Chapter 3: Diagnosis and Assessment

I. Cornerstones of Diagnosis and Assessment

II. Classification and Diagnosis
III. Psychological Assessment
IV. Neurobiological Assessment
V. Cultural and Ethnic Diversity and Assessment
1. _________________

2. _________________

3. _________________

4. _________________
Diagnosis

The classification of disorders by symptoms and signs.

Advantages of diagnosis:

Facilitates _________________ among professionals

Advances the search for _______________ and ______________

Cornerstone of clinical care
_________________ of measurement

Inter-rater
Observer agreement

Test-retest
Similarity of scores across repeated test administrations
or observations

Alternate Forms
Similarity of scores on tests that are similar but not
identical

Internal Consistency
Extent to which test items are related to one another
How well does a test measure what it is supposed to
measure?

_________________ validity
Extent to which a measure adequately samples the domain of interest,
e.g., all of the symptoms of a disorder

_________________ validity
Extent to which a measure is associated with another measure (the
criterion)

_________________
Two measures administered at the same point in time

Predic _________________ tive
Ability of the measure to predict another variable measured at some
future point in time
_________________ validity (Cronbach & Meehl,
1955)

A construct is an abstract concept or inferred attribute

Involves correlating multiple indirect measures of the
attribute
e.g., self-report of anxiety correlated with increased HR, shallow
breathing, racing thoughts

Important for validating our theoretical understanding of
psychopathology

Method for evaluating diagnostic categories
Construct validity of highest concern

Diagnoses are constructs
For most disorders, no lab test available to diagnose
with certainty

Strong construct validity predicts wide range of
characteristics
Possible etiological causes (past)
Clinical characteristics (current)
Predict treatment response (future)




_________________ and _________________ Manual of
Mental Disorders (DSM)

published by American ___________________ Association

First edition published in 1952

Current edition: DSM-5
Published in 2013!
Axis IV is replaced by descriptors used by the World
Health Organization (WHO) in the International
Classification of Diseases (ICD)

Axis V is replaced by the World Health Organization
Disability Assessment Schedule (WHODAS)
Full Interviewer Administered Version
http://www.who.int/classifications/icf/WHODAS2.0_36itemsINTER
VIEW.pdf
12-item version, self-administered
http://www.who.int/classifications/icf/WHODAS2.0_12itemsSELF.
pdf
DSM- I 106
DSM-II 182
DSM-III 265
DSM-III-R 292
DSM-IV-TR 297

DSM-5 _______
Cultural ___________________

9 Concepts of Distress
Replaces 25 separate diagnoses

Focus on influence of culture on disorder
presentation

Mental illness ___________________

Culture can influence:
Risk factors
Types of symptoms experienced
Willingness to seek help
Availability of treatments

DSM-IV-TR used a 5-axis system

DSM-5 uses 2 axes
Psychiatric & Medical Diagnoses

Psychosocial and Contextual Factors
Renamed from Psychosocial and Environmental Problems

(Anticipated severity index NOT included)
Names changed to better align with the WHO and
the ICD

___________________ Disability
Replaces Intellectual Developmental Disorder

Somatic Symptom & Related Disorders
Replaces Somatic Symptom Disorder

Substance-Related & Addictive Disorders
Replaces Substance Related Disorders

DSM-IV-TR based on ___________________
classification
If you have minimum number of symptoms, you are
diagnosed with disorder. If one short, you are not.
Little research support for this diagnosable threshold

DSM-5 preserves categorical approach
NOS (Not Otherwise Specified) likely to remain in use for
subthreshold cases

DSM-5 was to add a ________________ Severity Rating
Dimensional system describes degree of severity of disorder,
but relegated to an appendix (still too controversial!!!)
Note DSM-5 almost changed approach from
organizing disorders based on symptoms to organizing
disorders based on etiologies

But we dont know enough about ___________________
yet
Too many diagnoses?
Should relatively common reactions be pathologized?
Comorbidity
Presence of a second diagnosis
45% of people diagnosed with one disorder will meet criteria
for a second disorder
Emphasis on categorical rather than continuous
measurement of symptoms

Reliability in everyday practice
___________________ against mental illness.
Treated differently by others
Difficulty finding a job

Categories do not capture the uniqueness of a
person.
The disorder does not define the person.
She is an individual with schizophrenia, not a schizophrenic

Classification may emphasize trivial similarities
Relevant information may be overlooked.
Techniques employed to:
Describe clients problem
Determine causes of problem
Arrive at a diagnosis
Develop a treatment strategy
Monitor treatment progress
Conducting valid research

Ideal assessment involves multiple measures and
methods
Interviews, personality inventories, intelligence tests, etc.
Informal/less structured interviews
Interviewer attends to how questions are answered
Is response accompanied by appropriate emotion?
Does client fail to answer question?
Good rapport essential to earn trust
Empathy and accepting attitude necessary
Reliability lower than for structured interviews

Structured interviews
All interviewers ask the same questions in a predetermined
order
Structured Clinical Interview for Axis I of DSM (SCID)
Good interrater reliability for most diagnostic categories
Stress
Subjective experience of distress in response to
perceived environmental problems

Bedford College __________ Events and Difficulties
Schedule (LEDS)
Semi-structured interview
Evaluates stressors within the context of each
individuals circumstances

Self-Report Stress Checklists
Faster way to assess stress
Test-retest reliability low

Personality Tests
Self-reported Personality Inventories
Minnesota Multiphasic Personality Inventory
(MMPI)
Yields ___________________ of psychological
functioning
Specific subscales to detect lying and faking
good or bad
Projective Tests
Rorshach Inkblot Test and Thematic
Apperception Test (TAT)
Projective hypothesis
Responses to _________________________ stimuli
reflect unconscious processes
Intelligence tests (IQ tests)
Assess current mental ability
Wechsler Scales
Wechsler Adult Intelligence Scale, 4
th
ed. (WAIS-IV)
Wechsler Intelligence Scale for Children, 4
th
ed. (WISC-IV)
Wechsler Preschool and Primary Scale for Children, 3
rd
ed. (WPPSI-III)
Stanford-Binet, 5
th
ed. (SB5)
Used to predict school performance, diagnose learning
disabilities or intellectual developmental disorder (mental
retardation), identify gifted children, as part of a
neuropsychological examination
Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB)
Lower IQs associated with higher psychopathology and
mortality
Performance on IQ tests impacted by ___________________
Threat

Focus on aspects of ___________________

Characteristics of the person

Frequency and form of ___________________ behaviors

___________________ of problem behaviors
Observe behavior as it occurs

Sequence of behavior divided into segments

___________________ and ___________________

Behavioral Assessments often conducted in lab
setting
e.g., mother and child interact in a lab living room
Interaction observed through one-way mirror or
videotaped for later coding

Self-monitoring
Individuals observe and record their own behavior
e.g., moods, stressful events, thoughts, etc.

Ecological ___________________ Assessment (EMA)
Collection of data in real time using diaries or
smart phones

Reactivity
The act of observing ones behavior may alter it
Desirable behaviors tend to increase whereas undesirable
behaviors decrease
Use to help plan treatment targets

Format often similar to personality tests

Dysfunctional Attitude Scale (DAS)

Identifies ___________________ thought patterns
People will think less of me if I make mistakes
Computerized Axial Tomography (CT or CAT scan)

Reveals ___________________ abnormalities by
detecting differences in tissue density
e.g., enlarged ventricles

Magnetic Resonance Imaging (MRI)
Similar to CT but higher quality

fMRI (___________________ MRI)
Images reveal function as well as structure
Measures blood flow in the brain
(BOLD=blood oxygenation level dependent)

Positron Emission Tomography (PET scan)
Brain function
Postmortem studies

Metabolite assays
Metabolite levels

___________________ of neurotransmitter breakdown
found in urine, blood serum or cerebral spinal fluid
May not reflect actual level of neurotransmitter
Correlational studies

Neuropsychologist
Studies how brain abnormalities affect thinking,
feeling, and behavior
Neuropsychological Tests
Reveal performance deficits that can indicate ______
of brain malfunction
Halstead-Reitan battery
Tactile Performance Test-Time
Tactile Performance Test-Memory
Speech Sounds Perception Test
Luria-Nebraska battery
Assesses motor skills, tactile and kinesthetic skills, verbal
and spatial skills, expressive and receptive speech, etc.
Psychophysiology
Study of bodily changes that accompany psychological
characteristics or events

Electrocardiogram (EKG)
Heart rate measured by electrodes placed on chest

Electrodermal responding (skin conductance)
Sweat-gland activity measured by electrodes placed on hand

Electroencephalogram (EEG)
Brains electrical activity measured by electrodes placed on
scalp

Cultural __________ in Assessment
Measures developed for one culture or ethnic group may
not be valid or reliable for another.
Not simply a matter of language translation
Meaning may be lost

Cultural bias can lead to minimizing or
exaggerating psychological problems

Increase graduate students sensitivity to cultural
issues

Insure participants understanding of task

Establish rapport

Distinguish cultural ___________________ from
cultural stereotyping (Lopez, 1994)
Conclusions should be tentative and alternative hypotheses
should be entertained