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Psy 275 Ch. 7 and 8
| Question | Answer |
|---|---|
| What defines psychopathology | included criteria such as personal distress to the individual deviance from cultural norms, statistical infrequency, and impaired social functioning |
| Jerome WakeField (1990s) proposed a theory-harmful dysfunction theory | the definition of a disorder should include aspects of harmfulness and dysfunction |
| In DSM-5-TR, mental disorder is defined as a | "clinically significant disturbance" in "cognition, emotion regulation, or behavior" that indicates a "dysfunction" in "mental function" that is "usually associated with significant distress or disability" in work, relationships, or other areas |
| DSM reflects a medical model of psychopathology | in which each disorder is an entity defined categorically and features a list of specific symptoms |
| DSM I | published by the APA in 1952 |
| DSM II | followed as a revision in 1968. Psychoanalytic/ Freudian influence |
| Both DSM I and DSM II contained only 3 broad categories of disorders | 1. psychoses (schizo) 2. neuroses (depression) 3. character disorders (personality) |
| DSM I and DSM II represented | "the accumulated clinical wisdom of the small number of senior academic psychiatrists who staffed the DSM task force" -offering relatively vague descriptions of clinical conditions -not scientifically or empirically based |
| DSM III | published in 1980, very dissimilar from DSM I and II -it reflected an approach to defining mental disorders that differed substantially -much greater extent on empirical data, specific diagnosis criteria, dropped any allegiance to a theory of therapy |
| DSM III introduced the ______ ______ system and it had 265 disorders in total | multiaxial assessment |
| 5 distinct axes of the multiaxial assessment | Axis 1: included disorders thought to be more episodic Axis II: included disorders thought to be more long-lasting Axis III and IV: offered a place to list med. conditions and psychosocial problems Axis V (Global Assessment of Functioning Scale) |
| Axis V (Global Assessment of Functioning Scale) | provided clinicians an opportunity to place the client on a 100-point continuum describing the overall level of functioning |
| In May 2013 _____ was published | DSM-5 -first revision of the manual in about 20 yrs. -Led by David Kupfer and Darrel Regier |
| In March 2022, ______ was published. It is considered a minor revision, with only 1 new disorder added | DSM-5-TR |
| New Features in DSM-5 and DSM-5-TR | the authors shifted away from traditional Roman numerals toward Arabic numeral instead; enable more frequent minor updates -the multiaxial assessment system was dropped altogether from DSM-5 |
| New Disorders in DSM-5 and DSM -5-TR | Premenstrual dysphoric disorder -disruptive mood dysregulation -binge eating -mild neurocognitive disorder -somatic symptom disorder -hoarding disorder |
| Premenstrual dysphoric disorder | essentially a severe version of PMS including a combo. of at least 5 emotional and physical symptoms |
| Disruptive Mood Dysregulation Disorder | frequent temper tantrums in children 6-18 yrs. old that are clearly below the expected level of maturity and occur at least in 2 setting (3 tantrums per week) |
| Binge eating disorder | part of bulimia nervosa but lacks the part in which the person tries to subtract the calories through compensatory behaviors like excessive exercise |
| Mild neurocognitive disorder | a less intense version of major neurocognitive problems like dementia and amnesia |
| "Bereavement exclusion" formerly included in the | diagnostic criteria for a major depressive episode was dropped |
| The DSM IV diagnosis of autistic disorder, Asperger's disorder, and related developmental disorders were combined into | autism spectrum disorder in DSM V |
| ADHD, age at which symptoms first appeared changed from | 7 to 12 yrs. old, and number of symptoms required for diagnosis to apply to adults was 5 |
| Substance abuse and dependence combined into | substance use disorder |
| Mental retardation was renamed intellectual disability and then | intellectual development disorder |
| OCD removed from the anxiety disorder category and placed | into its own category |
| The category of mood disorders was split into two categories | depressive disorders and bipolar and related disorders |
| Frequency of binge eating decreased to | twice to once per week in bulimia nervosa |
| Controversy Surrounding DSM 5 and DSM 5-TR -was critical and most vocal critic was Allen Frances | -Diagnostic overexpansion: its diagnosis overlap too much with everyday life -Transparency of the revision process -Membership of the work groups: predominately researchers -field trial problems -price of the book: $199 hardback and $149 paperback |
| Field trial problems | some of the reliability ratings were too low, issues that could have been corrected were cancelled |
| Controversial cutoffs | criteria intended to establish a level of severity that must be met in order for the diagnosis to be assigned -one reason for cutoff- 3rd party payers -upcoding |
| Upcoding | falsely reporting that a client has a DSM diagnosis when in fact they fall short of the criteria -insurance fraud and violation of the professional ethics |
| Cultural Issues | DSM 5 and TR include an outline for cultural formulation designed to help clinicians assess clients -questioned the extent to which culturally diverse populations are included among empirical studies -not reflect minority experiences |
| Critics of the DSM have argued that some diagnostic categories are | biased toward pathologizing a particular gender |
| Premenstrual dysphoric disorder: feminist groups have opposed it as an official diagnosis in the DSM | emphasized it represents a form of gender bias likely to over pathologize women -better understood as a physical or gyn problem |
| Nonempirical Influences | political wrangling and public opinion -financial concerns -pharmaceutical companies |
| DSM is a _____ approach | categorical |
| Dimensional approach | the issue isn't the presence or absence of a disorder, instead is where on a continuum a client's symptoms fall |
| 5-factor model of personality | each of our personalities contains the same 5 basic factors-neuroticism, extraversion, openness to experience, agreeableness and conscientiousness -could constitute the dimensions |
| HiTOP; 5 levels | bottom level-dozens of problematic symptoms and trials that motivate people to seek help. Then they grouped together according to empirical literature. Next level- syndromes/disorders where symptoms and traits in lower level are grouped together |
| HiTOP pt. 2 | into familiar diagnostic terms then grouped into subfactors, which grouped even smaller number of spectra, then grouped into a single higher-order dimension called the p-factor |
| RDoc | based on a few fundamental ideas, all of which emphasize biology-mental disorders are illnesses of the brain, neuroscience is key to understanding, "biosignature" or brain image will identify -psychopathology defined biologically |
| What defines Abnormality? 3 D's | 1. deviance from cultural norms: behaviors or feelings are highly unusual 2. distress: causes the person or others significant distress 3. dysfunction: prevents the person from functioning from day to day life |
| DSM III-R (minor changes from DSM III) | published in 1987 |
| DSM IV | published in 1994 |
| DSM IV-TR | published in 2000 |
| Changes DSM-5 Did not make | emphasis on neuropsychic., dimensional definition of mental disorders, dimensional approach for personality disorders, removing 5 of the 10 personality disorders, emerging measures and models section |
| Validity | measures what it claims to measure |
| Content validity | has content appropriate for what is being measured |
| convergent validity | correlates with other techniques that measure the same thing |
| discriminant validity | does not correlate with techniques that measure something else |
| reliability | yields consistent, repeatable results |
| test-retest reliability | yields similar results across multiple administrators |
| interrater reliability | yields similar results across different administrators |
| internal reliability | consists of items that are consistent with one another |
| clinical utility | improves delivery of services or client outcome |
| An element common to all kinds of psych. assessment is | feedback |
| The Interviewer: Sommers-Flanagan emphasize several skills | 1. quieting yourself: quieting the interviewer's internal, self-directed thinking pattern 2. being self-aware: should be maximized is the interviewer's ability to know how they tend to affect other interpersonally 3. developing + working relationships |
| The Interviewer: Specific behaviors to do | -Eye contact -body language -vocal qualities -verbal tracking -referring to client's by proper name -observing client behavior |
| eye contact | not only facilitates listening but communicates learning |
| body language | face the client, appear attentive, minimize restlessness, and display appropriate facial expressions |
| vocal qualities | pitch, tone, volume and fluctuation in their own voices to let clients know that their words and feelings are deeply appreciated |
| verbal tracking | monitor the train of thought implied by clients' patterns of statements and are thus able to shift topics smoothly |
| Rapport | refers to a positive, comfortable relationship between interview and client 1. put client at ease (small talk) 2. acknowledge the unique situation of the interview 3. enhance rapport by noticing how the client uses language and then following the lead |
| Technique | is what an interviewer does with clients -Cultural mistrust -approach the interview with humility, compassion and appreciation -offer to answer questions -be flexible in methods you use -nonverbal communication -avoid microaggressions |
| cultural mistrust | a tendency to be wary or suspicious of people in positions of authority because of history or direct experiences with racist, unfair, or discriminatory treatment; originally applied to black Americans |
| directive styles | get exactly the info. they need by asking for it, tend to be targeted toward specific pieces of info. (yes or no questions) -historical info., presence or absence of a symptoms of a disorder, frequency of behaviors, and duration -can sacrifice rapport |
| nondirective styles | allow the client to determine the course. Choose to spend a lot of time on some topics and none on others, provide crucial info. that you may not know about -expand on anything that is essential -can fall short in terms of gathering specific info. |
| Specific Interviewer Responses | open and closed ended questions -clarification -confrontation -paraphrasing -reflection of feeling -summarizing/conclusions |
| Clarification | make sure the interviewer has an accurate understanding of the client's comments; sometimes its better to wait then to demand clarification |
| Confrontation | when they notice discrepancies or inconsistencies |
| paraphrasing | used simply to assure clients that they are being accurately heard |
| reflection of feeling | echoes the client's emotions |
| summarizing/conclusions | involves tying together various topics that may have been discussed, connecting statements that may have been made at different points and identifying themes -may consists of a specific diagnosis made or recommendations |
| Pragmatics of the Interview | note taking -audio and video recordings -the interview room: strike a balance between professional formality and comfort -confidentiality -clinical interviews by telepsychology |
| Types of Interviews | intake -diagnostic -structured and unstructured |
| Intake interviews | determines whether the client needs treatment; what form is needed, and whether the current facility can provide that treatment or is referred |
| Diagnostic interview | to diagnose one or more DSM diagnosis |
| Structured interview | predetermined, planned sequence of question, usually to diagnose -produce a diagnosis based on DSM, highly reliable, standardized and straightforward |
| Disadvantages of structured interview | rigid, inhibit rapport, lengthens the interview, don't allow other important topics |
| Unstructured interview | no predetermined or planned questions, improvise |
| SCID | a comprehensive list of questions that directly ask about the specific symptoms of the many disorders in the DSM; most prominent structured interview |
| Mental status exam | quickly assess how the client is functioning at the time of evaluation -categories covered: appearance, behaviors, attitudes, affect and mood, speech and thought, perceptual disturbances, orientation to person, place and time etc. |
| Crisis interviews | provide immediate and effective intervention via suicide hotlines, crisis lines etc. -quickly establishing rapport and expressing empathy |
| Safety planning | clinician helps client take a series of steps to help themselves through a potential suicide crisis: identify warning signs, recall and use own internal coping skills, list external sources of support, distraction, restrict access to weapons or stuff |
| European Americans tend to speak more _____ than native Americans | quickly |
| Jerome Wakefield is the creator of the theory of ____ _____ | harmful dysfunction |
| all editors of the DSM have been published by the | American Psychiatric Association |
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