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© Cengage Learning 2016 © Cengage Learning 2016
Assessment and Classification of Mental Disorders
3
© Cengage Learning 2016
• Degree to which a test or procedure yields the same results repeatedly under the same circumstances
• Test-retest reliability– Same results when given at two different
points in time
• Internal consistency – Various parts of measure yield similar or
consistent results
Reliability
© Cengage Learning 2016
• Interrater reliability – Consistency of responses when scored by
different test administrators
Reliability (cont’d.)
© Cengage Learning 2016
• Extent to which a procedure actually performs its designed function
• Predictive validity– How well a test predicts a person’s behavior
or response
• Construct validity– How well a test or measure relates to the
characteristics or disorder in question
Validity
© Cengage Learning 2016
• Content validity– How well a test measures what it is intended
to measure
– Assesses all areas known to be associated with a particular disorder
Validity (cont’d.)
© Cengage Learning 2016
• Standard administration
• Professionals administering a test must follow common rules or procedures
• Standardization sample– Group of people who initially took the
measure• Performance is used as standard or norm
– Test-takers should be similar to the standardization sample for test to be valid
Standardization
© Cengage Learning 2016
• Psychological assessment – Gathering information and drawing
conclusions• Traits, abilities, emotional function, and more
• Four main assessment methods– Observations
– Interviews
– Psychological tests and inventories
– Neurological tests
Assessment and Classification of Mental Disorders
© Cengage Learning 2016
• Controlled (analogue) observations – Made in laboratory, clinic, or other contrived
setting
• Naturalistic observations – Informal observations made in a natural
setting (schoolroom, office, hospital ward, home)
– Usually in conjunction with an interview
• Observe appearance and behavior
Observations
© Cengage Learning 2016
• Observe client and collect data about the person’s life history, current situation, and personality
• Analyze– Verbal behavior
– Nonverbal behavior
– Content
– Process of communication
Interviews
© Cengage Learning 2016
• Interviews vary in degree of structure and formality
• Structured interviews– Common rules and procedures
– Standard series of questions
– Disadvantage: limit conversation
– Advantage: collect consistent and comprehensive information
Types of Interviews
© Cengage Learning 2016
• Objective: evaluate client’s cognitive, psychological, and behavioral functioning
• Uses questions, observations, and tasks
• Clinician considers the appropriateness and quality of the client’s responses– Forms tentative opinion of diagnosis and
treatment needs
Mental Status Examination
© Cengage Learning 2016
• Standardized tools
• Measure characteristics such as personality, social skills, and more
• Projective personality tests– Test taker presented with ambiguous stimuli
and asked to respond in some way• Rorschach Technique
• Thematic Apperception Test (TAT)
• Sentence-completion test
• Draw-a-person test
Psychological Tests and Inventories
© Cengage Learning 2016
• Do not meet reliability and validity standards
• Analysis and interpretation of responses subject to wide variation
• May have limited cultural relevance
Problems with Projective Personality Tests
© Cengage Learning 2016
• Used to assess depression, anxiety, or emotional reactivity
• May involve completion of open-ended sentences
• Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2)– Interpretation is complicated
• Beck Depression Inventory (BDI)
Self-Report Inventories
© Cengage Learning 2016
The Ten MMPI-2 Clinical Scales and Sample MMPI-2 Tests (Partial)
© Cengage Learning 2016
• Primary functions– Obtain intelligence quotient (IQ), or estimate
of current level of cognitive functioning
– Provide clinical data
• Wechsler scales– Used for ages 16 and older
• Stanford-Binet scales– Used for ages 2 to 85
Intelligence Tests
© Cengage Learning 2016
• Fail to consider the effects of culture, poverty, discrimination, and oppression
• Do not consider multidimensional attributes of intelligence
• Have a poor level of predictive validity– Do not accurately predict future behaviors or
achievement
– Motivation and work ethic may matter more
Criticisms of Intelligence Tests
© Cengage Learning 2016
• Bender-Gestalt Visual-Motor Test– Involves copying geometric designs
• Halstead-Reitan Neuropsychological Test Battery– Differentiates patients with brain damage
• Can provide valuable information about the type and location of the damage
Tests for Cognitive Impairment
© Cengage Learning 2016
The Nine Bender Designs
© Cengage Learning 2016
• Allows noninvasive visualizations of brain structures
• Electroencephalograph (EEG)
• Computerized axial tomography (CT)
• Magnetic resonance imaging (MRI)– Functional MRI (fMRI)
– Diffusion tensor imaging (DTI)
• Magnetoencephalography (MEG)
• Positron emission tomography (PET)
Neurological Tests
© Cengage Learning 2016
• Psychiatric classification system– Similar to a catalogue, with detailed
descriptions of each disorder• Patterns of behavior are distinctly different
– Each category accommodates symptom variations
Diagnosing Mental Disorders
© Cengage Learning 2016
• Widely used classification system– DSM-I (1952): Identified 106 mental disorders– DSM-II (1968): Identified 182 disorders– Revisions (DSM-II, DSM-III, DSM-III-R, DSM-
IV, DSM-5) increase reliability and validity
Diagnostic and Statistical Manual of Mental Disorders (DSM)
© Cengage Learning 2016
DSM-5 Disorders – Categories and Features
© Cengage Learning 2016
DSM-5 Disorders – Categories and Features (cont’d.)
© Cengage Learning 2016
Interrater Reliability of DSM-5 Diagnostic Categories
© Cengage Learning 2016
Interrater Reliability of DSM-5 Diagnostic Categories (cont’d.)
© Cengage Learning 2016
• DSM-5 is a categorical model– Some professionals believe ineffective for
diagnosis
• Dimensional classification system– Disorders reside on a continuum from normal
to severe forms of a disorder
Dimensional Perspective
© Cengage Learning 2016
• Remains a categorical system with exceptions
• Exceptions to DSM-5 categorical system– Autism spectrum disorder
– Risk syndromes• Indicate milder forms of well-established disorders
– Enhanced assessment procedures• Allowing more than a “yes or no” answer
Final Version of the DSM-5
© Cengage Learning 2016
• Subtypes
• Specifiers
• Remission
• Cost-cutting measures
• Comorbidity– Presence of two or more disorders in the
same person
Other Attributes of the DSM-5
© Cengage Learning 2016
• Determining whether a behavior is consistent with cultural norms– Responsibility of the clinician
• Bias
• DSM-5 includes guidelines for conducting a cultural assessment– 16 questions
Cultural Factors in Assessment
© Cengage Learning 2016
• Changes in the criteria for some disorders– May increase the number of individuals
receiving a diagnosis
• Addition of some disorders– Example: gambling disorder
• Bereavement removed as an exclusionary criteria when diagnosing depression
Changes in the DSM-5 Classification System
© Cengage Learning 2016
• Labeling a person can lead to overgeneralization, stigma, and stereotypes
• Labeling may lead a person to believe they possess characteristics associated with the label
• Label are required by social systems– Do not provide precise information required
by health care organizations
Objections to Classification and Labeling
© Cengage Learning 2016
• Current trends– Increased reliance on the biological model
• Advances based on biological and neurological research
– Effort to discover specific biomarkers associated with different conditions
– Increased consideration of psychological, social, and sociocultural factors
– Growing consensus that mental health professionals not merely objective observers
Contemporary Trends and Future Directions
© Cengage Learning 2016
• How do we know if psychological tests and evaluation procedures are accurate?
• How do mental health professionals evaluate a client’s mental health?
• How do professionals make a psychiatric diagnosis?
• What changes are occurring that will affect assessment?
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