1. PowerPoint  Lecture Notes Presentation Chapter 3 Diagnosis and Assessment Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson

2. Copyright 2009 John Wiley & Sons, NY2 Diagnosis and Assessment l Diagnosis »The classification of disorders by symptoms and signs. l Advantages of diagnosis: »Facilitates communication among professionals »Advances the search for causes and treatments »Cornerstone of clinical care

3. Copyright 2009 John Wiley & Sons, NY3 Reliability l Consistency of measurement »Inter-rater –Observer agreement »Test-retest –Similarity of scores across repeated test administrations or observations »Alternate Forms –Similarity of scores on tests that are similar, but not identical »Internal Consistency –Extent to which test items are related to one another

4. Copyright 2009 John Wiley & Sons, NY4 Validity l How well does a test measures what it is supposed to measure? l Content validity »Extent to which a measure adequately samples the domain of interest e.g., all of the symptoms of a disorder. l Criterion validity »Extent to which a measure is associated with another measure (the criterion) –Concurrent l Two measures administered at the same point in time »Hopelessness scale and diagnosis of depression –Predictive l Ability of the measure to predict another variable measured at some future point in time »College GPA and annual salary after graduation

5. Copyright 2009 John Wiley & Sons, NY5 Validity l Construct validity (Cronbach & Meehl, 1955) »A construct is an abstract concept or inferred attribute »Involves correlating multiple indirect measures of the attribute –e.g., self-report of anxiety correlated with increased HR, shallow breathing, racing thoughts. »Important method for evaluating diagnostic categories

6. Copyright 2009 John Wiley & Sons, NY6 DSM-IV-TR Diagnostic System l Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) »4 th edition revised »Published by American Psychiatric Association l Multiaxial system »Diagnosis based on 5 axes or dimensions.

7. Copyright 2009 John Wiley & Sons, NY7 Five Axes of DSM-IV AXISDESCRIPTION IAll diagnostic categories except personality disorders and mental retardation IIPersonality disorders and mental retardation IIIGeneral medical conditions IVPsychosocial and environmental problems VGlobal assessment of functioning scale (GAF)

8. Copyright 2009 John Wiley & Sons, NY8 Selected Axis I Diagnostic Categories l Disorders usually first diagnosed in infancy, childhood or adolescence »Learning Disorders »Pervasive Developmental Disorders l Substance-related disorders »Alcohol-related and Amphetamine-related Disorders l Schizophrenia and other Psychotic Disorders l Anxiety disorders »Panic, Generalized Anxiety, Obsessive-Compulsive Disorders l Mood disorders »Major Depressive and Bipolar Disorders l Eating Disorders »Anorexia Nervosa and Bulimia Nervosa

9. Copyright 2009 John Wiley & Sons, NY9 Example: Multiaxial Diagnosis of Carol S. Axis IMajor Depressive Disorder Axis IIBorderline Personality Disorder Axis IIIThyroid disease Axis IV Problems with primary support group: marital separation Axis V GAF = 60 Moderate difficulty in social and occupational functioning

10. Early Foundations: Emil Kraepelin (1856-1926) l Pioneered classification of mental illness based on biological causes l Published 1 st psychiatry text (1883) l Mental illness as syndrome »Cluster of symptoms that co-occur l Proposed two major syndromes »Dementia praecox »Manic-depressive psychosis Copyright 2009 John Wiley & Sons, NY10

11. Copyright 2009 John Wiley & Sons, NY11 Improvements in the DSM-IV-TR 1. Specific diagnostic criteria »Less vague, more explicit and concrete than DSM-II (see Table 3.2) 2. More extensive descriptions »Essential features »Associated features (e.g., lab findings) »Differential diagnosis

12. Copyright 2009 John Wiley & Sons, NY12 Improvements in the DSM-IV-TR 3. Increasing number of diagnostic categories 4. Issues and possible diagnostic categories in need of further study lCaffeine withdrawal or Premenstrual Dysphoric Disorder

13. Copyright 2009 John Wiley & Sons, NY13 Table 3.2 Descriptions of Mania in DSM-II vs. DSM-IV-TR

14. Copyright 2009 John Wiley & Sons, NY14 Ethnic & Cultural Considerations l Mental illness universal l Culture can influence: »Risk factors »Types of symptoms experienced »Willingness to seek help »Availability of treatments l DSM-IV-TR includes: »Enhanced cultural sensitivity »Appendix of 25 culture-bound syndromes –Koro –Amok l Some researchers endorse looking for commonalities rather than differences across cultures

15. Table 3.4 Twelve month prevalence of the most common diagnoses by country Copyright 2009 John Wiley & Sons, NY15

16. Copyright 2009 John Wiley & Sons, NY16 Table 3.3 Number of Diagnostic Categories per Edition of DSM

17. Copyright 2009 John Wiley & Sons, NY17 Figure 3.1 Categorical vs. Dimensional Systems l Categorical »Presence/absence of a disorder –Either you are anxious or you are not anxious. l Dimensional »Rank on a continuous quantitative dimension –Degree to which a symptom is present –How anxious are you on a scale of 1 to 10? l Dimensional systems may better capture an individual’s functioning l Categorical approach has advantages for research and understanding

18. Copyright 2009 John Wiley & Sons, NY18 Figure 3.2 Interrater Reliability l Extent to which clinicians agree on the diagnosis.

19. Copyright 2009 John Wiley & Sons, NY19 Inter-Rater Reliability of Selected DSM Diagnoses l For most DSM diagnostic categories, reliability is good l Reliability in everyday settings may be lower than in formal research settings Diagnosis Kappa Bipolar Disorder.84 Major Depression.80 Schizophrenia.79 Alcohol Abuse1.0 Any Eating Disorder.77 Panic Disorder.65 Avoidant PD.97 Dependent PD.86

20. Copyright 2009 John Wiley & Sons, NY20 Validity of Diagnostic Categories l Construct validity of highest concern l Diagnoses are constructs »For most disorders, no lab test available to diagnose with certainty l Strong construct validity predicts wide range of characteristics

21. Table 3.5 Rates of marital distress and missed work days among people with mental illness in the past year Copyright 2009 John Wiley & Sons, NY21

22. Copyright 2009 John Wiley & Sons, NY22 Criticisms of Classification l Stigma against mental illness »Treated differently by others »Difficulty finding a job l Categories do not capture the uniqueness of a person. »The disorder does not define the person. –She is an individual with schizophrenia, not a “schizophrenic” l Classification may emphasize trivial similarities »Relevant information may be overlooked.

23. Possible Changes for DSM-IV l Including a Personal Health Index l Reorganizing categories based on overlap l Dimensional approach to diagnoses l Organizing diagnoses by causes l Defining disability Copyright 2009 John Wiley & Sons, NY23

24. Copyright 2009 John Wiley & Sons, NY24 Psychological Assessment l Techniques employed to: »Describe client’s problem »Determine causes of problem »Arrive at a diagnosis »Develop a treatment strategy »Monitor treatment progress l Ideal assessment involves multiple measures and methods »Interviews, personality inventories, etc.

25. Copyright 2009 John Wiley & Sons, NY25 Table 3.7 Major Psychological Assessment Methods

26. Copyright 2009 John Wiley & Sons, NY26 Characteristics of Clinical Interviews l Interviewer attends to how questions are answered »Is response accompanied by appropriate emotion? »Does client fail to answer question? l Paradigm influences information sought »CBT interviewer focuses on current, rather than early childhood, events. l Good rapport essential »Empathy and accepting attitude l Formal (structured) vs. informal »Structured interviews –All interviewers ask the same questions in a predetermined order –Structured Clinical Interview for Axis I of DSM (SCID)

27. Copyright 2009 John Wiley & Sons, NY27 Figure 3.4 Sample Item from SCID

28. Copyright 2009 John Wiley & Sons, NY28 Assessment of Stress l Social Readjustment Rating Scale (SSRS) »Holmes & Rahe (1967) »Relies on retrospective ratings »Stressfulness ratings fixed l Assessment of Daily Experiences (ADE) »Stone & Neale (1982) »Monitor and record thoughts and events on a daily basis l Bedford College Life Events and Difficulties Schedule (LEDS) »Semi-structured interview »Evaluates stressors within the context of each individual’s circumstances

29. Copyright 2009 John Wiley & Sons, NY29 Figure 3.5 Sample of Assessment of Daily Experience Scale

30. Copyright 2009 John Wiley & Sons, NY30 Figure 3.6 LEDS Life Events Timeline

31. Copyright 2009 John Wiley & Sons, NY31 Three Types of Psychological Tests l Self-report personality Inventories »Minnesota Multiphasic Personality Inventory (MMPI) –Yields profile of psychological functioning –Specific subscales to detect lying and faking “good” or “bad” l Projective Tests »Rorshach Inkblot Test and Thematic Apperception Test (TAT) »Projective hypothesis –Responses to ambiguous stimuli reflect unconscious processes l Intelligence tests »Wechsler Adult Intelligence Scale, 3 rd Ed (WAIS-III); Wechsler Intelligence Scale for Children, 3 rd Ed (WISC-III) »Assesses current mental ability

32. Copyright 2009 John Wiley & Sons, NY32 Figure 3.7 Hypothetical MMPI-2 Profile

33. Copyright 2009 John Wiley & Sons, NY33 Figure 3.8 Rorschach Inkblot Test

34. Copyright 2009 John Wiley & Sons, NY34 Behavioral Observation l Observe behavior as it occurs l Sequence of behavior divided into segments »Antecedents and consequences l Observation often conducted in lab setting »e.g., romantic partners discuss relationship problem –Interaction observed through one-way mirror or videotaped for later coding

35. Copyright 2009 John Wiley & Sons, NY35 Self-Observation l Self monitoring »Individuals observe and record their own behavior –e.g., moods, stressful events, thoughts, etc. l Ecological Momentary Assessment (EMA) »Collection of data in real time using diaries or PDAs l Reactivity »The act of observing one’s behavior may alter it –Desirable behaviors tend to increase whereas undesirable behaviors decrease

36. Copyright 2009 John Wiley & Sons, NY36 Self-report Inventories & Cognitive Assessment l Format often similar to personality tests l Dysfunctional Attitude Scale (DAS) »Identifies maladaptive thought patterns –People will think less of me if I make mistakes l Articulated Thoughts in Simulated Situations (ATSS) »Assesses immediate thoughts in specific situations

37. Copyright 2009 John Wiley & Sons, NY37 Neurobiological Assessment: Brain Imaging l Computerized Axial Tomography (CT or CAT scan) »Reveals structural abnormalities by detecting differences in tissue density. –e.g., enlarged ventricles l Magnetic Resonance Imaging (MRI) »Similar to CT but higher quality »fMRI (functional MRI) –Images reveal function as well as structure –Measures blood flow in the brain l (BOLD; blood oxygenation level dependent) l Positron Emission Tomography (PET scan) »Brain function

38. Copyright 2009 John Wiley & Sons, NY38 Neurobiological Assessment: Neurotransmitter Assessment l Postmortem studies l Metabolite assays »Metabolite levels –By-products of neurotransmitter breakdown found in urine, blood serum or cerebral spinal fluid »May not reflect actual level of neurotransmitter »Correlational studies

39. Copyright 2009 John Wiley & Sons, NY39 Neurobiological Assessment: Neuropsychological Assessment l Neuropsychologist »Studies how brain abnormalities affect thinking, feeling, and behavior l Neuropsychological Tests »Reveal performance deficits that can indicate areas of brain malfunction »Halstead-Reitan battery –Tactile Performance Test - Time –Tactile Performance Test - Memory –Speech Sounds Perception Test »Luria-Nebraska battery –Assesses motor skills, tactile & kinesthetic skills, verbal & spatial skills, expressive & receptive speech, etc.

40. Copyright 2009 John Wiley & Sons, NY40 Psychophysiological Assessment l Psychophysiology »Study of bodily changes that accompany psychological characteristics or events l Electrocardiogram (EKG) »Heart rate measured by electrodes placed on chest l Electrodermal responding (skin conductance) »Sweat-gland activity measured by electrodes placed on hand. l Electroencephalogram (EEG) »Brain’s electrical activity measured by electrodes placed on scalp.

41. Copyright 2009 John Wiley & Sons, NY41 Cultural Bias in Assessment l Measures developed for one culture or ethnic group may not be valid or reliable for another. »Not simply a matter of language translation –Meaning may be lost l Cultural bias can lead to minimizing or exaggerating psychological problems

42. Copyright 2009 John Wiley & Sons, NY42 Strategies to Avoid Bias l Increase graduate students’ sensitivity to cultural issues l Insure participants’ understanding of task l Establish rapport l Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994)

43. Copyright 2009 John Wiley & Sons, NY43 COPYRIGHT Copyright 2009 by John Wiley & Sons, New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner.