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Lecture

PSY240H1 Lecture Notes - Boogie 2Nite, Wechsler Adult Intelligence Scale, Rorschach Test


Department
Psychology
Course Code
PSY240H1
Professor
S.Cassin

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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
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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
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