1. Chapter 3 Diagnosis and Assessment
982 變態心理學

2. Diagnosis and Assessment
The classification of disorders by symptoms and signs.
Advantages of diagnosis:
Facilitates communication among professionals
Advances the search for causes and treatments
Cornerstone of clinical care: e.g.bipolar disorder

3. Cornerstones of Diagnosis & Assessment : Reliability
Consistency of measurement
Interrater
Observer agreement
Test-retest
Similarity of scores across repeated test administrations or observations

4. Cornerstone of Diagnosis & Assessment : Reliability
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

5. Cornerstone of Diagnosis & Assessment : Validity
How well does a test measures what it is supposed to measure?
Content validity
Extent to which a measure adequately samples the domain of interest.

6. Cornerstone of Diagnosis & Assessment : Validity
Criterion validity( ): Extent to which a measure is associated with the criterion
Concurrent
Two measures administered at the same point in time
Hopelessness scale and diagnosis of depression
Predictive
Ability of the measure to predict another variable measured at some future point in time
College GPA and annual salary after graduation

7. Cornerstone of Diagnosis & Assessment: Validity
Construct validity
A construct is an abstract concept or inferred attribute
Involves correlating multiple indirect measures of the attribute
Important method for evaluating diagnostic categories

8. Classification and Diagnosis
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
4th edition revised
Published by American Psychiatric Association
Multiaxial system
Diagnosis based on 5 axes or dimensions.

9. Five Axes of DSM-IV AXIS DESCRIPTION
I All diagnostic categories except personality disorders and mental retardation
II Personality disorders and mental retardation
III General medical conditions
IV Psychosocial and environmental problems
V Global assessment of functioning scale (GAF)

10. Example: Multiaxial Diagnosis of Carol S.
Axis I
Major Depressive Disorder
Axis II
Borderline Personality Disorder
Axis III
Thyroid disease
Axis IV
Problems with primary support group: marital separation
Axis V
GAF = 60 Moderate difficulty in social and occupational functioning

11. Improvements in the DSM-IV-TR
Specific diagnostic criteria
Less vague, more explicit and concrete than DSM-II
More extensive descriptions
Essential features
Associated features (e.g., lab findings)
A summary of the research literature (age of onset, course, prevalence and sex ratio, familial pattern, and differential diagnosis)

12. Improvements in the DSM-IV-TR
Increasing number of diagnostic categories
Issues and possible diagnostic categories in need of further study (Focus on discovery 3.2)

13. Ethnic & Cultural Considerations
Culture can influence:
Risk factors
Types of symptoms experienced
Willingness to seek help
Availability of treatments
The language used to describe distress
Clinicians are advised to be constantly mindful of how culture and ethnicity influence diagnosis and treatment.

14. Specific Criticisms of the DSM
Too many diagnoses?
Comorbidity: The co-occurrence of two disorders.
Categorical diagnoses v.s. Continuum
Reliability of the DSM
How valid are diagnostic categories?

15. Categorical vs. Dimensional Systems
Presence/absence of a disorder
Either you are anxious or you are not anxious.
advantages for research and understanding
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?
better capture an individual’s functioning

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17. Figure 3.2 Interrater Reliability
Extent to which clinicians agree on the diagnosis.
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18. Inter-Rater Reliability of Selected DSM Diagnoses
Diagnosis
Kappa
Bipolar Disorder
.84
Major Depression
.80
Schizophrenia
.79
Alcohol Abuse
1.0
Any Eating Disorder
.77
Panic Disorder
.65
Avoidant PD
.97
Dependent PD
.86
For most DSM diagnostic categories, reliability is good
Reliability in everyday settings may be lower than in formal research settings

19. How valid are diagnostic categories?
Construct validity of highest concern
Diagnoses are constructs
For most disorders, no lab test available to diagnose with certainty
Strong construct validity predicts wide range of characteristics

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21. Criticisms of Classification
Stigma against mental illness
Treated differently by others
Difficulty finding a job
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”
Classification may emphasize trivial similarities
Relevant information may be overlooked.

22. Psychological Assessment
Techniques employed to:
Describe client’s problem
Arrive at a diagnosis
Determine causes of problem
Develop a treatment strategy
Monitor treatment progress
Ideal assessment involves _________________________________

23. Clinical interviews Characteristics of clinical interviews
Interviewer attends to how questions are answered
Does client fail to answer question?
Is response accompanied by appropriate emotion?
Paradigm influences information sought
CBT interviewer focuses on ________, rather than early childhood, events.
Good rapport
Structured vs. Unstructured
Structured interviews
All interviewers ask the same questions in a predetermined order
Structured Clinical Interview for Axis I of DSM (SCID)

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Sample Item from SCID
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Assessment of Stress
Social Readjustment Rating Scale (SSRS)
Holmes & Rahe (1967)
Stressfulness ratings fixed
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Assessment of Stress -Sample of Assessment of Daily Experience (ADE) -Stone & Neale (1982) -Monitor and record thoughts and events
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27. LEDS Life Events Timeline
-Bedford College Life Events and Difficulties Schedule (LEDS)
-Semi-structured interview
-Evaluates stressors within the context of each individual’s circumstances
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28. Three Types of Psychological Tests
Self-report personality inventories
Minnesota Multiphasic Personality Inventory (MMPI)
Designed to detect a number of psychological problems
MMPI-2 (Butcher et al., 1989)

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30. Hypothetical MMPI-2 Profile
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31. Three Types of Psychological Tests
Projective Personality Tests
Projective hypothesis
Responses to ambiguous stimuli reflect unconscious processes
Rorschach Inkblot Test
Thematic Apperception Test (TAT)

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33. Three Types of Psychological Tests
Intelligence tests
Assesses current mental ability
Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV,2008);
Wechsler Intelligence Scale for Children, 4th edition (WISC-III, 2003)
Wechsler preschool and primary scale of intelligence, 3rd edition (WPPSI-III, 2002)

34. Behavioral and cognitive assessment
Aspects of the environment that might contribute to symptoms
Characteristics of the person
The frequency and form of problematic behaviors
Consequences of problem behaviors

35. Behavioral and cognitive assessment
Direct observation of behavior
Observe behavior as it occurs
Sequence of behavior divided into segments
Antecedents and consequences
Observation often conducted in lab setting
e.g., romantic partners discuss relationship problem
Interaction observed through one-way mirror or videotaped for later coding

36. Behavioral and cognitive assessment
Self-Observation
Self monitoring
Individuals observe and record their own behavior
e.g., moods, stressful experiences, etc.
Ecological Momentary Assessment (EMA)
Collection of data in real time
Reactivity
The act of observing one’s behavior may alter it

37. Behavioral and cognitive assessment
Cognitive-style questionnaires
Format often similar to personality tests
Dysfunctional Attitude Scale (DAS)
Identifies maladaptive thought patterns
Articulated Thoughts in Simulated Situations (ATSS)
Assesses immediate thoughts in specific situations

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39. Neurobiological Assessment: Brain Imaging
Computerized Axial Tomography (CT or CAT scan)
Reveals structural abnormalities by detecting differences in tissue density.
e.g., enlarged ventricles
Magnetic Resonance Imaging (MRI)
Similar to CT but _____________
fMRI (functional MRI)
Images reveal function as well as structure
Positron Emission Tomography (PET scan)
Brain function

40. Neurobiological Assessment: Neurotransmitter Assessment
Postmortem studies
Metabolite
Metabolite levels may not reflect actual level of neurotransmitter in the brain
Correlational nature of metabolite studies limits understanding of causation

41. Neurobiological Assessment: Neuropsychological Assessment
Neuropsychologist
Psychologist who studies how brain abnormalities affect thinking, feeling, and behavior
Not a neurologist
Neuropsychological Tests
Different psychological functions (memory, language…) rely on different areas of the brain
Halstead-Reitan battery
Luria-Nebraska battery
Assesses motor skills, tactile & kinesthetic skills, verbal & spatial skills, expressive & receptive speech, etc.

42. Psychophysiological Assessment
Psychophysiology
Study of bodily changes that accompany psychological characteristics or events
Electrocardiogram (EKG)
Heart rate measured by electrodes placed on chest
Electrodermal responding (skin conductance)
Sweat-gland activity measured by electrodes placed on hand.
Electroencephalogram (EEG)
Brain’s electrical activity measured by electrodes placed on scalp.

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44. Cultural Bias in Assessment
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
Cultural bias can lead to minimizing or exaggerating psychological problems

45. Strategies to Avoid Bias
Increase graduate students’ sensitivity to cultural issues
Modify assessment procedures to insure understanding of test takers
Establish rapport
Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994)