Chapter 3: Classification & Diagnosis

Question 1

Why do we need a classification system for mental disorders?

Answer 1

• common vocabulary for professionals
• provides information that is necessary when making decisions about treatment
• needed to conduct research on disorders and treatment
• need diagnostic systems in order to estimate the prevalence of disorders in the population

Question 2

What is an assessment?

Answer 2

• procedure through which information is gathered systematically in the evaluation of a condition
• yields information that serves as the basis for a diagnosis

Question 3

What would be the perfect diagnostic system?

Answer 3

Classify disorders on the basis of:

• presenting symptoms (pattern of behaviours)
• etiology (history of the development of the symptoms and underlying causes)
• prognosis
• response to treatment

Question 4

What are syndromes?

Answer 4

• set of symptoms representing the observable manifestation of an underlying disorder
• patient will not manifest all symptoms associated with any given syndrome
• may be overlap

Question 5

What is reliability?

Answer 5

• consistency in which measurement is given

Question 6

What is inter-rater reliability?

Answer 6

• extent to which two clinicians agree on the diagnosis of a particular patient
• affected mainly by the inadequacy of the diagnostic system itself rather than personal differences between clinicians

Question 7

What is diagnostic validity?

Answer 7

• whether a diagnostic category is able to predict behavioural and psychiatric disorders accurately

Question 8

What is concurrent validity?

Answer 8

• ability of a diagnostic category to estimate an individual’s present standing on factors related to the disorder but not part of the criteria
• i.e., academic underachievement and downward drift in socioeconomic status are linked with schizophrenia onset but not part of the main diagnosis

Question 9

What is predictive validity?

Answer 9

• ability of test to predict future course of an individual’s development

Question 10

What are the functions of a good classification system?

Answer 10

1 - Organization of clinical information
2 - Shorthand communication
3 - Prediction of natural development
4 - Treatment reccommendations
5 - Heuristic value
6 - Guidelines for financial support

Question 11

What are the three sections of the DSM-5?

Answer 11

SECTION I: Introduction and Use
- historical background and guidelines for proper use

SECTION II: Clinical Disorders

• recognized psychological disorders
• personality disorders newly added
• collects information about patient’s life circumstances

SECTION III: Experimental Measures

• optional measures and models in need of further study
• Outline for Cultural Formulation
• intended primarily for research purposes

Question 12

What are the positive changes made to the DSM-5?

Answer 12

• broad collaboration
• inclusion of cultural considerations
• more descriptive diagnosis
• reorganized to reflect etiology and shared factors
• recognition of life span issues related to specific disorder
• gender & cultural notes for individual diagnosis
• removal of diagnostic criterion not relevant across cultural groups

Question 13

What are some examples of Section II disorders of the DSM-5?

Answer 13

• neurodevelopmental
• schizophrenia/psychotic
• mood
• anxiety
• somatic
• feeding & eating
• sexual and gender
• personality

Question 14

What are arguments against classification?

Answer 14

MEDICAL MODEL
- psychological disorders aren’t as legitimate because they don’t seem to show deviations from anatomical structure of brain or anything
→ but we may find these physical deviations one day

STIGMATIZATION
- labels have major social and occupational impact
→ but that’s more a problem with society than the classification system

LOSS OF INFORMATION

• label gives false sense of confidence in understanding person and forcing assumptions on them
• not enough attention paid to uniqueness of individual

Question 15

What symptoms and history are investigated when diagnosing a patient?

Answer 15

• current symptoms
  → interfere with ability to function?
  → coping strategies?
• recent events
• personal and family history of psychological disorders

Question 16

What physical and neuropsychological factors are investigated when diagnosing a patient?

Answer 16

• physical condition
• drug and alcohol use
• intellectual and cognitive functioning

Question 17

What is a differential diagnosis?

Answer 17

• process of ruling out potential disorders (or determining which of a number of possible diagnoses is correct)

Question 18

What sociocultural factors are investigated when diagnosing a patient?

Answer 18

• social resources
  → any friends or family and the quality of these relationships
• sociocultural background
• acculturation

Question 19

How are unstructured interviews conducted?

Answer 19

• open-ended
• concentrate on person’s unique style or on certain aspects of the presenting problem
• no script
• avoids sensitive topics and builds rapport, mutual trust, and respect

Question 20

What are the limitations of unstructured interviews?

Answer 20

• poor reliability and validity

- clinicians tend to focus only on whatever their field of interest is and justify their own hypotheses

Question 21

How is a structured interview conducted?

Answer 21

• read from script
• can be done by trained layperson
• i.e. Diagnostic Interview Schedule

Question 22

What are the limitations of structured interviews?

Answer 22

• increased validity but poor rapport

Question 23

What are general limitations of interviews as an assessment tool?

Answer 23

• clients may be resistant

- clients select information to present

Question 24

What is face validity?

Answer 24

• test appears to measure what it is supposed to measure

Question 25

What is content validity?

Answer 25

- test assesses all important aspects of phenomenon

Question 26

What is concurrent validity?

Answer 26

- test yields the same results as other measures of the same behaviour, thoughts, or feelings

Question 27

What is construct validity?

Answer 27

- test measures what it is supposed to measure

Question 28

What is test-retest reliability?

Answer 28

- test produces similar results when given at two points in time

Question 29

What is alternate form validity?

Answer 29

- two versions of the same test produce similar results

Question 30

What is internal validity?

Answer 30

- different parts of the same test produce similar results

Question 31

When are neuropsychological tests used?

Answer 31

- used when neurological impairment or dysfunction is suspected (e.g., brain injury, or potential brain injury, sustained during a car crash; diagnosing or demonstrating effects of organically-based problems such as the dementia associated with Alzheimer’s disease)

Question 32

Compare and contrast the clinical approach and the actuarial approach.

Answer 32

CLINICAL: - no substitute for clinician's experience and personal judgment - prefer to draw on all available data in their own manner - guided by intuition honed by experience ACTUARIAL: - more objective standard needed - unbiased and scientifically validated approach needed - rely on statistical procedures, empirical methods, and formal rules

Question 33

What are the different types of brain-imaging techniques?

Answer 33

``` Computerized tomography (CT) - X-Ray beams are passed through the brain and images formed by the amount of radiation absorbed and reflected. - Addresses brain structure but not brain function. ``` Positron-emission tomography (PET) - Assesses brain activity by measuring movement of photons through the injection of a radioactive isotope. Magnetic resonance imaging (MRI) - Provides finely detailed pictures and does not expose the person to radiation - Relies on magnetically affecting hydrogen atoms in a way that provides 3D images of the brain

Question 34

What is the Bender Visual-Motor Gestalt Test?

Answer 34

- series of nine cards with lines and shapes drawn on - respondents asked to copy images on another card and then draw them from memory - errors in reproducing lines may indicate neuropsychological problems

Question 35

When are intelligence tests used in a clinical context?

Answer 35

- used to determine intellectual strengths and weaknesses especially when mental retardation or brain damage is suspected

Question 36

Which are the two most used IQ tests?

Answer 36

- Stanford-Binet | - Wechslet family of scales

Question 37

What are the criticisms of intelligence tests?

Answer 37

- little agreement of what it is to be "intelligent" - most only assess verbal and analytical abilities - biased toward middle and upper-class educated European Americans

Question 38

What are symptom questionnaires?

Answer 38

- cover wide variety of symptoms representing several different disorders - e.g., 21-item Beck Depression Inventory

Question 39

What are personality inventories?

Answer 39

- meant to assess people's typical ways of thinking, feeling, and behaving

Question 40

What is the Minnesota Multiphasic Personality Inventory (MMPI)?

Answer 40

- most widely used personality inventory - 10 clinical scales, 4 validity scales to help determine legitimacy of what is learned across clinical scales Scales include: - L (Lie, denial of small flaws people would readily admit to means they could be hiding something else) - F (Frequency, high on this score probably means the test was filled out carelessly) - K (Defensiveness, conceals real feelings on controversial topics to seem better)

Question 41

What is the Rorschach Inkblot Test?

Answer 41

- oldest and best known projective test - based on idea people see different things in same inkblot and that what they see reflects their personality - cards separated and handed in a certain sequence - Exner system developed to standardize scoring of responses

Question 42

What is a projective test?

Answer 42

- person is presented with an ambiguous stimulus and projects onto it their unconscious motives, desires, needs, drives, etc. - use to help form hypotheses about an individual's personality

Question 43

What is the Thematic Apperception Test?

Answer 43

- drawings on cards depicting ambiguous social interactions - respondents asked what they believe is happening and what lead up to it and stuff like that - assumption that client identifies with protagonist

Question 44

What are gender bias concerns about the DSM?

Answer 44

- societal gender bias is reflected in DSM descriptions of many psychiatric disorders - diagnosis more likely for women even with no pathology present

Question 45

What are cultural bias concerns in the DSM?

Answer 45

- "normal" v. "abnormal" is fraught with cultural and professional assumptions

Question 46

What are concerns about the politics of the DSM?

Answer 46

- secrecy of revision process | - composition of the membership of the committees e.g., ties to pharmaceutical companies