Psyc 380 1st Edition Lecture 5 Current Lecture Chapter 3 continued Diagnosis and Assessment I Cornerstones of Diagnosis and Assessment II Classification and Diagnosis III Psychological Assessment IV Neurobiological Assessment V Cultural and Ethnic Diversity and Assessment Construct Validity of 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 Possible etiological causes past Clinical characteristics current Predict treatment response future Construct Validity of Schizophrenia Etiology Associated with theoretically predicted risks Family history Psychosis proneness schizotypy Stress physical virus social life events Not associated with factors deemed non risks Gender Concurrent associations Symptoms as predicted Bleuler s 4 As First rank symptoms Neurophysiological signs Enlarged ventricles Prognostic Responds to predicted treatments Course episodic related to premorbid functioning Psychological Assessment Techniques employed to Describe client s problem Determine causes of problem Arrive at a diagnosis Develop a treatment strategy Monitor treatment progress Conducting valid research Ideal assessment involves multiple measures and methods Interviews personality inventories intelligence tests etc Clinical Interviews Informal less structured interviews Interviewer attends to how questions are answered Is response accompanied by appropriate emotion Does client fail to answer question Good rapport essential to earn trust Empathy and accepting attitude necessary Reliability lower than for structured interviews Structured interviews All interviewers ask the same questions in a predetermined order Structured Clinical Interview for Axis I of DSM SCID Good interrater reliability for most diagnostic categories Assessment of Stress Stress Subjective experience of distress in response to perceived environmental problems Bedford College Life Events and Difficulties Schedule LEDS Semi structured interview Evaluates stressors within the context of each individual s circumstances Self Report Stress Checklists Faster way to assess stress Test retest reliability low Life event stressors Major life events Death in family Divorce separation Jail Illness injury Daily hassles Weight concerns Health of family member Rising prices Home maintenance Misplacing something Psychological Tests Personality Tests Self reported Personality Inventories Minnesota Multiphasic Personality Inventory MMPI Yields profile of psychological functioning Specific subscales to detect lying and faking good or bad Projective Tests Rorshach Inkblot Test and Thematic Apperception Test TAT Projective hypothesis Responses to ambiguous stimuli reflect unconscious processes Behavioral and Cognitive Assessment Focus on aspects of environment Characteristics of the person Frequency and form of problematic behaviors Consequences of problem behaviors Observe behavior as it occurs Sequence of behavior divided into segments Antecedents and consequences Behavioral Assessments often conducted in lab setting e g mother and child interact in a lab living room Interaction observed through one way mirror or videotaped for later coding Cognitive Style Questionnaires Use to help plan treatment targets Format often similar to personality tests Dysfunctional Attitude Scale DAS Identifies maladaptive thought patterns People will think less of me if I make mistakes Self Observation Self monitoring Individuals observe and record their own behavior e g moods stressful events thoughts etc Ecological Momentary Assessment EMA Collection of data in real time using diaries or smart phones Reactivity The act of observing one s behavior may alter it Desirable behaviors tend to increase whereas undesirable behaviors decrease Reactivity Reactivity The act of observing one s behavior may alter it Desirable behaviors tend to increase whereas undesirable behaviors decrease 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 higher quality fMRI functional MRI Images reveal function as well as structure Measures blood flow in the brain BOLD blood oxygenation level dependent Positron Emission Tomography PET scan Brain function Neurobiological Assessment Neurotransmitter Assessment Postmortem studies Metabolite assays Metabolite levels Byproducts of neurotransmitter breakdown found in urine blood serum or cerebral spinal fluid May not reflect actual level of neurotransmitter Correlational studies Neurobiological Assessment Neuropsychological Assessment Neuropsychologist Studies how brain abnormalities affect thinking feeling and behavior 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 and kinesthetic skills verbal and spatial skills expressive and receptive speech etc 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 Cultural and Ethnic Diversity and Assessment 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