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Psychopath childhood- lec 03.docx

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Hywel Morgan

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 Ra
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