Lecture 3: Chapter 3: Diagnosis and Assessment

Question 1

What are 4 benefits and 6 disadvantages of a diagnosis?

Answer 1

+:
1. Can offer financial means and support
2. Explanation of symptoms and treatment is possible
3. Common language
4. Clarity: who do we help

-:
1. Label someone/stigma
2. Medicalizing problems
3. Time and culture dependent
4. Overdiagnosis
5. Heterogeneïty
6. Reïfication: turns label into a big thing so it gets explanatory value

Question 2

Why do clinicians need diagnoses?

Answer 2

To be able to communicate accurately with fellow clinicians and to be able to provide the right treatment

Question 3

What are the 4 types of reliability?

Answer 3

1. Interrater: 2 independent observers can come to the same conclusion
2. Test-retest: if doing test again give similar result
3. Internal consistency: whether items of a test are related to each other
4. Alternate form: the extent to which scores on two forms of the test are consistent

Question 4

What are 3 types of validity?

Answer 4

1. Construct: related to underlying constructs that can’t be measured directly (score high on depression test when depressive)
2. Criterion: if test scores correlate with scores on other tests testing the same dimension
3. Content: if a measurement reflects the content of what it wants to measure

Question 5

What does DSM stand for?

Answer 5

Diagnostic and Statistical Manual of Mental disorders

Question 6

What information does the DSM provide? (4)

Answer 6

1. Information and specific diagnostic criteria for each disorder
2. Diagnostic features and associated features (age of onset, course, prevalence, risk etc.)
3. Info on ways culture can shape symptoms and expression of a disorder
4. Ethnic and cultural considerations in diagnoses (cultural-related issues and cultural formulation)

Question 7

The diagnoses in the DSM are based on…

Answer 7

Symptoms (not causes)

Question 8

What are 4 points of criticism on the DSM?

Answer 8

1. Too many diagnoses which lead to comorbidity
2. Categorical classification rather than a dimensional diagnostic system
3. Reliability is still not ideal in practice
4. Question of validity of the diagnoses: do they make actual predictions on impairment and course of disorders

Question 9

Why is categorical classification of the DSM a problem?

Answer 9

1. Black-white image: someone who doesn’t meet criteria can still suffer
2. Leads to threshold definitions and the idea that disorders have actual boundaries

Question 10

What is a dimensional diagnostic system?

Answer 10

A system that describes the degree to which an entity is present

So not the DSM!

Question 11

What is the general criticism against diagnosing?

Answer 11

Fear of stigmatizing effect and losing sight of the actual person behind the diagnosis

Question 12

What are 3 additions in the DSM-5 that increases attention to cultural and ethnic variations in psychopathology?

Answer 12

1. Culture related issues are discussed in the test for almost all disorders
2. Cultural formulation interview provides questions clinicians can use to help understand how culture may be shaping clinical presentation
3. Appendix describes syndromes that appear in particular cultures

Question 13

What is Dhat syndrome?

Answer 13

Term used in India to refer to severe anxiety about discharge of semen

Question 14

What is Shenjing shuairuo?

Answer 14

Chinese diagnose, characterized by weakness, fatigue, negative emotions and sleep problems. Often concerns about work or family stressors, loss of face or failure

Question 15

What is Taijin Kyofusho?

Answer 15

Interpersonal fear disorder, mainly in Japan. The fear that one could offend others through inappropriate eye contact, blushing or body odor

Question 16

What is Kyal cap?

Answer 16

A syndrom in south-east Asian countries. Symptoms overlap with panic attacks, accompanied by the belief that kyal (wind) is rising in the body and may cause serious harm

Question 17

What is ataque de nervios?

Answer 17

Intense anxiety, anger, fear or grief and verbal or physical aggression. In Latino cultures, often preceded by acute life stressor

Question 18

What is ghost sickness?

Answer 18

Nativa Americans: extreme preoccupation with death and those who have died

Question 19

What is Hikikomori?

Answer 19

Syndrom in Japan, Taiwan and South Korea. A person shows profound withdrawal from school, work, family etc. Most typically shuts himself in his bedroom for 6 months

Question 20

How many diagnoses are in the DSM and how often is there comorbidity?

Answer 20

Over 300 diagnoses
Comorbidity: 45% of people with diagnosis meet criteria for other diagnosis

Question 21

What are 2 different approaches to eventually developing improved diagnostic systems?

Answer 21

1. HiTOP model: Hierarchical Taxonomy of Psychopathology
2. RDoC: research domain criteria

Question 22

What is the HiTOP (hierarchical taxonomy of psychology) model? Give an example of a higher order dimension

Answer 22

Focuses on how symptoms and syndromes cooccur using scientific data

Syndromes that often cooccur are assembled into subfactors which are assembled into higher-order dimensions

E.g. externalizing disorders (substance use disorder etc.) and internalizing (depression, PTSD etc)

Question 23

What does it mean that diagnoses are heterogenerous?

Answer 23

Two persons with the same diagnosis can each be very different and meet different criteria of the diagnosis

Question 24

What is the research domain criteria (RDoC) method?

Answer 24

Focuses on risk variables that are relevant for different conditions, including psychological, neuro-imaging and genetic dimensions of risk rather than just clinical symptoms

Question 25

What are 3 reasons why some think the DSM should combine diagnoses?

Answer 25

1. High comorbidity
2. Many different diagnoses are related to same causes
3. Symptoms of many diagnoses respond to the same treatments

Question 26

What are 4 broad types of characteristics that a valid diagnosis should help predict?

Answer 26

1. Etiology
2. Course
3. Social functioning
4. Treatment

Question 27

What is the difference between HiTOP and RDoC?

Answer 27

HiTOP: focus on overlap in syndromes
RDoC: focus on risk variables

Question 28

What is case formulation?

Answer 28

Make a theory and hypothesis about one specific patient. It’s used to make it more personal

Question 29

What are 3 aspects of a good diagnosis?

Answer 29

1. Classification
2. Client specific case formulation
3. Integration of client’s perspective