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Clinical Diagnosis

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Incomprehensibility. Rarity. Observer discomfort. Violate social standards. 5 ... Observer expectancy bias - Langer and Abelson 1974. Source credibility bias ... – PowerPoint PPT presentation

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Title: Clinical Diagnosis


1
Clinical Diagnosis
  • Assessment
  • DSMIV

2
Central Issues in Diagnosis
  • Description
  • Distinguish between normality and abnormality
  • Explanation
  • Etiology theory of cause
  • Prognosis future course
  • Intervention

3
What Defines Abnormality?
  • Distress
  • Disability
  • Impaired ability to function in personal or
    social roles

4
What Defines Abnormality?
  • Deviance
  • Incomprehensibility
  • Rarity
  • Observer discomfort
  • Violate social standards

5
What Defines Abnormality?
  • Abnormality - Normality Continuum
  • Consider Context
  • Consider Duration

6
Why Assign a Psychological Diagnosis?
7
Benefits of Diagnosis
  • Diagnostic system facilitates
  • Professional communication
  • Study of causes (etiology)
  • Study of future course (prognosis)
  • Development of interventions

8
Problems with Diagnosis
  • Societal misuse
  • Labeling/stigma
  • Primary labeling
  • Secondary labeling

9
Problems with Diagnosis
  • Diagnostic bias
  • Context bias - Rosenhan 1973
  • Observer expectancy bias - Langer and Abelson
    1974
  • Source credibility bias - Temerlin 1970

10
Temerlin 1970 Source Credibility Bias
11
Diagnostic and Statistical Manual of Mental
Disorders
  • 1952
  • 1968
  • 1980
  • 1987
  • 1994 - DSM-IV

12
Strengths of DSM-IV
  • Clearly specifies symptoms
  • Atheoretical
  • Increased precision

13
Strengths of DSM-IV
  • Multiaxial
  • Axis I - Clinical Syndromes
  • Axis II - Personality Disorders and Mental
    Retardation
  • Axis III - Relevant Physical Disorders

14
Strengths of DSM-IV
  • Axis IV - Psychosocial and Environmental Problems
  • Axis V - Global Assessment of Functioning

15
Strengths of DSM-IV
  • Improved reliability
  • Improved predictive validity

16
Limitations of DSM-IV
  • Reliability, Validity limitations
  • Description, not explanation
  • Individual focus
  • Labeling/stigmatization

17
Psychological Assessment
18
Purposes of Psychological Assessment
  • Make diagnosis
  • Increase understanding
  • Plan intervention
  • Gauge improvement

19
Criteria for a Good Psychological Assessment
  • Reliability Consistency
  • Test-retest reliability
  • Inter-judge reliability
  • Validity Utility for particular purpose
  • Predictive validity

20
Types of Assessment
  • Direct observation
  • Interview
  • Psychological Testing
  • Objective tests
  • Minnesota Multiphasic Personality Inventory

21
Types of Assessment
  • Projective tests
  • Rorschach Psychodiagnostic Inkblot Test
  • Intelligence tests
  • Neuropsychological tests
  • Physical tests

22
Methods for Studying Abnormality
23
Design Considerations
  • Internal validity
  • Only one plausible cause for effects observed
  • External validity
  • generalizable to other samples and settings

24
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

25
Methods
  • Controlled experimental research
  • Manipulate independent variable - random
    assignment
  • Measure dependent variable

26
Ethical Issues - History
  • World War II
  • Tuskegee
  • Willowbrook
  • Examples from Psychology?

27
Ethical Principles
  • Autonomy
  • Beneficence
  • Nonmaleficence
  • Justice
  • Fidelity

28
Ethical Safeguards
  • Risk/benefit assessment
  • Institutional Review Board
  • Informed consent
  • Provide treatment resources

29
Historical Perspectives on Psychological Disorder
  • Shifting Societal and Scientific Views Influence
  • Understanding of abnormality
  • Treatment of abnormality

30
Perceived Causes of Abnormality
  • Trephining
  • Squier - amulet
  • Broca - bone regeneration
  • allow escape of evil spirits
  • Importance of Empiricism - Scientific Study

31
Supernatural/Spiritual Causes of Abnormality
  • Trephining
  • Middle Ages 500 - 1500 AD
  • Possession by demons
  • Deliberate pact with Satan
  • Malleus Maleficarum (1486)
  • The Witches Hammer

32
Supernatural/Spiritual Causes of Abnormality
  • Modern Day
  • Anorexia is Gods Punishment

33
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

34
Biological Causes of Abnormality
  • Chinese Medicine
  • Imbalance of Yin/Yang

35
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

36
Biological Causes of Abnormality
  • Medical Model in the 1900s
  • electroconvulsive therapy
  • prefrontal lobotomy
  • medications

37
Biological Causes of Abnormality
  • Advantages of the Medical Model
  • Well-defined Method
  • Symptoms -gt Syndrome -gt Etiology -gt Treatment
  • Psychologically Disordered Individuals Are Sick

38
Biological Causes of Abnormality
  • Disadvantages of the Medical Model
  • Consequences of Sick Label
  • Does All Abnormality Brain Pathology?

39
Perceived Causes of Abnormality
  • Supernatural/Spiritual Causes
  • Biological Causes
  • Psychological Causes

40
Psychological Causes of Abnormality
  • Johann Weyer - 1563
  • The Deception of Demons
  • Treatment of Hysteria
  • Anton Mesmer (1734-1815)
  • animal magnetism
  • cure through imagination

41
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

42
Psychological Causes of Abnormality
  • Behaviorism
  • Observable behavior and learning history
  • Classical Conditioning
  • John B. Watson - 1913
  • Operant Conditioning
  • B.F. Skinner - 1953

43
History of Treatment
  • Monasteries and prisons pre-1500s
  • Asylums - 1500-1800
  • St. Mary of Bethlehem
  • La Bicêtre

44
History of Treatment
  • Moral Treatment - 1800s
  • Pinel, Rush, Dix
  • Mental Hospitals - 1900s
  • Deinstitutionalization - 1950s

45
Impetus for Deinstitutionalization
  • Overcrowded hospitals
  • Combat stress mental illness focus on
    early treatment, prevention

46
Impetus for Deinstitutionalization
  • Tranquilizing medications
  • Civil liberties
  • Community Mental Health Centers Act of 1963

47
Consequences of Deinstitutionalization
  • Increase independent living
  • Create revolving door
  • Create mentally ill homeless

48
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