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Lecture 3

PSY341H1 Lecture Notes - Lecture 3: American Psychiatric Association, World Health Organization, Intellectual Disability

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Hywel Morgan

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PSY341H1S Lecture 3: Assessment
- Assessment, diagnosis and treatment to be talked about in the future of this course; the
assessment process changes between children and adults, however
There are only two professions that can use the DSM-IV TR: physicians and psychiatrists
DSM-IV TR is the assessment used in Canada and the United States, published by
American Psychiatric Association, a group of physicians (mainly psychiatrists)
The rest of the world does not use this, they use the ICD: International Classification of
Diseases, currently on version 10 but going on 11 soon
There is a significant overlap. If you are getting diagnosed in Ontario, for i.e., you need to
get diagnosed by ICD as well
World Health Organization, a division of the United Nations, there are disorders that one
tool of assessment recognizes and the other doesn’t (and vice-versa)
The number one disadvantages of being diagnosed of the DSM-V TR is the poor validity
this chances of a misdiagnosis is very high with this particular tool
Decreased validity, increased misdiagnosis (negative correlation) but DMS-IV TR does
have utility (it is useful); when the diagnosis is correct, selection of treatment is very good,
but stigmatization also increases
In each of the categories of DSM-IV TR is called NOS (not otherwise specified) it is very
easy to ID abnormal behavior but it is hard to categorize with definitions
NOS decreases validity and increases misdiagnosis, however
What would you want to consider when making a good categorization system for mental
1. Categorizes are clearly defined
One problem with this is that here is a significant overlap in categorical symptoms from
one disorder to another
2. The categories exist
Meaning symptoms are seen to occur together all the time; we can use factor analysis or
consensus opinion from experts to decide whether they do or don’t
3. Reliability
Test-retest and inter-rater
4. Validity
Categories are clearly defined from one another; not so with DSM-IV TR because there is
significant symptom overlap
5. Clinical utility
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Polygraph has good utility but poor validity, therefore it would not be good to use in
disorder assessment
DSM-IV TR and IC are derived from consensus and other systems are statistically derived
DSM-IV TR first had only 2 categories relating to child disorders, but expanded later;
today it has 10
The categories of disorders will not be on the test; they will be introduced after the
first midterm
DSM-IV TR provides diagnosis on 5 dimensions/axis
Advantages of diagnosis:
a. selection of treatment
b. helps in the research of mental disorders
c. comfort in knowing that you have something others have and act the way that you do
Disadvantages of diagnosis:
a. restricted
b. misdiagnosis
A diagnosis should not be static, because it could change due to the fact that an assessment
should be ongoing (unfortunately, many do not acknowledge this)
3 Types of Assessment:
1. The interview
Utilizes verbal questions and replies. Structured and unstructured questions are used as
Most common in adults
Questions asked based on the referral: a big problem with the interview, and thus will ask
more detailed questions about compliant and little/no questions about history
There may be comorbid conditions not presented at the referral
Paradigmatic (behavioral/psychoanalytical/humanistic) nature of interviewer will affect
the approach taken in treatment and assessment
Must be addressed during the initial interview: identifying data, demographics, present
problem, and family history
Establishing rapport with children is much harder than it is for adults, therefore they prefer
to do interviews in non-stressful environments, i.e. a playful environment that provides
play materials and movement to assess child’s anxiety levels
Structured interviews include asking emphasized and thorough questions (which is good).
But it affects rapport (not good, especially with children)
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