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Samenvatting - Klinische Lessen (P_BKLINLES)
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Klinische LessenSamenvatti ng literatuur
Hoorcollege 1: Introductie DSM
Nolen-Hoeksema: Chapter 3 – Assessing and diagnosing abnormality
- Assessment: the process of gathering information about people’s symptoms and the possible
causes of these symptoms.
o Many types of information are gathered, including information about current
symptoms and ways of coping with stress, recent events and physical condition, drug
and alcohol use, personal and family history of psychological disorders, cognitive
functioning, and sociocultural background.
- Diagnosis: a label for a set of symptoms that often occur together.
- Assessment tools
o All assessment tools must be valid, reliable, and standardized.
o Validity: the accuracy of a test in assessing what it is supposed to measure.
Best way to determine: to see if the results of the test yield the same
information as an objective and accurate indication of what the test is
supposed to measure.
The validity of a test can be estimated in a number of other ways:
A test is said to have face validity when, on face value, the items
seem to measure what the test is intended to measure.
Content validity: the extent to which a test assesses all the important
aspects of a phenomenon that it purports to measure.
Concurrent (or convergent) validity: the extent to which a test yields
the same result as other, established measures of the same behavior,
thoughts, or feelings.
Predictive validity: the extent to which a test is good a predicting how
a person will think, act, or feel in the feature.
Construct validity: the extent to which a test measures what it is
supposed to measure and no something else altogether.
o Reliability: the consistency of a test in measuring what it is supposed to measure.
Several types of reliability:
Test-retest reliability: how consistent are the results of a test over
time. High reliability when the test produces similar result when
given at two points in time.
Alternate form reliability: two versions of the same test produce
similar results.
Internal reliability: different parts of the same test produce similar
results.
Interrater, or interjudge, reliability: two or more raters or judges who
administer and score a test come to similar conclusions.
o Standardization: way to improve both validity and reliability.
Standardize the administration and interpretation of tests. This prevents
extraneous factors from affecting a person’s response.
o Commonly used assessment tools:
Clinical interview
May include a mental status exam, which assesses the person’s
general functioning.
In the interview, the clinician probes for five types of information:
, o 1. The clinician assesses the individual’s appearance and
behavior.
o 2. The clinician will take not of the individual’s thought
processes, including how coherently and quickly he or she
speaks.
o 3. The clinician will be concerned with the individual’s mood
and affect.
o 4. The clinician will observe the individual’s intellectual
functioning – how well the person speaks and any indications
of memory or attention difficulties.
o 5. The clinician will note whether the individual seems
appropriately oriented to place, time, and person.
Clinicians often use a structured interview to gather information
about individuals.
o The clinician asks the respondent a series of questions about
symptoms he or she is experiencing or has experienced in
the past.
o Format of question and the entire interview is standardized,
and the clinician uses concrete criteria to score the person’s
answers.
Symptom questionnaire: a quick way to determine a person’s symptoms.
Personality inventories: usually questionnaires meant to assess people’s
typical way of thinking, feeling, and behaving.
Are used as a part of an assessment procedure to obtain information
on people’s well-being, self-concept, attitudes and beliefs, ways of
coping, perceptions of their environment, and social resources, and
vulnerabilities.
Behavioral observation and self-monitoring
Clinicians often will use behavioral observation of individuals to
assess deficits in their skills or their ways of handling situations.
Advantage: not relying on individuals’ reporting and interpretation of
their own behavior. Instead, the clinician sees first-hand how the
individuals handle important situations.
Disadvantage: individuals may alter their behavior when they are
being watched.
Disadvantage: different observers may draw different conclusions
about the individuals’ skills.
If direct observation is not possible, clinicians may require self-
monitoring by individuals – that is, keeping track of the number of
times per day they engage in a specific behavior.
Intelligence tests: used to get a sense of an individual’s intellectual strengths
and weaknesses, particularly when mental retardation or brain damage is
suspected.
Designed to measure basic intellectual abilities, such as the ability for
abstract reasoning, verbal fluency, and spatial memory.
Neuropsychological tests: may be useful in detecting specific cognitive
deficits such as a memory problem, as occurs in dementia.
Brain-imaging techniques: to identify specific deficits and possible brain
abnormalities.
Computerized tomography (CT): narrow X-ray beams are passed
through a person’s head in a single plane from a variety of angles.
, The amount of radiation absorbed by each beam is measured, and
from these measurements a computer program constructs an image
of a slice of the brain. construct a three-dimensional image
showing the brain’s major structures.
Positron-emission tomography (PET): can provide a picture of brain
activity.
o Requires injecting a radioactive isotope, that travels through
the blood to the brain. The parts of the brain that are active
need the glucose, so the isotope accumulates in active parts
of the brain.
Single photon emission computed tomography (SPECT): also to
assess brain activity.
o Different tracer substance is injected. Less accurate than PET
but also less expensive.
Magnetic resonance imaging (MRI): provides detailed pictures of the
anatomy of the brain.
o Structural MRI: provides static images of brain structure.
o Functional MRI: provides images of brain activity.
o Involves creating a magnetic field around the brain that
causes a realignment of hydrogen atoms in the brain.
Psychophysiological tests: used to detect changes in the brain and nervous
system that reflect emotional and psychological changes.
Electroencephalogram (EEG): measures electrical activity along the
scalp produced by the firing of specific neurons in the brain.
Projective tests: based on the assumption that when people are presented
with an ambiguous stimulus, they will interpret the stimulus in line with their
current concerns and feelings, relationships with others, and conflicts or
desires.
- Challenges in assessment
o Resistance to providing information
Sometimes the person does not wan to be assessed or treated.
Sometimes people have a strong interest in the outcome of the assessment
and therefor may be highly selective in the information they provide, may
bias their presentation of the information, or may even lie to the assessor.
o Evaluating children
In children, their understanding of the causes of their behaviors or emotions
may not be very well developed. Children, particularly pre-school-age
children, cannot describe their feelings or associated events as easily as
adults can.
Parents are often the first source of information about a child’s functioning.
However, parents are not always accurate in their assessment of their
children’s functioning.
o Evaluating individuals across cultures
A number of challenges to assessment arise when there are significant
cultural differences between the assessor and the person being assessed.
One of the most pervasive differences is in whether cultures experience and
report psychological distress in emotional or somatic (physical) symptoms.
- Diagnosis:
o Diagnosis: a label we attach to a set of symptoms that tend to occur together. This set
of symptoms is called a syndrome.
, Several symptoms make up a syndrome, but people differ in which of these
symptoms they experiences most strongly.
Syndromes are not a list of symptoms that all people have all the time if they
have any of the symptoms at all. Rather, they are lists of symptoms that then
to co-occur within individuals.
The symptoms of one syndrome may overlap those of another.
o A set of syndromes and the rules for determining whether an individual’s symptoms
are part of one of these syndromes constitute a classification system.
One of the first classification systems: proposed by Hippocrates who divided
all mental disorders into mania (states of abnormal excitement), melancholia
(states of abnormal depression), paranoia, and epilepsy.
Current systems divide the world of psychological symptoms into a much
larger number of syndromes than did Hippocrates.
Diagnostic an statistical manual of mental disorder (DSM).
Classification system most widely used in the United States.
First edition (1952): outlined the diagnostic criteria for all the mental
disorders recognized by the psychiatric community at the time. These
criteria were somewhat vague descriptions heavily influenced by
psychoanalytic theory.
The newer editions (DSM-III & DSM-IV) improved diagnosis by
replacing the vague description of disorders with specific and
concrete criteria for each disorder.
o These criteria are in the form of behaviors people must show
or experience, or feelings they must report, in order to be
given a diagnosis.
o These editions also specify how long a person must show
symptoms of the disorder in order to be given the diagnoses.
And the criteria for most disorders require that symptoms
interfere with occupational or social functioning.
Newest editions: DSM-V (2013).
o Removed some diagnoses, added some new diagnoses, and
modified the criteria for others.
o Also attempted to incorporate a continuum or dimensional
perspective into the diagnosis of several disorders.
Reliability of the DSM
o Despite the use of explicit criteria for disorders the reliability
of many of the diagnoses listed in the DSM-III was
disappointing.
o Low reliability of diagnoses can be due to many factors.
Many criteria still were vague and required the
clinician to make inferences about the individual’s
symptoms or to rely on the individual’s willingness to
report symptoms.
Different sources of information can provide very
different pictures of the person’s functioning.
o To increase the reliability in the DSM-IV, the task force that
developed it conducted numerous field trials. As a result, the
DSM-IV diagnoses had a higher reliability than their
predecessors.
Debates about the DSM
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