Upload
anne-price
View
224
Download
2
Tags:
Embed Size (px)
Citation preview
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 11
Assessment, Diagnosis, Assessment, Diagnosis, and Treatmentand Treatment
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 22
Who First Notices Abnormal Who First Notices Abnormal Behaviour?Behaviour?
A close family member…A close family member… Parents - children or adolescents with behaviour Parents - children or adolescents with behaviour
problemsproblems Self- referrals - most adult casesSelf- referrals - most adult cases Spouses, significant othersSpouses, significant others Children - elderly parents Children - elderly parents
Otherwise, it’s usually the legal system (court Otherwise, it’s usually the legal system (court cases)cases)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 33
Professionals Involved in Professionals Involved in AssessmentAssessment
Referral StageReferral Stage Family doctor - source of initial referralFamily doctor - source of initial referral Teachers - referrals for behaviourTeachers - referrals for behaviour School CounselorsSchool Counselors
Service StagesService Stages Psychiatrists - assessment, diagnosis, treatmentPsychiatrists - assessment, diagnosis, treatment Psychologists - assessment, treatmentPsychologists - assessment, treatment Social Workers - treatmentSocial Workers - treatment
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 44
AssessmentAssessment
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 55
What is Assessment?What is Assessment?
Multiple strategies: Multiple strategies:
Measurements (tests) are takenMeasurements (tests) are taken Needs or goals of the patient are determined, if Needs or goals of the patient are determined, if
applicableapplicable Decisions are made regarding classification, Decisions are made regarding classification,
diagnosis, placement, and treatmentdiagnosis, placement, and treatment Follow-up to determine the efficacy of treatmentFollow-up to determine the efficacy of treatment Adjustments made if necessaryAdjustments made if necessary
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 66
Test Results and InterpretationTest Results and Interpretation
Only approximations to real phenomena.Only approximations to real phenomena. Any type of assessment method is subject to Any type of assessment method is subject to
error.error. Chance error can occur.Chance error can occur. Systematic error or Systematic error or biasbias..
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 77
Standards for AssessmentStandards for Assessment
Reliability Reliability ValidityValidity UtilityUtility
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 88
ReliabilityReliability
Repeatability: Comparable scores each time a Repeatability: Comparable scores each time a test is administeredtest is administered
When is a test unreliable?When is a test unreliable? Ambiguous assessment procedures Ambiguous assessment procedures Poorly trained evaluatorsPoorly trained evaluators Varying behaviour of the patientVarying behaviour of the patient Growth and developmentGrowth and development Varying assessment conditionsVarying assessment conditions Learning effectsLearning effects
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 99
ValidityValidity
Is test accurately assessing what is was designed Is test accurately assessing what is was designed to assess?to assess?
Many types:Many types:
1.1. Concurrent: vary with other measures of the Concurrent: vary with other measures of the same phenomenonsame phenomenon
2.2. Content: how comprehensive the measure isContent: how comprehensive the measure is
3.3. Predictive: future outcomes (GRE, LSAT, MCAT)Predictive: future outcomes (GRE, LSAT, MCAT)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1010
ValidityValidity
What can affect validity?What can affect validity? Sampling the wrong or irrelevant content areaSampling the wrong or irrelevant content area The measure’s The measure’s reactivityreactivity – extent to which the – extent to which the
measure makes the patient want to respond a measure makes the patient want to respond a certain waycertain way
A mismatch between test difficulty and A mismatch between test difficulty and developmental level (ceiling or floor effects).developmental level (ceiling or floor effects).
Low reliability = lowers validityLow reliability = lowers validity
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1111
UtilityUtility
Usefulness: impact on appropriate placement Usefulness: impact on appropriate placement and treatmentand treatment
Also relates to issues of time and money.Also relates to issues of time and money.
Three Questions of UtilityThree Questions of Utility1.1. What is the percentage of correct decisions What is the percentage of correct decisions
made using this instrument?made using this instrument?2.2. What are the costs involved in getting the What are the costs involved in getting the
assessment information? assessment information? 3.3. What are the What are the valuesvalues or costs associated with or costs associated with
making a correct decision?making a correct decision?
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1212
How do you reduce How do you reduce assessment error?assessment error?
Rule of Multiples:Rule of Multiples:
Multiple Tests – use more than one testMultiple Tests – use more than one test Multiple EvaluatorsMultiple Evaluators Multiple Times –more than once, if possibleMultiple Times –more than once, if possible
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1313
A. Neuropsychiatric ApproachesA. Neuropsychiatric Approaches
Psychiatrists specialized in brain-based Psychiatrists specialized in brain-based diseases or disordersdiseases or disorders
Steps in assessmentSteps in assessment1.1. Clinical InterviewClinical Interview
2.2. Behavioural Observations (during interview)Behavioural Observations (during interview)
3.3. Medical Status (physical)Medical Status (physical)
4.4. Mental Status ExamMental Status Exam
5.5. Referral to neurologist if necessaryReferral to neurologist if necessary
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1414
1. Clinical Interviews 1. Clinical Interviews and Observationand Observation
StandardizedStandardized: explicit instructions/procedures : explicit instructions/procedures Same questions, same orderSame questions, same order
Not standardizedNot standardized: based on clinical judgment: based on clinical judgment Time constraintsTime constraints Omit irrelevant questionsOmit irrelevant questions May be loosely based on standardized measuresMay be loosely based on standardized measures
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1515
Purpose of InterviewPurpose of Interview
Initial meeting with the patient, their family, or Initial meeting with the patient, their family, or caregivercaregiver
Conversational approach that gauges concerns of Conversational approach that gauges concerns of patientpatient
Big emphasis on social skills, body language, Big emphasis on social skills, body language, nature of difficulties in a “casual” setting.nature of difficulties in a “casual” setting.• Personality issues regarding treatmentPersonality issues regarding treatment
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1616
2. Behavioural Observations2. Behavioural Observations
Examine many domains :Examine many domains :• appearanceappearance• motoric behaviourmotoric behaviour• mood and affectmood and affect• verbal outputverbal output• thoughtthought• perceptionperception
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1717
AppearanceAppearance
dress (style and amount)dress (style and amount) emotional display (appropriate, flat, over emotional display (appropriate, flat, over
aroused)aroused) attitude toward examination and questioning attitude toward examination and questioning
(cooperative, aloof, hostile, guarded)(cooperative, aloof, hostile, guarded) motor activity (agitated, flat, appropriate)motor activity (agitated, flat, appropriate)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1818
Motor behaviourMotor behaviour
gait (walking, balance)gait (walking, balance) posture posture spontaneous movement (tics, tremors)spontaneous movement (tics, tremors) speech speech
• speed, fluency, latency of reply, stutteringspeed, fluency, latency of reply, stuttering
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 1919
Mood and AffectMood and Affect
Mood = emotion as reported by patientMood = emotion as reported by patient Affect = emotion manifested nonverballyAffect = emotion manifested nonverbally
• tone of voice, behaviour, facial expressiontone of voice, behaviour, facial expression
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2020
Content of Thoughts…Content of Thoughts…
repetition repetition delusions, perseveration, obsessionsdelusions, perseveration, obsessions word saladword salad Coprolalia: involuntary utterance of obscenitiesCoprolalia: involuntary utterance of obscenities autistic thinking (personally idiosyncratic thought autistic thinking (personally idiosyncratic thought
not related to reality)not related to reality) loosening of associations (unrelated thoughts)loosening of associations (unrelated thoughts) poverty of expressionpoverty of expression thought blockingthought blocking flight of ideas (connection through rhyme, etc.)flight of ideas (connection through rhyme, etc.) tangential thinkingtangential thinking
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2121
PerceptionPerception
Modality: visual, auditory, tactile, gustatory, Modality: visual, auditory, tactile, gustatory, olfactory, vestibularolfactory, vestibular
ValenceValence: : • Positive = present - e.g. hallucinations (generated from Positive = present - e.g. hallucinations (generated from
mind), illusions (distortions of existing stimuli)mind), illusions (distortions of existing stimuli)• Negative = absent - e.g. neglect, blindness, agnosias Negative = absent - e.g. neglect, blindness, agnosias
(inability to recognize stimuli)(inability to recognize stimuli)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2222
3. Medical Status3. Medical Status
Psychiatrist or primary care physicianPsychiatrist or primary care physician Additional tests: ECG, blood pressure, reflexes, Additional tests: ECG, blood pressure, reflexes,
vision and hearing exams, etc.vision and hearing exams, etc. Are symptoms the result of a physical ailment Are symptoms the result of a physical ailment
that can be treated with medication or surgery?that can be treated with medication or surgery?
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2323
4. Mental Status Exam4. Mental Status Exam
Screening test of neuropsychological functionsScreening test of neuropsychological functions Particular responses suggest affected brain areasParticular responses suggest affected brain areas Must be aware of education level, socioeconomic Must be aware of education level, socioeconomic
status, and test awarenessstatus, and test awareness
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2424
Domains TestedDomains Tested
Attention and ConcentrationAttention and Concentration• Drowsiness (reticular formation)Drowsiness (reticular formation)• Distractibility/Mental Control (frontal lobe)Distractibility/Mental Control (frontal lobe)• Unilateral neglect –thalamus, parietal lobeUnilateral neglect –thalamus, parietal lobe• Tests: digit span, saying months of the year backwards, Tests: digit span, saying months of the year backwards,
line bisection testline bisection test
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2525
Domains TestedDomains Tested
Language (frontal, temporal lobes)Language (frontal, temporal lobes)• Spontaneous speechSpontaneous speech• Comprehension – token testComprehension – token test• RepetitionRepetition• NamingNaming• ReadingReading• WritingWriting• Word list generationWord list generation• Speech prosody (tone, rhyme, emotion)Speech prosody (tone, rhyme, emotion)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2626
Domains TestedDomains Tested
Memory (Hippocampus, medial thalamus)Memory (Hippocampus, medial thalamus)• Orientation Orientation • Short word lists – increasing delaysShort word lists – increasing delays• Visual Memory Visual Memory • Personal historyPersonal history
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2727
Domains TestedDomains Tested
Constructions (Right parietal lobe)Constructions (Right parietal lobe)• Copying drawingsCopying drawings• Clock drawingClock drawing
Calculation (Left parietal lobe)Calculation (Left parietal lobe)• Mental and written arithmeticMental and written arithmetic
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2828
Domains TestedDomains Tested
Abstraction (Frontal lobes)Abstraction (Frontal lobes)• ProverbsProverbs• MetaphorsMetaphors
Insight and Judgment (Frontal lobes) Insight and Judgment (Frontal lobes) • Usually asked in relation to symptomsUsually asked in relation to symptoms
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 2929
Domains TestedDomains Tested
ApraxiaApraxia
1.1. Ideomotor– inability to perform commands Ideomotor– inability to perform commands despite good motor functiondespite good motor function
2.2. Ideational– inability to synthesize a series of Ideational– inability to synthesize a series of individual actions into a complex activityindividual actions into a complex activity
• Both are seen in dementias, other diseases Both are seen in dementias, other diseases involving diffuse brain damageinvolving diffuse brain damage
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3030
Domains TestedDomains Tested
Executive Function (Dorsolateral prefrontal)Executive Function (Dorsolateral prefrontal)• Semantic memorySemantic memory• Complex constructionsComplex constructions• Problem solvingProblem solving• Rhythm tappingRhythm tapping• Verbal fluencyVerbal fluency
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3131
Domains TestedDomains Tested
Mental Status is often determined through use of Mental Status is often determined through use of the Mini Mental State Exam (MMSE)the Mini Mental State Exam (MMSE)
11 questions, 5-10 minutes to administer11 questions, 5-10 minutes to administer Total score 30, <23 implies clinical impairmentTotal score 30, <23 implies clinical impairment
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3232
5. Referral to Neurologist5. Referral to Neurologist
If brain damage is suspectedIf brain damage is suspected Will either confirm or disconfirm results of MMSEWill either confirm or disconfirm results of MMSE Includes tests of sensory and motor functioningIncludes tests of sensory and motor functioning
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3333
Neurological TestsNeurological Tests
Cranial nerve function – smell, visual fields, visual Cranial nerve function – smell, visual fields, visual acuity, pupillary responses, facial musculature, acuity, pupillary responses, facial musculature, auditory testing, facial reflexesauditory testing, facial reflexes
Motor system examination – muscle bulk, Motor system examination – muscle bulk, strength, muscle tone, gait, posturestrength, muscle tone, gait, posture
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3434
More Neurological TestsMore Neurological Tests
1.1. ElectroencephalogramElectroencephalogram
2.2. Neuroendocrine testsNeuroendocrine tests
3.3. Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI)
4.4. Positron emission tomography (PET)Positron emission tomography (PET)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3535
B. Neuropsychological B. Neuropsychological ApproachesApproaches
1.1. Clinical InterviewsClinical Interviews
2.2. Assessment of Cognitive FunctionAssessment of Cognitive Function
3.3. Brief assessment of social, emotional functionBrief assessment of social, emotional function
4.4. Correlations with Neurological findingsCorrelations with Neurological findings
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3636
1. Clinical Interviews1. Clinical Interviews
Determine current level of cognitive and Determine current level of cognitive and emotional functioningemotional functioning
Less diagnostically inclinedLess diagnostically inclined Determine areas of concern, strengths and Determine areas of concern, strengths and
weaknessesweaknesses
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3737
2. Assessment of 2. Assessment of Cognitive FunctionCognitive Function
Assessment of neuropsychiatric domainsAssessment of neuropsychiatric domains Also intellectual, academic, and adaptive Also intellectual, academic, and adaptive
functioningfunctioning
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3838
Intelligence TestsIntelligence Tests
WAIS – Wechsler Adult Intelligence ScaleWAIS – Wechsler Adult Intelligence Scale WISC-IV - Wechsler Intelligence Scale for ChildrenWISC-IV - Wechsler Intelligence Scale for Children WPPSI-R - Wechsler Preschool and Primary Scale WPPSI-R - Wechsler Preschool and Primary Scale
of Intelligence of Intelligence Stanford-Binet Intelligence Test - 4th editionStanford-Binet Intelligence Test - 4th edition Leiter International Performance Scale (non-Leiter International Performance Scale (non-
verbal)verbal)
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 3939
About intelligence tests…About intelligence tests…
• Good test-retest reliabilityGood test-retest reliability• Good inter-rater reliabilityGood inter-rater reliability• Good concurrent, predictive validityGood concurrent, predictive validity• Questionable content validityQuestionable content validity• Tests measure academic aspectsTests measure academic aspects
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4040
About intelligence tests…About intelligence tests…
• Infant and young children’s tests do not predict Infant and young children’s tests do not predict school performance very well.school performance very well.
• No clear relationship between IQ and behaviour No clear relationship between IQ and behaviour problems.problems.
• Not diagnostic – never use IQ tests alone to Not diagnostic – never use IQ tests alone to diagnose a disorderdiagnose a disorder
• Utility is questionable for people from different Utility is questionable for people from different cultures cultures
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4141
Projective Tests for ChildrenProjective Tests for Children
Projective hypothesis: child behaviour is driven by Projective hypothesis: child behaviour is driven by underlying sexual and aggressive urges.underlying sexual and aggressive urges.
• Association: what they see in a stimulus Association: what they see in a stimulus (inkblots), or word association.(inkblots), or word association.
• Construction: Thematic Apperception Test, Draw Construction: Thematic Apperception Test, Draw a Person Testa Person Test
• Expressive :create product of their own choiceExpressive :create product of their own choice
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4242
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4343
Personality Tests for ChildrenPersonality Tests for Children
Personality Inventory for Children (PIC)Personality Inventory for Children (PIC) Filled out by primary caregiverFilled out by primary caregiver Several questions correlate or cluster with each Several questions correlate or cluster with each
other during the standardization phase – indicates other during the standardization phase – indicates a traita trait
Valid and reliable, not necessarily predictive Valid and reliable, not necessarily predictive
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4444
Educational TestsEducational Tests
Achievement tests - assess what a child has Achievement tests - assess what a child has learned up until the point of testing.learned up until the point of testing. Woodcock Johnson, Wide-Range Achievement TestWoodcock Johnson, Wide-Range Achievement Test
Measure reading, spelling, arithmeticMeasure reading, spelling, arithmetic Good reliability and content validity Good reliability and content validity
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4545
4. Correlation with 4. Correlation with Neurological FindingsNeurological Findings
Compile own findings into a report Compile own findings into a report Compare areas of strengths and weakness with Compare areas of strengths and weakness with
known neurological damageknown neurological damage Be careful not to infer neurological underpinnings Be careful not to infer neurological underpinnings
of behaviourof behaviour
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4646
DiagnosisDiagnosis
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4747
Diagnosis of DisordersDiagnosis of Disorders
Diagnosis = process of using an accepted Diagnosis = process of using an accepted classification system classification system
match a person’s atypical behaviour match a person’s atypical behaviour characteristics to a set of operational definitionscharacteristics to a set of operational definitions
• Match of symptoms to criteria for disordersMatch of symptoms to criteria for disorders
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4848
Arriving at at diagnosisArriving at at diagnosis
Neurological and academic status determinedNeurological and academic status determined Neuropsychiatrist and neuropsychologist:Neuropsychiatrist and neuropsychologist:
• DISC (Diagnostic Interview Schedule for Children) or DISC (Diagnostic Interview Schedule for Children) or SCID (adult version) clinical interview used for diagnosis SCID (adult version) clinical interview used for diagnosis in DSM-IV categoriesin DSM-IV categories
• Child Behaviour Checklist (CBCL) for childrenChild Behaviour Checklist (CBCL) for children• Minnesota Multiphasic Personality Inventory (MMPI)Minnesota Multiphasic Personality Inventory (MMPI)• California Personality Inventory or Personality Inventory California Personality Inventory or Personality Inventory
for Childrenfor Children• self reports - depression, anxietyself reports - depression, anxiety
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 4949
DiagnosisDiagnosis
DSM-IV DSM-IV • Diagnostic and Statistical Manual – 4Diagnostic and Statistical Manual – 4thth edition edition• lists known causes lists known causes • Statistics:gender, age at onset, and prognosisStatistics:gender, age at onset, and prognosis• Optimal treatment approachesOptimal treatment approaches• North AmericanNorth American
Other systems: ICD-10 Other systems: ICD-10 • International Classification of DisordersInternational Classification of Disorders• Used more often in England and EuropeUsed more often in England and Europe
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5050
DSM-IV ClassificationDSM-IV Classification
Diagnostic and Statistical Manual of Mental Disorders (4th Diagnostic and Statistical Manual of Mental Disorders (4th Ed)Ed)
Multiaxial system – other dimensions can be coded with the Multiaxial system – other dimensions can be coded with the principal diagnosis.principal diagnosis.
Axis I – principal diagnosisAxis I – principal diagnosis
Axis II – developmental and personality disorders (long term Axis II – developmental and personality disorders (long term effects)effects)
Axis III – physical disordersAxis III – physical disorders
Axis IV – psychosocial stressors (family, employment status)Axis IV – psychosocial stressors (family, employment status)
Axis V – highest level of functioningAxis V – highest level of functioning
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5151
DSM-IV ClassificationDSM-IV Classification
Advantages:Advantages: Based on research findingsBased on research findings Systematically tested Systematically tested More disorders for children than in previous versions.More disorders for children than in previous versions. Multiaxial system addresses complexity of diagnosis.Multiaxial system addresses complexity of diagnosis.
Disadvantages:Disadvantages: Atheoretical – based on medical modelAtheoretical – based on medical model Includes educational problems that may be transitory.Includes educational problems that may be transitory. Not reliable for more specific disorders – true for broader disordersNot reliable for more specific disorders – true for broader disorders Distinctions between Axis I and II often unclearDistinctions between Axis I and II often unclear
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5252
Statistically Based Statistically Based Classification SystemsClassification Systems
Child Behavior Checklist (CBCL)Child Behavior Checklist (CBCL)• Parents, teachers, or child are asked to rate child’s behaviour Parents, teachers, or child are asked to rate child’s behaviour
among predetermined dimensionsamong predetermined dimensions• Compared to other childrenCompared to other children
MMPIMMPI• Self-report questionnaire with items randomly presented to Self-report questionnaire with items randomly presented to
examineeexaminee• Use of scales to determine if responses indicate clinical Use of scales to determine if responses indicate clinical
significant findingssignificant findings
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5353
About these other tests…About these other tests… Behaviour dimensions were determined through Behaviour dimensions were determined through
statistical sampling and factor analysisstatistical sampling and factor analysis Good validity – construct and contentGood validity – construct and content Good reliability (over .90)Good reliability (over .90)
Prone to cultural differencesProne to cultural differences CBCL - No scales to determine if person is over or CBCL - No scales to determine if person is over or
underreporting problem behaviourunderreporting problem behaviour
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5454
The Effects of Labeling through The Effects of Labeling through ClassificationClassification
1.1. Assumptions of behaviour that may not be Assumptions of behaviour that may not be present. present.
2.2. Can restrict a child to dead-end placements.Can restrict a child to dead-end placements.
3.3. Self-fulfilling prophecy.Self-fulfilling prophecy.
4.4. Focus on negative personal traits. Focus on negative personal traits.
5.5. Damage self-esteem.Damage self-esteem.
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5555
TreatmentTreatment
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5656
1. Psychopharmacology1. Psychopharmacology Usually administered by a psychiatristUsually administered by a psychiatrist Some U.S. states have given prescription rights to Some U.S. states have given prescription rights to
psychologistspsychologists
Most drugs are nonspecific and are used for a number of Most drugs are nonspecific and are used for a number of disorders disorders
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5757
What do drugs do?What do drugs do? to suppress dangerous behaviours to suppress dangerous behaviours to suppress behaviours that interfere with education to suppress behaviours that interfere with education to suppress bizarre behaviours to suppress bizarre behaviours to promote prosocial behaviour to promote prosocial behaviour
The don’t cure but can control diseaseThe don’t cure but can control disease Still controversy over the treatment of children with drugsStill controversy over the treatment of children with drugs
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5858
Effectiveness of Drug TreatmentsEffectiveness of Drug Treatments
1.1. Treatment complianceTreatment compliance
2.2. Side effectsSide effects
3.3. Long-term goalsLong-term goals
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 5959
2. Psychiatric Therapies2. Psychiatric Therapies
1. Psychodynamic/psychoanalytic 1. Psychodynamic/psychoanalytic Resolve internal conflict caused by repressionResolve internal conflict caused by repression Assessment by projective approaches or Assessment by projective approaches or
personality inventoriespersonality inventories• 45-50 minute sessions 3-5 times per week, over 45-50 minute sessions 3-5 times per week, over
months or yearsmonths or years
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6060
Psychiatric TherapiesPsychiatric Therapies
2. Client-Centred (insight-oriented) Therapy2. Client-Centred (insight-oriented) Therapy Therapist must accept client as they are and Therapist must accept client as they are and
encourages expression of feelingsencourages expression of feelings• 1-2 one-hour sessions per week1-2 one-hour sessions per week
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6161
3. Psychological Therapies3. Psychological Therapies
““Cognitive behavioural therapy”Cognitive behavioural therapy”• Many approaches based on Skinnerian Many approaches based on Skinnerian
reinforcement principlesreinforcement principles• Little or no concern for discovering the origins of Little or no concern for discovering the origins of
internal drives.internal drives.
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6262
Using well-know behaviouristic Using well-know behaviouristic approaches: approaches:
Extinction/response cost: removal of Extinction/response cost: removal of reinforcementreinforcement
Token reinforcementToken reinforcement Negative reinforcementNegative reinforcement
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6363
4. Social Worker Interventions4. Social Worker Interventions
• Adopting new response habits between family and other Adopting new response habits between family and other people close to the patientpeople close to the patient
1.1. Family systems therapyFamily systems therapy• problems due to atypical family interactionsproblems due to atypical family interactions• Understand and modify family dynamicsUnderstand and modify family dynamics2.2. Behavioural family therapyBehavioural family therapy• increase positive reinforcement between family membersincrease positive reinforcement between family members• decreasing use of coercion and negative reinforcementdecreasing use of coercion and negative reinforcement
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6464
5. Educational Interventions5. Educational Interventions
For children or adolescents in school setting For children or adolescents in school setting Address academic and behavioural difficultiesAddress academic and behavioural difficulties In-class educational assistants In-class educational assistants Behavioural therapy by a psychologist or trained Behavioural therapy by a psychologist or trained
studentstudent Not usually done by primary teacherNot usually done by primary teacher
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6565
6. Cognitive Rehabilitation6. Cognitive Rehabilitation
• Individualized remediation of cognitive difficulties Individualized remediation of cognitive difficulties to improve memory, attention, executive functionto improve memory, attention, executive function
• In a private clinic or through a hospitalIn a private clinic or through a hospital• Dementia, traumatic brain injury, epilepsyDementia, traumatic brain injury, epilepsy• Usually administered by psychologists or Usually administered by psychologists or
occupational therapistsoccupational therapists
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6666
7. Electroconvulsive Therapy7. Electroconvulsive Therapy
Controlled seizure: Low-voltage electric current Controlled seizure: Low-voltage electric current passed through the brain for 1-2 secondspassed through the brain for 1-2 seconds
Effective in depression, mania, schizophreniaEffective in depression, mania, schizophrenia Used there is resistance to drug treatmentsUsed there is resistance to drug treatments ““Resets” the electrochemical conductivity of Resets” the electrochemical conductivity of
neuronsneurons Truth: not sure why it worksTruth: not sure why it works
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6767
8. Psychosurgery8. Psychosurgery
Removal of parts of the brain that are Removal of parts of the brain that are malfunctioningmalfunctioning
Frontal lobotomies – not done any moreFrontal lobotomies – not done any more Used primarily for seizure and movement Used primarily for seizure and movement
disordersdisorders Procedure of last resortProcedure of last resort May also produce side effects: confusion, May also produce side effects: confusion,
epilepsy, personality change epilepsy, personality change
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6868
Psychosurgery: Other DiseasesPsychosurgery: Other Diseases
DepressionDepression OCDOCD Anorexia nervosaAnorexia nervosa AnxietyAnxiety PainPain AddictionAddiction Violence/rage attacksViolence/rage attacks Sexual aggression/pedophiliaSexual aggression/pedophilia
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 6969
9. Non-conventional therapies9. Non-conventional therapies
1.1. Nonprofessional Family SupportNonprofessional Family Support Preventive intervention e.g. Preventive intervention e.g. Head Start programHead Start program Decrease expense, increase availability of Decrease expense, increase availability of
educational mental health care for adults and educational mental health care for adults and childrenchildren
Formed by parent volunteers Formed by parent volunteers e.g. family counseling, drop-in centres, e.g. family counseling, drop-in centres,
information programsinformation programs Partially effectivePartially effective
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 7070
More non-conventional therapiesMore non-conventional therapies
2. Residential Treatment2. Residential Treatment last resort for intractable problemslast resort for intractable problems Large centres, group homes, or community Large centres, group homes, or community
residencesresidences Usually try to change living circumstances in Usually try to change living circumstances in
addition to problems of patientaddition to problems of patient Used when patient is a danger to self and othersUsed when patient is a danger to self and others
Very expensive and poor availabilityVery expensive and poor availability For adults onlyFor adults only
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 7171
More non-conventional therapiesMore non-conventional therapies
3. Parent Training3. Parent Training Behavioural Training for parenting skillsBehavioural Training for parenting skills Usually combined with direct intervention with Usually combined with direct intervention with
childchild individual or group settingindividual or group setting Particular effective for parents of young childrenParticular effective for parents of young children
PSYC4080 6.0DPSYC4080 6.0D Assessment, Diagnosis, TreatmentAssessment, Diagnosis, Treatment 7272
More non-conventional therapiesMore non-conventional therapies
4. Therapeutic Foster Family Treatment4. Therapeutic Foster Family Treatment Removal of child from family home and Removal of child from family home and
placement in a foster homeplacement in a foster home Foster parents have been trained on Foster parents have been trained on
psychological techniques and are supervisedpsychological techniques and are supervised Efficacy unknownEfficacy unknown