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Chapter 3 and Prologue

Psychology 46-228 Chapter 3 and Prologue: Notes on Assessment and Diagnosis

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University of Windsor

Chapter 1, P. 2-8  Psychological Disorder  a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected. (psychological dysfunction, distress or impairment, atypical response)  Phobia  a psychological disorder characterized by marked and persistent fear of an object or situation  Psychological dysfunction = a breakdown in cognitive, emotional, or behavioural functioning  Distress: the criterion is satisfied if the individual is extremely upset Defining psychological disorder by distress alone does not work, although contributes to a  good definition  Atypical response = deviates from the average; the greater the deviation, the more abnormal it is.  Is the behaviour beyond the individual's control?  (used in DSM-IV-TR) abnormal  behavioural, emotional, or cognitive dysfunctions that are unexpected in their cultural context and associated with personal distress or substantial impairment in functioning  Thomas Szasz promoted the idea that mental illness is a myth; argued that a fundamental difference exists between the use of diagnoses for physical diseases and their use in mental illnesses  To help define the definition of "disorder": o Carefully analyze the concepts that underlie disorders accepted in DSM-IV-TR o Survey mental health professionals worldwide to see striking commonalities o Using the same survey process, determine what separates people who truly meet the criteria for a disorder from those who have a mild form of the same problem that does not interfere with their functioning Psychopathology  study of psychological disorders (trained professionals: clinical and counselling psychologists, psychiatrists, psychiatric social workers, psychiatric nurses, marriage and family therapists, and mental health counsellors)  Clinical psychologists usually receive a Ph.D (Doctor of Philosophy) and a course of graduate-level study (approx. 5 years)  Psy.D = similar to the Ph.D but more emphasis on clinical practice and less on research training (not exists in Canada; in development in Quebec)  "therapist" and "psychotherapist" are not specific to a particular profession  Scientist-practitioners  mental health professionals take a scientific approach to their clinical work o Keep up with the latest scientific developments in their field and use the most current diagnostic and treatment procedures o They evaluate their own assessments or treatment procedures to see if they work o Might conduct research (often in clinics or hospitals) that produces new information about disorders or their treatment  Studying psychological disorders o Clinical description o Causation (etiology) o Treatment and outcome  Clinical description  represents the unique combination of behaviours, thoughts, and feelings that make up a specific disorder  Statistical data  Prevalence (how many people have the disorder); or incidence (how many new cases during a given period)  Course  individual pattern (chronic , episodic, or time-limited course)  Acute onset (begin suddenly) vs. insidious onset (over an extended time)  Prognosis  predicted future development of a disorder over time  Etiology  the study of origins (why a disorder begins; what causes it); includes biological, psychological, and social dimensions Chapter 3  Clinical assessment  the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorders  Diagnosis  the process of determining whether the particular problem afflicting the individual meets all the criteria for a psychological disorder Assessing Psychological Disorders  The process of clinical assessment is like a funnel: collecting a lot of information across a wide range of individual's functioning to determine where the source of the problem may lie. Then narrows down the focus by concentrating on areas that seem most relevant and ruling out those aren't  To help determine the value of assessments: reliability, validity, standardization  Reliability  the degree to which a measurement is consistent  Validity  whether something measures what it is designed to measure  Standardization  application of certain standards to ensure consistency across different measurements The Clinical Interview  Core of most clinical work  Gathers information on current and past behaviour, attitudes, and emotions, detailed history of individual's life in general and of presenting problem  Determine when the specific problem first started and identify other events that happened about the same time Mental Status Exam  Involves the systematic observation of somebody's behaviour; covers 5 categories: appearance and behaviour, thought processes, mood and affect, intellectual functioning, and sensorium Appearance and behaviour  physical behaviours; the individual's dress, general appearance, posture, and facial expression Thought processes  listening to a patient talk (pace of speech; make sense?) Mood and affect  predominant feeling state of the individual (mood); the feeling state the accompanies what we say at a given time (affect) Intellectual functioning  estimate of others' intellectual functioning just by talking to them (reasonable vocabulary? Can talk in abstract? How's memory?) Sensorium  our general awareness of our surroundings (do they know the date? Time? Where or who they are?  Unstructured interviews  follow no systemic format  Semistructured interviews  made up of questions that are carefully phrased and tested to elicit useful information in a consistent manner Behavioural Assessment  Behavioural Assessment  direct observation to assess an individual's thoughts, feelings and behaviour in specific situations or contexts; explains why he/she is having difficulties at the time  ABCs  Antecedent (what happened just before the behaviour); Behaviour; Consequence (what happened afterward) Psychological Testing  Intelligence testing  determine the structure and patterns of cognition  Neuropsychological testing  determines the possible contribution of brain damage or dysfunction to the patient's condition  Neurobiological procedures  use imaging to assess brain structure and function  Projective tests  given pictures or people or things and ask to describe what he/she sees (people project their own personality and unconscious fears onto other people and things, without realizing it, reveal their unconscious thoughts to the therapist) (ex. Rorschach inkblot and Thematic Apperception Test) o Hermann Rorschach (The Rorschach inkblot)  controversial because lack of data on reliability or validity (ex. responses can vary) o Morgan and Murray in 1935 (The TAT)  consists of 31 cards; 30 with pictures and 1 blank; asks test taker to tell a dramatic story about the picture  Personality Inventories (Minnesota Multiphasic Personality Inventory) o Lie Scale (L)  an indication that the person may be falsifying answers to look good o Infrequency Scale (F)  measure false claims about psychological problems or if the person is answering randomly o Defensiveness Scale (K)  assesses whether the person sees himself or herself in unrealistically positive ways o Cannot-Say Scale (?)  measures the number of items the test taker did not answer  Intelligence Testing o Stanford-Binet IQ test  MA/CA times 100 o Wechsler Adult Intelligence Scale-III (WAIS-III); Wechsler Intelligence
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