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IUPUI PSY 380 - Cornerstone of Diagnosis and Assessment

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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 AssessmentConstruct 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 risksFamily historyPsychosis proneness (schizotypy)Stress (physical-virus, social-life events)• Not associated with factors deemed non risksGender Concurrent associations• Symptoms as predictedBleuler’s 4 AsFirst rank symptoms• Neurophysiological signsEnlarged ventricles Prognostic • Responds to predicted treatments• Course episodic, related to premorbid functioningPsychological Assessment Techniques employed to:• Describe client’s problem• Determine causes of problemPsyc 380 1st Edition• 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 categoriesAssessment 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 somethingPsychological Tests Personality Tests• Self-reported Personality InventoriesMinnesota Multiphasic Personality Inventory (MMPI)Yields profile of psychological functioningSpecific subscales to detect lying and faking “good” or “bad”• Projective TestsRorshach Inkblot Test and Thematic Apperception Test (TAT)Projective hypothesisResponses to ambiguous stimuli reflect unconscious processesBehavioral 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 codingCognitive-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 behaviore.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 itDesirable behaviors tend to increase whereas undesirable behaviors decreaseReactivity Reactivity• The act of observing one’s behavior may alter itDesirable behaviors tend to increase whereas undesirable behaviors decreaseNeurobiological Assessment: Brain Imaging Computerized Axial Tomography (CT or CAT scan)• Reveals structural abnormalities by detecting differences in tissue densitye.g., enlarged ventricles  Magnetic Resonance Imaging (MRI)• Similar to CT but higher quality• fMRI (functional MRI)Images reveal function as well as structureMeasures blood flow in the brain (BOLD=blood oxygenation level dependent) Positron Emission Tomography (PET scan)• Brain functionNeurobiological 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 studiesNeurobiological 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 batteryTactile Performance Test-TimeTactile Performance Test-Memory Speech Sounds Perception Test• Luria-Nebraska batteryAssesses 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 scalpCultural 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 translationMeaning may be lost  Cultural bias can lead to minimizing or exaggerating psychological


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