Clinical Diagnosis

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Clinical Diagnosis

• Assessment
• DSMIV

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Central Issues in Diagnosis

• Description
• Distinguish between normality and abnormality
• Explanation
• Etiology theory of cause
• Prognosis future course
• Intervention

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What Defines Abnormality?

• Distress
• Disability
• Impaired ability to function in personal or
  social roles

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What Defines Abnormality?

• Deviance
• Incomprehensibility
• Rarity
• Observer discomfort
• Violate social standards

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What Defines Abnormality?

• Abnormality - Normality Continuum
• Consider Context
• Consider Duration

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Why Assign a Psychological Diagnosis?
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Benefits of Diagnosis

• Diagnostic system facilitates
• Professional communication
• Study of causes (etiology)
• Study of future course (prognosis)
• Development of interventions

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Problems with Diagnosis

• Societal misuse
• Labeling/stigma
• Primary labeling
• Secondary labeling

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Problems with Diagnosis

• Diagnostic bias
• Context bias - Rosenhan 1973
• Observer expectancy bias - Langer and Abelson
  1974
• Source credibility bias - Temerlin 1970

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Temerlin 1970 Source Credibility Bias
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Diagnostic and Statistical Manual of Mental
Disorders

• 1952
• 1968
• 1980
• 1987
• 1994 - DSM-IV

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Strengths of DSM-IV

• Clearly specifies symptoms
• Atheoretical
• Increased precision

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Strengths of DSM-IV

• Multiaxial
• Axis I - Clinical Syndromes
• Axis II - Personality Disorders and Mental
  Retardation
• Axis III - Relevant Physical Disorders

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Strengths of DSM-IV

• Axis IV - Psychosocial and Environmental Problems
• Axis V - Global Assessment of Functioning

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Strengths of DSM-IV

• Improved reliability
• Improved predictive validity

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Limitations of DSM-IV

• Reliability, Validity limitations
• Description, not explanation
• Individual focus
• Labeling/stigmatization

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Psychological Assessment
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Purposes of Psychological Assessment

• Make diagnosis
• Increase understanding
• Plan intervention
• Gauge improvement

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Criteria for a Good Psychological Assessment

• Reliability Consistency
• Test-retest reliability
• Inter-judge reliability
• Validity Utility for particular purpose
• Predictive validity

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Types of Assessment

• Direct observation
• Interview
• Psychological Testing
• Objective tests
• Minnesota Multiphasic Personality Inventory

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Types of Assessment

• Projective tests
• Rorschach Psychodiagnostic Inkblot Test
• Intelligence tests
• Neuropsychological tests
• Physical tests

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Methods for Studying Abnormality
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Design Considerations

• Internal validity
• Only one plausible cause for effects observed
• External validity
• generalizable to other samples and settings

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Methods

• 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

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Methods

• Controlled experimental research
• Manipulate independent variable - random
  assignment
• Measure dependent variable

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Ethical Issues - History

• World War II
• Tuskegee
• Willowbrook
• Examples from Psychology?

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Ethical Principles

• Autonomy
• Beneficence
• Nonmaleficence
• Justice
• Fidelity

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Ethical Safeguards

• Risk/benefit assessment
• Institutional Review Board
• Informed consent
• Provide treatment resources

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Historical Perspectives on Psychological Disorder

• Shifting Societal and Scientific Views Influence
  
• Understanding of abnormality
• Treatment of abnormality

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Perceived Causes of Abnormality

• Trephining
• Squier - amulet
• Broca - bone regeneration
• allow escape of evil spirits
• Importance of Empiricism - Scientific Study

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Supernatural/Spiritual Causes of Abnormality

• Trephining
• Middle Ages 500 - 1500 AD
• Possession by demons
• Deliberate pact with Satan
• Malleus Maleficarum (1486)
• The Witches Hammer

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Supernatural/Spiritual Causes of Abnormality

• Modern Day
• Anorexia is Gods Punishment

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Biological 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

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Biological Causes of Abnormality

• Chinese Medicine
• Imbalance of Yin/Yang

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Biological 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

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Biological Causes of Abnormality

• Medical Model in the 1900s
• electroconvulsive therapy
• prefrontal lobotomy
• medications

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Biological Causes of Abnormality

• Advantages of the Medical Model
• Well-defined Method
• Symptoms -gt Syndrome -gt Etiology -gt Treatment
• Psychologically Disordered Individuals Are Sick

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Biological Causes of Abnormality

• Disadvantages of the Medical Model
• Consequences of Sick Label
• Does All Abnormality Brain Pathology?

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Perceived Causes of Abnormality

• Supernatural/Spiritual Causes
• Biological Causes
• Psychological Causes

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Psychological Causes of Abnormality

• Johann Weyer - 1563
• The Deception of Demons
• Treatment of Hysteria
• Anton Mesmer (1734-1815)
• animal magnetism
• cure through imagination

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Psychological Causes of Abnormality

• Jean Charcot (1825 - 1893)
• Neurological -gt Psychological Basis for Hysteria
• Sigmund Freud (1856 - 1939)
• Psychoanalysis
• First Systematic Psychological Theory of
  Psychopathology

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Psychological Causes of Abnormality

• Behaviorism
• Observable behavior and learning history
• Classical Conditioning
• John B. Watson - 1913
• Operant Conditioning
• B.F. Skinner - 1953

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History of Treatment

• Monasteries and prisons pre-1500s
• Asylums - 1500-1800
• St. Mary of Bethlehem
• La Bicêtre

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History of Treatment

• Moral Treatment - 1800s
• Pinel, Rush, Dix
• Mental Hospitals - 1900s
• Deinstitutionalization - 1950s

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Impetus for Deinstitutionalization

• Overcrowded hospitals
• Combat stress mental illness focus on
  early treatment, prevention

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Impetus for Deinstitutionalization

• Tranquilizing medications
• Civil liberties
• Community Mental Health Centers Act of 1963

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Consequences of Deinstitutionalization

• Increase independent living
• Create revolving door
• Create mentally ill homeless

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