CPch.3 - Diagnostics & Assessment

Question 1

Reliability - Validity

Question 2

What is Reliability and it’s four types?

Answer 2

The consistency between measures
- Interrater reliability
- Test-retest reliability
- alternate-form reliability
- internal consistency reliability

Question 3

Interrater reliability

Answer 3

Two different observers agree on what they see

Question 4

Test-Retest Reliability

Answer 4

If you make someone take the same test twice (with a time gap between the first and second), the person will obtain the same scores

Question 5

Alternate-form Reliability

Answer 5

(In tests that have multiple forms), when scores on two different types of the same test are consistent (nearly the same)

Question 6

Internal Consistency Reliability

Answer 6

When items on a test are correlated to each other (how well a test/survey measures what you actually want to measure)

Question 7

What is Validity and it’s three types?

Answer 7

If a measure measures what it’s supposed to measure
- Criterion Validity
- Content Validity
- Construct Validity

Question 8

Criterion Validity

Answer 8

If scores on two different tests that measure the same variable are consistent
(e.g. somebody with depression: if BDI and PHQ [depression inventories] have criterion validity, then the person’s scores on the two tests will correlate/be similar)

Question 9

Content Validity

Answer 9

If a measure represents all facets/aspects of the measured construct
(e.g. measure anxiety, take into consideration social, panic, agoraphobia etc.)

Question 10

Construct Validity

Answer 10

When the measure measures the abstract construct of interest (if operationalization of construct is good or not)

Question 11

Diagnosis

Question 12

What is the reason for Diagnosis?

Answer 12

If you can’t diagnose what disorder a person suffers from, how can you determine what treatment to administer?

Question 13

What should a valid Diagnosis entail?

Answer 13

• information about related clinical characteristics and functional impairment (personal level or social level) !!! distress must be present for there to be a diagnosis !!!
• Information about course of disorder and response to different treatments
• Information about Etiology of Disorder: Possible causes of disorder
  !!! In general: STRONG CONSTRUCT VALIDITY -> Predict broad range of characteristics !!!

Question 14

What should a good Diagnosis include?

Answer 14

• Classification
• Dimensional Data
• Conceptualization of a client specific case
• The personal perspective of the clinician

Question 15

What is Classification?

Answer 15

Grouping mental disorders on the basis of their characteristics or symptoms

Question 16

What are some ways to gather info in order to make a classification?

Answer 16

• Interviews
• Hetero-amnesia (others memories of us, how we behave, events we were part of)
• Medical or previous clinical file
• Questionnaire

Question 17

What factors does classifying somebody as having a certain disorder influence?

Answer 17

• Self image of person
• Others perspective of the person
• Problem definition
• What treatment the person receives
• If and what insurance the person receives

Question 18

What are the two types of classifications?

Answer 18

• Categorical Classification
• Dimensional Classification

Question 19

Categorical Classification

Answer 19

Does somebody have a certain disorder? -> Yes or No answer
- For there to be a diagnosis, there must be specific symptoms and a specific number of them for diagnosis to be made

Question 20

What is a problem with Categorical Classification?

Answer 20

It creates a false impression that disorders have actual, specific boundaries

Question 21

Dimensional Classification system

Answer 21

Degree to which a symptom is present
- Describes threshold, all the way to severe symptoms

Question 22

Which classification type does the DSM-5 use?

Answer 22

Categorical Classification
- Work on personality disorders recommended the addition of a dimensional system
-> Rejected: Nowadays a few dimensions are included as a side-tool for the still-existing categories of disorders

Question 23

What are the positives of Classifications?

Answer 23

+ Common language
+ Clarity on whom to help
+ Make research easier
+ Make it easier to find literature
+ Grouping people into disorders or disorder types make the progress of treatment research easier

Question 24

What are the negatives of Classifications?

Answer 24

• Stigma
• Overdiagnosis (inflation of problem, even diagnose a problem when there isn’t one)
• Medicalizing problems
• Time/culture dependent
• Reification: Treating something abstract as if it was something concrete: VERY DIFFICULT (disorder (abstract) through DSM-5 (concrete) or Diagnosis (concrete))
• heterogeneity
• Don’t specify causes for disorders

Question 25

What are some examples of Dimensional Models?

Answer 25

- NEO-PI (Big 5) - Syndrome Scales (BDI, PDSS [Panic Disorder Severity Scale) - on DSM-5: Personality Disorder

Question 26

What conceptualizing a client specific case, what factors must a clinician take into account?

Answer 26

- Predisposing Factors - Inducing Factors (factors that trigger the observed problem) - Maintaining Factors - Problems - Indication - Personal Context Environment

Question 27

What are some ethnic & cultural considerations when it comes to diagnosing psychological disorders?

Answer 27

- Culture determines risk factors for psychological disorders (e.g. Mexicans in U.S. -> 2x more likely for substance use disorders than white Americans) - Culture determines the types of symptoms experienced - Culture determines stigma (e.g. Nigerians -> 2x more likely than Americans to develop schizophrenia, nonetheless these people with schizophrenia remain more engaged in society and in key roles, because of a lot less stigma)

Question 28

What are the two conflicting arguments when it comes to culture/ethnicity and psychological disorders?

Answer 28

- Some say: We should identify broad, CULTURAL-FREE syndromes. (There are specific, universal ways of expressing distress) - Others: believe in importance of culture-specific symptoms ~ Local beliefs shape cultural concepts of distress. Understanding how these local beliefs shape distress is important in understanding and treating disorders

Question 29

How does migration affect if and what psychological disorders people develop?

Answer 29

Migration increases likelihood for psychological disorders, because of increased stress, life-threatening events, and fear that comes about from uncertainty: - 1st generation migrated people: T-RD (treatment-resistant depression), PTSD, anxiety disorders, depression - 2nd generation migrated people: greater risk for psychotic disorders (schizophrenia)

Question 30

How does the DSM-5 take culture and ethnicity into account when making a diagnosis?

Answer 30

- Culture-related issues are taken into account for all disorders (clinicians don't diagnose symptoms unless they're atypical and problematic in a person's culture). - 16 questions for clinicians -> How culture may shape the clinical presentation of symptoms. - Appendix: specific symptoms in specific cultures (& cultural) explanations for symptoms

Question 31

Some general (few) notes on DSM-5

Question 32

What are some criticisms of the DSM-5?

Answer 32

- Reduced threshold for Diagnoses (for there to be a diagnosis of a specific disorder: fewer months, fewer symptoms, less severe etc.) -> This leads to many diagnoses of psychological disorders, even when some behaviors might not be a disorder ('Everything is a problem") - Too many minute distinctions/Too many distinctions based on small differences in symptoms -> Result: a lot of comorbidity (If disorders have 50 instead of 5 symptoms, it's more likely that these symptoms will overlap -> more difficult to make the correct diagnosis)

Question 33

What is Lumping and Splitting, and what are their differences?

Answer 33

- Lumping is when we emphasize on the similarities and ignore the differences (search for universal truths and combine categories - one of the above criticisms of the DSM-5) - Splitting is when we emphasize on the differences

Question 34

What are some arguments in favor of the Lumping?

Answer 34

- Many risk factors relate to many psychological disorders -> Many treatments are helpful for many disorders (put disorders in the same category so that we can administer treatment more surely and efficiently to patients) e.g. Anxiety, mood Disorders overlap in genetic risks (& other risk factors as well) Prozac helps in both diagnoses - General psychopathology factor ("p"): Maybe some risk factors are related to all psychological disorders (not just some risk factors to some disorders)

Question 35

What is the Reliability of the DSM-5?

Answer 35

- Before DSM-III -> reliability was poor. - Today's DSM -> ~ still needs work as well, but is it possible to achieve the desired reliability? (expecting high reliability might be unrealistic) ~ Reliability of DSM criteria in everyday language vs research studies is lower, because of: ` personal biases and judgements (for mania, there must be an "abnormally" elevated mood: what is abnormally?) ` we must take culture into consideration

Question 36

What are 2 models for Diagnostic Systems?

Answer 36

- HiTOP Model (Hierarchical Taxonomy of Psychopathology) -> specifies how symptoms/syndromes co-occur !!! SEE IMAGE !!! - Research Domain Criteria (RDoC) -> focuses only on risk variables that are relevant for may different conditions

Question 37

What are some criticisms of diagnosing Psychological Disorders?

Answer 37

- We view disorders negatively: Diagnosis can lead to stigma from others - When a diagnostic category is applied, we lose sight of uniqueness of that person (don't use adjectives [schizophrenic], but "person with schizophrenia) - Assessment costs valuable time - Client isn't helped during diagnostic phase