Cultural, Social, and

Emotions Interpersonal Factors

Not to be confused with Psychopathology can be associated
Mood- persistent period of emotionality with certain
Affect- momentary emotional tone that Cultures
accompanies what we say or do Haitian Voodoo or Malay “amok”
Facial expression or body language Genders
Emotions can have physical effects Phobias, Addictions, and Eating Disorders
which is studied in the field of Health Life stages
Psychology Different periods of development have
different vulnerabilities

Assessing Psychological
Disorders
Clinical Assessment, Diagnosis,
and Research Methods Processes that are central to the study of
psychopathology:
Clinical Assessment- systematic evaluation
and measurement of psychological, biological,
and social factors in a person presenting with
Chapter 3a psychological symptoms
Diagnosis- process of determining whether
the individual meets the DSM-IV- TR
criteria for a psychological disorder

Key concepts in Assessment Key concepts in Assessment

The value of assessments is Validity
Criterion-
measured by
Predictive- can predict course and consequence
Reliability- Consistency Concurrent or Descriptive- describes pop.
Test- retest- across time tested
Convergent- agreement between test and
Inter-rater- across raters theory
Validity- Measures what it’s designed to Standardization- process by which a
Construct- criteria differs for each category set of standards/norms is established for
Content- agreement between experts a technique to ensure its consistency
across different measurements
Methods for Acquiring Client
Key concepts in Assessment Information
One can have high reliability without Clinical Interview
validity, but not validity without Mental Status Exam
reliability Physical Exam
Behavioral Observation and
Assessment
Self-report
Psychological Testing

Acquiring Client Information Acquiring Client Information

Clinical Interview- Detailed history of Can be unstructured (PANSS),
the subject’s life and presenting semistructured (SCID), or structured
problem Important points to cover include
Gathers information on current and past precipitating events
Behaviors family composition and history
Relationships
sexual development
Events
religious beliefs and cultural concerns
Attitudes and Emotions
educational achievement
social-interpersonal history.

Areas covered by the Mental

Acquiring Client Information Status Exam
Mental Status Exam- is a systematic Appearance and Behavior
observation Overt Behavior
MSE is a process of preliminary Dress
determination about which areas should Posture and facial expression
be more thoroughly assessed Motor activity
Mood and Affect
Depressed mood
Inappropriate Affect
Flat
Blunted
Areas covered by the Mental Areas covered by the Mental
Status Exam Status Exam
Intellectual Functioning Thought Process
Vocabulary Speech rate and pattern
Abstractions Logical continuity
Metaphors Delusions (persecution, grandeur, and/or
Memory ideas of reference)
Sensorium Hallucinations (most commonly auditory)
Orientation x 3

Assessing Psychological Assessing Psychological

Disorders Disorders
Physical Exam- Determines the Behavioral Assessment- Measuring,
presence of medical/biological origins observing, and systematically
of symptoms evaluating the thoughts, feelings, and
behavior in the context of the actual
Hyperthyroidism- mimics some anxiety
d/o
situation
Community observation or Role-plays
Hypothyrodism- mimics depression
Goal is to identify target behaviors
Drug induced paranoia or dementia Usually used for children and non-verbal
Medicine overdose or side-effect adults
Brain tumors or other neuropathologies Backs up self-reports

Assessing Psychological Assessing Psychological

Disorders Disorders
Observation- Takes into account the Psychological Tests- Strict standards of
antecedents and consequences of target reliability, validity, and standardization,
behavior NOT like surveys or “personality tests”
Informal Observation and Formal found on web or magazines
Observation (operational definition of Projective Tests- Psychoanalytic measures that
behaviors in specific and measurable present ambiguous stimuli to clients with the
terms) assumption that responses will reveal
Self-Monitoring unconscious conflicts
Behavior Rating Scales Low reliability and validity, therefore
Reactivity- the mere act of observation controversial but sometimes useful
sometimes changes behavior
Rorschach Inkblot Test Thematic Apperception Test

Assessing Psychological Assessing Psychological

Disorders Disorders
Personality Inventories- Self-report Intelligence Quotient- Score on an
questionnaires that assess personal intelligence test estimating a person’s
traits by asking respondents to identify deviation from average test scores,
descriptions that apply to them usually valid, reliable, and normed
WAIS-III and all tests contain
MMPI (Minnesota Multiphasic Personality
Verbal Scales
Inventory) Performance Scales
Empirical (based on collected and evaluated
Shipley Institute of Living Scale
data)
True or False as opposed to a Likert Scale But IQ tests also measure attention,
perception, memory, reasoning, and
comprehension

Assessing Psychological Assessing Psychological

Disorders Disorders
Neuropsychological tests are screening Neuropsychological Tests- Assesses brain
devices which have a high accuracy but and nervous system functioning by
are not immune to testing performance on behavioral tasks
False positives- Finding disorder when there Bender Visual-Motor Gestalt Test
is none Halstead- Reitan Neuropsychological
False negative- No finding of disorder when Battery
there is one Rhythm Test
Strength of Grip Test
Tactile Performance Test
BRIEF-A
Assessing Psychological Assessing Psychological
Disorders Disorders
Neuroimaging- Sophisticated computer- Psychophysiological Assessment-
aided procedures that allow non- Measurement of changes in the nervous
intrusive exam of nervous system system reflecting emotions or cognitions
structure and function (evoked- potential)
CAT or CT Scans EEG- measure electrical activity in the brain
MRI and fMRI (cortex)
PET and SPECT Alpha waves (relaxed and awake)
Delta waves (deep sleep)

Assessing Psychological
Disorders
Clinical Assessment, Diagnosis,
Biofeedback treatments and Research Methods
Meters gauge physiological responses (HR,
BP, etc.) to events which are fed back to
the patient so patient can try to consciously
regulate them
Chapter 3b

Review Review
Two central processes: Two central processes :
Clinical Assessment- Getting information Diagnosis- Seeing where it fits
Clinical Interview Classification
Mental Status Exam Classical categorical approach – Clear
Physical Exam categories
Dimensional approach- Continuum
Behavioral Observation and Assessment
Prototypical approach- Essential 1º
Informal and Formal Observation & Rating
characteristics and a range of variation on 2º
Scales
characteristics
Psychological Testing
Projective, Personality, IQ, &
Neuropsychological
Diagnosing Psychological
Review Disorders
Value of both assessments and Diagnosis- identifying a general
diagnosis are determined by class of problems that hang
Reliability- Consistency together
Validity- Measuring what it says it’s Useful for obtaining information about
measuring Psychological profiles
Standardization (Norming)- Defining Etiology
what is “normal” or statistical majority Treatment
Prognosis

Diagnosing Psychological Diagnosing Psychological

Disorders Disorders
DSM-IV-TR DSM-IV-TR
Empirically based worldwide nosology for Multi-Axial System
psychological disorders Axis I- Clinical disorders
Social and cultural considerations Axis II- Personality disorders and MR
Axis III- Medical conditions
Axis IV- Psychosocial and environmental
factors
Axis V- Global Assessment of Functioning;
(GAF goes from 0 to 100)

DSM-IV-TR DSM-IV-TR
Labeling forces a fuzzy diagnosis into a Being revised at the moment to
category become a more dimensional
Might have negative connotations (stigma) classification system
May be applied erroneously, the person
becomes the disorder
Points on a continuum rather than
categories
Usually means more comorbidities
Sometimes sacrificed validity for The criticism of that is that if you
reliability remove a classification, diagnosis will
be even harder to make- similar to
the DSM-I
Conducting Research in Conducting Research in
Psychopathology Psychopathology
It starts with a an observation... Which leads to question...

Conducting Research in Conducting Research in

Psychopathology Psychopathology
The hypothesis is the educated guess But how do you know if your answer
to answer that question... is right and the information is useful?
Testability- ability to be subjected to
scientific scrutiny
comes in the form of a research design-
OR
plan of experimentation

Conducting Research in Conducting Research in

Psychopathology Psychopathology
The research design uses the aspects The value of the research design is
you want to measure in the people determined by two inverse forms of
you are studying validity
Independent variable- the factor that is
manipulated by the experimenter
expected to influence the dependent variable

Internal Validity External Validity

Dependent variable- the factor that is
measured and expected to be influenced
Conducting Research in Conducting Research in
Psychopathology Psychopathology
Internal validity - extent to which we are Internal validity is threatened by
confident that the independent variable
confounds
caused the dependent variable to change.
External validity -how well the findings Uncontrolled alternative explanations
generalize to people who were not part of that contaminate the result of the study
the research study. Its effects cannot be separated from
The more a study applies to its those of the variables being studied
participants, the less generalizable it
is

Three strategies to Ensure Three strategies to Ensure

Internal Validity Internal Validity
Control group - Similar to the Randomization - Study participants
experimental subjects in every way, are assured an equal chance of being
but are not exposed to the assigned to any of the groups (and in
independent variable (i.e. treatment turn any of the treatments)
received) + eliminates systematic differences
+ allows for comparison of differential across groups
effects from treatment

Three strategies to Ensure

Internal Validity Significance of Results
Analog model - A way of studying a Statistical significance - small
phenomenon by creating a probability that the research findings
comparable (analogous) environment were found by chance
within the laboratory Clinical significance - degree of
+ allows for replication under controlled meaningful applications of the finding
conditions to real world problems
Effect size determines whether a
statistically significant difference is also
clinically significant
Conducting Research in
Psychopathology Types of Research Methods
A problem with psychopathology Studying individual cases
research is that individual differences Case- studies in which a single person or
are often de-emphasized a small group is studied in detail
The patient uniformity myth- tendency to Freud
see all participants as one homogeneous - Does not use scientific method
group hides important difference in - Does not allow conclusions about cause
individual reactions to interventions and effect because of many confounding
variables
- Cannot be easily generalized

Types of Research Methods Types of Research Methods

Research by Correlation Correlation coefficient indicates the
Degree to which two variables are strength of the relationship, ranges from
associated +1.00 to -1.00
Positive Correlation How closely each point lies in a line
graph

Negative Correlation

Types of Research Methods Types of Research Methods

However, correlation does not imply Epidemiological Research
causation! Research method that examines
Just because two things occur together Prevalence- How many people have the
does not mean one causes the other disorder at one time
And if one does cause the other, Incidence- How many new cases during a
directionality is not indicated specific period of time
Distribution- What percentage of different
groups have the disorder
Consequence- Personal, social, and
economic impact of the disorder
Types of Research Methods Types of Research Methods
Research by Experiment Group experimental designs
Involves the manipulation of an Process experiments examine why it
independent variable and the works
observation of its effects of the Outcome experiments examine whether
dependent variable(s) of interest it works
Addresses issues of causality
Can be Group or Single Case
Experiments

Types of Research Methods Types of Research Methods

Outcome experiments are prone to Participants can be placed in a placebo
placebo effect (Latin: “I shall please”) control group could be given a similar
procedure
Experimental group has a positive
Sugar pills instead of actual medicine
expectation because they are getting
treatment The alternative is comparative treatment
method
Two or more treatment methods are
compared to see which is more effective

Types of Research Methods Types of Research Methods

There might also an expected Single-case Experiments involves
outcome from the researchers manipulating variables on only one
themselves person
As a countermeasure the experiment The individual serves as their own
could have a double-blind control control, by providing a baseline of
Both the participants and the researcher do function at the start of experiment
not know which treatment is being applied + Repeated measurement shows
Degree of variability (day to day change)
Trend (direction of overall change)
Conducting Research in
Types of Research Methods Psychopathology
Withdrawal Design
+ Makes sure that treatment is responsible for
change
- Treatment or its effects can’t always be
removed
Multiple Baseline design
Measures baselines of two or more related
behaviors or one behavior in two or more
different contexts
Intervention after each instance, if treatment
and changes coincide, then it is strong evidence
of effect

Research Across Time Research Across Time

A cross-sectional study compares Retrospective Information asks
the same characteristic in different people to look back into their own
people at different ages childhoods
+ A disorder can be can be studied in - Not very accurate
different cohorts (age group) to map the Sequential Designs repeated study
disorder’s progression
of different cohorts over time
- Developmental stages and experience
will be confounding factors in the study
leading to a cohort effect

Research Across Time Genetics

Longitudinal Designs study the Genetic studies are done through
same people across time Family Studies study the person with
the trait (proband)
+ No cohort effects
Twin Studies have same environment,
+ Can measure actual progression same genes
- Expensive and Long-term Adoption Studies have different
- Cross-generational effect limits environment, similar genes
generalizability Genetic linkage analysis and
association studies can locate the site
of the defective gene
Last Words
The clinical picture, causal factors,
and treatment process and outcome
are culturally influenced
A strong research design is both
Replicable and Ethical
Has strict scientific standards
Involves knowledgeable Consumers
Informed consent