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Psychiatric Assessment and Diagnosis

This chapter explores the advantages and disadvantages of psychiatric classification systems, focusing on DSM-IV-TR criteria, reliability, and validity. It delves into various assessment tools like interviews, intelligence tests, and personality tests used in diagnosing psychiatric disorders. The role of behavioral assessment and neuropsychological tests in understanding cognitive processes and behaviors is also discussed.

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Psychiatric Assessment and Diagnosis

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  1. Chapter 3 - Assessment & Diagnosis • Classification = ordering & grouping

  2. Advantages of Classification • Means of communication • Labels help to condense & order info • To guide treatment strategies • To facilitate research • Etiology & progression of disorder

  3. Disadvantages of Classification • Self-fulfilling prophecies & stigma - Rosenhan (1973) - Pygmalion in the classroom (“bloomers”) • Overlooking other important problems - aspects not typical of a diagnosis e.g., CD & depression

  4. Disadvantages, cont. • Automatically label those who seek help • Focus on weaknesses vs. strengths • Categories = less individual information

  5. DSM-IV-TR • The most widely used system • Pros - reliable - based on research (validity) - communication - atheoretical - multiaxial

  6. DSM axes I. Clinical disorders II Personality/enduring problems • Medical problems • Environment/psychosocial • Global assessment

  7. DSM Cons • Disorders created by committee • Labels => stigma • Culture-bound • No treatment suggestions • No causes • Focus on problems • Most axes rarely used -> reduces person to one disorder

  8. Reliability & Validity Reliability - consistency • Internal consistency - over all the items • Test-retest reliability - over time • Interrater reliability - over raters

  9. Validity - test measures what it purports to 1. Content - covers much of the trait 2. Concurrent - correlates with other measures of the trait • Predictive - predicts other measures of the trait {Concurrent & Predictive are both criterion} • Construct - test supports theory • Face - looks like what it measures

  10. Interviews Clinical interview • First step • Talk to client • Not reliable across examiners • Valid • Good for rapport • Nonverbal behavior

  11. Structured Interviews - decision trees - for diagnosis • Mental Status Exam - brief measure of cognitive functioning

  12. Intelligence Tests Reasons to use • Mental abilities affect other problems? • Strengths & weaknesses • General functioning

  13. Problems • Cultural bias • IQ = small part of intelligence

  14. Personality Tests Objective & Projective Objective Tests • unambiguous • reliably interpreted • usually self-report

  15. Multi-Trait Scales MMPI - 567 items • normed on psychiatric patients • items distinguished patient groups • 10 clinical scales & 3 validity scales • patterns suggest disorders & malingering

  16. Other multi-trait scales • MCMI (personality disorders) • Child Behavior Checklist • Strong Vocational Interest Test

  17. Single-trait self-report scales • Many scales ex. BDI • Face-valid • Good reliability & validity

  18. Projective Tests • Ambiguous stimuli -> responses reflect person • “Project” psyche onto stimuli • Given by trained person • Interpretations differ (? reliability) • ?Validity • Difficult to research • Used for getting ideas

  19. Rorschach Inkblot Test • Scoring system (reliability) • More validity research • Good for psychosis

  20. Thematic Apperception Test -TAT • Ambiguous scenes • Pattern of responses • Scoring system seldom used • Not reliable (subjective) • Suggests ideas

  21. Incomplete Sentence Blank

  22. Neuropsychological Tests • Brain damage & deterioration • Measures cognitive processes perception, memory, attention • Includes IQ testing

  23. Behavioral Assessment Focus on problem behavior • Antecedent conditions • Problem description • Person’s response • Result of response

  24. Leads to treatment • Self-rating - person monitors own behavior • Analogue Measures - simulate the problem in clinic/laboratory

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