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Ch. 4 - Assessment and diagnosis

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University of Toronto St. George

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 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 - 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
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