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Lecture 3

PSY341 Lecture 3 Notes.docx

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University of Toronto St. George
Hywel Morgan

PSY341 Lecture 3 - July 10, 2013 Diagnosis and Assessment ● Diagnosis is REQUIRED for treatment (“give a label or else no insurance”) ○ a contentious issue because requires a label Diagnostic Label ● Benefit ○ TREATMENT! ○ if diagnosis is accurate, the the treatment generally works! ○ BUT if diagnosis is wrong, :( ● Harm ○ STIGMA ○ a diagnostic label made especially mental retardation gets stuck with the person for the rest of their life ○ identifying a person by their illness (e.g. schizophrenia -> a schizophrenic) Kraepelin (founder of classifying disorders) -> wanted specific symptoms and treatments -> started the classifying movement Two Major Classification Systems 1. Diagnostic and Statistical Manual (DSM) ○ now at V, previously IV-TR ■ make DSM-V reasons: (a) make it 100% compatible with ICD (not quite there yet) (b) make it more statistical ○ by the American Psychiatric Association ○ used in US, Canada, UK, Japan ○ DSM stats are from North America 2. International Classification of Diseases (ICD) ○ now at version 10, version 11 will be released in 2014 ○ by the WHO which is part of UN ○ used by the rest of the world ○ ICD stats from all over the world Good Classification Systems ● Categories are clearly defined ○ YES on DSM IV-TR and V and ICD as well ○ addresses duration, intensity and frequency of symptoms ● Categories exist ○ symptoms do occur regularly ● Reliability ○ = “SAME RESULTS” -> same diagnosis with different physician ○ with clearly defined categories and clear symptoms, we EXPECT high reliability, but right now it is low ○ DSM and ICD very useful in choosing treatment, but so far there is a LOT of misdiagnosis ■ BC validity low for DSM -> symptoms overlap, which is one of the reasons they got rid of all the different types and chose with spectrum for DSM-V ■ e.g. depression -> “sad affect” ; bipolar disorder -> “sad affect” with sometimes mood swings that can be very quick and even mild ● Validity ○ = the diagnosis is actually what that person has ○ DSM-V aims to increase validity through statistics and gathering more data ■ statistic analysis using “factor analysis” -> collect a lot of data and using stats to see which things go together ■ turns out, DSM-V is not too successful bc sometimes not enough data for the factor analysis (which is very sophisticated stat analysis) ■ the DSM-V has been in development since 1998 ● all this time collecting data to show grouping of disorders with stats ● generally failed because still not enough data for the factor analysis, so it is STILL a clinically-derived system, which may contribute to low validity and reliability ○ DSM and ICD are both actually clinically-derived systems, meaning that this system was derived by consensus ● Clinical Utility ○ DSM and ICD aren‟t great with validity and reliability BUT it is useful ○ BUT significant misdiagnosis as well :( DSM IV-TR to DSM V CHANGES ● DSM V Section 1 “How diagnosis is constructed”, then Section 2 “Diagnostic Categories” and also Section 3 “ Future disorders” (not enough data/info yet) ● DSM V no more „Disorders first diagnosed in childhood and adolescence” ○ all the 10 disorders that used to be in this category are moved to other categories ● DSM IV-TR used an axial system, “multi-axial system” ○ diagnosis provided along 5 axises ○ Axis 1-3 -> more important for the most immediate complaint ■ 1) An existing mental or developmental disorder ● there can be more than 1 of them in the same person ● comorbidity can occur (e.g. ADHD with CD) ■ 2) Personality and Mental Retardation ● these can be treated but they are relatively permanent ■ 3) Diagnosis of any relevant, physical conditions ● frequently some disorders can be physical ● e.g. Autism -> not interaction with people in any way could look like deafness, we need to rule that out first!! ○ Axis 4) Severity of psychosocial circumstances ■ Nuture -> Stress ○ Axis 5) Global Assessment Functioning (GAF) of the past year ■ gives the client a score from 0-100 ■ 100 = high functioning -> goes to work, good social, etc... ■ 1 = low functioning ■ the lower the functioning, the less possible outcome 1 year later ○ in DSM-V, axis 1-3 are eliminated. Now only requires listing the disorders in axis 2 and altogether the primary complaints. Axis 5 is gone as well ● “Neurodevelopmental disorders” in DSM-V for autistic-like disorders and mental retardation ○ these are believed to be comorbid BUT that‟s still not clear ○ test of mental retardation is IQ test BUT this requires some form of social contact!! ■ in severely autistic children, facilitated communication does not work ■ e.g. overzealous facilitators being a problem Three Types of Assessment (1) Interview (2) Testing (3) Observation ● Testing is almost the exclusive domain of psychologists ● Psychiatrists are good with 1 and 3 ● 1940s and 1950s -> Binet develop testing and then WWII begin as well ● (1) Interview ○ most commonly used in adults ○ also for teenagers and adolescents ○ requires social and verbal interaction ● (2) Testing ○ Collecting data to see the norms ○ literally thousands types of psychological testing ○ tasks for the child to do and compare/collect norms ○ compare the child with those of the same age/peers ● (3) Observation ○ most commonly used in children because limited verbal/vocabulary ○ natural behaviour for a 5 year old is PLAY ○ (autistic children prefer simply toys) Assessment Process: 1) The Referral ● by GP, teacher, nurse, psychologist or psychiatrist, school psychologist, etc... ● initial interaction with the child and the professional ● WHY referral? -> child has behaviour that interferes/disruptive ● Parents typically don‟t want to bring child for assessment: ○ uninformed ○ fear of stigma ○ fear of being labeled as “bad parents” ○ denial ● This causes children usually being brought
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