Basics of Assessment
Assessment: Process of gathering information about symptoms and possible causes
.Also: Current symptoms, ways of stresscoping, recent events, substance abuse
cognitive functioning, sociocultural background.
Diagnosis: Label for a set of symptoms
- Validity:
- Ability of a test to measure what it is intended to measure
- Reliability:
- Indicates consistency of outcome
- Standardization:
- Prevent extraneous factors from influencing responses
- Administration and interpretation should be standardized à important for validity /reliability
Assessment Tools
- Clinical Interview:
- Mental status exam: 5 types of information
1. Appearance and behaviour (Slow?)
2. Thought processes, speed of speech
3. Mood and affect
4. Intellectual functioning (memory/attention difficulty?)
5. Orientation to place, time, person.
Structured interview: Format and sequence of questions is standardized
- Symptom Questionnaires:
- quick assessment
- cover wide variety of symptoms (BDI-Beck Depression Inventory)
- Personality Inventories:
- Questionnaires that asses typical way of thinking, feeling, behaving.
à Self-concept, attitudes, beliefs, well-being, coping strategies, perception of environment
social resources, vulnerability
- Minnesota Multiphasic Personality Inventory (MMPI) – 10 scales, 4 validity scales
- Problem with cross-cultural use
- Behavioral Observation and Self monitoring:
- Clinician assesses specific behaviour (eg. Fights) and what precedes and follows them
- Direct behavioural observation:
Problem: Individuals can alter behaviour when being watched (Hawthorne effect)Self-monitoring: Individuals keep track of the number and circumstances in which a specific
behaviour occurs (eg. Alcohol use)
- Intelligence Tests:
- Used when mental retardation or brain damage is suspected.
- Tests: Wechsler Adult Intelligence Scale, Stanford-Binet, Wechsler Intel. Scale for Children
Problem: Do not asses talents in humanities + biased in favour of WEIRD middle,
upper class society.
- Neuropsychological Tests:
- Used when neuropsychological impairment is suspected (memory – dementia)
- Tests: Bender Gestalt Test (Draw and remember set of 9 drawings)
à does not identify specific type of damage
Halstead-Reitan Test
Luria-Nebraska Test
à Test for concentration, dexterity, speed of comprehension
- Brain-Imaing Techniques:
- Good to identify specific deficits and brain abnormalities.
- Clinicians: Injury / tumor
- Researcher: Brain activity or structureComputerized tomography CT:
- Function: Narrow X-Ray beams pass through head in diff. angles. Amount of absorption
of each beam is measured à slice of brain
- Limitations: X-Ray
Image of brain structure, not activity
Positron-emission tomography PET:
- Function: Injection of radioactive isotope (eg. Fluorodeocyglucose FDG).
à accumulates in active parts of brain. Isotop decause, emits positrons which
collide with electrons. Both get annihilated à into photons.
Scanner detects photons at point of annihilation
- Limitation: Immage
- Variation:
Single photon emission computed tomography SPEC: Different tracer substance
à less accurated / expensive
Magnetic resonance imaing MRI fMRI:
- Advantages: No radiation, detailed pictures, any angle,
Structural MRI: Static image of brain structure
Functional MRI: Brain activity
- Function: Creates magnetic field, Hydrogen realigns. On/Off à hydrogen changes position
and emit magnetic signals
- Psychophysiological Tests:
- Alternatives to CT, PET, SPECT, MRI
- Can detect emotional and physiological changes.Electroencephalogram EEG:
- Function: Measures electrical activitiy on scalp, (firing of neurons below)
Measure reponse to stimuli. Evoked potentials, event-related potentials
- Use: To detect seizures, tumors, strokes.Lie detector:
- Function: Measures electrodermal response (electrical conductivity on the skin)
- Projective tests:
- People are shown pictures and the theory is that they interpret it according to their beliefs,
concerns, feelings, relationships, desires.
à uncover unconscious motives (if resistant or biased client)
- Tests: Rorschach Inkblot Test à inkblots
Thematic Apperception Test TAT: Series of pictures à client tells a story
- Used usually by psychodynamic therapists
- Problems: Validity /reliability, cultural backgrounds differ
Challenges in assessment
- Resistance:
- inability or unwillingness to provide accurate information
- Forced teenagers, Strong interest in outcome of assessment (report only selected
information),
- Evaluating Children:
- cannot describe feelings or events very good. React to situations and emotions different
than adults
à Parents, Teachers are source of information
- Problem: Biased view. 63% difference in child/parent reason what problem is
Teachers, Parents views differ, cause of different context
- Individuals across cultures:
- Language problem.
à Overdiagnosis: Assessor interprets unclear expression as more pathology
à Underdiagnosis: Client cannot describe situation accurately
- Solution: Interpreter, but needs to be trained and well matched with sociocultural/economic status
of client. (Dialect ect.)- Major difference of cultures: Reporting symptoms of psychopathology in emotions or
somatic (physical) symptoms.
Diagnosis
- Label for symptoms
- Cultural variation in symptoms and presentation (emotional, somatic)
Syndrome: Several symptoms form a syndrome
- are not list of symptoms that occur in all disorders but co-occur
Classification System: Set of syndromes and rules of determining if patients symptoms are
part of this set.
Diagnostic and Statistical Manual of Mental Disorders, DSM: APA
International Classification of Disease, ICD: Rest of the world
Reification of diagnoses: People tend to see it as real and existing, rather than a concept
made out of judgement.
Comorbidity: Criterias for one disorder are present in other disorder and lead to confusion
which disorder is actually present (eg Schizophrenia/Depression and irritability)
à not preventable because symptoms reflect problems in fundamental human
experience (sleep, emotion, cognition)
à Leads to several diagnosis (primary/secondary) and problem with which to
deal first
- DSM:
- DSM I (1952): vague descriptions, influenced by psychoanalytic theory
- DSM II (1968): similar, only 54% reliability
- DSM III (1980/87): 70% reliability, diagnosis relies heavily on clients statements,
Axial approach: I : Clinical disorders
II : Personality disorder, intellectual functioning
III : Medical, psychosocial, environmental, childhood.
IV : How does III affect diagnosis, treatment, prognosis
V : Global assessment of functioning GAF-scale 0-100
- DSM IV (1994/00): specific, concrete criteria for each disorder (behaviors, thoughts,
feelings) à increase reliability through field trials à successful
- DSM 5 (2013): Incorporation of continuum / dimensional model (noncategorical)
à Positive change: - How long symptoms must be present
- Symptoms must interfere with well-being and functioning
- Differentiation between disorders better establishedà nonaxial approach: - To be more in line with ICD-System published by WHO
- Axes I-III integrated in overall diagnostic scheme
- Former Axes IV-V are no longer diagnostic criteria
à To provide index of global functioning, use WHODAS
à WHO Disability Assessment Schedule
- Danger of diagnosing:
- Label leads clients and social surrounding to act according to their beliefs about the disorder
à Power, control that can be abused
- Psychologists made up Schizophrenia (Rosenhan 1973)
à Discovered errors in diagnosis and hospital system- Benefits: Good communication between clinicians, facilitates research by standardization.
Anxiety and Fear - Fight or Flight?
Fight or flight response:
Posttraumatic Stress Disorder + Acute Stress Disorder
PTSD: Result of experiencing expreme stress, traumatic experiences
à death, injury, sexual abuse
- women greater risk than men (gender related cultural experiences)
- Withdrawal from activies that resemble event
- Memory amnesia of details from event
- Hypervigilance, chronic arousal
- 20% of Vietnam veterans
- 50% of sexual assault develop itAccute Stress Disorder /PTSD with prominent dissociative (depersonalization/derealization) symptoms
- Symptoms within 1 month after stressor and duration of symptoms = 4+ weeks
- Flashbacks, nightmares
- dissociative symptoms: Feeling that everything is unreal, a dream.Theory of PTSD:
- Predictors: Severity, duration, proximity, social support
- Chronic exposure to straining situations
- Maladaptive coping styles (dissociation)
- Culture influences manifestation: e.g. attaque de nervios
Biological:
- PET + MRI Scan = different brain activity (fight or flight), amygdala, hippocampus, PFC.
à bad emotion regulation, overexposure to neurotransm. = shrinkage of hippocampus à bad sympathicus
regulation.
- Cortisol: Usually high levels à higher stressresponse, more time spend in reaction
- Higher neurotransmitter use: epinephrine + norepinephrine. à HPA axis cant shut down
- Genetics: Low cortisol is heritableTreatment of PTSD:
CBT:
- systematic desensitization
- integration of events in self-concept
stress-inoculation therapy: Therapist helps to cope with other problems that increase stress. à when
client is unable to expose to stimulusDrugs:
- SSRI
- BenzodiapezinesSpecific Phobias and Agoraphobia
Specific Phobia: Irrational fear towards specific object or situations à most common disorder
- 5 cathegories: animal, environment, situational, blood-injection-injury, other
Agoraphobia:
- Fear places where one cannot escape from or has trouble finding help
- Fear that others can see nervousness or embarrass oneselve during panic attack.
- more women than men. Start at early 20s.Theories of Phobias:
- Freud = unconscious anxiety is displaced onto neutral object.
- Behavioural: - classical conditioning leads to fear, operant conditioning maintains it. Negative reinforcement
- prepared classical conditioning: Through evolutionary past. Conditioning can occur faster
- Biological: First degree realtives = 4-5x more likelyTreatment for Phobias:
- Behavioural: systematic desensitization, modelling, flooding (injection inj. Blood= teach to rise blood pressure)
à applied tension technique
- Drugs:
- Benzodiapezines
Social Anxiety Disorder
- anxious and avoidant of social situations – fear of embarrassment, humiliation
à somato experiences of stress à evtl panic attack
- women more than men
- develops in adolescence
- Many comorbid disorders – Mood + other anxiety disordersTheories of Anxiety Disorder:
- Genetic component
- Cognitive perspective: irrealistically high standards for social performance, focus on negative aspects, self-evaluating
misinterpret everything in a self-defeating way, attention on own body sensations, ruminateTreatment of Social Anxiety Disorder:
- SSRI
- SNRI
- CBT: exposure, relaxation, challenge beliefs, group therapy?
- Mindfullnes based: less judgement
- ACT: Acceptance and commitment
- Future: Virtual reality exposurePanic Disorder
Panic attacks: Short period of extreme physical stress response without environmental trigger or with specific trigger
- 28 percent of adults at one time
- Fear of life threatening illness or to go crazy
- Co-occurrence with other disordersTheory of Panic Disorder:
- Biological:
- Heritability 50 %
- Poor regulation of neurotransmitters à flight or fight response is poor
- General arousal can trigger panic attacks
- Dysregulation of neurotransmitters in the locus ceruleus: Can cause panic attacks cause connected to limbic system
- Occurs postpartum or premenstrual periods
- Cognitive:
- Focus on bodily sensations
- Misinterpret these
- Engage in snowball catastrophic thinking
- anxiety sensitivity: belief that bodily symptoms have harmful consequences
- interceptive awareness: awareness of bodily cues
- interoceptive conditioning: bodily cues occurred at beginning of previous panic attack are now a cue.
even if not conscious
- felt controllability decreases risk of panic attackTreatment for Panic Disorder
- Drugs:
- SSRI
- SNRI
- Benzodiapezines à influence GABA- CBT:
- 1. Relaxation techniques
- 2. Identification of cognitions
- 3. Practice relaxation techniques during experience of symptoms with therapist
- 4. Challenge of catastrophizing cognitions
- 5. Systematic desensitization
- 90 % relief after 12 weeksGeneralized Anxiety Disorder
GAD: Excessive worry
- more women than men
- mostly chronic
- beginning in childhood or adolescence
- goes with comorbid disordersTheories of GAD:
- Cognitive:
- experience more intense negative emotions
- highly reactive to negative events
- feel that emotions are not controllable
- chronicically high stress levels
- maladaptive cognitions
- hypervigilant
- experienced high stress in past that was uncontrollable
- cognitive avoidance model: worrying helps them to become aware of threats. This constant level of anxiety is better
than a sudden jump in anxiety and reduces reactivity to negative events- Biological:
- Higher general activity of sympathetic system
- Abnormality in GABA regulation (lack of thought inhibition)
- heritableTreatments of GAD:
CBT:
- Challenge of cognitions
- Development of coping strategiesDrugs:
- Benzodiapezines
- Tricyclic antidepressantsSeparation Anxiety Disorder
- Occurs most often in childhood
- physical symptoms in abdomen, nightmares, cryingTheories of Separation Anxiety:
Biological:
- heritable. Behavioural inhibition: shy, fearful, irritable, cautious, quiet, introverted childrenPsychological:
- Controlling and intrusive parents, + critical and negative
- Give little control to childrenTreatment for Separation Anxiety:
- Coping skills
- Relaxation techniques
- Parents need to learn it as well, also to teach their childrenDrugs:
- Antidepressants
- SSRI
- Antianxiety: Benzodiapezines
- AntihistaminesObsessive- Compulsive Disorder
Compulsion: Repetitive acts that the individual “must” perform to get rid of obsessions or bad feelings
Obsession: Intruding and disturbing thoughts (mostly aggressive, sexual, religious) (magical thinking)3 types: sexual-aggressive, order-symmetry, contamination
subtypes: hoarding, hair-pulling, skin-picking, body dysmorphic disorder.
- Begins at young age
- Comorbid disorders: Panic attacks, phobias, substance abuse.Hoarding: cant throw away possessions, emotionally related to them (delusions)
Hair pulling: relive of tension or pleasure. Automatic
Body dysmorphic disorder: believe part of body is defective, preoccupied with hiding this. Bizarre, surreal.Theory of OCD:
- Circuit in the brain: PFC à Basal Ganglia (striatum) à Hypothalamus à PFC
- Hippocampus
à inable to turn off primitive impulses
- Children: Strep infection
- genetical componentsCognitive theory:
- inability to control or disregard thoughts
- Rigid, moralistic thinking
- feel very responsible for everything
- Belief they should be able to control every thought
- Convulsions develop through operant conditioningTreatment of OCD:
- Drugs:
- Antidepressants: SSRICBT:
- exposure and response prevention: expose clients to stimulus but prevent response. Habituation.
- Challenge negative cognitions à 60-90% success
- habit reversal training: become aware of unhealthy behaviour, replace with more healthy one
Summary Personality, Clinical and Healthpsychology
Summary Personality, Clinical and Healthpsychology. Chapters 1-2
Defining Abrnomality
- Mental Illness:
- Society thinks there is an underlying biological factor (no biological test for this available)
+ highly unlikely that single biolog. Cause underlies it.
- Mental health exp.: Mental disorder à collection of problems in thinking, emotion regulation and social behaviourPsychopathology: Study of people who suffer from physical, emotional, mental pain
- Cultural Norms:
- Large role in defining abnormality (especially gender stereotypical expectiations)
1. influence symptom expression
2. Influence willingness to admit to behaviors and feelings
3. Influence acceptable treatment methods
Cultural Relativism:
No universal standards to label behaviour as abnormal. Abnormal can only be defined in societal context
- The 4 D´s
- Definition of abnormal by:
1. Dysfunction: Person can´t have normal life
2. Distress: Distress themselves or people around them
3. Deviant: Behavior deviates from from social norm
4. Dangerous: Behavior is dangerous to ill person or others
à maladaptive
Historical perspectives:
1. Biological theories: Abnormality caused by physical breakdown
2. Supernatural Theories: Abnormality = Divine intervention
3. Psychological Theories: Result of traumas (stress)
- Ancient Theory:
- Evil spirits, treated with exorcismTrephination: Sections of skull drilled or cut away, so that spirits can depart
- Balancing Yin and Yang: Insane people (mania) have too much positive power à food taken away, so that positive power decreases. “Vital Air” had to be at the right parts of the body.
- Egypt, Greece, Rome:
Biological Theories: (wandering uterus = Egypt + Greek “hysteria = uterus”)
Supernatural theories (minimal): Infliction from Gods (Greek public, Rome)
à Mostly rejected from Greek physicians (Too much blood. Hiipocrates = first
attempt to find other explanations (social)
- Medieval views:
- Mostly supernatural explanations: WitchcraftPsychic epidemics: Many people engage in abnormal behaviour (dance frenzy / Tarantism)
- Spread of Asylums:
- 1200 start. Bad conditions. Warehousing
- Treatment was physical (bleeding)
- Moral treatment:
- 1800-1900Mental hygiene movement: People are separated from nature, too much stress cause of societal changes
Moral Treatment:
(Phillipe Pinel). Treat ill with respect and dignity.
(Dorothea Dix): Spreads the moral treatment and builds many mental health hospitals.
First popular, than unpopular because of exponential growth and declining results
Emergence of Modern Perspectives:
- Beginning of Biological Perspectives:
1800-1900: Understanding of body increased à leads to biological explanationsParts missing because fucking word shut itself down (p14-16)
Modern Mental Health Care:
1. 1950s: Drug treatment major breakthroughs:
Phenotiazines: Drug vs hallucination and delusion.
- Deinstitutionalization:
- 1960: Patients rights
Summary PCHP Chapter 3-4
Basics of Assessment
Assessment: Process of gathering information about symptoms and possible causes
.Also: Current symptoms, ways of stresscoping, recent events, substance abuse
cognitive functioning, sociocultural background.
Diagnosis: Label for a set of symptoms
- Validity:
- Ability of a test to measure what it is intended to measure
- Reliability:
- Indicates consistency of outcome
- Standardization:
- Prevent extraneous factors from influencing responses
- Administration and interpretation should be standardized à important for validity /reliability
Assessment Tools
- Clinical Interview:
- Mental status exam: 5 types of information
1. Appearance and behaviour (Slow?)
2. Thought processes, speed of speech
3. Mood and affect
4. Intellectual functioning (memory/attention difficulty?)
5. Orientation to place, time, person.
Structured interview: Format and sequence of questions is standardized
- Symptom Questionnaires:
- quick assessment
- cover wide variety of symptoms (BDI-Beck Depression Inventory)
- Personality Inventories:
- Questionnaires that asses typical way of thinking, feeling, behaving.
à Self-concept, attitudes, beliefs, well-being, coping strategies, perception of environment
social resources, vulnerability
- Minnesota Multiphasic Personality Inventory (MMPI) – 10 scales, 4 validity scales
- Problem with cross-cultural use
- Behavioral Observation and Self monitoring:
- Clinician assesses specific behaviour (eg. Fights) and what precedes and follows them
- Direct behavioural observation:
Problem: Individuals can alter behaviour when being watched (Hawthorne effect)Self-monitoring: Individuals keep track of the number and circumstances in which a specific
behaviour occurs (eg. Alcohol use)
- Intelligence Tests:
- Used when mental retardation or brain damage is suspected.
- Tests: Wechsler Adult Intelligence Scale, Stanford-Binet, Wechsler Intel. Scale for Children
Problem: Do not asses talents in humanities + biased in favour of WEIRD middle,
upper class society.
- Neuropsychological Tests:
- Used when neuropsychological impairment is suspected (memory – dementia)
- Tests: Bender Gestalt Test (Draw and remember set of 9 drawings)
à does not identify specific type of damage
Halstead-Reitan Test
Luria-Nebraska Test
à Test for concentration, dexterity, speed of comprehension
- Brain-Imaing Techniques:
- Good to identify specific deficits and brain abnormalities.
- Clinicians: Injury / tumor
- Researcher: Brain activity or structureComputerized tomography CT:
- Function: Narrow X-Ray beams pass through head in diff. angles. Amount of absorption
of each beam is measured à slice of brain
- Limitations: X-Ray
Image of brain structure, not activity
Positron-emission tomography PET:
- Function: Injection of radioactive
Summary PCHP Chapter 5-6
Index
6.0 Somatic Symptom and Dissociative Disorder, Basics. 1
6.1 Somatic Symptom Disorder. 1
6.2 Illness anxiety disorder. 1
6.4 Conversion Disorder ( Functional Neurological Symptom Disorder). 2
7.0 Factitious Disorder – Munchhausen´s syndrome. 2
8.1 Dissociative Identity Disorder (Former: Multiple Personality Disorder). 3
8.3 Depersonalization/Derealization Disorder. 3
9.0 Controversies Around Dissociative Disorders. 3
6.0 Somatic Symptom and Dissociative Disorder, Basics
Somatic symptoms disorder: physiological symptoms that are caused by emotional pain
- Shows mind/body fluidity
- worry
- no diagnosable physical symptoms (eg. Child only has stomach pain in morning)
pseydocyesis: Person thinks she is pregnant. (e.g. Anna O)
5 disorders in this cathegory: 1. Somatic symptom disorder
2. Illness anxiety disorder
3. Conversion disorder
4. Factirious disorder
5. Psychological factors affecting other medical conditions
(former psychosomatic disorder)
Dissociative disorders: develop multiple personality, or forgets important moments of life (loses consciousness)
6.1 Somatic Symptom Disorder
Identification: - 1 or more physical symptoms
- excessive thinking or seeking treatment (even surgery) à persist even with contrary evidence
- interfere with daily functioning à avoidance of activity, becomes defining personality trait
6.2 Illness anxiety disorder: - are just afraid of developing a serious illness. Seek excessive treatment
à spend their time with many doctors
- Worry about environmental causes for their illness. (pollution, food,)
- Experience anxiety and depression, substance abuse, mild physical symptoms
- physical symptoms mirror their emotional state
- Duration: Longterm
- Prognosis: More likely to develop obesity, high blood pressure, death
- Children: Report emotional distress as symptoms
6.2.1 Theories of Somatic Symptom and Ilness Anxiety Disorder:
- Cognitive factors (catastrophizing, ruminative thinking, self-fullfilling prophecy, wrong interpretation,
baseline bias, pay more attention to body)
à presents symptoms differently à becomes more affection from family àreinforced
- Female more than men (female anxiety + depression; men substance abuse + asocial personality)
- Children: May model parents (only way to get attention)
- Common in PTSD patients
6.2.2 Treatment
- They are treatment resistan
- Psychodynamic therapy: Uncover the traumatic event that triggered the symptoms
- Behavioral therapy: Focus on reinforcers + eliminating them
- Cognitive therapy: Focus on beliefs, reinterpret bodily symptoms (like
Summary PCHP Chapter 7 + 9 + 16
Schizophrenia Spectrum
1.0 Schizophrenia Spectrum (Split mind). 2
6.0 Other Psychotic Disorders. 5
· 7.2 Structural and Functional Brain Abnormalities: 5
· 8.1 Social drift and urban birth: 6
· 8.4 Cognitive Perspective. 6
· 8.5 Cross-Cultural Perspective. 6
· 9.2 Psychological and Social Treatment. 7
1.0 Schizophrenia Spectrum (Split mind)
- 5 Domains of symptoms (4 positive , 1 negative)
- Cognitive deficits (not criteria for diagnosis)
- Anhedonia (but feel same amount of emotion and more physical arousal)
- Recovery rate (40% employed, 37% functioning well)
- Negative symptoms are the bigger problem (marker for low socioeconomic status)
Psychosis: Being unable to differentiate between reality and illusion
2.0 Symptoms
- 2.1 Positive Symptoms: Overt expression
- Delusions
- Hallucinations
- Disorganized thought + speech + behaviour- Delusions: Person believes things that are highly unlikely or untrue, that are not amenable to change
! Not self-deceptions !
à because, not possible, actively behave in concordance with the belief, resist neg. evidencepersecutory delusions: being watched, tormented, spied after
delusion of reference: random events are meant to tell them something, related to them
grandiose delusion: believe that one is special or perceives superpower
delusion of thought insertion: belief that thoughts are controlled from outside
à can occur together in a story
à difference in content from cultural difference, maybe not abnormal if culture holds this belief
- Hallucinations: Unreal perceptual experiences, sometimes entwined with delusions
auditory: hearing voices, music à often negative qualities
visual: seeing things à often entwined
- 1 of 2
- volgende ›
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