Beruflich Dokumente
Kultur Dokumente
also must cope with the personal pain associated with the
disorder itself.
Social attitudes toward people with psychological disorders range
from DISCOMFORT to out-right PREJUDICE.
put yourself in the place of the people who have these conditions.
Consider how they feel and how they would like people to treat them.
However defined -- best conceptualize abnormal behavior from multiple perspectives that
incorporate biological, psychological, and sociocultural factors.
Biological Causes
Includes –
GENETIC
ENVIRONMENTAL INFLUENCES ON PHYSICAL FUNCTIONING.
Of particular interest are inherited factors that alter the functioning of the NERVOUS
SYSTEM.
also physiological changes -- affect behavior, which other conditions in the body cause, such as
brain damage or exposure to harmful environmental stimuli.
For example, a thyroid abnormality can cause a person’s moods to fluctuate widely.
Brain damage resulting from a head trauma can result in aberrant thought patterns.
Toxic substances or allergens in the environment can also cause a person to experience
disturbing emotional changes and behavior
Psychological Causes
involve disturbances in thoughts and feelings.
Discrimination, whether based on social class, income, race and ethnicity, or gender,
can influence the development of abnormal behavior.
For people who are diagnosed with a psychological disorder, social stigmas
associated with being “mental patients” can further affect their symptoms.
increasing the burden for them and for their loved ones,
deters people from obtaining badly needed help,
thereby perpetuates a cycle in which many people in need become much worse.
affects people from ethnic and racial minorities more severely than those
from mainstream society.
• For example, European-American adolescents and their caregivers are twice as likely as
members of minority groups to def ine problems in mental health terms or to seek help for
such problems (Roberts, Alegría, Roberts, & Chen, 2005).
The Biopsychosocial Perspective
criteria still refer to “clinically significant” to establish the fact that the behaviors
under consideration are not passing symptoms or minor difficulties.
Both the DSM-IV and DSM-5 state that disorders must occur outside the norm
of what is socially accepted and expected for people experiencing particular life
stresses.
DSM-5 also specifies that the disorder must have “clinical utility,” meaning that, for
example, the diagnoses help guide clinicians in making decisions about treatment.
During the process of writing the DSM-5, the authors cautioned against
changing the lists of disorders (either adding to or subtracting)
without taking into account potential benefits and risks.
For example, they realized that adding a new diagnosis might lead to labeling
as “abnormal” a behavior previously considered “normal.”
The advantage of having the new diagnosis must outweigh the harm of
categorizing a “normal” person as having a “disorder.”
With these cautions in mind, the DSM-5 authors also recommend that the
criteria alone are not sufficient for making legal judgments or
eligibility for insurance compensation.
It simply was not possible to cure people by providing them with the
well-intentioned, but ineffective, interventions proposed by moral
treatment.
Even people suffering from the least severe psychological disorders were often housed in
the “back wards” of large and impersonal state institutions, without adequate or
appropriate care.
Institutions restrained patients with
Public outrage over these abuses in mental hospitals finally led to a more
widespread realization that mental health services required dramatic changes.
federal government took emphatic action in 1963 with the passage of
groundbreaking legislation.
Many of the promises and programs -- ultimately failed to come through because of
inadequate planning and insufficient funds.
Patients shuttled back and forth between hospitals, half-way houses, and shabby boarding
homes, never having a sense of stability or respect.
Although the intention of releasing patients from psychiatric hospitals was to free people
who had been deprived of basic human rights, the result may not have been as
liberating as many had hoped.
The U.S. federal government has also become involved in antistigma programs
as part of efforts to improve the delivery of mental health services through the President’s
New Freedom Commission (Hogan, 2003).
Looking forward into the next decade, the U.S. government has set the 2020 Healthy People
initiative goals as focused on improving significantly the quality of treatment
services
Scientific Approach
The work of Russian physiologist Ivan Pavlov (1849–1936), known for his
discovery of CLASSICAL CONDITIONING became the basis for the
behaviorist movement begun in the United States by John B. Watson
(1878–1958).
criteria still refer to “clinically significant” to establish the fact that the behaviors
under consideration are not passing symptoms or minor difficulties.
Both the DSM-IV and DSM-5 state that disorders must occur outside the norm
of what is socially accepted and expected for people experiencing particular life
stresses.
DSM-5 also specifies that the disorder must have “clinical utility,” meaning that, for
example, the diagnoses help guide clinicians in making decisions about treatment.
During the process of writing the DSM-5, the authors cautioned against changing the
lists of disorders (either adding to or subtracting) without taking into account
potential benefits and risks.
For example, they realized that adding a new diagnosis might lead to labeling as “abnormal” a
behavior previously considered “normal.”
The advantage of having the new diagnosis must outweigh the harm of categorizing
a “normal” person as having a “disorder.”
Similarly, deleting a diagnosis for a disorder that requires treatment (and hence insurance
coverage) might leave individuals who still require that treatment vulnerable to withholding
of care or excess payments for treatment.
With these cautions in mind, the DSM-5 authors also recommend that the criteria alone
are not sufficient for making legal judgments or eligibility for insurance
compensation.
These judgments would require additional information beyond the scope of the diagnostic
criteria alone.
Characteristics of Psychological Assessments
Most USE
to provide a diagnosis, or
at least a tentative diagnosis, of an individual’s psychological disorder.
other reasons.
in forensic assessments, clinicians determine whether a suspect meets
the criteria of being competent to stand trial.
The test’s validity reflects the extent to which a test measures what
it is designed to measure.
An intelligence test should measure intelligence, not personality.
given score on the test that one person obtains should have a
clear meaning.
These are relatively harmless situations, unless you decide to invest a great deal
of money
may also use cues from the client’s appearance that give further indication of
the client’s symptoms, emotional state, or interpersonal difficulties.
The typical clinical interview covers the areas – age, reason for referral, edu and
work history, current social situation, physical and mental history, drugs, family
history, beh obs,
The clinician can vary the order of questions and the exact wording he or
she used to obtain this information.
Unlike the clinical interview, the structured
interview provides STANDARDIZED
QUESTIONS that are worded the same way
for all clients.
A structured interview can either provide
a diagnosis on which to further base treatment or
Both SCIDs are designed so that the clinician can adapt to the interviewee’s particular
answers.
questions -- worded in standard form
but the interviewer chooses which questions to ask based on the client’s answers to previous
questions.
For example, if a client states that she experiences symptoms of anxiety, the interviewer
would follow up with specific questions about these symptoms.
The interviewer would only ask follow-up questions if the client stated that she was
experiencing anxiety symptoms.
anyone with the proper training can administer the SCID, not necessarily just
licensed mental health professionals.
ANALOG OBSERVATIONS
take place in a setting or context such as a clinician’s office or
a laboratory specifically designed for observing the target
behavior.
A clinician assessing the disruptive child would need to arrange a
situation as comparable as possible to the natural setting of the
classroom for the analog observation to be useful.
Clients may also report on their own
behavior rather than having someone observe
them.
BEHAVIORAL SELF-REPORT
client records -- target behavior
antecedents and consequences of the behavior
SELF-MONITORING
client keeps a record of the frequency of specified
behaviors,
No. of cigarettes --smoker calories he or she consumed,
No. of times in a day that a particular unwanted
thought comes to the client’s mind.
BEHAVIORAL INTERVIEWING
Clinicians may also obtain information from their clients
using in which they ask questions about the target
behavior’s frequency, antecedents, and consequences.
Multicultural Assessment
The client’s age is another factor that the clinician takes into account.
Tests appropriate for older adults are not necessarily either appropriate or useful for
diagnosing a child or adolescent.
Certain neuropsychological tests are derived from or the
same as tests on the WAIS-IV, such as
Digit Span (used to assess verbal recall and auditory attention) and
Similarities (used to assess verbal abstraction abilities).
each of these tests is related to brain damage in particular areas.
most impaired -- unable to reproduce a clock face at all, or make mistakes in writing the
numbers or placing them around the clock.
The Wisconsin Card Sorting Test (WCST)
requires -- client match a card to one of a set of cards that share various
features.
Originally developed using -- physical cards
Now -- computerized format.
Requires - client shift mental set because the basis for a correct match
shifts from trial to trial.
The client must respond before hearing the next digit to score the
response correctly.
includes tests of working (short-term) and long-term memory for visual and verbal
stimuli.
Eg., Logical Memory (recall of a story), Verbal Paired Associates (remembering the
second in pairs of words), and Visual Reproduction (drawing a visual stimulus).
relatively rapid growth of this field more extensive normative data will be
available clinicians -- more confident about their utility.
Glasglow Coma Scale (GCS)
Neurological scale
ELECTROENCEPHALOGRAM (EEG)
measures electrical activity in the brain.
Atheoretical approach–
Describes psychological disorders in terms of observable
phenomena rather than in terms of possible causes.
Validity
The diagnosis represent real and distinct clinical phenomenon.
Drawbacks---
* Vague and poor reliability
* Theoretical– Emotional problems or reactions -
caused the disorder.
DSM-II
Published in 1968
First classification based on the system of ICD
Move away from theoretical framework
Authors tried to use diagnostic terms that would not imply a
particular theoretical framework.
DISADVANTAGES---
In retrospect, based on psychoanalytic concepts.
Loose criteria – not describing actual cond
Published in 1980
Major improvement
provided precise
rating criteria
definitions for each disorder.
Enabled clinician – more quantitative and objective
PROBLEMS—
did not go far enough in specifying criteria.
Published in 2000
With a common diagnostic system, the 110 member nations can compare
illness rates and have assurance that countries employ the same terminology
for the sake of consistency.
The ICD is available in WHO’s six official languages (Arabic, Chinese, English,
French, Russian, and Spanish), as well as in 36 other languages.
What’s New in the DSM-5
Changes in the DSM-5 Structure
All editions of the DSM have generated considerable controversy, and
the fifth edition seems to be no exception.