Lecture 2-Diagnoses and treatment Flashcards
What is abnormal behaviour?
Normative approach
Does it conform to societal standards, expectations and norms?
BUT whose ‘norms’ are they?
Subjective interpretation
Self-judgement if own behaviour is abnormal/needs change
Behaviour may not be culturally ‘abnormal’
Clinical judgements
Expert judges what behaviour is ‘abnormal’
Degree of interference on life, work, relationships
Does not rely on societal norms or individual self-assessment
But individual may not see the behaviour as ‘abnormal’
what do psychologists deal with?
Clinical psychologists may deal with whole series of ‘problems’
But may not represent identifiable clinical disorder
Relationship problems
Personal difficulties
Achievement problems
Physical problems
Distressing life events
But these experiences may lead to clinical disorder
Or may be part of the symptoms that are treated
And abnormal behaviour may reflect adaptation across time
what are the processes involved in psychological problems
Emotions
Negative emotion present in most psychological disorders
Perhaps none more so than depressive and anxiety disorders
Emotional regulation
Ability to control experience/expression of negative emotion
Reduced emotion expression also important
Blunted/flat affect in psychosis
Lack of empathy, remorse, or guilt in several conditions
Cognition
Thought, intellectual functioning, information processing…
Bizarre thought and delusions in psychosis
Negative schema towards world, self, and future in depression
Rumination in OCD (dealing with intrusive thoughts)
Perception
Similar to cognitive processes
Hallucinations in psychosis
Attention biases in anxiety disorders
Interpersonal problems Relationships with others key good psychological functioning Intimate relationships Friendships Social support networks Family Colleagues
Relationship with self
Self-esteem, self-regard, self-criticism in mood disorders
Grandiose thought in psychosis
Coping styles
How people can deal with life’s demands
Effectiveness focuses on adaptive and maladaptive styles
Development
Dealing with developmental milestones throughout life
Childhood, adolescence, marriage, parenthood…
How past experience affects current behaviour
Early relationships, learning history, identity…
Environment
Exploring the context is crucial
May cause or maintain current problems
But can also provide the setting for treatment
how are psychological disorders classified?
International Classification of Diseases (ICD-10)
International Classification of Diseases (ICD-10)
Developed by World Health Organisation (WHO)
Broad classification of diseases and causes of death
Most widely used of all systems (Sorensen, et al. 2005)
Chapter V: ‘Classification of Mental and Behavioural Disorders’
Describes clinical features (and associated factors)
Suggests number of symptoms needed for ‘confident’ diagnosis
Provision for ‘tentative’ diagnoses
ICD-10 used in 42 countries
Mental and Behavioural Disorders categories:
Organic, including symptomatic, mental disorders
Mental and behavioural disorders due to psychoactive substance use
Schizophrenia, schizotypal and delusional disorders
Mood (affective) disorders
Neurotic, stress-related and somatoform disorders
Behavioural syndromes associated with physiological disturbances and physical factors
Disorders of adult personality and behaviour
Mental retardation
Disorders of psychological development
Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
how are psychological disorders classified?
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Developed by American Psychiatric Association (APA)
Specifically designed for diagnosis of psychological disorders
DSM-I published in 1952
Extended and revised several times… (e.g. DSM-IV 1994)
Text revisions 2000 DSM-IV-TR
Some books (and many published articles) still focus on this
DSM-5 published May 2013
DSM-IV-TR had five ‘axes’ (elements) Axis I: Clinical disorders Major mental disorders Depression, anxiety, psychosis… Learning disorders Autism, etc Substance Use Disorders Axis II: Personality disorders and intellectual disabilities e.g. avoidant personality disorder Includes mental retardation (very low IQ)
what are the DSM-IV-TR 5 axes?
Axis III: Acute medical conditions and physical disorders
Includes neurological disorders
Any associated medical condition – such as diabetes
Axis IV: Psychosocial and environmental factors contributing to the disorder
Such as recent stressors
Axis V: Global Assessment of Functioning
Identifies patient’s level of function
Scale of 0-100 (100 = top-level functioning)
what’s new about the DSM5?
First major change – the axes have gone
APA argue that this “removes artificial distinctions”
Now three sections:
Section I (DSM-5 Basics)
How to use the manual
Section II (Disorders)
Diagnostic criteria and codes
ALL of the ‘mental disorders’ are here now
Many changes to diagnostic criteria
Section III (Emerging measures and models)
Self-assessment tools
Areas needing more research e.g. ‘dimensions’ for personality disorders
Limitations of the DSM5
Despite changes, DSM-5 is still ‘categorical’
Except for those proposed dimensional changes to PD
Diagnostic classification open to much criticism
Validity and reliability
Superficial symptoms
Dividing lines vs. continuum
Cultural bias
Focus on medical model
what is psychological testing/interviews?
Administering, scoring, and interpreting psychological tests
Tests provide the information
Patient’s issues, problems, concerns, limitations
Some investigate whole spectrum of psychological disorder
To explore or confirm clinical diagnoses
Often via are structured interviews
Mini International Neuropsychiatric Interview (MINI)
Structured Clinical Interview for Diagnosis (SCID)
Others explore specific conditions
Often via a battery of self-complete tests and interviews
Wechsler Intelligence Test (Wechsler, 1997)
Minnesota Multiphasic Personality Inventory 2 (MMPI-2; Butcher, 1990)
Child Behavior Checklist (CBCL; Archenbach & Edelbrock, 1992)
what is psychological assessment?
A more thorough expert examination by clinical psychologist
Draws on much wider information
what is the Mini International Neuropsychiatric Interview (MINI)?
Structured interview
what is assessed through a mental state examination?
Appearance Behaviour Orientation and awareness Memory Psychomotor activity Affect and mood Personality Thought content and processes Intellect Insight
Most of this based on clinical observation
why is Illness severity rating helpful?
Once condition is diagnosed, often useful to measure severity
Examples
Hamilton Rating Scale for Depression (Hamilton, 1960)
State-Trait Anxiety Inventory (Spielberger, et al. 1970)
Liebowitz Social Anxiety Scale (Liebowitz, 1987)
Positive and Negative Symptoms Scale (Kay, et al. 1987)
Yale-Brown Obsessive-Compulsive Scale (Wayne, et al. 1989)
Panic and Agoraphobia Scale (Bandelow, 1995)
And many, many more…
But, once diagnosis and severity established the looking at treatment options is then the next step
what are the treatment and therapy options
Medication
Can only be prescribed by medically qualified personnel
Such as GPs and psychiatrists
Treat symptoms, but not cure
Antidepressants, antipsychotics, mood stabilisers, tranquilisers, sleeping pills, etc
Can be very effective
Enable patient to function, regain insight, more receptive to talking therapies
But most have side effects
Can make people ‘feel worse’
Potential dependency and addiction
Psychological interventions Often with clinical psychologist But could be any trained and certified professional Counselling Psychotherapy Behavioural therapy Cognitive therapy and CBT Mindfulness-based therapies Group therapy Relationship or family therapy Psycho-education Rehabilitation
Complementary therapies Hypnotherapy, massage, acupuncture… See https://www.cnhc.org.uk/ Complementary medication St. John’s wort, kava kava, valerian, etc Effective in milder conditions Often with fewer side effects See Mayers, et al. 2003
who can help with MI?
Non-NHS mental health service providers
Mental health charities, local-government community teams
Charities and other third-sector support groups (many more like this) Mind, Rethink Mental Illness, SANE… Samaritans Localised groups e.g. Dorset Mind
NHS GP and primary care Psychiatrists and secondary/tertiary care Outpatient clinics Community Mental Health Team (CMHT) Community psychiatric nurse (CPN), psychologist, occupational therapist, social worker… Hospital treatment Crisis intervention Retreats
