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Abnormal Psychology: Chapter 3 – Assessment & Diagnosis

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Clinical Assessment
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clinical assessment the process of gathering information about a person and his or her environment to make decisions about the nature, status, and treatment of psychological problems.
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Screening
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An assessment process that attempts to identify psychological problems or predict the risk of future problems among people who are not referred for clinical assessment.
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AUDIT Screening Tool
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A 10-item screen can quickly identify substance abuse problems (known as Alcohol Use Disorders Identification Test)
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Sensitivity
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Describes the ability of the screener (or the instrument) to identify a problem that actually exists.
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Specificity
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Indicates the percent of the time that the screener accurately identifies the absence of a problem (e.g., the cutoff score suggests no depression, and the patient truly is not depressed).
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False Positives
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Occur when a screening tool indicates a problem when no problem exists (exceeds cutoff score but there is no problem).
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False Negatives
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Occur when a screening tool indicates there is no (depression etc) when there actually is.
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Qualities of a good screening tool
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Sensitive and specific: It identifies problems that do exist and does not indicate problems when none exist.
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Diagnosis
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The identification of an illness.
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differential diagnosis
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A process in which a clinician weighs how likely it is that a person has one diagnosis instead of another.
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What is used to make a psychological diagnosis?
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A clinical assessment that leads to a diagnosis usually includes the evaluation of symptom and disorder severity, patterns of symptoms over time (number, frequency, and duration of episodes), and the patient’s strengths and weaknesses. The assessment may also include the results from personality tests, neuropsychological tests, and/or a behavioral assessment.
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Diagnostic assessments
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Are more extensive than screens and are designed to provide a more thorough understanding of a person’s psychological status.
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How is a diagnosis beneficial?
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It facilitates communication across clinicians and researchers, is critical for planning appropriate treatment, and is often needed for insurance companies to reimburse a psychologist or other health care provider.
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What is a functional analysis of symptoms and who uses it?
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Behavioral psychologists use a functional analysis to identify the relations between situations and behaviors (what happens before, during, and after certain problem behaviors, moods, or thoughts) to aid in devising a treatment strategy.
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What is an Outcome Evaluation?
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A repeat assessment at the end of treatment using the same measures used throughout treatment in order to determine whether the patient is getting better or if treatment is completed. (measure of change, functionality)
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Clinical Significance
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An observed change that is meaningful in terms of clinical functioning. (example: Reliable Change Index)
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Psychometric Properties
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An instrument’s psychometric properties used to dtermine it’s value include standardization, reliability, and validity.
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What is Standardization?
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Standard ways of evaluating scores which can involve normative or self-referent comparisons (or both).
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What is a Normative comparison?
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Normative comparisons require comparing a person’s score with the scores of a sample of people who are representative of the entire population (with regard to characteristics such as age, sex, ethnicity, education, and geographic region) or with the scores of a subgroup who are similar to the patient being assessed.
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How is Standard Deviation used?
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SD is a measure that tells us how far away from the mean (average) a particular score is. A score that is more than 2 SDs away from the mean is found in only 5% of the population and is considered meaningfully different from what is normal.
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What are Self-referent comparisons?
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Self-referent comparisons are those that equate responses on various instruments with the patient’s own prior performance, and they are used most often to examine the course of symptoms over time. (normal temperature, scores on tests).
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reliability
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the extent to which a test produces similar scores over time when given to the same individual(s)
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test-retest reliability
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the extent to which a psychological assessment instrument produces consistent results each time it is given (measured by a correlation coefficient – Correlations of .80 or higher indicate that a measure is highly reliable over time).
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interrater agreement
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the amount of agreement between two clinicians who are using the same measure to rate the same symptoms in a single patient (prevents diagnosis based on clinician bias)
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validity
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Validity refers to the degree to which a test measures what it was intended to assess.
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Criterion validity
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assesses how well a measure correlates with other measures that assess the same or similar constructs
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concurrent validity
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One type of criterion validity, assesses the relationship between two measures that are given at the same time, such as the Scholastic Aptitude Test (SAT) and the American College Testing Program (ACT).
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construct validity
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Construct validity reflects how well a measure accurately assesses a particular concept, not other concepts that may be related.
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Predictive validity
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refers to the ability of a measure to predict performance at a future date, such as the ability of the SAT to predict performance in college.
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Statistical prediction
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Statistical prediction results when a clinician uses data from large groups of people to make a judgment about a specific individual.It has been proven to be more accurate than a clinical prediction.
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Clinical prediction
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Is a prediction based on the clinicians judgement-it is less accurate than a statistical prediction. It is useful when relevant statistical data do not exist and when new hypotheses need to be developed.
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What is one of the most important factors the guide a clinician’s choice of assessment techniques and instruments?
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Probably the most important factors are patient’s age and developmental status but cultural factors are also important.
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According to the American Psychological Association Code of Ethics, Psychologists must adhere to section 9 when administering tests:
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That psychologists only use tests on which they have received training, have good reliability and validity and are appropriate for the purpose of the examination. Tests must also not be outdated.
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Informed Consent
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Informed consent indicates that the person to be tested understands the test’s purpose, its related fees, and who will see the results.
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unstructured interview
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the clinician decides what questions to ask and how to ask them
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Clinical Interview
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a conversation between an interviewer and a patient whose purpose is to gather information and make judgments related to assessment goals.
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Self-report measures
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Patient is asked to rate their own symptoms
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Clinician-rated measures
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Clinician rates the symptoms
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Subjective responses
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What the patient perceives
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Objective responses
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what can be observed
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Test Battery
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group of tests given together
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Minnesota Multiphasic Personality Inventory (MMPI)
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567 item personality test developed using empirical keying by Hathaway and McKinnley in 1943, it is very long and was based on a white population.
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The Millon Clinical Multiaxial Inventory (MCMI)
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175-item true-false inventory that corresponds to eight basic personality styles, three pathological personality syndromes, and nine symptom disorders scales. It has reliability and validity & is shorter than MMPI, but does not match well the categories of disorders as they are described in the DSM & may be culturally biased.
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Selection of assessment tools is largely determined by the patient’s symptoms, age, and medical status. One other factor may be the
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Culture
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Global Assessment of Functioning Scale (GAF)
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A rating assigned by a clinician to describe a patient’s overall functioning and well-being. The clinician chooses a number on a scale from 0 to 100 to indicate how well the patient is functioning. The rating includes consideration of both symptom severity and level of impairment in social relationships and job or school performance. Comparing GAF scores can serve as a broad indicator of clinical improvement.
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General Health Questionnaire (GHQ)
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GHQ is a 12 item rating score that gives a snapshot of mental health status over the previous weeks and can provide a meaningful change score. Each item is rated on a 4-point scale indicating degree of deviation from the individual’s usual experience.
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Halstead-Reitan Neuropsychological Battery
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widely used to evaluate the presence of brain damage. The battery differentiates healthy individuals from those with cortical damage and includes 10 measures of memory, abstract thought, language, sensory-motor integration, perceptions, and motor dexterity.
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Wisconsin Card Sorting Test
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Involves card shifting and the ability to use flexible thinking-individuals with frontal lobe lesions do poorly on it. Because it discriminates between frontal and nonfrontal lesions, it is useful for testing patients with schizophrenia, brain injuries, and neurodegenerative diseases such as dementia or Parkinson’s disease.
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Bender Visual Motor Gestalt Test
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A simple screening tool often used to detect problems in visual-motor development in children and general brain damage and neurological impairment-patients copy figures on paper.
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Luria-Nebraska Neuropsychological Battery
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The Luria-Nebraska is similar to the Halstead-Reitan test but is a more precise measure of organic brain damage. It uses an unstructured qualitative method, generating 14 scores includ- ing motor, rhythm, tactile, expressive speech, writing, reading, arithmetic, memory, intellectual processes, and left and right hemispheric function.
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Stanford-Binet
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the widely used American revision (by Terman at Stanford University) of Binet’s original intelligence test
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Wechsler Adult Intelligence Scale (WAIS-IV)
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*Adult Age 16-90 yrs. *General Intellectual Functioning/Cognition and IQ: *Working memory tests for learning difficulties *Working memory, processing speed, attention, verbal comprehension index.
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Wechsler Intelligence Scale for Children (WISC-IV)
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a test for children that provides separate measures of verbal and performance (nonverbal) skills, as well as a total score (6-16 yrs)
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Wechsler Preschool and PrimaryScale of Intelligence (WPPS-III)
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Intelligence scale used for children ages 2-7
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Crticisms of IQ tests
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Many argue that because intelligence tests are standardized primarily on white male populations, they are inappropriate for women, ethnic minorities, non-English speakers, and people who are physically challenged.
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Rorschach Inkblot Test
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the most widely used projective test, a set of 10 inkblots, designed by Hermann Rorschach; seeks to identify people’s inner feelings by analyzing their interpretations of the blots
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Thematic Apperception Test
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a projective technique using black-and-white pictures on 31 cards, a projective personality test in which respondents reveal underlying motives, concerns, and the way they see the social world through the stories they make up about ambiguous pictures of people
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Brief Psychiatric Rating Scale
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Brief Psychiatric Rating Scale is used to assess the effectiveness of treatment interventions for many psychopathologies, not in making diagnosis. It includes 18 items that address somatic concern, anxiety, emotional withdrawal, conceptual disorganization, guilt feelings, tension, mannerisms and posturing, grandiosity, depressive mood, hostility, suspiciousness, hallucinatory behaviors, motor retardation, uncooperativeness, unusual thought content, blunted affect, excitement, and disorientation
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Beck Depression Inventory
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measurement of the presence and depth of depression -Method: 1) administered by interview or completed as a questionnaire by the individual 2) the individual rates his/her feelings relative to 21 characteristics associated with depression, items are scored as o to 3, with 3 being the most severe; a score greater than 21 indicates severe depression, used for adolescents and adults
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Beck Anxiety Inventory
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This self-report test is designed to help you pinpoint the difference between depression and anxiety. Other instruments didn’t adequately discriminate depression from anxiety. Scoring is asking what is wrong with the patient on a scale of 0 to 3 on a 4-point scale out of a list of 21 items. Uses include in determining anxiety in the setting of a clinic or for research.
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Behavioral Assessment
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a form of assessment that involves a full range of inquiry methods (observation, interview, testing, and the systematic manipulation of antecedent or consequence variables) to identity probable antecedent and consequent controlling variables.
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Self-Monitoring
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A procedure whereby a person systematically observes his behavior and records the occurrence or nonoccurrence of a target behavior. It allows real-time information about frequency, duration and nature of symptoms and increases patient awareness.
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Interval recording
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divide observation period (e.g. 10 minutes) into a number of equal time intervals, usually ranging from 5 sec to 30 sec. Then the observer notes whether or not the defined behavior occurred during each interval. Interval length should be such that a behavior typically occurs only once in each interval
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Event Recording
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measurement procedure for obtaining a tally or count of the number of times a behavior occurs
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analogue observation
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In contrast to naturalistic direct observation, a type of behavioral observation that typically takes place in the clinic room, where the real life situation is stimulated
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actigraphy
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monitoring of body movement through a small monitor worn on the wrist, activity is used as a proxy for measuring sleep and wakefulness
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behavior avoidance test
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the behavioral assessment strategy used to assess avoidance behavior by asking a patient to approach a feared situation as closely as possible
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psychophysiological assessment
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the evaluation strategies that measure brain structure, brain function, and nervous system activity
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EEG
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an amplified recording of the waves of electrical activity that sweep across the brain’s surface. These waves are measured by electrodes placed on the scalp. EEGs are useful tools for monitoring and diagnosing certain clinical conditions, such as a coma state and brain death, and for monitoring brain function while under anesthesia
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Event-related potential
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This is the measured brain response that resulting from a sensory, cognitive, or motor event
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NREM-1
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Lightest level of sleep Lasts a few minutes Decreased physiological activity beginning with a gradual fall in vital signs and metabolism Person easily aroused by sensory stimuli such as noise
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NREM-2
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Sound Sleep Progressive Relaxation Arousal Fairly Easy 10-20 Minutes Continued Slowing of Body Functions
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NREM-3
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Deepest stage of sleeps, brain emits large, slow delta waves, and you are hard to awaken. During this stage, sleepwalking (somnambulism) and sleeptalking (somniloquy) occur, as well as night terrors and nocturnal enuresis
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Electrodermal Activity (EDA)
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Skin Conductance detected by applying small amount of electricity to palm bc water (sweat) conducts electricity (more water on skin the more skin conducts electricity). Measures sympathetic nervous system activity.
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biofeedback .
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A clinical technique used to help a person learn to relax by monitoring muscle tension, heart rate, brainwave activity, or other body activities. A vivid illustration of how feelings and emotions affect bodily functions and how changing emotional states can directly affect physical functioning
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Clinical biofeedback
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using specially designed machines to amplify/display various body signals (e.g., heart rate, muscles tension, skin response, etc.) and their intensity
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DSM
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the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, a widely used system for classifying psychological disorders (categorical classification system)
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Axis I
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All clinical disorders EXCEPT personality disorders and mental retardation
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Axis II
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Personality disorders and mental retardation
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Axis III
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any physical disorder or general medical condition that is present in addition to the mental disorder
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Axis IV
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Psychosocial and environmental problems.
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Axis V
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Global Assessment of Function (GAF) 0-100 DSMIV category for the rating of patients current behavior: 1= can’t function and 100= functioning well
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ICD (International classification of diseases and related health problems)
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a classification system for mental disorders developed in Europe that is an international standard diagnostic system for epidemiology and many health management purposes
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Culture Bound Syndromes
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a cluster of symptoms that is considered a recognizable disease only within a specific culture or society
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When is the diagnostic system harmful?
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*not all people with the same diagnosis experience the same symptoms *most diagnostic classifications do not require that the symptoms be connected to a particular etiology (cause) *different patients with the same disorder may have developed the symptoms in different ways *two people who have the same diagnosis do not necessarily respond to the same treatments. *It can cause stereotyping and stigma *Self-fullfilling prophecies *Discrimination
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Dimensional Classification System
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abnormal behavior/disorders are a product of severity on a variety of dimensions, benefit is that a patient would not have to necessarily have ALL characteristics ISSUES: we need some kind of statistical cut-offs but we are not there yet
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Selection of assessment tools is largely determined by the patient’s symptoms, age, and medical status. One other factor may be the:
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therapist’s theoretical perspective
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Physicians and other practitioners may choose to give new patients a screening assessment, which is:
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a brief measure in which a cutoff score indicates the pos- sibility of significant problems
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With psychological disorders, the diagnosis given is primarily based on:
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A cluster of symptoms
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Diagnosis is important to physicians and psychologists because it facilitates
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treatment planning, communication across clinicians and researchers, understanding
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A measure of clinical significance tells us that
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And observed change in a patient is meaningful improvement
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Comparing a person’s score on a psychological test to the average scores obtained on that test from a large representative sample of people is
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normative comparison
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After an interview, a psychiatrist rates Jim’s depression as severe. The next day a clinical psychologist also conducts an interview and rates Jim’s depression as severe. The two clinicians are demonstrating
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interrater agreement
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Dr. Smith develops the Smith Depression Inventory and gives it to hundreds of patients with depression. He also gives those patients the widely used Beck Depression Inventory. He finds that the average scores on the two questionnaires are highly correlated. Dr. Smith has demonstrated that the Smith Depression Inventory has
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concurrent validity
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A test publisher describes a psychological test as having extremely high predictive validity. This means the test
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has the ability to forecast particular outcomes
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Administering psychological tests to someone from another country may produce biased results if which of the following is not considered?
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the language in which the test was written the education of the person taking the test cultural beliefs and values of the person taking the test
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Compared with unstructured interviews, structured interviews have several advantages including
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increased reliability
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Susan was sent to a neuropsychologist after a car accident left her having trouble concentrating and remembering things. The neuropsychologist gave her a battery of 10 measures assessing memory, abstract thought, language, sensory-motor integration, perceptions, and motor dexterity.This test battery is called the
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Halstead-Reitan
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Although intelligence tests are controversial, they are useful in assessing
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prediction of academic success
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Sally suffers from an eating disorder. The psychologist asked her to keep a diary and record what she eats, when she eats something, where she is when she eats, and what she is feel- ing right before, during, and after she eats. This is called
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self-monitoring
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A patient has an extreme spider phobia. He is taken to a room with a cage of spiders against the opposite wall. He is asked to walk as close to the cage as he can. He takes two steps toward the cage and says he cannot go any closer. The psychologist measures the distance on the floor from the patient’s feet to the cage. This is a
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behavior avoidance test
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The great advantage of the electroencephalogram (EEG) is that it
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is the only measure that directly assesses electrical activity in the brain
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The primary classification system used in the United States and published by the American Psychiatric Association is the
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DSM
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Psychosocial or environmental problems that may impact the patient’s behavior or functioning is recorded on which of the following dimensions?
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Axis IV
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The purpose of the multiaxial system is to
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offer more information about patients than a clinical diagnosis alone
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Dimensional classification is an alternative to categorical systems such as the DSM. One advantage of a dimensional system is
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a better description of patients whose problems do not fit into a single category