PowerPoints Abnormal
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angbatiato on March 17, 2012
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63 terms
Terms | Definitions |
|---|---|
 What makes behavior "abnormal" | -Distress -Impairment -Risk -Socially/Culturally unacceptable |
| Stigma | A label that causes certain people to be regarded as different, defective, and set apart from mainstream members of society. |
| History of Abnormal Psych | -witch hunts -trepanning (drill hole in brain) -exorcism |
| Hippocrates | -470-377 BC -Black bile ("melancholic") -Yellow bile ("choleric") -Phlegm ("phlegmatic") -Blood ("sanguine") |
| Benjamin Rush | Used fright to counteract patients' mental illness |
| Middle Ages | -explanations of abnormality -asylums (Bedlam) -treatments |
| Key Figures of Reform Movement | Vincenzo Chiarugi Philippe Pinel-ordered removal of chains from women in insane asylum Jean- Baptiste Pussin |
| Challenges of the late 20th Century Reform Movement | -Medications -Deinstitutionalization Movement -Managed Health Care |
| Contemporary Trends | -Positive Psychology -Drug Revolution -Managed Health Care -Research |
| Influence of Multicultural Psychology | -Social conditioning -Cultural values and influences -Sociopolitical influences -Bias in diagnosis |
| What is culture? | Shared elements involved in perceiving, communicating, believing, passed down from one generation to the next. |
| Intersection between Clinical Reality and Culture | -Culture affects clinical reality (treatment dependent on culture, stigmatized?, can be 2 different realities) -Curing the Disease vs Healing the Client -Ways in which mental illness has meaning--client may not want to be treated for psychological (focus might be on somatic) -Clinical continues to evolve |
| C's of Cultural Formulation | -Cultural identity -Cultural explanation of illness -Cultural interpretations of social stressors/supports -Cultural elements between client and clinician -Cultural element of stigma |
| Questions about cultural formulation | -Client's cultural identity -Does client provide a good cultural explanation of problem -Cultural factors related to psychosocial env that affects functioning -Does presentation fall into culture-bound syndromes -Multicultural differences -Cultural assessment for diagnosis/care |
| Mental Disorder | -Def: A clinically significant behavioral or psychological syndrome -Associated with present distress or risk of suffering pain/death -Is NOT just a response to an event |
| Deviance | Only a dysfunction if it is a SYMPTOM of dysfunction |
| DSM-IV | -Classification system based on medical model -Descriptive, not explanatory -Doesn't focus on a theory -Polythetic: different levels of symptoms but still meet criteria of dysfunction -Multiaxial |
| Diagnostic Process | -Reported and observable symptoms -Diagnostic and differential diagnosis -Case formulation (how YOU understand client) -Final diagnosis reported using DSM codes |
| Differential diagnosis | Ruling out all possible alternative diagnoses |
| Decision tree | Yes/no questions in DSM about client's symptoms that lead to diagnosis |
| SCID | Structured Clinical Interview for DSM-IV used to diagnose disorders |
| Axis I | Clinical syndrome that is focus of attention -More than one dx -- label principle dx -More info needed -- deferred |
| Axis II | -Personality disorders - Pervasive, long-term, adolescent onset. Stable over time but leads to impairment -Mental Retardation - Subaverage IQ (below 70), onset before 18, impairment in adaptive functioning **borderline is also coded on Axis II |
| Axis III | Medical conditions relevant to mental disorder -if no GMC, code None -Differential: May code on Axis I and II -Can consider Medical Disorder due to GMC |
| Axis IV | Psychosocial and environmental problems -Stressors and negatives -Problem with primary support group, educational problems, housing problems, economic problems, etc. |
| Axis V | Clinician's judgment of level of functioning -Global Assessment of Functioning (GAF) -Changes and is monitored -Subjective -Clinician rates based on worst case scenario (look at severity and level of functioning) |
| Has full criteria been met for diagnosis? | -Consider number and intensity of symptoms, along with resulting impairment. Code the severity. |
| Rule outs | R/O -- when you have a suspicion but cannot confirm diagnosis |
| Provisional Dx | Strong presumption |
| NOS | Not Otherwise Specified |
| Culture "ADRESSING" | Age Disability Race Ethnicity Sexual Orientation SES Indiginous Nationality Gender |
| Cultural Competency | Knowledge Skills Awareness |
| Culture and Diagnosis | -Remember that personality disorders may present differently, depending on how connections are made within the culture -Health issues may be private -Stressors could include SES or type of support group |
| Example: Culture and Schizophrenia | -1% prevalence -Universal, so must be genetic component |
| Neurobiology of adaptation and learning | -Brain adapts to emotion, stress, trauma, therapy, experience, cultural learning---The Brain is Influenced by CULTURE |
| Clinical Method of Making Decisions | Aggregating data from clients through interviewing to make decisions/judgments |
| Actuarial Method of Making Decisions | Aggregating data from empirical evidence to make decisions/judgment |
| Self Report | -Can be helpful (a lot goes on internally) -People aren't always best historians -Social desirability may come into play |
| Meehl, 1954 | -Said that equations are better than clinical judgment |
| Goldberg, 1968 and Leli & Filskov, 1984 | -Proved better than clinicians in judgment |
| Einhorn, 1978 | -Studied Lymphoma and survival time and found that clinical judgment produced no relation to survival time |
| 4 Ways to Aggregate Information as a Clinician | I: Actuarial & Self-report - ex: BDI II: Clinical & Self-report - Client subjectively reports symptoms, and questions must be good III: Clinician & Actuarial - Clinicians sorted data IV: Clinician & Informal - Case conceptualization with no actual data |
| Clinical Guidelines | -Guidelines: Rely on standard set of items (like BDI), but not often used in practice -Practice: More judgment that works = More practice (???) -Matching: If practiced technique matches diagnosis and yields positive results (Pitfall: not being comfy w/technique) |
| When Do Clinicians Make Valid Judgments | -When based on theory -When it 's a rare event that does not fit actuarial formula -When it's a complex event, and nuances are noticed |
| Why Don't Clinicians Follow Rules | -Lazy -Time constraints -Biased by personal experience -Gravitate toward diagnosis -Overconfident |
| Benefits of Actuarial Judgment | -Stats are consistent, but clinicians may vary -Stats based on predictive power, but clinicians weigh issues differently -No self-fulfilling prophecies (leading ?s) -Stats don't see skewed sample of humanity -Stats can't be overconfident in judgments |
| Pros and Cons of Client Self-Report | Pros: Client is expert, easy to administer, good psychometric qualities Cons: It's all relative, lack expertise when evaluating own symptoms, dishonesty |
| Pros and Cons of Clinician Report | Pros: Nonverbals, more objective than client, can handle rare events, use of theory Cons: Theory can negatively influence what you see/don't see, reliability isn't great, inconsistency |
| Westen & Weinberger Reading, 2004 | -All judgment is clinical and subjective, because it is humans that come up with formula -Clinical aggregation may be inferior but it's needed to frame hypothesis, create formulas, and think about client |
| Psychological Assessment | -Procedure in which clinician evaluates a person in terms of psychological, physical, and social factors that influences functioning |
| Unstructured Interview | -Series of open questions |
| Structured Interview | -Standardized series of questions with predetermined wording and order -Ex: SCID |
| Mental Status Examination | -MSE -Assess appearance, speech, mood, affect, thought content, sensorium, awareness, etc. -Remember culture can affect MSE |
| Appearance and Behavior | -Physical appearance (malodorous, disheveled, thin, under the influence -Attitude (suspicious, guarde, proximity) -Motor behavior (hyperactivity, psychomotor agitation/retardation, catatonia) |
| Abnormal Speech | -Look to culture first -Rate, rhythm, pitch, quantity, pressured, variation |
| Affect | -Outward expression of emotion and mood -Non verbals are important -Blunted, flat, reactive, heightened (up), overly restricted |
| Mood | -Person's individual experience -euthymic (happy), dysphoric (down), euphoric, etc. -Was Affect Congruent with Mood?? |
| Thought Process | -Goal directed? -Illogical? -Tangentiality? -Confabulation (making up memories)? -Mania? |
| Perceptual Experiences | Hallucinations and are they related to GMC |
| Thought Content | -Ideas in person's head (obsessions, delusions, overvalued idea, magical thinking, suicidal, homicidal, phobia) |
| Cognition | -assessed with neuropsychological tests -mini MSE administered |
| Orientation | -Is client aware of time, place, person, event -AOX3 (Alert and oriented with time, place, person) -AOX4 (Alert and oriented with time, place, person, event) |
| Insight and Judgment | -Understanding of illness, events, self, world -Ability to make decisions/plans -Compliance with treatment -Impulsiveness |
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