PSY341H1 Lecture Notes - American Psychiatric Association, Mental Disorder, Intellectual Disability

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Published on 14 Aug 2012
School
UTSG
Department
Psychology
Course
PSY341H1
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Psychopath childhood- Lec 03
Classification and assessment
Diagnosis is a tool- DSM IV-TR can be used only by physians and psychologists
DSM IV TR- used in north America- produced by American psychiatric association
DSM 4- was devised for American psychiatry department
Rest of the world does not use this tool
ICD- 10- international classification of diseases-used by the rest of the world
Two systems significant overlap- the goal since 1995 has been to completely
compatible
There are disorders that dsm can identify and not by icd
Icd developed by WHO
Number one harm of diagnosis is that it can be stick with you and stigmatized
Chance of misdiagnosis with dsm is pretty high
Validity not good- increased misdiagnosis- negative correlation
Although validity is not great, it is useful. What is the benefit?
Major advantage: selection of treatment
Major disadvantage: stigmatizing
Each of the diagnostic category- last category is called NOS (not otherwise specified)
Problem with nos is decreased validity therefore increase misdiagnosis
Good classification system
1. Categories are clearly defined- dsm does that well- the problem is there is a
significant overlap of categorical symptoms from one disorder to the other
2. Categories exist- person who’s being given those diagnostics has those
symptoms- certain behaviour occur together regularly- in stats called factor
analysis
3. Reliability- test retest, inter-rater- dsm reliable
4. Validity- categories discriminable from one another- dsm fails because
significant symptoms overlap
5. Clinical utility- dsm is useful- polygraph has utility but not good validity
Two types of systems clinically derived and other systems are empirically derived
Clinically derived symptoms
Dsm introduced in 1950s- today it has 10 categories related to mental
disorder- autism, Ret syndrome
There will be significant change in childhood disorders
Categories will not be on MIDTERM
One of the reason dsm has utility is because 5 axis
Axis 1- primary presenting complaint- what you going to treat first- allows
diagnosing comobid disorder- ANXIETY AND DEPRESSION
Axis 2- disorders that are relatively permanent but can still be treated. For
adults usually referred to as PERSONALITY DISORDERS- one childhood
disorder- MENTAL RETARDATION
Axis 3- relevant physical conditions
Axis 4- severity of psychosocial stresses- primary psychological task is to
attach itself to caregiver- most stressful situation for a child
Axis 5- global assessment of functioning- how are you functioning in an
environment? At school, home, family- over a one year period what their
global functioning look like occupationally, recreationally and relationship
wise- dsm scales it out- 5 (extremely functioning)- 1 (poor)
Prognosis- outcome- if you are not getting support, prognosis is even worser
Empirically derived systems
Derived totally from factor analysis therefore often has poor utility-
Selection of treatments and helps in the research of mental disorders and the third
disadvantage is providing comfort and reason- there is a reason for act the way you
do
Disadvantages- stigmatizing and restrictive, significant amount of misdiagnosis
Diagnosis should not be static- it can change
There are 3 types of assessment
1. Interviews- structured and unstructured- common in adults
2. Testing more formal than interviews- cognitive and projective
3. Observational- can be structured or unstructured common in
children
Stages of assessment
1. Referral- parents are reluctant to admit that child has a problem- seeking
problem is harder to avoid when the behaviour doesn’t hurt others- nature of
the referral is important- because it gives clue to better understanding-
parents can bring a child to doctor’s office and doctor can refer the child to
psychologist- child’s motivation is important for referral- anger and anxiety
is important to note in
Rapport- frontal lobes not fully developed- more important in children and
elders- creating an emotional connection during referral
Poor motivation of the child leads to poor prognostic indicator- threat or
punishment will increase motivation
2. The most useful technique of children is observation because children are
not verbally sophisticated as adults are- they cannot properly explain what
they feel
There are caveats in observational method- you are observing behaviour at
one particular time- you must acknowledge that behaviour is changeable- 2nd
caveat is that you could commit observer bias
5 categories of observational behaviour
1. General appearance and attire- observing how the child and parent dress
themselves, groom- can tell about physical, social things about
personality- deformaties and bruises, epilepsy might be a clue to seizures,
extreme thinness might indicate anorexia-
2. Emotional gestures and facial expressions- these can be subtle- might
indicate rapport- verbal language and body language- children are easy to
detect and interpret-
3. gross and fine motor act- can get neurological, chemical, brain,
physiological and psychological functioning- is the child overactive?
ADHD, Drugs can make overactive, chemical imbalances- extremely
underactive- sleep disorder, autism,
involuntary movements- tic disorder, tourette
perseveration movements (repeated movements)- ocd, autism
4. quality of relationships- important for axis 4 & 5
5. assess the content of verbalizations and structure- quick measurement of
intellectual functioning- serious problems can be detected by neologisms,
in coherences- maybe an indication of psychosis and brain injuries
confabulations- indicate brain damage, conduct disorder
second form of assessment- INTERVIEW
more formal and verbal
questions are based on referrals- you don’t want to miss any info that maybe
relevant- comorbid info
paradigms will affect approach of taking the assessment-
demographics, present problem and family history clearly must be addressed
in an interview
interview requires interaction
place a child in play environment to get optimal response- provide freedom
of movement- carefully assess the level of anxiety- show the parent how to
prepare the child for subsequent visits
structured interviews
advantage- thorough
disadvantage- affects rapport
unstructured interviews- allows you to pick out questions- more conversational and
less formal- increases rapport but you can miss stuffs

Document Summary

Diagnosis is a tool- dsm iv-tr can be used only by physians and psychologists. Dsm iv tr- used in north america- produced by american psychiatric association. Dsm 4- was devised for american psychiatry department. Rest of the world does not use this tool. Icd- 10- international classification of diseases-used by the rest of the world. Two systems significant overlap- the goal since 1995 has been to completely compatible. There are disorders that dsm can identify and not by icd. Number one harm of diagnosis is that it can be stick with you and stigmatized. Chance of misdiagnosis with dsm is pretty high. Validity not good- increased misdiagnosis- negative correlation. Although validity is not great, it is useful. Each of the diagnostic category- last category is called nos (not otherwise specified) Problem with nos is decreased validity therefore increase misdiagnosis. Two types of systems clinically derived and other systems are empirically derived.