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Lecture 3

Psychology 2320A/B Lecture Notes - Lecture 3: Executive Functions, Bipolar Disorder, Ms-Dos


Department
Psychology
Course Code
PSYCH 2320A/B
Professor
Elizabeth Hayden
Lecture
3

This preview shows pages 1-2. to view the full 7 pages of the document.
What%is%classification?
Classification+of+mental+disorders: branch%of%psychiatry/clinical%psychology%
concerned%with%description%of%disorder
Based%on%symptoms;%course
Advantages/purposes+of+classification
Theory:%classification%is%in%a%sense%a%theory%of%how%disorder%is%organized
Description
Essential%for%research%of%any%kind
Essential%for%discovering%etiological% factors
Prediction:%can%predict%what%will%happen%to%people%that%have%certain%
factors
Communication
Drawbacks+of+classification
Labeling%(stigma)
Expectancy%fulfillment/self-fulfilling%prophecy:%people%are%given%a%
diagnosis%and%learn%about%the%features%of%the%disorder%does%this%mean%that%
they%start%to%act%in%ways%that%reflect%this/shape%further%behaviour
Loss%of%information%or%uniqueness:%not%every%person%looks%the%same/act%
the%same%even%when%they%have%the%same%diagnosis
Boundary%cases:%some%people%will%fit%the%category%very%well%where%others%
don't/should%meet%the%criteria%but%do%not%show%certain%symptoms;%some%
cases%that%don't%fit%a%given%disorder%very%well
Classification%systems%such%as%the%DSM-IV%are%sometimes%described%as%
"Procrustean"%(making%patients%fit%into%a%category):%a%guy%who%would%either%
stretch%them%out%or%cut%of%limbs%if%they%did%not%fit%on%the%bed;%so%element%of%
making%something%fit%when%it%doesn't%make%a%lot%of%sense
Evolution%of%DSM
Diagnostic+and+Statistical+Manual+of+Mental+Disorders+(DSM): classification%
system%for%mental%disorders
Six%major%versions
DSM-I%(1952)
DSM-II%(1968)
DSM-III%(1980)
DSM-III-R%(1987)
DSM-IV%(1994)
DSM-V%(2013)
Pre-1970,%most%clinicians%uninterested%in%diagnosis
Psychoanalytic%theory%predominant
Rise%of%biological%psychiatry,%attempts%to%make%psychopathology%a%"modern"%
science
Diagnosis%increasingly%viewed%as%important,%but%reliability%was%low
Why%was%agreement%so%low?%How%to%fix%it?
Problem+1:+poor%diagnostic%criteria/criteria' variance
Develop%specific%diagnostic%criteria
§
Choose%criteria%that%optimize%reliability
§
Problem+2: inconsistencies%in%interviewing%practices/information'variance
Develop%structured%interviews
§
Mid-70s:%Spitzer%spearheads%group%to%revise%DSM-II
Result: DSM-III%(all%diagnoses%had%inclusion%(factors%they%have%to%exhibit),%
exclusion%(cannot%exhibit),%and%duration%criteria)%in%1980
Criteria%variance%addressed
Resistance%to%the%change%was%high%at%first,%but%became%widely%accepted
Why%was%the%shift%to%DSM-III%controversial?
Doubled #%of%disorders%from%DSM-II
Added%learning%disorder;%caffeine%&%nicotine%disorders
§
Was%atheoretical%(there%is%nothing%in%it%referring%to%ideology)
One%exception:%PTSD%which%requires%a%stressor
§
No%more%neuroses
§
There%were%standard%criteria,%but%what%about%information%variance?
Present%State%Exam%(PSE)
Schedule%for%Affective%Disorders%and%Schizophrenia%(SADS)
Diagnostic%Interview%Schedule%(DIS)
Structured%Clinical%Interview%for%the%DSM%(SCID)
Child%interviews%more%recent%(K-SADS;%PAPA)
Bottom+line: these%ensure%that%clinicians%&%researchers%ask%consistent%
questions%about%the%same%set%of%symptoms
DSM-III%onwards:%intended%to%be%descriptive,%atheoretical
DSM-III-R%(1987)
Idea%was%to%clarify%ambiguities;%resolve%inconsistencies
But%all%criteria% changed
50%disorders%added
DSM-IV%(1994)
To%make%DSM%compatible%w/%ICD-10
But%all%criteria% changed%again%&%still%not%compatible
DSM-5
Increase%dimensionality;%emphasis%on%developmental%perspective
Why%all%the%revisions?
DSM-III%profits%helped%establish%APA%press,%profit%driven?
Can%cause%problems%for%research%assessment,%epidemiology,%public%
awareness%when%criteria% change
Current+Status+of+Diagnosis
Reliability% is%generally%high%(with%a%few%exceptions)
Two%clinicians%who%make%a%decision%on%diagnosis%are%more%likely%to%come%
to%the%same%conclusion
Reliability% is%comparable%to%general%medical%tests%&%procedures%(e.g.,%x-rays)
Validity%is%still%a%problem%
there%is%no%gold%standard%(for%certain%medical%conditions/genetic%disorders%
there%is%a%biological%test%and%if%the%person%has%a%biological%marker,%they%
have%the%disorder)%-don’t%have%this%for%psychiatric%disorders
Research%Domain%Criteria% (RDoC)%project:%an%alternative%to%the%DSM
Ongoing%issues%in%classification:%dimensions%v.%categories
DSM-5%implies%that%psychopathological%conditions%are%discrete%disorders%
that%are%either%present%or%absent%(either%have%a%disorder%or%you%don't)
Losing%meaningful%information%when%just%focuses%on%DSM
§
Example:%a%high-functioning%guy%who%believes%he%is%from%another%
planet;%symptoms%in%the%DSM%can%also%be%seen%in%people%that%do%not%
necessarily%have%a%disorder,%everyone%feels%sad/guilty/or%have%low-
self-esteem%some%days%(we%call%one%a%disorder%b/c%of%impairment,%
but%from%an%ideological%standpoint%they%are%not%both%depression)
§
Categories:
Simplify%communication
§
Mirror%natural%language%and%thought
§
Not%generally%supported%by%data%on%etiology,%familiality,%treatment
§
Dimensions:
Convey%more%information
§
Less%arbitrary,%may%better%reflect%reality
§
But…more%complicated
§
Ongoing%issues%w/%validity:%comorbidity
When%two%disorders%co-occur%at%higher%rates%than%would%be%expected%by%
chance
Concurrent%or%"lifetime"%co-occurrence%of%disorder
Psychiatric%comorbidity%is%widespread%and%systematic
Implication: many%children%(and%adults)%who%meet%criteria%for%one%
disorder%will%also%meet%criteria%for%another
Why%is%comorbidity%a%problem?
Influences%course
The%more%disorders%you%meet%criteria% for%predicts%the%course%of%the%
lifetime%of%disorders
§
Impacts%treatment
Raises%the%question%of%how%well%our%diagnostic%systems%(and%theories)%
reflect%the%true%nature%of%psychopathological%conditions
In%defense%of%DSM
Advantages%of%DSM-III%et%seq.%over%DSM-II:
Clearer
§
More%informative%(manual%&%diagnoses)
§
Generally%more%reliable,% for%many%diagnoses
§
If%followed%strictly,%eliminates%various%biases%(e.g.,%diagnostician%race%
bias%african%american%more%like%to%be%diagnosed%with%schizophrenia,%
while%a%white%person%with%the%same%symptoms%would%be%more%likely%
to%be%diagnosed%with%bipolar%disorder)
§
Assessment%in%child%clinical%psychology:%symptoms%and%behaviour%problems
Clinical+interviews
Gold%standard%for%diagnosis%(considered%state%of%the%art)
Gold%standard%for%clinical% research%(if%structured)
Questionnaires:%self-,%parent-,%and%teacher-reports
Behavioural%assessments%&%observations
Intelligence,%achievement,%and%neuropsych%testing
Typical%child%assessment%battery%=%symptom%checklists,%intelligence% &%
achievement%testing
Structured+interviews
Tied%to%specific%criteria% (e.g.,%DSM-IV)
Such%interviews%spell%out:
What%questions%to%ask
§
What%order%to%ask%them%in
§
(often)%how%to%ask%them,%&%how%to%follow%them%up
§
(often)%how%to%interpret%(code)%the%answers
§
Example:%%Structured%Clinical%Interview%for%DSM-5
About%100%pages%long
§
Covers: affective,%psychotic,%substance%use,%anxiety,%somatoform,%
eating%&%adjustment%disorders
§
Nominally%takes%1+%hr,%usually%2-4hrs
§
Used%in%much%research,%some%clinical%work
§
Example:%Kiddie%Schedule%for%Affective%Disorders%&%Schizophrenia%(K-
SADs)
About%191%pages
§
Covers: affective,%psychotic,%substance%use,%anxiety,%eating,%
disruptive%behaviour%disorders,%and%enuresis%&%encopresis
§
Nominally%takes%1+hr,%but%usually%takes%2-4hrs
§
Parent%&%child%interviewed,%attempt%to%get%info%from%school
§
Used%in%much%research,%some%clinical%work
§
Advantages+of+structure+interviews
Minimize%information%and%criteria%variance;%different%clinicians%will%
be%assessing/diagnosing%%a%disorder%in%the%same%way
§
More%reliable%than%unstructured
Indexed%via%Kappa
§
Comprehensive
§
Disadvantages+of+structured+interviews
Long
§
Boring%for%clinician
§
Some%allege%they%interfere%with%client%rapport%(data%refute%this)
§
Questionnaire+measures
NOT%used%for%diagnosis%(strictly%speaking),%but%widely%used%to%get%
information%on%child%symptoms
Example:%Achenbach%family%of%measures
CBCL%(preschool%&%school-age%versions)
§
TRF%(preschool%&%school-age%versions)
§
YSR%(school-age)
§
Versions%to%assess%adult%symptoms%also
§
Parent-child+(dis)agreement+on+children's+symptoms
Issue%with%both%interview%and%checklists
Parents%>%children%on%externalizing%symptoms;%may%be%more%accurate
Children%>%parents%on%internalizing%symptoms;%may%be%more%accurate
Behavioural+assessments
From%behavioural/learning%theories
Why%a%behaviour%occurs
A-B-C%model
Antecedent,%behaviour,%consequence
§
Often%used%with%PDD%populations%&%child%oppositional%behaviour;%applied%
behavioural%analysis
Parents,%teachers,%clinicians%can%all%do
Behavioural+observations
Direct%observation%of%children%(and%sometimes%parents)%in%standardized%
tasks%and/or%naturalistic%circumstances%
Context%of%oppositional-defiant%behaviour
Context%of%autistic%disorder%diagnosis%(e.g.,%ADOS)
Assessment%of%play,%interaction,%and%social%communication
§
Assessment+in+child+clinical+psychology:+Intelligence+&+Achievement+Testing
Intelligence%tests
Stanford-Binet%scales
WISC-IV
Achievement%tests
Woodcock-Johnson-III
Used%to%determine%discrepancy%b/t%intellectual%ability%(predicted%achievement)%
&%actual%achievement,%useful%for%LD,%ADHD%diagnosis
Assessment%in%child%clinical%psychology:%Neuropsychological
To%evaluate%brain-behaviour%relationships;%possibility%of%brain%disease/damage
Cognitive%functioning
Perceptual%functioning
Motor%functioning
Executive%functioning
Halstead-Reitan+battery
Older%children's%battery%(ages%9-14)
Younger%children's%battery%(ages%5-8)
Objective+Tests
Objective: results%independent%of%examiner%judgment
Paper%and%pencil,%self-report,%forced-choice,%problem%solving
Standardized%in%format,%administration,%scoring
Provide%quantified%estimate%of%attribute
Norms
Computer%scoring
Examples:
Wechsler%intelligence% tests%(WAIS,%WISC,%etc.)
MMPI-2
Beck%Depression%Inventory
All%the%Achenbach%measures
Projective+Tests
Test%development%influenced%by%psychoanalytic%theory
Oral%or%written%response%to%an%ambiguous%stimulus
Examples:
Rorschach%Inkblot
Thematic%Apperception%Test
Tend%not%to%be%standardized,%normed,%reliable,% valid
Little%evidence%for%incremental%validity
Use%is%controversial
Diagnosis(&(Assessment
Tuesday,% January%24,%2017
10:42%AM

Only pages 1-2 are available for preview. Some parts have been intentionally blurred.

What%is%classification?
Classification+of+mental+disorders: branch%of%psychiatry/clinical%psychology%
concerned%with%description%of%disorder
Based%on%symptoms;%course
Advantages/purposes+of+classification
Theory:%classification%is%in%a%sense%a%theory%of%how%disorder%is%organized
Description
Essential%for%research%of%any%kind
§
Essential%for%discovering%etiological% factors
§
Prediction:%can%predict%what%will%happen%to%people%that%have%certain%
factors
Communication
Drawbacks+of+classification
Labeling%(stigma)
Expectancy%fulfillment/self-fulfilling%prophecy:%people%are%given%a%
diagnosis%and%learn%about%the%features%of%the%disorder%does%this%mean%that%
they%start%to%act%in%ways%that%reflect%this/shape%further%behaviour
Loss%of%information%or%uniqueness:%not%every%person%looks%the%same/act%
the%same%even%when%they%have%the%same%diagnosis
Boundary%cases:%some%people%will%fit%the%category%very%well%where%others%
don't/should%meet%the%criteria%but%do%not%show%certain%symptoms;%some%
cases%that%don't%fit%a%given%disorder%very%well
Classification%systems%such%as%the%DSM-IV%are%sometimes%described%as%
"Procrustean"%(making%patients%fit%into%a%category):%a%guy%who%would%either%
stretch%them%out%or%cut%of%limbs%if%they%did%not%fit%on%the%bed;%so%element%of%
making%something%fit%when%it%doesn't%make%a%lot%of%sense
Evolution%of%DSM
Diagnostic+and+Statistical+Manual+of+Mental+Disorders+(DSM): classification%
system%for%mental%disorders
Six%major%versions
DSM-I%(1952)
DSM-II%(1968)
DSM-III%(1980)
DSM-III-R%(1987)
DSM-IV%(1994)
DSM-V%(2013)
Pre-1970,%most%clinicians%uninterested%in%diagnosis
Psychoanalytic%theory%predominant
Rise%of%biological%psychiatry,%attempts%to%make%psychopathology%a%"modern"%
science
Diagnosis%increasingly%viewed%as%important,%but%reliability%was%low
Why%was%agreement%so%low?%How%to%fix%it?
Problem+1:+poor%diagnostic%criteria/criteria' variance
Develop%specific%diagnostic%criteria
Choose%criteria%that%optimize%reliability
Problem+2: inconsistencies%in%interviewing%practices/information'variance
Develop%structured%interviews
Mid-70s:%Spitzer%spearheads%group%to%revise%DSM-II
Result: DSM-III%(all%diagnoses%had%inclusion%(factors%they%have%to%exhibit),%
exclusion%(cannot%exhibit),%and%duration%criteria)%in%1980
Criteria%variance%addressed
Resistance%to%the%change%was%high%at%first,%but%became%widely%accepted
Why%was%the%shift%to%DSM-III%controversial?
Doubled #%of%disorders%from%DSM-II
Added%learning%disorder;%caffeine%&%nicotine%disorders
Was%atheoretical%(there%is%nothing%in%it%referring%to%ideology)
One%exception:%PTSD%which%requires%a%stressor
No%more%neuroses
There%were%standard%criteria,%but%what%about%information%variance?
Present%State%Exam%(PSE)
Schedule%for%Affective%Disorders%and%Schizophrenia%(SADS)
Diagnostic%Interview%Schedule%(DIS)
Structured%Clinical%Interview%for%the%DSM%(SCID)
Child%interviews%more%recent%(K-SADS;%PAPA)
Bottom+line: these%ensure%that%clinicians%&%researchers%ask%consistent%
questions%about%the%same%set%of%symptoms
DSM-III%onwards:%intended%to%be%descriptive,%atheoretical
DSM-III-R%(1987)
Idea%was%to%clarify%ambiguities;%resolve%inconsistencies
But%all%criteria% changed
50%disorders%added
DSM-IV%(1994)
To%make%DSM%compatible%w/%ICD-10
But%all%criteria% changed%again%&%still%not%compatible
DSM-5
Increase%dimensionality;%emphasis%on%developmental%perspective
Why%all%the%revisions?
DSM-III%profits%helped%establish%APA%press,%profit%driven?
Can%cause%problems%for%research%assessment,%epidemiology,%public%
awareness%when%criteria% change
Current+Status+of+Diagnosis
Reliability% is%generally%high%(with%a%few%exceptions)
Two%clinicians%who%make%a%decision%on%diagnosis%are%more%likely%to%come%
to%the%same%conclusion
Reliability% is%comparable%to%general%medical%tests%&%procedures%(e.g.,%x-rays)
Validity%is%still%a%problem%
there%is%no%gold%standard%(for%certain%medical%conditions/genetic%disorders%
there%is%a%biological%test%and%if%the%person%has%a%biological%marker,%they%
have%the%disorder)%-don’t%have%this%for%psychiatric%disorders
Research%Domain%Criteria% (RDoC)%project:%an%alternative%to%the%DSM
Ongoing%issues%in%classification:%dimensions%v.%categories
DSM-5%implies%that%psychopathological%conditions%are%discrete%disorders%
that%are%either%present%or%absent%(either%have%a%disorder%or%you%don't)
Losing%meaningful%information%when%just%focuses%on%DSM
§
Example:%a%high-functioning%guy%who%believes%he%is%from%another%
planet;%symptoms%in%the%DSM%can%also%be%seen%in%people%that%do%not%
necessarily%have%a%disorder,%everyone%feels%sad/guilty/or%have%low-
self-esteem%some%days%(we%call%one%a%disorder%b/c%of%impairment,%
but%from%an%ideological%standpoint%they%are%not%both%depression)
§
Categories:
Simplify%communication
§
Mirror%natural%language%and%thought
§
Not%generally%supported%by%data%on%etiology,%familiality,%treatment
§
Dimensions:
Convey%more%information
§
Less%arbitrary,%may%better%reflect%reality
§
But…more%complicated
§
Ongoing%issues%w/%validity:%comorbidity
When%two%disorders%co-occur%at%higher%rates%than%would%be%expected%by%
chance
Concurrent%or%"lifetime"%co-occurrence%of%disorder
Psychiatric%comorbidity%is%widespread%and%systematic
Implication: many%children%(and%adults)%who%meet%criteria%for%one%
disorder%will%also%meet%criteria%for%another
Why%is%comorbidity%a%problem?
Influences%course
The%more%disorders%you%meet%criteria% for%predicts%the%course%of%the%
lifetime%of%disorders
§
Impacts%treatment
Raises%the%question%of%how%well%our%diagnostic%systems%(and%theories)%
reflect%the%true%nature%of%psychopathological%conditions
In%defense%of%DSM
Advantages%of%DSM-III%et%seq.%over%DSM-II:
Clearer
§
More%informative%(manual%&%diagnoses)
§
Generally%more%reliable,% for%many%diagnoses
§
If%followed%strictly,%eliminates%various%biases%(e.g.,%diagnostician%race%
bias%african%american%more%like%to%be%diagnosed%with%schizophrenia,%
while%a%white%person%with%the%same%symptoms%would%be%more%likely%
to%be%diagnosed%with%bipolar%disorder)
§
Assessment%in%child%clinical%psychology:%symptoms%and%behaviour%problems
Clinical+interviews
Gold%standard%for%diagnosis%(considered%state%of%the%art)
Gold%standard%for%clinical% research%(if%structured)
Questionnaires:%self-,%parent-,%and%teacher-reports
Behavioural%assessments%&%observations
Intelligence,%achievement,%and%neuropsych%testing
Typical%child%assessment%battery%=%symptom%checklists,%intelligence% &%
achievement%testing
Structured+interviews
Tied%to%specific%criteria% (e.g.,%DSM-IV)
Such%interviews%spell%out:
What%questions%to%ask
§
What%order%to%ask%them%in
§
(often)%how%to%ask%them,%&%how%to%follow%them%up
§
(often)%how%to%interpret%(code)%the%answers
§
Example:%%Structured%Clinical%Interview%for%DSM-5
About%100%pages%long
§
Covers: affective,%psychotic,%substance%use,%anxiety,%somatoform,%
eating%&%adjustment%disorders
§
Nominally%takes%1+%hr,%usually%2-4hrs
§
Used%in%much%research,%some%clinical%work
§
Example:%Kiddie%Schedule%for%Affective%Disorders%&%Schizophrenia%(K-
SADs)
About%191%pages
§
Covers: affective,%psychotic,%substance%use,%anxiety,%eating,%
disruptive%behaviour%disorders,%and%enuresis%&%encopresis
§
Nominally%takes%1+hr,%but%usually%takes%2-4hrs
§
Parent%&%child%interviewed,%attempt%to%get%info%from%school
§
Used%in%much%research,%some%clinical%work
§
Advantages+of+structure+interviews
Minimize%information%and%criteria%variance;%different%clinicians%will%
be%assessing/diagnosing%%a%disorder%in%the%same%way
§
More%reliable%than%unstructured
Indexed%via%Kappa
§
Comprehensive
§
Disadvantages+of+structured+interviews
Long
§
Boring%for%clinician
§
Some%allege%they%interfere%with%client%rapport%(data%refute%this)
§
Questionnaire+measures
NOT%used%for%diagnosis%(strictly%speaking),%but%widely%used%to%get%
information%on%child%symptoms
Example:%Achenbach%family%of%measures
CBCL%(preschool%&%school-age%versions)
§
TRF%(preschool%&%school-age%versions)
§
YSR%(school-age)
§
Versions%to%assess%adult%symptoms%also
§
Parent-child+(dis)agreement+on+children's+symptoms
Issue%with%both%interview%and%checklists
Parents%>%children%on%externalizing%symptoms;%may%be%more%accurate
Children%>%parents%on%internalizing%symptoms;%may%be%more%accurate
Behavioural+assessments
From%behavioural/learning%theories
Why%a%behaviour%occurs
A-B-C%model
Antecedent,%behaviour,%consequence
§
Often%used%with%PDD%populations%&%child%oppositional%behaviour;%applied%
behavioural%analysis
Parents,%teachers,%clinicians%can%all%do
Behavioural+observations
Direct%observation%of%children%(and%sometimes%parents)%in%standardized%
tasks%and/or%naturalistic%circumstances%
Context%of%oppositional-defiant%behaviour
Context%of%autistic%disorder%diagnosis%(e.g.,%ADOS)
Assessment%of%play,%interaction,%and%social%communication
§
Assessment+in+child+clinical+psychology:+Intelligence+&+Achievement+Testing
Intelligence%tests
Stanford-Binet%scales
WISC-IV
Achievement%tests
Woodcock-Johnson-III
Used%to%determine%discrepancy%b/t%intellectual%ability%(predicted%achievement)%
&%actual%achievement,%useful%for%LD,%ADHD%diagnosis
Assessment%in%child%clinical%psychology:%Neuropsychological
To%evaluate%brain-behaviour%relationships;%possibility%of%brain%disease/damage
Cognitive%functioning
Perceptual%functioning
Motor%functioning
Executive%functioning
Halstead-Reitan+battery
Older%children's%battery%(ages%9-14)
Younger%children's%battery%(ages%5-8)
Objective+Tests
Objective: results%independent%of%examiner%judgment
Paper%and%pencil,%self-report,%forced-choice,%problem%solving
Standardized%in%format,%administration,%scoring
Provide%quantified%estimate%of%attribute
Norms
Computer%scoring
Examples:
Wechsler%intelligence% tests%(WAIS,%WISC,%etc.)
MMPI-2
Beck%Depression%Inventory
All%the%Achenbach%measures
Projective+Tests
Test%development%influenced%by%psychoanalytic%theory
Oral%or%written%response%to%an%ambiguous%stimulus
Examples:
Rorschach%Inkblot
Thematic%Apperception%Test
Tend%not%to%be%standardized,%normed,%reliable,% valid
Little%evidence%for%incremental%validity
Use%is%controversial
Diagnosis(&(Assessment
Tuesday,% January%24,%2017 10:42%AM
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