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Chapter 3 Practice Exam Questions

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Konstantine Zakzanis

Chapter 3: Diagnosis and Assessment LEARNING GOALS 1. Be able to describe the purposes of diagnosis and assessment. 2. Be able to distinguish between the different types of reliability and validity. 3. Be able to identify the basic features, strengths, and weaknesses of the DSM-IV-TR. 4. Be able to describe the goals, strengths, and weaknesses of psychological and neurobiological approaches to assessment. 5. Be able to discuss the ways in which culture and ethnicity impact diagnosis and assessment. Summary In gathering diagnosis and assessment information, clinicians and researchers must be concerned with both reliability and validity. Reliability refers to whether measurements are consistent and replicable; validity refers to whether assessments are tapping into what they are meant to measure.Assessment procedures vary greatly in their reliability and validity. Certain diagnostic categories are more reliable than others. Diagnosis  Diagnosis, the process of assessing whether a person meets criteria for a mental disorder, is a critical aspect of the field of abnormal psychology. Having an agreed-on diagnostic system allows clinicians to communicate effectively with each other and facilitates the search for causes and treatments. Clinically, diagnosis provides the foundation for treatment planning.  The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by theAmerican PsychiatricAssociation, is an official diagnostic system widely used 1 by mental health professionals.Arevision of the fourth edition of the manual, referred to as DSM-IV-TR, was published in 2000.An important feature of the current DSM is its multiaxial organization. In the multiaxial classification system of DSM, Axes I and II make up the mental disorders per se;Axis III lists any physical disorders believed to have bearing on the mental disorder in question; Axis IV is used to indicate the psychosocial and environmental problems that the person experiences; andAxis V rates the person’s current level of adaptive functioning.  Some critics of the DSM argue against diagnosis in general. They point out that diagnostic classifications may ignore important information and may also increase stigma. Specific shortcomings of the DSM have also been identified. These include the high rates of comorbidity, the reliance on a categorical classification system, limited reliability for some disorders, and questions about the validity of a few of the diagnostic categories. Most researchers and clinicians, though, recognize that the DSM is an enormous advancement compared to historical systems. Assessment  Clinicians rely on several modes of psychological and neurobiological assessment in trying to find out how best to describe a client, search for the reasons the patient is troubled, arrive at an accurate diagnosis, and design effective preventive or remedial treatments. Regardless of what assessment method is used, it inevitably reflects the paradigm of the clinician. The best assessment involves multiple types of methods. 2  Psychological assessments include clinical interviews, assessments of stress, psychological tests, and behavioral and cognitive assessments.  Clinical interviews are structured or relatively unstructured conversations in which the clinician probes the patient for information about his or her problems. Assessing stress is key to the field of abnormal psychology. Despite difficulties with defining stress, a number of useful methods for assessing it have been developed, including the LEDS andADE.  Psychological tests are standardized procedures designed to assess personality or measure performance. Personality assessments range from empirically derived self-report questionnaires, such as the Minnesota Multiphasic Personality Inventory, to projective tests in which the patient interprets ambiguous stimuli, such as the Rorschach Test. Intelligence tests, such as the WechslerAdult Intelligence Scale, evaluate a person’s intellectual ability and predict how well he or she will perform academically.  Behavioral and cognitive assessment is concerned with how people act, feel, and think in particular situations.Approaches include direct observation of behavior,interviews and self-report measures that are situational in their focus, and specialized, think-aloud cognitive assessment procedures that attempt to uncover beliefs, attitudes, and thinking patterns related to specific situations.  Neurobiological assessments include imaging techniques, such as fMRI—that enable us to see various structures and access functions of the living brain,neurochemical assays that allow clinicians to make inferences about levels of neurotransmitters, neuropsychological tests, such as the Halstead–Reitan, 3 which seek to identify brain defects based on variations in responses to psychological tests; and psychophysiological measurements, such as heart rate and skin conductance, which are associated with certain psychological events or characteristics.  Cultural and ethnic factors play a role in clinical assessment. For example, assessment techniques developed on the basis of research with Caucasian populations may be inaccurate when used with clients of different ethnic or cultural backgrounds. Clinicians can have biases when evaluating ethnic minority patients, which can lead to minimizing or exaggerating a patient’s psychopathology. Clinicians use various methods to guard against the negative effects of cultural biases in assessment. 1. Diagnostic systems allow clinicians and scientists to a. conduct psychotherapy. b. communicate accurately with one another about cases and research. c. understand the role of cultural bias. d. All of the above are correct. Answer: B Type:Applied Page: 61 2. Jim was given an intelligence test in March and re-administered the same test one year later. His score both times was the same. This indicates that the intelligence test has a. high test-retest reliability. b. high interrater agreement. c. internal consistency. d. None of the above is correct. Answer:AType:Applied Page: 62 3. Generally it is impossible for measures to be a. reliable but not valid. b. valid but not reliable. 4 c. neither reliable nor valid. d. both reliable and valid. Answer: B Type:Applied Page: 62-63 4. Britney was taking a test to measure levels of depression. All of the items covered typical symptoms of depression. This inventory would be said to have a. high construct validity. b. high content validity. c. high criterion validity. d. high statistical validity. Answer: B Type:Applied Page: 62 5. Jackson appears to have social phobia. This diagnosis was made by looking at his scores on a particular measure of social fear. Scores like his in the past have been shown to be related to social phobia, as well as correlated with a variety of measures of social and occupational disability associated with social phobia. The measure Jackson took would be said to have a. high construct validity. b. high content validity. c. high criterion validity. d. high statistical validity. Answer:AType:Applied Page: 63 6. In 1994, the DSM-IV was published by the a.American Psychopathological and StatisticalAssociation. b. World Health Organization. c. Congress of Mental Science. d. American Psychiatric Association. Answer: D Type: Factual Page: 64 7. In 2000, the DSM-IV-TR was published a. to clarify issues surrounding prevalence rates, course, and etiology. b. to describe diagnoses in objective terms. c. to include response to treatment in the descriptions of diagnoses. d. for use by laypersons as well as professionals. Answer:AType: Factual Page: 64 5 8. The letters in the abbreviation DSM refers to a. Diseases and Symptoms of the Mind. b. Diagnostic and Statistical Manual. c. Diseases and Symptoms Manual. d. Disorders and Symptoms Manual. Answer: B Type: Factual Page: 64 9. The DSM-IV-TR provides diagnoses along 5 areas. These areas are called a. axes. b. classifications. c. multiple dimensions. d. differential diagnoses. Answer:AType: Factual Page: 64 10. Axes I and II are separated a. to distinguish mood disorders from psychotic disorders. b. to allow distinctions between medical conditions and psychological conditions. c. to distinguish longstanding disturbances from acute problems. d. All of the above are correct. Answer: C Type: Factual Page: 64 11. In DSM-IV-TR, long-standing diagnoses such as personality disorders are identified on a. onlyAxis I. b. onlyAxis II. c. onlyAxis III. d. Axis II and III. Answer: B Type:Applied Page: 64 12. Axis V is included to a. provide a current rating of functioning. b. estimate probability of recovery. c. assist in clarifying diagnoses made onAxis I or II. d. None of the above is correct. Answer:AType:Applied Page: 64 6 13. The purpose ofAxis IV is to a. identify personality disorders. b. determine acute disturbance. c. evaluate environmental and psychosocial problems. d. account for medical problems affecting mental disorders. Answer: C Type: factual Page: 64 14. WithoutAxis IV, which of the following would not be included in the DSM-IV-TR diagnosis? a. a developmental disorder b. alcoholism c. diabetes d. homelessness Answer: D Type:Applied Page: 64 15. Jose has major depression and has multiple sclerosis. He would be diagnosed on a.Axis I: major depression and Axis III: multiple sclerosis. b. Axis I: major depression;Axis II: multiple sclerosis. c.Axis I: major depression and multiple sclerosis. d. Axis II: major depression andAxis III: multiple sclerosis. Answer:AType:Applied Page: 64 16. Sheila was recently robbed and subsequently developed an acute stress disorder. She was blinded during the robbery and is now unable to find work because of her loss of sight. Using DSM-IV, how would Sheila's problems be diagnosed? a.Axis I: no diagnosis;Axis II:Acute Stress Disorder;Axis III: blindness b. Axis I: Acute Stress Disorder; Axis II: blindness c.Axis I:Acute Stress Disorder;Axis II: blindness;Axis III: Psychosocial and Environment Problem: robbery d. Axis I:Acute Stress Disorder;Axis III: blindness;Axis IV: Psychosocial and Environmental Problem: robbery Answer: D Type:Applied Page: 64 17. Axis V of the DSM-IV-TR considers all but which of the following? a. social relationships b. use of leisure time c. occupational functioning 7 d. psychosocial problems experienced Answer: D Type: Factual Page: 64 18. The multiaxial approach in DSM-IV-TR encourages clinicians to make assessment judgments a. on the most appropriate axis. b. based on ethnic and cultural considerations. c. considering a wide range of information. d. using a variety of assessment measures. Answer: C Type:Applied Page: 64 19. Major improvements since the DSM-III include all of the following EXCEPT a. more specific diagnostic criteria. b. more extensive descriptions of diagnosis onAxes I and II. c. decrease in diagnostic categories. d. more emphasis on laboratory findings and results from physical exams. Answer: C Type:Applied Page: 66 20. Which of the following diagnostic categories were at one time included in the DSM and were then removed from the DSM? a. homosexuality b. bipolar disorder c. panic disorder d. None of the above is correct. Answer:AType: Factual Page: 66 21. Previous editions of the DSM were criticized for their a. lack of attention to childhood disorders. b. lack of attention to cultural and ethnic variations in psychopathology. c. inability to accurately diagnose individuals with schizophrenia. d. overemphasis on mood disorders. Answer: B Type: Factual Page: 66 22. Which of the following statements is TRUE? a. Culture can have a large influence on which symptoms of a given disorder are expressed. 8 b. For most diagnoses in the DSM-IV-TR, it is advised not to consider cultural context. c. Most symptoms of psychiatric disorders manifest themselves in similar ways across cultures. d. The DSM-II was the first edition of the DSM to consider cultural and ethnic variations in psychopathology. Answer:AType: Factual Page: 67-68 23. Culture bound syndromes a. are coded onAxis II. b. are listed in the appendix of the DSM. c. are only found in cultures outside the United States. d. are very, very rare. Answer: B Type: Factual Page: 67 24. Adissociative episode found primarily among men that involves brooding followed by violent episodes is called a. brain fag. b. koro. c. amok. d. dhat. Answer: C Type: Factual Page: 68 25. In the DSM-IV, anxiety about the penis receding into the body is termed a. amok. b. ghost sickness. c. dhat. d. koro. Answer: D Type: Factual Page: 69 26. Studies of psychopathology in other cultures suggest that a. people diagnosed with a culture-bound syndrome may also meet DSM criteria for a specific disorder. b. the prevalence of eating disorders in WestAfrican adolescents is approximately the same as the prevalence in American adolescents. c. worldwide, depression is more common in men. d. koro is quite common in NativeAmerican cultures. Answer:AType:Applied Page: 70 9 27. The DSM-IV-TR includes approximately _____ different diagnostic categories. a. 300 b. 490 c. 125 d. 75 Answer:AType: Factual Page: 71 28. Some critics of the DSM-IV-TR believe that a. there are not enough different diagnoses. b. the DSM-IV-TR has pathologized too many problems without good justification. c. there is not enough comorbidity in diagnoses. d. another diagnostic category should be added titled “ Conditions that may be a focus of clinical attention in elderly populations.” Answer: B Type:Applied Page: 71 29. Comorbidity refers to a. the likelihood that a given psychological disorder will result in death. b. how long a person is expected to live with a given psychological disorder. c. the presence of a second diagnosis. d. the absence of anAxis I disorder. Answer: C Type: Factual Page: 71 30. The DSM-IV-TR is an example of which approach to classification? a. categorical b. dimensional c. quantitative d. atheoretical Answer:AType: Factual Page: 71 31. Which of the following is a dimensional classification system? a. gender b. college major c. telephone number d. grade point average Answer: D Type:Applied Page: 72 10 32. Dr. Kline classified her patients according to hair color. Some were classified as blonde, some brunette, some red- haired. This is an example of a a. continuous classification. b. etiological classification. c. categorical classification. d. dimensional classification. Answer: C Type:Applied Page: 71 33. You are relying on a dimensional classification scheme and work with individuals who struggle with delusions. Your diagnoses are going to be based upon _________ of delusions. a. presence or absence b. social consequences c. underlying cause d. severity Answer: D Type:Applied Page: 72 34. The fact that SSRI’s often relieve symptoms of anxiety as well as depression suggests to some clinicians and researchers that a. SSRI’s are inadequate drugs for depression. b. anxiety and depression should be part of the same diagnostic category. c. anxiety should be treated with anxiolytics. d. Axis I and II should be a dimensional diagnostic system. Answer: B Type:Applied Page: 71-73 35. What is one reason categorical systems are popular? a. Freud was a proponent of such a system. b. They define a certain threshold for treatment. c. They describe the degree to which an entity is present. d. It is more helpful to know severity of a symptom rather than whether or not it is present. Answer: B Type:Applied Page: 72 36. Caleb went to see two different psychologists about his depressive symptoms. One told him that he suffered from major depressive disorder and the other told him that he had bipolar disorder. This is an example of a problem with ____________ 11 a. interrater reliability. b. content validity. c. internal consistency. d. construct validity. Answer:AType:Applied Page: 72 37. When Dr. Smith diagnoses a patient with schizophrenia and Dr. Jones diagnoses that same patient with obsessive-compulsive disorder, we would say that Dr. Smith and Dr. Jones have a. low validity. b. low reliability. c. low accuracy. d. low criteria. Answer: B Type:Applied Page: 72 38. In order to study the reliability of a diagnostic category, we would study whether a. it acknowledges the uniqueness of each individual. b. it has explicitly stated criteria. c. patients with the label respond to treatment the same. d. diagnosticians apply it consistently. Answer: D Type: Factual Page: 72 39. Reliability, as used in diagnosis, is the same as a. agreement. b. validity. c. judgment. d. utility. Answer:AType: Factual Page: 72 40. If a diagnosis helps clinicians make good predictions and informs them of the likely course of the disorder, psychologists would say that the diagnosis has a. interrater reliability. b. construct validity. c. test validity. d. internal consistency. Answer: B Type:Applied: Page: 72 12 41. Which of the following situations is most similar to the concept of reliability in making psychiatric diagnoses? a. You see identical twins that have identical mannerisms. b. After watching a new T.V. show, you and a friend independently decide that it is lousy. c. You're not sure what time a baseball game is on and guess it is at 1:00. You look in the T.V. guide and it is, in fact, at 1:00. d. You meet someone new at a party and decide she/he is a shy person. Sure enough, she/he hardly speaks to anyone at the party. Answer: B Type:Applied Page: 72 42. Aline judge in a football game calls a player for holding. The head linesman disagrees, but instead calls a player for unnecessary roughness. These referees have a problem with a. reliability. b. etiological validity. c. concurrent validity. d. predictive validity. Answer:AType:Applied Page: 72 43. Avalid classification system is one that a. has clear criteria for making diagnoses. b. ensures that two or more people will agree on a classification. c. leads to accurate predictions and statements. d. has a clear purpose. Answer: C Type: Factual Page: 72-73 44. Just before he died, several physicians were treating Joe for a stroke; an autopsy showed he had Alzheimer's disease. Joe's physicians showed a. neither reliability nor validity. b. validity but not reliability. c. reliability but not validity. d. both reliability and validity (despite very bad luck). Answer:AType:Applied Page: 72-73 45. Construct validity of a diagnosis refers to a. diagnoses that arise due to known medical factors. b. the consistency of diagnosing the same condition. 13 c. an inference regarding a diagnosis on the basis of a set of observed symptoms. d. the likelihood that two diagnosticians would come up with the same diagnosis. Answer: C Type:Applied Page: 72 46. Unlike most conversations with a friend, a clinical interviewer would focus on a. structure. b. how the person responds. c. objectivity. d. humor. Answer: B Type:Applied Page: 75 47. In clinical interviews, most clinicians pay particular attention to a. manner of responding. b. truthfulness. c. childhood. d. current social functioning. Answer:AType: Factual Page: 75 48. Clinical interviewers typically a. focus on observable behavior. b. highlight the importance of rapport. c. are psychodynamic in orientation. d. focus on medical conditions. Answer: B Type:Applied Page: 76 49. Which of the following is true regarding interviewing the clinical interview? a. It enables one to obtain vast amounts of information. b. It is too subjective to be of much value in assessment. c. It provides the most valid information in assessment. d. Behavioral clinicians consider it unnecessary, though clinicians from other paradigms find it useful. Answer:AType:Applied Page: 76 50. Which of the following guides a clinical interview? a. time of day b. location of interview 14 c. paradigm used by interviewer d. structured instrument used by interviewer Answer: C Type:Applied Page: 76 51. Which of the following is a structured interview? a. SRRS b. SCID c.ADE d. Rorschach Answer: B Type:Applied Page: 76 52. Which of the following is not a measure of psychological stress? a. Social Readjustment Rating Scale b. Assessment of Daily Experience c. Life Events and Difficulties Schedule d. ThematicApperception Test Answer:AType: Factual Page: 78 53. Why has the Social Readjustment Scale been criticized? a. It is a self-report measure. b. It contains items that are both outcomes and antecedents of stress. c. It contains items that most people have never experienced. d. It relies on prospective methods. Answer: B Type: Factual Page: 78 54. Ava creates a scale that assesses stress during the first year of college. She plans to administer this scale to graduating seniors. What is a likely criticism of her methods? a. She will have low interrater reliability. b. She will be collecting retrospective reports which are subject to considerable distortion. c. Most graduating seniors will not have the time to complete such a scale. d. She should use a validated scale like the MMPI. Answer: B Type:Applied: Page: 78 55. TheADE was most helpful in addressing which of the following issues? a. retrospective reports 15 b. prospective reports c. internal consistency d. clinical interviews Answer:AType:Applied: Page: 78 56. An advantage of the Life Events and Difficulties Schedule (LEDS) over other life stress assessments is that a. it is a very structured interview. b. it takes a shorter time to complete. c. it allows for the evaluation of life events in the context of a person’s unique life circumstances. d. it relies less on determining when an event actually occurred. Answer: C Type: Factual: Page: 79 57. The Bedford College Life Events and Difficulties Schedule (LEDS) was designed to measure stress a. in response to major life changing events. b. in the context of the individual’s circumstances. c. as it occurs in the individual’s routine daily life. d. over especially long periods of time. Answer: B Type: Factual
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