Clinical Assessment and Diagnosis
Clinical assessment: systematic evaluation and measurement of psychological, biological and social
factors in an individual presenting with a possible psychological disorder
Diagnosis: process of determining whether the particular problem afflicting the individual meets all
criteria for a psychological disorder
Begin by asking patient to describe the issues that brought him or her to the clinic in the first place.
Ask questions pertaining to present life circumstances to get a better picture of the patient's current
Assessing Psychological Disorders
Process of assessment like a funnel; begin by collecting lots of information across a broad range of
functioning to determine the source of the problem. After getting a sense of overall functioning,
narrow the focus by ruling out problems in some areas and concentrating on areas that seem most
Value of assessment depends on: validity, reliability and standardization.
o Reliability: degree to which a measurement is consistent.
Ensuring that two or more raters will get the same answers is interrater reliability.
Ability to produce the same results is test-retest reliability.
Validity: whether something measures what it is designed to measure; whether it assess what
it’s supposed to assess.
Comparing results of one assessment with the results of another is concurrent or
How well the assessment tells you what will happen in the future is predictive validity.
The measure accurately discriminating between groups is discriminate validity.
Extent to which a measurement accurately represents a construct and produces an
observation distinct from that produced by a measure of another construct is called
The degree to which study results generalize to populations and contexts beyond the
particular ones included in the study itself is external validity.
Standardization: process by which a certain set of standards or norms is determined for a
technique to be consistently useful across different measurements.
Strategies and procedures used to acquire information needed to understand and assist patients:
clinical interview, mental status exam, physical examination, behavioural observation and
assessment, and psychological tests
The Clinical Interview
Gathers information on current and past behaviours, attitudes and emotions, current and past
interpersonal social history
Determine when the problem started , identify other events that may have occurred around the
same time Mental status exam; systematic observation of someone's behaviour; test of a client's judgement,
orientation to time and place and emotional and mental sate
o Designed to give the clinician sufficient information to determine whether a psychological
disorder might be present
o Determines which areas should be assessed in more detail
o Covers 5 categories
Appearance and Behaviour: overt physical behaviour, dress, general appearance, facial
Thought process: how the person talks, structures their sentences, content, evidence of
Mood and affect: apparent mood, tone of voice, affect for current life situations
Intellectual functioning: vocabulary, use of metaphors, memory
Sensorium: general awareness of surroundings; the date, the time, where they are, who
o Unstructured interviews have no systematic format. Room for flexibility but not efficient at
obtaining lots of information
Semi structured: somewhat formatted. Questions carefully phrased to elicit useful
o Structured interview: complete formatted, obtains lots of information, loses conversational
ability to gain information for directly related to the question but still useful.
o Persistence-distress: how often something occurs and how much stress it causes
o Resistance: attempts made by the patient to get rid of the obsession
Particular attention paid to medical conditions sometimes associated with the specific psychological
Problems presenting as disorders of behaviour, cognition or mood can sometimes have a
relationship to a temporary toxic state (bad food, wrong dosage of medicine, wrong medicine)
Ex. Thyroid difficulties may produce symptoms that mimic certain anxiety disorders
(hyperthyroidism) or depression (hypothyroidism). Psychotic symptoms may be associated with
development of a brain tumour.
Uses direct observations to assess an individual’s thoughts, feelings and behaviour in specific
situations or contexts
Appropriate for assessing those who are not old enough or skilled enough to report their problems
Target behaviours: identified and observed to determine the factors that influence those behaviours
Attention usually focused on immediate behaviour, what happened before it and its consequences
Informal observation: clinician takes rough notes and elaborates later. Relies on observers
recollection and interpretation
Formal observation: identifying specific behaviours that are observable and measurable
Self monitoring/self observation: people monitor their own behaviours
Behaviour rating scales: assessment tool used before and during treatment to assess changes in
Brief Psychiatric Rating Scale: assesses 18 general areas of concern. Includes somatic concerns
(preoccupation with physical health), guilt feelings (self blame, shame, remorse), grandiosity
(arrogance, exaggerated self opinion) Reactivity: behaviour is in response to the situation; clients may act differently than normal when
the clinician is present
Include specific tests to determine cognitive, emotional or behavioural responses that may be
associated with a specific disorder
Projective tests: ambiguous stimuli are presented to a person who is asked to describe what she or
o Theory is that people project their personality and unconscious fears onto other people and
things. Reveals unconscious thoughts to the therapist
o Rorschach inkblot test: inkblots serve as the ambiguous stimuli, person responds with what
they see in the inkblot. Controversial due to lack of data on reliability and validity
o Comprehensive System: standardized version of Rorschach inkblot. Specifies how cards should
be presented, what the examiner should say, how responses should be recorded.
o Thematic Apperception Test: uses 30 cards with images on them and the client is asked to tell
a dramatic story about what is happening in the picture.
Personality Inventories: questionnaires that assess personal traits by asking respondents to identify
descriptions that apply to them
o Most widely used in the Minnesota Multiphasic Personality Inventory (MMPI). Has 4
additional scales to determine validity: Lie (L), Infrequency (random answer)(F), Defensiveness
(K), Can't-Say (?)
o Based on an empirical approach
o Revised Psychopathy Checklist; directly assesses psychopathy. Checklist has things like
pathological lying and superficial charm.
o Stanford-Binet test used to predict academic success. Provided a score known as an
intelligence quotient (IQ): mental age divided by chronological age multiplied by 100.
o Deviation IQ: score is compared with others of the same age
o Wechsler Tests: contain verbal scales (measure vocabulary, short term memory, verbal
reasoning) and performance scales (psychomotor ability, nonverbal reasoning, ability to
learn). Taps four distinct intellectual abilities: verbal comprehension, perceptual organisation,
processing speed and working memory.
o IQ is a score, not quantified intelligence. There is a lack of agreement on what constitutes as
Measures abilities in areas such as receptive and expressive language, attention, concentration,
memory, motor skills, perceptual abilities, and learning in a way that the clinician can make
educated guesses about the person's performance and possible existence of brain impairment.
Bender Visual-Motor Gestalt Test: child is given a series of cards on which lines and shapes are
drawn. Task is for the child to copy what is drawn on the card. Errors are compared with test results
from children of the same age; if the number of errors exceeds a certain amount a brain dysfunction
o Nature of the problem cannot be determined with this test
Luria-Nebraska Neuropsychological Battery: offers more precise determination of location of the
problem. Halstead-Reiten Neuropsychological Battery: includes Rhythm test (compare rhythmic beats, sound
recognition),Strength of Grip Test (compares grip of right and left hands), Tactile Performance Test
(wooden blocks on a board while blindfolded).
o Most often used to help differentiate those who already have a cognitive