The present study was conducted to examine the effects of early orientation of counseling related students to the two most prevalent paradigms of psychodiagnostic decision-making on first, the integration of the model, and second, on the ability to make proficient diagnostic decisions while in training. Using an experimental, pretest posttest design, 60 participants from two higher educational sites were randomly assigned to two treatment groups. Participants in each group were oriented to one of two treatment conditions -- a binary decision tree model or a problem-solving model (multiple competing hypotheses). Participants were then introduced to DSM Axis II diagnostic categories utilizing a computer assisted learning laboratory. Results suggested that participants learned diagnosis during the experiment. However, no significant difference in diagnostic proficiency occurred as a result of the two treatment conditions. Additional analyses raised questions about use of case studies as a means of assessing diagnostic proficiency. Item difficulty appeared to be linked to diagnostic clusters and individual diagnoses. Item difficulty factors influenced the internal consistency and validity of test instruments. The assumption of the unidimensial weight of syndromes in the construction of assessment instruments is suspect. Considering the preponderance of case study use for counselor training assessment, caution during instrument construction and use is advised. Evidence also existed that treatment groups responded differently to particular DSM diagnostic clusters and items. This suggested that cluster and item difficulty may be important to consider for instruction of diagnosis in the classroom. Results also suggested that as diagnoses become more complex, problem-solving diagnostic decision-making may become more important. Secondary analysis of computer assisted learning resulted in significant evidence that nonsequential, user-friendly computer assisted instruction may overcome teaching-study style mismatch, resulting in more even distribution of learning over the sample population. / Graduation date: 1998

Thesis (M.A.)--Carleton University, 2000. / Includes bibliographical references. Also available in electronic format on the Internet.

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This dissertation develops several new statistical methods for disease classification that directly account for the unique logic structure of criteria sets found in the Diagnostic and Statistical Manual of Mental Disorders. For psychiatric disorders, a clinically significant anatomical or physiological deviation cannot be used to determine disease status. Instead, clinicians rely on criteria sets from the Diagnostic and Statistical Manual of Mental Disorders to make diagnoses. Each criteria set is comprised of several symptom domains, with the domains determined by expert opinion or psychometric analyses. In order to be diagnosed, an individual must meet the minimum number of symptoms, or threshold, required for each domain. If both the overall number of domains and the number of symptoms within each domain are small, an exhaustive search to determine these thresholds is feasible, with the thresholds chosen to minimize the overall misclassification rate. However, for more complicated scenarios, such as incorporating a continuous biomarker into the diagnostic criteria, a novel technique is necessary. In this dissertation, we propose several novel approaches to empirically determine these thresholds. Within each domain, we start by fitting a linear discriminant function based upon a sample of individuals in which disease status and the number of symptoms present in that domain are both known. Since one must meet the criteria for all domains, an overall positive diagnosis is only issued if the prediction in each domain is positive. Therefore, the overall decision rule is the intersection of all the domain specific rules. We fit this model using several approaches. In the first approach, we directly apply the framework of the support vector machine (SVM). This results in a non-convex minimization problem, which we can approximate by an iterative algorithm based on the Difference of Convex functions algorithm. In the second approach, we recognize that the expected population loss function can be re-expressed in an alternative form. Based on this alternative form, we propose two more iterative algorithms, SVM Iterative and Logistic Iterative. Although the number of symptoms per domain for the current clinical application is small, the proposed iterative methods are general and flexible enough to be adapted to complicated settings such as using continuous biomarker data, high-dimensional data (for example, imaging markers or genetic markers), other logic structures, or non-linear discriminant functions to assist in disease diagnosis. Under varying simulation scenarios, the Exhaustive Search and both proposed methods, SVM Iterative and Logistic Iterative, have good performance characteristics when compared with the oracle decision rule. We also examine one simulation in which the Exhaustive Search is not feasible and find that SVM Iterative and Logistic Iterative perform quite well. Each of these methods is then applied to a real data set in order to construct a criteria set for Complicated Grief, a new psychiatric disorder of interest. As the domain structure is currently unknown, both a two domain and three domain structure is considered. For both domain structures, all three methods choose the same thresholds. The resulting criteria sets are then evaluated on an independent data set of cases and shown to have high sensitivities. Using this same data, we also evaluate the sensitivity of three previously published criteria sets for Complicated Grief. Two of the three published criteria sets show poor sensitivity, while the sensitivity of the third is quite good. To fully evaluate our proposed criteria sets, as well as the previously published sets, a sample of controls is necessary so that specificity can also be assessed. The collection of this data is currently ongoing. We conclude the dissertation by considering the influence of study design on criteria set development and its evaluation. We also discuss future extensions of this work such as handling complex logic structures and simultaneously discovering both the domain structure and domain thresholds.

Converging research on the diagnostic criteria for personality disorders (PDs) reveals that most criteria have different psychometric properties. This finding is inconsistent with the DSM-IV-TR PD diagnostic system, which weights each criterion equally. The purpose of the current study was to examine the potential effects of using equal weights for differentially-functioning criteria. Using data from over 2,100 outpatients, response patterns to the diagnostic criteria for nine PDs were analyzed and scored within an item response theory (IRT) framework. Results indicated that combinations that included the same number of endorsed criteria (the same "raw score") yielded differing estimates of PD traits, depending on which criteria were met. Moreover, trait estimates from subthreshold criteria combinations often overlapped with diagnostic combinations (i.e., at threshold or higher), indicating that there were subthreshold combinations of criteria that indicated as much or more PD traits than some combinations at the diagnostic threshold. These results suggest that counting the number of criteria an individual meets provides only a coarse estimation of their PD trait level. Suggestions for the improved measurement of polythetically-defined mental disorders are discussed.

The Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) published by the American Psychiatric Association (APA) in 1987 is currently the primary tool used by counselors in clinical settings for diagnosing clients' psychological and behavioral problems. Beginning with the third edition of the manual (DSM-III; APA, 1968) a multiaxial process for diagnosis was introduced to encourage a biopsychosocial perspective of client's problems.This study was designed to investigate if alterations in diagnosis on Axis IV and V could further encourage a biopsychosocial perspective. It was designed to imitate the rapid diagnostic process that takes place in many clinical settings. In the present study, the criterion for a biopsychosocial perspective was the maintenance of neutral perceptions and unbiased hypothesis-testing strategies following diagnosis of a client.Twenty-four counseling psychology trainees participated in the study. The counselor trainees diagnosed a client after listening to approximately 20 minutes of an audio-tape of an initial assessment interview. The 12 counselor trainees in the control group diagnosed the client using the standard multiaxial format for diagnosis. The 12 counselor trainees in the experimental group diagnosed the client using an alternative format which encouraged a focus on positive aspects of the client and the client's environment.The counselor trainees completed the Impression Formation Questionnaire to assess their perceptions of the client. They then wrote 12 questions they would ask the client in the next counseling session. These questions constituted their hypothesis-testing strategies for their diagnoses on Axis I and Axis II.The counselor trainees in both groups maintained primarily neutral perceptions of the client as measured by the IFQ. The counselor trainees in both groups favored confirmatory hypothesis-testing strategies when assigned to groups based on their hypothesis-testing strategy score (p < .05).The results of this study indicated that the standard and alternative multiaxial formats for diagnosis may encourage neutral perceptions of a client when counselors must diagnose the client based on very little information. Neither format for diagnosis was successful, however, in discouraging a biased, confirmatory search for information. / Department of Counseling Psychology and Guidance Services

This study was conducted to determine why counselors use the Diagnostic and Statistical Manual of Mental Disorders (Third Edition, Revised) (DSM-III-R), to describe their opinions regarding the advantages and disadvantages of its use, to determine whether they believe deliberate misdiagnosis of clients occurs, to determine whether they believe they are adequately trained in the use of the DSM-III-R, and to identify counselor characteristics that are significantly related to their evaluations of the DSM-III-R. A mailed questionnaire was used to collect data from a random sample of 550 Certified Clinical Mental Health Counselors. The response rate was 70.7%. Results of the study indicate that the respondents use the DSM-III-R for billing insurance, case conceptualization, treatment planning and communication with other professionals, meeting requirements of employers and external entities such as the courts, and for educational and evaluative functions. These reasons for its use are also considered to be the advantages of using the DSM-III-R. Disadvantages of the using the DSM-III-R identified include possible negative results of its use, bias and labeling, and difficulty in usage as well as difficulty applying it in marriage and family counseling. Respondents believe clients are deliberately misdiagnosed using the DSM-III-R, and a majority of respondents (62.87%) who indicated whether reported they had training in the use of the DSM-III-R and whether they believe they are adequately trained in its use said their training is adequate. Results of canonical correlation analyses indicate that respondents' amounts of training in the use of the DSM-III-R, their work settings, and their clients' being charged for counseling services are significantly related to various aspects of their evaluations of the advantages and disadvantages of the DSM-III-R. / Ph. D.

Consensus is lacking on early diagnostic criteria and the exact symptoms of Alzheimer's disease (AD). A new, in-office test may help physicians detect the early symptoms of AD, based upon new National Institute of Aging (NIA) criteria. However, a gap exists in knowledge regarding physicians' current use or intent to use the new protocols. Choreographing the descriptive AD terminology in the Diagnostic and Statistical Manual of Mental Disorders IV-TR and the International Classification of Diseases (ICD-10) is recommended. Thus, the purpose of this study was to understand possible contributing factors to physician's use or intent to use of the new NIA's diagnostic protocol. Data collected from 55 clinicians within 2 Northern California counties were analyzed using a bivariate test. The 2 dependent variables were physicians' use of, or intent to use, the NIA protocol; the 6 independent variables were number of years since graduating from medical school, area of specialty, percentage of patients over age 60 years, physician's gender, age, and knowledge about AD, as indicated by performance on the Alzheimer's Disease Knowledge Scale. The results of regression analyses indicated no statistical significant associations between the variables of interest (p = or greater than .05). This study is a first attempt at understanding physician attitudes toward, and usage patterns of, an important new in-office tool for early detection of AD. Further research using a larger sample size to increase power is needed. These findings have implications for positive social change by promoting an earlier detection of Alzheimer's disease, underscoring the need for additional training, and revising the terminology used in clinicians' desktop references.

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No description available.