An Accepted Definition

CHAPTER 1 Signs – objective

Symptoms – subjective The most widely accepted definition used in DSM-5 describes behavioral, psychological, or biological
dysfunctions that are unexpected in their cultural context and associated with present distress and
ABNORMAL PSYCHOLOGY A) blood, b) black bile, c) impairment in functioning, or increased risk of suffering, death, pain, or impairment
yellow bile, and d) phlegm.
− studying, explaining and treating ‘abnormal’ behavior Blood (heart)
A. Syndrome: group of symptoms that appear together and represent a specific type of disorder
− application of psychological science to study mental disorders Excess: lively, impulsive,
B.
C.
Prototype: consider how the apparent disease or disorder matches a “typical” profile of a disorder
Clinical Description: patient “presents” with a specific problem
energetic
− nature, causes and treatment of mental disorder Deficiency: depressive D. Prevalence: population as a whole have the disorder
E. Incidence: new cases occur during a given period
Black Bile (spleen) F. Sex ratio - what percentage of males and females have the disorder
RELATED FIELDS Excess: melancholic
Course of the Disorder
Yellow Bile Choler (Liver)
Pathology – branch of science that studies diseases a. Chronic course - last a long time, sometimes a lifetime.
Excess: temperament; anger
Psychopathology – scientific study of psychological disorders Deficiency: lack of motivation b. Episodic course - likely to recover within a few months and will reoccur or repeat
Psychopathologist – person who studies psychopathology c. Time-limited course – improve without treatment in a relatively short period
Developmental Psychology – study of changes over time Phlegm (Brain)
Excess: lacking enthusiasm Onset of the Disorder
Developmental Psychopathology – study of changes of abnormal behavior
a. Acute onset- meaning that they begin suddenly
Life-span developmental Psychopathology – study abnormal behavior across entire age span
b. Insidious onset - develop gradually over an extended period
Clinical Psychologists and Counseling Psychologist Course of Disorder
− receive Ph.D., Ed.D. or Psy.D. Prognosis - the anticipated course of a disorder
− 5 years a. Good prognosis - meaning the individual will probably recover
− Conduct research into the causes and treatment of psychological disorders b. Guarded prognosis - meaning the probable outcome doesn’t look good.

Psychiatrists Informed Consent

− M.D. degree
− Specialize in psychiatry during residency training that lasts 3-5 years − research participant’s formal agreement to cooperate in a study following full disclosure of the nature of the
− Psychiatrists also investigate the nature and cause of psychological disorders research and the participant’s role in it
− Make diagnoses and treatments − The basic components are competence, voluntarism, full information, and comprehension on the part of the
Psychiatric Social Worker participant

− Master’s degree in social work as they develop expertise in collecting information relevant to social and family The American Psychological Association (APA)
situation of the individual with a psychological disorder 1. Beneficence and Nonmaleficence: strive to benefit and do no harm.
− Treat disorders and family problems associated with them
2. Fidelity and Responsibility: trust in their professional relationships.
Psychiatric Nurses 3. Integrity: promote accuracy, honesty, and truthfulness in their work.
− Advanced degrees, Masters/Ph.D.
4. Justice: fairness and equality
− Specialize in car and treatment of patients with psychological disorders
5. Respect for People's Rights and Dignity: respect the dignity and rights of all individuals.
Marriage and Family Therapists and Mental Health Counselors
− 1-2 years in MD
− Clinical services by hospitals or clinics
− Under supervision of a doctoral-level clinician

Diagnostic Criteria or Elements or Indicators of Abnormality

A. Psychological Dysfunction or Maladaptiveness
B. Personal Distress and Impairment
C. Atypical or Not Culturally Expected or Statistical Deviancy
Chapter 3 Clinical Assessment and Diagnosis
1. Reliability: We expect, in general, that presenting the same symptoms to different
physicians will result in similar diagnoses.
ASSESSING PSYCHOLOGICAL DISORDERS
CLINICAL ASSESSMENT a. To improve reliability, psychologists carefully design their assessment devices to ensure
The systematic evaluation and measurement of psychological, biological, and social factors in that two or more raters will get the same answers (interrater reliability)
an individual presenting with a possible psychological disorder. b. Also determine whether these assessment techniques are stable across time. You should
expect a similar result if you take the same test again on Thursday. (test-retest reliability)
DIAGNOSIS
The process of determining whether the particular or presenting problem afflicting the 2. Validity: Comparing the results of an assessment measure under consideration with the
individual meets all criteria for a psychological disorder, as set forth in the fifth edition of the results of others that are better known allows you to begin to determine the validity of the
DSM5. first measure.

So where do we go from here? Where do you think Brian got these ideas? And how do we If the results from a standard, but long, IQ test were essentially the same as the results from a
determine whether Frank has a psychological disorder or if he is simply one of many young men new, brief version,you could conclude that the brief version had (concurrent or descriptive
suffering the normal stresses and strains of a new marriage who, perhaps, could benefit from validity.)
some marital counseling? How well your assessment tells you what will happen in the future. (predictive validity)
e.g. Does it predict who will succeed in school and who will not (which is one of the goals of an
Key Concepts in Assessment IQ test)?
To understand the different ways clinicians assess psychological problems, we need to
Standardization: a certain set of standards or norms is determined for a technique to make its
understand three basic concepts that help determine the value of
use consistent across different measurements. The standards might apply to the procedures of
our assessments: Reliability, Validity and Standardization.
testing, scoring, and evaluating data.
Reliability: The degree to which a measurement is consistent.
e.g Scores would be pooled with individuals with same factors such as age, race, gender.
Value of Socioeconomic status and diagnosis and then be used as a standard, or norm, for comparison
Validity: The degree to which a technique measures what is
assessment purposes.
designed to measure
depends
on: Standardization: Application of certain standards to ensure Clinical Assessment consists of a number of strategies and procedures that help clinicians
consistency across different measurements acquire the information they need to understand their patients and assist them.

These procedures include a clinical interview1 and, within the context of the interview, a
mental status exam that can be administered either formally or informally; often a thorough
physical examination2; a behavioral observation and assessment3; and psychological tests4
 e.g. If a friend just told you his mother died and is laughing about it, or if your friend has just won the
The Clinical Interview lottery and she is crying, you would think it strange, to say the least. A mental health clinician would
- The core of most clinical work that is used by psychologists, psychiatrists, and other mental health note that your friend’s affect is “inappropriate.” Then again, you might observe your friend talking
professionals. about a range of happy and sad things with no affect whatsoever. In this case, a mental health
- The interview gathers information on current and past behavior, attitudes, and emotions, as well clinician would say the affect is “blunted” or “flat.”
as a detailed history of the individual’s life in general and of the presenting problem
4. INTELLECTUAL FUNCTIONING
MENTAL STATUS EXAM A rough estimate of others’ intellectual functioning just by talking to them and that is noticeable if it
The systematic observation of an individual’s behavior. Systematic evaluation and measurement of deviates from normal
psychological, biological, and social factors in a person presenting with e.g. Do they seem to have a reasonable vocabulary? Can they talk in abstractions and metaphors (as
a possible psychological disorder. most of us do much of the time)? How is the person’s memory?
This type of observation occurs when any one person interacts with another.
5. SENSORIUM
1. APPEARANCE AND BEHAVIOR General awareness of our
e. g. slow and effortful motor behavior, sometimes referred to as psychomotor retardation, may surroundings
indicate severe depression Does an individual know what
the date is, what time it is,
2. THOUGHT PROCESSES where he or she is, who he or
Rate Or Flow of Speech: Does the person talk quickly or slowly? she is, and who you are?
Continuity of Speech: Does the patient e.g. If the patient knows who he
make sense when talking, or are ideas presented with no apparent connection. is and who the clinician is and
e. g. In some patients with schizophrenia, a disorganized speech pattern, referred to as loose has a good idea of the time and
association or derailment, is quite noticeable. “Can you think clearly, or is there some problem place, the clinician would say
putting your thoughts together? Do your thoughts tend to be mixed up or come slowly?” that the patient’s sensorium is
What About the Content: Is there any evidence of delusions1 (distorted views of reality)? “clear” and is “oriented times
a. Delusions of Persecution: thinks people are after him and out to get him all the time three” (to person, place, and
b. Delusions of Grandeur: in which an individual thinks she is all-powerful in some way time).
c. Ideas of reference: in which everything everyone else does somehow relates back to the
individual. The most common example would be thinking that a conversation between two
SEMISTRUCTURED CLINICAL INTERVIEWS
strangers on the other side of the room must be about you.
are made up of questions that have been carefully phrased and tested to elicit useful information
in a consistent manner so that clinicians can be sure that they inquired about the most important
Hallucinations2 are things a person sees or hears when those things really aren’t there.
aspects of particular disorders. This is developed by most clinicians after training which are their
e. g. The clinician might say, “Let me ask you a couple of routine questions that we ask everybody. Do
own methods of collecting information from patients.
you ever see things or maybe hear things when you know there is nothing there?”
SEMISTRUCTURED
3. MOOD AND AFFECT - may also depart from set questions to follow up on specific issues
Mood: the predominant feeling state of the individual.
Does the person appear to be down in the dumps or continually elated? Does the individual talk in a
Disadvantages
depressed or hopeless fashion? How pervasive is this mood? Are there times when the depression
1. It robs the interview of some of the spontaneous quality of two people talking about a problem
seems to go away?
2. Inhibit the patient from volunteering useful information that is not directly relevant to the
questions being asked
Affect: to the feeling state that accompanies what we say at a given point. Usually our affect is
“appropriate”
Physical Examination The ABCs of Observation
The clinician’s attention is usually directed to the immediate behavior, its antecedents
- If the patient presenting with psychological problems has not had a physical exam
(what happened just before the behavior), and its consequences (what happened
in the past year. Particular attention to the medical conditions sometimes associated
afterward)
with the specific psychological problem
e.g. (1) his mother asking him to put his glass in the sink (antecedent), (2) the boy
e.g. thyroid difficulties, particularly hyperthyroidism (overactive thyroid gland), may throwing the glass (behavior), and (3) his mother’s lack of response (consequence).
produce symptoms that mimic certain anxiety disorders, such as generalized anxiety
Informal Observation: relies on the observer’s recollection, as well as interpretation, of
disorder. Hypothyroidism (underactive thyroid gland) might produce symptoms
the events
consistent with depression. Certain psychotic symptoms, including delusions or
hallucinations, might be associated with the development of a brain tumor. Formal Observation: identifying specific behaviors that are observable and measurable
Withdrawal from cocaine often produces panic attacks, but many patients presenting (called an operational definition). To see whether there is a pattern and then design a
with panic attacks treatment based on these patterns.

e.g. it would be difficult for two people to agree on what “having an attitude” looks
Behavioral Assessment like. An operational definition, however, clarifies this behavior by specifying that this is
- using direct observation to formally assess an individual’s thoughts, feelings, and behavior in “any time the boy does not comply with his mother’s reasonable requests.” Once the
specific situations of contexts.
target behavior is selected and defined, an observer writes down each time it occurs,
- more appropriate in terms of assessing individuals who are not old enough or skilled enough
along with what happened just before (antecedent) and just after (consequence).
to report their problems and experience

a. clinicians go to the person’s home or workplace or even into the local community to
Self-Monitoring/Self Observation
observe the person and the reported problems directly. - writing down
b. set up role-play simulations in a clinical setting to see how people might behave in - using smartphones
similar situations in their daily lives or arrange analogue or similar, settings
a. Behavior rating scales
c. produce analogue assessments (conditions that mimic real-life clinical symptoms or
Used as assessment tools before treatment and
situations) by inducing symptoms of psychopathology in healthy individuals to study then periodically during treatment to assess
these characteristics in a more controlled way changes in the person’s behavior.
d. analogue models e.g. Brief Psychiatric Rating Scale, assess 18
For instance, one study examined the tendency of some men to sexually harass women (Bosson general areas of concern
et al., 2015). Men in the study had the opportunity to send film clips—some with potentially
offensive sexual content and others without—to a fake female partner online who claimed to REACTIVITY
dislike sexual content in films. Choosing to send the explicit film clips corresponded with the distort any observational data. Any time you
men’s history of sexual assault over the past year. This type of assessment allowed the observe how people behave, the mere fact of
researchers to study aspects of sexual harassment without having to subject others to negative your presence may cause them to change their
behaviors. Useful when developing screenings and treatments behavior
Psychological Testing
• Psychological tests include specific tools to determine cognitive, emotional, or behavioral responses that might be
associated with a specific disorder and more general tools that assess longstanding personality features, such as a
tendency to be suspicious.
• Specialized areas include intelligence testing to determine the structure and patterns of cognition.
• Neuropsychological testing determines the possible contribution of brain damage or dysfunction to the patient’s
condition. Neuroimaging uses sophisticated technology to assess brain structure and function

DIAGNOSING PSYCHOLOGICAL DISORDERS

• Developed in 1952 by the American Psychiatric Association
• Contains descriptions of all psychological disorders
• The recent versions have taken an atheoretical approach. They have attempted to describe psychological
disorders in terms that refer to observable phenomena, rather than presenting the disorders in terms of their
possible causes.
• In the 1840 census, the frequency of one category “idiocy/insanity” was recorded.
• ICD (International Classification of Diseases)
• 1952as the first edition of the DSM. DSM-Icontained a glossary of descriptions of the diagnostic categories and
was the first official manual of mental disorders to focus on clinical utility; has 106 disorders.
• DSM-II (1968) listed 182 mental disorders
• DSM-III (1980) introduced explicit diagnostic criteria, multiaxial system, a descriptive approach, and contained
265 mental disorders.
• Revisions and corrections led to DSM-III-R in 1987. Six categories were deleted while others were added. It
contained 292 disorders.
• 1994, DSM-IV was published listing 297 disorders.
• A major change from previous versions was the inclusion of a clinical significance criterion to almost half of all the
categories, which required symptoms cause “clinically significant distress or impairment in social, occupational, or
other important areas of functioning”.
• Text Revision" of the DSM-IV,known as the DSM-IV-TR, was published in 2000. The text sections giving extra
information on each diagnosis were updated, as were some of the diagnostic codes in order to maintain
consistency with the ICD.