Title: Clinical Diagnosis
1Clinical Diagnosis
2Central Issues in Diagnosis
- Description
- Distinguish between normality and abnormality
- Explanation
- Etiology theory of cause
- Prognosis future course
- Intervention
3What Defines Abnormality?
- Distress
- Disability
- Impaired ability to function in personal or
social roles
4What Defines Abnormality?
- Deviance
- Incomprehensibility
- Rarity
- Observer discomfort
- Violate social standards
5What Defines Abnormality?
- Abnormality - Normality Continuum
- Consider Context
- Consider Duration
6Why Assign a Psychological Diagnosis?
7Benefits of Diagnosis
- Diagnostic system facilitates
- Professional communication
- Study of causes (etiology)
- Study of future course (prognosis)
- Development of interventions
8Problems with Diagnosis
- Societal misuse
- Labeling/stigma
- Primary labeling
- Secondary labeling
9Problems with Diagnosis
- Diagnostic bias
- Context bias - Rosenhan 1973
- Observer expectancy bias - Langer and Abelson
1974 - Source credibility bias - Temerlin 1970
10Temerlin 1970 Source Credibility Bias
11Diagnostic and Statistical Manual of Mental
Disorders
- 1952
- 1968
- 1980
- 1987
- 1994 - DSM-IV
12Strengths of DSM-IV
- Clearly specifies symptoms
- Atheoretical
- Increased precision
13Strengths of DSM-IV
- Multiaxial
- Axis I - Clinical Syndromes
- Axis II - Personality Disorders and Mental
Retardation - Axis III - Relevant Physical Disorders
14Strengths of DSM-IV
- Axis IV - Psychosocial and Environmental Problems
- Axis V - Global Assessment of Functioning
15Strengths of DSM-IV
- Improved reliability
- Improved predictive validity
16Limitations of DSM-IV
- Reliability, Validity limitations
- Description, not explanation
- Individual focus
- Labeling/stigmatization
17Psychological Assessment
18Purposes of Psychological Assessment
- Make diagnosis
- Increase understanding
- Plan intervention
- Gauge improvement
19Criteria for a Good Psychological Assessment
- Reliability Consistency
- Test-retest reliability
- Inter-judge reliability
- Validity Utility for particular purpose
- Predictive validity
20Types of Assessment
- Direct observation
- Interview
- Psychological Testing
- Objective tests
- Minnesota Multiphasic Personality Inventory
21Types of Assessment
- Projective tests
- Rorschach Psychodiagnostic Inkblot Test
- Intelligence tests
- Neuropsychological tests
- Physical tests
22Methods for Studying Abnormality
23Design Considerations
- Internal validity
- Only one plausible cause for effects observed
- External validity
- generalizable to other samples and settings
24Methods
- Case study
- Correlational research
- two (or more) variables co-occur
- directionality problem
- A -gtB or B -gt A
- third variable problem
- C -gt A and B
25Methods
- Controlled experimental research
- Manipulate independent variable - random
assignment - Measure dependent variable
26Ethical Issues - History
- World War II
- Tuskegee
- Willowbrook
- Examples from Psychology?
27Ethical Principles
- Autonomy
- Beneficence
- Nonmaleficence
- Justice
- Fidelity
28Ethical Safeguards
- Risk/benefit assessment
- Institutional Review Board
- Informed consent
- Provide treatment resources
29Historical Perspectives on Psychological Disorder
- Shifting Societal and Scientific Views Influence
- Understanding of abnormality
- Treatment of abnormality
30Perceived Causes of Abnormality
- Trephining
- Squier - amulet
- Broca - bone regeneration
- allow escape of evil spirits
- Importance of Empiricism - Scientific Study
31Supernatural/Spiritual Causes of Abnormality
- Trephining
- Middle Ages 500 - 1500 AD
- Possession by demons
- Deliberate pact with Satan
- Malleus Maleficarum (1486)
- The Witches Hammer
32Supernatural/Spiritual Causes of Abnormality
- Modern Day
- Anorexia is Gods Punishment
33Biological Causes of Abnormality
- Hippocrates 460-377 BC
- Psych disorderbrain pathology
- Hysteria
- wandering womb
- Mania, Melancholia, Phrenitis
- Imbalance of 4 humours - blood, black bile,
yellow bile, phlegm - Treatment humane
34Biological Causes of Abnormality
- Chinese Medicine
- Imbalance of Yin/Yang
35Biological Causes of Abnormality
- Medical Model in the 19th Century
- Developments in Science
- Pasteur, Darwin
- Kraepelin (1883) disease model classification of
psychological disorders - General paresis
- syphilis
36Biological Causes of Abnormality
- Medical Model in the 1900s
- electroconvulsive therapy
- prefrontal lobotomy
- medications
37Biological Causes of Abnormality
- Advantages of the Medical Model
- Well-defined Method
- Symptoms -gt Syndrome -gt Etiology -gt Treatment
- Psychologically Disordered Individuals Are Sick
38Biological Causes of Abnormality
- Disadvantages of the Medical Model
- Consequences of Sick Label
- Does All Abnormality Brain Pathology?
39Perceived Causes of Abnormality
- Supernatural/Spiritual Causes
- Biological Causes
- Psychological Causes
40Psychological Causes of Abnormality
- Johann Weyer - 1563
- The Deception of Demons
- Treatment of Hysteria
- Anton Mesmer (1734-1815)
- animal magnetism
- cure through imagination
41Psychological Causes of Abnormality
- Jean Charcot (1825 - 1893)
- Neurological -gt Psychological Basis for Hysteria
- Sigmund Freud (1856 - 1939)
- Psychoanalysis
- First Systematic Psychological Theory of
Psychopathology
42Psychological Causes of Abnormality
- Behaviorism
- Observable behavior and learning history
- Classical Conditioning
- John B. Watson - 1913
- Operant Conditioning
- B.F. Skinner - 1953
43History of Treatment
- Monasteries and prisons pre-1500s
- Asylums - 1500-1800
- St. Mary of Bethlehem
- La Bicêtre
44History of Treatment
- Moral Treatment - 1800s
- Pinel, Rush, Dix
- Mental Hospitals - 1900s
- Deinstitutionalization - 1950s
45Impetus for Deinstitutionalization
- Overcrowded hospitals
- Combat stress mental illness focus on
early treatment, prevention
46Impetus for Deinstitutionalization
- Tranquilizing medications
- Civil liberties
- Community Mental Health Centers Act of 1963
47Consequences of Deinstitutionalization
- Increase independent living
- Create revolving door
- Create mentally ill homeless
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