diagnosis diagnosis: labeling a set of symptoms. does the problem meet the criteria for a...
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DiagnosisDiagnosis
Diagnosis: Labeling a set of symptoms. Does the problem meet the criteria for a psychological disorder?
Syndrome: a set of behavioral or psychological symptoms that tends to occur together.
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Diagnostic & Statistical Diagnostic & Statistical Manual Manual of Mental Disorders (DSM)of Mental Disorders (DSM)
Compiled by the American Psychiatric AssociationEditions: DSM (1952), II (1968), III (1980), III-R (1987), IV (1994), IV-TR(2000)The official manual for diagnosing psychological disorders in U.S. since 1952.Provides specific, concrete criteria for each disorder.
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Assumptions of the DSM
Medical Model – psychological disorders as “diseases”Atheoretical Orientation – descriptive rather than explanatoryCategorical Approach – disorders are grouped into discrete categoriesPrototypical Approach – identifies certain essential characteristics, while allowing for nonessential variationsMultiaxial System – assesses 5 axes or areas of functioning
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The 5 AxesThe 5 Axes
Axis I: Clinical Disorders - all major disorders and adjustment disordersAxis II: Personality Disorders & Mental Retardation - lifelong, chronic conditions
Axis III: General Medical Conditions - causes, consequences, or coincidentalAxis IV: Psychosocial & Environmental Stressors - causes, consequences, or coincidentalAxis V: Global Assessment of Functioning – rating of overall level of functioning
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Axis I Developmental/Childhood DisordersCognitive Disorders (Delirium, Dementia, Amnesia, etc.)Substance-Related DisordersSchizophrenia & Other Psychotic DisordersMood DisordersAnxiety DisordersDisorders due to a General Medical Condition
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Axis I continuedSomatoform Disorders Factitious DisordersDissociative DisordersSexual & Gender Identity DisordersEating DisordersSleep DisordersAdjustment DisordersImpulse Control Disorders“V” Codes
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Axis II
Paranoid Schizoid SchizotypalAntisocialBorderline
Histrionic NarcissisticAvoidant DependentObsessive-Compulsive
Mental Retardation
Personality Disorders:
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Axis IV: Psychosocial & Environmental Problems
Primary support groupSocial environmentEducationalOccupationalHousingFinancialAccess to health care servicesLegal system/ crime
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Axis V: Global Assessment of Functioning
91-100 no sx, superior functioning81-90 absent or minimal sx, good functioning71-80 slight, transient sx or impairment in
functioning61-70 mild sx & impairment in functioning51-60 moderate sx & impairment in functioning41-50 serious sx & impairment in functioning31-40 major impairment in functioning, difficulties
with reality testing or communication21-30 serious impairment in communication &
judgment, psychotic sx, inability to function11-20 danger to self or others, gross impairment in
communication1-10 persistent danger to self or others, inability to
maintain hygiene
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Issues to Consider in Issues to Consider in DiagnosisDiagnosis•Culture & Ethnicity
•Gender
•Age
•Social Class
•The Danger of Labeling
•Stigmatization
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Psychological Assessment
The systematic evaluation and measurement of the psychological, biological, and social factors that have the most influence on the person’s functioning.In an individual presenting with a possible psychological disorder, information is gathered about the person’s symptoms.
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Clinical InterviewPsychological symptoms: current & past Family history of psych problemsCoping strategiesLife events: recent & significantSocial support and functioningCulture, ethnicity, religion, SESMedical conditions & medicationsDrug & alcohol useIntellectual and cognitive functioningMotivation for treatment
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The Clinical Interview
Unstructured Interviews
Semi-Structured & Structured Interviews Structured Clinical Interview for the DSM (SCID) Diagnostic Interview Schedule (DIS)
Limitations Resistance to being assessed or disclosing
information Biased presentation of information – omission,
distortions, outright lying
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Mental Status Exam1) Appearance & Behavior – appearance,
grooming, attire, mannerisms, posture, expressiveness, activity level, bodily movements
2) Thought Processes – rate, flow, & continuity of speech, thought content, obsessions, delusions
3) Mood & Affect – expression, intensity, appropriateness, reactivity, range, & personal experience of emotion.
4) Intellectual Functioning – rough estimate of cognitive strengths & weaknesses based on vocabulary, memory, attention, insight, knowledge.
5) Sensorium – general awareness of surroundings in terms of person, place, & time.
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BEHAVIORAL ASSESSMENTPurpose: To identify & monitor target behaviors and to determine the factors that influence them.Methods:Behavioral Observation – naturalistic vs. analogue, structured vs. unstructuredBehavioral Self-Report & Behavioral Self-Monitoring – assessing one’s thoughts, feelings & behaviors in specific situations & contextsLimitations: reactivity
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Personality & Diagnostic Testing:Self-Report
Inventories/QuestionnairesPurpose: -to assess symptoms & diagnose disorders-to assess one’s typical ways of thinking, feeling, and behavingExamples:•Beck Anxiety Inventory (BAI)•Hamilton Rating Scale for Depression (HRSD)•Minnesota Multiphasic Personality Inventory (MMPI-2)•Millon Clinical Multiaxial Inventory (MCMI-III)•Myers Briggs Type Indicator (MBTI)
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Projective Tests
Examples: Rorschach Inkblot Test; Thematic Apperception Test; Sentence Completion Test; Draw-A-Person Test
Purpose: assesses person’s underlying concerns, conflicts, and desires
Strengths: doesn’t rely on person’s level of self-insight or willingness to shareWeaknesses: usefulness for diagnosis, reliability and validity, subjective interpretation
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Intelligence TestingPurposes: •Assess cognitive strengths and weakness•Detect mental retardation or brain damage•Identify special needs or gifted children•Screening in occupational or military settings
Examples:•Wechsler Intelligence Scales (WAIS-III, WISC-III)•Stanford-Binet Intelligence Test (SB-IV)Limitations:•Differing conceptions of intelligence•Cultural and class bias
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Psychophysiological Assessment
Electroencephalogram (EEG) – measures brain wave patterns & electrical activity in the brain
Electrocardiogram (EKG) – measures cardiovascular functioning
Electromyography (EMG) – measures muscular tension
Galvanic Skin Response (GSR) – measures electrodermal response, e.g. sweat gland activity
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Neuropsychological Assessment
Purpose: • Assess motor skills, sensory &
perceptual abilities, language, attention, concentration, memory, & learning
• Detect brain abnormalities, damage, & deterioration
Examples:• Halstead-Reitan Neuropsych Battery• Luria-Nebraska Neuropsych Battery
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Neuroimaging Techniques
Purpose: to test for brain activity, structure, & damage, e.g. injury or tumor
Computerized Tomography (CT/CAT scan) – produces an x-ray image of the structure of the brain
Magnetic Resonance Imaging (MRI) – produces high resolution pictures of brain anatomy, activity, and functioning
Positron Emission Tomography (PET) -displays brain activity & metabolism
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Problems in Assessment
Self-Report IssuesLack of self-awarenessDiscomfort with self-disclosure
Cultural BiasLanguage barriersCultural differences in the manifestation of disorders & presentation of symptoms