Class Notes (903,577)
CA (538,023)
UTSG (45,699)
PSY (3,647)
PSY240H1 (253)
S.Cassin (41)
Lecture

Ch. 4 - Assessment and diagnosis

6 Pages
119 Views

Department
Psychology
Course Code
PSY240H1
Professor
S.Cassin

This preview shows pages 1-2. Sign up to view the full 6 pages of the document.
Chapter 4: Assessment and Diagnosis
Diagnosis of Abnormality
Advantages of Classification
-Statistical purposes (governments and other agencies, its important to have records of how frequent of
certain conditions in the population are and changes over time)
-Must first define a disturbance before understanding the aetiology (like what is depression, and what
causes it?)
-Helps determine appropriate treatment
-Assists in the prediction or prognosis (transient or over a lifetime? If anxiety follows a stressful event, it
would be considered an adjustment disorder six months or less but if longer than that, it would be
considered a chronic disorder)
-Assists in intercommunication within the field aids in research (Ex: People classified as bulimic should
have similar characteristics, duh)
-Assists in communication with other professionals
-Can be a relief to clients (for some, if they’ve been experiencing problems that didn’t make sense, the fact
that there is a possible treatment for it would provide relief, such as with OCD or borderline personality
disorder)
Disadvantages of Classification
-Classification systems are all somewhat arbitrary (it can be subjective; hard to apply diagnoses with
statistics only; and determining severity has ambiguous cut-offs)
-Classification ignores the continuum between normality and abnormality
not many disorders that are discretely different from what many people will experience; most people will
experience some anxiety, depression, occasional eating binges, occasional obsessive thoughts
- Categorical vs. Dimensional approaches
Many symptoms can be aspects of different disorders; not discrete
-Classification systems can be misused
Sometimes diagnosing a patient with the wrong disease will make things less complicated; doctor can
have an attentional bias [EX: she witnesses many cases of schizophrenia] and sees someone come in
with similar behaviour, she might diagnose the patient with schizophrenia even if the patient doesnt have
it
Disease model, Labelling
-Heterogeneity within diagnostic categories (multiple ways of being diagnosed with a disorder; many
different symptoms and people only need a minimum number to be diagnosed)
-Reliability and validity problems
Reliability/Validity
-Reliability Consistency or agreement in diagnosis across examiners, time, & patients
- E.g. inter-rater, test-retest
- Its easier to have reliability for one overall diagnosis than the finer details
EX: its easy to diagnose schizophrenia but harder for specific types of schizophrenia
- Patient variables: may have real variations in their symptoms (like a seasonal effect)
- Some patients react differently to different clinicians
- Clinician variables: may come from a certain psychological approach/discipline and may focus
more on certain factors
to increase reliability: try and make conditions as similar as possible when assessing patients, use the same
criteria, record assessments and ask other clinicians, make the criteria as specific as possible [like if sleep
www.notesolution.com
disruption is a symptom one should specify the type of sleep disruption], place more emphasis on
external/observable behaviours
-Validity The extent to which a diagnosis is useful
- E.g. Construct (extent to which test measures what its supposed to measure);
concurrent (can use different methods and they all point to same conclusion);
predictive (how they will respond to treatment)
- Does diagnosis assess what clinician really want to assess?
Major Diagnostic Systems
-International Classification of Diseases 10 (ICD-10)
- Published by the World Health Organization (1993) with both health and mental diseases
-Diagnostic and Statistical Manual IV (DSM-IIV)
- Published by the American Psychiatric Association (1994)
- DSM-IV-TR (Text Revision) in 2000
DSM-V is currently being worked on
DSM-IV
-Multi-axial in nature
- Has 5 axes or dimensions along which you diagnose any disorder
global picture, including environment and functioning
-More and more refined diagnoses (diagnoses used to be based more on subjective opinion after an
interview)
-Descriptive rather than theoretical (Ex: psychodynamic theories don’t dominate)
-All diagnoses have specific criteria
-Includes epidemiological information
DSM-IV Multiaxial System
-AXIS I: Clinical Syndromes (vast majority of disorders discussed in class)
-AXIS II: Personality Disorders & Mental Retardation (develop early, enduring, therapy persistent, treatment
focuses on quality on life but cannot cure’ these)
-AXIS III: General Medical Conditions
-AXIS IV: Psychosocial & Environmental Problems
-Axis V: Global Assessment of Functioning Scale (GAF)
may also deal with temporal scale
AXIS I & II deal with predictions and is the principle psychological diagnosis; other symptoms may stem from it
AXIS III: May link symptoms with psychological disorders (thyroid problems related to depression)
AXIS IV: Social support, environment (like family?)
DSM-IV Multiaxial Diagnosis (EXAMPLE)
AXIS I: Major depressive disorder, single episode, in full remission
AXIS II: borderline personality disorder
III: none reported
IV: Lack of social support, unemployed, limited income
V: GAF = 50 (has pretty serious symptoms/impairment in functioning as result of disorder)
AXIS I Disorders
-Disorders usually first diagnosed in infancy, childhood, or adolescence
I.e.: ADHD, inappropriate conduct, autismDUNNO WHY THIS IS HERE CAUSE IT’S
PROLONGEDpsychologists are thinking about correcting this for DSM-V
-Delirium, dementia, amnestic, and other cognitive disorders (Alzheimers)
-Substance related disorders
-Schizophrenia and other psychotic/delusional disorders
www.notesolution.com

Loved by over 2.2 million students

Over 90% improved by at least one letter grade.

Leah — University of Toronto

OneClass has been such a huge help in my studies at UofT especially since I am a transfer student. OneClass is the study buddy I never had before and definitely gives me the extra push to get from a B to an A!

Leah — University of Toronto
Saarim — University of Michigan

Balancing social life With academics can be difficult, that is why I'm so glad that OneClass is out there where I can find the top notes for all of my classes. Now I can be the all-star student I want to be.

Saarim — University of Michigan
Jenna — University of Wisconsin

As a college student living on a college budget, I love how easy it is to earn gift cards just by submitting my notes.

Jenna — University of Wisconsin
Anne — University of California

OneClass has allowed me to catch up with my most difficult course! #lifesaver

Anne — University of California
Description
Chapter 4: Assessment and Diagnosis Diagnosis of Abnormality Advantages of Classification - Statistical purposes (governments and other agencies, it’s important to have records of how frequent of certain conditions in the population are and changes over time) - Must first define a disturbance before understanding the aetiology (like what is depression, and what causes it?) - Helps determine appropriate treatment - Assists in the prediction or prognosis (transient or over a lifetime? If anxiety follows a stressful event, it would be considered an adjustment disorder six months or less… but if longer than that, it would be considered a chronic disorder) - Assists in intercommunication within the field – aids in research (Ex: People classified as bulimic should have similar characteristics, duh) - Assists in communication with other professionals - Can be a relief to clients (for some, if they’ve been experiencing problems that didn’t make sense, the fact that there is a possible treatment for it would provide relief, such as with OCD or borderline personality disorder) Disadvantages of Classification - Classification systems are all somewhat arbitrary (it can be subjective; hard to apply diagnoses with statistics only; and determining severity has ambiguous cut-offs) - Classification ignores the continuum between normality and abnormality not many disorders that are discretely different from what many people will experience; most people will experience some anxiety, depression, occasional eating binges, occasional obsessive thoughts - Categorical vs. Dimensional approaches Many symptoms can be aspects of different disorders; not discrete - Classification systems can be misused Sometimes diagnosing a patient with the wrong disease will make things less complicated; doctor can have an attentional bias [EX: she witnesses many cases of schizophrenia] and sees someone come in with similar behaviour, she might diagnose the patient with schizophrenia even if the patient doesn’t have it Disease model, Labelling - Heterogeneity within diagnostic categories (multiple ways of being diagnosed with a disorder; many different symptoms and people only need a minimum number to be diagnosed) - Reliability and validity problems Reliability/Validity - Reliability – Consistency or agreement in diagnosis across examiners, time, & patients - E.g. inter-rater, test-retest - It’s easier to have reliability for one overall diagnosis than the finer details EX: it’s easy to diagnose schizophrenia but harder for specific types of schizophrenia - Patient variables: may have real variations in their symptoms (like a seasonal effect) - Some patients react differently to different clinicians - Clinician variables: may come from a certain psychological approach/discipline and may focus more on certain factors to increase reliability: try and make conditions as similar as possible when assessing patients, use the same criteria, record assessments and ask other clinicians, make the criteria as specific as possible [like if sleep www.notesolution.com disruption is a symptom… one should specify the type of sleep disruption], place more emphasis on external/observable behaviours - Validity – The extent to which a diagnosis is useful - E.g. Construct (extent to which test measures what it’s supposed to measure); concurrent (can use different methods and they all point to same conclusion); predictive (how they will respond to treatment) - Does diagnosis assess what clinician really want to assess? Major Diagnostic Systems - International Classification of Diseases – 10 (ICD-10) - Published by the World Health Organization (1993) with both health and mental diseases - Diagnostic and Statistical Manual – IV (DSM-IIV) - Published by the American Psychiatric Association (1994) - DSM-IV-TR (Text Revision) in 2000 DSM-V is currently being worked on DSM-IV - Multi-axial in nature - Has 5 axes or dimensions along which you diagnose any disorder global picture, including environment and functioning - More and more refined diagnoses (diagnoses used to be based more on subjective opinion after an interview) - Descriptive rather than theoretical (Ex: psychodynamic theories don’t dominate) - All diagnoses have specific criteria - Includes epidemiological information DSM-IV Multiaxial System - AXIS I: Clinical Syndromes (vast majority of disorders discussed in class) - AXIS II: Personality Disorders & Mental Retardation (develop early, enduring, therapy persistent, treatment focuses on quality on life but cannot ‘cure’ these) - AXIS III: General Medical Conditions - AXIS IV: Psychosocial & Environmental Problems - Axis V: Global Assessment of Functioning Scale (GAF) may also deal with temporal scale AXIS I & II deal with predictions and is the principle psychological diagnosis; other symptoms may stem from it AXIS III: May link symptoms with psychological disorders (thyroid problems related to depression) AXIS IV: Social support, environment (like family?) DSM-IV Multiaxial Diagnosis (EXAMPLE) AXIS I: Major depressive disorder, single episode, in full remission AXIS II: borderline personality disorder III: none reported IV: Lack of social support, unemployed, limited income V: GAF = 50 (has pretty serious symptoms/impairment in functioning as result of disorder) AXIS I Disorders - Disorders usually first diagnosed in infancy, childhood, or adolescence I.e.: ADHD, inappropriate conduct, autismDUNNO WHY THIS IS HERE ‘CAUSE IT’S PROLONGEDpsychologists are thinking about correcting this for DSM-V… - Delirium, dementia, amnestic, and other cognitive disorders (Alzheimer’s) - Substance related disorders - Schizophrenia and other psychotic/delusional disorders www.notesolution.com - Mood disorders (depression) - Anxiety disorders (OCD, social phobia, PTSD) - Somatoform disorders - Factitious disorders (faking symptoms, undergoing unnecessary surgery, etc) - Dissociative disorders (multi-personality disorder AKA dissociative identity disorder) - Sexual and gender identity disorders (fetishes, voyeurism, erectile dysfunction [unless it has a very strong biological component… diagnoses is arbitrary]) - Eating disorders - Sleep disorders (sleepwalking, chronic nightmares) - Impulse control disorders NOS (gambling, kleptomania, pyromania) - Adjustment disorders (mood/anxiety reaction as a result of life stressor) - Other conditions that may be a focus of clinical attention (not necessarily AXIS I disorders but serious enough of clinical attention) - E.g. bereavement (losing someone, grief as result?), acculturation problem (trouble settling into new place), abuse AXIS II Disorders Personality Disorders: - Cluster A – paranoid, schizoid (zero desire for interpersonal relationships), schizotypal (low grade schizophrenia) odd/eccentric - Cluster B – antisocial, borderline (unstable emotions, self concept, etc), histrionic (really dramatic like extreme superficial affection), narcissistic dramatic/emotional/erratic - Cluster C – avoidant (similar to social phobia), dependent (always need to be taken care of, rely on others), obsessive-compulsive (different from OCD; need for perfection and orderliness) anxious/fearful Mental Retardation: - Mild, moderate, seve
More Less
Unlock Document


Only pages 1-2 are available for preview. Some parts have been intentionally blurred.

Unlock Document
You're Reading a Preview

Unlock to view full version

Unlock Document

Log In


OR

Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


OR

By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.


Submit