface by psychological and sociocultural factors. Treatment is at least more effective when medications are combined with cognitive-behavioral techniques to treat OCD. Treatment combinations are a welcome development.

Assessment

Collecting relevant information in an effort to reach a conclusion

Emil Kraepelin

German psychiatrist responsible for creating the first truly comprehensive classification system of psychological disorders

Paul Meehl

In the 1950's Meehl argued that statistical interpretation of test results is better than clinical interpretation. Indeed, where appropriate statistical information exists, clinical interpretation cannot improve on it. However, "where appropriate statistical information" is the key phrase, since statistical predictions will only be as good as the empirical evidence on which they are based.

Personality Assessment

Method used by psychodynamic clinicians that assess a client's personality and probe for any unconscious conflicts he or she may be experiencing.

How many forms of therapy are currently in practice?

Over 400

What is the gold standard in medical/psychological research?

Placebo double blind study and ethics

Sentence-Completion Test

Projective technique utilizing incomplete sentences that a person is to complete, analysis of which enables a clinician to infer personality dynamics

Who uses the DSM

Psychiatrists, clinical psychologists, social workers, nurses, counselors...

Affective Inventories

Response inventories that measure the severity of such emotions as anxiety, depression, and anger.

Psychological tests must meet three criteria:

Standardization, Reliability, and Validity

Psychometrician/Psychometrics/Psychometry

The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and personality traits. Also called psychometry.

Reliability

The extent to which a test yields consistent results

Interrater/Interjudge reliability

The level of agreement between two or more raters who have evaluated the same individual independently. Agreement can refer to consensus on behaviors, attributes, and so on.

Minnesota Multiphasic Personality Inventory (MMPI)

The most widely researched and clinically used of all personality tests. Originally developed to identify emotional disorders (still considered its most appropriate use), this test is now used for many other screening purposes. • These inventories don't take much time to administer and they are objectively scored. They have greater validity than projective tests. Hardly valid though. More diverse standardization needed.

Clinical Interviews

These usually involve a face-to-face discussion during which a mental health professional asks a series of questions designed to obtain information about a person's personality, current and past behaviour, attitudes and emotions.

Validity

Validity of a test refers to what the test is supposed to measure or predict

Syndrome

a cluster of symptoms that usually occur together.

Diagnosis

a determination that a person's problems reflect a particular disorder.

Uniformity Myth

a false belief that all therapies are equivalent despite differences in therapists training, experience, theoretical orientations, and personalities.

Empirically Supported/Evidence-based Treatment

a movement in the clinical field that seeks to identify which therapies have received clear research support for each disorder, to develop corresponding treatment guidelines, and to spread such information to clinicians.

Psychopharmacologist

a psychiatrist who primarily prescribes medications.

Mental Status Exam

a set of interview questions and observations designed to reveal the degree and nature of a client's abnormal functioning

Neurological Test

a test that directly measures brain structure or activity

Predictive Validity

a tool accurately predicts future characteristics or behavior.

Face Validity

a tool appears to measure what it is supposed to measure; does not necessarily indicate true validity.

Concurrent Validity

a tool's results agree with independent measures assessing similar characteristics or behavior.

Rapprochment Movement

an effort to identify a set of common strategies that run through the work of all effective therapists.

Social Skills Inventories

behavioral and family-social clinicians. Ask clients how they'd respond in a variety f social situations.

Drawings

clinicians ask clients to draw human figures and talk about them. Evaluated based on solidity of pencil line, shape, details, location on paper, features, size, etc.

Structured Interviews

clinicians ask prepared questions, often from a published interview schedule (SCID, PCL, Mental Status Exam)

Clinical Observations

clinicians may simply observe a client's behavior.

Intelligence Quotient

defined originally as the ratio of mental age (ma) to chronological age (ca) multiplied by 100 (thus, IQ = ma/ca × 100). On contemporary intelligence tests, the average performance for a given age is assigned a score of 100. High reliability, high validity. Most carefully produced of all clinical tests.

Clinical Tests

devices for gathering information about a person's psychological functioning

Unstructured Interviews

interviews that use open-ended questions

Intelligence Tests

method for assessing an individual's mental aptitudes and comparing them with those of others, using numerical scores

Behavioral Assessment

method that reveals specific dysfunctional behaviors and cognitions. Goal is to produce a functional analysis of a persons behavior.

Naturalistic observation

observing and recording behavior in naturally occurring situations without trying to manipulate and control the situation.

Beck Depression Inventory

psychometric assessment created by cognitive theorist Aaron Beck used to assess the severity of depression that has already been diagnosed.

Cognitive Inventories

reveal a person's typical thoughts and assumptions and can uncover counterproductive patterns of thinking. (not used by cognitive therapists)

Rosenthal Effect

self-fulfilling prophecy; tendency to behave according to expectations of others--biased observers can give signals/cues to subjects

Robert Rosenthal

studied experimenter bias, a researcher's unintended influence on the behavior of subjects

Response Inventories

tests designed to measure a person's responses in one specific area of functioning, such as affect, social skills, or cognitive processes

Personality Inventories

tests designed to measure broad personality characteristics, consisting of statements about behaviors, beliefs, and feelings that people evaluate as either characteristic or uncharacteristic of them. Clinicians then use responses to draw conclusions about the persons personality and psychological functioning.

DSM-IV-TR

the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with an updated "text revision"; a widely used system for classifying psychological disorders.

Rorschach Test

the most widely used projective test, a set of 10 inkblots, designed by Hermann Rorschach; seeks to identify people's inner feelings by analyzing their interpretations of the blots

Standardization

the process in which a test is administered to a large group of people whose performance then serves as a standard or norm against which any individuals score can be measured. Involves administering the test to a representative sample of future test takers in order to establish a basis for meaningful comparison

Clinical Assessment

used to determine how and why a person is behaving abnormally and how that person may be helped. Also used to evaluate progress of a person already in therapy.

Test-Retest Reliability

using the same test on two occasions to measure consistency.

Multiaxial Classification in DSM

• Axis I: is a clinical syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? • Axis ii: a personality disorder or mental retardation present? • Axis iii: Is a general medical condition (diabetes, hypertension, or arthritis etc) also present? • Axis IV: are psychosocial or environmental problems (school or housing issues) also present? • Axis V: what is the global assessment of the person's functioning?

Labeling and the DSM

• Critics of the DSM-IV argue that labels stigmatize individuals • Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. • "insanity" labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. • Labels bias perceptions and change reality by serving as self-fulfilling prophecies.

Galvanic Skin Response & Polygraph

• Galvanic Skin Response: skin reactions • Polygraph: lie detection

Ten Scales of MMPI

• Hypochondriasis • Depression • Hysteria • Psychopathic deviate • Masculinity-femininity • Paranoia • Psychasthenia (obsessions/compulsions/abnormal fears/guilt) • Schizophrenia • Hypomania (over activity, emotional excitement) • Social Introversion

Limitations of Clinical Interviews

• Individuals may intentionally mislead in order to present themselves in a positive light/avoid discussing certain things. • Individuals not giving accurate report • Lack reliability. • Clinicians race, gender, age, etc may influence client's responses.

Therapy Outcome Studies

• Is therapy in general effective? • Are particular therapies generally effective? • Are some therapies overall better than others? • Are particular therapies effective for particular problems?

The Purpose of the DSM

• To classify mental disorders • To provide descriptions of diagnostic categories • To enable clinicians to diagnose, talk about, and treat people