Assessment, Diagnosis and the DSM

Question 1

Objectives in assessment

Answer 1

• Determine a diagnosis
• Conceptualize current problem
• Understand the sociocultural context of the symptoms
• Tailor a treatment strategy

Question 2

What type of questions test your hypothesis during assessment?

Answer 2

• Questions related to suspected diagnosis

- Questions related to alternative and rule-out conditions

Question 3

What sources of info can you use in assessment?

Answer 3

• patient self-report
• spouse/parent/sibling
• clinician’s observations
• formal psych testing
• available medical records
• school/legal/medical records
• internet

Question 4

Assessment techniques

Answer 4

-interviews
-psychological tests (questionnaires, formalized tests)
-behavioral observations
(multiple sources of info are generally preferred)

Question 5

Types of reliability measures

Answer 5

• inter-rater

- test-retest

Question 6

How is reliability measured?

Answer 6

correlation coefficients +1 to -1, .8 or better

Question 7

What is validity?

Answer 7

A measure of the accuracy of a test’s or study’s results; are you measuring what you intend to measure?

Question 8

Types of validity

Answer 8

• construct validity
• content validity
• concurrent/criterion: the degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques.

Question 9

Structured interviews

Answer 9

Mental Stats Exam (MSE)- physician administered
Structured Clinical Interview for DSM-SCID
Clinician administered PTSD Scale- CAPS

Question 10

Semi-structured interviews

Answer 10

Less formal, more guided by clinical judgment

Question 11

Types of self-report questionnaires

Answer 11

Screening tools like BDI
Patient Health Questionnaire
PTSD Checklist
WHO Disability Assessment Schedule
Brief Addiction Monitor

Question 12

What are the downsides to self-report questionnaires?

Answer 12

Bias and misrepresentation from patient because they know what is being measured.

Question 13

Types of personality inventories

Answer 13

Minnesota Multiphasic Personality Inventory
Millon Clinical Multiaxial Inventory (MCMI)
NEO Personality Inventory Revised
Personality Assessment Inventory - 5 factor models

Question 14

What types of projective measures are used in assessment?

Answer 14

Rorshach test
Thematic Apperception Test
Sentence Completion
Draw a person

Question 15

Types of Neuropsychologcial assessments

Answer 15

Wechsler Adult Intelligence Scale, WAIS-IV (and the children’s version, WISC-V)
Repeatable Battery for the Assessment of Neuropsych Status (RBHNS)
Trail Making Test A and B (executive functioning)
Delis-Kaplan Executive Functioning System (D-KEFS)

Question 16

Purpose of neurological assessment

Answer 16

Assess ability to carry out various functions that tap into different structures in brain

Question 17

CAT or CT scan

Answer 17

shows brain structure

Question 18

PET scan

Answer 18

Shows chemical activity

Question 19

fMRI scan

Answer 19

shows detailed neuronal activity by looking at blood flow in the brain

Question 20

What types of things are measured with biofeedback?

Answer 20

Heart rate variability
Galvanic skin response
EMG- muscle tension
Thermal
EEG- used for brain training in autism disorders

Question 21

Idiographic

Answer 21

Focuses on the individual

Question 22

Nomothetic

Answer 22

Understanding general rules and laws; based on research and scientific method

Question 23

How does a good assessment combine both idiographic and nomothetic approaches?

Answer 23

Application of science to the individual
Common language/understanding
Tailors treatment to individual

Question 24

What is a categorical approach to diagnosis?

Answer 24

Each diagnosis is unique with non-overlapping and essential features. (medical model)

Question 25

What is a prototypical approach to diagnosis?

Answer 25

It is a type of categorical approach that is a combination of essential features and minimum number of common features- used since DSM-III

Question 26

What is a dimensional approach to diagnosis?

Answer 26

a rating of how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality and behavior

Question 27

DSM-5 diagnoses

Answer 27

- List disorders, with codes - "provisional" specifier can be used when strong presumption criteria will be met but not enough current info - "rule out" can be used when suspect a potential diagnosis or think there could be enough evidence - other conditions that may be Focus of Clinical Attention

Question 28

What would be included in a "other condition that may be focus of clinical attention"?

Answer 28

Other problems that are not mental disorders but may be the presenting problem. Not meant to be a laundry list but targets for treatment or factors that impact dx or tx.

Question 29

Level 1 DSM 5 assessment measure

Answer 29

Brief screening measures targeted to a variety of problem areas (eg mood, anxiety)- helps identify areas for further inquiry.

Question 30

Level 2 DSM 5 assessment measure

Answer 30

Brief targeted assessment measures on specific problem areas (eg depression anger)

Question 31

Value of diagnostic categories

Answer 31

- Behavioral problems can be grouped into clusters - Aids communication: etiology, course, epidemiology, treatment - Heuristic value by stimulating research - Normalizes problems and provides guidance

Question 32

Logical problems with the DSM

Answer 32

300% increase in diagnostic categories in last 40 years | Categories become reified and used to explain the very behavior they describe

Question 33

Empirical problems with the DSM

Answer 33

Overlap in diagnostic categories and comorbidities | Validity: relationship to treatment is questionable

Question 34

Practical problems with the DSM

Answer 34

Social stigma Pathologizes "problems in living" Diagnostic categories often used to alleviate responsibility for behavior. Diagnostic errors: wrong category, ignores sociocultural context, culture and gender bias, behaviors may be accentuated/ignored to fit category.

Question 35

Using the DSM-5 in diagnosis

Answer 35

- not everyone requires a diagnostic label - clinical significance is critical - be patient and cautious - constantly revisit a diagnosis

Question 36

Criticisms of the validity of DSM

Answer 36

- Have mental illnesses remained the same over time? - Does mental illness look the same across cultures? - Is the DSM applicable to all cultures? - Do we have it right with the idea of mental illness being due to biology?