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Cultural, Social, and

Emotions Interpersonal Factors


 Not to be confused with  Psychopathology can be associated
 Mood- persistent period of emotionality with certain
 Affect- momentary emotional tone that  Cultures
accompanies what we say or do  Haitian Voodoo or Malay “amok”
 Facial expression or body language  Genders
 Emotions can have physical effects  Phobias, Addictions, and Eating Disorders
which is studied in the field of Health  Life stages
Psychology  Different periods of development have
different vulnerabilities

Assessing Psychological
Disorders
Clinical Assessment, Diagnosis,
and Research Methods  Processes that are central to the study of
psychopathology:
 Clinical Assessment- systematic evaluation
and measurement of psychological, biological,
and social factors in a person presenting with
Chapter 3a psychological symptoms
 Diagnosis- process of determining whether
the individual meets the DSM-IV- TR
criteria for a psychological disorder

Key concepts in Assessment Key concepts in Assessment


 The value of assessments is  Validity
 Criterion-
measured by
 Predictive- can predict course and consequence
 Reliability- Consistency  Concurrent or Descriptive- describes pop.
 Test- retest- across time tested
 Convergent- agreement between test and
 Inter-rater- across raters theory
 Validity- Measures what it’s designed to  Standardization- process by which a
 Construct- criteria differs for each category set of standards/norms is established for
 Content- agreement between experts a technique to ensure its consistency
across different measurements
Methods for Acquiring Client
Key concepts in Assessment Information
 One can have high reliability without  Clinical Interview
validity, but not validity without  Mental Status Exam
reliability  Physical Exam
 Behavioral Observation and
Assessment
 Self-report
 Psychological Testing

Acquiring Client Information Acquiring Client Information


 Clinical Interview- Detailed history of  Can be unstructured (PANSS),
the subject’s life and presenting semistructured (SCID), or structured
problem  Important points to cover include
 Gathers information on current and past  precipitating events
 Behaviors  family composition and history
 Relationships
 sexual development
 Events
 religious beliefs and cultural concerns
 Attitudes and Emotions
 educational achievement
 social-interpersonal history.

Areas covered by the Mental


Acquiring Client Information Status Exam
 Mental Status Exam- is a systematic  Appearance and Behavior
observation  Overt Behavior
 MSE is a process of preliminary  Dress
determination about which areas should  Posture and facial expression
be more thoroughly assessed  Motor activity
 Mood and Affect
 Depressed mood
 Inappropriate Affect
 Flat
 Blunted
Areas covered by the Mental Areas covered by the Mental
Status Exam Status Exam
 Intellectual Functioning  Thought Process
 Vocabulary  Speech rate and pattern
 Abstractions  Logical continuity
 Metaphors  Delusions (persecution, grandeur, and/or
 Memory ideas of reference)
 Sensorium  Hallucinations (most commonly auditory)
 Orientation x 3

Assessing Psychological Assessing Psychological


Disorders Disorders
 Physical Exam- Determines the  Behavioral Assessment- Measuring,
presence of medical/biological origins observing, and systematically
of symptoms evaluating the thoughts, feelings, and
behavior in the context of the actual
 Hyperthyroidism- mimics some anxiety
d/o
situation
 Community observation or Role-plays
 Hypothyrodism- mimics depression
 Goal is to identify target behaviors
 Drug induced paranoia or dementia  Usually used for children and non-verbal
 Medicine overdose or side-effect adults
 Brain tumors or other neuropathologies  Backs up self-reports

Assessing Psychological Assessing Psychological


Disorders Disorders
 Observation- Takes into account the  Psychological Tests- Strict standards of
antecedents and consequences of target reliability, validity, and standardization,
behavior NOT like surveys or “personality tests”
 Informal Observation and Formal found on web or magazines
Observation (operational definition of  Projective Tests- Psychoanalytic measures that
behaviors in specific and measurable present ambiguous stimuli to clients with the
terms) assumption that responses will reveal
 Self-Monitoring unconscious conflicts
 Behavior Rating Scales  Low reliability and validity, therefore
 Reactivity- the mere act of observation controversial but sometimes useful
sometimes changes behavior
Rorschach Inkblot Test Thematic Apperception Test

Assessing Psychological Assessing Psychological


Disorders Disorders
 Personality Inventories- Self-report  Intelligence Quotient- Score on an
questionnaires that assess personal intelligence test estimating a person’s
traits by asking respondents to identify deviation from average test scores,
descriptions that apply to them usually valid, reliable, and normed
 WAIS-III and all tests contain
 MMPI (Minnesota Multiphasic Personality
 Verbal Scales
Inventory)  Performance Scales
 Empirical (based on collected and evaluated
 Shipley Institute of Living Scale
data)
 True or False as opposed to a Likert Scale  But IQ tests also measure attention,
perception, memory, reasoning, and
comprehension

Assessing Psychological Assessing Psychological


Disorders Disorders
 Neuropsychological tests are screening  Neuropsychological Tests- Assesses brain
devices which have a high accuracy but and nervous system functioning by
are not immune to testing performance on behavioral tasks
 False positives- Finding disorder when there  Bender Visual-Motor Gestalt Test
is none  Halstead- Reitan Neuropsychological
 False negative- No finding of disorder when Battery
there is one  Rhythm Test
 Strength of Grip Test
 Tactile Performance Test
 BRIEF-A
Assessing Psychological Assessing Psychological
Disorders Disorders
 Neuroimaging- Sophisticated computer-  Psychophysiological Assessment-
aided procedures that allow non- Measurement of changes in the nervous
intrusive exam of nervous system system reflecting emotions or cognitions
structure and function (evoked- potential)
 CAT or CT Scans  EEG- measure electrical activity in the brain
 MRI and fMRI (cortex)
 PET and SPECT  Alpha waves (relaxed and awake)
 Delta waves (deep sleep)

Assessing Psychological
Disorders
Clinical Assessment, Diagnosis,
 Biofeedback treatments and Research Methods
 Meters gauge physiological responses (HR,
BP, etc.) to events which are fed back to
the patient so patient can try to consciously
regulate them
Chapter 3b

Review Review
 Two central processes:  Two central processes :
 Clinical Assessment- Getting information  Diagnosis- Seeing where it fits
 Clinical Interview  Classification
 Mental Status Exam  Classical categorical approach – Clear
 Physical Exam categories
 Dimensional approach- Continuum
 Behavioral Observation and Assessment
 Prototypical approach- Essential 1º
 Informal and Formal Observation & Rating
characteristics and a range of variation on 2º
Scales
characteristics
 Psychological Testing
 Projective, Personality, IQ, &
Neuropsychological
Diagnosing Psychological
Review Disorders
 Value of both assessments and  Diagnosis- identifying a general
diagnosis are determined by class of problems that hang
 Reliability- Consistency together
 Validity- Measuring what it says it’s  Useful for obtaining information about
measuring  Psychological profiles
 Standardization (Norming)- Defining  Etiology
what is “normal” or statistical majority  Treatment
 Prognosis

Diagnosing Psychological Diagnosing Psychological


Disorders Disorders
 DSM-IV-TR  DSM-IV-TR
 Empirically based worldwide nosology for  Multi-Axial System
psychological disorders  Axis I- Clinical disorders
 Social and cultural considerations  Axis II- Personality disorders and MR
 Axis III- Medical conditions
 Axis IV- Psychosocial and environmental
factors
 Axis V- Global Assessment of Functioning;
(GAF goes from 0 to 100)

DSM-IV-TR DSM-IV-TR
 Labeling forces a fuzzy diagnosis into a  Being revised at the moment to
category become a more dimensional
 Might have negative connotations (stigma) classification system
 May be applied erroneously, the person
becomes the disorder
 Points on a continuum rather than
categories
 Usually means more comorbidities
 Sometimes sacrificed validity for  The criticism of that is that if you
reliability remove a classification, diagnosis will
be even harder to make- similar to
the DSM-I
Conducting Research in Conducting Research in
Psychopathology Psychopathology
 It starts with a an observation...  Which leads to question...

Conducting Research in Conducting Research in


Psychopathology Psychopathology
 The hypothesis is the educated guess  But how do you know if your answer
to answer that question... is right and the information is useful?
 Testability- ability to be subjected to
scientific scrutiny
 comes in the form of a research design-
OR
plan of experimentation

Conducting Research in Conducting Research in


Psychopathology Psychopathology
 The research design uses the aspects  The value of the research design is
you want to measure in the people determined by two inverse forms of
you are studying validity
 Independent variable- the factor that is
 manipulated by the experimenter
 expected to influence the dependent variable

Internal Validity External Validity


 Dependent variable- the factor that is
 measured and expected to be influenced
Conducting Research in Conducting Research in
Psychopathology Psychopathology
 Internal validity - extent to which we are  Internal validity is threatened by
confident that the independent variable
confounds
caused the dependent variable to change.
 External validity -how well the findings  Uncontrolled alternative explanations
generalize to people who were not part of that contaminate the result of the study
the research study.  Its effects cannot be separated from
 The more a study applies to its those of the variables being studied
participants, the less generalizable it
is

Three strategies to Ensure Three strategies to Ensure


Internal Validity Internal Validity
 Control group - Similar to the  Randomization - Study participants
experimental subjects in every way, are assured an equal chance of being
but are not exposed to the assigned to any of the groups (and in
independent variable (i.e. treatment turn any of the treatments)
received)  + eliminates systematic differences
 + allows for comparison of differential across groups
effects from treatment

Three strategies to Ensure


Internal Validity Significance of Results
 Analog model - A way of studying a  Statistical significance - small
phenomenon by creating a probability that the research findings
comparable (analogous) environment were found by chance
within the laboratory  Clinical significance - degree of
 + allows for replication under controlled meaningful applications of the finding
conditions to real world problems
 Effect size determines whether a
statistically significant difference is also
clinically significant
Conducting Research in
Psychopathology Types of Research Methods
 A problem with psychopathology  Studying individual cases
research is that individual differences  Case- studies in which a single person or
are often de-emphasized a small group is studied in detail
 The patient uniformity myth- tendency to  Freud
see all participants as one homogeneous  - Does not use scientific method
group hides important difference in  - Does not allow conclusions about cause
individual reactions to interventions and effect because of many confounding
variables
 - Cannot be easily generalized

Types of Research Methods Types of Research Methods


 Research by Correlation  Correlation coefficient indicates the
 Degree to which two variables are strength of the relationship, ranges from
associated +1.00 to -1.00
 Positive Correlation  How closely each point lies in a line
graph

 Negative Correlation

Types of Research Methods Types of Research Methods


 However, correlation does not imply  Epidemiological Research
causation!  Research method that examines
 Just because two things occur together  Prevalence- How many people have the
does not mean one causes the other disorder at one time
 And if one does cause the other,  Incidence- How many new cases during a
directionality is not indicated specific period of time
 Distribution- What percentage of different
groups have the disorder
 Consequence- Personal, social, and
economic impact of the disorder
Types of Research Methods Types of Research Methods
 Research by Experiment  Group experimental designs
 Involves the manipulation of an  Process experiments examine why it
independent variable and the works
observation of its effects of the  Outcome experiments examine whether
dependent variable(s) of interest it works
 Addresses issues of causality
 Can be Group or Single Case
Experiments

Types of Research Methods Types of Research Methods


Outcome experiments are prone to  Participants can be placed in a placebo
placebo effect (Latin: “I shall please”) control group could be given a similar
procedure
 Experimental group has a positive
 Sugar pills instead of actual medicine
expectation because they are getting
treatment  The alternative is comparative treatment
method
 Two or more treatment methods are
compared to see which is more effective

Types of Research Methods Types of Research Methods


There might also an expected Single-case Experiments involves
outcome from the researchers manipulating variables on only one
themselves person
 As a countermeasure the experiment  The individual serves as their own
could have a double-blind control control, by providing a baseline of
 Both the participants and the researcher do function at the start of experiment
not know which treatment is being applied  + Repeated measurement shows
 Degree of variability (day to day change)
 Trend (direction of overall change)
Conducting Research in
Types of Research Methods Psychopathology
 Withdrawal Design
 + Makes sure that treatment is responsible for
change
 - Treatment or its effects can’t always be
removed
 Multiple Baseline design
 Measures baselines of two or more related
behaviors or one behavior in two or more
different contexts
 Intervention after each instance, if treatment
and changes coincide, then it is strong evidence
of effect

Research Across Time Research Across Time


 A cross-sectional study compares Retrospective Information asks
the same characteristic in different people to look back into their own
people at different ages childhoods
 + A disorder can be can be studied in  - Not very accurate
different cohorts (age group) to map the Sequential Designs repeated study
disorder’s progression
of different cohorts over time
 - Developmental stages and experience
will be confounding factors in the study
leading to a cohort effect

Research Across Time Genetics


 Longitudinal Designs study the  Genetic studies are done through
same people across time  Family Studies study the person with
the trait (proband)
 + No cohort effects
 Twin Studies have same environment,
 + Can measure actual progression same genes
 - Expensive and Long-term  Adoption Studies have different
 - Cross-generational effect limits environment, similar genes
generalizability  Genetic linkage analysis and
association studies can locate the site
of the defective gene
Last Words
 The clinical picture, causal factors,
and treatment process and outcome
are culturally influenced
 A strong research design is both
Replicable and Ethical
 Has strict scientific standards
 Involves knowledgeable Consumers
 Informed consent