Abnormal psych ch 2

Assessment, Classification, and Treatment

• Learning Outcomes: By the end of the class, students should be able to identify, describe, and apply methods of assessment, approaches to classification, approaches to treatment, and abnormal behavior and society.

Assessment Methods

• Clinical Interview: The most widely used assessment method. Formats vary, but typically involve gathering information on present complaints, precipitating events, and how the problem impacts daily functioning. Examples include "What brings you to see a psychologist today?"
• Types of Clinical Interviews:
  • Unstructured: Open-ended questions based on client responses. Pros: flexible, gets maximum information, rapport with client. Cons: can stray from topic and lack consistency, not repeatable.
  • Semi-structured: Slightly more structured with guidelines to gather specific information (e.g., family history), with some flexibility. Pros: good blend of flexibility and structure, more consistent across interviewees. Cons: still less structured than structured.
  • Structured: Follows a pre-set checklist and asks questions in a fixed order. Pros: consistent, repeatable, easier to standardize. Cons: less flexible, minimizing client input.
• Mental Status Examination: In formal interviews, interviewers observe appearance (attire, grooming), mood, attention, thinking processes, memory, orientation, and judgment, all providing insights into potential mental illness.
• Psychological Tests of Intelligence:
  • Intelligence: A global capacity to understand the world and adapt to its challenges, measured with variable outcomes.
  • Intelligence Tests: Include aspects like literacy, numeracy, and other skillsets. Intelligence is dependent on time, culture, and worldly practices.
  • Stanford-Binet Intelligence Scale (SBIS): Measures mental age, which is compared to chronological age to derive IQ (intelligence quotient). IQ = MA/CA x 100.
  • Background of SBIS: In 1904, the French government sought to develop tools for identifying students needing extra help in school. This led Alfred Binet to develop intelligence assessments, eventually leading to scales like SBIS
  • Wechsler Scales: Include verbal and performance subtests assessing various cognitive abilities (knowledge of verbal concepts and spatial relations); commonly used.
  • IQ Distribution: Standardized IQ scores, particularly the Wechsler and Stanford-Binet scales, are frequently used in North America and follow a normal distribution. The average IQ is 100.
• Psychological Tests of Personality: Assessing personality traits, typically through:
  • Self-report tests: Include questions or statements for individuals to rate their own thoughts, feelings, and behaviors (e.g., Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI), Personality Assessment Inventory (PAI), Millon Clinical Multiaxial Inventory (MCMI)). Advantage: Can account for cultural variances, standardized tests, but can still be affected by biases.
  • Projective tests: Individuals respond to ambiguous stimuli, with the assumption responses reveal personal attitudes, beliefs, and values (e.g., Rorschach Inkblot Test, Thematic Apperception Test (TAT), House-Person-Tree Test). Advantage: good for establishing rapport, often used with children, but subjective/interpretations of results dependent on examiner.
  • Rorschach Inkblot Test: Participants describe what they see in inkblots; interpretations are used to understand personality features.
  • Thematic Apperception Test (TAT): Participants tell stories about ambiguous scenes; these stories reveal insights into the individual's experience and motives.
  • House-Person-Tree test: Participants draw these; interpretations of the drawing are used in evaluating the emotional, social and cognitive functioning.
  • Neuropsychological Assessment: Used to determine if psychological issues are related to neurological damage or brain defects (e.g., Bender Visual Motor Gestalt Test, Luria-Nebraska Neuropsychological Battery (LNNB), Halstead-Reitan Neuropsychological Battery (HRNB)).
• Behavioural Assessments: Focuses on observable behavior; a psychometric approach using tests like Rorschach. TAT, and MMPI to analyze personality in determining behavior patterns; Includes behavioral interviews and direct observations and self-monitoring.

Classification

• Current Systems:
  • Diagnostic and Statistical Manual of Mental Disorders (DSM): Classifies abnormal behavior patterns as mental disorders; based on shared symptoms/features, with criteria that are used to determine a diagnosis.
  • International Statistical Classification of Diseases and Related Health Problems (ICD): A worldwide standard for classifying diseases.
  • Chinese Classification of Mental Disorders (CCMD): A classification system tailored to Chinese and Asian contexts.
• DSM Features:
  • Grouping of abnormal behaviors by shared characteristics.
  • Diagnosis is based on meeting specific criteria.
• Evaluation of DSM System:
  • Reliability: Consistency of diagnoses.
  • Validity: Accuracy in classifying disorders.
  • Predictive Validity: Effectiveness in forecasting future outcomes.
  • Cultural Factors: Consideration of cultural influences on mental health.
• Details of DSM:
  • DSM-5 published in 2013, with a revised edition (DSM 5-TR) published in 2022.
  • DSM-5 classifies psychological disorders according to developmental models.
  • Incorporates new diagnoses and reclassifies some existing ones.

Treatment Methods

• Helping Professionals:
  • Clinical Psychologist: Usually requires a doctoral degree, specializes in administering tests, diagnosing psychological disorders, and practicing psychotherapy.
  • Psychiatrist: Has a medical degree (M.D.) and residency in psychiatry, can diagnose, and treat disorders, conduct therapy and prescribe medications.
  • Social Worker: Holds a master's degree, knowledgeable in community resources, and often conducting individual or family therapy.
• Biological Therapies:
  • Medication: Anti-anxiety drugs, anti-psychotic drugs, antidepressants, lithium.
  • Electroconvulsive Therapy (ECT): Induces a seizure to treat severe depression. Usually a last resort.
  • Deep Brain Stimulation: Implants electrodes into the brain to influence mood.
  • Psychopharmacology: Examines drug effects on behavior and psychological functioning; studies the use of psychoactive medications to treat emotional disorders.
• Types of Psychotherapy:
  • Psychodynamic Therapies: Focus on unconscious drives impacting behavior; rooted in early experiences; techniques include free association and transference.
  • Behavioral Therapies: Focus on observable behaviors and environmental factors. Techniques like systematic desensitization and gradual exposure are employed. Focuses on adapting behavior, not personality.
  • Humanistic-Existential Therapies: Focus on self-awareness, personal growth, and individual choices in shaping experience.
  • Cognitive-Behavioral Therapies (CBT): Focus on identifying and changing maladaptive beliefs and thought patterns. Common techniques include Rational Emotive Therapy (RET), Beck's Cognitive Therapy, and Meichenbaum's Cognitive-behavioral Therapy.
  • Eclectic Therapy: Draws on various approaches, depending on the situation.
  • Group, Family, and Couple Therapy: Involves groups or families to explore issues.
  • Computer-assisted Therapy: Use of technology, often suitable for dementia patients.
  • Indigenous Healing Perspectives: Emphasizes the importance of mental well-being through a balanced approach considering physical, mental, emotional, and spiritual aspects; views treatment through various levels (individual, family, and community) promoting interpersonal connection.

Abnormal Psychology & Society

• Civil vs. Legal Commitment: Legal frameworks governing placement of a person in a psychiatric institution; (with or without consent). Different depending on nature and cause of behavior.
  • Civil Commitment: Individual deemed mentally disordered and dangerous to themselves or others.
  • Legal Commitment (Criminal): Used for placing individuals found "Not Criminally Responsible" due to mental disorder.
• Predicting Dangerousness: Often complex; various factors need careful consideration, including the person's current behavior, history, and circumstances.
• Duty to Warn: Therapists' obligation to warn potential targets of threats made by a patient towards them. There may be legal conflict of confidentiality.
• Tarasoff Case (1976): Landmark legal case which established that in some scenarios, the therapist's duty to warn overrides the patient's right to confidentiality.
• Patient's Rights: Patients retain the right to treatment. More specifically, the right to refuse treatment (except in certain cases)
• Mental Illness and Criminal Responsibility: The legal parameters surrounding diagnosing and determing responsibility after mental illness; includes competency to stand trial and the insanity defense which are often based on mental disorder severity.