Assessment and Classification of Abnormal Behavior

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Assessment and Classification of Abnormal
Behavior

• RCS 6931
• 5/17/07
• Steven R. Pruett, Ph.D., CRC

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Assessment of Psychopathology

• Pattern of Assessment
• Review of records
• Interviewing
• Administering interpreting traditional
  psychological test
• Behavior assessment

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Additional Areas of Assessment

• Topics of assessment
• Personality disorders
• Stress coping
• Hypnotic responsiveness
• Psychological health
• Adaptation to new cultures
• Changes associated with increasing modernization
• Family systems interactions
• Relationship between an individual and her/his
  environment
• Cognitive processes related to behavioral
  disorders
• Levels of personal control

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Code of Fair Testing Practices in Education

• Is a guide for professions to make sure they
  fulfill their obligation that they develop and
  use fair, non-biased tests.
• The code was developed by a joint committee made
  of representative from
• American Counseling Association (ACA),
• American Educational Research Association (AERA),
  American Psychological Association (APA),
• American Speech-Language-Hearing Association
  (ASHA),
• National Association of School Psychologists
  (NASP),
• National Association of Test Directors (NATD)
• National Council on Measurement in Education
  (NCME).
• The code can be downloaded at http//www.apa.org/
  science/FinalCode.pdf

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Types of Assessments

• Personality
• Generally two methods of assessing
  psychopathology
• Objective tests
• Usually in a self-report format and involve
  reading
• Examples include
• MMPI-2
• MCMI
• PAI
• Projective tests
• Usually involve stories or pictures
• Examples include
• Rorschach
• TAT
• Bender-Gestalt
• House-Tree Person

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Types of Assessment

• Cognitive
• Generally measures intelligence
• Different tests use different theories of
  intelligence
• Most popular tests are
• WAIS-III
• WISC-IV
• Woodcock-Johnson III
• Slosson

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Cognitive Assessments

• There are some shorten versions of intelligence
  tests. These may miss certain types of cognitive
  intelligence (such as spatial reasoning) but may
  give a quick overall IQ estimate
• Kaufmann Brief Intelligence Test (K-BIT)
• WASI
• Select subtests of major intelligence scales

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Cognitive Assessments

• Mental status exams
• Designed to determine if an individual is
  oriented to person, place, time, and
  circumstance.

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Neuropsychological Tests

• Designed to answer questions about an
  individuals organic deficits.
• There is a relationship between some of the
  intelligence tests and neuropsych tests

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Behavioral Assessment

• Behavioral checklists/behavioral analysis (BPRS)
• Physiological Responses (GSR, EMG)
• Self-reports (BDI-II, Aggression scales)

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Records

• Previous mental health professionals
• Physicians/medical records
• Law enforcement
• Schools
• Family members
• Other legal

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Interviews

• Probably the most important source of information
  for making a diagnosis
• History
• Family
• Psychosexual
• Academic
• Employment
• Legal

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Interviews

• Observations
• Paraliguistics
• Avoidance/changing of topics
• Therapy savvy?

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Interviews

• Structured, semi-structured vs unstructured
  interview
• Reliability
• Validity
• Clinical Judgment
• Professional bias
• Competence

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Classification

• Kraeplin
• Father of modern classification of
  psychopathology
• Influenced by 2 different traditions
• Scientific approach to medicine
• Believed mental disorders were biological in
  nature
• Experimental Psychology
• Applied Wundts experimental psychological
  mehtods to the study of mental disorders.
• Reputation is based on his textbooks of
  psychiatry
• Texts were organized into chapters on each major
  groupings of mental disorders
• These became known as Kraeplins classification
  of mental disorders.

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Kraeplin

• In the 6th edition of his text he introduced the
  concept of dementia praecox (schizophrenia) which
  included subtypes of
• Hebophrenia
• Catatonia
• Paranoia
• The other group he discussed was manic depressive
  insanity
• This was very unique since this combined mania
  and depression which had been considered separate.

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International Classifications

• The first ICD was generated in 1909 and was
  concerned with the causes of mortality
  (International Classification of Death)
• The ICD was revised several times until after
  WWII there was a call for a classification of
  Disease (ICD-6).
• Shortly after the publication of the ICD-6 the
  American Psychiatric Association published its
  first version of the DSM.

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DSM

• Reason for development of the DSM is that there
  were 4 different classification systems of
  psychopathology used in the US before WWII and
  this was embarrassing for the American
  Psychiatric Association.
• Thus the US began using the DSM vs. the ICD-6
  nomenclature for psychopathology.

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DSM

• The DSM-II was released following the revision of
  the ICD to version 8.
• The DSM-II provided short prose descriptions of
  each mental disorder
• Reliability
• Only 42 inter-relater reliability with DSM-I
• By late 1960s criticism with psychiatric
  classification included
• Concerns about reliabilty
• Concerns about the medical model as an
  appropriate model for understanding mental
  disorders
• Concerns about the labeling and stigmatizing
  nature of diagnosis and classification.

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On Being Sane in Insane Places

• Published in Science by Rosenhan (1973)
• 8 Normal people sought admission to 12 different
  inpatient units
• All accurately reported information about
  themselves (except they changed their name)
• All reported hearing an auditory hallucination in
  which a voice said thud empty or hollow
• All were admitted
• 11 of the admissions resulted in the Dx of
  Schizophrenia and the other as mania
• Average hospitalization was 20 days all
  received the diagnosis of Schizophrenia in
  remission
• Rosenhan concluded that mental health
  professionals were unable to distinguish between
  sanity and insanity.

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Neo-Kraepelians

• Small influential group of psychiatry researchers
  in North America sought to reaffirm psychiatry as
  a branch of medicine
• With this assertion they proposed that psychiatry
  should use and be based on modern scientific
  principles
• Psychiatrys focus should be on psychopathology
  treatment of the mentally ill.

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Neo-Kraepelians

• There is a boundary between the sick and the well
• There are discrete mental illnesses Mental
  illness is not a myth. There are many mental
  illness.
• Psychiatric physicians should focus on the
  biological aspects of mental illness
• There should be a clear intentional concern
  regarding the classification of mental illness
• Diagnostic criteria should be codified and
  validated through research

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DSM-III

• Published in 1980
• Largely due to the efforts of the
  Neo-Kraepelians.
• Differed from DSM-II by
• Adopting diagnostic criteria
• Proposed a multi-axial system of diagnosis.
• Reorganized the hierarchy of mental disorders
• No longer organic-non organic as in DSM-1 II
• Instead used 17 major headings
• DSM-III was much longer
• 256 categories and 494 pages in length

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DSM-III-R

• published in 1987
• New categories introduced
• Sleep disorders
• Revised disorders
• Histronic personality disorder
• Dropped disorder
• Attention deficity disorder without hyperactivity
• Added disorder
• Premenstrual syndrome

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DSM-IV

• Published in 1994
• Attempted to make it more similar to ICD-10
• Yet despite this attempt there is significant
  differences between the ICD-10 and the DSM-IV

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