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Lecture 3

PSY341H1S Lecture 3.docx

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University of Toronto St. George
Hywel Morgan

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 disease? 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  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 well.  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)  Unstructured interviews allow you to determine which questions you’d like to ask. Less questions, more conversational, less formal and increases rapport but you could miss vial information  Not good for assessing mental retardation, autism, and other conditions wherein children may not be verbal  Clinician must listen carefully and only note the important information 2. Testing  More formal, and there are 2 types of tests: cognitive tests and projective tests  The psychological assessment  Looks at cognitive functioning and emotional functioning  Exclusive domain for psychologists  WEIS test and Standford-Bennet testing. Carefully structured with normative data; projective tests have been standardized to some degree  The most common personality test is the Rorschach Test (the inkblot test, which is very subjective) there is a system developed by Exner to classify all of the potential replies statistically an
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