* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Psyc 303_Assessment and Diagnosis_class Spring 2014
Mental health professional wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Moral treatment wikipedia , lookup
Autism spectrum wikipedia , lookup
Conversion disorder wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Mental disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Spectrum disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Asperger syndrome wikipedia , lookup
History of psychiatry wikipedia , lookup
Mental status examination wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Abnormal psychology wikipedia , lookup
History of mental disorders wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Assessment and Diagnosis Chapter 3 Chapter Outline Clinical Assessment Assessment Instruments Diagnosis and Classification Clinical Assessment Process of gathering information about a person and his/her environment to make decisions about the nature, status, and treatment of psychological problems -Begins with a set of referral questions -Questions determine goals of assessment -Selection of appropriate psychological tests and measurements Goals of Assessment Differential diagnosis is a process in which a clinician weighs how likely it is that a person has one diagnosis instead of another. Deciding what assessment Screening (identify psychological procedures and instruments to administer When conducting an assessment, it is important to take into consideration the age, developmental level, and cultural implications of the testtaker. problems or predict the risk for future problems) Diagnosis (identification of illness) Description Treatment plan (individual’s plan of care to meet mental health needs) Outcome evaluation The Usual Properties of Assessment Instruments Are… Standardization Normative comparisons Self-referent comparisons Reliability These are important in reviewing the psychometric properties of instruments to ensure a clinician’s confidence in the testing results. -Test-retest reliability -Interrater agreement Validity -Construct, criterion, concurrent, predictive Developmental and Cultural Considerations Age Nature of test chosen Developmental Testing environment status Cultural factors People involved in “Cultural fair” testing Assessment Instruments – Informed Consent prior to any type of assessment Self-report measures (ask patients to evaluate their own symptoms) Clinician-rated measures (clinician rates symptoms) Subjective responses vs. objective responses Types of assessments -Clinical interviews -Psychological tests -Behavioral Assessments -Psychophysiological Assessments Remember a patient’s “perception is their reality” when they report information related to the assessment. Self-Report Measures Is a type of survey/questionnaire in which patients read the question and select a response by themselves without interviewer interference. Usually administered at the beginning of treatment, and depending on the treator, throughout the treatment process. Clinical Interviews Conversation between an interviewer and a patient, the purpose of which is to gather information and make judgments related to assessment goals Purpose of interviews (screening, diagnosis, treatment planning, or outcome evaluation) Types of interviews -Unstructured (open-ended questions that allow flexibility and close ended questions) -Structured (asking a standard set of questions, typically for diagnostic purposes) Psychological Tests Personality tests (psychological test that measures personality characteristics) Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) – over 500 items Nine clinical subscales: hypochondriasis, depression, hysteria, psychopathic deviance, masculinity-femininity, paranoia, psychasthenia, schizophrenia, & hypomania The Million Clinical Multiaxial Inventory (MCMI) Tests for specific symptoms Validity scales of MMPI The F scale: “faking good” or “faking bad.” asks questions designed to determine if test-takers are contradicting themselves in their responses. The L scale: “lie scale,” this validity scale was developed to detect attempts by patients to present themselves in a favorable light. The K scale: “defensiveness scale,” is a more effective and less obvious way of detecting attempts to present oneself in the best possible way. TRIN Scale: The True Response Inconsistency Scale - to detect patients who respond inconsistently. This section consists of 23 paired questions that are opposite of each other. VRIN Scale: The Variable Response Inconsistency Scale - to detect inconsistent responses. The Fb Scale: This scale is composed of 40 items that less than 10% of normal respondents support. High scores on this scale sometimes indicate that the respondent stopped paying attention and began answering questions randomly. Number of items unanswered: 30 or more Neuropsychological Testing Used to detect impairment in cognitive functioning Measures: memory, attention and attention, motor skills, perception, abstraction, and learning abilities Halstead-Reitan Neuropsychological Battery (Reitan & Davidson, 1974) Wisconsin Card Sorting Test (WCST) Bender Visual Motor Gestalt Test Mini Mental State Exam A brief 30-point questionnaire used to screen for cognitive impairment. Commonly used to screen for dementia, to estimate the severity of cognitive impairment, and to follow the course of cognitive changes in an individual over time. It is also used by mental health clinicians at intake, in order to test how oriented or disoriented a patient is, and how their cognition is affected by their symptoms. Wisconsin Card Sorting Task: This instrument measures set shifting or the ability to display flexibility in thinking as the goal of the task changes – requires attention memory, working memory, and visual processing – frontal lobe test (schizophrenia, brain injuries, dementia, Parkinson’s etc.) From Nevid/Rathus/Greene, Abnormal Psychology in a Changing World, 5e, p. 91 . Copyright © 2008 Pearson/Prentice Hall. Reprinted by permission. Figure 3.6 The Bender Visual Motor Gestalt Test The average IQ is 100 (mean) and the standard deviation is 15. So if someone has an IQ of 130 that means their IQ is two standard deviations above the mean. Intelligence Tests Used to measure Stanford-Binet Intelligence Scale intelligence quotient (IQ) Intelligence Quotient (a source of Wechsler Adult Intelligence Scale cognitive functioning that compares a person’s performance to his or her age-matched peers) (WAIS-IV; Wechsler, 2008) Wechsler Intelligence Scale for Children (WISC-IV, 7-16 years) Wechsler Preschool and Primary Scale of Intelligence (WPPS-III, 2½-7 years) Wechsler Adult Intelligence Scale (WAIS-IV) Currently in its fourth edition Adapted from the tests that the US Army used. Produces four index scores Verbal Comprehension Index (VCI) Working Memory Index (WMI) Perceptual Reasoning Index (PRI) Processing Speed Index (PSI) WAIS-IV CONTD. Verbal Comprehension Index Vocabulary (timed) Comprehension (timed) Why do plants need water? Similarities How are an apple and orange similar? Reading rate (timed) Working Memory Index Digit Span “46”, “583”, “6835”, “79248” backwards Arithmetic WAIS-IV CONTD. Perceptual Reasoning Index Visual puzzles Arrange a set of blocks so that they reproduce a design Matrix reasoning Choose which pattern logically follows after a set of patterns WAIS-IV CONTD. Processing Speed Index Trails making (timed) Making a trail Projective Tests Tests derived from psychoanalytic theory in which people are asked to respond to ambiguous stimuli Rorschach Inkblot Test (Rorschach, 1921) Thematic Apperception Test (TAT; 1935) -Consists of 31 black-and-white pictorial cards and the patient is asked to make up a story about the image Can you please describe to me what you see? Where do you see it? Plate 1 The nine questions in scoring: 1.What is the location? 2.What is the developmental quality 3.What are the determinants? 4.What is the form quality? 5.Is there a pair? 6.What are the contents? 7.Is it a popular? 8.Are there any special scores? The Rorschach Inkblot Test Fact: 75% of the Exner’s Examine the Evidence: It’s important to Comprehensive System remember 25% of the CS scores are not (CS) scores warrant considered reliable, “the norms” published by Exner is extremely internal validity which is outdated (from the 1970s and 1980s), based on sums of and adequate validity only exists for 20 individual scores. of the 180 CS scores. Some previous studies found that validity increases when clinicians use their clinical judgment to incorporate the Rorschach results with information gathered from other sources. Conclusion: There continues to be critics and advocates for the utility of the Rorschach; however no sound empirical data exists. The goal of behavioral assessments is to understand behavior within the context of learning, “learned behavior.” Behavioral Assessment Functional analysis – where a clinician identifies causal links between behavior and environment Self-monitoring – a patient records and observes his or her own behavior (advantage: not retrospective) Behavioral observation – measurement of behavior by a trained observer. (event recording or interval recording in a natural or analogue fashion) Behavioral avoidance tests – strategies used to assess avoidance behavior Psychophysiological Assessment Assessment strategies that measure brain and nervous system activity Electroencephalography (EEG, a noninvasive procedure that measures and records brainwaves) sleep, comatose, and relaxation states Electrodermal activity (EDA, measures changes in electrical conductance produced by increased or decreased sweat gland activity) formerly called Galvanic Skin Response Biofeedback (trains patients to recognize and modify physiological signals) The Historical Roots of Diagnosis… American Psychiatric Association (APA, 1952) Diagnostic and Statistical Manual of Mental Disorders (DSM, current edition DSM-V, 2013) Multiaxial system of diagnosis and classification International Classification of Diseases (ICD-10, 1992) published by WHO Global Assessment of Functioning (GAF) a way for clinician’s to use a rating system to assess one’s functioning. 91-100 Excellent functioning in all aspects of life 81-90 Good functioning, only everyday problems like traffic 71-80 Starting to shows slight impairment in Axis IV areas 61-70 Starting to show mild symptoms and social supports still intact 51-60 Starting to show moderate symptoms and an increase in the level of distress and impairment in Axis IV areas Global Assessment of Functioning (GAF) continued… 41-50 Symptoms are severe and obvious and there is severe impact on one’s Axis IV areas 31-40 Major difficulties in reality orientation, judgment, and communication, as well as extreme difficulties in Axis IV areas 21-30 One is actively having delusions and hallucinations and an inability to function in all aspects of life 11-20 One is experiencing thoughts of DTO/DTS (e.g., danger to others and danger to self) behaviors and poor hygiene 1-10 Actively suicidal and homicidal with a current plan and continued poor hygiene Comorbidity The presence of more With each new edition than one disorder of the DSM new diagnostic categories 50% of people who meet diagnostic criteria arise for one mental disorder The DSM has tripled meet criteria for at least in size since the 1st one other disorder edition Why do you think so many individuals meet diagnostic criteria for more than one mental disorder? How do you feel about the increasing number of disorders with each new DSM? Developmental and Cultural Considerations Diagnostic criteria may need to vary across the life span Differences in prevalence (men vs. women) -Women and depression vs. men and substance abuse disorders Differences in symptoms and disorders (based on ethnicity and race) Culture-bound syndrome (sets of symptoms that occur together uniquely in certain ethnic or racial groups) When is a diagnostic system harmful? Stereotypes & Prevention of a labels Premature or inaccurate assumptions by clinicians Self-fulfilling prophecies thorough evaluation or comprehensive treatment plan Stigma DSM (limited knowledge of an era and too many disorders) Over-medicalization Common issues related to DSM Distinction between what is normal and not normal or mental disorder and problem of living Mind-body dualism (mental vs. physical disorders) Limited understanding of mental disorders Mostly descriptive rather than explanatory Categorical and prototypical approach vs. dimensional approach Gender biases and too much emphasis on culturally accepted norms Dimensional Systems vs. Categorical Systems Dimensional (suggests that people with disorder are not qualitatively distinct from people without disorders) -Psychiatric illness conceptualized as dimensions of functioning versus discrete clinical conditioning Features that support the value of dimensional approaches -High frequency of comorbidity and within category variability -“Common language” of classification Cons of dimensional system Issues with the DSM-IV-TR: Criticism Lacks an overarching conceptual base (theory) No consistent rationale for different diagnoses Emphasis on reliability over validity No vision for a better society Lacks treatment specificity Comorbidity still an issue Complex, long, and not user-friendly Issues with the DSM-IV-TR Support Based on empirical data – empirical review carefully done and further tests are on their way Complex due to the inherent nature of mental disorders Gender biases have been a concern, but the differences in ratio may just reflect differences in men and women traits DSM-5: PROPOSED REVISIONS: Removal of the multiaxial system Changes in the names of certain disorders Autism-related disorders changed to Autism- spectrum disorders, Asperger’s deleted; Mental retardation may be changed to intellectual disability Addiction related disorders for substance abuse or dependence DSM-5: PROPOSED REVISIONS: Proposal of new disorders behavioral addictions – gambling; binge eating disorder; temper dysregulation with dysphoria ‘disruptive mood dysregulation disorder’ to “diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year”. DSM-5: PROPOSED REVISIONS: Risk syndromes category To identify risk of cognitive impairment earlier in the progression of psychotic and neurocognitive/neurodegenerative disorders (like dementia) New suicide and self-harm assessment criteria seperately for children and adults Changes to the diagnosis of certain disorders Bereavement exclusion is not included in the diagnosis of depressive episode anymore DSM-5: PROPOSED REVISIONS: Proposal of a dimensional system Severity ratings (mild, moderate, severe, very severe) for disorders Quantitative cross-cutting measures of the presence of symptoms that cut across the boundaries of any specific diagnoses or disorders– stepwise evaluation Level 1 assessment: cross-cutting symptoms on a 4-rating scale (none, slight, mild, moderate, severe) Level 2 assessment: for those symptoms that are scored higher than a certain cutoff – in a clinically significant range. DSM 5 The DSM-V Task Force: 27 members, including a chair and vice chair, collectively represent research scientists from psychiatry and other disciplines. Scientists experienced in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy.