Week 3 - Diagnosis and Assessment

Question 1

Multidimensional model

Answer 1

Biological influences - genes, NTs, hormones
Behavioural influences - conditioning, learning
Emotional/cognitive influences - fight/flight, implicit memory
Social influences - culture, gender
Developmental influences - prenatal, childhood, adulthood

Question 2

Tripartite model of emotions

Answer 2

Physiology - how body reacts
Cognitive - thinking alongside emotion
Behavioural - what you do

These three do not always align

Question 3

Equifinality

Answer 3

Several paths to one outcome

Question 4

Cause vs maintenance

Answer 4

Cause does not explain why a problem persists.
Typically more important to know maintaining factors for treatment

Question 5

Historical overview - diagnosis

Answer 5

Major approaches - APA’s DSM, WHO’s ICD
DSM - used by Americans, regularly used for research
ICD - used by everyone else (70% psychiatrists in daily work, 1% in US, 15% in Aus)

Question 6

International Classification of Diseases (ICD)

Answer 6

1853 - Farr and d’Espine develop standardised death causes
1893 - International List of Causes of Death
1922 - Illnesses integrated
1948 - WHO founded and ICD-6 published with section on psychiatric disorders
Current - ICD-11 (DSM-5 overlap)

Question 7

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Answer 7

1840 - US began classifying mental disorders
1923 (statistical manual for mental diseased for hospitals) and 1945 (Medical 203) form foundations for DSM-I
1952 - DSM-I
DSM-II and ICD-8 - joint effort
1980 - DSM-III (symptoms and thresholds, rise of medical model, insurance involved, SCIDs developed)
1994 - DSM-IV (joint effort with WHO, disorders proliferated)
2013 - DSM-5 (not huge changes, research not advanced enough on genetics and biomarkers, board didn’t trust dimensional approach

Question 8

DSM evolution

Answer 8

106 diagnoses in DSM-1
298 diagnoses in DSM-5
Unclear whether more people being diagnosed or same amount being diagnosed in different ways

Question 9

ICD vs DSM

Answer 9

ICD - world agenda, underfunded
DSM - American agenda, lots of money
Multiple voices in one book with agendas and biases
No independent diagnoses tests, must use clinical judgement

Question 10

Classification (Nosology)

Answer 10

Groups of symptoms that hang together
Zone of rarity - clear boundaries between symptom groupings (not always completely clear however)
Diagnosing can be uncertain and arbitrary

Question 11

Diagnosing psychological disorders

Answer 11

Hierarchical and categorical.
Using DSM or ICD identifies client symptoms and allows for treatment plans and information searching.
Categorical vs dimensional
Nomothetic vs idiographic
Differential diagnosis required to rule out other possibilities

Question 12

Reification

Answer 12

Equating individual with their symptoms.
Labelling encourages reification

Question 13

Why use DSM?

Answer 13

Pros - improved care, improved study, improved communication, helps advocation
Cons - heterogenous disorders, comorbidity, culturally limited, atheoretical, reification, stigma, lack of validity, medicalisation of normality

Question 14

Basic features of psychological disorder

Answer 14

Clinically significant difficulties
Dysfunction in processes
Personal distress
Not culturally expected
Not the result of social deviance

Question 15

A valid diagnosis

Answer 15

Clinical description (what it looks like)
Lab research accompanying disorder
Natural history (acute/chronic)
Family studies

Question 16

Clinical assessment

Answer 16

Systematic evaluation (biopsychosocial)
Diagnosis - fit between symptoms and diagnostic criteria
Purpose - understanding, predicting, treatment, outcome, evaluation
Depends on - reliability, validity, standardisation

Question 17

Clinical interview

Answer 17

Assesses - presenting problem, current/past behaviour, detailed history, attitudes, emotions
Structured or semi-structured (ADIS-5, SCID5)

Question 18

Mental status exam

Answer 18

Appearance/behaviour, thought processes, mood, intellectual functioning, sensorium

Question 19

Physical exam

Answer 19

Helpful to rule out aetiologies (toxicity, medication, allergic reactions, metabolic conditions)

Question 20

Behavioural/functional assessment

Answer 20

Identify/observe target behaviours
ABCs - antecedent, behaviours, consequences
Assessment (observing) vs analysis (manipulation of A or C to see results)
Self-monitoring - simply monitoring behaviour can be enough to change it (reactivity)

Question 21

Psychological assessment

Answer 21

Standardised tools to assess cognition, emotion, behaviour
E.g. projective tests, objective tests (intelligence, neuropsychological, neuroimaging, physiological assessment)

Question 22

Case formulation

Answer 22

Hypotheses about cause and maintenance
Learn about antecedents to mechanisms
Understand how environment may influence treatment
Select best intervention and monitor outcomes