CHYS 2P35 - Lecture 2: Diagnosis and Treatment PDF

CHYS 2P35 -- Diagnosis and Treatment Lecture 2 notes [Experiences of Client and Clinician ] Patient: A person who receives treatment Client: A person seeking psychological services - This language reflects the view that the people in treatment ***collaborate*** with those who treat them ra...

CHYS 2P35 -- Diagnosis and Treatment Lecture 2 notes [Experiences of Client and Clinician ] Patient: A person who receives treatment Client: A person seeking psychological services - This language reflects the view that the people in treatment ***collaborate*** with those who treat them rather than a passive recipient - Child voice Clinician: The person providing treatment **The Clinician** Psychologist: Health care professional offering psychological services Psychiatrists: People with degrees in medicine (MDs) - Receive specialized advanced training in diagnosing and treating people with psychological disorders Clinical psychologist: A mental health professional with training in the behavioral sciences who provides direct service to clients; scope of practice includes diagnosis *Q. How about other professions?* Child and Youth Care Practitioner, Registered Psychotherapist, Social Worker, etc. - children having a safe place and resource for them to go and talk to when they are in a tough spot - Working on their emotional regulation and working that into a school setting [Importance of Language ] **Labels to describe behaviour -- not the individual** its important using the language that the client is most comfortable using some people are proud of their disorder and want to be identified by it... some do not **Looking at things differently...but what is most preferred?**  [The Diagnostic Process] Definition: A systematic approach to classifying the disorders clinicians see in clients DIAGNOSTIC MANUAL - serves to provide consistent diagnoses across people - With an accurate diagnostic manual, it is possible to provide consistent diagnoses based on the presence or absence of certain symptoms. \*An example... Anxiety Disorder - BUT...is a label needed? - Emphasis on observation and interview (indirect assessment)... TEXTBOOK Reliability: The degree to which clinicians provide diagnoses consistently across individuals who have a particular set of symptoms\ E.g., generalized anxiety disorder vs. not\ E.g., generalized anxiety disorder vs. social anxiety\ \ Validity: The extent to which a test, diagnosis, or rating accurately and distinctly characterizes a person's psychological status.\ - In lay terms, you are using the appropriate tool for the measure that you are trying to take. See Connect also! **Example: Validity** Invalid: measuring height with a scale.\ Valid: measuring height with a tape measure. Q. How about ADHD?\ Use of Standardized Measures\ Degree of Correspondence ***Diagnostic and Statistical Manual of Mental Disorders* (*DSM)*** - A book published by the American Psychiatric Association that contains standard terms and definitions of psychological disorders - Currently in the 5th edition (*D S M-5-TR, 2022*) - The *D S M-5* is divided into 22 chapters that include sets of related disorders. It contains standard terms and definitions of psychological disorders. - It is in print and online version making it more user-friendly. - Still a lot of work to be done...research around cause. It does include - psychological and biological challenges together... TABLE 1: Disorders in D S M-5 +-----------------------+-----------------------+-----------------------+ | **Category** | **Description** | **Examples of | | | | diagnoses** | +=======================+=======================+=======================+ | **Neurodevelopmental | **Disorders that | **Autism spectrum | | disorders** | usually develop | disorder** | | | during the earlier | | | | years of life, | **Specific learning | | | primarily involving | disorder\ | | | abnormal development | Attention-deficit | | | and maturation** | hyperactivity | | | | disorder** | +-----------------------+-----------------------+-----------------------+ | **Schizophrenia | **Disorders involving | **Schizophrenia** | | spectrum and other | symptoms of | | | psychotic disorders** | distortion in | **Brief psychotic | | | perception of reality | disorder** | | | and impairment in | | | | thinking, behavior, | | | | affect, and | | | | motivation** | | +-----------------------+-----------------------+-----------------------+ | **Bipolar and related | **Disorders involving | **Bipolar disorder\ | | disorders** | elevated mood** | Cyclothymic | | | | disorder** | +-----------------------+-----------------------+-----------------------+ | **Depressive | **Disorders involving | **Major depressive | | disorders** | sad mood** | disorder\ | | | | Persistent depressive | | | | disorder** | +-----------------------+-----------------------+-----------------------+ | **Anxiety disorders** | **Disorders involving | **Panic disorder\ | | | the experience of | Agoraphobia\ | | | intense anxiety, | Specific phobia** | | | worry, fear, or | | | | apprehension** | **Social anxiety | | | | disorder** | +-----------------------+-----------------------+-----------------------+ | **Obsessive-compulsiv | **Disorders involving | **Obsessive-compulsiv | | e | obsessions and | e | | and related | compulsions** | disorder\ | | disorders** | | Body dysmorphic | | | | disorder\ | | | | Hoarding disorder** | +-----------------------+-----------------------+-----------------------+ | **Trauma and | **Responses to | **Posttraumatic | | stressor-related | traumatic events** | stress disorder\ | | disorders** | | Acute stress | | | | disorder\ | | | | Adjustment disorder** | +-----------------------+-----------------------+-----------------------+ | **Dissociative | **Disorders in which | **Dissociative | | disorders** | the normal | identity disorder\ | | | integration of | Dissociative | | | consciousness, | amnesia** | | | memory, sense of | | | | self, or perception | | | | is disrupted** | | +-----------------------+-----------------------+-----------------------+ | **Somatic symptom | **Disorders involving | **Illness anxiety | | disorders** | recurring complaints | disorder\ | | | of physical symptoms | Functional | | | that may or may not | neurological symptom | | | be associated with a | disorder** | | | medical condition** | | +-----------------------+-----------------------+-----------------------+ | **Feeding and eating | **Disorders | **Anorexia nervosa\ | | disorders** | characterized by | Bulimia nervosa\ | | | severe disturbances | Binge eating | | | in eating behavior** | disorder** | +-----------------------+-----------------------+-----------------------+ **Diagnostic Steps** Principal diagnosis: The disorder that is considered to be the primary reason the individual seeks professional help Differential diagnosis: The process of systematically ruling out alternative diagnoses \*Example... Comorbid: The situation that occurs when multiple diagnostic conditions occur simultaneously within the same individual. - For example, major depression and O C D exist together [Case Formulation, Treatment, and Rapport Building] **Case Formulation** To gain a full appreciation of the client's disorder, the clinician develops a case formulation: - A clinician's analysis of the factors that might have influenced the client's current psychological status - protective and risk factors - Biopsychosocial model **Cultural Formulation** Includes the clinician's assessment of the client's degree of \*\*\**identification* with the culture of origin - The culture's beliefs about psychological disorders, the ways in which the culture interprets particular events, and the cultural supports available to the client - Cultural concepts of distress...ways in which individuals or specific cultural groups tend to 'live' the experience, interpret it, and cope with interfering thoughts and emotions. Q. Why is this important? Bring in identification... **Planning the Treatment** Treatment plan: The outline for how therapy should take place Goals of treatment - Immediate goals - include crisis management and ensuring an individual is not a risk to themselves or to other people. Rapport building and therapeutic listening are also important in this stage. Why and how is this done differently with clients? - Making sure the person and the people around them are safe - Building a therapeutic relationship - Short-term goals - aimed at symptom reduction and addressing interfering behaviour, emotions, and thinking patterns. - Teaching coping strategies - Long-term goals - more deep rooted changes to the client's overall psychological health. Component: Relapse Prevention -- e.g, fear of flying - ways to prevent the individual by putting in plans ahead of time to prevent form fears and anxiety coming back - \*Who should be continually consulted? Determine treatment site - Psychiatric hospitals - Specialized inpatient treatment centers - Outpatient treatment - Day Treatment A CASE Sally has been seeing a psychologist for several weeks. They have been successful equipping Sally with coping strategies to help support her report of depressive symptoms. Coping strategies include: an assessment of values, reframing thoughts, deep breathing. Sally is completing a daily record of her thoughts and attempting to reframe them. What stage is she at? **Academic Goals** - The more it can be written out in a concrete manner, you have more criteria to go by - Help for the individual working and the parents to say "did I meet that goal" **Modality of Treatment** Modality: Form in which the clinician offers psychotherapy - Individual psychotherapy - Treatment in which therapist works on a one-to-one basis with the client - Can take place in a private practice, a hospital setting, clinic setting (wide range) - Family therapy - Treatment in which the therapist works with several or all members of the family - Can be working on family dynamics or family issues - Group therapy - Treatment in which therapist facilitates discussion among several clients who talk together about their problems - Individuals who have a commonality where it makes more sense to allow clients to share experiences Q. What are some variables that may be important in choosing modality? - Family issue family therapy may be important due to separation of parents or divorce (family therapy) - Individual psychotherapy it is important to work on depressive symptoms and may be better in a 1 on 1 format (individual therapy)  **Evidence Based Practice in Psychology** Clinical decision making that integrates the best available research evidence and clinical expertise in the context of the cultural background, preferences, and characteristics of clients COURSES OF TREATMENT - The clinician's role in treatment - Quality of the relationship between the client and clinician is a crucial determinant of whether therapy will succeed or not - Making sure that you are able to obtain that relationship as it helps to foster the clients treatment - Making the process a collaboration regardless of clients age (offering a choice) - The client's role in treatment - Psychotherapy is a joint enterprise in which the client plays an active role OUTCOME OF TREATMENT - The client remains in treatment until the treatment runs its course, shows improvement, and maintains this improved level of functioning Remission: - Occurs when the individual's symptoms no longer interfere with his or her behavior and are below those required for a DSM diagnosis - E.g., OCD work Q. How about prevention? - e.g., Kindergarden classrooms